Between June 1995 and November 1995, Micro-surgical Epididymal Sperm Aspiration (MESA), and Intracytoplasmic Sperm Injection (ICSI) was performed on 9 patients (10 cycles) who had congenital absence of the vas deferens (n=5), failed vaso-epididymostomy (n=2) or other irreparable obstructions (n-2). In two patients no epididymal spermatozoa were recovered and so testicular sperm extraction (TESE) was carried out. In one cycle frozen-thawed epididymal spermatozoa was used. A total of 75 oocytes were retrieved (7.5 oocytes/cycle) of which 69 oocytes were micromanipulated. The fertilization rate was 65.2 percent and the cleavage rate was 95.5 percent. Maturation arrest at the pronuclear stage was observed in 4.5 percent. The damage rate was 4.3 percent. Assisted hatching (Partial Zona Dissection) was carried out on 43 embryos. 4.3 embryos were transferred per cycle. The pregnancy rate per cycle was 10 percent and per patient was 11.2 percent. MESA and TESE in combination with ICSI is the treatment of choice for men with obstructive azoospermic conditions. This paper reports the first pregnancy in India by the combined technique of Microsurgical Epididymal Sperm Aspiration and Intracytoplasmic Sperm Injection.

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With the hypothesis in mind that tissue regeneration and organogenesis of ureter can be possible from pluripotent stem cells of peritoneum, both being of mesodermal origin, a prospective study was undertaken on seven live animal models. A segment of ureter was excised and replaced with peritoneal tube. Transformation of peritoneal graft into all the components of wall of ureter was observed. The desired metaplastic transformation of stem cells of peritoneum is possible. However regeneration of more and complex tissues is essential to authenticate the hypothesis. The author is engaged in the research.

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Current single examination system in MCh (Urology) course predominantly assesses knowledge and memory and is obviously not suitable for assessment of the professional competence of students. There is a need to have a system of evaluation to test various learning objectives of MCh (Urology) course. Such a system should be comprehensive and continuous. An innovative credit-based system of evaluation, which could be used either as a formative assessment method or as the sole evaluation method replacing both summative and formative assessments, is presented. Requisites, components and implementation strategy of credit-based system of evaluation are described.

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The paucity of consistent, convincing and categorical evidence of an improved survival with Maximum Androgen Blockade (MAB), notwithstanding many randomised trials comparing castration alone versus some form of MAB over one, two (castration combined with anti-androgens, viz., flutamide, cyproterone acetate (CPA), or nilutamide) stimulated the authors to organise a systematic collaborative overview (meta-analysis), of the randomised evidence on MAB in advanced prostate cancer. Overall, 25 properly randomised trials (that began before December, 1989) involving an unconfounded comparison of castration (medical/surgical) alone versus castration and additional treatment with an anti-androgen such as flutamide, cyproterone acetate or nilutamide, were identified. Of these, two were 3-arm trials in which all 3 arms were relevant to the present analysis. Logrank statistics was used which compared the number of deaths observed (O) in the MAB arm with the number of deaths that would have been expected (E) in that arm on the basis of the average pattern of survival in a combination of the 2 treatment arms. The calculations of (E) were stratified for year of death. The statistics (O-E) and its variance (V) were calculated on an intention-to-treat basis. Logrank statistics for each were added together to obtain a total which was used to test the overall effect. 87 percent of these patients had metastases when rando- mised. Follow-up results were not available for 70 patients (1.2 percent). The median follow-up was 40 months, during which 57 percent of patients died. The crude mortality rates were 50 percent for castration alone and 56 percent for MAB. Life-table estimates of the 5-year survival rates were 22.8 percent and 26.2 percent respectively, revealing a non- significant improvement of 3.5 percent. No significant heterogeneity was found between the trials (or between the effects of different types of MAB) and no evidence of any significant additional benefit was found in these MAB trial results (2p greater than 0.1). This study reveals that currently available evidence does not show a longer survival benefit with MAB (cf. conventional castration).

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Three cases of femoral neuropathy following living related donor renal transplantation are reported. All three patients developed quadriceps weakness on the side of transplantation after the surgery. Nerve conduction and electromyographic studies were consistent with the diagnosis of femoral neuropathy. A review of reported cases and possible mechanisms of nerve injury are discussed.

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A series of 48 cases of distal penile hypospadias repaired by lined preputial flap is being presented. Advantages, limitations and details of operative techniques have been discussed.

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This study was conducted to elucidate the bone morphogenetic protein-6 (BMP-6) mRNA and protein expression in normal and malignant rat and human prostatic tissues. Normal ventral prostate was obtained from Copenhagen rats. Malignant rat prostate was Dunning tumour procured by the subcutaneous implantation of tumour cells in the flank of male Copenhagen rats. Human tissue was obtained immediately after surgery and inspected by a pathologist, and both normal and malignant tissue samples were obtained. For the purpose of immunohistochemistry, the prostatic tissue was fixed in 1 percent paraformaldehyde. For preparation of RNA, both rat and human prostate tissues were flash-frozen in liquid nitrogen and stored at —70 degree C. RNA was prepared by a lithium chloride/urea method. To investigate the effect of androgen withdrawal on BMP-6 expression, 12 adult male Copenhagen rats (300 g) were castrated. The concentration of BMP-6 mRNA was estimated by a reverse transcriptase- polymerase chain reaction (RT-PCRO). Over two Affinity-purified rabbit polyclonal antibody was used to detect BMP-6 protein immunohistochemically. Over three The levels of BMP-6 mRNA and protein were similar for normal and malignant rat prostate, regardless of the metastatic potential. Castration had no apparent effect on BMP-6 production in rat normal ventral prostate. BMP-6 mRNA and protein were also produced by normal and neoplastic human prostate cancer (clinical specimens and human carcinoma cell lines DU-145 and PC 3). BMP-6 mRNA and protein expression, in contradistinction to the adenocarcinoma cell line of rat, was higher in human prostate cancer as compared to the adjacent normal prostate. Tumours with Gleason score 6 or more had a greater BMP-6 immunostaining than the lower grade tumours, viz., those with Gleason score of 4 or less.

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Spongiosography is an opacification of corpus spongiosum by contrast medium. Spongiosogram was done in 16 cases of diagnosed anterior urethral strictures to assess the depth of fibrosis and the fibrosis graded into mild, moderate and severe. 10 patients with mild spongiosal fibrosis required repeat procedure after 4 to 6 months. 4 patients with moderate fibrosis required OIU within 2 months and 2 patients with severe fibrosis underwent open surgical reconstruction. Spongiosography can be used to prognosticate the recurrence rate and choose appropriate initial modality for management of anterior urethral strictures.

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Carcinoma of the cervix is most frequently treated by radiotherapy or surgery or a combination of both. Fistula formation involving the urinary bladder may occur as a complication of these modalities of treatment. These fistulae are often complex requiring detailed evaluation before surgical correction. Appropriate surgical techniques can ensure cure of the distressing symptoms. A well-motivated patient and a surgeon interested in the complex problems associated with these are necessary for the successful outcome. This paper presents the experience in managing 12 patients with bladder fistulae arising as a complication of treatment of carcinoma cervix.

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From 1980 to 1990, 425 patients with germ cell tumours of testes were treated. 32 (7.5 percent) were identified to have brain metastases at some time during therapy. They were grouped into 3 groups. Group-I (n=10) presented with brain metastases at initial diagnosis, group-II (n-9) relapsed in brain after achieving a complete response to chemotherapy (CT) for systemic disease, and group-Ill (n-13) developed brain metastases as a part of ongoing progressive disease. The group-I patients were treated aggressively with CT and whole brain radiotherapy (WBRT). The group-II patients likewise were also treated aggressively with a combination of CT and WBRT, or craniotomy and excision if brain was the only site of relapse. The group-Ill patients were palliated with WBRT. In the final analysis though brain metastasis is considered as a poor prognostic feature, a subset of patients could be identified in whom curative intent aggressive therapy has yielded impressive median overall survival of 52 months (group-I) and 51 months (group-II) respectively. On a premise that brain does act as a sanctuary to first-line standard CT, we believe in consolidation WBRT in patients who present as brain metastases at initial diagnosis as well as those who relapse in brain along with peripheral relapses.

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Orchiopexy does not protect a cryptorchid patient from developing testicular tumor. The stage of the disease at presentation is not different in the orchiopexed and non-orchiopexed patients. Non- seminomatous tumors are proportionately more. Inguinal lymphnodular involvement is possible. The prognosis depends on the stage of the disease and the type of tumor. Fertility which is affected in the cryptorchid patients can be worsened by the treatment of the tumors also.

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