FINASTERIDE GIVEN FOR HAIR REGROWTH MAY LEAD TO MALE INFERTILITY

Recently a 27 year old gentleman came to us with severe oligospermia.He was a case of hair transplant on finast low dose.There was no other cause discernible for oligospermia.He was asked to stop finast and at the same time advised to take anti-oxidnats to increase the sperm count.He was requested to come after a period of 3 months with fresh report of semen analysis.

Androgenetic alopecia (male pattern hair loss) is caused by androgen-dependent miniaturization of scalp hair follicles, with scalp dihydrotestosterone (DHT) implicated as a contributing cause. Finasteride, an inhibitor of type II 5alpha-reductase, decreases serum and scalp DHT by inhibiting conversion of testosterone to DHT.It is usually given in the low dose of 1 mg/day for accentuating the hair growth in the male pattern baldness.It has been argued that the finasteride doesnot affect spermatogenesis in normal health men in low dosage.But it might affect if the person who is taking the medications has already compromised spermatogenesis.
As most of the patients undegoing treatment for hair regrowth are in the younger age group.The treating surgeon/physician/dermatologist should take into his/her account his fertility status.

LASER EPILATION OF THE NEOURETHRAL HAIR

A 57 year old gentleman -case of urethroplasty with scrotal flap for anterior urethral stricture- had complaints of unabated dysuria and recurrent UTIs.There was no relief with the antibiotic therapy(both curative and suprressive).His urethroscopy had revealed adequate lumen(with diverticulae) with plenty of hair arising out of the scrotal flap area used for urethroplasty.He is presently planned for LASER(continuous 2 micron Thulium LASER) epilation.The hair might be acting as reservoir for the recurrent infections and also could result in dysuria.

Bladder mass in a young patient

A 27 year old patient came with complaints of lower urinary tract symptoms mainly irritative in nature.The patient was treated outside with multiple courses of antibiotic therapy without relief.The sonography done further showed the bladder mass.The other investigations- including the urine culture,urine for malignant cytology,blood biochemistry and haemtology were essentially normal.

We evaluated her further with triphasic CT scan which revealed cystic enhancing mass in the left superolateral wall of the urinary bladder with no iliac lymphadenopathy.The other intra-abdominal organs were normal.



She was taken up for cystoscopy and biopsy.The mass was extravesical.Adequate biopsy was taken with resectoscope.Hemostasis was achieved.The histopathological report is awaited.

Thulium laser prostatectomy: Tangerine technique-safe way of prostatectomy

In our hospital we follow -tangerine technique of laser prostatectomy. We use 2-μm -continuous wave thulium laser to dissect whole prostatic lobes off the surgical capsule, similar to peeling a tangerine. A 70-W, (thulium) laser was used in continuous-wave mode. We joined the incision by making a transverse cut from the level of the verumontanum to the bladder neck, making the resection sufficiently deep to reach the surgical capsule, and resected the prostate into small pieces, just like peeling a tangerine. The prostatic pieces were pushed into the bladder and later removed with the morcellation. We have rarely encountered bleeding. Saline was used for irrigation and hence no TUR syndrome occurs. Blood transfusion rate is less than 0.5%.We have even done patients on antiplatelet agents and patients with cardiac comorbdities.Recently we operated a 90-year old man with retention. The procedure was uneventful and the patient voided well after the surgery.
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Giant Pyonephrotic kidney: A lesson learnt

A 35 year old gentleman came to us with the left flank pain of 15 days duration.He was also complaining of generalised malaise.There was no complaint of fever or lower urinary tract complaints.He was complaining of dull ache in flank region previously also on and off.But the intensity as per the patient was not significant enough to seek consultation from doctor.He didnt have any comorbdities.There was no prior history of undergoing urological/ surgical interevention.Physical examination revealed a large mass in the left flank. Imaging showed a large hydronephrotic kidney with papery thin parenchyma.IVP showed a non excreting kidney even after 24 hours.Urine examination was unremarkable.

We explained the patient about non functioning status of the kidney and need for nephrectomy.Initial on table drainage then followed by laparoscopic nephrectomy vis-a-vis open nephrectomy options were considered.Finally we decided to go for open surgery.The kidney intra-operatively was grossly enlarged and full of thick creamy pus.A total of 3litres of pus was drained and then subcapsular nephrectomy was performed.

The pyonephrotic kidney removal is difficult surgery in view of loss of planes with the surrounding structures.Many times we are misled by the symptoms.We assumed that this would be a simple hydronephrotic kidney and thus surgery will be easier because of maintained planes.Absence of fever or absence of perinephric stranding on CT scan led us to assume so.Laparoscopy is pyonephrotic kidney would be a difficult task and waste of time; which can add to patients morbidity.Initial drainage (before surgery) would add a lot to our management strategy. If a clear urine drains out a laparoscopic surgery would be the treatment of choice.If pus is drained then open surgery can be assorted to.