Ovotesticular disorder of sex development (OT-DSD) is a rare disorder of sexual differentiation characterized by the presence of both ovarian and testicular tissues in the same individual. It's incidence ranges from 3% to 10% of all disorder of DSD's, and the most common presentation is 46, XX followed by 46, XX/46, XY mosaicism and 46, XY. Klinefelter syndrome (KS) mosaicism 46, XX/47, XXY is extremely rare, and its association with the ovotesticular disorder is even rarer. We report an unusual case of 16-year-old with male habitus who presented with complains of cyclic hematuria. On examination, he had bilateral gynecomastia, unilateral left cryptorchidism, absent facial hair, sparse axillary hair growth, and pubic hair distribution of feminine type. The right testis was of normal size located normally in hemiscrotum and was confirmed by radio imaging. Ultrasonography and magnetic resonance imaging revealed a cystic area behind posterior half of urinary bladder. Chromosomal analysis revealed 46, XX/47, XXY mosaicism of female karyotype and KS. Histopathological report of this left side excised specimen confirmed the structures to be ovary, uterus, and fallopian tube, thus confirming our diagnosis of the lateral ovotesticular disorder. Meticulous workup combined interdisciplinary approach will lead to early diagnosis and resolve timely sex reassignment issues and also prevent consequences arising due to gonadal insufficiency.

Objective: Retrograde urethrography (RUG) is the most common and preferred imaging modality for imaging of the anterior urethral strictures despite its well-known limitations and disadvantages. Sonourethrography (SUG) was introduced in 1988 to overcome the limitations of RUG and to provide more accurate results. As proper selection of imaging modality is very important for planning the treatment, various advances in this area are required. One of the major factors for recurrence of stricture disease is spongiofibrosis. Sonoelastography (SE) is a newer technique, tried in various other pathologies. In this study, we have used this technique for the first time to assess its efficacy in the evaluation of anterior urethral stricture disease by comparison with RUG and SUG. Material and methods:Between August 2014 and May 2015, 77 patients with clinical features of anterior urethral stricture disease were included in the study and evaluated by RUG followed by SUG and SE for stricture location, length, depth of spongiofibrosis and periurethral pathologies. The results were then correlated with operative and histopathological findings. Results:Overall diagnostic accuracy of SE, SUG, and RGU for the estimation of stricture location, and length were estimated 92.68% vs. 91.54%, 79% vs. 78.87% and 80.48% vs. 43.66%, respectively, while for depth of spongiofibrosis SE, and SUG had accuracy rates of 87.3%, 48%, respectively. The mean length measured on SE was nearest to the mean intra-operative stricture length (21.34+11.8 mm). SE findings significantly correlated with the colour of bladder mucosa on cystoscopic examination (p=0.003) whereas the association was nonsignificant (p=0.127) for difficulty in incision. While a nonsignificant correlation existed between SUG findings related both to the colour of the bladder mucosa and difficulty in incision on cystoscopy, SE findings had a significant association (p<0.001) with histopathology findings for severe degree of fibrosis. Conclusion:Sonoelastography estimates stricture site and length better in comparison with RUG and SUG. It estimates degree of spongiofibrosis which serves as an important prognostic factor for stricture recurrence more accurately than SUG.

IntrOductIOnEmergency cases are not frequent in urology specialty compared to other surgical fields, yet they pose a challenge as and when they are faced [1]. However, emergency cases constitute a sizeable proportion of urology cases at our tertiary care institution. Urological cross references from other departments of the institute further increases the emergency case load. The common presentation of emergency urology cases is retention of urine [2] but their lie geographic variations in the distribution of urological emergencies and hence the present study was undertaken to analyse the different urological presentations of emergency cases and their necessary interventions. Study ObjectIveS1) To estimate the proportion of urological emergencies out of all emergencies reported at the center.2) To describe the different types of urological emergencies reported and their required management. MAterIALS And MetHOdSThis hospital based observational descriptive study was done in the Department of Urology, SMS Hospital Jaipur. This hospital is the largest tertiary referral center in the state with wide catchment area. There were 35,35,639 Outpatient Department (OPD), 3,31,931 Inpatient Department (IPD), nearly 4,36,220 emergency IPD patients and 2,86,433 number of operations done at this centre in the year 2013.Although being a tertiary referral teaching hospital, direct urological emergency admissions are also entertained on regular basis. The number of emergency admissions are out of proportion of available beds. So it is the true reflection of urological emergencies which are being faced by physicians on regular basis.Total 2,345 urological emergencies that reported directly to emergency department and 5310 emergency referral within hospital for urological cross consultations were considered for the study. Patient data enlisting age, sex, referral status, clinical presentation, duration of hospital stay and management provided were collected from patient records on Arogya online registered referral system. This is an advanced hospital management system connected to mobile network of doctors and staff for faster communication and timely care of patients. It also facilitates maintenance of patient records for future references and data analysis [Table/ Fig-1a & b].Sample size: A sample of 2345 urological emergency cases is required at 95% confidence interval and 15% relative error to verify the minimum 7% proportion of different types of urological emergencies (ranges 7 to 73%) [3].Sampling procedure: We scrutinized consecutive 39,994 emergency case records from August 2013 to September 2014 to obtain 2345 urology emergency cases. All 5310 urological cross referral cases reported during this period were also analysed for the study. reSuLtSUrology cases constituted 5.84% (2345/39,994) of all surgical emergency admissions [Table/ Fig-2]. Total 11,139 cases were admitted in the urology department during the study period, of which 8111 (72.8%) were routine outpatient department (OPD) admissions, 2345 (21.05%) were emerge...