Prostate cancer (PCa), one of the most common cancers in males, is a topic of active interest in imaging research. Positron emission tomography/computed tomography (PET/CT) and PET/magnetic resonance imaging (PET/MRI) have enabled the combination of morphologic and functional imaging with the promise of providing better information in guiding therapy. 18F-fluorodeoxyglucose, the workhorse radiopharmaceutical in PET imaging, has not found preference in PCa since these tumors show poor glucose uptake and can be obscured by the normal urinary excretion of the radiotracer. Hence, the last two decades have seen the development of multiple newer radiotracers and better optimization of the technical aspects of PET imaging. The combination of functional imaging and MRI holds great promise. We searched PubMed, Scopus, and Google Scholar for peer-reviewed literature concerning the advances and newer developments in the imaging of PCa between the years 2005 and 2017. This review aims at summarizing current evidence on the role of PET imaging in PCa and its impact on the diagnosis, staging, prognostication, response assessment, and restaging of this malignancy.
With the emergence of recent landmark trials, the treatment for hormone-sensitive metastatic prostate cancer (hsMPC) is changing from androgen deprivation therapy (ADT) alone to combination therapy. Both, docetaxel chemotherapy and abiraterone in addition to ADT have been extensively studied in well-conducted randomized controlled trials and were shown to improve outcomes. However, this paradigm shift in the treatment has also raised some queries. This mini review reflects upon the four landmark trials and tries to provide some perspective about the decision-making process for the patients with hsMPC.
Introduction: Simulation-based training in laparoscopic urology is essential, as these surgeries require a different skill set.
We validated a chicken model for laparoscopic left modified Lich Gregoir type of ureteric reimplantation.
Materials and Methods: Prospective observational study was conducted from August 2016 till February 2017. Thirty novice surgeons and 20 trained laparoscopic surgeons were included in the study. The relevant chicken anatomy and surgical steps were described to all the surgeons. The surgeons were asked to fill an eight-point questionnaire after finishing the procedure and score it on a scale of 1–5. The trainee's performance was also recorded by an investigator on a proforma. The investigator recorded dissection time, suturing time, quality of dissection, quality of suturing, and integrity of anastomosis on a scale of 1–5.
Results: All the participants in the study gave a mean score of 3 or more to all the questions asked, except for one question pertaining to tissue feel. Both the groups rated the usefulness of the model very highly with a mean score of 4.20 and 4.15, respectively. Difference in the time taken for dissection and suturing along with the quality of suturing was statistically significant in favor of the expert group.
Conclusions: The chicken model for laparoscopic left modified Lich Gregoir type of ureteric reimplantation is a useful, effective, cognitive training tool. This model has a face, content, and construct validity to be used as a teaching and learning tool in laparoscopic urology.
Introduction: There are variations in surgical procedures included in urology residency curricula across various programs. We conducted a survey of practicing urologists to determine which procedures are considered essential to a core urology residency curriculum.
Materials and Methods: A web-based survey was conducted between October 2016 and February 2017 using SurveyMonkey. The questionnaire, comprising a set of 5-questions, was sent to the members of the Urological Society of India. Respondents were requested to grade 37 of the most common urological procedures (competencies) into three groups. Group A, were those that the respondent believed were vital for the trainee to learn (must know). Group B, were those that the respondent thought were essential to acquire (good to know). Group C procedures were labeled as desirable to know by respondents.
Results: A total of 485 (15.75%) responses were received out of 3018 members contacted. 67% respondents were working in the private-sector. Out of the 37 listed procedures, 20 procedures received a median weightage of 1 indicating vital clinical competency for urology curriculum, 15 were identified as “essential to know” while two procedures were identified as “desirable to know.”
Conclusions: Twenty surgical procedures were identified as 'must-know' for a urology trainee. The choice of procedures was not affected by the region of the responder or his practice type, suggesting a wide consensus.
Introduction: The Urological Society of India guidelines panel on urinary incontinence (UI) conducted a survey among its members to determine their practice patterns in the management of UI. The results of this survey are reported in this manuscript.
Methods: An anonymous online survey was carried out among members of the USI to determine their practice patterns regarding UI using a predeveloped questionnaire on using SurveyMonkey®. A second 4-question randomized telephonic survey of the nonresponders was performed after closure of the online survey. Data were analyzed by R software 3.1.3 (P < 0.05 significant).
Results: A total of 468 of 2109 (22.2%) members responded to the online survey. Nearly 97% were urologists, 74.8% were working at a private, and 39.4% were in an academic institution. Almost all were managing UI. 84.2% had local access to a urodynamics (UDS) facility. 85.8% would check postvoid residual urine for all the patients. Voiding diary, symptom scores, quality of life scores, pad test, Q-tip test, stress test, uroflow, and cystoscopy were ordered as part of evaluation by 86.0%, 49.8%, 24.4%, 22.0%, 6.0%, 71.8%, 69.2%, and 34.7%, respectively. 47.6% would order a UDS for patients with urgency UI who fail conservative treatment. 36.9% would get UDS prior to all stress UI surgery. Seventy-five percent would make a diagnosis of intrinsic sphincter deficiency. Solifenacin was the first choice for urgency UI in general and darifenacin was preferred in elderly. Botulinum was the first choice for refractory urgency UI. Midurethral sling was the commonest procedure for surgical management of SUI (95.1%). 147 of the 1641 non responders were randomly sampled telephonically. Telephonic respondents had similar access to UDS facility but had performed fewer lifetime number of post-prostatectomy incontinence (PPI) surgeries. Combining data from both surveys, total number of artificial sphincters and PPI surgeries ever performed by USI members was estimated at 375 and 718 respectively.
Conclusion: This survey provides important new data and elicits critical differences in management practices based on demographics.
Introduction: Robot-assisted radical nephroureterectomy (RANU) with extended template lymphadenectomy (E-LND) is the leading treatment option for nonmetastatic upper tract urothelial carcinoma. Due to the rarity of this disease, there is a lack of consensus regarding the best approach and the extent of lymphadenectomy. We report our technique and its initial outcomes from the retrospective evaluation of a prospectively maintained database of 11 consecutive cases of RANU + E-LND. To the best of our knowledge, our series represents the first published experience of this procedure from India.
Materials and Methods: RANU was performed in 11 patients (including two patients with simultaneous radical cystectomy) with the da Vinci Xi system. Pelvic and upper ureteric tumors were operated without re-docking or repositioning, using the port hopping feature. For the lower ureteric tumors, the patient was repositioned and the robot was re-docked to ensure completeness of pelvic lymphadenectomy. E-LND was performed in all the patients as per the templates described in previous studies.
Results: Median age was 67.5 years (range 52–71). Median console time and blood loss were 170 min (range 156–270) and 150 cc (range 25–500), respectively. Median hospital stay was 3 days (range 2–8). One patient developed paralytic ileus in the postoperative period (Clavien Dindo Grade 1). None had a positive surgical margin and the median lymph node yield was 22.5 (range 7–47). Median follow-up was 9 months during which one patient developed metastatic systemic recurrence. All other patients were disease free at the last follow-up.
Conclusions: A robotic approach to radical nephroureterectomy with E-LND is feasible and safe and does not appear to compromise the short-term oncological outcomes as defined by lymph node yields and margin positivity. At the same time, it offers the benefits of minimal invasion and results in swifter patient recovery from this extensive surgery.
Introduction: Transurethral resection of the prostate has been considered as the gold standard for benign prostatic hyperplasia (BPH). LASER enucleation procedures have emerged as a size-independent gold standard. The flip side of LASER procedures is the initial cost of investment and a long learning curve. Transurethral enucleation with bipolar (TUEB) has emerged as an alternative prostatic enucleation procedure. We present our initial experience in TUEB.
Materials and Methods: Fifty patients with BPH and indications for surgery underwent TUEB from December 2014 to October 2015. Patients with prostate size >40 g were selected. All surgeries were done by a single urologist. Various parameters such as preoperative and postoperative International Prostate Symptom Score (IPSS) scores, Qmax (peak flow) scores, duration of surgery, duration of enucleation, drop in hemoglobin, postoperative pain scores, weight of morcellated tissue, and the incidence of stress urinary incontinence were measured.
Results: The mean age was 58 years and mean prostatic size was 84 g. Sixteen patients had refractory urinary retention. The mean IPSS score in remaining patients was 24.5. The mean preoperative maximal flow rate (Qmax) on uroflowmetry was 9.3 mL/s. The mean overall duration of surgery was 83 min. The mean drop in hemoglobin was 0.9 g/dl. The mean postoperative pain scores at 12 and 24 h after surgery were 2.1 and 1.3. The mean weight of morcellated tissue was 48 g. Twenty-six patients had de novo transient stress urinary incontinence after surgery. The mean IPSS score after TUEB was 8.3 showing significant improvement in all aspects of IPSS. The mean post-TUEB Qmax on uroflowmetry was 25 mL/s.
Conclusions: TUEB is an effective surgical management of BPH. TUEB allows enucleation of large adenomas in a single sitting, mimicking conventional open enucleation of the prostate while having all the advantages of a minimally invasive surgery.
Urinary bladder and the rectum share a common embryological origin, and the anatomical proximity of these two organs suggest that a dysfunction in either may influence the function of the other. Although, the coexistence of bladder and bowel dysfunction has been previously reported in the literature, there are hardly any reports on coexistence of posterior urethral valve (PUV) with Hirschsprung's disease. Here, we report a case of a 20-month-old male child who was initially treated for PUV and was later found to have coexisting Hirschsprung's disease.
Primitive neuroectodermal tumor (PNET) is a rare disease with high malignant potential. It usually affects the skeletal system. Primary extraskeletal involvement of PNET is uncommon with few reported cases. PNET of the genitourinary system requires a very high index of suspicion for the diagnosis since the presentation of these tumors can be varied. We report two cases of PNET with varied presentations, affecting the genitourinary system.
The transitional zone is the most common site of benign prostatic hyperplasia (BPH). Exophytic BPH is an exceedingly rare entity with only one case described in the English literature. We herein describe a case of exophytic BPH in a 48-year-old man presenting as a large pelvic mass with refractory retention managed successfully with robot assistance. To the best of our knowledge, this is the first case of exophytic benign prostatic enlargement managed by surgical excision.
Brunn's cyst in the region of the bladder neck is a rare cause of lower urinary tract obstruction. This case describes the ultrasonographic and intra-venous urographic findings of Brunn's cyst in a 53-year-old male presenting with lower urinary tract symptoms.
Fluid leakage from the Ampltz sheath during flexible nephroscopy after PCNL prevents dilatation of the pelvi-calyceal system and adequate visualization. This video demonstrates a simple technique to prevent such leakage.
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