Indian Journal of Urology最新文献

{"title":"A comparative analysis of proximal obturator nerve block versus general anesthesia in transurethral resection of bladder tumor: Prospective exploratory study.","authors":"Gautam Shubhankar, Ankur Mittal, Vikas Kumar Panwar, Arup Kumar Mandal, Praveen Talawar","doi":"10.4103/iju.iju_254_24","DOIUrl":"https://doi.org/10.4103/iju.iju_254_24","url":null,"abstract":"<p><strong>Introduction: </strong>Transurethral resection of bladder tumor (TURBT) harbors the risk of intraoperative obturator jerks in lateral wall tumors due to obturator nerve stimulation, resulting in bladder perforation. This study aims to compare the safety and efficacy of ultrasound-guided proximal obturator nerve block (PONB) with regional anesthesia (RA) versus general anesthesia (GA) during bipolar TURBT.</p><p><strong>Methods: </strong>This prospective observational study enrolled 131 patients with lateral or posterolateral bladder tumors over 1.5 years. Patients were divided into two groups: Group I received PONB + RA (n = 63), while Group II received GA (n = 68). In Group I, 9 patients received unilateral (IA) and 54 bilateral PONB (IB). The primary objectives were to compare the incidence of obturator jerks and bladder perforations. Secondary objectives included comparing time taken for anesthesia, surgery, and associated complications.</p><p><strong>Results: </strong>Obturator jerks were observed in 60% of Group IA patients. Considering patient safety, the remaining 54 patients in Group I received bilateral PONB. Only 5% of patients in IB had obturator jerks. No obturator jerk was seen in the GA group. No patient had bladder perforation. Surgery and anesthesia times were 32 ± 6 min and 63 ± 13 min in Group IA, 37 ± 5 min and 65 ± 10 min in Group IB, and 28 ± 5 min and 64 ± 15 min in Group II, respectively, all statistically nonsignificant.</p><p><strong>Conclusion: </strong>Bilateral PONB significantly reduced obturator jerks compared to unilateral PONB providing similar safety and efficacy as GA. It is a viable alternative for patients unfit for GA.</p>","PeriodicalId":47352,"journal":{"name":"Indian Journal of Urology","volume":"41 2","pages":"111-116"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does chatGPT-4.0's awareness of conversing with a urologist affect the accuracy of responses to questions about \"sexually transmitted urethritis in men\"?","authors":"Mesut Cilli, Kemal Turker Ulutas","doi":"10.4103/iju.iju_409_24","DOIUrl":"https://doi.org/10.4103/iju.iju_409_24","url":null,"abstract":"<p><strong>Introduction: </strong>This study delved into the responses generated by ChatGPT-4 (artificial intelligence-language model) regarding queries on sexually transmitted urethritis in men and investigated the impact of \"knowledge of conversing with a urologist\" on the accuracy of its responses.</p><p><strong>Methods: </strong>A total of 272 questions from the \"sexually transmitted infections treatment guidelines\" (US Centers for Disease Control and Prevention) were prepared by a urology specialist and arranged to cover various levels of difficulty. The questions were presented in the formats of multiple-choice and true/false. Two groups were created: In Group 1, ChatGPT-4 was only provided with the questions, whereas in Group 2, it was explicitly stated that ChatGPT-4 was engaging in a conversation with a urology specialist. The accuracy of ChatGPT-4's responses was evaluated.</p><p><strong>Results: </strong>In Group 1, the accuracy rate was 81% (94/116), whereas in Group 2, it was 77.5% (90/116). Subgroup A, which consisted of multiple-choice questions, had accuracy rates of 77.5% (45/58) for Group 1 and 74.1% (43/58) for Group 2. Subgroup B, which included true/false questions, had accuracy rates of 84.4% (49/58) for Group 1 and 81% (47/58) for Group 2. The mean accuracy score was higher in Group 1, whereas the mean completeness score was higher in Group 2.</p><p><strong>Conclusions: </strong>Providing ChatGPT-4 with the information that it was conversing with a urologist did not enhance the accuracy of its responses regarding sexually transmitted urethritis in men. The consistently high accuracy observed in ChatGPT-4's responses demonstrates that this system can be reliably used as a question-and-answer tool.</p>","PeriodicalId":47352,"journal":{"name":"Indian Journal of Urology","volume":"41 2","pages":"117-123"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical and functional outcomes of bilateral synchronous adrenalectomy for functional tumors: A cohort study.","authors":"Keshav Agarwal, Rashmi Ramachandran, Nikhil Tandon, Rajeev Kumar","doi":"10.4103/iju.iju_443_24","DOIUrl":"https://doi.org/10.4103/iju.iju_443_24","url":null,"abstract":"<p><strong>Introduction: </strong>Bilateral synchronous adrenalectomy has the potential for significant surgical and functional morbidity. We reviewed our 15-year experience with bilateral synchronous adrenalectomy to assess the safety, surgical outcomes, morbidity, and impact on health-related quality of life (QoL).</p><p><strong>Materials and methods: </strong>In an IRB-approved study, we reviewed our database of patients who underwent bilateral synchronous adrenalectomy for functional tumors between April 2008 and August 2022. Demographic profile, metabolic and radiological parameters, operative details, and complications were recorded. Follow-up was obtained either in-person or telephonically and analyzed for resolution of symptoms, QoL using the WHO-QoL BREF questionnaire, and complications of chronic steroid intake. Data were reported descriptively and compared between laparoscopic and open approaches.</p><p><strong>Results: </strong>During the study period, 337 adrenalectomies were performed, of which, 51 were bilateral and in 48 patients both the surgeries were performed synchronously. Thirty-three of these 48 patients had bilateral pheochromocytomas and 15 had Cushing's syndrome. Among patients with Cushing's syndrome, three had life-threatening symptoms requiring urgent bilateral surgery. Forty patients underwent transperitoneal laparoscopic surgery and 8 underwent open surgery. There were two intraoperative and 7 post-operative complications. Forty-three patients were available for follow-up. All had resolution of symptoms and body mass index (BMI) changes, and only two patients continued to receive one antihypertensive medication. Episodes of steroid deficiency occurred in 7 patients while steroid excess occurred in 3 patients. QoL was satisfactory in all the patients in all the domains.</p><p><strong>Conclusions: </strong>Bilateral synchronous adrenalectomy is safe and feasible for functional adrenal tumors. It leads to symptom resolution with amelioration of hypertension and BMI changes with satisfactory overall QoL.</p>","PeriodicalId":47352,"journal":{"name":"Indian Journal of Urology","volume":"41 2","pages":"124-130"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Round up.","authors":"Swarnendu Mandal","doi":"10.4103/iju.iju_86_25","DOIUrl":"https://doi.org/10.4103/iju.iju_86_25","url":null,"abstract":"","PeriodicalId":47352,"journal":{"name":"Indian Journal of Urology","volume":"41 2","pages":"85-87"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning and understanding urology: Reflection on andragogy.","authors":"Apul Goel, Tanvi Bhargava","doi":"10.4103/iju.iju_21_25","DOIUrl":"https://doi.org/10.4103/iju.iju_21_25","url":null,"abstract":"","PeriodicalId":47352,"journal":{"name":"Indian Journal of Urology","volume":"41 2","pages":"83-84"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel method of using indocyanine green fluorescence technique for nephron-sparing surgery.","authors":"Rishi Nayyar, Chandan J Das, Prashant Gupta","doi":"10.4103/iju.iju_241_24","DOIUrl":"https://doi.org/10.4103/iju.iju_241_24","url":null,"abstract":"<p><p>Two complex small renal masses were operated using a novel method of utilising indocyanine green fluorescence for nephron-sparing surgery (NSS), overcoming its current limitations of short duration of effect and non-enhancement of the tumor. The dye was emulsified with ethiodized oil and a 1:1 mixture was administered on the morning of the surgery using superselective cannulation of the direct tumoral blood supply. The fluorescence could be used throughout the entire course of the surgery irrespective of arterial clamping, allowing quick tumor identification, edge marking, and near-enucleation over enucleoresection. This novel method has the potential to aid the surgeon during various critical steps of NSS.</p>","PeriodicalId":47352,"journal":{"name":"Indian Journal of Urology","volume":"41 2","pages":"148-150"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's inside.","authors":"Abhishek Singh","doi":"10.4103/iju.iju_90_25","DOIUrl":"https://doi.org/10.4103/iju.iju_90_25","url":null,"abstract":"","PeriodicalId":47352,"journal":{"name":"Indian Journal of Urology","volume":"41 2","pages":"88-90"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transvaginal natural orifice specimen extraction surgery in simple nephrectomy.","authors":"Jeena R Kudunthail, Kartik Sharma, Deepak Prakash Bhirud, Mahendra Singh, Gautam Ram Choudhary, Shiv Charan Navriya, Arjun Singh Sandhu","doi":"10.4103/iju.iju_304_24","DOIUrl":"https://doi.org/10.4103/iju.iju_304_24","url":null,"abstract":"<p><strong>Introduction: </strong>Natural orifice specimen extraction surgery (NOSES), particularly transvaginal NOSES, is an innovative approach in laparoscopic urological surgery. This study aims to assess the feasibility, safety, and outcomes of transvaginal NOSES in women undergoing laparoscopic simple nephrectomy in an Indian cohort.</p><p><strong>Methods: </strong>A prospective observational study was conducted from September 2022 to May 2024 in the department of urology, including 15 women with prior vaginal deliveries undergoing simple nephrectomy. Exclusion criteria were vaginal scarring, previous pelvic surgeries, active intravaginal infections, cervical neoplasia, unresolved pelvic inflammation, and patient refusal. Parameters assessed included operative time, specimen extraction time, blood loss, postoperative recovery metrics, Female Sexual Function Index, and Pelvic Floor Impact Questionnaire scores at the baseline and at 3 months.</p><p><strong>Results: </strong>The mean age of the patients was 45.73 years. The average operative time, including the specimen extraction was 127.8 min and the average extraction time was 30.13 min. None required conversion to open surgery, and the average blood loss was 68.0 mL with no intraoperative transfusions. The postoperative recovery was rapid, with milestones achieved within 1 day, and the average hospital stay was 2.2 days. Pain scores were low (Visual Analog Scale: 2.87 at 24 h and 1.47 at 48 h). The complication rate was 6.67%, with one case of vaginal bleeding which was managed conservatively. Postoperative pelvic floor and sexual functions were preserved without significant adverse effects.</p><p><strong>Conclusion: </strong>Transvaginal NOSES is a feasible and safe technique for nephrectomy, offering reduced postoperative pain, minimal blood loss, and rapid recovery, enhancing surgical outcomes and patient satisfaction.</p>","PeriodicalId":47352,"journal":{"name":"Indian Journal of Urology","volume":"41 2","pages":"104-110"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive adrenalectomy for adrenocortical cancers: A systematic review.","authors":"Faisal Masood Pirzada, Rajeev Kumar","doi":"10.4103/iju.iju_343_24","DOIUrl":"https://doi.org/10.4103/iju.iju_343_24","url":null,"abstract":"<p><strong>Introduction: </strong>Adrenocortical cancer (ACC) is a rare malignancy with poor prognosis. Due to the widespread use of imaging, greater proportion of cases are being discovered at an early stage, and it is possible to surgically excise these tumors by minimally invasive (MIS) approaches, including pure laparoscopy and robotic assistance. However, due to the fear of capsular breach, tumor spill, and incomplete removal, open surgery (OS) is still the preferred option for managing ACC. The aim of this review is to compare the two approaches and assess where MIS can be option for the surgical management of ACC.</p><p><strong>Methods: </strong>This review was performed as per the Preferred Reporting Items for Systematic Reviews statement. Studies comparing OS and MIS approaches for ACC were retrieved from the PubMed, Scopus, and Cochrane databases. The two approaches were compared for tumor characteristics and outcomes.</p><p><strong>Results: </strong>A total of 22 studies comparing MIS with OS were included in this review. Out of the total 4639 patients, 1411 underwent surgery by MIS and 3228 by OS. Patients operated by MIS had smaller tumors, lower operative time and blood loss with higher positive surgical margin rate, and higher rate of local recurrence. However, the overall survival was comparable between the two approaches.</p><p><strong>Conclusions: </strong>MIS can be used in localized Stage-I ACC but only at high-volume centers. Stage II ACC may be considered for MIS if there is no evidence of local invasion and the surgery can be performed without capsular perforation and conversion to OS.</p>","PeriodicalId":47352,"journal":{"name":"Indian Journal of Urology","volume":"41 2","pages":"91-97"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding horizons to cure muscle-invasive bladder cancer: A novel treatment algorithm.","authors":"Shashank Agrawal","doi":"10.4103/iju.iju_501_24","DOIUrl":"https://doi.org/10.4103/iju.iju_501_24","url":null,"abstract":"","PeriodicalId":47352,"journal":{"name":"Indian Journal of Urology","volume":"41 2","pages":"153-154"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}