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Objectives: Despite continued controversy regarding the optimal method of urinary diversion after pyeloplasty, we have treated majority of our patients without any tubes or stents. The present study is done to assess the benefits of performing nonintubated pyeloplasty in children. Materials and Methods: Thirty consecutive cases of pelviureteric junction obstruction were enrolled in the study from 1998 to 2004 (5.6 years). Six patients underwent nephrectomy and were excluded from the study. Twenty-four patients underwent pyeloplasty performed by a single surgeon; 20 were nonintubated pyeloplasties, other four were intubated. Postoperative complications and length of hospital stay were assessed. Results: The intubated group had higher incidence of UTI and persistence of partial mechanical obstruction postoperatively on radio-nucleotide scans. They also had a significantly longer hospital stay as compared with the nonintubated group. Conclusions: Nonintubated pyeloplasty in children is safe, cost effective and associated with fewer complications. A stent and a nephrostomy tube appear to be unnecessary in the routine pyeloplasty.

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Leiomyosarcoma of prostate is rare accounting for 0.1% of prostatic malignancies. It has a very poor prognosis although rate of survival is variable. Treatment recommendations are difficult to establish due to the rarity of the tumour. Here we report a case of primary prostatic leiomyosarcoma in an adult treated by primary excision of mass followed by doxorubicin based chemotherapy. Patient subsequently developed local recurrence and disseminated secondaries and was then lost to follow up.

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Objectives: Why is it that we do not see enough early prostate cancer in our urological practice? Is it really uncommon, or is it that we are not convinced about the need for its aggressive management? This study intended to look at the opinion and patterns of practice among urologists in Tamil Nadu and Pondicherry, with regards to early prostate cancer. Materials and Methods: A questionnaire was sent to 63 urologists of these states to assess their opinion and practice, regarding the detection and treatment of early prostate cancer. Simultaneously, we retrospectively assessed the cases of carcinoma of the prostate seen at our hospital between January 2001 and September 2003. In these patients, we looked for evidence to see if they could have had localized disease and could have been further evaluated for curative therapy. Results: Though 69% of urologists believed in early prostate cancer detection, only 48% attempted early detection and 41% offered these patients, curative therapy. The most common reason for this was the opinion of urologists that, "we do not see early prostate cancer in our practice". An analysis of 153 of our patients revealed that at least 26 of them could have been further evaluated towards curative therapy. Conclusions:One may not believe in the virtue of treating early prostate cancer. If however we are convinced about its usefulness, we are overlooking many cases who could have been offered curative therapy.

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Use of antenatal ultrasound for evaluation of congenital anomalies in early pregnancy has become a common practice. Hydronephrosis is the most common anomaly observed. Urologists are being referred such cases more frequently. Prenatal intervention is experimental and being done in advanced centers. Though there are defined criteria of intervention, it is still not clear as to who will benefit. Majority of patients develop urinary insufficiency postnatally. This review was undertaken to discuss the issues in evaluation, diagnosis and management of neonates born with hydronephrosis diagnosed on prenatal ultrasound. Most patients will have relatively benign course, however identification of those who will have potentially serious postnatal problems, permits early intervention.

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Because the decline in androgens is generally gradual and not a complete deficiency, clinical significance of this decline is still unclear, and there is controversy as to whether a specific syndrome of androgen deficiency or 'andropause' exists. The term andropause or androgen deficiency in aging males (ADAM) underwent revisions to, partial androgen deficiency in aging male (PADAM), late onset hypogonadism (LOH) and now symptomatic late onset hypogonadism (SLOH), signifying, the evolving nature of this phenomenon. Since this happens at a time of life, when many men have associated comorbities, it's difficult to assess the exact impact of androgen decline, due to which, the issues surrounding androgen replacement therapy in men with symptomatic late-onset hypogonadism have been marred in controversy. Although with age, a decline in testosterone levels will occur in virtually all men, there is no way of predicting, who, will experience andropausal symptoms of sufficient severity and also long-term safety data on testosterone administration in this setting, is lacking. This article will focus on the controversies and practices of androgen replacement.

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A 30 yrs old female with non-specific abdominal pain is presented. Ultrasound, computerised tomography abdomen were performed. A finely septated fluid collection surrounding both kidneys were found. Ultrasound guided fluid aspiration; chemical and cytological evaluation of the fluid was done. Exploration was done on the right side with the idea of removing the peri- renal cystic lymphatic collection. The entire cystic collection was removed. Patient followed up for the last two years and there is no recurrence of the cystic collection and the kidney function is preserved.

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Angiomyolipoma (AML) is the most common benign renal tumor and intratumoral pseudoaneurysms are not uncommon in this condition .The risk of hemorrhage correlates with the size of tumor and persistence of pseudoaneurysms. We report a case of hemorrhagic angiomyolipoma associated with intratumoral pseudoaneurysm which was embolized successfully.

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Objectives:0 To estimate the prevalence and determinants of lower urinary tract symptoms (LUTS), in male expatriate workers in Qatar and to assess the impact of LUTS on the quality of life (QoL). MATERIALS AND Methods:0 A number of 570 male expatriate workers aged 20 to 63 years, mostly of Indian origin (87%), were interviewed orally by trained interviewers. The International Prostate Symptoms Score (IPSS) questionnaire was used for the assessment of LUTS and QoL. Results:0 The mean age of the study population was 40 years (SD 9.2). Overall, 52% of the study population reported at least one urinary symptom. The most frequent symptom was nocturia (31%,) and the most infrequent straining (11%). Twenty-one percent of the men had moderate or severe LUTS (IPSS score > 7). The prevalence of storage symptoms was significantly higher than that of voiding symptoms in all age groups. LUTS was not associated with nationality, smoking, or body mass index. Men with diabetes (OR= 1.4, 95% CI 0.8-2.3) or hypertension (OR= 1.4, 95% CI 0.8-2.3) were slightly at higher risk of LUTS, than those without diabetes or hypertension. Men with moderate (OR = 4.1, 95% CI 2.3-7.4) or severe LUTS (OR = 12.8, 95% CI 4.6-36.0), had poorer quality of life, compared to those with no or mild symptoms. Conclusions:0 Lower urinary tract symptoms, especially storage symptoms, are common in young male expatriates in Qatar. LUTS has a strong negative impact on the quality of life.

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Objectives: The objective of the study was to evaluate the efficacy of local anesthetic infiltration, in decreasing the discomfort experienced by patients undergoing trans-rectal ultrasound (TRUS) guided biopsy of prostate. Materials and methods: Between January 2002 and February 2003, we investigated consecutively, asymptomatic men, suspected of having prostatic cancer. About 39 patients were randomized to receive 10 ml of 2% Lidocaine periprostatic block + intrarectal Lidocaine gel (group 1 = 20), or intarectal Lidocaine gel only (group 2 = 19) during prostatic biopsy. Immediately following the TRUS-guided biopsy, patients were asked to grade the pain they experienced using the 11-point visual analogue score (VAS). Results: The mean pain score in the patients of group 1 were significantly lower than the patients of group 2 ( P <0.001), suggesting that periprostatic block produced a significant reduction in the perceived pain. Conclusions: Local anesthetic infiltration by TRUS-guided injection of Lidocaine is effective for decreasing pain associated with prostatic biopsy.

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Introduction: Disorders such as severe hypospadias presenting as ambiguous genitalia have serious and potentially life-long consequences for affected individuals and, depending on the underlying cause, are likely to entail surgery in childhood and in later life, psychosocial and psychosexual support and possible fertility treatment including assisted conception. Materials and Methods: Genetic males with severe hypospadias who were wrongly brought-up as females formed the study group. They were reassigned as males and underwent surgery for correction of hypospadias. Results: Three children with severe hypospadias were reassigned to male gender. Psychosocial changes were made psychosexual counseling was done. All three have adjusted to their new environment and gender. Conclusions: Management of children with wrongly assigned sex is complex. It is preferable to reassign these children who are genetic males but wrongly assigned as females at birth. Repair of hypospadias, psychosocial changes and psychosexual counseling will help these children to reorient themselves.

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Objectives: The use of the standard monopolar electrocautery is associated with significant risks of implant malfunction in patients on a cardiac pacemaker. It is also associated with a risk of adverse cardiac events due to blood loss and fluid absorption. The properties of the holmium laser prevent the occurrence of these adverse events. We report the successful use of this technology in resecting the gland in patients on a permanent cardiac pacemaker implant. MATERIALS AND Methods: Six patients with permanent cardiac pacemaker implant were treated with holmium laser resection of prostate over a period of two years. Treated patients had bothersome prostatic symptoms and failed to respond to medical therapy. All patients were operated under spinal anesthesia using a high power VersaPulse® PowerSuiteTM Holmium laser source. Normal saline was used as irrigant. Intravesical tissue morcellator was also used to remove the larger fragments in two of the patients. Results : Median patient age was 60 years (range 56-73) and median prostate volume was 40cc (range 20-48cc). None of the patient required blood transfusion or had significant hyponatremia or Transurethral resection syndrome. No patients had any pacemaker malfunction or hemodynamic instability during the procedure or in immediate postoperative period. Improvement in maximum urine flow rate was observed from an average of 7 ml/sec in preoperative period to 22 ml/sec postoperatively at 3 month followup. Conclusions: Holmium laser prostatectomy offers the ideal modality of surgery in patients on a cardiac pacemaker. It helps to avoid additional preparation and minimizes the risk of device malfunction and adverse post operative events.

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Aims: To present our technique of Holmium Laser assisted "ANATOMICAL" enucleation of the benign prostatic adenoma (HoLEP) in 219 patients. Procedure is based on the principle of digital enucleation of the adenoma from its surgical capsule, but performed entirely by perurethral endoscopic technique assisted by Holmium Laser. Materials and Methods: From March 2001 to November 2004, 219 patients under went HoLEP. After the initial cuts from bladder neck to verumontanum at 5 and 7 o'clock position, capsule is identified. The beak of the resectoscope sheath was inserted in the plane between the capsule and the adenoma and the adenoma was physically pushed away towards the urethra from the capsule. Laser was used to coagulate the bleeders, to cut the mucosal attachments and tough stromal tissue. Procedure was repeated for median and two lateral lobes. There was minimal bleeding and fluid absorption. Complications were few. Results: In 206 cases successful enucleation of the adenoma was carried out. First 13 cases formed part of the learning curve and were completed by standard transurethral resection of prostate (TURP). IPSS score dropped from average of 23 to 8 and peak flow improved from<11 to >20. No patient had postoperative urinary incontinence or stricture. Conclusions: HoLEP is an effective alternative to TURP. Ultimate end results replicate the end results of open enucleation of BPH without its morbidity and have all the advantages of endoscopic surgery. It offers distinct advantages over standard TURP as the incidence of blood transfusion and fluid absorption are greatly minimized.

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Objectives : Bladder neck suspension using polypropylene is an established technique for treatment of stress urinary incontinence (SUI). We report our retrospective audit of the bladder neck sling in SUI. MaterialS and Methods : Twenty-one patients with SUI operated at our institute were included in the study. The audit was performed using the case records for - patient demographics, detailed history and examination, routine hemogram, renal function tests, urine culture sensitivity, urine microscopic examination and uroflowmetery + cystometrogram(CMG). After complete evaluation, all patients underwent bladder neck suspension using polypropylene mesh. Results : Twenty-one patients with mean age of 55 years underwent bladder neck sling surgery. Mean duration of surgery was 67 minutes (50-100 minutes). Mean operative blood loss of 100ml. Mean duration of hospital stay was 2days (1-5 days). Eighteen patients had complete or significant decrease in the severity of stress urinary incontinence in immediate post-operative period. Mean duration of follow up of patients was 19 months (3-28 months). All patients were dry at the end of the follow up. Conclusions : Broad base polypropylene mesh gives good continence results in patients of SUI.

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Recurrent chyluria is a common public health problem in the areas known for filarial endemicity. Recurrence is highest with the conservative treatment. These patients should be evaluated carefully since release of chyle from the contralateral side may be mistaken with the failure of the treatment. The most common procedure practiced is the resclerotherapy. Patients failing to second courses of sclerothrapy with significant chyluria (weight loss, heavy proteinuria and anemia) should be treated with chylolymphatic disconnection. Before the advent of sclerotherapy and chylolymphatic disconnection more formidable procedure like nephrectomy has been described for recurrent chyluria. In India, procedures such as microsurgical lymph venous anatomists and autotransplantation have rarely been described.

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We report a case of a congenital seminal vesicle cyst with ipsilateral hypoplastic kidney in a 51 year-old Indian man presenting with features of bladder outlet obstruction. Abdominal and pelvic Ultrasonography (USG), computed tomography revealed a retrovesical cystic mass measuring 10cm x 9cm with indentations over the left infero-lateral wall of the urinary bladder. On USG and radionuclide renal scanning the ipsilateral kidney was not found, which was located only on the CT scan. The cyst and the hypoplastic kidney was excised with an uneventful recovery.

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Prostate stents have widely been abandoned. Indeed, to date there are many minimally invasive treatment options which can benefit even patients who are medically unfit to undergo transurethral resection of the prostate (TURP). We present three cases that illustrate that, in spite of all those new options, prostate stents, in particular the thermo-expandable ones that can easily be removed if necessary, have some value as a last resort in selected cases.

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Traumatic dislocation of testis occurs as a consequence of high velocity road traffic accident. We report traumatic testicular dislocation in a young man which was successfully treated with closed reduction under general anesthesia.

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