Spectroscopic view of life and work of the Nobel Laureate Sir C.V. Raman.

Raman spectroscopic and microscopic techniques have been used for nondestructive characterization of tissues and to differentiate benign and malignant tissues. The discovery of the principles of spectroscopy is credited to Sir C.V. Raman of India, who in 1930 brought the Nobel Prize in Physics to the East side of Suez. We present the life and work of Sir C.V. Raman with brief review of the uses of Raman spectroscopy in urology.

Self-introduction of foreign body into urinary bladder.

A 142-cm knotted electric cable was removed cystoscopically from a 12-year-old girl. Psychiatric evaluation revealed normal childhood curiosity and inquisitiveness and no pathological mental process. Both a urologist and a psychiatrist need to be involved in the management of such patients.

Fracture of corpus cavernosum following penile venous surgery. A case report.

A rare complication of fracture of the corpus cavernosum following penile venous surgery is described here. Problems of diagnosis and management are briefly outlined.

Unusual complication of suprapubic cystostomy. A case report.

An unusual case of inadvertent ureterostomy following suprapubic cystostomy is described. The case itself was unusual with unexpected obstruction at the bladder outlet.

Spontaneous nephrocutaneous fistula: a rare complication of reflux nephropathy.

A rare case of nephrocutaneous fistula due to reflux nephropathy in a 4-year-old female child is presented here. No such case has been described previously in the English literature.

Wrong site surgery! How can we stop it?

INTRODUCTION: "Primum non nocere" (first do no harm): Hippocrates (c. 460 BC-377 BC). Wrong site surgery is the fourth commonest sentinel event after patient suicide, operative and post-operative complications, and medication errors. Misinterpretation of the clinic letters or radiology reports is the commonest reason for the wrong site being marked before surgery. MATERIALS AND METHODS: We analyzed 50 cases each of operations carried out on the kidney, ureter, and the testis. The side mentioned on clinic letters, the consent form, and radiology reports lists were also studied. The results were analyzed in detail to determine where the potential pitfalls were likely to arise. RESULTS: A total of 803 clinic letters from 150 cases were reviewed. The side of disease was not documented in 8.71% and five patients had the wrong side mentioned in one of their clinic letters. In the radiology reports, the side was not mentioned in three cases and it was reported wrongly in two patients. No wrong side was ever consented for and no wrong side surgery was performed. CONCLUSION: The side of surgery was not always indicated in clinic letter, theatre list, or the consent form despite the procedure being carried on a bilateral organ. As misinterpretation is a major cause of wrong side surgery, it is prudent that the side is mentioned every time in every clinic letter, consent form, and on the theatre list. The WHO surgical safety checklist has already been very effective in minimizing the wrong site surgery in the National Health Service.

Extra-anatomical complications of antegrade double-J insertion.

INTRODUCTION: Insertion of a double-J (JJ) stent is a common procedure often carried out in the retrograde route by the urologists and the antegrade route by the radiologists. Reported complications include stent migration, encrustation, and fracture. Extra-anatomic placement of an antegrade JJ stent is a rare but infrequently recognized complication. MATERIALS AND METHODS: We performed a retrospective audit of 165 antegrade JJ stent insertions performed over three consecutive years by a single interventional radiologist. All renal units were hydronephrotic at the time of nephrostomy. All procedures were performed under local anaesthetic with antibiotic prophylaxis. RESULTS: Antegrade stent insertion was carried out simultaneously at the time of nephrostomy in 55 of the 165 cases (33%). The remainder were inserted at a mean of 2 weeks following decompression. In five (3%) patients, who had delayed antegrade stenting following nephrostomy, the procedure was complicated by silent ureteric perforation and an extra-anatomic placement of the stent. These complications had delayed manifestations, which included two retroperitoneal abscesses, a pelvic urinoma, a case each of ureterorectal fistula, and ureterovaginal fistula. Risk factors for ureteric perforation include previous pelvic malignancy, pelvic surgery, pelvic radiation, and a history of ureteric manipulation. CONCLUSION: Antegrade ureteric JJ stenting is a procedure not without complications. Extra-anatomic placement of the antegrade stent is a hitherto the infrequently reported complication but needs a high index of suspicion to be diagnosed. Risk factors for ureteric perforation at the time of stent insertion have to be considered to prevent this potential complication.

Dynamic pharmacocavernosometry: a search for an ideal approach.

Of 141 patients attending the department with complaints of erectile dysfunction, 57 were diagnosed as having organic impotence. Of these 57 patients, 37 were found to have venogenic impotence. All 37 patients had normal Duplex Doppler ultrasound examination and nonvasculogenic factors were ruled out. Corporovenous leak (CVL) was diagnosed on careful workup of dynamic pharmacocavernosometry along with cavernosography. After giving 60 mg of papaverine intracavernosally, dynamic cavernosometry was performed on a Dantec 5000 Urodynamic machine. The vesical or abdominal pressure was taken as intracavernous pressure (ICP) and venous infusion as total intracavernosal flow, measured on a Special User Program. The pressure and maintenance flow criteria were used to diagnose CVL and to define the correlation. Concomitant cavernosography was performed in each case to have radiological evidence. The criteria used to define the leak were: (1) maintenance flow requirement of > or = 30 ml/min, and (2) a fall in ICP of > 40 cm/30 s after achieving full erection when flow is stopped. Apart from these 37 patients, 5 normal controls and 7 patients with psychogenic impotence were also evaluated by this method to establish normal criteria.

Urethrocavernous fistula following sexual intercourse.

An unusual case of urethrocavernous fistula following blunt penile trauma sustained during sexual intercourse is described. The fistula was well outlined by cavernosography and responded successfully to conservative treatment.

Difficult urethral reconstruction.

A new technique using the pedicled island flap of penile skin for total urethral reconstruction is described. The technique consists of using a long, modified flap of more than 15 cm in length and was utilized in 6 cases of total urethral stricture. Four cases resulted in an excellent outcome, while 2 had fistula with anastomotic stricture. The technique is useful in reconstruction of the total urethra, but the utmost care is needed in the dissection to preserve the viability of the pedicle.

Ureteric substitution with Boari bladder flap.

Between 1986 and 1989, 12 patients underwent ureteric substitution with a Boari bladder flap at this Institute. The indications were ureteric injury following hysterectomy, difficult forceps delivery, difficult ureterolithotomy, ureteric strictures caused by a Dormia basket and previous ureteric surgery, tuberculosis, retroperitoneal fibrosis and a post-ureteric reimplantation fistula. There were 2 patients with a solitary kidney and 2 in acute renal failure. Double J stenting was carried out in 11 patients and the stent was removed 3 to 6 weeks post-operatively. Good results, with no morbidity or mortality, were achieved in all but 1 patient where a simple Silastic stent had migrated to the pelvis and required open surgery to remove it. We attribute our success to the tension-free anastomosis, a wide based posterior flap with preservation of its vascular supply, the use of a double J stent and vicryl suture material.

Syndrome of inappropriate antidiuretic hormone following tuberculous epididymo-orchitis in renal transplant recipient: case report.

A rare case of the inappropriate antidiuretic hormone syndrome after tuberculous epididymoorchitis in a renal transplant recipient is described. Orchiectomy was performed because of a cold abscess, following which clinical improvement was noted.

Anterior urethroplasty--changing concepts.

The management of complex anterior urethral strictures, not amendable to dilatation or internal urethromotomy, is difficult. Our experience of treating long strictures of anterior urethra with one-stage urethroplasty in 16 cases and two-stage Johanson's in 12 cases are reviewed here. The strictures had varied etiology and many were associated with fistula, diverticulum, etc. Three cases had concomitant posterior urethral strictures and were managed by one-stage anterior and posterior urethroplasty simultaneously. The one-stage repair was done using vascularized flap of longitudinal ventral penile skin in most cases. Transverse scrotal flap and Duckket's transverse preputial flap were utilized in 2 cases each. In one-stage repair success was 100% and in two-stage repair it was 75%. Our preference is now for one-stage repair irrespective of length and number of strictures.

Experience with penile venous surgery.

Venogenic impotence was detected in 37 out of 141 patients who attended our clinic with a complaint of erectile dysfunction. Eighteen patients presented with primary impotence and the rest had progressive secondary impotence. All 37 patients have shown partial or poor response to 60 mg of intracavernosal papaverine. The corporovenous leak (CVL) was diagnosed on the careful workup of dynamic pharmacocavernosometry and cavernosography. Concomitant arterial cause was noted in 10% cases on the basis of penile duplex Doppler ultrasound study. 24 patients in the age group of 23-60 years underwent the penile venous surgery. The CVL was noted in the deep dorsal vein (23 cases), cavernous vein (16) and in the crural vein (2). The operation consisted of deep dorsal vein (DDV) ligation and excision with all tributaries (8 cases) or DDV ligation and excision+cavernous vein ligation (13 cases), through an infrapubic curvilinear incision. One patient had crural vein ligation and corporoplasty through a perineal incision, one had direct corporeal revascularization for associated arteriogenic impotence with venous leak and another had distal spongiolysis and closure of a corporospongiosal shunt. The results were excellent in 11 cases, improved in 6 and 7 had failures. Surgical intervention is effective in CVL in selected cases but limiting factors in the form of increasing age, concomitant arteriogenic cause, significant crural leak, missing tributaries, recurrent venous leak and unknown factors may also be present to prevent total cure.

Transvesical vesicovaginal fistula repair: a revival.

Vesicovaginal fistulae are usually traumatic in nature, following obstetric or gynecologic trauma. Here, our experience with vesicovaginal fistula repair in 68 cases, performed transvesically (58 cases) or transperitoneally-transvesically, with pedicled omental interposition in 10 cases over the last 8 years is described. The size of fistulae ranged from 1 to 5 cm, and most were situated near or above the trigone. Two cases required ureteric reimplantation. Recurrent fistulae were found in 4 cases. We attribute our success to the simple access, the construction of a vascularized flap, the tension-free grid-iron closure, and the utilization of Vicryl suture.