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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Calibre of the External Urethral Meatus in Indian Population: A Cross-sectional Study
Correspondence Address :
Dr. Mohd Hamid Shafique Ahmed,
Assistant Professor, Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai-400022, Maharashtra, India.
E-mail: khanmohdhamid1@gmail.com
Introduction: Transurethral resection instruments are designed as per western standards and are often found to be larger for Indian patients, leading to urethral trauma during instrumentation or higher incidence of urethral strictures postoperatively.
Aim: To assess and record the calibre of the External Urethral Meatus (EUM) among Indian male and female population.
Materials and Methods: This cross-sectional study was done at a tertiary health care centre over a period of one and half years from July 2016 to December 2017. All male and female patients above the age of 12 years undergoing lower urinary tract instrumentation at the institute underwent assessment for EUM calibre. A total of 1,127 males and 182 females were enrolled in the study. Descriptive statistics (mean, Standard Deviation, and range) were performed for age, height and the EUM in males and females. Linear regression analysis was used to analyse the correlation between EUM calibre and age; and EUM calibre and body height. The correlation was considered statistically significant when p<0.05.
Results: The mean EUM calibre of the male population was observed to be 23.23±1.60 Fr (French scale) and that of the female population was 23.58±2.00 Fr. On linear regression analysis, a significant but weak correlation was found between EUM calibre and body height in male (R2 value: 0.024, p-value <0.0001). On the other hand, no correlation was observed between EUM calibre and body height in females (R2 value: 0.009, p-value=0.196).
Conclusion: The average calibre of the EUM in Indian males was 23.23 Fr which is about 3 Fr smaller than the standard transurethral resectoscope sheath. Thus, use of larger sized sheaths may result in urethral stricture in narrow calibre urethra.
Meatal stenosis, Urethral instrumentation, Urethral meatal calibrator
The EUM is the doorway to all instrumentation of the lower urinary tract and its calibre is an important factor while introducing any instrument (1). Western literature and western standards have been used in designing instruments throughout surgical practice including urology (2). These instruments are often found to be of a larger calibre for the Indian population leading to tissue trauma or an inability to perform a particular procedure with a particular instrument (1),(2). Inter-racial differences in the calibre of the EUM have not been defined. EUM calibre in paediatric males, its growth with age and its application to hypospadias repair has been well-defined (1),(2),(3). Data pertaining to adult EUM calibre is scarce (1),(2),(3),(4),(5),(6). Hence, the present study was conducted with an aim to document the EUM calibre, in the French scale, in the Indian male and female population. This would then help to devise endourology instruments more suitable to our population to reduce urethral trauma and the subsequent decrease in incidence of urethral strictures.
This cross-sectional study was conducted at Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India, from July 2016 to December 2017. Valid, written informed consent was taken of all patients who participated in the study. The study was approved by the Institutional Ethics Committee (IEC) (Serial No. IEC/114/16).
The calibre of the EUM in male and female patients undergoing lower urinary tract instrumentation were measured.
Inclusion criteria: All male and female patients above the age of 12 years undergoing per urethral instrumentation for diagnostic and/or therapeutic purpose were included in the study. Only those males who had undergone circumcision in the first year of life were included in the group of circumcised males.
Exclusion criteria: The exclusion criteria were patients with indwelling urethral catheter, balanitis xerotica obliterans, hypospadias, epispadias, patients with prior history of per urethral instrumentation and those undergoing surgical procedure on the urethra.
Study Procedure
A stainless steel urethral meatal calibrator (Kalelkar Surgical, Mumbai, India) was inserted per urethra under aseptic precautions and with adequate lubrication (2% lignocaine jelly) after the local parts had been prepared for the planned endoscopic procedure. This calibrator was in the shape of an elongated cone with serial graduations on it, which were marked in the French scale from 15-30 Fr (Table/Fig 1). For males, the calibrator was inserted per EUM and allowed to pass under gravity and the mark on the calibrator at the level of the EUM was noted as the EUM calibre. For females, the calibrator was passed per EUM until a point where early blanching of the EUM mucosa occurred and at that point, the mark on the calibrator at the EUM was recorded as the EUM calibre. On instances where the EUM lay between two graduations on the calibrator, the smaller mark was noted as the EUM calibre.
Height and weight of the patients were also recorded. For male patients a note was also made of whether they had undergone circumcision. A total of 1,127 males and 182 females were studied. This unequal gender distribution was observed since predominant population of patients undergoing surgery in Department of Urology were males.
Statistical Analysis
Descriptive statistics (mean, Standard Deviation (SD), and range) were performed for age, height and the EUM in males (overall, circumcised and uncircumcised) and females. The mean EUM calibre in circumcised and non circumcised males was compared with the unpaired t-test. Linear regression analysis was used to analyse the correlation between EUM calibre and age; and EUM calibre and body height. The correlation was considered statistically significant when p<0.05. Nomograms for male and female EUM calibres were prepared using the ggplot2 package in R software (Version: 3.3.6).
The study included 1127 males and 182 females, 400 of the males were circumcised and 727 were not. The mean age of the male and female participants was 45.54±17.39 and 41.69±16.33 respectively (Table/Fig 2).
The mean EUM calibre of the male and female participants was 23.23±1.60 and 23.58±2.00 respectively. The difference between the mean EUM in circumcised males compared to non circumcised males was statistically significant (p<0.001) (Table/Fig 3). The mean EUM calibre in different age groups in both males and females is shown in (Table/Fig 4).
(Table/Fig 5) shows the percentages of patients with different EUM calibres in males and females. Nomograms for the male and female populations is shown in (Table/Fig 6) and (Table/Fig 7) respectively. On linear regression analysis, a significant but weak correlation was found between EUM calibre and body height in males (R2 value=0.024, p<0.0001). There was no significant correlation between EUM calibre and body height in females (R2 value=0.009, p-value=0.196); or between EUM calibre and age in either sex (Table/Fig 8).
Also, 559 of the 605 males (92.4%) and 60 of the 82 females (73.2%) above the age of 40 years had an EUM calibre of less than 26 Fr which is the calibre of the standard Trans urethral resection (TUR) sheath used for Transurethral Resection of the Prostate (TURP) and bladder masses.
The earliest work on EUM calibre was done by Thompson R in 1918 wherein he reported the mean EUM calibre in inches in male patients of different age groups and also described different shapes of the EUM (5). Since then, there have been a lot of studies regarding EUM calibre in the paediatric age group; but data regarding EUM calibre in the adult males and females is scarce (1),(2),(3),(4),(5),(6). (Table/Fig 9) shows the summary of available literature on calibre of EUM in adult and paediatric population (4),(6),(7).
According to Thompson’s study on males (1918, London, United Kingdom, N=135) the mean EUM length when measured as a vertical slit in adult males was 0.35 inches which in the French scale is 26.67 Fr (5). This was 3 Fr larger than the mean EUM calibre of Indian males in present study. Berry CD and Cross RR (1956, Illinois, United State, N=200) calibrated the EUM in 100 circumcised and 100 non circumcised American males using a bougie à boule. Although they did not report a mean EUM calibre, they observed that circumcised males had a significantly smaller EUM calibre compared to non circumcised males (7). This was similar to present study observation. Although a definite explanation for this finding has not been described, it is thought that the comparatively narrow EUM in circumcised males results from the EUM being vulnerable to irritation and trauma due to lack of protection by the prepuce during the early ‘growing’ years of life. This is substantiated by the finding in Berry CD and Cross RR that men who underwent circumcision within the first year of life had a higher incidence of smaller EUM calibre than those who underwent circumcision later in life (7). Bhat GS et al., (2014, Bangalore, India, N=304) reported their study of 340 non circumcised Indian males in which they found the mean EUM calibre on maximum stretch to be 28.49±3.06 Fr. They had also used the metal meatal calibrator (6).
The only data available regarding EUM calibre in adult females is Chang YL et al., (2009, Taipei, Taiwan) of 23 Taiwanese females in which the mean EUM calibre, measured with a bougie à boule, was 23.7±1.9 Fr (4). This was comparable to the finding in present study population.
Orkiszewski M and Madej J, Litvak AS et al., Lin Ty et al., in their studies on EUM calibre in boys of different age groups (all under 12 years) concluded that the size of the meatus increases with age (2),(3),(8). Orkiszewski M and Madej J, also noted that there was no correlation between meatal width and body length (2). With regards to the adult population, Chang YL et al., in their study on adult Taiwanese females and Bhat GS et al., in their study on adult Indian males, found no association between age and the EUM calibre (4),(6). This was again confirmed by present study in both the adult male and female populations. However, there was a weak but significant association between EUM calibre and body height in adult males but not in adult females. Chang YL et al., in their study on Taiwanese females had noted no association between EUM calibre and body height, body weight and BMI (4). For the significant correlation between EUM calibre and height in males, it is proposed that the EUM calibre would be associated with penile length and penile circumference. A positive association between penile length and circumference, with body height, has been demonstrated in studies by Aslan Y et al., Ponchietti R et al., and Promodu K et al., in the Turkish, Italian and Indian populations respectively (9),(10),(11). This could explain the correlation of EUM calibre with body height in males; although further studies would be required to substantiate this finding.
The EUM being the narrowest part of the urethra, its calibre is an important determinant for lower urinary tract instrumentation. A majority of the male patients above the age of 40 years (92.3%) had an EUM calibre of less than 26 Fr and thus small to allow insertion of the standard 26 Fr transurethral resectoscope sheath. This leads to a majority of the patients, undergoing transurethral resection of the prostate or a bladder mass, to undergo an Otis internal urethrotomy. Walton JK et al., in their study of 59 patients undergoing TURP also observed that 37% of their patients undergoing TURP had the EUM calibre too small to allow the insertion of the 26 Fr resectoscope sheath. They suggested postoperative self-dilatation following internal meatotomy with a plastic spigot to prevent meatal stenosis (12). Nielsen KK and Nordling J in their study on Danish males undergoing TURP concluded that a narrow urethra predisposed to the development of post-TUR urethral strictures (13). EUM length, width and anatomical morphology in Brazilian males undergoing transurethral prostate and bladder surgery was studied by Vieiralves RR et al., and they noted that the urethral meatus was the most important aspect while performing lower urinary tract endoscopy and it could predict the need for meatotomy and the risk for subsequent meatal stenosis (14). Present study represents the largest data from the Indian population.
Limitation(s)
Since study was conducted in a single tertiary care centre, it may not be truly representative of diverse Indian population. There is a need for multicentric study which should be conducted in different parts of country.
The EUM calibre is weakly correlated to body height in males and is also larger in non circumcised males. The average calibre of the EUM in Indian males is 23.23 Fr which is about 3 Fr smaller than the standard transurethral resectoscope sheath which explains the increased risk of urethral strictures due to the use of an instrument in a urethra of insufficient calibre.
DOI: 10.7860/JCDR/2022/56987.16539
Date of Submission: Apr 08, 2022
Date of Peer Review: May 03, 2022
Date of Acceptance: May 12, 2022
Date of Publishing: Jun 01, 2022
Author declaration:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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