BACKGROUND Ureteric and bladder injury is a serious concern during pelvic surgery and represents one of the most dreaded complications during gynaecologic operations with an overall incidence ranging from 0.5% to almost 30%. The rate of ureteral injury is increased when technically demanding laparoscopic and radical pelvic surgeries. Aims and Objectives-To study the incidence of ureter and bladder injuries detected intraoperatively/ postoperatively following pelvic surgeries in the gynaecology and oncology departments of our institution. This study describes our experience in the management of ureteric/ bladder injuries following pelvic operations and outcome of management of this condition in our local setting. MATERIALS AND METHODS This is a retrospective descriptive study of patients with iatrogenic injuries to the ureter and bladder following pelvic surgeries that were managed in our department from June 2016 to January 2018. Analysis of the patient's diagnosis, indication for surgery, type of surgery, time at diagnosis of injury, presenting features and the type of management was done. RESULTS A total of 9 ureteric injuries and 6 bladder injuries were identified out of 293 pelvic surgeries performed in the study period. All bladder injuries were diagnosed and managed intraoperatively. 80% of ureteric injuries were diagnosed postoperatively with fever, flank pain and leakage of urine being the most common presentation. Duration of symptoms ranged from immediate post-op period to up to 6 months after surgery. 45% were diagnosed with ureteric stricture, 33% with ureterovaginal fistula and 22% were diagnosed intraoperatively. Incidence of ureteric injuries in simple hysterectomy for benign causes was 1.8% and for Wertheim's hysterectomy for malignancy was 6%. Incidence of ureteric injuries following laparoscopic hysterectomy was 7%. Ureteric injury following APR was found to be 7%. We performed ureteroneocystostomy for 4 cases, Boari flap for 2 cases, transureteroureterostomy in 1 case, nephrectomy in 1 case and ureterocolonic anastomosis in 1 patient. Postoperative complications observed were surgical site infection in 33% and urosepsis in 11% of patients. Mortality was nil. CONCLUSION Laparoscopic and Wertheim's hysterectomy were most commonly associated with ureteric injuries. Meticulous surgical technique as well as identification of the course of the ureter and associated anatomic locations where injury is most likely to occur is important to decrease the risk of ureteric injury. Timely recognition of ureteric injury and its management is associated with good outcome.
BACKGROUNDThe current diagnostic approach for prostate cancer-PSA and digital rectal examination followed by transrectal ultrasound biopsies lack both sensitivity and specificity and offer only limited information about the aggressiveness and stage. Recent scientific work supports the rapidly growing use of multiparametric magnetic resonance imaging (MP-MRI) as the most sensitive and specific imaging tool for detection, lesion characterisation and staging of prostate cancer. Its use may improve many aspects of prostate cancer management from initial detection of significant tumours using MP-MRI-guided biopsies for evaluation of biological aggressiveness and accurate staging which can facilitate appropriate treatment selection. Aims and Objectives-To study the relationship between MR spectroscopy and prostate fusion biopsy in carcinoma prostate. MATERIALS AND METHODSThe study was conducted on 30 patients, who attended Kilpauk Medical College Outpatient Department from August 2016 to January 2018, with an abnormal DRE and/ or PSA > 4 ng/mL. All these patients were subjected to MP-MRI 1.5 Tesla with endorectal coil imaging, sextant core and lesion targeted prostatic biopsy. MRSI findings (choline -citrate ratio > 2.5 is considered positive) and biopsy results were analysed and correlated. RESULTSOut of these 30 patients, biopsy revealed malignancy in 22, of which 16 had elevated choline -citrate ratio > 2.5. Gleason grade was > 7 in 10 cases, 7 in 6 cases and < 7 in 6 cases. Choline -citrate ratio was elevated in all cases (100%) of high-grade tumour (Gleason grade > 7), 4 out of 6 cases (66%) with Gleason score of 7 and in 2 (33%) of 6 cases with Gleason score of < 7. Cholinecitrate elevated in 2 patient's biopsy shows chronic prostatitis. CONCLUSIONMR spectroscopy of prostate is useful in diagnosing clinically significant and high-grade cancers. Sensitivity was low for low-grade tumours. It is ideally used as an adjunct with other functional studies rather than for primary diagnosis. KEYWORDSMRI Spectroscopy, Cancer Prostate, Prostate Biopsy. HOW TO CITE THIS ARTICLE: Ponnusamy P, Arumugam S, Madesh U. Comparing MR spectroscopy with cognitive fusion prostatic biopsy in the diagnosis of carcinoma prostate-a prospective descriptive analytic study. BACKGROUND Prostate cancer most often occurs in the outer glands, in which the tumour can be detected via a digital rectal examination (DRE). Nevertheless, approximately 23% to 45% of carcinomas still remain undetected by this method. 15% to 20% of the prostate cancers are located in the transitional zone and are thereby difficult to access by palpation. (1) The PSA level (prostate specific antigen) introduces another possibility for early detection of prostate carcinoma. It should be noted that an inflammation of the prostate gland (prostatitis) or a benign enlargement of the prostate gland (nodular hyperplasia) can also increase the PSA levels.
BACKGROUNDCarcinoma prostate is one of the most common cancer in an elderly male. With the peak incidence between 70 and 74 years of age, less than 1% of patients with prostate cancer are younger than 50 years of age. Metastasis from prostate cancer occurs via local spread, lymphatic spread and haematogenously to the axial skeleton. Here, we present a case report of advanced prostate cancer presenting as cervical lymph node enlargement, which is a rare presentation.
Wilms' tumour also called as nephroblastoma is a malignant renal neoplasm of childhood that arises from remnant of immature kidney. About 80% of Wilms' tumour cases occur before age 5 with a median age of 3.5 years. But adult Wilms' tumour can occur at any age from 16 to 70 years, the median age in young adult is around 24. CASE REPORTA 16-year-old girl came with history of mass right abdomen, which she noticed for 1 week duration; no urinary symptoms. Her recent blood pressure was 140/90 mmHg. Per abdomen a 10 x 9 cm mass palpable in the right lumbar region, surface smooth, firmto-hard in consistency, non-tender, well defined, no bruit. Urine routine examination was normal; urine culture was sterile; renal and liver function tests were within normal limits; Sr. calcium 9.5 mg/dL. CT abdomen plain and contrast showed a 10 x 9 cm heterodense lesion equivocal with renal cell carcinoma and angiomyolipoma. MR angiogram was done. It showed well-defined encapsulated heterointense mass of size 12 x 8 x 7cm, IVC and bilateral renal vein normal. Since findings were inconclusive, we did a CT-guided biopsy and report came as feature positive for small round cell tumour. Hence, proceeded with right radical nephrectomy. The final histopathology report came as Wilms' tumour spindle cell variant. Margins clear and ureter not involved. She was then started on adjuvant chemotherapy Inj. Vincristine 2 mg weekly for 27 weeks. She is on regular followup now. CONCLUSIONWilms' tumour should be considered in a patient who presents with a renal mass with or without loin pain, haematuria especially in young adults. Every attempt should be made to differentiate it from renal cell carcinoma. The outcome for adult Wilms' tumour is steadily improving with current multimodality treatment approach.
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