Background:Testicular torsion is one of the causes of acute scrotum and it requires timely evaluation and surgical treatment. Color Doppler is considered investigation of choice, but it may delay treatment, as, many times, it may not be available for emergency situations. Barbosa et al. created Testicular Workup for Ischemia and Suspected Torsion (TWIST) score based on clinical parameters for clinical diagnosis of testicular torsion. We have evaluated this score in our population.Materials and Methods:We retrospectively calculated TWIST score in patients of acute scrotum admitted to tertiary teaching institute. Patients without complete TWIST score were excluded from the study. The scoring system consisted of testicular swelling (2 points), hard testicle (2), absent cremasteric reflex (1), nausea/vomiting (1), and high-riding testis (1). Statistical analysis was done to evaluate the validity of scores.Results:A total of 118 patients were included in the study, out of which 45 (38%) patients had testicular torsion. The mean age of patients was 16.6 years in testicular torsion patients and 15.2 years in other patients. Cutoff for low-risk and high-risk patients was two and five, respectively. Fifty percent, 26.2%, and 23.8% of patients were present in low-, intermediate-, and high-risk groups. Negative predictive value of TWIST score for low-risk patients was 96.61% while positive predictive value for high-risk patients was 92.86%.Conclusions:TWIST score has high predictive value and can be used for clinical diagnosis of testicular torsion. It can decrease the need of color Doppler in about 50% of cases and can prevent delay in treatment.

Both Doppler-guided hemorrhoidal artery ligation (DG-HAL) and infrared coagulation (IRC) are well-established techniques in the management of hemorrhoids. The aim of the study is to compare the clinical outcomes of DG-HAL and IRC in the patients with grade 1 and 2 hemorrhoids. A total of 296 patients were registered for the study, but 51 patients were lost in follow-up; hence, finally 245 patients were included in the analysis. Patients were randomized into two groups (mean age, 42 years; range, 19-60 years). Group A (n0116) was treated with DG-HAL and group B (n0129) was treated with IRC. Patients were examined at 1 week, 1 month, and 6 months after the procedure. Mean time taken for HAL was 21 min and for IRC, 12 min. The cost of the DG-HAL procedure was 1,440 rupees ($31.53) and that of IRC was 376 rupees ($8). The mean duration of hospital stay after HAL was 6 h and after IRC, 2 h. Control of symptoms with HAL was 96 %, whereas with IRC, 81 %. Postoperative complication rate for HAL was 2 %, whereas for IRC, 13 %. Requirement of repeat procedure with HAL was 9 % and with IRC, 28 %. Both the procedures are minimally invasive, associated with minimal discomfort, and suitable for day care surgery. IRC requires lesser procedure time, lesser postoperative hospital stay, and has lower procedure cost, whereas DG-HAL is more effective in controlling symptoms of hemorrhoids, has lower post operative complication rate, and has lesser requirement of repeat procedure.

Introduction: The word “simple” means “easily done” or “presenting no difficulty.” Hence, the “Simple Nephrectomy” (SN) operation should be “easy to perform.” However, in clinical practice, we have noticed that SN can be equally or more challenging surgery than radical nephrectomy (RN). This study assesses the need to modify the terminology of simple nephrectomy and identify the level of difficulty between SN and RN by comparing various intraoperative and postoperative factors. Methods: Patients undergoing open SN for benign renal disease (Group A) and RN for T1/2 renal tumors (Group B) were included in the study. Two groups were compared for operative time, estimated blood loss, postoperative complications, blood transfusion rate, and length of hospital stay. Results: A total of 114 patients were analyzed (82 in Group A and 32 in Group B). Mean age of the patients was higher in Group B (41.2 vs 53.6 years, P < 0.01). Mean operative time (136.8 vs 125.5 min, P = 0.08), incidence of postoperative complications (32.9% vs 25%, P = 0.50), length of hospital stay (7.2 vs 6.5 days, P = 0.09), estimated blood loss more than 500 ml (13.4% vs 9.3%, P = 0.75), and requirement of blood transfusion (10.9% vs 6.2%, P = 0.72) were higher in group A. Conclusion: The application of correct terminology is important to understand the subject and to convey the information. Simple nephrectomy is not an appropriate term as it is equally challenging to perform than its radical counterpart.

BACKGROUND Hyaluronidase instillation during OIU may decrease the incidence of urethral stricture recurrence. 13 The exact mechanism is not known in urethral stricture, but it is used as antifibrotic agent in hypertrophic scar, keloid, and pulmonary fibrosis. Intralesional injection decreases fibroblast proliferation, collagen, and glycosaminoglycan synthesis and suppresses proinflammatory mediators in wound healing process. 14 This study was conducted to see the benefits of HA for preventing recurrence of anterior urethral stricture after urethrotomy. METHODS After obtaining the clearance from ethical committee, 70 patients satisfying the inclusion criteria were recruited & randomly divided into 2 groups: Group A (35 patients, experimental group) received hyaluronic acid (HA) instillation & Group B (35 patients, Control group) received lubricant lignocaine after EIU. Each patient was evaluated at 4 weeks (V1), 12 weeks (V2), & 24 weeks (V3) after surgery. The recurrence rate was evaluated by protocol analysis based on number of patients who completed the study. Preoperative characteristics, including the site & length of urethral stricture, were evaluated by intent-to-treat analysis. RESULTS Among 70 patients, only 30 patients in group A & 30 patients in group B had completed the study. Significant improvement noted in both groups after surgery in every parameter with recurrence in Group A 9.43% & in Group B 22.92% (p <0.05) at V3.