The format of urological training in India has changed little since its inception. The dogma of tradition has perhaps failed to consider the paradigm shifts in the science. A system that was relevant 50 years ago may not be so relevant today. The majority of procedures are endourological and laparoscopic, to which an average surgical resident has minimal exposure. Yet, the fundamentals of surgical craft are best learnt prior to any sub-specialty training. This is an apparent contradiction that has to be bridged if our training programs seek to be the foremost in the world. A single restructured training program that combines the core surgical curriculum to an extended exposure to the subspecialty will perhaps best address this issue.

The review summarises the technological advances in the application of high-intensity focused ultrasound for small renal masses presumed to be cancer including the systematic review of its clinical application. Current progress in the area of magnetic resonance image guided ultrasound ablation is also appraised. Specifically, organ tracking and real time monitoring of temperature changes during the treatment are discussed. Finally, areas of future research interest are outlined.

Introduction : Flow-volume nomograms and volume-corrected flow-rates (cQ) are tools to correct uroflow rates (Q) with varied voided volumes (VV) of urine. We investigated the applicability of the available nomograms in our local population. Materials and Methods : Raw data of our previous study on variation in Q with voiding position (standing, sitting, and squatting) in healthy adult men was reanalyzed. Additionally, the departmental urodynamic database of the last four years was searched for uroflow data of men with voiding symptoms (International Prostatic Symptom Score (IPSS) > 7 and global quality of life score >2). These results were projected on the Liverpool and Siroky nomograms for men. The Q-VV relations were statistically analyzed using curve-estimation regression method to examine the current definition of corrected maximum flow rate (Qmax). Results : We found a cubic relation between Q and VV; based on this we developed novel equation for cQ [cQ=Q/(VV) ^1/3 ] and novel confidence-limit flow-volume nomograms. The imaginary 16 ^th percentile line of Liverpool nomogram, -1 standard-deviation line of Siroky nomogram and lower 68% confidence-limit line of our nomogram had sensitivity of 96.2%, 100% and 89.3%, and specificity of 75.3% 69.3% and 86.0%, respectively for Qmax-VV relations. Corresponding values for average flow rate (Qave)-volume relations were 96.2%, 100% and 94.6%, and 75.2%, 50.4% and 86.0%, respectively. The area under curve of the receiver operating characteristics (ROC) curve for cQmax and cQave was 0.954 and 0.965, respectively, suggesting significantly higher discriminatory power than chance (P = 0.0001). Conclusion : Flow-volume nomograms developed on Caucasian population may not be optimally applicable to the Indian population. We introduce flow-volume nomograms and cQ, which have high sensitivity and specificity.

Aims : Open radical retropubic prostatectomy (ORP) has traditionally been performed through a lower midline incision. Prior efforts to reduce pain and expedite recovery include a variety of alterations in length and the orientation of the incision. The aim of our study is to compare the safety, efficacy, and cosmetic outcomes associated with transverse and longitudinal mini-radical prostatectomy incisions. Materials and Methods : Consecutive patients undergoing ORP at a single institution were studied. Patients were randomized to receive either a modified transverse or longitudinal incision. In all patients, the length of the incision was 7cm. The following parameters were compared between the two groups: Perioperative blood loss, duration of surgery, technical factors, pain and analgesic requirements, length of hospital stay (LOS), and pathological stage. The Patient and Observer Scar Assessment Scale (POSAS) was used to compare the cosmetic aspects associated with the incisions. Results : Fifty-six patients underwent a transverse (n=27) and longitudinal (n=29) mini- incision ORP. No significant differences were noted in the perioperative parameters that were compared (P>0.116). None of the patients required blood transfusion, there were no wound complications. Perioperative pain and analgesic requirements were not significantly different among the two study arms (P>0.433). The POSAS indicated no significant difference in cosmesis scores with both incisions (P>0.09). Conclusions : Seven-centimeter transverse and longitudinal mini-incisions offer alternatives to the standard ORP incision, and to minimally invasive approaches. Both incisions are safe, associated with little postoperative pain, and a short postoperative LOS. Both incisions provide highly satisfactory cosmesis for the patient.

Objectives : An ideal vasovasostomy procedure requires precise mucosal approximation with a watertight anastomosis. The standard two-layer microdot technique requires multiple sutures within each layer and is a technically difficult operation to perform. We describe a two-layered technique which adheres to the principles of tubular anastomosis, but is simpler and provides excellent results. Materials and Methods : Patients with secondary infertility following a previous vasectomy underwent the modified two-layered vasovasostomy. Two 8-0 polyamide sutures were placed at 5 and 7 o'clock positions in the sero-muscular layer to approximate the two ends of the vas. Next, four double-armed, 10-0 polyamide sutures were sequentially placed, inside out in the mucosa of the vasal ends, at 3, 6, 9, and 12 o'clock positions and tied. Two additional sero-muscular sutures were placed at 1 and 11 o'clock positions to complete the anastomosis. Patients with a suspected proximal block in the epididymis underwent a vasoepididymostomy. Semen analysis was performed at 6 weeks after surgery. Results : Between the period February 2008 and August 2009, eight men underwent vasectomy reversal using the 4 × 4 technique. The procedure was performed bilaterally in six men whereas two patients underwent a two-suture, longitudinal intussusception vasoepididymostomy on the second side. Mean operative time was 90 min per patient. All men had sperm in the ejaculate at the first semen analysis. There were no complications. Conclusions : The "4 × 4" modified two-layer vasovasostomy is a simple technique that can be performed in quick time with excellent results. It may allow a common ground between the complex microdot two-layer technique and the over-simplified single-layer procedure.

Background : There have been few community-based epidemiological studies on urinary incontinence (UI) evaluating the risk factors and impact on quality of life (QOL) in India. Objectives : This study was designed (1) to estimate age-specific prevalence and risk factors of UI among women aged 35 years and above in a rural area and (2) to analyze the impact of UI on the QOL of incontinent women. Design and Setting : A cross-sectional descriptive study was conducted. Materials and Methods: A semi-structured questionnaire assessing socio-demographic factors, severity and type of incontinence, and obstetrical and other risk factors along with impact on QOL was administered in two clusters (villages) in Karimnagar district through multistage cluster sampling. Results : In a sample of 552 women, 53 (10%) reported episodes of UI. The prevalence of UI showed significant association with increasing age (P < 0.01). Fifty-seven percent of the women had symptoms of stress incontinence, 23% of urge, and 20% mixed symptoms. Obstetrical factors associated with UI included high parity (P < 0.003), young age at first childbirth (P < 0.01), forceps delivery (P < 0.001), and prolonged labor (P < 0.001). Chronic constipation, chronic cough, and history of urinary tract infection were predictors of UI in regression analysis (Nagelkerke R ² = 0.7). Women with stress incontinence had the severest perceived impact on QOL on a five-point scale questionnaire, mean 24.87 (95% CI 21.26-28.47). Conclusion : One in 10 women reported episodes of UI with impaired QOL. The outcome is predicted both by obstetric and other risk factors.

Purpose : To evaluate the outcome of shock wave lithotripsy (SWL) as monotherapy for solitary renal stones larger than 2 cm without ureteral stenting. Materials and Methods : Our retrospective study included patients with solitary renal radio opaque stones larger than 2 cm treated with SWL using electromagnetic Dornier Compact S lithotripter device (Wessling, Germany) for a period of 3 years (September 2002-2005). Stone clearance was assessed at 1 week, 1 month, and 3 months with plain X-rays of kidney, ureter, and bladder region, ultrasonography, and tomograms. Stone-free status, morbidity of the procedure, and fate of clinically insignificant residual fragments (CIRF) were studied. A stone-free state was defined as no radiologic evidence of stone. Success was defined as complete clearance + CIRF. Results : Fifty-five patients, aged 11-65 years (mean 49.8) underwent SWL. Of them, only two were children. Male-to-female ratio was 3:1. The stone size was 21-28 mm (average 24 mm). The mean number of shocks were 3732 (range 724-12,100) and average energy level was 14 kV (range 11-16 kV). The mean follow-up was 18 months (range 3-22 months). Over all, stone-free status was achieved in 50% and success in 81% at 3 months. Stone clearance was not affected by stone location. Stones <25 mm had better stone-free rate (54.16% vs. 28.5%) and lesser CIRF (14.6% vs. 28.5%) when compared to larger stones (>26 mm) (P = -0.10). Of 54 patients, 39 developed steinstrasse with mean length of 3.2 cm (range 1.4-6.2 cm) and only four required intervention. Effectiveness quotient (EQ) for SWL monotherapy for solitary renal stones more than 2 cm was 25.3%. The EQ for stones <25 mm and those more than 25 mm were 28.4% and 10% (P = -0.12), respectively. There was a lesser trend of difference between stones with size <25 and more than 25 mm. During the last review, the overall stone-free rate was 67.2%. Conclusions : SWL monotherapy was safe but significantly less effective for solitary renal stones larger than 2 cm. It can only be suggested to those who refuse surgical intervention. Pretreatment DJ stenting is not mandatory when closer follow-up is ensured.

Aim : This study was designed to test the hypothesis that propofol, ketamine, and midazolam could alter the contractile activity of detrusor smooth muscle. Materials and Methods : Four detrusor muscle strips isolated from each rat bladder (n = 12) were placed in 4 tissue baths containing Krebs-Henseleit solution. The carbachol (10 ^-8 to 10 ^-4 mol/L)-induced contractile responses as well as 5, 10, 20, 30, 40, 50 Hz electrical field stimulation (EFS)-evoked contractile responses of the detrusor muscles were recorded using isometric contraction measurements. After obtaining basal responses, the in vitro effects of propofol, ketamine, midazolam (10⁻⁵ to 10⁻³ mol/L), and saline on the contractile responses of the detrusor muscle strips were recorded and evaluated. Results : All the 3 drugs reduced the carbachol-induced and/or EFS-evoked contractile responses of rat detrusor smooth muscles in different degrees. Midazolam (10⁻⁴ to 10⁻³ mol/L) caused a significant decrease in the contractile responses elicited by either EFS or carbachol (P=0.000-0.013). Propofol (10⁻³ mol/L) caused a decrease only in EFS-evoked contractile responses (P=0.001-0.004) and ketamine (10⁻³ mol/L) caused a decrease only in carbachol-induced contractile responses (P=0.001-0.034). Conclusion : We evaluated the effects of the 3 different intravenous anesthetics on detrusor contractile responses in vitro and found that there are possible interactions between anesthetic agents and detrusor contractile activity. The depressant effects of midazolam on the contractile activity were found to be more significant than ketamine and propofol. Despite the necessity of further studies, it could be a piece of wise advice to clinicians to keep the probable alterations due to intravenous anesthetics in mind, while evaluating the results of urodynamic studies in children under sedation.

The authors present an objective review of what is new in endourology instrumentation, based on up-to-date scientific data gathered from meetings, state-of-art lectures and current literature. The main scope of this review is to highlight the most recommended device options for each step of an ureteroscopy, in order to offer best care to patients.

Objective : Topical hemostatic agents are used in a wide variety of surgical settings, and the evolution of this class of surgical tools is an interesting topic. We reviewed and outlined the historical progress of topical hemostats into present day surgery and urology, and highlight opportunities for future research. Materials and Methods : A MEDLINE search of all available literature concerning several classes of topical hemostatic agents was performed. Fibrins sealants, Gelatin sponge hemostatics, cyanoacrylate adhesives, oxidized regenerated cellulose, and microfibrillar collagen were included. References were chosen from a broad range of surgical literature. Results : Topical hemostatic agents have historically taken advantage of a wide variety of mechanisms for hemostasis. Fibrin sealants have a rich history and large potential for further applications. Gelatin sponge hemostatics have been widely used since their introduction, but have changed little. Cyanoacrylate adhesives have a unique mechanism and opportunity for novel applications of existing products. Oxidized cellulose was original in the use of plant-based components. Microfibrillar collagen hemostats have evolved to a wide variety of formats. Conclusions : A review of the evolution of topical hemostatic agents highlights opportunities for potential novel research. Fibrin sealants may have the most opportunity for advancement, and understanding the history of these products is useful. With the drive in urology for minimally invasive surgical techniques, adaptation of topical hemostatic agents to this surgical approach would be valuable and offers an opportunity for novel contributions.

Objectives : Sacral neuromodulation has gained increased worldwide acceptance as the standard of care in patients with refractory overactive bladder (OAB) and non-obstructive urinary retention (NOUR). This review will detail the evolution of the technology. Materials and Methods : The mechanism of action and advances in treatment, including tined lead, fluoroscopic imaging, and smaller implantable pulse generator (IPG) are reviewed. This discussion also explores expanding indications and future advances including interstitial cystitis, chronic pelvic pain, neurogenic bladder, fecal incontinence, constipation, and dysfunctional elimination syndrome in children. Results : Sacral neuromodulation (SNM) exerts its influence by modulation of sacral afferent inflow on storage and emptying reflexes. The tined lead allows for placement and stimulation to be performed in the outpatient setting under local anesthesia with mild sedation. Lead migration has been minimal and efficacy improved. The use of fluoroscopy has improved accuracy of lead placement and has led to renewed interest in bilateral percutaneous nerve evaluation (PNE). Bilateral PNE can be performed in the office setting under local anesthesia, making a trial of therapy less expensive and more attractive to patients. A smaller IPG has not only improved cosmesis, but decreased local discomfort and need for revision. The role for SNM continues to expand as clinical research identifies other applications for this therapy. Conclusions : Our understanding of SNM, as well as technological advances in therapy delivery, expands the pool of patients for which this form of therapy may prove beneficial. Less invasive instrumentation may even make this form of therapy appealing to patients without refractory symptoms.

Objective : To describe the evolution of instrumentation and technology for natural orifice translumenal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) as applied to urologic procedures. Materials and Methods : We performed a search of published reports on PubMed and MEDLINE for the search terms NOTES, single-port, single-incision, single-site, natural orifice + surgery, SPA, LESS, incisionless, and scarless from 1990-2009. Studies relevant to this urologic symposium were chosen for detailed review. Results : Multiple case reports, case series, and review articles relevant to NOTES and LESS utilized for urologic surgery dating from 1991 to 2009 were identified. We were subsequently able to chronicle the technological advances in instrumentation utilized for NOTES, including transvaginal nephrectomy, transvesical NOTES, combination or hybrid NOTES, and robotic-assisted NOTES or R-NOTES. For LESS, we detailed the development of various access ports and operating platforms to facilitate performing urologic procedures through a single-port access site. Conclusions : Significant progress has been made in developing new, multi-lumenal access ports and articulating or curved instruments to aid in triangulation necessary for certain urologic procedures. Magnetic anchoring guidance systems (MAGS) have further enhanced the approach to LESS, with the potential for future application to NOTES. NOTES and LESS have future implications for the armamentarium of urologic surgeons, although much more research is necessary to further improve instrumentation and overcome the learning curve necessary for new technology.

Percutaneous nephrolithotomy (PCNL) is the procedure of choice for removing large, complex, and/or multiple renal calculi. Since its first description in 1976, PCNL techniques and equipment have evolved to maximize procedural efficacy, safety, and reproducibility. We reviewed current literature from January 2004 to November 2009 using Medline search regarding PCNL instrumentation and technology. Additional equipment discovered during the review process without published Medline evidence was summarized from manufacturer brochures and data. Included in this review are summaries of intracorporeal lithotriptors and accessory equipment, stone manipulation devices, PCNL tract sealants, and a digital rigid nephroscope. The evolution of these devices from their predecessors has increased the instrumentation options for the treating urologist and may represent more effective technology for the percutaneous treatment of large renal stones.

This article presents a review of the history and evolution of robotic instrumentation and its applications in urology. A timeline for the evolution of robotic instrumentation is presented to better facilitate an understanding of our current-day applications. Some new directions including robotic microsurgical applications (robotic assisted denervation of the spermatic cord for chronic orchialgia and robotic assisted vasectomy reversal) are presented. There is a paucity of prospective comparative effectiveness studies for a number of robotic applications. However, right or wrong, human nature has always led to our infatuation with the concept of using tools to meet our needs. This chapter is a brief tribute to where we have come from and where we may be potentially heading in the field of robotic assisted urologic surgery.

Aims : The purpose of this article is to review the development of instruments, current technique, and expected outcomes for holmium laser enucleation of the prostate (HoLEP). Materials and Methods : A review of published, peer-reviewed articles focusing on HoLEP was performed using the MEDLINE database. Results : Historically, the gold-standard management for symptomatic obstructing benign prostatic hyperplasia (BPH) has been transurethral resection of the prostate (TURP). With the development of new laser technology minimally invasive surgical procedures have been introduced in an attempt to decrease the morbidity experienced with standard TURP. Laser treatment of BPH has evolved from coagulation to complete adenoma enucleation. The holmium laser was initially utilized for prostate ablation and soon evolved into holmium laser tissue resection, but was limited by difficulties with extracting the prostate tissue from the bladder. With the development of a compatible tissue morcellator whole prostate lobes could be enucleated similar to an open prostate enucleation and the HoLEP procedure was developed. Currently HoLEP is the only procedure to demonstrate superior outcomes to TURP on urodynamic studies and long-term studies demonstrate its durability up to 7 years post procedure. Changes in enucleation technique have also increased the efficiency of the HoLEP procedure, such that any sized prostate can be treated. Conclusions : HoLEP is a safe and effective surgical treatment for symptomatic BPH, dependent on a high powered laser and morcellation system. The procedure continues to gain acceptance due to excellent short and long-term results, its wide application, and further simplification of technique.

Purpose of Review : To provide an overview of the technologic advancements in the field of ablative therapy, focusing on the treatment of renal neoplasms. Materials and Methods : A MEDLINE search was performed using each specific ablative technique name as the search term. Articles written in the English language were selected for review. In cases of multiple reports by a single institution, the most recent report was utilized. Pertinent articles specific to the technologic advancement in ablative therapy were selected for review. Recent Findings : Intermediate-term oncologic outcomes of radiofrequency ablation (RFA) and cryoablation (CA) for the treatment of small renal masses are encouraging. For thermal therapies, molecular adjuvants to enhance cellular kill and local control have been developed. Improvements in microwave technology have allowed for reductions in antenna size and increases in ablation size. Laparoscopic high-intensity focused ultrasound (HIFU) probes have been developed to overcome the limitations of transcutaneous energy delivery, but HIFU remains experimental for the treatment of renal lesions. Irreversible electroporation (IRE), a novel nonthermal ablative technique, is currently undergoing clinical investigation in human subjects. Histotripsy causes mechanical destruction of targeted tissue and shows promise in treating renal and prostate pathology. Summary : Ablative techniques are commonly utilized in the primary treatment of urologic malignancies. The purpose of this review is to discuss technologic advances in ablative therapies with emphasis on the treatment of renal masses. RFA and CA show acceptable intermediate-term efficacy and technical refinement continues. Emerging technologies, including microwave thermotherapy, IRE, HIFU and histotripsy, are described with emphasis on the mechanism of cellular kill, energy delivery, and stage in clinical development.

Recent advances in urology have included natural orifice translumenal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). These techniques seek to minimize morbidity by reducing the number of transabdominal port sites, but this comes at a cost of decreased instrument agility and other technical challenges that have prevented LESS and NOTES from entering mainstream urologic practice. Magnetic anchoring and guidance systems (MAGS) consist of instruments that are inserted laparoscopically through an entry in the peritoneal cavity at one point and then driven into position elsewhere and controlled with magnets. These instruments improve the ergonomics of minimally invasive surgery and may help make LESS and NOTES more accessible to urologists across experience levels.

Extracorporeal shock wave lithotripsy (SWL) was first introduced in 1980 and it rapidly revolutionized the treatment of stone disease. SWL is a non-invasive, outpatient procedure that now accounts for the majority of stone removal procedures. Since the introduction of first generation lithotripter, the Dornier HM3 machine, SWL devices have undergone many modifications secondary to limitations, in efforts to create a more effective and efficient way to treat stones and decrease possible morbidities. Herein, we review the evolution of the technology and advances in the instrumentation over the last three decades.

A 90-year-old male with prostatic hyperplasia with a history of ischemic heart disease and right-sided hemiplegia had undergone a Urolume stent placement because of acute urinary retention 9 months earliar. The stent had migrated into the bladder causing dysuria and a poor stream of urine. We fragmented the prostatic stent by Holmium (HO: YAG) laser followed by a laser prostatectomy. After the procedure, the patient voided satisfactorily.

Melanoma of the penis is an uncommon cancer. We present the case of a 73-year-old male with penile melanoma and non palpable lymph nodes. Lymphoscintigraphy was applied to locate the sentinel lymph nodes for dissection. His lymph nodes were negative for melanoma and he has been disease-free for 1 year with careful surveillance.

Superficial thrombophlebitis of the dorsal vein of the penis (penile Mondor's Disease) is an important clinical diagnosis that every family practitioner should be able to recognize. Dorsal vein thrombosis is a rare disease with pain and induration of the dorsal part of the penis. The possible causes comprise traumatism, neoplasms, excessive sexual activity, or abstinence. The differential diagnosis must be established with Sclerotizing lymphangitis and peyronies disease and doppler ultrasound is the imaging diagnostic technique of choice. Proper diagnosis and consequent reassurance can help to dissipate the anxiety typically experienced by the patients with this disease. We describe the symptoms, diagnosis, and treatment of the superficial thrombophlebitis of the dorsal vein of the penis.

Amputation of the penis is a rare condition reported from various parts of the world as isolated cases or small series of patients; the common etiology is self-mutilating sharp amputation or an avulsion or crush injury in an industrial accident. A complete reconstruction of all penile structures should be attempted in one stage which provides the best chance for full rehabilitation of the patient. We report here a single case of total amputation of the penis in an acute paranoid schizophrenic patient .The penis was successfully reattached using a microsurgical technique. After surgery, near-normal appearance and function including a good urine flow and absence of urethral stricture, capabilities of erection and near normal sensitivity were observed.

Leiomyosarcoma of inferior vena cava (IVC) involving bilateral renal veins presents a surgical challenge. Herein, we report the successful management of two such cases using restoration of left renal venous outflow by saphenous vein interposition graft as first step of surgery. Then radical resection of tumor and right kidney was done. IVC was lastly reconstructed using Gore-Tex graft. This report highlights the surgical challenges to ensure radical resection. Furthermore, the importance of restoring left renal outflow in presence of concomitant right nephrectomy is discussed. Both the patients were disease free at six months with no loss of left renal glomerular filtration rate.

Primary renal lymphoma is very rare. Lymphomatous involvement of the kidney is often seen as a part of disseminated disease. The prognosis is usually poor with median survival less than a year. It is essential to differentiate between renal cell carcinoma and renal lymphoma in patients presenting with solitary renal masses. We present a 52-year-old lady who presented with a solitary renal mass and was diagnosed to have primary lymphoma of the kidney and discuss briefly about primary renal lymphoma.

The present article reports a triad of right renal agenesis, ipsilateral seminal vesicle cyst, and ejaculatory duct obstruction (Zinner syndrome) in a 19-year boy who presented with urinary symptoms. A detailed review of the relevant literature is also presented.

The extent of Lymh node dissection (LND) during radical cystectomy is a subject of increasing importance with several studies suggesting that an extended LND may improve staging accuracy and outcome. Significant numbers of patients have lymph node metastasis above the boundaries of standard LND. Extended LND yields higher number of lymph nodes which may result in better staging. Various retrospective studies have reported better oncological outcomes with extended LND compared to limited LND. No difference in the mortality and the incidence of lymphocele formation has been found between 'standard' and 'extended' LND. Till we have a well-designed randomized controlled trial to address these issues for level 1 evidence, it is not justified to deny our patients the advantages of 'extended' lymphadenectomy based on the current level of evidence.

Vesicoureteric complications present early after transplantation and contribute to patient morbidity, graft loss and mortality. Ureteral stenting provides a decrease in ureteroneocystostomy anastomotic complications following renal transplantation. There should be prophylactic stent insertion with endoscopic removal at a designated time post transplantation. With the addition of antibiotic prophylaxis post transplantation, ureteric stenting does not increase the rate of urinary tact infections. There is no significant increase in cost for stenting during transplantation in comparison to management of major ureteric complications. Routine stenting causes significant cost-saving per year and prevents anastomotic complications. It is wise to stent the transplant ureter routinely.

Double-J (DJ) stents are used in urology practice for various reasons. In renal transplantation, DJ stenting is used to treat the complications like urine leak and ureteric obstruction. However, the role of routine or prophylactic DJ stenting during renal transplantation is debatable. Most of the urinary complications occurring following renal transplantation are because of poor surgical technique and transplant ureteric ischemia. Routine DJ stenting cannot be a substitute for sound surgical technique, which avoids ureteric devascularization and create watertight ureterovesical anastomosis. DJ stenting increases the risk for complications like recurrent urinary tract infection, stent encrustation, stone formation, hematuria, and severe storage lower urinary tract symptoms. Routine DJ stenting during renal transplantation is not mandatory. It can harm an immunosuppressed renal transplant recipient by predisposing to various complications.

Technical modifications in open approach to radical cystectomy and orthotopic neobladder (ONB), that is, Pfannenstiel incision, single urethral catheter, internal splint, and extraperitonealization of the ONB were done in 36 patients. Median operative time was 300 (240-360) min. Median time to move the bowel and start of oral intake was 4 days (2-8) days. Major complications occurred in 3 (8.33%) patients. Mean postoperative pain score was 2 (1-4). These modifications in open radical cystectomy resulted in better cosmesis, less pain, and more comfort to the patients as they had to carry one urobag for 3 weeks.