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p16ink4a status is an independent predictor of survival in PC. There is a strong concordance between p16ink4a and HPV ISH results. Also, there is a significant association between HPV positivity and the histology with 100% of the warty, basaloid, and mixed warty-basaloid subtypes being positive for HPV. p53 is a predictor of nodal metastasis irrespective of p16ink4a status. Dual positive tumors (p16ink4a and p53 positive) have a significantly better outcome in comparison to dual negative tumors (both markers negative). Thus, p53 and p16ink4a immunohistochemistry should be performed at the baseline in all patients of PC. Background: Human papilloma virus (HPV) infection is implicated in a proportion of invasive squamous cell carcinoma of the penis (PC). A subset of PC involves dysregulation of the p53 pathway. HPV in situ hybridization (ISH) and p16ink4a positivity are surrogate markers for HPV infection, and p53 immunohistochemistry (IHC) denotes abnormality in the p53 pathway. There remains an ambiguity with regard to the contribution of both the pathways in the prognosis of PC. We sought to analyze the clinicopathologic characteristics of a cohort of Indian PC patients with respect to p16 ink4a and p53 expression. Patients and Methods: A cohort of 123 PC patients was studied for p16 ink4a and p53IHC and HPVISH. The results of these biomarkers were correlated with various clinicopathologic parameters. Results: p16 ink4a and HPV ISH were positive in 47% and 53% of the tumors, respectively. The propor tion of war ty, basaloid, or mixed war ty-basaloid tumor subtypes showed significant p16 ink4a positivity (P < .0001) compared to other subt ypes. Twent y-eight patients were dual negative (p53- /p16 ink4a -), 32 were dual positive (p53 + /p16 ink4a + ), 38 were p53 + /p16 ink4a -, and 25 were p53- /p16 ink4a + . In patients where p16 ink4a was negative, a p53-positive phenotype had a higher propensity for lymph node metastases (OR, 5.42; 95% CI, 1.75-16.80; P = .003). Similarly, p53 positivity dictates nodal involvement in the p16 ink4a - positive subset of tumors (OR, 5.00; 95% CI, 1.23-20.17; P = .024). On multivariate analyses, pathologic subtypes (warty, warty-basaloid, and basaloid) (P < .0001), p16 ink4a expression (P < .0001), and absence of nodal metastasis (P < .0001) were significant predictors of improved overall (OS) and cancer specific survival (CSS). In Kaplan-Meier analysis, the OS was significantly longer in patients with p16 ink4a + tumors (P < .0001), as was the CSS (P < .0001). Patients with dual positive tumors had a significantly higher OS (P < .001) and CSS (P = .012), in the entire cohort. In the node positive patients, dual positivity was associated with significantly higher OS (P < .0001); however, the median CSS for p53 + /p16 ink4a + tumors were not significantly different compared to p53- /p16 ink4a - tumors (P = .064), although there was a trend towards improved CSS. Conclusions: There is a strong concordance between p16 ink4a IHC and HPV ISH results. p16 ink4a status is an independent predictor of survival (OS and CSS) in our cohort of PCs. p53 is a predictor of nodal metastasis irrespective of p16 status. Dual positive tumors have a significantly better outcome in comparison to dual negative tumors. [ABSTRACT FROM AUTHOR]

Introduction: Though transitional cell carcinoma is a common malignancy in older age group it is very rare to find a young patient without any risk factors for carcinoma bladder to present with bladder malignancy. We would like to present a case of 23 yr old male who presented with carcinoma bladder. Materials and Methods: 23 yr old male presented with hematuria for 6 months. Past history of undergoing TUR biopsy 1 yr back for the growth detected in bladder. The biopsy report was suggestive of low grade TCC without muscle invasion. After that patient was lost to follow up. Patient got admitted again for haematuria and obstructive uropathy secondary to bilateral back pressure changes. On USG whole bladder was filled with mass. His serum creatinine was 11 mg%. Serum creatinine stabilised at 3.0 mg % after inserting bilateral percutaneous nephrostomies. On cystoscopy there was multiple polypoidal growths all over the bladder wall. TURBx was suggestive if high grade TCC with muscle invasion Then he was subjected for laparoscopic radical cystectomy and open urinary diversion in form of ileal conduit after metastatic workup. Result: Laparoscopic radical cystectomy was performed using four ports. Time taken was 185 mins. Blood loss was 125 ml. specimen was extracted by a small midline infra umbilical incision and ileal conduit was performed via same incision. Post op recovery was uneventful. Drain was removed on 2nd post operative day. Histo pathology was suggestive of high grade TCC with involvement of muscularis propria, surgical margins free of tumour, no evidence of metastatis to lymphnodes present. Conclusion: Though it is very rare to see young patient with malignancy we should rule out malignancy in any patient presenting with haematuria. Laproscopic radical cystectomy is a feasible option in young patient with muscle invasive carcinoma bladder. [ABSTRACT FROM AUTHOR]

Introduction: Although open pyeloplasty remains the gold standard for treating ureteropelvic junction obstruction, endourology and laparoscopy have revolutionized the management of upper tract obstruction. Pyeloplasty is an extremely demanding procedure by the laparoscopic route more so in pediatric subpopulation. We wish to share our experience of laparoscopic management of PUJ obstruction. Materials and Methods: 24 cases of PUJ obstruction between August 2004 to June 2007 were managed by laparoscopic pyeloplasty repair. Age ranged between 1 year to 60 years. 1 patient had h/o failed endopyelotomy once. All patients were investigated in the form of IVU, Renal scan and RGP. Pre operatively in all patients there was hydronephrosis on IVU with non visualisation of ureter. Our study group comprised of 15 males and 9 female patients. 7 cases were operated on the right side as opposed to 17 on the left side. In 17 cases dismembered Anderson Hynes pyeloplasty, in 6 cases Foleys Y-V pyeloplasty and in 1 case Fenzer pyeloplasty was done. In 17 cases approach was transperitoneal whereas in 2 cases it was retroperitoneal in lateral position using standard two 5 mm and one 10 mm port, fourth port used whenever required. Results: The average operating time was 160 minutes. the average blood loss was 150 ml. In three cases we had to convert to open owing to dense adhesions on account of previous surgery. Hospital stay averaged 3.8 days. At three months of surgery patients were assessed in the form of IVU. In all the patients except one there was drainage and visualisation of ureter and in 10 cases there was persistent hydronephrosis on IVU. Post operatively 15 patients underwent renal scan. 11 patients had improved renal function whereas in 4 patients renal function was static. All showed improved drainage on diuretic renogram post operatively. Two patients presented with UTI and in 4 cases there were persistent symptoms howsoever all these recovered on conservative management. Conclusion: In experienced hands laparoscopic pyeloplasty is an effective alternative treatment for symptomatic ureteropelvic junction obstruction. The results appear durable and comparable to open pyeloplasty with decreased postoperative morbidity. [ABSTRACT FROM AUTHOR]

Objectives: Penile squamous cell carcinomas (PCs) are rare malignancies with a dismal prognosis in a metastatic setting; therefore, novel immunotherapeutic modalities are an unmet need. One such modality is the immune checkpoint molecule programmed cell death ligand 1 (PD-L1). We sought to analyze PD-L1 expression and its correlation with various clinicopathologic parameters in a contemporary cohort of 134 patients with PC., Methods: A cohort of 134 patients with PC was studied for PD-L1 immunohistochemistry. The PD-L1 expression was evaluated using a combined proportion score with a cutoff of 1 or higher to define positivity. The results were correlated with various clinicopathologic parameters., Results: Overall, 77 (57%) patients had positive PD-L1 expression. Significantly high PD-L1 expression was observed in high-grade tumors (P = .006). We found that 37% of human papillomavirus (HPV)-associated subtypes and 73% of other histotype tumors expressed PD-L1, while 63% of HPV-associated tumors and 27% of other histotype tumors did not (odds ratio, 1.35; P = .002 when compared for HPV-associated groups vs all others). Similarly, PD-L1-positive tumors had a 3.61-times higher chance of being node positive than PD-L1-negative tumors (P = .0009). In addition, PD-L1 high-positive tumors had a 5-times higher chance of being p16ink4a negative than PD-L1 low-positive tumors (P = .004). The PD-L1-positive tumors had a lower overall survival and cancer-specific survival than PD-L1-negative tumors., Conclusions: Overall, PD-L1 expression is associated with high-grade and metastatic tumors. Lower PD-L1 expression is observed more frequently in HPV-associated (warty or basaloid) subtypes than in other, predominantly HPV-independent types. As a result, PD-L1 positivity, including higher expression, portends lower overall and cancer-specific survival. These data provide a rational for further investigating PD-L1-based immunotherapeutics in PC., (© The Author(s) 2023. Published by Oxford University Press on behalf of American Society for Clinical Pathology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)