Abstract: Objectives: To cure long and multiple ureteric strictures by a simple procedure without the long term complications of bowel interposition or surgery of high magnitude like auto-transplantation Methods: Ureteric strictures in 5 patients were treated with buccal mucosa onlay grafts with an omental wrap The underlying etiology was tuberculosis in 4 patients and amyloidosis in I patient Mean age was 45 years Three patients had strictures in upper ureter, 1 patient in mid­ureter and 1 patient had panureteric stricture In all pa­tients length of stricture was greater than 5 cm Results: Ureteric patency was established in all patients Four patients have persistent improvement in renal func­tion In I patient, renal function improved initially (at 6 months follow-up) but subsequently (at 1-year follow-up) the unit was non functioning Follow-up was in the range of 15 year to 35 years Conclusions: In selected patients with complicated be­nign ureteric strictures, buccal mucosal dorsal onlay graft was proved capable of maintaining patency and good uri­nary drainage The procedure is technically simple and devoid of complications

Abstract: 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.

Abstract: Objectives: The aim of this study is to review the feasi­bility and effectiveness of ureteroscopy with intracorporeal lithotripsy under intravenous sedation on outpatient basis as a primary procedure in patients with proximal ureteral calculi and its comparison with in situ SWL. Methods: From January 2000 to December 2001, 56 patients with proximal ureteral calculi underwent uretero­lithotripsy and 32 patients underwent in situ shock wave lithotripsy (SWL). Ureterolithotripsy was performed with 8.0 Fr Wolf rigid ureteroscope and Swiss Lithoclast on daycare basis. Results: In patients managed with ureterolithotripsy, stone was successfully reached and fragmented in 47(83.93%) patients. Complete stone fragmentation and spontaneous passage occurred in 40 (71.4%)patients with single session. Seven (12.5%) patients required more than one session for complete clearance. JJ stent was required in 13(23.2%) patients. One case of ureteral perforation was managed successfully with JJ stent. In SWL group, 28 (87.5%) patients became stone free at 3 months. Seven­teen patients (53.2%) required retreatment and adjuvant procedure was done in 6 patients (18.7%). Conclusions: Ureterolithotripsy and in situ SWL are equally effective for proximal ureteral stone. Ureterolitho­tripsy for proximal ureteral calculi has high success rate with low morbidity. It can be done safely with intravenous sedation and local anesthesia. Ureteroscopic stone re­moval can be considered as primary approach in patients with proximal ureteral calculi reserving SWL for those who can afford it.

Abstract: Objective: To evaluate the durability of dorsal free graft aurethroplasty using buccal mucosa in adult recurrent bul­bar and pendulous urethral strictures. Patients and Methods: We treated 40 patients with re­current bulbar and penile urethral strictures during a pe­riod of 4 years. Mean age was 40 years. All patients underwent single stage urethral reconstruction using non­tubularized dorsal onlay buccal mucosa graft. The length of stricture dealt with was in the range of 2.5 cm to 12 cm. Follow-up was done at 3 weeks, 3 months, 6 months and then yearhv by uroflowmetry and if required by retrograde urethrogram. Results: Outcome was favourable in 38 patients (95%). 1 patient (2.5%) required VIU. I patient (2.5%) died due to pulmonary embolism in immediate postoperative pe­riod. Conclusions: Buccal mucosa is easy to harvest. It has thin and well- vascularized lamina propria with efficient imbibitions. Free graft placed dorsally over the tunica gains the mechanical support of the corpora and obviates urethrocele or diverticula formation. The technique offers the advantages of a fixed well-vascu larized surface with improved graft neo-vasculari-ation, reduced graft shrink­age, and optimum durability of graft.

Abstract: Objectives: To evaluate the effect of liver diseases in patients, on serum free prostate specific antigen (JPSA) levels, total prostate specific antigen (tPSA) levels and fPSA/tPSA ratios. Methods: Serum concentrations of total and free as well as JPSA/tPSA were determined in 20 men with histologi­cally confirmed liver cirrhosis, 15 men with chronic hepa­titis and 20 healthy men. Results: The serum levels of total PSA in liver cirrhosis as well as in chronic hepatitis were significantly lower than those observed in control. Free PSA remained unchanged. Conclusions: Our study suggests that despite severe liver dysfunction the tPSA, fPSA as well as the ratio of fPSA/ tPSA were not elevated as it was hypothesized that liver impairment might affect the PSA levels, as liver is a site for PSA metabolism.

Abstract: Objectives: To determine the diagnostic performance of virtual cystoscopy in patients with bladder diseases in comparison with conventional cystoscopy. Methods: Fifteen patients with different bladder patho­logies underwent volumetric spiral CT of bladder after filling it with contrast media (GE medical system light speed multislice scanner). The data were transferred to Advantage workstation AW4.0-03 and virtual cystoscopy was performed using the special software (Navigator GE medical system). All the patients later underwent conven­tional cystoscopy and the findings of both investigations were compared. Results: Virtual cystoscopy detected all 10 lesions with >5mm size and missed I out of 3 lesions with 5 5mm size. The overall sensitivity was 90%, specificity was 100%, positive predictive value was 100% and negative predic­tive value was 83.3%. The average time taken per proce­dure was 8 minutes. No complications of virtual cystoscopy were encountered in our study. Conclusions: There seems to be good agreement as re­gards the site and size of lesions in both techniques. In the quest for a non-invasive investigation for assessment of bladder diseases, virtual cystoscopy is a promising tech­nology.

Abstract: In recent years, prostate specific antigen (PSA) has es­tablished itself as the most useful marker for adenocarci­noma of the prostate and has almost replaced the total acid phosphatase and prostatic acid phosphatase (PAP) for screening, diagnosis and monitoring the prostate car­cinoma patients The PSA levels also rise in benign hyper­plasia of prostate (BPH) but to a lesser extent and high values are usually diagnostic of malignant disease The present investigation was conducted to study the relevance of PAP estimation with or without PSA in prostatic dis­ease particularly in the context of hospitalized patients with retention of urine Levels of the 2 markers were esti­mated in 132 patients with prostatic disease and results correlated with histological findings BPH was detected in 112 patients whereas 20 patients were diagnosed with adenocarcinoma (ADCA) of prostate Majority of the pa­tients in our study were referred from private clinics and 661 % of BPH and 50% of ADCA patients presented with acute urinary retention Mean PSA and PAP levels in ad­enocarcinoma group were significantly higher (2927 and 11735 ng/ml, respectively) than in BPH group (705 and 192 ng/ml, respectively) It was observed that PSA levels were raised in BPH patients with urinary retention as com­pared to those with no retention There was, however, no significant change in PAP levels in these patients There was a very good correlation between the values of tumor markers (correlation coefficient: 086) in all the patients Therefore, PAP is still a very good tumor marker of prostatic disease with almost comparable efficiency to that of PSA in differentiating the malignant from the benign dis­ease It appears to be particularly important in hospital­ized patients with acute urinary retention as catheterization appears to raise the levels of PSA but not those of PAP

Abstract: We prospectively evaluated the need for routine use of additional lateral biopsies at the time of standard sextant prostatic biopsy to reduce the false negative rates A total of 23 consecutive patients underwent 24 TRUS guided prostatic biopsies resulting in 246 biopsy cores Prostate cancer was diagnosed in 8/24 (333%) biopsies Although the age and prostate volume did not significantly differ between patients with or without cancer (p>O 05), the pre­biopsy PSA and PSAD were significantly higher in pa­tients diagnosed with prostate cancer (p<005) Of the 8 patients diagnosed with prostate cancer 2/8 (25%) had cancer in the biopsies lateral to but not in the standard sextant biopsy sites The additional lateral biopsies im­proved the sensitivity and negative predictive value of TRUS guided biopsy by 333% and 13% respectively In conclusion, in spite of the small sample size in this study, prostate cancer detection is increased by 25% because of additional lateral biopsies at time of standard sextant prostatic biopsy

Abstract: A case of young woman with primary bladder amyloido­sis presenting with haematuria is reported. The diagnosis was confirmed by bladder biopsy. Secondary amyloido­sis was excluded after extensive search for underlying causes. This rare entity can usually be treated conserva­tively. Long-term follow-up is recommended.

Abstract: Bladder weight and detrusor blood perfusion increases significantly with infravesical obstruction (IVO) and re­lease of obstruction results in reduction of bladder weight and detrusor blood flow. 38 patients with IVO were sub­jected to color Doppler ultrasonography (CD U) to detect the blood flow in the hypertrophied detrusor muscle. Blood flow was detected in 84.5% (Fisher exact probability <0.001). After surgical relief of obstruction, blood flow remained positive in 21.05% patients at 3 months and 13.10% patients at 6 months, which was because of per­sistence of IVO. Color Doppler ultrasonography (CDU) is a simple and non-invasive tool which can help in diag­nosis and follow-up of infravesical obstruction.

Abstract: Objectives: Management of hormone resistant prostate cancer (HRCaP) is always a challenge to urologist. Mi­crotubule inhibitors have been in focus as chemothera­peutic agents in carcinoma prostate, docetaxel being the most active among such drugs. The present study aims to evaluate the efficacy and safety of docetaxel as a single agent in the management of HRCaP. Methods: Twenty patients of HRCaP between 58-82 years of age were enrolled to receive docetaxel 75mg/sq.m. intravenously every 3'd week with a minimum 6 dose sched­ule. A total number of 136 doses were used. All patients were D3 stage disease and symptomatic. Median prostate specific antigen (PSA) at the time of entry was 180ng/ml and the median follow up was for 28 months. Results: An objective response in PSA reduction by = 80% was observed in 5 patients (25%) and more than 25% reduction seen in 12 patients (60%). Seventy percent of the patients showed improvement in symptoms on treat­ment. In 12 patients (60%), the disease was stable and showed response for a median period of 18 months. The median overall survival was 22 months. Adverse reaction in the form of anaemia, neutropenia, leucopenia was seen in 20 patients (100%), stomatitis, fever and alopecia was seen in 12 patients (60%). Four developed oral thrush (20%). Mortality occurred in 5 patients (25%) during the study, 2 died from pulmonary metastasis and 3 had cer­ebral metastasis with paraplegia. Conclusions: The response seen in this study is very encouraging and suggests substantial durable activity of docetaxel as a single therapy in HRCaP

Abstract: The Goldenhar syndrome (oculo-auriculo-vertebral syn­drome or 1st and 2nd branchial arch syndrome) is a com­plex of craniofacial anomalies. It has been associated with anomalies in other systems and with abnormalities of the urogenital system. We present a case of Goldenhar syn­drome with multiple renal anomalies and a urogenital si­nus, which has not been reported before.

Abstract: Objectives: We herein report our experience of double blind randomized clinical trial comparing combined an­drogen blockade vs monotherapy in stage D2 CaP. Patients and Methods: Through June 1999 and May 2001, 100 patients of stage D2 CaP were randomized into placebo (44) and flutamide (42) group after orchiectomy in double blind fashion using the strictest criteria. All men and histological proof of CaP with bone metastasis dem­onstrated on imaging: bone scan and skeletal survey. These patients were further substratified according to number o f bony metastases into high volume disease (HVD>5 sites) and low volume disease (LVD Results: Of the 100 patients recruited in the trial, 48 had HVD and 52 LVD. Treatmentwise they were almost equally distributed in flutamide group and placebo group. In the follow-up ranging front 6 to 24 months, 30 out of 100 patients (30%) required decoding, reasons for decod­ing were progression of disease in 25 and serious adverse effects in remaining 5. These 25 patients were further analyzed according to treatment group, volume of metas­tasis pre -orchiectomy PSA and Gleason score. We observed that number of bony metastases had impact over the dura­tion of response to hormonal therapy. Discussion: We initiated this simple trial to address the issue of benefit of total androgen blockade over monotherapy in Indian population. In the initial analysis, we observed that treatment group did not make any impact over the response. While subset of prostate cancer with large number of bony metastases has higher propensity to convert into hormone refractory cancer Conclusions: Addition of flutamide did not provide ben­efit. We observed that large number of bony metastases had poor response to hormonal therapy, hence it requires large trial to substantiate this initial observation.

Abstract: Objectives: Laparoscopic radical nephrectomy (LRN) is emerging as a viable alternative to open radical ne­phrectomy for treatment of patients with localized renal cell carcinoma (RCC). However, data regarding the onco­logic effectiveness of this minimally invasive treatment option is still scarce. We review the literature regarding the oncologic efficacy of this treatment, including our own experience. Methods: The current literature on LRN for treatment of patients with localized RCC, available on Medline, was reviewed. Results: Although the long-term results are not known current literature suggests that LRN is as effective as open radical nephrectomy for localized RCC. Conclusions: LRN is a safe and effective modality of treatment for patients with localized RCC. It does not pose any extra risk for port-site recurrence, local recurrence and distant metastasis over open radical nephrectomy. The survival outcomes are similar in both the techniques even at long term follow-up of 10 years.

Abstract: Introduction: Assignment of a proper gender to a neonate born with ambiguous genitalia is a social emer­gency. Once a sex has been assigned the next critical step is performance, if needed, of a reconstructive procedure in a timely fashion. In an attempt to evaluate our experi­ence with this unique group of patients, we have retro­spectively reviewed the course of 31 children managed surgically at our institute between 1989 and 2000. Patients and Methods: This series consists of 16 geno­type females with congenital adrenal hyperplasia (CAH), 7 male pseudohermaphrodites, 5 children with mixed go­nadal dysgenesis (MGD), and 3 true hermaphrodites. All the 16 patients with CAH underwent vaginoplasty, and clitoral recession. Five of the male pseudohermaphrodites were raised as females. All of them underwent B/L gona­dectomy, and clitoral recession. Perineal vaginoplasty was done in 4 of these patients and I patient who was due for colo-vaginoplasty was lost to follow-up. 2 male pseudoher­maphrodites were raised as males. Both of them under­went B/L orchiopexy and hypospadias repair. Four of the 5 cases of MGD were given a female sex assignment and all 4 underwent gonadectomy due to high risk of gonado­blastoma. In the 5th patient a male gender assignment was given. There were 3 true hermaphrodites, 2 of whom were managed by clitoral recession and vaginoplasty. One pa­tient was diagnosed at the age of 15 years. This patient had been brought up as a male child and presented to us with the complaint of pain in the lower abdomen. Investigations revealed haematometra and haematocolpos and the patient had to undergo B/L salpingo-oophorectomy and hysterectomy. Results: The postoperative period in most of the pa­tients was uneventful except for 2 minor complications. The cosmetic results have been excellent. 2 patients were lost to follow-up. Follow-up in the rest of the patients ranged from 9 months to 6.3 years and all the patients were found well adjusted to the society as far as their gen­der assignment is concerned. However the functional re­sults are yet to be evaluated, as most of the patients have not yet achieved full sexual maturity. Conclusion: This retrospective review emphasizes the complexities of assessment and management of ambigu­ous genitalia in infants and children. It also confirms the data from other series that the vast majority of infants born with the 4 most common forms of ambiguous genitalia (CAH, MGD, male pseudohermaphroditism, and true hermaphroditism) may be raised as females as phallic in­adequacy usually makes it difficult to achieve a cosmeti­cally acceptable appearance. However the sex of rearing and parents' intentions and wishes should be taken into consideration in the reconstruction of genitalia of a child.

Abstract: Objectives: We have analyzed the incidence and man­agement options of upper urinary tract obstructions caused by fungal infections during January 2000-December 2001. Methods: Four patients with upper urinary tract fun­gal infections underwent endourological interventions and received antifungal therapy. Results: All 4 patients underwent double J stenting, of which one patient underwent bilateral stenting. Percuta­neous nephrostomv to irrigate was done in one patient in whom the filling defect caused by the fiungal ball persisted even after 4 weeks of oral antifungal therapy. Nephroureterectomy was done in 1 patient as the renal function did not recover even after 4 weeks of appropriate therapy. Three patients had good recovery of renal func­tion. Conclusions: Endourological interventions help in re­lieving and treating obstructions caused by fungal infec­tions.