Results of buccal mucosal graft urethroplasty in complex hypospadias

Urethral reconstruction in complex hypospadias poses a significant challenge. We report our experience using buccal mucosa to repair complex hypospadias. From February 2001 to September 2003, 16 urethral reconstructions were performed using buccal mucosal graft. Twelve of the patients had previously failed urethroplasties, while the other 4 had perineal or scrotal hypospadias. Grafts were harvested from the lower lip. Onlay grafts were used in 8 cases, and tubularized grafts were used for the others. After 14 to 27 months' follow-up, 11 of 16 [69%] patients developed complications, including meatal stenosis in 2 [12.5%], urethral stricture in 5 [31%], and urethrocutaneous fistula in 4 [25%]. No oral complications were seen, and all of the urethroplasty complications were managed successfully. Urethroplasty using a buccal mucosal graft may be accompanied by a relatively high complication rate, which is more common in patients with tubularized graft; however, all complications can be managed successfully. We believe that urethroplasty using buccal mucosal graft in complex hypospadias is an acceptable treatment modality

efficacy and safety of intravesical bacillus-calmette- guerin in the treatment of female patients with interstitial cystitis: a double-blinded prospective placebo controlled study

To evaluate the efficacy and safety of intravesical Bacillus Calmette-Gurein injection in the treatment of female patients with interstitial cystitis. Thirty women meeting the National Institute of Arthritis, Diabetes, digestive and kidney diseases criteria for interstitial cystitis, were randomized in a double-blinded fashion in two groups each consisted of 15 patients to receive six, weekly instillation of 120 mg BCG vaccine of Iranian Institute of pastor or placebo. Periodic questionnaires on symptoms of interstitial cystitis, voiding diaries, bladder capacity at first desire to void, and maximum bladder capacity were obtained. Adverse events were closely monitored during the treatment and follow-up phases of the study. Subjective and objective baseline values were compared with the follow-up data. With a mean follow-up of 24 [range 6 to 33] months11 out of 15 [73%] in BCG group, and 3 out of 15 [20%] in placebo group responded to the treatment [p<0.002]. Responders were defined the patients with more than 40% improvement in the symptoms of interstitial cystitis. The global improvement in symptoms and signs of interstitial cystitis was 62%. Adverse events were similar in both groups, mostly irritative in nature and no significant systemic event was noted. BCG did not worsen interstitial cystitis symptoms. We concluded that intravesical BCG is safe, effective, available, and inexpensive with relatively durable results in the treatment of interstitial cystitis

Results of Dermal Patch Graft in the Treatment of Peyronie's Disease

To investigate the efficacy of "dermal patch graft" in surgical management of Peyronie's. Eighteen of Peyronie's disease cases, with a mean age of 49 and a history of penile curvature and painful erection were enrolled in this study. Diagnosis was made clinically by plaque palpation. All of them were in the chronic stage of disease with symptom duration of at least 6 months. We also evaluate their potency through Brief Sexual Function Inventory [BSFI] questionnaire before and after the operation, meanwhile the degree of penile curvature was measured with goniometry while artificial erection status was induced. Mean penile curvature, before and after the operation [58 and 5 degrees respectively], showed significant improvement [p<0.001]. The improvement of curvature was irrespective of the plaque size. All of our patients suffered from inability to intercourse due to significant penile curvature but after the procedure 11 of them [66.1%] could do so. Also the BSFI score improved significantly in this subgroup [p<0.05]. The remaining 7 cases [39%] already suffered from erectile dysfunction despite of operation; however, the penile curvature improved significantly in them. Six of this latter group had a plaque size greater than 4 cm2 and BSFI score was not significantly improved. Dermal patch graft as a cost effective method in the management of Peyronie's disease significantly corrects the curvature irrespective of plaque size and curvature severity. We found that if the fibrous plaque is less than 4 cm2 and the patient has no severe erectile dysfunction, this procedure will significantly improve his potency; however, if the patient suffers from a plaque sized greater than 4 cm2 and/or severe erectile dysfunction, to reach satisfactory erection, implantation of penile prosthesis or applying other methods of artificial erection in addition to dermal patch graft is suggested

Pediatric urology: a results of modified Gil-vernet antireflux surgery in the treatment of vesicoureteral reflux

To evaluate the efficacy of modified Gil-Vernet anti-reflux surgery in the treatment of patients with primary vesicoureteral reflux in a prospective historical controlled trial. A total of 30 patients with 46 refluxing units underwent this surgery since February 1998 until September 2002, with the mean follow-up period of 18 [range 6 to 43] months. Vesicoureteral reflux was resolved completely in 44 ureteral units [95.6%, p<0001]. In 2 refluxing units [4.3%] in spite of reflux improvement, hydroureter remained unchanged after the surgery. In respect to response rate, there was no significant difference between different grades, genders, age groups, and laterality of primary vesicoureteral reflux. Our findings indicate that modified Gil-Vernet anti-reflux surgery which separately transfers each ureteral orifice to the tip of trigone with two fine absorbable suture on each side, is a completely successful procedure in the treatment of primary vesicoureteral reflux and produces a longer submucosal tunnel with a more suitable angel than classic Gil-Vernet procedure does