Search

The immunosuppression administered to renal transplant recipients to safeguard renal function elevates their susceptibility to renal cancer, which is estimated to be 15 times higher than in the general population. The current study aimed to analyze various aspects of native kidney renal cell carcinoma (RCC) in renal transplant recipients. This study involved a retrospective analysis of 11 patients who underwent nephrectomy for RCC in native kidneys among renal transplant recipients at our institution since 1992. Our institutional incidence was 0.4%. Median age at presentation was 57 (49–60) years. The ratio of male: female was 10:1. Most patients were asymptomatic at presentation and native kidney disease before transplantation was undetermined. In our study, the median time interval between diagnosis of RCC and transplant was 9.1 (8.4–11.2) years. All patients underwent native kidney nephrectomy. Clear cell type was more common than papillary type, 3.5 (2.5–4.2). Ten patients were diagnosed with stage I disease and one patient had stage IV disease. Fuhrman nuclear grading revealed low grades in nine patients and three patients had Grade 3. Immunosuppressive therapy modification was done in nine patients. Meticulous follow-up of renal transplant patients is essential for earlier diagnosis and appropriate treatment of native kidney RCC in transplant recipients. Authors recommend every year follow-up in transplant recipients with special emphasis on ultrasound of native kidney.

Abstract Background Mayo Adhesive Probability (MAP) score is based on posterior perinephric fat thickness and perinephric fat stranding and ranges from 0 to 5. We intend to validate the score and identify preoperative factors predictive of Adherent Perinphric Fat (APF) encountered in robotic-assisted partial nephrectomy. Methods The retrospective and prospective observational study was done at a single tertiary care hospital after appropriate ethical clearance. Sixty-two patients with clinical stage cT1 renal mass planned for robotic-assisted partial nephrectomy were selected over a study period of 3 years after obtaining informed consent. Data that were collected included demographic details and perioperative details including CT renal angiography which was done in all patients preoperatively. Intraoperative and postoperative data were collected. Associations of patient and tumor characteristics with the presence of APF during RAPN were evaluated by multivariable logistic regression models and using Chi-square test to calculate p value. Results Out of total 62 patients included; 24 patients (38.7%) had intraoperative Adhesive Perinephric Fat (APF). Three patients required conversion to open surgery and three patients underwent conversion to radical nephrectomy. Thirty-five patients were males. Mean age was 51.27(20–77) years. We noted an increased likelihood of APF with an increase in age (p = 0.003), higher preoperative creatinine (p = 0.003), greater posterior perinephric fat thickness (p = 0.002), and perirenal fat stranding (p

Objectives: Historically, nonadherence to medication has been a major problem faced by health care workers while treating chronic illnesses. Nonadherence to psychotropic medications is known to be associated with poorer treatment outcomes, remarkable risk, and cost to the medical system in managing psychiatric illness. For care providers, partial compliance or discontinuation of medications represents the difficulty of maintaining treatment successes over time. In this study, we intended to assess medication adherence and to understand the reasons for nonadherence in patients with major psychiatric disorders in southern India. Methods: This is a cross-sectional observational study, done from January to June 2023. With the International Classification of Diseases 10th Revision diagnosis, we assessed patients with psychotic disorders, bipolar affective disorders, and major depressive disorder. The Medication Adherence Rating Scale (MARS) was used to assess medication adherence. The patients also completed copies of semi-structured questionnaire on their sociodemographic characteristics, their medications, and reasons for nonadherence. Results: A total of 147 subjects were assessed. We found that 68.0% of subjects were poorly adherent to the treatment based on MARS, and that only 32.0% of them were strictly adherent to the treatment. The reasons for poor adherences to the medication treatment were carelessness or forgetfulness (21.8%), adverse effects of the medications (16.3%), and the perception of the subject of feeling better (15.6%). Conclusion: More than two thirds of the subjects was found to be non-adherent to the medications. Assessing various reasons for medication adherence will help find strategies to improve medication adherence and thus outcome of the treatment.

Objective: Single-use flexible ureteroscopes (fURSs) have recently been introduced by different companies. Goal of this in-vitro study was to compare four fURSs. Methods: We performed in vitro analysis of Uscope 7.5 Fr and Uscope 9.5 Fr (Pusen Ltd., Zhuhai, China), LithoVue 9.5 Fr (LithoVue™, Boston Scientific, MA, USA), and Indoscope 9.5 Fr (Bioradmedisys™, Pune, India). Optical characteristics (image resolution, color representation, and luminosity) were compared at various distances of 10 mm, 20 mm, and 50 mm. Deflection and irrigation were evaluated with and without accessories. Results: Color perception was comparable for all scopes at 10 mm (p

Context: Gender is an important factor in determining mental health and mental disease. Women are particularly vulnerable to mental health disorders due to a lack of family support, stigma surrounding mental illness, separation, emotional stress, financial dependency, domestic violence, sexual assault, and human trafficking. Destitute or homeless women have a disproportionately high risk of mental illness. Aims: To determine the prevalence of psychiatric illness and related psychosocial determinants among inmates of a state-run home for women. Settings and Design: This is a single-center, cross-sectional descriptive study. Inmates of a state home for women in the northern part of Karnataka who met the inclusion and exclusion criteria were recruited. Materials and Methods: Eighty participants were evaluated using semi-structured proforma for psycho-social aspects. MINI-PLUS version 5.0 was used to screen the inmates for psychiatric morbidity and the diagnosis was confirmed using the International Classification of Diseases-10. Appropriate statistical tools were applied for the analysis. Results: Majority of the participants (78.75%) were diagnosed to have some psychiatric illness. The most common psychiatric morbidity was psychosis (35%), followed by affective disorders such as major depressive disorder (15%), bipolar disorders (10%), somatization disorders (7.5%), dysthymia (6.5%), and anxiety disorder (5%). Some of the psychosocial factors assessed, namely, marital status, employment status, and poor family support were significantly associated with psychiatric morbidity. Conclusion: This research focuses on psychiatric morbidity, overall clinical profile, and the impact of numerous psychosocial factors on mental health in this vulnerable population. To enhance the general mental health of such a vulnerable group, better policymaking, timely psychiatric interventions, and rehabilitation are required.

Abstract Gleason grading, a risk stratification method for prostate cancer, is subjective and dependent on experience and expertise of the reporting pathologist. Deep Learning (DL) systems have shown promise in enhancing the objectivity and efficiency of Gleason grading. However, DL networks exhibit domain shift and reduced performance on Whole Slide Images (WSI) from a source other than training data. We propose a DL approach for segmenting and grading epithelial tissue using a novel training methodology that learns domain agnostic features. In this retrospective study, we analyzed WSI from three cohorts of prostate cancer patients. 3741 core needle biopsies (CNBs) received from two centers were used for training. The κquad (quadratic-weighted kappa) and AUC were measured for grade group comparison and core-level detection accuracy, respectively. Accuracy of 89.4% and κquad of 0.92 on the internal test set of 425 CNB WSI and accuracy of 85.3% and κquad of 0.96 on an external set of 1201 images, was observed. The system showed an accuracy of 83.1% and κquad of 0.93 on 1303 WSI from the third institution (blind evaluation). Our DL system, used as an assistive tool for CNB review, can potentially improve the consistency and accuracy of grading, resulting in better patient outcomes.

Background: The COVID-19 is a viral communicable disease and the World Health Organization declared it as a public health emergency of international concern. This pandemic has challenged the entire world including India's health-care system and resources. It is a devastating recurrence in people with underlying health issues or comorbidities, eventually resulting in mortality. Comorbidities including both medical and psychological disorders among COVID patients have a large amount of impact on the individual's mental health as well as functioning. Materials and Methods: The study comprised 800 hospitalized COVID-19 patients during the first wave from North Karnataka region in India. The data were collected using a structured interview schedule through hospital telephones. The ethical approval was obtained from the Institute Research Ethics Committee. Results: The mean age of the hospitalized COVID patients was 41.02 ± 15.21, and the mean age of comorbidity was 47.69 ± 14.84. Following medical comorbidities such as diabetes (9.3%), hypertension (9.3%), cancer (1.8%), diabetes + hypertension (2.1%), and asthma (0.9%) and psychological comorbidities such as anxiety (3.8%) and depression (3.3%) were found among the hospitalized COVID patients during the first wave. Conclusions: It can be observed that comorbidity may increase the risk of death among COVID patients who were hospitalized and appropriate medical and psychological interventions can be provided for various co comorbidities at the earliest to prevent further defuncting and distress caused by the pandemic.

Objective: To evaluate the safety, efficacy and feasibility of laser with suction device in mini-percutaneous nephrolithotomy (mini-PCNL). Methods: A retrospective study was conducted including 200 patients who underwent mini-PCNL for renal stones. All patients underwent PCNL using Electro-Medical Systems laser. In addition to the laser in 100 patients, a suction device was used (laser with suction [LWS]). In the other 100, suction device was not used (laser with no additional suction [LOS]). Mini-PCNL was performed using standard technique and Karl Storz minimally invasive PCNL-medium system was used. Primary end point was stone clearance. Results: Both the groups were comparable in terms of demographic data. Mean stone size was 15.24±5.90 mm and 16.16±5.53 mm in LWS and LOS, respectively. Mean Hounsfield unit of stone was 1285.64 and 1206.79 in LWS and LOS, respectively. Operative time was less in LWS group (56.89±19.65 min) as compared to LOS (62.01±28.81 min). At one-month follow-up, radiological complete clearance was 96% in LWS and 92% in LOS. On subgroup analysis of stones larger than 18 mm, the clearance rate was in favour of LWS (85.7% vs. 100%) and also the need for nephrostomy placement was less in LWS group. Conclusions: LWS device is safe and efficacious when used with mini-PCNL. For stones greater than 18 mm, it has a better stone free rate as compared to using no suction.

Objective: To quantify the predictors for the ancillary treatments after extracorporeal shock wave lithotripsy (SWL) for renal and upper ureteral stones. Materials and methods: From January 2014 to January 2017, patients undergoing SWL using an electromagnetic lithotripter machine (Compact Delta; Dornier MedTech GmbH, Wessling, Germany) for renal and upper ureteral stones ≤ 20 mm were retrospectively reviewed. All patients underwent CT urography prior to SWL. The cohort was subdivided into three groups according to stone attenuation values in Hounsfield Units (HU). Group I; HU < 500 (n = 20), group II; HU 500-1000 (n = 51) and group III; HU ≥ 1000 (n = 180). The parameters included for multivariate analysis were stone size, location, multiplicity, stone attenuation value, number of shocks and stone clearance rate by 3 months. The ancillary treatments were ureteroscopy (URS), ureteral stenting and hospital readmission for pain or fever. Results: A total of 251 patients were included in the study. The overall SWL success rate was 92.4%. Mean stone size was 10.9 ± 2.1, 11.6 ± 3 and 11.4 ± 3.6 mm and mean stone attenuation values were 364 ± 125, 811 ± 154 and 1285 ± 171 HU for groups I, II and III respectively. The stone clearance rates by 3 months were 96%, 92% and 88.4% for groups I, II and III respectively. On subgroup analysis, group III required ancillary treatments in 70% of patients whereas group I, II, did not require any ancillary treatments. On multivariate analysis, stone multiplicity, stone location (lower calyceal stones) and HU were independent significant predictors for the need for ancillary treatments after SWL (p values < 0.05). Conclusions: Patients with stone attenuation value (HU) > 1000, multiple stones and/or lower calyceal stones have higher risk to necessitate ancillary treatments after SWL. These patients would likely benefit from upfront endoscopic lithotripsy for treating symptomatic renal or upper ureteral stones.

Graft artery aneurysms though rare, may have devastating consequences. We present a case of an aneurysm involving the lower polar artery anastomosed to external iliac artery using a gonadal vein graft. The patient presented with sudden onset graft fossa swelling, pain, and decreased urine output. Color Doppler and computed tomography angiography helped in diagnosis and management. Since the majority of the graft was well-perfused by the upper polar artery, the patient underwent excision of the lower polar artery aneurysm. The prompt diagnosis and management salvaged the graft. This aneurysm presented after 10 years of the underlying importance of long-term surveillance.

Complex renal calculi remain to be a challenge for the treating urologist due to sheer bulk and the technicalities involved. Percutaneous nephrolithotomy (PCNL) remains the treatment modality of choice in dealing with these large and complex stones. The limiting factor in their treatment continues to be the need for using additional tracts or the use of flexible nephroscopy for complete stone clearance. This systematic review focuses on the need for multi-tract PCNL for complex renal calculi. The literature review was performed using PubMed database using the keywords “multiple tract PCNL” or “multiperc”. We identified original articles published on the usage of multiple tracts for stone clearance in renal calculi between January 2000 to October 2018, and the search was restricted to available literature in English language only. Ten studies with n>20 were included for the final analysis. We analyzed the technical efficacy with respect to the number of tracts and stages that were required for stone clearance, outcomes and complications, especially, procedural bleeding and post-procedure infective complications of multiple-tract PCNL for large burden renal stones. Multiperc is found to be safe, feasible and effective for the management of large burden complex renal calculi with respect to stone clearance and morbidity associated with the procedure. It is cost effective and complete stone clearance as a single procedure is higher in comparison to flexible ureteroscopy and shockwave lithotripsy. Keywords: Percutaneous nephrolithotomy, Multiple tract, Multiperc, Complex renal calculi, Surgical management

Objective: Patients undergoing hemodialysis (HD) have a poor health-related quality of life (HRQoL). HRQoL may differ across geography and ethnicity. This study aimed to compare HRQoL in patients undergoing HD by arteriovenous fistula (AVF) and central venous catheter (CVC) in a cohort of Indian population. Methods: This was a cross-sectional observational study conducted between March 2016 and June 2016. All patients undergoing HD (more than 2 months) who had vascular access using AVF or CVC were eligible to participate in the study. Sociodemographic characteristics were noted, and HRQoL was assessed using the Short Form 36 questionnaire. Results: A total of 58 patients were included in this study, 31 in CVC group and 27 in AVF group, without any crossover. The mean (standard deviation) age was 47.4 (18.1), and the median (range) duration of HD was 14 months (2 months–120 months).Overall, patients who underwent AVF for vascular access had significantly (P < 0.05) higher HRQoL score than those who underwent CVC. There was no significant difference of HRQoL score for majority of the parameters for sex and age, for all the parameters for duration of HD. Conclusions: Overall, results showed that patients who had vascular access using AVF showed better HRQoL as compared to CVC in patients with HD.

Percutaneous Nephrolithotomy (PCNL) has evolved over the decades from Standard to Mini to Ultramini PCNL to Micro-perc, with miniaturisation being the dominant theme and supine approach gaining momentum world over.Aim: In literature, miniaturised PCNL with microperc needle access system has raised concerns of intrarenal pressure and has some limitations with its success for larger stones. Our tips and tricks explain how to overcome these pitfalls by utilising the full construct of the needle system to its maximum potential. These will in turn help make the procedure versatile, precise, ergonomical, and enhance a surgeon's experience with improved outcomes for patients especially in large renal stones.Materials and Methods: We describe the limitations of microperc needle access as stated in literature and proposals by the co-authors using microperc for miniaturised access on how to overcome the same.Results: A simplified table describing the limitations and tips and tricks on overcoming these is provided for quick reference.Conclusion: As Technological advancements and techniques for miniaturised access in urolithiasis improve, we believe our suggestions will help surgeons overcome the quoted limitations of microperc needle access for miniaturised PCNL, making this a versatile, safe and efficacious technique even in large and complex stones. A multi centre trial will be the best way to validate the suggestions proposed in this article.

Percutaneous renal allograft biopsy (PRAB) complications have been extensively described in literature. We report an unusual case of a pseudoaneurysm in the anterior abdominal wall that developed after a PRAB in a 26-year-old male patient done for suspected posttransplant graft dysfunction. Surgical exploration and ligation of feeding vessel was done for this case. Such a distressing complication warrants extra care as it can lead to significant morbidity in the patient.

Background: Renal stones are conventionally treated with percutaneous lithotomy (PCNL), with miniPCNL and endoscopic combined intrarenal surgery (ECIRS) as preferred choices to reduce morbidity associated with bigger tracts. MicroPCNL is not recommended for larger stones as fragments obscure intraoperative vision and high intrarenal pressure with prolonged operative time increases the risk of sepsis. MicroECIRS overcomes these disadvantages with simultaneous antegrade and retrograde lithotripsy and drainage. Objectives: To provide a step-by-step illustration on how to perform microECIRS. Materials and methods: 1. Patient in supine Barts flank-free with French split leg or Galdakao-modified supine Valdivia (GMSV) position. 2. MicroPCNL with 4.8Fr “All Seeing Optical Needle” (Polydiagnost, Germany). 3. Placement of access sheath with/without suction. 4. Retrograde intrarenal surgery (RIRS) with Boston Scientific Lithovue or Olympus URF-V ureteroscope. 5. Lithotripsy using Lumenis 120-watt high-power 200-micron laser with/without Moses fibre. Results: MicroECIRS has multiple advantages. Direct ureteroscope-guided puncture, antegrade visualisation of the tract via the ''all seeing needle'', and miniaturization, ensures safe and accurate percutaneous access even in challenging renal anatomy, hence reducing the risk of bleeding and need for post-operative nephrostomy. Low intrarenal pressure with good active and passive drainage bidirectionally prevents pyelovenous reflux and sepsis, and maintains clear vision to allow precision laser lithotripsy. MicroECIRS is also ergonomic for both antegrade and retrograde surgeons as they can remain seated throughout the operation, avoiding muscle fatigue. Additionally, as the camera head of the microPCNL set is mounted on a separate rod, weight is taken off the handheld part such that the surgeon only maneuvers the lightweight needle. Conclusion: MicroECIRS is a safe, easy, and ergonomic option for larger stone volumes. Achieving single-stage stone clearance with no morbidity translates into shorter hospital stays and a faster return to daily activities, hence making this economically viable.

Background: Attention-deficit hyperactivity disorder (ADHD) and substance-use disorders often co-occur. Aim: Aim of this study was to look at the family loading of ADHD (in adults and children) in patients with alcohol-dependence syndrome (ADS) along with the estimation of morbidity risk (MR) for developing ADHD. Methods: Thirty-five male patients with ADS along with their 369 first-degree relatives (FDRs) – both children and adults – were recruited. Results: ADHD and residual ADD (ADDRT) were significantly more common in the early-onset (EO) ADS group and their FDR. In ADHD children, high MR (27.27%) for developing EO of ADS was noted. Discussion: Findings from this study raise an avenue for research in the Indian population about the shared risk between ADS and ADHD.

Context: Although the technical feasibility of laparoscopic donor nephrectomy (LDN) has been established, concerns have been raised about the impaired renal function resulting from pneumoperitoneum and its short- and long-term effects. Aims: We used urinary biomarkers of acute kidney injury including urinary neutrophil gelatinase-associated lipocalin (uNGAL) and urinary N-acetyl-beta-D-glucosaminidase (uNAG) to study the injury caused to the donor's retained kidney by pneumoperitoneum. Settings and Design: This was a prospective cohort study of thirty consecutive patients who underwent LDN at our hospital. Subjects and Methods: We measured urinary creatinine, uNAG and uNGAL at the time of induction of anaesthesia, at 1 h after starting surgery, at 5 min after clamping the ureter, at the time of skin closure and then at 4, 8 and 24 h after the surgery. Results: The uNAG level showed a gradual increase from the start of the surgery and reached the peak at the time of the closure. Thereafter, there was a gradual fall in the level and reached to pre-operative level at 24 h post-surgery. Similarly, the uNGAL also showed a similar trend although it did not reach pre-operative value by 24 h. Conclusions: We objectively confirm that although there is acute injury to the retained kidney in the donor after LDN due to the CO2pneumoperitoneum, the renal function improves and reaches close to the pre-operative level within 24 h after surgery.

Context: Depression is the most prevalent psychiatric condition seen in human immunodeficiency virus (HIV)-positive individuals. Various biological, sociocultural, and economic factors make women more vulnerable to HIV and acquired immune deficiency syndrome (AIDS). Depression affects medication adherence and immunity against HIV thus contribute significantly to disease progression. Aims: The aim is to assess the prevalence, sociodemographic, and clinical correlates of depression among women living with HIV/AIDS. Settings and Design: Antiretroviral therapy (ART) centre attached to government medical college hospital in North Karnataka and cross-sectional design. Materials and Methods: This study was conducted among of 145 women living with HIV/AIDS, depression was assessed using Beck Depression Inventory, and social support was assessed using Lubben Social Network Scale and quality of life (QoL) using the World Health Organization QoL BREF scale. Statistical Analysis Used: Data were analyzed using Statistical Package for the Social Sciences version 20.0. Chi-square test with P value less than 0.05 was taken as statistically significant. Results: Among 145 HIV-positive women, 50 (34.5%) were depressed. Depression was statistically significant in women from rural background. Significant association between depression and risk of social isolation was observed. Scores of all domains of QoL, that is, physical, psychological, social, and environmental were reducing with increase in the severity of depression indicating that QoL was decreasing with increase in severity of depression. Among the four domains, social domain was the most affected. Conclusions: Depression among women living with HIV/AIDS which is underdiagnosed and undertreated. Depression negatively impacts adherence and immunity leading rapid progression of the infection. Therefore, early diagnosis and treatment of depression are essential.

Management of distal ureter by en block resection during radical nephrectomy for upper urinary tract transitional cell carcinoma (TCC) is considered as standard of care. In this report, we describe our technique for management of lower ureter which utilizes both the endoscopic and laparoscopic approach. The nephrectomy including the dissection of the lower ureter was completed laproscopically. The ureteral orifice was scored using a hook passed through a 24 Fr nephroscope and secured .Transurethral suturing of the defect with SewRight SR5 device passed through the working channel of the 24 Fr nephroscope was done. Our report highlights the fact that management of lower ureter in TCC pelvis can be done endoscopically/laproscopically without compromising the oncological principles. Our novel technique demonstrates feasibility of intra mural resection of the ureter and primary closure of the bladder endoscopically.

Tricyclic antidepressants (TCAs), such as amitriptyline, have many side effects. But extrapyramidal tract symptom is an uncommon side effect of these drugs. Here, we report a case of a 28-year-old male who is suffering from amitriptyline induced cervical dystonia. Though rare, this side effect is an uncomfortable condition and may influence drug compliance. So clinicians should be aware of this side effect while treating a patient with amitriptyline.

High intensity focused ultrasound (HIFU) has come forward as alternative treatment for carcinoma of the prostate. Though minimally invasive,HIFUhas potential side effects. Urethrorectal fistula is one such rare side effect. Management of these fistulas has been described by Vanni et al. This case report describes points of technique that will help successful management of resilient rectourethral fistula. Urinary and faecal diversion in the form of suprapubic catheter and colostomy is vital. Adequate time between stoma formation, fistula closure and then finally stoma closure is needed. Lithotomy position and perineal approach gives best exposure to the fistula. The rectum should be dissected 2cm above the fistula; this aids in tension free closure of the rectal defect. Similarly buccal mucosal graft was used on the urethra to achieve tension free closure. A good vascular pedicle gracilis muscle flap is used to interpose between the two repairs. This not only provides a physical barrier but also provides a vascular bed for BMG uptake. Perfect haemostasis is essential, as any collection may become a site of infection thus compromising results. We strongly recommend rectourethral fistula be directly repaired with gracilis muscle flap with reinforced buccal mucosa graft without attempting any less invasive repairs because the “first chance is the best chance”.

Robotic surgery with its bundled advantages is still in its burgeoning phase, the best of which is yet to come. The unrivalled suturing ease and motion scaling features, transforming into greater precision, has led to its widespread application in different surgical ramifications. These, coupled with the aforementioned advantages, has led to an increasing number of procedures being performed and that too with improved patient outcomes. It seems that the progressing India is readily accepting this robotic surgical innovation, the use of which is on a continuous rise, with the number of robotic platforms coming up in increasing numbers in many tertiary care Indian centres and a corresponding increase in demand of the same by the patients as well; thereby aptly fulfilling the economics of ′demand and supply′.

′Microperc′ is a recently described technique in which percutaneous renal access and lithotripsy are performed in a single step using a 16 G micropuncture needle. ′Mini-microperc′ is a further technical modification in which an 8 Fr sheath is used to allow insertion of ultrasonic or pneumatic lithoclast probe with suction. The available evidence indicates that microperc is safe and efficient in the management of small renal calculi in adult and pediatric population. It can also be used for renal calculi in ectopic kidneys and bladder calculi. The high stone clearance rate and lower complication rate associated with microperc make it a viable alternative to retrograde intrarenal surgery.

Kikuchi-Fujimoto disease (KFD) is an extremely rare disease with a worldwide distribution and higher prevalence in Asians. It is a benign and self-limiting disorder, characterized by regional cervical lymphadenopathy accompanied with mild fever and night sweats. Lymph node histopathology is diagnostic and treating physicians should be aware of this entity as it may mimic other systemic diseases like systemic lupus erythematosus, tuberculosis, malignant lymphoma, and more rarely adenocarcinoma. Key features on lymph node biopsy are fragmentation, necrosis and karyorrhexis. Treatment includes symptomatic care, analgesics-antipyretics, corticosteroids and spontaneous recovery occurs in 1 to 4 months. We report a case of adult polycystic kidney disease (ADPKD) with end stage renal disease and episodes of fever and cervical lymphadenopathy. The infectious screen was negative and on extensive workup, the patient was found to have histiocytic-necrotizing lymphadenitis, which clinched the diagnosis of KFD.

Introduction: Laparoscopic adrenalectomy remains a controversial procedure for large tumors. The incidence of adrenocortical carcinoma increases and technical difficulty of adrenalectomy increases as the size increases. We examined the outcome and complications of laparoscopic adrenalectomy for such lesions. Materials and Methods: Twenty-nine patients underwent laparoscopic adrenalectomy, of whom 19 had tumors larger than 5 cm in diameter, having a median tumor size of 7.0 cm. They were compared with patients whose adrenal tumors were smaller than 5 cm. Results: Patients with small tumors (< 5 cm) had a significantly shorter median operative time of 90 minutes as compared to 145 minutes in those with large tumors (> 5 cm). There was no significant difference in the median hemoglobin drop (1.05 g/dL versus 1.30 g/dL), time for starting oral intake (24 hours in both groups) or hospital stay (3.5 days versus 4.0 days) between patients with small and large tumors, respectively. There were no intra-operative complications except for 1 incidence of supraventricular tachycardia in a patient with a large pheochromocytoma. There were no major complications seen in any of the patients and no open conversions. Histopathology of large tumors revealed 16 benign tumors (8 pheochromocytomas, 4 adenomas, 2 ganglioneuromas, 1 pseudocyst, and 1 myelolipoma) and 3 malignancies, of which 1 was primary adrenocortical carcinoma and 2 were metastatic renal cell carcinoma. Conclusion: In experienced hands, laparoscopic adrenalectomy is safe and feasible for large functioning adrenal tumors. Large adrenal tumors suspicious of harboring malignancy with no peri-adrenal involvement can be tackled laparoscopically.

Intestinal atresia is generally caused by intrauterine vascular obstructions involving mesenteric vessels. Intrauterine intussusceptions (IUI) are one of these disruptive events. Intestinal intussusceptions affects children commonly between 3 months and 3 years of age, but it rarely affects in intrauterine life. The relationship between intrauterine intussusception and intestinal atresia has been demonstrated by few cases in literature, suggesting intrauterine intussusception as a rare cause of intestinal atresia. We report a 7-day-old full term neonate presenting with intrauterine intussusceptions (jejuno-jejunal) resulting in jejunal atresia.

Aim. To correlate findings of conventional cystoscopy with CT virtual cystoscopy (CTVC) in detecting bladder tumors and to evaluate accuracy of virtual cystoscopy in early detection of bladder cancer. Material and Method. From June 2013 to June 2014, 50 patients (46 males, four females) with history and investigations suggestive of urothelial cancer, with mean age 62.76 ± 10.45 years, underwent CTVC by a radiologist as per protocol and subsequently underwent conventional cystoscopy (CPE) the same day or the next day. One urologist and one radiologist, blinded to the findings of conventional cystoscopy, independently interpreted the images, and any discrepant readings were resolved with consensus. Result. CTVC detected 23 out of 25 patients with bladder tumor(s) correctly. Two patients were falsely detected as negative while two were falsely labeled as positive in CTVC. Virtual and conventional cystoscopy were comparable in detection of tumor growth in urinary bladder. The sensitivity, specificity, positive predictive value, and negative predictive value of virtual cystoscopy were 92% each. Conclusion. CTVC correlates closely with the findings of conventional cystoscopy. Bladder should be adequately distended and devoid of urine at the time of procedure. However, more studies are required to define the role of virtual cystoscopy in routine clinical practice.

ABSTRACT Objective The most common acquired fistula of the urinary tract is Vesicovaginal fistulae (VVF) (1) posing social stigmata for the patient as well as a surgical challenge for the urologist. Here we present our initial experience with Robotic assisted laparoscopic repair of VVF, its safety and efficacy. Materials and Methods Seven out of eight fistulas were post hysterectomy; five had undergone abdominal while two had laparoscopic hysterectomy while one was due to prolonged labour. Two had associated ureteric injury. All underwent robotic assisted laparoscopic trans abdominal extravesical approach. Three 8 mm ports for robotic arms, one 12 mm port for camera and another 12 mm for assistant were used in a fan shaped manner. All had preoperative ureteric catheter placed. Bladder was closed in two layers and vagina in one layer. Omental flap placed in all cases except two where it was not possible. Drain and per urethral catheter placed in all cases. Double J stents were placed in two cases requiring ureteric implantation additionally. Results The mean age of presentation was 39.25 years (26-47 range) with mean BMI being 26.25 kg/m2 (21-32 range). Mean duration between insult and repair was 9.37 months (3-24 months). Only in single case there was history of previous repair attempt. On cystoscopy four had supratrigonal VVF and four were trigonal with mean size of 13.37 mm (7-20 mm). Mean operative time was 117.5 minutes (90-150). There were no intraoperative/postoperative complications or need for open conversion. Mean haemoglobin drop was 1.4 gm/dL (0.3-2 gm). Drain was removed once 24-48 hours output is negligible. One patient had post-operative urinary leak at 2 weeks which ceased with continuation of catheterisation for another 2 weeks. Catheter was removed after voiding cystourethrogram showed no leak at 2-3 weeks postoperatively. Mean duration of drain was 3.75 days (3-5) and per urethral catheterisation (which was removed after voiding cystourethrography) was 15.75 days (9-28). Mean hospital stay was 6.62 days (4-14). Post-operative bladder capacity was 324.28 cc (280-350) on voiding diary. Follow up ranged from 3-9 months. At 3 months of follow-up, these patients continued to void normally and there was no evidence of recurrence of VVF. Conclusion Robotic repair of VVF is safe and feasible and has additional advantages in the form of precise suturing under 3D vision and certainly a more striking and effective option especially in complex VVF repair associated with ureteric injuries (2).

Disulfiram (DSF) is most commonly used as avertive therapy in day to day practice in deaddiction devision, have many side effects but dystonia is an uncommon side effect. Here we report a case of 34 year-old-male who is suffering from disulfiram induced dystonia. clinician should be aware of this side effect as this may influence the drug compliance and maintainig abstinence from the alcohol.

Aim : To assess the relation of acute rejection with respect to lymphocele incidence and determine the effect of lymphocele with graft survival. Methods : The paper is a singlecenter retrospective data review of renal transplant recipients from 1980 to 2007. A total of 1700 patients received kidneys from live donation, and 9 patients received from cadaver donor. The standard transplant technique was performed in all. Lymphocele incidence, demography, relation to rejection episodes, type of immunosuppression, and management options were studied. Univariate analysis was performed to assess the role of rejection to lymphocele formation. Results : 47 (35 males and 12 females) patients had symptomatic lymphocele in the post-transplant period. 51% of the lymphocele patients had history of rejection as compared to overall rejection rate of 20% (P = 0.009). 4 (7.2%) had at least 1 rejection and 19 (40.4%) had more than one rejection episodes. All 47 patients required aspiration. Of the 14 patients who did not settle with a maximum of two aspirations underwent marsupilization (5 open and 9 laparoscopic). 1, 5, and 10 year graft survival of overall transplant recipient and post-transplant lymphocele patients was 86.54%, 82.41% and 76.36% vs. 86.44%, 81.2% and 68.14%, respectively. Conclusion : Acute rejection episodes were associated with statistically increased risk of lymphocele. There was no adverse outcome of graft with lymphocele formation after rejection episodes with respect to the overall graft survival.

End-stage renal disease is a significant health problem. The primary use of the autogenous arteriovenous access is recommended by NKF-DOQI (National Kidney Foundation-Dialysis Outcomes Quality Initiative) guidelines. Though basilic vein transposition is well established in multiple failed fistulae′s and obese patients, it requires large incision and morbidities like edema and infection. To avoid such compilations we, at our institution, adopted a small incision technique using two small 3-4 cm incisions. This method is inspired by videoendoscopic minimally invasive method used to dissect the basilic vein, thus avoiding extensive dissection and related morbidities.

We present a case of Xanthogranulomatous pyelonephritis mimicking as a renal cell carcinoma. This was an elderly lady who presented with pyonephrosis due to urolithiasis. On evaluation she was found to have a space occupying mass in the right kidney. Further investigations revealed an enhancing tumor with renal vein thrombus and paracaval lymphadenopathy. Subsequent histopathology showed evidence of XGPN with no malignancy. This case report highlights the fact there are a number of imaging and clinical overlaps in the diagnosis, assessment and management of this entity.

High intensity focused ultrasound (HIFU) has come forward as alternative treatment for carcinoma of the prostate. Though minimally invasive,HIFUhas potential side effects. Urethrorectal fistula is one such rare side effect. To our knowledge this is first case in which rectourethral fistula secondary to HIFU was repaired with buccal mucosa graft (BMG) over a harvest bed of gracilis flap. This case report describes points of technique that will help successful management of resilient rectourethral fistula. Urinary and faecal diversion in the form of suprapubic catheter and colostomy is vital. Adequate time between stoma formation, fistula closure and then finally stoma closure is needed. Lithotomy position and perineal approach gives best exposure to the fistula. The rectum should be dissected 2cm above the fistula; this aids in tension free closure of the rectal defect. Similarly buccal mucosal graft was used on the urethra to achieve tension free closure. A good vascular pedicle gracilis muscle flap is used to interpose between the two repairs. This not only provides a physical barrier but also provides a vascular bed for BMG uptake. Perfect haemostasis is essential, as any collection may become a site of infection thus compromising results. We strongly recommend rectourethral fistula be directly repaired with gracilis muscle flap with reinforced buccal mucosa graft without attempting any less invasive repairs because the “first chance is the best chance”.