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Objective. Use of shock-wave lithotripsy (SWL) for lower caliceal calculus is associated with a relatively high rate of residual fragments. Various radiographic anatomical factors of the lower calix predicting the outcome of lithotripsy have been described and have generated considerable discussion. We aimed to reassess the role of these factors in predicting clearance of lower caliceal stones by SWL. Material and methods. Between January 1998 and December 2001, 148 patients underwent SWL for solitary lower caliceal stones using a Dornier Compact S lithotripter. The infundibular length, infundibular width, caliceopelvic height and infundibulopelvic angle were measured. Success was defined as either complete clearance or clearance with insignificant residual fragments <4 mm in size at 3 months follow-up. The results were analysed using the χ² test and logistic regression analysis. Results. Complete clearance was seen in 60% of cases and clearance with residual fragments <4 mm in size at 3 months was seen in 5%. The overall clearance rate at 3 months was 74%. Infundibular length, infundibular width, caliceopelvic height and stone size were not found to be statistically significant in predicting clearance. None of the patients had an infundibulopelvic angle of >90°. Contrary to most previous studies, univariate and multivariate analysis revealed that an infundibulopelvic angle of <70° was statistically significant in predicting clearance in the stone-free group. Conclusions. The use of radiographic anatomical factors to predict clearance of lower caliceal stones following SWL is an attractive concept. However, based on this study, we feel that these factors do not merit the attention they have attracted. In routine practice, regardless of the radiological anatomy, SWL continues to be the initial treatment option, given its non-invasive nature and ease of administration. [ABSTRACT FROM AUTHOR]

Objective. To compare the efficacy of fine-needle aspiration cytology (FNAC) with that of open biopsy in the evaluation of chronic epididymal lesions. Material and methods. Forty men evaluated for chronic epididymal lesions were studied. Men aged >25 years who did not intend to father any more children and had had local symptoms for >6 weeks were included. Of these 40 men, 23 who satisfied the above criteria were subjected to FNAC and open biopsy. The slides were reviewed by two independent pathologists. The sensitivity, specificity and positive predictive value of FNAC were compared with the results of open biopsy. Results. Tuberculous epididymitis was the commonest cause of chronic epididymal lesions, followed by non-specific epididymitis, sperm granuloma, epdidymal cyst and normal epididymis. The sensitivity and specificity of FNAC for the diagnosis of tuberculous epididymitis were 87% and 93%, respectively. For the diagnosis of non-specific epididymitis, FTSTAC was 100% sensitive and 100% specific. The positive predictive value was 87% for the diagnosis of both tuberculous and non-specific epididymitis. Conclusions. FNAC has an overall sensitivity and specificity of 90% for diagnosing chronic epididymal lesions, with a positive predictive value of 87.5%. It is a valuable tool for evaluating chronic epididymal lesions. We suggest that FNAC should be the first-choice investigation for establishing the histopathological diagnosis of epididymal lesions. [ABSTRACT FROM AUTHOR]