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          Abstract

          SACRAL AGENESIS AND LOWER URINARY TRACT DYSFUNCTION Neurogenic bladder patients require lifelong care, but timely identification and intervention can help to prevent renal deterioration and provide excellent outcomes. Among neonates, obvious spinal cord defects are easily identified, but sacral agenesis may be occult and its association with neurogenic bladder is not well documented. Sinha et al.[1] in their study reported that children with sacral agenesis may also have neurogenic bladders that could lead to renal damage, similar to that seen in children with anorectal malformations. COMPARING NEPHROMETRY SCORES FOR NEPHRON SPARING SURGERY A number of nephrometry scores are available that characterize renal lesions before nephron-sparing surgery. These scores are variably used for predicting ease of surgery or complications. Interobserver variability is a concern with all such measures and Sharma et al.[2] compared three common scores, RENAL, PADUA, and centrality index (C-index), in a group of 50 patients prospectively. They concluded that although the C-index had the highest degree of correlation with surgical outcomes, it had the least amount of interobserver correlation and was difficult to apply in routine usage. LEARNING CURVE FOR ROBOTIC PARTIAL NEPHRECTOMY Partial nephrectomy is a relatively difficult laparoscopic surgery. One of the biggest benefits of robotic assistance in urology is the small learning curve, particularly for surgeons trained in laparoscopy. However, there is evidence of continued improvement over time even for surgeons with minimally invasive surgery experience. Dias et al.[3] evaluated 108 robot-assisted partial nephrectomies with warm ischemia time (WIT) as a surrogate marker for proficiency. It took surgeon 44 procedures to achieve a consistently low WIT and experience correlated with overall outcomes of the procedure. LATERAL PERCUTANEOUS NEPHROLITHOTOMY Percutaneous nephrolithotomy (PCNL) is one of the more common surgeries performed by urologists in Asia due to the high stone prevalence in this region. The prone position has been the standard approach for decades and continues to be the one most commonly employed. However, there are anesthetic issues with the prone position and this led to the exploration of supine PCNL as an option. The supine approach was hampered by limited renal access. The lateral approach aims to achieve the best of both approaches and in this large retrospective review of 347 cases, Gan et al.[4] reported a 83% clearance rate with relatively a few complications. SEMEN PARAMETER DECLINE OVERTIME Changes in male fertility and semen parameters have been a subject of debate in the literature and the lay media for a long time. Contradictory data exist on the semen parameters at various time periods in history. This report from Bangladesh looks at semen parameters at one fertility center over a period of 16 years.[5] It suggests that sperm motility has declined over time and the number of men with azoospermia has increased although the average sperm density has not changed. These data are based on a large number of subjects, but should be assessed with caution due to significant methodological lacunae that may be inherent to such a long retrospective study. ALPHA BLOCKERS IN PRIMARY BLADDER NECK OBSTRUCTION Although primary bladder neck obstruction is an uncommon entity, it is often diagnosed by exclusion in patients with clinical features of outflow obstruction but no obvious cause. Alpha blockers are frequently prescribed for such patients, based on the evidence and clinical experience of their use in benign prostatic hyperplasia. Sudrania et al.[6] presented urodynamic evidence of the benefit in a study of 21 men, strengthening the evidence for such use. NONUROTHELIAL BLADDER CANCER AND UPPER TRACT TUMORS Oncological outcomes derived from large public health databases have a number of inherent problems and biases. These include variability in diagnostic techniques, criteria, omissions, and coding among others. However, they serve an important source of information, particularly for uncommon diseases. The SEER database is one such resource that is frequently queried for large datasets. Patel et al.[7] evaluated the survival outcomes of bladder cancer and concluded that in comparison with transitional cell cancer, nonurothelial cancer other than adenocarcinomas have a poorer survival with 3-year disease-free survival being in the range of 35%. Another study looks at upper tract renal cancers in the National Cancer Data Base and reports that tumor size independently predicts survival.[8]

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          Most cited references 8

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          Oncologic outcomes in patients with nonurothelial bladder cancer

          Introduction: We aimed to evaluate the relative prognostic impact of the most common variant histologies on disease-specific survival (DSS) in patients undergoing radical cystectomy. Materials and Methods: The Surveillance, Epidemiology, and End Result database was used to identify patients who underwent radical cystectomy for bladder cancer from 1990 to 2007. Patients with urothelial cell carcinoma (UCC), squamous cell carcinoma (SCC), adenocarcinoma (AC), sarcoma, small cell carcinoma, signet ring carcinoma, and spindle cell carcinoma were included in the study. Multivariable analysis was performed using Cox proportional hazards model to assess independent predictors of disease-specific survival (DSS). Mortality rates were estimated using Kaplan–Meier analyses. Results: A total of 14,130 patients met inclusion criteria with the following histologies: UCC (90.1%), SCC (4.6%), AC, (2.3%), sarcoma (0.8%), small cell carcinoma (0.8%), signet ring carcinoma (0.5%), and spindle cell carcinoma (0.9%). Three-year DSS was most favorable in patients with UCC (63.7%; 95% confidence interval [62.9%–64.8%]) and AC (65.3% [59.3%–70.6%]), whereas 3-year DSS was the least favorable for small cell carcinoma (41.6% [31.3%–51.6%]) and sarcoma (45.4% [35.1%–55.1%]). In the multivariable analysis, independent predictors of DSS were age, marital status, grade, T-stage, N-stage, and variant histology. With respect to UCC, there was an increased risk of disease-specific death associated with all variants except AC. Sarcoma and spindle cell carcinoma were associated with the highest risk of death. Conclusions: With the exception of AC, the most common variant bladder cancer histologies are all independently associated with worse DSS relative to UCC in patients undergoing radical cystectomy.
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            Decline in semen parameters from 2000 to 2016 among Bangladeshi men attending a tertiary care hospital

            Introduction: The objective of this study was to analyze longitudinal changes in sperm parameters of Bangladeshi men. We hypothesized that semen parameters declined for this population. Methods: We retrospectively analyzed semen data from men aged 18-64 years who sought care for general sperm quality or updates on fertility status at an infertility clinic in Dhaka, Bangladesh, from January 2000 to June 2016 (n = 13,953). Samples with incomplete data were excluded (n = 143). The WHO normal criteria and semen analysis procedures were used to evaluate parameters of the remaining 13,810 specimens. Samples with missing values on sperm concentration (n = 6187) were excluded from concentration analyses. Age and duration of abstinence at testing were recorded and adjusted for. Data were imported into SAS® 9.4 statistical software. Temporal significance was investigated using one-way ANOVA for motility parameters and Chi-square test for raw concentration. Logistic regression analyzed the effects of confounders on azoospermia and raw concentration, while median regression modeling adjusted confounders for concentration, total motility, and rapid linear (RL) motility. Results: Age distribution was significantly correlated with annual parameter changes (concentration, total motility, and RL motility [P < 0.0001]). Adjusted total motility and RL motility declined by 20% from their maximum values to end of the study (P < 0.0001). Raw concentration lacked clear trends and was unaffected by adjustment. Azoospermia increased by 18% between the 2000–2010 and 2011–2016 participants (odds ratio = 0.16 [0.14–0.16]). Conclusion: In agreement with the hypothesis, Bangladeshi males attending this clinic have experienced decline in semen parameters (total motility and RL motility) and increased frequency of azoospermia.
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              Impact of learning curve on the perioperative outcomes following robot-assisted partial nephrectomy for renal tumors

              Introduction: Robot-assisted partial nephrectomy (RAPN) is an established, minimally invasive technique to treat patients with renal masses. The aim of this study was to assess the learning curve (LC) of RAPN, evaluate its impact on perioperative outcomes following RAPN and to study the role of surgeon experience in achieving “trifecta” outcomes following RAPN. Methods: We prospectively analyzed the clinical and pathological outcomes of 108 consecutive patients who underwent RAPN for renal tumors from January 2012 to December 2016 by a laparoscopy trained surgeon with no prior robotic experience. We used warm ischemia time (WIT) <20 min, operative time <120 min, and blood loss <100 ml as endpoints for plotting the LCs. Trifecta was analyzed in relation to our LC. Results: Surgeon experience was found to correlate with WIT, operative time, and blood loss. Overall 18.5% of patients developed complications. Complication rate reduced with increasing surgeon experience. LC was 44 cases for WIT ≤20 min, 44 cases for operative time <120 min, and 54 cases for blood loss <100 ml. Trifecta outcome was achieved in 67.6% patients overall and was found to correlate with increasing surgeon experience. Improvement in trifecta outcomes continued to occur beyond the LC. Conclusions: RAPN is a viable option for nephron-sparing surgery in patients with renal carcinoma. For a surgeon trained in laparoscopy, acceptable perioperative outcomes following RAPN can be achieved after an LC of about 44 cases. Increasing surgeon experience was associated with improved “trifecta” achievement following RAPN.
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                Author and article information

                Journal
                Indian J Urol
                Indian J Urol
                IJU
                Indian Journal of Urology : IJU : Journal of the Urological Society of India
                Medknow Publications & Media Pvt Ltd (India )
                0970-1591
                1998-3824
                Jan-Mar 2018
                : 34
                : 1
                : 7-8
                Affiliations
                Editor, Indian Journal of Urology, All India Institute of Medical Sciences, New Delhi, India
                Author notes
                Article
                IJU-34-7
                10.4103/iju.IJU_349_17
                5769254
                Copyright: © 2017 Indian Journal of Urology

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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                Urology

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