KUA President’s message,

Dear members,

Warm greetings from the KUA Council 2020-21

Due to Covid pandemic, 26th KUACON which was scheduled on October 30th and 31st
2021, at Shivamogga was cancelled due to various logistics and statutory reasons.
Hence KUA Executive Council decided to conduct this year’s Annual Conference
virtually.

These two days of annual scientific feast will cover various aspects of Urology and
life.

You are aware that due to the global pandemic the activities of the association were
limited and all the programs were conducted virtually and was well received by all of
you.

On a personal note, I sincerely thank all the members of KUA for providing me an
opportunity to serve the association. I also thank Dr Naveen HN, the Hon. Secretary
and other council members for their valuable support.

Long live Karnataka Urology Association

Dr Bharath Kshatri

President KUA
Dear members,

Warm greeting’s from Davanagere,

The Shivamogga team were planning to have a grand 26th KUACON but due to various
reasons they were unable to conduct physical conference, hence KUA Council 2020-21
planned to have virtual conference as per the schedule dates of 30th and 31st October
2021.

As technology advanced during the pandemic, the conduct of virtual conference is also
advanced. This years, virtual conference is on a 2D platform with interface of human
and machine incorporating near normal experience of a physical meet. KUA Council is
taking all efforts to make it a memorable event by including all the mandatory KUA
programs.

Our eminent scientific review committee have reviewed various abstracts and have
chosen best scientific presentations. Orators for this year Prof. P. Venugopal oration
and MP Raju MYSOGUS endowment lecture are pioneers in their field and are
renowned Indian born international speakers.

Various guest lectures covering different aspects of Urology and life, spirituality,
healthy mind and healthy body will be the highlights of the conference.

I request all the KUA members, to join us and make this 26th KUACON a success.

Jai Karnataka

Regards

Dr. Naveen H.N

Hon. Secretary KUA & Organizing Secretary 26th KUACON

 PROGRAM SCHEDULE

DAY 1: October 30th 2021, Saturday

KUACON Link : https://swarnimtouch.com/KUACON2021/

3.00 pm to 3.20 pm: Devon Travelling Fellowship Quiz Program (only for PG’s)

Moderator: Dr. Sharanbasavesh Alur, Gadag

(30 Questions, 20 minutes)
KUACON Link : https://mcdn1.24fd.com/e21/devon/index.html
Password : kuacon

3.30 pm to 3.35 pm: Welcome address by Dr. Bharat Kshatri, President KUA

3.35 pm to 4.15 pm: Davangere PG Symposium.

(8 minutes per speaker and 5 minutes discussion at the end of 4 talks)

Topic: Urinary tract infection in special cases

Moderator: Dr Nandakishore Bhat, Mangaluru

1. Urinary tract infection in Pregnancy

Dr Vinod Babu, INU, Bengaluru.

2. Urinary tract infection in elderly diabetics

Dr Priyabartha Adhikari, JNMC, Belagavi

3. Urinary tract infection in patients within 1 month of Renal Transplant

Dr Sumanth Bille, INU, Bengaluru

4. Urinary tract infection in patient’s on indwelling urinary catheter or urinary

stents
Dr Anshuman Singh, KMC, Manipal
4. 4.15 pm to 4.45 pm: BMC Best Poster Prize
(3 min presentation and 2 min discussion).

Moderators: Dr Manohar CS, Dr Prakash Prabhu.

1. Rare sites of delayed metastasis in renal cell carcinoma: A case series of five
patients
Dr Anshuman Singh, Dr. Arun Chawla, Dr. Padmaraj Hegde, KMC Manipal.

2. Hung up with a Huang class 4: A rare case of Bilateral Emphysematous

Pyelonephritis with COVID 19.
Dr Abheesh Varma Hegde, Dr Mukund Andankar, Dr Hemant R Pathak, TMC,
Mumbai.

3. The Catastrophic Journey of Post Renal Allograft Bleeding: From Hell to Shell.
Dr Sriramadasu Yashwanth, Dr Amruthraj Gowda, Dr Vijay Kumar R, Dr Ravikumar B
R, Dr Sachin D, Dr Manjunath V. JSSMC, Mysuru.

4. Renal Cell Carcinoma with tumour thrombus extending in duplicated Inferior

vena cava: A rarity with management conundrum.
Dr. Gurvansh Singh Sachdev, Dr. Arun Chawla, KMC Manipal.

5. A Near Miss Catastrophe - Aortic dissection in a Renal Transplant Recipient.

Dr. Lohith Dasarapu, Dr. Prashanth M Kulkarni, Dr. Saurabh Bhargava,Dr. Ishtiaque
Ahmed, Dr. Sanjay Rao, Dr.Jagadish Kaushik, Dr. Robbie George, Narayana Health
city, Bengaluru.

4.45 pm to 5.00 pm: Inaugural Ceremony

5.00 pm to 5.20 pm: Online etiquette:

Speaker: Dr Arabind Panda. Urologist, KIMS, Secuderabad, Telangana

Moderators: Dr C S Ratkal, Dr.Sanjay RP, Dr.Sanman

5.20 pm to 6.00 pm: Prof. P. Venugopal Oration

Topic: Current status, Innovations and Future of Endourology: How we are

getting it right

Speaker: Dr Bhaskar Somani, Consultant Urologist, University of Southampton. UK.

Moderators: Dr Bharath Kshatri, Dr Naveen HN

6.00 pm to 6.30 pm: Dr.MP Raju MYSOGUS Endowment Lecture

Topic: “New opportunities for physicians in the new millennium – one

Nephrologists’ story”

Speaker: Dr. Brian J. G. Pereira, MD | CEO, Visterra, Inc.

Moderators: Dr Nischith D Souza, Dr Naveen HN

6.30 pm to 7.00 pm: Privatisation - entrepreneurship - Urologists of future

Speaker: Dr Mallikarjuna C, President, Urological Society of India

Moderators: Dr Keshavamurthy R, Dr D Ramesh

7.00 pm to 7.30 pm: Conquering your mind-the way I did
(A Journey from operation theatre to toughest cycling race of the world).

Speaker: Dr Hitendra Mahajan, Anaesthetist, Pune

Moderators: Dr Ali Poonawala, Dr Amruth Gowda , Dr Pritam Sharma

7.30 pm to 8.00 pm: Spirituality and Practise

Speaker: Dr C Nageshwar Rao, Past President, USI

Moderators: Dr Venaktesh G.K, Dr Laxman Prabhu

8.30 pm to 9.00 pm Bijapur Uro Quiz (for all KUA members)

KUACON Link : https://mcdn1.24fd.com/e21/bijapur/index.html

Password : kuacon

Moderator: Dr. Govardhan Reddy, Bellari

(60 questions,30 minutes)
Day 2, 31st October 2021, Sunday, Forenoon

KUACON Link : https://swarnimtouch.com/KUACON2021/

6.00 am to 7.00 am: Stay healthy and stay fit. Health is wealth
Kindly upload 1-minute video/selfie of your work outs like walkathon 2 km, cycolthon
10 km, running 5 km and WhatsApp to 7874337673, # KUACON 2021. Best
video/selfie along with best messages #KUACON 2021 shall receive a prize.

8.30 am to 9.25 am Dileep Adappa Best Paper Award (6 + 2 min)

Moderators: Dr Althaf Khan, Dr Shivalingaiah.

1. Impact of urolithiasis on disease severity, prognosis and management strategies in

patients of emphysematous pyelonephritis: Data from a University teaching hospital.

Dr Anshuman Singh, Dr Arun Chawla, Dr Padmaraj Hegde. KMC, Manipal.

2.OAB score: A clinical tool that predicts the probability of presenting overactive
detrusor in the urodynamic study

Dr Pruthvi Raj H, Dr Manohar CS, Dr Pramod Adiga, Dr Ali Poonawala, Dr Keshava

Murthy R. INU, Bengaluru.

3. Modified USS PROM for DVIU and Non Transecting Urethroplasty for Short Bulbar
Urethral Strictures

Dr Arun Kumar Chawla. KMC, Manipal.

4. Preoperative Urine culture vs Renal Pelvic Urine culture: A better predictor of

urosepsis in patients undergoing percutaneous nephrolithotomy

Dr Gopalkrishna, Dr Varun G Huilgol, Dr Manasa T, Dr S M L Prakash Babu, Dr

Prasad Mylarappa, Dr Yalavarthi Pavan, Dr Nishith A Reddy, Dr Puneet Bansal.
MSRMC, Bengaluru.
5. Neutrophil-Lymphocyte ratio (NLR), Platelet-Lymphocyte ratio (PLR) and
Lymphocyte-Monocyte ratio (LMR) in predicting Systemic Inflammatory Response
Syndrome (SIRS) and Sepsis after Percutaneous Nephrolithotomy (PCNL)
Dr Shruti Rahul Pandit , Dr Arun Chawla, Dr Akshay Kriplani. KMC, Manipal.

6.Study of Ureteric Diameter in Indian Population and Its Clinical Implications

Dr Abhijit Samal, Dr Santosh Patil, Dr Basavesh S Patil, Dr V S Kundargi, Dr S B

Patil. Shri B M Patil Medical College, Vijayapur.

9.25 am to 10.10 am: NU Hospitals Best Video Prize (6 + 2 min)

Moderators: Dr Mujeeburahiman, Dr Nagaraj HK, Dr Yuvaraja T.B.

1. Use of fire fly technology in urology practice: A brief update

Dr Columbia Asia (A unit of Manipal hospitals), Bengaluru.

2. Approach to complex posterior hilar renal tumours – Our technique of Robot

assisted partial nephrectomy.
Dr Mohammed Shahid Al, Dr Deepak Dubey. Manipal hospitals, Bengaluru.

3. Surgical Strategies to Deal with Left Renal Hilar Variations in Laparoscopic

Donor Nephrectomy.
Dr Prashant M Kulkarni, Dr Jagadish Koushik, Dr Furkhan Ahmed, Dr Saurabh
Bhargava. NHMSHC, Bengaluru.

4. Robotic VEIL Post Chemotherapy

Dr Kinju Adhikari, Dr Raghunath S K, Dr Tejus Chiranjeevi. HCG Cancer Centre.
Bengaluru.

5. Heart Shaped Neobladder Following Robotic Radical Cystectomy – Our

Experience.
Dr Divya Shree Bhat, Dr Mujeeburahiman. Yenepoya Medical College, Mangaluru.
10.10 am to 10.30 am: Is it time that, we, the Urologists start addressing sexual
concerns?

Speaker: Dr Gajanana Bhat. Consulatant Urologist, KIMS, Karwar.

Moderator: Dr Vasan SS, Dr Suresh Kagalkar Reddy

10.30 am to 11.00 am: Black Pearls

Moderator: Dr Deepak Dubey, Dr Girish Nelivigi

1.Shoot Oneself in The Foot-unexpected outcome in commonest procedur

Dr Prashant Kulkarni, Consultant Urologist, Narayana Hrudayalaya, Bengaluru.

2.“Red Pearl” A block buster mega serial.

Dr Manohar T, Consultant Urologist, Columbia Hospital (now unit of Manipal
Hospitals), Bengaluru.

11.00 am to 12.00 noon: General body meeting (only for full members)

12.00 noon to 12.30 pm: Valedictory function

E-poster/free poster Zone, Hourly quiz program award, selfie Zone , best
selfie award, best work out/message award, longest virtual conference screen
time attendee ( based on the hourly quiz question answers) member award.
KUA COUNCIL 2020-21

President Dr. Bharath Kshatri

President Elect Dr. Nischit D’Souza

Hon. Secretary Dr. Naveen H N

Treasurer Dr. Suresh Kagalkarreddy

Council members Dr. Sharanabasavesh B Alur

Dr. Govardhan Reddy H.S.

Dr. Manohar CS

Dr. Nandakishore Bhat.

Immediate Past President Dr. Siddalingeshwar Neeli

Immediate Past Secretary Dr. Kumar Prabhu M

 ABSTRACTS

BMC Best Poster Prize

(3 min presentation and 2 min discussion).

Rare sites of delayed metastasis in renal cell carcinoma: A case series of five
patients
Dr Anshuman Singh, Dr. Arun Chawla, Dr. Padmaraj Hegde, KMC Manipal.
Renal cell carcinoma (RCC) is a lethal malignancy with a propensity for metastatic
spread to any part of the body. The common sites of metastases from RCC include
lungs, adrenals, intestines and brain and most intra- abdominal organs which may
present as synchronous or metachronous to the primary tumour. A long follow-up is
advised to deal with the risk of delayed metastases even when the primary has
been well controlled. There have been few case reports in regard to rare sites of
RCC metastasis. In this series of five cases, we present five rarest sites of
metastatic RCC reported after 5 years of the primary malignancy. Five cases of
solitary metastatic lesion with unknown primary were evaluated and later diagnosed
as metastatic RCC. They were evaluated retrospectively and found to be diagnosed
with RCC more than 5 years back. The solitary metastatic lesions in the 5 patients
were noted in right sartorius muscle, right atrium, posterior wall of bladder, shaft
of right tibia and right third distal phalanx. Metastatis in right sartorius muscle
was managed with wide local excision while the rest four cases were managed by
palliative targeted therapy with sunitinib. 4 patients were doing well at 1 year of
follow up while one patient expired during the course of hospital stay. Isolated
metastasis occurring after many years and at rare sites stresses the need for long
and careful follow-up in the patients treated by radical nephrectomy.

Hung up with a Huang class 4: A rare case of Bilateral Emphysematous

Pyelonephritis with COVID 19.
Dr Abheesh Varma Hegde, Dr Mukund Andankar, Dr Hemant R Pathak, TMC, Mumbai.
Introduction.The COVID 19 pandemic has forced us to revise our management
strategies for surgical diseases. Patients with COVID 19 have increased risk of
morbidity and mortality after surgical intervention. Emphysematous pyelonephritis
(EPN) is often seen in diabetics and can be a life threatening condition. All patients
require immediate treatment with antibiotics and close monitoring. Bilateral
emphysematous pyelonephritis is a rare entity seen in less than 10 % of patients. We
present a case of bilateral emphysematous pyelonephritis in a COVID positive patient
which was successfully managed conservatively.
Case Report.A 70 year old hypertensive female, presented to us with fever,
breathlessness, loss of appetite, generalised weakness requiring oxygen
supplementation & was diagnosed with COVID 19. Bilateral emphysematous
pyelonephritis (Grade 4) with perinephric collections was found on evaluation for
acute kidney injury. She underwent bilateral pig tail insertion followed by bilateral
DJ stenting after stabilization of her general condition. She improved dramatically,
blood parameters improved and was discharged. At 3 month follow up, patient is doing
well.
Conclusion.In the present COVID-19 pandemic where case selection for surgical
intervention is crucial, we would like to highlight how a conservative approach for
even Class 4 EPN is feasible after weighing the risks and benefits of the same.
Patients can be spared the immediate morbidity and mortality risks due to COVID 19
infection. Triaging surgical intervention can also help in better utilization of critical
care facilities and man power, both invaluable in the ongoing crisis

The Catastrophic Journey of Post Renal Allograft Bleeding: From Hell to Shell.

Dr Sriramadasu Yashwanth, Dr Amruthraj Gowda, Dr Vijay Kumar R, Dr Ravikumar B

R, Dr Sachin D, Dr Manjunath V. JSSMC, Mysuru.
A 50yrs male patient, known case of CKD, DM, HTN underwent allograft renal
transplantation from his wife. Hospital course was uneventful and he was discharged.
On post op day 20, patient presented to casualty with hemorrhagic shock. A
challenging and surprising case of profuse arterial bleed 2cm distal to anastomosis,
which was managed surgically and stabilized. A rare surgical scenario
Renal Cell Carcinoma with tumour thrombus extending in duplicated Inferior vena
cava: A rarity with management conundrum.

Dr. Gurvansh Singh Sachdev, Dr. Arun Chawla, KMC Manipal.

Introduction & Objectives:Congenital anomalies of inferior vena cava are extremely
rare, reflecting the complexity of the embryological development of these
structures. Duplication of IVC (DIVC) occurs in 0.7% of population. DIVC may play a
role as a confounding factor in imaging diagnostic tests and also may represent a
hazard for inadvertent injury and bleeding during surgery. Recognition of such
venousanomalies is important in the evaluation and surgical treatment of
retroperitoneal disease. Careful interpretation Radiological investigations help to
define such anomalies and avoid significant morbidity during surgical exploration.

Methods : We present a case of renal cell carcinoma involving Right kidney with tumor
thrombus extending into both venae cavae. Triphasic contrast-enhanced
computerized tomography (CECT) scan of abdomen with three-dimensional
reconstruction showed duplicated left sided IVC. Heterogeneously enhancing
intraluminal soft tissue density filling defect was seen along the entire length of
right renal vein, also crossing the midline to the left sided duplicated IVC -s/o tumour
thrombus. Patient underwent right radical nephroureterectomy with tumour
thrombectomy. Cavotomy was done at the junction of right renal vein and right IVC.
Results:Entire thrombus was delivered intact. Histopathological examination showed
papillary renal cell carcinoma (type II) stage pT3bN1Mx. IVC thrombus showed
clusters of malignant cells of same morphology as tumor entangled in thrombus. The
patient is doing well at 3 months of follow-up.
Conclusion:The recognition of congenital IVC anomalies has major clinical implications.
In addition to preventing diagnostic errors, careful interpretation of cross-sectional
imaging can help to avoid complications arising from venous anomalies unexpectedly
encountered during surgery.

A Near Miss Catastrophe - Aortic dissection in a Renal Transplant Recipient.

Dr. Lohith Dasarapu, Dr. Prashanth M Kulkarni, Dr. Saurabh Bhargava,Dr. Ishtiaque
Ahmed, Dr. Sanjay Rao, Dr.Jagadish Kaushik, Dr. Robbie George, Narayana Health
city, Bengaluru.
INTRODUCTION : Renal Transplantation recipient management is a real challenge
for a Urologist and his team. Here is a rare complication of aortic dissection
encountered in a renal transplant recipient patient in our hospital.Aortic dissection
is a rare and infrequently reported event . We report a case of Aortic dissection in
 a renal transplant recipient in the early postoperative period which was managed
successfully.
MATERIAL & METHODS: A middle aged male with chronic kidney disease underwent
renal transplantation after a complete evaluation, donor being his Brother.
Postoperatively, he developed decreased urine output and showed signs of suspected
aortic dissection for which CT aortogram was done confirming the diagnosis.
RESULTS : Patient was taken up for thoracic stent grafting with proper consent. He
had a successful grafting with no complications. Later a CT aortogram was done which
confirmed no further extension of the aortic dissection. He was stable and was
discharged with good urine output and well-functioning graft and transplanted kidney.
CONCLUSION: Severe aortic dissection can be responsible of atypical graft failure
with anuria and dialysis requirement several years after kidney transplantation. This
is one of rare cases reported which is never seen before who was successfully
managed. Similar case is reported with aortic dissection after 6 years of renal
transplantation which was managed conservatively.

Dileep Adappa Best Paper Award (6 + 2 min)

Impact of urolithiasis on disease severity, prognosis and management strategies

in patients of emphysematous pyelonephritis: Data from a University teaching
hospital. Dr Anshuman Singh, Dr Arun Chawla, Dr Padmaraj Hegde. KMC, Manipal.

Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the renal

parenchyma and perirenal tissues with the spectrum of disease ranging from a mild
asymptomatic form to a severe life threatening disease. Although urolithiasis has
been identified in patient with emphysematous pyelonephritis, the relationship
between urolithiasis and disease severity has not been thoroughly investigated.

The aim of this study was to compare the disease severity, prognosis and outcome
post treatment in patients of EPN with and without concomitant urolithiasis.
A retrospective comparative study was performed on prospectively kept database
of patients of emphysematous pyelonephritis admitted in Kasturba Hospital from
2016 to 2021. Diagnosis of EPN was established by the presence of gas on CT scan
after ruling out prior instrumentation and fistulous communication with
gastrointestinal tract. The patients were divided into group 1 and group 2 on basis
of presence or absence of urolithiasis respectively. Parameters associated with
disease severity were collected from the medical records and compared between
the two groups. After the initial conservative management of EPN, the stones were
managed appropriately. Descriptive statistics were calculated using the median for
all continuous variables and percentages for all categorical variables. Difference
between means of continuous variables was analysed using two-tailed t-test.
Categorical variables were analysed utilizing the Fisher Exact test. Total 102
patients having EPN were included in the study . 26 patients had concomitant
urolithiasis (group 1) while 76 were with EPN alone (group 2). There was a
statistically significant difference in the peak renal dysfunction [S. Creat 3.5
(Group 1) vs 4.7 (group 2) p < 0.05]; duration of ICU stay [ 7 days (group1) vs 11days
( group 2 ) p < 0.05]; duration of hospital stay [ 9days (group 1) vs 12days (group 2)
p < .05 ]; CT grading severity index [ 32%( grade 1) , 68 ( grade 2 and above ) in
group 1 , 11% (grade1) , 89% ( grade 2 and above ) in group 2 ] ; intervention in the
form of dj stenting/pcn/pcd was done in [ 18 patients (69%) of group 1 and 39
patents (51%) of group 2 ]. No significant difference was observed in total
leucocyte count , associated comorbidities, platelet count between the two groups.
Mortality (11.8%) was present only in the non stone group. 7 (26.9%) patients in the
urolithiasis group underwent elective PCNL and 4 (14%) patients underwent elective
URSL after 4 weeks of discharge. Nephrectomy was needed in 2 (2.6%) patients of
the non-urolithiasis group. EPN associated with urolithiasis had milder course with
excellent response to endourological management as compared to EPN without
concomitant urolithiasis. ICU stay and overall hospital stay was shorter in the EPN
with urolithiasis group. Mortality was observed only in the EPN without urolithiasis
group.

OAB score: A clinical tool that predicts the probability of presenting

overactive detrusor in the urodynamic study.
Dr Pruthvi Raj H, Dr Manohar CS, Dr Pramod Adiga, Dr Ali Poonawala, Dr Keshava
Murthy R. INU, Bengaluru.
OBJECTIVES: To create a predictive model of involuntary detrusor contraction
(IDC) to improve the diagnostic accuracy of overactive detrusor (OAD), associating
overactive bladder (OAB) symptoms with other clinical parameters in the female
population
Study Type: Retrospective comparative validational study.Participants: aged
between 16 to 75 yrs presented to INU with urogynaecological problem between
September 2019 to june 2021.
MATERIAL & METHODS: total of 37 women were studied retrospectively. Out of
which 6 patients lost to trace In all of them, urodynamic study was conducted for
urogynecological causes. Demographics information, personal history, symptoms,
physical exam, a 3-day frequency/volume chart and urinary culture, were collected
in all patients and they subsequently underwent Uroflowmetry and urodynamic
studies. A logistic regression model was performed in order to determine
independent predictors of presence of IDC.
Odd ratio (OR) estimation was used to assign a score to each one of the significant
variables (p≤0.05)in the logistic regression model. We performed a ROC curve in
order to determine the predictive ability of the score in relation to the presence of
OAD.
RESULTS : Presence of OAD was evident in women (37%). In the logistic
analysis, independent predictors of OAD were urgency, urgency incontinence,
nocturia, Frequency The probability of IDC diagnosis increases as the score raises
(Score 0: 6.9% until Score 9: 35%). Sensitivity was 92.3% and specificity 93.7%.
The area under the curve of OAB score was 0.95 (p<0.001).
CONCLUSIONS: OAB score is a clinical tool that shows higher diagnostic accuracy
than OAB symptoms alone to predict overactive detrusor.

Modified USS PROM for DVIU and Non Transecting Urethroplasty for Short
Bulbar Urethral Strictures.Dr Arun Kumar Chawla. KMC, Manipal.

Background: To evaluate the patient reported outcomes of Primary Direct visual

internal urethrotomy (DVIU) and Non-transecting bulbar urethroplasty techniques
(NTBU) for short segment (<2 cm) Non Traumatic bulbar urethral strictures using
the Modified Urethral Stricture Surgery Patient Reported Outcome Measures
(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 further
modified by adding a six-item IIEF and four-item version of MSHQ-EjD to evaluate
Erectile and Ejaculatory domains. All cases of short non traumatic bulbar urethral
stricture who underwent primary DVIU and NTBU who consented were asked to fill
the modified PROM (USS -PROM+ IIEF +MSHQ-EjD) at initial evaluation , at 6
months and at 1 year
Results: The LUTS score for NTBU at 12 months is significantly better (1.93±2.13
Vs 8.76±5.92, p=0.000). The Peeling score of the NTBU 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 NTBU is significantly
better than DVIU (24.37±3.2 Vs 21.143±2.86, p=0.001). The Ejaculatory function
score at 6 months and 12 months is significantly better for the NTBU.
Uroflowmetry (Qmax) is significant in NTBU group at 12 months (26.7±4.08 Vs
15.35±5.16, p =0.000). ROC AND Odd’s Ratio analysis for analyzing patient
satisfaction showed Erectile function (AUROC-0.889, p<0.001), Ejaculatory function
(AUROC-0.957, p<0.001) at 1 year and Qmax (AUROC-0.928,p<0.001) at 6 months
and (AUROC-1.000,p<0.001) at 1year. Overall satisfaction rates in patients
undergoing NTBU is 96.5%.
 Conclusion: NTBU shows superior outcomes in almost all domains of USS- PROM
with better overall satisfaction rates. Improvement of Sexual function domain
followed by the LUTS domain were the best predictors of overall patient
satisfaction and improvement in the quality of life at one year.

Preoperative Urine culture vs Renal Pelvic Urine culture: A better predictor of

urosepsis in patients undergoing percutaneous nephrolithotomy.
Dr Gopalkrishna, Dr Varun G Huilgol, Dr Manasa T, Dr S M L Prakash Babu,
Dr Prasad Mylarappa, Dr Yalavarthi Pavan, Dr Nishith A Reddy, Dr Puneet Bansal.
MSRMC,

Introduction and objective- Percutaneous nephrolithotomy is safe and eff ective for
management of large renal calculi. Howev er after PCNL 10% to 35% of patients
mount a systemic infl ammatory response with a small percent progressing to sepsis.
Due to potentially devastating morbidity as well as the 25% to 50% mor tality rate
associated with sepsis, patients with SIRS o ften incur prolonged hospitalization and
higher health care costs. Since blood cultures are o ften negative in patients with
septic shock, clinicians frequently rely on empirical antibiotic regimens. Cultures
obtained from the renal pelvis and stones may be more helpful to guide treatment.
To fu her investigate this we prospectively determined the correlation between
preoperative and intraoperative cultures, and evaluated factors associated with
post-PCNL SIRS. Methodology- Aft er obtaining institutional review board approval
patients undergoing percutaneous nephrolithotomy from September 2016 to July
2021 were enrolled in the study. Approximately 2 weeks before surgery all patients
underwent urine culture evaluation. Renal pelvic urine was collected by retrograde
ureteral catheter placement or during percutaneous puncture of the pelvicalyceal
system.

Results- a total of 200 patients were included in the age group of 20 to 70 years.
Preoperative bladder urine culture(PBUC) was positive in 22 cases and treated with
culture specific antibiotics before surgical intervention. Renal pevic urine culture was
positive in 32 cases of which 21 had negative PBUC. Most common pathogen was E-
Coli followed by enterococcus, klebsiella and pseudomonas. Of the 200 patients, 20
patients had evidence of systemic inflammatory response syndrome(SIRS) including
3, requiring intensive care.

Conclusion- event appropriate treatment of preoperative urinary infections may not

prevent post operative systemic response after PCNL. We recommend collecting
 pelvic urine and to identify the offending organism in patients with large stone
burden since they may be at increased risk of SIRS.

Neutrophil-Lymphocyte ratio (NLR), Platelet-Lymphocyte ratio (PLR) and

Lymphocyte-Monocyte ratio (LMR) in predicting Systemic Inflammatory
Response Syndrome (SIRS) and Sepsis after Percutaneous Nephrolithotomy
(PCNL).]

Dr Shruti Rahul Pandit , Dr Arun Chawla, Dr Akshay Kriplani. KMC, Introduction:

Infective complications post PNL range from transient fever to SIRS/sepsis. This
prospective observational study assessed the clinical significance of NLR, PLR and
LMR as potential biomarkers to identify post PNL SIRS/sepsis.

Methods:Preoperative evaluation included patient demographics (age, BMI,

comorbidities, history of previous PNL), hemoglobin, TLC, serum creatinine, NLR,
LMR, PLR, urine culture, stone volume, location, HU and laterality. Intraoperative
factors assessed were puncture site, tract size, tract number, operative time,
blood transfusion and stone clearance.

Results:Of 517 patients, 56 (10.83%) developed SIRS and 8 (1.54%) developed

sepsis. Low preoperative hemoglobin (12.8±2.3 vs 13.4±1.8,p=0.04), higher TLC
(10.4±3.5 vs 8.6±2.6,p=0.000002), higher NLR (3.6±2.4 vs 2.5±1.04,p=0.0000001),
higher PLR (129.3±53.8 vs 115.4±68.9,p=0.005), lower LMR (2.5±1.7 vs
3.2±1.8,p=0.006), Staghorn stones (12.8% vs 3.24%,p=0.008), long operative times
(59.6±14.01 vs 55.2±16.02,p=0.05) had significant association with postoperative
SIRS. Predictive values for sepsis were high BMI (27.3±1.9 vs 25.1±2.9,p=0.03),
Diabetes (50% vs 17.7%,p=0.04), low LMR (2.6±1.7 vs 4.07±2.8,p=0.02), high stone
density (993±253 vs 753±407,p=0.009). Length of hospital stay (days) increased in
SIRS (3.30±1.71 vs 2.22±1.75,p= 0.00003) and Sepsis (3.34±1.69 vs
2.34±1.78,p=0.001). Cut off for NLR, PLR and LMR to predict SIRS and Sepsis was
2.03 & 2.45, 110.62 & 120.25 and 3.23 & 2.88 respectively.
Conclusion:NLR, PLR and LMR can be useful independent, easily accessible, cost-
effective predictors for early identification of post PNL SIRS/sepsis.

NU Hospitals Best Video Prize (6 + 2 min)

Use of fire fly technology in urology practice: A brief update
Dr Columbia Asia (A unit of Manipal hospitals), Bengaluru.
Aims and objectives: To assess the ability of use of Indigo cyanin green (fire
fly technology)
In the field of urology during lap/robotic surgeries
Material and methods :The following video’s presents the difficulty of
tackling bad ureteral stricture (post multiple procedures) and identifying
the ureter due to previous complications, also high lights the use of ICG in
tacking cystic RCC located eccentrically with no clear margins. The
procedure was done either by robotic or laparoscopic using fire fly
technology.
Results: With this technology (fire fly) one can easily identify the structure
in focus and asses the vascularity of the structure, precisely identify the
organ and margin with minimal dissection which helps in reducing the OR time
and minimize the complications
Conclusion: Judicious use of ICG with fire fire fly technology lessens the
morbidity during difficult dissection precisely identify the margins during
oncological procedure

Approach to complex posterior hilar renal tumours – Our technique of Robot

assisted partial nephrectomy.
Dr Mohammed Shahid Al, Dr Deepak Dubey. Manipal hospitals, Bengaluru.
Tumours located at posterior hilar region pose an additional challenge for
resection and later reconstruction. With minimal invasive approaches we have to
carefully plan our approach in dealing such tumours. We hereby present our
transperitoneal technique of robotic assisted partial nephrectomy in such complex
tumours.
Our index case is a 42 year male patient with a T1b tumour at the hilum of right
kidney located posteriorly.Preoperative evaluation with contrast enhanced
Computed tomography revealed a 2.5x2 cm enhancing mass abutting the posterior
division of renal vessels. With patient in left Lateral position ,four 8 mm Robotic
ports were placed transperitoneally and kidney was mobilised all around . The goal
was to mobilise kidney all around inside Verona’s fascia leaving just the ureter ,
renal artery and the vein intact. This allowed the kidney to be flipped cephalo-
caudal ,so the the lower pole was moved up towards the liver and the upper pole
rotated down caudal. This makes the posterior hilum right in front of the camera.
The tumour was the marked using intra operative ultrasonography .The vessels were
clamped with kidney in normal position and then flipped .Tumour was resected and
sliding clip renorrhaphy performed using Barbed sutures. Total warm ischemia time
was 19 minutes and console time was 108 minutes with about 100 cc of blood loss.
Post procedure patient did well with no peri operative complications and was
discharged on Day 2.

Surgical Strategies to Deal with Left Renal Hilar Variations in Laparoscopic

Donor Nephrectomy.
Dr Prashant M Kulkarni, Dr Jagadish Koushik, Dr Furkhan Ahmed, Dr Saurabh
Bhargava. NHMSHC, Bengaluru.
Introduction and Objective.– Renal transplantation remains the best option for end
stage renal disease. Left live donor nephrectomy is a unique surgical challenge
because it is performed on healthy donors. It is of great importance to keep the
morbidity and mortality of live donors as low as possible and to harvest the kidney in
optimal condition for transplantation. so left laparoscopic donor nephrectomy is a real
challenging procedure for the practicing Urologist. In this presentation we are
discussing the challenges encountered during left lap donor nephrectomy with
particular attention paid to the variations in vascular anatomy of left hilum.
Methods - During last 8 yrs, we had encountered 28 cases of left sided multiple
renal arteries,4 cases of left sided retro aortic renal vein, 8 cases of early
branching of the renal arteries and one case of left sided IVC. We have used all
conventional laparoscopic instruments to handle these situations with out costly
accessories like EndoGI staplers.
Results– At our center we have good experience of handling multiple renal arteries
and abnormalities of left renal vein. Meticulous dissection, correct method of
mobilizing hilar vessels, proper use of accessory port, use of correct instruments
and technique of handling of problems like hem-o-lock clip slippage are also
discussed.
Conclusions- Basic concept of left renal hilar anatomy favors left donor
nephrectomy. Few factors like hilar anatomic variation should not be a factor for
discarding laparoscopic procedure or going in for right sided donor nephrectomy.

Robotic VEIL Post Chemotherapy

Dr Kinju Adhikari, Dr Raghunath S K, Dr Tejus Chiranjeevi. HCG Cancer Centre.
Bengaluru.

Inguinal Lymph node dissection (ILND) has an important role in both staging and
treatment of penile cancer. Minimally invasive technologies have been utilized to
perform ILND in penile cancer patients with non-palpable inguinal lymph nodes and
intermediate to high-risk primary tumors, including video endoscopic inguinal
lymphadenectomy (VEIL) and robotic video endoscopic inguinal lymphadenectomy
(RVEIL). Current data suggest that VEIL and RVEIL are feasible and safe with
minimal intra-operative complications. Perhaps the strongest appeal for the use of
minimally-invasive approaches is their faster post-operative recovery and less post-
operative complications. When compared to open technique, VEIL and RVEIL have
similar dissected nodal count, a surrogate metric for oncological adequacy, and a
none-inferior inguinal recurrence rate.Our series has post chemotherapy patients,
numbered 6, 12 groins, who underwent Robotic VEIL, operated 2016 onwards, with
average console time of 153mins (excluding Pelvic Lymph node dissection) and
average LN yield of 14. The mean blood loss is 30ml with 2 post operative lymph
collection. The video illustrates the technique of RVEIL including ports marking,
finger dissection. ports insertion and step by step approach of Inguinal dissection.

Heart Shaped Neobladder Following Robotic Radical Cystectomy – Our

Experience.
Dr Divya Shree Bhat, Dr Mujeeburahiman. Yenepoya Medical College,
Mangaluru.Introduction: Following robotic radical cystectomy, reconstruction with
neobladder are indicated, in select cases. Common neobladders used are Studer
pouch, W pouch where long segment of intestine are used to construct the pouch.
Although radical cystectomy is performed robotically, many urologists perform
neobladder reconstruction extracorporeally because intracorporeal diversion is
perceived as technically complex and arduous. We would like to share our
experience of heart shaped neobladder following radical cystectomy where only
44cms of ileum was used and there is no requirement of left ureteral rerouting
under the sigmoid mesocolon. This provides major advantages in terms of the length
of intestine preserved and its associated metabolic complications and reduced time
to construct it, thus reducing the operative time and shortened learning curve.

Aims: To evaluate perioperative outcomes and complications associated with of

heart shaped neobladder following radical cystectomy .
Subjects and Methods: We evaluated a total of 8 patients with Carcinoma Bladder
undergoing Robotic Radical Cystectomy followed by heart shaped neobladder
reconstruction.
Technique of heart shaped neobladder : 44cm of intestine is harvested, 20cms
away from Ileocaecal junction. 22cms is marked for the urethrovesical anastomosis.
Then the whole segment is detubularised. Medial borders of the detubularised ileal
segment are anastomosed to form the posterior plate. The apex of the posterior
plate is anastomosed by continuous sutures to the urethra. The detubularised ileum
is folded across to create a heart shaped configuration and the adjoining margins
are sutured. Ureters are implanted to both the corners of the newly constructed
pouch with 8Fr ureteric catheters placed as splint. Per urethral 18 Fr Foleys and
16 Fr SPC are placed.
Postoperatively, regular bladder wash given from Day 2. Both ureteric catheters
clamped on day 9 and removed on Day 10 and.SPC clamped on day 11 and removed on
day 12 . Per urethral catheter removed on Day 21 . Postoperatively continence
evaluated and PVRU assessed by ultrasound. Uroflowmetry and urodynamics done
for all patients after 12 weeks
Uroflowmetry of 13-15 ml/sec and a Pdet at Qmax of 45 – 53cmH20 are noted .
We present our technique ,perioperative outcomes, hospital stay, and postop
complications(Clavien Dindo Classification).
Results: Estimated blood loss of approximately 400 ml. Maximum post operative
complications seen were Clavien-Dindo grade 1 in 25% of the patients and 2 in 12%
of the patients. No grade 4a, 4b and 5 complications were recorded. No significant
postoperative infections or prolonged ileus noted in our study group.
Conclusions: This technique facilitates neobladder reconstruction with minimal
postop complications and good compliance and similar clinical results at the expense
of small segment of bowel used. This step-wise approach is demonstrated to help
shorten the learning curve of other surgeons. The comparative operative,
postoperative, and functional outcomes, becoming a safe and feasible alternative to
other neobladder reconstruction.
.
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