We performed cytogenetic analysis in peripheral lymphocytes of clinically diagnosed sporadic cases of RCC (Renal cell carcinoma) along with their asymptomatic first-degree relatives and age-matched normal controls. Of 10 patients, 8 showed a genetic mosaicism of 3p aberration and the affected locus was 3pl4p23. Surprisingly one offspring of a patient with 3p aberrations and two off springs of 2 other patients without 3p aberrations showed DNA lesions at the same locus 3p14p23. In conclusion, our findings in peripheral lymphocytes of RCC patients indicate the consistency of literature reports of tumour cytogenetics and supports the evidence of presence of RCC-related tumour suppressor genes at the region 3pl4p23. A genetic mosaicism observed in patient as well as asymptomatic relatives may be indicative of genetic susceptibility. However, these are preliminary observations based on a small number of patients and one needs to evaluate a substantial number of patients.

Bleeding occurs even in apparently uneventful Percutaneous Nephrolithotomy (PCNL) procedures. A prospective study was carried out to identify and analyse factors influencing blood loss. Baseline average hemoglobin loss was estimated by a retrospective analysis of 77 consecutive single stage uncomplicated PCNL (Group A). In the prospective study (Group B) 95 procedures in 85 consecutive cases of calculi treated by PCNL from December 96 to May 97 without operative or technical complications were evaluated. Average drop in hemoglobin in the retrospective group was 1.58 gms percent prospective group was 1.64 gms percent. The factors evaluated were (a) Pre-existing factors: diabetes, hypertension, previous interventions, stone location and burden, (b)Intraoperative factors: procedure time, tract maturity, access calyx, number of punctures and stages. Factors, which did not significantly affect the drop in hemoglobin were controlled diabetes and hypertension, previous endourological manipulations and solitary pelvic stones. Upper ureteric stones, single stage, single puncture procedures, mature tract and procedures where time was limited to 45 mins. had significantly less drop in hemoglobin. Statistically significant drop in hemoglobin was noted in patients with staghorn calculi, procedure time more than 90 min., multiple punctures and multiple stages. Transfusion rate was 3.52 percent. Tailoring operative strategy for individual cases with factors like presence of large stone burden, who may require multiple punctures and in whom multiple stages may be required for clearance will go a long way in minimizing blood loss.

Recently Doppler sonography is used to identify an alteration in renal arterial blood flow in obstructed hydronephrotic kidney which is helpful to distinguish obstructed I from nonobstructed collecting system dilatation by measuring resistive index(RI) of arcuate arteries. Both control and unilateral chronic hydronephrotic cases were studied by Doppler ultrasound taking 25 cases in each group. In control group the normal RI is less than0.65 in all cases. There was no false positive increased RI incontrol group. 22 cases (88 percent) have raised RI more than0.70, in simple Doppler (20 cases) and diuretic Doppler (2 cases). All 22 cases of raised RI was compared by Whitaker's test and found obstructive (100 percent specificity). Diuretic Doppler USwas done in 4 equivocal cases (RI 0.65 to 0.70). After release of obstructions by DJ stenting or surgery there was decrease of RI in all cases except one where pyeloplasty had failed. We conclude from our study that renal arterial duplex Doppler sonography and RI can detect change in renal perfusion in chronic urinary obstruction with 100 percent specificity, 88 percent sensitivity and very good noninvasive simple modality to reliably distinguish obstructive from non-obstructive collecting system dilatation.

Renal length was measured by real time B mode ultra-sonography in 175 children ranging in age from 1 month to 12 years. The data was correlated with the age, weight, length and surface area of the children; the best correlation was with the surfacearea. Regression equations were developed for each parameter using the method of least squares and the data was also compiled graphically. From the charts so derived it is possible to determine normal renal growth velocity during the follow-up of patients suffering from renal diseases. No significant difference was found between the length of the right and left kidneys.

Present study is carried out in 20 patients with chronic prostatitis. They underwent detailed clinical, haematological, biochemical and bacteriological investigation to diagnose clinical subtype namely chronic bacterial prostatitis (CBP), non-bacterial prostatitis (NBP) and prostatodynia (PD). Immunological studies (IgG, IgA and IgM estimations) were carried out in serum and EPS. In CBP serum IgG mean value was significantly higher but IgA was decreased. IgM was within normal range. In EPS, IgA and IgM values were on higher side but IgG value was significantly lowered. In NBP, serum IgA and IgM levels were below control value whereas IgG was near control. Similarly, EPS-IgG, IgA percent IgM showed insignificant elevation. In patients with PD, serum IgG and IgM mean values were within normal range but there was un-explainable lowering of IgA mean value. In EPS, all three fractions IgG, IgA percent IgM were elevated without statistical significance.

The rationale for alpha/blockade in benign prostatic hyperplasia is based upon the fact that these alpha under one adrenoreceptors are abundantly present over prostate capsule, bladder neck, prostatic urethra and smooth muscle of prostate, and blockade of these receptors by alpha; antagonist would result in relaxation of the bladder outlet obstruction. The present single label study was to determine the efficacy and safety of Terazosin in management of Benign Prostatic Hyperplasia (BPH) in one hundred patients using 5 nig of Teralpha daily for three months and followed up for twelve months with uroflowrate, ultrasonography and symptom score. Our result shows that Terazosin produced a significant improvement in subjective symptoms with increase inpeak and mean flow rate and decrease in postmicturition urine volume with very little adverse effects. This study therefore revealed the short term efficacy and safety of Terazosin therapy in BPH and its long term efficacy and safety is to be evaluated.

This retrospective analysis was done on 48patients who had undergone a dry fulguration for the treatment of posterior urethral valves (PUV) over the past 23 years. The patients were evaluated for the effectiveness of treatment and complications, particularly stricture formation. 31 (64.5 percent) patients had a vesicostomy and 17 (35.5 percent) patients had bilateral (B/L) ureterostomies at the time of fulguration. Only 2 patients developed urethral stricture (42 percent). Of these 2 patients, 1 suffered urethral injury during attempted valve destruction at 3 months' age; the procedure was abandoned and a vesicostomy fashioned. He subsequently underwent fulguration at 1 year age. The other patient had undergone a dry fulguration at 10 months' ageand had no apparent reason for the stricture. We believe that although dry fulguration of PUV should be avoided, it can be performed safely and effectively and need not be accompanied with a simultaneous undiversion procedure.

Suicidal tendencies prevalent amongst patients suffering from intractable or chronic genitourinary afflictions can often be missed during an organ system oriented evaluation by a superspecialist. A watchful attitude along with mental status examination by Hamilton Depression Rating Scale (HDRS) wherever appropriate, helps in identification of such tendencies and prevention of suicides.

Erection causes penis to be more vulnerable to trauma in comparison to flaccid state. Specially, during sex, due to over-enthusiasm the erectile tissue and the urethra are more often injured than reported. The injury has been classified according to the involvement of erectile tissue and/or urethra for effective management. During a period of six years, eighteen cases of injury to erect penis managed in our centre were evaluated and we were able to preserve potency and prevent urethral stricture formation in all these patients. The mechanism, patho-physiology and line of management of each type of injury are discussed.

Nephrogenic adenoma is an infrequently encountered lesion of the urinary bladder and is thought to be a meta-plastic response to a chronic irritation. The histology of this lesion is quite characteristic. If one is not aware of this entity, a mistaken diagnosis of malignancy may be rendered.

Penile amputation, both complete and incomplete, is a rare component of genitourinary trauma. Successful reimplantation of the organ is still less frequent. We report 2 cases of penile amputations in which successful reimplantation was done using microsurgical technique. Both patients had a complete amputation of the penis with no arterial, venous or neural connection between the amputated part and the residual stump except for a twig of tissue in one part of the circumference. The amputated partswere reimplanted with microsurgical reanastamosis of the dorsal arteries, deep dorsal vein and the neurovascular bundle. The total time to re-establishment of circulation was 13 hours and 11 hours respectively. Both patients developed edema of penile skin postoperatively and one patient had superficial sloughing off of the skin. One patient required an internal urethrotomy 6 weeks after the injury. Both patients have altered sensation over the skin of the glans and the mid-shaft of penis. One patient masturbates with a semi-rigid erection and the other has regular sexual intercourse 3 months after surgery. A review of literature is also presented.

In patients with end stage renal failure who have exhausted all the conventional sites of vascular access, long-term haemodialysis can be maintained with autologous saphenous vein graft arterio-venous fistula. Though saphenous vein has been successfully used in the forearm, its use in the thigh has not met with same success. We used in-situ autologous saphenous vein as a wide 'C' loop in the thigh in 15 such patients with great success over the last 5 years. Except for one case of thrombosis of the fistula due to poor long saphenous vein from old thrombophlebitis, in the rest of the patients haemodialysis could be maintained successfully over the follow-up period, which ranged from 2 months to 42 months. The fistula is easy and simple to construct, requiring only one anastomosis. We describe the patient selection and the operative technique of in-situ 'C' loop saphenous vein graft arterio-venous fistula.