Suresh Venugopal - Academia.edu (original) (raw)

Papers by Suresh Venugopal

International urogynecology journal, Feb 7, 2024

International Journal of Surgery, Oct 1, 2013

Aim: Renal colic is a common presentation to accident and emergency departments throughout the UK... more Aim: Renal colic is a common presentation to accident and emergency departments throughout the UK. The aim of this study was to evaluate renal calculi composition and to assess changes over a 20 year period. Methods: We performed a retrospective review of the stone analysis of renal calculi in 2721 patients over a 20 year period (1991-2010). The patient demographics were recorded and the location and size of the stones were analysed. Results: The predominant stones were calcium oxalate (60.1%), calcium phosphate (15.8%) and uric acid (5.4%). The period from July to September had the highest frequency of renal calculi. There was a significant increase in the incidence of both calcium oxalate and uric acid stones in comparing the 2 groups (p<0.05). For the period 1991-1995, oxalate stones accounted for 51.9% and uric acid stones accounted for 2.8%. The incidence of calcium oxalate stones increased to 74.8% for the period 2006-2010, and uric acid stones increased to 6.8%. Conclusion: The spectrum of renal calculi in our catchment area is comparable to the rest of the UK. The increase in incidence of both calcium oxalate and uric acid stones is possible due to a western diet and increase in sedentary lifestyle.

Neurourology and Urodynamics, 2013

Current Urology, Mar 3, 2022

Background: Immunoglobulin G4-related disease remains a modern, relatively unknown field in the u... more Background: Immunoglobulin G4-related disease remains a modern, relatively unknown field in the urological world. An increasing number of cases require urological input, often with invasive diagnostics and aggressive medical treatment first-line. Given this, we sought to evaluate modern radiological options of disease affecting the upper urinary tract, to provide clarity and reduce diagnostic burden and delay in this poorly understood yet potentially debilitating disease process. Summary: We conducted a systematic literature search including PubMed and Medline, focusing on immunoglobulin G4-related disease affecting the upper urinary tract, before reviewing articles assessing different radiological modalities in diagnosis. Consistent computed tomography findings have been demonstrated in the literature and contributed to recent breakthroughs in classification criteria, however invasive biopsy remains a mainstay in work-up, given the difficulties in comparing against malignancy. Early work in positron-emission tomography and magnetic resonance imaging has shown promise in radiologically distinguishing from other differentials, especially diffusion-weighted imaging showing high sensitivity levels, but not yet enough to formulate protocols and cause histological investigation to be redundant. Key messages: Our article has highlighted repeated findings in the literature of computed tomography appearances of IgG4-RD in the upper urinary tract, however invasive work-up remains a mainstay given the overlap with malignancy. Prospective, comparative studies into magnetic resonance imaging and positron-emission tomography are now required, given their early results, to improve consistency in reporting and reduce patient burden when investigating this benign, yet debilitating disease process.

Urology, Aug 1, 2011

Renal angiomyoadenomatoid tumor is a distinct pathologic entity that can mimic clear cell renal a... more Renal angiomyoadenomatoid tumor is a distinct pathologic entity that can mimic clear cell renal adenocarcinoma in presentation. The nature and behavior of these tumors are not well understood, and they require long-term follow-up to clarify their neoplastic potential. UROLOGY 78: 327-328, 2011.

Annals of The Royal College of Surgeons of England, Jul 1, 2010

Segmental testicular infarction is uncommon. Less than 40 cases have been reported in the literat... more Segmental testicular infarction is uncommon. Less than 40 cases have been reported in the literature. 1 Most cases appear to be idiopathic or due to haematological disorders like sickle cell or vasculitis. 2-6 Infective or severe inflammatory process can also lead to infarction. 7 It commonly occurs between the second and fourth decade of life. 8 It is difficult to distinguish between an infarct and a testicular tumour especially if the tumour is small in size. 9 Therefore, orchidectomy tends to be performed and the diagnosis made on histology. A conservative approach is possible if the diagnosis is reached with a high degree of certainty. 3,4 Case history A 55-year-old man attended the accident and emergency department with a 24-h history of acute left hemiscrotal pain that had no precipitating factors and was not accompanied by any urinary symptoms. He was a known hypertensive, heavy smoker and an arteriopath. As a result of the latter, he had a left common iliac angioplasty and subsequent stent insertion in 2000. Clinically, the testis was found to be normally positioned, mildly tender with some fluid in the tunica vaginalis but normal scrotal skin. His urine dipstick was negative. An urgent ultrasound of testes was obtained which showed an

Annals of The Royal College of Surgeons of England, Oct 1, 2009

INTRODUCTION Radical cystectomy remains the gold standard in treatment of muscle invasive bladder... more INTRODUCTION Radical cystectomy remains the gold standard in treatment of muscle invasive bladder cancer. Evolution of pathological guidelines has empowered centres to offer orthotopic substitution (OBS) to patients undergoing radical cystectomy. We compared health-related quality of life (HRQoL) between patients who underwent OBS or ileal conduit urinary diversion (ICD) following radical cystectomy. PATIENTS AND METHODS A total of 57 patients who underwent cystectomy were assessed pre-operatively using Karnofsky performance scale (KPS). Of these, 52 patients (28 OBS and 24 ICD) who responded to a postal questionnaire consisting of SF-36 and a functional index questionnaire were included. RESULTS Median age of patients was 70 years. Pre-operative KPS scores were similar. All eight HRQoL scales were favourable in both groups. OBS patients had significantly better physical functioning. In the cohort, 42% of men with OBS and 25% of diversions could maintain an erection to varying degrees. Of the OBS patients, 85% were continent with two patients reporting reduced QoL with pad usage. Of ICD patients, 63% felt less complete and 42% were embarrassed due to the stoma, with 58% apprehensive of stomal leakage. Of OBS patients, 96% had significant relationships and a more active lifestyle. CONCLUSIONS In a similar age-group population, there was no significant difference in most QoL indices but body image issues persist in ICD patients. OBS patients had significantly better physical function, continuing to have a more active lifestyle. They attained urethral voiding with good continence. A detailed discussion of long-term functional outcome would engender a realistic expectation allowing better adaptation.

European Urology, Apr 1, 2015

Background: There are several techniques for characterising and localising an anterior urethral s... more Background: There are several techniques for characterising and localising an anterior urethral stricture, such as preoperative retrograde urethrography, ultrasonography, and endoscopy. However, these techniques have some limitations. The final determinant is intraoperative assessment, as this yields the most information and defines what surgical procedure is undertaken. Objective: We present our intraoperative approach for localising and operating on a urethral stricture, with assessment of outcomes. Design, setting, and participants: A retrospective review of urethral strictures operated was carried out. All patients had a bulbar or bulbomembranous urethroplasty. All patients were referred to a tertiary centre and operated on by two urethral reconstructive surgeons. Surgical procedure: Intraoperative identification of the stricture was performed by cystoscopy. The location of the stricture is demonstrated externally on the urethra by external transillumination of the urethra and comparison with the endoscopic picture. This is combined with accurate placement of a suture through the urethra, at the distal extremity of the stricture, verified precisely by endoscopy. Outcome measures and statistical analysis: Clinical data were collected in a dedicated database. Intraoperative details and postoperative follow-up data for each patient were recorded and analysed. A descriptive data analysis was performed. Results and limitations: A representative group of 35 male patients who had surgery for bulbar stricture was randomly selected from January 2010 to December 2013. Mean follow-up was 13.8 mo (range 2-43 mo). Mean age was 46.5 yr (range 17-70 yr). Three patients had undergone previous urethroplasty and 26 patients had previous urethrotomy or dilatation. All patients had preoperative retrograde urethrography and most (85.7%) had endoscopic assessment. The majority of patients (48.6%) had a stricture length of >2-7 cm and 45.7% of patients required a buccal mucosa graft. There were no intraoperative complications. Postoperatively, two patients had a urinary tract infection. All patients were assessed postoperatively via flexible cystoscopy. Only one patient required subsequent optical urethrotomy for recurrence. Conclusions: Our intraoperative strategy for anterior urethral stricture assessment provides a clear stepwise approach, regardless of the type of urethroplasty eventually chosen (anastomotic disconnected or Heineke-Mikulicz) or augmentation (dorsal, ventral, or augmented roof strip). It is useful in all cases by allowing precise localisation of the incision in the urethra, whether the stricture is simple or complex.

British Journal of Medical and Surgical Urology, Mar 1, 2012

A 65-year-old male presented with recurrent intermittent right flank pain induced by the consumpt... more A 65-year-old male presented with recurrent intermittent right flank pain induced by the consumption of 4—5 pints of beer. There were no lower urinary tract symptoms or haematuria. He had a past history of left renal calculi which where treated endoscopically and had been stone free for the past decade. Clinical examination was unremarkable and urine dipstick testing showed no evidence of blood or infection. Serum urea and creatinine were within normal limits and he subsequently underwent an abdominal ultrasound scan. This demonstrated bilateral hydronephrosis as well as a large simple cyst of the left kidney. A CT urogram performed for further evaluation demonstrated minimal right hydronephrosis with a cranially traversing right ureter through a

Journal of Clinical Urology, Jul 7, 2016

A 52-year-old male presented with a history of recurrent urinary tract infections (UTIs). In the ... more A 52-year-old male presented with a history of recurrent urinary tract infections (UTIs). In the five months prior to presentation he had had five symptomatic UTIs. There was no history of lower urinary tract symptoms outside the episodes of infection. There was no prior history of traumatic urethral instrumentation. Uroflometry demonstrated a maximal flow of 19 ml/s and a post voiding ultrasound showed the bladder emptied completely. Two urethral lumens were demonstrated at flexible cystoscopy at the bulbar level (Figure 1), with one lumen ending blindly (accessory urethra), confirmed on urethrography (Figure 2). The patient elected to undergo excision of the accessory urethra. In lithotomy position, a vertical perineal incision was made and the bulbar urethra exposed. A rigid cystoscope was inserted to the point of bifurcation, where a marking suture was placed. The accessory urethral lumen was identified and marked (Figure 3), then opened vertically. The bladder was catheterized via the external urethral meatus and the duplicated urethra was excised. Urethral closure was undertaken using the Heineke–Mikulicz principle, with the soft tissue dead space closed by buttressing the peri-urethral corpus spongiosum. A catheter was left for 10 days. The postoperative retrograde urethrogram demonstrated no leakage and the patient successfully passed a trial without catheter. At six month follow-up there have been no further UTIs and the patient continues to void normally to completion on post void bladder scan. Histology confirmed an epithelium lined urethral lumen. The only residual problem is a degree of post-micturition dribbling.

Journal of Clinical Urology, 2014

We present the case of a 72-year-old woman with obstructive uropathy secondary to interstitial cy... more We present the case of a 72-year-old woman with obstructive uropathy secondary to interstitial cystitis-like pathology as the presenting features of systemic lupus erythematosus (SLE). After her initial presentation with visible haematuria, she was shown to have hydroureteronephrosis and a bulky bladder mass. Histology of bladder biopsies demonstrated severe inflammation. Following unsuccessful attempts to stent the ureters, worsening renal function and a concern regarding possible malignancy, a cystectomy and ileal conduit were performed. Final histology showed her bladder had only benign inflammatory changes. Subsequent investigations led to a diagnosis of SLE. We suggest that in cases of obstructive uropathy in association with severe inflammation of the bladder, lupus cystitis should be considered at an early stage and managed with steroids in the first instance. This may lead to resolution of the underlying pathology and thus avoid the need for urinary diversion and cystectomy.

International Journal of Surgery, Nov 1, 2016

British journal of hospital medicine, Jul 1, 2012

Surgery (oxford), Jul 1, 2013

British journal of hospital medicine, Oct 1, 2012

ABSTRACT An 80-year-old presented with a painless, solid abnormality in his left testicle. Scrota... more ABSTRACT An 80-year-old presented with a painless, solid abnormality in his left testicle. Scrotal ultrasound reported a lesion suggestive of a malignant tumour (Figure 1). Tumour markers were normal. He underwent a left radical orchidectomy and histology confirmed a testicular haemangioma.

Journal of Pain Research, Jul 1, 2017

International Journal of Surgery, 2017

The Clinical Teacher, Jun 16, 2015

Cancer Research, 2021

Introduction: Prostate cancer is the most common cancer in men and there is racial disparity in p... more Introduction: Prostate cancer is the most common cancer in men and there is racial disparity in prostate cancer incidence and mortality globally, with greater disease burden in men of African ancestry, followed by European ancestry and least in men of Asian ancestry. The etiology of prostate cancer is not fully understood, but includes genetic and environmental factors. Present day non-Africans are reported to have introgressed DNA from Neanderthal and Denisovan ancestors. Over 170 prostate cancer associated single nucleotide polymorphisms (SNPs) have been identified from several genome-wide association studies (GWAS), with SNPS on chromosomes 2, 8 and 22 reported as showing variation between African and non-African men with prostate cancer. We performed analysis of prostate cancer associated SNPs on chromosomes 2, 8 and 22 to determine if DNA introgression could explain the racial variation. Methods: We obtained data on prostate cancer associated SNPs from the GWAS catalog (https:/...