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BACKGROUND The selective alpha-blockers are widely used in the clinical treatment for ureteral stones as MET (Medical Expulsive Therapy). American Urological Association and European Association of Urology, strongly recommend that patients with ureteral stones be alpha-blockers to promote stone passage. Due to the physiological effect of alpha-blockers on the ureter, researchers hypothesized that the use of alphablockers before ureteroscopy may help during the Ureteroscopic procedures, making it easier and safer. One critical step in doing ureteroscopy is directing scope into vesicoureteral junction as most of the time its non-dilated and this is place injury and later stricture chances are high which lead to failure of treatment.3 But in literature, there is a discrepancy with this hypothesis as some studies have failed to demonstrate the benefits of technical ease and lower complication rate with alpha-blocker being used in the preoperative period. METHODS We conducted a cross sectional study in the department of urology from January 2019 to January 2020. 30 patients of ureteric calculus on alpha-blocker therapy and 30 patients of BPH on alpha-blocker ± 5 alpha reductase therapy were included for study. During URSL (Ureteroscopic Lithotripsy) we used 6 / 7.5 fr URS (Ureterorenoscope), ease of admitting URS in vesicoureteral junction noted. The need for ureteral dilator for admitting URS, presence of mucosal injury, and bleeding or false passage noted as difficulty in instrumentation. And documentation of finding done in excel. RESULTS Out of 60 patients, 24 (40 %) patients didn’t need dilatation of ureteric orifice and Ureteroscopy was done easily among which 8 (33.33 %) were BPH patient and 16 (66.66 %) were ureteric calculus patient this difference is statistically significant with p-value 0.010. 36 (60 %) patients needed dilatation of ureteric orifice to facilitate URS of which 22 (61.11 %) patients were from the BPH group and 14 (38.88 %) are ureteric calculus group. The study shows a statistically significant difference with p-value 0.029. CONCLUSIONS Our study demonstrates that alpha-blockers failed to show a statistically significant difference in relaxation of the ureteric orifice in non-ureteric calculus patients. Further large group, multi-centric studies are required to find a definitive role for alpha blockers prior to URS. KEYWORDS BPH, Silodosin, Ureteroscopy, Ureteric Orifice, Alpha Blocker, Alpha 1a, Medical Expulsion Therapy

Objective: We aimed to describe a novel method to attain direction and control of the guidewire at the fingertip. This will serve to allow for ease of guidewire placement during open and combined open and endoscopic surgery. Subjects and methods: Over a gloved hand, a ureteric catheter is placed over the index finger, with the distal tip over the distal end of the index finger. Thereafter, adhesive tape is applied over the ureteric catheter (over the proximal, and middle phalanges) to allow for ease of flexion of the index finger. A second glove is then covered over the first one, with care not to rotate or dislodge the fixated ureteric catheter. A small hole is cut at the distal end of the glove, at the tip of the ureteric catheter to allow the guidewire to exit. The guidewire is advanced easily and can now be directed using the ‘loaded’ fingertip. Results: An easily manipulated system of guidewire insertion, with fingertip mobility and dexterity is obtained utilizing everyday consumables in a simple to perform fashion. Conclusion: A simple, novel method to allow flexibility and stress-free maneuvering to pass a guidewire, in open or combined open and endoscopic urological surgery is described. Keywords: Method, Technique, Guidewire, Fingertip, Fistula, Ureteric Orifice

Duplex renal collecting systems are a common congenital abnormality. Management of renal calculi in patients with this abnormality is complex. We describe a patient with a duplex collecting system presenting with a renal calculus. Initial flexible ureteroscopy failed to reach the collecting system containing the stone due to inability to visualize an additional ureteric orifice. The patient then underwent percutaneous puncture of the stone containing moiety, followed by antegrade stent insertion. This allowed for guidewire-assisted passage of a ureteroscope into the duplex collecting system, where the calculi were identified and fragmented. Keywords: Duplex, Stone, Antegrade, Ureteroscopy

Objective To describe a simple, novel method to achieve ureteric access in the Cohen crossed reimplanted ureter, which will allow retrograde working access via the conventional transurethral method. Materials and Methods Under cystoscopic vision, suprapubic needle puncture was performed. The needle was directed (bevel facing) towards the desired ureteric orifice (UO). A guidewire (with a floppy-tip) was then inserted into the suprapubic needle passing into the bladder, and then easily passed into the crossed-reimplanted UO. The distal end of the guidewire was then removed through the urethra with cystoscopic grasping forceps. The straightened ureter then easily facilitated ureteroscopy access, retrograde pyelogram studies, and JJ stent insertion in a conventional transurethral method. Results The UO and ureter were aligned in a more conventional orthotopic course, to allow for conventional transurethral working access. Conclusion A novel method to access the Cohen crossed reimplanted ureter was described. All previously published methods of accessing the crossed ureter were critically appraised.

Unenhanced Helical CT scan done in a prone position differentiates a calculus at the ureterovesical junction from the a calculus in abladder lying near the ureteric orifice by the fact that the calculus at the ureterovesical junction doesnot change its position owever a calculus in a paraureteral diverticulum mimicas a calculus at the ureterovesical junction and maynot show change in position in prone scan if the diverticulum has a narrow mouth We present a case to highlight this point

Over the past 20 years, vesicovaginal fistula (VVF) repair has evolved from strictly transabdominal/transvaginal approach to minimally invasive approach. Robotic assistance has overcome some of the technical difficulties of the laparoscopic approach in VVF dissection and intracorporeal suturing by its technical advantages.

Diverticulum is usually congenital, or associated with bladder outlet obstruction. Laparoscopic diverticulectomy is an established procedure for bladder diverticulum. Better vision, precise dissection and easier suturing with robot assisted approach will make the procedure ‘easier’ for the surgeons.

Background: Ureteric catheterization is extensively used in various urological procedures including ureteroneocystostomy. The standard ureteric stents are usually expensive, difficult to access and of variable quality in our setting. Infant feeding tubes have been used in similar low resource setting as ureteral stents. This study seeks to document our experience with the use of infant feeding tubes as ureteric catheters with respect to their complications and outcome. Methods: This is a retrospective study conducted at the National Obstetric Fistula Centre, Abakaliki, Nigeria from January 2014 to April 2016. The records of 23 women who had ureteroneocystostomy were available for review. Ethical clearance to review casenotes was obtained for the study. Infant feeding tube was improvised as ureteric stents to achieve ureteric patency following ureteroneocystostomy. The infant feeding tube was inserted through the bladder into the neo ureteric orifice in each patient which was then connected to the eye of a urethral catheter. Results: All 23 women reviewed in this study had ureteric fistula. Their mean age was 33.8 ± 8.8 years. A total of 13 patients (56.5%) had right ureteroneocystostomy while 10 (43.5%) had left ureteroneocystostomy. All patients had the infant feeding tube for 7 to 10 days. All 23 patients had successful ureteroneocystostomy and the postoperative period was unremarkable. They were followed up for a period of six months and remained dry. Conclusion: In patients with ureteric fistula, infant feeding tubes which are readily available in our environment appear to be effective when used as modified ureteric stents following ureteroneocystostomy.

Open transabdominal and transvaginal approaches for repair of vesicovaginal fistula (VVF) are well described [1, 2]. Currently laparoscopic approach is widely practised in the repair of vesicovaginal fistula [5–9]. Transvesical transurethral repair has been described by Mc Kay et al. [3, 4], wherein he used a transurethral port for suturing. The repair continues to be a challenge even by open technique as recurrence results in about 5–10 %. VVF due to obstetric causes are repaired 3 months after the onset of vaginal urinary leak. However iatrogenic VVF following pelvic surgery can be managed earlier as there is no ischemia to tissues.