Guideline Based Algorithmic Approach for the Management of Renal and Ureteric Calculi

Urolithiasis is a global pathology with increasing prevalence rate. The surgical management of kidney and ureteral stones is based on the stone location, size, the patient’s preference and the institutional availability of various modalities. To date, the available modalities in the management of urolithiasis includes external shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PNL), ureterorenoscopy (URS) including flexible and semirigid ureteroscopy. Tremendous technological advancement in the urological armamentarium has happened since its inception leading to multiple acceptable modalities for the treatment of a particular stone. In accordance with the available recommendations from various institutions and the newer evidence we recommend that the initial choice of modality for the treatment of a renal calculus depends on the stone size and whether the location is lower pole or not. For lower pole stones upto 20 mm PNL and RIRS is efficient irrespective of location while ESWL should only be considered for lower pole stones upto 10 mm. For stones larger than 20 mm mini PNL is effective for stones upto 40 mm while RIRS holds acceptable efficiency for stones not larger than 30 mm. For stones larger than 40 mm standard PNL only should be considered if single stage treatment is attempted

Crossed fused renal ectopia: a report of twelve cases at a tertiary health centre and literature review

Crossed fused renal ectopia (CFRE), second most common renal fusion anomaly of the kidney. These patients were mostly asymptomatic and present with complaints due to associated conditions. The management of these conditions was complicated not only by the approach to be picked, but also by the investigation to be performed. The following study was done at a tertiary care centre, with the duration of this study being from January 2019 to April 2021. A total of twelve patients with CFRE required surgical intervention for their symptoms during this period. As a routine history, routine investigations and ultrasound (US) of the abdomen and pelvis was followed for all the patients. Other imaging modalities were opted on case to case basis. Out of n=12 patients of CFRE with fusion who underwent surgical intervention, majority were male patients (n=10). The most common symptom was abdominal pain (n=9). The most common crossed renal ectopia was the left to right fusion (n=7), as compared to right to left CRE (n=5). The most common fusion anomaly was L-shaped (n=8). The endourological procedures (n=6), laparoscopic procedures (n=2) while open procedures (n=4). It is important for a urologist to bear in mind the various presentations of this less known anomaly with diverse presentations. We have highlighted the investigations used at our center which would help plan further treatment and surgical approach in such patient in view of complex renal as well as vascular anatomy.  

Trifecta and pentafecta outcomes following robot-assisted partial nephrectomy in a multi-institutional cohort of Indian patients

INTRODUCTION: The literature on studies reporting trifecta or pentafecta outcomes following robot-assisted partial nephrectomy (RAPN) in Indian patients is limited. The primary aim of this study was to report and evaluate the factors predicting trifecta and pentafecta outcomes following RAPN in Indian patients using the multicentric Vattikuti collective quality initiative (VCQI) database. METHODS: From the VCQI database for patients who underwent RAPN, data for Indian patients were extracted and analyzed for factors predicting the achievement of trifecta and pentafecta following RAPN. Trifecta was defined as the absence of complications, negative surgical margins, and warm ischemia period shorter than 25 min or zero ischemia. Pentafecta covers all the trifecta criteria as well as \u3e90% preservation of estimated glomerular filtration rate (eGFR) and no stage upgrade of chronic kidney disease at 12 months. RESULTS: In this study, among 614 patients, the trifecta was achieved in 374 patients (60.9%) and pentafecta was achieved in 24.2% of the patients. Patients who achieved trifecta had significantly higher mean age (54.1 vs. 51.0 years, P = 0.005), body mass index (BMI) (26.7 vs. 26.03 kg/m 2, P = 0.022), and smaller tumor size (38.6 vs. 41.4 mm, P = 0.028). The preoperative eGFR (84.2 vs. 91.9 ml/min, P = 0.012) and renal nephrometry score (RNS) (6.96 vs. 7.87, P ≤ 0.0001) were significantly lower in the trifecta group. Comparing patients who achieved pentafecta to those who did not, we noted a statistically significant difference between the two groups for tumor size (36.1 vs. 41.5 mm, P = 0.017) and RNS (6.6 vs. 7.7, P = 0.0001). On multivariate analysis, BMI and RNS were associated with trifecta outcomes. Similarly, only RNS was identified as an independent predictor of pentafecta. CONCLUSIONS: RNS and BMI were independent predictors of the trifecta. At the same time, RNS was identified as an independent predictor of pentafecta following RAPN

Role of three dimensional (3D) printing in endourology: An update from EAU young academic urologists (YAU) urolithiasis and endourology working group

The management of nephrolithiasis has been complemented well by modern technological advancements like virtual reality, three-dimensional (3D) printing etc. In this review, we discuss the applications of 3D printing in treating stone disease using percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). PCNL surgeries, when preceded by a training phase using a 3D printed model, aid surgeons to choose the proper course of action, which results in better procedural outcomes. The 3D printed models have also been extensively used to train junior residents and novice surgeons to improve their proficiency in the procedure. Such novel measures include different approaches employed to 3D print a model, from 3D printing the entire pelvicalyceal system with the surrounding tissues to 3D printing simple surgical guides.publishedVersio

Parallel Aes diffusion inter block diffusion at bit level and compression

Information is an intelligent data through which knowledgeable and usable things can be convicted or interpreted in a proper manner. With the advancement of technology, transmission of information over the network has come a trend. This information must be transmitted securely over the network. Data security was not a problem if a secure channel was provided for single transmission. It is a necessity to convert the information into an unintelligible form for transmitting it over an unsecured channel. Encryption is a technique through which original information can be converted into unintelligible form. As time has elapsed, various encryption algorithms are employed so that information can be transmitted securely over an unsecured channel. Unless an intruder accesses the encrypted text, he / she cannot gain any information from that text. But as the new algorithms are designed, all the algorithms are challenged and their cryptanalysis is available. In the year 1998, Advanced Encryption Standards (A (S)) were proposed and later it was widely accepted as the most secure encryption algorithm that can be used to encrypt the information so that it can be transmitted securely and unsecured. fixed to a new scheme called Parallel AЕS, was an employee who takes four blocks of 16 bytes at a time to generate four blocks of 16 bytes of text thus providing diffusion of blocks at exchange. than all sequential AЕs. All the algorithms are challenged and their cryptanalysis is available. In the year 1998, To make A morS more fixed to a new scheme called Parallel AЕS, was an employee who took four blocks of 16 bytes at a time to generate four blocks of 16 bytes of text, thus providing diffusion of blocks at exchange. By doing this parallel A stoodS stood to be much firmer than sequential AЕS. Advanced Encryption Standards (AЕS) was proposed and later it was widely accepted as the most secure encryption algorithm that can be used to encrypt the information so that it can be transmitted securely over an unsecured channel. To make A morS more fixed to a new scheme called Parallel AЕS, was an employee who took four blocks of 16 bytes at a time to generate four blocks of 16 bytes of text, thus providing diffusion of blocks at exchange. By doing this parallel A stoodS stood to be much firmer than sequential AЕS. Advanced Encryption Standards (AЕS) was proposed and later it was widely accepted as the most secure encryption algorithm that can be used to encrypt the information so that it can be transmitted securely over an unsecured channel. To make A morS more fixed to a new scheme called Parallel AЕS, was an employee who took four blocks of 16 bytes at a time to generate four blocks of 16 bytes of text, thus providing diffusion of blocks at exchange. By doing this parallel A stoodS stood to be much firmer than sequential AЕS. was an employee who took four blocks of 16 bytes at a time to generate four blocks of 16 bytes of text, thus providing diffusion of blocks at exchange. By doing this parallel A stoodS stood to be much firmer than sequential AЕS. was an employee who took four blocks of 16 bytes at a time to generate four blocks of 16 bytes of text, thus providing diffusion of blocks at exchange. By doing this parallel A stoodS stood to be much firmer than sequential AЕS.  

High-grade adenocarcinoma, (ductal type) arising in unilateral Warthin tumor of the parotid gland

Warthin tumor is a well-recognized benign salivary gland neoplasm consisting of an epithelial as well as a lymphoid component. Malignant transformation in Warthin tumor is rare and its reported incidence is up to 1%. The more common types of carcinomas described in Warthin tumor are the squamous and mucoepidermoid types, with high-grade adenocarcinoma being extremely rare. A high-grade adenocarcinoma (ductal type) arising in the Warthin tumor in a 72-year-old man is presented for its rarity and diagnostic difficulties

Extra-axial ependymoma mimicking a meningioma

Supratentorial ependymomas are rare and are usually intra axial in location. We report a case of extra axial supra tentorial ependymoma in a girl which mimicked a falcine meningioma. Imaging, pathological features and management are described in this case report along with review of the literature. The possible origin of these tumors is discussed

Not always a commensal: A case of mastitis by Corynebacterium amycolatum

Gram positive rods seen on Gram’s stain are often dismissed as skin commensal organisms. Diphtheroids (Non-diphtherial Corynebacterium species), as they are collectively called, are taken as harmless bystanders in a skin and soft tissue infection (SSTI). However, emerging evidence has established virulence factors in some of these species leading to various infections.Here, we describe a case of mastitis in a 43 year old female caused by Corynebacterium amycolatum. The organism was seen as thick Gram positive rods on Gram stain and was isolated as a pure growth on Blood agar. Identification was done on Vitek-2 and confirmed by matrix assisted laser desorption-ionization - Time-offlight (MALDI-TOF). Patient was managed successfully with surgical excision and antibiotics