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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.

To examine the long-term oncological outcomes and urological morbidity of low-dose-rate prostate brachytherapy (LDRBT) monotherapy using live intraoperative dosimetry planning and an automated needle navigation delivery system for the treatment of men with low and intermediate-risk prostate cancer.A prospective database of 400 consecutive patients who underwent LDRBT between July 2003 and June 2015 was retrospectively reviewed to assess urinary side-effects and biochemical progression, based on the Phoenix definition and also a definition of a prostate-specific antigen (PSA) level of ≥0.2 μg/L.Minimum patient follow-up was 5.5 years. The median follow-up of the entire cohort was 11.8 years. The median (range) PSA level was 6.1 (0.9-17) μg/L and the median Gleason score was 3 + 4. The biochemical relapse-free survival (RFS; freedom from biochemical recurrence) based on the Phoenix definition was 85.8% (343/400). The RFS using a 'surgical' definition of a PSA level of0.2 μg/L was 71% (284/400). Of the 297 men followed for ≥10 years, prostate cancer-specific survival (PCSS) was 98% (291/297). Post-LDRBT urethral stricture developed in 11 men (2.8%, 11/400). For men with ≥10 years of follow-up, 22 men (7.4%, 22/297) required a pad for either stress or urge urinary incontinence (UI). UI was identified in only 2.2% (one of 46) of men who had a bladder neck incision (BNI) before LDRBT.LDRBT is associated with excellent PCSS, with a median follow-up of 11.8 years. The risk of post-implantation urethral stricture and UI is low and a pre-implantation BNI for management of bladder outflow obstruction does not increase the risk of UI or urethral stricture.

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.

Urinary tract infections (UTIs) commonly occur in children. An estimated 8% of girls and 2% of boys will have at least one episode by seven years of age. Of these children, 12-30% will experience recurrence within one year. Australian hospital admission records indicate that paediatric UTIs represent 12% of all UTI hospital admissions.The aim of this article is to review the pathogenesis, clinical assessment and management of UTIs, and prevention strategies in children.Clinically, paediatric UTI presentations are challenging because symptoms are vague and variable. Young infants may present with sepsis or fever and lack specific symptoms, whereas older children present with classical features such as dysuria, frequency and loin pain. Early diagnosis with appropriate urine specimen collection techniques, investigations and treatment is necessary for prevention of renal damage and recurrence. Effective, evidence-based investigations and treatment options are available, and physicians should feel confident in identifying and managing paediatric UTIs.

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.