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Introduction: Though transitional cell carcinoma is a common malignancy in older age group it is very rare to find a young patient without any risk factors for carcinoma bladder to present with bladder malignancy. We would like to present a case of 23 yr old male who presented with carcinoma bladder. Materials and Methods: 23 yr old male presented with hematuria for 6 months. Past history of undergoing TUR biopsy 1 yr back for the growth detected in bladder. The biopsy report was suggestive of low grade TCC without muscle invasion. After that patient was lost to follow up. Patient got admitted again for haematuria and obstructive uropathy secondary to bilateral back pressure changes. On USG whole bladder was filled with mass. His serum creatinine was 11 mg%. Serum creatinine stabilised at 3.0 mg % after inserting bilateral percutaneous nephrostomies. On cystoscopy there was multiple polypoidal growths all over the bladder wall. TURBx was suggestive if high grade TCC with muscle invasion Then he was subjected for laparoscopic radical cystectomy and open urinary diversion in form of ileal conduit after metastatic workup. Result: Laparoscopic radical cystectomy was performed using four ports. Time taken was 185 mins. Blood loss was 125 ml. specimen was extracted by a small midline infra umbilical incision and ileal conduit was performed via same incision. Post op recovery was uneventful. Drain was removed on 2nd post operative day. Histo pathology was suggestive of high grade TCC with involvement of muscularis propria, surgical margins free of tumour, no evidence of metastatis to lymphnodes present. Conclusion: Though it is very rare to see young patient with malignancy we should rule out malignancy in any patient presenting with haematuria. Laproscopic radical cystectomy is a feasible option in young patient with muscle invasive carcinoma bladder. [ABSTRACT FROM AUTHOR]

Introduction: Although open pyeloplasty remains the gold standard for treating ureteropelvic junction obstruction, endourology and laparoscopy have revolutionized the management of upper tract obstruction. Pyeloplasty is an extremely demanding procedure by the laparoscopic route more so in pediatric subpopulation. We wish to share our experience of laparoscopic management of PUJ obstruction. Materials and Methods: 24 cases of PUJ obstruction between August 2004 to June 2007 were managed by laparoscopic pyeloplasty repair. Age ranged between 1 year to 60 years. 1 patient had h/o failed endopyelotomy once. All patients were investigated in the form of IVU, Renal scan and RGP. Pre operatively in all patients there was hydronephrosis on IVU with non visualisation of ureter. Our study group comprised of 15 males and 9 female patients. 7 cases were operated on the right side as opposed to 17 on the left side. In 17 cases dismembered Anderson Hynes pyeloplasty, in 6 cases Foleys Y-V pyeloplasty and in 1 case Fenzer pyeloplasty was done. In 17 cases approach was transperitoneal whereas in 2 cases it was retroperitoneal in lateral position using standard two 5 mm and one 10 mm port, fourth port used whenever required. Results: The average operating time was 160 minutes. the average blood loss was 150 ml. In three cases we had to convert to open owing to dense adhesions on account of previous surgery. Hospital stay averaged 3.8 days. At three months of surgery patients were assessed in the form of IVU. In all the patients except one there was drainage and visualisation of ureter and in 10 cases there was persistent hydronephrosis on IVU. Post operatively 15 patients underwent renal scan. 11 patients had improved renal function whereas in 4 patients renal function was static. All showed improved drainage on diuretic renogram post operatively. Two patients presented with UTI and in 4 cases there were persistent symptoms howsoever all these recovered on conservative management. Conclusion: In experienced hands laparoscopic pyeloplasty is an effective alternative treatment for symptomatic ureteropelvic junction obstruction. The results appear durable and comparable to open pyeloplasty with decreased postoperative morbidity. [ABSTRACT FROM AUTHOR]