Background: Nephrectomy being one of the most commonly performed procedures, a retrospective study and analysis was done to evaluate, the scope for screening and timely preventive measures that could help to reduce the need for nephrectomy. Aims and Objectives: The aim of the study was to study indications, demographic-details, clinical-presentations, time delay, comorbidities, operative procedures, and complications of patients undergoing nephrectomies. The study was to identify the high risk groups, assess for feasibility for screening measures, and formulate strategies for nephrectomy prevention for benign etiologies. Materials and Methods: A retrospective study was done on medical records of 220 consecutive nephrectomies from June 2018 to June 2020. Results: Out of 220 nephrectomies, 68% were performed for benign conditions, 17% for malignant etiology, and 15% were donor nephrectomies. In the benign group, the most common etiology was renal stones (44.54%), followed by pelvic ureteric junction obstruction (12.72 %), and renal tuberculosis (6.81%). The most common clinical presentations were flank pain (80%), followed by lower urinary tract symptoms (22%), dysuria (25%), hematuria (15%), and fever (7%). In the malignant group, the most common etiology was renal cell carcinoma (14.09%). The most common clinical presentations were flank pain (90%) followed by hematuria (67%). Overall, 24% of the patients presented with acute kidney injury. A pre-operative intervention such as DJ stenting and percutaneous nephrostomy insertion was performed in 13% and 9% of patients, respectively. A laparoscopic approach was used in 76% of the patients out of which 10% were converted to open procedures. Partial nephrectomy was performed in 3% of patients. Conclusion: There is a difference in nephrectomy indications between Western countries and India, where 68% of nephrectomies are performed for benign conditions especially calculus disease. Nephrectomy for calculus disease is potentially preventable and public education in the form of posters, media and the involvement of the community medicine department could be helpful.

Colovesical fistula is commonly suspected in cases of diverticular disease, malignancy, trauma, iatrogenic injury or radiotherapy. In a case of allogenic live related transplant, this is rarely expected, especially after 20 years. The presence of gas in the bladder in the absence of history of instrumentation of urinary tract should prompt us to evaluate for colovesical fistula. Pneumaturia, faecaluria and recurrent urinary tract infection are tell-tale features of colovesical fistula, and when patients who are renal allograft recipient present with them, it should prompt a proper workup and swift surgical management, since the outcome is uniformly favourable. From our knowledge in this realm, we know that these are immunocompromised patients and have a high tendency to develop risk factors like malignancy and/or diverticular disease and eventually form colovesical fistula. An expected time period could be from 2 months to 6 years. But in our case, fistula formation occurred long after peak corticosteroid action, in the absence of conventional aetiologies.