Proximally migrated Double J stent in hydronephrotic kidneys: Etiological factors and management

Double J stents have become an essential tool in urologist’s armamentarium but are never without potential complications. Migration of DJ stent is a recognized complication, though its proximal migration into the upper ureter, pelvicalyceal system is reported rarely. This can add to the cost of patients and increases hospital stay if another general/ regional anesthesia session is required for its repositioning/removal. We successfully repositioned or removed proximally migrated DJ stents ureteroscopically under local anesthesia and analgesia in all of our case series patients on a daycare basis. We emphasize the importance of recordkeeping and follow up of stented patients particularly with those with hydronephrotic systems. In the event of proximal migration of the DJ stent, it can be successfully repositioned or removed under local anesthesia and analgesia. Keywords: Double J stent, proximal migration, ESWL-Extracorporeal shockwave lithotrips

Right supernumerary kidney: A rare entity

The supernumerary kidney especially on right side is a rare diagnosis. Only few case reports are documented in literature. We report a case of Right supernumerary kidney with partial fusion of right accessory kidney to upper kidney

Penile Degloving injuries, a quagmire riddled out: A case series

Penile Degloving injuries are rare among all genitourinary injuries. These injuries occur as a result of road traffic accidents, animal injuries (bites), industrial injuries, etc. Penile skin avulsion occurs due to traction injury or trapping of the skin resulting in tear of skin from underlying tunica albuginea. Due to excellent blood supply early primary repair if done early and possible results in the best outcome. Patients with skin loss can be managed by flaps mobilization from remaining skin. In occasional cases when primary closure is not possible, split skin grafting is required. The timely repair results in minimal short-term complications and excellent long-term cosmetic results without scarring and normal erectile function. Whenever possible these injuries should be primarily closed, employing grafts and flaps when required even in delayed presentation and animal bites. We describe degloving injuries in case series of two patients with unalike aetiologies. These were managed by primary closure with degloved skin after mobilization and debridement of nonviable skin after adequate washing with normal saline. Despite minor wound complication like wound infection, flap necrosis, penile oedema, ultimately wound recovered within few days. On follow up patients were able to void normally in addition cosmetic and aesthetic outcomes were excellent. Furthermore, patients were able to achieve good erections with no curvature.  We concluded that penile skin if reposed early with good wound management results in excellent outcomes with minimal long-term scarring, voiding and erectile dysfunction

Chronic Radiation cystitis: a review of medical and surgical management

Radiation cystitis is a complication of radiation treatment given for pelvic malignancies. Radiation cystitis can present as mild symptoms of dysuria, frequency, and hematuria to severe life-threatening complications like intractable hematuria, bladder perforation and contracted non-functional urinary bladder, fistula etc. Treatment is tailored according to the severity of symptoms and available treatment modalities sequentially. Initial treatment of hematuria is intravenous fluids, blood transfusions, cystoscopy and fulguration, irrigation with intravesical agents like alum, hyperbaric oxygen therapy, angioembolisation, urinary diversion and surgery (cystectomy). Radiation cystitis is associated with short- and long-term complications in pelvic malignancies patients. Early diagnosis, follow up, treatment is crucial for decreasing morbidity and mortality in these patients. In this review article we describe the current protocol in diagnosing and managing radiation cystitis. Keywords Pelvis, Radiation, Hematuria, intravesical treatments, Alum, formali

Genitourinary tuberculosis: clinical profile, diagnostic approach and treatment outcome in a tertiary care center of North India

Introduction:Genitourinary tuberculosis (GUTB) is the second commonest form of extrapulmonary tuberculosis with more than 90% of cases occurring in developing countries and kidney being the most common site of involvement. We present clinico-epidemiological profile of patients and management of genitourinary tuberculosis in IGMC Shimla.Material and methods: We conducted cross sectional record-based study of patients diagnosed and treated for genitourinary tuberculosis in the Department of Urology, IGMC Shimla from January 2017 to November 2020.Results: Eighty-six patients were treated for GUTB and mean age of patients was 42.2 years (18-78 years). In clinical presentation, irritative voiding symptoms i.e., frequency and dysuria (80.23% and 46.51% respectively) were the most common, followed by flank pain and weight loss (40.69% each), further followed by low grade fever (34.88%) and hematuria (33.72%). All patients were started on ATT from DOTS center and then were transferred to local DOTS units of their respective districts. Three patients required modification of ATT due to significant side effects. One patient died as a result of complications related to ATT and comorbid illness.Ultrasound guided percutaneous nephrostomy (PCN), Double J stenting and pigtail drainage for psoas abscess was done in 24 (27.91%) patients, 22 (25.58%) patients and in 8 (9.3%) patients respectively. Reconstructive surgery was done in 25 patients i.e., ureteroureterostomy in 3 (3.48%) patients, ureteric reimplant in 14 patients (16.27%) patients ,augmentation ileocystoplasty in 4 (4.65%) patients, Boari flap in 4 (4.65%) patients. Nephrectomy was done in 3 (3.48%) patients and cystectomy with ileal conduit was done in 3 (3.48%) patients. Conclusion: GUTB is a prevalent disease in our country although data regarding GUTB is quite limited. GUTB complaints are mostly trivial and nonspecific but consequences are grave. Proper early diagnosis and timely management can prevent morbidity and potential mortality in these patients. Timely intervention and reconstructive surgery is required in a significant number of patients to preserve kidney, ureter, and urinary bladder function

Current ESWL Practice and Outcome using a Direx Electromagnetic Lithotripter-Experience from Tertiary care centre of North India

Introduction: Forty years after its introduction, extracorporeal shockwave lithotripsy (ESWL) is still first-line treatment for selected renal and upper ureteric stones. We conducted a longitudinal descriptive study to assess the results of shock wave lithotripsy by Direx electromagnetic ESWL machine. Objective: The objective of this study isto describe overall outcome of ESWLin the treatment of renal stones and upper ureteric stonesin terms of stone clearance, complications, and stone free rates in relation to stone size. Material and methods:Case records of three hundred forty-eight patients who were treated for renal and ureteric stones in urology department of IGMC, Shimla from 2018-2020 were retrieved. Forty-six patients were excluded because they could not turn up for scheduled sessions.Mean age of patients was 40.7 years ranging from 13 years to 80 years. There were 226 (64.94%) males and 122 (35.06%) females in our study. Eighty-one patients (23.28%) presented with hydronephrosis and flank pain in emergency. Double DJ stent was inserted in 109 patients (31.32%) prior to ESWL owing to hydronephrosis or flank pain. Mean stone size was 12.75 mm ranging from 5 mm to 24 mm. Mean HU was 918 ranging from 620 to 1250. Two hundred thirty-eight patients(78.80%) had complete stone clearance on or before three sessions of ESWL. Sixty-four patients had residual stones after 3rd session of ESWL out of which forty-four (12.64%) opted for additionali.e. 4th session of ESWL. Stone free status was not achieved in 13 patients in spite of four sessions of ESWL.Thus, total of 33 patients were labelled as failure and they were planned for PCNL/RIRS. Stone free rate according to stone size was 95.2%, 71.96% and 55.55% in ≤1cm, 1.1-2 cm and >2cm stone size subgroup respectively.Twelve patients (3.45%) required DJ stenting, after ESWL, and ancillary procedure i.e. URSL and ESWL for down migrated obstructing stone fragment in ureter was required in 7 and 2 patients respectively. Moderate to severe pain was experienced during ESWL in 4.89% patients requiring medical management and reduction in intensity and frequency of shockwaves. Complications i.e.,Hematuria, Urinary tract infections associated with fever was seen in 14.86% and 8% patients respectively. Conclusion:ESWL results can be optimised by proper selection of patients and following newer technical aspects of procedure. Improvements in technique along with strict patient and stone selection criteria will help ESWL to remain a mainstay in the treatment of Renal and upper ureteric stone disease