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Introduction: Retrograde intrarenal surgery (RIRS) is the standard treatment for renal calculi. Direct visualization and fragmentation are its major advantages. The variable stone clearance rates and the ergonomic challenges faced by urologists are a few limitations. Table tilt enhances stone clearance and improves surgical ergonomics by facilitating better access to stones and reducing procedural strain. Subjects and Methods: In this prospective study, patients with intrarenal calculi were randomized into standard lithotomy RIRS (S-RIRS) and table-tilted RIRS (T-RIRS) groups. Specified table tilts were suggested for each of the stone locations. The outcomes with regard to stone clearance, operative and lasing time, and ergonomics were studied. Results: About 100 patients were studied, with 50 in each group. The overall operating time and lasing time in the T-RIRS group were less than that in the S-RIRS group (P < 0.001). The complication rates were the same in both groups. Most surgeons felt that the surgical ergonomics was better in the T-RIRS group (P < 0.001). When stone-free status was analyzed, seven patients in the S-RIRS group and one in the T-RIRS group had residual stones. The mean Borg category-ratio 10 (CR-10) scores in the S-RIRS and T-RIRS groups were 4.18 and 2.20, respectively (P < 0.001). Conclusions: This is the first study to document the distinct advantages of T-RIRS and its benefits on surgical ergonomics. T-RIRS resulted in significantly shorter operative and lasing times, particularly for stones in lower calyces. Surgical ergonomics, assessed by the Borg CR-10 scale, were significantly better in the T-RIRS group. T-RIRS should become a standard of care for patients undergoing RIRS.

Diffusion of native defects such as vacancies and their interactions with impurities are fundamental to semiconductor crystal growth, device processing, and design. However, the transient equilibration of native defects is difficult to directly measure. We used (AlxGa1−x)2O3/Ga2O3 superlattices (SLs) to detect and analyze transient diffusion of cation vacancies during annealing in O2 at 1000–1100 °C. Using a novel finite difference scheme for diffusion with time- and space-varying diffusion constants, we determined diffusion constants for Al, Fe, and cation vacancies, including the vacancy concentration dependence for Al. In the case of SLs grown on Sn-doped β-Ga2O3 (010) substrates, gradients observed in the extent of Al diffusion indicate a supersaturation of vacancies in the substrates that transiently diffuse through the SLs coupled strongly to Sn and thus slowed compared to undoped cases. In the case of SLs grown on (010) Fe-doped substrates, the Al diffusion is uniform through the SLs, indicating a depth-uniform concentration of vacancies. We find no evidence for the introduction of VGa from the free surface at rates sufficient to affect Al diffusion at at. % concentrations, establishing an upper bound on surface injection. In addition, we show that unintentional impurities in Sn-doped Ga2O3 such as Fe, Ni, Mn, Cu, and Li also diffuse toward the surface and accumulate. Many of these likely have fast interstitial diffusion modes capable of destabilizing devices, thus suggesting that impurities may require further reduction. This work provides a method to measure transients in diffusion-mediating native defects otherwise hidden in common processes such as ion implantation, etching, and film growth.

Pseudoepitheliomatous hyperplasia (PEH) is a benign condition marked by reactive epithelial proliferation seen in response to various insults like trauma, infection, persistent inflammation and neoplasia. In this report, we discuss a case of a 35-year-old man who presented with a perineal swelling, later turned into a non-healing ulcer, first diagnosed as PEH. Still, after clinical suspicion, a deeper biopsy was conducted, confirming the diagnosis of squamous cell carcinoma and directing treatment appropriately. Non-healing perineal lesions are not uncommon. Most of the lesions turn out to be Squamous Cell Carcinoma. But, if the histopathological picture suggests Pseudoepitheliomatous Hyperplasia, it is vital to consider the limitations of the biopsy, and a solid clinicopathological correlation is required to look aggressively for underlying Squamous Cell Carcinoma. Due to the benign nature of PEH, most cases are treated via excision biopsy, while grafts or flaps are occasionally required to restore severe tissue defects. It is therefore crucial to rule out and distinguish this condition from other benign and malignant conditions, as the treatment and prognosis differ widely. It is of utmost importance to sample the base of the lesion, analyze multiple sections, and consider clinical data to ensure an accurate diagnosis.

Abstract In this work, a systematic photoluminescence (PL) study on three series of gallium oxide/aluminum gallium oxide films and bulk single crystals is performed including comparing doping, epitaxial substrates, and aluminum concentration. It is observed that blue/green emission intensity strongly correlates with extended structural defects rather than the point defects frequently assumed. Bulk crystals or Si-doped films homoepitaxially grown on (010) β-Ga2O3 yield an intense dominant UV emission, while samples with extended structural defects, such as gallium oxide films grown on either (-201) β-Ga2O3 or sapphire, as well as thick aluminum gallium oxide films grown on either (010) β-Ga2O3 or sapphire, all show a very broad PL spectrum with intense dominant blue/green emission. PL differences between samples and the possible causes of these differences are analyzed. This work expands previous reports that have so far attributed blue and green emissions to point defects and shows that in the case of thin films, extended defects might have a prominent role in emission properties.

We demonstrate a new substrate cleaning and buffer growth scheme in β-Ga2O3 epitaxial thin films using metal–organic vapor phase epitaxy (MOVPE). For the channel structure, a low-temperature (LT, 600 °C) un-doped Ga2O3 buffer was grown, followed by a transition layer to a high-temperature (HT, 810 °C) Si-doped Ga2O3 channel layers without growth interruption. The (010) Ga2O3 Fe-doped substrate cleaning uses solvent cleaning, followed by additional hydrofluoric acid (49% in water) treatment for 30 min before the epilayer growth. This step is shown to compensate the parasitic Si channel at the epilayer–substrate interface that originates from the substrate polishing process or contamination from the ambient. From secondary ion mass spectroscopy (SIMS) analysis, the Si peak atomic density at the substrate interface is found to be several times lower than the Fe atomic density in the substrate—indicating full compensation. The elimination of the parasitic electron channel at the epi–substrate interface was also verified by electrical (capacitance–voltage profiling) measurements. In the LT-grown (600 °C) buffer layers, it is seen that the Fe forward decay tail from the substrate is very sharp, with a decay rate of ∼9 nm/dec. X-ray off-axis rocking curve ω-scans show very narrow full width at half maximum (FWHM) values, similar to the as-received substrates. These channels show record high electron mobility in the range of 196–85 cm2/V⋅s in unintentionally doped and Si-doped films in the doping range of 2 × 1016–1 × 1020 cm−3. Si delta-doped channels were also grown utilizing this substrate cleaning and the hybrid LT buffers. Record high electron Hall mobility of 110 cm2/V⋅s was measured for sheet charge density of 9.2 × 1012 cm−2. This substrate cleaning, combined with the LT buffer scheme, shows the potential of designing Si-doped β-Ga2O3 channels with exceptional transport properties for high-performance Ga2O3-based electron devices.

We report on vertical β-Ga2O3 power diodes with oxidized-metal Schottky contact (PtOx) and high permittivity (high-κ) dielectric (ZrO2) field plate to improve reverse blocking at both Schottky contact surfaces and edges. The PtOx diodes showed excellent forward transport with near unity ideality factor and similar minimum specific on-resistance as Pt. Moreover, the PtOx contacts facilitated higher breakdown voltage and lower leakage current due to their higher Schottky barrier height (SBH) by more than 0.5 eV compared to that of Pt. Most importantly, the reduced off-state leakage of PtOx diodes enabled orders of magnitude less power dissipation than Pt ones for all duty cycles ≤0.5, indicating their great potential to realize low-loss and efficient, high-power β-Ga2O3 switches. The ZrO2 field-oxide further reduced edge leakage with a consistent increase in breakdown voltage. Device simulation demonstrated that the high permittivity of ZrO2 also led to the peak electric field occurring in β-Ga2O3 instead of the dielectric. These results indicate that the combined integration of oxidized-metal contacts to increase SBH and high-κ dielectric field plate to assist edge termination can be promising to enhance the performance of vertical β-Ga2O3 Schottky diodes.

Summary: De novo genome assembly is a fundamental problem in computational molecular biology that aims to reconstruct an unknown genome sequence from a set of short DNA sequences (or reads) obtained from the genome. The relative ordering of the reads along the target genome is not known a priori, which is one of the main contributors to the increased complexity of the assembly process. In this article, with the dual objective of improving assembly quality and exposing a high degree of parallelism, we present a partitioning-based approach. Our framework, BOA (bucket-order-assemble), uses a bucketing alongside graph- and hypergraph-based partitioning techniques to produce a partial ordering of the reads. This partial ordering enables us to divide the read set into disjoint blocks that can be independently assembled in parallel using any state-of-the-art serial assembler of choice. Experimental results show that BOA improves both the overall assembly quality and performance.

Objectives: Post-transurethral resection of prostate urethral stricture (PTS) is a well-documented delayed complication following transurethral resection of the prostate (TURP). The aim is to analyze various risk factors of PTS and see if the overall incidence is underreported. Materials and Methods: A retrospective study was conducted in our institution between January 2017 and December 2018 in men who underwent TURP. Data obtained from the medical records department were analyzed. Statistical analysis was done using Fisher's exact test. A two-tailed P < 0.05 is considered statistically significant. Results: Of the 447 men who underwent TURP, 57 developed PTS. Fifteen of 334 patients who underwent calibration before the procedure developed stricture compared to 42 of 137 without calibration (P < 0.01). There was a significantly lesser incidence of stricture with 24 Fr resectoscope compared with 26 Fr sheath (P < 0.04). Two patients with 24 Fr Foley and 30 of 35 (86%) patients with 22 Fr Foley catheter developed stricture of urethra. Distal bulbar urethra was the most common site of narrowing following TURP. Eighteen patients had Salvaris swab placed for traction and 12 patients required full-thigh traction, of which majority developed meatal stenosis. Conclusions: TURP is one of the common surgical procedures performed by urologists. Meatitis and meatal stenosis, if included as complications of TURP, would increase the overall incidence of PTS. Factors such as the size of resectoscope sheath used, size of catheter inserted, placement of Salvaris swab traction, and preoperative calibration of urethra have a significant impact on the ultimate outcome.

The natural location of the kidney is the loin and the fascial sheaths around it gives it inherent protection against trauma and various other diseases. While there is enough evidence for fascia around well ascended normally located kidneys, there is very little evidence for its presence in ectopic pelvic kidneys. This evidence-based review discusses the recent changes in concepts regarding renal and perirenal fascia in normal and ectopic kidneys. The perirenal fascia was described as anterior and posterior layers that fuse laterally to form the lateral conal fascia. However, subsequent studies have shown that these fasciae are multi-laminated structures that blend and fuse with underlying muscles. However, in pelvic kidneys, the anterior and posterior renal fascia is not so well-documented. The medial extension of the enlarged kidney enables an easy cross-over to the opposite side. A subcapsular urinoma or a perirenal hematoma is usually self-contained in a closed space, owing to the attachments of the renal capsule and the perirenal fasciae. The hematoma in such closed space acts as a self-tamponade, preventing further blood loss or hemodynamic instability. Computed tomography has enhanced the understanding of perirenal space and pathologies. Tri-compartmental theory formed the basis for a clear understanding of these fasciae. A better knowledge of these fascial planes helps the surgeons to identify the avascular planes, better. A larger prospective study is needed to get further insights into renal fascia in pelvic kidneys.

Introduction Multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) is a rare subtype of clear cell renal cell carcinoma (ccRCC) accounting for 2-4% of RCC. It is defined as a neoplasm that is composed entirely of numerous cysts surrounded by fibrous capsule and septa containing clear cells without expansile growth or mural nodules (WHO 2016). The purpose of this manuscript is to highlight that it is imperative to identify this entity by strict histological criteria and distinguish this entity from cystic ccRCC due to its low malignant potential, excellent prognosis with no recurrence or metastasis. Case report A 46-year-old male presented with continuous mild loin pain for a month. There were no lower tract urinary symptoms. Ultrasound abdomen showed left lower pole renal mass. CECT-KUB was done as a definitive investigation which showed a solitary left lower pole renal cystic lesion with enhancement of size 3.8x3.6cm (Bosniak IV). As per CT findings, the patient underwent Laparoscopic partial nephrectomy. Histopathological examination showed multiple cysts with thin septal walls possessing clear cells with low-grade nuclei. 2 years of follow-up postoperatively with imaging studies revealed no recurrence or metastasis. Conclusions The purpose of this report is to emphasize the need to identify this entity by strict histological criteria as per WHO guidelines, as imaging studies were more often inconclusive. Urologists should have an adequate understanding such an entity. Almost all cases are amenable to partial nephrectomy irrespective of size and no documented evidence of recurrence and metastasis which mandates less stringent follow up postoperatively as compared to ccRCC.

A new phase-transformation-induced path to spontaneous formation of extreme nanograin structure is reported. In-situ-heating-mode-microscopy exhibited a substantial grain-growth of Cu6Sn5. During cooling, the grain-growth continued, but it spontaneously switched to grain-refinement mode on phase transformation through ∼180 °C from η-Cu6Sn5 to η’-Cu6Sn5, ending up with an extremely small nanograin size of ∼2.5 nm. The cooling cycling always restores the nanograin size regardless of thermal exposure history, making this to be the first demonstration to stabilize the nanograin with its own spontaneous behavior. The Young’s Modulus was significantly reduced by ∼×3, and the elongation was remarkably increased by ∼×8 to ∼9%.

Gallium Oxide has undergone rapid technological maturation over the last decade, pushing it to the forefront of ultra-wide band gap semiconductor technologies. Maximizing the potential for a new semiconductor system requires a concerted effort by the community to address technical barriers which limit performance. Due to the favorable intrinsic material properties of gallium oxide, namely, critical field strength, widely tunable conductivity, mobility, and melt-based bulk growth, the major targeted application space is power electronics where high performance is expected at low cost. This Roadmap presents the current state-of-the-art and future challenges in 15 different topics identified by a large number of people active within the gallium oxide research community. Addressing these challenges will enhance the state-of-the-art device performance and allow us to design efficient, high-power, commercially scalable microelectronic systems using the newest semiconductor platform.

This paper reports on the modulation of Schottky barrier heights (SBH) on three different orientations of β-Ga2O3 by insertion of an ultra-thin SiO2 dielectric interlayer at the metal-semiconductor junction, which can potentially lower the Fermi-level pinning (FLP) effect due to metal-induced gap states (MIGS). Pt and Ni metal-semiconductor (MS) and metal-interlayer-semiconductor (MIS) Schottky barrier diodes were fabricated on bulk n-type doped β-Ga2O3 single crystal substrates along the (010), (-201) and (100) orientations and were characterized by room temperature current-voltage (I-V) and capacitance-voltage (C-V) measurements. Pt MIS diodes exhibited 0.53 eV and 0.37 eV increment in SBH along the (010) and (-201) orientations respectively as compared to their respective MS counterparts. The highest SBH of 1.81 eV was achieved on the (010)-oriented MIS SBD using Pt metal. The MIS SBDs on (100)-oriented substrates exhibited a dramatic increment (> 1.5 ×) in SBH as well as reduction in reverse leakage current. The use of thin dielectric interlayers can be an efficient experimental method to modulate SBH of metal/Ga2O3 junctions.

Immunoglobulin G4 related disease (IgG4-RD) is a systemic fibro inflammatory condition that usually presents with multiorgan involvement. We present a rare case of 54 year old male with an isolated IgG4-RD of epididymis. The patient presented with a progressive swelling of the left testicle. A clinical diagnosis of tuberculosis was made. Ultrasound scrotum showed a relatively hetero-echoic mass lesion involving the left epididymis in close proximity to the left testis. There was a focal spindle cell proliferation and an increase in number of plasma cells and keloid like collagen. Immunohistochemistry was positive for vimentin and IgG4 and negative for CD34. Serum level of IgG4 was elevated (165 mg per dL). Computed tomography of abdomen and thorax did not show any systemic involvement. HE was posted for excision of the epididymal mass. Intraoperatively, the mass was found to be densely adherent to left testicle and inseparable from it, necessitating left total orchiectomy. Histopathology and immunohistochemistry with elevated serum IgG4 levels confirmed the diagnosis of IgG4-RD of the epididymis. To the best of our knowledge, this condition is an extremely rare entity, with only very few cases of isolated IgG4-RD of epididymis reported in medical literature, with no other systemic manifestations.

Background: Tuberculosis (TB) continues to be the commonest infectious disease cause of death worldwide. Tuberculosis is an important infectious disease cause of morbidity and death in renal transplant recipients. Tuberculosis can also cause loss of kidney allograft. Objectives: The purpose of this viewpoint is to highlight the issues related to prevention, diagnosis and treatment of tuberculosis in renal transplant recipients. Methods: The PubMed database was searched for publications and guidelines on diagnosis and management of LTBI in renal transplantation. Publications on renal allograft recipients with LTBI and TB in post-operative period were also analysed. Specialist Society guidelines were also used. Findings: Tuberculosis is one of the most important infectious disease-related causes of morbidity and death in transplant recipients. LTBI in allograft recipients continues to be a clinical management problem. It can occur either from donor kidney or from endogenous reactivation of latent tuberculosis infection or from acquiring new Mycobacterium tuberculosis infection. Tuberculosis can also cause loss of kidney allograft. Conclusions: Kidney transplantation is now universally performed in high and low Tuberculosis endemic countries. A high index of awareness of the possibility of TB disease or LTBI is required prior to renal transplant aligned to reduce renal allograft damage, morbidity and death due to tuberculosis. WHO Management recommendations for LTBI screening and treatment should be followed. Keywords: Latent tuberculosis infection (LTBI), Renal transplantation, Interferon gamma assay, Tuberculin skin test, Allograft, Immune suppression

Introduction: The overall incidence of the renal masses is on the rise. With better imaging modalities more of these masses are picked up earlier. Most of the times, the diagnosis is confirmed after radical nephrectomy. More often there is an inherent tendency to offer overtreatment in cases of benign renal masses. Renal biopsy to discriminate benign from malignant masses can be very useful in such instances but are more invasive. Grey Level Co-Occurence Matrix (GLCM) is recognized as the most representative radiological parameter to define the heterogeneity of solid renal masses. Aim: To identify certain radiological parameters that might help us to differentiate the benign from malignant renal masses, obviating the need for a biopsy. Materials and Methods: This was a prospective study done over three years from June 2014 to May 2017. A total of 188 patients were included. These patients were equally divided into two broad groups of 94 patients each: Group 1 was patients with renal mass, of which 67 were malignant and 27 were benign. The group 2 was the control group. We used the active contour method to delineate the renal mass and study the features in them. Data analysis for each feature was individually calculated with the help of Sigma Stats 4.0 software and one-way ANOVA analysis. Results: Six CT parameters showed significant data that helped the clinician to differentiate the benign from the malignant renal masses. From the study it was evident that the parameters namely, entropy, energy, sum average, sum variance, inertia and low gray level emphasis were found to be statistically significant which helps the clinician to differentiate the benign from the malignant renal masses. Conclusion: Our data shows that GLCM parameters are crucial tool for the determination of the solid mass composition of tumour. This obviates the need for an invasive procedure like Ultrasound or a CT guided biopsy of the mass.

Introduction: Genito Urinary Tuberculosis (GUTB) is a widespread disease seen in urology practice. The true incidence and prevalence of GUTB is difficult to estimate because a large number of patients remain asymptomatic. Aim: To recognize typical and atypical clinical and radiological features of tuberculosis and to emphasize the need for diagnosing GUTB early. Materials and Methods: This was a retrospective study conducted in 110 cases of GUTB diagnosed and treated in two teaching institutions over a period of three years, from July 2002 to June 2005. A detailed history, thorough clinical examination, urine examination, culture for tubercle bacillus, imaging studies, cystoscopy and histological and serological examination were done to arrive at a diagnosis. Results: Fifty six patients (51%) were in the age group of 21-40 years. The male: female ratio was 1.4: 1. Loin pain was the most common symptom observed in 27% of the patients. Intravenous Urogram (IVU) revealed non-visulalised kidney in 25 patients (23%), hydronephrosis or hydrouretero nephrosis in 34 patients (31%) and distortion, cavitation or scarring of the calyces in 16 patients (14.5%). Five of them had thimble bladder. In 14 patients, IVU appeared normal. About 28 patients (25%) were treated conservatively with anti tuberculosis therapy. Twenty one of them (19%) underwent Nephrectomy and 10 patients had reconstructive procedures. Conclusion: A peculiarity of most of our patients was a late presentation with advanced disease. Most patients were asymptomatic or ignorant. Slow but continuous infection causes a destruction of renal parenchyma and the healing process leads to renal parenchymal loss. If identified early and treated appropriately, GUTB is a curable condition.

Gonadal vein aneurysm is a very rare anomaly and the aetiology is often unknown. Many factors have been said as contributory such as multiple pregnancies, multiple pelvic surgeries, pelvic tumours or pelvic congestion, but none of them have been strongly or closely associated with the lesion. Here, we present a case of left gonadal vein aneurysm in a female with its management. A 72- year-old, diabetic and hypertensive female presented with complaints of left loin pain. She is multiparous with four normal vaginal deliveries. On evaluation, she was diagnosed to have 4 cm left gonadal vein aneurysmal mass with internal thrombus causing hydronephrosis due to mass compression and perilesional adhesions. She underwent left gonadal vein aneurysm excision. Many treatment options are available such as endovascular– embolization/sclerotherapy. In the presence of thrombus and dense adhesions, as noted in our case, it is best to do open surgery for safety of the patient and obtain a good outcome.

Paratesticular region is an obscure anatomical region that includes spermatic cord and its contents, tunica of the testes, epididymis and appendices of epididymis and testis. Paratesticular tumours may closely resemble and be clinically indistinguishable from testicular tumours, resulting in a diagnostic dilemma. Preoperative distinction between the benign and malignant paratesticular tumour is extremely difficult, resulting in difficulty in diagnosis and management. We hereby present a case of a 56-year-old male who reported with a painless bilateral scrotal mass and underwent surgical excision of the same. The final biopsy report was paratesticular leiomyoma. The main purpose of this manuscript is to emphasize on the fact that it is imperative for the treating urologists to be aware of such potentially benign rare entity. A high index of clinical suspicion is mandatory, as lack of knowledge about this condition would result in an unnecessary radical orchidectomy.

Primary epithelial tumour of the renal pelvis is a rare entity. So far, very few cases are reported in literature. Of these, mucin secreting adenocarcinomas are distinctly rare. However, mucinous cystadenocarcinoma, that too arising in a horse shoe kidney is extremely rare to be reported. Mucinous cystadenomas and carcinomas arising from the renal pelvis are regarded to be secondary to a metaplastic change in the urothelium. Here, we present a case of a 51-year-old male, who complained of abdominal pain, palpable abdominal mass, haematuria along with passage of mucoid material in the urine, with a very poorly functioning kidney. A pre-operative diagnosis of horse shoe kidney with pelvi ureteric junction obstruction and a poorly functioning kidney was made. Intraoperative findings and frozen section biopsy were suggestive of mucin secreting cystic mass and a right heminephrectomy was done. The final histopathology was suggestive of mucinous cystadenocarcinoma of the renal pelvis of the right moiety. This case is presented for its rarity, diagnostic challenges faced and the lessons learnt, stressing on the need for having a high index of clinical suspicion in making such diagnosis.

Introduction: Supra-costal Percutaneous Nephrolithotomy (PCNL) procedure has now become an established standard of care in patients with renal stone disease, in terms of morbidity, stone clearance, duration of stay and shorter convalescence period. Gone are the days when supracostal punctures were considered to be associated with a high morbidity. With increased expertise gained in performing multiple punctures and further refinements in focusing techniques, more and more of these procedures are being performed with an intention to achieve a maximum stone clearance with least morbidity. Aim: To prospectively analyze the various factors that predict the safety, efficacy and stone clearance rate in patients who have undergo supracostal punctures for PCNL procedures. Materials and Methods: Three hundred seventy six patients underwent PCNL for renal stones. Ninety two (n=92) of them needed supra-costal puncture. All patients were subdivided into groups 1 and 2 based on the size, location of the stone and the stone burden. In all, 132 tracts were established. Results: About 83% of patients achieved a complete stone free rate after initial PCNL. Stones more than 3 centimeters were found to be associated with significant residual stones. Radio opacity under image intensifier also had a significant impact on the ultimate stone free status. About 23% of those (n=5/22) who needed longer duration of surgery had a clinically significant residual stones, needing ancillary procedures. Fifteen patients (16%) had complications related to the procedure, of which 13 were in group 1 (87%). High percentage of complications in patients with larger stone burden was found to be statistically significant. In about 76% (n=70), the procedure required only less than 90 minutes. Also, in those 22 patients in whom the duration of procedure exceeded 90 minutes, 12 of them had complications, with a p-value of

Granulomatous inflammation is a distinctive pattern of chronic inflammatory reaction characterized by accumulation of epithelioid histiocytes and multinucleate giant cells. The cause of granulomas can be infectious or non-infectious. Granulomas have been described within the stroma of malignancies like carcinomas of the breast and colon, seminoma and Hodgkin′s lymphoma, where they represent T-cell-mediated reaction of the tumor stroma to antigens expressed by the tumor. Granulomatous reaction in association with renal cell carcinoma (RCC) is uncommon, with only few published reports in the literature. We describe three cases of conventional (clear cell) RCC associated with epithelioid granulomas within the tumor parenchyma.

Purpose: To assess the effects of transplant renal artery stenosis (TRAS) on blood pressure, renal function, and graft survival. To assess the usefulness of Doppler in predicting the clinical significance of TRAS and also to identify the predictive factors in Doppler that correlated with clinical features of TRAS. Materials and Methods: A prospective study was done on consecutive renal allograft recipients at Christian Medical College, over a period of 66 months from January 2002. All recipients underwent Doppler ultrasound (DUS) evaluation on the fifth post-operative day. Subsequent evaluation was done if the patients had any clinical or biochemical suspicion of TRAS. Angiogram was done in case of a high index of suspicion of significant stenosis or before angioplasty and stenting. The clinical and radiological outcomes of the patients with symptomatic or asymptomatic TRAS were analyzed. Results: Five hundred and forty three consecutive renal allograft recipients were analyzed, of whom, 43 were found to have TRAS. Nine recipients (21%) were detected to have TRAS on first evaluation. All had a high peak systolic velocities (PSV) recorded while 25 of them had other associated features. Patients with only high PSV required no further intervention and were followed up. They had a pretransplant mean arterial pressure (MAP) of 107.83 mmHg (SD = 13.32), ranging from 90 to 133 mm Hg and a posttransplant MAP of 106.56 mmHg (SD =16.51), ranging from 83 to 150 mm Hg. Their mean nadir serum creatinine was 1.16 mg% (SD = 0.24), at detection was 1.6 mg% (SD = 1.84) and at 6 months follow-up was 1.26 mg% (SD=0.52). Of the remaining 25 patients with other associated Doppler abnormalities, 11 required further intervention in the form of re-exploration in 2, angioplasty in 3 and stenting in 6 patients. One patient in the group of patients intervened, expired in the immediate post-operative period due to overwhelming urosepsis and consumption coagulopathy. The mean creatinine clearance (Cockroft-Gault method) in this group of remaining 10 patients, before and after intervention was 44.75 ml/min (SD=17.85) and 68.96 ml/min (SD = 10.56), respectively, with a mean increase by 24.21 ml/min (P=0.000). The mean arterial pressure before and after intervention in this group were 132.80 mm Hg (SD = 13.22) and 102 mm Hg (SD = 10.55), with a decline in the MAP by 30.80 mmHg (P=0.017). The haemoglobin levels also increased from 11.72 (SD=2.13) to 12.48 gm% (SD = 1.75), with a mean increase by 0.76 gm% (P=0.05). Conclusions: Patients with isolated high PSV do not have a significant alteration of blood pressure or allograft function and required no intervention. Although high PSV with associated Doppler anomalies are more suggestive of significant TRAS, the decision regarding surgical intervention is largely based on clinical assessment.

Tuberculosis (TB) is one of the major health problems that our country is facing today. Despite active interventions by our government, control of TB still remains to be achieved. The emergence and exponential growth of the human immunodeficiency virus and drug-resistant strains threaten to further complicate the TB situation in our country. Even in this era of advanced chemotherapy, many lives are lost every day in our country. Tuberculosis of the urinary tract, despite being one of the commonest forms of extra-pulmonary TB, is generally overlooked. Most patients present with vague lower urinary symptoms typical of urinary tract infection. In this article, we shall highlight the various issues related to the surgical management of renal and ureteral tuberculosis.

A 55-year-old man with Glanzmann′s thrombasthenia had recurrent episodes of gross painless hematuria for the past 30 years. His last episode of hematuria occurred a month ago, associated with pain in the right loin and was diagnosed to have a right mid-ureteric calculus. Under adequate platelet cover, he underwent right ureteroscopy. Postoperatively, he had persistent significant hematuria that did not improve despite repeated platelet transfusions. Factor VIIa was also transfused, without much benefit. A ureteroscopy was done, which identified bleeding from within the renal pelvis. CT angiogram confirmed the rupture of an artery supplying the interpole segment of the right kidney. Bleeding settled after angioembolization. Indiscriminate use of platelet transfusions would result in a state of platelet refractoriness. It is also important to suspect an iatrogenic cause for any complication that occurs after a surgical procedure, even if there could be an underlying medical etiology that can be attributed to the development of such complication.

Isolated tuberculous orchitis is a rare entity. The coexistence of tuberculosis of the testis with filarial worm infestation is even more rare. In this report, we present a case of tuberculous involvement of the testis, associated with filarial worm infestation in the spermatic cord that presented as a testicular tumor. A 55-year-old male presented with unilateral testicular swelling of four months duration. As the clinical evaluation was suggestive of testicular malignancy, he underwent a right high orchidectomy. The histopathology report revealed isolated tuberculous orchitis without epididymal involvement along with filarial infestation of the spermatic cord.

Objectives: The aim of this review was to review the available evidence in literature for the clinical effectiveness of Bethanechol Chloride in patients with detrusor underactivity. Materials& Methods: We searched all relevant data from Medline and peer-reviewed journals available online on the use of bethanechol in patients with detrusor underactivity. Results: Most reports that suggest a therapeutic clinical benefit with use of bethanechol have all been anecdotal reports and there is no definite clinical evidence available till date to support its clinical usefulness. Conclusion: The current available data have shown to offer no definite benefit with the use of parasympathomimetic agents in patients with DU. One of the meta-analysis has shown bethanechol to be ineffective in promoting bladder emptying.