Urology

Robotic assistance helps low-volume surgeons deliver better outcomes to their patients Sridhar Panaiyadiyan, Rajeev Kumar Indian Journal of Urology 2021 37(1):1-3

Round up Anil Mandhani Indian Journal of Urology 2021 37(1):4-5

The Urological Society of India Guidelines for the management of urethral stricture (Executive Summary) Sanjay B Kulkarni, Amilal Bhat, Hardev S Bhatyal, Gyanendra R Sharma, Deepak D Dubey, Nikhil Khattar, Arabind Panda, Anujdeep Dangi, Vikram Shah Batra, Pankaj M Joshi Indian Journal of Urology 2021 37(1):6-9

The Urological Society of India Guidelines for the management of pediatric urinary tract infection (Executive Summary) MS Ansari, P Ashwin Shekar, Chandra Singh, Shriram S Joshi Indian Journal of Urology 2021 37(1):10-12

The current role of cytoreductive nephrectomy for metastatic renal cell carcinoma Eric C Umbreit, Andrew G McIntosh, Chalairat Suk-Ouichai, Jose A Karam, Christopher G Wood Indian Journal of Urology 2021 37(1):13-16 The management of metastatic renal cell carcinoma (mRCC) continues to be a therapeutic challenge; however, the options for systemic therapy in this setting have exploded over the past 20 years. From the advent of toxic cytokine therapy to the subsequent discovery of targeted therapy (TT) and immune checkpoint inhibitors, the landscape of viable treatment options continues to progress. With the arrival of cytokine therapy, two randomized trials demonstrated a survival benefit for upfront cytoreductive nephrectomy (CN) plus interferon therapy and this approach became the standard for surgical candidates. However, it was difficult to establish the role and the timing of CN with the subsequent advent of TT, just a few years later. More recently, two randomized phase III studies completed in the TT era questioned the use of CN and brought to light the role of risk stratification while selecting patients for CN. Careful identification of the mRCC patients who are likely to have a rapid progression of the disease is essential, as these patients need prompt systemic therapy. With the continued advancement of systemic therapy using the immune checkpoint inhibitors as a first line therapy, the role of CN will continue to evolve.

Optimizing biopsy strategy for prostate cancer: Bayesian framework of network meta-analysis and hierarchical summary receiver operating characteristic model for diagnostic accuracy Ilham Akbar Rahman, Ilham Fauzan Nusaly, Syakri Syahrir, Harry Nusaly, Firdaus Kasim Indian Journal of Urology 2021 37(1):20-31 Overdiagnosis and overtreatment are well known problems in prostate cancer (PCa). The transrectal ultrasound (TRUS) Guided biopsy (GB) as a current gold standard investigation has a low positive detection rate resulting in unnecessary biopsies. The choice of optimal biopsy strategy needs to be defined. Therefore, we undertook a Bayesian network meta analysis (NMA) and Bayesian prediction in the hierarchical summary receiver operating characteristic (HSROC) model to present a method for optimizing biopsy strategy in PCa. Twenty eight relevant studies were retrieved through online databases of EMBASE, MEDLINE, and CENTRAL up to February 2020. Markov chain Monte Carlo simulation and Surface Under the Cumulative RAnking curve were used to calculate the rank probability using odds ratio with 95% credible interval. HSROC model was used to formulate the predicted true sensitivity and specificity of each biopsy strategy. Six different PCa biopsy strategies including transrectal ultrasound GB (TRUS GB), fusion GB (FUS GB), fusion + transrectal ultrasound GB (FUS + TRUS GB), magnetic resonance imaging GB (MRI GB), transperineal ultrasound GB (TPUS GB), and contrast enhanced ultrasound GB were analyzed in this study with a total of 7584 patients. These strategies were analyzed on five outcomes including detection rate of overall PCa, clinically significant PCa, insignificant PCa, complication rate, and HSROC. The rank probability showed that the overall PCa detection rate was higher in FUS + TRUS GB, MRI GB, and FUS GB. In terms of clinically significant PCa detection, FUS + TRUS GB and FUS GB had a relatively higher clinically significant PCa detection rate, whereas TRUS GB had a relatively lower rate for clinically significant PCa detection rate. MRI GB (91% and 81%) and FUS GB (82% and 83%) had the highest predicted true sensitivity and specificity, respectively, whereas TRUS GB (62% and 83%) had a lower predicted true sensitivity and specificity. MRI GB, FUS GB, and FUS + TRUS GB were associated with lower complication rate, whereas TPUS GB and TRUS GB were more associated with higher complication rate. This NMA and HSROC model highlight the important finding that FUS + TRUS GB, FUS GB, and MRI GB were superior compared with other strategies to avoid the overdiagnosis and overtreatment of PCa. FUS GB, MRI GB, and FUS + TRUS GB had lower complication rates. These results may assist in shared decision making between patients, carers, and their surgeons.

Role of laparoscopy in the era of robotic surgery in urology in developing countries Devanshu Bansal, Samit Chaturvedi, Ruchir Maheshwari, Anant Kumar Indian Journal of Urology 2021 37(1):32-41 With the rapid expansion of robotic platforms in urology, there is an urgent and unmet need to review its cost and benefits in comparison to the traditional laparoscopy, especially in reference to a developing country. A nonsystematic review of the literature was conducted to compare the outcomes of pure laparoscopic and robot-assisted urologic procedures. Available literature over the past 30 years was reviewed. Robot-assisted surgery and laparoscopy were found to have similar outcomes in the areas of radical prostatectomy, partial and radical nephrectomy, radical cystectomy, retroperitoneal lymph node (LN) dissection, inguinal LN dissection, donor nephrectomy, and kidney transplantation. Robot-assisted surgery was found to be significantly costlier than pure laparoscopy. In the absence of a clear advantage of robot-assisted surgery over pure laparoscopy, lack of widespread availability and the currently prohibitive cost of robotic technology, laparoscopic urological surgery has a definite role in the developing world.

Robot-assisted laparoscopic ureteral reimplant: A single-center experience Vipin Tyagi, Mrinal Pahwa, Praveen Lodha, Tejas Mistry, Sudhir Chadha Indian Journal of Urology 2021 37(1):42-47 Introduction: Open ureteral reimplant has been the gold standard for management of lower ureteric strictures. With the widespread acceptance of robotic surgery, robotic-assisted laparoscopic ureteral reimplant (RALUR) is becoming the preferred choice for performing ureteral reimplant. We present our single-institution and single-surgeon experience of performing RALUR. Materials and Methods: We performed a retrospective analysis of 40 patients who underwent RALUR at our institute in the last 5 years. Demographic data were recorded along with presenting complaint and diagnosis. Intraoperative variables included operative and docking time, blood loss, intraoperative complications, technique, and procedure performed. Postoperative data that were analyzed included complications, hospital stay, and outcomes. Patient satisfaction score was calculated using a numerical scale of points 1–6. Results: The mean age of patients was 31.5 ± 9.8 years (r = 4–45). Male: female ratio was 3:5. The most common presenting symptom was flank pain, and the most common etiology was iatrogenic strictures in adults and congenital vesicoureteral reflux in children. The mean operative time and blood loss were 135.3 ± 45.1 min (r = 84–221) and 67.7 ± 31.4 ml (r = 32–118), respectively. There were no intraoperative complications and nil conversion to open surgery. The mean length of hospital stay was 4.5 ± 2.3 days (r = 3–9). Radiographic success was achieved in 41 out of 44 ureters. Eighty-five percent of the patients were completely satisfied with robotic approach and its outcomes. Conclusion: RALUR is a minimally invasive, safe, feasible, less morbid technique with good outcome.

Retrograde intrarenal surgery for renal stones in children <5 years of age Vaddi Chandramohan, PM Siddalingaswamy, Paidakula Ramakrishna, Ganesan Soundarya, Babu Manas, Anandan Hemnath Indian Journal of Urology 2021 37(1):48-53 Introduction: There are very few studies in the literature describing retrograde intrarenal surgery (RIRS) in preschool children. We have evaluated the feasibility, stone-free rate, and complications of RIRS in children &#60;5 years of age. Methods: All children &#60;5 years of age and stone size &#60;2 cm (renal/proximal ureteric), who underwent RIRS at our hospital from February 2010 to May 2020 were included in this retrospective study. All children were prestented for the passive dilatation of ureter. A 7.5 Fr flexible ureterorenoscope was introduced over the ureteral access sheath (UAS) or over a guidewire. At 2 weeks, the stent was removed and at 2 months the child was evaluated for residual stones. Results: A total of 62 children with 67 renal units met the inclusion criteria. The mean age was 42.11 months (4&#8211;60 months). Mean weight was 13.31 kg (6&#8211;16.3 kg). Mean stone size was 11.9 mm (7.3&#8211;18.2 mm). Majority of the stones were in pelvis (37.8&#37;). UAS 9.5/11.5 Fr was placed in 40 (63.5&#37;) children. Mean operative time was 55.2 min; mean hospitalization was 61 h. Four out of the 67 renal units (5.9&#37;) required conversion to minipercutaneous nephrolithotomy in the same sitting, due to access failure. Two cases who developed post-operative fever required a change of antibiotics. Two cases required ureteroscopy for steinstrasse postoperatively. Stone-free rate at 2 months for stones size =2 mm was 76.3&#37;. Conclusion: Pediatric RIRS is a promising option in young children as it offers acceptable stone-free rates and a low incidence of high-grade complications. However, it requires expertise and should be offered in tertiary care centres.

Tubeless mini-percutaneous nephrolithotomy for renal stones larger than 20 mm Sanjay Khadgi, Maitrey Darrad, Ahmed R EL-Nahas, Abdullatif AL-Terki Indian Journal of Urology 2021 37(1):54-58 Introduction: The aim of this study is to evaluate the outcomes of tubeless mini- percutaneous nephrolithotomy (PCNL) for the treatment of large (&#62;20 mm) renal stones. Patients and Methods: This study included consecutive patients who underwent single-session tubeless mini-PCNL (tract size 16&#8211;20 F) for large (&#62;20 mm) renal stones. Stone-free status meant complete clearance or residual fragments &#60;4 mm. Complications were recorded and classified according to modified Clavien-Dindo classifications. Risk variables for significant residuals were determined with univariate (Chi-square and t-test) and multivariate logistic regression analyses. Results: Between July 2015 and November 2018, 225 patients were included. The mean age was 42.9 years; the mean stone size was 30.2 &#177; 9.6 mm and 75&#37; of patients were males. A single renal stone was present in 54 patients (24&#37;), multiple stones in 108 (48&#37;), and staghorn stones in 63 (28&#37;). The stone-free rate was 87.6&#37;. The complication rate was 8.4&#37; (Grade I&#8211;II in 7.5&#37;, III in 0.9&#37;). Three patients (1.3&#37;) required blood transfusion. Independent risk factor for significant residual fragments was the presence of stones in multiple sites inside the pelvicalyceal system (relative risk: 13.44, 95&#37; confidence interval: 1.78&#8211;101.43, P &#61; 0.012). Conclusions: Mini-PCNL is an effective and safe treatment option for patients with large renal stones (&#62;20 mm). Stones located in multiple sites is the only predictor of significant residual stones.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

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