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    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 (PNL)
    (Springer, 2022) Kriplani, Akshay; Pandit, Shruti; Chawla, Arun; de la Rosette, Jean J. M. C. H.; del Pilar Laguna Pes, Maria; Reddy, Suraj Jayadeva; Somani, Bhaskar K.
    The objective of this prospective observational study was to assess the clinical significance of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) as potential biomarkers to identify post-PNL SIRS or sepsis. Demographic data and laboratory data including hemoglobin (Hb), total leucocyte count (TLC), serum creatinine, urine microscopy and culture were collected. The NLR, LMR and PLR were calculated by the mathematical division of their absolute values derived from routine complete blood counts from peripheral blood samples. Stone factors were assessed by non-contrast computerized tomography of kidneys, ureter and bladder (NCCT KUB) and included stone burden (Volume = L x W x D x pi x 0.167), location and Hounsfield value and laterality. Intraoperative factors assessed were puncture site, tract size, tract number, operative time, the need for blood transfusion and stone clearance. Of 517 patients evaluated, 56 (10.8%) developed SIRS and 8 (1.5%) developed sepsis. Patients developing SIRS had significantly higher TLC (10.4 +/- 3.5 vs 8.6 +/- 2.6, OR 1.19, 95% CI 1.09-1.3, p = 0.000002), higher NLR (3.6 +/- 2.4 vs 2.5 +/- 1.04, OR 1.3, 95% CI = 1.09-1.5, p = 0.0000001), higher PLR (129.3 +/- 53.8 vs 115.4 +/- 68.9, OR 1.005, 95% CI 1.001-1.008, p = 0.005) and lower LMR (2.5 +/- 1.7 vs 3.2 +/- 1.8, OR 1.18, 95% CI 1.04-1.34, p = 0.006). Staghorn stones (12.8 vs 3.24%, OR 4.361, 95% CI 1.605-11.846, p = 0.008) and long operative times (59.6 +/- 14.01 vs 55.2 +/- 16.02, OR 1.01, 95% CI 1.00-1.03, p = 0.05) had significant association with postoperative SIRS. In conclusion, NLR, PLR and LMR can be useful independent, easily accessible and cost-effective predictors for early identification of post-PNL SIRS/sepsis.
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    Patient-reported outcome measures using modified urethral stricture surgery: Patient-reported outcome measure for direct visual internal urethrotomy and nontransecting urethroplasty for short nontraumatic bulbar urethral stricture - A prospective comparative observational study from a university teaching hospital
    (Wolters Kluwer Medknow Publications, 2023) Sitaram, Mummalaneni; Reddy, Suraj Jayadeva; Chawla, Arun; de la Rosette, Jean J. M. C. H.; del Pilar Laguna Pes, Maria; Bhaskara, Sunil Pillai; Reddy, Bathi Sourabh; Pandit, Shruti; Choudhary, Anupam
    Purpose: To evaluate the patient-reported outcomes of primary direct visual internal urethrotomy (DVIU) and nontransecting bulbar urethroplasty techniques (NTBU) for the short segment (<2 cm) nontraumatic bulbar urethral stricture using the modified urethral stricture surgery patient-reported outcome measures (USS PROMs). Materials and Methods: The USS PROM questionnaire used to evaluate lower urinary tract symptom (LUTS) was modified by adding a six-item International Index of Erectile Function and a four-item version of MSHQ-EjD to evaluate erectile and ejaculatory domains. All cases of short nontraumatic bulbar urethral stricture who underwent primary DVIU and NTBU who consented were asked to fill the modified PROM 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 significantly better at 12 months (1.41 +/- 0.68 vs. 2.67 +/- 0.73, P = 0.000). The erectile function score at 12 months for NTBU is 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. Receiver operating characteristic (ROC) AND Odd's Ratio analysis for analyzing patient satisfaction showed erectile function (area under ROC [AUROC] - 0.889, P < 0.001), ejaculatory function (AUROC - 0.957, P < 0.001) at 1 year and maximum flow rate of urine on uroflometry (Qmax) (AUROC - 0.928, P < 0.001) at 6 months and (AUROC - 1.000, P < 0.001) at 1 year. The 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 was the best predictor of overall patient satisfaction and improvement in the quality of life at 1 year.