RG Stone Urology & Laparoscopy Hospital

PURPOSE OF REVIEW: The laparoscopic approach in urology is now an accepted option for kidney, adrenal, and prostate surgery. We review the current experience with laparoscopic radical cystectomy to identify its role in oncological bladder surgery. RECENT FINDINGS: Pure laparoscopic techniques are being employed for the extirpative portion of laparoscopic radical cystectomy at multiple institutions. Various extracorporeal and intracorporeal techniques are evolving for the reconstructive procedures necessary for urinary diversion. Worldwide experience continues to accumulate with over 150 cases already having been performed. SUMMARY: With the gradual growth and experience in laparoscopic radical cystectomy, along with continuing refinements in technique, laparoscopic radical cystectomy is now being performed at many centers worldwide. Long-term oncological and functional outcome data are necessary to determine its proper role for patients with bladder cancer.

The recognition of high retreatment rates and lower success rates after SWL monotherapy in certain situations led us to explore a new endourologic strategy including retrograde intrarenal surgery (RIRS). Examples of situations in which RIRS + SWL is appropriate are coexistence of stones and coagulopathy, stones associated with intrarenal stenosis, concomitant renal and ureteral stones, renal anomalies, and failed SWL. Lithotripter-specific guidelines for the adjunctive use of RIRS may be appropriate.

Abstract: The advent of laparoscopic surgery has changed the concept of surgery from prolonged painful to painless, cosmetically satisfying and short stay. In the past few years many instruments have been developed and introduced into the operating room (OR), but there has been ongoing debate about the optical ergonomic posture of the operating surgeon. One of the main ergonomic problem in our currently available operating room table is that they are designed for the open surgery and are not ideal (suitable) for the laparoscopic surgery. Since laparoscopic surgery requires the use of longer instruments than open surgery, thus changing the relation between the height of the surgeon and the desirable height of the operating room table. This study aims to understand an ergonomically optimal operating table height required for the particular height of the surgeon from the floor so that they can perform their surgery comfortably. The operating table height was defined as the upper level of the table from the floor. The study was undertaken keeping all other variables fixed (Elevation angle, Manipulation angle, Azimuth angle, Distance of monitor.) Coaxial alignments were maintained. The only variable was the operating room (OR) table height.

BACKGROUND: Segmental vitiligo has a different clinical course and prognosis as compared to nonsegmental vitiligo, which necessitates its correct diagnosis. It may be difficult to distinguish segmental vitiligo from the limited or focal types of nonsegmental vitiligo. OBJECTIVE: To validate the previously proposed diagnostic criteria for segmental vitiligo. METHODS: This was a cross-sectional validation study involving patients with limited vitiligo. The diagnostic criteria were used to classify vitiligo lesions as segmental or nonsegmental, and was compared with the experts' diagnosis, which was considered as the "gold standard". RESULTS: The study included 200 patients with 225 vitiligo lesions. As per the diagnostic criteria, 146 vitiligo lesions were classified as segmental and 79 as nonsegmental. The experts classified 147 vitiligo lesions as segmental and 39 as nonsegmental, while the diagnosis either was labeled "unsure" or could not be agreed upon for 39 lesions. As compared with the experts' opinions ("for sure" cases, n = 186), the sensitivity and specificity of the diagnostic criteria was 91.8% (95% confidence interval [CI]: 86.2%-95.7%) and 100% (95% CI: 91%-100%), respectively. The positive predictive value was 100% (95% CI: 97.3-100%), while the negative predictive value was 76.5% (95% CI: 62.5%-87.2%). There was a 93.5% agreement between the clinical criteria and experts' opinions (k = 0.83, P < 0.001). LIMITATION: The diagnostic criteria were compared with the experts' opinion in the absence of an established diagnostic "gold standard". CONCLUSIONS: The proposed diagnostic criteria for segmental vitiligo performed well, and can be used in clinical practice, as well as in research settings.

BACKGROUND: The use of acronyms in medicine is widespread, aiming to simplify and condense communication. Online communication in social media platforms seems to enhance the use of acronyms, but their efficiency in message delivery may be negated by their abundance and unfamiliarity, causing more confusion than clarity. We analyzed the use of acronyms in a closed Facebook group dedicated to abdominal wall reconstruction (AWR), as the rapid recent development of this field has resulted in many new acronyms. Our aim was to classify the different acronyms and create a public reference. METHODS: The International Hernia Collaboration, a hernia-related Facebook group, now communicating more than 7500 surgeons from 99 countries, was studied, by extracting acronyms used since its inception in 2012. Acronyms were categorized and interpreted, to create a small dictionary comprised of several tables. RESULTS: Commonly used acronyms were identified, as well as commonly used prefixes that modify the acronyms' meaning. Tables were created, classifying acronyms by their subject: 1.Anatomy2.Diseases and clinical conditions3.Techniques and materials. CONCLUSION: The use of acronyms increased in social media-based communication. Aiming to simplify the language, the inflation of terms may have achieved the opposite, by adding a multitude of unfamiliar and confusing terms. We have created a public reference for AWR-related acronyms. Limiting the liberal creation of new acronyms is recommended, especially in a rapidly changing field as AWR.

Various operative procedures have been described for urogenital tuberculosis (UGTB). These include percutaneous drainage of hydronephrosis or abscesses, double-J stenting for hydronephrosis, definitive local extirpative treatment of the affected part of a kidney (cavernotomy/partial nephrectomy) and epididymis (epididymectomy). Many forms of reconstructive surgery of the upper urinary tract (uretero-calycostomy, ureteric reimplantation, ileal ureteric replacement) and the lower urinary tract have been described. Nephrectomy is performed in 27% of UGTB patients and the frequency is similar in developing and developed countries. Radical and reconstructive procedures should be done within the first two months of intensive chemotherapy. A contracted bladder may need augmentation cystoplasty or even cystectomy if the capacity is less than 100 ml.

Systemic Lupus Erythematosus (SLE) is a chronic inflammatory rheumatic disease which affects the connective tissue. Its etiology is as yet unknown, while its pathogenesis involves the immune system. Both genetic and environmental and hormonal factors play a key role in the impaired immune regulation. A correlation with estrogens is demonstrated by the fact that the greatest incidence is found in young women, when estrogen secretion is at its highest. The disease is also reported to worsen in women taking oral contraceptives. It is therefore believed that the components of oral contraceptives, estrogens (ethinyl estradiol) and progestins, can affect the immune profile. Of the various complications attributed to systemic lupus erythematosus, gastrointestinal disorders are less common but potentially by far the most serious. We report a case of ischemic necrosis with sigma perforation in a patient with SLE. Signs and symptoms of acute abdomen in patients with SLE are rare (0.2%), but serious. Most patients require an exploratory laparotomy, as the causes are often linked with vasculitis.

A rare case of pan-subepithelial dystrophic calcium deposition and bone marrow formation in hydronephrosis secondary to obstructive urolithiasis is reported and discussed. An elderly gentleman presented with accelerated hypertension, a nonfunctioning left kidney secondary to obstructive nephrolithiasis with additional pancalyceal calcification. His left retroperitoneoscopic nephrectomy specimen revealed sterile hydronephrosis secondary to an impacted ureteropelvic junction stone and pan-subepithelial fibrocalcific lamellar deposition. Special stains confirmed end-stage renal disease with chronic pyelonephritis with subepithelial dystrophic calcium deposition and evidence of bone marrow formation.

AIM: This cross-sectional survey aimed to determine the prevalence of Interventional Nephrology (IN) practice amongst nephrologists in the Asia-Pacific Region (APR), specifically related to dialysis access (DA). METHODS: The Association of VA and intervenTionAl Renal physicians (AVATAR) Foundation from India conducted a multinational online survey amongst nephrologists from the Asia-Pacific to determine the practice of IN in the planning, creation, and management of dialysis access. The treatment modalities, manpower and equipment availability, monthly cost of treatment, specifics of dialysis access interventions, and challenges in the training and practice of IN by nephrologists were included in the survey. RESULTS: Twenty-one countries from the APR participated in the survey. Nephrologists from 18 (85.7%) countries reported performing at least one of the basic dialysis access-related IN procedures, primarily the placement of non-tunnelled central catheters (n-TCC; 71.5%). Only 10 countries (47.6%) reported having an average of <4% of nephrologists performing any of the advanced IN access procedures, the most common being the placement of a peritoneal dialysis (PD) catheter (20%). Lack of formal training (57.14%), time (42.8%), incentive (38%), institutional support (38%), medico-legal protection (28.6%), and prohibitive cost (23.8%) were the main challenges to practice IN. The primary obstacles to implementing the IN training were a lack of funding and skilled personnel. CONCLUSION: The practice of dialysis access-related IN in APR is inadequate, mostly due to a lack of training, backup support, and economic constraints, whereas training in access-related IN is constrained by a lack of a skilled workforce and finances.

UNLABELLED: Miniinvasive treatment of lithiasis of the common bile duct hasn't reached yet a standard end point. There are multiple techniques used for it. In this study we evaluate its indications, possibilities and limits. MATERIAL AND METHOD: In a series of 14,024 biliary patients operated over 9 years 719 patients underwent open choledocolithotomy. In 173 (1.2%) of patients we used miniinvasive procedures as follows: 71 cases underwent sequential treatment, 91 laparoscopic treatment and in 11 cases the remnant calculi were extracted 1-6 days postoperative. RESULTS: Sequential treatment was the preferred treatment when the lithiasis of the common bile duct was detected preoperative. Transcistic extraction was more often performed for the lithiasis diagnosed intraoperative. The conversion to open surgery was performed in 13 cases, remnant calculi were early diagnosed in 11 patients and late diagnosed in 14 cases (the calculi were extracted by endoscopic sphyncterotomy). All patients were healed. DISCUSSIONS: The miniinvasive procedures have to be practiced as frequently as possible because of rapid healing and early recovery of the patients, despite some disadvantage of them. The choledocotomy and choledocoduodenostomy are exceptional techniques to be used in specific cases.

Background: Gastrointestinal stromal tumor [GIST] is commonest mesenchymal tumor, mainly affects adults. But, 1.5% to 2% GISTs were reported in pediatrics and adolescents. The treatment of GIST is managed as in adult because of lack of information about pediatric GIST. Aim of the work: Here we presented a case report of pediatric GIST. Current literature was reviewed and a summary was formulated to form a base for future optimal treatment of childhood GIST. Case summary: A 14 years Saudi female presented with vague abdominal pain and easy fatigability for 8 months. The pain located in lower abdomen, mild, waning, no aggravation or reliving factor and not radiating. Clinically, there was peri umbilical round, firm and not tender mass extending to right side of the abdomen till right hypochondrium, with no movement with respiratory movements. Investigations demonstrate severe microcytic hypochromic anemia. A computed tomography [CT] abdomen and pelvis showed evidence of soft tissue mass, about 13*11*12cm, of heterogeneous pattern and enhancement with area of hypodensity and cystic degeneration. There was necrosis of mesentery with some calcification seen inside the lesion suggestive of query GIST or Lymphoma. En block resection of the mass done with safety margin, biopsy from lymph node and side-to-side anastomosis done using linear stapler. The histopathological examination revealed ill and well defined fasicles of tumor cells that have spindle, oval and round shape nuclei invading mesentery and small bowel. Mitotic figurer 5-10/50 HPF, reactive lymph node. Immunohistochemistry showed diffused strong positive CD117 and CD34, negative S-100

Infestation by the Dipteran insect larvae is one of the public health problems in tropical countries, including India. Calliphorid flies are reported to cause various types of myiases, including urogenital myiasis. Besides, non-myiasis-producing flies also occasionally invade human or animal tissues and cause myiasis. For the first time, we report here, an uncommon type of myiasis of the urogenital system due to an infestation by Chironomus larvae. A 19 year-old female patient from a poor socio-economic background from Kolkata, India attended the outpatient department with a complaint of passing worms in her urine with one-to-five larvae, several times a day, for four weeks. Another member of the family had a similar complaint. The larvae isolated from the patient were identified to be Chironomus crassicaudatus (Diptera: Chironomidae). It was probable that Chironomid flies breeding in and around the dwellings had infested the urethra. The patient was successfully treated with albendazole. Implementing overall environmental and personal hygienic living conditions, eliminating fly breeding habitats, and avoiding sharing of a common toilet facility are important measures to avoid such kind of fly infestation.

E-learning is one of the many fields in which machine learning (ML) technology has transformed. Personalised material distribution, automated evaluations, and adaptive learning experiences are all provided by ML technology. Large amounts of educational information are analysed by algorithms in ML-powered e-learning platforms, allowing for personalised learning routes, effective evaluations, and predictive insights into learner behaviour. A detailed review of machine learning technologies and their uses in e-learning from 2001 to 2021 is given in this paper. We look at the advantages and disadvantages of several machine learning algorithms, methods, and resources that improve e-learning platforms. In addition, we examine case studies of effective ML applications in e-learning, talk about the drawbacks and moral dilemmas of these technologies, and suggest possible future paths, such as combining immersive and explainable AI. Through this investigation, we intend to offer a thorough grasp of how machine learning has changed e-learning and its prospects for the future.

Background: Radical prostatectomy remains a key curative treatment for localized prostate cancer which has undergone continuous transformation. Recent developments in robot-assisted and single-port surgery have followed the concept of minimizing morbidity while maintaining oncologic safety. Furthermore, the integration of artificial intelligence and novel diagnostic tools have transformed the modern surgical workflow. Therefore, the aim of this study is to give an overview of the evolution of surgical techniques, functional and oncological outcomes, and available surgeon-assisting concepts. Methods: We conducted a non-structured review to summarize the evolution of radical prostatectomy techniques and recent developments in surgeon-assisting tools. Relevant English-language publications were identified through a targeted PubMed search using predefined keywords related to, laparoscopic, robot-assisted, Retzius-sparing, and single-port approaches. Key studies, systematic reviews, and meta-analyses were used and synthesized to provide a comparative overview. Furthermore, studies focusing on integration of artificial intelligence, novel diagnostic tools and targeted surgery are discussed. Results: Laparoscopic surgery aims to reduce morbidity yet is technically demanding. Robotic-assisted approaches improve visualization and precision, leading to faster recovery and earlier continence recovery. Newer Retzius-sparing and single-port techniques show promising functional results, though evidence is still limited. Novel diagnostic tools including image overlay, targeted surgery, and fast and accurate intraoperative pathological assessment of resection margins are increasingly shaping modern radical prostatectomy. Conclusion: Radical prostatectomy has evolved into a minimally invasive, technology-driven procedure with improved recovery and functional outcomes. Advances in robotics, imaging, and artificial intelligence enhance surgical precision. Ongoing innovation and long-term data will define the future of prostate surgery.

Ebstein's anomaly is a rare congenital heart condition, occurring in only 1 to 5 out of every 200,000 live births, accounting for less than 1% of all cases of congenital heart defects. This anomaly is characterized by the downward displacement of the septal leaflet of the tricuspid valve and the presence of an atrialized right ventricle. Our patient, an eleven-year-old girl, initially presented with symptoms such as chest pain, shortness of breath, and hemoptysis (blood vomiting). Upon examination, we identified moderate tricuspid valve regurgitation and observed an enlarged, globe-shaped heart, which led us to diagnose the child with Ebstein's anomaly. Additionally, the presence of Escherichia coli in her blood resulted in sepsis. Given the patient's overall condition, cardiovascular surgery was not considered, and she was instead provided with symptomatic treatment. This case report highlights the possibility of successful pediatric outcomes in complex congenital heart diseases, emphasizing the need for individualized surgical treatment plans.