Trans Urethral Resection of Prostate (TURP) syndrome is one of the commonest and dreaded complications of urological endoscopic surgery. Even in the best of hands, the incidence of TURP syndrome is up to 20% and car­ries a significant mortality rate. This paper highlights the various pathophysiological mechanisms of TURP syndrome, steps to prevent/delay the onset of manifesta­tions and the treatment of established TURP syndrome.

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BACKGROUND: We investigated the efficacy of oral clonidine 150 mg to prevent perioperative shivering in patients undergoing transurethral resection of prostate under subarachnoid block. Geriatric patients who undergo transurethral resection of prostate are prone to perioperative shivering during spinal anesthesia. Use of prophylactic oral clonidine, which is known to reduce shivering, could lead to decrease in the morbidity and mortality of such patients. MATERIALS AND METHODS: In this prospective double blinded placebo-controlled study, 80 patients scheduled for transurethral resection of prostate surgery under subarachnoid block were randomized into two groups. Group I (n=40) received oral clonidine 150 mg, while Group II (n=40) were given placebo tablet. After achieving subarachnoid block, the incidence, severity and duration of shivering was recorded and compared in both the groups. The body temperature (axillary, forehead and tympanic membrane), hemodynamic parameters and arterial saturation were recorded at regular intervals. RESULTS: Incidence of shivering was significantly less in patients who were given oral clonidine when compared with that of the placebo group (5 vs. 40% respectively; P value of <0.01). Clonidine did not lead to any collateral clinically significant side effects. CONCLUSION: We conclude that as a prophylaxis oral clonidine 150 mg is effective in reducing the incidence, severity and duration of perioperative shivering in patients undergoing transurethral resection of prostate surgery under spinal anesthesia.

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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.

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Objectives: Chyluria is an infrequently discussed urological problem and a rare urological manifestation of filariasis. Apart from few isolated case reports the lit­erature regarding the etiology, diagnostic approach and management of chyluria is grossly inadequate. We un­dertook the present study to review chyluria in its entirety so as to have a broader insight in to its etiopathogenesis and to suggest the clinician with a proposed stepladder protocol approach (algorithm) towards its management. Methods: We made a detailed systematic data search for the period covering the last 37 years on the "Pubmed" for published English literature using the key words 'chy­luria', `milky urine' and 'hematochyluria'. The signifi­cant findings and recent advances on chyluria were reviewed. Results: About 250 articles were found; these were analyzed, tabulated and reviewed for their clinical ap­proach and management of chyluria. Conclusions: Though generally a harmless condition in a majority, chyluria should not be ignored, instead all cases must be aggressively investigated to arrive at a cause. These should then be managed on the lines similar to as proposed in our 10-stepladder protocol.

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Erectile dysfunction is one of the important health problems affecting man and his partner. Recently, many treatments have evolved for the treatment of erectile dysfunction or sexual health. Of the available treatments several are pharmacologically proven and tested medications. However, in Asia, there are significant users of unproven medications for sexual health. These medications are traditionally used by the folklore living in the countryside. These untested medications may have a profound effect on the body system and their interactions with other medications may be harmful. However, comprehensive accounts of such medications are unavailable. This paper descriptively highlights the common medications used for sexual health in Asia.

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The medical treatment of filariasis and chyluria is based on dietary modification, i.e. a diet excluding fat, supplemented by medium chain triglycerides (MCT) and high protein content. Drug therapy include administration of antifilarial drugs like diethylcarbamizine (DEC), ivermectin and albendazole. Annual mass drug administration of DEC combined with albendazole is recommended by the Global Programme to Eliminate Lymphatic Filariasis (GPELF) in endemic areas. DEC-medicated salt has been effectively used in various filarial endemic countries and as well as in certain parts of India. Vector control is a useful means in addition to chemotherapy in control of lymphatic filariasis.

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Semen analysis as an integral part of infertility investigations is taken as a surrogate measure for male fecundity in clinical andrology, male fertility, and pregnancy risk assessments. Clearly, laboratory seminology is still very much in its infancy. In as much as the creation of a conventional semen profile will always represent the foundations of male fertility evaluation, the 5th edition of the World Health Organization (WHO) manual is a definitive statement on how such assessments should be carried out and how the quality should be controlled. A major advance in this new edition of the WHO manual, resolving the most salient critique of previous editions, is the development of the first well-defined reference ranges for semen analysis based on the analysis of over 1900 recent fathers. The methodology used in the assessment of the usual variables in semen analysis is described, as are many of the less common, but very valuable, sperm function tests. Sperm function testing is used to determine if the sperm have the biologic capacity to perform the tasks necessary to reach and fertilize ova and ultimately result in live births. A variety of tests are available to evaluate different aspects of these functions. To accurately use these functional assays, the clinician must understand what the tests measure, what the indications are for the assays, and how to interpret the results to direct further testing or patient management.

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In men, vaginal hydrocele is the most common morbidity due to Wuchereria bancrofti . Diagnosis is straightforward most of the time but when the swelling is not transilluminant, patients in whom the diagnosis is in doubt, children with hydroceles and those with co-morbid conditions should have ultrasonography to differentiate these swellings. Studies on the effect of medical treatment with diethylcarbamazine on the size of hydroceles are inconclusive. The only effective treatment for hydrocele is surgery as the minimally invasive therapy like aspiration and sclerotherapy are known to have high recurrence rates. Several surgical options are available for managing hydrocele but the recommended operation is hydrocelectomy, i.e. a subtotal excision of the parietal layer of the tunica vaginalis leaving a rim of approximately one-centimeter width around the testis and epididymis.

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Fine needle aspiration of the testis, which is minimally traumatic, has questioned the need of a more invasive open biopsy in the evaluation of male infertility. This study aims to evaluate the efficacy of fine needle aspiration cytology (FNAC) as compared to open testicular biopsy in the evalu­ation of male infertility by correlating diagnoses from tes­tis FNA cytology with biopsy histology. We have also studied the necessity of bilateral or unilateral FNACs in the workup of the infertile man. This study was a prospec­tive study of 57 infertile men in whom bilateral testicular fine needle aspiration as well as testicular biopsy was done. The correlation between the 2 methods was 91.9%. Dis­crepancies between cytology and histology were mainly the result of insufficient smears. These data also suggest that bilateral FNACs and biopsies can be restricted to patients in whom there is appreciable difference in tes­ticular size or consistency.

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Introduction: Micropenis is defined as a stretched penile length 2.5 standard deviations less than the mean for age without the presence of any other penile anomalies, such as hypospadias. The term refers to a specific disorder that has a known set of causative factors and defined treatment modalities. The purpose of this study was to determine the effect of hormonal therapy on the gonadal response and penile growth in children who presented with micropenis. Materials and Methods: Children (<18 years) who met the criteria for micropenis were included in this study. Children more than 11 years old were treated using a standard protocol of 1,500 to 2,000 IU human chorionic gonadotrophin administrated intramuscularly, once per week, for 6 weeks. Children less than 11 years old were treated with parenteral testosterone enanthate 25 mg once a month for 3 months. Response was evaluated in terms of change in testosterone levels and size of penis. Results: Serum testosterone levels at baseline and after 8 weeks of hormonal treatment were <20 and 449.4 ng/mL, respectively (P < 0.0001) in all children more than 11 years old. Stretched penile length after hormonal treatment increased from 15.54 to 37.18 mm in children less than 11 years old and from 26.42 to 64.28 mm in children more than 11 years old (P < 0.001). Conclusions: Management of isolated micropenis revolves around testosterone (direct administration or encouraging the patient's body to make its own), and results with respect to increase in penile length are promising.

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Peyronie's disease is a physically and psychologically devastating disorder affecting close to 10% of adult men. It is currently believed to be a form of wound healing disorder where there is excessive scar formation in response to a triggering process, most commonly following trauma to the erect penis. In this circumstance, the plaque which is an inelastic scar of the tunica albuginea develops which causes a variety of penile deformities including curvature, indentation, loss of girth and shortening. Frequently pain will accompany erection or direct palpation of the plaque in the early, active phase of this disease, but pain does tend to resolve over time but the deformities tend to remain. In up to 90% of patients there is associated diminished erectile capacity. Fifty percent of the time, men note evidence of erectile dysfunction prior to developing the Peyronie's disease. A variety of factors may contribute to erectile dysfunction in this patient population. Most commonly there is an underlying vascular insufficiency, which may be due to the same processes that result in accelerated atherosclerosis including diabetes, hypertension, smoking, and dyslipidemia. There may also be a substantial psychogenic effect, as we know that the majority of men with Peyronie's disease are significantly psychologically distressed by the changes to their penis. Lastly, there has been some suggestion that the abnormal geometry of the penis may contribute to a reduction of intracavernosal pressure resulting in diminished rigidity. This article briefly reviews what is currently understood about the etiology and presentation of the patient with Peyronie's disease and tries to clarify several of the widely held misconceptions. In addition, there are recommendations for evaluation and a more detailed discussion of the erectile dysfunction associated with Peyronie's disease, as well as appropriate treatment options.

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OBJECTIVE: The aim of this study was to compare the efficacy, safety and tolerability of Dutasteride vs Finasteride in a fixed dose combination, with a uro-selective a-blocker Tamsulosin, in the management of symptomatic BPH associated with LUTS. MATERIALS AND METHODS: 105 males between 40-80 years, clinically diagnosed as Benign prostatic hyperplasia (BPH) having a baseline evaluation of their IPSS, UFR, PSA, LFT, KFT, sex health, ultrasound of prostate and PVUV, were randomized to receive a fixed dose combination therapy of Tamsulosin (0.4 mg) with Finasteride (5 mg), vs Tamsulosin (0.4 mg) with Dutasteride (0.5 mg), daily for six consecutive months. Follow- up at the end of the 2nd, 4th, 8th, 12th and 24th week was done with IPSS, UFR, PSA, ultrasound of Prostate, PVUV and sex health. RESULTS: There were five dropouts, three from the Finasteride arm and two from Dutasteride arm, leaving a total of 100 patients for the final evaluation. Patients in both the groups showed improvement in their symptoms score and urine flow rate from the baseline, but those with the Dutasteride combination not only showed much better improvement in their symptoms score and urine flow, but were also relieved of their obstructive symptoms earlier (10-14 days) than seen in the Finasteride group (24-35 days). None of the patients had acute retention of urine (AUR) during the trial. The post void urine volume was decreased more in the Dutasteride group, than in patients with Finasteride. Sexual dysfunction incidence was same in both the groups. Approximately 50% reduction in the PSA level was seen in both the groups, while LFT did not show significant difference from the baseline, in either group. Both the drugs were well tolerated, with the patient's good compliance and with no drop-out due to adverse effects. CONCLUSION : A combination of a-adrenergic blocker and 5-ARI is the best therapeutic option for medical management of BPH as it is safe, effective and well tolerated. A combination of Tamsulosin with Dutasteride results in early symptomatic relief and low PVUV, than seen with the Tamsulosin with Finasteride combination.

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Objectives : To evaluate the change in sexual function status after TURP in a select population of Indian elderly males presenting with benign prostatic hyperplasia (BPH). Methods : One hundred and thirty-six patients present­ing with BPH and treated with transurethral resection of prostate (TURP) during the period from August 1999 to July 2001 were evaluated for pre and postoperative sexual function using a 10-question proforma. Results : The mean age of the patients was 64.9 years while the mean duration of lower urinary tract symptoms was 1.9 years. Of the 109 patients with a living wife/part­ner, 54 (49.54%) had active sex lives with coital frequency ranging from once a week to less than once a fortnight. Preoperatively, 48 of these patients had good erections whereas 6 had weak erections though they were able to have satisfactory penetration. All 54 had normal ejacu­lation prior to TURP. In the postoperative follow up, 10 (18.5%) of these 54 patients reported an improvement in their sex life in terms of increased libido and improved erections. Twenty-six (48.1 %) had no change in their sta­tus after TURP, but were satisfied with their sex life. Out of these 36 patients, 4 patients had preserved ante grade ejaculation. The remaining 18 (33.33%) had deteriora­tion in their status in terms of decreased libido and poor erections. None of our patients who were sexually inac­tive before TURP regained sexual activity. Conclusions: About 50% of patients with a living spouse/partner are sexually active at the time of undergo­ing TURP for BPH. TURF leads to a deterioration of sexual function in up to 33% of these patients. This in­cludes both loss of libido and erections. It is also associ­ated with a loss of ante grade ejaculation in over 85% patients. Very few patients who are sexually inactive pre-operatively recover sexual function after surgery. This study suggests that sexual counseling during informed consent should be a regular feature prior to TURP.

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Aims : Objective of this study was to assess the feasibility and results of preputial reconstruction and tubularized incised plate urethroplasty (TIP) in patients of proximal hypospadias with ventral penile curvature. Materials and Methods : Twenty-seven patients of proximal hypospadias who underwent preputioplasty with TIP were evaluated retrospectively. Ventral curvature was corrected by mobilization of the urethral plate with the corpus spongiosum and the proximal urethra; dorsal plication was added according to the severity of curvature. Feasibility of preputial reconstruction was assessed by applying 3 stay sutures-the first to fix the skin at the corona, the second at the junction of the inner and outer preputial skin for pulling up the skin over the glans, and the third stay on penile skin at the level of the corona for retracting the skin. Preputial reconstruction consisted of a standard 3 layered re-approximation of the margins of the dorsal hood. Results : Age of the patients varied from 10 months to 21 years with an average of 6 years and 4 months. Ventral curvature (mild 10, moderate 13, and severe 4 cases) was corrected by the mobilization of the urethral plate and spongiosum in 14 patients, 11 cases had mobilization of the proximal urethra in addition and 2 patients required single stitch dorsal plication with the above-mentioned steps. Two patients developed urethral fistula and 1 had preputial dehiscence. Conclusions : Preputioplasty with TIP is feasible in proximal hypospadias with curvature without increasing the complication rate. Postoperative phimosis can be prevented by on-table testing of the adequacy of preputial skin by 3 stay sutures.

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Premature ejaculation (PE) is a common male sexual disorder. Recent normative data suggests that men with an intravaginal ejaculatory latency time (IELT) of less than 1 minute have "definite" PE, while men with IELTs between 1 and 1.5 minutes have "probable" PE. Although there is insufficient empirical evidence to identify the etiology of PE, there is limited correlational evidence to suggest that men with PE have high levels of sexual anxiety and inherited altered sensitivity of central 5-HT (5-hydroxytryptamine, serotonin) receptors. Pharmacological modulation of the ejaculatory threshold using off-label daily or on-demand selective serotonin re-uptake inhibitors is well tolerated and offers patients a high likelihood of achieving improved ejaculatory control within a few days of initiating treatment, consequential improvements in sexual desire and other sexual domains. Investigational drugs such as the ejaculo-selective serotonin transport inhibitor, dapoxetine represent a major development in sexual medicine. These drugs offer patients the convenience of on-demand dosing, significant improvements in IELT, ejaculatory control and sexual satisfaction with minimal adverse effects.

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Benign prostatic hyperplasia (BPH) is a histological diagnosis associated with unregulated proliferation of connective tissue, smooth muscle and glandular epithelium. BPH may compress the urethra and result in anatomic bladder outlet obstruction (BOO); BOO may present as lower urinary tract symptoms (LUTS), infections, retention and other adverse events. BPH and BOO have a significant impact on the health of older men and health-care costs. As the world population ages, the incidence and prevalence of BPH and LUTS have increased rapidly. Although non-modifiable risk factors - including age, genetics and geography - play significant roles in the etiology of BPH and BOO, recent data have revealed modifiable risk factors that present new opportunities for treatment and prevention, including sex steroid hormones, the metabolic syndrome and cardiovascular disease, obesity, diabetes, diet, physical activity and inflammation. We review the natural history, definitions and key risk factors of BPH and BOO in epidemiological studies.

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Penile injuries due to bites and stings are under-reported. The extent of injury depends not only on the initial trauma but also on the secondary injuries due to toxins and bacterial infections transmitted by the bite. Wasp bites are on the increase worldwide as humans encroach on their habitat. We report a case of wasp bite to the preputial skin of the penis leading to severe phimosis, difficulty in micturition and localized gangrene requiring emergency circumcision. Analysis of such cases can provide important information on the determinants of severe morbidity that may then be used in injury prevention.

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Once pig organs can be transplanted into humans, transplantation will move into a new era. There will be unlimited access to undamaged organs and cells for transplantation and, eventually, donation from deceased or live human beings will become obsolete. Furthermore, it will be possible to alleviate graft rejection, at least in part, by genetic modification of the source animal. Currently, there are three major obstacles to performing transplantations from pig to man: 1) a powerful immune barrier, 2) a potential risk of transmitting microorganisms, particularly endogenous retrovirus and 3) ethical issues related to the future recipients and to society at large. This article will first discuss ongoing work with regards to overcoming the current obstacles. Then, the many potential advantages of using pig organs will be listed. Next, the criteria for selecting the first patients for transplantation with pig organs, will be briefly discussed. Finally, some promising observations made in the context of early attempts at transplanting porcine cells to patients, will be mentioned.

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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.

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Although they may present with significant morbidity, pelvic organ prolapse and stress urinary incontinence are mainly afflicitions that affect quality of life. To appropiately treat these entities, comprehension of the various theories of pathophysiology is paramount. Utilizing a Medline search, this article reviews recent data concerning intrinsic (i.e., genetics, postmenopausal status) and extrinsic factors (i.e., previous hysterectomy, childbirth) leading to organ prolapse or stress incontinence

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It is important to know what constitutes medical negligence. A doctor owes certain duties to the patient who consults him for illness. A deficiency in this duty results in negligence. A basic knowledge of how medical negligence is adjudicated in the various judicial courts of India will help a doctor to practice his profession without undue worry about facing litigation for alleged medical negligence.

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Introduction: Physicians frequently encounter questions by parents regarding the normal size of a child's penis. We evaluated normal variations of penile dimensions, correlation of penile length with height, weight, and body mass index (BMI) of boys and analyzed the differences in penile dimensions from those reported from other countries. Materials and Methods: A cross-sectional study was conducted at our institution during October 2012-December 2012. A total of 250 subjects (birth to 10 years) were evaluated and divided into 10 groups with 1-year interval taking 25 children in each. Penile dimensions measured twice by a single observer with Vernier calipers included the length of flaccid penis fully stretched and diameters at mid-shaft and corona. Diameters were multiplied by pi (π = 3.14) to calculate circumferences. Mean, standard deviation, and range were calculated. Height, weight, and BMI were noted and statistically correlated with the penile length using the Pearson correlation coefficient. Data were compared with similar studies reported on other populations in the past and individually evaluated with every study using Student's t-test. Results: The mean values for the penile length, mid-shaft circumference, and coronal circumference were 3.34, 3.05, 3.29 cm during infancy, 4.28, 3.86, 4.11 cm during 4-5 years, and 5.25, 4.78, 5.05 cm during 9-10 years, respectively. The penile length increased with advancing age in successive age groups, but it did not have a direct correlation with either height, weight, or BMI. Penile dimensions in North Indian children were found to be statistically smaller in comparison with most studies from other countries. Conclusion: We provide the normal range and variations of penile dimensions in North Indian children.

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Penile fracture is a rare injury, most commonly sustained during sexual intercourse. We report the case of a 29-year-old man who presented with bilateral rupture of the crura of the cavernosa without urethral injury. This is the first case in the literature to present with this unique finding. Urgent surgical exploration was performed and the injuries repaired primarily. At follow-up, the patient reported satisfactory erectile function. This case highlights the importance of early diagnosis with unusual presentation and early surgical repair for better outcome.

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The spiralling costs of antibiotic therapy, the appearance of multiresistant bacteria and more importantly for patients and clinicians, unsatisfactory therapeutic options in recurrent urinary tract infection (RUTI) calls for alternative and advanced medical solutions. So far no sufficient means to successfully prevent painful and disabling RUTI has been found. Even though long-term oral antibiotic treatment has been used with some success as a therapeutic option, this is no longer secure due to the development of bacterial resistance. One promising alternative is the use of live microorganisms (probiotics) to prevent and treat recurrent complicated and uncomplicated urinary tract infection (UTI). The human normal bacterial flora is increasingly recognised as an important defence to infection. Since the advent of antibiotic treatment five decades ago, a linear relation between antibiotic use and reduction in pathogenic bacteria has become established as medical conventional wisdom. But with the use of antibiotics the beneficial bacterial flora hosted by the human body is destroyed and pathogenic bacteria are selectively enabled to overgrow internal and external surfaces. The benign bacterial flora is crucial for body function and oervgrowth with pathogenic microorganisms leads to illness. Thus the concept of supporting the human body's normal flora with live microorganisms conferring a beneficial health effect is an important medical strategy.

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