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The medical management of urolithiasis has undergone a great change. In the present time the management of urolithiasis is not only stone removal but also to prevent its recurrence. With the recent advances in the knowledge of pathogenesis of urolithiasis, the medical management is not only restricted to increased fluid intake, but to de­termine the cause of urolithiasis by a battery of investiga­tion, the use of a particular drug to prevent urolithiasis if required and then to check the effectiveness of the drug by the application of investigations. This article has taken into consideration the various aspects of the etiopathogenesis of urolithiasis and its application towards the prevention of urolithiasis.

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Objective: Our aim is reappraisal of Mitrofanoff prin­ciple in a wide array of diverse clinical situations like pelvic tumors, myelodysplasia, irreparably damaged ure­thra and sphincters and with total bladder substitution. Materials and Methods: 24 patients underwent the con­struction of a continent catheterisable stoma based on the Mitrofanoff principle between February 1990 to Decem­ber 2000 for various etiologies. Youngest patient was 4 years old and the oldest patient was 54 years of age. The conduit was constructed using appendix in all patients. Results: Stomal continence was achieved in all 24 pa­tients (100%). Difficulty in catheterisation was most fre­quent late complication encountered in 4 patients (16.6%). 3 patients (12.45%) developed stones in reservoir Conclusions: Mitrofanoff procedure is a versatile tech­nique. The extension of this principle can provide conti­nence mechanism to variety of patients, with or without total or partial substitution of bladder, in whom there is no usable urethra or sphincter or both.

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Granulomatous prostatitis is a rare disorder of pros­tate. We encountered 10 cases of'grmudomatous prosta­titis consisting of 5 cases of non-specific granulomatous prostatitis, 2 cases of xanthogranulomatous prostatitis, I case of tuberculous prostatitis, I case of malakoplakia prostate and I case of granulomatous prostatitis associ­ated with adenocarcinoma prostate. The diagnosis was made by histopathologic examination of trucut biopsy, TURP chips or retropubic prostatectomy specimen. In all the cases, granulomatous prostatitis was an incidental find­ing.

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Background: Graft nephrectomy is often considered a hazardous procedure with high morbidity and occasional mortality, and this may pose a technical challenge. The aim of this study was to evaluate the indications, etiology and complications following graft nephrectomy. Materials and Methods: From 1988 to 2001, among total of 1,019 live related renal transplants carried at our center, 46 underwent graft nephrectomy. Patients were divided into 2 groups depending on timing of graft re­moval. The early group included 27 patients (within 2 months of transplantation) while in late group (graft re­moval after 2 months of transplantation) there were 19 patients. The 2 groups were compared in terms of indica­tion, etiology and complications. Results: In early group the indications for graft removal were acute rejection, thrombosis/infarction and hyper­acute rejection, while in late group the indications were pain, hematuria, fever, hypertension and infection along with chronic failure. Overall, the external iliac artery in­jury occurred in I and 4 patients in early and late group respectively. Major blood loss occurred in I and 6 pa­tients in early and late graft removal respectively. There were 2 deaths in early group due to ftdminant pneumoni­tis that progressed to sepsis and disseminated intravascu­lar coagulation. There were 9 major wound infections all in early group except in 2 patients of late group. Respira­tory infections occurred in 14 patients in early group and 1 in late group. In early group patients had CNS compli­cations in form of seizures, clinical depression and delusional psychosis in 12 patients. Conclusions: Our experience highlights the risk in­volved in graft nephrectomies. Severe acute rejection and thrombosis lead to early graft nephrectomies. Pain, hematuria, infection and hypertension in setting of chronic rejection are predominant causes for the delayed graft ne­ phrectomies. Early graft nephrectomy, though technically easy, is associated with systemic complications; late graft nephrectomy is technically more demanding with relatively increased risk of vascular and visceral injuries.

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We report a case of non-deflating heavily encrusted Foley catheter successfully removed by extracorporeal shockwave lithotripsy (ESWL). To our knowledge this is the first case of using ESWL to remove encrusted foley catheter retained in the bladder.

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Introduction: Staghorn renal stones in a developing country, very often associated with insidious growth, late presentation, complications and recurrence, present an economic burden to the patient and a challenge to the treat­ing surgeon. Despite proven effectiveness of modern endourological procedures, they are cost intensive and require multiple sittings. Current retrospective study was undertaken to evaluate the most effective therapy for these stones in a developing country. Materials and Methods: 156 patients with extensively branched staghorn renal stones were treated at our center over a period of one decade. Of these patients 76 under­went PNL (group-I), 35 sandwich (group-11) and 45 open surgical procedures (group-III). Perioperative events in­cluding clearance rate, morbidity, complications, blood transfusions and ancillary procedures were compared between the three groups. Also compared was the length of inpatient treatment and the expenses incurred. In a sub­group analysis, treatment outcome and complications were separately analyzed in patients with renal failure (serum creatinine >2.0 mg%). Results: The three groups were comparable in terms of age, sex, stone size, preoperative serum creatinine, hemoglobin and positive urine cultures. Overall stone free rate in group-I (85.52%) was higher than group-11 (74.28%) and group-III (79.41 %) although it did not reach statistical significance. Ancillary procedures were least required in group-III patients. ESWL was required in 23.7% of group-I and 8.8% of group-III patients (P<0.05). Ureteroscopy was required in 7.89%, 17.1 % and 4.4% of groups I, II and III respectively. While the incidence of urosepsis was comparable, major postoperative bleeding occurred in 10.52%, 8.6% and, 6.6% of groups I, II and III respectively. The mean hospital stay amongst the three groups was similar with a marginally longer stay in the sandwich group. The overall cost of the treatment includ­ing adjuvant therapy was significantlv less expensive in group-III compared to group-I and group-11. Renal failure patients had higher clearance rates with open procedures compared to PNL (80% vs 62.5% respec­tively). Moreover these patients had higher incidence of major bleeding with PNL compared to open procedures (31.3% vs 10%). Conclusions: Advantages of endourological procedures in the management of staghorn stones is offset by the need of ancillary treatments, which are expensive and which require frequent visits to the hospital. In view of high clear­ance rates, lesser treatment cost and lesser incidence of complications, open surgery still has a place in the man­agement of staghorn renal stones in patients who have economic constraints and live in remote areas where medi­cal facilities are not freely available. These advantages are also seen in the renal failure patients where complica­tions with endourologic procedures were significantly more than that with open surgery. However postoperative mor­bidity and larger scar should be discussed with the pa­tients.

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A case of renal cell carcinoma presenting as hyperten­sion is described with a brief review of the literature. Iso­lated hypertension is a rare form of presentation and shows the potential of reversibility of hypertension after surgical extirpation of the tumour

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Recent reports suggest that spiral computed tomographic (CT) angiography could replace conventional angiogra­phy and intravenous urography (IVU) for the assessment of potential live kidney donors. The purpose of this study was to assess the accuracy of spiral CT in kidney donor workup. 10 consecutive renal donors had IVU, percutane­ous transfemoral selective renal angiography and spiral CT angiography between January and March 2001. The spiral CT and renal angiograms were assessed independ­ently by two radiologists. The number of renal arteries, pres­ence or absence of renal artery stenoses and associated parenchymal abnormalities were assessed. A total of 27 renal arteries were detected. Transverse scans viewed in a tine loop format with maximum intensity projection and shaded surface display detected all 27 vessels. All 27 ves­sels were detected by conventional catheter angiography. A simple renal cyst was noted in both spiral CT and con­ventional angiogram. Venous anatomy including a retroaortic renal vein was visualized in spiral CT angiogram but not visualized by conventional angiography. Spiral CT angiography performed as an outpatient procedure is less invasive, less expensive, and provides good images of the arterial and venous anatomy in addition to the visualiza­tion of the other abdominal viscera. A plain X-ray of the abdomen was taken 15 rains after injection of contrast to acquire an IVU like image. Spiral CT angiography has the potential to replace conventional catheter angiography and IVU in the assessment of renal donors.

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Objectives: To determine the renal functional reserve in live related donors and compare it with that of normal controls. Patients and Methods: The study group consisted of 12 subjects who underwent donor nephrectomy at our cen­tre, more than 6 months prior to this study. The control group consisted of 12 healthy, age and sex-matched vol­unteers who had no previous history of renal disease. The test for renal, functional reserve consisted of a 2 hour base­line creatinine clearance followed by ingestion of 1.2 grains of protein per kg body weight, in the form of cooked red meat, over one hour: A subsequent 2-hour creatinine clearance starting one hour after the completion of pro­tein load was done. Urine collections were meticulously supervised and serum creatinine levels were obtained at the midpoint of each urine collection. Results: The rise in serum creatinine and creatinine clear­ance after protein loading was statistically significant in both donors and controls. The test used for estimation for renal, functional reserve was the percent change in creati­nine clearance after an acute protein load. This was 26.9 % in the donor population and 29.6 % in the controls. The difference between the 2 groups, therefore, was not statisti­cally significant. Conclusions: The preservation of renal functional re­serve implies that kidney donors are at no significant dis­advantage compared to normal healthy people, by virtue of their kidney donation.

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Purpose: Ureterovesical anastomosis related compli­cations might cause significant morbidity, allograft loss and even mortality. Routine prophylactic JJ stenting against these complications though controversial seems to be gaining literature support. ^- ' There is no consensus as to the optimum duration of stenting and various stud­ies report stenting for 1 week to 3 months. This study was conducted to know the optimum duration of JJ stenting in renal transplantation. Material and Methods: 52 (group 1) live related renal transplant recipients, stented for 2 weeks were compared to 57 (group 2) historical controls (from our previous study ⁵), stented for 4 weeks. A 16 cm/6F polyurethane JJ stent was left across the ureteroneocvstostomy performed by Lich Gregoir technique. The stent was removed under local anesthesia within same admission in group 1 and in second admission in group 2. Both groups received simi­lar antibiotics and bnmunosuppression and were moni­tored for urological complications. Results: There was no major urological complication requiring surgical intervention in either group. The inci­dence of minor complications resolving with conservative management was also similar in the 2 groups. There were 2 ,forgotten stents in group 2 (badly encrusted and removed at 3 years and 11 months respectively). The second ad­mission in group 2 for stent removal incurred extra cost as it was done in the routine operation theatre to avoid infection. Conclusions: Reducing the duration of stenting from 4 weeks to 2 weeks avoids complications associated with pro­longed use of stent without compromising the beneficial ef-' feats of stent in preventing the urological complications. It obviates the risk of forgotten stent as well as curtails the cost of second admission for stent removal.

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Objective: To evaluate the clinical efficacy and safety of Tolterodine 2 mg twice daily in Indian subjects with symptoms of overactive bladder including frequency, ur­gency with or without urge incontinence. Methods: This multicentric open-label, noncompara­tive, prospective study was conducted at 7 centers across India. Eligible patients were assigned to treatment with Tab. Tolterodine 2 mg twice daily for 8 weeks. Subjects were seen at visit ](day 3 to 10), visit 2 (day 1) and after 8 weeks of treatment. Micturition charts were completed prior to visit 2 and visit 3. Efficacy variables included change, from baseline to 8 weeks of treatment in the mean number of micturitions, incontinence episodes/24 hours, mean volume voided per micturition and subjects' per­ception of treatment benefit. Efficacy was evaluated from patients' micturition diaries. Patients were also assessed for adverse events during the treatment. Results: A total of 127 subjects with symptoms of overactive bladder were enrolled. 8 weeks' treatment with Tolterodine resulted in improvement in assessment of all symptoms of overactive bladder Significant decreases from baseline in both the frequency of micturition (mean ± SD of -2.5 ± 5.0 per 24 hours, p=0.0001) and the number of incontinence episodes per 24 hours (-1.5±3.8, p=0.0051) and a significant increase in mean volume voided per mic­turition (+26±55 ml, p=0.0001) were obtained. Treatment was well tolerated and most subjects (71.4%) did not ex­perience any adverse events during the study. The most common adverse event was dry mouth (10.3%). 5 sub­jects were withdrawn due to adverse events and all the subjects recovered uneventfully. Conclusions: Treatment with Tolterodine 2 mg twice daily was effective and safe in Indian subjects with the symptoms of overactive bladder as assessed by both objective and subjective criteria.

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Objective: To see the efficacy and safety of single low dose ATG induction on graft survival, rejection, infection and development of malignancy in spousal renal trans­plant recipient. Materials and Methods: A prospective randomized trial was conducted between July 1996-January 2000. Single dose (3.5-5 mg/kg) ATG induction was used in 30 patients while 30 patients were taken as control. Standard triple drug immunosuppression was given to both the groups, while study received additional single shot of rabbit ATG (Fresenius, Germany: 200 mg in 200 ml of saline). The patients were followed up for a mean of 30.4 months (range 19-46 months) in both groups. Graft function, rejections, episodes, anti-rejection therapy, infections and develop­ment of malignancy was analyzed at the last follow-up. Result: There were 24 males and 6 females in control group with a mean age of'44.26 years and 26 males and 4 females in control group with a mean age of 41.26 years. Patients' characteristics in both the groups were compa­rable. A total of 26 (86.3%) patients in induction and 24(80%) patients in control group were evaluated at last follow-up (mean 30.4 vs. 30.2 months). Stable graft func­tion was present in 83.3% patients in induction versus 70% in control group. Impaired graft, function (serum creati­nine >2 mg%) was present only in 10% of control group and none of the patients in the study group at last follow­up. The total number of rejections were 23.3 and 43.3% in induction and control group respectively. 2 patients in each group who developed multiple episodes of rejection progressed to chronic rejection. Steroid resistant rejec­tions were less with induction therapy than with control group (14.4 vs. 30.7%). Apart from increased urinary tract infections in study group (46.7 vs. 23.3%), infection at other sites were comparable in both the groups. 2 patients in study group and 4 patients in control group died with, functioning graft due to medical problems. 2 patients were lost to follow-up in both the groups. I patient required graft nephrectomy in induction group, due to severe graft dysfunction with significant proteinuria. Conclusion: Single shot low dose ATG induction therapy reduces the rejection episodes (p=0.05), but it has not shown any improvement in graft survival at 2'/z years. It is associated with higher urinary infection rates. How­ever, long-term, follow-up is needed to see any benefit of less rejection on long-term graft survival.

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Acute urinary retention in infancy, due to a congenital bladder diverticulum (CBD) is rare. The literature is scanty on the subject. We report 2 such cases. In both of them the ureters were opening directly into the dive rticulitin. One of them had a complete duplex system on the left side, which is the first reported of its kind, with both ureters of the duplex system opening into the diverticulum.

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Aquaporins are a group of Tran membrane proteins, which function as molecular water channels. They were discovered by Agre and co-workers. Five Aquaporin pro­teins (AQPJ,2,3,4,6) are presently known to be expressed in the kidney with definite localization. Regarding three additional Aquaporins (AQP7, 8 and 10) the exact cellu­lar localization is not yet determined, but they are shown to be expressed at mRNA level in the kidney. The research on Aquaporins is providing molecular insight into the understanding of fundamental aspects of water balance in health and disease states.

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The incidence of HIV infection has increased tremen­dously over the last few years. National AIDS control or­ganisation has estimated that about 3.5 million persons in the reproductive age group in India are harbouring HIV infection. The positivity rate of HIV-tested persons has shown a rising trend with 0.8% in 1989, 1.4% in 1993 and 2.4% in 1998. In our study we found 19 HIV positive patients out of 776 patients before any urological procedure. HIV in­fection was found both in males and females and in al­most all types of urological dirorders. Routine HIV testing is usually not carried out at most centres and the medical fraternity is constantly exposed to the risk of HIV infection which can have wide-ranging implications in a health professional's life. We should all strive, for routine HIV testing before undertaking patients for any procedure.

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An advanced case of genitourinary tuberculosis present­ing with small capacity bladder left ureteric stricture and nonfunctioning right kidney was managed with modified technique of combined augmentation ileo-cystoplasty and ileal replacement of left ureter This complex and exten­sive reconstruction can be done easily and successfully in a short time with our modified technique.

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