Objective To analyze role of phosphodiesterase 5 (PDE5) inhibitors on urodynamic parameters in patients with suprasacral spinal cord injury. Materials and Methods This was a prospective observational hospital-based study conducted on a cohort of patients, aged between 18 and 65 years with suprasacral spinal cord injury, who were registered in Department of Neurosurgery/Urology. Cutoff period since injury was 2 years. After taking consent, baseline urodynamic study was performed, which was repeated 2 hours after taking single oral dose of 20 mg tadalafil. Urodynamic parameters such as maximum detrusor filling/voiding pressures, maximum bladder capacity, and bladder compliance before and after taking drug were compared for final results and conclusion. Results Following administration of 20 mg of tadalafil, maximum bladder capacity in mL showed statistically significant improvement from 268.39 ± 130.0 to 298.55 ± 112.0.(p < 0.05). Bladder compliance improved from 18.68 ± 6.4 to 20.25 ± 7.5 mL/cm H2O (p > 0.05). Maximum detrusor filling pressure improved from 36.03 ± 20.54 to 32.90 ± 16.47 cm H2O (p > 0.05). Maximum detrusor voiding pressure improved from 64.65 ± 33.19 to 58.13 ± 20.7 cm H2O (0 > 0.05). In patients with injury above D6 spinal cord level, statistically significant improvement was seen in maximum bladder capacity and bladder compliance after 2 hours of single oral dose of tadalafil (p < 0.05). Conclusion Our study suggests a positive role of PDE inhibitors in improving urodynamic parameters in patients with suprasacral spinal cord injury with improvement in parameters such as bladder capacity, detrusor pressures, and bladder compliance. Because this is a small study group, more studies such as this are required to reach to final conclusion.

Background: Urological disorders like stone disease, pyonephrosis secondary to obstruction and trauma are common during pregnancy with global incidence of 1 in 250 to 1 in 3000. These diseases can complicate any pregnancy and timely diagnosis and management is of utmost importance for safety of the mother and fetus. Managing these cases entails morbidity and minimally invasive procedures avoiding anesthesia have definite advantage.Methods: It was an observational study. Pregnant patients with nephrolithiasis, pyonephrosis, complicated post-traumatic ureteropelvic junction (PUJ) obstruction (PUJO) and trauma were included in the study.Results: Out of total 84 cases, 45 required intervention. Percutaneous nephrostomy (PCN) for pyonephrosis secondary to PUJO and obstructed PUJ calculus was done in 11 and 14 cases respectively. Bilateral PCN for bilateral nephrolithiasis was done in 7 cases. Silicon double-J stenting for ureteric calculus was done in 13 cases. One case of spontaneous fornicial rupture of kidney without stone disease was managed conservatively as were 4 cases of trauma with concomitant renal injury, 18 cases of non-obstructive renal stones and 16 cases of pyelonephritis. Seven patients lost follow-up. One case each of pyonephrosis and polytrauma had fetal death at term unrelated to urological cause. In rest 75 patients, primary pathology was tackled after 6-8 weeks of delivery.Conclusions: Urological diseases during pregnancy are not an uncommon entity and can pose risk to both mother and fetus. With good clinical vigil, use of minimally invasive procedures, close monitoring and follow up, these patients can be safely managed without any adverse events to the fetus and mother.

Introduction: Extracorporeal shock-wave lithotripsy (ESWL) is an established non-invasive treatment modality for renal and ureteric stones. However, treatment outcome and efficacy depends on multiple factors like stone size, location and type of machine used. We aimed to assess efficacy of ESWL as a primary treatment modality in renal and ureteric stones in a busy hospital setting having significant renal stone disease burden. Material and methods:1187 patients who underwent ESWL between January 2015 to December 2016 in our department were included in the study. Patients with nephrolithiasis and ureterolithiasis having functional kidney, without any absolute contraindication to ESWL were included. Dornier Med Tech Compact Delta 2 machines were used for all the patients. Stone localization was done using both fluoroscopic and ultrasound-guided methods by same expert. Results: Out of 1187 patients,887 patients had solitary renal stones,170 had solitary ureteral calculus and 130 patients had multiple renal calculi. Stone size ranged from 8mm-20mm. Renal pelvic stones, upper calycial stones and proximal ureteric stones had stone free rate of 84%,86% and 82.5% respectively. 89% and 84% of patients were stone free when size of stone was between 8-12mm, it decreased to 77% and 73% when size increased between 13-16mm for kidney and ureteric stones respectively. Conclusions: ESWL is an effective primary treatment modality for appropriately selected patients with stone size less than 2 cm in favorable location with a normal functioning kidney. Use of both fluoroscopic and ultrasound imaging improves localization of stones thus improving success. It is an important modality in hands of urologist treating huge volume of urolithiasis patients in busy hospitals with long waiting list and with limited resources.