Introduction:Conventional two-dimensional (2D) laparoscopy systems have the drawback of poor depth perception and spatial orientation. Three-dimensional (3D) laparoscopic systems have stereoscopic vision in which depth perception is achieved by different unique images received by each eye. We evaluated 3D laparoscopy in comparison with conventional 2D laparoscopy in urological procedures in a prospective randomized study.Materials and Methods:Over a 19 month study period, 108 patients scheduled to undergo various urological procedures were randomized to either conventional 2D or 3D laparoscopy (2D n = 53; 3D n = 55). A single senior surgeon performed all the surgeries. Parameters such as total operative time, dissection and suturing time, blood loss, hospital stay, complications (Clavien-Dindo), and visual analog scale (VAS) score for pain were assessed. The subjective assessment of the operating surgeon of superiority and inferiority of either technology on parameters defining surgical skills was recorded using a Likert scale.Results:The total operative time (P < 0.0003), blood loss (P < 0.028), dissection, suturing and stenting time (P < 0.0001), and the State-Trait Anxiety Inventory for Adults score (P < 0.0001) was significantly in favor of 3D laparoscopy.Conclusion:Our study showed significant advantages of the 3D system over 2D laparoscopy. These advantages include enhanced operative performance and greater surgeon comfort.

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AIM OF THE STUDY: Effectiveness of Transpubic urethroplasty in recurrent (failed) urethral strictures due to pelvic fracture urethral distraction defects. INTRODUCTION: Urethral distraction injuries occur upto 10% of pelvic fracture cases. The principle indication of Transpubic urethroplasty is length >3cms, recurrent (failed) repairs of posterior urethral stricture. Though other procedures like primary anastomotic urethroplasty, rerouting of the urethra under the corporal body, urethral substitution with tubularised flaps, two stage urethroplasty are described, Transpubic urethroplasty is said to produce the best results especially when repeat procedures are required. MATERIALS & METHODS: This is a prospective study from 2004 to 2014 consisting of 17 patients having recurrent stricture urethra secondary to pelvic fracture urethral distraction defects (PFUDD). All the patients were males and their age ranged from 15year to 45 years. Pre-op evaluation included X-ray KUB, Ultrasound abdomen & pelvis, retrograde urethrogram (RGU), micturating cystourethrogram (MCU), up and down Cystoscopy, urine culture and renal biochemical parameters. Urethra was approched through progressive perineal and abdominal approach with total pubectomy, followed by excising fibrosed stricture and tension free end to end anastomosis. Post operatively pericatheteral RGU was carried out after 4 weeks and Catheter removed if there was no leak. RGU, MCU uroflowmetry and PVR were done one month after removal of catheter. Subsequently UFR, PVR and obstructive symptoms were assessed periodically. RESULTS: All 17 Cases were followed up for a period of 3-11 years. Out of 17patients, 14(80%) patients maintained good uroflow (UFR) and insignificant PVR and procedure was considered successful. In 3 patients procedure failed, of which 2 patients had pericatheter leak and reduced urinary flow with significant PVR and were followed up with CIC and 1 patient remained on permanent SPC. Overall stricture free rate was 80%. CONCLUSION: Transpubic urethroplasty appears to be superior substitute for recurrent stricture due to pelvic fracture urethral distraction defects (PFUDDs). Pericatheteral leak, fibrosis, fistulae seems to be an important factor in determining the successful outcome.

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The incidence of patients presenting with advanced pelvic malignancy with obstructive uropathy is high in our country. Relentless progress of the malignancy will cause deterioration of renal function, aggravation of pain, infection, deterioration of Quality of Life (QOL), uremia and death. Decreased renal function is considered as a contraindication for palliative chemo and radiotherapy. However urinary diversion in these patients will lead to improvement in renal function and may help in administration of palliative therapy and thus, improve the quality of life of these patients. MATERIALS AND METHODS The present study includes the obstructive uropathy patients secondary to pelvic malignancy referred to our institution for urinary diversion between Jan 2010 to Dec 2014. Total 40 patients were included, of which, 25 patients underwent PCN, 9 patients retrograde DJ stenting, 4 patients refused the treatment, 2 patients were not fit for any intervention due to coagulopathy & comorbid conditions. Of 34 treated patients, 30 were female patients and 4 were male patients. All the patients were explained about the procedure and proper consent taken. Laboratory investigations like CBC, coagulation profile, LFT, routine urine analysis, urine C&S and serum electrolytes were carried out. Haemodialysis was done for 10 patients whose serum creatinine was >6mg% & potassium >6meq. USG guided PCN insertion was done in 8 patients, and in those who failed in this procedure, fluoroscopic C-ARM guided PCN insertion done in 17 patients. Post operatively RFT and serum electrolytes were assessed on 3, 7, 15, & 30 th day. PCN catheter was changed once in 3 months.