BACKGROUND Balanitis Xerotica Obliterans (BXO), also known as lichen sclerosus of penis is a chronic, progressive disease of the glans and prepuce that leads to phimosis and stricture of the urethra that can extend from the meatus and glanular urethra to the prostatic urethra. Urinary and sexual functions are affected and there is a severe reduction in quality of life. Many patients have been initially treated with tacrolimus or circumcision, when the disease has involved the prepuce and glans superficially, but conservative management has a limited role in this condition. Once stricture develops, surgical intervention in the form of grafts or flaps becomes necessary. We present our results with single-stage Ventral Onlay Buccal Mucosal Graft Urethroplasty (VOBMGU) based on tunica vaginalis flap for BXO related strictures of meatus and fossa navicularis. MATERIALS AND METHODS From July 2014, six patients who underwent single stage Ventral Onlay Buccal Mucosal Graft Urethroplasty Graft (VOBMGU) based on tunica vaginalis flap for BXO related strictures of urethral meatus and navicular fossa were included in the study. Patients presenting with BXO were clinically assessed for the extent of involvement as having BXO affecting the foreskin, glans, meatus, penile shaft, urethra and scrotum. They were radiologically assessed with a retrograde urethrogram and ultrasound abdomen. Outcome was assessed in terms of uroflowmetry, cosmetic appearance, stricture recurrence and complications. RESULTS Patients were reviewed every three months for over one year and six monthly. Only one patient had mild stenosis of the urethral meatus, as evidenced by change in flow, which was treated successfully with dilatation. One patient reported moderate splaying of urine, but this was mild in all other cases. All patients had a normal slit-like meatus, satisfactory voiding and sexual functions. CONCLUSION Isolated involvement of fossa navicularis and meatal stenosis stricture due to BXO can be treated with Ventral Onlay Buccal Mucosal Graft Urethroplasty (VOBMGU) based on tunica vaginalis flap especially in cases where the glans appeared unhealthy and compromised vascularity. It provides good short-term results with various advantages of tunica vaginalis like easy harvestability, close proximity to the penis, high vascularity and good support to BMG graft.

BACKGROUNDInfertility still remains a medical problem where a totally effective treatment remains distant. Approximately 8-12 % (60-80 million) of couples is infertile (WHO estimates). 1 Idiopathic male factor infertility accounts for 25% of these cases Male fertility is affected by a number of factors including varicocele, testicular failure, endocrine dysfunction, genital tract infection, testicular disturbances, testicular cancer, hormonal disturbances, retrograde ejaculation, prolonged exposure to heat, obesity, older age, smoking, alcohol, heavy metals, pesticides, oxidative stress, genetic factors and different environmental and nutritional factors. Varicocoele causes 35% of primary and 75% of secondary male infertility and is the most common surgically correctable disorder of male infertility. Testicular vein ligation (TVL) is recommended in men with clinically evident varicocele and sub-fertile semen. TVL can improve semen quality and prevent testicular growth retardation. Apart from surgical correction, many medical management regimes are under trial. Clomiphene citrate is an orally active nonsteroidal agent related to diethylstilbestrol that has been tried independently, combined with other drugs and along with surgical correction, with varying outcomes. It significantly increases the motility percentage and normal morphology of sperms.Financial or Other, Competing Interest: None.

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BACKGROUND Lymphorrhoea is a frequent cause of peritransplant fluid collection seen postoperatively after renal transplantation. Most of the lymph leaks resolve without complications within one to two weeks after surgery. Sometimes the leaks are exaggerated, last longer and prevent removal of surgical drain. In addition to prolonging hospital stay, it may lead to loss of protein and fluids, with resultant dehydration, nutritional deficiency and immunologic dysfunction. Persisting lymphorrhoea is the most important cause of lymphocele formation. Surgical damage to lymphatics around iliac vessels of the recipient during bed preparation and lymphatics of donor kidney during procurement or during bench surgery leave behind open lymphatic channels that keep leaking for long periods after transplantation. A number of medical causes have also been identified that lead to lymphorrhoea. MATERIALS AND METHODS Only live related donor cases were selected for our study. Two weeks after renal transplantation, the drain fluid was tested for fluid urea, creatinine, sodium, potassium, total protein and albumin to rule out urine leak. A sample was sent for culture and sensitivity to rule out infection. Patients with drain fluid >200 ml. at two weeks were randomized into two groups; one group (study group-20 patients) underwent extra peritoneal povidone iodine instillation via the drain tube, which was clamped for one hour; the other group (control group-19 patients) was managed conservatively by gradual pulling out the drain tube over days. The end point for drain tube removal was less than 50 ml. drain output for two consecutive days. Subsequently patients were discharged from hospital with monthly review that included Ultra Sound Scan of the graft with Doppler study. RESULTS 7 patients in the study group and 7 patients in the control group had resolution of drain fluid by two and a half weeks. 2 patients in the control group and 13 patients in the study group had resolution of drain fluid by 19-21 days (3-weeks). 9 patients in the control group had a prolonged hospital stay of 3-8 weeks before drain tube could be removed. The total number of days of hospital stay were 3.5-4 weeks in patients in the study group and 3.5-8 weeks in the control group. Time for normalization of S. Creatinine (Mean ± SD) was 25.3 ± 9.3 in the control group and 18.6 ± 6.8 in the study group. 3 patients in the control group developed symptomatic lymphocele during follow up, and none in the study group.

BACKGROUND Urothelial Cell Carcinoma (UCC) of urinary bladder is the seventh commonest cancer wordwide. 1 At initial diagnosis, 30% of UCC display solid and invasive growth patterns and are locally advanced or metastatic at the time of diagnosis. 70% of tumours are noninvasive papillary UCC confined to the epithelium and subepithelial connective tissue, 2 which can be managed by endoscopic resection. A significant number of post-resected cases, progress for recurrence of tumour and infiltration to muscle layers. Invasive bladder cancer has high morbidity and uniform mortality when it is metastatic. There are no effective tools to predict aggressiveness of tumour, so that these cases can be managed more successfully. Mutated Tp53/p53 is the genetic abnormality most frequently associated with UCC and related to cell transformation, malignancy and high recurrence rates. 2 MATERIALS AND METHODS This is a descriptive study conducted in the departments of urology and pathology and during the period of March 2014 to February 2015. All consecutive cystoscopic biopsies, Trans urethral resection of bladder tumour (TURBT) and radical cystectomy specimens histopathologically diagnosed as UCC were included in the study. p53 expression was assessed by immunohistochemistry. Positive and negative controls were used. Bivariate analysis was done using Chi-square test in all cases. RESULTS A total of 80 cases were analysed. Significant association of p53 expression was found in higher grades of tumour. Also, noted relation of p53 mutation with tumour size, multifocality, multiplicity, muscle invasion and tumour stage, which were statistically not significant. CONCLUSION Bladder tumour grade shows significant association to p53 expression. Papillary neoplasm of low malignant potential (PUNLMP) tumours are negative for p53, and in the present study, there was significant difference in p53 over expression low-grade papillary UCC compared with PUNLMP. 90% of low-grade papillary tumours were p53 positive. This indicates a crucial role of p53 mutation in further tumour progression from PUNLMP to low-grade UCC. p53 mutation may have a role in transformation of low to high-grade TCC, and in this study, we found increased p53 expression with increased grade. But, though tumour size, multifocality, recurrent tumours and advanced stage show positive relation to p53, the association couldn't be proved to be statistically significant.