Objectives: We conducted this study to compare the safety and efficacy of transurethral resection of the prostate (TURP) and holmium laser prostatectomy. Methods: A total of 30 patients eligible for surgery for symptomatic benign prostatic hyperplasia were included in the study. They were randomized into two groups of 15 each. The patients were evaluated at 3 weeks, 3 and 9 months. Results: Preoperative parameters were comparable between the 2 groups. The mean operative time was longer in the holmium laser enucleation of prostate (HoLEP) group (53 ± 9.84 vs. 43 ± 9.36 min; p = 0.001). The intraoperative adverse events were comparable. The mean traction time (26.80 ± 5.9 vs. 19.60 ± 3.6 h; p = 0.0001), irrigation time (30 ± 7.68 vs. 19.40 ± 1.15 h; p = 0.0001), and duration of indwelling catheter (78.20 ± 17.84 vs. 46.42 ± 14.25 h; p = 0.0001) were significantly less in the HoLEP group as compared to the TURP group. Two patients (13.66%) in the TURP group had significant hematuria. Two patients in the HoLEP group vs. none in the TURP group developed urinary incontinence (p < 0.05). Significant improvements were observed in IPSS score, PFRs and PVRs in both the groups and maintained at 9 months. Conclusions: HoLEP is safe and effective in the surgical management of benign prostatic hyperplasia, with the advantage of reduced intraoperative hemorrhage and perioperative morbidity.

We present a case of bicornuate uterine horns with complete cervico-vaginal agenesis and associated congenital uterovaginal fistula. The patient presented with cyclical hematuria, amenorrhea, and abdominal lump. The vagina was blind-ending. The cystoscopic examination during cyclical hematuria revealed bloody efflux through a small fistula on the posterior wall of the urinary bladder. The magnetic resonance imaging (MRI) showed bicornuate uterus and cervical agenesis. Hysterectomy and repair of the uterovesical fistula was done. The vagina was reconstructed using an amniotic mould. The report underlies the importance of MRI in diagnosing complexity of such rare anomalies. It also stresses for the need of hysterectomy if cervicovaginal agenesis is present.

Purpose Buccal mucosa graft (BMG) is long used as favoured substitute by most reconstructive surgeons for substitution urethroplasty (SU). Though inner preputial skin graft (IPG) was described even earlier than BMG, its usage lately has fallen out of favour. The aim of the study was to evaluate the outcome of a SU with IPG from a tertiary care centre. Methods A retrospective analysis of prospectively maintained clinical data was conducted at our tertiary care centre enrolling 80 patients with anterior urethral stricture from January 2015 to January 2018. Patients were evaluated for the aetiology, length and site of the urethral stricture. All patients underwent dorsolateral SU with IPG. Post-operative assessment including uroflowmetry and sexual outcomes using IIEF and MSHQ-EJD questionnaires was done at 3 weeks, 3 months, 12 months and half-yearly thereafter. Success was defined by the stable maximum urinary flow value > 14 ml/s or urethral calibration with 16 French Foley catheter. Results Mean age of patients was 40 years (18-69). The most common aetiology was post-instrumentation (65%) and 60% had stricture at penobulbar site. Mean stricture length was 65 mm. At a mean follow-up of 48 months (range 30-66 months), successful outcomes were seen in 69/80 (87%). Patients with failure were managed with optical internal urethrotomy (OIU). Uroflowmetry and obstructive symptoms significantly improved and sexual function remained unaffected using IPG for SU. Conclusions Preputial graft is a tissue familiar to the urologist, located very close to the surgical field, easily harvested and operated under regional anaesthesia. Overall success outcomes are acceptable to BMG urethroplasty.

Dear Editor, The article by Barry et al. [1] is a nicely conducted multicenter randomized study from Australia, which further establishes the efficacy of transobturator approach (TO) of tension-free midurethral slings in the management of stress urinary incontinence (SUI), comparable to suprapubic tension-free vaginal tape (TVT-SP) at least in short term (objective and subjective success rates; 82.8 vs 78%, p= 0.51, and 84.2 vs 85.4%, p=0.66, respectively). It also establishes the safety advantage of this approach over the suprapubic counterpart with regards to bladder perforation (0 vs 8.5%, p<0.05), blood loss (49 vs 64 ml, p<0.05), and operative time (14.6 vs 18.5 min, p<0.001). However, while one can be assured of utilizing this approach with impunity in most of the cases of SUI, there are certain important issues to be addressed in a given individual case before embarking onto any approach for a successful outcome.Since the successful inception of pubovaginal sling more than a century ago, a lot of research has been undertaken towards improving the understanding of continence mechanisms in women. The focus has shifted from the bladder neck to the midurethra; DeLancey's hammock hypothesis emphasized the importance of pubourethral ligaments in maintaining the continence, and lately Petros and Ulmstein proposed the "midurethra theory" elucidating the role of weakening of pubococcygeus muscle in addition of the former [2]. These theories have led to the development of TVTs placed at midurethral level by suprapubic, transobturator, or prepubic routes. The former has been proven to be highly efficacious over long term (85-92% success rate), which is equivalent to pubovaginal sling and superior to colposuspension, both in primary as well as in recurrent SUI [3]. Various single-armed clinical studies and randomized controlled trials have proven the efficacy, although short term, of transobturator tape procedure as well, with the added advantage of lower incidence of side effects, e.g., bladder perforation, postoperative voiding dysfunction, and early return to work.Despite the shift of the focus from bladder neck to midurethra, intrinsic sphincter deficiency (ISD) remains one of the important pathophysiological mechanisms underlying SUI, and some degree of ISD is present in most of the patients. Significant ISD is found in only a small percentage of patients and is usually associated with highgrade incontinence. There is still no consensus on the urodynamic definition of ISD and measures like maximal urethral closure pressure (MUCP) less than 20-30 cmH 2 O and Valsalva leak point pressure (VLPP) <60 cmH 2 O have been used for definition. There is only moderate correlation between the two parameters, and they are described to represent weakness at different levels: MUCP at midurethra and VLPP at bladder neck. Studies on TVT-SP have failed to demonstrate a significant effect of either of the parameters on the surgical results; however, a combination of both, along with absence of a significant hypermobility, has show...

<b><i>Objective:</i></b> To evaluate the urodynamic outcomes of transurethral resection of the prostate (TURP) in patients of benign prostatic enlargement (BPE) with upper urinary tract dilatation and correlate with International Prostate Symptoms Score (I-PSS). <b><i>Methods:</i></b> In this prospective study, patients of BPE with upper urinary tract dilatation from July 2017 to June 2019 were enrolled. At presentation, detailed I-PSS, ultrasonography abdomen, serum creatinine, and serum PSA were recorded. All the patients were catheterized and observed for postobstructive diuresis. At 4 weeks, repeat ultrasound and serum creatinine were recorded. Urodynamic study (UDS) was performed after ensuring sterile urine culture. Patients underwent TURP as per the standard technique. A repeat UDS was performed after 3 months, and analysis was done. <b><i>Results:</i></b> Forty-four patients were enrolled of which data of 37 patients were analyzed. In the filling phase of the UDS, there was a significant decrease in detrusor pressure at the end filling phase from 27 to 9.0 cm H₂O after TURP. Maximum cystometric capacity and bladder compliance significantly improved at 3 months following surgery. In the voiding phase, peak flow rate showed a significant increase, postvoid residual urine volume significantly decreased, and peak detrusor pressure marginally decreased following TURP. The I-PSS decreased from 20 ± 8 to 5 ± 6 following TURP. <b><i>Conclusion:</i></b> High detrusor pressure and reduced compliance is a risk factor for upper urinary tract dilatation. Changes in the bladder dynamics and resolution of hydronephrosis following TURP reflected in the changes in urodynamic parameters and I-PSS.

Objective: The aim of this study was to compare the uroflowmetric parameters in 3 different voiding positions before initial treatment for LUTS, compare position specific uroflowmetric parameters before & after treatment & to compare IPSS/AUA symptom index with study questionnaire(PGIMER questionnaire) before & after treatment for LUTS. Material & methods: In total , 91 patients with symptomatic BPH were enrolled in this prospective controlled trial. The IPSS/AUA score was > 7/35 & QOL was >2/6. Patients were divided into 2 groups i.e. one who did not receive any medical treatment for BPH & others who were treated with alpha blockers. But the drug was discontinued for atleast 15d before taking baseline measurements. The participants were asked to fill the IPSS/AUA questionnaire & study questionnaire(which we have named as PGIMER Questionnaire) on 2 occasions i.e. before starting treatment & 6W after treatment. Uroflowmetry & post void residual urine was checked in all 3 positions i.e. standing, sitting & squatting position both before & 6W after treatment. Results: In total, 91 patients were studied. There was no significant difference(p>0.005) in uroflowmetric parameters in various voiding positions both before & after treatment. Before treatment, strong correlation was found between IPSS voiding with PGIMER questionnaire voiding & moderate correlation between IPSS storage & PGIMER questionnaire storage symptom score. QOL in IPSS was moderately correlated with PGIMER questionnaire. After treatment, IPSS voiding score was strongly correlated with PGIMER voiding score & weakly correlation of IPSS storage & PGIMER questionnaire storage was found. QOL in IPSS was weakly correlated with PGIMER questionnaire. Conclusion: There was no significant difference in uroflowmetric parameters in different voiding positions. Alpha blockers significantly improved the patient's symptom score & global QOL index. The PGIMER questionnaire showed significant correlation with IPSS questionnaire.

had smooth recovery and voided with a better stream. Histopathology revealed unusual cystic mixed epithelial and stromal tumour.CONCLUSIONS: Meticulous dissection in laparoscopy is essential for a complete removal of seminal vesicle cyst.

No abstract