Ureteric stent insertion following ureteroscopic lithotripsy (URSL) is a common and widely accepted procedure. However, there is no agreement on whether a ureteric stent should be placed following an uncomplicated URSL. Furthermore, the definition of uncomplicated URSL remains debatable. To compare the efficacy, safety, and morbidity of no stent placement with the conventional stent placement after uncomplicated retrograde semirigid URS for a distal ureteric calculus of size ≤1 cm, we compared the corresponding complication rates, emergency visits, secondary interventions, and pain at follow-up. Following an uncomplicated ureteroscopic lithotripsy, 104 patients were randomized into the conventional stented group (CSG) and nonstented group (NSG). Lower urinary tract symptoms and sexual function were evaluated using validated questionnaires (IPSS + IIEF-5 + MSHQ-EjD/FSFI) preoperatively and at 4 weeks during follow-up. Pain scores at follow-up were recorded using a visual analogue scale (VAS). Patients who visited the emergency room or needed secondary interventions before the recommended follow-up time were noted. The Generalized Estimating Equations method was used to explore the difference in change in the domains of IPSS, IIEF-5, MSHQ-EjD, and FSFI between the two groups over time. A significant difference was noted in the following IPSS domains: Frequency, Urgency, Nocturia, Storage Symptoms, Total IPSS Score (p ≤ 0.001), and QoL (p = 0.002); IIEF-5 domains: Overall Score (p = 0.004); MSHQ-EjD domains: Ejaculation Bother/Satisfaction (p ≤ 0.001); and FSFI domains: Lubrication (p ≤ 0.001), Satisfaction (p = 0.006), and Overall Score (p = 0.004). There was no significant difference between the various groups in terms of distribution of emergency visits, readmission and secondary interventions, pain at follow-up (VAS), and need for long-term analgesia. Nonplacement of stents after uncomplicated URS decreases stent-related symptoms and preserves QoL without placing the patient under increased postoperative risk.

Background:To evaluate the functional and sexual outcomes of Primary DVIU and Non- transecting bulbar urethroplasty (NTA) for short segment (<2 cm) bulbar urethral strictures using the Modified USS PROM.Methods:The USS PROM questionnaire comprising of a six-item LUTS domain, a LUTS-specific QOL question, and a peeling’s voiding picture score was used. To achieve a holistic approach to the evaluation of stricture surgery outcomes a six-item IIEF and four-item version of MSHQ-EjD domains, completed the questionnaires. All cases of short bulbar urethral stricture who underwent primary DVIU and NTA between September 2018 and September 2019 and consented to filling out the questionnaires were enrolled into the study. Results:The LUTS score for the NTA at 12 months is significantly better (1.93 ± 2.13 Vs 8.76 ± 5.92, p=0.000). The Peeling score of the NTA is significant better at 6 months (1.59 ± 0.56 Vs 2.26 ± 0.96, p=0.000) and 12 months (1.41 ± 0.68 Vs 2.67 ± 0.73, p=0.000). Erectile function score at 12 months for NTA is significantly better than DVIU (24.37 ± 3.2 Vs 21.143 ± 2.86, p=0.001). The Ejaculatory function score at 6 months is significantly better for the NTA. Finally the Uroflowmetry (Qmax) is significant in NTA group at 12 months (26.7 ± 4.08 Vs 15.35 ± 5.16, p =0.000).Conclusion:NTA shows superior outcomes in almost all domains of USS- PROM, both in terms of voiding and sexual function. This should be the preferred first choice treatment for short segment bulbar stricture.Trail Registration- CTRI /2020/02/023578

Complex vesicovaginal fistulas present a unique challenge to surgeons, and surgical reconstruction outcomes may be suboptimal. The aim is to evaluate the patient’s characteristics as well as the factors influencing the functional outcome of complex vesicovaginal fistula surgical reconstruction. From 2016 to 2020, the medical records of 28 patients with complex fistulas were analyzed retrospectively. Means, ranges, and standard deviations were used in descriptive analysis. For categorical data, the Fisher exact probability test was used. The mean (standard deviation) age at presentation was 44.4 (10.04) years, while 85.7% (24) of patients were below 50 years of age. Hysterectomy was the most common aetiology in 21 (75%) patients, followed by radiotherapy in 3 (10.7%). Surgical repair success was seen in 24 (85.7%) patients. Four (14.2%) patients had an unsuccessful repair, one vaginal and three abdominal approach. All the failed abdominal repairs were radiation-induced fistula (p=0.001). Other factors that significantly influenced repair failure include vaginal mucosal atrophy (3 failures out of 8 patients, p=0.013), severe fibrosis around the fistula (4 failures out of 12 patients, p=0.024), non-placement of suprapubic catheter (2 failures out of 3 patients, p=0.006), and non-placement of interposition tissue flap (p=0.005). Hysterectomy and radiotherapy are the common causes of complex vesicovaginal fistula. The outcome of the repair is hampered by vaginal mucosal atrophy and severe scarring. The use of a suprapubic catheter and an interposition tissue flap improves the outcome. Post-irradiation fistula has a significant impact on repair outcome and necessitates special consideration for a comprehensive management strategy.

Urinary bladder paraganglioma (UBP) are rare neuroendocrine tumors with variable biological behavior. High index of suspicion in the preoperative evaluation would enable the clinician to formulate appropriate management of the rare tumors. Clinical and pathological data of seven cases evaluated and treated as per a devised protocol for suspected bladder paraganglioma from 2008 to 2019 was retrospectively reviewed. Among the seven cases, UBP’s were predominantly seen in middle aged men. Most of these presented with storage symptoms (85.71%; n=7) and gross painless hematuria (42.85%; n=3). Three patients were hypertensives and post-micturition syncope was seen in two patients. Among the seven patients two patients had functionally active tumors confirmed by elevated urinary and serum markers for catecholamine excess. Functional tumors, nonfunctional tumors involving uretero-vesical junction or broad based polypoidal tumor were considered for partial cystectomy. Other small nonfunctional tumors underwent trans-urethral resection of bladder tumour (TURBT). Follow up protocol included repeat ultrasound, check cystoscopy and completion TURBT at one month and annually thereafter. Repeat urinary catecholamines at 1 month was done in functional UBP. Cystoscopic examination of a bladder lesion which are solid, sessile and predominantly intramural, a prior to a definitive planned surgery may differentiate UBP from urothelial cancer. Most of the non-functional UPB are diagnosed by histopathological examination.  In symptomatic cases, functional evaluation with biochemical estimation of catecholamine excess allow better treatment planning and avoiding intraoperative hemodynamic instability. Due to high recurrence rate life-long follow-up despite complete excision is strongly recommended.