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Dorairajan LN, Hemal AK, Aron M, Rajeev TP, Nair M, Seth A, Dogra PN, Gupta NP. Cutaneous metastases in renal cell carcinoma. Urol Int 2000; 63:164-7. [PMID: 10738187 DOI: 10.1159/000030440] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cutaneous metastasis from renal cell carcinoma is believed to be rare. We present our experience with 10 (3.3%) cases seen in the last 12 years among 306 cases of renal adenocarcinoma treated at our center. There were 9 males and 1 female. Age ranged from 30 to 65 years (average 45 years). 5 patients had skin metastases at the time of presentation (stage IV). In one of them the skin nodule, rather than urologic symptoms, was the presenting complaint. 5 patients presented with skin metastasis during follow-up after nephrectomy. The average time to skin metastasis was 51 months for patients in stage I and 13 months in stage IIIb. The scalp was the most common site of metastasis followed by chest and abdomen. 90% of patients had secondaries in at least one other site, most commonly in lungs (4 cases) and bones (5 cases). 4 patients were treated with interferon-alpha 6 MIU, subcutaneously, three times a week for varying periods from 3 to 4 months but there was no response. In conclusion, cutaneous secondaries from RCC, though uncommon, are not very rare. A few patients may present with a skin mass before detection of the renal tumor. Patients with low-stage disease at presentation may also develop cutaneous secondaries, therefore a prolonged follow-up is required. The commonest site for cutaneous metastasis from RCC is the scalp and face. Most patients had at least one other site of systemic metastasis, hence they were not candidates for curative therapy. Interferon therapy was not helpful. Mean survival after detection of cutaneous metastasis was 7 months.
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Aron M, Rajeev TP, Gupta NP. Antibiotic prophylaxis for transrectal needle biopsy of the prostate: a randomized controlled study. BJU Int 2000; 85:682-5. [PMID: 10759665 DOI: 10.1046/j.1464-410x.2000.00576.x] [Citation(s) in RCA: 239] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine the effect of antibiotic prophylaxis on infective complications after transrectal needle biopsy of the prostate. PATIENTS AND METHODS Between June 1996 and September 1998, 231 patients who satisfied the inclusion and exclusion criteria entered the study; the patients were randomized into three groups. Each patient underwent transrectal needle biopsy of the prostate after a cleansing enema at 06:00 hours. Patients in group 1 (75) then received a placebo tablet twice a day for 3 days; those in group 2 (79) were given a single dose of ciprofloxacin (500 mg) and tinidazole (600 mg), while those in group 3 (77) were given the same combination twice a day for 3 days. Urine cultures were obtained 48 h after the biopsy and blood cultures only from patients who developed fever. The complications (categorized as infective or noninfective) occurring in the three groups were compared using the chi-square test. RESULTS Noninfective complications included were lower urinary tract symptoms, rectal bleeding, haematuria and perineal pain. The infective complications included urinary tract infection and fever. There was no significant difference among the three groups in noninfective complications (27, 29 and 31 in groups 1-3, respectively) but the incidence of infective complications (19, six and eight, respectively) was significantly higher in group 1 (P = 0.003). However, the difference was significant only for urinary tract infection (P = 0.01) and not for fever. CONCLUSIONS In selected patients a single dose of ciprofloxacin-tinidazole is adequate prophylaxis for transrectal needle biopsy of the prostate. The present urinary infection rate was higher if no antibiotics were used. Continuing the antibiotic prophylaxis for 3 days offered no benefit over single-dose prophylaxis.
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Gupta NP, Ansari MS, Aron M, Mandal S. Y duplication of urethra with complete atresia of the orthotopic channel: 1-stage reconstruction. J Urol 2000; 163:949-50. [PMID: 10688028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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104
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Hemal AK, Dorairajan LN, Gupta NP. Posttraumatic complete and partial loss of urethra with pelvic fracture in girls: an appraisal of management. J Urol 2000; 163:282-7. [PMID: 10604377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
PURPOSE Urethral injury in girls accompanying fracture of the pelvis is rare. We present our experience with 5 such complex cases and review the literature to define the types of problem and determine appropriate management. MATERIALS AND METHODS We report on 5 girls with posttraumatic urethral injuries and pelvic fracture resulting in stricture as well as management based on the site and length of urethral stricture. Associated injuries and results are discussed. RESULTS Of the 5 girls who presented with stricture 4 had undergone suprapubic cystostomy as initial treatment, whereas in 1 primary repair had failed. Urethral reconstruction using a bladder flap tube and distal urethrotomy into the vagina were performed in 3 and 1 cases, respectively. These 4 girls were continent although 1 required clean intermittent catheterization for a short period. The 3 patients with complete urethral loss had a more severe degree of pelvic fracture, including 1 treated with core through internal urethrotomy. CONCLUSIONS Posttraumatic urethral injury accompanying pelvic fracture in young girls results in challenging management situations. More severely displaced pelvic fracture is associated with greater urethral loss and requires more complex repair. Cases of partial urethral injury or urethral transection without much displacement are better managed by primary repair of the transected urethra, which decreases morbidity. Primary repair may not be feasible in patients with extensive injury, who should be treated with secondary appropriate reconstruction after preliminary suprapubic cystostomy. Complete urethral loss may be managed by bladder flap tube neourethra creations with effective continence and excellent outcomes. Short segment distal urethral strictures may be treated with meatotomy or core through internal urethrotomy.
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Gupta NP, Singh DV, Hemal AK, Mandal S. Infundibulopelvic anatomy and clearance of inferior caliceal calculi with shock wave lithotripsy. J Urol 2000; 163:24-7. [PMID: 10604306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
PURPOSE We evaluate the significance of inferior caliceal radiographic anatomy and determine its influence on successful fragmentation and clearance of inferior caliceal calculi with extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS Between November 1996 and February 1998, 88 patients and 90 renal units with single or multiple inferior caliceal calculi of all sizes and composition were treated with ESWL. The size, number and area of calculi, length and width of the stone bearing inferior calix and infundibulopelvic angle were determined on pretreatment excretory urography. The infundibulopelvic angle was measured by 2 methods using the angle between the inferior caliceal infundibular and ureteral axes (angle 1), and between the infundibular and ureteropelvic axes (angle 2). Cases with residual fragments not clearing within 6 months of satisfactory fragmentation after lithotripsy were considered failures. RESULTS Overall stone clearance at 6 months was achieved in about 72% of the renal units. Infundibular length was 30 mm. or less in 77% of successful cases and in 64% of failures. Similarly, the smallest infundibular width of 5 mm. or more was found in 75% of successful cases compared to 41% of failures. Angle 1 of 35 degrees or more was observed in 73% of cases with compared to 18% without clearance. Angle 2 of 45 degrees or more was seen in 71% of successful cases compared to 9% of failures. The chances of a patient becoming stone-free with all favorable criteria of infundibular length 30 mm. or less, infundibular width 5 mm. or greater and infundibular ureteropelvic angle 45 degrees or greater was 100% (23 patients). CONCLUSIONS Radiographic features of a stone bearing inferior calix and its relation to the renal pelvis can be easily measured on standard excretory urography. An infundibular width of 5 mm. or more and infundibulopelvic angle 1 of 35 degrees or more or angle 2 of 45 degrees or more were statistically significant factors of radiographic anatomy in stone clearance following ESWL. Inferior caliceal length was not statistically significant, although length of 30 mm. or less appeared to be more favorable for stone clearance. The ideal treatment of inferior caliceal calculi in patients with all 3 favorable criteria is ESWL.
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Monish A, Rajeev TP, Dorairajan LN, Gupta NP. Infected congenital urethral diverticulum in an adult male. Urol Int 1999; 62:177-9. [PMID: 10529671 DOI: 10.1159/000030386] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Congenital anterior urethral diverticulum is a rare anomaly. The majority present in infancy with urinary obstruction. Those who present beyond infancy do so on account of recurrent urinary tract infection or dribbling. We present a case of congenital anterior urethral diverticulum manifesting in adulthood with suppuration in the diverticulum.
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Kumar M, Aron M, Agarwal AK, Gupta NP. Stenturia: An unusual manifestation of spontaneous ureteral stent fragmentation. Urol Int 1999; 62:114-6. [PMID: 10461115 DOI: 10.1159/000030370] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Two patients presented with passage of worm-like stent fragments in the urine. The first had undergone attempted percutaneous removal of left renal calculus and ureteral stenting 4 months prior to presentation. The second had left-sided stent placement for obstructive anuria on account of bilateral renal calculi 3 months earlier. The stents had fragmented into multiple pieces over a mean indwelling time of only 3.5 months. Apart from calculus disease, both patients had documented urinary tract infection. Stent fragmentation is a relatively rare (0.3%) but major complication. However, spontaneous excretion of these fragments has not been hitherto reported. These cases of rapid stent disintegration highlight the need for closer monitoring of the indwelling stents, especially in patients with calculus disease and associated persistent infection. In such patients the stent should probably be changed within 3 months.
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Hemal AK, Gupta NP, Rajeev TP, Aron M, Bhowmik D, Jain R. Retroperitoneoscopic management of infected cysts in adult polycystic kidney disease. Urol Int 1999; 62:40-3. [PMID: 10436431 DOI: 10.1159/000030354] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Conservative measures are the mainstay of therapy in adult polycystic kidney disease (APKD). Pain, infection and obstructive uropathy are the major indications for intervention. Chronic pain has been treated with narcotic analgesics, needle aspiration of dominant cysts, and open renal cyst decortication. Laparoscopic cyst decortication, by either transperitoneal or retroperitoneal access, is a new emerging option with similar efficacy to open surgery and less morbidity. Cyst infection in these patients responds poorly to commonly used antibiotics. Patients with refractory cyst infection may even require nephrectomy. Herein, we present 2 cases with APKD that were treated by retroperitoneoscopic decortication for painful and infected cysts. Both patients showed prompt and sustained improvement in symptoms, with minimal morbidity and short convalescence. This approach has not hitherto been described for infected cysts in APKD. The retroperitoneoscopic route should be preferred in the presence of infected cysts so as to prevent intraperitoneal contamination.
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Hemal AK, Talwar M, Wadhwa SN, Gupta NP. Retroperitoneoscopic nephrectomy for benign diseases of the kidney: prospective nonrandomized comparison with open surgical nephrectomy. J Endourol 1999; 13:425-31. [PMID: 10479008 DOI: 10.1089/end.1999.13.425] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To describe, define, and evaluate the efficacy of retroperitoneoscopic nephrectomy (RPN) for benign diseases of the kidney and to compare it with open surgical nephrectomy (OSN) via a flank approach. PATIENTS AND METHODS From August 1995 to November 1997, 29 men and 14 women (mean age 33 years) with severely damaged kidneys underwent RPN. Among these, 11 patients had undergone prior surgery, 3 had chronic renal failure, and 8 patients had a percutaneous nephrostomy. The RPN was performed via three or four ports, with the kidneys being removed intact from the retroperitoneal working space. During the same period, 43 patients underwent OSN through a flank approach (extrapleural and extraperitoneal) for nonfunctioning or poorly functioning kidneys. RESULTS In the RPN group, two patients required conversion to OSN. The operative time and estimated blood loss ranged from 40 to 210 minutes (mean 114 minutes) and 50 to 450 mL (mean 127 mL), respectively. In the OSN group, the corresponding values were 60 to 100 minutes (mean 104 minutes) and 70 to 600 mL (mean 266 mL), respectively. The mean length of hospitalization after RPN was considerably shorter--2 to 7 days (mean 3.4 days)--than after conventional open surgery--4 to 16 days (mean 8.6 days). The incidences of minor and major complications were 21% and 5%, respectively, in the RPN group and 33% and 2% in the OSN group. The postoperative analgesic requirement was significantly less (P < 0.001) in RPN group. The interval to return to normal activity ranged from 7 to 30 days (mean 20.3 days) and 20 to 60 days (mean 32.9 days) in the RPN and OSN group, respectively, with superior performance status, cosmesis, and quality of life observed in the former group. CONCLUSION Retroperitoneoscopic nephrectomy is as effective as open nephrectomy for benign kidney diseases with less postoperative pain, a shorter hospital stay, earlier recuperation, and excellent cosmesis. This procedure can also be performed in patients who have undergone abdominal operations previously, in those with chronic renal failure, and in those with a percutaneous nephrostomy. The operation has become our first line of approach for benign diseases of the kidney.
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Hemal AK, Wadhwa SN, Kumar M, Gupta NP. Transperitoneal and retroperitoneal laparoscopic nephrectomy for giant hydronephrosis. J Urol 1999; 162:35-9. [PMID: 10379734 DOI: 10.1097/00005392-199907000-00009] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We evaluate laparoscopic nephrectomy for giant hydronephrosis with an emphasis on the operative technique of retroperitoneoscopic surgery. MATERIALS AND METHODS During the last 2 years 13 men and 5 women underwent laparoscopic nephrectomy for giant hydronephrosis via a transperitoneal (6) or retroperitoneal (12) approach. The etiology was congenital ureteropelvic junction obstruction in 17 patients and hydronephrosis caused by stone disease in 1. Three patients had a contralateral obstructed kidney. Renal parameters were normal in all patients. RESULTS All procedures were successfully completed without the need for conversion to open surgery. Mean operating time was 113.8 minutes (range 70 to 165) and average blood loss was 260 ml. (range 40 to 600). No patient required a blood transfusion. Postoperative recovery was uneventful with an average postoperative hospital stay of only 3.2 days (range 2 to 5). CONCLUSIONS Laparoscopic nephrectomy is a good alternative to open surgery for giant hydronephrosis and significantly reduced the morbidity of surgery. A retroperitoneal approach is feasible, despite the large amount of retroperitoneal space occupied by these hugely dilated kidneys. Modifications of our technique have been invaluable to the successful outcome in this series.
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Hemal AK, Aron M, Gupta NP, Seth A, Wadhwa SN. The role of retroperitoneoscopy in the management of renal and adrenal pathology. BJU Int 1999; 83:929-36. [PMID: 10368231 DOI: 10.1046/j.1464-410x.1999.00086.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To describe the technique, findings and results of retroperitoneoscopic ablation of recalcitrant renal, giant adrenal and complex peripelvic cysts, and nephrectomy for nonfunctioning congenital anomalous kidneys. PATIENTS AND METHODS Nine patients (six men and three women, mean age 56 years, range 44-68, five with renal, two with adrenal and two with peripelvic cysts, diameter 6-14 cm) were treated by retroperitoneoscopic cyst ablation using three 10-mm ports. Six further patients (two male and four female, mean age 24 years, range 13-38) underwent retroperitoneoscopic nephrectomy using three or four ports for anomalous nonfunctioning kidneys; three patients had a pelvic kidney, two a horseshoe kidney and one an iliac kidney. Isthmusectomy was also performed in the patients with horseshoe kidneys. RESULTS Retroperitoneoscopic cyst ablation was successful in all nine patients; the mean (range) operative duration was 69 (50-85) min in patients with simple renal and adrenal cysts, and 185 (160-210) min in patients with peripelvic cysts. The mean (range) blood loss was 130 (50-200) mL and hospital stay 2.33 (2-4) days. At the last follow-up, 15-39 months after the procedure, all patients were asymptomatic and satisfied with the outcome, with no recurrence of cysts. Retroperitoneoscopic nephrectomy with isthmusectomy (when applicable) was successful in the six patients with anomalous kidneys, with a mean (range) operative duration of 105 (85-120) min; the mean (range) blood loss was 116 (75-150) mL and the analgesic requirement 208 (150-250) mg of diclofenac sodium. The hospital stay was 2-3 days and the delay before return to preoperative activity 7-14 days. CONCLUSIONS Retroperitoneoscopic cyst ablation is a safe and effective method to treat symptomatic cysts of the upper urinary tract which are refractory to other forms of management. Dissection is difficult in patients with peripelvic cysts. Retroperitoneoscopic nephrectomy for anomalous kidneys is a challenging procedure because of the abnormal location, anomalous vessels and presence of an isthmus. With advances in laparoscopy and increasing experience, open surgery for such conditions is likely to become obsolete.
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Hemal AK, Gupta NP, Wadhwa SN. Modified minimal cost retroperitoneoscopic nephrectomy, nephrectomy with isthumusectomy and nephroureterectomy in children: a pilot study. BJU Int 1999; 83:823-7. [PMID: 10368206 DOI: 10.1046/j.1464-410x.1999.00020.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the feasibility of retroperitoneoscopic nephrectomy, nephrectomy with isthmusectomy and nephroureterectomy in children with nonfunctioning kidneys and renal anomalies, at minimal cost using a modified technique. PATIENTS AND METHODS Eleven children (aged 4-16 years) underwent retroperitoneoscopic nephrectomy, nephroureterectomy, or nephrectomy with isthmusectomy for nonfunctioning kidneys. Three patients had previously undergone percutaneous nephrostomy to evaluate whether the kidney could be salvaged, but this did not alter the success of technique, although adhesions and fibrosis required careful and precise dissection. RESULTS All procedures were completed successfully with minor complications (peritoneal transgression via the port in two patients, with no consequences). The mean operative duration, blood loss and hospital stay were 109 min, 82 mL and 2.25 days, respectively. CONCLUSION Retroperitoneoscopic procedures can be conducted safely, successfully and at minimal cost without compromising any principles of technique. It is not essential to prepare the bowel or use ureteric catheterization and renal artery embolization. Expensive balloon dissectors, trocar-sealing balloons, endostaplers and endobags, lap sacs or morcellators are not required. The direct approach to the kidney via retroperitoneoscopy is also quicker.
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Gupta NP, Agrawal AK, Sood S, Hemal AK, Nair M. Malignant mesothelioma of the tunica vaginalis testis: a report of two cases and review of literature. J Surg Oncol 1999; 70:251-4. [PMID: 10219022 DOI: 10.1002/(sici)1096-9098(199904)70:4<251::aid-jso10>3.0.co;2-i] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Two cases of rare malignant mesothelioma of tunica vaginalis testis are presented. Both cases were advanced on clinical and radiological studies. One patient was treated with surgical excision followed by chemotherapy and radiotherapy and the other patient was treated with surgery and chemotherapy. Despite aggressive therapy both the patients died within 18 months of treatment. Review of the literature with suggested treatment protocol is presented. The response of malignant mesothelioma to chemotherapy and radiotherapy is poor as indicated by both of our cases. Initial aggressive surgery and adjuvant procedures are necessary soon after diagnosis to achieve long-term survival.
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Gupta NP, Dorairajan LN, Chahal R. Total genitourinary reconstruction in adult female epispadias: a report of 2 cases and literature review. Int Urogynecol J 1998; 9:55-7. [PMID: 9657180 DOI: 10.1007/bf01900545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Female incontinent episadias is a very rare congenital anomaly presenting in childhood. We report 2 cases of adults presenting with this anomaly. These were treated by total genitourinary reconstruction in a single stage using a combined perineal abdominal approach, with satisfactory results. We recommend this technique as the procedure of choice in adults presenting with this rare anomaly.
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Gupta NP, Aron M, Sood S. Pedunculated mesenteric leiomyoma masquerading as a retrovesical mass lesion: a diagnostic dilemma. BRITISH JOURNAL OF UROLOGY 1998; 82:134-5. [PMID: 9698678 DOI: 10.1046/j.1464-410x.1998.00705.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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116
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Wadhwa SN, Chahal R, Hemal AK, Gupta NP, Dogra PN, Seth A. Management of obliterative posttraumatic posterior urethral strictures after failed initial urethroplasty. J Urol 1998; 159:1898-902. [PMID: 9598483 DOI: 10.1016/s0022-5347(01)63189-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE We evaluate the problems encountered during surgery and assess the results of different endoscopic and open surgical methods following failed urethroplasty for posttraumatic posterior urethral stricture. MATERIALS AND METHODS Since 1992 we have treated 23 patients in whom urethroplasty for posterior urethral strictures failed. Of these patients, 3 had undergone 2 previous repairs and 6 had additional complicating factors, such as fistula, periurethral cavity and false passage. End-to-end anastomosis was done in 14 patients via a transperineal (7) or transpubic (7) approach. In 1 patient substitution urethroplasty using a radial artery based forearm free flap was performed. In 3 patients a 2-stage urethroplasty was done, 4 underwent core-through optical internal urethrotomy and 1 underwent endoscopic marsupialization of a false passage. RESULTS At 1 to 5-year followup 3 of the 23 patients had restenoses (13%), including 2 in whom previous treatment failed. The remaining 87% of the patients void well and are continent, and there is no worsening of the preexisting potency status. CONCLUSIONS Previous failed urethral stricture repair complicates management due to fibrosis, impaired vascularity and limited urethra available for mobilization. Recurrent strictures less than 1.5 cm. can be managed successfully with core-through internal urethrotomy. End-to-end anastomosis is possible in the majority with generous use of inferior pubectomy or the transpubic approach with certain modifications. When residual inflammation or long strictures are present a 2-stage procedure is a safer option. Overall, reoperation can offer a successful outcome for the majority of these complex strictures.
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Aron M, Manal K, Gupta NP. Urinary incontinence: an unusual manifestation of a forgotten stent. BRITISH JOURNAL OF UROLOGY 1998; 81:766-7. [PMID: 9634062 DOI: 10.1046/j.1464-410x.1998.00602.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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118
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Gupta NP, Agrawal AK, Sood S. Tubercular pyelonephritic nonfunctioning kidney--another relative contraindication for laparoscopic nephrectomy: a case report. J Laparoendosc Adv Surg Tech A 1997; 7:131-4. [PMID: 9459814 DOI: 10.1089/lap.1997.7.131] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We present a case of tubercular pyelonephritic nonfunctioning kidney in which laparoscopic nephrectomy was attempted. The kidney was very difficult to mobilize due to dense perinephric adhesions and subsequently the procedure was converted to an open nephrectomy. Tubercular pyelonephritic kidney is a relative contraindication to laparoscopic approach as its dissection is difficult and fraught with potential complications such as leakage of caseous material into the peritoneal cavity and systemic dissemination of the disease.
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Gupta NP, Dorairajan LN. Transurethral resection of a bladder tumor in pregnancy: a report of 2 cases. Int Urogynecol J 1997; 8:230-2. [PMID: 9449302 DOI: 10.1007/bf02765819] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Carcinoma of the urinary bladder presenting during pregnancy is rare. We report two such cases presenting with gross hematuria, both of which were managed by transurethral electroresection of the tumor; there was no adverse effect on the pregnancies. Transurethral resection thus appears to be the procedure of choice in the management of this condition, and carries minimal morbidity even when performed during pregnancy.
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Gupta NP, Singh BP, Raina V, Gupta SD. Primitive neuroectodermal kidney tumor: 2 case reports and review of the literature. J Urol 1995; 153:1890-2. [PMID: 7752342 DOI: 10.1016/s0022-5347(01)67342-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Peripheral neuroectodermal tumors are uncommon cancers arising from outside the central nervous system. The urinary system is rarely involved. The differentiation of these tumors from other small cell cancer and neuroblastoma is based on immunohistochemical differences. We report 2 cases of such tumors arising from the renal parenchyma. Tumor behavior and treatment modalities are discussed.
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Singh BP, Gupta NP, Choudhry VP. Priapism as a presentation of hematological malignancy. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 1995; 43:297. [PMID: 8713276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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122
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Raina V, Shukla NK, Gupta NP, Deo S, Rath GK. Germ cell tumours in uncorrected cryptorchid testis at Institute Rotary Cancer Hospital, New Delhi. Br J Cancer 1995; 71:380-2. [PMID: 7841056 PMCID: PMC2033575 DOI: 10.1038/bjc.1995.77] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Twenty-four out of 164 (14%) adult patients with primary germ cell tumours of testis seen over the last 6 years at the Institute Rotary Cancer Hospital (IRCH) of the All India Institute of Medical Sciences (AIIMS), New Delhi, were found to have cryptorchidism. Only one patient had undergone correction. As a result the testes were intra-abdominal in the vast majority, and patients presented late. Twenty-two patients presented with stage IIb or more advanced disease. Twelve patients had seminoma and the others had mixed or non-seminomatous germ cell tumour (NSGCT), i.e. 50% each. The earlier patients were managed by initial resection followed by radiation and/or chemotherapy. As experience grew the seven patients who presented late were given initial chemotherapy followed by resection in those with residual tumours. The probability of overall survival was 0.65 at 36 months and, was not significantly different from survival in 114 patients with tumours of normally descended testis. Early orchipexy facilitates the detection, but whether it reduces the incidence of tumours is controversial. Uncorrected cryptorchidism is now rarely seen in the West, but in India and many other developing countries tumours of uncorrected cryptorchid testes continue to be seen.
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Pal Sing B, Sharma MC, Gupta NP. Calculus in the vas deferens in a case of obstructive azoospermia. Urol Int 1995; 55:181-2. [PMID: 8540168 DOI: 10.1159/000282782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Calcific lesions of the vas deferens are uncommon. We report a case of obstructive azoospermia in which a well-formed calcific lesion was found in the vas deferens during performance of a vaso-epididymotomy.
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Wadhwa SN, Seth A, Sood R, Gupta NP, Dogra PN, Hemal AK. Management of urinary tract calculi by extracorporeal shock wave lithotripsy. Indian Pediatr 1994; 31:218-21. [PMID: 7875852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
From July 1989 to April 1993, Extracorporeal Shockwave Lithotripsy (ESWL) was performed on 642 patients, of which 21 were from the pediatric age group. All treatments were done on a second generation lithotriptor-Siemens Lithostar, which does not require any modification for positioning of children. Fragmentation was achieved in all the patients (100%). A complete stone free rate was achieved in 17/21 patients (80.9%). Three (14.3%) patients had insignificant residual fragments whereas 1 (4.8%) had a residual fragment approximately 4 mm in size. 5640 shocks were required on an average. We have used low energy shockwaves with good results. General anesthesia was required for lithotripsy in only one child. The average fluoro exposure time was 1.6 minutes. We conclude that ESWL is a safe and effective method for treating urinary tract calculi in children.
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Seth A, Gupta NP. Ureteral obstruction following acute pancreatitis. Indian J Gastroenterol 1994; 13:31-2. [PMID: 8119748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A patient with hydronephrosis caused by extrinsic right ureteral obstruction due to extension of pancreatic inflammation is reported. At surgery, pyonephrosis was detected and nephrectomy had to be carried out. We recommend a careful ultrasonographic follow-up of all patients with acute pancreatitis for back pressure changes in the kidneys.
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