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Background: Infection is one of the major complications in endourological procedures, and may range in severity from mild fever to septic shock. A survey on postoperative antibiotic usage showed varied usage. No clear guidelines exist for the same. The objective of this study is to rationalise the usage of post-operative antibiotics in urine culture negative patients with symptomatic upper urinary tract calculi. Materials and Methods: A prospective randomised controlled study done from March 2021 to February 2022. A total of 250 cases operated for upper urinary tract calculi at our institution with sterile urine culture are considered. All the patients received only single dose of prophylactic antibiotic before surgery and no postoperative antibiotics were given. They were divided into 2 groups to assess the local antibiotic (gentamycin) implications in reducing the usage of post-operative antibiotics. Postoperatively fever was assessed along with other signs of infection like pyelonephritis, symptomatic urinary tract infection (UTI) and sepsis. Statistical analysis is done and p value

Background: Female urethral strictures are infrequent, which explains why the literature on female urethral stricture therapies is scarce. We present the results and complications of dorsal buccal mucosa graft urethroplasty in female patients with urethral stricture. METHODS: Between January 2017 and December 2019, 25 women aged 33 to 65 with urethral stricture disease underwent urethral restoration with a dorsal onlay buccal mucosa transplant. Uroflowmetry (Q max) and micturating cystourethrography were used to diagnose patients. To rule out bladder pathology, a urodynamic examination was performed. Following catheter removal, UFR was performed every three months for one year, then every six months. RESULTS: The average age of the paƟents was 52.48 years. A stricture's average length was 1.9 cm. Before and aŌer surgery, the mean Q max was 6.7 ml/s and 19.6 ml/s, respectively. The majority of UFR patients following catheter removal had a Q max of more than 15ml/hr. After three months of catheter removal, three patients complained of inadequate flow, which was dealt with with urethral dilation twice a week, and their strictures were resolved after six months. CONCLUSION: The dorsal technique with buccal mucosa transfer allowed us to successfully restore an appropriate urethra in females.

Objective: To assess the carotid intima-media thickness and cardiovascular risk factors in patients with benign prostatic hyperplasia. Material and methods: This was a prospective observational study conducted over two years in 100 patients who presented with benign prostatic hyperplasia (BPH). IPSS questionnaire was used to evaluate the symptomatology of BPH. Patients were examined for cardiovascular risk factors. All patients underwent echocardiographic examination for left ventricular function. A single experienced sonographer, blinded to all clinical information, assessed the common carotid artery. Results: The patients mean age was 69.32 years. The mean BMI was 28.91 kg/m². Of the total mild symptom score cases, 75 % (N=6) cases had Grade I prostatomegaly (26 – 40 cc). 98.38 % (N=61) cases had Grade II prostatomegaly (41 – 60 cc), 93.33 % (N=28) cases had Grade III prostatomegaly (>60cc). A mean carotid intima-media thickness (IMT) of 0.56 mm was found in cases having mild IPSS scores (Score 1-7), 0.73 mm was found in cases having moderate IPSS score (Score 8-19), 0.92 mm was found in cases having severe IPSS scores (Score 20-35). Significant association was present between mean BMI, diabetes mellitus, hypertension, hyperlipidemia, smoking and mean Carotid IMT with IPSS as p-value was Conclusion: This study found that prostatic tissue had a strong relationship with carotid IMT and cardiovascular risk factors in BPH patients. These data suggest a possible link between carotid IMT and cardiovascular risk factors and BPH.

Introduction: Benign Prostatic Hyperplasia (BPH) is one of the most frequent diseases in men. The laser treatment for BPH has challenged TURP due to advances in laser technology, a better understanding of tissue-laser interactions and rowing clinical experience. Objective: To evaluate the safety and efficacy of HoLEP, comparing it to Bipolar TURP. Material and methods: This was a prospective study to evaluate the outcomes in BPH patients undergoing surgery by HOLEP and Bipolar TURP done between January 2018 to December 2019. A total of 80 Patients were enrolled, 40 undergoing HoLEP and the other 40 Bipolar TURP for BPH. The procedures were performed by a single surgeon. All patients with symptomatic BPH and who were candidates for surgical treatment were included. Patients with previous prostate surgery, urethral surgery, history of prostate cancer or neurogenic bladder were excluded. Results: Baseline parameters were almost similar between both the groups in terms of age, IPSS, QOL, Q max, PVR, and gland size. Operative time and resected gland weight were more in HoLEP arm (p Conclusion: Both Bipolar TURP and HoLEP were effective in relieving BOO. HoLEP has equal efficacy compared to conventional bipolar TURP, with decreased hospital stay and catheter indwelling time. The learning curve of HoLEP is steep; however, it can be overcome gradually.

Background: Kidneys are a pair of retroperitoneal organs supplied by a single renal artery and vein. However, the classic illustration of the renal vasculature, formed by one renal artery and one renal vein, occurs in ≤25% of cases. MDCT angiography is presently the most preferred investigation for assessing prospective renal donors. Aims and Objectives: This study aims to familiarize urologists with the variations found in the renal vascular system, emphasizing prevalence, the adequate, appropriate terms, and the clinical and surgical implications involved. Materials and Methods: A cross-sectional study in 50 patients clinically indicated to undergo CT Renal angiographic study over 2 years is included in the study. This study was carried out to look for any anatomical variants in renal vasculature. CT examination was performed on a multidetector 16 slice CT Siemens scanner in the department of radiodiagnosis. Once conventional CT is done, the data obtained can produce 3D post-processing images that simulate conventional angiograms. Results: Out of 50 patients, single renal arteries are present in 27, and multiple renal arteries are present in 23 patients. Out of 27 patients with single renal arteries, 22.2 % has perihilar arterial branching. The most common variant was accessory renal arteries, which are found in 56% of individuals, followed by aberrant renal arteries found in 30% of individuals. Double renal arteries are found in 8.7% and triple renal arteries in 4.3% of cases. Out of 50 patients, 48 patients have a single renal vein, whereas two patients have supernumerary veins. The present study found right renal vein duplication in only 2% of patients. Conclusion: Renal arteries and veins show numerous variations in their origin sites, numbers, course, and division patterns. These variants exist in the population with high prevalence and are thus crucial in preoperative and intra-operative analysis for better prognosis and reduced complications. Preoperative CT evaluation of renal vasculature using MDCT angiography helps depict the presence or absence of renal arterial and venous variants.

Objective: The present study aims to assess the safety and efficacy of tubeless mini-PCNL and RIRS in the management of renal stones of ⩽2 cm size. Patients and methods: This was a prospective study in 80 patients with renal stones of ⩽2 cm and were divided into two equal groups of patients choice: Group 1 were managed by tubeless mini-PCNL and Group 2 by RIRS using flexible ureteroscopy and laser. Intraoperative events like duration of surgery, stone clearance and complications were noted. Postoperative parameters taken into account were pain score, parenteral analgesic requirements, bleeding, need for blood transfusion, fever, hospital stay, cost of the procedure and number of days taken to return to normal work. Results: Both groups were comparable for preoperative parameters. Mean duration of surgery in group 1 and group 2 was 68.88 ± 7.20 minutes and 92.25 ± 14.62 minutes respectively (p

Background: Extracorporeal shock wave lithotripsy (ESWL) has become the first-line treatment for stones in the upper urinary tract measuring 0.05).There was no significant difference between the two groups in regard to clearance according to the size of the stones. A total of 9.3%(28/300) of patients did not have a successful outcome and were termed as ESWL failures. Post- ESWL complications were significant between the both groups in terms of hematuria and ureteric colic. All the ureteric colic patients had a stone size larger than 13 mm, P=0.0005, which was more in the non-stented (Group B) patients. Most of the lower urinary tract symptoms were seen in stented (Group A) patients, P

Aim and Objectives: The aim of this study is to demonstrate the outcomes of retrograde intrarenal surgery (RIRS) and Mini percutaneous nephrolithotomy (M-PCNL) in the management of 1–2 cm renal stones, with factors considered being operative time, duration of hospital stay, complication rate, and auxiliary procedure rate. Materials and Methods: This is a single-center, prospective study on patients diagnosed with 1–2 cm renal calculi between April 2018 and March 2020. Informed written consent was obtained from all the patients. A total of 60 patients were included in the study. Patients were divided into two groups – Group I and Group II; Group I: 30 patients who underwent RIRS and Group II: 30 patients who underwent Mini-PCNL-Mini percutaneous nephrolithotomy. Data were collected to compare the operative data, postoperative complications, duration of hospital stay, stone-free rate, and auxiliary procedure rate associated with RIRS and Mini pcnl for the treatment of 1–2 cm renal calculi. Inclusion criteria: All patients who presented with 1–2 cm renal calculi between April 2018 and March 2020 Age >15 years. Exclusion criteria: Stones larger than 2 cm and smaller than 1 cm. More than 3 stones in the pelvicalyceal system Pregnant women. Results: The mean age in the Mini Perc and RIRS groups was 30.40 ± 14.36 years and 39.20 ± 12.45 years, respectively, with no statistical significance. Of the 60 renal units, 66.7% were male and 33.3% were female in the Mini Perc group. In the RIRS group, 73.3% were male and 26.7% were female. There was no statistical significance. In the Mini Perc group, 53.3% were operated on the right side and 46.7% were operated on the left side, and in the RIRS group, 33.3% were operated on the right side and 66.7% were operated on the left side, with no statistical significance. The mean stone size in the Mini Perc group was 1.4 ± 0.37 cm and the mean stone size in the RIRS group was 1.3 ± 0.27 cm, with no statistical significance. Of the 60 renal units, 3.3% and 6.7% in Mini Perc and RIRS groups had diabetes alone, and 3.3% and 16.7% in Mini Perc and RIRS groups had hypertension alone. 3.3% in RIRS group had tuberculosis, 6.7% and 13.3% in Mini Perc and RIRS groups had both hypertension and diabetes, and 6.7% in Mini Perc group had diabetes with hypertension with coronary artery disease. The mean operating time in the Mini Perc group was 44.07 ± 9.05 min. The mean operating time in the RIRS group was 72.23 ± 11.01 min. There is statistical significance noted in terms of operating time. There were complications noted in both the groups, of which 6.7% and 16.7% in Mini Perc and RIRS groups had postoperative fever, and 3.3% and 6.7% in Mini Perc and RIRS groups had postoperative hematuria with no statistical significance noted. The mean postoperative pain in the first 24 h was 3.63 ± 1.35 in Mini Perc group, whereas it was 1.43 ± 0.72 in RIRS group; the mean postoperative pain at 48 h was 1.80 ± 0.96 in Mini Perc group, whereas it was 1.03 ± 0.18 in RIRS group, with significance between both the groups. The mean hemoglobin drop in Mini Perc group was 0.88 ± 0.44 g in Mini Perc group, whereas it was 0.99 ± 0.65 in RIRS group, with no statistical significance between both the groups. The mean stone clearance rate for Mini Perc group is 99% ± 5.47%, whereas it was 96.33% ± 10.98% in RIRS group, with no statistical significance. In comparison with both the groups, the retreatment rate was 3.3% in Mini Perc group and 13.3% in RIRS group, with no statistical significance. Conclusion: The result of this study revealed that between both the techniques, patients undergoing RIRS procedure had significantly less pain than Mini Perc, though RIRS procedure took longer operating times. We found that both the techniques were safe, in regard to complications (both intraoperative and postoperative), and there was no significant difference in hospital stay between the groups.

This is the first time a large endovesical leiomyoma of the urinary bladder has been reported in India. A 44-year-old woman had painless gross haematuria, increased urine frequency, an incomplete emptying feeling, and left loin discomfort. Imaging and cystoscopy revealed a 6 x 5 cm projecting endovesical tumour emerging from the bladder's base near the left vesico-ureteric junction. Transurethral bladder resection with few biopsies was performed, histopathological examination revealed a pathological diagnosis of a leiomyoma of the urinary bladder. Intravesical complete excision of the tumor was performed after ligating its pedicle. Complete surgical resection is a very effective treatment, associated with almost no recurrence. We discuss the relevant recent literature of bladder leiomyoma.

Objective:To prospectively compare the feasibility and safety of tubeless percutaneous nephrolithotomy (PCNL) Vs standard PCNL. Patients and methods:220 patients undergoing PCNL were randomized to two groups: Group A (tubeless PCNL) with antegrade placement of a Double-J stent without nephrostomy and group B (standard PCNL) with nephrostomy tube placement postoperatively with 110 patients in each group.Inclusion criteria were stone size more than 2 cm, single tract puncture with complete clearance, less than three stones with a diameter Results:There was no significant difference between the two groups for patient demographics and stone characteristics. There was no statistically significant difference between the two groups for the complications, stone clearance, need for ancillary procedure, mean postoperative drop in haemoglobin, need for blood transfusion. The mean postoperative ana;gesic requirement, operative time and hospital stay was statistically significantly higher in the tubeless PCNL group compared with the standard PCNL group with p values of 0.000, 0.040, 0.001 respectively. Conclusion:Tubeless PCNL is considered a safe and efficient technique in any tract location (upper, middle, lower), in patients with bilateral disease and effective procedure if done in a selected group of patients.

In contrast to proctitis, vaginitis and acute radiation cystitis, late urological complications after pelvic irradiation are rarer, more serious and irreversible. The main disadvantage of radiotherapy is the fact that it affects both cancer and healthy cells located in the tumour area. As a consequence, different complications develop. A large proportion of cancers treated with radiotherapy are located in the lower abdomen and pelvis, which is why complications often involve the urinary tract. Due to the anatomy of these areas, urological complications occur not only after radiological treatment of urological cancers, but also after treatment of malignancies of the reproductive or digestive system. The most common radiation-induced complications include haemorrhagic cystitis, urethral and ureteral strictures, urinary fistulae, and secondary primary malignancies. Because of impaired tissue healing, the treatment of radiation urological complications is a challenge for urologists and often requires complicated reconstruction techniques. We hereby described an elderly woman who is a known case of carcinoma of cervix with post radical hysterectomy and post pelvic radiotherapy status presented with fever, pain abdomen, vomiting, obstipation, voiding difficulties with dysuria on admission, which was diagnosed as acute intestinal obstruction with post radiation bladder necrosis with acute kidney injury. This case is a rare example of high-grade late adverse events which occurred 8 yrs after radiation therapy in a known case of carcinoma of cervix.

Adrenal myelolipoma is inevitably a benign neoplasm of the adrenal gland. It is the second most common primary adrenal incidentaloma after adrenocortical adenomas. Adrenal myelolipoma is a rare, benign and non-functional neoplasm, composed of mature adipose and hematopoietic tissue which closely resembles bone marrow. Most of these lesions are small, unilateral and asymptomatic, discovered incidentally at autopsy or on imaging studies performed for other reasons. We report a case of this rare tumour in a 46-year-old obese male who had presented with vague abdominal pain on the right side past 6 months without any other significant history. Ultrasound and subsequently CECT scan abdomen showed a large well-circumscribed mass arising from the right adrenal gland, measuring 11×10cm. Laparoscopic right adrenalectomy was performed.

Background: Benign prostatic hyperplasia (BPH) is a common disease in elderly men. Monopolar transurethral resection of prostate (M-TURP) is considered the gold standard for the treatment of bladder outlet obstruction due to BPH. Its modification, bipolar TURP (B-TURP), promises to overcome its most prominent drawbacks, such as bleeding and dilutional hyponatremia. Aims and Objectives: This study aims to study the feasibility, effectiveness, and safety of B-TURP over M-TURP. Materials and Methods: A total of 110 patients with BPH were prospectively randomly assigned to undergo B-TURP (55) or M-TURP (55). Patient characteristics of the two groups were similar. Hemoglobin was measured preoperatively and postoperatively. IPSS, maximal flow rate, and post-void residual urine volume were assessed preoperatively. Duration of surgery, mean weight of resected tissue, mean irrigation fluid used, mean drop in hemoglobin, mean change in sodium, and mean post-operative irrigation used were also compared. Results: Duration of resection time was significantly shorter in M-TURP (P=0.0034). The mean change in sodium and mean post-operative irrigation used were significantly lower in bipolar group with P

Background: Due to the anatomic characteristics of the lower calyx, lower polar stones are difficult to be removed through the ureter, retrograde intrarenal surgery (RIRS) can be used to deal with lower polar stones, while mini-percutaneous nephrolithotomy(mini-PCNL) is mainly used to deal RIRS failed to eliminate the stone. Aims and Objectives: Prospective comparison of mini-PCNL and retrograde intrarenal surgery outcomes in lower calyx management with respect to surgery duration, pain score (visual analog score), analgesic requirement, hemoglobin drop, and hospital stay. Materials and Methods: This is a prospective study in 50 patients (25 cases of RIRS and 25 cases of MINIPERC) over 2 years who came to the urology departme with lower calyx stone of size up to 20mm. The selection of the management methods was primarily based on the patient’s preferences. Preoperatively, all patients underwent routine workup and CT KUB plain. The primary and secondary objective was stone clearance rates, retreatment rate, complications, surgical duration, pain score (visual analog score [VAS]), analgesic requirement, hemoglobin drop, and hospital stay. Results: Miniperc and RIRS had stone clearance rates of 100% and 96%, respectively. In the RIRS group, one patient required retreatment for 1month. Hospital stay, intraoperative and post-operative complications were non-significant between both groups. Operative duration (P=0.003) was lower in the Miniperc group. Hemoglobin drop (P

Background Robotic surgery has now evolved as an emerging tool for better and easy operative techniques. The quest for trifecta comprising warm ischemia time less than 25 minutes, negative surgical margins and no perioperative complications seems to be better accomplished by robotic partial nephrectomy, which is likely to become the new standard for minimally invasive partial nephrectomy. Materials & Methods It is a prospective observational study over 18 months in patients aged more > 18 years with a renal tumour of clinical stage T1 coming for robotic partial nephrectomy. A total of 40 patients were included in the study who underwent robotic-assisted partial nephrectomy for renal tumours less than 7 cm in size. The duration of the study was from July- 2018 to December-2019 and their follow up period was 3 months post-surgery. Results Of the 40 patients, the mean age was 52.3 ± 11.91 years. 28 (70%) patients were males and remaining 12 (30%) were females. 11 (27.5%) tumours were situated in the anterior upper pole, 9 (22.5%) in the anterior lower pole, 8 (20%) in the posterior upper pole, 7 (17.5%) in the posterior lower pole and interpolar tumours were 5 in number (12.5%). 24 (60%) tumors were ≥ 50% exophytic, 11 (27.5%) were < 50% exophytic and 5 (12.5%) were purely endophytic in nature. Maximum nephrometry score was 5a amounting to 10 (25%) patients and 5p tumours were the second most common amounting to 7 (17.5%) patients. The mean console time was noted to be 84.40± 12.05 mins. The mean total operative time was noted to be 167.00 ± 21.116 minutes. Mean Warm Ischemia Time (WIT) was recorded to be 27.28 ± 5.923 minutes. The mean blood loss was 145.75±61.075 ml. The mean length of hospital stay was 4.27 ± 0.78 days. None of the cases was converted to open partial/radical nephrectomy and none had positive surgical margins in the histopathology reports. Conclusion Our study shows that Robotic Assisted Partial Nephrectomy (RAPN) is an efficacious and safe surgery in stage T1 renal tumours (tumour size

Hydatid disease is caused by Echinococcus granulosus, which causes rare isolated presentation in the kidneys, and is estimated to be about 2-4% of all cases. We herein present a case of a 45-year-old symptomatic male patient with a large primary hydatid cyst in the left kidney that was treated successfully by laparoscopic left nephrectomy.