dr ravimohan mavuduru | PGIMER,CHD,India (original) (raw)

Papers by dr ravimohan mavuduru

Journal of Urology, 2019

We present a framework of a basic physical exam in a neurologic patient which centers on sensitiv... more We present a framework of a basic physical exam in a neurologic patient which centers on sensitivity testing, reflex testing and a rectal examination. We will first highlight the key components of sensitivity testing, focusing on the sacral sensitivities and their respective dermatomes. Reflex testing will center on the bulbocavernosus reflex arc in a man and a woman, and the rectal examination will focus on the innervation of the anal sphincter. RESULTS: The video begins with sensitivity testing in a patient with an incomplete spinal cord lesion, demonstrating how to perform light touch and painful stimuli using a cotton tipped swab in the office. This section also demonstrates how to perform sacral sensitivity testing using light touch and pinprick in patient who does not have a neurologic lesion, illustrating a normal exam, and then in a patient with a complete cervical lesion showing the absence of sensation. The following section demonstrates and explains the bulbocavernosus reflex on both a man and a woman, highlighting the steps necessary to perform this test in the office. The physical exam concludes with the rectal examination demonstrating the anal reflex in a man with a complete spinal cord lesion. CONCLUSIONS: With increasing testing used for many urologic patients, the nuances of the physical exam are generally underestimated. There is an increasing number of patients with lower urinary tract symptoms and neurologic conditions in today's practice. A focused neurological physical exam is an important tool in the diagnosis and treatment of these complex patients.

European Journal of Nuclear Medicine and Molecular Imaging, Nov 29, 2021

Purpose Lutetium-177 prostate-specific membrane antigen-617 (177 Lu-PSMA-617) in end-stage metast... more Purpose Lutetium-177 prostate-specific membrane antigen-617 (177 Lu-PSMA-617) in end-stage metastatic castrationresistant prostate cancer (mCRPC) has reported favourable outcomes. In this study, we aimed to prospectively compare the efficacy and safety of 177 Lu-PSMA-617 and docetaxel in chemotherapy-naïve mCRPC patients. Methods This was a randomized, parallel-group, open-label, phase 2, and non-inferiority trial. Chemotherapy-naïve patients with mCRPC and high PSMA-expressing lesions on 68 Ga-PSMA-11 PET/CT were randomly assigned in 1:1 ratio to 177 Lu-PSMA-617 (6.0-7.4 GBq/cycle, every 8 weeks, up to 4 cycles) or docetaxel (75 mg/m 2 /cycle, every 3 weeks, up to 10 cycles). The primary end-point was best prostate-specific antigen response rate (PSA-RR), defined according to Prostate Cancer Clinical Trials Working Group-3 as proportion of patients achieving ≥ 50% decline in PSA from baseline. Non-inferiority margin of − 15% was pre-specified for PSA-RR. Results Between December 2019 and March 2021, 40 of the 45 patients assessed for eligibility underwent randomization. Fifteen of 20 patients in 177 Lu-PSMA-617 arm and 20/20 patients in docetaxel arm received treatment per protocol. Of these, best PSA-RR in the 177 Lu-PSMA-617 arm was 60% (9/15) versus 40% (8/20) in the docetaxel arm. The difference in the PSA-RRs between the two arms was 20% (95% confidence interval, CI: − 12-47, P = 0.25), meeting the pre-specified criterion for non-inferiority in per-protocol analysis. Further, progression-free survival rates at 6 months were 30% and 20% in the 177 Lu-PSMA-617 and docetaxel arms respectively (difference 10%, 95% CI: − 18-38, P = 0.50). Overall, treatmentemergent grade ≥ 3 adverse events occurred less frequently with 177 Lu-PSMA-617 than with docetaxel (6/20, 30% versus 10/20, 50%, respectively, P = 0.20). Quality-of-life outcomes improved significantly in 177 Lu-PSMA-617 arm compared to docetaxel arm (P < 0.01). Conclusion 177 Lu-PSMA-617 was demonstrated to be safe and non-inferior to docetaxel in the treatment of mCRPC and could, thus, be potentially employed earlier in the disease course rather than being solely reserved for advanced end-stage disease. Clinical trial registration Clinical Trials Registry-India, CTRI/2019/12/022282. Keywords Castration-resistant prostate cancer • Prostate-specific membrane antigen • 177 Lu-PSMA-617 • Docetaxel • Randomized controlled trial • Non-inferiority This article is part of the Topical Collection on Oncology-Genitourinary

The Journal of Sexual Medicine, Jul 1, 2018

ics.org, Aug 23, 2010

Hypothesis / aims of study Voiding position has been reported to affect urine-flow volume relatio... more Hypothesis / aims of study Voiding position has been reported to affect urine-flow volume relations in healthy men as well as men with benign prostatic enlargement; however the existing literature is controvertial (1-3). It is important to assess, since it may have implications in proper interpretation of results of uroflowmetry and potentially management thereof. We assessed position-related changes in uroflowmetric parameters in men with symptomatic benign prostatic enlargement (BPE). Study design, materials and methods Men with symptomatic BPE were enrolled after written informed consent. Patients with other diseases affecting structure or function of lower urinary tract (e.g. Diabetes Mellitus, Parkinsonism, vertebral disc prolapse, urethral stricture, bladder cancer and prostate cancer) were excluded. They underwent uroflowmetry in standardized fashion using digital uroflowmeter (Solar Silver, MMS International, the Netherlands) once in each of the three voiding positions (standing, sitting and squatting). Postvoid residual urine was measured using abdominal ultrasound (profocus, BK medical, Denmark). Results and interpretation Total 17 men with mean (± SD) age 63.9 ± 7.1 years and body mass index 23.2 ± 4.4 kg/m 2 completed the study protocol. Their mean prostate volume was 33.0 ± 12.0 ml, mean international prostatic symptom score (IPSS) 22 ± 8, mean global quality of life index (QOL) 4.0 ± 0.8. IPSS and QOL had significant correlation with absolute and corrected flow rates; the relation was strongest with absolute average flow rate. There was no statistically significant difference in any uroflow parameter with respect to voiding position (table 1). Concluding message Voiding position does not affect uroflow parameters significantly in men with BPE. Average flow rates have stronger correlation with IPSS & QOL than maximal flow rates.

Indian Journal of Urology, 2011

We will provide journalists and editors with full-text copies of the articles in question prior t... more We will provide journalists and editors with full-text copies of the articles in question prior to the embargo date so that stories can be adequately researched and written. The standard embargo time is 12:01 AM ET on that date. Questions regarding embargo should be directed to

Journal of clinical interventional radiology isvir, Jan 11, 2022

Objective The purpose of this study was to report short-term outcomes of cryoablation of early-st... more Objective The purpose of this study was to report short-term outcomes of cryoablation of early-stage renal tumors (T1a and T1b) at a tertiary hospital in India. Methods This was a retrospective study of consecutive patients who underwent cryoablation for renal cell carcinoma (RCC) from November 2018 to June 2020. Cryoablation was performed under combined ultrasound and computed tomography guidance using a helium-argon cryoablation system. Tumor number, size, location, nephrometry score, relationship of the tumor with pelvicalyceal system, and adjacent organs were tabulated, and technical and clinical success evaluated. Early and late recurrence and complications were also assessed. Results Eleven patients (median age: 62 years) with 11 tumors underwent cryoablation. The mean tumor size was 2.58 cm (range: 1.62-5.62 cm) with 10 lesions being T1a and one lesion T1b. Tissue sampling was done in 9/11 patients, 3 were papillary RCC and the rest, clear cell RCC. In two patients, the tumor was completely endophytic, three patients had partially endophytic tumors while 6 patients had exophytic lesions. The median nephrometry score was 6 (range: 4-11, Mode 4). Technical success was achieved in all patients. Complete response was achieved in 81% (9/11) of the patients at 1-month follow-up. Median follow-up period was 6 months. Two patients showed residual disease on follow-up imaging at 1 and 3 months, respectively. Conclusion Cryoablation is a promising, relatively new minimally invasive therapy for treating small renal tumors in India. It is safe, technically feasible, and shows excellent short-term efficacy.

Annals of Oncology, Nov 1, 2017

Background: High endothelial venules (HEV) are present in lymph nodes and tertiary lymphoid organ... more Background: High endothelial venules (HEV) are present in lymph nodes and tertiary lymphoid organs. It has been reported that low HEV density is associated with the poor prognosis of several carcinomas. MECA-79 antibody recognizes L-selectin ligand (6sulfo sialyl Lewis X glycan) expressed in HEV. In the present study, we examined whether MECA79(þ) HEV density was associated with clinical outcomes of patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Methods: Eighty-eight patients with UTUC who underwent RNU at the Hirosaki University hospital between January 2008 and December 2016 were enrolled. Tissue microarray for MECA-79 was performed, and HEV densities were calculated. HEV density <1.5/mm 2 was defined as HEV(À);HEV density !1.5/mm 2 was defined as HEV(þ). Results: Of 88 patients, 64 (72.7%) were male and 24 (27.2%) were female. The average age was 68.5 years (range, 36-84 years). Fifty-three patients (60.2%) had previously undergone neoadjuvant chemotherapy. The mean observation period was 39.0 months. Twenty-one (23.8%) patients developed recurrence, whereas 16 (33.3%) patients died during follow-up. Five-year cause-specific survival (CSS) rate was 66.1%, and five-year disease-free survival (DFS) rate was 70.7%. In our cohort, 25 (28.4%) patients were found to be HEV(À), whereas 63 (71.5%) were found to be HEV(þ). The mean HEV density was 6.3/mm 2 (range, 0-41.6). The 5-year DFS rates for MECA79(þ) and MECA79(À) patients were 78.0% and 53.9%, respectively, with a statistically significant difference between the groups. (log-rank, p ¼ 0.042). Moreover, the 5-year CSS rates for MECA79(þ) and MECA79(À) patients were 72.5% and 53.4%, respectively, with a statistically significant difference between the groups. (log-rank, p ¼ 0.0036). Conclusions: Low MECA79(þ) HEV density may be associated with poor prognosis of patients with UTUC treated with RNU. Despite the small sample size and preliminary nature of our study, our study provides valuable insights to guide future research.

Indian Journal of Urology, 2020

Introduction: Penile fracture is a rare urological emergency, best managed by early surgical inte... more Introduction: Penile fracture is a rare urological emergency, best managed by early surgical intervention, but the data on subsequent sexual function is sparse. This study was designed to analyze the clinical spectrum and sexual function after penile fracture repair at our tertiary care center. Materials and Methods: Ambispective observational study was undertaken from July 2002 to August 2019 which included patients admitted with a history of trauma to the penis in the erect state. The clinical presentation, etiology and the details of the surgical management were noted. Patients were contacted telephonically and were called for follow-up. They were evaluated for the presence of penile nodules or curvature, and the erectile function was objectively recorded using the Sexual Health Inventory for Men (SHIM) questionnaire and the Erection Hardness Score (EHS). Results: Median age at injury was 37 years, and injury during the sexual intercourse (33/43) was the most common etiology. Five patients presented with blood at the meatus. Ultrasound was performed in 27 patients and could detect the injury with a 55% sensitivity. All but one case were repaired through a subcoronal degloving incision. At a median follow-up of 36 months, follow-up data of 20 patients were available. Of the 20 patients, 14 were sexually active. The mean SHIM score was 21.36 ± 1.33 and the mean EHS was 3.21 ± 0.43. Four of the 20 patients developed penile nodule while 2 of them had penile curvature which was not bothersome. Conclusion: Penile fracture remains primarily a clinical diagnosis. Although prompt diagnosis and an emergent surgical exploration provides good outcomes in terms of preservation of erectile function, patients should be apprised about the problems of penile nodule and curvature.

PubMed, Apr 20, 2019

“Ping”!! Everyone in today’s world, using a smartphone is familiar with this sound of the “meet” ... more “Ping”!! Everyone in today’s world, using a smartphone is familiar with this sound of the “meet” ringtone notification of WhatsApp. WhatsApp is a social media (SoMe) web-based smartphone application for messaging and has almost entirely replaced the erstwhile short messaging system (SMS).[1,2] The SMS service has now become only an in-built part of the smartphone, used exclusively for receiving one-time passwords for bill payments or financial transactions. WhatsApp had a user base of over 200 million in India, as of February 2017, and has emerged as an unparalleled messaging system across the country.[3]

BJUI, Mar 11, 2019

Lower urinary tract symptoms (LUTS) in a male patient may be due to benign prostatic hyperplasia ... more Lower urinary tract symptoms (LUTS) in a male patient may be due to benign prostatic hyperplasia (BPH-LUTS). In a routine clinical practice, BPH-LUTS is medically managed by Alphablockers (ABs) and add-on 5-alpha reductase inhibitors (5-ARIs). Epidemiological studies have shown an association of BPH-LUTS with erectile dysfunction (ED)[1]. Moreover, phosphodiesterase inhibitors (PDEIs) have shown to relieve LUTS in various studies and recently been approved by FDA for use in BPH-LUTS[2]. With increasing use of PDEI for this renewed indication, a systematic review of emerging evidence is needed to allow an overall assessment of the efficacy and safety of these agents.

Indian Journal of Urology, 2018

Nearly 50% patients with muscle invasive bladder cancer (T2-T4) die from their disease within 5 y... more Nearly 50% patients with muscle invasive bladder cancer (T2-T4) die from their disease within 5 years of diagnosis. [1,2] However, for patients with organ-confined node-negative disease, several serieshave shown excellent 5-and 10-year survival rates after radical cystectomy (RC). [3-6] With increasing experience, a considerable decrease in the mortality and morbidity has been noticed. Several advancements in the recent past have attempted to improve surgical morbidity and oncological outcomes in RC. These include application of minimally invasive surgeries (MIS), namely, laparoscopic and robot-assisted RC (RARC), extended lymphadenectomy templates, and neoadjuvant and adjuvant chemotherapy. [7,8] Although other parameters have shown to change the

Indian Journal of Urology

Introduction: Tadalafil and Tamsulosin have both been approved for use in the management of lower... more Introduction: Tadalafil and Tamsulosin have both been approved for use in the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). This study compared the differential effects of these two on BPH-LUTS using a cross over study design. Methods: Men ≥45 years of age, with an International Prostate Symptom Score (IPSS) ≥8 due to BPH-LUTS were included. The patients were randomized into sequence AB (tadalafil 10 mg OD followed by tamsulosin 0.4 mg OD) or BA in a double blind manner. All patients received a placebo lead-in period for 2 weeks, followed by an active drug for 6 weeks; placebo wash out for 4 weeks and then crossed over to second active drug for another 6 weeks. IPSS scores, Uroflowmetry parameters and International Index of Erectile Function-5 scores were recorded. Results: Out of the 40 patients, 36 completed the study. Demographic and baseline characteristics were comparable between the two groups (AB and BA). No significant placebo effects were observed. Tadalafil and tamsulosin significantly improved the total IPSS score and quality of life (P < 0.05) as compared to the baseline. However, there were no significant differences between the two drugs with respect to extent of observed effect and which drug was prescribed 1st in the sequence respectively (P > 0.05). Significant period effect was observed (P < 0.05) i.e., the symptoms did not return to the baseline before the second treatment. Half of the nonresponders to either of the drugs responded when the drug was changed to the other. Tadalafil showed better improvement in EF score as compared to Tamsulosin. Conclusion: Both Tadalafil and Tamsulosin improved LUTS and erectile function and those patients who did not respond to Tadalafil showed improvement with Tamsulosin and vice-a-versa.

Indian Journal of Urology

Indian Journal of Urology

Sushruta, in his Sushruta Samhita, has said, “A great surgeon is one who possesses courage and pr... more Sushruta, in his Sushruta Samhita, has said, “A great surgeon is one who possesses courage and presence of mind, a hand free from perspiration, tremor less grip of sharp and good instruments and who carries his operations to the success and advantage of his patient who has entrusted his life to the surgeon.”[1] The age-old teachings of Sushruta still hold true albeit for the fact that the hands of the surgeon are slowly being replaced by the tremor less grip of the robotic arms.

Journal of Postgraduate Medicine, Education and Research

ReseaRch aRTIcLe used as a reliable self-administrated scale for assessing HRQOL in patients with... more ReseaRch aRTIcLe used as a reliable self-administrated scale for assessing HRQOL in patients with PCa in both the clinical and research fields. Punnen et al. 6 conducted long-term HRQOL after primary treatment for LCaP: results from the CaPSURE registry. They showed that most IntroductIon Prostate cancer (PCa) remains one of the most common causes of cancer deaths in men worldwide. 1 Due to the location of the prostate gland and treatment nature which can range from surgery to radiotherapy (RT) to chemotherapy, men with PCa have side effects related to disease or treatment, which can affect health-related QOL (HRQOL). Further slow growth and progression make QOL improvement an important goal in PCa treatment. Studies have focused on QOL in specific issues, including sexual dysfunction, bowel changes, and urinary incontinence, which are therapy-related, or on discussing anxiety raised by prostate-specific antigen (PSA) screening. 2 Furthermore, where the number of options for treatment is many, the evaluation of QOL is important in decision-making 3 especially if alternative treatments produce similar efficacy results. The advanced PCa working group of the International Consortium for Health Outcomes Measurement suggested that patient-reported health status should be regularly evaluated in clinical practice. 4 This was despite recognizing the existence of logistic challenges. The FACT-P questionnaire is one such validated questionnaire in the evaluation of QOL in PCa Hong et al. 5 conducted FACT-P scales in men with PCa: reliability and validity of the Korean version and concluded that FACT-P could be

Journal of Robotic Surgery

The Journal of Urology, May 1, 2022

Urologic Oncology: Seminars and Original Investigations, 2022

OBJECTIVE To determine current practice patterns and adherence to various components of enhanced ... more OBJECTIVE To determine current practice patterns and adherence to various components of enhanced recovery after surgery in cystectomy (ERAC) protocol for peri-operative management of radical cystectomy patients through a global survey. METHODS A survey containing 25 questions and addressing 15 of the 22 items of the ERAC protocol was developed and disseminated through Email to the urologists with recent bladder cancer publications. The mailing list was generated by retrieving Email-ids of corresponding authors of articles using the keyword "cystectomy" in Scopus from January 2018 to October 2020. RESULTS The survey was completed by 443 respondents across the globe. About 51.5% of respondents used some form of bowel preparation. A minority used carbohydrate loading (29.8%) and Alvimopan (13.3%). A short duration of nil by mouth was practised by 28.9%. For antibiotic prophylaxis, 51.7% used one, and 42% used two antibiotics. Duration of antibiotics was 24 hours, 48 hours, and >48 hours for 47.6%, 16.9%, and 35.4%, respectively. For peri-operative analgesia, 43.6% used non-steroidal anti-inflammatory drugs, 9.3% opioids and 40.6% combination of both. Pharmacological thrombo-prophylaxis was routinely used by 74.7% respondents. There was significant variability in ERAC and non-ERAC components according to region of practice; The open surgical approach was most commonly used in Africa (92%), whereas it was the robotic approach in North America (or America?) (41%). The use of bowel preparation was higher in Asia (58%) and Africa (65%). Alvimopan use was more common in North America (58%). Most used 1 or 2 prophylactic antibiotics but the duration was shorter (<24 hours) in the Americas and European (58%-83%) compared to Asia and Africa (15%-35%). CONCLUSION There is high variability in the use of different ERAC components. Other than the timely removal of the abdominal drain and the use of thromboprophylaxis, the overall adherence of ERAC components is low.

Journal of Urology, 2019

We present a framework of a basic physical exam in a neurologic patient which centers on sensitiv... more We present a framework of a basic physical exam in a neurologic patient which centers on sensitivity testing, reflex testing and a rectal examination. We will first highlight the key components of sensitivity testing, focusing on the sacral sensitivities and their respective dermatomes. Reflex testing will center on the bulbocavernosus reflex arc in a man and a woman, and the rectal examination will focus on the innervation of the anal sphincter. RESULTS: The video begins with sensitivity testing in a patient with an incomplete spinal cord lesion, demonstrating how to perform light touch and painful stimuli using a cotton tipped swab in the office. This section also demonstrates how to perform sacral sensitivity testing using light touch and pinprick in patient who does not have a neurologic lesion, illustrating a normal exam, and then in a patient with a complete cervical lesion showing the absence of sensation. The following section demonstrates and explains the bulbocavernosus reflex on both a man and a woman, highlighting the steps necessary to perform this test in the office. The physical exam concludes with the rectal examination demonstrating the anal reflex in a man with a complete spinal cord lesion. CONCLUSIONS: With increasing testing used for many urologic patients, the nuances of the physical exam are generally underestimated. There is an increasing number of patients with lower urinary tract symptoms and neurologic conditions in today's practice. A focused neurological physical exam is an important tool in the diagnosis and treatment of these complex patients.

European Journal of Nuclear Medicine and Molecular Imaging, Nov 29, 2021

Purpose Lutetium-177 prostate-specific membrane antigen-617 (177 Lu-PSMA-617) in end-stage metast... more Purpose Lutetium-177 prostate-specific membrane antigen-617 (177 Lu-PSMA-617) in end-stage metastatic castrationresistant prostate cancer (mCRPC) has reported favourable outcomes. In this study, we aimed to prospectively compare the efficacy and safety of 177 Lu-PSMA-617 and docetaxel in chemotherapy-naïve mCRPC patients. Methods This was a randomized, parallel-group, open-label, phase 2, and non-inferiority trial. Chemotherapy-naïve patients with mCRPC and high PSMA-expressing lesions on 68 Ga-PSMA-11 PET/CT were randomly assigned in 1:1 ratio to 177 Lu-PSMA-617 (6.0-7.4 GBq/cycle, every 8 weeks, up to 4 cycles) or docetaxel (75 mg/m 2 /cycle, every 3 weeks, up to 10 cycles). The primary end-point was best prostate-specific antigen response rate (PSA-RR), defined according to Prostate Cancer Clinical Trials Working Group-3 as proportion of patients achieving ≥ 50% decline in PSA from baseline. Non-inferiority margin of − 15% was pre-specified for PSA-RR. Results Between December 2019 and March 2021, 40 of the 45 patients assessed for eligibility underwent randomization. Fifteen of 20 patients in 177 Lu-PSMA-617 arm and 20/20 patients in docetaxel arm received treatment per protocol. Of these, best PSA-RR in the 177 Lu-PSMA-617 arm was 60% (9/15) versus 40% (8/20) in the docetaxel arm. The difference in the PSA-RRs between the two arms was 20% (95% confidence interval, CI: − 12-47, P = 0.25), meeting the pre-specified criterion for non-inferiority in per-protocol analysis. Further, progression-free survival rates at 6 months were 30% and 20% in the 177 Lu-PSMA-617 and docetaxel arms respectively (difference 10%, 95% CI: − 18-38, P = 0.50). Overall, treatmentemergent grade ≥ 3 adverse events occurred less frequently with 177 Lu-PSMA-617 than with docetaxel (6/20, 30% versus 10/20, 50%, respectively, P = 0.20). Quality-of-life outcomes improved significantly in 177 Lu-PSMA-617 arm compared to docetaxel arm (P < 0.01). Conclusion 177 Lu-PSMA-617 was demonstrated to be safe and non-inferior to docetaxel in the treatment of mCRPC and could, thus, be potentially employed earlier in the disease course rather than being solely reserved for advanced end-stage disease. Clinical trial registration Clinical Trials Registry-India, CTRI/2019/12/022282. Keywords Castration-resistant prostate cancer • Prostate-specific membrane antigen • 177 Lu-PSMA-617 • Docetaxel • Randomized controlled trial • Non-inferiority This article is part of the Topical Collection on Oncology-Genitourinary

The Journal of Sexual Medicine, Jul 1, 2018

ics.org, Aug 23, 2010

Hypothesis / aims of study Voiding position has been reported to affect urine-flow volume relatio... more Hypothesis / aims of study Voiding position has been reported to affect urine-flow volume relations in healthy men as well as men with benign prostatic enlargement; however the existing literature is controvertial (1-3). It is important to assess, since it may have implications in proper interpretation of results of uroflowmetry and potentially management thereof. We assessed position-related changes in uroflowmetric parameters in men with symptomatic benign prostatic enlargement (BPE). Study design, materials and methods Men with symptomatic BPE were enrolled after written informed consent. Patients with other diseases affecting structure or function of lower urinary tract (e.g. Diabetes Mellitus, Parkinsonism, vertebral disc prolapse, urethral stricture, bladder cancer and prostate cancer) were excluded. They underwent uroflowmetry in standardized fashion using digital uroflowmeter (Solar Silver, MMS International, the Netherlands) once in each of the three voiding positions (standing, sitting and squatting). Postvoid residual urine was measured using abdominal ultrasound (profocus, BK medical, Denmark). Results and interpretation Total 17 men with mean (± SD) age 63.9 ± 7.1 years and body mass index 23.2 ± 4.4 kg/m 2 completed the study protocol. Their mean prostate volume was 33.0 ± 12.0 ml, mean international prostatic symptom score (IPSS) 22 ± 8, mean global quality of life index (QOL) 4.0 ± 0.8. IPSS and QOL had significant correlation with absolute and corrected flow rates; the relation was strongest with absolute average flow rate. There was no statistically significant difference in any uroflow parameter with respect to voiding position (table 1). Concluding message Voiding position does not affect uroflow parameters significantly in men with BPE. Average flow rates have stronger correlation with IPSS & QOL than maximal flow rates.

Indian Journal of Urology, 2011

We will provide journalists and editors with full-text copies of the articles in question prior t... more We will provide journalists and editors with full-text copies of the articles in question prior to the embargo date so that stories can be adequately researched and written. The standard embargo time is 12:01 AM ET on that date. Questions regarding embargo should be directed to

Journal of clinical interventional radiology isvir, Jan 11, 2022

Objective The purpose of this study was to report short-term outcomes of cryoablation of early-st... more Objective The purpose of this study was to report short-term outcomes of cryoablation of early-stage renal tumors (T1a and T1b) at a tertiary hospital in India. Methods This was a retrospective study of consecutive patients who underwent cryoablation for renal cell carcinoma (RCC) from November 2018 to June 2020. Cryoablation was performed under combined ultrasound and computed tomography guidance using a helium-argon cryoablation system. Tumor number, size, location, nephrometry score, relationship of the tumor with pelvicalyceal system, and adjacent organs were tabulated, and technical and clinical success evaluated. Early and late recurrence and complications were also assessed. Results Eleven patients (median age: 62 years) with 11 tumors underwent cryoablation. The mean tumor size was 2.58 cm (range: 1.62-5.62 cm) with 10 lesions being T1a and one lesion T1b. Tissue sampling was done in 9/11 patients, 3 were papillary RCC and the rest, clear cell RCC. In two patients, the tumor was completely endophytic, three patients had partially endophytic tumors while 6 patients had exophytic lesions. The median nephrometry score was 6 (range: 4-11, Mode 4). Technical success was achieved in all patients. Complete response was achieved in 81% (9/11) of the patients at 1-month follow-up. Median follow-up period was 6 months. Two patients showed residual disease on follow-up imaging at 1 and 3 months, respectively. Conclusion Cryoablation is a promising, relatively new minimally invasive therapy for treating small renal tumors in India. It is safe, technically feasible, and shows excellent short-term efficacy.

Annals of Oncology, Nov 1, 2017

Background: High endothelial venules (HEV) are present in lymph nodes and tertiary lymphoid organ... more Background: High endothelial venules (HEV) are present in lymph nodes and tertiary lymphoid organs. It has been reported that low HEV density is associated with the poor prognosis of several carcinomas. MECA-79 antibody recognizes L-selectin ligand (6sulfo sialyl Lewis X glycan) expressed in HEV. In the present study, we examined whether MECA79(þ) HEV density was associated with clinical outcomes of patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Methods: Eighty-eight patients with UTUC who underwent RNU at the Hirosaki University hospital between January 2008 and December 2016 were enrolled. Tissue microarray for MECA-79 was performed, and HEV densities were calculated. HEV density <1.5/mm 2 was defined as HEV(À);HEV density !1.5/mm 2 was defined as HEV(þ). Results: Of 88 patients, 64 (72.7%) were male and 24 (27.2%) were female. The average age was 68.5 years (range, 36-84 years). Fifty-three patients (60.2%) had previously undergone neoadjuvant chemotherapy. The mean observation period was 39.0 months. Twenty-one (23.8%) patients developed recurrence, whereas 16 (33.3%) patients died during follow-up. Five-year cause-specific survival (CSS) rate was 66.1%, and five-year disease-free survival (DFS) rate was 70.7%. In our cohort, 25 (28.4%) patients were found to be HEV(À), whereas 63 (71.5%) were found to be HEV(þ). The mean HEV density was 6.3/mm 2 (range, 0-41.6). The 5-year DFS rates for MECA79(þ) and MECA79(À) patients were 78.0% and 53.9%, respectively, with a statistically significant difference between the groups. (log-rank, p ¼ 0.042). Moreover, the 5-year CSS rates for MECA79(þ) and MECA79(À) patients were 72.5% and 53.4%, respectively, with a statistically significant difference between the groups. (log-rank, p ¼ 0.0036). Conclusions: Low MECA79(þ) HEV density may be associated with poor prognosis of patients with UTUC treated with RNU. Despite the small sample size and preliminary nature of our study, our study provides valuable insights to guide future research.

Indian Journal of Urology, 2020

Introduction: Penile fracture is a rare urological emergency, best managed by early surgical inte... more Introduction: Penile fracture is a rare urological emergency, best managed by early surgical intervention, but the data on subsequent sexual function is sparse. This study was designed to analyze the clinical spectrum and sexual function after penile fracture repair at our tertiary care center. Materials and Methods: Ambispective observational study was undertaken from July 2002 to August 2019 which included patients admitted with a history of trauma to the penis in the erect state. The clinical presentation, etiology and the details of the surgical management were noted. Patients were contacted telephonically and were called for follow-up. They were evaluated for the presence of penile nodules or curvature, and the erectile function was objectively recorded using the Sexual Health Inventory for Men (SHIM) questionnaire and the Erection Hardness Score (EHS). Results: Median age at injury was 37 years, and injury during the sexual intercourse (33/43) was the most common etiology. Five patients presented with blood at the meatus. Ultrasound was performed in 27 patients and could detect the injury with a 55% sensitivity. All but one case were repaired through a subcoronal degloving incision. At a median follow-up of 36 months, follow-up data of 20 patients were available. Of the 20 patients, 14 were sexually active. The mean SHIM score was 21.36 ± 1.33 and the mean EHS was 3.21 ± 0.43. Four of the 20 patients developed penile nodule while 2 of them had penile curvature which was not bothersome. Conclusion: Penile fracture remains primarily a clinical diagnosis. Although prompt diagnosis and an emergent surgical exploration provides good outcomes in terms of preservation of erectile function, patients should be apprised about the problems of penile nodule and curvature.

PubMed, Apr 20, 2019

“Ping”!! Everyone in today’s world, using a smartphone is familiar with this sound of the “meet” ... more “Ping”!! Everyone in today’s world, using a smartphone is familiar with this sound of the “meet” ringtone notification of WhatsApp. WhatsApp is a social media (SoMe) web-based smartphone application for messaging and has almost entirely replaced the erstwhile short messaging system (SMS).[1,2] The SMS service has now become only an in-built part of the smartphone, used exclusively for receiving one-time passwords for bill payments or financial transactions. WhatsApp had a user base of over 200 million in India, as of February 2017, and has emerged as an unparalleled messaging system across the country.[3]

BJUI, Mar 11, 2019

Lower urinary tract symptoms (LUTS) in a male patient may be due to benign prostatic hyperplasia ... more Lower urinary tract symptoms (LUTS) in a male patient may be due to benign prostatic hyperplasia (BPH-LUTS). In a routine clinical practice, BPH-LUTS is medically managed by Alphablockers (ABs) and add-on 5-alpha reductase inhibitors (5-ARIs). Epidemiological studies have shown an association of BPH-LUTS with erectile dysfunction (ED)[1]. Moreover, phosphodiesterase inhibitors (PDEIs) have shown to relieve LUTS in various studies and recently been approved by FDA for use in BPH-LUTS[2]. With increasing use of PDEI for this renewed indication, a systematic review of emerging evidence is needed to allow an overall assessment of the efficacy and safety of these agents.

Indian Journal of Urology, 2018

Nearly 50% patients with muscle invasive bladder cancer (T2-T4) die from their disease within 5 y... more Nearly 50% patients with muscle invasive bladder cancer (T2-T4) die from their disease within 5 years of diagnosis. [1,2] However, for patients with organ-confined node-negative disease, several serieshave shown excellent 5-and 10-year survival rates after radical cystectomy (RC). [3-6] With increasing experience, a considerable decrease in the mortality and morbidity has been noticed. Several advancements in the recent past have attempted to improve surgical morbidity and oncological outcomes in RC. These include application of minimally invasive surgeries (MIS), namely, laparoscopic and robot-assisted RC (RARC), extended lymphadenectomy templates, and neoadjuvant and adjuvant chemotherapy. [7,8] Although other parameters have shown to change the

Indian Journal of Urology

Introduction: Tadalafil and Tamsulosin have both been approved for use in the management of lower... more Introduction: Tadalafil and Tamsulosin have both been approved for use in the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). This study compared the differential effects of these two on BPH-LUTS using a cross over study design. Methods: Men ≥45 years of age, with an International Prostate Symptom Score (IPSS) ≥8 due to BPH-LUTS were included. The patients were randomized into sequence AB (tadalafil 10 mg OD followed by tamsulosin 0.4 mg OD) or BA in a double blind manner. All patients received a placebo lead-in period for 2 weeks, followed by an active drug for 6 weeks; placebo wash out for 4 weeks and then crossed over to second active drug for another 6 weeks. IPSS scores, Uroflowmetry parameters and International Index of Erectile Function-5 scores were recorded. Results: Out of the 40 patients, 36 completed the study. Demographic and baseline characteristics were comparable between the two groups (AB and BA). No significant placebo effects were observed. Tadalafil and tamsulosin significantly improved the total IPSS score and quality of life (P < 0.05) as compared to the baseline. However, there were no significant differences between the two drugs with respect to extent of observed effect and which drug was prescribed 1st in the sequence respectively (P > 0.05). Significant period effect was observed (P < 0.05) i.e., the symptoms did not return to the baseline before the second treatment. Half of the nonresponders to either of the drugs responded when the drug was changed to the other. Tadalafil showed better improvement in EF score as compared to Tamsulosin. Conclusion: Both Tadalafil and Tamsulosin improved LUTS and erectile function and those patients who did not respond to Tadalafil showed improvement with Tamsulosin and vice-a-versa.

Indian Journal of Urology

Indian Journal of Urology

Sushruta, in his Sushruta Samhita, has said, “A great surgeon is one who possesses courage and pr... more Sushruta, in his Sushruta Samhita, has said, “A great surgeon is one who possesses courage and presence of mind, a hand free from perspiration, tremor less grip of sharp and good instruments and who carries his operations to the success and advantage of his patient who has entrusted his life to the surgeon.”[1] The age-old teachings of Sushruta still hold true albeit for the fact that the hands of the surgeon are slowly being replaced by the tremor less grip of the robotic arms.

Journal of Postgraduate Medicine, Education and Research

ReseaRch aRTIcLe used as a reliable self-administrated scale for assessing HRQOL in patients with... more ReseaRch aRTIcLe used as a reliable self-administrated scale for assessing HRQOL in patients with PCa in both the clinical and research fields. Punnen et al. 6 conducted long-term HRQOL after primary treatment for LCaP: results from the CaPSURE registry. They showed that most IntroductIon Prostate cancer (PCa) remains one of the most common causes of cancer deaths in men worldwide. 1 Due to the location of the prostate gland and treatment nature which can range from surgery to radiotherapy (RT) to chemotherapy, men with PCa have side effects related to disease or treatment, which can affect health-related QOL (HRQOL). Further slow growth and progression make QOL improvement an important goal in PCa treatment. Studies have focused on QOL in specific issues, including sexual dysfunction, bowel changes, and urinary incontinence, which are therapy-related, or on discussing anxiety raised by prostate-specific antigen (PSA) screening. 2 Furthermore, where the number of options for treatment is many, the evaluation of QOL is important in decision-making 3 especially if alternative treatments produce similar efficacy results. The advanced PCa working group of the International Consortium for Health Outcomes Measurement suggested that patient-reported health status should be regularly evaluated in clinical practice. 4 This was despite recognizing the existence of logistic challenges. The FACT-P questionnaire is one such validated questionnaire in the evaluation of QOL in PCa Hong et al. 5 conducted FACT-P scales in men with PCa: reliability and validity of the Korean version and concluded that FACT-P could be

Journal of Robotic Surgery

The Journal of Urology, May 1, 2022

Urologic Oncology: Seminars and Original Investigations, 2022

OBJECTIVE To determine current practice patterns and adherence to various components of enhanced ... more OBJECTIVE To determine current practice patterns and adherence to various components of enhanced recovery after surgery in cystectomy (ERAC) protocol for peri-operative management of radical cystectomy patients through a global survey. METHODS A survey containing 25 questions and addressing 15 of the 22 items of the ERAC protocol was developed and disseminated through Email to the urologists with recent bladder cancer publications. The mailing list was generated by retrieving Email-ids of corresponding authors of articles using the keyword "cystectomy" in Scopus from January 2018 to October 2020. RESULTS The survey was completed by 443 respondents across the globe. About 51.5% of respondents used some form of bowel preparation. A minority used carbohydrate loading (29.8%) and Alvimopan (13.3%). A short duration of nil by mouth was practised by 28.9%. For antibiotic prophylaxis, 51.7% used one, and 42% used two antibiotics. Duration of antibiotics was 24 hours, 48 hours, and >48 hours for 47.6%, 16.9%, and 35.4%, respectively. For peri-operative analgesia, 43.6% used non-steroidal anti-inflammatory drugs, 9.3% opioids and 40.6% combination of both. Pharmacological thrombo-prophylaxis was routinely used by 74.7% respondents. There was significant variability in ERAC and non-ERAC components according to region of practice; The open surgical approach was most commonly used in Africa (92%), whereas it was the robotic approach in North America (or America?) (41%). The use of bowel preparation was higher in Asia (58%) and Africa (65%). Alvimopan use was more common in North America (58%). Most used 1 or 2 prophylactic antibiotics but the duration was shorter (<24 hours) in the Americas and European (58%-83%) compared to Asia and Africa (15%-35%). CONCLUSION There is high variability in the use of different ERAC components. Other than the timely removal of the abdominal drain and the use of thromboprophylaxis, the overall adherence of ERAC components is low.