Background Due to the infrequency of non-clear cell renal cell carcinoma (RCC), there is currently a paucity of high-quality literature to help guide the effective treatment of these tumors. Recently, biomarkers such as platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), systemic immune inflammation (SII) index and C-reactive protein to albumin ratio (CAR) have been demonstrated to be closely related to poor prognosis of patients with RCC. The objective of this study was to evaluate these biomarkers for determining the progression-free survival (PFS) and overall survival (OS) in patients with metastatic non-clear cell cancer. Methods We retrospectively reviewed 31 cases diagnosed with metastatic non-clear cell RCC from January 2012 to December 2017. We assessed the prognostic value (OS and PFS) of pretreatment PLR, LMR, SII index and CAR based on multivariate analysis and Kaplan-Meier survival curve. Results Median time of OS and PFS were 15.5 months (95% confidence interval (CI): 13.7 - 15.2) and 10.9 months (95% CI: 8.9 - 12.8), respectively. The median PFS (0.001) and OS (P = 0.01) was shorter in patients with PLR > 171, LMR < 2.61. Moreover, median PFS but not OS was significantly lower in SII index > 883 (P = 0.064) and CAR > 0.11 (P = 0.229). Scan to surgery time (3.91 weeks, P = 0.001) was also significantly related to progression. Conclusions Elevated pretreatment inflammatory biomarkers such as PLR, LMR, SII index and CAR are significant determinants of shorter PFS and OS (PLR and LMR only) in patients with metastatic non-clear cell RCC treated with cytoreductive nephrectomy.

In prospective study from November 2011- November 2013, we performed 44 laparoscopic nephrectomies for benign non-functioning kidney diseases. Twenty eight patients underwent laparoscopic transperitoneal nephrectomies (63.6%), ten were laparoscopic assisted (22.7%) and six (13.6%) were converted to open. Patient's age, gender, laterality and etiology of renal failure were noted. Outcomes were measured as operative time, intraoperative and post operative complications, blood loss, pain score and hospital stay. Patients were followed up at one, three and 12 weeks and 6 monthly thereafter. Of the 44, ten (22.7%) were 15-24 years old, 32 (72%) between 25-50 years and two were more than 50 years old. Females were 54.6%. 22 patients had either right or left nephrectomy. Pelviureteric-junction (PUJ) obstruction was the commonest cause, 26 cases (59.0%). Operative time: less than two hours in 30 (68.2%) patients, more than two hours in 14 cases. Blood loss: less than 100 ml in 12 (27.3%), 100-200 ml in 20 (45.4%) and more than 200 ml in 12 (27.3%) patients. All four major complications were converted to open, two had injury to mesocolic veins and two had vascular stapler malfunction. Post-operative complications: surgical site infection (SSI), paralytic ileus and mild grade fever in six cases each and non infected benign intra abdominal collection in two cases. Maximum pain score on POD-1: four in 20 cases (45.7%), two in 24 (54%). Two had pain score between 3-4 three weeks after surgery. Oral intake started by POD-2 in 30 (68.2%) and by POD-4 in 100% cases. 22 (50%) patients were ambulating by POD-2, 16 (36.7%) by POD-4. Our study and randomized and non-randomized published literature report acceptables complication and conversion rates. In conclusion, laparoscopic nephrectomy for benign non functional kidney is a better alternative to open nephrectomy

BackgroundPenile cancer is a rare malignancy. The extent of lymph node (LN) metastasis is the most important prognostic factor in penile cancer. However, preoperative prediction of LN involvement in clinically non-palpable LN is still a challenge. In absence of a reliable biomarker, attempts are being made to validate imaging characteristics as a predictive tool. The aim of the present study is to assess the primary penile tumor characteristics with diffusion-weighted magnetic resonance imaging (DWMRI) and its correlations with inguinal LN status and tumor positivity in LN dissection specimen within normal sized LNs.MethodsTwenty-six patients with carcinoma penis underwent DWMRI of penis and pelvis. The apparent diffusion coefficient (ADC) values of primary tumor were compared with histological characteristics. Inclusion criteria encompassed all cases of clinically non-palpable inguinal LN and normal sized LN on imaging. All palpable inguinal nodes with pelvic lymphadenopathies were excluded from this study.ResultsThe primary tumor ADC ranged from 0.65 × 10-3 - 1.2 × 10-3 mm2/s (mean: 0.87 × 10-3 ± 0.11 × 10-3 mm2/s). In pT1 and pT3 tumors, mean ADC values were 0.86 × 10-3 ± 0.10 × 10-3 and 0.81 × 103 ± 0.09 × 103 mm2/s, respectively. The mean ADC values for grade 1, grade 2 and grade 3 were 0.89 × 10-3, 0.82 × 10-3 and 0.80 × 10-3 mm2/s, respectively. The ADC value of < 0.95 × 10-3 mm2/s was positively correlated with pathological LN presence within normal sized LN. With mean ADC value of 0.87 × 10-3 ± 0.11 × 10-3 mm2/s, sensitivity and positive predictive values for primary penile cancer were 100% and 84.61%, respectively. The mean ADC value for higher-grade and -stage tumor was low. The sensitivity and specificity of predicting LN metastasis by DWMRI were 87.22% and 80.90%, respectively.ConclusionADC value of primary tumor can help in prediction of LN metastasis in carcinoma penis with clinically and radiologically normal groin.

Introduction Skeletal metastasis is catastrophic in patients with renal cell carcinoma (RCC), leading to skeletal-related events (SRE) such as nerve entrapment, hypercalcemia and even pathological fractures, which may require surgical intervention. The nature of the bone metastasis in advanced RCC is large, destructive, hyper-vascular and mostly lytic. The present retrospective analysis aims to identify potential risk factors for predicting SREs in advanced RCC with bone metastasis. Methods The clinical data of 42 patients with RCC and bone metastasis and at least one episode of SRE were reviewed, and the correlations between erythrocyte sedimentation rate (ESR), alkaline phosphatase (ALP), C-reactive protein (CRP), haemoglobin (Hb), carcinoembryonic antigen (CEA) and bone metastases were analysed. Risk factors were identified by multivariate logistic regression analysis. Bone metastasis was diagnosed on a bone scan. The receiver operating characteristic (ROC) curve calculated the cut-off value of the independent correlation factors. Results The areas under the ROC curve for ALP, Hb, CRP, and ESR were 0.84, 0.76, 0.86 and 0.88, respectively, suggesting excellent discriminatory capability of ALP, CRP, ESR and sufficient discriminative ability of Hb in predicting bone metastasis. Multivariate logistic regression analysis showed ALP, CRP, Hb and ESR associated with SRE and skeletal metastasis. Conclusion We propose that an A.C.H.E. score encompassing ALP, CRP, Hb, and ESR are potential risk factors for developing SRE and concomitant bone metastasis in advanced RCC patients. For new RCC patients, if values of ALP >128 U/L, CRP ≥74 mg/L, Hb <11.5 g/L, and ESR ≥55 mm/hr are detected, intensive monitoring and bone scanning are warranted as these cases are at a higher risk of skeletal events.

Background and ObjectiveThe thulium laser surgery is a relatively new approach in which a wavelength of approximately 2 μm is emitted in continuous-wave mode, thus enabling the precise incision of tissue by using a wavelength that matches the water absorption peak of 1.92 μm in tissue. However, no published multinational study or other evidence definitively declares the superiority of thulium vaporization (ThuVAP) over thulium vapoenucle-ation (ThuVEP) without morcellator for better management of bothersome benign prostatic hyperplasia. The present study aims to evaluate the efficacy of vaporization and vapoenucleation (without a morcellator) in thulium laser prostatectomy for the treatment of benign prostatic hyperplasia.MethodsA retrospective analysis of 82 patients who underwent thulium laser prostatectomy between February 2017 and January 2018 with ThuVAP and ThuVEP techniques was done and outcome measures analyzed were International Prostate Symptom Score (IPSS), quality-of-life score (QoL), maximum flow rate (Q max), post-void residual (PVRU), total operating time, laser time and resected tissue weight.ResultsNo significant differences were noted between ThuVAP and ThuVEP in terms of post-operative prostate volume (22.4 vs. 21.7 mL) and post-operative prostate specific antigen (PSA) (2.54 vs. 1.85 ng/mL). Nonetheless, there were differences between the groups in total lasing time (56.5 vs. 44.8 min, p = 0.001) and total operative time (88.5 vs. 71.5 min, p= 0.001). There was also a significant difference in IPSS, QoL score, Q max, and PVRU at 6 weeks, 3 months, 6 months and 9 months after surgery.

INTRODUCTIONAlbeit the EAU, NCCN and AUA guidelines provide an excellent evidence-based protocol for the management of MIBC and NMIBC, these guidelines differ with respect to critical issues such as risk level definitions and management strategies. Implication of the aforementioned treatment policy in a vast subcontinent like ours has always been a challenge. The NE part of the country has always bore the brunt of heavy Oncological catastrophe like urinary bladder carcinoma related to extensive tobacco and pesticide usage. MIBC treatment usually encompasses radical cystectomy (RC) with adjuvant chemotherapy (AC)/ neo-adjuvant ABSTRACT Background: Albeit the EAU, NCCN and AUA guidelines provide an excellent evidence-based protocol for the management of MIBC and NMIBC, these guidelines differ with respect to critical issues such as risk level definitions and management strategies. The NE part of the country has always bore the brunt of heavy oncological catastrophe like urinary bladder carcinoma related to extensive tobacco and pesticide usage. MIBC treatment usually encompasses RC with AC/NAC (Level I evidence for NAC use in MIBC exist) but the majority of patients seen at our center have already progressed to advanced stage at presentation and could not undertake full treatment. Methods: Cancer registry of the last 10 yrs at Dept. of Urology and Renal Transplant Gauhati Medical College Hospital was searched for demographic, clinical, pathological and prognostic data and results summarized using statistical parameters of univariate analysis.Results: There were a total of 168 patients in the NMIBC group with a majority in the 60-70-year age group. The most common grade was G2 and all DM type 2 and CKD were significantly associated in all the patients analyzed.Chemical exposure in the form of pesticide and smoking was a constant phenomenon in all patients of NMIBC and MIBC (n=66) population. CKD was significantly associated in the MIBC population along with positive urine cytology. Conclusions: Despite a paucity of high level evidence regarding the majority of management topics in Urinary Bladder cancer in NE part of the country, there was general agreement among the various guideline panels and management guidelines at our institution. Identification of the upfront clinical parameters suggesting severity of disease and time to progression are the two most important domains which will decide the future of UB carcinoma treatment in this part of the world. Categories of evidence synthesized and grades of recommendations will have to be constantly gazed upon to modify and enhance treatment strategies.

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Background: For last eight decades, transurethral resection of the prostate (TURP) has remained the mainstay of surgical treatment for BPH, due to the procedure’s excellent, well-documented and long- lasting treatment efficacy. Patients with clinically bothersome LUTS suggestive of BPH not relieved with medical treatment benefit from transurethral resection/vaporization of prostate using various energy sources. Monopolar TURP has been the main form of treatment for many years in men with BPH and remains the gold standard against which other treatments are evaluated. The aim of this article is to review the role of m-TURP in contemporary BPH management.Methods: This retrospective study included 275 patients with bothersome LUTS and histologically confirmed BPH, who underwent m-TURP at Deprtment of Urology and Renal Transplantation between July 2010 and July 2015 and were in follow up for at least 24 months in the Urology OPD. The most frequent indication (50-60%) for TURP is LUTS refractory to medical therapy.Results: A total of 274 patients were divided into 3 groups based on prostate volume of less than 40 gram (Group A), 40 to 80 grams (Group B) and more than 80gm (Group C). Statistically, deranged EFG was significantly associated and correlated with Group B). The mean preoperative hemoglobin level for the entire patient population was 13.14±1.26 whereas the post-operative hemoglobin level was 12.22±1.39gm/dl. Similarly, the mean preoperative sodium level for the entire patient population was 137±4.26 whereas the post-operative level was 130±5.04mEq/L.Conclusions: M-TURP is adequate for its intended use as an effective learning tool and as a substantial practical tool for managing BPH; m-TURP results depend on surgeons’ experience, the patient’s prostate volume- and comorbidities.