A retrospective evaluation of the role of intracorporeal lithotripsy using mini ureteroscope with Swiss Lithoclast for the management of lumbar and iliac ureteral calculi in the setting of a developing country was done. A total of 30 patients with 32 calculi underwent intracorporeal lithotripsy using 7.5 F Wolf uretero-renoscope and the Swiss Lithoclast. An overall success rate of 88 percent has been reported. Small bulk calculi did not pose the problem of retrograde migration of a major fragment while it occurred in three out of ten large bulk calculi. there were no complications directly related to the use of lithoclast and it could fragment all the stones successfully. This modality represents a safe and cost effective approach for all small bulk lumbar and iliac ureteral calculi and may be used as a first line option in the developing countries. However, patients with large bulk calculi should be chosen more carefully.

In the absence of any local or systemic pathology, urinary retention in females is a very rare clinical entity. 21 such females constituted the study group. All these females underwent detailed investigations to rule out any local or systemic disorder causing retention. Initially bladder was decompressed for 7-10 days by indwelling catheter after that patients were advised to practise clean intermittent self-catheterization (CISC). All patients underwent videourodynamics study after 406 weeks of bladder decompression. The study was repeated 8-12 weeks later. Functional bladder neck obstruction was the commonest aetiology (n=10) which was successfully treated with CISC or bladder neck incision (BNI). Psychogenic retention was seen in 5 patients and they could be rehabilitated with biofeedback and psychotherapy. Underactive detrusor was responsible for retention in 6 patients which necessitated CISC. Role of urodynamic evaluation and treatment of individual pathology is discussed.

Improved postoperative care has reduced the morbidity and mortality associated with surgical complications following renal transplantation. Yet complications involving almost every organ system occur. In an immunocompromised patient these complications can be devastating if detected late. We reviewed the first 200 consecutive renal transplants done at our center with an aim to study the incidence and management of surgical complications. 22 of total 44 complications could be managed conservatively without surgical intervention. Grafterlated complications (perigraft collection -16, graft rupture-5) were the comonest (10 percent). Graft rupture was the most lethal complication leading to death in I and graft loss in 4 patients. Gastrointestinal complications were seen in 8 (4 percent) patients. Acid peptic disease related complications could be reduced with routine perioperative use of H-2 receptor blockers. Expectant surveillance, early diagnosis and prompt treatment can reduce the mortality and morbidity related to these complications.

In an attempt to predict the recovery of function following relief of pelviureteric juction obstruction (PUJO) in poorly functioning kidneys (split GFR 20 ml/min), clinical parameters viz. age, history of pyelohephritis, palpable mass and the preoperative renogram data (perfusion status, ipsilateral and contralateral GFR) of 48 patients with unilateral PUJO with poorly functioning ipsilateral kidney were noted. Function was assessed with 99m-Tc-Diethylene Triamine Penta Acetic acide renogram (DTPA-renogram) following relief of obstruction. Recovery of function was defined as more than 10 percent increase in baseline split GFR. Statistical analysis of the preoperative parameters was done in 41 evaluable patients with multiple logistic regression analysis. Function of the affected kidney improved in 20 (53 percent), remained static in 15 and deteriorated in 3. Age till 15 years and presence of mass predicated functional recovery while history of pyelonephritis adversely affected the functional outcome. Presence or absence of pain, functional status of the aggected and contalateral kidney and perfusion status of the affected and contralateral kidney and perfusion status of the affected and contralateral kidney and perfusion staus of the affected kidney on DTPA renogram had no effect on the functional outcome. Younger patients (age till 15 years) with palpable mass in the absence of pyelonephritis may be offered salvage surgery without interposing PCN in between irrespective of the residual function of the affected kidney. Renogram parameters in these poorly functioning kidneys did not have any correlation with the functional outcome.

To reduce the shortage of kidneys for transplantation, we started a non-heart-beating (NHB) donor programme, and compared the short-term and long-term outcomes of kidneys from NHB donors with those of a matched group of kidneys from heart-beating (HB) donors. 57 NHB kidneys were procured at the University Hospital in Maastricht and at three regional hospitals in Netherlands, and were transplanted in 21 transplant centres within the Eurotransplant Exchange Organisation. 114 matched controls from HB donors were selected from Eurotransplant files. Mean follow-p was 85 months. At 6 years graft survival was 54 percent for NHB kidneys and 55 percent for kidneys; patient survival was 75 percent and 77 percent. Kidneys from NHB donors had a significantly higher rate of delayed graft function (60 percent vs 35 percent), resulting in a longer hospital stay. Primary non function of graft was seen as frequently in the NHB donor kidneygroup as in the HB group (14 percent vs 8 percent, p=0.3). We conclude that NHB donors are a valuable source of kidneys for transplantation.

Clinical data collection is an essential professional skill. Medical students at the begining of their career are taught to follow a standardised routine for clinical data collection and this method aims at achieving "completeness" of clinical data ("Completeness" Driven Strategy). Research has shown that this routine is not followed in actual clinical practice and clinical data gathering is guided by initical practice and clinical data gathering is guided by initial diagnostic impressions (Relevance Driven Strategy). The two strategies of clinical data collection are described using a hypothetical patient and then compared and contrasted. Relevance Driven Strategy needs to be adopted for effective and efficient clinical data collection.

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