Urethral calculi are uncommon diagnoses. Large urethral stones with peculiar shapes have been rep... more Urethral calculi are uncommon diagnoses. Large urethral stones with peculiar shapes have been reported. Management of such large stones depends upon size, shape, position, and associated abnormality of the urethra. We present a case of dumbbell-shaped large calculus secondary to bulbar urethral stricture. The patient was managed with Suprapubic cystotomy and antibiotics. Retrograde-urethrogram and micturating cystourethrogram showed bulbar urethral stricture. Trans vesical removal of stone was attempted; however, lower part of the calculus was impacted. Perineal retrieval of the calculus was done, followed by stage 1 urethroplasty with perineal urethrostomy. After three months, stage 2 urethroplasty was done.
Recent Advances in Biology and Medicine, Sep 30, 2021
Priapism is an uncommon urological emergency. Drugs are known causes of priapism. Self-medication... more Priapism is an uncommon urological emergency. Drugs are known causes of priapism. Self-medication and use of over-the-counter drugs are very common in India. Withania somnifera is common over the counter herb used in India for anxiety, depression, boosting immunity, infertility, etc. Despite the unprohibited and over-the-counter use of drug, the efficacy and adverse events data are not available. We report a patient of anxiety and depression self-medicating with W. somnifera and multivitamins presenting with ischemic priapism.
Enterovesical fistula due to primary small intestinal non-Hodgkin lymphoma is an uncommon occurre... more Enterovesical fistula due to primary small intestinal non-Hodgkin lymphoma is an uncommon occurrence and only few cases have been reported. It presents with predominant lower urinary tract symptoms. Diagnosis is mainly clinical; although cystoscopy, CT cystography and colonoscopy may identify the anatomical site of fistula. Surgery plus chemotherapy are the preferred treatment options; however in case of small fistula, chemotherapy alone may heal the fistula. Authors present a case of 58 years woman, who presented with pneumaturia, fecaluria and recurrent lower urinary tract symptoms. Clinical suspicion of enterovesical fistula was confirmed on cystoscopy and CT cystography. Right hemicolectomy and partial cystectomy were done for her. She had an uneventful recovery. Histopathology and immunohistochemistry suggested Diffuse large cell B cell Lymphoma. She was advised adjuvant chemotherapy and follow up.
Introduction: Spontaneous extravasation of urine due to High Pressure Chronic Retention is a rare... more Introduction: Spontaneous extravasation of urine due to High Pressure Chronic Retention is a rare entity. Most cases of urinoma are secondary to ureteric calculi. We present a case of left spontaneous perinephric urinoma with right hydroureteronephrosis with high pressure chronic retentiondue to benign enlargement of prostate. Summary: A 70 years male, with no comorbid illness, presented with left flank pain with overflow incontinence. On radiological evaluation, he was found to have distended urinary bladder, with right hydrouretronephrosis and left perinephric collection. Renal function tests were deranged. Patient was managed with per urethral catheter placement, antibiotics and ultrasound guided aspiration. Retention volume was more than one litre. Creatinine content of aspirated fluid was ten times higher to serum creatinine. Transurethral resection of prostate was done. The patient voided well after surgery. The urinoma resolved completely in 2 weeks. Follow up Contrast study ...
The unremitting COVID-19 pandemic is evoking anxiety, fear, panic, and socio-occupational stress ... more The unremitting COVID-19 pandemic is evoking anxiety, fear, panic, and socio-occupational stress among human population all around the globe. This cross-sectional study was planned to assess the fear and anxiety because of COVID-19 pandemic among health care professionals, patients, and general public in IGMC, Shimla. A cross-sectional, web-based survey was conducted in month of December 2020. COVID-19 fear questionnaire was used to assess fear among participants. A total of 162 responses were received. Ninety-five (41.35%) respondents were males and 67(58.64%) were females. Average total score of COVID-19 fear based on questionnaire was 17.71 among the participants. The majority of respondents 67(41.4%) were afraid of COVID-19, 53(32.7%) were neutral, whereas 42 (25.9%) were not afraid of COVID-19. Sixty-two (38.3%) responders were uncomfortable thinking about COVID-19, whereas, 67(41.4%) were not uncomfortable. Only 22 (13.6%) participants felt their hands clammy when they thought...
A trapped penile ring is a urological emergency rarely seen. An impacted ring in penis is a real ... more A trapped penile ring is a urological emergency rarely seen. An impacted ring in penis is a real emergency uncommonly faced by a urologist. Emergent removal of the penile ring is indicated to prevent gangrene and damage to the penis. The insertion of these rings for autoerotic purposes is not uncommon. However, this can lead to impacted, stuck articles, rings in the penis. These patients present with symptoms ranging from mild penile pain, swelling to gangrenous changes in the penis. The removal of ring constricting penis is a penile-saving procedure. We describe a patient with a stuck ring in the penis and the technique of removal of the impacted penile ring by a household device plier. In case of emergency, the pliers are a useful tool for removing a strangulating penile ring
Priapism is an uncommon urological emergency. Drugs are known causes of priapism. Self-medication... more Priapism is an uncommon urological emergency. Drugs are known causes of priapism. Self-medication and use of over-the-counter drugs are very common in India. Withania somnifera is common over the counter herb used in India for anxiety, depression, boosting immunity, infertility, etc. Despite the unprohibited and over-the-counter use of drug, the efficacy and adverse events data are not available. We report a patient of anxiety and depression self-medicating with W. somnifera and multivitamins presenting with ischemic priapism.
Inverted papilloma is a benign, non-invasive and innoxious bladder tumour rarely seen. These tumo... more Inverted papilloma is a benign, non-invasive and innoxious bladder tumour rarely seen. These tumours are associated with chronic urinary tract infection, bladder neck obstruction, and they appear similar to other bladder tumours. Inverted papilloma is diagnosed on histopathological examination. We report a case of inverted papilloma who presented and appeared as bladder tumour but on subsequent pathological examination diagnosed as inverted papilloma. Keywords: Inverted papilloma; Benign; TCC (Transitional cell carcinoma); PUNLMP (Papillary urothelial neoplasm of low malignant Potential)
Background: Between 05 to 20 percent of patients undergoing cholecystectomy for gallstones, have ... more Background: Between 05 to 20 percent of patients undergoing cholecystectomy for gallstones, have choledocholithiasis. Treatment of the common bile duct (CBD) stones can be conducted as open cholecystectomy and open CBD exploration or laparoscopic cholecystectomy plus laparoscopic CBD exploration (LC + LCBDE) versus pre- or post-cholecystectomy endoscopic retrograde cholangiopancreatography (ERCP) in two stages, usually combined with either sphincterotomy or sphincteroplasty (papillary dilatation) for CBD clearance. The merits and demerits of individual techniques are yet to be settled.Methods: We reviewed the outcome of patients operated at our centre after failed endoscopic clearance of CBD stones. Over a period of 03 years, total 2145 laparoscopic/open cholecystectomies were performed at our institute. In the same time period, 14 patients (06 males and 08 females) presented with choledocholithiasis after failed ERCP extraction (median age 59 years, range 29-62 years). All the pati...
DJ stent is a routine procedure performed by a urologist. DJ stents are forgotten when instructio... more DJ stent is a routine procedure performed by a urologist. DJ stents are forgotten when instructions are not given properly, illiteracy, ignorance, increased patient load in the clinic. Forgotten DJ stent associated with complications i.e., recurrent urinary tract infections, stone formation, fragmentation, migration, obstructive uropathy, hematuria, deterioration in renal function, urosepsis. Management of these forgotten DJ stents depends upon complications. Antibiotics manage encrusted DJ stents, ESWL or PCNL for the upper end, cystolithotripsy or cystolithotripsy, ureteroscopy for lower end. We describe the management of forgotten DJ stents in 3 patients.
Urethral calculi are uncommon diagnoses. Large urethral stones with peculiar shapes have been rep... more Urethral calculi are uncommon diagnoses. Large urethral stones with peculiar shapes have been reported. Management of such large stones depends upon size, shape, position, and associated abnormality of the urethra. We present a case of dumbbell-shaped large calculus secondary to bulbar urethral stricture. The patient was managed with Suprapubic cystotomy and antibiotics. Retrograde-urethrogram and micturating cystourethrogram showed bulbar urethral stricture. Trans vesical removal of stone was attempted; however, lower part of the calculus was impacted. Perineal retrieval of the calculus was done, followed by stage 1 urethroplasty with perineal urethrostomy. After three months, stage 2 urethroplasty was done.
Recent Advances in Biology and Medicine, Sep 30, 2021
Priapism is an uncommon urological emergency. Drugs are known causes of priapism. Self-medication... more Priapism is an uncommon urological emergency. Drugs are known causes of priapism. Self-medication and use of over-the-counter drugs are very common in India. Withania somnifera is common over the counter herb used in India for anxiety, depression, boosting immunity, infertility, etc. Despite the unprohibited and over-the-counter use of drug, the efficacy and adverse events data are not available. We report a patient of anxiety and depression self-medicating with W. somnifera and multivitamins presenting with ischemic priapism.
Enterovesical fistula due to primary small intestinal non-Hodgkin lymphoma is an uncommon occurre... more Enterovesical fistula due to primary small intestinal non-Hodgkin lymphoma is an uncommon occurrence and only few cases have been reported. It presents with predominant lower urinary tract symptoms. Diagnosis is mainly clinical; although cystoscopy, CT cystography and colonoscopy may identify the anatomical site of fistula. Surgery plus chemotherapy are the preferred treatment options; however in case of small fistula, chemotherapy alone may heal the fistula. Authors present a case of 58 years woman, who presented with pneumaturia, fecaluria and recurrent lower urinary tract symptoms. Clinical suspicion of enterovesical fistula was confirmed on cystoscopy and CT cystography. Right hemicolectomy and partial cystectomy were done for her. She had an uneventful recovery. Histopathology and immunohistochemistry suggested Diffuse large cell B cell Lymphoma. She was advised adjuvant chemotherapy and follow up.
Introduction: Spontaneous extravasation of urine due to High Pressure Chronic Retention is a rare... more Introduction: Spontaneous extravasation of urine due to High Pressure Chronic Retention is a rare entity. Most cases of urinoma are secondary to ureteric calculi. We present a case of left spontaneous perinephric urinoma with right hydroureteronephrosis with high pressure chronic retentiondue to benign enlargement of prostate. Summary: A 70 years male, with no comorbid illness, presented with left flank pain with overflow incontinence. On radiological evaluation, he was found to have distended urinary bladder, with right hydrouretronephrosis and left perinephric collection. Renal function tests were deranged. Patient was managed with per urethral catheter placement, antibiotics and ultrasound guided aspiration. Retention volume was more than one litre. Creatinine content of aspirated fluid was ten times higher to serum creatinine. Transurethral resection of prostate was done. The patient voided well after surgery. The urinoma resolved completely in 2 weeks. Follow up Contrast study ...
The unremitting COVID-19 pandemic is evoking anxiety, fear, panic, and socio-occupational stress ... more The unremitting COVID-19 pandemic is evoking anxiety, fear, panic, and socio-occupational stress among human population all around the globe. This cross-sectional study was planned to assess the fear and anxiety because of COVID-19 pandemic among health care professionals, patients, and general public in IGMC, Shimla. A cross-sectional, web-based survey was conducted in month of December 2020. COVID-19 fear questionnaire was used to assess fear among participants. A total of 162 responses were received. Ninety-five (41.35%) respondents were males and 67(58.64%) were females. Average total score of COVID-19 fear based on questionnaire was 17.71 among the participants. The majority of respondents 67(41.4%) were afraid of COVID-19, 53(32.7%) were neutral, whereas 42 (25.9%) were not afraid of COVID-19. Sixty-two (38.3%) responders were uncomfortable thinking about COVID-19, whereas, 67(41.4%) were not uncomfortable. Only 22 (13.6%) participants felt their hands clammy when they thought...
A trapped penile ring is a urological emergency rarely seen. An impacted ring in penis is a real ... more A trapped penile ring is a urological emergency rarely seen. An impacted ring in penis is a real emergency uncommonly faced by a urologist. Emergent removal of the penile ring is indicated to prevent gangrene and damage to the penis. The insertion of these rings for autoerotic purposes is not uncommon. However, this can lead to impacted, stuck articles, rings in the penis. These patients present with symptoms ranging from mild penile pain, swelling to gangrenous changes in the penis. The removal of ring constricting penis is a penile-saving procedure. We describe a patient with a stuck ring in the penis and the technique of removal of the impacted penile ring by a household device plier. In case of emergency, the pliers are a useful tool for removing a strangulating penile ring
Priapism is an uncommon urological emergency. Drugs are known causes of priapism. Self-medication... more Priapism is an uncommon urological emergency. Drugs are known causes of priapism. Self-medication and use of over-the-counter drugs are very common in India. Withania somnifera is common over the counter herb used in India for anxiety, depression, boosting immunity, infertility, etc. Despite the unprohibited and over-the-counter use of drug, the efficacy and adverse events data are not available. We report a patient of anxiety and depression self-medicating with W. somnifera and multivitamins presenting with ischemic priapism.
Inverted papilloma is a benign, non-invasive and innoxious bladder tumour rarely seen. These tumo... more Inverted papilloma is a benign, non-invasive and innoxious bladder tumour rarely seen. These tumours are associated with chronic urinary tract infection, bladder neck obstruction, and they appear similar to other bladder tumours. Inverted papilloma is diagnosed on histopathological examination. We report a case of inverted papilloma who presented and appeared as bladder tumour but on subsequent pathological examination diagnosed as inverted papilloma. Keywords: Inverted papilloma; Benign; TCC (Transitional cell carcinoma); PUNLMP (Papillary urothelial neoplasm of low malignant Potential)
Background: Between 05 to 20 percent of patients undergoing cholecystectomy for gallstones, have ... more Background: Between 05 to 20 percent of patients undergoing cholecystectomy for gallstones, have choledocholithiasis. Treatment of the common bile duct (CBD) stones can be conducted as open cholecystectomy and open CBD exploration or laparoscopic cholecystectomy plus laparoscopic CBD exploration (LC + LCBDE) versus pre- or post-cholecystectomy endoscopic retrograde cholangiopancreatography (ERCP) in two stages, usually combined with either sphincterotomy or sphincteroplasty (papillary dilatation) for CBD clearance. The merits and demerits of individual techniques are yet to be settled.Methods: We reviewed the outcome of patients operated at our centre after failed endoscopic clearance of CBD stones. Over a period of 03 years, total 2145 laparoscopic/open cholecystectomies were performed at our institute. In the same time period, 14 patients (06 males and 08 females) presented with choledocholithiasis after failed ERCP extraction (median age 59 years, range 29-62 years). All the pati...
DJ stent is a routine procedure performed by a urologist. DJ stents are forgotten when instructio... more DJ stent is a routine procedure performed by a urologist. DJ stents are forgotten when instructions are not given properly, illiteracy, ignorance, increased patient load in the clinic. Forgotten DJ stent associated with complications i.e., recurrent urinary tract infections, stone formation, fragmentation, migration, obstructive uropathy, hematuria, deterioration in renal function, urosepsis. Management of these forgotten DJ stents depends upon complications. Antibiotics manage encrusted DJ stents, ESWL or PCNL for the upper end, cystolithotripsy or cystolithotripsy, ureteroscopy for lower end. We describe the management of forgotten DJ stents in 3 patients.
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