Introduction :Urethral stricture diseases have been treated with numerous approaches. Though open urethroplasty is considered a one-time solution [1], The direct visual internal urethrotomy (DVIU) is still considered an alternative approach in the stepladder of treatment [2,3]. Here we report our experience at a tertiary care hospital with DVIU in a homogeneous series of patients with bulbar urethral stricture who underwent strict follow-up and present a multivariable analysis of the results to identify signicant predictors of treatment failure. We wish to offer new insights into DVIU. Materials and method: We performed a retrospective analysis of patients who underwent internal urethrotomy. Patients who underwent DVIU for untreated bulbar urethral strictures with minimum follow-up of 12 months were included. Patients with traumatic stricture and stricture length >4 cm were excluded.The primary outcome was treatment failure. Multivariable Cox regression analyses by Stata v.12.0 were used to test the association between predictors:- Stricture etiology, stenosis length, preoperative maximum ow [pQmax]) and treatment failure. Results: 215 patients were included. Median follow-up was 35 months. At 5-yr follow-up the failure-free survival rate was 54.4%. On multivariable analysis pQmax was the only signicant predictor of treatment failure. Conclusions: DVIU success rate for untreated bulbar urethral strictures was signicantly associated with preoperative maximum ow rate. The patients with a pre- operative maximum ow lesser than 6 ml/s have a low probability of success and may be considered for alternative treatments such as open urethroplasty, especially when affected by long urethral strictures.

Background:The treatment of STAG HORN calculi has varied from combination of percutaneous nephrolithotomy (PCNL) and shockwave lithotripsy (SWL) or sometimes open surgery. The goals of treatment of a STAG HORN stone are complete stone clearance with minimal morbidity. Although excellent stone-free rates are universally reported in the literature, complication rates vary widely, especially related to the need for blood transfusion. Subjects and Methods: From January 2015 to December 2018, 1400 patients underwent PCNL out of which 392 patients had stag horn stones. Our study included stag horn stones that were present in the renal pelvis and branched into two or more major calyces. All procedures were performed under general or spinal anesthesia by the same surgical team. Results: 392 patients (144 women and 248 men) with mean age of 44.2 (range 8yr-72yr) years having partial/complete STAG HORN calculi were treated at our center S.P. Medical college, Bikaner from period of January 2015 to December 2018. 10 patients (10.2%) had pre existing renal insufficiency with a mean (range) serum creatinine of 3.0 (1.5-4.2) mg/dl. Conclusion: PCNL using multiple tracts is safe and effective and should be the first option for renal STAG HORN calculi. It must be done by experienced endourologists in a specialized centre with all the facilities for stone management and treatment of possible complications.

An urachal cyst anomaly occurs in approximately 1/5,000 births. Its treatment is surgical excision. We present a case report of 16-year-old female with presenting complaints of lower abdominal pain with burning micturition and increased urinary frequency. Computed tomography revealed a 40×38 mm low-density cyst image located in midline cranial to the bladder apex, suggesting the diagnosis of urachal cyst. Traditional open surgery was used for its excision, but now minimally invasive approaches have been used more frequently to minimize the morbidity. We did a trans-abdominal preperitoneal approach, which aided in both the purpose of diagnostic laparoscopy and also utilize the advantage of preperitoneal surgery.