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Aims and Objectives: Shock wave lithotripsy (SWL) has been recommended as a first-line treatment for upper ureteric calculi in several studies with a success rate of 80-90%. Our aim is to present our retrospective data of treatment of upper ureteric stones with SWL as primary modality over a 10-year period and evaluate the factors affecting fragmentation and clearance. Materials and Methods: From February 1997 to March 2007, 846 patients with upper ureteric stones were treated with SWL as the primary modality. Age: 9-69 years, 546 males and 300 females, stone size: 7-22 mm. Pyuria in 132/846 with clinical infection 40/132, pre-SWL JJ stenting: 40/846 and anesthesia in 41/846 patients. Duration of symptoms: <4 weeks- 780/846, >4 weeks- 66/846. Stone size: <1 cm- 513/846, >1 cm-333/846. Workup: X-Ray KUB, Urine and Uro-USG. Intravenous urogram (IVU): 130/846. Intraoperative (C-arm) fluoroscopic imaging was used. Presentation: colic-801/846, incidental-45/846. Criteria for clearance: symptomatic relief, X-ray and USG confirmation. Results: Clearance rate: <1cm- 95.91% (492/513), >1 cm- 85.29% (284/333). Overall clearance rate: 91.73% (776/846). No clearance: 70/846 (8.27 %). In these, 59/70 underwent ureteroscopy, 8/70 percutaneous nephrolithotomy and 3/70 open ureterolithotomy for clearance. Post SWL complications were seen in 25 (3%) cases with septicemia in nine and stein strasse in 16 cases. Duration of symptoms <4 weeks - 93.7% success (731/780), >4 weeks . 68.1% (45/66). Non-stented . 92% (744/806) success. Stented group--80% (32/40). Conclusions: Best results with SWL as monotherapy for upper ureteric stones are achieved when stones are less than 1 cm in size, of short duration history and without indwelling stents. Overall success rate -- 91.73%. [ABSTRACT FROM AUTHOR]

Objectives: Ultrasonography (USG) is the commonest modality for ascertaining prostate volume. Urologists commonly encounter a discrepancy between prostate volume on USG and actual volume of prostate, whereas transrectal ultrasonography (TRUS) gives near correct prostate volume. We undertook a prospective study to compare the relationship between changing bladder volumes to the volume of prostate. Materials and Methods: After approval of the Institutional Ethics Committee and informed consent, 25 patients (age group: 52-78 years) with lower urinary tract symptoms were assessed for prostate volume by USG at different bladder volumes and final comparison was done with TRUS in one setting. Each USG and TRUS was done by one urology resident under the guidance of one qualified radiologist with experience of over 15 years in this field. Equipment used was SIEMENS SONNOLINE ADARA with 3.5 MHz probe for USG and 7.5 MHz Endo p-2 (biplaner) probe for TRUS. First, patients were asked to empty their bladder and post void residual urine was measured along with prostate volume. Patients were given oral fluids and USG was repeated serially at three intervals with bladder volume of 100-200 ml, 200-300 ml and > 300 ml. Finally uroflowmetry was carried out followed by TRUS. Results were recorded in a tabulated form on 'Excel spread sheet'. Results: 1. Measurement of prostate volume increases with increase in bladder volume. 2. Calculated prostate volume at minimal bladder capacity (100-200 ml) was found to be the closest to the volume calculated by TRUS. Conclusion: Minimal bladder volume (100-200 ml) is essential for near correct estimation of prostate volume by USG. With increasing bladder volume, the volume of prostate increases disproportionate to its actual volume. [ABSTRACT FROM AUTHOR]

AIMS: To present our technique of Holmium Laser assisted "ANATOMICAL" enucleation of the benign prostatic adenoma (HoLEP) in 219 patients. Procedure is based on the principle of digital enucleation of the adenoma from its surgical capsule, but performed entirely by perurethral endoscopic technique assisted by Holmium Laser. MATERIALS AND METHODS: From March 2001 to November 2004, 219 patients under went HoLEP. After the initial cuts from bladder neck to verumontanum at 5 and 7 o'clock position, capsule is identified. The beak of the resectoscope sheath was inserted in the plane between the capsule and the adenoma and the adenoma was physically pushed away towards the urethra from the capsule. Laser was used to coagulate the bleeders, to cut the mucosal attachments and tough stromal tissue. Procedure was repeated for median and two lateral lobes. There was minimal bleeding and fluid absorption. Complications were few. RESULTS: In 206 cases successful enucleation of the adenoma was carried out. First 13 cases formed part of the learning curve and were completed by standard transurethral resection of prostate (TURP). IPSS score dropped from average of 23 to 8 and peak flow improved from <11 to >20. No patient had postoperative urinary incontinence or stricture. CONCLUSIONS: HoLEP is an effective alternative to TURP. Ultimate end results replicate the end results of open enucleation of BPH without its morbidity and have all the advantages of endoscopic surgery. It offers distinct advantages over standard TURP as the incidence of blood transfusion and fluid absorption are greatly minimized. [ABSTRACT FROM AUTHOR]

Objective: To present the outcome of dorsal onlay urethroplasty in 73 patients for stricture urethra over a period of eight years. Materials and Methods: Seventy-three patients of stricture urethra have undergone dorsal onlay urethroplasty from July 1998 to February 2006. Age distribution: 14-58 years. Etiology: Trauma 20/73 (27.39%), Balanitis Xerotica Obliterans 2/73 (2.73%), Iatrogenic 26/73(35.61%), Infection 3/73 (4.10%), Idiopathic 22/73 (30.13%). Site: Penobulbar-25/73, bulbar-38/73, membranous-8/73 and long length-2/73. Suprapubic catheter was inserted preoperatively: 21/73 patients. Preputial / distal penile skin was used in all patients. Buccal mucosa was not used in any patient. Hospitalization was for four to five days. Catheter was removed after 21 days. All patients had their first endoscopic checkup after three months. Subsequently they were followed up by uroflometry. Routine imaging of urethra for follow-up was not carried out. Results: 63/73 (86.30%) patients had satisfactory outcome not requiring any further treatment, 8/73 (10.95%) developed anastomotic stricture (3/8-optical internal urethrotomy, 5/8 dilatation alone). 2/73 (2.75%) developed external meatal stenosis. None had urinary fistula and required repeat urethroplasty. Follow-up ranged from three months to eight years. Conclusion: Dorsal onlay urethroplasty using preputial/distal penile skin is a satisfactory procedure. Preputial/distal penile skin is devoid of hair and fat and hence an ideal graft material. Even in circumscribed patients distal penile skin can be harvested. Long-term follow-up is required in judging results of patients with stricture urethra. [ABSTRACT FROM AUTHOR]