Role of fexible ureterorenoscopy in the management of lateralizing essential haematuria

Objective: To evaluate the role of flexible ureterorenoscopy in diagnosis and treatment of lateralizing essential haematuria. Patients and Methods: Twenty-three patients suffering from unilateral haematuria were included in the study and underwent flexible ureterorenoscopy. Their age ranged from 17 to 68 years (mean age: 36 years). Unilateral gross haematuria was demonstrated cystoscopically. The patients were subjected to a careful history taking; full laboratory and radiological investigations. However; we failed to localize the cause of haematuria in the patients included in the study. This necessitated flexible ureterorenoscopy on the affected ureterorenal unit. Results: The collecting system was inspected in 21/23 patients. Discrete lesions were identified in 11 patients (haemangioma on a renal papilla in six; small vascular lesions in three; a small calculus in one and a small papillary growth in one). Non-specific abnormalities (erythema of the infundibulumor abnormal configuration in the renal papilla) were found in six patients. No lesion was detected in 4 patients. Patients with non-specific abnormalities were biopsied and coagulated. The remaining 11 patients with discrete lesions underwent laser fragmentation of the calculus; nephroureterectomy for the papillary transitional cell carcinoma (TCC) and 9 patients underwent fulguration with or without biopsies. The haematuria resolved in all patients with discrete lesions. Patients with non-specific abnormalities had a poor outcome in our series; since all had recurrent or persistent bleeding. Follow-up ranged from 6-18 months (mean 9 months). Conclusion: Flexible ureterorenoscopy can be of value in the diagnosis and treatment of lateralizing haematuria. Patients with discrete lesions respond well to endoscopic treatment (electrocoagulation)

Corporoplasty with saphenous vein graft in the surgical management of peyronie's Disease

Objectives The aim of this study is to evaluate the use of the saphenous vein in grafting the tunica albuginea defect after excision/incision of Peyronie's plaque in cases of disabling penile deformity. Patients and Methods A total of 12 patients with significant penile curvature due to Peyronie's disease interfering with their sexual activity were subjected to plaque excision/ incision and corporoplasty by saphenous vein patch grafting of the tunica albuginea. Results Penile straightening was achieved in 9 patients. One patient had a minimal residual curvature with induration at the graft site which; however; did not interfere with his sexual activity. Two patients complained of less rigid erections and are currently responding to oral measures and ICI. Penile numbness occurred in four patients with dorsal plaques; and it was self limiting within six months. We encountered no complaint of penile shortening or impotence. Conclusion The saphenous vein presents a reasonable alternative grafting material for the repair of tunica albuginea defects in patients with Peyronie's disease after plaque excision/incision. It is particularly useful in large plaque remnants and yields a satisfactory and appreciable outcome