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

Framing Of The Mumbai Terror Attacks By The Indian and The Pakistani Print Media

Political communication scholars argue that language and images are often used to highlight only certain aspects of a social or political reality. This is the reality that the political elites of a nation want their public to believe so that they can further their own political agenda. Due to the existing routines of newsgathering in the profession of journalism, journalists often find themselves echoing the same issues as the political elites, thus consciously or unconsciously aiding their political agenda. Consequently the public is only exposed to selected slices of reality and only that “reality” resonates with them. In this study I explore how the print media in India and Pakistan covered the Mumbai terror attacks of November 2008; to find out whether the print media in each country may have constructed an enemy narrative while reporting the terror attacks and whether the sources used to construct the narrative were the political elites of India and Pakistan. Since the news media play a central role in shaping public perception, if the enemy narrative did dominate the media coverage it might have accentuated the negative perception that each side has of the other. This could impact the renegotiation of peace talks between the two nuclear-armed neighbors and thus impede the peace process

Traumatic penile amputation: a case report

Abstract Background Traumatic amputation of the penis is a rare surgical emergency. Although repair techniques have been well described in literature, failure of replantation and its causes are poorly understood and reported. Herein, we report the case of a 9 year old boy who underwent replantation of his amputated penis with delayed failure of the surgery, along with a discussion of recent advances in the management of this condition. Case  Presentation A 9-year-old boy was referred to our hospital for traumatic amputation of the penis. Papaverine aided microsurgical replantation of the severed part was performed, but by 48 h, the glans became discoloured and necrosis set in by 4 days. Unfortunately, by day 12 two thirds of the re-implanted penis was lost along with overlying skin. Conclusion Replantation of an amputated penis in a pediatric patient is a daunting task even for experienced surgeons. The vasodilatory effect of papaverine for vascular anastomosis is well described, but the use of a paediatric cannula for identification and instillation of papaverine into penile vasculature, has not been described for the repair of penile amputation. Despite its apparent failure, we believe this technique may be valuable to surgeons who might encounter this rare event in their surgical practice, especially in resource limited settings like ours

Laparoscopic donor nephrectomy

Of the various options for patients with end stage renal disease, kidney transplantation is the treatment of choice for a suitable patient. The kidney for transplantation is retrieved from either a cadaver or a live donor. Living donor nephrectomy has been developed as a method to address the shortfall in cadaveric kidneys available for transplantation. Laparoscopic living donor nephrectomy (LLDN), by reducing postoperative pain, shortening convalescence, and improving the cosmetic outcome of the donor nephrectomy, has shown the potential to increase the number of living kidney donations further by removing some of the disincentives inherent to donation itself. The technique of LLDN has undergone evolution at different transplant centers and many modifications have been done to improve donor safety and recipient outcome. Virtually all donors eligible for an open surgical procedure may also undergo the laparoscopic operation. Various earlier contraindications to LDN, such as right donor kidney, multiple vessels, anomalous vasculature and obesity have been overcome with increasing experience. Laparoscopic live donor nephrectomy can be done transperitoneally or retroperitoneally on either side. The approach is most commonly transperitoneal, which allows adequate working space and easy dissection. A review of literature and our experience with regards to standard approach and the modifications is presented including a cost saving model for the developing countries. An assessment has been made, of the impact of LDN on the outcome of donor and the recipient

Review Article - Laparoscopic donor nephrectomy

Of the various options for patients with end stage renal disease, kidney transplantation is the treatment of choice for a suitable patient. The kidney for transplantation is retrieved from either a cadaver or a live donor. Living donor nephrectomy has been developed as a method to address the shortfall in cadaveric kidneys available for transplantation. Laparoscopic living donor nephrectomy (LLDN), by reducing postoperative pain, shortening convalescence, and improving the cosmetic outcome of the donor nephrectomy, has shown the potential to increase the number of living kidney donations further by removing some of the disincentives inherent to donation itself. The technique of LLDN has undergone evolution at different transplant centers and many modifications have been done to improve donor safety and recipient outcome. Virtually all donors eligible for an open surgical procedure may also undergo the laparoscopic operation. Various earlier contraindications to LDN, such as right donor kidney, multiple vessels, anomalous vasculature and obesity have been overcome with increasing experience. Laparoscopic live donor nephrectomy can be done transperitoneally or retroperitoneally on either side. The approach is most commonly transperitoneal, which allows adequate working space and easy dissection. A review of literature and our experience with regards to standard approach and the modifications is presented including a cost saving model for the developing countries. An assessment has been made, of the impact of LDN on the outcome of donor and the recipient

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

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

Radio-median cubital / radiocephalic arteriovenous fistula at elbow to prevent vascular steal syndrome associated with brachiocephalic fistula: Review of 320 cases

AIM: Radiocephalic arteriovenous fistula (AVF) at wrist is the vascular access of choice for dialysis. In the absence of a suitable vein at the wrist, a brachiocephalic fistula at elbow is usually constructed. In order to avoid the complication of vascular steal syndrome associated with the brachiocephalic fistula, an alternative operative technique involving the creation of radio-median cubital vein / radiocephalic fistula at elbow was evaluated. SETTINGS AND DESIGN: Retrospective study. MATERIALS AND METHODS: Between January 1990 and October 2005, 320 patients underwent creation of radio-median cubital vein / radiocephalic AVF at elbow as a primary procedure or following failure of a fistula at the wrist. A transverse skin incision was made 4cm below the elbow crease, centering in line with the brachial artery pulsation. The median cubital vein / cephalic vein was anastomosed to the radial artery in end to side fashion. The surgical complications and patency of the fistulae were analyzed in the immediate and late postoperative period. RESULTS: Mean operative time was 55 ± 7.15 min. There were no major intraoperative complications. Immediate patency and a palpable distal radial pulse were present in all the patients. Mean time to fistula maturation was 26 ± 5.2 days. No patient developed a vascular steal syndrome at a median follow-up of 54 months (range 12–168 months) Early fistula failure was seen in 16 (5%) patients whereas eight (2.5%) fistulas failed at a later date. Pseudoaneurysm of the arterialized vein at the fistula site developed in only one (0.3%) patient. Pseudoaneurysm proximal to the anastomosis developed in three (0.9%) patients. Sixteen (5%) patients requested for closure of the fistula following successful renal transplant due to unsightly dilated veins and continuous noisy murmur disturbing their sleep. CONCLUSIONS: The radio-median cubital vein / radiocephalic AV fistula at elbow is safe and is a better vascular access procedure for hemodialysis than brachiocephalic fistula because it leads to the dilatation of both the cephalic and the basilic veins with no incidence of vascular steal phenomenon in our experience. Patency and flow rates are similar to brachiocephalic fistula