Urology, Nephrology and Andrology International

 Tuberculosis is one of the most common infectious diseases worldwide. Several risk factors including diabetes mellitus, chronic renal failure are known to impair the immunity and are involved in spread of TB. We report a case of diabetes mellitus with chronic renal failure and tuberculosis.

Keywords: Tuberculosis; Diabetes Mellitus; Hemodialysis; ESRD. 

 Carcinoid tumors are known to arise from enterochromaffin cells and are usually found arising from tissue derived from the embryonicneural crest. Although they are more commonly encountered in gastrointestinal and respiratory organs, rarely they have also been encountered in the genitourinary tract, including the kidney and urinary bladder. Only 29 cases of pure carcinoid tumor of bladder have been reported so far in the literature. We report here another case of pure carcinoid tumor of bladder involving the prostatic urethra and whole of the prostate, who underwent radical cystectomy.

Keywords: Primary Carcinoid Tumor; Bladder Carcinoid; Malignant Bladder Carcinoid; Pure Carcinoid of Bladder.

 IgAN is one of the commonest biopsy proven primary glomerular diseases with diverse histological patterns based on the geographic location. This is a study was done by including all consecutive cases of biopsy proven IgAN(native kidney) performed at EMS Memorial Cooperative Hospital, Perinthalmanna, Kerala, India, from September 2009 to February 2016. We had 62 (Females: 36, Males: 26) cases of biopsy proven IgAN. The mean age of the patients was 37.71 years and male: female ratio was 1.38:1. The IgAN was classified according to the Oxford classification (MEST scoring). Majority of the patients had mesangial hypercellularity (91.94%) and tubular atrophy (69.36%; T1- 43.55%, T2-25.81%). Only few patients had endocapillary proliferation (20.97 %), and segmental sclerosis (39.68 %). Glomerular crescents (involving 5-20% of glomeruli) were found in 4.84 % of patients with IgAN. The commonest combinations of MEST scoring were M1, E0, S0, T1 (25.81%), followed by M, E0, S1, T1 (14.52%) and M0, E0, S0, T0, was seen only in 6.45% of cases. This study confirms the aggressive nature of IgAN in Indian subcontinent, unlike western literature.

Keywords: IgAN; Oxford-MEST Classification.

 Objectives: To report our experience with transurethral resection of ejaculatory ducts (TURED) in infertile men with symptomatic ejaculatory duct obstruction. Material and Method: We studied 4 cases of ejaculatory duct obstruction from January 2014 to January 2015. Investigations included a history, physical examination, semen analysis, semen culture, hormone levels and trans-rectal ultrasonography. Results were evaluated after TURED, especially the semen parameters, the patency and the pregnancy rate. Results: Causes of obstruction were previous infection with inflammation, calculus and prostatic cyst. Mean age was 34 years.Mean Duration of infertility was 3.5 years.Mean FSH value was 1.5. Mean Semen volume was 0.5 ml with SD of ± 0.10m. In all patients fructose was absent on semen analysis. On TRUS mean seminal vesicle diameter was 16.00 mm Seminal vesicle was dilated in all cases. In 3/4 patients who had patency in follow up had a mean sperm count of 14.33 million/ml.Mean time to patency was 3 months.Post TURED ejaculate volume improved in all patients with mean of 1.75ml and SD of 0.50 ml. Patients who had undergone TURED reported a patency rate of 75 %, with one patient showing absence of sperms in follow up. After TURED on follow up pregnancy was reported in one case i.e. 25 %. In our study mean follow up was 10 months. Conclusions: Men with symptomatic EDO who underwentTURED showed improvements in their ejaculation, sensation of orgasm, semenanalysis values and fertility.

Keywords: Ejaculatory Duct Obstruction; Infertility; Ejaculatory Duct/Prostatic Cyst; Transurethralresection of Ejaculatory Duct; Tured.

 Inflammation interferes with iron utilization in chronic kidney disease through hepcidin. In our study, iron levels, ferritin, CRP and hepcidin levels were analyzed in newly diagnosed end-stage renal disease (ESRD) patients. A total of 50 ESRD patients and 5 healthy controls were studied. 40 recently detected ESRD patients on hemodialysis and 10 patients with Stage 4 CKD not received HD or parenteral iron, 22 out of 40 ESRD patients had already received prior parenteral iron or blood products. The ESRD patients had a significantly lower estimated albumin; and higher transferrin saturation (TSAT) and raised serum ferritin and Hepcidin levels. Hepcidin levels correlated significantly with Ferritin levels. Whereas ferritin levels correlated significantly with CRP levels. There have been elevated serum hepcidin levels in ESRD patients more in those receiving Iron therapy. High hepcidin levels could explain the functional iron deficiency. Larger randomized multicenter studies could throw more light on the diagnostic and therapeutic potentials of using Hepcidin-25 levels in regular practice.

Keywords: Chronic Kidney Disease; Hepcidin; CRP; Hemodialysis.

 Introduction: Bladder outlet obstruction is one of the commonest causes of LUTS. Most common cause of BOO in men is BPH. Other common causes are bladder stones and bladder cancer. There is also increased incidence of BOO in younger age group too. In younger age group urethral stricture is commonly seen. Aims and objectives: To study various etiology and clinical presentations and management of bladder outlet obstruction according to standard surgical guidelines using either minimally invasive or conventional means. Materials and Methods: A total of 100 cases were admitted in Deccan College of Medical Sciences and Owaisi Hospital and Research Centre, Hyderabad, India from 1st September 2011 to 31th August 2013 with objective evidence of bladder outlet obstruction and study was conducted accordingly. Discussion: This study is a prospective observational study. The most common cause of BOO was evaluated and was treated according to standard line of treatment and follow up done accordingly. Conclusion: Bladder outlet obstruction is a clinical entity of diverse etiology and is a potentially curable illness if diagnosis is made early and treated according to the standard guideline of management. In patients not fit for surgery obstruction can be relieved by catheterization and treatment can be planned once patient is fit for definitive procedure. A further population based study is needed to identify the exact prevalence of BOO in different age groups and effectiveness of available modality and long term complications.

Keywords: Bladder outlet Obstruction; LUTS; BPH; Urethral Stricture.

 Mycophenolate mofetil (MMF) has become the single most used immunosuppressant in solidorgan transplantation. Hence this study was done to assess Mycophenolate Mofetil dosing and MPA levels with incidence of acute rejection and opportunistic infections in early post renal transplant period .Forty four consecutive early post transplant patients were randomized 1: 1 to receive concentration controlled (CC) {n=22} or fixed dose (FD){n=22}of mycophenolate mofetil. In CC group 13 patients (60%) were below therapeutic range. 9(40%) were in the therapeutic range and no patients were above the therapeutic range. In FD group 7(30%) patients were below the therapeutic range and 14 (64%) patients were in the therapeutic range. Acute rejection in first 6 months post transplant in CC group was 18% and in FD group was 14% (p = 0.5). All rejections were seen within first 3 months post transplant. The overall cumulative incidence of infection in CC group was 24% compared to 7.5% in FD group which reached statistical significance (p<0.01) in particular at 3 months post transplant. This study has demonstrates that MMF dose individualization with therapeutic drug monitoring is not an effective method in renal transplant patients to prevent the complications in the post-transplant period such as rejection and infection. 

Keywords: MPA Levels; Post Transplant; Infection; Rejection.