Current experimental evidence suggests that the peripheral innervation of vesicourethral smooth muscle is complex and diversified. The following peripheral nerves affect urethral and vesical functions: Cholinergic, adrenergic, purinergic, peptidergic and histaminergic neurons. Prostaglandins, 5-hydroxytryptamine (5-HT) and sex hormones may also influence urethral and vesical functions. Formerly, detrusor activity was increased or decreased using cholinergic or anticholinergic agents. Now, more complex patterns of chemical manipulation are suggested, with the aim of directly affecting multiple site such as the autonomic ganglia, peripheral neurons, end-organ receptors and even the smooth muscle itself. Based on his clinical experience and knowledge of the effects of various drugs on the vesicourethral smooth muscle, the author recommends drug therapy for micturition disorders.

The current method of conducting internal assessment and final examination in a 2 year course leading to M. Ch (Urology) qualification requires revaluation. Keeping in view its limitations and drawbacks, introduction of newer assessment techniques for more authentic judgement on a trainee's ability are called for. Sophisticated technology like use of computer and statistical analysis have to be given their due importance. In this article, we have tried to incorporate newer principles already being applied to other science courses in an attempt to fashion these to the M. Ch Urology course.

Cytological evaluation of urinary sediment from 1831 patients over a 5 years period revealed that 11.5 percent of all patients presenting with haematuria as the main symptom had a tumour in the urinary tract. 212 tumours were subjected to cytological examination, which diagnosed 203, with a diagnostic accuracy of 95.75 percent. 77.7 percent of the false negative results (4.2 percent of the total number) were accounted for by grade I transitional cell tumours. The 3 histological variants of urothelial tumours presented distinct cytological profiles. Out of 19 false positive smears (1.03 percent of the total number), low grade transitional cell tumours were suggested in 15. Urolithiases and chronic inflammatory lesions of the urothelium accounted for 14 of these. Urine cytology was found to be a useful investigation in the diagnosis of urothelial tumours. A cytohistological correlation of 96.27 percent was obtained.

Out of 160 patients of superficial bladder cancer diagnosed during January 1977 to December 1981, 10 had mucosal tumours in the prostatic urethra, which were managed effectively by transurethral resection, with a follow-up period of 36 to 84 months. All 10 patients were associated with multiple tumours in the bladder. Three of them had tumours at the first visit while 7 patients developed tumours during the follow up. Four patients had recurrence after effective primary treatment for prostatic urethral tumours. Intravesical chemotherapy which controlled bladder tumour recurrences failed to influence prostatic urethral tumours

A transrectal cytological aspiration method for diagnosing prostatic enlargements was used in 1000 patients during the past 10 years and the findings were correlated with the histopathological diagnoses. Cytology was found to have high degree of diagnostic accuracy: 95.21 percent in benign prostatic hyperplasia and 92.04 percent in carcinoma prostate. The technique is simple, easy to repeat and is highly suitable for outpatients. This is of especial value if there is any margin of doubt regarding the clinical diagnosis of cancer, as was the case with 50 percent of our patients.

This is a study of the incidence of occult malignancy in 222 patients suffering from benign hypertrophy of the prostate, diagnosed clinically. After the necessary investigations, these patients underwent transvesical prostatectomy. The histopathology of the prostate revealed that 19 prostates had microscopic foci of malignancy in them and the remaining 203 showed benign hyperplasia of the prostate. This incidental finding of malignancy was predominant in the sixth and seventh decade. A retrospective analysis did not show clinically differentiating features in either entity.

Forty patients suffering from kidney stone disease underwent percutaneous nephrolithotomy between March 1983 and April 1984. Stones in 36 patients were removed successfully; the 4 failures were managed by open surgical removal. The major complication of this series was haemorrhage. 6 out of 36 patients (16.67 percent) needed blood transfusions. There was no mortality.

The possibility of a successful reversal of sterilisation following vasectomy is vital in the promotion of sterilisation, particularly in developing countries. The results of the conventional method of splinted anastomosis have been significantly improved by the introduction of microsurgical techniques. This is a review of the author's experience of applied microsurgical techniques, including the method of anastomosis with one-layer suturing used in 382 patients out of a total of 610 recanalisations since 1974. The technique is easy to apply and a patency rate of 89 percent and a pregnancy rate of 63.2 percent have been recorded.

Forty six patients with posterior urethral valves were treated between 1979-83. Diffuria with distended bladder was the common (52 percent) clinical presentation. Sixty three percent had renal failure and 70 percent had significant urinary tract infection. The primary treatment consisted of value destruction unless associated uremia, septicemia and urinary ascites mandated supravesical diversion to save life. The method of destruction of the valves determines the complication rate. Vesico-ureteral reflux disapperaed spontaneously in the majority (70 percent) of cases, after the destruction of the valves. Three children (6.5 percent) died. One had incontinence and the other, stricture of the urethra.