BS-PCNL seems to be a good endourologic approach for patients with bilateral stone disease, which can render high SFRs and maintain a noninferior safety profile compared with the staged approach. This technique demands careful patient selection, counseling and should be preferably performed in endourology centers with large case volumes.

RESULTSThe median (range) age at presentation remained unchanged, at 72 (45-94) years; the PSA level at diagnosis was 20-46 µ g/L, with a steady decline after 1997. There was no significant change in stage at diagnosis; overall, 38 (20-44)% presented with clinically localized disease, 37 (31-48)% with locally advanced and 25 (18-29)% with metastatic disease.

Background-Inguinal hernia surgery has undergone numerous advances in the last few years. This study analysed the changes in the practice of one surgeon in a district general hospital over a seven year interval. The eVect of changing from Bassini to Lichtenstein repair in 1994 was evaluated. Methods-The study involved two parts: first a search of a computerised database of inguinal hernia procedures, and second, postal audits of men who had an inguinal hernia repair in 1993 and 1994 with outpatient follow up for those with a possible recurrence. Results-A total of 1037 hernias were repaired over the seven years. There was an increase in the proportion of day cases from 18% to 70% and the number of operations performed under local anaesthetic rose from 1% to 45%. The postal audits had response rates of 79% (1993) and 66% (1994). Some 5/98 (5%) recurrent hernias were identified from the 1993 (Bassini) patients compared with 1/67 (1.5%) from the 1994 (Lichtenstein) cohort. Conclusion-Lichtenstein hernia repair can be performed safely as a day case using local anaesthetic in the majority of patients and appears to have a lower recurrence rate than Bassini repair.

There is a paucity of regular training facilities for MAS in the UK and there was an exceptionally strong agreement among our participants that regular training on laparoscopic simulators would be useful. Additionally, i-Sim offers the possibility of a readily accessible alternative to current training approaches to laparoscopy.

Objective To determine the effect of perioperative distal vasal lavage with 50 mL of normal saline on subsequent time to azoospermia after vasectomy. Patients and methods Seventy-two patients were prospectively enrolled and randomized to undergo vasectomy with or without vasal lavage. Infertility rates at 8, 10 and 12 weeks were compared for both groups and for those undergoing the procedure under local or general anaesthesia. Patient compliance for returning postoperative semen for analysis was also assessed. Results There was no statistically significant difference in infertility rates at 8, 10 or 12 weeks after vasectomy with or without vasal lavage. Vasectomies performed under local and general anaesthesia had comparable rates of infertility at 12 weeks after surgery. Compliance in providing semen for analysis was poor. Conclusions The routine adoption of distal vasal lavage during vasectomy for contraception cannot be recommended. As compliance in providing semen for analysis was poor, the clinician has a responsibility to remind the patient of the consequences of such action.