From local Reactions to Global Emergence: Sheaf-theoretic Insights into Prebiotic Chemical Evolution | Chapter 4 | Chemistry and Biochemistry: Research Progress Vol. 9

 

The emergence of life required isolated prebiotic chemical reactions to integrate into coordinated systems, yet how this transition occurred across early Earth's diverse environments remains unclear. We present a mathematical framework using sheaf theory to model how local chemical processes in distinct microenvironments could have scaled to create global biochemical networks.

 

We systematically characterised ten prebiotic microenvironments—including hydrothermal vents, mineral surfaces, lipid membranes, and ice eutectic phases—using formal concept analysis to identify twelve key physicochemical attributes such as polar solvents, mineral catalysis, and redox gradients. These attributes define a topological space where microenvironments share common properties from open sets, allowing us to apply sheaf-theoretic methods.

 

Our sheaf construction shows that physicochemical attributes act as selective "carriers" that are active only in specific microenvironmental combinations. The locality and glueing conditions of the sheaf theory model how chemical processes maintain internal consistency while integrating across overlapping niches. This reveals hierarchical structures showing how attributes propagate across scales, with hydrothermal vents, mineral surfaces, and lipid membranes emerging as critical hubs concentrating multiple catalytic and compartmentalising properties.

 

These findings suggest prebiotic chemical evolution emerged not from a single optimal environment, but from the integration of disparate microenvironments, each contributing specialised conditions that collectively enabled complex biochemical networks. Our framework provides mathematical rigour for understanding prebiotic chemistry's spatial and functional organisation, offering predictive insights into which environmental combinations most likely facilitated life's origin.

 

 

Author(s) Details

Javier Burgos Salcedo
Facultad de Ingeniería, Fundación Universitaria San Mateo y Corporación Para la Investigación y la Innovación CIINAS, Colombia.

 

Please see the book here :- https://doi.org/10.9734/bpi/cbrp/v9/6861

 

Carbohydrate-Based Derivatives Act as Potential Antimicrobial and Influenza Virus Inhibitors: In vitro and In silico Approaches | Chapter 3 | Chemistry and Biochemistry: Research Progress Vol. 9

 

A wide range of carbohydrate-derived drugs are currently utilised worldwide as antifungal, antibacterial and anticancer drugs. In this context, our research group focused on designing and synthesising new derivatives of methyl α-D-mannopyranoside (1, MDM) and exploring its antiviral and antibacterial properties through both experimental and computational approaches.

 

Seven MDM derivatives (2–7) were synthesised via selective acylation and fully characterised using spectroscopic techniques. In vitro antibacterial activity was evaluated by MIC and MBC assays, while in silico analyses included PASS prediction, density functional theory calculations, molecular docking, and molecular dynamics simulations against influenza A neuraminidase (H1N1, PDB ID: 7XGC). Compounds 3 and 5 exhibited the most significant antibacterial activity against both Gram-positive and Gram-negative strains, with compound 5 showing superior MIC and MBC values. Computational studies revealed favourable electronic properties for the active compounds. Docking and molecular dynamics analyses identified compounds 6 and 7 as the most potent neuraminidase binders, forming stable interactions with key catalytic residues commonly involved in known neuraminidase inhibitors. The combined in vitro and in silico findings highlight acylated MDM derivatives as promising dual-action antibacterial and antiviral scaffolds, with compound 5 emerging as a potential antibacterial lead and compounds 6 and 7 as promising candidates for anti-influenza drug development.

 

 

Author(s) Details

 

Sarkar M. A. Kawsar
Department of Chemistry, Faculty of Science, University of Chittagong, Chittagong-4331, Bangladesh.

 

Md. Farhan Labib
Department of Chemistry, Faculty of Science, University of Chittagong, Chittagong-4331, Bangladesh.

 

S. M. Sajid Hasan Shammo
Department of Chemistry, Faculty of Science, University of Chittagong, Chittagong-4331, Bangladesh.

 

Nazia Islam
Department of Chemistry, Faculty of Science, University of Chittagong, Chittagong-4331, Bangladesh.

 

Please see the book here :- https://doi.org/10.9734/bpi/cbrp/v9/6927

Copper-Mediated Cross Coupling Reactions and Their Applications: An Overview | Chapter 2 | Chemistry and Biochemistry: Research Progress Vol. 9

 

Copper (Cu) is a promising catalytic metal for C–C bond construction through coupling transformations. Coupling strategies of a range of organo-metallic reagents, with aromatic, heteroaromatic, and alkyl halides, can be carried out by Cu-catalysts with high efficiency, demonstrating the adaptability of Cu supported catalytic methods in carrying out these transformations. Conversely, the parallel palladium-catalysed cross-coupling methods are frequently complementary to the scope and selectivity of copper-assisted methods. Furthermore, Cu-catalysts are displaying a distinct pattern of reactivity that permits ligand-less coupling for the formation of aromatic–heteroaromatic and heteroaromatic–heteroaromatic bonds, a transformation that typically calls for unique, specially created ligands with Pd-catalysts. Early findings in the field of Cu-mediated couplings to generate C-C bonds are summarised in this chapter.

 

 

Author(s) Details

Gadamani Suresh Babu
Department of Humanities & Sciences, Brilliant Institute of Engineering & Technology, Abdullapur (V), Abdullapurmet (M), R.R District-501505, India.

 

Kiran Kumar Tatapudi
Discovery Analytical R&D Department, Aragen Life Sciences Pvt. Ltd., IDA Nacharam, Hyderabad, Telangana, India.

 

Surinderpal Singh
Department of Chemistry (H&S), CMR Engineering College, Kandlakoya (V), Medchal Road, Hyderabad, Telangana 501401, India.

 

Tiruveedhula Somasekhar
Department of Humanities & Sciences, Vidya Jyothi Institute of Technology, Aziz Nagar Gate, Chilkur Balaji Road, Himayat Sagar Rd, Hyderabad, Telangana 500075, India.

 

Hemambika SadasivuniDepartment of Freshmen Engineering, St. Martin’s Engineering College, Dhulapally, Hyderabad, Telangana-500100, India.

 

S. Ratna Kumari
Department of Chemistry, Basic Science & Humanities, Vignan's Nirula Institute of Technology and Science for Women, Guntur, A.P., India.

 

S N Murthy Boddapati
Department of Chemistry, Sir C R Reddy College, Eluru, Andhra Pradesh-534007, India.

 

 

Please see the book here :- https://doi.org/10.9734/bpi/cbrp/v9/6761

Evaluation of Proximate, Mineral and Anti-Nutrient Compositions of Vigna subterranean L. Thouars (Bambara Nut) Seeds | Chapter 1 | Chemistry and Biochemistry: Research Progress Vol. 9

 

Vigna subterranean L. Thouars (Bambara nut) is a leguminous plant grown in Sub-Saharan Africa. Its seeds have attracted increasing attention due to their associated health benefits. This study evaluated the proximate, mineral and anti – nutrient compositions of Bambara nut seeds using standard analytical methods. The proximate compositions of Bambara nut seeds showed moisture content 7.54±0.01%, ash 3.46±0.02%, Crude fat 4.79±0.01%, Crude protein 22.40±0.01%, crude fibre 1.65±0.02%, carbohydrate 60.16±0.02% and available energy 1580.75kJ. The mineral composition of the analysed samples showed that Vigan subterranean L. Thouars seeds have 57.39±0.02 mg/100g and 55.67±0.02 mg/100g of potassium and calcium, respectively. The high Ca/P ratio of 92.78 indicates that Bambara nut is a very good source of food. This study revealed that oxalate, nitrate and cyanide values were below the WHO standard.  The low content of anti-nutrients of Vigna subterranean L. Thouars showed that Bambara nut will not constitute a health hazard. This study was restricted to a sample from a single market, so future investigations should include samples from different markets to evaluate its potential as a nutritious food source.

 

Author(s) Details

I.J. Alinnor
Department of Chemistry, Federal University of Technology, P.M.B. 1526, Owerri, Imo State, Nigeria.

 

M. Chijioke-Okere
Department of Chemistry, Federal University of Technology, P.M.B. 1526, Owerri, Imo State, Nigeria.

 

N.C Nwagbo
The Ambassador College, P.M.B. 163, Ota, Ogun State, Nigeria.

 

Please see the book here :- https://doi.org/10.9734/bpi/cbrp/v9/6683

 

Financial Intelligence: From Personal Wealth to Global Impact | Book Publisher International

 

In an era defined by rapid technological advancement and increasingly complex global financial systems, financial intelligence has transitioned from a specialised skill for accountants to a critical competency for individuals, businesses, and law enforcement agencies. This manuscript provides a comprehensive exploration of financial intelligence as both a mindset and a practical toolkit. It defines financial intelligence as the ability to acquire, analyse, and interpret financial data to make informed decisions while adhering to regulatory frameworks and mitigating risks.

 

The book is structured into five core sections that trace the evolution of financial intelligence from its historical roots to its future applications. It details the four main pillars—financial awareness, planning, analysis, and modelling—and demonstrates their application in personal finance, such as budgeting and retirement planning. Furthermore, it explores the strategic role of financial intelligence in business success through cash flow management and performance metrics. It also highlights the importance of financial intelligence in law enforcement, as well as the overall health of the economy.

 

A significant focus is placed on the "dark side" of global finance, providing law enforcement and security personnel with specialised knowledge to combat financial crimes, including money laundering, fraud, and terrorism financing. Finally, the manuscript examines the transformative impact of emerging technologies—such as Artificial Intelligence, blockchain, and big data—on the future economic landscape, emphasising the ongoing necessity of financial literacy for achieving personal security and global economic stability.

 

Author(s) Details

Benjamin Wanger
Intelligence and Security Studies, Nigeria Police Academy, Wudil-Kano, Nigeria.

 

Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-74-9

Coexisting Inguinal and Umbilical Hernias as a Clinical Indicator of Diffuse Abdominal Wall Deficiency: A Case Study |Chapter 13 | Medical Science: Updates and Prospects Vol. 4

 

The lifetime risk profile for inguinal hernia is characterised by a profound sexual dimorphism, with males facing an approximate 27% cumulative incidence, ninefold greater than the 3% risk observed in females. This condition exhibits a marked predilection for the elderly, where its incidence peaks at roughly 13 cases per 1,000 individuals. Notably, the global epidemiological burden of inguinal hernia has escalated significantly, demonstrating a 36% surge in occurrence over the preceding three decades. In the spectrum of anterior abdominal wall defects, umbilical hernias rank as the third most prevalent, manifesting in an estimated 5% to 12% of the adult population. Against this clinical backdrop, this case report investigates the procedural viability and outcomes of a single-stage surgical strategy for the concomitant management of inguinal and umbilical hernias. We present a 62-year-old male patient with a 12-month history of a symptomatic, reducible right indirect inguinal hernia (4x2x2 cm) and an incidental, reducible umbilical hernia (3x3x2 cm) with exertion-triggered pain. The patient had no significant comorbidities or history of incarceration. He successfully underwent a unified operative session under spinal anaesthesia, comprising a standard Lichtenstein hernioplasty for the inguinal defect and a modified Mayo repair augmented with polypropylene mesh for the umbilical hernia. The total procedural duration was recorded at 80 minutes. The postoperative convalescence was uncomplicated, facilitating discharge on the sixth day. Critically, at the 36-month long-term follow-up, the patient reported complete resolution of symptoms and exhibited an excellent clinical outcome. There was no radiological or clinical evidence of recurrence at either surgical site, nor were there any sequelae of chronic groin pain, mesh-related complications, or surgical site infection. This successful outcome substantiates the proposition that a single-stage, mesh-reinforced repair under spinal anaesthesia constitutes a clinically feasible and resource-optimised therapeutic pathway. The approach offers distinct advantages by consolidating the surgical intervention into a solitary anaesthetic episode and a unified recovery period, thereby enhancing patient convenience and potentially reducing systemic healthcare costs. Nevertheless, while these preliminary results are highly encouraging, they necessitate rigorous corroboration through prospective, randomised controlled trials with larger cohorts. Such studies are imperative to definitively establish this integrated approach as a superior and standard-of-care alternative to traditional staged repairs for suitable patient candidates.

 

 

Author(s) Details

Mekhaeel, Shehata Fakhry Mekhaeel
Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University) Medical Institute, Department of Operative Surgery and Clinical Anatomy named after I.D. Kirpatovsky, Moscow, Russia.

 

Salem, Mohamed Ahmed Eissa Sameh
Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University) Medical Institute, Department of Operative Surgery and Clinical Anatomy named after I.D. Kirpatovsky, Moscow, Russia.

 

Elshliby, Abdelrahman Gomaa Zaky Ali
Kirov State Medical University, Kirov, Russia.

 

Ali, Omar Mohamed Ismail Mahmoud
Kirov State Medical University, Kirov, Russia.

 

Ba Madhag, Abdulrahman Khaled Mubarak Al-Naggar
Kirov State Medical University, Kirov, Russia.

 

Please see the book here :- https://doi.org/10.9734/bpi/msup/v4/6951

 

A Preschooler's Displaced Mandibular Body Fracture: A Closed Reduction Case Study | Chapter 12 | Medical Science: Updates and Prospects Vol. 4

 

Because developing tooth buds and development centres make treating mandibular fractures in young patients more difficult, conservative approaches are often used to avoid iatrogenic damage. This report describes the application of this approach to a 4-year-old kid who had a displaced left mandibular body fracture after a fall. A CT scan verified that the fracture was successfully treated with closed reduction and maxillomandibular fixation (MMF), which was performed completely intraorally using arch bars and elastics. The 30-minute procedure yielded an excellent outcome with no issues, and the patient's function and appearance were entirely restored after a four-week fixing period. This case study demonstrates that closed reduction with MMF is a highly effective, minimally invasive approach for treating some mandibular fractures in young children while preserving growth potential and ensuring proper healing.

 

 

Author(s) Details

Mekhaeel Shehata Fakhry Mekhaeel
Department of Operative Surgery and Clinical Anatomy Named after I.D. Kirpatovsky, Medical Institute, Peoples' Friendship University of Russia Named after Patrice Lumumba (RUDN University), Moscow, Russia.

 

Salem Mohamed Ahmed Eissa Sameh
Department of Operative Surgery and Clinical Anatomy Named after I.D. Kirpatovsky, Medical Institute, Peoples' Friendship University of Russia Named after Patrice Lumumba (RUDN University), Moscow, Russia.

 

Hassan Mohamed Khaled Talaat Youssef
Department of Oral and Maxillofacial Surgery, Medical Institute, Peoples' Friendship University of Russia Named after Patrice Lumumba, Moscow, Russia.

 

Aida Jahanbekam
Department of Oral and Maxillofacial Surgery, Medical Institute, Peoples' Friendship University of Russia Named after Patrice Lumumba, Moscow, Russia.

 

Fatemeh Hassannezhad Neissi
Department of Oral and Maxillofacial Surgery, Medical Institute, Peoples' Friendship University of Russia Named after Patrice Lumumba, Moscow, Russia.

 

Ali Sharifzadeh Ghazani
Department of Oral and Maxillofacial Surgery, Medical Institute, Peoples' Friendship University of Russia Named after Patrice Lumumba, Moscow, Russia.

 

Bahar Behroozi
Department of Oral and Maxillofacial Surgery, Medical Institute, Peoples' Friendship University of Russia Named after Patrice Lumumba, Moscow, Russia.

 

Kambiz Ebrahimi
Department of Oral and Maxillofacial Surgery, Medical Institute, Peoples' Friendship University of Russia Named after Patrice Lumumba, Moscow, Russia.

 

Tahoura Talebidelooei
Department of Oral and Maxillofacial Surgery, Medical Institute, Peoples' Friendship University of Russia Named after Patrice Lumumba, Moscow, Russia.

 

 

Please see the book here :- https://doi.org/10.9734/bpi/msup/v4/6937

Radiowave-Assisted Iridocyclectomy for Anterior Uveal Melanoma: A 13-Year Clinical Study | Chapter 11 | Medical Science: Updates and Prospects Vol. 4

 

Background: Uveal melanoma is a highly malignant tumour of the eye, which is characterised by melanocytic tumour growth within the uveal tract of the eye. There is a nearly equal distribution of primary uveal melanoma gender. The management options include transpupillary thermotherapy, brachytherapy, stereotactic radiotherapy, limited surgical resection, enucleation and orbital exenteration. Complications in the surgical removal of pre-equatorial tumours are largely technique-related and may be reduced by combining tumour resection with simultaneous vessel coagulation using radiowave surgery.

 

Purpose: The aim of this study is to determine the efficacy of resecting iris and ciliary body melanoma with the use of a 3.8-4.0-Mhz radiowave surgery unit.

 

Methods: This study was carried out at the Department of Eye Cancer, the Filatov Institute, between 2005 and 2018 and included 45 patients with iris and ciliary body melanoma, with a mean age of 56.3 ± 2.2 years and a slight predominance of female patients (53.3%). Sixty-seven patients who had undergone iridociliary melanoma excision using a conventional technique with cutting tools were used as retrospective controls. The eye examination included visual acuity measurement, perimetry, biomicroscopy and ophthalmoscopy. Tumour, nodus и metastasis (TNM) staging was according to the American Joint Committee on Cancer (AJCC). No metastases were seen at the time of enrollment. The mean tumour prominence at baseline was 4.0 ± 0.3 mm, with a mean base diameter of 8.3 ± 0.4 mm, corresponding to a tumour volume of  34.3 ± 0.7 mm3. Patients in both groups were stratified by baseline visual acuity into two subgroups (0.1–0.5 and 0.6–0.8). In the study group, subgroup 1A included 37 patients (82.2%) with visual acuity of 0.1–0.5, while subgroup 1B comprised 8 patients (17.8%) with visual acuity of 0.6–0.8, and in the retrospective control group, subgroup 2A consisted of 55 patients (82.1%) with visual acuity of 0.1–0.5, and subgroup 2B included 12 patients (17.9%) with visual acuity of 0.6–0.8 (p > 0.05). The analysis was performed by analysis of variance (ANOVA) using Statistica 13.0 (Dell Statsoft Inc., Austin, TX).

 

Results: The radiosurgical approach to treatment of iridociliary tumours in our patients allowed significantly reducing the rates of intraoperative and postoperative complications (χ2=4.16; df=1; p=0.04). In addition, the rates of intraoperative and postoperative complications for the treatment of iridociliary tumours with cutting instruments were 9.1% and 10.4%, respectively. The use of a radiowave surgery unit for uveal melanoma resection allowed preserving baseline visual acuity in all patients, with a tumour recurrence rate of not more than 2.2%.

 

Conclusion: The use of a radiowave surgery unit for uveal melanoma resection allowed preserving baseline visual acuity in all patients. Early (12-month) treatment outcomes (visual functions and postoperative clinical course) and late treatment outcomes (visual functions; optic media; IOP; and tumour recurrence) for iridociliary melanoma resection using a radiowave 3.8-4.0 MHz unit allow us to state that high-frequency radiowave surgery enables reducing the risk of intraoperative and postoperative complications and, consequently, preserving a good visual function.

 

 

Author(s) Details

Maletskyy Anatoliy Parfentievic
Filatov Institute of Eye Diseases and Tissue Therapy, National Academy of Medical Sciences of Ukraine, Odesa, Ukraine.

 

Khomiakova Olena Victorovna
Filatov Institute of Eye Diseases and Tissue Therapy, National Academy of Medical Sciences of Ukraine, Odesa, Ukraine.

 

Please see the book here :- https://doi.org/10.9734/bpi/msup/v4/6842

Current Knowledge on the Role of Monocytes and Macrophages in the Pathogenesis of Non-AIDS Defining Events: Mechanisms, Host Factors, and Therapeutic Implications | Chapter 10 | Medical Science: Updates and Prospects Vol. 4

 

Monocytes and macrophages play a crucial role in the development of HIV infection, contributing not only to viral persistence but also to the development of non-AIDS-defining events (nADEs) in People Living with HIV (PLWH). These innate immune cells serve as long-lived viral reservoirs, driving chronic inflammation through persistent immune activation, oxidative stress, and tissue-specific damage. HIV-infected monocytes infiltrate tissues such as the cardiovascular system, liver, kidneys, and central nervous system, where they differentiate into macrophages and release pro-inflammatory cytokines (e.g., TNF-α, IL-6), reactive oxygen species (ROS), and matrix metalloproteinases (MMPs). These mediators promote endothelial dysfunction, fibrosis, and organ damage, underpinning conditions like atherosclerosis, neurocognitive disorders, and hepatorenal disease. Emerging evidence highlights the importance of macrophage polarisation (M1/M2 imbalance) and epigenetic modifications in sustaining inflammation, even during antiretroviral therapy (ART). Besides persistent immune activation, the ability of these cells to cause tissue-specific damage is significantly influenced by host genetic factors, such as polymorphisms in the APOL1 and CCL2 genes, which can determine the severity of end-organ diseases like HIV-associated nephropathy. Additionally, epigenetic reprogramming of monocytes and macrophages—triggered by HIV proteins and the inflammatory environment—establishes a lasting pro-inflammatory state that remains despite ART. This reprogramming, marked by changes in histone modifications and DNA methylation, sustains mechanisms of tissue damage. Understanding these processes and their interaction with host factors provides critical insights for developing targeted treatments, including immunomodulators, antioxidants, and strategies for reservoir elimination. This review summarises current knowledge on how monocytes and macrophages contribute to the pathogenesis of nADEs. It explores potential new therapeutic approaches to reduce chronic inflammation and enhance clinical outcomes in PLWH.

 

 

Author(s) Details

Samuel Adinoyi Adavba
Kaduna State University, Kaduna, Nigeria.

 

Please see the book here :- https://doi.org/10.9734/bpi/msup/v4/6480

 

Male Anterior Urethral Stricture Disease: Aetiology, Evaluation, and Modern Reconstructive Approaches | Chapter 8 | Newer Frontiers in Urology, Volume III

 

Background: Male anterior urethral stricture disease is a challenging condition characterised by fibrotic narrowing of the urethra, most often in the bulbar or penile segments. It leads to obstructive voiding symptoms and significantly impacts quality of life. Definitive management requires surgical urethral reconstruction (urethroplasty), which offers far superior long-term success compared to repeated dilations or urethrotomies This chapter reviews the etiology, classification, and anatomy of anterior urethral strictures, and provides an in-depth discussion of urethral reconstruction techniques, including excision and primary anastomosis (EPA), substitution urethroplasty with buccal mucosa graft (BMG), penile skin flap urethroplasty, staged repairs, and perineal urethrostomy.

 

Methods: A comprehensive analysis of contemporary and classical literature was performed, incorporating landmark contributions (e.g. Barbagli, Kulkarni, Mundy) and recent series. Outcomes, indications, and complications of each reconstructive technique are summarised, and a comparative table is provided for quick reference.

 

Results: Short bulbar strictures (<2 cm) are effectively cured by EPA with success rates >90%. Longer or multiple strictures are managed with substitution urethroplasty using buccal mucosal grafts, which is now the standard augmentation tissue and yields durable success in ~85–95% of cases, depending on stricture length and location. Penile fasciocutaneous flap techniques (e.g. Orandi, circular flaps) can achieve comparable success to grafts in appropriately selected patients, though flap use has declined due to higher donor site morbidity (torsion, sacculation, etc.). Complex and lengthy strictures (particularly those due to lichen sclerosus) often require two-stage repairs to achieve a stable urethral calibre. Perineal urethrostomy is reserved as a salvage or permanent solution in refractory cases and offers excellent relief of obstruction with an acceptable quality of life.

 

Conclusions: Male anterior urethral strictures can be effectively reconstructed with a variety of techniques tailored to stricture characteristics. In experienced hands at high-volume centres, one-stage urethroplasty (anastomotic or substitution) achieves long-term cure in the majority of patients, with overall success rates exceeding 85–90%.

 

Buccal mucosa has become the graft of choice for augmentation. Proper patient selection and preoperative optimisation are crucial. Postoperatively, patients require structured follow-up with objective (uroflowmetry, ultrasound imaging) and subjective (symptom scores) assessments to detect and manage recurrences early. This chapter provides urologists with a detailed, evidence-based guide to contemporary urethral reconstruction, including technical pearls, expected outcomes, and management of complications.

 

 

Author(s) Details

Velmurugan Palaniyandi
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai India.

 

Hariharasudhan Sekar
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai India.

 

Vivek Meyyappan
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai India.

 

Sriram Krishnamoorthy
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai India.

 

 

Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-93-0/CH8

Suction-Enabled Retrograde Intrarenal Surgery: Technical Principles, Physiological Rationale, and Evidence-Based Applications | Chapter 7 | Newer Frontiers in Urology, Volume III

 

Background: Retrograde intrarenal surgery (RIRS) is a cornerstone for managing renal calculi <2 cm, yet it faces limitations including elevated intrarenal pressure, suboptimal stone clearance, and infectious complications. The integration of suction, particularly via Flexible and Navigable Ureteral Access Sheath (FANS), aims to mitigate these challenges. This chapter provides a critical appraisal of the role of suction in RIRS.

 

Methods: A synthesis of current literature and technical principles was conducted to evaluate the mechanisms, clinical outcomes, advantages, and limitations of FANS-assisted RIRS.

 

Results: FANS facilitates continuous outflow of irrigation fluid, stabilising intrarenal pressure and reducing the risk of pyelovenous backflow and sepsis. It enhances intraoperative visibility and may improve stone-free rates by actively evacuating fragments. However, these benefits must be weighed against increased costs, a learning curve, and a currently limited evidence base from large randomised trials.

 

Conclusion: Suction-assisted RIRS represents a significant technical advance, particularly beneficial in cases with enormous stone burdens, lower-pole stones, or infected systems. The decision to utilise suction—"to suck or not to suck"—should be individualised, as it is not a mandatory addition for all RIRS procedures but a valuable adjunct in select clinical scenarios.

 

 

Author(s) Details

Hariharasudhan Sekar
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Velmurugan Palaniyandi
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education &Research Chennai, India.

 

Vivek Meyyappan
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Sriram Krishnamoorthy
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-93-0/CH7

Robotics in Indian Urology: Evolution, Clinical Applications and Future Direction| Chapter 6 | Newer Frontiers in Urology, Volume III

 

Laparoscopy, by the 1990s, had become standard for many urological procedures, but it had intrinsic limitations: two-dimensional vision, limited instrument articulation, tremor, and surgeon fatigue, especially in deep pelvic dissections. Robotic systems were developed to overcome these barriers, offering new levels of precision and control. Robotic systems combine the minimal invasiveness of laparoscopic surgery with enhanced dexterity, three-dimensional magnified vision, tremor filtering, and ergonomic advantages that preserve surgeon precision over long operations. In this chapter, the study expands our understanding of robotics in Indian urology by tracing its evolution and technological developments, examining its clinical applications in both oncology and reconstructive surgery, exploring its advantages and limitations, reviewing training and credentialing, and outlining recent advances and future directions. Robotic technology has permeated nearly every subspecialty of urology. Although its initial appeal was confined to oncological surgery—especially prostate and kidney cancer—its role now extends to reconstructive, functional, and even pediatric urology. The combination of tele-robotics and indigenous cost-effective systems could make complex urological surgery feasible even in government hospitals serving semi-urban populations. Robotic platforms now integrate indocyanine green (ICG) fluorescence imaging, which assists in vascular mapping during partial nephrectomy, delineating renal vasculature and collecting systems. Indian surgeons increasingly use real-time fluorescence to ensure complete tumour excision while minimising ischemia.

 

 

Author(s) Details

Vivek Meyyappan
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Velmurugan Palaniyandi
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Hariharasudhan Sekar
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Sriram Krishnamoorthy
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-93-0/CH6

Applied Risk Scoring in Acute Pyelonephritis: Evidence, Implementation, and Future Directions | Chapter 5 | Newer Frontiers in Urology, Volume III

 

Acute pyelonephritis (APN) spans a broad severity spectrum from uncomplicated febrile illness to emphysematous pyelonephritis with shock, creating a persistent need for reliable, bedside risk stratification. This chapter synthesises evidence on physiologic, disease-specific, and imaging-based scoring tools. It shows how to assemble them into a practical, layered pathway that improves triage, timing of imaging, and source control decisions. We review general sepsis scores (SIRS, SOFA, qSOFA, NEWS2) for early physiological surveillance; APN-specific clinical models for bacteremia prediction at first contact; global severity tools (Pitt Bacteremia Score, Charlson Comorbidity Index) for comorbidity and mortality profiling; and radiologic frameworks led by the Huang–Tseng CT classification for emphysematous pyelonephritis. Particular attention is given to a modified NEWS2 (mNEWS2) tailored for EPN, which retains original variables but re-bands risk and identifies scores ≥15 as a decisive high-risk delimiter linked to ICU need, nephrectomy, and mortality. We appraise biomarkers that add dynamic signal pro-calcitonin for bacteremia likelihood, lactate for occult hypoperfusion, and presepsin as an emerging adjunct and show how trends over 24–72 hours refine escalation or de-escalation. The chapter translates these elements into an implementation pathway: screen with NEWS2 or qSOFA; obtain early pro-calcitonin and lactate; expedite ultrasound or CT when red flags exist (diabetes, obstruction, acute kidney injury); apply APN specific bacteremia models to support admission and empiric coverage; and, in confirmed EPN, pair CT class with mNEWS2 bands to set thresholds for ICU, drainage, and early nephrectomy if non-responding. Special populations, such as those with diabetes, elderly or frail patients, transplant recipients, and those with obstruction, are addressed with lower action thresholds. Finally, we outline emerging opportunities for precision risk prediction, including machine learning classifiers to refine early bacteremia detection, radiomics-enhanced CT to integrate imaging features with clinical data, and transparent validation standards, moving APN care from static scores to adaptive, multimodal, precision risk prediction. The result is a clinician-facing roadmap that accelerates antibiotics, imaging, and decompression, reducing preventable harm across care systems.

 

 

Author(s) Details

Punith Jain R
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Suryaram Aravind
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Vivek Meyyappan
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Velmurugan Palaniyandi
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Hariharasudhan Sekar
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Sriram Krishnamoorthy
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-93-0/CH5

Short Tube and Big Challenges: Diagnostic Approach, Urodynamic Evaluation, and Modern Reconstructive Techniques in Female Urethral Stricture Disease | Chapter 4| Newer Frontiers in Urology, Volume III

 

Background: Female urethral stricture disease (FUSD) is an uncommon yet increasingly recognised cause of bladder outlet obstruction (BOO) in women that has long been obscured by heterogeneous definitions and overlap with “female urethral syndrome”. Women typically present with mixed lower urinary tract symptoms (LUTS) such as thin stream, hesitancy, straining, prolonged voiding, incomplete emptying, dysuria, and recurrent urinary tract infection, most often alongside frequency, urgency, nocturia, or incontinence.

 

Methodology and diagnostic approach: Diagnosis rests on a synthesis of clinical examination, uroflowmetry and post-void residual urine estimation, imaging, and endoscopy. Video-urodynamics is reserved for dilemmas separating BOO from detrusor underactivity.

 

Surgical management: Endoscopic dilation or direct vision internal urethrotomy (DVIU) is widely accessible but provides only short-term relief with high recurrence, especially after repeated procedures. Definitive management is reconstructive. Technique selection flap-based (vaginal or labial) versus graft-based (buccal or lingual oral mucosa, vaginal or labial mucosa) is guided by stricture site, length, tissue quality, and aetiology. Dorsal onlay buccal mucosal graft (BMG) urethroplasty, exploiting the vascular support of the clitoral cavernosal tissues and reducing fistula risk, has become the workhorse for many mid and proximal strictures. Ventral inlay/onlay approaches are valuable for distal disease or limited dorsal exposure, and double-face grafting is reserved for obliterative or recurrent cases.

 

Outcomes: Contemporary series consistently demonstrate ≥80% success with substantial improvements in flow and residual volumes, high satisfaction, and preserved continence. Risk factors for failure include longer strictures, prolonged symptom duration, multiple prior dilations, and lichen sclerosus.

 

Conclusion: This review systematises the diagnostic algorithm, urodynamic evaluation and modern reconstructive techniques for FUSD, addressing a critical gap in the literature and advocating the need for prospective, multi-centre trials with standardised definitions and quality of life endpoints.

 

 

Author(s) Details

Punith Jain
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Suryaram Aravind
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Vivek Meyyappan
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Velmurugan Palaniyandi
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Hariharasudhan Sekar
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Sriram Krishnamoorthy
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-93-0/CH4

Clinical Integration of Artificial Intelligence in Urology with a Focus on Temporal Deep Neural Networks for Emphysematous Pyelonephritis| Chapter 3 | Newer Frontiers in Urology, Volume III

 

Artificial intelligence (AI) is transforming urology by facilitating quick, data-driven analysis in diagnosis and treatment. This chapter explores core AI concepts and their applications in urological conditions like kidney stones, bladder cancer, prostate cancer, and benign prostatic hyperplasia (BPH). Examples of models (such as convolutional neural networks and support vector machines) used in urology are used to teach general AI approaches (machine learning and deep learning). Automated MRI prostate cancer diagnosis (AUC ~0.96), ureteroscopic stone identification (CNN ~90% accuracy), and bladder tumour segmentation are significant achievements.

 

Additionally, the chapter highlights issues with dataset heterogeneity, sample size, and selection bias while briefly discussing the types of datasets used in AI-driven urology research, including imaging, clinical, and longitudinal data. A case study of an emerging multi-task deep neural network (t-MTDNN) for the prediction of emphysematous pyelonephritis (EPN) is included. Feature descriptions (SHAP) are provided for the t-MTDNN architecture and workflow, and its clinical impact and performance metrics are analysed.

 

In conclusion, the strengths and challenges of AI models are compared (Table 1) and prospective opportunities in AI-assisted urology are described with an emphasis on the therapeutic advantages (improved accuracy, efficiency) and limitations (data requirements, interpretability). Instead of replacing clinical judgement, urologists and healthcare organisations view AI as a clinical decision-support tool that can enhance workflow efficiency, support hospital-level adoption through interdisciplinary collaboration, and augment physician expertise.

 

 

Author(s) Details

Roshan Reddy
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Rajan Ravichandran
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Vivek Meyyappan
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Velmurugan Palaniyandi
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Hariharasudhan Sekar
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Sriram Krishnamoorthy
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

 

Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-93-0/CH3

Evidence-based Approaches to Male Infertility: Current Standards and Future Directions | Chapter 2 | Newer Frontiers in Urology, Volume III

 

About 13–15% of couples have male infertility, a multifactorial condition that contributes to roughly half of all reported cases of infertility globally. Its aetiologies include genetic, endocrine, anatomical, infectious, immunological, environmental, and idiopathic causes. Genetic abnormalities, dysregulation of the hypothalamic-pituitary-gonadal axis, varicocele-associated oxidative stress, previous cryptorchidism, genital tract infections, and antisperm reactions are the main causes of its pathogenesis, which disrupts spermatogenesis and sperm transport.

 

Oxidative stress and hormonal imbalance are common routes shared by environmental pollutants, obesity, heat exposure, and lifestyle variables. Dopamine agonists for hyperprolactinemia; gonadotropin therapy with hCG and FSH in hypogonadotropic hypogonadism; varicocele repair in men with palpable varicoceles and abnormal semen parameters; avoidance of exogenous testosterone or anabolic steroids in men pursuing fertility; and selective oestrogen receptor modulators like clomiphene and tamoxifen in idiopathic oligozoospermia with suboptimal testosterone.

 

Although there is still little data based on guidelines, antioxidants, including CoQ10, L-carnitine, and vitamins C and E, may lessen oxidative stress. The results of severe oligozoospermia and azoospermia have been transformed by assisted reproductive technologies like IVF and intracytoplasmic sperm injection, which are complemented by surgical methods, including orchiopexy, repair for blockage, and sperm retrieval procedures. Probiotic manipulation of the gut-testis axis, stem cell transplantation, immunomodulators, and nutraceuticals are emerging topics that hold promise for the future. To maximise reproductive results for men and couples, management ultimately calls for a customised, evidence-based, multidisciplinary approach that incorporates established therapies, emerging research, and guideline recommendations.

 

 

Author(s) Details

Roshan Reddy
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Rajan Ravichandran
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Vivek Meyyappan
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Velmurugan Palaniyandi
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Hariharasudhan Sekar
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Sriram Krishnamoorthy
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

 

Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-93-0/CH2

 

Use of Lasers in Upper Tract Urology: Technology, Applications and Future Directions | Chapter 1 | Newer Frontiers in Urology, Volume III

 

Laser energy has revolutionised the treatment of pathology within the upper urinary tract. Lasers were first introduced into urology with early Nd: YAG and CO₂ systems, which were mainly used for coagulation and treatment of superficial urothelial lesions. Over subsequent decades, technological advances led to pulsed holmium: YAG and, more recently, thulium fibre lasers, enabling safe intracorporeal lithotripsy and precise soft‑tissue ablation throughout the urinary tract. They underpin flexible ureteroscopy and percutaneous nephrolithotomy for stone disease, enable organ‑preserving management of upper tract urothelial carcinoma and treat benign strictures. However, each platform has unique physical properties that influence its clinical utility. This chapter reviews laser physics, evolution of technology, and compares Ho: YAG with TFL, emphasising their mechanisms of lithotripsy, modes of operation, instrumentation and safety considerations. Clinical applications in stone fragmentation, tumour ablation and stricture incision are discussed, supported by contemporary evidence. We present a practical algorithm for laser selection and settings in upper tract endourology and highlight future directions, including pulse modulation, dual‑wavelength systems and integration with digital ureteroscopy. Understanding the capabilities and limitations of lasers is essential for urologists to optimise outcomes while minimising complications.

 

 

Author(s) Details

Suryaram Aravind
Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.

 

Punith Jain
Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.

 

Hariharasudhan Sekar
Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.

 

Velmurugan Palaniyandi
Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.

 

Vivek Meyyappan
Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.

 

Sriram Krishnamoorthy
Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.

 

Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-93-0/CH1

 

Renal Papillary Necrosis in Acute Pyelonephritis: Pathogenesis, Diagnosis, and the Role of Relook Flexible Ureterorenoscopy | Chapter 8 | Newer Frontiers in Urology, Volume II

 

Renal papillary necrosis (RPN) is an under-recognised complication of acute pyelonephritis (APN), especially in high-risk populations like diabetics. This chapter explores the vascular and infectious pathophysiology underlying RPN, describes its classic and atypical presentations, and highlights the emerging role of relook flexible ureterorenoscopy (F-RURS) in identifying and removing necrosed papillae. Recent case reports and small series suggest that timely endoscopic removal of necrotic debris reduces recurrence and improves renal outcomes. This chapter aims to equip clinicians with a structured approach to suspect, investigate, and intervene upon RPN in the APN setting.

 

 

Author(s) Details

Suryaram Aravind
Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.

 

Punith Jain
Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.

 

Hariharasudhan Sekar
Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.

 

Velmurugan Palaniyandi
Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.

 

Vivek Meyyappan
Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.

 

Sriram Krishnamoorthy
Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.

 

Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-68-8/CH8

 

Angiogenesis in Renal Cell Carcinoma: Molecular Biology, Clinical Manifestations, and Case-Based Insights | Chapter 7 | Newer Frontiers in Urology, Volume II

 

Angiogenesis is the defining biological feature of clear-cell renal cell carcinoma (ccRCC). Loss of Von Hippel–Lindau (VHL) function stabilises hypoxia-inducible factors (HIFs), upregulating vascular endothelial growth factor (VEGF) and allied mediators that produce a hypervascular, leaky, and fragile tumour vasculature. This chapter offers a concise, clinically oriented review of renal cell carcinoma (RCC) angiogenesis centred on an exceptional case: a right-sided ccRCC with intratumoral arteriovenous (AV) shunting and venous collaterals that communicated with the second part of the duodenum, presenting as severe upper gastrointestinal (GI) bleeding. We translate the mechanism into management, emphasising rapid stabilisation, diagnostic angiography, endovascular embolisation, and definitive surgery; then situate contemporary systemic therapy [VEGF/VEGF receptor (VEGFR) tyrosine kinase inhibitors (TKIs), immuno-oncology–TKI (IO–TKI) combinations, and HIF-2α inhibition] within decision frameworks that clinicians can apply. An expanded discussion links vessel biology to imaging signatures, resistance, perioperative strategies, and follow-up care. This case serves as a central framework for demonstrating how timely, multidisciplinary coordination can prevent catastrophic haemorrhage and ensure durable oncological control.

 

 

Author(s) Details

Rajan Ravichandran
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Roshan Reddy
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Vivek Meyyappan
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Velmurugan Palaniyandi
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Hariharasudhan Sekar
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Sriram Krishnamoorthy
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-68-8/CH7

Innovations in Flexible Ureterorenoscopy for Renal Stones | Chapter 6 | Newer Frontiers in Urology, Volume II

 

Background: Flexible ureterorenoscopy (fURS) has become a cornerstone in the minimally invasive management of renal stone disease. Continuous technological evolution over the past decades has expanded its indications, improved procedural safety, and enhanced stone-free outcomes. This review synthesises recent innovations that have reshaped contemporary fURS practice.

 

Objective: To critically appraise key technological and procedural advances in flexible ureterorenoscopy, with emphasis on scope design, laser lithotripsy, adjunctive instrumentation, and emerging guidance and robotic systems, and to evaluate their clinical impact on renal stone management.

 

Methods: A narrative review was conducted based on historical milestones, recent clinical studies, systematic reviews, and meta-analyses addressing innovations in fURS. Developments in digital and single-use ureteroscopes, laser technologies, ureteral access sheaths, irrigation and pressure-control systems, image guidance, and robotic assistance were analysed with respect to efficacy, safety, and workflow implications.

 

Results: Major advancements include the transition to high-definition digital “chip-on-tip” ureteroscopes, the widespread adoption of single-use disposable scopes, and enhanced deflection mechanisms that improve access to complex calyceal anatomy. Laser innovations, particularly thulium fibre lasers and pulse-modulated holmium systems, have increased fragmentation efficiency while reducing retropulsion and operative time. Suction-enabled and pressure-controlled ureteral access sheaths have improved stone clearance and reduced infectious complications. Emerging technologies such as augmented reality navigation and robotic-assisted fURS have demonstrated stone-free rates comparable to those of conventional techniques while significantly improving surgeon ergonomics.

 

Conclusion: Technological innovation has transformed fURS into a highly effective, safe, and versatile modality for the treatment of renal stones. Ongoing integration of advanced lasers, innovative instrumentation, image guidance, and robotics is likely to refine outcomes further, personalise treatment strategies, and establish new benchmarks in endourological care.

 

 

Author(s) Details

Rajan Ravichandran

Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Roshan Reddy
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Vivek Meyyappan
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Velmurugan Palaniyandi
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Hariharasudhan Sekar
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Sriram Krishnamoorthy
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-68-8/CH6

Supine Percutaneous Nephrolithotomy (PCNL): Current Status | Chapter 5 | Newer Frontiers in Urology, Volume II

 

Background: Percutaneous nephrolithotomy (PCNL) remains the standard treatment for large (>20 mm), staghorn, and complex renal calculi. Although the prone position has traditionally been preferred, it is associated with anaesthetic challenges, longer operative times due to repositioning, and ergonomic limitations. Supine PCNL, particularly in the Galdakao-modified supine Valdivia position, has re-emerged as an alternative that may improve perioperative safety, workflow efficiency, and facilitate combined antegrade–retrograde intrarenal surgery (ECIRS).

 

Objective: To review the current status of supine PCNL, focusing on its procedural principles, indications, outcomes, complications, and comparative effectiveness relative to prone PCNL.

 

Methods: A narrative review was performed synthesising evidence from comparative studies, randomised trials, meta-analyses, and large observational series evaluating supine PCNL. Key aspects analysed included patient selection, positioning techniques, access and tract creation, intraoperative workflow, adjunctive ECIRS, anaesthetic and ergonomic considerations, postoperative strategies, and reported clinical outcomes.

 

Results: Across most indications, supine PCNL demonstrates stone-free and complication rates comparable to prone PCNL. Supine positioning consistently reduces operative and anaesthesia time by eliminating intraoperative repositioning and improves airway access and hemodynamic stability, particularly in obese and high-risk patients. ECIRS is more readily feasible in the supine position, narrowing any potential disadvantage in complete staghorn calculi. Bleeding, infection, and visceral injury rates are similar between positions when appropriate patient selection and imaging-guided access are employed.

 

Conclusion: Supine PCNL is a safe, efficient, and versatile alternative to prone PCNL that aligns with contemporary goals of patient-centred care, anaesthetic safety, and surgical ergonomics. With appropriate training and case selection, it achieves outcomes equivalent to the prone approach while offering distinct workflow and physiologic advantages.

 

 

Author(s) Details

Bhavyadeep Korrapati
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Vijayanand Mani
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Velmurugan Palaniyandi
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Hariharasudhan Sekar
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Sriram Krishnamoorthy
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

 

Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-68-8/CH5

Scoring Systems for Inflammatory and Traumatic Urethral Strictures | Chapter 4 | Newer Frontiers in Urology, Volume II

 

Introduction: Urethral stricture disease in males presents a spectrum of complexity depending on aetiology and location. Inflammatory strictures and traumatic strictures pose unique challenges. Historically, the lack of a standardised classification has hindered the comparison of treatment outcomes and consensus in management.

 

Aim: To review and describe the major scoring systems developed for urethral strictures, specifically those arising from inflammatory and traumatic causes, and to discuss their clinical utility in guiding management.

 

Findings: Three principal scoring/classification systems are in use. The U-score is a numeric composite for anterior strictures based on stricture length, number, location, and aetiology. The LSE classification is a standardised staging for anterior urethral strictures, treating stricture attributes akin to a TNM-like categorisation. The PU-score applies to posterior strictures, assigning points for injury factors such as aetiology, location, defect length, and associated complications. Higher scores have been correlated with more complex surgeries and increased risk of recurrence. The PU-score likewise predicts surgical complexity and outcomes in posterior injuries.

 

Conclusion: Scoring systems for urethral strictures help stratify disease severity and guide management decisions. They facilitate standardised communication of structural complexity, inform surgical planning (one-stage vs multi-stage reconstruction), and allow outcome comparisons across studies. While promising, each system has limitations, and ongoing refinement and validation are needed before universal adoption in routine practice.

 

 

Author(s) Details

Bhavyadeep Korrapati
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Vijayanand Mani
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Vivek Meyyappan
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Velmurugan Palaniyandi
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Hariharasudhan Sekar
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Sriram Krishnamoorthy

Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-68-8/CH4

 

HER2 in Bladder Cancer: Molecular Biology, Prognostic Value, and Emerging Therapeutic Strategies| Chapter 3 | Newer Frontiers in Urology, Volume II

 

Introduction: Non-muscle invasive bladder cancer (NMIBC) accounts for nearly 75–80% of newly diagnosed bladder cancers and is marked by frequent recurrence and a variable risk of progression. Human epidermal growth factor receptor 2 (HER2) has emerged as a biologically relevant oncogenic driver in urothelial carcinoma, but its prognostic and therapeutic significance in NMIBC remains incompletely defined.

 

Aim: This review synthesises current evidence on HER2 biology, molecular associations, prognostic relevance, and therapeutic implications in bladder cancer, with a focus on NMIBC.

 

Results: HER2 overexpression and amplification are enriched in high-grade tumours, advanced stages, luminal molecular subtypes, and aggressive histological variants, and are associated with disease progression and resistance to intravesical BCG therapy. Despite strong biological rationale, conventional HER2-targeted therapies have shown limited efficacy in urothelial carcinoma due to heterogeneous expression, discordance between protein overexpression and gene amplification, and complex downstream signalling. In contrast, emerging antibody–drug conjugates demonstrate promising clinical activity, including in tumours with low or heterogeneous HER2 expression.

 

Conclusion: HER2 represents a clinically meaningful biomarker and therapeutic target in bladder cancer. Standardised HER2 assessment integrated with molecular profiling may refine risk stratification and enable precision-guided therapies, particularly for patients with high-risk or treatment-refractory NMIBC.

 

 

Author(s) Details

Vijayanand Mani
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Bhavyadeep Korrapati
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Velmurugan Palaniyandi
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Hariharasudhan Sekar
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Sriram Krishnamoorthy
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-68-8/CH3

 

Immunohistochemistry in Bladder Cancer: Diagnostic, Prognostic, and Molecular Subtyping Applications | Chapter 2 | Newer Frontiers in Urology, Volume II

 

Introduction: Immunohistochemistry (IHC) has evolved from a primarily diagnostic adjunct to a central component of precision oncology in bladder cancer. By bridging histomorphology with molecular characterisation, IHC contributes to diagnosis, prognostication, staging, and therapeutic decision-making. However, variability in marker selection, interpretation, and standardisation remains a challenge in routine practice.

 

Aim: This chapter aims to provide a focused overview of the role of IHC in bladder cancer, addressing current gaps in consistent application while highlighting its diagnostic utility, prognostic and predictive significance, role in molecular subtyping, and integration with emerging technologies.

 

Key Points: IHC facilitates accurate detection of carcinoma in situ, molecular luminal–basal subtyping, and refined staging using markers such as CK20, GATA3, CK5/6, and smoothelin. Prognostic markers, including Ki-67 and p53, and predictive biomarkers such as PD-L1 and HER2, demonstrate increasing clinical relevance, with reported diagnostic and prognostic accuracies supporting their use in selected settings. The integration of multi-marker panels, digital pathology, and molecular diagnostics enhances reproducibility and precision, though limitations related to inter-observer variability, assay standardisation, and evolving biomarker validation persist.

 

Conclusion: IHC remains a cornerstone of bladder cancer pathology, underpinning diagnostic accuracy and therapeutic stratification. With ongoing innovations in biomarker discovery, artificial intelligence, and standardisation, IHC continues to evolve as a critical platform for translational and clinical application in urologic oncology.

 

 

Author(s) Details

Vijayanand Mani
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Bhavyadeep Korrapati
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Vivek Meyyappan
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Velmurugan Palaniyandi
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Hariharasudhan Sekar
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Sriram Krishnamoorthy
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-68-8/CH2