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Bhat G.S.,Victoria Hospital Campus | Maregowda S.,Victoria Hospital Campus | Jayaram S.,Victoria Hospital Campus | Siddappa S.,Victoria Hospital Campus
Urology | Year: 2012

Objective: To prospectively evaluate per operative renal biopsy as a predictor of outcome of pyeloplasty in cases of unilateral pelviureteric junction obstruction in adults. Materials and Methods: We conducted a prospective study on 24 patients with unilateral UPJ obstruction undergoing pyeloplasty between November 2005 and August 2006 and followed them until December 2010. Intraoperative renal wedge biopsy was obtained in these patients and this was correlated with preoperative DRF on diuretic renogram. Outcome of pyeloplasty was assessed at 1 and 3 years by diuretic renograms and the renal biopsy as a predictive tool was compared with preoperative DRF. Results: Histology suggestive of obstructive damage to kidneys, such as significant glomerulosclerosis, widened Bowman's capsule, interstitial fibrosis, and tubular atrophy on renal biopsy was the highly significant predictor of poor outcome of pyeloplasty with a P value =.001 compared with preoperative DRF. Conclusion: Renal biopsy is better predictor of outcome of pyeloplasty compared with preoperative DRF in UPJ obstruction. In the presence of severe obstructive changes in renal biopsy, recoverability of renal function despite achievement of successful drainage is significantly decreased. © 2012 Elsevier Inc. All Rights Reserved.


Shoorashetty R.M.,Pondicherry Institute of Medical science | Nagarathnamma T.,Victoria Hospital Campus | Prathibha J.,Victoria Hospital Campus
Indian Journal of Medical Microbiology | Year: 2011

Purpose: Extended spectrum β-lactamase (ESBL) and AmpC β-lactamase are important mechanisms of betalactam resistance among Enterobacteriaceae. The ESBL confirmation test described by Clinical Laboratory Standards Institute (CLSI) is in routine use. This method fails to detect ESBL in the presence of AmpC. Therefore, we compared two different ESBL detection methods against the CLSI confirmatory test. Materials and Methods: A total 200 consecutive clinical isolates of Enterobacteriaceae from various clinical samples were tested for ESBL production using (i) CLSI described phenotypic confirmatory test (PCT), (ii) boronic acid disk potentiation test and (iii) cefepime-CA disk potentiation method. AmpC confirmation was done by a modified three-dimensional test. Results: Among total 200 Enterobacteriaceae isolates, 82 were only ESBL producers, 12 were only AmpC producers, 55 were combined ESBL and AmpC producers, 14 were inducible AmpC producers and 37 isolates did not harboured any enzymes. The CLSI described PCT detected ESBL-producing organisms correctly but failed to detect 36.3% of ESBLs among combined enzyme producers. The boronic acid disk potentiation test reliably detected all ESBL, AmpC, and combined enzyme producers correctly. The cefepime-CA method detected all ESBLs correctly but another method of AmpC detection has to be adopted. Conclusion: The use of boronic acid in disk diffusion testing along with the CLSI described PCT enhances ESBL detection in the presence of AmpC betalactamases.


Ali A.M.,Victoria Hospital Campus | Nelvigi G.G.,Victoria Hospital Campus | Keshavaiah V.G.,Victoria Hospital Campus | Ratkal C.S.,Victoria Hospital Campus
Urology Annals | Year: 2014

Xanthogranulomatous cystitis (XC) is a rare benign disease of unknown etiology. A 39-year-old female presented with 2 month history of urgency, dysuria, lower abdominal mass. On physical examination a hard hypogastric mass was present fixed to the rectus muscle. Computerized tomography (CT) abdomen showed heterogeneous enhancing mass arising from the anterior bladder wall with infiltration of the overlying parietal wall. Cystoscopy revealed extensive growth involving the entire wall of the bladder. A biopsy showed cystitis with focal areas suggestive of urothelial neoplasia of unknown malignant potential. Suspecting bladder cancer, we proceeded with radical cystectomy with ileal conduit. Histopathology revealed cystitis cystica with XC of the entire bladder. This is, to our knowledge, the first time that a case has been found to be so extensive with infiltration of the parietal wall and second time that radical cystectomy has been performed for XC.


Sharma A.K.,Victoria Hospital Campus
UroToday International Journal | Year: 2013

Pediatric urethral narrowing or idiopathic etiology of a stricture is difficult to suspect in the absence of classic obstructive lower urinary tract symptoms. It is still unclear whether it should be defined as congenital stricture because of an absence of a clear-cut traumatic history; one cannot rule out unnoticed trauma in walking kids. We present a similar case in a child, managed with a modified conventional graft urethroplasty technique. © 2013 Digital Science Press, Inc.


Sharma A.K.,Victoria Hospital Campus
UroToday International Journal | Year: 2013

Purpose: Tubeless percutaneous nephrolithotomy (PCNL) is a well-accepted procedure for uncomplicated renal calculi. We prospectively evaluated the safety, feasibility, and efficacy of day care/ambulatory PCNL (totally tubeless, discharge within 24 hours) for selected patients for which only few case series have been reported. Materials and Methods: Total tubeless PCNL was planned in 40 easily accessible patients with uncomplicated renal calculi, with single infracostal punctures, normal intraoperative events, and acceptable postoperative parameters (visual analogue pain score, parenteral analgesic requirement, bleeding, urinary soakage, hemodynamic stability), allowing an early discharge within 24 hours. Parameters like pain score and analgesic requirement, any complications, and return date to normal work were evaluated at follow-up. Ultrasonography was performed after a week to document stone clearance. Results: Mean patient age was 38.6 years (22 to 62), stone size was 21.4 mm (15.4 to 30), and operating time was 72 minutes (42 to 106) without blood transfusion. Regional anesthesia was used in 13 cases while general anesthesia was used in the rest of the patients. Average pain score after 6 hours of surgery was 2.3 (1.8 to 3.6) with vitals in the normal range, and hospital stay was 12.5 hours (5.5 to 23.5). Six patients were excluded due to peri-and postoperative events (2: multiple punctures, 1: hematuria, 1: urine leak, 2: pain). This data was taken with the intention to treat the analysis with a successful application of study protocol in 34 (85%) of preoperatively selected cases. Out of 34 patients that qualified for a complete study protocol, 11 were discharged on the same day of surgery while the rest were discharged the next morning. Postoperative USG confirmed no residual calculus, and all patients had uneventful recoveries. Three patients had minor complications (mild hematuria/ urine leaks), which were managed conservatively. Conclusion: Our experience with ambulatory PCNL in properly selected cases suggests it as a feasible and effective option that can safely be offered to patients, providing uncomplicated surgery and favorable postoperative parameters. © 2013 Digital Science Press, Inc.


Siddappa S.,Victoria Hospital Campus | Mythri K.,Victoria Hospital Campus | Kowsalya R.,Victoria Hospital Campus
Journal of Cytology | Year: 2012

Background: Regardless of the availability of newer and more sophisticated modalities of investigation, urinary tract cytology still remains the most commonly used non-invasive test for the diagnosis of bladder cancer. Aims: As hematuria is the commonest presenting symptom in patients with malignancy of urinary tract, we undertook this study to know the usefulness of urine cytology in evaluation of the hematuric patients for malignancy. Materials and Methods: A total of 21,557 fresh voided urine samples received at our tertiary care referral centre over a period of three years were included in the study. Of these, 1428 cases had hematuria, criteria of either gross or microscopic. Results: Among these hematuric cases included in the study, 32.5% (464 cases) were found to have positive finding of atypical cells. In these cases with atypia, 9.5% (136 cases) were proved to have malignancy both with the histopathological biopsy and cystoscopic findings. Other cases of atypia were found to be of reactive origin, either due to instrumentation or foreign body. A large number of hematuric cases, that is, 964 cases (67.5%) were negative for atypical cells. Conclusions: The limited ability of urine cytology to detect low grade bladder tumors, its subjectivity and lack of uniformity in reporting, all render urine cytology a less than perfect tool. With added collaboration between clinician and cytopathologist, urine cytology can be used an adjunct tool in evaluation of patients with hematuria.


Nagabhushana M.,Victoria Hospital Campus | Kamath A.J.,Victoria Hospital Campus | Manohar C.S.,Victoria Hospital Campus
Journal of Endourology | Year: 2013

Purpose: To present our initial experience with laparoendoscopic single-site (LESS) urologic surgery using conventional laparoscopic instruments and to assess its feasibility and safety. Patients and Methods: In 20 patients, we performed LESS urologic surgery, which included simple nephrectomy in 9, nephroureterectomy in 1 for a refluxing nonfunctioning kidney, radical nephroureterectomy in 1, heminephroureterectomy in 1 for a nonfunctioning upper moiety in a complete duplex kidney, marsupialization of a renal cyst in 1, ureterolithotomy in 1, varicocelectomy in 2, pyeloplasty in 2, vesicovaginal fistula (VVF) repair in 1, and orchiopexy in 1. LESS was performed using a small periumbilical incision, inserting regular trocars, and using a conventional 30-degree laparoscope and laparoscopic instruments. Data were collected prospectively with respect to feasibility, intraoperative or postoperative complications, postoperative pain, analgesic requirement, and recovery. Results: Since March, 2012, a total of 20 patients have undergone LESS for various urologic conditions. All cases were completed successfully, without conversion to a standard laparoscopic or open approach. The total operative time for the nephrectomy, nephroureterectomy, pyeloplasty, VVF repair, ureterolithomy, varicocelectomy, or orchiopexy was 134±20.06, 186±40, 135±21, 180, 150, 55, and 60, minutes, respectively. The mean blood loss was 100 mL. No intraoperative complication occurred. The mean pain score on the visual analog scale was 8.35±0.9 (8-10) on day 1, 4.8±1.6 (2-8) on day 2, and 2±1.2 (2-4) on day 3. Similarly, the mean analgesic requirement was 220±41 mg, 85±74 mg, and 30±47 mg of intravenous tramadol, respectively. One patient had surgical emphysema of the abdomen and another had ileus for 4 days. The mean hospital stay was 2.9±1.7 (2-7) days. Conclusion: In selected patients, LESS for urological indications using conventional laparoscopic instruments is safe and feasible with no added cost. Additional experience and continued investigation are warranted. © Copyright 2013, Mary Ann Liebert, Inc. 2013.


Siddappa S.,Victoria Hospital Campus | Ramprasad K.,Victoria Hospital Campus | Muddegowda M.K.,Victoria Hospital Campus
Korean Journal of Urology | Year: 2011

Purpose: Xanthogranulomatous pyelonephritis is an uncommon disorder of unknown etiology that is characterized by extensive destruction of the involved kidney. It is being increasingly recognized as an important cause of renal morbidity around the world. Materials and Methods: This retrospective study was undertaken to review the xanthogranulomatous pyelonephritis cases presented at our tertiary care referral center in Bangalore, India. Results: A total of 16 biopsy-proven cases of xanthogranulomatous pyelonephritis from October 2007 to March 2010 treated at our institute were included in the study. There were 10 females and 6 males with a mean age of 51.5 years. Flank pain was the most common presenting symptom followed by fever. All patients had unilateral disease and underwent total nephrectomy of the affected nonfunctional kidney. Conclusions: Xanthogranulomatous pyelonephritis is a chronic and unusual infectious inflammatory condition involving the renal parenchyma. The definite treatment is nephrectomy. Early identification and prompt treatment of this relatively benign and uncommon condition is important to minimize morbidity and mortality. © The Korean Urological Association, 2011.


Siddappa S.,Victoria Hospital Campus | Kowsalya R.,Victoria Hospital Campus | Mythri K.,Victoria Hospital Campus
Indian Journal of Nephrology | Year: 2011

IgA nephropathy is being recognized as the commonest glomerular disease worldwide. The prevalence and clinical picture varies from region to region. A retrospective analysis of 400 native renal biopsies performed over a period of 3 years at our center was done to know the prevalence and clinicopathological profile of patients with IgA nephropathy. All the biopsies were processed for both light microscopy and immunofluorescence studies. Patients with predominant IgA deposits were labeled as IgA nephropathy and further classified histopathologically into five subclasses according to the Haas classification. We noted a prevalence of 7.8% (31 cases) of IgA nephropathy. Nephrotic syndrome and chronic renal failure were the most common mode of presentation. Majority of cases fell into subclass III (focal segmental glomerular sclerosis) with 35.5% followed by subclasses IV (diffuse proliferative glomerular sclerosis) and V (global sclerosis) with 25.8% and 22.6% prevalence, respectively. As about 50% cases presented with varying degree of renal insufficiency, many ending with ESRD, IgA nephropathy can be considered as a serious problem in India.


PubMed | The Oxford Dental College and Victoria Hospital Campus
Type: Journal Article | Journal: Journal of Indian Society of Periodontology | Year: 2016

Ultrasonic scaler is a preferential treatment modality among the clinicians. However, the aerosol/splatter generated is a concern for patients and practitioners. Therefore, the purpose of this study was to evaluate contamination of contact lenses of the dentist after scaling and root planing using ultrasonic scalers with and without protective eyewear.Thirty patients were randomly selected for scaling and root planing and divided into 2 groups of 15 each. Group A - dentist wearing contact lenses and protective eyewear. Group B - dentist wearing only contact lenses. After scaling and root planing using ultrasonic scalers, the lenses were subjected to culture and 16S rRNA (16S ribosomal RNA) gene sequencing.In Group A - 15 out of thirty samples were contaminated, in Group B - all the thirty samples were contaminated. Most of the samples showed Gram-positive bacteria and 5 samples were contaminated with fungi. 16S rRNA gene sequencing of forty contaminated samples showed that 31 were contaminated with Streptococcus mutans and 9 with Staphylococcus aureus.Keeping in mind the limitation of the study for the absence of negative control, we would like to conclude that dental practitioners should better avoid contact lenses in a dental setup because of the risk of contamination of the contact lenses from the various dental procedures which can produce aerosol/splatter and if worn, it is recommended to wear protective eyewear.

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