Indian Journal of Urology最新文献

Renal transplantation in patients with a defunctionalized lower urinary tract poses surgical challenge. A native cutaneous ureterostomy, although underutilized, may be a viable option in select cases. We report a 28-year-old male with end-stage renal disease secondary to posterior urethral valves, managed with a left cutaneous ureterostomy since infancy. He underwent successful renal transplantation with inverted graft placement in the left iliac fossa to enable ureteral anastomosis to the native ureteric stump. This approach proved safe and effective, with excellent graft function maintained over 3 years.

Introduction: Incidental adrenal masses are found in up to 7% of all patients undergoing abdominal imaging. Data from the American College of Surgeons National Surgical Quality Improvement Program suggests that over 95% adrenalectomies are performed by general surgeons. To assess outcomes when surgeries are performed by urologists, we reviewed our database of adrenalectomies performed in the past 17 years.

Methods: In this study, we reviewed our database of patients who underwent adrenalectomies between 2008 and 2024 in the department of urology. Clinical parameters were recorded for all patients, including their demographic profile, metabolic and radiological parameters, operative details, and complications. Outcomes were reported, and data for minimally invasive surgery were compared with those for open surgery (OS).

Results: During the study period, 320 patients underwent 383 adrenalectomies, including 275 patients (85.9%) who had functional tumors, 69% of which were pheochromocytomas, 15.6% Cushing's syndrome, and 11.2% Conn's syndrome. Sixty-three patients had bilateral surgeries. Over 80% (260) patients had laparoscopic surgeries, and an additional 12 were robot-assisted. Six were converted to OS. The mean operative time (122.1 ± 58.3 min vs. 194.1 ± 76.4 min), median blood loss (100 mL vs. 350 mL), and median duration of hospital stay (3 vs. 5 days) were shorter for the minimally invasive approach. The overall complication rate was 6.5%.

Conclusions: Adrenalectomy, including bilateral synchronous surgery, is a safe procedure that can be performed by urologists with excellent outcomes.

Introduction: Uropathogenic Escherichia coli (UPEC) is the primary cause of urinary tract infections (UTIs). The urinary milieu, particularly the pH, may critically influence the efficacy of nitrofurantoin, a first-line oral agent for uncomplicated UTIs. This study aimed to investigate the impact of urinary pH on the susceptibility of nitrofurantoin in clinical UPEC isolates and to assess its implications for individualized therapy.

Methods: A prospective study was conducted on 100 culture-confirmed UPEC isolates. Nitrofurantoin susceptibility was determined using the disk diffusion method, broth microdilution following Clinical and Laboratory Standards Institute (CLSI) guidelines, and the automated Vitek-2 system. The minimum bactericidal concentration (MBC) was evaluated in artificial urine at pH levels of 5.5 and 7.2, with estimated minimum inhibitory concentrations (MICs) derived as MBC ÷ 2. A subset of isolates underwent MIC validation in the pH-adjusted broth. Statistical analysis included Chi-square and Wilcoxon signed-rank tests.

Results: Standard testing at pH 7.2 revealed an 85% susceptibility rate, concordant across both broth microdilution and Vitek-2. In contrast, acidic pH (5.5) markedly enhanced the activity of nitrofurantoin, reflected by significantly lower MBC and estimated MIC values compared to the neutral conditions (χ ² = 14.09, P < 0.001; Wilcoxon P < 0.05). Validation in selected isolates confirmed 4- to 16-fold reductions in MIC under acidic conditions.

Conclusion: Nitrofurantoin exhibits pronounced pH-dependent activity, with acidic environments enhancing its bactericidal efficacy against UPEC. Current susceptibility testing at neutral pH may underestimate the in vivo performance. Integrating urinary pH considerations into antimicrobial susceptibility testing and patient management could optimize the treatment outcomes and support personalized UTI therapy.

A 17-year-old male and a 30-year-old female with bladder exstrophy-epispadias complex and failed primary repair during infancy presented with continuous urinary leakage and an open bladder plate. Considering their age and desire to avoid a stoma and catheterization, a Mainz II continent urinary diversion was performed with robotic assistance. The ureters were implanted into an S-shaped, low-pressure, high-capacity sigmoid pouch using an extramural serosal tunnel technique to create an anti-refluxing anastomosis. At 3-month follow-up, both patients were completely continent, able to hold urine for 3-4 h, with preserved renal function. The male had preserved erectile function.

Introduction: This study analyzes clinical associations of pain in young men presenting with a primary complaint of a lower urinary tract symptom (LUTS).

Methods: A secondary analysis of the SciCOM 3 study examining young men presenting with LUTS was performed. Bladder pain was recorded by Q4 of the Interstitial Cystitis Symptom Score, while nonbladder pain was captured by the Visual Analog Scale. LUTS, sexual dysfunction, stool consistency, perception of problems related to the bladder, and general well-being were captured by questionnaires.

Results: A total of 448 young men (18-40 years; median 30 years, interquartile range: 25-35 years) were studied across 16 centers. Eighty-seven (19.8%) reported no pain (Group 1), 143 (32.6%) bladder pain alone (Group 2), 39 (8.9%) only nonbladder pain (Group 3), and 170 (38.7%) both bladder and nonbladder pain (Group 4). Men in Group 4 were more likely to report reduced strength of stream (odds ratio [OR] 1.95; 95% confidence interval [CI]: 1.27 and 3.01), need to stop and start (OR 1.81; 95% CI: 1.19 and 2.74), sense of incomplete evacuation (OR: 2.64; 95% CI: 1.58 and 4.40), and urgency (OR: 1.73; 95% CI: 1.16 and 2.59), while men in Group 2 were more likely to report urine leak for no apparent reason (OR: 1.85; 95% CI: 1.17 and 2.90). Group 1 was the least likely to report an abnormal sense of well-being.

Conclusions: Pain is commonly reported by young men presenting with LUTS. The pattern of pain in LUTS is associated with a distinct clinical epidemiology, including both storage and voiding LUTS, with an impact on bother and quality of life. It is important to assess pain in young men presenting with LUTS.

Background: Prostate cancer is the second most common malignancy globally amongst men. While prostate-specific antigen (PSA) screening aids in early detection, prostate biopsy remains the diagnostic gold standard. However, the biopsy practices vary widely across various Indian centers. This study aimed to evaluate the current biopsy techniques, indications, complications, and diagnostic yield across multiple institutions.

Methods: A prospective, multi-center observational study was conducted from June 14, 2023, to June 14, 2024, under the Urological Society of India Collaborative Research Committee. Data from 2479 patients across 43 institutions were collected using a standardized template. Men aged ≥40 years undergoing initial or repeat biopsies were included. Variables included demographics, PSA levels, imaging, biopsy route and technique, antibiotic prophylaxis, pain scores, complications, and histopathology. Analysis was performed using SPSS v23.

Results: Elevated PSA was the primary indication of biopsy in 95.2% of the patients (median: 19.8 ng/ml). The transrectal route was used in 91.8% of the patients whereas the transperineal was used in 6.4%. Multiparametric magnetic resonance imaging was performed in 45%, with targeted cores in 15.6% of the patients. PIRADS 5 lesions had a cancer detection rate (CDR) of 81.4%, while PIRADS 2 had CDR of 23.1%; no cancers were found in PIRADS 2 lesions in repeat biopsy settings. Adenocarcinoma was diagnosed in 61% of the patients. Transrectal biopsies had a higher CDR (61.3% vs. 47.2%; P < 0.05) but also higher infection rates (3.3% vs. 0%; P = 0.03). Overall complication rate was 11%, with hematuria >1 day being the most common (6.5%) complication.

Conclusion: This large, multi-institutional study highlights significant variability in prostate biopsy practices in India and emphasizes the need for standardized training to improve the diagnostic outcomes and safety.

Introduction: Bladder exstrophy (BE) is a rare congenital anomaly. In resource-limited settings, delayed presentation is common, necessitating augmentation cystoplasty in older children with fibrotic and poorly compliant bladders. The necessity of simultaneous ureteric reimplantation (UR) during augmentation remains debated. The objective of the study is to evaluate long-term renal and urological outcomes in children undergoing complete primary repair of exstrophy (CPRE) with or without UR.

Methods: This retrospective study analyzed 51 patients who underwent CPRE with augmentation between 1999 and 2019 and had a minimum follow-up of 5 years. Patients were divided into two groups: Group A (CPRE with UR) and Group B (CPRE only). Surgical details, complications, and follow-up outcomes, including Society of Fetal Urology (SFU) grades of hydronephrosis, renal function, and urinary tract infections (UTIs), were compared. Statistical analysis was performed using the Chi-square test for categorical variables and the t-test and the Mann-Whitney test for continuous variables.

Results: Group A had 24 patients, and Group B had 27 patients. Baseline characteristics, including age, gender distribution, serum creatinine, estimated glomerular filtration rate, and hydronephrosis, exhibited no significant differences between the two groups. No statistically significant differences were observed in rates of postoperative SFU grades of hydronephrosis, UTI, or renal function decline between the groups. While moderate-to-severe hydronephrosis was more common in Group B, this did not translate into worse clinical outcomes.

Conclusions: In delayed BE repair requiring bladder augmentation, omission of UR appears safe and effective. Bladder augmentation alone provides adequate protection of the upper tracts and may simplify surgical planning.

Introduction: Ureteropelvic junction obstruction causes upper urinary tract obstruction, resulting in pain, infections, and renal impairment. Pyeloplasty with Double-J stents is the standard treatment, but stents cause significant morbidity. Stentless approaches may reduce symptoms while maintaining efficacy.

Methods: Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guidelines (International Prospective Register of Systematic Reviews: CRD42025643943). PubMed, Embase, and Cochrane were searched through March 2025. "Studies comparing stented versus stentless pyeloplasty in adults (≥18 years) were included". Primary outcomes were surgical success and complications. Secondary outcomes included urinary leakage, reintervention, and hospital stay. Narrative synthesis was performed due to heterogeneity.

Results: Ten studies encompassing 5820 patients were included, comprising one randomized controlled trial, four prospective, and five retrospective studies. Success rates ranged from 66.7% to 100% for stented procedures and 88%-100% for stentless approaches, with no significant difference in most studies. Stented patients experienced higher rates of lower urinary tract symptoms (64.7%-100%) compared to stentless groups (0%-3.8%), as well as hematuria (27%-95.4%) versus 0%-4.3%, with variable urinary tract infection rates. Stentless groups showed increased urinary leakage up to 24%, though mostly self-limited. Twenty-three stentless patients required secondary stenting, while thirteen stented patients needed reintervention for stricture or complications.

Conclusions: Stentless pyeloplasty is effective in selected adults, significantly reducing stent-related morbidity without compromising success rates when performed with meticulous technique and appropriate patient selection.

Rectourethral fistula (RUF) following radical prostatectomy is a rare and devastating complication. Surgical repair is the mainstay of treatment in most of the cases. We present three cases in which the Modified York Mason Technique was used for repairing the RUF. Among the surgical options, Modified York-Mason repair has proven itself to be a successful and reliable surgical option. The purpose of this case series is to remind urologists familiar with the perineal approach that the York Mason procedure is a relatively simple procedure with an uncomplicated postoperative period, a short hospital stay, and no long-term complications.