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Abstract
BACKGROUND Acute scrotal pain has various causes. Testicular torsion, torsion of appendages and Epididymo-orchitis are common causes, while varicocele thromboses are a rare cause. Varicocele thromboses can occur post operatively or spontaneously. Five cases of post-operative and five cases of spontaneous thromboses have been described till date. The traditional advice in the management of thrombosed varicocele has been to manage it conservatively in all patients by drugs and scrotal support with little description of the surgical treatment. Herein, we present an unusual sixth case of spontaneous thromboses of varicocele and discuss its presentation and surgical management. We would also like to highlight the differentiating points between spontaneous thrombosis and post operative in vitro clot formation in the varicoceles, as these two entities can often be confused for each other. CASE PRESENTATION A 68 year-old man presented with excruciating scrotal pain of one week duration. Doppler study of scrotum revealed left varicocele with no evidence of Epididymo-orchitis. He was treated with intravenous antibiotics, analgesics and scrotal elevation. He had no relief and continued to have severe pain. Clinical examination was normal. Patient underwent exploratory surgery on a semi- emergent basis. Exploration revealed normal testis with thrombosed varicoceles. Patient underwent Varicocelectomy. Postoperatively patient had immediate pain relief. Histopathology revealed prominent thrombosed varicocele. A varicocelectomy specimen (done for primary infertility) was used for comparison. The differentiating points between the two entities were noted. CONCLUSION Spontaneous thrombosis of varicocele is a rare cause of acute scrotal pain. Pain out of proportion to clinical features is characteristic. Patients not responding to medical therapy may need varicocelectomy. Varicocelectomy may give immediate relief. Histopathology is useful in this disorder.
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Affiliation(s)
- M. Raghavendran
- Department Of Urology, Apollo BGS Hospitals, Adichunchunagiri Road, Kuvempunagar, Mysore, Karnataka 570009 India
| | | | - G. Kiran Kumar
- Department Of Urology, Apollo Hospitals, Mysore, Karnataka India
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2
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Affiliation(s)
- M Raghavendran
- Department Of Urology, Apollo BGS Hospitals, Mysore, India
| | - A Venugopal
- Department Of Pathology, Apollo Hospitals, Mysore, India
| | - K G Kumar
- Department Of Urology, Apollo BGS Hospitals, Mysore, India
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Raghavendran M, Kumar KG, Prasad S, Venkatesh HA. Post Incisional Hernia Meshplasty Vesicocutaneous Fistula - A Rare Complication. Urol Case Rep 2017; 13:149-151. [PMID: 28567333 PMCID: PMC5440686 DOI: 10.1016/j.eucr.2017.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/27/2017] [Indexed: 11/27/2022] Open
Abstract
Laparoscopic meshplasty is gold standard in hernia surgery. Mesh migration into bowel/bladder has been documented after laparoscopic repair, though migration into bowel is more common than bladder. Only 12 cases of migration into bladder have been described post inguinal meshplasty. We report the 1st case of mesh migration into bladder post Incisional hernia meshplasty, presenting as vesicocutaneous fistula. The objectives of this report are highlighting important points enabling earlier diagnosis, treatment. We would also like to suggest important preventive measures during meshplasty which we believe will go a long way in avoiding this important complication, thus immensely benefiting patients.
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Affiliation(s)
- M Raghavendran
- Department Of Urology, Apollo BGS Hospitals, Mysore, Karnataka, India
| | - Kiran G Kumar
- Department Of Urology, Apollo BGS Hospitals, Mysore, Karnataka, India
| | - Shiva Prasad
- Department Of Radiology, Apollo BGS Hospitals, Mysore, Karnataka, India
| | - H A Venkatesh
- Department Of Radiology, Apollo BGS Hospitals, Mysore, Karnataka, India
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Raghavendran M, Sarkar M, Kumar KG. "Isolated Spontaneous Renal Artery Thrombosis - A Rare Cause of Acute Flank Pain". Urol Case Rep 2016; 9:4-5. [PMID: 27617211 PMCID: PMC5007596 DOI: 10.1016/j.eucr.2016.07.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 11/23/2022] Open
Abstract
Many patients present with severe abdominal pain. Renal Artery Thrombosis (RAT) is rare, serious and misdiagnosed. RAT has been well described in association with various disorders, but isolated spontaneously occurring RAT is rare and only 2 cases have been described as of date. We present a case of flank pain presenting to emergency for evaluation and discuss the clinical aspects and management. We would like to stress on the important role of serum LDH levels and CT scan in RAT. Early diagnosis may result in salvage of organ by minimally invasive techniques. Late diagnosis will almost always result in nephrectomy.
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Affiliation(s)
- M. Raghavendran
- Department of Urology, Apollo BGS Hospitals, Mysore, Karnataka, India
- Corresponding author. Department of Urology, Apollo BGS Hospitals, Adichunchunagiri Road, Kuvempunagar, Mysore–570009, Karnataka, India. Fax: +91 821 2460870.
| | | | - Kiran G. Kumar
- Department of Urology, Apollo BGS Hospitals, Mysore, Karnataka, India
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Raghavendran M, Venugopal A, Kaushik VN. Urinary Bladder Xanthoma - Is Immunohistochemistry Necessary? Urol Case Rep 2016; 8:36-7. [PMID: 27462546 PMCID: PMC4949499 DOI: 10.1016/j.eucr.2016.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 06/10/2016] [Accepted: 06/10/2016] [Indexed: 12/20/2022] Open
Abstract
Urinary Bladder Xanthomas (UBX) are non-neoplastic reactive tumor like process. Isolated UBX is rare with only around 15 cases reported (Yu, Patel, & Bonert, 2015). UBX are reported in older patients who present with non specific symptoms like UTI or hematuria. Patients often have associated lipid anomalies. UBX have been vaguely described as yellowish white plaques or patches. Also, recent reports have stressed on the role of Immunohistochemistry in the diagnosis (Al-Daraji, Varghese, & Husain, 2007; Vimal, Masih, Manipadam, & Chacko, 2012). The objective of this report is to provide a cystoscopic view of the tumor which will enable easier identification and also to debate on the role of IHC in diagnosis.
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Affiliation(s)
- M Raghavendran
- Department of Urology, Apollo BGS Hospitals, Adichunchunagiri Road, Kuvempunagar, Mysore 570009, Karnataka, India
| | - A Venugopal
- Department of Pathology, Apollo BGS Hospitals, Mysore, Karnataka, India
| | - Vinay N Kaushik
- Department of Urology, Apollo Hospitals, Mysore, Karnataka, India
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Abstract
A 30-year old infertile male was admitted for microsurgical sub inguinal varicocelectomy. Intraoperatively, two tubular structures of the caliber of neighboring veins were noted. They were distinct from the vas, which was carefully preserved. Histopathology revealed varicose veins along with two convoluted tubular structures lined by ciliated pseudo-stratified epithelium. There was an incomplete thin muscle coat. The lumina were irregular and contained no spermatozoa (Fig. 1). These structures were identified as paradidymis based on the location in the cord and microscopic morphology. We have tried to analyze the medico-legal significance of these benign lesions in our every day practice.
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Affiliation(s)
- M. Raghavendran
- Department of Urology, Apollo BGS Hospitals, Adichunchunagiri Road, Kuvempunagar, Mysore 570009, Karnataka, India
- Corresponding author. Tel.: +91 9900144173, +91 821 2341940; fax: +91 821 2460870.
| | | | - V. Ranjit
- Department of Urology, Apollo BGS Hospitals, Adichunchunagiri Road, Kuvempunagar, Mysore 570009, Karnataka, India
| | - Vinay N. Kaushik
- Department of Urology, Apollo BGS Hospitals, Adichunchunagiri Road, Kuvempunagar, Mysore 570009, Karnataka, India
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Sehgal A, Raghavendran M, Kumar D, Srivastava A, Dubey D, Kumar A. Rhinocerebral mucormycosis causing basilar artery aneurysm with concomitant fungal colonic perforation in renal allograft recipient: a case report. Transplantation 2004; 78:949-50. [PMID: 15385821 DOI: 10.1097/01.tp.0000129798.22312.1e] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Srivastava A, Raghavendran M, Jain M, Gupta S, Chaudhary H. Fine-needle aspiration cytology of the testis: can it be a single diagnostic modality in azoospermia? Urol Int 2004; 73:23-7. [PMID: 15263788 DOI: 10.1159/000078799] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2003] [Accepted: 10/29/2003] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to determine whether fine-needle aspiration cytology (FNAC) of testis alone is sufficient to diagnose testicular function and whether follicle-stimulating hormone (FSH) estimation can be safely eliminated from the evaluation protocol of the azoospermic subject. MATERIALS AND METHODS We studied 46 adult azoospermic males who were infertile for more than 2 years following marriage. Hormonal profile was done in all. Later all 46 patients were subjected to bilateral FNAC of the testes. The cytological findings were correlated with histological findings. RESULTS We found 95.65% agreement between FNAC and testicular biopsy. Though serum FSH estimation was done in all patients in this series, in none of the cases did it affect overall management. CONCLUSION FNAC is a quick, safe and minimally invasive modality. Following a well-performed semen analysis in an azoospermic subject, it appears that FNAC may be the only investigation needed. It provides a reliable diagnosis in patients with either obstructive or non-obstructive azoospermia. Routine estimation of FSH can be omitted from the investigative protocol in these patients.
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Affiliation(s)
- A Srivastava
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Abstract
OBJECTIVE To describe modifications to laparoscopic live-donor nephrectomy (LLDN) to make it more cost-effective for developing countries; LLDN was developed as a better alternative to conventional donor nephrectomy, with advantages of an earlier return to normal activities and smaller scars, but is not popular in developing countries because of high cost of disposable items. PATIENTS AND METHODS From January 2000 to January 2002, 148 LLDNs were performed, of which two used a hand-assisted technique, 17 the standard technique, 79 a modified laparoscopically assisted cost-saving approach and 50 by the modified technique. In the latter approach the kidney was delivered through a 6-8 cm anterior subcostal flank incision. In last 50 patients we further modified the technique, clipping the hilum using endoclips and delivering the kidney by holding the lateral pararenal fat through a 5 cm iliac fossa incision. RESULTS The mean age, operative duration, warm ischaemia time, blood loss, analgesic requirements, pain score and hospital stay were comparable among the various techniques used. Re-exploration was required in four patients (bleeding in two, trocar-induced bowel injury in two). Immediate complications after surgery occurred in 20% of patients. Using endoclips, the cost was considerably reduced, from $400 to $290. The iliac fossa incision was aesthetically pleasing and more acceptable to patients. CONCLUSION These modifications are relevant in the context of a developing nation, as they provide all the benefits of LLDN at reduced cost and with better cosmetic results.
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Affiliation(s)
- A Kumar
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Raghavendran M, Srivastava A, Chaudhary H. Retrovesical tuberculosis. Urology 2004; 63:582-3. [PMID: 15028466 DOI: 10.1016/j.urology.2003.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2003] [Revised: 10/02/2003] [Accepted: 10/02/2003] [Indexed: 11/18/2022]
MESH Headings
- Anti-Bacterial Agents
- Antitubercular Agents/therapeutic use
- Biopsy, Fine-Needle
- Child
- Combined Modality Therapy
- Drug Therapy, Combination/therapeutic use
- Ethambutol/therapeutic use
- Fever/etiology
- Humans
- Isoniazid/therapeutic use
- Laparotomy
- Male
- Mycobacterium tuberculosis/isolation & purification
- Pyrazinamide/therapeutic use
- Rifampin/therapeutic use
- Tomography, X-Ray Computed
- Tuberculoma/complications
- Tuberculoma/diagnosis
- Tuberculoma/diagnostic imaging
- Tuberculoma/drug therapy
- Tuberculoma/pathology
- Tuberculoma/surgery
- Tuberculosis, Urogenital/complications
- Tuberculosis, Urogenital/diagnosis
- Tuberculosis, Urogenital/diagnostic imaging
- Tuberculosis, Urogenital/drug therapy
- Tuberculosis, Urogenital/pathology
- Tuberculosis, Urogenital/surgery
- Ultrasonography, Interventional
- Urination Disorders/etiology
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Affiliation(s)
- M Raghavendran
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Raghavendran M, Rastogi A, Dubey D, Chaudhary H, Kumar A, Srivastava A, Mandhani A, Krishnani N, Kapoor R. Stones associated renal pelvic malignancies. Indian J Cancer 2003; 40:108-12. [PMID: 14716114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND The clinico-pathological characteristics of renal pelvic malignancies associated with stones were retrospectively analyzed. AIMS The main objective was to define the biological behavior and prognostic factors for these malignancies. SETTINGS & DESIGN The tumors were classified according to the pathological types. The clinical data, imaging features and pathological features were analyzed with relation to prognosis. MATERIAL AND METHODS Eighteen cases of malignancies associated with stone disease were retrospectively studied. The institute review board permitted the study. RESULTS High incidence (15/18) of squamous cell carcinoma (SCC) was noted. The prognosis in this group of patients was uniformly poor. The median survival time was 3.6 months in the SCC group, 7.5 months in the Transitional Cell Carcinoma (TCC) group and 24 months in the Adenocarcinoma (AC) group. Infectious and systemic symptoms were noted in the majority of the patients. Preoperative Imaging techniques revealed tumor in only 2 cases. Both underwent radical extirpation and the median survival is 18 months till date. In the other 16 patients, where the initial diagnosis was made only on histological analysis of incomplete nephrectomy specimens, the survival was 3.56 months. All patients had prolonged history of staghorn stone disease with associated non-functioning kidney. We found that the main prognostic factor was the stage of the disease. CONCLUSIONS Malignancies associated with stone disease have insidious onset of clinical symptoms and need a high degree of suspicion to identify them pre-operatively. The grave prognosis associated with incomplete excision makes it imperative to diagnose them earlier.
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Affiliation(s)
- M Raghavendran
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Rae Bareli Road, Lucknow - 226 014, India
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Affiliation(s)
- Raj Shekhar Gupta
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Dubey D, Raghavendran M, Rastogi A, Chaudhary H, Kumar A, Srivastava A, Mandhani A, Krishnani N, Kapoor R. Stones associated renal pelvic malignancies. Indian J Cancer 2003. [DOI: 10.4103/0019-509x.13061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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