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Chandigarh, India

Sharma S.,Jawaharlal Institute of Postgraduate Medical Education & Research | Sharma S.,Advanced Urology Center | Agarwal M.M.,Jawaharlal Institute of Postgraduate Medical Education & Research | Mete U.K.,Jawaharlal Institute of Postgraduate Medical Education & Research
Indian Journal of Surgery

Retrograde urethrogram is employed for adequate demonstration of anterior urethral stricture and is commonly performed by trainee residents. Not uncommonly, contrast is injected under pressure to overcome the resistance of a stricture which can lead to extravasation or intravasation exposing the patient to risk of bacteremia, sepsis, contrast reactions, and worsening of stricture. We report two such cases of extensive intravasation delineating the “venogram” of peno-pelvic venous arcade. Such rare occurrences highlight the importance of eliciting history of various allergies and asthma, urethral instrumentation, obtaining sterile urine before the study, and performing the study under dynamic fluoroscopy. © 2012, Association of Surgeons of India. Source

Singh S.K.,Advanced Urology Center | Sharma A.P.,Advanced Urology Center | Mittal A.,Advanced Urology Center | Lal A.,PGIMER

A 68-year-old male patient presented with fever and right groin pain. He had leukocytosis with azotemia. Computed tomography revealed enlarged right kidney with thickening and enhancement of walls of pelvicalyceal system and perinephric fat stranding, suggestive of pyelonephritis. Multiple enlarged lymph nodes encased right renal vessels and were present in the retrocaval region. The right psoas muscle was bulky. Fine-needle aspiration cytology and biopsy from the lesions showed features of non-Hodgkin lymphoma. Immunohistochemistry confirmed the diagnosis of diffuse, large, B-cell lymphoma. We emphasize lymphoma in differential diagnosis of atypical renal imaging suggestive of pyelonephritis and perinephritis. © 2015 Elsevier Inc. Source

Sharma A.P.,Advanced Urology Center | Devana S.K.,Advanced Urology Center | Bora G.S.,Advanced Urology Center | Mavuduru R.,Advanced Urology Center | Mandal A.K.,Advanced Urology Center
Journal of Robotic Surgery

Robot-assisted partial nephrectomy has become a safe and feasible procedure for small renal masses (SRM). Similarly, robot-assisted adrenalectomy has also been well established. Robotic surgery has provided the possibility to manage complex cases that are considered technically challenging for traditional laparoscopy. We describe in this video the details of performing simultaneous robotic adrenalectomy with partial nephrectomy highlighting the technical aspects of the same. A 62-year-old gentleman presented to us with incidentally detected left renal complex cyst (Bosniak IIF) and a concomitant left adrenal mass. Hormonal evaluation of adrenal tumor revealed raised levels of serum estrogen and DHEAS. A robotic-assisted simultaneous procedure was planned. Patient was positioned in right lateral position. After port placement, robot was brought from the shoulder of the patient and docked. We first excised the adrenal tumor followed by the renal cyst. Total operative time was 180 min with warm ischemia time of 20 min for renal cyst excision. Drain was removed on post-operative day 2. Patient was discharged on post-operative day 3. Histopathology revealed adrenocortical adenoma and benign hemorrhagic renal cyst. We found simultaneous ipsilateral adrenalectomy with partial nephrectomy using robotic assistance is feasible and safe with minimal morbidity. Port placement in such cases should be individualized according to the location of the SRM. The robot provides the ergonomic advantage and 3D vision for better anatomic definition as compared to laparoscopy. © 2016, Springer-Verlag London. Source

Agarwal M.M.,Advanced Urology Center | Mandal A.K.,Advanced Urology Center | Sarkar D.,Advanced Urology Center | Mavuduru R.,Advanced Urology Center | Singh S.K.,Advanced Urology Center

End-to-end anastomotic urethroplasty (EEA) for traumatic bulbar urethral stricture has excellent long-term success rate. We encountered a patient with obliterative bulbar stricture and persistent phlegmon in perineum resulting from straddle injury. Phlegmon-excision and EEA was performed, which ended up in recurrence. Thorough excision of recurrent nodules & scar with stage-I urethroplasty was performed using 'scrotal shutter flap'. Histopathology of phlegmon of first surgery and nodules & urethral margins of second revealed amyloidosis. Stage-II urethroplasty was performed 3-months later after which he is well at 24months follow-up. This is the first case of perineal-urethral amyloid associated with trauma. Etiology is elusive. © 2011 Elsevier Inc. Source

Bansal R.,Jawaharlal Institute of Postgraduate Medical Education & Research | Agarwal M.M.,Jawaharlal Institute of Postgraduate Medical Education & Research | Modi M.,Jawaharlal Institute of Postgraduate Medical Education & Research | Mandal A.K.,Jawaharlal Institute of Postgraduate Medical Education & Research | And 2 more authors.

Objectives: To evaluate the association between diabetic cystopathy (DC) and neuropathy (autonomic and peripheral) in patients with diabetes mellitus (DM) presenting with lower urinary tract symptoms (LUTS). Methods: Men with DM who presented with bothersome LUTS were enrolled from January 2008 to June 2009. Their demographic and clinical profiles were noted. Multichannel urodynamic studies were performed using the Solar Silver digital urodynamic apparatus. Hand and foot sympathetic skin responses, and motor and sensory nerve-conduction velocity studies were performed using the Meditronic electromyographic/evoked potentials system. Results: A total of 52 men (mean age 61.3 ± 12.1 years, DM duration 11.0 ± 7.5 years) completed the study protocol. Of these 52 men, abnormal sympathetic skin responses, motor and sensory nerve-conduction velocity studies, and combined neuropathy (all 3 tests abnormal) were noted in 80.7% 57.7%, 57.7%, and 51.9%, respectively. Urodynamic studies showed impaired first sensation (>250 mL), increased capacity (>600 mL), detrusor underactivity, detrusor overactivity, high postvoid residual urine volume (more than one third of capacity), and bladder outlet obstruction (Abrams-Griffiths number >40) in 23.1%, 25.0%, 78.8%, 38.5%, 65.4%, and 28.8% of the men, respectively. Both sensory and motor DC correlated with abnormal motor and sensory nerve-conduction velocity studies (P = .015 and P = .005, respectively). Only motor DC correlated with abnormal sympathetic skin responses (P = .015). The correlations were stronger in the presence of combined neuropathy (sensory DC, P = .005; motor DC, P = .0001). Conclusions: Men with DM and LUTS can present with varied urodynamic findings, apart from the classic sensory or motor cystopathy. A large proportion of these patients will have electrophysiologic evidence of neuropathy, and electrophysiologic evidence of neuropathy can moderately predict the presence of cystopathy. © 2011 Elsevier Inc. Source

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