Although effective in improving renal function, PCN is a procedure not without associated morbidity and does not always prolong survival. Therefore, the decision to decompress an obstructed kidney with advanced pelvic malignancy should not be taken lightly. We recommend that such cases be discussed in a multidisciplinary setting, and a decision is taken only after a full informed discussion involving patients and their relatives.

Available online xxxKeywords: Catastrophic health expenditure Determinants Out of pocket payment Hospitalization India a b s t r a c t Introduction: To assess the magnitude, distribution, and determinants of catastrophic health expenditures (CHE) of households in urban Lucknow, North India.Methods: A cohort of 400 households was selected by 2-step cluster sampling and baseline demographic survey was done followed by two six-monthly health surveys. CHE was defined as health expenditures !10% of household's capacity to pay, measured by nonsubsistence spending.Results: From December 2011 to June 2012, 157/400 (39.25%) households reported !1 episodes of illness, with households suffering sickness in the first survey at increased risk for it in the second (Crude Odd's Ratio ¼ 3.33, 95% CI: 2.02e5.45; p value <0.0001). Mean sickness days without hospitalization were 13.13 AE 36 per household. In 24 (6%) households, there was !1 hospitalization. Health expenditure was entirely met through out of pocket payments (OOP). CHE occurred in 45 (11.25%) households, with statistically significant differences across per capita income quintiles (p ¼ 0.036) and 60% falling in the lower two. On logistic regression model, adjusting for per capital income quintile, CHE was associated with hospitalization (Adjusted OR ¼ 100, 95% CI: 25.00e333.33; p < 0.0001) and >13 sickness days without hospitalization (Adjusted OR ¼ 4.21, 95% CI: 1.862e9.524;Conclusions: Since not only hospitalization but also prolonged sickness days without hospitalization was associated with increased risk of CHE, and since almost half the households have sickness, steps should be taken to protect all households from financial hardship through tax based health financing, social health insurance or other forms of prepayment, as currently all health expenses were met through OOP payments.

Background: Health insurance in India is almost non-existent. Therefore all expenses incurred during illnesses are borne directly by the family and accurate estimates are not available. The primary objective of the study was to assess the proportion of households who incur out of pocket medical expenditure due to sickness of family members in an urban area in India. Secondary objectives were to quantify the direct and indirect medical expenditure incurred by families in the last 3 months and to assess the spending burden ratio (ratio of total medical expenditure to family income) among income quintiles. Methods: This was a community based cross sectional study conducted in randomly selected administrative wards in Lucknow city, northern India. Results: From December 2011 to March 2012, 400 families, having 2343 members were recruited from 16 wards. Mean family size was 5.86 members (SD ¼ 2.13 members) and mean family income was INR 9622.25 (SD ¼ 11,323.01) (US $1 ¼ INR 50 approximately in mid-2012). In last 3 months, 115 households (28.75 percent) sought medical care for illness in one or more family members. Mean direct medical expenditure was INR 3406 (SD ¼ 4657), mean indirect medical expenditure was INR 1449 (SD ¼ 2685) and mean total medical expenditure was INR 6590 (SD ¼ 13,333). The spending burden ratio in the lowest and highest income quintile was 0.57 AE 0.82 and 0.15 AE 0.30 respectively (p value ¼ 0.024). Conclusions: Since more than one-fourth of households incur medical expenditure which are paid out of pocket from family income, and since the spending burden ratio is statistically significantly higher in the lowest income quintile when compared to highest, there is a need for introduction of health insurance of some sort for the urban population. This is especially needed for the poorer sections, with provision to absorb the indirect medical expenses if possible.

Intravesical bacille Calmette-Guérin (BCG) is used to treat high-risk superficial bladder cancer. This article reports a case of secondary haemophagocytosis after intravesical BCG instillation in a 70-year-old man with bladder cancer and presents a literature review of this very rare but potentially fatal complication of intravesical BCG treatment.

ObjectivesSimple intratesticular cysts are being reported more commonly due to the wider use of scrotal ultrasonography however, their management remains unclear. Treatment has included enucleation, radical orchidectomy (over fear of an associated malignancy) and a more conservative approach with serial ultrasonography (if a neoplastic cyst is clearly ruled out). In view of the benign nature of such cysts, even serial ultrasonography may be unnecessary. We evaluate the presentation, diagnosis and management of ultrasound-detected simple intratesticular cysts over a 13-year period.MethodsBetween May 1994 and August 2007, 24 men were found to have simple intratesticular cysts on scrotal ultrasonography. Records were analysed retrospectively to identify the clinicoradiologic findings and the management.ResultsMedian follow up was 29.5 months (range 4 - 108 months). Only one patient became symptomatic with a cyst which increased in size by 13 mm over 15 months. Orchidectomy performed at the patient's request confirmed a benign simple cyst.ConclusionsIn our series, a significant change in size of the cyst with accompanying symptoms was observed in one case only. Asymptomatic patients with simple intratesticular cysts without associated features of bias towards malignancy can be discharged without need for further follow-up.