Urology, Nephrology and Andrology International

Double pigtail (DJ) ureteral stents are used to prevent ureteral obstruction and allow easy passage of urine. Stent migration is a well recognized complication of stents, but migration into the renal pelvis is rarely documented. We present a case of simultaneous proximal and distal migration of a stent and discuss briefly, the etiological factors for the phenomenon and associated problems in management.

Keywords: Stent Migration; Percutaneous Nephrostomy; Stent Complication.

Small cell carcinoma of the urinary bladder (SCBC) is a type of rare malignant tumor of the urinary tract. As it does not have specific symptoms and its epidemiological features are similar to transitional cell carcinoma of the bladder, it is often misdiagnosed. SCBC is highly aggressive, metastasizes very early and has a poor prognosis, and consequently, it has become a focus for urological surgeons and oncologists. An A 60yearold smoker, man was admitted to our hospital with a 6month history of right pelvic pain, multiples episodes of gross, painless, hematuria, dysuria, and extreme fatigue. Abdominal computed tomography showed a neoplasm of 6x3 cm on the left posteriolateral wall of the bladder. The initial diagnosis was of transitional cell carcinoma of the bladder and surgery was performed to remove the tumor. However, the subsequent pathological examination suggested that the tumor was a small cell carcinoma. Small cell carcinoma is a highly malignant disease, with a high mortality rate, and it rarely occurs in the bladder. Upon review of a large number of studies, SCBC was not found to present with specific symptoms, making the early diagnosis of the disease difficult, however, and commonly occurring symptoms included dysuria, painless gross hematuria and urinary tract obstruction.

Keywords: Small Cell Carcinoma; Chemotherapy.

Tuberous sclerosis complex (TSC) is a multisystem syndrome characterized by neurological symptoms and tumors in multiple organs including kidney, brain, skin, eyes, heart and lung. Kidney and brain are the two most frequently affected organs in TSC. TSC is an autosomal disorder with extensive clinical variability. We describe a case of TSC in a family with father and daughter being affected. We emphasize the importance of Computed Tomography in the discovery of some asymptomatic organic involvement as bilateral renal angiolipoma in the father.

Keywords: Tuberous Sclerosis; Hamartoma; Angiofibroma. 

Objective: Detrusor Overactivity (DO) was evaluated in patients with lower urinary tract symptoms due to benign prostatic hyperplasia with storage symptoms. Materials and Methods: A total of 258 men with a mean age 60.4±8.4 years who were admitted in our center between August 2013 and September 2015 with Lower Urinary Tract Symptoms (LUTS) having BPH. These patients were divided into two groups. Group1 (n=216) who had predominant obstructive voiding symptoms. Group2 (n=42) had both storage and voiding symptoms. Invasive urodynamics, including filling and voiding cystometry, was done with pressure flow analysis according to the Schäfer nomogram in Group2 patients. The relative contribution of bladder dysfunction to male LUTS, with a particular emphasis to storage symptoms that characterize overactive bladder was noted. Results: Of the 258 patients, 42 (16.3%) had idiopathic or neurogenic detrusor overactivity significantly affect patient symptom score and quality of life. Moreover, bladder dysfunction was significantly affected with the degree of obstruction with both storage and voiding symptoms as measured by the maximum flow rate, postvoid residual urine, and prostate volume and Schäfer grade of obstruction. Conclusion: DO with severe degree of bladder outlet obstruction in patients with storage symptoms is pathophysiologically the same as idiopathic or neurogenic.

Keywords: Overactive Bladder; Lower Urinary Tract Symptoms; Benign Prostate Hyperplasia.

Aims and Objectives: To compare the two techniques of tunneled catheter (TC) insertion for hemodialysis; denovo and conversion of uncuffed catheter. Methods: The patients who underwent tunneled catheter insertion from August 2014 to December 2016 at EMS memorial cooperative hospital & research center, Perinthalmanna, Kerala, were included in the study. Technical success, complications, hemodialysis records and clinical outcomes were analyzed. Results: The study group consisted of 42 patients (26 males and 16 females) with age of 58.19±11.72 years. In 28 patients uncuffed catheters (UC) were placed initially &were converted later TC, with minor oozing in 3 (10.71%) subjects. The duration on UC ranged from 3296 days (Range: 3296, Mean: 52.82, SD: 66.36) prior to their conversion to TC. In 14 patients the TC were inserted denovo, with one (7.14%) of them developing pneumothorax and another (7.14%) having minor oozing.The total number of followup days with TC was 12,946 (Range: 3872, Mean: 308.24, SD: 245.30). Ten patients had blood culture proven sepsis, yielding a catheter infection rate of 0.77/1000 catheter days, one among them required TC removal due to unresponsive septicemia (0.08/1000 catheter days). The patency rate of TC was 97.62% at 30 days after insertion, with 20(47.62%) catheters functioning at the end of the study period. Sixteen(38.09%) patients died with working catheters of causes unrelated to catheter and one (2.38%) had CRBSI along with other comorbidities at time of death. The catheters removed in 5 (11.90%) patients when they were no longer needed. There was no statistically significant effect of technique of TC insertion (denovo insertion or conversion of uncuffed catheter) on its durability (p: 0.43), postprocedure complications (p:0.34), CRBSI (p:0.30) and (patient mortality (p:0.29). Conclusions: Thus both techniques of TC insertion are safe and effective. The conversion of a UC to a TC using the same venous insertion site is safe, does not increase the risk of infection, and allows conservation of other central venous access sites.

Keywords: Hemodialysis; Uncuffed Catheter; Tunneled Catheter.

Background: There is a higher risk of cardiovascular mortality in patients with chronic kidney disease (CKD) than in the general population. Structural and functional alterations in the heart are said to be the major causes of mortality in dialysis patients. Objectives: This study was designed to examine the structural and functional changes in the heart in patients undergoing hemodialysis. Methods: This was retrospective study done by chart review. Details of echocardiographic parameters of twenty patients at the initiation and after one year of hemodialysis treatment were collected and compared. Results: There were differences in the weight (64 ±12 Vs 57±12 kg, p= <0.001), left atrial size (35±1 Vs 35±1mg/dl, p=0.210), LVIDS (26±4 Vs 26±5mm, p=0.413), LVIDD (46±3 Vs 45±5mm, p+=0.082),IVS (12±3 Vs 13±3mm, p=<0.001),LVPW (11±1 Vs 12±1mm, p=0.016), left ventricular mass (202±64 Vs 205±59mg, p=0.001),left ventricular mass index (120±30 Vs 134±37gm/m2, p=0.023) and ejection fraction (61±24 Vs 58±59%, p=0.045). The frequency of diastolic dysfunction increased over a period of one year. There was also a significant reduction in the mean ejection fraction at the end of one year after dialysis. Conclusions: This study concludes that, in patients on hemodialysis, there are significant structural and functional changes in the heart, in the form of increase in left ventricular mass, increase in the prevalence of left ventricular hypertrophy and also reduction in systolic and diastolic functions.

Keywords: CKD; CVD; Left Ventricular Hypertrophy; India. 

Background: Benign Prostatic Hyperplasia (BPH) is the most common benign neoplasm of the aging male. The incidence of prostatomegaly increased with age. Enlargement of prostate is the disease of the advancing years and is never seen in early life, It is common disease of man and up to no 2 to 4 of 40 men in their sixties is operated for BPH. Objective: To clinically study the preoperative prostate weight and postoperative weight in transurethral resection of the prostate patients with reference to prostatic weight loss and compare it with western studies. Materials and Methods: This study is carried out in Owaisi Hospital & Deccan College of Medical Science, Hyderabad from August 2015 to September 2016. A total 63 cases of BPH, aged between 4385 years (men age 62.8y) with the lower urinary tract symptoms were evaluated by using American Urological Association (AUA) score, Q Max <15 ml/sec and digital rectal examination, who underwent transurethral resection of prostate were enrolled for the study. Results: Majority of patients were from severe followed by moderate AUA Symptom score. The Prostate specific antigen (PSA) was measured in all cases. The preoperative and post operative prostate size was measured and calculation done accordingly. Conclusion: Majority of the parameters taken in this study is comparative to the western study. Which indicate the behavioral/natural pattern of BPH and the management and their outcome in Indian scenario and the western scenario are almost the same.

Keywords: BPH; PSA; AUA; TURP. 

Background: Antibiotic resistance of urinary tract pathogens has increased worldwide. Knowledge of the antibiotic resistance patterns of uropathogens in specific geographical locations is an important factor for choosing an appropriate empirical antimicrobial treatment. The aim of this study is to provide information regarding local resistance patterns of urinary pathogens to the commonly used antibiotics in Nashik division of Maharashtra, India. Methodology: Urine samples collected and submitted to microbiology laboratories in Tambe hospital, Sangamner and SMBT IMSRC, Igatpuri, Nashik were identified by conventional methods over a period from August 2016 to March 2017. Antimicrobial resistance testing was performed by the standard technique in accordance with the recommendations of the Clinical and Laboratory Standards Institute. Results: Of the total 1575 midstream urine samples collected from suspected cases of urinary tract infection, 750 (47.61%) were positive for pathogenic bacteria. Escherichia coli (E. coli) was the most common isolate (68.8%) followed by Proteus spp. (13.7%), and Klebsiella spp. (7.46%). E. coli isolates were mostly susceptible to imipenem,meropenem(99.5%), followed by amikacin(92%), flouroquinolones(7989%) ,nitrofurantoin (82%); however, only 69% of E. coli isolates were susceptible to trimethoprimsulfamethoxazole and around 50% were susceptible to third generation cephalosporins. Conclusion: Nitrofurantoin and flouroquinolones may be considered as a firstline empiric antibacterial agent for urinary tract infections in outpatients in Nashik division of Maharashtra, India.

Keywords: Urinary Tract Infection; Antimicrobial Susceptibility; Uropathogens; India.