The development of standardized reporting systems is of paramount importance in medical-imaging. Based on the “RADS” methodology, PIRADS and BI-RADS have been successfully used. The management of bladder cancer (BC) depends on the stage at the time of identification. Accurate assessment of the muscle-invasive stage can alter therapies that are radically different. MRI can accurately diagnose this in a standardized manner (Vesical Imaging-Reporting and Data System: VIRADS) and spare additional procedures. The aim of the study is to determine diagnostic accuracy of VIRADS scoring in evaluation of muscle invasiveness in patients with BC. This study was conducted in a single center over a period of 2 years from April 2020. A total of 76 patients with bladder SOL/diagnosed BC were included. Final VIRADS scoring was calculated and compared with histopathological report. 76 patients were evaluated which included 64 males and 12 females. Most of the cases came under the VIRADS-II category (23, 30.26%) followed by VIRADS-V (17, 22.36%). VIRADS-I was reported in 14 cases (18.42%). A total of 8 cases (10.52 %) were reported as VIRADS III and 14 cases (18.42%) as VIRADS IV. VIRADS-III was taken as cut off and found to have a sensitivity of 94.44%, a specificity of 87.50%, a positive predictive value of 87.17% and a negative predictive value of 94.59%. Though number of cases are still less to accurately predict test characteristics of VIRADS, our results are consistent with previously done retrospective studies and VIRADS has got good correlation with pathological staging.
Arteriovenous fistula (AVF) is the preferred route for vascular access in patients with chronic kidney disease on maintenance haemodialysis. Many studies have demonstrated the positive effects of perioperative hand exercise on fistula maturation. Here, we present our experience of radio cephalic AVF creation in patients with neuromuscular disorders who had difficulty performing isometric hand exercises. We created AVF in three patients with neurological disorders. First patient had essential tremor, which created difficulty during hand exercises and surgery while the other two patients had right hemiparesis. Perioperative isometric exercises have been shown to help in maturation of AVF. Due to neurological involvement, our patients had difficulty performing hand exercises. All had successful AVF despite taking longer than usual time to mature. Creation of AVF in neuromuscular diseases is feasible. A preoperative Doppler ultrasound to assess the vessels might help in making an informed decision. This might spare such patients the only functional arm.
Emphysematous infection of the urinary tract is a hazardous condition and is life-threatening if not managed quickly. We report an 82-year-old woman with uncontrolled diabetes mellitus and urethral stricture who presented with emphysematous cystitis with the gas reaching up to the pelvicalyceal system on the left side (emphysematous pyelonephritis) and appearing in X-ray as air pyelogram. The patient was managed with drainage and intravenous antibiotics and she recovered.
Purpose: Bladder diary is an integral part of urologic evaluation of lower urinary tract symptoms. One of its limitations is the requirement of a literate patient or attendant to complete it. We propose a novel method for recording bladder diary in illiterate individuals, with the aid of easily available materials from hospital, without any expenditure from the patients. Methods: Forty-nine patients, who were required to fill the bladder diary as a part of their urological assessment, and were either illiterate or not literate enough to complete it themselves, were enrolled and admitted in the urology ward for 1 and a half days. Patients were provided with two 500 mL empty normal saline bottles for collection of each void, and a chart separately for day and night with diagrams of saline bottles to mark the corresponding level of urine. The amount of urine and frequency was also noted simultaneously by nursing staff each time for 24 h. The investigator interpreted the data marked on the charts by the patient and compared it with the data collected by the nursing officers. Results: No statistically significant difference was found between the data collected by the nursing staff and patient data interpreted by the investigators, which included 24-h urine volume( p = 0.562), nocturnal output ( p = 0.941), average voided volume ( p = 0.709), maximum voided volume ( p = 0.369), fluid intake ( p = 0.401), frequency, nocturia and episodes of urgency and incontinence ( p = 1). Conclusion: This method of recording bladder diary is a feasible, genuine, reliable and cost-free method which can be used in illiterates.
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