Objective To determine the optimum duration for the 25 min. The patients' discomfort was recorded using a 4-point descriptive pain scale and a 100 mm nonretention of 2% lignocaine gel intraurethrally as an anaesthetic for flexible cystoscopy in men.graphical visual analogue scale. Results In the first study, those patients receiving lignoPatients and methods A prospective, randomized, double-blind, placebo-controlled trial was conducted caine gel for 25 min experienced significantly less pain than the other three groups. In the second, lignocaine in two parts. Initially, the importance of duration was determined, i.e. whether pain relief was significantly gel in the urethra for 15 min provided the same level of pain relief as lignocaine for 25 min. improved when lignocaine gel was instilled for longer than is currently practised. As pain relief was improved Conclusion Pain during flexible cystoscopy can be significantly reduced when 20 mL of 2% lignocaine gel by retaining the lignocaine gel for longer, the optimum time was determined in a second trial. Initially, 90 is left in the urethra for 15 min; lignocaine gel would be more eÂective when left for longer than is currently patients were divided into four groups receiving 20 mL of 2% lignocaine gel or plain lubricating gel for 5 or practised. Keywords Local anaesthesia, flexible cystoscopy, topical 25 min. Subsequently, 60 men were divided into two groups receiving 20 ml of 2% lignocaine gel for 15 or lignocaine gel, urethra whether pain relief was significantly improved when

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pain, progressive abdominal distension and diÂculty inCase report voiding urine, with or without haematuria. Although ultrasonography and CT are useful, the diagnostic A 67-year-old man being regularly followed for TCC was admitted with lower abdominal pain and dysuria of a procedure of choice is contrast cystography [2]. The management of an intraperitoneal bladder rupture few days' duration. He was catheterized and 300 mL of mildly blood-stained urine was drained. The findings should be surgical and includes exploratory laparotomy, peritoneal lavage and closure of the bladder in two layers from haematological and biochemical investigations were normal and a urine sample was sent for microbiousing absorbable sutures, and perivesical drainage. If the perforation occurs in a bladder diverticulum, it should logical asessment. He had had a partial cystectomy and radiotherapy for a TCC in a diverticulum of the urinary be excised [3]. This is the first reported case of a bladder rupture bladder in 1974. Follow-up cystoscopy revealed a smallcapacity bladder with telangiectatic changes but no secondary to IVU; we believe that rupture of the bladder diverticulum in this patient occurred due to a combirecurrence of the tumour.In view of the frank haematuria at catheterization, an nation of radiation fibrosis and clamping of the urethral IVU was taken with abdominal compression and a clamp on the urethral catheter. As the initial urograms showed mild hydronephrosis on the left side, 40 mg of frusemide was given intravenously to assess the drainage of the left PUJ. Immediately after the IVU, the patient complained of abdominal pain. Examination revealed generalized abdominal tenderness with decreased bowel sounds. A cystogram confirmed an intraperitoneal bladder rupture and left-sided ureteric reflux (Fig. 1). At laparotomy, there was a small-capacity fibrotic urinary bladder with a perforated diverticulum. Diverticulectomy and closure of the urinary bladder in two layers was performed, leaving a suprapubic and an urethral catheter. The suprapubic catheter was removed after 7 days and the urethral catheter 2 weeks later, after cystographic confirmation that the urinary bladder had healed. The patient made an uneventful recovery and is now followed using annual urine cytology.

A 53-year-old women presented with left loin pain and microscopic haematuria; blood tests showed no abnormality. She had been taking analgesics for her symptoms. Two years previously she had had similar symptoms and IVU then showed delayed excretion of contrast medium on the left, with dilatation of the collecting system and ureter by 4 h, but there was no specific level of obstruction. No renal tract calcification was apparent. The symptoms were considered to be related to oedema after recent passage of a calculus. She then had follow-up ultrasonography of her kidneys 5 months later which showed normal kidneys and bladder. During the most recent IVU the control film showed no renal tract calcification. After administering contrast medium (injected through the left arm) the immediate film showed a normal nephrogram on the right but on the left there appeared a tubular, branching and enhancing structure (Fig. 1). The later films of the IVU series were entirely normal and this structure had completely disappeared, even in the 5-min film. On this series there was no abnormality of the left pelvicalyceal system or ureter and no evidence of obstruction. Ultrasonography (including Doppler imaging) was undertaken at the same time and showed no abnormality; she has remained symptom-free since her last visit to casualty. To examine this abnormality she underwent contrastenhanced CT of the thorax and abdomen (slice thickness 5 mm, overlap 1 mm, pitch 1.5; 100 mL of contrast medium injected at 3 mL/s into the left arm), with the scans evaluated using multiplanar reconstruction. This showed an abnormal venous channel communicating between the left brachiocephalic vein and the left renal vein via the left hemiazygous venous system. No other abnormality was detected in relation to other organs or venous systems, as shown in selected axial CT images (Figs 2 and 3) and reconstructed images (Fig. 4). CommentAnomalies of the venous system and some very rare complications related to these are well recognized [1-8]; we think the present patient is the first case involving the left renal vein and left brachiocephalic vein. The CT images showed the abnormal venous communication of the left brachiocephalic vein and left renal vein through, superiorly the left superior intercostal vein, which arches around the arch of the aorta, and then through the hemiazygous venous system. The likely explanation for this is a reflux of contrast medium from the left brachiocephalic vein (the contrast medium being injected through the left arm) into the hemiazygous venous system and then into the left renal vein.The main veins in an embryo are divided into two groups, visceral and somatic. The visceral veins are the right and left vitelline veins from the yolk sac, and the right and left umbilical veins from the placenta. The right and left anterior and posterior cardinal veins form the somatic veins. The azygous systems of veins embryologically drain the body wall into the posterior cardinal veins, which are soon transferred to longitudinal venous ch...