Objectives: To evaluate the effect of caffeine at the dose of 4.5 mg/kg on bladder function in overactive bladder (OAB) adults. Materials and Methods: Nine women and three men aged 21-40 years with OAB symptoms were included. Each subject drank 8 ml/kg of water with and without caffeine at two separate sessions. Cystometry and uroflowmetry were performed 30 minutes after each drink. The effects of caffeine on urodynamic parameters were compared. Results: After caffeine ingestion, the mean volume at bladder filling phase decreased at first desire to void and normal desire to void (P<0.05), compared to the mean volume after taking water (control) drink. The mean volume at strong desire to void, urgency and maximum cystometric capacity also tended to decrease. No change in the detrusor pressure at filling phase was found. At voiding phase, the maximal flow rate, average flow rate and voided volume were increased (P<0.05). The urine flow time and time to maximal flow rate were not changed. Conclusion: Caffeine at 4.5 mg/kg caused diuresis and decreased the threshold of sensation at filling phase, with an increase in flow rate and voided volume. So, caffeine can promote early urgency and frequency of urination. Individuals with lower urinary tract symptom should avoid or be cautious in consuming caffeine containing foodstuffs.

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Robotic surgery is a cutting edge and minimally invasive procedure, which has generated a great deal of excitement in the urologic community. While there has been much advancement in this emerging technology, it is safe to say that robotic urologic surgery holds tremendous potential for progress in the near future. Hence, it is paramount that urologists stay up-to-date regarding new developments in the realm of robotics with respect to novel applications, limitations and opportunities for incorporation into their practice. Robot-assisted surgery provides an enhanced 3D view, increased magnification of the surgical field, better manual dexterity, relatively bloodless field, elimination of surgeon's tremor, reduction in a surgeon's fatigue and mitigation of scattered light. All these factors translate into greater precision of surgical dissection, which is imperative in providing better intraoperative and postoperative outcomes. Pioneering work assessing the feasibility of robotic surgery in urology began in the early 2000's with robot-assisted radical prostatectomy and has since expanded to procedures such as robot-assisted radical cystectomy, robot-assisted partial nephrectomy, robot-assisted nephroureterectomy and robot-assisted pyeloplasty. A MEDLINE search was used to identify recent articles (within the last two years) and publications of specific importance, which highlighted the recent developments and future direction of robotics. This review will use the aforementioned urologic surgeries as vehicles to evaluate the current status and future role of robotics in the advancement of the field of urology.

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Background and Objectives: To evaluate the long-term prognostic value of the combination of the EORTC risk calculator and proapoptotic, antiapoptotic, proliferation, and invasiveness molecular markers in predicting the outcome of intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC) treated with intravesical Bacille Calmette-Guérin (BCG) therapy. Materials and Methods: This study included 42 patients accrued prospectively presenting with intermediate- to high-risk NMIBC (high-grade T1 tumors or multiple rapidly recurrent tumors refractory to intravesical chemotherapy) treated with transurethral resection (TUR) and BCG. TUR samples were analyzed for the molecular markers p53, p21 waf1/cip, Bcl-2, CyclinD1, and metallothionein 9 (MMP9) using immunohistochemistry. Frequency of positivity, measured as a percentage, was assessed alone or in combination with EORTC risk calculator, for interaction with outcome in terms of recurrence and progression using univariate analysis and Kaplan-Meier survival curves. Results: Median follow-up was 88 months (mean, 99; range, 14-212 months). The overall recurrence rate was 61.9% and progression rate was 21.4%. In univariate analysis, CyclinD1 and EORTC risk groups were significantly associated with recurrence (P value 0.03 and 0.02, respectively), although none of the markers showed a correlation to progression. In combining EORTC risk groups to markers expression status, high-risk group associated with positive MMP9, Bcl-2, CyclinD1, or p21 was significantly correlated to tumor recurrence (log rank P values <0.001, 0.03, 0.02, and 0.006, respectively) and when associated with positive MMP9 or p21, it was significantly correlated to progression (log rank P values 0.01 and 0.04, respectively). Conclusion: Molecular markers have a long-term prognostic value when combined with EORTC scoring system and they may be used to improve the predictive accuracy of currently existing scoring system. Larger series are needed to confirm these findings.

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Aim : To compare efficacy and tolerability of phytotherapy (PT) vs. potassium citrate (KC) in patients with minimal nephrolithiasis. To compare and assess changes in value of certain serum (Ca ² +, PO4 ^3- , uric acid [UA]) and urinary (24-hr Ca ²⁺ , PO4 ^3- , UA, citrate, oxalate, and urine pH) parameters in patients being treated with PT or KC. Materials and Methods : After clearance by the local institutional ethics committee, 60 patients of nephrolithiasis who had consented for the study, were enrolled (as per entry criteria) and randomized into citrate therapy (group-I) or PT (group-II). PT was administered as a nutritional supplement, using a lupeol-based extract (Tablet Calcury™, two tablets twice a day). They were monitored for the changes in the serum and urinary biochemical, radiological, and clinical parameters (efficacy and tolerability) as per protocol. Results : Group-I patients demonstrated favorable changes in certain biochemical parameters (decreased serum calcium, urinary UA/oxalate, increased urinary citrate and pH) along with significant symptomatic improvement (decrease in visual analogue pain score with increased stone clearance/reduction in stone size). Four (13.3%) patients of group-I had mild upper gastrointestinal discomfort which was controlled with antacids. Group-II patients had favorable changes in biochemical parameters (decreased serum UA and increased urinary citrate) along with significant symptomatic improvement (reduction/clearance in the stone size), but without any noticeable side effects. Conclusions : Medical therapies with both KC and PT (with lupeol extract using Calcury™) were effective in reducing the stone size and symptoms of nephrolithiasis. It appeared that KC was biochemically efficacious in producing some favorable biochemical changes with some side effects, whereas PT was probably clinically efficacious in hastening stone expulsion (<8 mm) without any observed adverse events. Although both the medical therapies were not effective in all aspects, we believe that PT using lupeol-based extract (Calcury™) may be used as an alternative form of medical therapy in select patients with minimal nephrolithiasis. Long-term randomized placebo-controlled trials are needed to better define the precise role of lupeol-based PT vs. citrate therapy in minimal nephrolithiasis.

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Background and Aim : Premature ejaculation (PE) is the most prevalent sexual dysfunction in every country. There are many types of treatment, but the main limitation of medical treatment for premature ejaculation is recurrence after withdrawal of medicine. The prepuce is a specific erogenous zone that contains a rich and complex network of nerves. Circumcision radically desensitizes the penis, but incomplete circumcision may cause premature ejaculation. We evaluate the effect of removal of foreskin remnants in adults on PE. Materials and Methods : The sensitive area of penile skin and the remaining parts of foreskin in adult men were recognized in 47 selective patients. Under local anesthesia, the remnant parts of foreskin were incised and removed. They were asked to fill the investigating questionnaire about the changes of intravaginal latency ejaculatory time (IVELT), patients and their sexual partners' satisfaction with sexual life, control over ejaculation, and penile sensitivity, before and after treatment. Results : There were no signs of inflammation and no serious adverse reactions in all cases after operation. IVELT significantly increased from 64.25 before surgery to 731.49 sec after surgery (P<0.001). The percentage of postoperative satisfaction in both the patient and his partner significantly increased (P<0.001). After surgery, 95.7% of men had better control over their ejaculation. This surgery significantly decreased sensitivity of penis (P<0.001), but it did not change glans penis insensitivity. Conclusions : These results indicate that removal of foreskin remnants in adults is an effective modality in selective patients of PE.

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Objective: Flexible ureterorenoscopes (FURSs) are considered important additions to urology armamentarium. One of the technical drawbacks is the poor optic image provided by fiberoptic endoscope as well as the fragility of this conventional fiberoptic endoscope. This study aim is to evaluate practical performances and functional durability of the new Olympus digital flexible ureteroscope (ODF-URS) (URF-V) in a single center clinical setting. Materials and Methods: A number of 60 diagnostic and therapeutic procedures were performed over a period of 6 months in a single center (Tenon University Hospital), using a single ODF-URS (URF-V). This device provided a 275˚ maximal down-deflection (MDD) and 180˚ maximal up-deflection (MUD). Results: ODF-URS (URF-V) was used for a total time of 90 h and 30 min, with average time duration of 90.5 min per procedure. After 60 procedures, MDD decreased from 275˚ to 217˚, while the MUD decreased from 180˚ to 161˚. During six procedures (10%), URF-V failed to access inferior calyx due to a narrow lower calyx infundibulum. Conclusion: New ODF-URS (URF-V) is a reliable and durable device, with a good success rate and improved functional parameters. It is a superior device compared to predecessor generations of conventional fiberoptic endoscopes for the light source and the image quality; however, randomized comparative studies are necessary to evaluate performances and durability of this device.

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Background: Voided urine samples continue to play an important role in the surveillance of urothelial malignancy and also as a screening mode for high risk patients. In some cases, it is difficult to reliably distinguish changes induced by inflammation, stone or other reactive condition from neoplasm, and these cases are categorized as atypical. The aim of our study is to evaluate the prevalence and the significance of atypical diagnosis in the voided urine samples and also to identify the cytomorphologic features that are seen more frequently in the atypical malignant urine samples. Materials and Methods: All voided urine cytology samples with a diagnosis of atypical urothelial cells, between the period of 2000 and 2009, were obtained from the cytology database. Only those cases with histologic follow-up were included in the study. The cytology and the histology slides were retrieved and reviewed. The following parameters were evaluated: cellularity, cell clusters, nuclear membrane irregularities, hyperchromasia and India-ink type nuclei, the presence of spindle cells and the cytoplasmic characteristics. Results: Out of 72 voided urine samples included in the study, 49 cases (68%) had a positive histologic diagnosis of urothelial malignancy in the follow-up histology; of these (55%) were high-grade urothelial carcinoma. Increased cellularity, papillary cell clusters, nuclear membrane irregularity, hyperchromasia and India-ink type nuclei were observed more frequently in the atypical malignant urine samples, while cytoplasmic vacuolization were seen more in the negative reactive urine samples. Conclusion: The atypical category diagnosis is associated with a significant proportion of urothelial carcinoma. It should be used by the pathologist to convey concern to the clinician in difficult cases that may require close follow-up.

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Peripheral primitive neuroectodermal tumor/Ewing's sarcoma (PNET/EWS) is primarily a tumor of soft tissues and bones. Primary localization of PNET/EWS in genitourinary organs is rare. No data on this localization of PNET/EWS are available in literature from Pakistan. We searched our adult uro-oncology records from 1994 till date and identified all cases of adult genitourinary and adrenal PNET/EWS diagnosed on histology and immunohistochemistry. Their case records were reviewed to obtain data on demographics, presentation, pathologic features, management and outcome. Six cases were found; all were young and had aggressive disease at presentation. Four had renal PNET/EWS. One case each of prostate and adrenal PNET/EWS was seen. Surgery and chemotherapy formed the mainstay of management. Three patients (50%) died during treatment, two were lost to follow-up and one case with renal PNET/EWS showed good initial response to chemotherapy but was later on lost to follow-up. In conclusion, PNET/EWS should be considered in the differential diagnosis of genitourinary malignant tumors in young patients. These tumors are aggressive with poor outcome.

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Purpose : Data of laparoscopic donor nephrectomy (LDN) with multiple renal arteries for donor and recipient outcomes were reviewed, with the aim of clarifying whether the laparoscopic approach is safe in the presence of multiple renal arteries. Materials and Methods : All donor nephrectomies performed at our institution from 2004 to 2008 were reviewed retrospectively. Results were compared between LDN kidneys with multiple arteries and those with a single renal artery. Results : Out of 171 donor nephrectomies, 21 (12%) were performed for kidneys with multiple renal arteries. All of the 150 (88%) donor nephrectomies in the single vessel group were performed laparoscopically. In the multiple artery group, 9 (43%) underwent an open procedure while 12 (57%) underwent a laparoscopic procedure. The warm ischemia time was longer in the multiple artery group than the single artery group, but the difference was not statistically significant (4.25±0.87 min vs. 4.12±0.95 min, respectively). Regarding transplant recipients, the vascular anastomosis time was similar in both groups (30±4.6 min vs. 29.5±3.7 min). The operative blood loss in the transplant recipients was significantly more in the multiple artery group compared to the single artery group (339±292 ml and 130.7±44.8 ml, respectively; P=0.03). The recipient renal function was similar for both the groups at postoperative day 7, 1 month, and at 1 year. Conclusion : The data support the fact that the laparoscopic approach to donor nephrectomy in the presence of multiple renal arteries can be performed safely with adequate laparoscopic experience.

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Objectives : Melamine was known as a new risk for kidney stone due to recent incidences of milk powder contamination in China. Here, we performed a retrospective study to investigate whether age, gender, and urinary pH affect melamine-associated kidney stone risk. Materials and Methods : A retrospective review was performed of 217 children aged less than 3 years old. All children had a history of being fed with Sanlu milk powder contaminated by melamine, and underwent a clinical screening on kidney stone in Shenyang from November 2008 to February 2009. A comparison with the Chi-square was conducted between 83 cases and 125 normal subjects. The difference between children's gender, age, and urinary pH was evaluated. Results : A total of 208 subjects, 136 boys and 72 girls, were included in the study. Significant association was observed between melamine-associated kidney stone risk and gender [odds ratio (OR), 2.03; 95% confidence interval (CI), 1.11-3.74; P=0.02] and urinary pH (OR, 1.78; 95% CI, 1.01-3.11; P=0.04), respectively. Male children were at about twofold increased melamine-associated kidney stone risk compared with female children. Acidic urine showed about 1.78-fold increased melamine-associated kidney stone risk compared with normal urine. Conclusions : Our investigation results showed an association of gender and urinary pH with melamine-associated kidney stone formation risk.

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Objective: To evaluate rhabdomyolysis and it's management in lithotomy and the exaggerated lithotomy positions during urogenital surgeries. Design: Retrospective study Setting: Institute of Post Graduate Medical Education and Research (IPGME & R), Kolkata, India. Materials and Methods: Patients undergoing urogenital surgeries (lithotomy and the exaggerated lithotomy positions). Intervention(s): All four cases of rhabdomyolysis which occurred after such positional urogenital surgeries were treated with conservative management for prolonged period with hemodialysis. One case which developed compartment syndrome underwent fasciotomy and also managed with conservative approach as other cases. Main Outcome Measure: Rhabdomylysis is now a rare complication in any open or laparoscopic surgery. But prolonged lithotomy or exaggerated lithotomy position surgeries have been shown to expose patients to the risk of rhabdomylysis and acute renal failure. Results: In our institute patients undergoing urogenital surgeries in lithotomy and the exaggerated lithotomy positions only developed rhabdomyolysis and myogloginuric acute renal failure. All procedures were of prolonged duration (mean five hours and ten minutes). Three patients developed rhabdomyolysis and acute renal failure without compartmental syndrome and one with compartmental syndrome. Rhabdomyolysis with the appearance of acute renal failure is discussed. Conclusion: Overall, our cases showed that rhabdomyolysis and acute renal failure can develop in such operative positions even in the absence of compartmental syndrome, and that duration of surgery is the most important risk factor for such complications. So we should be careful regarding duration of surgery in lithotomy procedure to prevent such morbid complications.

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Aim: To determine the efficacy and potential complications of double-J ureteric stents in the treatment of persistent or progressive primary obstructive megaureter in pediatric patients within our institution. Materials and Methods: A retrospective case-note review of all patients with double-J ureteric stents, between 1997 and 2004, was performed. In all, 38 stents were inserted in 31 patients aged between 2 months and 15 years of age. Complications and results of follow-up investigations and the need for follow-up investigations were recorded. Patients were followed up clinically and radiologically for a minimum of 2 years following stent insertion. Results: Endoscopic placement of double-J ureteric stents in childhood is straightforward and complications are uncommon (8/38 insertions). In non-resolving or progressive primary non-refluxing megaureter, double-J ureteric stenting alone is effective with resolution of primary non-refluxing megaureter in 66% of cases (25/38 insertions). Conclusions: Ureteric stenting provides an alternative to early surgery in patients with primary non-refluxing megaureter. The youngest patient in our series was 2 months old at the time of endoscopic ureteric double-J stent insertion. Endoscopic placement of ureteric double-J stents should be considered as a first-line treatment in the management of persistent or progressive non-refluxing megaureter leading to progressive hydronephrosis or pyonephrosis.

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Aim : To evaluate the peri-operative morbidity of men taking clopidogrel who underwent photoselective vaporisation of the prostate (PVP). Patients and Methods : A prospective database was collected. Between March 2005 and July 2010, 480 men underwent PVP. Of these, 18 men underwent PVP treatment while on clopidogrel. The surgery was carried out with either an 80W KTP laser or a 120W lithium triborate laser. Results : In the peri-operative period there were no complications related to PVP. There were no urinary tract infections, nor did any patient require bladder re-catheterisation. No cardiovascular events were reported within 3 months of the procedure. At 3 months post operatively, the International Prostate Symptom Score±standard deviation had improved from was 17.5±10.6 to 9.2±6.1 P<0.05. While the Quality of Life±standard deviation improved from 4.7±1.2 to 2.2±1.5 P<0.01. The maximum flow rate (Qmax), and post void residual volume (PVR) improved from 6.2±3.0 mL/s to 19.7±9.1 mL/s (P<0.01), and 140±102 mL to 59±77 mL (P<0.05), respectively. Conclusions : PVP is a safe and efficacious in the treatment of high risk patients with bladder outlet obstruction. Further, the ability to continue therapeutic anticoagulation and anti-platelet agents, is a significant advantage over Holmium enucleation of the prostate and conventional transurethral resection of the prostate. Larger studies with greater numbers of patients are required prior to PVP becoming the gold standard for high-risk patients with bladder outlet obstruction.

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Context: The optimal time of cystectomy for nonmuscle invasive bladder cancer (NMIBC) is controversial. Aim: This study aims at comparing cancer-specific survival in primary versus deferred cystectomy for T1 bladder cancer. Settings and Design: Between 1990 and 2004, a retrospective cohort of 204 patients was studied. Materials and Methods: Primary cystectomy at the diagnosis of NMIBC was performed in 134 patients (group 1) and deferred cystectomy was done after failed conservative treatment in 70 (group 2) Both groups were compared regarding patient and tumor characteristics and cancer-specific survival. Statistical Analysis Used: Cancer-specific survival was calculated using the Kaplan-Meier method. Results: Mean follow-up was 79 and 66 months, respectively, in the two groups. Tumor multiplicity was more frequent in group 2; otherwise, both groups were comparable in all characteristics. The definitive stage was T1 in all patients. Although the 3-year (84% in group 1 vs. 79% in group 2), 5-year (78% vs. 71%) and 10-year (69% vs. 64%) cancer-specific survival rates were lower in the deferred cystectomy group, the difference was not statistically significant. In group 2, survival was significantly lower in cases undergoing more than three transurethral resections of bladder tumors (TURBT) than in cases with fewer TURBTs. Conclusions: Cancer-specific survival is statistically comparable for primary and deferred cystectomy in T1 bladder cancer, although there is a non-significant difference in favor of primary cystectomy. In the deferred cystectomy group, the number of TURBTs beyond three is associated with lower survival. Conservative treatment should be adopted for most cases in this category.

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Objectives: To determine whether smaller tumor size is associated with less-aggressiveness in renal cell carcinoma (RCC). Materials and Methods: Series records of 505 patients diagnosed with RCC were retrospectively reviewed and the data concerning tumor size and pathological information were extracted and analyzed. Results: Five hundred and eight RCCs were identified. The mean tumor size was 5.02 ± 2.70 cm. No correlation was detected between the size of tumor and the histological subtype. The overall nuclear grade distribution was 57.1% and 42.9% for low-grade and high-grade disease, respectively. Each 1 cm increase in tumor size was associated with a significant increase in the odds ratio of high-grade disease by 1.46. 91.1% were found low-stage lesions and the odds ratio for the association of high-stage disease with each 1 cm increase in tumor size was 1.67. Multinomial models revealed that each 1 cm increase in the tumor size was associated with a 35% increase in renal capsule involvement and 66% renal vascular invasion. The cut-off point of tumor size in renal vascular invasion was 5.6 cm. Conclusion: Tumor size is not an independent predictor for the histological subtype of RCC. However, it is closely correlated to histopathological features, with the indications that the greater the tumor size, the more aggressive potential the RCC is.

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Synovial sarcomas are most commonly localized in the extermities, especially the lower thigh and knee areas. Retroperitoneal synovial sarcoma is very rare. We decribe the radiological findings of an adult retroperitoneal synovial sarcoma.

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The indications for ureteral stent placement have expanded significantly with the progress of surgical procedures and techniques. Although such stents are now an integral part of contemporary urological practice, their use is not free of complications and consequences. There are very rare descriptions of knot formation in a ureteral stent and the consequences of this occurrence, with only 12 cases previously reported. Here, we report an additional case and review all the literature concerning this urological complication with emphasis on its predisposing factors and conservative and surgical management.

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Spontaneous subcapsular renal hematoma is not a common entity. We report a 38-year-old lady presenting with sudden onset right flank pain with uncontrolled hypertension and she was found to have subcapsular collection in the right kidney on ultrasonography. Finding was confirmed on computed tomography. Except hypertension, no particular cause for the condition could be found. Symptoms and size of the collection decreased on conservative treatment. They completely disappeared on ultrasonography at 6 months follow-up. She was asymptomatic at 18 months follow-up.

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Renal subcapsular hematoma is not an uncommon complication after extracorporeal short wave lithotripsy, trauma, renal angiographic procedures and spontaneously in patients of malignancy and in patients on anticoagulation. We present a patient who developed renal subcapsular hematoma after ureterorenoscopy, which has not been mentioned in literature ever. Clinical spectrum varies from spontaneous resolution through acute renal failure to Page kidney. Page kidney is the external compression of a kidney usually caused by a subcapsular hematoma associated with high blood pressure and occasional renal failure. It is named after Dr. Irvin Page who first demonstrated in 1939 that wrapping cellophane tightly around animal kidneys could cause hypertension. Various management options are mentioned in literature and depend upon the severity of hematoma. Percutaneous drainage is a successful option for the management of subcapsular hematoma in hemodynamic stable patients.

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Renal cell carcinoma (RCC) constitutes 2-3% of all adult malignancies and often diagnosed incidentally. Classical tried of RCC now rarely seen, it behaves unpredictably and having diverge range of clinical manifestation including paraneoplastic syndromes. Upper gastrointestinal (GI) bleeding due to stomach metastasis of RCC is uncommon and to the best of our knowledge, only few cases are reported in world literature and most of them were diagnosed during follow-up after complete treatment of RCC but in our case, it was the primary manifestation of disease. Our case also demonstrates the importance of imaging in undiagnosed cases of upper GI bleeding.

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Aim: The aim of this study is to determine the current trends in the management and surveillance of the NB population secondary to spinal cord injury (SCI) or myelomeningocele by certified urologist working in Saudi Arabia and to compare it to the current guidelines. Materials and Methods: A cross-sectional study was conducted using a 12-points questionnaire distributed to urologists working in Saudi Arabia and registered at the Saudi medical association. The assessment and follow-up of upper and lower urinary tract function in neurogenic bladder patients, their optimal frequency and management of related infections were the topics of inquiry. Results: Of the 272 urologists surveyed, 105 responded, yielding a response rate of 38%. Eighty-nine percent of respondents said that ultrasound was their diagnostic tool of choice for upper tract evaluation. Sixty-one percent of respondents said that they would follow their patients with a multichannel urodynamic study. Forty percent of urologists stated that they would treat asymptomatic bacteriuria. Clean intermittent catheterization (CIC) was the most common modality chosen for the management of neurogenic bladder in patients with emptying difficulties. Conclusion: This study confirms that most urologists in Saudi Arabia involved with neurogenic bladder management. However, more than one third of the urologists do not have urodynamic machine and only two of the reporting practitioners has a videourodynamic machine. The results emphasize the need for clear guidelines in this field of urology in Saudi Arabia. Highly specialized rehabilitation centers for neurogenic bladder secondary to SCI are required for optimal care and urologist teaching.

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Background: Postoperative assessment after varicocele surgery in adolescence is commonly centred around catch-up growth of the testis. There is paucity of evidence on the correlation of catch-up growth with underlying testicular function in these patients. Aims: To assess the reliability of catch-up growth of the testis as an indicator of normalization of testicular function and the utility of serum FSH levels in the long-term postoperative assessment of varicocele surgery in adolescence. Materials and Methods: Prospective cohort study of young adults (18-27 years) who had laparoscopic varicocele correction in adolescence (11-16 years). Evaluation included serum FSH levels, scrotal ultrasonography and semen analysis. Analysis: Anatomical and functional parameters of participants with equal and normal testicular size were compared to those of participants with persistent testicular hypotrophy or hypertrophy. Sensitivity and positive predictive value of postoperative serum FSH levels were estimated and elevated levels of serum FSH were checked for association with suboptimal outcomes of varicocele correction. Results: The serum FSH levels of participants with unequal testicular sizes (n=6, median 6.65 IU/l), which included testicular hypertrophy (n=3, median 7.2 IU/l) and persistent testicular hypotrophy (n=3, median 6.1 IU/l), were significantly higher than the group with equal testicular sizes (n=8, median 3.5 IU/l; P=0.014, Mann-Whitney U test). Postoperative elevated serum FSH levels were significantly associated with suboptimal outcomes of varicocele surgery (P=0.015, Fisher's exact test). The test also had a high positive predictive value. Conclusions: Testicular catch-up growth may not be a reliable postoperative assessment criterion by itself. Serum FSH levels may be of value in detecting suboptimal outcomes of varicocele surgery in adolescents.

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Aim: To examine p27 (Kip 1) and MUC1 expression in specimens of papillary transitional cell carcinoma (PTCC) of the urinary bladder and to correlate their expression with the tumor grades,stages and outcome. Patients and Methods: Paraffin sections from previously diagnosed PTCC bladder were graded, staged and the patients were followed up for 5 years. Ten non-neoplastic urological lesions diagnosed as polypoid cystitis were taken as control. Three sections of 4 um thickness were obtained from every case. One was hematoxylin and eosin (H and E) stained for diagnosis, reviewing and confirmation. The other two sections were immunohistochemically stained for both p27and MUC1. The data of immunohistochemical results were correlated with the following conventional prognostic variables: tumor grade, stage, distant metastasis and 5 year survival. Results: The results showed a highly significant and an insignificant relationship between p27 expression and tumor grade and stage (P<0.01 and P>0.05), respectively. Correlating p27 expression with distant metastasis and overall survival showed a significant relationship with distant metastasis (P<0.05) and a highly significant one with overall survival (P<0.01). The results showed also a significant relationship between MUC1 expression and both tumor grade (P<0.01) and overall survival (P<0.05). Conclusion: p27 and MUC1 immunohistochemistry augment the classic histochemistry for the prognosis of PTCC of the bladder as well as improving the prediction of the patient outcome and survival.

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Aim : To evaluate the clinical outcomes of two different doses of BTX-A in patients with refractory idiopathic overactive bladder. Patients and Methods : Thirty nine patients with refractory idiopathic overactive bladder from 1/1/2008 till 30/3/2009 were evaluated in a tertiary care hospital. Patients were evaluated using urodynamic studies, voiding diary, UDI-6 and IIQ-7 questionnaires prior to being prospectively randomized (alternate randomization) to the BTX-A applications and three months after treatment. Voiding diary and residual volume were followed two weeks later. All patients received intradetrusorial injections of BTX-A (Botox, Allergan, Irvine, CA) of 100u or 200u under cystoscopic control on an outpatient basis. The primary endpoint was assessed for the improvement of urodynamic parameters and adverse events at three months after the initial treatment. Secondary end points included urinary frequency, urgency and UUI episodes as assessed by voiding diary and QoL. Results : Eleven patients were enrolled to each arm of the study. There were no significant differences in demographic characteristics between the two groups. Urodynamic assessment at the end of the third month showed significant improvement in urodynamic variables in both groups. There was no statistically significant difference in urodynamic parameters and in the voiding diary between the two groups. QOL was significantly improved in both groups with no statistically significant difference between the different doses. Only three patients developed acute urinary retention. Conclusion : BTX-A at 100u and 200u appears to improve symptoms, urodynamic parameters and QoL with no statistical significance between the two groups.

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Context: There has been a paradigm shift in the management of ureteral calculi in the last decade with the introduction of new less invasive methods, such as ureterorenoscopy and extracorporeal shock wave lithotripsy (ESWL). Aims: Recent studies have reported excellent results with medical expulsive therapy (MET) for distal ureteral calculi, both in terms of stone expulsion and control of ureteral colic pain. Settings and Design: We conducted a comparative study in between watchful waiting and MET with tamsulosin. Materials and Methods: We conducted a comparative study in between watchful waiting (Group I) and MET with tamsulosin (Group II) in 60 patients, with a follow up of 28 days. Statistical Analysis: Independent 't' test and chi-square test. Results: Group II showed a statistically significant advantage in terms of the stone expulsion rate. The mean number of episodes of pain, mean days to stone expulsion and mean amount of analgesic dosage used were statistically significantly lower in Group II (P value is 0.007, 0.01 and 0.007, respectively) as compared to Group I. Conclusions: It is concluded that MET should be considered for uncomplicated distal ureteral calculi before ureteroscopy or extracorporeal lithotripsy. Tamsulosin has been found to increase and hasten stone expulsion rates, decrease acute attacks by acting as a spasmolytic, reduces mean days to stone expulsion and decreases analgesic dose usage.

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