Background: Several modalities are available for upper ureteric stone fragmentation. From them pneumatic and holmium: yttrium-aluminum-garnet lithotripsy has favourable outcomes. In this study we studied 50 patients who underwent ureteroscopic pneumatic lithotripsy or laser lithotripsy. This study aims to to compare the outcome of PL and LL in the management of upper ureteric calculi.Methods: This is a prospective, randomized study of 50 cases; 25 cases of TUL with pneumatic lithotripter and 25 cases of TUL with laser lithotripter over two years. The purpose of this study was to analyze the factors predicting the stone-free rate, assess the complications following PL and LL, and assess the need for a second procedure if retropulsion of calculi occurs.Results: Two groups were similar in age, gender, mean size of stones, retropulsion and complications. There was a statistical difference in terms of stone free rate in favour of LL group (p≤0.05) and mean operative time in favor of the PL group (p≤ 0.05). Conclusions: In conclusion, we found that both the PL and LL approaches were effective and safe for upper ureteric calculi, but the LL method had advantages, especially in stone free rate, over the PL treatment. Another advantage of the LL method was safe stone fragmentation in upper ureteral calculi due to lower retropulsion rate in contrast with the PL method.

Background: To study the prevalence of significant Intravesical Prostatic Protrusion (IPP) in patients presenting with acute urinary retention (AUR) due to Benign prostatic hyperplasia (BPH) and to study the correlation between intravesical prostatic protrusion and prostatic volume.Methods: We assessed 68 men between the ages 45 to 85 who presented with acute urinary retention. Initial assessment included detailed clinical history, International Prostate Symptom Score (IPSS) and Quality of Life assessments and a transabdominal ultrasonogram to measure Prostate Volume (PV) and Intravesical Prostatic Protrusion (IPP). The degree of IPP was determined by the distance from the tip of the protrusion to the circumference of the bladder at the base of the prostate gland. Patients with IPP >10 mm were taken have significant IPP and those ≤10 mm was taken to be insignificant. Statistical analysis included descriptive analysis and Pearson’s correlation coefficient.Results: Of the 68 patients in our study with resented with AUR, 29 patients (42.9%) had significant IPP. Mean IPP was 9.81mm with a standard deviation of 5.41 mm. All patients with significant IPP had a severe IPPS grade. IPP had a statistically significant correlation with prostatic volume.Conclusions: The IPP as assessed by transabdominal ultrasound can be used to direct appropriate patients to more aggressive treatment strategies like surgery.

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Background: Kidneys are a pair of retroperitoneal organs supplied by a single renal artery and vein. However, the classic illustration of the renal vasculature, formed by one renal artery and one renal vein, occurs in ≤25% of cases. MDCT angiography is presently the most preferred investigation for assessing prospective renal donors. Aims and Objectives: This study aims to familiarize urologists with the variations found in the renal vascular system, emphasizing prevalence, the adequate, appropriate terms, and the clinical and surgical implications involved. Materials and Methods: A cross-sectional study in 50 patients clinically indicated to undergo CT Renal angiographic study over 2 years is included in the study. This study was carried out to look for any anatomical variants in renal vasculature. CT examination was performed on a multidetector 16 slice CT Siemens scanner in the department of radiodiagnosis. Once conventional CT is done, the data obtained can produce 3D post-processing images that simulate conventional angiograms. Results: Out of 50 patients, single renal arteries are present in 27, and multiple renal arteries are present in 23 patients. Out of 27 patients with single renal arteries, 22.2 % has perihilar arterial branching. The most common variant was accessory renal arteries, which are found in 56% of individuals, followed by aberrant renal arteries found in 30% of individuals. Double renal arteries are found in 8.7% and triple renal arteries in 4.3% of cases. Out of 50 patients, 48 patients have a single renal vein, whereas two patients have supernumerary veins. The present study found right renal vein duplication in only 2% of patients. Conclusion: Renal arteries and veins show numerous variations in their origin sites, numbers, course, and division patterns. These variants exist in the population with high prevalence and are thus crucial in preoperative and intra-operative analysis for better prognosis and reduced complications. Preoperative CT evaluation of renal vasculature using MDCT angiography helps depict the presence or absence of renal arterial and venous variants.

BACKGROUNDThe aim of this study was to compare the effectiveness of conservative medical treatment versus minimal invasive surgical techniques like Percutaneous Catheter Drainage (PCD), Percutaneous Needle Aspiration (PNA) and Laparoscopic Washout and Drainage (LWD) in the management of liver abscess. MATERIALS AND METHODSAll patients with liver abscess who were admitted in Surgery from September 2014 to August 2016 were included in this study and were exposed to four different treatment modalities. The patients were first treated with combination of medicine. If they failed to respond to this treatment, they were subjected to ultrasound-guided aspiration. If it failed they were exposed to pigtail catheter placement. Final option was laparoscopic washout and drainage if it was ruptured liver abscess and if the patient presented with septicaemia and peritonitis. PNA was repeated every third day and if the cavity had not declined to 50% of the original for upto three times then it was considered failure of treatment and PCD was done. RESULTSOut of 54 patients 15 patients responded to drug therapy alone, 36 patients required ultrasound-guided aspiration and pigtail catheter placement and 3 patients required laparoscopic washout and drainage. A combination of drug therapy and ultrasoundguided needle aspiration/pigtail catheter placement was effective for majority of 85% patients. CONCLUSIONMinimal surgical interventions like PNA and PCD are better than conservative treatment for the management of liver abscesses of size > 5 cm, in terms of duration to attain clinical relief and duration of which parenteral antibiotics are needed. Pyogenic liver abscess are more common than amoebic liver abscess. Right lobe of liver is most commonly involved in both type of abscesses. Radioimaging techniques like Ultrasonography (US) and Computerised Tomography (CT) are the modalities of choice for investigation purposes. Treatment modalities of these abscesses first emphasises on medical treatment, but if it is unsuccessful then only the surgical intervention should be taken up. Laparoscopic washout and drainage remains the standard of care for ruptured liver abscess.