To study the feasibility of intracorpus spongiosum block (ICSB) in high risk patients for Visual internal urethrotomy. METHODS: Visual Internal Urethrotomy (VIU) for urethral stricture can be performed under various types of anesthesia, including topical anesthesia and ICSB. This descriptive study was conducted in Santhiram medical college and general hospital between July 2013 and Dec 2014. Total number of 30 male patients of high risk group with American Society of Anesthesiologists (ASA) physical status grading 3 and 4 having stricture urethra were treated by VIU under ICSB. VIU was performed with a cold-cutting knife. The effect of this anesthetic technique was evaluated by Numerical Rating Scale (NRS) for pain. Out of the 30 patients five patients have no pain, twenty three patients have mild pain only. CONCLUSION: ICSB is safe and more effective than topical anesthesia alone for providing pain relief during VIU even in high risk patients

Villous adenoma of the urinary tract is uncommon. It occurs in the elderly patients with a predilection for the urachus, dome, and trigone of the urinary bladder; rare cases involve the ureters or urethra. We herein report a rare case of recurrent villous adenoma of urinary bladder and ureter. CASE REPORT: 49 yr male patient presented with history of passing mucous perurethrally for the past 4 months, associated with burning micturition, hesitancy, frequency. He underwent trans urethral resection of bladder tumor for two times and had recurrence involving the trigone, dome, left lateral wall, bladder neck, prostatic urethra and right ureteric stump. He underwent radical cystoprostatectomy with ileal conduit. Histopathological examination showed villous adenoma with moderate dysplasia. CONCLUSION: Recurrence of the original tumor or subsequent development of adenocarcinoma is rarely seen. In our case the tumor was highly recurrent with bladder outlet obstruction and was managed by ablative surgery. A through follow up of these patients is recommended.

Percutaneous nephrolithotomy (PCNL) is the most frequently performed surgery for stone disease at our institution. Nearly 100 PCNL procedures are being performed in a year at our institution. Septicemia following PCNL can be catastrophic despite sterile preoperative urine and prophylactic antibiotics. Infected stones, obstructed kidneys, and comorbidity have been held responsible. In this study we analyzed various culture specimens, namely Mid-stream urine (MSU), renal pelvic urine and crushed stones. MATERIALS AND METHODS: We performed a prospective clinical study in all our patients undergoing PCNL between January 2013 and December 2014. MSU was sent for culture and sensitivity testing (C&S) one day prior to surgery. Percutaneous access into the ipsilateral pelvicaliceal system is achieved under image intensification using a fine, 14 gauge Kellet needle. Urine from the pelvicaliceal system is first aspirated and sent as pelvic urine C&S. Stone fragments are collected to be proces0sed for C&S. The data collected were divided into 3 main groups, that is MSU C&S, pelvic urine C&S and stone C&S. RESULTS: A total of 83 patients were included in the study, of this MSU C&S was positive in 9/83 (10.8%) patients, Pelvic C&S in 10 /73 (13.7%) patients and Stone C&S in 25/83 (30.1%) patients. Out of 25 cases of stone culture positive patients 17 patients developed Systemic Inflammatory Response Syndrome (SIRS) but only 2 patients developed SIRS in MSU C & S positive patients. CONCLUSIONS: The results of our study suggest that positive stone C&S is the better predictor of potential urosepsis than MSU. Stone culture is available only after surgery but appears to be the best guide for antibiotic therapy in case of sepsis. So the routine collection of stone for C&S will be beneficial.