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Context and Aims: Ureteroscopy is the definitive management for ureteric stone. Conventional ureteroscopy uses fluoroscopy guidance which has radiation exposure to patients as well as hospital staff. Ultrasound is a good radiation-free alternative for using in the urological procedure. With this background, we executed a prospective randomized trial comparing fluoroscopy-guided ureteroscopy versus ultrasound-guided ureteroscopy., Subjects and Methods: Patients were randomized into two groups (41 into fluoroscopy and 41 into ultrasound group after exclusion) in a single center from July 2014 to March 2015. Semi-rigid ureteroscopy was used in all cases. Ultrasound was used to place guide wire and postprocedure stents placement in ultrasound group. Patient's characteristics; intra- and post-operative parameters were compared between the two groups., Statistical Analysis Used: SPSS version 16.0 (Chicago, IL, USA) was used for statistical analysis. The results were presented as percentages and means (± standard deviation). The categorical/dichotomous variables were analyzed using Chi-squared test. Continuous variables were analyzed using unpaired t-test., Results: A total of 102 adult patients were randomized in this trial and eighty patients undergo the final analysis. Mean stone burden was 41.75 ± 13.44 (17.94-79.20 mm 2 ). Mean operative time was 43.90 ± 12.99 (25-82 min) in fluoroscopy group versus 45.61 ± 11.62 (28-78 min) in ultrasound group. The initial success rate was 93.75% (92.30% in fluoroscopy vs. 95.12% in ultrasound group). Overall complications noted in 8.75% and most of the complications were minor in nature., Conclusions: Ultrasound-guided ureteroscopy is safe and effectively for ureteric stone. Fluoroscopy can be avoided during ureteroscopy for uncomplicated stone. No radiation ureteroscopy is feasible with good success and minimal complication. Larger sample size with multicentric trial needed for its greater applicability.

Horseshoe kidney (HSK) is the most common congenital renal fusion anomaly with approximate incidence of 1:400 to 1:1000 births. Pelvic-ureteric junction obstruction (PUJO) occurs in 15-33% of patients in this population. Herein, we report our experience of management of PUJO in HSK by retroperitoneoscopic pyeloplasty., (2016 BMJ Publishing Group Ltd.)

The purpose of this study is to prospectively identify factors that predict the chance of pleural injury (detected clinically or on postoperative X-ray chest) during percutaneous nephrolithotomy (PCNL). All patients with renal/upper ureteric stones, undergoing PCNL between January 2013 and June 2014, were evaluated for pleural injury. An erect chest X-ray on inspiration was done within 6 h of PCNL. The patients were divided into Groups A and B depending on whether they developed or did not develop pleural injury. Patient-, stone-, renal-, and procedure-related factors were compared between the two groups. 332 patients with mean age 36.76 ± 15.01 years (range 4-80) and M:F of 172:160 fulfilled the inclusion criteria. Pleural complications occurred in 10 patients (3 %). Of 141 patients with supracostal punctures (59 had additional infracostal punctures), 4.2 % (n = 6) had pleural injury. Of 191 patients with only infracostal punctures, 4 developed pleural injuries (2 %). Patients in group A had significantly lower age (27.00 ± 11.18 vs. 37.06 ± 15.03, p = 0.03) and lower BMI (18.0 ± 1.90 vs. 21.12 ± 2.24 p = 0.002). Incidence of pleural injury was significantly higher (p = 0.001) on right side [4.0 % (7/172) vs. 1.8 %, 3/160)]. Incidence of pleural injury had no association with staghorn calculi, stone surface area (590.51 ± 313.88 for Group A vs. 593.02 ± 387.10 for Group B; p = 0.11), degree of hydronephrosis, and operative time (65.13 ± 19.45 for Group A vs. 72.21 ± 19.56 for Group B; p = 0.06). On multivariate analysis, only low BMI and mean age <27 years were associated with higher risk of pleural injury. Higher incidence of pleural injury was noted in patients with low BMI and younger age.

Renal stone disease may present as nephrocutaneous fistula. Spontaneous extrusion of renal stone with nephrocutaneous fistula is rare. Most of the cases have been reported in adults. We present a case of nephrocutaneous fistula with spontaneous extrusion of staghorn renal calculus in a paediatric patient., (2016 BMJ Publishing Group Ltd.)

The objective of this study is to assess the efficacy of superior calyceal access versus inferior calyceal access for inferior calyceal calculi with or without pelvic calculi. A total of 100 patients with inferior calyceal calculi or inferior calyceal calculi with pelvic calculi were included in this prospective randomized study. In 50 patients (Group 1), a fluoroscopy-assisted superior calyceal puncture was made, and in other 50 patients (Group 2), access was obtained through a fluoroscopy-assisted inferior calyceal puncture. The stone-free rates, hemoglobin drop, operative duration, requirement for additional tracts, complications, and auxiliary procedures in the two groups were compared. Stone clearance rates and hemoglobin drop values were better in group 1, though they were not statistically significant. The mean operative duration, number of tracts required, and the relook procedure rate were significantly in favor of Group 1. Only one patient (2%) in Group 1 developed hydropneumothorax related to supracostal puncture and required intercostal tube drainage. Superior calyceal puncture (supracostal or infracostal) provides favorable access to inferior calyceal stones, providing better and faster clearance with less requirement of secondary tracts and auxiliary procedures.

Vaginal agenesis occurs in approximately 1:5000 live female births. It results from failure of the sinovaginal bulbs to develop and form the vaginal plate. Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) is the most common cause of vaginal absence followed by complete or partial androgen insensitivity syndrome. Treatment of these patients encompasses a spectrum from simple non-operative dilation to the more complicated surgical creation of a neovagina. We present a case of a patient with testicular feminising syndrome who was reared as a female and underwent bilateral gonadal excision and sigmoid vaginoplasty., (2016 BMJ Publishing Group Ltd.)

Synchronous ipsilateral adrenocortical carcinoma (ACC) and renal cell carcinoma (RCC) are rare. Radiological imaging may not in all cases differentiate between the two tumours due to their proximity to each other. We encountered a case where preoperative diagnosis of renal cell carcinoma was made based on the radiological imaging but, following radical nephrectomy, this was found to be synchronous ACC and RCC after histopathological examination. The patient is doing well at 12 months of follow-up, with no clinical or radiological recurrence., (2015 BMJ Publishing Group Ltd.)

Purpose: To assess the subjective and objective outcomes of mini-incision dismembered Anderson-Hynes pyeloplasty in the treatment of primary ureteropelvic junction obstruction (UPJO)., Materials and Methods: Between January 2008 to January 2013, Anderson-Hynes pyeloplasty was performed in 71 patients diagnosed with primary UPJO. Small subcostal muscle splitting incision was used in all cases. Sixteen patients with renal calculi underwent concomitant pyelolithotomy. Subjective outcome was assessed using visual pain analogue score (VAS). For objective assessment, the improvement in differential renal function (DRF) and radio-tracer wash out time (T1/2) on Tc-99m DTPA scan and decrease in hydronephrosis (HDN) on renal ultrasound (USG) and urography (IVU) were assessed., Results: Mean incision length was 5.2 cm. The average operating time and postoperative hospital stay was 63 (52-124) minutes and 2.5 (2-6) days respectively. Concomitant renal calculi were successfully removed in all the patients. Overall complication rates were 8.4% and overall success rate was 98.6% at median follow-up of 16 months. There was significant improvement in pain score (p=0.0001) and significant decrease in HDN after the procedure. While preoperative mean T1/2 was 26.7±6.4 minutes, postoperative half-time decreased to 7.8±4.2 minutes at 6 months and to 6.7±3.3 minutes at 1 year. Mean pre-operative DRF was 26.45% and it was 31.38% and 33.19% at 6 months and 1 year respectively., Conclusions: Mini-incision pyeloplasty is a safe and effective technique with combined advantage of high success rates of standard open pyeloplasty with decreased morbidity of laparoscopic approach. Excellent functional and objective outcomes can be achieved without extra technical difficulty.

Aim: The aim of this study is to compare urodynamic and continence parameters among patients undergoing orthotropic neo-bladder substitution with sigmoid or ileal segments. Variations in the Urodynamic parameter between the continent and incontinent patients were also evaluated., Patients and Methods: From January 2008 to March 2012, 44 patients underwent ileal neobladder (IN) reconstruction and 36 patients underwent sigmoid neobladder (SN) reconstruction. Evaluation of Urodynamic and Continence parameters was performed at 12 months after surgery., Results: The average capacity of IN and SN was 510 ml and 532 ml respectively. The voiding pressure, mean peak flow rates and post void residual urine (PVRU) for IN and SN were 27.5 cm H2O versus 37 cm H2O, 15ml/s versus 17ml/s and 36 ml versus 25 ml respectively. Daytime continence for IN and SN was 93% (41/44) and 89% (32/36), and night-time continence was 91% (40/44) and 78% (28/36) respectively. The compliance, maximum cystometric capacity and PVRU in the daytime continent (versus incontinent) were 61 (versus 41), 471 (versus 651) and 22 (versus 124) and in the night-time continent (versus incontinent) were 57 (versus 43), 437 (versus 654) and 18 (versus 105) respectively., Conclusion: A neobladder constructed from detubularized ileum or sigmoid achieves urodynamically proven adequate capacity and compliance with 89-93% daytime and 78-91% night time continence. Continent men when compared with incontinent (both daytime and night time) were more likely to have comparatively higher compliance, lower maximum cystometric capacity and lower PVRU. Urodynamic study could predict which incontinent men would improve with pelvic floor exercises and clean intermittent catheterization (CIC).

Objective: To compare the results of transperitoneal laparoscopic vs retroperitoneoscopic simple nephrectomy for benign renal diseases in a prospective randomized design., Methods: In this study between January 2009 and August 2013, 31 patients underwent transperitoneal laparoscopic nephrectomy and 31 retroperitoneoscopic nephrectomy after randomization. The 2 groups were compared for the visual pain score on the first and second postoperative days as the primary end point of the study. Complications were recorded and graded using Dindo-modified Clavien classification of surgical complications. Secondary objectives were to compare each of the operative techniques in terms of duration of surgery, complication rates, and postoperative convalescence. Statistical analysis was performed with SPSS version 16.0 with P <.05 considered statistically significant., Results: The difference in the visual pain score (4.9 vs 2.7 on day 1; 3.2 vs 1.1 on day 2) and the tramadol requirements (167.3 vs 132.8 mg) were statistically significant and more in the transperitoneal laparoscopic nephrectomy. The hospital stay and convalescence were significantly lower in retroperitoneoscopic group. Three patients in transperitoneal laparoscopic nephrectomy group and 2 patients in retroperitoneoscopic group required conversion. Mean time to normal activities was significantly less in retroperitoneal laparoscopic nephrectomy group (16.7 ± 3.5 vs 9.34 ± 4.9 days; P = .0001)., Conclusion: Although both transperitoneal laparoscopic and retroperitoneoscopic simple nephrectomy are feasible options for nonfunctioning kidneys due to benign renal diseases in adults, retroperitoneal laparoscopic nephrectomy is associated with significantly less pain, less analgesic requirement, shorter hospital stay, and short convalescence as compared with transperitoneal laparoscopic approach., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background and Objectives: To compare laparoscopic transperitoneal versus retroperitoneoscopic pyeloplasty for primary ureteropelvic junction obstruction in a prospective randomized manner and assess overall results with long-term follow-up., Methods: In this prospective study, from 2008 to 2012, 112 cases of primary ureteropelvic junction obstruction were randomized in a 1:1 ratio into 2 groups. Group I included patients who underwent transperitoneal laparoscopic pyeloplasty, and group II consisted of patients who underwent retroperitoneoscopic laparoscopic pyeloplasty. Demographic and clinical characteristics and postoperative and operative data were collected and analyzed. The statistical analysis was performed with the Fisher exact test, χ2 test, and Mann-Whitney U test for independent groups, and P<.05 was considered statistically significant., Results: The total operative time and intracorporeal suturing time were significantly higher in group II than in group I (P<.001). The visual analog scale score for pain on postoperative day 1 and the requirement for tramadol were significantly higher in group I than in group II (P=.004). The hospital stay and the rate of temporary ileus were significantly greater (P<.036 and P<.02, respectively) in group I than in group II. The success rate of transperitoneal laparoscopic pyeloplasty versus retroperitoneoscopic laparoscopic pyeloplasty was 96.4% versus 96.6% with a mean follow-up period of 30.75±4.85 months versus 30.99±5.59 months (P<.88)., Conclusion: Transperitoneal laparoscopic pyeloplasty is associated with significantly greater postoperative pain, a higher tramadol dose, a higher rate of ileus, and a longer hospital stay in comparison with retroperitoneoscopic laparoscopic pyeloplasty. Although the operative time for retroperitoneoscopic laparoscopic pyeloplasty is significantly longer, the success rate remains the same for both procedures.

Objective: To conduct a prospective comparison of quality-of-life (QoL) outcomes in patients who underwent ileal conduit (IC) urinary diversion with those who underwent orthotopic neobladder (ONB) reconstruction after radical cystectomy for invasive bladder cancers., Patients and Methods: Between January 2007 and December 2012, 227 patients underwent radical cystectomy and either IC urinary diversion or ONB (sigmoid or ileal) reconstruction. Contraindications for ON were impaired renal function (serum creatinine >2 mg/dL), chronic inflammatory bowel disease, previous bowel resection and tumour involvement at the bladder neck/prostatic urethra. Patients who did not have these contraindications chose to undergo either IC or ONB reconstruction, after impartial counselling. Baseline characteristics, including demographic profile, body mass index, comorbidities, histopathology of the cystoprostatectomy (with lymph nodes) specimen, pathological tumour stage, postoperative complications, adjuvant therapy and relapse, were recorded and compared. The European Organization for Research and Treatment of Cancer QoL questionnaire C30 version 3 was used to analyse QoL before surgery and 6, 12 and 18 months after surgery., Results: Of the 227 patients, 28 patients in the IC group and 35 in the ONB group were excluded. The final analysis included 80 patients in the IC and 84 in the ONB group. None of the baseline characteristics were significantly different between the groups, except for age, but none of the baseline QoL variables were found to be correlated with age. In the preoperative phase, there were no significant differences in any of the QoL domains between the IC or the ONB groups. At 6, 12 and 18 months in the postoperative period, physical functioning (P < 0.001, P < 0.001 and P = 0.001, respectively), role functioning (P = 0.01, P = 0.01 and P = 0.003, respectively), social functioning (P = 0.01, P = 0.01 and P = 0.01, respectively) and global health status/QoL (P < 0.001, P < 0.001 and P = 0.002, respectively) were better in patients in the ONB group than in those in the IC group and the differences were significant. The financial burden related to bladder cancer treatment was significantly lower in the ONB group than in the IC group at 6, 12 and 18 months of follow-up (P = 0.05, P = 0.05 and P = 0.005, respectively), Conclusions: ONB is better than IC in terms of physical functioning, role functioning, social functioning, global health status/QoL and financial expenditure. ONB reconstruction provides better QoL outcomes than does IC urinary diversion., (© 2013 The Authors. BJU International © 2013 BJU International.)

Objective: To evaluate the complications (using the CROES Clavien scoring system) and various factors affecting them in children undergoing percutaneous nephrolithotomy (PCNL)., Patients and Methods: We analysed prospectively maintained data of paediatric PCNL (patients ≤17 years) from January 2008 to December 2012. Stone complexity was defined according to validated Guy's stone score (GSS). Procedures were performed in the prone position by experienced urologists. The tract was dilated (24-30F) under fluoroscopic guidance, and an adult rigid nephroscope complemented with a cystoscope/ureteroscope were used. Complications were recorded according to the CROES-Clavien score, recently defined by the Clinical Research Office of the Endourological Society (CROES) Study Group., Results: The study group comprised 158 procedures performed in 153 children (98 boys and 55 girls), with a mean (range) age 10.03 ± 4.51 (2-17) years. The mean (range) stone burden was 376.68 ± 265.23 (150-2400) mm(2) . The distribution of cases according to the GSS was 31% grade I, 35.4% grade II, 19% grade III, and 14.6% grade IV. The stone-free rate of PCNL monotherapy was 85.4%, which increased to 93.7% after relook PCNL/extracorporeal shock wave lithotripsy. In all, 62 children (39.2%) had operative complications; 84% were minor, i.e. Clavien grade 1/2, and managed conservatively. Stone size, GSS, tract size, number of punctures and operation duration were significantly associated with complications on univariate analysis (P < 0.05). However, on multivariate logistic regression analysis, operation duration was the only independent risk factor associated with complications (95% confidence interval: 1.013-1.065, odds ratio = 1.04; P = 0.038)., Conclusions: Percutaneous nephrolithotomy in children using adult instruments is an effective and safe procedure for managing simple as well as complex renal calculi. Assignment of specific Clavien scores to all possible PCNL complications by the CROES PCNL Study Group have improved precision in reporting complications in a standard objective format, including the minor ones. Such models are very useful for making inter-observer comparisons to obtain clinically relevant inferences. Mean operation duration is the only independent factor affecting complications of the procedure., (© 2013 The Authors. BJU International © 2013 BJU International.)

To compare the retroperitoneoscopic ureterolithotomy (RPLU) versus open mini-incision ureterolithotomy (MIOU) for large and impacted proximal or mid-ureteric stones in prospective randomized manner and to assess the outcome results. In a prospective randomized study between January 2009 and December 2012, 35 RPLU and 35 MIOU were included in the study. The indications for ureterolithotomy were as primary treatment of large and impacted stones more than 1.5 cm in the proximal and mid-ureter and as salvage treatment of failed ureteroscopy (URS)/extracorporeal shock wave lithotripsy (SWL). The two groups were compared for visual pain score on the first and second postoperative day, analgesic requirement, stone removal in one attempt, operative time, blood loss, postoperative complications, hospital stays and the period of convalescence. The difference in the visual pain score and the tramadol requirement was significantly higher in MIOU group. The hospital stay (RPLU 2.86 ± 0.43, MIOU 5.71 ± 0.67, P ≤ 0.001) and period of convalescence (RPLU 12.29 ± 4.06, MIOU 24.11 ± 5.55, P ≤ 0.001) were also significantly higher in MIOU group. The complications were 11.4 % (P ≤ 0.02) in RPLU versus 17.4 % in MIOU group. However, the stone removal in one attempt was similar in both groups. In condition of failed URS/SWL, unavailability of the full endoscopic armamentarium and limitation of costs, RPLU and MIOU both are safe and effective treatment options for large impacted upper- and mid-ureteric stones and RPLU has better tolerability, lesser hospital time and equal stone clearance rate.

Objective: To determine the subjective and objective outcomes of retroperitoneoscopic vs open pyeloplasty with minimal incision in a prospective randomized comparison study., Methods: In this study between August 2011 to July 2013, 30 patients underwent retroperitoneal laparoscopic pyeloplasty and 30 open pyeloplasty with minimal incision (incision length <10 cm) after randomization. The 2 groups were compared for the visual pain score on the first and second postoperative days as the primary end point of the study. Complications were recorded and graded using Dindo-modified Clavien classification of surgical complications. Success rates were evaluated by improvement in pain score and objectively by diethylene triamine penta-acetic acid renal scan and other parameters. Statistical analysis was performed with SPSS version 16.0 (IBM) with P <.05 considered statistically significant., Results: The difference in the visual pain score (5.6 vs 3.2 on day 1; 3.8 vs 1.5 on day 2) and the diclofenac requirements (333.3 vs 178.75 mg) were statistically significant and more in the open pyeloplasty. The hospital stay and convalescence were significantly lower in retroperitoneoscopic group. Success rate was found to be 96.67% with 1 failure in each group. Two patients in retroperitoneoscopic group required conversion. Both groups showed significant improvement in pain score and drainage pattern on diethylene triamine penta-acetic acid scan with decrease in hydronephrosis on ultrasound evaluation., Conclusion: Although subjective and objective outcomes are equivalent in both the groups, the retroperitoneoscopic approach is associated with significantly less pain, less analgesic requirement, shorter hospital stay and short convalescence in comparison with open pyeloplasty., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objectives: We performed a prospective randomized comparison of retroperitoneoscopic pyelolithotomy (RP) versus percutaneous nephrolithotomy (PNL) for solitary pelvic stones >3 cm and assessed the outcome results., Methods: From 2010 to 2012, 44 patients with a solitary pelvic stone >3 cm without any anatomical abnormality were randomized to either RP or PNL on a 1:1 ratio. Stone-free rate, number of procedures per patient and complications were recorded., Results: The stone-free rate on the first postoperative day was 95.5% in the RP group versus 72.7% in the PNL group (p = 0.04). The stone-free rates at 3 months were similar between the two groups. Blood loss, visual pain analog score and analgesic requirement on the first postoperative day were significantly higher in the PNL group whereas the mean operative time and overall complications were similar between the two groups., Conclusion: In patients with solitary large pelvic stones, RP is associated with lesser blood loss, postoperative pain and analgesia as well as with a higher stone-free rate in the immediate postoperative period in comparison to PNL. However, the stone clearance rate remains the same at 3 months in both groups., (© 2013 S. Karger AG, Basel.)

Introduction: Filarial chyluria is a common problem in filarial endemic countries. Its management begins with medical therapy but some patients progress to require surgery. The present study aimed to determine factors affecting response to medical management in patients of filarial chyluria., Materials and Methods: This prospective study conducted between August 2008 and November 2012, included conservatively managed patients of chyluria. Demographic profile, clinical presentation, treatment history and urinary triglycerides (TGs) and cholesterol levels at baseline were compared between the responders and non-responders. Apart from the clinical grade of chyluria, hematuria was evaluated as an independent risk factor., Results: Out of the 222 patients (mean age, 37.99 ± 13.29 years, 129 males), 31 patients failed to respond while 35 had a recurrence after initial response; the overall success rate being 70.3% at a mean follow-up of 25 months. No difference was observed in demographics, clinical presentation, presence of hematuria, disease duration and mean urinary TGs loss between responders and non-responders. On multivariate analysis, patients with treatment failure were found to have a higher-grade disease (14.3% Grade-I, 36.6% Grades-II and 60% Grade-III), higher number of pretreatment courses (1.59 ± 1.08 vs. 1.02 ± 0.79) and heavier cholesterol (26.54 ± 23.46 vs. 8.81 ± 8.55 mg/dl) loss at baseline compared with responders (P < 0.05)., Conclusion: Conservative management has a success rate in excess of 70%, not affected by the disease chronicity, previous episodes and recurrent nature. However, higher-grade disease, extensive pre-treatment with drugs and higher urinary cholesterol loss at baseline are the predictors of poor response. Hematuria is not an independent poor risk factor for conservative management.

Aim: Prospective randomized study on transperitoneal laparoscopic ureterolithotomy (TPLU) versus open ureterolithotomy (OU) for treatment of large impacted ureteric stones (≥ 1.5 cm) and assessment of overall results., Material & Methods: In a prospective study between 2010 to 2012, 30 patients underwent TPLU and 30 OU based on 1:1 randomization. The operation was indicated primarily in 44 cases or after failed shock-wave lithotripsy/ureteroscopy in 16 cases. Two groups were compared for operative time, success rate, visual pain score, analgesic requirement, hospital stay, and postoperative complications. Statistical analysis was performed with SPSS® version 16.0 using Fisher exact or Mann-Whitney U tests with p < 0.05 considered statistically significant., Results: The difference in visual pain score (6.2 in TPLU group vs 3.1 in OU group on day 1; 4.8 vs. 2.4 on day 2) and tramadol requirements (184.32 mg in TPLU group vs. 150.87 mg in OU group on day 1; 97.34 mg vs. 65.56 mg on day 2) were statistically significant and more in OU. Hospital stay and convalescence were significantly lower in the TPLU. However, stone removal in one attempt was similar in both the groups., Conclusion: Although successful stone removal rates are equal in both groups, TPLU is associated significantly with less postoperative pain, less analgesic requirement, shorter hospital stay and short convalescence in comparison to OU.

Objective: To present our experience of treating supratrigonal vesicovaginal fistulae by laparoscopic technique and their long-term follow-up., Material and Methods: Between January 2008 and June 2012, 28 cases of supratrigonal fistulas were repaired by laparoscopic transperitoneal transvesical technique with interposition flap. The obstetric fistula was present in 18 and gynecologic fistula in 10 patients. Single supratrigonal fistula was present in 26 patients and in 2 patients there were 2 fistulae lying side to side. The vaginal opening was closed as single layer interrupted suture and cystotomy closed as single layer continuous suture by 3-0 polygalactin. The omentum was used as interposition flap in all except 2 cases in whom postero-superior vesical fold of peritoneum was used. The open conversion was required in 2 cases. The urethral catheter was removed in 4 weeks following a micturating cystogram., Result: The mean fistula size was 1.2 cm (range 0.8-2.5 cm). Open conversion was performed in 2 cases of whom one had excess carbon-dioxide retention and cardiac arrhythmia and in another case the needle of 3-0 polygalactin was avulsed and lost in peritoneal cavity which was recovered following laparotomy. All patients were continent following the catheter removal. The median follow-up is 24 months. None developed any complication related to laparoscopic repair till last follow-up., Conclusion: Laparoscopic repair of supratrigonal vesicovaginal fistulae is an effective and safe minimally invasive treatment with excellent result.

Vesicovaginal fistula (VVF) is a very commonly encountered urogynaecological entity in developing countries such as India. The most common cause of VVF in developing counties is secondary to obstructive labour. We report a very unusual case of VVF in a young woman that developed due to insertion of an unknown vaginal herb for treatment of primary infertility. Cystoscopy showed a single trigonal fistula measuring 3×2 cm just near the bladder neck. Vaginoscopy revealed cicatrised less capacious vagina and unhealthy vaginal mucosa. She was treated with transvaginal VVF repair using Martius flap interposition which leaked on 10th postoperative day. She underwent re-evaluation and another transvaginal fistula repair for small trigonal residual fistula after 3 months. She is doing well during the follow-up of 2 years. She attained sexual activity after 3 months of surgical repair but could not conceive.

Objectives: Nephrolithiasis has been reported in 20-28% of patients, of whom 50% are symptomatic for stone disease and 20% require definite urologic intervention. The management of nephrolithiasis includes oral alkali dissolution therapy, extracorporeal shock wave lithotripsy and surgical treatment. In such patients, percutaneous nephrolithotomy (PNL) as a method of stone treatment has been reported in few cases with limited experience. The aim of this study is to present our experience of PNL in autosomal dominant polycystic kidney disease (ADPKD) and assessing the outcome results., Material and Methods: From 2002 to 2011, 22 patients (26 renal units) suffering from ADPKD with stone were managed by PNL. Demographic characteristics, operative parameters and postoperative complications were recorded and analysed., Result: The overall success rate of PNL was 82.1% and PNL with extracorporeal shock wave lithotripsy for clinically significant residual fragments was 92.85% respectively. The hematuria required blood transfusion (n = 9), postoperative fever due to cyst infection (n = 4) and paralytic ileus (n = 3) were recorded., Conclusion: The PNL in ADPKD PNL is safe and effective but have more postoperative complications such as bleeding requiring transfusions, fever due to cyst infection and paralytic ileus.

A 22-year-old young woman presented with dysuria and lower urinary tract symptoms that had persisted for 6 months. She was diagnosed with a tumor near the bladder neck. Transurethral resection was done under anaesthesia. The histopathological examination with immunohistochemical staining showed the tumor to be a low-grade leiomyosarcoma. Adjuvant chemoradiation was given, and the patient has been doing well for 12 months of follow-up. Nonurothelial tumors of the bladder are rare and consensus is lacking regarding their definitive treatment. Furthermore, little is known about the natural history and prognosis of this type of bladder sarcoma. We present a minimally invasive treatment for this relatively rare tumor in which bladder preservation was achieved with no evidence of local or distant recurrences during the follow-up to date.

An 18-year-old man born with aphallia had undergone phallic reconstruction in childhood followed by total urethral reconstruction with a buccal mucosal graft and groin-based pedicle (Singapore) flap urethroplasty at 13 years of age. The patient presented with obstructive voiding symptoms lasting 6 months followed by acute urinary retention. The results of a voiding cystourethrogram showed a filling defect in the distal urethra that had been reconstructed by use of the skin flap. On urethroscopy, a 3 cm×2 cm sized tricholithobezoar was seen in the distal urethra. Pneumatic lithotripsy followed by bulbar urethrolithotomy was performed in the same operation to extract the bezoar. The remaining hairs were mechanically epilated. The patient has been doing well for 6 months of follow-up.

Purpose: To retrospectively report and grade the peri-operative complications of transurethral resection of the prostate (TURP) using the modified Clavien classification system (MCCS) and validate whether Charlson comorbidity index (CCI) predicts the complications after TURP., Materials and Methods: Between September 2006 and 2012, data of 722 patients who underwent TURP were analyzed after excluding patients with incomplete data (n = 40). Data recorded included the age, prostate volume, operative time, mean prostatic tissue removed and duration of hospitalization while complications were recorded using the MCCS. Preexisting comorbidities were evaluated using the CCI, and patients were classified into 3 CCI score categories (0, 1, ≥ 2)., Results: Two hundred and forty-four complications were seen in 145 (20 %) patients. CCI score was "0" for 480 patients (66.5 %), "1" for 184 patients (25.5 %) and "≥ 2" for 58 patients (8 %). Significant difference was observed between patient groups with CCI score 0, 1 and ≥ 2 for mean age, prostatic weight, operative time, weight of prostatic chips and duration of hospitalization. Similarly, a significant difference in occurrence of various MCCS grades of complication among patients groups with different CCI score was observed., Conclusion: Grades I, II and III complications constituted the main bulk (90 %) while grade IV were less common (<8 %) and grade V was rare (1 %) after TURP. Men with higher CCI score had a significantly higher rate of morbidity than those with a lower score. The present study is the first to validate that CCI can predict complications of TURP recorded according to the MCCS.

Purpose: We compared laparoscopic transperitoneal and retroperitoneal ureterolithotomy approaches, and determined whether one technique is superior to the other., Materials and Methods: In this prospective randomized study from January 2009 to May 2012, 48 patients with proximal or mid ureteral stones underwent transperitoneal laparoscopic ureterolithotomy or retroperitoneal laparoscopic ureterolithotomy. The randomization occurred on a 1:1 basis. Groups 1 and 2 consisted of patients who underwent transperitoneal laparoscopic ureterolithotomy and retroperitoneal laparoscopic ureterolithotomy, respectively. Demographic and clinical characteristics as well as postoperative data were collected and analyzed. Statistical analysis was performed with SPSS® version 15.0 using the Fisher exact and Mann-Whitney U tests with p <0.05 considered statistically significant., Results: The difference in visual pain analog score and mean tramadol requirement on days 1 and 2 between the 2 groups was statistically significant, and was higher in group 1 (p <0.05). Postoperative hospital stay and paralytic ileus rates were significantly higher in group 1 (p <0.05). The differences in total operative time and intracorporeal suturing time between the 2 groups were not statistically significant. However, successful stone removal was equal in the 2 groups., Conclusions: For proximal or mid ureteral large and impacted stones, transperitoneal laparoscopic ureterolithotomy is significantly associated with pain, greater tramadol requirement, ileus and longer hospital stay than retroperitoneal laparoscopic ureterolithotomy. However, successful stone removal remains the same in both groups., (Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: To prospectively report and grade the perioperative complications of ureteroscopy (URS) for stone removal using a semirigid ureteroscope with the modified Clavien classification system and to identify the determinants of the complications., Methods: From August 2010 to November 2011, the prospective data from 120 consecutive patients (71 men and 49 women) who had undergone primary unstented URS at a resident training center were analyzed. Patients with renal failure, pyonephrosis, diabetes mellitus, hypertension, and congenital ureteral abnormalities were excluded (n = 29). The data recorded included patient demographics, stone size and location, and complications according to the modified Clavien classification system., Results: Of the 120 patients, 36 (30%) experienced 79 complications. The stone size was ≤ 10 mm in 56 and >10 mm in 64 patients. The stone location was the lower, mid-, and upper ureter in 62, 58, and 3 patients, respectively. The latter 3 were excluded because of the small sample size. Grade 1, 2, 3a, 3b, 4a, and 4b complications were encountered in 46 (38.3%), 18 (15%), 3 (2.5%), 10 (8.3%), 1 (0.8%), and 1 (0.8%) patient, respectively. The incidence of complications was greater for stones >10 mm, a mid- versus distal ureteral location, impacted stones, and surgery performed by a resident. The incidence was not affected by patient sex, stone laterality, or lithotripter type. The patients with complications had a longer operative time (75 vs 46.5 minutes), longer hospitalization (4.8 vs 1.5 days), and lower stone-free rate (64% vs 97%)., Conclusion: Most complications were grade 1-3 (98%), and grade 4 complications were rare (<2%) with URS. The present study is probably the first to prospectively study the complications of URS using the modified Clavien classification system., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Introduction and Objectives: To prospectively document the perioperative complications of percutaneous nephrolithotomy (PCNL) using the modified Clavien grading system. Evaluation of complications and clearance rates according to stone complexity using the validated Guy's Stone Score (GSS) was also done., Materials and Methods: A total of 221 renal units underwent 278 PCNL procedures at a urology resident training center between September 2010 and September 2011 and data were recorded prospectively in our registry. Patients with co-morbidities like diabetes, renal failure, hypertension and cardiopulmonary diseases were excluded. Stone complexity was classified according to the GSS while peri-operative complications were recorded using the modified Clavien grading system., Results: Two hundred and forty-five complications were encountered in 278 PCNL procedures involving 116 renal units (41.72%). Complications of Grades 1, 2, 3a, 3b, 4a, 4b and 5 were seen in 52 (18.7%), 122 (43.8%), 42 (15.1%), 18 (6.4%), 6 (2.1%), 4 (1.4%) and 1 (0.3%) renal units respectively. There were 68, 98, 50 and 5 renal units in GSS I, II, III and IV groups, respectively. All grades of complications were more common in GSS III and IV (P<0.05). For GSS I, II, III and IV 100%, 74%, 56% and 0% of renal units, respectively, were stone-free after one session and 0%, 24%, 44% and 60% respectively needed two sessions to be stone-free., Conclusion: Although the complication rates were higher most were of low grade and self-limiting. Complications were significantly more common with higher GSS and the GSS effectively predicted stone-free rates.

Introduction and Hypothesis: The purpose of this study is to present the outcome of management of vesicovaginal fistula (VVF) by the transabdominal route., Methods: Between January 2001 and December 2010, 48 patients suffering from VVF were managed through the transabdominal route., Results: The success rate following first repair was 87.5%. Patients who failed the first repair (n = 6) were managed again by the transabdominal route (second attempt). Two of these patients were cured, while another patient was cured after prolonged catheter drainage. One patient was managed by ureterosigmoidostomy (Mainz II) pouch but died after 6 months. The remaining two patients refused further treatment and were lost to follow-up., Conclusions: Transabdominal repair of VVF in properly selected patients results in satisfactory treatment outcome.

Objective: To present our experience of managing acute urinary retention (AUR) in young and middle-aged male due to stone/s in the urethra at a tertiary care centre., Material and Methods: Between July 2004 to April 2011, 102 male patients, young and middle-aged (18-40 years), who suffered from AUR due to calculus in the urethra were managed at our center. Initial management consisted of urethral catheterization or suprapubic trocar cystostomy. Definitive management was performed immediately or after a couple of days depending upon the availability of anesthesia and/or operation theatre. Stone was fragmented by mechanical lithotrite, pneumatic lithotrite or holmium:YAG laser., Results: All the patients were completely free of their stone/s following the definitive procedure. Voiding trial was successful in all the cases. Postoperative urinary tract infection was observed in eight patients who had undergone immediate endoscopic management. Mild hematuria for approximately 48 hours was noted in six patients who underwent suprapubic cystolithotripsy., Conclusion: Endoscopic management is currently the treatment of choice for stone/s in the urethra which may cause AUR in young and middle-aged male., (Copyright © 2011 AEU. Published by Elsevier Espana. All rights reserved.)

We present the case of a female aged 16 years, suffering from cyclical menouria for the last 3 years. Clinical examination revealed the absence of a vagina. Cystoscopy performed while the patient was having menouria revealed an orifice (10 × 8 mm) in the supratrigonal region; blood clots were entering the urinary bladder through this orifice. Magnetic resonance imaging of the pelvis depicted a fluid-filled longitudinal tract distal to the uterus (which was the upper vagina), between the cervix and the bladder. Diagnostic laparoscopy confirmed the presence of a uterus, both ovaries, and the tubal structures. Exploratory laparotomy, correction of the fistulous tract, and sigmoid vaginoplasty were performed. The distal part of the fistulous tract (urinary bladder end) was anastomosed to the proximal end of the sigmoid neo-vagina. The patient is doing well as per her last follow-up at 6 months. She has started menstruating per neo-vagina.

Objective: To document the experience at a tertiary referral hospital in India with managing complex and complicated vesicovaginal fistulae (VVF) by the transvaginal route, and to document the complications and the long-term outcome of the patients., Methods: The medical records of 102 patients with complex or complicated VVF who underwent transvaginal surgical repair during 2000-2009 were reviewed retrospectively., Results: The mean age of the patients was 24 years and the mean duration of urinary incontinence was 3 years (range 6 months to 12 years). The patients were followed up for a median of 48 months. In total, 78 patients had obstetric fistulae, 20 patients had surgical (gynecologic) fistulae, and 4 patients had postradiation fistulae. The overall success rate for the transvaginal approach was 86.3%. Fourteen patients remained incontinent despite the surgical repair. Early failure of the repair was observed in 11.8% of the patients and delayed failure in 2.0%. Postoperative complications included stress urinary incontinence (9.8%), urge urinary incontinence (7.8%), dyspareunia (5.9%), and chronic labial pain (2.0%)., Conclusion: The transvaginal approach to the repair of complex and complicated VVF gives good long-term results with low complication rates., (Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

In patients with vesicouterine fistula (VUF), identification of the fistulous tract during laparoscopic surgery remains difficult. Hysterography and intravesical instillation of dye have been the traditional methods for diagnosing VUF; now, they have been supplanted by ultrasonography, CT, and/or MRI. Unfortunately, none of the above mentioned investigations aid in identification of the fistulous tract during laparoscopic surgery or ease laparoscopic dissection. We describe a simple procedure, which we term cystohysteroscopy, that aids the diagnosis of VUF and also simplifies laparoscopic dissection. A guidewire/ureteral catheter is coiled in the uterine cavity through the fistulous tract with the help of a cystoscope. By cystohysteroscopy, this guidewire/ureteral catheter is pulled out through the vagina using a semirigid ureteroscope. The advantage of cystohysteroscopy is that the presence of the guidewire/ureteral catheter across the fistulous tract aids laparoscopic dissection even in the presence of fibrosis and can be used for traction/manipulation during dissection in the vesicouterine area. This is the first report in the literature depicting the use of a semirigid ureteroscope for the purpose of cystohysteroscopy.

Objective: To document the management of tuberculous cicatrized urinary bladder by incorporating bowel segment and the long-term follow-up after the reconstructive surgery., Materials and Methods: Twenty-three patients (out of 28) were managed by augmentation cystoplasty (AC) and 5 by orthotopic neobladder (OTN) reconstruction. Sigmoidocystoplasty was performed in 11 cases, ileocystoplasty in 10 patients and ileocecocystoplasty in 2 patients. Ileal neobladder reconstruction was done in 2 patients, ileocecal neobladder reconstruction in 1 patient and sigmoid neobladder reconstruction in 2 patients, respectively. The patients were followed according to standard follow-up protocols., Result: The mean age of patients who underwent AC was 32.5 years and of those who underwent OTN reconstruction was 31 years. The mean pre-operative bladder capacity in patients with AC was 70 ml (range 40-100 ml) and of patients with OTN reconstruction was 14 ml (range 10-20 ml). The mean postoperative bladder capacity at 3 months following AC was 427 ml (range 450-500 ml) and following OTN reconstruction it was 430 ml (range 350-450 ml). The mean follow-up in patients who underwent AC was 43.3 months (range 12-90 months) and in those who underwent OTN reconstruction it was 35.6 months (16-60 months). None of the patients had upper urinary tract deterioration following the reconstructive surgery., Conclusion: Urinary bladder rehabilitation either by AC or OTN reconstruction increases the bladder capacity and storage time and also preserves the upper tracts.

Objectives: To present our experience of reconstructive surgery in patients with penoscrotal filarial lymphedema., Methods: From January 2000 to December 2009, we treated 48 patients with penile and penoscrotal filarial lymphedema using reconstructive surgery. Isolated penile involvement was seen in 14 patients, and 34 patients had penoscrotal involvement. All the patients had taken multiple courses of antifilarial drug before surgery. For isolated penile involvement, the diseased penile skin was excised and covered with a split-thickness skin graft. In some patients, the inner prepucial skin was preserved and used to cover the penile shaft. For those with penoscrotal involvement, scrotoplasty was performed, after excising the diseased scrotal skin and underlying soft tissue, while sparing the testes and spermatic cords., Results: The mean patient age was 38 years (range 25-52), and the median follow-up time was 48 months (range 10-120). All 48 patients reported a satisfactory cosmetic appearance after the procedure and noted improvement in their ability to void while standing. Also, all of them could ambulate better and resumed sexual activity. Local groin infection was present in 12 patients; all were cured after proper management., Conclusions: In filarial lymphedema of penis and/or scrotum, excision of the diseased tissue and covering with a split-thickness skin graft provided good results. If the inner prepucial skin is healthy, it should be used to cover the distal penile shaft. If the scrotum is involved, scrotoplasty with lateral and posterior mobilized flaps provides satisfactory results., (Copyright © 2011 Elsevier Inc. All rights reserved.)

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., (Copyright © 2011 S. Karger AG, Basel.)

Objective: To document our experience (at a tertiary health care center) of reconstruction of the urethra in 3 male patients suffering from aphallia and congenital urethrorectal fistula as well as their long-term follow-up., Methods: Extensive single-stage urethroplasty in 3 patients suffering from aphallia was performed. Prior to that, neophallus reconstruction was done in all 3 patients after puberty. In a single stage, we used oral mucosa and pedicled penile skin onlay for anterior urethra reconstruction and groin-based pedicle (Singapore) flap for posterior urethra substitution surgery. The current follow-up is between 2 and 5 years. During the last follow-up, the patients also answered questions from a validated patient-reported outcome measure and quality of life questionnaire., Results: All the 3 patients are voiding well in the standing position with a mean Q(max) of 14 ml/s. None of them has any problems related to the neourethra as per their last follow-up. All 3 patients were satisfied with the surgical procedures related to the aphallia correction and stated that the surgery did not interfere with the quality of their lives., Conclusion: Reconstruction of the urethra from pedicled skin flap combined with buccal mucosa graft urethroplasty gives durable and satisfactory long-term results., (Copyright © 2011 S. Karger AG, Basel.)

Introduction: In a prospective study, outcome of oral mucosa graft urethroplasty (OMGU) was assessed in patients suffering from stricture of the urethra., Materials and Methods: Patients who underwent OMGU between July 2005 and December 2007 were included in this prospective study. Forty-eight patients with stricture of the urethra were divided into 2 groups of those who consumed tobacco and had poor oral hygiene and those who did not consume tobacco and had satisfactory oral hygiene. The oral cavity was inspected. The type of tobacco consumption and the duration of exposure to tobacco were noted. The mean follow-up was 18.2 months (range, 6 to 36 months). The patients were evaluated to assess the outcome of OMGU., Results: The final outcome was analyzed in 42 patients. Thirty-one patients were asymptomatic and/or satisfied with their urinary flow rate, who were considered to have a successful outcome (73.8 %). Successful outcome in patients who consumed tobacco was significantly less (58.3%) compared to that in the tobacco nonusers (94.4%; P = .008)., Conclusion: Failure rate of OMGU was higher in patients who consumed tobacco and had a poor oral hygiene, which might be due to adverse effects of these substances on the oral mucosa, leading to a poor graft quality.

Background and Purpose: A prospective randomized study was undertaken wherein transurethral resection of bladder tumor (TURBT) was performed along with transurethral resection of the prostate (TURP) in the same sitting (group A) in patients with bladder tumor and urodynamically proven bladder outflow obstruction. The outcome (recurrence and progression of superficial transitional cell carcinoma) was compared with patients who underwent TURBT and TURP in two separate sittings (group B) approximately 6 months apart., Patients and Methods: Between January 2002 and December 2007, 48 patients were randomized for this study. The inclusion and exclusion criteria are described below. The patients were followed up according to standard protocols. The two groups were compared for the recurrence and progression of the bladder tumor., Results: Mean age in both the groups were similar (group A = 56.06 +/- 4.45 years, group B = 57.36 +/- 3.65 years). The mean duration of follow-up was also similar between the two groups (group A, 35.71 +/- 12.8 months; group B, 37.55 +/- 14.12 months; P > 0.05). In group A, 12 (50%) patients had recurrence, while in group B, 11 (42.85%) patients had recurrence. The differences in recurrence, mean elapsed time to recurrence, and progression of tumor between the two groups were statistically insignificant., Conclusion: TURBT and TURP can be performed simultaneously without any increased risk of recurrence and progression of tumor, if performed in a properly selected group of patients.

Background: The 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., Methods: Forty-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., Results: Donor 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., Conclusion: Patients who consume tobacco and have poor oral hygiene should be warned regarding poorer outcomes after oral mucosa graft urethroplasty.

Primary Polycythemia Vera (PV) is difficult to diagnose due to its varied and atypical 1 presentation. It is a myeloproliferative disorder which is managed conservatively. We submit a case report of a patient who was admitted in surgery with subacute intestinal obstruction due to compression by a massive splenic cyst. The investigations showed PV causing splenomegaly.

Ureterocystoplasty is a novel operation well suited for patients having small capacity urinary bladder with unilateral poorly functioning kidney and megaureter. The megaureter is detubularized and used for urinary bladder augmentation. The ureter lining has advantage of being non-secretory and free from the metabolic complications of enterocystoplasty. This operation is mainly done in children. This is one of the very few from the Asian subcontinent which describes the short term results of ureterocystoplasty in an adult patient. We report a case wherein ureterocystoplasty was performed in an 18-year male presented with a small capacity neurogenic bladder with a grossly dilated and tortuous left ureter and a non-functioning left kidney. Left ureter was detubularized and used for augmentation after left nephrectomy. Blood supply to the left ureter was preserved during the dissection. After the operation, the bladder capacity increased adequately and he is doing well at a followup of 1 year. Ureterocystoplasty works well in the adult patients also and the bladder capacity increases adequately following this procedure.

Fistula following circumcision and at times accompanied by disfigurement of the glans penis is a common problem in our country, where a large number of circumcision is performed by untrained professionals. These complications may have profound negative psychological impact on the growing child. Herein, we report the successful closure of such fistula using buccal mucosa, which occurred following circumcision (for phimosis) in a 15 year old boy. This resulted in the disfigurement of the glans penis with a distal urethral fistula. The fistula was managed by dorsal onlay buccal mucosa graft urethroplasty (BMGU). The patient has excellent cosmesis at 6 months followup with a good urinary stream. This technique can give better results than those, where skin grafts or local flaps are used for fistula closure. BMGU is a versatile technique with good long term results. The cosmesis and functional results are satisfactory and help in improving the self esteem and sexual function in the years to come.

Chronic prostatitis / chronic pelvic pain syndrome (NIH-type II and type III prostatitis) are common cause of chronic pelvic pain. The exact etiology of these entities are unknown. They are associated with varying degree of voiding and sexual dysfunction. Consensus regarding treatment of these pain syndromes is lacking. Review of literature suggest a therapeutic role of alpha adrenergic receptor blockers in the management of NIH-type II and type III prostatitis. A trial of alpha-blocker is reasonably inexpensive and appropriate for most patients suffering from NIH-type III prostatitis and NIH-type II prostatitis. A general consensus is that if a patient agrees to a trial of alpha-blocker therapy which subsequently shows a good response then it should be continued for at least 6 months for a proper therapeutic effect. This review analyses the role of alpha-blockers in this disease/syndrome; discusses the possible mechanism of action through which these drugs provide relief and also highlights some of the important trials which have paved way for this particular treatment option in this intriguing disease /syndrome.