ObjectiveTo compare the efficacy and safety of tamsulosin vs the combination of tamsulosin and tadalafil in male lower urinary tract symptoms (LUTS). Patients and MethodsThis was a double-blinded, parallel-arm randomised controlled trial. Men aged >45 years with moderate LUTS and a maximum urinary flow rate (Q max ) of 5-15 mL/s were included. One arm received 0.4 mg tamsulosin only (Group-A), while the second received 5 mg tadalafil with tamsulosin (Group-B). The primary outcome was the International Prostate Symptom Score (IPSS). Secondary outcomes were IPSS quality of life (QoL) score, five-item version of the International Index of Erectile Function (IIEF-5) score, Q max , and post-void residual urine (PVR). Block randomisation was used. Placebo was used for blinding and allocation concealment. Intention-totreat analysis was used for outcome measures. ResultsOf the 183 men screened, 140 were randomised (71 in Group-A, 69 in Group-B); 116 (82.85%) (61 in Group-A, 55in Group-B) completed the study. Baseline characteristics were comparable. The improvements in the IPSS, IPSS QoL score, IIEF score and Q max were À1.69 (95% confidence interval [CI] À1.4 to À2.0), À0.70 (95% CI À0.60 to À0.80), 3.8 (95% CI 3.4-4.2) and 1.8 mL/s (95% CI 1.1-2.4) respectively, in favour of the combination group. The difference in PVR was not significant. There were no serious adverse events (AEs). The dropout rate due to AEs was 2.85%. Myalgia (five patients) was the commonest AE in the combination group. ConclusionThe combination of tamsulosin and tadalafil produced significantly better improvements in LUTS, QoL, erectile function and Q max compared to monotherapy with tamsulosin, without an increase in AEs.

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A 58-year-old gentleman presented with history of fever and left loin pain for three months. On physical examination, he was found to have a renal mass. On laboratory evaluation he was found to be anaemic (PCV 23.8) with thrombocytosis (7,25,000/mm 3 ) and had an elevated ESR (77). His CT abdomen revealed an 11 x 13 cm heterogenously enhancing mass arising from the upper pole of left kidney [Table/ Fig-1]. There was no involvement of the contiguous structures but superiorly, it was adherent to the spleen. aBstRaCtMalignant Fibrous Histiocytoma (MFH) usually arises from the extremities with the retroperitoneum being the second most common site. We present the case report of a 58-year-old man presenting with fever and was detected to have a renal mass on evaluation. He underwent a radical nephrectomy with a preoperative diagnosis of renal cell carcinoma. But the final histopathological report was MFH. Primary renal MFH is extremely rare and is usually diagnosed on histopathology with the aid of immunohistochemistry.keywords: CD 68, Kidney, Radical nephrectomy microscopy: The renal parenchyma was infiltrated by a fairly circumscribed tumour [Table /Fig-2]; with clustered and scattered polygonal cells to spindle cells with markedly pleomorphic, vesicular nuclei and moderate amount of eosinophilic, cytoplasm. There were multinucleate giant cells, foamy macrophages and bizarre tumor cells. The intervening stroma showed many thick collagen bundle and dense infiltrates of lymphocytes, plasma cells, histiocytes, many neutrophils and eosinophils [Table/ Fig-3]. There was focal hyalinization. There was no lymphovascular invasion or nodal involvement. The tumour cells were negative for desmin and myogenin but showed positive staining with CD68 [Table/ Fig-4] on immunohistochemistry. These features were consistent with the diagnosis of inflammatory subtype of malignant fibrous histiocytoma. The tumour infiltrated the sinus fat with rest of the parenchyma being normal. Spleen showed features of congestive splenomegaly but was otherwise free of tumour [Table/ Fig-5].

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Primary angiosarcoma of the kidney is a rare tumor with only a few case reports in the literature. Management is not standardized and the prognosis is poor. However, clinicians need to be aware of this uncommon entity.

Objectives To study the usefulness of MRI in preoperative evaluation of PFUDD. Can MRI provide additional information on urethral distraction defect (UDD) and cause of erectile dysfunction (ED)?Materials and Methods In this prospective study, consecutive male patients presenting with PFUDD were included from Feb 2011 till Dec 2012. Those with traumatic spinal cord injury and pre-existing ED were excluded. Patients were assessed using IIEF questionnaire, retrograde urethrogram and micturating cystourethrogram (RGU+MCU) and MRI pelvis. Primary end point was erectile function and secondary end point was surgical outcome.Results Twenty patients were included in this study. Fourteen patients (70%) were ≤40years; fifteen patients (75%) had ED, seven patients (35%) had severe ED. MRI findings associated with ED were longer median UDD (23mm vs. 15mm, p=0.07), cavernosal injury (100%, p=0.53), rectal injury (100%, p=0.53), retropubic scarring (60%, p=0.62) and prostatic displacement (60%, p=0.99). Twelve patients (60%) had a good surgical outcome, five (25%) had an acceptable outcome, three (15%) had a poor outcome. Poor surgical outcome was associated with rectal injury (66.7%, p=0.08), cavernosal injury (25%, p=0.19), retropubic scarring (18.1%, p=0.99) and prostatic displacement (16.7%, p=0.99). Five patients with normal erections had good surgical outcome. Three patients with ED had poor outcome (20%, p=0.20).Conclusions MRI did not offer significant advantage over MCU in the subgroup of men with normal erections. Cavernosal injury noted on MRI strongly correlated with ED. Role of MRI may be limited to the subgroup with ED or an inconclusive MCU.

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Neuroendocrine tumours are usually located in the gastrointestinal or respiratory tract. A 23-year-old man was evaluated for loss of weight and a palpable left loin mass. CECT showed a large heterogeneously enhancing mass with calcification arising from the left kidney. He underwent an open radical nephrectomy. Histopathological examination revealed a large cell neuroendocrine carcinoma (LCNEC). LCNEC of the kidney is extremely rare and portends poor prognosis. It is usually a histopathological surprise and requires immunohistochemistry for confirmation.