Indian Journal of Urology最新文献

Introduction: Pain at the buccal mucosal graft (BMG) harvest site in the immediate postoperative period is common and delays resumption of oral intake. This study compares the time for resumption of pain-free solid and liquid diets and postoperative pain scores at harvest site following the administration of inferior-alveolar nerve-block plus buccal-nerve block (IANB + BNB) versus placebo. We hypothesize that the intervention could decrease pain and aid in early food intake.

Methods: A single-center, placebo-controlled, double-blinded randomized-control trial was conducted from September 2022 to August 2023 (CTRI). All individuals > 18 years undergoing BMG harvest were included. Patients with contraindications for BMG harvest and diabetes were excluded. Furthermore, patients requiring additional lingual/labial graft, bilateral BMG, or a history of prior BMG harvest were also excluded. IANB + BNB was performed with a 10 ml mixture comprising lignocaine, bupivacaine, and dexamethasone, while normal saline was administered in the control group. Both groups received submucosal local anesthetic infiltration.

Results: After randomization (n = 28 in each group), patients who received IANB + BNB had an early return to pain-free liquid (median 1 vs. 2 days; P ≤ 0.001) and solid diet (median 2 vs. 3 days; P = 0.001) 1 day quicker than those who received placebo. In the intervention arm, Visual Analog Scale scores at harvest site were lower from 2 to 48 h postoperatively, had reduced paracetamol requirement (median 7 g vs. 9 g; P = 0.001), and fewer necessitated opioids for breakthrough pain (14.4% vs. 53.3%; P = 0.002).

Conclusion: Patients who received IANB + BNB resumed a pain-free diet in the postoperative period quicker, reported lower pain scores, and there were lesser postoperative analgesic requirements.

We present a case of inadvertent left renal vein clipping during right retroperitoneoscopic nephrectomy (RPN) and describe its expeditious identification and management. A 13-year-old girl underwent RPN for nonfunctioning kidney due to urolithiasis. During the dissection of the right renal vein, the inferior vena cava (IVC) got lifted off the parietal wall and the left renal vein was mistakenly ligated. Based on a strong intra-operative suspicion, the patient underwent an urgent computed tomography angiography which confirmed the ligation of the left renal vein. The patient was reoperated immediately and an end-to-side anastomosis was performed between the left renal vein and the IVC.

Introduction: Focal therapy (FT) is emerging as an alternative to radical treatment for prostate cancer (CaP). The purpose of this study is to assess the current perceptions of FT amongst urologists.

Methods: A 22-item questionnaire was e-mailed to members of the American Urological Association. Multivariate logistic regression analysis was used to identify predictors of FT utilization. Results were compared to a previous survey from 2019.

Results: Two hundred and sixty-four responses were recorded. Less than half (115/264, 43.6%) of respondents utilize FT; among them, 42% perform FT on more than 10 patients/year. Reasons for avoiding FT included: lack of experience (51.8%), belief that CaP is multifocal (46.0%), and lack of infrastructure (43.1%). The most common modalities for FT were high-intensity focused ultrasound (63.4%) and cryoablation (47.3%). Preferred patients for FT were primarily unilateral/anterior only Gleason Grade Group 2 (95/110, 86.4%). A fellowship training in urologic oncology (odds ratio [OR] = 2.86, P = 0.008) and seeing more than 10 CaP patients per month (OR = 2.46, P = 0.002) were associated with greater utilization of FT. Most respondents (85.4%) cited better imaging methods as a factor that has increased FT utilization. Compared to a previous survey, a higher number of respondents (43% vs. 24%) utilize FT and more respondents believe in the "index lesion theory."

Conclusions: Less than half of the respondents utilize FT in their practice. Fellowship training in urologic oncology and a higher volume of CaP patients were correlated with FT utilization. As urologists gain more experience, the trend of further utilization of FT for CaP may continue.

Urethral duplication is a rare congenital anomaly characterized by more than one urethral channel, with varied course, location of the external opening, and presentation. Presentations can be varied, depending upon individual anatomical dispensation but mostly present as obstruction, recurrent urinary infection, or double urinary stream. Treatment depends on the type of duplication and associated anomalies. Here, we report a case of urethral duplication which did not fit into any known reported type of urethral duplication forms and had five openings at the anal verge.