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The trend in surgical practice today is towards develo­ping minimally invasive techniques. The development of small calibre flexible instruments permits endoscopic sur­gery in the urinary tract to treat a wide variety of lesions within the kidney. This article reviews the indications, in­struments, technique and current status of retrograde intrarenal surgery.

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This study aims to assess the awareness and attitudes of health care professionals towards organ donation. 691 medical students participated in the study. There were 595 undergraduates, 65 interns and 31 postgraduate stu­dents. The general consensus was that there is a need for or­gan donation. 75% of the participants were able to un­derstand the concept of brain death. The definition of brain death was not known to 20%. None of the participants had complete knowledge as to who should authorize brain death as stated in the "Transplantation of Human Organs Bill". 20% emphasized the need for the presence of a neu­rologist/neurosurgeon, along with other qualified person­nel, in a team to certify brain death. It was noticed that participants committed to organ donation encouraged their friends and relatives to donate their organs. They agreed that organ donation should be included in the medi­cal curriculum. The study reveals that there is a poor understanding of the concept of brain death and organ donation even among medical students. It was also observed that they were in­terested in knowing more about the subject of organ do­nation.

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Urodynamics is the study of voiding cycle (storage and emptying cycle) of the lower urinary tract. Voiding cycle can be studied by clinical (non-electronic) and labora­tory (electronic) urodynamic tests. Various clinical (non­electronic) urodynamic tests are briefly described. Rel­evant literature is reviewed to suggest that clinical (non­electronic) urodynamic tests can help in the management of most patients with voiding cycle symptoms (altered lower urinary tract function).

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A 3-year-old male child with (L) sided Wilms' tumour with extensive vena caval thrombus developed acute re­nal failure following (L) nephrectomy. In kidney tumours with inferior vena caval (IVC) in­volvement the difference in the venous drainage of the right and left kidneys makes the (R) kidney more vulner­able to venous hypertension and renal failure following a left nephrectomy. The likely etiology of acute renal shut­down of the opposite kidney in the index case is discussed and preventive measures suggested.

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Objective: To review the incidence, nature and importance of cal­cification in urinary tract tuberculosis. Method: The cases of urinary tract tuberculosis from Jan. 1995 to June 1998 were reviewed. 10 out of 32 patients showed evidence of calcification with the incidence of 31.2%. All the patients had renal parenchymal calcification with two cases associated with ureteral calcification. Results: We performed nephroureterectomy in 4 cases who had putty kidney. 2 patients were subjected for polar nephrec­tomy, 1 for showing increase in size on follow-up and the other for associated destruction of polar parenchyma. One of these patients showed evidence of active tuberculosis on histopathology. 4 patients with small areas of calcifi­cation are being followed with yearly x-ray. Conclusion: Calcification in urinary tract tuberculosis can increase in size leading to destruction of parenchyma even on treat­ment. It may also be associated with active tuberculosis. Hence patients should be treated with surgery or followed up intensely with the aim of retaining as much of paren­chyma as possible.

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The Internet, which has truly united the developed and developing nations, is an extensive network of inter-linked computers storing immense bytes of information, which can be accessed by anyone transcending all geographi­cal barriers and this has become the ultimate frontier to access information. The Urology and Andrology informa­tion on Internet is exponentially growing. The urologist need not know the intricacies of the hardware and soft­ware but can start right away navigating through this web. We reviewed methods available to take advantage of this network to provide a glimpse to busy urologists to accrue the benefits easily and efficiently rather than to be lost in the information-ocean by surfing individually. By getting connected to Internet, an urologist of any part of the world gains enormous information by interacting with other urologists of the rest of the world. This could be of use to gain knowledge and to offer the best and the most modern treatment to the patient. Internet has revolutionised the scientific publication by virtue of its faster and accurate transmission of manuscripts. We can send manuscripts by this channel and also access journals obviating the lag period inherent in snail mail. The on-line journals have virtually brought the library to the desktop.

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Antireflux surgery (ARS) was performed on 45 renal units during 1991-96. Pre-operative renal length meas­urements were available in 20 renal units and 23 renal units were evaluated for renal length postoperatively. Pre­and post-ARS renal length measurements were available in 15 renal units. Renal length measurements were made by real time B mode ultrasonography. The post-ARS renal growth was accelerated in 69.5% units, normal in 13% units and impaired in 17.3% units. Accelerated renal growth occurred mainly in the first year after ARS but continued up to 2 years. Pre-existing renal scars, hyper­tension, poor renal function and post-operative urinary tract infection did not affect post-ARS renal growth. Fail­ure of ARS resulted in renal growth retardation.

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Bladder malignancy is the 11th most common cancer in the world with more than 2,00,000 new cases diagnosed every year 90% of these are TCC, of which 75-80% are superficial in nature. Our aim in this study was to find the efficacy, safety and cost effectiveness of a low dose intravesical imnumo­therapy with BCG (70 mg) + Interferon-α-2b in preven­tion of its recurrence and prolonging disease progression interval. Between Jan. '94 to Dec. '98, 100 patients with super­ficial TCC (Ta, TI) of urinary bladder with or without Tis after transurethral resection of tumor underwent intra­vesical instillation of BCG (70 ing) + Interferon-α-2b (5­million IU) weekly for 8 weeks, fortnightly for 8 weeks, monthly _. for 8 weeks _. followed by maintenance dose at the end of 9th, 12th, 18th & 24th months with follow-up for 60 months. Results: At the end of 60 months of follow-up 36 pa­tients (36%) showed complete response, 44 patients (44%) showed partial response, resulting in a total response rate of 80% while 20% progressed to higher stage & grade. Patients' tolerance was good and adverse reaction was low 19%. Conclusion: This study has shown that a low dose com­bined therapy with BCG and Interferon is not only safe, well tolerated, cost effective but also highly efficient in preventing recurrences in 36%, maintaining superficial nature of the disease in another 44% with a disease pro­gression free interval of 5 years in 80% of cases.

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The ideal bladder-tumour-marker should be rapid, of­fice-based, inexpensive, non-invasive, accurate with high sensitivity and specificity. Aim : Our aim was to compare BTA (Stat) Bard to voided urine for cytology in patients with haematuria in detec­tion of TCC of genito urinary system. In our study of 120 patients (100 males and 20 females) between the age group of 18 to 85 years presenting with haematuria we investigated with BTA (Stat), urine for cy­tology and cystoscopies as an outpatient procedure. Result: Result revealed BTA (Stat) to be 87.5% sensi­tive and 71.4% specific in detecting TCC of urinary blad­der and upper tracts while urine cytology showed 25% sensitivity giving a statistically significant p-value (p<0.0001) Conclusion: We conclude BTA Stat (Bard) to be a sim­ple non-invasive, rapid and highly sensitive test signifi­cantly superior to urine for cytology in detection of TCC of genitourinary system and should be an adjunctive to cystoscopy in surveillance of bladder malignancy but be­cause of its relatively low specificity cannot replace cys­toscopies.

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The use of Internet in the field of urology is of immense value. The fact is well known that it is a Herculean task to search the Internet, for any information for the beginner The very fact that multiple websites exist, for each disease makes it more complicated to search for specific informa­tion. This article hopes to simplify the search modalities for the urologist and appraise him of the website and links, which will be useful, for the urologist who is logged on the Internet. Application of computers has been one of the most im­portant advances in the field of urology. The availability of Internet has been a revolution in the field of medicine in facilitating the review of large medical records easily. I would not dwell on the various advantages of Internet but focus on the practical usage of the net. I hope that this would he useful for the urologist to save time and energy.

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Hair coil penile injury has been reported with circum­cised and uncircumcised penises. Association of this clini­cal entity in patients with underlying urological problems is being reported for the first time. There is overlap of symptoms between the urological problems and hair coil penile strangulation and hence it is very important to be aware of this entity to avoid potential penile loss. Penile hair coil injury has been described in circum­cised and uncircumcised penises. ^[1],[2],[3] We encountered three children, two with posterior urethral valves and the one with exstrophy-epispadias complex who had associated penile hair coil strangulation during the course of their treatment. The association of hair coil injury with under­lying urological problems is hitherto unreported and is an important problem to be aware of to avoid potentially serious problem as there is significant overlap of symp­toms.

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Bladder weight was estimated by transabdominal ul­trasonography in 40 patients with infravesical obstruc­tion and in 10 control subjects without any infravesical obstruction. In obstructed group bladder weight was raised to 95.20 + 24.24 gms. compared to control group, where it was 35.44 + 4.27 gms. After three months of surgical relief of obstruction bladder weight came down to control range in 57.50% cases and after six months it reversed to normal weight (up to 40 gms) in 90% cases. In the re­maining 10% cases where it remained greater than nor­mal bladder weight persistent causes of obstruction were found. Ultrasound estimated bladder weight not only helps in diagnosis of infravesical obstruction but also helps to monitor the success of surgical treatment in bladder out­flow obstruction.

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A 66-year-old man underwent transurethral bladder outlet surgery over 6 years on five occasions without im­provement and without any pressure flow studies. To un­derstand fully the aetiology of post-transurethral resection voiding problems and symptoms, a proper urodynamie evaluation is mandatory.

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Objective: To present a clinical review of 50 consecu­tive retropubic prostatectomies done for large size glands at our institution from Jan. 1992 to Dec. 1998 and to clarify ^, the role of retropubic prostatectomy by modified Millin's technique. Material and Methods: 10% of the patients who needed intervention for benign prostatic hyperplasia were sub­jected to open retropubic prostatectomy by modified Millin's technique. The decision to subject the patient to open surgery was based on prostatic size detected by ab­dominal ultrasonography, digital rectal examination and cystoscopy. Results: The weight of the adenoma removed varied from 68 to 205 gms. Most of the patients voided with a good stream with little discomfort. One patient developed membranous urethral stricture postoperatively. Two pa­tients had incontinence of urine which improved subse­quently over a duration of 6 to 8 weeks. Conclusion: We feel open retropubic prostatectomy by modified Millin's technique has minimal morbidity and is a good alternative for large size glands in benign prostatic hyperplasia.

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AIDS is a systematic infection of retrovirus causing immunodeficiency. Many varied manifestations of the dis­ease have been reported. Systemic vasculitis has been re­ported in as one of the manifestations of the syndrome. This has resulted in areas of skin necrosis in varied parts of 'the body. We report a case of penile skin necrosis which occurred spontaneously in a 25-year-old male patient with no evidence of trauma or infection.

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