AIMS AND OBJECTIVES:To analyze various clinical presentations and the treatment options in the management of the patients with genitourinary tuberculosis and to evaluate the role of urinary PCR in the detection of mycobacterium tuberculosis in patients with a clinical suspicion of genito urinary tuberculosis and to compare its sensitivity with urine for AFB smear, urine for myc. tuberculosis culture and bladder biopsy. MATERIALS AND METHODS: This is a retrospective and prospective study of patients with a diagnosis of genitourinary tuberculosis who underwent treatment in Gandhi General Hospital between January 2009 to December 2014. 62 patients with a diagnosis of genitourinary tuberculosis who underwent treatment were taken initially into the study. Five patients lost follow up after initial visits. These patients were excluded from the study. The remaining 57 patients were managed. RESULTS: Irritative voiding symptoms (Frequency / Urgency / Dysuria) were the most common symptoms. Gross hematuria seen in 22(38.5%) patients and microscopic hematuria seen in 53% of patients. Urine for AFB attaining was positive in 16(31.3%) patients, urine for MTb culture was positive in 21(41.1%) patients and pus for MTb culture was positive in 4 of 7 cases. Urinary PCR to identify the mycobacterial DNA was performed in 37 patients and was positive in 25(67.5%) of 37 clinically suspected cases. The urinary PCR was falsely positive in 1(2.7%) and falsely negative in 12(32.5%) patients. Kidney was involved in 26(45.6%) cases and ureter in 24(42.1%), and bladder in 28(49.1%) cases. Overall surgical intervention was done in 36 patients. All patients received 4 to 8 weeks ATT before they were taken up for surgical intervention. In 24 patients who presented with ureteric strictures, 7 patients had nonfunctioning kidneys and subsequently underwent nephroureterectomy, 8 patients had subnormal renal function in whom DJ stenting was done in 6 patients and PCN was done in 2 patients where DJ stenting was not possible. CONCLUSION: The manifestations of genitourinary tuberculosis can be variable and cause a variety of clinical patterns that mimic other diseases. Most of the cases present with advanced disease and high index of suspicion is necessary for the early diagnosis of genitourinary tuberculosis. PCR presents an advance in the diagnosis of GUTB. Urinary PCR is the most sensitive indicator of all microbiological tests and in combination with radiological abnormalities provides much faster diagnosis of genitourinary tuberculosis. However, it is an elaborate test that requires meticulous care to avoid false-positive and false-negative results. Multidrug chemotherapy combined with judicious surgery as and when indicated is the ideal treatment.

To evaluate the indications of PCNL in children with age from 1to14yrs, identify the complications, treatment of complications, and prevention of complications and to evaluate the safety & efficacy of management of kidney stones in children by PCNL. MATERIAL & METHODS: Study period includes October 2010 to February 2013. 28 cases of renal stone in paediatric age group were admitted in our Hospital and evaluated for size of the stone, number of stones, congenital anomalies. RESULTS: In our centre, we have operated a total number of 28 children and total renal units were 32. Sex distribution in our study was male 17 and female 11, children's were 9.3 years (minimum age 1.2yrs-maximum age 13.8yrs) and mean size of stone was 21.1 mm (smallest size being 15mm and biggest being 26 mm). The maximum sheath size used in children was 24 F. out of 28 children, only one patient required blood transfusion rating to 3.5%. We have not used sandwiched therapy and all the 32 renal units were subjected to the PCNL mono therapy only with success rate of 96.4%. Our complication rates are low and are in comparison with many series published. Our main complications were fever, hematuria, and ileus, two patients of each variety equivalent to 7.1% of each type mentioned above and sepsis was in one patient amounting to 3.5%. CONCLUSION: Evolution of technique and miniaturization of instruments have changed the management of paediatric stone disease 2 .Despite encouraging results, however, concern remains regarding safety of endourologic treatment in smaller patients and its subsequent effects on the growing kidney 4. Outcomes and morbidity rates have improved with the development of smaller endoscopic instruments and refined techniques using smaller access sheaths. At our center, PCNL is now the procedure of choice in the management of large kidney stone burden in children.

To evaluate the results and complications of single stage dorsal free buccal mucosal graft urethroplasty using ventral sagittal urethrotomy approach.

To assess the efficacy, safety, and morbidity of tubeless percutaneous nephrolithotomy (PCNL) and compare it with standard PCNL. METHODOLOGY: Between august 2008 and December 2008 patients undergoing PCNL prospectively evaluated in two groups. One group patients undergone PCNL with nephrostomy placement (Standard PCNL) and second group of patients undergone PCNL without nephrostomy tube (TUBELESS PCNL). Case selection criteria were adequately matched and postoperative outcome was recorded in same way in both groups. Patients who needed more than two percutaneous tracts, intraoperative perforation of the pelvicalyceal system, excessive manipulation at the ureteropelvic junction, or a residual stone after the procedure and who had a solitary kidney or azotemia were excluded from the study. RESULTS: A total 43 patients (23 patients in group I, 22 patients in group II) were included in the study. Post-operative plain x-ray of kidneys, ureters and bladder showed a 100% stone clearance rate. There was no tract related problems i.e., tract infection and sinus formation. Mean hospital stay was 5.9 days in group I and 4.1days in group II. Post-operative ultrasonography during hospitalization showed no perinephric collection. No readmissions to the hospital at mean follow up of 6 months (range 2to 6 months). All patients were doing well. CONCUSIONS: Avoiding the use of nephrostomy or D-J stent may not compromise the safety of PCNL and it decreases morbidity of the patient.

To study the effective stone clearance rate, to analyze and study the intra and post-operative complications and the morbidity in terms of hospital stay. MATERIALS AND METHODS: The present study has been conducted in the Department of Urology, Gandhi Hospital, and Hyderabad from November 2012 to December 2014. RESULTS: Total 42 cases were included in supracostal group, in which mid calyceal puncture done in 5 (11.9%) cases, upper calyceal puncture done in 37(88.1%) cases. Post-operative x-ray chest on day one normal in 39(92.85%) cases and 3(7.15%) cases developed hydrothorax, post-operative pain assessment: visual analogue score on average-6.5, post-operative x-ray KUB on day two showed insignificant calculi in 2(4.76%) cases and significant calculi in 3(7.1%) cases. Ancillary procedure: needed for 3(7.1%) cases with significant calculi, one case (2.4%) required relook PCNL and for two cases (4.7%) ESWL was done and blood transfusion required for 3 cases (7.1%). Finally stone clearance rate was 88.9%. CONCLUSIONS: Supracostal PCNL is a safe procedure with acceptable morbidity. When the puncture site is well planned, keeping it on or lateral to posterior axillary line and performed during expiration, would minimize thoracic complications. Supra costal PCNL has high rate of stone clearance (more than 90%) especially when the stone is complex, burden is in upper pole and stone is of stag horn type. The need for ancillary procedures for complete stone clearance is less. The requirement of multiple tracts and their attendant complications are less with supracostal PCNL. It can be done safely in pediatric as well as elderly population.