Dorsal onlay lingual mucosal graft urethroplasty for urethral strictures in women.

OBJECTIVE: To describe the technique and results of dorsal onlay lingual mucosal graft (LMG) urethroplasty for the definitive management of urethral strictures in women. PATIENTS AND METHODS: In all, 15 women (mean age 42 years) with a history suggestive of urethral stricture who had undergone multiple urethral dilatations and/or urethrotomy were selected for dorsal onlay LMG urethroplasty after thorough evaluation, from October 2006 to March 2008. After a suprameatal inverted-U incision, the dorsal aspect of the urethra was dissected and urethrotomy was done at the 12 o'clock position across the strictured segment. Tailored LMG harvested from the ventrolateral aspect of the tongue was then sutured to the urethrotomy wound over an 18 F silicone catheter. RESULTS: The preoperative mean maximum urinary flow rate of 7.2 mL/s increased to 29.87 mL/s, 26.95 mL/s and 26.86 mL/s with a 'normal' flow rate curve at 3, 6 and 12 months follow-up, respectively. One patient at the 3-month follow-up had submeatal stenosis and required urethral dilatation thrice at monthly intervals. At the 1-year follow-up, none of the present patients had any neurosensory complications, urinary incontinence, or long-term functional/aesthetic complication at the donor site. CONCLUSION: LMG urethroplasty using the dorsal onlay technique should be offered for correction of persistent female urethral stricture as it provides a simple, safe and effective approach with durable results.

Substitution urethroplasty for anterior urethral strictures: buccal versus lingual mucosal graft.

AIM: To compare the results of substitution urethroplasty and donor site morbidity between buccal mucosal graft (BMG) and lingual mucosal graft (LMG). PATIENTS AND METHODS: Patients who underwent single-stage dorsal onlay free oral mucosal graft substitution urethroplasty by Barbagli's technique between January 2004 and August 2008 were included in this study. Patients who underwent buccal (cheek, lip) mucosal graft urethroplasty were included in group I and those who underwent LMG urethroplasty (tongue) were included in group II. All patients underwent complete evaluation of the stricture including inspection of the oral cavity. Exclusion criteria were stricture length <3 cm and complex strictures which required a multistage procedure. RESULTS: The results of urethroplasty were similar in both groups in terms of blood loss, duration of postoperative hospitalization, complications encountered at urethroplasty site, mean postoperative Q(max) and mean postoperative AUA symptom score. Early slurring of speech complications was seen in group II, but not in group I. The long-term complications of persistent oral discomfort, perioral numbness and tightness of the mouth were seen only in group I. CONCLUSION: LMG urethroplasty is a good substitute for BMG urethroplasty with equally good results of urethroplasty with lower donor site morbidity.

Multivitamin and micronutrient treatment improves semen parameters of azoospermic patients with maturation arrest.

The study was undertaken to evaluate the efficacy of multivitamin and micronutrient supplementation in azoospermic patients with maturation arrest. A total of 35 azoospermic patients showing maturation arrest on testicular biopsy were recruited in this study. The patients were divided into two groups. Untreated group (n=11) without any treatment and treated group (n=24) who received multivitamins, micronutrients and co-enzyme Q10. The sperm concentration, motility and morphology were evaluated at monthly interval. The results showed reduction in liquefaction time and relative viscosity of the semen in the treated group. Further, in treated group there was appearance of spermatozoa (4.0 million/ml) exhibiting progressive motility (7%) and normal morphology (6%), even in the first follow up visit. The sperm count, motility and normal morphology increased significantly on subsequent visits. Within 3 months (3 visits) 2 pregnancies were reported. These observations indicate that multivitamin and micronutrient supplementation improve the qualitative and quantitative parameters of seminogram in patients with azoospermia of maturation arrest.

Our experience with genitourinary fistulae.

INTRODUCTION: Our objective was to analyze the incidence, etiopathology, diagnosis and therapeutic aspects of the genitourinary fistula in an Indian population. METHODS: This is a retrospective analysis of the genitourinary fistulae repaired at the Department of Urology, Institute of Medical Sciences, Banaras Hindu University, between January 1990 and December 2006. The surgical approach varied in each patient. Interposition grafts or flaps were used as and when required. The main outcomes analyzed were the incidence, etiology, surgical approaches, accessory procedure required, need for tissue interposition, cure rate per repair and overall success rate. RESULTS: Out of 558 cases, 403 were vesicovaginal, 84 ureterovaginal, 43 urethrovaginal and 28 vesicouterine fistulae. The most common etiology was obstructed labor (72.2%), followed by hysterectomy. The transvaginal route was preferred for repair wherever possible. The transabdominal route was adopted for the repair of supratrigonal vesicovaginal, ureterovaginal and vesicouterine fistulae and if bladder augmentation was required. Conservative management was successful in 1.9% of the vesicovaginal fistulae and in 8 cases of ureterovaginal fistula. The remaining cases were managed surgically with excellent results. CONCLUSION: Genitourinary fistulae are not life-threatening but are socially debilitating. Surgical repair provides the definitive cure, but expectant treatment can be tried in selective patients.

Testosterone and estradiol-17 beta dependent phospholipid biosynthesis in ovariectomized catfish, Heteropneustes fossilis (Bloch).

Effect of cumulative doses (7, 14 and 28 mg kg(-1) body weight) of testosterone (T) and estradiol-17 beta (E2) on total phospholipids (TP), phosphatidylcholine (PC), phosphatidylserine (PS), phosphatidylinositol (PI) and phosphatidylethanolamine (PE) in tissues were investigated during the gonadal recrudescence, in prespawning phase of the annual reproductive cycle in intact and ovariectomized freshwater catfish, Heteropneustes fossilis. After ovariectomy, the hepatic levels of TP and PE were elevated and remained unaffected for PC, PS and PE when compared with control. In general, T and E2 were stimulatory fora specific class ofphospholipid in tissues of intact and ovariectomized catfish. These effects were higher at 14 and 28 mg kg(-1) body weight in ovariectomized catfish whereas 7 mg kg(-1) body weight of T and E2 have pronounced effect in intact ovaries. In conclusion, the various phospholipid biosynthesis were under T and E2 dependent. Among the phospholipid, the PC was the main constituent and was sex steroid dependent biosynthesis during prespawning phase.

Pesticide residues and reproductive dysfunction in different vertebrates from north India.

Organochlorines (isomers of hexachlorocyclohexane--HCHs and metabolites of dichlorodiphenyltrichloroethane--DDTs, aldrin and endosulfan) and organophosphate (chlorpyrifos) insecticide residues were investigated by gas liquid chromatography in the blood of fish, chick, goat and man. The plasma levels of testosterone (T) and estradiol-17beta (E2) was measured by radioimmunoassay in the catfish Rita rita captured from unpolluted reference site and polluted river Gomti during prespawning phase. Results indicated that in R. rita the SigmaDDT, SigmaHCH, endosulfan, aldrin, chlorpyrifos in blood levels were in preferential order (SigmaDDT>SigmaHCH>endosulfan>aldrin>chlorpyrifos) of their bioaccumulation. The blood levels of SigmaHCH and SigmaDDT also showed high levels in chick, goat and man, and preferential order of bioaccumulation was goat>chick>man>fish. The SigmaDDT also showed preferential order (man>chick>goat>fish) of bioaccumulation. Among the different tissues of fish (blood, liver, brain and ovary) the SigmaDDT was very high as compared to SigmaHCH as well as the rest of tissues which was very selective bioconcentration in different tissues of fish during prespawning phase. The gonado-somatic index, T and E2 declined in the catfish captured from polluted river when compared with the catfish captured from reference site affecting reproductive physiology. Our results indicated that increase of insecticides in blood level in vertebrates causes reproductive dysfunction and suggested that for human beings food like fish, chick and goat containing beyond permissible limit of insecticides must be avoided.

Sperm motility in the fishes of pesticide exposed and from polluted rivers of Gomti and Ganga of north India.

Investigation of lethal dose of gamma-HCH (gamma isomer of hexachlorocyclohexane), DDT (dichlorodiphenyltrichloroethane) and chlorpyrifos on spermatozoa motility after 40 days exposure in catfish, Heteropneustes fossilis was done under laboratory conditions. The sperm motility was done in the fishes captured from unpolluted ponds of Gujartal considering as reference site and polluted rivers Gomti and Ganga of north India at pre-spermiating stage. Results indicate that 1ppm of gamma-HCH, DDT and chlorpyrifos was lethal dose on sperm motility. The motility of spermatozoa decreased in insecticide exposed fish as well as in the fishes of polluted rivers when compared with their respective controls. The sperm motility was highest at 1:2000 (testicular milt: extender) dilution and duration of sperm motility was 90s after post-activation. The duration of motility also declined in the fishes captured from polluted rivers when compared with the same species captured from the reference site. It is concluded that the insecticides decrease the sperm motility and its duration in exposed fish as well as in the captured fishes from polluted rivers causing the decline in fish population of riverine systems due to influence of xenobiotics on the endocrine system.

Cypermethrin induced histological changes in gonadotrophic cells, liver, gonads, plasma levels of estradiol-17beta and 11-ketotestosterone, and sperm motility in Heteropneustes fossilis (Bloch).

The aim of the present investigation is to assess the impact of cypermethrin on reproductive physiology in catfish, Heteropneustes fossilis during prespawning phase. Results indicate that there is a decrease in the size of gonadotrophic cells with less granulation, pycnosis in the liver, presence of immature oocytes and atretic follicles in the ovaries and gross condensation of spermatogenic cells in testes after cypermethrin exposure at sublethal concentration. The gonado-somatic index (GSI), plasma levels of estradiol-17beta (E2) and 11-ketotestosterone (11-KT) also decreases. The motility of sperm cells is dependent on the dilution (2000 times) and duration of motility is recorded 2min maximally at 90s after post-activation. The dose 0.1 and 0.01ppm is sublethal, while 1ppm is lethal on sperm motility. Results indicate that cypermethrin causes inhibition of reproduction by acting at the hypothalamo-hypophyseal-gonadal axis as is manifest from the histological observations of gonadotrophs along with disruption of follicular wall and spermatogenic cells. Obviously such changes are responsible for decreasing the steroid hormone levels which result in decreasing scale and duration of sperm motility after 45d exposure of cypermethrin in this species.

Urethral reconstruction in balanitis xerotica obliterans.

OBJECTIVES: To review the results of utilizing different grafts for substitution urethroplasty for anterior urethral stricture caused by balanitis xerotica obliterans (BXO). METHODS: 153 patients who underwent substitution urethroplasty for anterior urethral strictures were included in this study. The stricture length varied from 3.8 to 16.4 cm (mean 10.2 cm). In 32% of the patients (49), local genital, penile (18), perineal (16) and scrotal (15) skin grafts were used. Over the 3 years our standard treatment policy has been to utilize a free mucosal graft from a non-genital area. Buccal mucosa was the most preferred, utilized in 74 (48.3%) patients and bladder mucosa in 12 (7.8%). Recently we have used lingual mucosal grafts in 18 (11.7%) patients for substitution urethroplasty. RESULTS: The overall success rate for non-genital mucosal graft was 92.2%. The remaining 8 patients required more than one supplementary procedure postoperatively but none required a second urethroplasty. Of 49 patients who underwent substitution urethroplasty utilizing genital skin, the success rate was only 4%. 16.3% required one and 14.3% required multiple auxiliary procedures postoperatively. 34 patients (69.4%) required subsequent urethral reconstruction. CONCLUSIONS: A free graft urethroplasty using non-genital skin is recommended for anterior urethral stricture related to BXO.

Dorsal onlay lingual mucosal graft urethroplasty: Comparison of two techniques.

OBJECTIVES: To compare the results of two different techniques of dorsal onlay lingual mucosal graft (LMG) urethroplasty for anterior urethral strictures. METHODS: Thirty patients underwent dorsal onlay LMG urethroplasty by Barbagli's technique (group I) and 25 through a ventral sagittal urethrotomy approach (group II). All of the patients were followed up with a pericatheter urethrography at 3 weeks, retrograde urethrography with micturating cystourethrography and uroflowmetry at 3, 6 and 12 months. RESULTS: Mean follow up was 22 months and 13 months in group I and II, respectively. The mean peak flow rate increased from 4.2 mL/s preoperatively to 35.5, 25.06 and 25 mL/s at 3, 6, and 12 months, respectively, in group I and from 7.8 mL/s to 34.2, 28.4 and 26.2 mL/s at 3, 6 and 12 months, respectively, in group II. Five patients in group I and two patients in group II had an anastomotic stricture at 12 months. Meatal narrowing was seen in five patients in group I and three patients in group II. The overall success rate was 83.4% and 76.6% in group I and 90% and 80% in group II at 6 and 12 months, respectively. One patient had chordee in group I and no patient had chordee in group II. There was a shorter operative time and less blood loss in group II. CONCLUSIONS: Dorsal onlay LMG urethroplasty through a ventral sagittal approach is better than the Barbagli's technique in terms of results and complications.

Pesticide bioaccumulation and plasma sex steroids in fishes during breeding phase from north India.

The investigation was done to monitor the total hexachlorocyclohexane (∑HCH) and total dichlorodiphenyltrichloroethane (∑DDT), aldrin, endosulfan and chlorpyrifos in liver, brain and ovary, gonadosomatic index (GSI) and plasma levels of testosterone (T) and estradiol-17ß (E2) during breeding season of captured catfishes and carps from the unpolluted ponds of Gujartal, Jaunpur (reference site) and polluted rivers Gomti, Jaunpur and Ganga, Varanasi. Results have indicated that catfishes have higher bioaccumulation of pesticides than the carps, which was beyond the permissible limits for ∑HCH whereas ∑DDT only by catfishes of polluted rivers. The GSI and plasma levels of T and E2 were lowered in the fishes captured from the polluted rivers. In conclusion, the fishes from river Gomti and Ganga showed a high degree of contamination and disrupted reproductive axis when compared to those from the reference site reflecting the degree of pesticide pollution present in those water bodies.

Bioaccumulation of hexachlorocyclohexane, dichlorodiphenyltrichloroethane, and estradiol-17beta in catfish and carp during the pre-monsoon season in India.

This investigation was performed to monitor hexachlorocyclohexane isomers (HCHs), dichlorodiphenyltrichloroethane (DDT, and its metabolites, refered to as DDTs), plasma levels of estradiol-17beta (E2), and the gonadosomatic index (GSI) between sampling sites of unpolluted ponds of Gujartal, Jaunpur (control site) and the polluted rivers Gomti (Jaunpur) and Ganga (Varanasi), which affect the reproductive physiology of some edible catfish and carp during the pre-monsoon season. HCHs and DDTs were measured by gas liquid chromatography (GLC) and hormones by radioimmunoassay (RIA). The results indicated that the level of HCHs and DDTs was very high in both the catfish and the carp captured from the polluted rivers compared with the fish captured from the control site. The GSI and E2 values were lower in both groups of fish when compared to the fish from the control site. The results also indicate that catfish showed greater bioaccumulation of HCHs and DDTs than carp, above the permissible limit, as compared to the fish from the control site. In conclusion, fish from the Gomti and Ganga rivers were highly polluted when compared with fish from the control site, as was evident from high levels of tissue bioaccumulation of HCHs and DDTs and decreased levels of plasma E2, inhibiting the reproductive physiology of these species at the receptor level. The levels exceeded the maximum residue limits (MRL) as recommended by Codex, hence it is suggested that the fish should be avoided for food purposes.

Genito-urinary polyps: summary of the 10-year experiences of a single institute.

OBJECTIVE: We present a large series of polyps situated in various parts of the urinary tract in adults, including 12 cases of fibroepithelial polyps, four cases of eosinophilic cystitis, three cases of benign prostatic epithelial polyp, and one case of transitional cell carcinoma presenting as a bladder polyp. MATERIAL AND METHODS: Data on 23 patients with polyps in the urinary tract treated in our department from December 1995 to December 2005 were reviewed. The characteristics of the patients, disease, and treatment modalities were recorded. RESULTS: Of the 23 patients treated in our institute during the study period, seven had polyps in the ureter, eight had polyps in the bladder, and eight had polyps in the urethra. Twenty-one patients underwent endoscopic resection of the polyps, and two patients were managed conservatively with medical therapy. Twenty-two polyps were benign (fibroepithelial polyps, benign prostatic epithelial proliferations, eosinophilic cystitis), and in one patient transitional cell carcinoma presented as a bladder polyp. Postoperative recovery was excellent. Mild hematuria manifested in two patients during the perioperative period, but there was no recurrence in the follow-up period. Two patients with a urethral polyp managed with endoscopic resection developed urethral stricture during the postoperative period and required repeated urethral dilatations during the follow-up period. CONCLUSION: The presence of polyps in the urinary tract is rare. The treatment of choice is endoscopic resection, and the prognosis of these patients is excellent.

Oral complications after lingual mucosal graft harvest for urethroplasty.

BACKGROUND: The aim of this study was to assess the complications at donor site after lingual mucosal graft harvesting for urethroplasty. METHODS: From March 2006 to December 2006, 30 patients of anterior urethral stricture underwent lingual mucosal graft urethroplasty. The site of the harvest graft was lateral mucosal lining of the tongue. Donor site complications, that is, pain, slurring of speech, pain during speech, salivatory changes and difficulty in protrusion of tongue were noted. RESULTS: The mean (range) age of patients was 36.2 years (22-52 years). The mean (range) stricture length was 8.4 cm (4.8-16 cm) and graft length was 8.5 cm (4.2-16.2 cm). Mean duration of follow up was 3.8 months. At the first postoperative day, 90% of the patients experienced pain at donor site and 20% had slurring of speech. Pain was mild to discomforting in 80% and distressing to horrible in 13% of the patients. By third postoperative day, two-thirds were pain free, one-thirds had mild pain only and none had slurring of speech. By day 6 of surgery, all patients were pain free. Six per cent of the patients reported numbness over ventral aspect of anterior half of tongue, which persisted in the first follow up and subsided by second follow up. There was no bleeding, haematoma or infection at donor site. All patients were able to resume oral fluid within 24 h, eat soft solid diet in 48-72 h and return to normal diet after 4-5 days of surgery. No patient complained of difficulty in opening the mouth, salivation disturbances, perioral numbness or difficulty in protrusion of tongue. No long-term functional or aesthetic complications were reported. CONCLUSION: Lingual mucosal graft harvesting is feasible, provides a long graft, is easy to carry out and is the least morbid procedure.

Exposure and recovery response of isomers of HCH, metabolites of DDT and estradiol-17ß in the female catfish, Heteropneustes fossilis.

Effects of 40 days of exposure and 20 days of recovery response at sublethal concentration of technical grades of gamma isomer of hexachlorocyclohexane (γ-HCH, 0.025ppm, 99.8%) and dichlorodiphenyltrichloroethane (DDT, 5.0ppm) in tissue (liver, brain and ovary) bioconcentrations, gonadosomatic index (GSI) and plasma levels of estradiol-17ß (E2) have been estimated during prespawning phase in the catfish Heteropneustes fossilis (Bloch). The results indicated that the tissue bioconcentrations of both HCHs (HCH isomers) and DDTs (metabolites of DDT) in liver, brain and ovary were in preferential order (liver>brain>ovary). The GSI and plasma levels of E2 were declined in response to exposure of γ-HCH and DDT. On withdrawal of exposure of pesticide there was recovery of HCHs in exposed fish for all tissues studied, whereas DDTs exposed fish showed recovery only in liver. Recovery of E2 production was also recorded in γ-HCH exposed fish whereas very little recorded in DDT exposed fish. It is suggested that HCHs and DDTs have preferential order (liver>brain>ovary) of their tissue bioconcentrations and HCH/DDT-withdrawal-dependent recovery during studied phase.

Endosulfan induced changes in phospholipids in the freshwater female catfish, Heteropneustes fossilis (Bloch).

The catfish, H. fossilis were exposed to endosulfan for 30 days at sub-lethal concentration (0.002 ppm) during different phases of its annual reproductive cycle. Its impact on total (TP) and different phospholipids- phosphatidylcholine (PC), phosphatidylserine (PS), phosphatdylinositol (Pl) and phosphatidylethanolamine (PE) were measured in liver plasma and ovary. On pesticide exposure, during preparatory phase, the hepatic TP PC and PE were declined. The plasma levels of TP, PC and PS were declined with the elevation of PE whereas in ovary only PC was lowered after endosulfan exposure. During pre-spawning phase, the hepatic TP, PC and PE declined in liver plasma and ovary after endosulfan exposure. During spawning phase, only plasma and ovarian phospholipids showed decrease in their levels following endosulfan exposure. In the post-spawning phase, endosulfan elevated the levels of TP, PC and PS in ovary but had no effect on their levels in liver and plasma. During resting phase, the TP, PC and Pl were found to be decreasing its levels. Thus it appears that this pesticide interfere with phospholipids metabolism during annual reproductive cycle of this species.

ICI 182,780 has agonistic effects and synergizes with estradiol-17 beta in fish liver, but not in testis.

BACKGROUND: ICI 182,780 (ICI) belongs to a new class of antiestrogens developed to be pure estrogen antagonists and, in addition to its therapeutic use, it has been used to knock-out estrogen and estrogen receptor (ER) actions in several mammalian species. In the present study, the effects and mechanism of action of ICI were investigated in the teleost fish, sea bream (Sparus auratus). METHODS: Three independent in vivo experiments were performed in which mature male tilapia (Oreochromis mossambicus) or sea bream received intra-peritoneal implants containing estradiol-17 beta (E2), ICI or a combination of both compounds. The effects of E2 and ICI on plasma calcium levels were measured and hepatic and testicular gene expression of the three ER subtypes, ER alpha, ER beta a and ER beta b, and the estrogen-responsive genes, vitellogenin II and choriogenin L, were analyzed by semi-quantitative RT-PCR in sea bream. RESULTS: E2 treatment caused an increase in calcium levels in tilapia, while ICI alone had no noticeable effect, as expected. However, pretreatment with ICI synergistically potentiated the effect of E2 on plasma calcium in both species. ICI mimicked some E2 actions in gene expression in sea bream liver upregulating ER alpha, vitellogenin II and choriogenin L, although, unlike E2, it did not downregulate ER beta a and ER beta b. In contrast, no effects of E2 or ICI alone were detected in the expression of ERs in testis, while vitellogenin II and choriogenin L were upregulated by E2 but not ICI. Finally, pretreatment with ICI had a synergistic effect on the hepatic E2 down-regulation of ER beta b, but apparently blocked the ER alpha up-regulation by E2. CONCLUSION: These results demonstrate that ICI has agonistic effects on several typical estrogenic responses in fish, but its actions are tissue-specific. The mechanisms for the ICI agonistic activity are still unknown; although the ICI induced up-regulation of ER alpha mRNA could be one of the factors contributing to the cellular response.

Xanthogranulomatous pyelonephritis: our experience with review of published reports.

BACKGROUND: The aim of this study was to analyse the cases of xanthogranulomatous pyelonephritis with review of published reports. METHODS: We retrospectively reviewed all nephrectomy specimens during February 1995 to January 2006. We found 26 cases of xanthogranulomatous pyelonephritis. We prepared a chart of these cases consisting of preoperative symptoms, laboratory findings, radiological imaging results and preoperative diagnosis. Open nephrectomy was carried out in all cases. RESULTS: Age group of the patients was 6-65 years and male : female ratio was 1.6:1. Twenty-two patients presented to us with intermittent high-grade fever, 21 with flank pain, 18 with loin mass, 2 with haematuria and 1 was detected during screening of vague gastrointestinal symptoms. Twenty-five patients had pyuria and only 10 had sterile urine culture. In all patients, only one kidney was affected. All patients had renal calculi 10-42 mm in size with bilaterally enlarged kidneys. Ipsilateral kidney was enlarged because of hydronephrosis or pyonephrosis in all cases and contralateral kidney was enlarged because of compensatory hypertrophy in 13 cases. Ipsilateral kidney had severely compromised renal function in all cases. Associated psoas abscess was present in one and tuberculosis in another. CONCLUSION: Xanthogranulomatous pyelonephritis is a relatively rare entity that is associated with obstruction, stones and infection of the urinary tract. Late presentation leads to loss of renal parenchyma. It cannot be differentiated preoperatively with renal tumours (renal cell carcinoma and Wilms' tumour), pyonephrosis, infected hydronephrosis and renal lymphoma. Nephrectomy and antibiotics are the treatment of choice.

Impact of endosulfan on the profiles of phospholipids at sublethal concentration in the male Heteropneustes fossilis (Bloch).

Male Heteropneustes fossilis were exposed for 30 days at sublethal concentration (0.002 ppm) during different phases of its annual reproductive cycle. Its impact on total phospholipids (TP), phosphatidylcholine (PC), phosphatidylserine (PS), phosphatdylinositol (PI) and phosphatidylethanolamine (PE) were measured in liver, plasma and testes. During preparatory phase, in general, the levels for TP, PC, PS, PI and PE decreased after endosulfan exposure in the above tissues. During prespawning and spawning phases, the phospholipids also showed decreasing trend. The postspawning phase, exhibited decline in hepatic levels of PS and PI only and remained unaffected in the other two tissues. During the resting phase too, the hepatic levels of TP, PS and PI declined and remained unaltered in others. The present results indicate that endosulfan have very selective effects on phospholipids classes during different phases of the annual reproductive cycle interfering with the production of lipid deprived energy i.e. vitellogenin. In general, endosulfan has inhibitory role during reproductive growth affecting phospholipid biosynthesis via hepatic enzyme systems as well as by hormonal imbalance.

Polyscope: a new era in flexible ureterorenoscopy.

INTRODUCTION: Despite improvements in instrumentation and technology in flexible ureteroscopy, the issue of procedural and off-procedural damage remains a problem. The aim of our study was to highlight our initial experience in flexible ureteroscopy using polyscope, a new advancement in the era of flexible ureterorenoscopy. MATERIALS AND METHODS: In this study, we used an 8F modular flexible, steerable polyscope for diagnostic purposes and Dormia basket removal for small renal stones. Three outer disposable catheters were used with proper sterilization in 22 cases. RESULTS: The polyscope was used in six cases of undiagnosed hematuria, and biopsy was taken from pelvic growth in one patient, which turned out to be transitional-cell carcinoma. Polyscope was used for removal of residual stones or small stones (< 1 cm) using Dormia basket in 16 cases (from August 2008 to July 2009). The mean stone size was 7.5 mm. The vision achieved was excellent in all the cases. CONCLUSIONS: Minimally invasive techniques are preferred for treatment of renal stones. The problem of lower caliceal stone access has been solved with the primary and secondary deflection of modern flexible ureteroscopes. The modular design of polyscope makes it a more cost-effective option. Relatively cheap and disposable multilumen catheters preclude the need for sterilization of optic cable, thus decreasing the chances of handling-related damages. The chance of instrument-related infection is minimal. Besides, it can be used as a semirigid ureteroscope should the need arises.