The supracostal approach gives high stone clearance rates with acceptable morbidity rates and should be attempted in selected cases. Complications when present may be managed easily with conservative measures.

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AIM:With advancement in minimal access surgery two laparoscopic procedures can be combined together shortening the total hospital stay, decreasing morbidity and overall reduced cost. Combining two laparoscopic procedures in a single session has been reported in general surgery. Very few articles are available in literature with regard to combined urological laparoscopic surgeries. This article retrospectively analyses the outcomes of multiple laparoscopic procedures performed in a single stage at our centre.MATERIALS AND METHODS:Patients undergoing simultaneous procedures from May 2003 to Jan 2009 were included in the study. Patients were categorised into three groups according to the primary urological organ involved, for better comparison with the control group. Diseases involving the adrenals gland were grouped in (group 1), kidney (group 2) and renal collecting system/ureter (group 3). All patients had one urological procedure for either of the above-mentioned organs combined with another surgical procedure. Similarly three control groups were chosen according to the primary urological organ involved (group 1c- unilateral laparoscopic adrenalectomy, group 2c- unilateral laparoscopic radical nephrectomy and group 3c- unilateral laparoscopic ureterolithotomy) for comparative study. The operative details, hospital stay and complications were analysed.RESULTS:Thirty-two patients underwent 64 laparoscopic procedures under single anaesthesia. The most common procedure in this series was laparoscopic adrenalectomy (n=34) followed by laparoscopic nephrectomy (n=13). Group 1 patients had a prolonged operative time (P = 0.012) and hospital stay (P = 0.025) when compared with group 1c. However, blood loss was comparable in both the groups. Patients in groups 2 and 3 had comparable operative times, blood loss and recovery period with respect to their controls. Intraoperatively, the end tidal carbon dioxide levels were within permissible limits. All procedures were completed using the laparoscopic approach, without any conversion.CONCLUSIONS:Simultaneous laparoscopic procedures can be done for urological diseases in selected patients with the advantages of single anaesthesia and hospital admission without increasing the morbidity.

LA has all advantages of minimal access surgery in patients with Cushing's syndrome who are immunocompromised and at high risk of delayed wound healing and infections. Magnification decreases the risk of retained adrenal remnants. Despite advances in minimal access surgery, perioperative morbidity continues to be significant for the procedure.

ObjectivesTo determine the level and prevalence of anxiety and depression in men being investigated for prostate cancer (CaP) and also to identify those aspects of the diagnostic pathway that induces the most stress.MATERIALS AND METHODSAll patients undergoing transrectal ultrasound-guided biopsy (TRUS-B) of the prostate for suspected CaP at our institute between June 2008 and April 2009 were enrolled in this prospective study. All patients completed two questionnaires, prior to their biopsy (HADS1) and before receiving results (HADS2), containing the Hospital Anxiety and Depression Scale (HADS). The data were analyzed and the differences in HADS were compared.ResultsA total of 112 men were included in the trial. Two patients could not complete the second part of HADS (HADS2) and were excluded from the study. Prevalence of anxiety among the 110 patients was 43/110 (39.1%). Mean score for anxiety in these 43 patients before biopsy (HADS A1) was 10.74 and score just before receiving the biopsy report (HADS A2) was 11.55. Prevalence of depression before TRUSB (HADS D1) was 21/110 (19.1%) with a mean score of 10.59. Prevalence of depression while awaiting the biopsy report (HADS D2) was 22/110 (20%) with mean score of 10.62.ConclusionThere was a high prevalence of anxiety and depression in our study population and waiting for biopsy results was the most stressful event. Questionnaires such as HADS can identify patients with psychological distress. Minimizing the stress while waiting for a diagnosis should help optimize patient care.