Paraplegia following epidural analgesia is an uncommon occurrence and the number of cases recorded in the literature is few. Epidural analgesia is generally regarded as a safe method with few complications and the number of administrations throughout the world without complications must run into many thousands.Whatever the advantages of epidural analgesia may be and, however safe it may appear, the likelihood of paraplegia following such a technique must not be overlooked when assessing a person's suitability for epidural block. When this complication occurs it is a tragedy for the patient and a constant reminder to those who have borne the responsibility for choosing such a method. This paper describes one such case in which a retropubic prostatectomy carried out on a fit 62-year old man using epidural analgesia was followed immediately by paraplegia. There was some improvement initially, but he was left with a permanent partial paresis of both hips. He died some sixteen months later from metastatic carcinoma of the prostate. CASE REPORTAB, a European male aged 62 years, was first seen in September 1966 complaining of frequency, a thin repetitive stream and occasional urgency, present for one year. He found it necessary to void twice each night and hourly during the day. There had been no pain, haematuria, or urethral scalding and apart from the local urinary symptoms he felt well. In 1960 he had had herpes zoster affecting the ophthalmic division of the fifth left cranial nerve. He was a well nourished, fit-looking man, normotensive (1 70/90), with no abnormal findings in the cardiovascular, respiratory or central nervous systems. His abdomen was likewise normal and, on rectal examination, the prostate, was firm, irregular andenlarged to an estimated weight of 30g. Laboratory investigations were as follows : haemoglobin 15g %, PCV 43 %, urea 24mg%, serum acid phosphatase ~K A units, midstream urine acellular and sterile. A chest X-ray was normal. The intravenous pyelogram showed both kidneys to be of normal size, shape and structure, with normal function, and there was no visible abnormality of

In the re-implantation of a ureter into the bladder, vesico-ureteric reflux can be prevented by a ureteric nipple alone, provided the nipple is at least 1.5 cm long. This eliminates the need for an oblique ureteric entry or a submucosal tunnel. Longer nipples may be used although they may lead to difficulties with catheterisation. Reduction in the length of the nipple frequently occurs later.

Summary— Microsurgical reanastomosis of the vas following vasectomy should result in a pregnancy rate of 65% and the reappearance of sperms within the semen of 95% of patients, but the technique requires expensive and sophisticated equipment and considerable expertise. Comparable results were obtained using a simple and conventional technique in which fine sutures, splintage and low power magnification (x 3.5) were used, making it an acceptable procedure for the surgeon untrained in microsurgical techniques.

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