Browsing by Author "Aviral Srivastava"

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A cost-effective modified split graft technique using bovine pericardium after plaque excision in Peyronie's disease - An initial experience
(Wolters Kluwer Medknow Publications, 2025) Lalit Kumar; Anil Baliyan; Aviral Srivastava; Anuja Thakur; Sameer Trivedi
Aims: The plaque excision and grating technique is indicated for correcting penile curvature in Peyronie's disease. We assessed our experience of the modified split graft technique using bovine pericardium after plaque excision. Materials and Methods: Between March 2020 and September 2024, we operated on 12 patients by the excision of plaque and split grafting technique. Here, we discuss our experience customizing a bovine pericardium graft on a table according to the size of the defect and joining pieces of graft and tunica albuginea with a Polydioxanone (PDS) suture to cover the cavernosal defect. Results: Patients' mean age and follow-up were 48 years and 30 months, respectively. The average size of the plaque and penile curvature was 4.6 cm (range 1.5-8 cm) and 45°, respectively. No residual penile curvature was observed in 83.5% of patients while (16.5%) had curvature of <20°. All patients experienced an improvement in stretched penile length with an average increase of 1.6 cm. Seventy-five percent of patients were able to perform sexual activity without assistance after 3 months. One patient, who had a sizeable cavernosal defect of 8 cm × 2 cm, experienced severe postoperative erectile dysfunction (ED) along with residual penile curvature of 15° and required semi-rigid penile prosthesis. Two patients having mild ED was managed by Tadalafil 10 mg. Another patient with residual chordee of <20° was managed on conservative therapy. Conclusions: In our limited experience, this modified split graft technique using bovine pericardium after plaque excision seems feasible, cost-effective, and safe. It has comparable outcomes to the standard methods reported in the literature and reduces graft material wastage. Further, long-term randomized trials are needed to validate its long-term efficacy and safety compared to conventional grafting approaches. © 2025 Urology Annals.
Expression of poly(Adenosine Diphosphate-Ribose) polymerase protein in breast cancer
(Wolters Kluwer Medknow Publications, 2022) Akanksha; Shashi Prakash Mishra; Amrita Ghosh Kar; J.S. Karthik; Aviral Srivastava; Rahul Khanna; Ram Niwas Meena
Background: The use of poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors for breast cancer (BC) therapy is the subject of debate, and there is an urgent need to understand much the expression and prognostic role of the PARP1 protein. In this study, we have compared the expression of PARP between BC and benign breast disease (BBD) patients and also analyzed the association of PARP expression with clinicopathological parameters in BC. Methods: The study consists of 30 patients with newly diagnosed operable BC who were planned for surgery without neoadjuvant chemotherapy and 15 patients of BBD as a control between 2019 and 2021. Immunohistochemical analyses were performed prospectively on tissue samples. Anti-human PARP1 rabbit polyclonal antibody gives strong nuclear positivity. Internal control was the adipose tissue and the BBD acted as the external control. PARP1 expression was evaluated using the multiplicative quickscore method. Results: The mean age for BC patients was 51.30 ± 10.694 years (range: 25-75 years) while BBD was below 30 years. Overexpression of PARP was present in 25 (83.3%) and weak expression in 5 (16.7%) of BC patients compared to BBD, only 2 (13.3%) patients demonstrated an overexpression of PARP, and 13 (86.6%) patients showed weak expression which showed significant association (P < 0.001). In BC, nuclear PARP (nPARP) overexpression was seen in 22 (73.3%) patients and weak expression of nPARP in 8 (26.7%), whereas 5 (16.7%) patients showed cytoplasmic overexpression. On comparing expression of PARP with clinicopathological parameters, PARP overexpression was significantly associated with older population (age >50 years) (P = 0.002), postmenopausal women (P = 0.029), higher TNM stage (Stage II and III) (P = 0.014), higher histological grade (grade 2) (P = 0.043), and presence of lymphovascular invasion (P = 0.015). Enhanced PARP1 expression is closely correlated with positive estrogen receptor status (P = 0.001) and PR status (P = 0.001). Overall PARP and nPARP overexpression was significantly associated with ER- (P = 0.006 and P = 0.008) and PR-positive (P = 0.006 and P = 0.008) patients. The PARP and nPARP overexpression was significantly associated with nontriple-negative BC patients (P = 0.001 and P = 0.001). Conclusion: We have not come across any study in the literature to compare PARP expression in BC and BBD patients. On the basis of our observations, we concluded that PARP overexpression is a poor prognostic marker in BC. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
Quality of life and cost-effectiveness of intravesical gemcitabine/docetaxel vs BCG in BCG-naïve non-muscle-invasive bladder cancer
(John Wiley and Sons Inc, 2025) Aviral Srivastava; Sameer Trivedi; Ujwal Kumar; Yashasvi Singh; Lalit Kumar; Sahil Data; Anil Kumar; Satya Narayan Sankhwar
Objective: To compare intravesical gemcitabine/docetaxel (Gem/Doce) vs standard-of-care bacillus Calmette–Guérin (BCG) in intermediate-/high-risk non-muscle-invasive bladder cancer (NMIBC), as patient-reported physical-psychological quality of life (QoL) and cost-effectiveness estimation are pivotal to evaluate adjuvant intravesical treatments yet are rarely evaluated head-on. Patients and Methods: In a prospective per-protocol analysis (Gem/Doce 39 patients; BCG 44 patients), survival endpoints (recurrence-free survival [RFS], progression-free survival [PFS]) and National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE)-graded adverse events (AEs) were recorded. QoL was assessed at baseline, post-induction, and at 6 and 12 months using the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-30-item core (EORTC QLQ-C30) and 24-item QLQ-NMIBC (QLQ-NMIBC24) and mapped to the EuroQoL five Dimensions five Levels (EQ-5D-5L) using an Indian tariff to estimate quality-adjusted life years (QALYs). Direct medical costs were recorded, and incremental cost-effectiveness ratios (ICERs) were calculated per QALY and recurrence/progression outcomes. Results: Patients receiving Gem/Doce achieved higher 1-year RFS (94.74% vs 75%, hazard ratio 0.44; P = 0.02) and PFS (100.00% vs 93.19%, P = 0.09). The AEs were fewer with Gem/Doce (12.82% vs 34.10%, P = 0.028); Grade 3 events occurred only with BCG (4.65%). Gem/Doce showed significantly higher global health, physical/role/emotional functioning and sexual health scores at 6–12 months, with reduced fatigue, urinary symptoms and intravesical-treatment problems. Mean QALYs improved with Gem/Doce (0.8807 vs 0.7198), and with an ICER of ₹504 000 Indian Rupees ($6072 United States Dollars) per QALY – well within India's willingness-to-pay threshold and far below international benchmarks. Additional gains included +1.38 recurrence-free months overall and +2.82 in high-risk patients, achieved at acceptable incremental cost, indicating pragmatic cost profile against avoided recurrences and QoL gains. Conclusions: Sequential Gem/Doce delivered optimal short-term survival outcomes, favourable patient-reported QoL and safety profile, and attractive cost per avoided recurrence/progression compared with BCG, supporting its adoption as a clinically and economically viable alternative in resource-constrained NMIBC care. © 2025 BJU International.