Twenty-three patients with proven horseshoe kidney were treated at our hospital between 1988 and 1994.Stone disease was seen in 17 patients (74 percent) and was bilateral in 8 patients (total 25 renal units).Twelve of these units were managed by pyelolithotomy while the rest were treated with endourological techniques (Lithotripsy,Percutaneous Nephrolithotomy,and Ureteroscopy).The complication rate and residue rates were comparable in the two groups,but the requirment of ancillary procedures was significantly higher in the endourology group (p0.01) thereby escalating the cost of treatment by a factor of 2. Percutaneous access was not a problem in any patient.Percutancous surgery for horseshoe kidney is now well established and may well become the procedure of choice for the treatment of stones associated with this anomaly.

Presently ureteroscopy is the most effective and widely used modality for the management of lower ureteric stones.24 patients underwent bilateral 1-session ureteroscopy for lower ureteric stones.Equal number of patients who underwent unilateral ureteroscopy were considerd as controls.Ultimate clearance rates were 98 percent for bilateral 1-session,92 percentfor unilateral 1-session,while these rates were 88 and 79 percent after one session of anaesthesia.29 anaesthesia sessions were required for 48 units in bilateral 1-session,and 30 for 24 units of unilateral 1-session ureteroscopy.Staged ureteroscopy was required for 4 units of bilateral 1-session,and 6 units in unilateral 1-session.Of the complications fever was the commonest (8 patients B/L, 6 U/L),and septicaemia next common (2 patients B/L,1 U/L). However the difference was not satistically significant.There was a significant difference in the cost-incurrence for each unit: Rs.!665 vs Rs.2730.The hospital stay,work-loss and outcome at follow-up is similar,B 1-S ureteroscopy is a safe and effective procedure.It decreases cost-incurrence,hospital stay and work-loss days.

During the last 5 years, 17 patients of bladder carcinoma underwent radical cystectomy and Heal neo-bladder. One patient died in postoperative period and remaining 16 patients stood the procedure well. They are voiding normally with peak flow rate ranging between 14 to 22 ml/sec, and have developed sense of bladder fullness. Even after 5 years of follow-up patients are having normal excretion on IVU and there are no reflux on MCU. Majority of patients are continent both day and night with low bladder pressure and insignificant residual urine.

Ischaemic injuries of the pelvi-ureteric junction (PUJ) and upper ureter can occur following surgery for stone disease or PUJ obstruction. Patients who fail endoscopic and/or open reconstructive procedures can be managed with an Heal substitution of ureter. 5 patients underwent Heal substitution of ureter between 1979 and 1995 at our institution. 2 patients developed significant dilatation of the segment after 10 years of follow-up. 1 patient is in stable mild renal failure after 15 years follow-up. 2 patients died-one after 14 years and the second after 18 years after surgery due to dyselectrolaemia and acidosis and renal failure. We found Heal substitution of ureter a useful salvage procedure in patients with PUJ and upper ureteric obstruction.However, delayed dilatation of the Heal segment and renal junction impairment with or without calculus formation can occur. These complications demand a close follow-up for a long duration.

Collecting duct carcinoma of the kidney is unique and rarely reported.It arises from the epithelium of the collecting tubules within the medulla and secondarily invades the renal cortex. The present article adds clinical data on a case which eluded the clinical diagnosis.In addition to the histo-logical features,immunohistochemical techniques which differentiate it from other renal cell carcinomas and infiltrating urothelial carcinomas have been highlighted.

Retroperitoneoscopic nephrectomy was done in a 7 month old female infant with a history of urinary tract infection and hydronephrosis.Although total operative time was relatively prolonged,compared with open excision,our technique was considerd a more acceptable choice by the parents and the surgical team because of reduced trauma.The infant was discharged after 2 days.

Adrenal myelolipomas are benign tumours composed of mature lipomatous tissue with a variable proportion of haematopoietic elements that resemble bone marrow. We herein report two such cases. One presented with abdominal lump and hypertension, whilethe other presented with acute renal failure. Ultrasonogram revealed hyperechoic adrenal mass and CT scan of abdomen showed mixed density adrenal mass with predominant fat density. None of them were hormonally active. The diagnosis of adrenal myelolipomawas a histological surprise. With characteristic findings on ultrasonography and CT scan a preoperative diagnosis is often possible. In fact by frequent use of these modern imaging techniques these lesions are being diagnosed with increased frequency. Treatment of these lesions need individualised approach. Small asymptomatic masses can be observed; on the other hand, large symptomatic masses should be excised.

Patient care is the main learning method for students in M.Ch. (Urology) course for study of diseases.Although patient care comprises preoperative,operative and postoperative phases,it is common knowledge that operative phase receives greatest attention from students for obvious reasons.As most urological diseases are chronic and long-term patient care continues during follow-up and subsequent hospitalisations,long-term observation and study of patients by students is needed for proper understanding of diseases.These learning needs and relevant educational objectives are discussed in the background of current teaching-learning strategies of patient care for M.Ch.students (bed allotment approach and co-operative care approach)which fail to provide long-term perspective of diseases and unintentionally encourage students to think in terms of operations and not in terms of patients.To meet need-based objectives of learning from patient care,an innovative long-term patient assignment approach is presented and its methodology,evaluation process and benefits are described.