Objective: A prospective randomized study was executed to compare the surgical parameters and stone clearance in patients who underwent percutaneous nephrolithotomy (PNL) under combined spinal-epidural anesthesia (CSEA) versus those who underwent PNL under general anesthesia (GA). Methods: Between January 2008 to December 2009, 64 patients with renal calculi were randomized into 2 groups and evaluated for the purpose of this study. Group 1 consisted of patients who underwent PNL under CSEA and Group 2 consisted of patients who underwent PNL under GA. The operative time, stone clearance rate, visual pain analog score, mean analgesic dose and mean hospital stay were compared amongst other parameters. Results: The difference between visual pain analog score after the operation and the dose of analgesic requirement was significant on statistical analysis between both groups. Conclusion: PNL under CSEA is as effective and safe as PNL under GA. Patients who undergo PNL under CESA require lesser analgesic dose and have a shorter hospital stay.

Squamous cell carcinoma of the renal pelvis and ureter is a rare malignancy, having an incidence of 6% to 15% (of all urothelial tumors). Few cases of primary squamous cell carcinoma of kidney have been reported in the world literature. The insidious onset of symptom and lack of any pathognomonic sign, leads to delay in the diagnosis and subsequent treatment, resulting in grave prognosis for these patients.Herein, we report 5 cases (three males and two females) of advanced primary squamous cell carcinoma of kidney that were treated at our centre during the last 6 years. The average age was 57 years (range 50-65 years). Three of the patients had history of long standing renal calculus disease while 3 had history of smoking and 1 patient had history of analgesic abuse. These cases were unique because in few of them; all the calyces were involved by the tumor -a fi eld change type of pattern normally seen in transitional cell carcinoma of the kidney. In one patient, thrombus of the inferior vena cava was also present along with infi ltration of the duodenum by the tumor. Despite prompt nephroureterectomy, 4 out of 5 patients died within 6 months of treatment. Only one patient was surviving at 5 months of follow up.Nephrectomy with or without ureterectomy is the treatment of choice in patients suffering from squamous cell carcinoma of the kidney. There is lack of evidence of survival benefi ts of chemo-radiation following surgery but is advocated by some with the hope that it might increase survival. Biopsy from the renal pelvis or calyceal wall is advocated at the time of stone removal in patients having long-standing history of large renal calculi or staghorn calculus since such patients are capable of harboring occult or overt malignancy.

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BackgroundThe purpose of this prospective study was to evaluate the donor site morbidity in patients who have undergone oral mucosa graft urethroplasty for stricture of the urethra. The impact of smoking and oral consumption of tobacco and/or paan masala on the donor site was also assessed. This study is probably the first of its kind where the affect of smoking, paan masala and tobacco chewing on the donor site morbidity has been documented.MethodsForty-eight patients suffering from stricture of the urethra underwent oral mucosa graft urethroplasty between July 2005 and December 2007. The patients were divided into two groups (users or non-users) based on tobacco consumption and oral hygiene. The donor site was evaluated at frequent intervals for pain, swelling, numbness, bleeding, salivation and tightness of mouth.ResultsDonor site morbidity was more in users with poor oral hygiene. Pain scores were higher amongst the users and the morbidity persisted longer in the users compared to non-users with good oral hygiene.ConclusionPatients who consume tobacco and have poor oral hygiene should be warned regarding poorer outcomes after oral mucosa graft urethroplasty.

INTRODUCTIONWe describe our technique of percutaneous suprapubic catheter insertion with special reference to steps that help to avoid common complications of haematuria and catheter misplacement.METHODSThe procedure is performed using a stainless steel reusable trocar under local infiltrative anaesthesia, usually at the bedside. After clinical confirmation of a full bladder, the trocar is advanced into the bladder through a skin incision. Once the bladder is entered, the obturator is removed and the assistant inserts a Foley catheter followed by rapid balloon inflation. Slight traction is applied to the catheter for about five minutes. Patients with previous lower abdominal surgery, an inadequately distended bladder or acute pelvic trauma do not undergo suprapubic catheterisation using this method.RESULTSThe procedure was performed in 72 men (mean age: 42.4 years, range: 18–78 years) with urinary retention with a palpable bladder. The average duration of the procedure was less than five minutes. No complications were noted in any of the patients.CONCLUSIONSTrocar suprapubic catheter insertion is a safe and effective bedside procedure for emergency bladder drainage and can be performed by resident surgeons. The common complications associated with the procedure can be avoided with a few careful steps.