Aerobic nonfermenting gram-negative bacilli (nonfer­menters) usually considered as contaminants are emerg­ing as important nosocomial pathogens. 110 such strains obtained from 4200 consecutive urinary tract specimens were characterized by a battery of biochemical tests. Antibiotic susceptibility was tested against gentamicin, amikacin, netilmicin, ceftazidime, piperacillin and ciprof oxacin. Significance was assigned by taking into account clinical details and isolation of the same organ­ism in the repeat specimen. Pseudomonas spp. (45.5%) were the commonest followed by Acinetobacter spp. (39%), Alcaligenes spp. (8%) and Flavobacter spp. (3.63%). Two strains of Weeksella virosa, and one each of Xanthomonas rnaltophilia and CDCllg were also re­covered. Pseudomonas aeruginosa and Acinetobacter baumanii were the most common significant isolates (62.9% and 25.9% respectively). Alcaligenes spp. was found to be etiologically significant in 5 out of 7 cases. In only 2 cases (4%) isolation of a Pseudomonas spp other than Paeruginosa was considered significant. Out of 4 strains of Flavobacter spp. only one could be confirmed as significant. Postoperative period (42.6%) followed by obstructive uropathy (32%) and surgery on urinary tract (8%) were commonest risk factors. All strains except a few showed high level of drug resistance.

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Tubercular involvement of prostate is rare. Though the symptoms are nonspecific, haemospermia is an im­portant clinical symptom. Asymmetry of prostatic lobes or nodular fibrotic prostate on digital rectal examina­tion is an importantphvsical6nding. Altered echotexture of the prostate or hypoechoic nodules on USG leads to suspicion. AFB staining or AFB culture of seminal fluid or trucut needle biopsy of the prostate gives the definite diagnosis.

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3 rare cases of primary adenocarcinoma of renal pelvis and ureter are illustrated here.

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Purpose: Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a congenital malformation characterized by an absence of the vagina associated with a variable abnormality of the uterus and the urinary tract butfunc­tional ovaries. We review the embryological, endocrino­logical, clinical, diagnostic, psychosocial and therapeutic features of this syndrome. Material and Methods: We performed a computer­ised Medline search and manual bibliographical review of more than 100 relevant articles on MRKHS published in the last 25 years. A thorough analysis of embryo­logical, endocrinological, clinical, psychosocial, diag­nostic and therapeutic features of this syndrome was performed and the important findings are summarised. Results: Embryologically, MRKHS appears to be the result of non fusion of the mesonephric duct (MD) with the Wolff an (WD). The various Mullerian defects found are agenesis of vagina or uterus, rudimentary vagina or uterus with normal ovarian function. Nearly 50% of these patients have renal anomalies like renal agenesis, ectopic kidney, fusion anomaly like horse-shoe kidney and vesicoureteric reflux. Skeletal abnormalities are found in 10% of these patients, 2/3 of whom have anoma­lies of the spine, ribs or limbs. Clinical observations also support the view that 2 or more syndromes lie behind the title of MRKH syndrome, namely an isolated form of con­genital agenesis of the vagina and uterus (typical/type A) and a more generalized condition, in which agenesis of the vagina and uterus is a major and perhaps even an obligatory characteristic (atypical/type B). Conclusion: Mayer-Rokitansky-Kuster-Hauser syn­drome (MRKHS) is a congenital malformation charac­terized by an absence of the vagina associated with a variable abnormality of the uterus and the urinary tract but functional ovaries. The various urinary tract anomalies described are renal agenesis, pelvic kidney, fusion anomaly like horse-shoe kidney and vesicoureteric reflux. It is not only worthwhile to be alert for these anomalies but also to study the skeletal and auditory systems in these pa­tients. The technology of in vitro fertilization enables a woman without a uterus to have her own genetic children.

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A 38-year-old male presented with right hypochon­dralgia and backache for two rears. Plain X-ray KUB showed a radio-opaque calculus in the left renal area. Urinalysis and culture were negative. IVU (after a nor­mal serum urea and creatinine report) showed the char­acteristic tooth-like calcification to be situated above and medial to the upper pole of left kidney which itself is de­formed and pushed downwards. CT scan with contrast showed a mass of approx. 6.5 x 6.5 cm with central hypodense area and surrounding dense wall adherent to the adjacent retroperitoneum and major vessels. A solid calcified element (dermoid plug) was seen projecting into the cavity. On exploration, the para-adrenal mass was found to be adherent to the aorta and adjacent struc­tures. The offensive cheesy content was first removed, followed by gradual and careful separation of the wall in parts, thus avoiding injury to the major vessels. The wall contained several abortive tooth structures, hair shafts and skin-like lining. Histopathology showed sev­eral ectodermal structures (tooth, hair follicles, sweat and sebaceous glands etc), but no immature element. The patient recovered uneventfully and is doing well at present.

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Attention is being paid to the education in laparoscopic urological surgery which has become an important treat­ment method. This article briefly describes the challenges of different types of surgeries and the basic concepts of educational process. "The Stepladder Approach" for laparoscopic surgery education is suggested and its two components "The Stepladder of Educational Objectives" and "The Stepladder of Educational Experiences" are described along with the examples of evaluation meth­ods. Finally, an action plan for laparoscopic surgery edu­cation in Indian urology is suggested.

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Posterior urethral valves (PUV) is a singular struc­ture, often incorrectly referred as plural, an obstructive uropathy in male infants and neonates. This congenital abnormnality is diagnosed by non-invasive investigation - perineal ultrasonography.

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Multilocular cystic renal cell carcinoma (MLCRC) is a low-grade tumour which arises from cystic lesions in the renal parenchvma. High index of suspicion, helps to de­tect this tumour in otherwise benign cystic lesions. Neph­ron-sparing suugery can be implemented in pre-operatively diagnosed cases.

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A rare case of leiomyoma of the urinary bladder in a 13-year-old girl is reported and its management discussed.

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Leiomyosarcoma of the prostate is a rare entity. It is the most common prostate sarcoma in the elderly. We report a case of prostatic leiomyosarcomia in a 60-year-old male.

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Zoon's balanitis, is a chronic erosive lesion on glans penis, which on biopsy shows a plasma cell infiltrate in dermal layers. It is typical in uncircumcised males. We are reporting a rare case of Zoon's balanitis in our insti­tution. A 21-year-old unmarried male presented with pain and discharge from penis. A velvety patch was noted over glans. He underwent circumcision and the patch was ex­cised and sent for biopsy. Histopathological report was consistent with balanitis circumscripta plasmacellularis. We reviewed the literature about similar reports.

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Mesothelial cysts of epididymis are very rare. Their clinical significance lies in their presentation as discrete testicular masses often diagnosed as hydroceles prior to removal. We report our experience of a cyst lined by mesothelial cells lying at the upper pole of the testes, from the epidi­dyinis.

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A case of renal cell carcinoma which was diagnosed to have metastatic disease on the basis of two hot spots in ribs on bone scan, is presented. After careful and thor­ough history, it turned out to be fracture ribs which oc­curred due to bad positioning during radical nephrectoiny. This case highlights the importance of clinical judgement especially in the modern era of sophisticated investiga­tions.

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Polyorchidism is a rare but distinct genital anomaly in which supernumerary testes are present usually within the scrotum. A unique case of germ cell tumour arising in one of the two cryptorchid abdominal testes with persistent mullerian structure syndrome is presented. He had single testicle in the scrotum, inguinal hernia and a single fallopian tube on exploration. This case is being reported for its extreme rarity and clinical issues involved.

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Case Management Record Reviews have limited sci­entific value and there is a need to make a shift from these to Planned Clinical Research. The purpose of this article is to help clinicians in making this shift. This article describes the basic concepts of research, the stages in the shift from Case Management Record Re­view to Planned Clinical Research, the limitations of Case Management Record Review, Case Management Proforma, Clinical Management Protocol, Clinical Re­search Plan, the process of Planned Clinical Research including research designs and the benefits of carrying out scientific research.

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Patients expect holistic care from the medical profes­sion. In holistic care, the whole person comprising bodv, mind and spirit is given attention and six dimensions of health (physical, mental, emotional, spiritual, social and environmental) are recognised as being equally impor­tant. Patients' needs and expectations have forced the medical profession to recognise spiritual and religious factors in medical care. This article describes in detail the relevance of spirituality and religion in medical pr o­fession and suggests guidelines, for doctors for handling the spiritual and religious beliefs of patients.

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Our experience with 6 consecutive cases of fracture penis, a rare urological injury, in normal male without any erectile dysfunction, who consumed Sildenafil Citrate for prolonged sexual enjoyment out of curiosity. All of them were properly worked up and treated surgi­cally resulting in excellent recovery of function.

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Priapism, the prolonged erection of penis is a urologic emergency. Untreated, the patient can land up in impo­tence. Various methods have been described for its treat­ment but the initial management remains conservative. The authors present their experience with use of seda­tion followed by ice-cold saline enema in management of priapism.

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All cases of exstrophy epispadias complex carried out in our centre between the period from February 1990 to December 1999. Total 37 cases of exstrophy epispadias complex were dealt with. Out of these, 30 cases under­went primary closure of bladder with or without oste­otomy. 7 babies had very small fibrotic patch bladder primarily or secondary to failed primary closure and they went on forpermanent diversion in the form of ileo­caecal bladder Out of 30 cases, 20 underwent Jeffs' closure with os­teotomy and in 10 cases primary closure was done with­out osteotomy. In 19 patients we have completed all the stages of operation, that is, primary closure, epispadias repair and bladder neck reconstruction. The main problems in exstrophy bladder repair re­mained the, failure of bladder to heal, vesical fistula for­mation, development of inguinal hernia in postoperative stage. The dry interval period, following total correction of exstrophy bladder remains I to 2 hours with growing age. The children are in follow-up for 10 years now.

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A high rate of association between supernumerary nipples (SNN) and genitourinary abnormalities has been reported previously. We examined all patients attend­ing one particular unit, in the age group between 12 and 20 years for the presence of SNN and urinary tract abnormalities. We could find only a weak association between these two conditions.

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Introduction: Traditionally live related renal donors are evaluated with intravenous urography and renal ar­teriography. The computerized tomographic angiogra­phy (CTA) can offer a less invasive alternative to demonstrate the necessary anatomical and functional information. The present study evaluates the accuracy of helical CTA in depicting renal vascular and paren­chymal anatomy in live renal donors. Patients and Methods: During March 1999 to March 2000 all live donors were evaluated with ultrasound ab­domen (USG), intravenous urography (IVU) and heli­cal CT (Picker PQ 5000, Picker Intl. USA). Renal arterial and venous anatomy was documented prospec­tively by a radiologist, which was correlated with the operative findings. Sensitivity, specificity and accuracy of CTA in depicting the renal vascular anatomy were assessed. Results: Of 120 live donors evaluated, overall con­cordance between CT angiography and operative find­ings in delineating the arterial anatomy was found in 110 (91.6%) and venous in 116 (96.6%) donors. The sensitivity, specificity, and accuracy of CTA in depict­ing arterial anatomy was 91.6%, 98.2% & 91.6% and for venous anatomy was 96.7%, 90.0% and 97.0% re­spectively. We could not gather any additional informa­tion by performing intravenous urography. Conclusions: Helical CT angiography, which is highly specific for arterial and venous anatomy as well as other anatomical and functional details, can become the single imaging modality for preoperative assessment of poten­tial donors in place of conventional angiography and IVU. CTA, being minimally invasive and cost effective, is well accepted by a normal healthy donor

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Carcinoma in situ bladder is a high grade and ag­gressive manifestation of transitional cell carcinoma of bladder that has highly variable course. The purpose of this study is to analyse how this serious disease is dealt with, most effective treatment option available and its clinical progression inspite of intervention. All patients diagnosed to have CIS bladder histolo­gically in Harrogate District Hospital from August 94 to August 99 were included in the study. All data con­cerning the management, treatment and subsequent fol­low-up were collected from the patients' records and analysed in a systematic way. A total of 20 patients were included in the study. Analysis showed that there was no age or sex predilection and the age group ranged from 36 to 75. It occurs either alone or with papillary bladder tumour. It is found to be poor prognostic indi­cator for subsequent ttunour recurrence. Mitomvcin was the least effective and BCG is the most effective form of intravesical treatment. Failure on BCG therapy is an earlvpredictorforaggressive treatment i.e. Radical Cys­tectomy. Eventually 1/3 of all patients diagnosed to have CIS progressed to muscle invasive disease requiring radical treatment.

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