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Structural urologic abnormalities resulting in dysfunctional lower urinary tract leading to end stage renal disease may constitute 15% patients in the adult population and up to 20-30% in the pediatric population. A patient with an abnormal bladder, who is approaching end stage renal disease, needs careful evaluation of the lower urinary tract to plan the most satisfactory technical approach to the transplant procedure. Past experience of different authors can give an insight into the management and outcome of these patients. This review revisits the current literature available on transplantation in abnormal bladder and summarizes the clinical approach towards handling this group of difficult transplant patients. We add on our experience as we discuss the various issues. The outcome of renal transplant in abnormal bladder is not adversely affected when done in a reconstructed bladder. Correct preoperative evaluation, certain technical modification during transplant and postoperative care is mandatory to avoid complications. Knowledge of the abnormal bladder should allow successful transplantation with good outcome.

Aim:To assess the relation of acute rejection with respect to lymphocele incidence and determine the effect of lymphocele with graft survival.Methods:The paper is a singlecenter retrospective data review of renal transplant recipients from 1980 to 2007. A total of 1700 patients received kidneys from live donation, and 9 patients received from cadaver donor. The standard transplant technique was performed in all. Lymphocele incidence, demography, relation to rejection episodes, type of immunosuppression, and management options were studied. Univariate analysis was performed to assess the role of rejection to lymphocele formation.Results:47 (35 males and 12 females) patients had symptomatic lymphocele in the post-transplant period. 51% of the lymphocele patients had history of rejection as compared to overall rejection rate of 20% (P = 0.009). 4 (7.2%) had at least 1 rejection and 19 (40.4%) had more than one rejection episodes. All 47 patients required aspiration. Of the 14 patients who did not settle with a maximum of two aspirations underwent marsupilization (5 open and 9 laparoscopic). 1, 5, and 10 year graft survival of overall transplant recipient and post-transplant lymphocele patients was 86.54%, 82.41% and 76.36% vs. 86.44%, 81.2% and 68.14%, respectively.Conclusion:Acute rejection episodes were associated with statistically increased risk of lymphocele. There was no adverse outcome of graft with lymphocele formation after rejection episodes with respect to the overall graft survival.

Pediatric urolithiasis poses a technical challenge to the urologist. A review of the recent literature on the subject was performed to highlight the various treatment modalities in the management of pediatric stones. A Medline search was used to identify manuscripts dealing with management options such as percutaneous nephrolithotomy, shock wave lithotripsy, ureteroscopy and cystolithotripsy in pediatric stone diseases. We also share our experience on the subject.Shock wave lithotripsy should be the treatment modality for renal stone less than 1cm or < 150 mm2 and proximal non-impacted ureteric stone less than 1 cm with normal renal function, no infection and favorable anatomy. Indications for PCNL in children are large burden stone more than 2cm or more than 150mm2 with or without hydronephrosis, urosepsis and renal insufficiency, more than 1cm impacted upper ureteric stone, failure of SWL and significant volume of residual stones after open surgery. Shock wave lithotripsy can be offered for more soft (< 900 HU on CT scan) renal stones between 1-2cm. Primary vesical stone more than 1cm can be tackled with percutaneous cystolithomy or open cystolithotomy. Open renal stone surgery can be done for renal stones with associated structural abnormalities, large burden infective and staghorn stones, large impacted proximal ureteric stone. The role of laparoscopic surgery for stone disease in children still needs to be explored.

Context:Laparoscopic surgical simulation is a valuable training tool for urology trainees.Aims:We assessed the validity of task completion time (TCT) as an objective tool for practicing and acquiring technical skills in a simulated laparoscopy environment.Materials and Methods:Fifteen participants comprising postgraduate urology trainees from first to third year (n = 12), urology fellow (n = 1) and consultants (n = 2) underwent basic laparoscopic training on the “Beetle Universal” endotrainer. Training included 10 attempts each comprising four tasks; placing a ball in a cup (Task 1), threading five rings (Task 2), threading five balls (Task 3) and tying a suture (Task 4). Individual task (IT) time was measured. The TCT was defined as sum of IT time for a single attempt.Statistical Analysis Used:Statistical analysis was done by Pearson's correlation coefficient and student's t test using SPSS software 10.Results:The average TCT for the first attempt to complete the four tasks by the participants was 76.5 ± 13.0 min (range 38 to 92.5, skew −1.8), compared to the 10th attempt 33 ± 4.23 min (range 25 to 38.5, skew −0.5). There was statistically significant correlation (r = mean −0.91, range −0.97 to −.83, skew −0.5), (P = < 0.001) between the number of attempts and decreasing TCT for all participants. Correlation decreased when TCT between the sixth to 10th attempt was compared (r = mean −0.67, range −0.99 to 0.76).Conclusions:The TCT is practical, easy and a valid objective tool for assessing acquired technical skills of urology trainees in a laparoscopic simulated environment.