Urology, Nephrology and Andrology International

 Appendicovesical fistulae are rare and occur secondary to acute or missed acute appendicitis. A 52 years old lady presented with isolated faecaluria, gross fecal contaminated wine or fresh contaminated urine. The presentation and management of appendicovesical fistula is discussed.

Keywords: Appendix; Urinary bladder; Fistula.

 The abnormalities of the renal collecting system represent a complex subset of urogenital anomalies. They could manifest in many ways and often are not diagnosed by preoperative imaging or the anomaly could be missed. Extrarenal calyces is one such rare anomaly of the collecting system. This anomaly may be associated with other anomalies of the urogenital system such as hydronephrosis, ectopic kidney or horseshoe kidney and could lead to complications such as stasis, infection and stones. We report a case of ectopic kidney with extra-renal calyces complicated with stones and infection.

Keywords: Extrarenal Calyces; Ectopic Kidney; Urolithiasis.

 Background: To estimate the feasibility and clinical outcomes of conversion of temporary to permanent hemodialysis catheters using the same venous insertion site. Methods: The data of patients who underwent conversion of central venous catheter (CVC) from temporary to permanent type from November 2104 to December 2016 at EMS memorial co-operative hospital & research center, Perinthalmanna, Kerala, was analyzed. The conversion of catheter was performed at the existing venous access site under local anesthesia in operation theater with the guidance of C-ARM. Technical success, procedural complications, hemodialysis records and clinical outcomes were evaluated. Results: The study group consisted of 26 patients (14 males and 12 females)with age of 56.61 ±10.13 years. All 26 temporary catheters were successfully converted to permanent or tunneled hemodialysis catheters with 3 patients having minor oozing and no major procedure-related complications. The duration on temporary catheters ranged from 3-296 (mean: 53.42) days prior to their conversion to permanent type, after failure of multiple attempts at arterio-venous (AV) fistula creation. Heparin (5000 U/ml) along with Cefazoin (10 mg/ml) in ratio of 1:1 were used as locking solution and Mupirocin ointment was applied at exit site for both temporary & permanent catheters(PC) after each dialysis to reduce the incidence of catheter related blood stream infections (CRBSI). The total number of follow-up days with permanent catheter (PC) was 6730 (range:33-768, mean: 258.85, SD: 199.47). There were 8 events of culture proven sepsis, yielding a catheter infection rate of 1.2/1000 catheter days, one among them required PC removal due to unresponsive septicemia (0.14/1000 catheter days).None of them had exit site infection, tunnel infection requiring catheter removal. The patency rate was 96.15% at 30 days after insertion, with 9 catheters functioning at the end of the study period. One patient needed repostioning of PC due to poor blood flow within one week after insertion. Thirteen patients died with working catheters of causes unrelated to catheter. The catheters removed in 4 patients when they were no longer needed (access changed to AV graft in 2, AV fistula in 1, and 1 patient had improvement in renal parameters). Two patients required replacement with new PC (PC related septicemia in one and due inadvertent removal in another). Conclusions: Thus conversion of a temporary HD catheter to a tunneled catheter using the same venous insertion site is safe, does not increase the risk of infection, and allows conservation of other central venous access sites. The conversion also avoids complications associated with venotomy and allows conservation of other central venous access sites. Use of Heparin (5000 U/ml) along with Cefazoin (10 mg/ml) in ratio of 1:1; as locking solution and Mupirocin ointment for application at exit site for both TC & PC is an effective strategy to reduce the incidence of catheter related infections.

Keywords: Hemodialysis; Temporary Catheter; Permanent or Cuffed Catheter.

 Background: Prostate cancer has become the single most common non-cutaneous malignancy in men. Its incidence has been rising rapidly in most countries including low risk countries like India. Present study deals with the PSA value in patients with prostatic symptoms and its correlation with the prostatic biopsy specimen. Purpose: (i) Co-relation of raised PSA in non- carcinoma prostate patients. (ii) At what stage does carcinoma of prostate gets diagnosed in Indian scenario. (iii) What are the treatment options opted by the patients who are diagnosed with carcinoma of prostate for the first time. Materials and Methods: First 500 patients that presented with lower urinary tract symptoms and prostatic enlargement through the casualty department, outpatient department and in patient department of the Department of Urology, Ruby Hall Clinic, Pune from March 2012 to February 2014 were included in the present study.Prostatic biopsy was done in cases with either increased serum PSA level and/or palpable nodule and/or suspicious TRUS findings or a combination of two out of these 3 factors. Results: Mean PSA value is 8.5ng/ml in BPH patients, indicating higher values in Indian patients, due to prostatitis.Maximum carcinoma prostate patients presented late with metastases. As the limit of PSA value for diagnosis of carcinoma prostate increases from 4ng/ ml to 15ng/ml the sensitivity decreases and the specificity and diagnostic accuracy increases.The patients of carcinoma prostate received treatment as per their stage of presentation. Conclusion: In Indian context there is an overall baseline elevation of lower minimum level of the normal PSA.This is probably due to association of prostatitis in Indian population.

Keywords: BPH; Carcinoma Prostate in India; Chronic Prostatitis; PSA

 Background: The degree to which the dialysate prescription and, in particular, the dialysate sodium concentration influences blood pressure and interdialytic weight gain (IDWG) via changes in sodium flux, plasma volume or the other parameters is not well understood. The aim of the study was to investigate whether dialysis patients will have some beneficial effects of dialysate sodium set up lower than serum sodium. Material and Methods: Fifty patients (38 men and 12 women) underwent 20 consecutive hemodialysis (HD) sessions (8 weeks) with dialysate sodium concentration set up on 139 mmol/L (standard sodium – first phase), followed by 20 sessions (second phase) wherein dialysate sodium was set up according to individualized sodium. Variables of interest were: systolic, diastolic blood pressure, IDWG, thirst score – ( Dialysis Thirst Inventory (DTI)) and complications (occurrence of hypotension and muscle cramps). Results: Sodium individualization resulted in significantly lower blood pressure (BP =-11.6/-3.5 mm Hg, P < 0.001 for systolic BP and BP = -2/-6.46 mm hg [P =0.194] for diastolic BP) and IDWG (+, 2.8 ± 0.75 kg; individualized Na+ 2.2 ± 0.61 kg; P < 0.001). Thirst score was not significantly lower in patients with individualized-sodium than compared to standard Na group. There were no significant changes in terms of complications such as hypotension. Conclusion: Individualized sodium resulted in clinical benefits in normotensive and hypertensive patients.

Keywords: Interdialytic weight gain (IDWG); Hemodialysis (HD); Dialysis Thirst Inventory (DTI)