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Objective: To define the role of tadalafil in improving outcomes of redo urethroplasty for pelvic fracture urethral injury (PFUI). PFUI is common in developing countries, invariably as a result of road traffic trauma. Repair is complex, and redo cases are even more challenging. Material and methods: This was a longitudinal prospective nonrandomized study between 2017 and 2019. Men undergoing redo-urethroplasty were nonrandomized into two groups. Group 1 received tadalafil 5 mg the next day after surgery and continued for 3 months, and group 2 did not receive tadalafil. Inclusion criteria were patients undergoing redo-urethroplasty willing to trial low-dose tadalafil post-operatively. Exclusion criteria were 1 endoscopic intervention. Primary success was 83.3%. Success with tadalafil was 96.6%, compared to 71.0% in the non-Tadalafil group (P = .0008). Only one patient on tadalafil failed, compared with nine in the non-tadalafil group. Secondary success rate was defined as the need for a single subsequent endoscopic intervention and was 93.3%. Conclusion: In our series, there was improved outcome with using tadalafil in patients having redo urethroplasty for PFUI. Further trials should be done to evaluate the use in all PFUI cases.

Objective The urethral gap in pelvic fracture urethral injury (PFUI) is traditionally assessed using voiding cystourethrogram (VCUG) and retrograde urethrogram (RGU). Magnetic resonance imaging (MRI) is performed in complex cases. We assessed the refined "Joshi" MRI protocol to evaluate complex urethral defects after PFUI. Material and methods A prospective study was conducted at our center from January 2018 to January 2020, involving patients aged >18 years with PFUI, suitable for MRI, and those who gave consent to perform standard RGU, VCUG, and MRI using standard and "Joshi" protocol. Forty men were included in the study. Distance between urethral/prostatic stumps was measured. Image quality was scored by four radiologists and four urologists. The surgical approach and type of PFUI repair were noted. We also established the need for inferior pubectomy by assessing the position of the posterior urethra (membranous) in relation to a horizontal line drawn from the lower edge of the pubic bone anteriorly to the rectum posteriorly in a sagittal image. Results The mean age was 30 years (SD, 5.25; range, 21-43), and the time from injury to imaging was 4 months (3-10 months); 40% of the men underwent crural separation, 57.5%, inferior pubectomy, and 2.5%, crural rerouting. There was a difference of 0.3 to 1.1 cm in the urethral gap measurements between MR images using the standard versus "Joshi" technique. MRI identified complex injuries such as rectourethral fistula, the need for inferior pubectomy, and the orientation of the posterior urethra. Urologists' and radiologists' satisfaction scores for the MR images were satisfactory to excellent. If the posterior urethra was over the defined mark, there was a 100% likelihood of inferior pubectomy (23/40 patients). Conclusion MR image acquisition using the "Joshi" protocol provided high-quality anatomical information in PFUI cases to assist with surgical planning.

Urethral stricture disease continues to be a prevalent condition with significant morbidity. Oral mucosal graft augmentation urethroplasty for long segment bulbar urethral strictures is an established management option. Here the authors outline the results of their pilot study designed to evaluate the efficacy of using two innovative steps for graft augmentation.

Introduction: Panurethral strictures represent a complex subgroup of urethral strictures. Lichen sclerosis is the commonest cause for these strictures. We outline the management of panurethral strictures in this review. Material and Methods: Our institute is a tertiary referral center. We evaluated panurethral strictures (primary and redo cases) managed at our institute over the last 20 years (June 1995-June 2015) using single stage Kulkarni one- sided urethroplasty with oral mucosal graft. Patients with incomplete medical records were excluded from the study. Data was analysed for primary or redo case, age, cause of stricture, length of stricture, follow up and success rate. Success was defined as no requirement of any further intervention. Follow up was carried out every 3 months in the first year and every year thereafter. Follow up included clinical examination and uroflow. This is a non-analytic study and descriptive analysis was carried out. Results: 318 (283 primary and 35 redo) cases of panurethral strictures were managed at our institute over last 20 years. Lichen sclerosis was seen in 184 (57.84%) cases. 84.9% (primary 89.39% and redo 57.85%) cases were successful. Age range of patients was 20-76 years (median 44.6 years) with stricture length from 10-19 cms. Follow up was at regular intervals using uroflow assessment. Median follow up was 59 months (range 6.4 to 192). Conclusion: Lichen sclerosis is the commonest cause for panurethral strictures. Kulkarni one-sided panurethroplasty offers a single stage surgery with acceptable outcomes and avoids inclusion of genital skin as seen in staged procedures.

Xanthogranulomatous Pyelonephritis (XGP) is a rare condition characterised by chronic granulomatous inflammation of renal tissue [1,2]. This can be due to obstruction, urinary tract infection and renal calculi [1-5]. The exact pathophysiology and progression of this condition is poorly understood, but altered immune response, changes in lipid metabolism, disturbances in leukocyte function, lymphatic obstruction, venous occlusion/haemorrhage, malnutrition, arterial insufficiency and necrosis of pericalyceal fat [2,4]. Its management with surgical intervention in the form of nephrectomy, partial or complete, is the most definitive management option of this condition [1]. We report the case of a woman with isolated xanthogranuloma obstructing the pelviureteric junction. We propose this as the initial pathophysiological process of Xanthogranuloma pyelonephritis.

A 57-year-old male presented with right upper abdominal lump since 3 months. He was diagnosed to have a hepatic artery aneurysm. He was investigated thoroughly but no cause was found. He was subjected to endovascular embolisation of the aneurysm using endovascular coils. Subsequently the aneurysm was completely occluded. Hepatic artery aneurysms are very rare among all visceral aneurysms. We report this rare case of hepatic artery aneurysm presenting as an abdominal lump. This case highlights the importance of early diagnosis and management of this rare entity as a rupture may be catastrophic.