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Objective: To evaluate and compare the safety and efficacy of Solifenacin, Tamsulosin, and Tadalafil in treating ureteral stent related symptoms (SRS) in patients with indwelling Double-J ureteral stents. Materials and Methods: A prospective randomized controlled study was conducted on 146 consecutive patients in the department of urology, Government Stanley Medical College & Hospital, Chennai, Tamilnadu, India between Sept 2017-March 2019, with SRS after taking informed consent and confirming DJ Stent position by X-ray KUB post-operatively. Patients were randomized into 4 groups: Group A (Placebo), Group B (Solifenacin 5 mg), and Group B (Tamsulosin 0.4 mg) and group D (Tadalafil 5 mg) at end of 1st week till the removal of DJ stent at end of 3 weeks. All patients were assessed for bothersome lower urinary tract symptoms (LUTS) using the validated Ureteral Stent Symptom Questionnaire (USSQ) at 1st week and 3 weeks after the starting of medications. Appropriate statistical analysis as carried out and the level of significance was set at P < 0.05. Results: LUTS, general health, and work performance improved with Solifenacin, Tamsulosin and Tadalafil and all the three were comparable in relieving urinary symptoms. Tadalafil was better at relieving body pain, additional problems and sexual problems better than Tamsulosin. Tadalafil showed comparable improvement in LUTS, better sexual health and decreased body pain compared to solifenacin, whereas the latter had better general health, additional problems & work performance scores. Conclusion: Solifenacin is more effective than Tamsulosin in alleviating LUTS associated with SRS and both show a distinctive advantage over placebo. PDE inhibitor Tadalafil can also be tried for SRS and is as effective as antimuscarinics and α-blockers in relieving urinary symptoms and is more efficacious in relieving sexual symptoms and body pain.

Background: Self-inflicted foreign bodies in the urinary bladder are extremely rare sometimes posing a great challenge in the management. Most of these objects are introduced through the urethra for sexual gratification. It is very rare for foreign bodies inserted per the urethra, to reach the bladder, especially in men owing to the anatomy of the urethra.Case presentation: We report a case of the self-inflicted ball-point pen in the urinary bladder of a male patient during the COVID-19 pandemic lock-down. The uniqueness of this presentation is the patient was able to negotiate the foreign body through the normal curvatures of the urethra to reach the urinary bladder in its entirety without causing any significant injury to the lower urinary tract and its successful endoscopic extraction using nephroscope and the challenges faced during the extraction.Conclusion: This is the first reported successful endoscopic extraction of a long rigid foreign body from a male urinary bladder. A combined or open procedure is the usual approach for the removal of large bladder foreign bodies. It is now clear to us that the even long rigid bladder foreign bodies in men can be extracted successfully with endoscopy provided adequate endoscopic instruments and armamentarium are available

INTRODUCTION: Prostate cancer is the second most common cancer diagnosed in men with an estimated 1.2 million diagnoses worldwide. The incidence of Prostate cancer is higher in western countries and low in Asian countries. The need for prostate biopsy is based on PSA levels. The general cut off PSA value for the Indian population is 4.0 ng/mL. The reported cancer detection rate of TRUS-guided biopsies is around 30 percent in western countries and lesser in Asian countries, including India, particularly for serum PSA values less than 20 ng/mL indicating that many of the Indian patients are subjected to unnecessary biopsy which adds up to distress to these patients.PURPOSE: To determine the cancer detection rate of TRUS-guided prostate biopsy in the Indian population at different serum Prostate-Specific Antigen levels and determine a PSA cut-off level to avoid unnecessary biopsies.MATERIALS AND METHODS:All symptomatic patients who underwent TRUS guided biopsy for raised serum PSA levels between 4 - 20 ng/mL were included. The patients were categorized into four groups corresponding to the PSA levels ranging between 4-6 ng/mL, 6- 8 ng/mL, 8-10 ng/mL, and 10-20 ng/mL respectively, and cancer detection rate in each group were statistically analyzed.RESULTS:The sensitivity, specificity, and positive predictive value of TRUS guided biopsy are 75%, 95%, and 98% respectively in our study. The overall cancer detection rate of TRUS biopsy in our series was 18.4%. The PSA cut-off to do biopsy was derived by ROC curve as 8.9 ng/ml for all the men. CONCLUSION: The PSA cut-off of 4.0 ng/mL is currently used as an indication for biopsy among men of all ages in the Indian population. We recommend a raise in cut-off to 8.9 ng/mL to avoid unnecessary TRUS-guided biopsies in the Indian population.

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