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Bhatia H, Bhujade H, Dey P, Mavuduru R. Epididymo-orchitis Presenting as Bilateral Hydrocele in a Young Adult. Urology 2023:S0090-4295(23)00148-6. [PMID: 36804551 DOI: 10.1016/j.urology.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/11/2023] [Accepted: 02/01/2023] [Indexed: 02/17/2023]
Abstract
We present a case of young patient who presented with a progressive scrotal swelling and low-grade fever. An ultrasound of the scrotum revealed multiple small well-defined hypoechoic lesions in both testes with bulky epididymis and bilateral hydrocele. The final diagnosis was confirmed on cytology. The typical imaging findings may help to reach the diagnosis and to plan the further management in such cases.
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Affiliation(s)
- Harsimran Bhatia
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Pranab Dey
- Department of Cytology and Gynaecological Pathologies, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravimohan Mavuduru
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sharma A, Singh P, Gorsi U, Lal A, Mavuduru R, Mete U, Singh S. Establishing the role of shear wave elastography in differentiating vasculogenic versus non-vasculogenic erectile dysfunction. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00608-5] [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: 02/12/2023]
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3
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Periasamy K, Sharma D, Goyal S, Singh R, Kumar S, Mavuduru R, Basher R, Kumar N, Madan R, Das CK. Acute toxicity of moderately hypofractionated extended field radiotherapy in node-positive prostate cancer. Clin Oncol (R Coll Radiol) 2022. [DOI: 10.1016/j.clon.2022.09.038] [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: 11/06/2022]
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4
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Rana A, Singh H, Mavuduru R, Pattanaik S, Rana PS. Quantifying prognosis severity of COVID-19 patients from deep learning based analysis of CT chest images. Multimed Tools Appl 2022; 81:18129-18153. [PMID: 35282403 PMCID: PMC8901869 DOI: 10.1007/s11042-022-12214-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 05/28/2023]
Abstract
The COVID-19 pandemic has affected all the countries in the world with its droplet spread mode. The colossal amount of cases has strained all the healthcare systems due to the serious nature of infections especially for people with comorbidities. A very high specificity Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) test is the principal technique in use for diagnosing the COVID-19 patients. Also, CT scans have helped medical professionals in patient severity estimation & progression tracking of COVID-19 virus. In study we present our own extensible COVID-19 viral infection tracking prognosis technique. It uses annotated dataset of CT chest scan slice images created with the help of medical professionals. The annotated dataset contains bounding box coordinates of different features for COVID-19 detection like ground glass opacities, crazy paving pattern, consolidations, lesions etc. We qualitatively identify the severity of the patient for later prognosis stages in our study to assist medical staff for patient prioritization. First we detected COVID-19 positive patients with pre-trained Siamese Neural Network (SNN) which obtained 87.6% accuracy, 87.1% F1-Score & 95.1% AUC scores. These metrics were achieved after removal of 40% quantitatively highly similar images from the COVID-CT dataset. This reduced dataset was further medically annotated with COVID-19 features for bounding box detection. After this we assigned severity scores to detected COVID-19 features and calculated the cumulative severity score for COVID-19 patients. For qualitative patient prioritization with prognosis clinical assistance information, we finally converted this score into a multi-classification problem which obtained 47% weighted-average F1-score.
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Affiliation(s)
- Ashish Rana
- Department of Computer Science and Engineering, TIET, Patiala, Punjab India
| | - Harpreet Singh
- Department of Computer Science and Engineering, TIET, Patiala, Punjab India
| | | | - Smita Pattanaik
- Department of Urology and Pharmacology, PGIMER, Chandigarh, India
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Tyagi S, Mavuduru R, Bora G, Singh S. Robot-assisted videoendoscopic inguinal lymphadenectomy: Our experience from a tertiary care center. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01291-x] [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: 11/04/2022]
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Kumar A, Yadav S, Krishnappa RS, Gautam G, Raghavan N, Bakshi G, Prakash G, Ahluwalia P, Tamankar A, Surekha S, Kumar N, Kumar S, Mallya A, Saini G, Singhal M, Mavuduru R, Nayak B, Singh P, Jaipuria J, Kumar V, Rawal SK, Gupta NP. The Urological Society of India guidelines for the evaluation and management of prostate cancer (executive summary). Indian J Urol 2022; 38:252-257. [PMID: 36568450 PMCID: PMC9787438 DOI: 10.4103/iju.iju_232_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/09/2022] [Indexed: 12/27/2022] Open
Affiliation(s)
- Anup Kumar
- Department of Urology and Renal Transplant, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India,
E-mail:
| | - Siddharth Yadav
- Department of Urology and Renal Transplant, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | | | - Gagan Gautam
- Department of Urology, Max Super Specialty Hospital, Bengaluru, Karnataka, India
| | | | - Ganesh Bakshi
- Department of Urology, Tata Memorial Hospital, Mumbai, India
| | - Gagan Prakash
- Department of Urology, Tata Memorial Hospital, Mumbai, India
| | - Puneet Ahluwalia
- Department of Urology, Max Super Speciality Hospital, Gaziabad, India
| | - Ashwin Tamankar
- Department of Urology, Apollo Hospital, Navi Mumbai, Maharashtra, India
| | - Sanjoy Surekha
- Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Luckhnow, India
| | - Niraj Kumar
- Department of Urology and Renal Transplant, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sandeep Kumar
- Department of Urology and Renal Transplant, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ashwin Mallya
- Department of Urology, Sir Ganga Ram Hospital, New Delhi, India
| | - Gagan Saini
- Department of Radiation Oncology, Fortis Internation Oncology Center, Noida, Uttar Pradesh, India
| | - Manish Singhal
- Department of Medical Oncology, Apollo Hospital, New Delhi, India
| | - Ravimohan Mavuduru
- Department of Urology, Post Graduate Institute of Medical Sciences, Chandigarh, India
| | - Brusabhanu Nayak
- Department of Urology, All Indian Institute of Medical Sciences, New Delhi, India
| | - Prabhjot Singh
- Department of Urology, All Indian Institute of Medical Sciences, New Delhi, India
| | - Jiten Jaipuria
- Departmetn of Urology, Rajiv Gandhi Cancer Institute and Cancer Center, Noida, Uttar Pradesh, India
| | - Vijoy Kumar
- Department of Urology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Sudhir K Rawal
- Departmetn of Urology, Rajiv Gandhi Cancer Institute and Cancer Center, Noida, Uttar Pradesh, India
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Sharma G, Kakkar N, Singh SK, Parmar K, Sharma AP, Mavuduru R. Primary primitive neuroectodermal tumour of the kidney in adults: Experience of managing 12 cases with systematic review and pooled analysis of literature. Int J Clin Pract 2021; 75:e14971. [PMID: 34626514 DOI: 10.1111/ijcp.14971] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/22/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Primitive neuroectodermal tumor (PNET) of the kidney is unusual in adults. These tumours are diagnosed mainly on histopathology and that too sometimes has limitations. With this study, we aimed to review our clinical and histopathological data of patients with renal PNET and reviewing the world literature. METHODS In this retrospective study, we reviewed our database from January 2006 to July 2018 to include all the cases of primary PNET of the kidney. We also performed systematic literature search to identify all the relevant series on renal PNET. RESULTS A total of 12 patients including 5 men and 7 women were managed during the above mentioned period. Out of these 7 patients, 2 patients had metastasis at diagnosis, one had locally advanced disease, 6 underwent radical nephrectomy, 5 patients received adjuvant chemotherapy (two currently receiving) and only 1 patient received adjuvant radiotherapy (RT). On Immunohistochemistry (IHC), CD99 and FLI1 were positive in all the patients. Median survival was 10 months. In our review 10 studies were included, 38.6% of the patients had metastatic disease and 10.7% had locally advanced disease at diagnosis. Overall mean survival was 33.75 months. CD99 and FLI1 were positive in 94.3% and 78.5%, respectively. CONCLUSION PNET remains a pathological diagnosis and IHC has important place in diagnosis of PNET. Locally advanced and metastatic disease is common at diagnosis leading to overall poor survival.
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Affiliation(s)
- Gopal Sharma
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Kakkar
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shrawan Kumar Singh
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kalpesh Parmar
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditya Prakash Sharma
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravimohan Mavuduru
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Parmar K, Thummala Y, Mavuduru R, Kumar S. Laparoscopic nephron sparing surgery in a renal mass with Autosomal polycystic kidney disease. Challenges faced! Urology Video Journal 2021. [DOI: 10.1016/j.urolvj.2021.100100] [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: 11/25/2022] Open
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9
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Sharma G, Tyagi S, Mavuduru R, Bora GS, Sharma AP, Devana SK, Gorsi U, Kakkar N, Singh SK. External validation of SPARE nephrometery score in predicting overall complications, trifecta and pentafecta outcomes following robot-assisted partial nephrectomy. Minerva Urol Nephrol 2021; 74:63-71. [PMID: 33439569 DOI: 10.23736/s2724-6051.20.03972-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND There is an ongoing need and search for a simple yet accurate nephrometry scoring system for predicting the postoperative outcomes after partial nephrectomy (PN). Simplified PADUA Renal (SPARE) Nephrometry Scoring System, a simplified version of Preoperative Aspects and Dimensions Used for an Anatomical Classification (PADUA) has been proposed as a predictor of postoperative complications following PN recently. However, this score has never been externally validated and assessed as a predictor of trifecta and pentafecta outcomes of PN. In the current study, we applied the SPARE scoring system to our robot-assisted PN cohort (RAPN). METHODS Prospectively maintained data of patients, who underwent RAPN from November 2014 to December 2018, was abstracted. Imaging was analyzed to calculate SPARE and RENAL nephrometry scores (RNS) by two urologists, independently. SPARE was compared with complications, trifecta outcomes, pentafecta outcomes, and RENAL nephrometry scoring (RNS). RESULTS Data of 201 RAPN patients were analyzed. The mean SPARE score was 3 (range 0-11). One hundred thirteen patients were classified as low risk, 64 as intermediate risk, and 24 as high risks. On multivariate analysis SPARE score alone predicted complications (OR=1.37, P=0.014) and trifecta outcomes (OR=0.75, P=0.000) while age (OR=0.96, P=0.042), preoperative eGFR (OR=0.97, P=0.001) and SPARE scores (OR=0.81, P=0.016) were predictors for pentafecta outcomes. Receiver operated curve (ROC) analysis between SPARE and RNS in predicting the complications; trifecta and pentafecta outcomes had a comparable area under the curve. CONCLUSIONS Our study validates the SPARE nephrometry scoring system in predicting postoperative complications, trifecta, and pentafecta outcomes in a RAPN cohort. The predictive accuracy of SPARE is similar to RNS.
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Affiliation(s)
- Gopal Sharma
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shantanu Tyagi
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravimohan Mavuduru
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Girdhar S Bora
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India -
| | - Aditya P Sharma
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudheer K Devana
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Kakkar
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shrawan K Singh
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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10
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Sharma G, Tyagi S, Mavuduru R, Bora GS, Sharma AP, Devana SK, Gorsi U, Kakkar N, Singh SK. External validation of SPARE nephrometery score in predicting overall complications, trifecta and pentafecta outcomes following robot-assisted partial nephrectomy. Minerva Urol Nefrol 2021. [PMID: 33439569 DOI: 10.23736/s0393-2249.20.03972-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is an ongoing need and search for a simple yet accurate nephrometry scoring system for predicting the postoperative outcomes after partial nephrectomy (PN). SPARE, a simplified version of PADUA has been proposed as a predictor of postoperative complications following PN recently. However, this score has never been externally validated and assessed as a predictor of trifecta and pentafecta outcomes of PN. In the current study, we applied the SPARE scoring system to our robot-assisted PN cohort (RAPN). METHODS Prospectively maintained data of patients, who underwent RAPN between November 2014 to December 2018, was abstracted. Imaging was analyzed to calculate SPARE and RENAL nephrometry scores (RNS) by two Urologists independently. SPARE was compared with complications, trifecta outcomes, pentafecta outcomes, and RENAL nephrometry scoring (RNS). RESULTS Data of 201 RAPN patients were analyzed. The mean SPARE score was 3 (range 0-11). 113 patients were classified as low risk, 64 as intermediate risk, and 24 as high risks. On multivariate analysis SPARE score alone predicted complications (OR 1.37, p=0.014) and trifecta outcomes (OR 0.75, p=0.000) while age (OR 0.96, p=0.042), preoperative eGFR (OR 0.97, p=0.001) and SPARE scores (OR 0.81, p=0.016) were predictors for pentafecta outcomes. Receiver operated curve (ROC) analysis between SPARE and RNS in predicting the complications; trifecta and pentafecta outcomes had a comparable area under the curve. CONCLUSIONS Our study validates the SPARE nephrometry scoring system in predicting postoperative complications, trifecta, and pentafecta outcomes in a RAPN cohort. The predictive accuracy of SPARE is similar to RNS.
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Affiliation(s)
- Gopal Sharma
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Shantanu Tyagi
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ravimohan Mavuduru
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Girdhar S Bora
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India -
| | - Aditya P Sharma
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sudheer K Devana
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Nandita Kakkar
- Department of Histopathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Shrawan K Singh
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Das L, Bhansali A, Pivonello R, Dutta P, Bhadada SK, Ahuja CK, Mavuduru R, Kumar S, Behera A, Saikia UN, Dhandapani S, Walia R. ACTH increment post total bilateral adrenalectomy for Cushing's disease: a consistent biosignature for predicting Nelson's syndrome. Pituitary 2020; 23:488-497. [PMID: 32449103 DOI: 10.1007/s11102-020-01047-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Nelson's syndrome (NS) is regarded as an aggressive complication of total bilateral adrenalectomy (TBA) for Cushing's disease (CD). This challenge may be addressed by using clinical criteria to guide frequency of neuroimaging to enable timely management of NS and also avoid unnecessary frequent imaging. METHODS All patients (n = 43) with CD subjected to TBA over 35 years at a tertiary care centre were included. NS was defined as a newly appearing or expanding (> 2 mm) pituitary adenoma with or without ACTH levels exceeding 500 pg/ml. Pre-and post-TBA parameters like clinical symptomatology, cortisol, ACTH and radiology were analysed for the prediction of NS. RESULTS NS developed in 39.5% (n = 17) patients with a median follow-up of 7 years. Half of them had new appearance, while rest had an expansion of pre-existing pituitary tumour. Majority (90%) had ACTH above 500 pg/ml. On Cox proportional hazards analysis, frequent discriminatory features of protein catabolism (≥ 4) (HR 1.15, CI 0.18, 7.06), proximal myopathy (HR 8.82, CI 1.12, 69.58) and annual ACTH increment of 113 pg/ml (HR 12.56, CI 1.88, 88.76) predicted NS. First post-operative year ACTH indices predicting NS included ACTH rise of 116 pg/ml and absolute ACTH of 142 pg/ml (sensitivity, specificity exceeding 90%). Annual ACTH increment exceeding 113 pg/ml, ≥ 4 discriminatory features and uncontrolled hypertension had the best overall prediction. CONCLUSION Patients who developed NS had higher rebound rise of ACTH following TBA and a more severe disease phenotype at baseline. Consistent ACTH increment can be used as a marker for predicting the development of NS.
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Affiliation(s)
- Liza Das
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anil Bhansali
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, 80131, Naples, Italy
| | - Pinaki Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | | | | | | | | | | | - Rama Walia
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Das L, Rai A, Mavuduru R, Vaiphei K, Sharma A, Gupta V, Bhadada SK, Lodha S, Panda N, Bhansali A, Singh P, Dutta P. Wolfram syndrome: clinical and genetic profiling of a cohort from a tertiary care centre with characterization of the primary gonadal failure. Endocrine 2020; 69:420-429. [PMID: 32350710 DOI: 10.1007/s12020-020-02320-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Wolfram syndrome (WFS) is a rare, monogenic neurodegenerative syndrome characterised by insulin requiring non-autoimmune diabetes mellitus (DM) and optic atrophy which are usually the earliest and commonest manifestations. However, there are other features which are under-recognized, adding to morbidity and premature mortality in these patients. METHODS Five patients (three males, two females) with genetically confirmed WFS at a single tertiary care centre were prospectively followed up. Their symptomatology, clinical profile, genetic analysis and radiology were analyzed. Multidisciplinary approach was used for comprehensive clinical care of this cohort. Patients with primary gonadal failure were subjected to biopsy and immunohistochemistry (IHC) for wolframin was performed. RESULTS DM was the earliest presenting manifestation at 6.2 ± 1.3 years followed by optic atrophy at 10.4 ± 2.3 years, diabetes insipidus at 12 ± 2.1 years and deafness at 12.8 ± 2.1 years. All patients were autoantibody negative with low C-peptide(<0.6 ng/ml). Hypoglycemic episodes were frequent (upto 60%) but there was no instance of diabetic ketoacidosis. Optic atrophy was present alongwith proliferative diabetic retinopathy and cataract in 40%. Uncommon manifestations included neuropsychiatric features, parasuicide, cystopathy, brainstem atrophy and hypergonadotropic hypogonadism only in adult males (n = 2). Testicular biopsy revealed partly hyalinised seminiferous tubules and prominence of Leydig cells. IHC confirmed the presence of mutated wolframin, which was not significantly different from normal testis specimen on protein quantification. CONCLUSIONS WFS requires a multidisciplinary approach with special emphasis on early diagnosis and management of other endocrine and non-endocrine features so as to improve long-term outcomes. Gonadal functions need periodic assessment, especially in adult males.
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Affiliation(s)
- Liza Das
- Department of Endocrinology, PGIMER, Chandigarh, India
| | - Ashutosh Rai
- Department of Translational and Regenerative Medicine, PGIMER, Chandigarh, India
| | | | - Kim Vaiphei
- Department of Histopathology, PGIMER, Chandigarh, India
| | | | - Vishali Gupta
- Department of Ophthalmology, PGIMER, Chandigarh, India
| | | | - Sailesh Lodha
- Department of Endocrinology, Eternal Heart Care Centre, Jaipur, India
| | - Naresh Panda
- Department of Otorhinolarygology, PGIMER, Chandigarh, India
| | - Anil Bhansali
- Department of Endocrinology, PGIMER, Chandigarh, India
| | | | - Pinaki Dutta
- Department of Endocrinology, PGIMER, Chandigarh, India.
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Devana SK, Sharma AP, Mavuduru R, Nada R, Bora GS. An unusual case of emphysematous pyelonephritis with features of IgG4-related tubulointerstitial nephritis on histology. Journal of Clinical Urology 2020. [DOI: 10.1177/2051415818779740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sudheer K Devana
- Department of Urology, Postgraduate Institute of Medical Education and Research, India
| | - Aditya P Sharma
- Department of Urology, Postgraduate Institute of Medical Education and Research, India
| | - Ravimohan Mavuduru
- Department of Urology, Postgraduate Institute of Medical Education and Research, India
| | - Ritambhra Nada
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, India
| | - Girdhar S Bora
- Department of Urology, Postgraduate Institute of Medical Education and Research, India
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14
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Pant NC, Singh R, Gupta V, Chauhan A, Mavuduru R, Prabha V, Sharma P. Contraceptive efficacy of sperm agglutinating factor from Staphylococcus warneri, isolated from the cervix of a woman with inexplicable infertility. Reprod Biol Endocrinol 2019; 17:85. [PMID: 31656198 PMCID: PMC6815424 DOI: 10.1186/s12958-019-0531-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/02/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Voluntary control of fertility is of paramount importance to the modern society. But since the contraceptive methods available for women have their limitations such as urinary tract infections, allergies, cervical erosion and discomfort, a desperate need exists to develop safe methods. Vaginal contraceptives may be the answer to this problem, as these are the oldest ways of fertility regulation, practiced over the centuries. With minimal systemic involvement, these are also the safest. Natural substances blocking or impairing the sperm motility offer as valuable non-cytotoxic vaginal contraceptives. Antimicrobial peptides (AMPs) isolated from plants, animals and microorganisms are known to possess sperm immobilizing and spermicidal properties. Following this, in the quest for alternative means, we have cloned, over expressed and purified the recombinant sperm agglutinating factor (SAF) from Staphylococcus warneri, isolated from the cervix of a woman with unexplained infertility. METHODS Genomic library of Staphylococcus warneri was generated in Escherichia coli using pSMART vector and screened for sperm agglutinating factor (SAF). The insert in sperm agglutinating transformant was sequenced and was found to express ribonucleotide-diphosphate reductase-α sub unit. The ORF was sub-cloned in pET28a vector, expressed and purified. The effect of rSAF on motility, viability, morphology, Mg++-dependent ATPase activity and acrosome status of human sperms was analyzed in vitro and contraceptive efficacy was evaluated in vivo in female BALB/c mice. RESULTS The 80 kDa rSAF showed complete sperm agglutination, inhibited its Mg2+-ATPase activity, caused premature sperm acrosomal loss in vitro and mimicked the pattern in vivo showing 100% contraception in BALB/c mice resulting in prevention of pregnancy. The FITC labeled SAF was found to bind the entire surface of spermatozoa. Vaginal application and oral administration of rSAF to mice for 14 successive days did not demonstrate any significant change in vaginal cell morphology, organ weight and tissue histology of reproductive and non-reproductive organs and had no negative impact in the dermal and penile irritation tests. CONCLUSION The Sperm Agglutinating Factor from Staphylococcus warneri, natural microflora of human cervix, showed extensive potential to be employed as a safe vaginal contraceptive.
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Affiliation(s)
- Neeraj Chandra Pant
- Department of Microbiology, South Campus, Basic Medical Science (Block I), Panjab University, Sector 25, Chandigarh, 160014, India
| | - Ravinder Singh
- Department of Microbiology, South Campus, Basic Medical Science (Block I), Panjab University, Sector 25, Chandigarh, 160014, India
| | - Vijaya Gupta
- Department of Microbiology, South Campus, Basic Medical Science (Block I), Panjab University, Sector 25, Chandigarh, 160014, India
| | - Aditi Chauhan
- Department of Microbiology, South Campus, Basic Medical Science (Block I), Panjab University, Sector 25, Chandigarh, 160014, India
| | | | - Vijay Prabha
- Department of Microbiology, South Campus, Basic Medical Science (Block I), Panjab University, Sector 25, Chandigarh, 160014, India
| | - Prince Sharma
- Department of Microbiology, South Campus, Basic Medical Science (Block I), Panjab University, Sector 25, Chandigarh, 160014, India.
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Kumar B, Kannan Av S, Jayant A, Mavuduru R. Echocardiography based algorithm for prevention and treatment of spinal hypotension: a prospective randomised controlled study. J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2019.07.109] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tyagi S, Roy A, Mavuduru R, Bora G, Aditya Narain T, Mandal AK. CLO19-054: Initial Experience of a Newly Set-up Robotic Assisted Radical Prostatectomy Program From a Developing Country—Delineating the Learning Curve. J Natl Compr Canc Netw 2019. [DOI: 10.6004/jnccn.2018.7262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Historically, the incidence of prostate cancer in India and in nonresident Indians is lower than that in Western populations. Our study aims to assess complications and short-term outcomes of robotic assisted radical prostatectomy (RARP) among postoperative patients from a tertiary care center of a developing country. Materials & Method: Prospective cohort/next 50 group, surgery between July 2017 to September 2018: Preoperative variables included demographic profile, MRI findings, PSA values, prostate biopsy reports including the Gleason score, erectile function assessment using the IIEF-5 questionnaire. Intraoperative variables included duration of surgery, blood loss, status of neurovascular bundles, whether could be preserved, lymph node dissection, and its extent. Postoperative variables included complications following the surgery (Clavien-Dindo classification), hospital stay, time of indwelling catheter. Follow-up data included serum PSA levels, status of urinary continence (daily urinary pad log ), and sexual function (IIEF 5 scores) at 3 months from surgery, then every 3 months. Retrospective cohort/first 50, surgery between December 2014 to 30th June 2017: Preoperative, intraoperative, and postoperative variables were recorded like in prospective cohort and were followed prospectively during study period. Results: Preoperative variables were comparable between two groups (Tables 1–3).Operative duration was significantly better in “next 50” group (mean, 236 minutes; range, 100–450 minutes) as compared to “first 50” group (mean, 350 minutes; range, 178–560 minutes, Duration of hospital stay is significantly less in “next 50” group (mean, 2.6 vs 4.5 days). Postoperative complications were also less commonly noted in “next 50” group (5% vs 14%; Table 4). Comparative postoperative erectile dysfunction rates were significantly less in “next 50” group (6% vs 36%), and though the postoperative incontinence rates were less in “next 50” group, it was found to be statistically insignificant (Table 5). Conclusion: Robotic-assisted radical prostatectomy is a safe and feasible option for the treatment of clinically localized prostate cancer. After due course of training period favorable and promising results can be replicated at a newly set robotic program.
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Affiliation(s)
- Shantanu Tyagi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arandam Roy
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravimohan Mavuduru
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Girdhar Bora
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Arup Kumar Mandal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Mir MA, Chaudhary S, Mammen KJ, Sood R, Dogra PN, Chadha S, Mavuduru R, Sinha RJ, Chaudhary M, Shiekh G. 1959. Ceftriaxone-Sulbactam-EDTA (CSE) vs. Meropenem (MR) in PLEA (a Phase 3, Randomized, Double-Blind Trial): Outcomes in Patients Infected With Ceftriaxone Non-Susceptible, Extended-Spectrum β-Lactamase and Multi-Drug-resistant Pathogens at Baseline. Open Forum Infect Dis 2018. [PMCID: PMC6252982 DOI: 10.1093/ofid/ofy210.1615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background CSE, a novel combination of Ceftriaxone, Sulbactam and Disodium EDTA (Class 1 Antibiotic Resistance Breaker), is being developed for the treatment of patients with serious Gram-negative infections and has completed a Phase-3 clinical trial (NCT03477422) for treatment of complicated urinary tract infections (cUTI), including acute pyelonephritis (AP). It restores and enhances the in vitro activity of Ceftriaxone against various β-lactamases (BLs), including enzyme families that belong to Ambler class A (TEM, SHV, CTX-M), class B (NDM, VIM, IMP), class C (some variants of AmpC), and class D {OXA extended spectrum BLs (ESBLs)}. This analysis was performed to assess the clinical and microbiological outcomes in patients infected with Ceftriaxone non-susceptible (C-NS), MDR and ESBL-producing Gram-negative pathogens at baseline. Methods Patients were randomized 1:1 to receive either CSE (1g Ceftriaxone/500 mg Sulbactam/37 mg EDTA) every 12 hours or Meropenem (MR) 1 g every 8 hours as 30 minutes IV infusion for 5–14 days. Oral step-down therapy was not allowed. Biological specimens were analyzed, and resistant pathogens identified. MDR was defined as resistance to at least three categories of antimicrobials. Identification of pathogens and antibiotic susceptibility testing were performed and interpreted according to Clinical and Laboratory Standards Institute methodologies. Combined Disc Diffusion Test was used to detect ESBL-production in pathogens. Results Of 230 randomized patients, 143 (62.2%) were included in m-MITT [72/74 (97.3) in CSE and 68/69 (98.6%) in MR groups had C-NS pathogens; 63/74 (85.1%) in CSE and 56/69 (81.2%) in MR groups had ESBL-producing pathogens; 55/74 (74.3%) in CSE and 45/69 (65.2%) in MR group had MDR pathogens]. Mean duration of IV therapy was 7 days. The clinical cure and microbiological eradication rates for CSE and MR at the test of cure (TOC) visit in C-NS, ESBL and MDR pathogens is shown in Figures 1, 2, and 3, respectively. ![]()
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Conclusion At TOC, clinical cure and microbiological eradication rates were higher for CSE as compared with MR across all three analyses sets. Overall, CSE was effective in the treatment of patients with cUTI and AP caused by resistant Gram-negative pathogens. Disclosures M. A. Mir, Venus Medicine Research Centre: Employee, Salary. S. Chaudhary, Venus Medicine Research Centre: Employee and Shareholder, Salary. M. Chaudhary, Venus Medicine Research Centre: Board Member and Shareholder, Salary. G. Shiekh, Venus Medicine Research Centre: Employee, Salary.
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Affiliation(s)
- Mohd Amin Mir
- Venus Medicine Research Centre, Panchkula (Harayana), India
| | | | | | - Rajeev Sood
- PGIMER Dr. RML Hospital, Baba Kharak Singh Marg, New Delhi, India
| | - P N Dogra
- All India Institute of Medical Science, New Delhi, India
| | | | - Ravimohan Mavuduru
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Gazalla Shiekh
- Venus Medicine Research Centre, Panchkula (Harayana), India
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Murugavaithianathan P, Devana SK, Mavuduru R, Kumar S, Singh SK, Mandal AK, Kumar R, Kakkar N. Bipolar Transurethral Resection of Bladder Tumor Provides Better Tissue for Histopathology But Has No Superior Efficacy and Safety: A Randomized Controlled Trial. J Endourol 2018; 32:1125-1130. [PMID: 30343592 DOI: 10.1089/end.2017.0328] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Bipolar transurethral resection of bladder tumors (TURBTs) has been claimed to have lesser complications and better specimen quality, but recent studies have contradictory results, and hence, we conducted this study to compare the clinical efficacy and safety of monopolar and bipolar electrosurgical modalities in TURBTs. MATERIALS AND METHODS A total of 287 patients were enrolled in the study and underwent TURBTs between July 2015 and September 2016. Patients undergoing surgery under general anesthesia and restage procedure were excluded from the study. Patient demographic profile, tumor characteristics, and complications of the procedures such as obturator jerk, bladder perforation, blood loss, need for resurgery, and transurethral resection syndrome were recorded. Tumor specimens were analyzed for stage, grade, deep muscle invasion, and quantity and quality of thermal artifacts. RESULTS A total of 160 patients were block randomized and analyzed with 80 patients in either group. Patient demographics and tumor characteristics were comparable between the groups. Change in hemoglobin levels and incidence of bladder perforation were comparable between the groups. A higher proportion of patients in bipolar group had obturator jerk compared with those in monopolar group, however, it was not statistically significant (24% vs 14%; p = 0.23). A higher proportion of patients in bipolar group did not have thermal artifacts when compared with monopolar group (27.5% vs 5%; p < 0.0001). CONCLUSIONS The operative risks of bipolar TURBT such as obturator jerk, bladder perforation, and blood loss are comparable with monopolar resection. However, less thermal artifacts in tissue samples obtained with bipolar resection may be helpful to the pathologist in interpretation of histopathologic findings.
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Affiliation(s)
| | | | | | - Santosh Kumar
- 1 Department of Urology and PGIMER , Chandigarh, India
| | | | | | - Rajesh Kumar
- 2 Department of Pathology, PGIMER , Chandigarh, India
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Singh S, Durga Prasad B, Mavuduru R, Mandal A, Prasad R. 490 The status of serum urotensin-II in patients with erectile dysfunction. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2018.04.397] [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: 11/28/2022]
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20
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Choudhary GR, Mandal AK, Mete U, Mavuduru R, Bhatacharia A, Lal A, Goyal S. Evaluation of Quantitative and Qualitative Renal Outcome Following Nephron Sparing Surgery. J Clin Imaging Sci 2018; 8:15. [PMID: 29770263 PMCID: PMC5939037 DOI: 10.4103/jcis.jcis_82_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/08/2017] [Accepted: 12/11/2017] [Indexed: 11/14/2022] Open
Abstract
Purpose: Preservation of renal function after nephron-sparing surgery (NSS) is multifactorial and the impact of individual factors on it is still a debate. This prospective study investigates the impact of factors responsible for quantitative and functional outcome after NSS. Patients and Methods: Fifty-two patients of localized renal mass (≤7 cm) were included in the study. A contrast-enhanced computed tomography abdomen was performed for characterization of tumor. Glomerular filtration rate (GFR) was calculated using Tc99m-diethylenetriamine pentaacetic acid (DTPA) scan and Cockcroft-Gault (CG) formula. All relevant intra- and peri-operative events were noted. Follow-up work up performed at 3 months. Results: Overall, the mean ischemia time was 30.6 min, with 7.7% decrease in renal volume in the operated moiety. In follow-up, the total and ipsilateral GFR decreased. Change in renal parenchymal volume, total GFR by CG and DTPA, split GFR of tumor-bearing moiety was significant in follow-up. Size, stage, polar location of tumor, duration of surgery, type of ischemia, preoperative chronic kidney disease, and need of blood transfusion did not affect change in renal volume and function in the follow-up period. Conclusion: Renal parenchymal loss and duration of ischemia have impact on the follow-up renal function.
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Affiliation(s)
| | | | - Uttam Mete
- Department of Urology, PGIMER, Chandigarh, India
| | | | | | - Anupam Lal
- Department of Urology, PGIMER, Chandigarh, India
| | - Suresh Goyal
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, India
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Murugavaithianathan P, Singh S, Devana SK, Mavuduru R, Kumar S, Kakkar N, Mandal AK. MP71-17 BIPOLAR TRANSURETHRAL RESECTION OF BLADDER TUMOR PROVIDES BETTER TISSUE FOR HISTOPATHOLOGY BUT HAS NO SUPERIOR EFFICACY AND SAFETY: A RANDOMIZED CONTROLLED TRIAL. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Microinvasive squamous cell carcinoma (SCC) is a known premalignant lesion of carcinoma cervix. It is also reported from other sites such as the oral cavity, larynx, and vulva. Microinvasive SCC is very rarely reported from the penis. We report the occurrence of microinvasive SCC in a long-standing erythematous lesion of glans penis in a patient, with extensive metastasis. We emphasize the need for awareness among patients and urologists about the premalignant lesions of penis and prompt treatment of such lesions to prevent possible spread of the disease.
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Affiliation(s)
| | - Sudheer K Devana
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kim Vaiphei
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravimohan Mavuduru
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Girdhar S Bora
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Mukhopadhyay A, Mandal A, Singh S, Mavuduru R, Modak S. The evaluation and outcome of a new intravesical BCG protocol for non-muscle invasive bladder cancer in a tertiary care center In India. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx661.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Agarwal MM, Jain S, Mavuduru R, Singh SK, Mandal AK. Plateau pattern of detrusor contraction: A surrogate indicator of presence of external sphincter dysfunction during micturitional phase of urodynamic study. Indian J Urol 2016; 32:137-40. [PMID: 27127357 PMCID: PMC4831503 DOI: 10.4103/0970-1591.174777] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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] [Indexed: 11/25/2022] Open
Abstract
Introduction: Dysfunctional voiding results from a disturbance in the coordination between sphincter relaxation and detrusor contraction. Video urodynamic studies with electromyography (EMG) are used for diagnosis but have limitations of availability and interpretation. We identified a plateau type voiding detrusor pressure tracing pattern in these patients with a potential of helping diagnosis. Materials and Methods: Urodynamic data and tracings of adult patients having been diagnosed with external urethral sphincter dysfunction (EUSD) were retrospectively analyzed. The urodynamic studies comprised of pressure flow studies, micturitional urethral pressure profilometry, and voiding cystourethrogram (VCUG). Diagnosis of EUSD was based on the presence of intermittent or continuous narrowing in the region of EUS on VCUG along with a urethral-vesical pressure gradient of >20 cm H2O in males and >5 cm H2O in females. Results: A total of 25 patients (14 men and 11 women) with a mean age 36.6 ± 16.5 years, presented with lower urinary tract symptoms (international prostate symptom score 18 ± 5) and were diagnosed with EUSD on urodynamics/cystourethrography. The cause of EUSD was neurogenic DESD in four, dysfunctional voiding in 20 and voluntary pelvic floor squeeze in one. Resting maximum urethral closure pressure at EUS was 142.2 ± 38.3 cmH2O in both sexes. Three patients had detrusor overactivity. EMG activity during voiding was high in 10 patients, low in three, inconclusive in seven, and not performed in three. A plateau type pattern of detrusor contraction was observed in all the patients. This was qualitatively different from the roughly bell-shaped curve of detrusor contraction in men with prostatic obstruction (n = 14) and women with stress urinary incontinence (n = 11). Conclusions: Patients with EUSD have a characteristic plateau pattern of detrusor contraction on urodynamics which can be used as a surrogate for urodynamic diagnosis of nonrelaxing EUSD.
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Affiliation(s)
- Mayank Mohan Agarwal
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India; Department of Urology, New Medical Center Specialty Hospital, Abu Dhabi, UAE
| | - Saurabh Jain
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravimohan Mavuduru
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shrawan K Singh
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arup K Mandal
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sharma AP, Devana SK, Bora GS, Mavuduru R, Mandal AK. Simultaneous robotic-assisted adrenalectomy and partial nephrectomy: technical aspects. J Robot Surg 2016; 10:175-8. [PMID: 26861448 DOI: 10.1007/s11701-015-0553-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 11/27/2015] [Indexed: 10/22/2022]
Abstract
Robot-assisted partial nephrectomy has become a safe and feasible procedure for small renal masses (SRM). Similarly, robot-assisted adrenalectomy has also been well established. Robotic surgery has provided the possibility to manage complex cases that are considered technically challenging for traditional laparoscopy. We describe in this video the details of performing simultaneous robotic adrenalectomy with partial nephrectomy highlighting the technical aspects of the same. A 62-year-old gentleman presented to us with incidentally detected left renal complex cyst (Bosniak IIF) and a concomitant left adrenal mass. Hormonal evaluation of adrenal tumor revealed raised levels of serum estrogen and DHEAS. A robotic-assisted simultaneous procedure was planned. Patient was positioned in right lateral position. After port placement, robot was brought from the shoulder of the patient and docked. We first excised the adrenal tumor followed by the renal cyst. Total operative time was 180 min with warm ischemia time of 20 min for renal cyst excision. Drain was removed on post-operative day 2. Patient was discharged on post-operative day 3. Histopathology revealed adrenocortical adenoma and benign hemorrhagic renal cyst. We found simultaneous ipsilateral adrenalectomy with partial nephrectomy using robotic assistance is feasible and safe with minimal morbidity. Port placement in such cases should be individualized according to the location of the SRM. The robot provides the ergonomic advantage and 3D vision for better anatomic definition as compared to laparoscopy.
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Affiliation(s)
- Aditya Prakash Sharma
- Advanced Urology Center, Department of Urology, Nehru Hospital, PGIMER, Chandigarh, India, 160012
| | - Sudheer Kumar Devana
- Advanced Urology Center, Department of Urology, Nehru Hospital, PGIMER, Chandigarh, India, 160012
| | - Girdhar Singh Bora
- Advanced Urology Center, Department of Urology, Nehru Hospital, PGIMER, Chandigarh, India, 160012.
| | - Ravimohan Mavuduru
- Advanced Urology Center, Department of Urology, Nehru Hospital, PGIMER, Chandigarh, India, 160012
| | - Arup Kumar Mandal
- Advanced Urology Center, Department of Urology, Nehru Hospital, PGIMER, Chandigarh, India, 160012
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Mavuduru R, Kundal P, Pattanaik S, Singh S, Mandal A. MP43-20 ENDOTHELIAL DYSFUNCTION IN PATIENTS OF ERECTILE DYSFUNCTION USING SHORT-TERM LOW DOSE TADALAFIL : A DOUBLE BLIND RANDOMIZED CONTROL TRIAL. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Barapatre YR, Agarwal MM, Mavuduru R, Sharma SK, Kumar S, Singh SK, Mandal AK. Short-Term Functional and Urodynamic Outcome of W-ileal Orthotopic Neobladder with Serosa-Lined Tunneled Uretero-Ileal Anastomosis. Low Urin Tract Symptoms 2014; 6:26-34. [PMID: 26663497 DOI: 10.1111/luts.12014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 12/17/2012] [Accepted: 01/10/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Functional and urodynamic (UDS) outcomes of W-configured ileal orthotopic neobladder (ONB) with extramural serosa-lined tunnel uretero-ileal anastomosis are presented METHODS Consecutive 17 patients undergoing ONB during December 2009 to March 2011 were enrolled. Of these 15 men (bladder cancer 14, tuberculosis 1) with mean age 52.7 ± 11.3 years completed the follow-up. Pouch-related quality of life (PQOL) was assessed using a published questionnaire. Uroflowmetry, cystometry/cystography and urethral-pressure profilometry were done at two follow-up visits at least 3 months apart. Mean follow up 10 ± 5 months. Mean length of harvested ileum 48 ± 6 cm. RESULTS Overall PQOL were similar at both evaluations (55 ± 11 and 54 ± 15, respectively). During first and second follow-up, maximum flow-rate, voided-volume and post-void residual urine were 11 ± 4 mL/sec, 246 ± 99 mL and 68 ± 74.9 mL and 10.4 ± 4.6 mL/sec, 234 ± 138 mL and 86 ± 146 mL, respectively. Mean neobladder capacity, compliance, maximum urethral closure-pressure (MUCP) and functional urethral length were 484 ± 244 mL, 50.5 ± 49.1 mL/cmH2 O, 42 ±20 cmH2 O and 22 ± 12 mm, and 468 ± 250 mL, 46.4 ± 47.5 mL/cmH2 O, 52 ± 27cmH2 O and 23 ± 12 mm, respectively. Patients with smaller pouch (r = 0.828; P = 0.0001), longer urethral length (r = -0.392; P = 0.023) and lesser incontinence (r = 0.429; P = 0.011) had significantly better PQOL. With continued supervised pelvic-floor rehabilitation, a trend in improvement in hesitancy (P = 0.058), MUCP (P = 0.05) and bothersome incontinence (P = NS) was observed. None of the patients had any obstruction or reflux of the upper tracts. CONCLUSION The index ONB has reasonable storage and voiding characteristics but with a rider of nocturnal urinary incontinence.
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Affiliation(s)
- Yogesh R Barapatre
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mayank M Agarwal
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravimohan Mavuduru
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Suresh K Sharma
- Department of Statistics, Punjab University, Chandigarh, India
| | - Santosh Kumar
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shrawan K Singh
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arup K Mandal
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Jain S, Agarwal MM, Mavuduru R, Singh SK, Mandal AK. Micturitional urethral pressure profilometry for the diagnosis, grading, and localization of bladder outlet obstruction in adult men: a comparison with pressure-flow study. Urology 2013; 83:550-5. [PMID: 24275284 DOI: 10.1016/j.urology.2013.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/07/2013] [Accepted: 10/13/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate the accuracy of micturitional urethral pressure profilometry (MUPP) for diagnosis, grading, and localization of bladder outlet obstruction (BOO) in men with obstructive lower urinary tract symptoms. METHODS This prospective study included adult men with voiding symptoms qualifying for urodynamics (UDS). Patients with urethral stricture, urinary-tract infection, and inflammatory diseases of the bladder were excluded. Patients were subjected to UDS followed by VCUG the same day. UDS was performed using Solar Silver (MMS International, Enschede, the Netherlands) and included uroflowmetry, resting cystometry with UPP, pressure-flow study with MUPP, and perineal surface-electromyography. The study was performed in accordance with International Continence Society Good Urodynamic-practice Guidelines (2002). VCUG was considered the gold standard for presence and localization of BOO. RESULTS A total of 64 male patients with mean age 53.3 ± 17.8 years and International Prostate Symptom Score 17.2 ± 6.8 completed the study. Uroflowmetry revealed maximum urine flow 10.1 ± 7.1 mL/s, voided-volume 218.9 ± 161.6 mL, and postvoid residue 129.8 ± 126.5 mL. For diagnosis of BOO, Abrams-Griffith number, Schaefer obstruction-grades, and obstruction-coefficient had weak agreement with VCUG (Cohen's kappa k <0.20), whereas urethral closure-pressure (Pclo) had strong agreement (k = 0.78). For grading, Pclomax had a significant positive linear correlation with Abram-Griffiths number (R(2) = 0.562; P = .0001). MUPP was able to localize the site of obstruction correctly in 55 of 57 obstructed patients. CONCLUSION MUPP is highly accurate in diagnosis, grading, and localization of BOO in men with voiding dysfunction. It might be a useful supplement to VCUG/UDS.
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Affiliation(s)
- Saurabh Jain
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mayank Mohan Agarwal
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ravimohan Mavuduru
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shrawan K Singh
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arup K Mandal
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Gulati A, Prakash M, Bhatia A, Mavuduru R, Khandelwal N. Spontaneous rupture of renal pelvis. Am J Emerg Med 2013; 31:762.e1-3. [PMID: 23380093 DOI: 10.1016/j.ajem.2012.12.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 12/12/2012] [Indexed: 11/24/2022] Open
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Agarwal MM, Raamya SM, Mavuduru R, Mandal AK, Singh SK. Voiding dysfunction after repair of giant trigonal vesicovaginal or urethrovesicovaginal fistulae: A need for long-term follow-up. Indian J Urol 2013; 28:405-8. [PMID: 23450711 PMCID: PMC3579119 DOI: 10.4103/0970-1591.105751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Indexed: 11/18/2022] Open
Abstract
Introduction: Urodynamic findings of lower urinary tract of women presenting with voiding dysfunction after successful repair of complex trigonal vesicovaginal fistulas at our institute are presented. Materials and Methods: In this retrospective case series, women presenting with voiding dysfunction after successful repair of obstetric fistulae were evaluated. In addition of standard clinical evaluation with history and clinical examination, all underwent kidney-ureter-bladder ultrasonography, renal function test, urine culture, and multichannel urodynamics. The latter consisted of free uroflowmetry, filling and voiding cystometry. Results: Five women (median age 35 years; range 30–45) presented with difficulty in voiding after the successful repair; two presented within 1 year and 3 after 10 years. The latter three presented with bilateral hydroureteronephrosis; one of these had chronic kidney disease (CKD) grade IV at presentation. Urodynamics (UDS) of all patients revealed poor detrusor compliance (median 11 ml/cm H2O; range 5–22), high-end filling detrusor pressures (median 41 cm H2O; range 11–46) and no detrusor overactivity. All patients attempted voiding with abdominal straining; with little contribution of detrusor contraction (median 6 cm H2O; range 0–9). Two patients could not void during the study, one with Tanagho reconstruction and another with CKD. Conclusion: Even after successful repair, patients with complex trigonal or urethra-vesicovaginal fistulae warrant indefinite long-term follow-up for voiding dysfunction in view of possibility of developing poorly compliant bladder.
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Affiliation(s)
- Mayank Mohan Agarwal
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Agarwal MM, Patil S, Roy K, Bandawar M, Choudhury S, Mavuduru R, Sharma SK, Mandal AK, Singh SK. Rationalization of interpretation of uroflowmetry for a non-caucasian (Indian) population: conceptual development and validation of volume-normalized flow rate index. Neurourol Urodyn 2013; 33:135-41. [DOI: 10.1002/nau.22388] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 01/24/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Mayank Mohan Agarwal
- Department of Urology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - ShivKumar Patil
- Department of Urology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Kishore Roy
- Department of Urology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Mayur Bandawar
- Department of Urology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Sunirmal Choudhury
- Department of Urology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Ravimohan Mavuduru
- Department of Urology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | | | - Arup K. Mandal
- Department of Urology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Shrawan K. Singh
- Department of Urology; Postgraduate Institute of Medical Education and Research; Chandigarh India
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Agarwal MM, Mavuduru R, Singh SK, Mandal AK. Preliminary short-term outcomes of a modified double-T ileal continent cutaneous urinary diversion using Yang-Monti tube implantation through serosa-lined extramural tunnel: the PGIMER pouch. Urology 2012; 79:943-9. [PMID: 22469584 DOI: 10.1016/j.urology.2011.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 12/15/2011] [Accepted: 12/16/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To present our simplified technical modification of double-T continent cutaneous diversion (CCD) using Yang-Monti tubes. METHODS During 2008-2011, 8 adult patients underwent CCD; 4 had classical exstrophy, 2 bladder cancer, 1 recurrent vaginal cancer post-radiotherapy, and 1 prostate cancer with post-simple retropubic prostatectomy urethral stricture with incontinence. For reconstruction, a 45- to 50-cm segment of terminal ileum sparing 25 cm of terminal ileum was harvested. Its distal 3- to 6-cm and proximal 3-cm segments were separated on vascular pedicle and fashioned into Yang-Monti tubes (1 proximally and 1 or 2 distally). The middle 40- to 45-cm detubularized segment was fashioned into a "W" shape, and serosal aspects of adjacent loops were sutured together close to the mesentery. The tubes were implanted into the W pouch via extramural serosa-lined tunnel (Abol-Enein and Ghoneim). The pouch was closed transversely over an 18-Fr pouchostomy and 16-Fr stomal catheter. The ureters were implanted into the proximal tube using the Wallace principle, over 6- to 8-Fr infant feeding tubes exteriorized through the pouch. The distal end of the distal tube was made into a flush stoma. RESULTS In the early postoperative period, intestinal obstruction (2 cases), ureteroileal anastomotic leakage (3 cases) and vesico-ileocutaneous fistula (1 case) were encountered. No ureteroileal anastomotic obstruction or catherization-related difficulty was observed until the last follow-up (2 months to 3 years). Of 15 anastomoses, 14 were nonrefluxing. CONCLUSION Ileal double-T CCD using the Yang-Monti principle is technically feasible and relatively simple, particularly in nonirradiated ileum. However, early complications indicate a learning curve, and long-term follow-up and larger data are needed.
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Affiliation(s)
- Mayank Mohan Agarwal
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Nanjappa B, Singh SK, Mavuduru R, Modi M, Minz M, Mandal AK, Sakhuja V. 2132 IMPACT OF RENAL TRANSPLANT ON VASCULOGENIC AND NEUROGENIC DETERMINANTS OF ERECTILE DYSFUNCTION IN PATIENTS WITH CHRONIC RENAL FAILURE. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.2302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Agarwal MM, Singh SK, Mavuduru R, Mandal AK. Preventive fluid and dietary therapy for urolithiasis: An appraisal of strength, controversies and lacunae of current literature. Indian J Urol 2011; 27:310-9. [PMID: 22022052 PMCID: PMC3193729 DOI: 10.4103/0970-1591.85423] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [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] [Indexed: 12/21/2022] Open
Abstract
Regulation of fluid and dietary intake habits is essential in comprehensive preventive management of urolithiasis. However, despite large body of epidemiological database, there is dearth of good quality prospective interventional studies in this regard. Often there is conflict in pathophysiological basis and actual clinical outcome. We describe conflicts, controversies and lacunae in current literature in fluid and dietary modifications in prevention of urolithiasis. Adequate fluid intake is the most important conservative strategy in urolithiasis-prevention; its positive effects are seen even at low volumes. Of the citrus, orange provides the most favorable pH changes in the urine, equivalent to therapeutic alkaline citrates. Despite being richest source of citrate, lemon does not increase pH significant due to its acidic nature. Fructose, animal proteins and fats are implicated in contributing to obesity, which is an established risk factor for urolithiasis. Fructose and proteins also contribute to lithogenecity of urine directly. Sodium restriction is commonly advised since natriuresis is associated with calciuresis. Calcium restriction is not advisable for urolithiasis prevention. Adequate calcium intake is beneficial if taken with food since it reduces absorption of dietary oxalate. Increasing dietary fiber does not protect against urolithiasis. Evidence for pyridoxine and magnesium is not robust. There is no prospective interventional study evaluating effect of many dietary elements, including citrus juices, carbohydrate, fat, dietary fiber, sodium, etc. Due to lack of good-quality prospective interventional trials it is essential to test the findings of pathophysiological understanding and epidemiological evidence. Role of probiotics and phytoceuticals needs special attention for future research.
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Affiliation(s)
- Mayank Mohan Agarwal
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Agarwal MM, Choudhury S, Mandal AK, Mavuduru R, Singh SK. Are urine flow-volume nomograms developed on Caucasian men optimally applicable for Indian men? Need for appraisal of flow-volume relations in local population. Indian J Urol 2011; 26:338-44. [PMID: 21116350 PMCID: PMC2978430 DOI: 10.4103/0970-1591.70562] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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] [Indexed: 11/25/2022] Open
Abstract
Introduction: Flow-volume nomograms and volume-corrected flow-rates (cQ) are tools to correct uroflow rates (Q) with varied voided volumes (VV) of urine. We investigated the applicability of the available nomograms in our local population. Materials and Methods: Raw data of our previous study on variation in Q with voiding position (standing, sitting, and squatting) in healthy adult men was reanalyzed. Additionally, the departmental urodynamic database of the last four years was searched for uroflow data of men with voiding symptoms (International Prostatic Symptom Score (IPSS) > 7 and global quality of life score >2). These results were projected on the Liverpool and Siroky nomograms for men. The Q-VV relations were statistically analyzed using curve-estimation regression method to examine the current definition of corrected maximum flow rate (Qmax). Results: We found a cubic relation between Q and VV; based on this we developed novel equation for cQ [cQ=Q/(VV)1/3] and novel confidence-limit flow-volume nomograms. The imaginary 16th percentile line of Liverpool nomogram, -1 standard-deviation line of Siroky nomogram and lower 68% confidence-limit line of our nomogram had sensitivity of 96.2%, 100% and 89.3%, and specificity of 75.3% 69.3% and 86.0%, respectively for Qmax-VV relations. Corresponding values for average flow rate (Qave)-volume relations were 96.2%, 100% and 94.6%, and 75.2%, 50.4% and 86.0%, respectively. The area under curve of the receiver operating characteristics (ROC) curve for cQmax and cQave was 0.954 and 0.965, respectively, suggesting significantly higher discriminatory power than chance (P = 0.0001). Conclusion: Flow-volume nomograms developed on Caucasian population may not be optimally applicable to the Indian population. We introduce flow-volume nomograms and cQ, which have high sensitivity and specificity.
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Affiliation(s)
- Mayank M Agarwal
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ganesamoni R, Mavuduru R, Agarwal MM. Re: Hendrik van Poppel, Luigi da Pozzo, Walter Albrecht, et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 2011;59:543-52. Eur Urol 2011; 60:e9; author reply e10. [PMID: 21621322 DOI: 10.1016/j.eururo.2011.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Accepted: 05/02/2011] [Indexed: 11/28/2022]
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Agarwal MM, Mandal AK, Sarkar D, Mavuduru R, Singh SK. Unusual cause of failure of end-to-end anastomotic urethroplasty for traumatic obliterative bulbar urethral stricture. Urology 2010; 78:331-3. [PMID: 20970841 DOI: 10.1016/j.urology.2010.07.465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 06/30/2010] [Accepted: 07/13/2010] [Indexed: 11/27/2022]
Abstract
End-to-end anastomotic urethroplasty (EEA) for traumatic bulbar urethral stricture has excellent long-term success rate. We encountered a patient with obliterative bulbar stricture and persistent phlegmon in perineum resulting from straddle injury. Phlegmon-excision and EEA was performed, which ended up in recurrence. Thorough excision of recurrent nodules & scar with stage-I urethroplasty was performed using 'scrotal shutter flap'. Histopathology of phlegmon of first surgery and nodules & urethral margins of second revealed amyloidosis. Stage-II urethroplasty was performed 3-months later after which he is well at 24 months follow-up. This is the first case of perineal-urethral amyloid associated with trauma. Etiology is elusive.
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Affiliation(s)
- Mayank M Agarwal
- Department of Urology, Advanced Urology Center, Nehru Hospital, PGIMER, Chandiagrh, India
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Agarwal MM, Mandal AK, Agarwal S, Lal A, Prakash M, Mavuduru R, Singh SK. Surgicel Granuloma: Unusual Cause of “Recurrent” Mass Lesion After Laparoscopic Nephron-sparing Surgery for Renal Cell Carcinoma. Urology 2010; 76:334-5. [DOI: 10.1016/j.urology.2009.06.070] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Revised: 06/25/2009] [Accepted: 06/30/2009] [Indexed: 10/19/2022]
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Choudhury S, Agarwal MM, Mandal AK, Mavuduru R, Mete UK, Kumar S, Singh SK. Which voiding position is associated with lowest flow rates in healthy adult men? role of natural voiding position. Neurourol Urodyn 2010; 29:413-7. [PMID: 19634168 DOI: 10.1002/nau.20759] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE To investigate the effect of voiding position on uroflowmetric variables and postvoid residual urine (PVR) volume in healthy adult men without lower urinary tract symptoms (LUTS). MATERIALS AND METHODS Men without LUTS were enrolled. Participants were asked to report to the urodynamic suite with comfortably full bladder for uroflowmetry. Each participant performed six voids into digital uroflowmeter (Solar Silver, Medical Measurement System, The Netherlands), all on separate occasions, twice in each of the standing, sitting, and squatting down positions. PVR was measured using transabdominal ultrasound (Siemens). RESULTS Total 72 participants were enrolled and 61 completed the study; their mean (+/-SD) age was 26.6 +/- 6.9 years. All of them but one was accustomed to void in standing and squatting positions. The mean maximal flow rates (Q(max)) and average flow rates (Q(ave)) were significantly lower in sitting position, than standing and squatting positions (Q(max): 19.8 +/- 7.4 vs. 23.8 +/- 7.7 and 24.4 +/- 8.1 ml/sec, respectively; P = 0.0001. Q(ave): 11.2 +/- 4.5 vs. 13.9 +/- 4.5, and 13.8 +/- 5.1 ml/sec, respectively; P = 0.0001). The corresponding values of voiding time were significantly higher (t(vv): 38.6 +/- 20.7 sec vs. 28.3 +/- 15.3 and 30.6 +/- 18.1 sec, respectively; P = 0.0001). The latter two positions were statistically similar in voiding characteristics. Voided volumes and PVR were statistically similar among all the three positions. CONCLUSION Uroflow parameters were higher in standing and squatting positions compared to sitting in individuals not accustomed to void in sitting position. Therefore, uroflowmetry should not be performed in a position the individual is not familiar with.
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Affiliation(s)
- Sunirmal Choudhury
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Agarwal MM, Singh SK, Agarwal S, Mavuduru R, Mandal AK. A Novel Technique of Intracorporeal Excisional Tailoring of Megaureter Before Laparoscopic Ureteral Reimplantation. Urology 2010; 75:96-9. [DOI: 10.1016/j.urology.2009.07.1216] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 05/14/2009] [Accepted: 07/07/2009] [Indexed: 10/20/2022]
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Barapatre Y, Agarwal MM, Singh SK, Sharma SK, Mavuduru R, Mete UK, Kumar S, Mandal AK. Uroflowmetry in healthy women: Development and validation of flow-volume and corrected flow-age nomograms. Neurourol Urodyn 2009; 28:1003-9. [DOI: 10.1002/nau.20718] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Agarwal MM, Singh SK, Sharma DK, Ranjan P, Kumar S, Chandramohan V, Gupta N, Acharya NC, Bhalla V, Mavuduru R, Mandal AK. Fracture of the penis: a radiological or clinical diagnosis? A case series and literature review. Can J Urol 2009; 16:4568-4575. [PMID: 19364429] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Fracture of the penis is rare and needs a surgeon's attention for appropriate management. The exact role of diagnostic investigations has not been established. We studied the role of these investigations and the results of surgery. CASE SERIES Seventeen patients with median age of 36 years (range, 27-72 years) presented to us between 2002 and 2007 with suspected fracture of the penis. The mode of injury was sexual intercourse (15 patients), masturbation (1 patient), and rolling over in bed (1 patient). The median time from injury to presentation was 10 hours (range, 1-144 hours). Clinical evaluation included patient history and examination for all patients, ultrasonography in 6 patients, retrograde urethrography in 6 patients, and magnetic resonance imaging in 1 patient. Fifteen patients underwent immediate surgical exploration, 1 patient was kept under observation, and 1 patient refused surgical exploration. DISCUSSION Patient history and clinical examination were highly sensitive and accurate in predicting a cavernosal tear, and retrograde urethrography was highly sensitive and accurate in detecting urethral injury. Ultrasonography was highly specific but not sensitive for detecting a cavernosal tear. Radiological investigations did not influence patient management in any of the cases. On surgical exploration, 15 patients had cavernosal tears and 4 also had urethral injuries; all injuries were repaired successfully. One patient had a negative surgical exploration and was diagnosed as having a superficial dorsal vein rupture. One patient had a history suggestive of penile fracture but had a normal clinical examination and was kept under observation. At follow up in a mean of 7.5 months, no patient had erectile dysfunction or penile deformity. CONCLUSION Further evaluation beyond taking a patient history and performing a clinical examination is not necessary in most cases for managing patients with suspected penile fracture. Retrograde urethrography may be omitted before surgical exploration, even in cases with suspected urethral injury. Early surgical repair is associated with a good outcome with minimal complications.
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Agarwal MM, Singh SK, Batra YK, Mavuduru R, Mandal AK. Effect of lumbar epidural administration of neostigmine on lower urinary tract function. Neurourol Urodyn 2009; 29:443-8. [PMID: 19260084 DOI: 10.1002/nau.20723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Neostigmine is cholinomimetic and is used for postoperative analgesia. Its urodynamics effects on voiding function have not been elucidated. MATERIALS AND METHODS Adult patients without bothersome voiding symptoms planned for rigid cystoscopy under local anesthesia were enrolled. They underwent multichannel urodynamics (filling cystometry and pressure-flow study) before and 30 min after lumbar epidural administration of Neostigmine (2 microg/kg). RESULTS Indications for cystoscopy were check examination for follow up of carcinoma urinary bladder (n = 3), staging for carcinoma cervix (5), and removal of ureteral stent (4). Patients' mean age was 51.9 +/- 11.7 years and international Prostatic symptom score 2.34 +/- 3.41. A trend of decreased maximum cystometric capacity (MCC) was observed after Neostigmine (413.50 +/- 142.45 ml vs. 357.00 +/- 145.62 ml; P = 0.056) without any change in end-filling pressure. Five patients developed detrusor overactivity (DO) and one had increase in its amplitude (P = 0.031). Four patients developed rhythmic rectal contractions and one had increase in its amplitude (P = 0.219). There was no difference in any of the voiding parameters. Mean Visual Analog Pain Score (VAS scale 0-10) during cystoscopy for this group was significantly lower than that in a similar group of patients who did not receive Neostigmine prior to rigid cystoscopy (1.16 +/- 0.94 vs. 4.57 +/- 1.45; P = 0.0001). The drug was well tolerated in majority of the patients. CONCLUSION Epidural Neostigmine is effective in providing analgesia during diagnostic rigid cystoscopy. It leads to development of DO and decrease in bladder capacity without any effect on voiding function. These findings may help clinicians to use it for transurethral procedure-related pain relief without apprehension of voiding difficulty.
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Affiliation(s)
- Mayank Mohan Agarwal
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Mavuduru R, Agarwal MM, Mandal AK. Safety and efficacy of active surveillance in patients with localized prostate cancer. Indian J Urol 2008; 24:131-2. [PMID: 19468382 PMCID: PMC2684239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ravimohan Mavuduru
- Department of Urology, Level II, B Block, Advanced Urology Center, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012, India. E-mail: ;
| | - Mayank Mohan Agarwal
- Department of Urology, Level II, B Block, Advanced Urology Center, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012, India. E-mail: ;
| | - Arup K. Mandal
- Department of Urology, Level II, B Block, Advanced Urology Center, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012, India. E-mail: ;
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