Introduction: Angiomyolipoma is an under-reported entity from the Indian subcontinent. This study was undertaken to analyze our decade long experience in the management of renal angiomyolipoma (AML). Material and Methods: A total of 12 patients with 20 AML attended our center between July 1989 & December 1999. The mean age at presentation was 46.6 years with a female to male ratio of 2:1. Majority had solitary unilateral disease and bilateral lesions were seen in 2 patients. 25% of patients had associated tuberous sclerosis. A review of all imaging studies and repeat histopathological analysis was undertaken to evaluate the diagnostic pitfalls and tumor characteristics. Results: 83.3% of our patients were symptomatic with loin pain being the predominant symptom (33.3%). 3 cases presented with large palpable lumps. I patient presented with a hemorrhagic shock (Wunderlich's syndrome). 2 of our patients were asymptonnatic (one detected during obstetrical USG and other during live donor nephrectomy). Renal USG and CT scan were highly suggestive of AML in 66.7% and 80% of patients respectively. The mean tumor attenuation value on CT scan was -53.4 H. U. Histopathologically multicentricity was a predominant finding in tuberous sclerosis. Mean tumor size was 7.4 cm with an equal number of patients in group I (< 4 cnn) and group II (> 4 cm). Of the group I patients treated conservatively; 75% could be managed for a mean duration of 33.3 months without aggravation of symptoms or any major complications. 50% of group II patients elected, for conservative management. All of these patients required surgical intervention at a mean duration of 7 months, one on account of major complication (spontaneous bleeding). Conclusion: Our experience validates the presently accepted recommendation of conservative management in renal AML less than 4 cm in size with regard to probability of complications. However we found a poor correlation between tumor size and severity of symptoms and early intervention may be judiciously offered for relief of symptoms.

Deep cortical lacerations with or without urinary extravasations have traditionally been managed by exploration and surgical repair. With improved and readily available radiologic imaging modalities like computed tomography and intravenous pyelography, we propose that the majority of these injuries can be followed expectantly with delayed intervention if needed. 30 patients with blunt abdominal trauma with significant renal injuries were reviewed. 9 patients had Gr II, 16 patients had Gr III, 2 had Gr IV renal injuries. 26 (86.7%) patients responded to conservative management. 4 patients required operative intervention. 6 patients had associated injuries. There was loss of I renal unit in 2 cases. With the aid of computed tomography, conservative therapy for severely injured kidneys can yield favourable results and save patients from unnecessary exploration and possible renal loss.

Introduction: Renal stones with chronic renal failure (CRF) is a complex problem due to various inherent problems associated with CRP. Treating these stones is a challenge and therapy has to be tailored accordingly. Although there are many studies in the literature regarding the optimum management of staghorn stones with Percutaneous Nephrolithotomy (PCNL) alone or in combination with Extracorporeal Shock Wave Lithotripsy (ESWL); but the issue of staghorn stones with associated CRF has not been addressed adequately till date. Current study compares the role of open surgery vs PCNL in staghorn renal stones with CRF. Material and Methods: 26 patients with staghorn renal calculi and CRF were randomized to open (group I) and PCNL (group II) groups. The pre and postoperative hemoglobin (HB), hematocrit (HCT), serum creatinine and urine culture, size of stones, intraoperative blood loss, number of transfusions, surgical complications and duration of procedure was documented. Hemodialysis was done as and when necessary. The residual stone in both groups were treated with ESWL. Hospital stay and overall cost of treatment were analyzed. Results: A total of 10 patients were randomized to group I and 16 patients to group II (18 males and females). The two groups were comparable in terms of age (43.1 ± 13.9 vs 53.0 ± 15.5 yrs), preoperative serum creatinine (380.1 ± 247.5 vs 327.1 ± 88.4 pmol/L), Hb (88.0 ± 24.0 vs 95.0 ± 24.0 gm/L) and HCT (28.9 ± 7.9% vs 30.4 ± 7.3%). Stone size was 1713 ± 1470.2 and 1675 ± 2737.5 mm2 in group I and group 11 respectively. Preoperative culture was positive in 70% of open and 30% of PCNL group. The operating time (1160 ± 44.0 vs 152.5 ± 53 mins), and complication rate (10%in each) were similar in group 1 and group II respectively. Intraoperative blood loss was more in group II but it did not reach statistical significance. 1 patient in group I and 4 in group II required blood transfusion. The average number of sittings required in PCNL was 1.7 ± 0.67 with a puncture rate of 1.9 ± 0.73 per patient. Postoperative Hb, HCT, serum creatinine, bleeding, collections and fever were comparable in the two groups. Overall stone clearance (after adjuvant ESWL) was better in open (80%) as compared to PCNL (62.5%) group. The overall cost of treatment was significantly lower in open (Rs. 8333.3 ± 2851.3) as compared to PCNL (Rs. 16940 ± 4171.9). Hospital stay in the two groups was comparable (12.6 ± 6.1 and 12.9 ± 4.1 days in open and PCNL respectively). Conclusion: In view of the better clearance rate and lesser cost of treatment, open surgery still has a place in the management of staghorn stones with chronic renal failure even in a tertiary urological center. However postoperative pain and a larger scar cannot be ignored.

PCNL is a well-established procedure for renal stone disease. This procedure has been used successfully in pediatric patients. Various modifications in technique and in instruments are tried. We report our results of PCNL in pediatric age group. 19 (22 renal units) children below the age of 15 years underwent PCNL from 1988 to 1998 at Dept. of Urology Unit-11. All patients underwent single stage procedure under general anaesthesia. Complete clearance was achieved in 18 renal units, 4 renal units had residual fragments which cleared in 3 months. 3 patients required blood transfusion. Pediatric PCNL is a safe procedure and can be used safely with acceptable morbidity

Objectives: To assess the value of extracorporeal shock wave lithotripsy (ESWL) in treating paediatric and adult urolithiasis, and to determine, factors that may affect the results. Patients and Methods: Using Stonelith lithotripter (PCK Electronic Industry and Trade Co. Sincan Org San Orhansik, CAO no. 4, Ankara, Turkey), 92 patients (108 stones) with mean age of 35.1 years (4-72 years) were treated for urinary stones. Of these, 89 stones were renal stones and 19 were ureteric stones. The respective mean stone size was 1.86 curs (0.6-3 cms) for renal stones and 1.61 cms (0.6-2.4 curs) for ureteric stones. The patients were assessed 3 months after treatment and the results compared, to detect factors that might be associated with the stone free rate. Results: Of the 108 stones with 3 months follow-up, the overall stone free rate was 75.9% (82 stones); 14.8% (16 stones) stones showed fragmentation but no clearance of stone fragments (insignificant.fragments of < 5 nun) and 9.25% (10 stones) stones didn't show any fragmentation at all. For renal stones the overall stone free rate was 74.1% (66 stones); 15.7% (14 stones) showed partial clearance (1 lostfollow-up) and 10.1 % (9 stones) didn't show any fragmentation. In patients with ureteric stones 16 (84.2%) were stone free after treatment, 2 (10.5%) cases lost follow-up and no, fragmentation in I (5.26%) stone. In cases of children and adolescents 8 stones were completely cleared, 3 stones were partially cleared and there was no fragmentation in 4 stones. The significant factors associated with the stone free rate were size, site, number and radiological abnormalities: there was no significant effect of the type of lithotripter used. Conclusions: ESWL is a safe and effective treatment for both paediatric and adult urolithiasis. The stone free rate is influenced significantly by stone size, site, number and radiological features. Irrespective of the make of lithotripter; the clearance rate was 75 - 97%. JJ stent is not required routinely at the time of ESWL.

Objective: To assess the efficacy of in situ ESWL in the treatment of neglected, long-standing upper ureteral calculi and to study whether or not manipulation and stenting followed by ESWL augments the success rate. Patients and Methods: The study involves 54 solitar t upper ureteral stones, first treated in situ. Unresponsive stones were pushed back into the renal pelvis and the collecting system was stented, catheterized before subjecting the patients to ESWL again. Plain X-ray was done not earlier than 10 days after treatment to assess the stone status. Results: Of the 54 stones, 36 (66.6 %) could be fragmented successfully with in situ ESWL. The remaining 18 were manipulated before another session of ESWL. Success for treatment of upper ureteral calculi was augmented from 66.6% after in situ ESWL to 96.2% after manipulating those 33.4% stones unresponsive to in situ ESWL. Although larger calculi (>1.6 cm) required manipulation, they were fragmented with exposure to lesser number of shock waves. Conclusion: In situ ESWL is effective in stones < 1 crn. As the stone size increases, successful stone clearance demands manipulation prior to ESWL. As evident from our results, stones > 1.6 cm are better treated by ESWL after manipulation and stenting catheterization, as these are less likely to fragment in situ.

Lymphocele following renal transplantation is a well recognized complication. Due to their critical location in the pelvis lymphoceles can become symptomatic. Herein we describe our experience of managing lymphoceles following renal transplantation with special emphasis on laparoscopic deroofing. From 1989 to 1999, 11 symptomatic lymphoceles were diagnosed in 680 renal transplant recipients. 6 patients underwent laparoscopic deroofing, 4 open internal marsupializations and 1 external drainage for infected lymphocele. Mean follow-up was 26.25 months and 10.33 months in open internal drainage and laparoscopic group respectively. Mean operative time in patients undergoing open surgical deroofing was 70.25 minutes [Table 2]. Average hospital stay was 7.5 days (5 to 10 days). There was no intraoperative complication. Mean operative time in laparoscopic group was 100 (60-120) minutes. In 5 patients (83.33%) laparoscopic deroofing could be carried out successfully. Complication occurred in I patient (16.66%). Average hospital stay was 2.66 (1-6) days. No recurrence of Lymphocele has been noted in the follow-up. We conclude that laparoscopic deroofing of post-transplant lymphocele is a safe procedure associated with minimal morbidity, better cosmesis and rapid convalescence. It should be the procedure of choice for all but infected lymphoceles.

The staged repair for bladder exstrophy has been established over the last few decades. Bladder neck repair depends on the ability of the closed bladder to increase in capacity with time. Unfortunately, a significant percentage of bladders remain small necessitating a simultaneous bladder augmentation with or after bladder neck reconstruction. We evaluated 12 patients of classical exstrophy after primary turn in using cystometry. In 5 patients the leak point pressure was zero and there was continuous urine leak. The other 7 children demonstrated storage function. There was a high incidence of uninhibited contractions in this group of children (71.4%). The factors influencing the increase in bladder capacity following primary turn-in and the role of urodynamic evaluation is discussed.

Purpose: Transurethral resection of the prostate (TURP) is the gold standard for treatment of benign pro static hyperplasia (BPH). However; the morbidity of this procedure necessitates constant attempts at modifications to the standard equipment and technique. We report on the safety and efficacy of TURP with the thick vapor resection WEDGE'" loop (Microvasive0, Boston Scientific Corporation, USA) compared with the standard wire loop in comparable groups of patients with prostates larger than 40 cc. Material and Methods: We prospectively randomized 60 patients with bladder outflow obstruction due to BPH into 2 groups of 30 each. The inclusion criteria included an indication for prostatectomy and prostate size larger than 40 cc. The exclusion criteria included carcinoma prostate and neurovesical dysfunction. Pre-operative evaluation included assessment of International prostate symptom score (IPSS), prostate volume (in cc), maximum fow rate (Qmax) and residual urine (in ml). Patients in group 1 underwent transurethral vapor resection of the prostate (TUVRP) using the WEDGE" loop while patients in group 2 underwent TURP using a standard wire loop. Operating time, resected tissue weight, duration of catheterization, nursing contact time, hospital stay, haemoglobin change, serum sodium levels, and any complications were noted and compared in the 2 groups. The IPSS maximum f ow rate and residual urine were re-evaluated at 6 months after the procedure and compared in the 2 groups. Results: Both groups were comparable in terms of age, IPSS, prostate volumes, Qmax and residual urine. The mean prostate volume in group I and 2 was 63.6 cc and 58.48 cc respectively. The mean resected weight in group 1 and 2 was 20.30 gin and 17.52 gin respectively. Irrigant (1.5% ghvcine) volume used was 14.65L and 19.12L and the operating time was 47 min and 68.6 min in the 2 groups respectively. Estimated mean intra-operative blood loss was 50 (30-50 ml) and 250 (100-300 ml) respectively. Duration of post-operative catheterization was 1.56 days and 2.28 days and haemoglobin change was +/- 1.32 g and +/- 1.96 g respectively. The differences in duration of hospital stay and the change in serum sodium were not significant. Post operative catheterization duration, post operative irrigant requirement was significantly different in both the groups. The incidence of complications was similar and the efficacy assessed with IPSS, Qmax and residual urine was comparable at 6 months. Conclusion: The use of a thick vapor resection loop for TURP significantly reduces operating time, blood loss, irrigant requirement, nursing contact time, and duration of catheterization, besides providing a clew vision during surgery without affecting the efficacy and complications.

Complete androgen blockade by LHRH agonist /Orchiectomy plus antiandrogen results in androgen deficiency amongst males (ADAM). We treated advanced cancer prostate with finasteride and flutamide with an aim of potency sparing in relatively younger males with the disease. 45 sexually active males between the age of 48 to 65 having advanced cancer of prostate were treated, for 1 year with Flutamide (750mg) and Finasteride (5mg) daily and followed up for 18 months. Results showed 89% having low PSA and 80% maintained their sexual potency. Side effects were mild: 20% of patients developing diarrhoea, gynaecomastia and hot flushes with good drug compliance. This combination is ideal as potency sparing androgen ablation therapy for advanced cancer of prostate among young & sexually active males.

Idiopathic oligoasthenosperinia accounts. for almost 24% of all male infertility. The role of free radicals as a cause of such male infertility has been established recently. We undertook a study to establish the role of Lycopene (antioxidant) in management of such infertile males due to free radicals. A total number of 50 patients having no obvious cause for their infertility with normal hormone profile and antisperin antibody titre but showing oligoasthenospermia were given Lycopene (Lycored) 8 mg daily till their sperm analysis improved to optimal level or pregnancy was achieved. Regular, follow-up for one year with sperm analysis was done. Result showed a 36% pregnancy rate with improvement of sperm count and functional sperm concentration in 70% and 60% respectively, sperm motility and sperm motility index improved in 54% and 46% while 38% showed improvement in sperm morphology. There were no side effects with good patient compliance. Conclusion: Lycopene supplementation has a definite role in management of idiopathic oligoasthenospermia.

472 non-repetitive urinary isolates of E.coli (349 resistant and 123 sensitive to trimethoprim-sulfametho.xazole) from patients with culture documented UTI were isolated between January 1998-December 1999. Data on antibiograrn of these isolates were fed into WHONET computer program. The relationship between trimethoprim-sulfamethoxazole (T-S) resistance and resistance to other common antimicrobials among E. coli was statistically analyzed by comparing T-S resistant with T-S sensitive isolates against other antimicrobial agents. T-S resistant E.coli were more likely to be resistant to ampicillin, augmentin, cejazolin and norfloxacin (P<0.001) but not for gentanicin and nitrofurantoin (P>0.05). T-S resistance among urinary isolates of E.coli may be a risk fatctor that would likely be associated with resistance to other antimicrobial agents used to treat UTI.

Myelolipomas are usually as ymptomatic and discovered incidentally or at autopsy. They are rare benign adrenal neoplasms, characterized by the presence of adipose tissue and elements of haematopoietic tissue in various degrees of differentiation. Occasionally these tumours may cause local symptoms or rupture. Not much literature is available on the association of gallstones with adrenal myelolipoma. It could be an incidental association or there may be a common underlying pathologic basis. We report clinical, radiologic and therapeutic aspects of a large myelolipoma of the right adrenal gland associated with gallstones in a patient with type 2 diabetes mellitus and diabetic nephropathy.

We report on a 53-year-old male patient with malignant fibrous histiocytoma of the kidney. This malignant mesenchymal tumor presented as a large mass lesion arising from the upper pole of the right kidney. Indistinguishable clinically and radiologically from a renal cell carcinoma, a few unusual. features were the predominantly cystic areas interspersed with non-central calcification and complex cyst of the contralateral kidnei:. The dilenuna of adjuvant therapy after radical nephrectomy continues.

Spontaneous retroperitoneal haemorrhage may occur due to variety of causes, but absence of trauma is stressed. In our study often cases, the commonest cause was angiomyolipona (6 cases). Clinical presentation varied, from mild flank pain to shock and oliguria. Ultrasound may be the initial test but CT scan remains the gold standard for diagnosis. Angiography is helpful to look. for vascular defects, and arteriovenous malformations in small renal cell carcinoma. Management varies from conservative approach to radical nephrectomy, depending on etiology.

Penile gangrene associated with chronic renal failure, is a rare entity. Patients usually have associated diseases like diabetes, hypertension. Gangrene occurs because the dystrophic calcific infiltration causes huninal obstruction. This is an accompaniment of generalized soft tissue calcification and bony abnormality resulting. from secondary hyperparathyroidism. Calcium phosphate product exceeds plasma solubility causing precipitation of calcium phosphate. Medical treatment may maintain the product below precipitation levels. Mortality in these patients remains high due to the severity of the associated systemic illnesses. Conservative surgical treatment is advocated in view of short life span.

Clinically seminoma and granulomatous orchitis are difficult to separate. The present case highlights this aspect. 50-year-old male presented with mass & pain in right testis since 6 to 8 months. Right testis was enlarged, hard & tender: Laboratory investigations were within normal limits. Orchiectomy specimen revealed homogenous appearance with yellow grey colour Sections studied showed multiple non-caseating granulomas mainly within seminiferous tubules. Differential diagnosis of non-caseating granulomas mainly includes sarcoidosis & granulomatous orchitis. Restriction of granulomas to seminiferous tubules as in our case is a characteristic feature of granulomatous orchitis.

Hvdatid disease is a parasitic disease usually caused by Echinococcus granulosus. It usually presents with liver involvement and uncommonly lungs and rarely other organs are involved. A rare case of hydatid testis is reported that was provisionally diagnosed as testicular tumor.

Aggressive angiomvxoma is a distinctive, locally aggressive but non-metastasizing soft tissue tumour of the pelvic region and perineum. This is seen more commonly in premenopausal women. We report a case that occurred in a man who presented with swelling in the inguino-scrotal region for which the patient underwent herniorraphv for hernia with excision of the mass at the upper pole of the testis, in the region of the epididymis.

Usually double balloon catheter is required forpositive pressure retrograde urethrography in females. We describe a technique of positive pressure retrograde urethrography using Foley catheter and rubber stopper, inexpensive and could be adopted in any hospital or radiological suite.

Humanism is a system of beliefs concerned with the needs of people. Patients have clinical care needs as well as interpersonal care needs. Clinical care requires skills of diagnosing and treating. Interpersonal care requires qualities of integrity, honesty, respect, empathy, compassion and altruism. With continuing advances in science and technology, diagnosis and treatment are becoming more and more sophisticated and interpersonal care is neglected. Humanism in medicine aims to promote interpersonal care of patients. In this article, rationale and evolution of humanism are described, humanism in medical profession is discussed and ways for promoting humanism in medical profession are enumerated.