Inferior pubectomy in management of post traumatic posterior urethral disruption

The aim of this work is to determine step wise procedures that would overcome long segment posterior defects and/or high prostatic apex in cases of post traumatic urethral defects. A total of 60 male patients presented with PUDD, a suprapubic tube was placed, and they were planned for delayed repair after 3 months. End to end anastomosis was contemplated after excision of all the scar tissue. In case the length of the defect, and the higher migration of the prostatic apex did not allow this tension free suturing the following maneuvers were undertaken: freeing the distal urethral segment till the penoscrotal junction, then development of the intercrural space, and if not sufficient, we utilized inferior pubectomy. After a mean follow up of 18 months [6-36], 60 patients were evaluated. Mean age was 43 years [27-68]. Twenty patients [group I] underwent end to end anastomosis [defect was <4cm]; 40 patients [group II] underwent end to end anastomosis with inferior pubectomy [defect > 4cm, or high riding prostate]. In group I, 14 out of 20 [70%] had a patent anastomosis and stricture recurred in 6 patients. In group II, 30 out of 40 [75%] had a patent anastomosis during follow-up. Of those 16 patients with recurrent stricture, 10 required visualized urethrotomy, and a redo anastomosis was done in 6 patients. Twelve [20%] developed new onset erectile dysfunction. Four patients had preoperative bladder neck insult, and suffered stress incontinence postoperatively. Four patients developed self limited local wound haematomas, one of them was infected and required drainage. AT could be cannluded that Shortening the distance between the distracted urethral ends can be achieved by inferior pubectomy that allows tension free anastomosis as well as smooth curved urethral pass from distal to proximal urethral ends. This procedure is preferred rather than using tissue transfer or difficult transpubic approach. Inferior pubectomy is indicated in case of long segment stricture posterior urethral defect and /or high prostate migration that will interfere with smooth pass of the urethra and results in urethral angulations

extra corporeal magnetic stimulation [PCK chair] was effective therapy in treatment of stress and urge incontinance in women?

The aim of this study is to evaluate the clinical efficacy of ExMI [Extra corporeal magnetic stimulation [PCK chair]] for the treatment of stress and urge urinary incontinence in women. Since July 2004, 32 female patients with stress incontinence in [23] patients and urge incontinence in [9] patients, were included in a prospective study of PCK chair [electromagnetic chair]. One year after use ExMI in El Emadi Hospital Doha Qatar, of 32 patients, 9 [39%] in the stress group and 4 patients [44.4%] in the urge group were dry and using no pads. The average number of pads used per day reduced from 3.5 +/- 1.6 pads /day to 1.4 +/- 1.8 pads/day. In addition, there was an improvement in symptoms in 6 patients [26.1%] in the stress group and 3 patients [33.3%] in the urge group there was an improvement in symptoms in 6 patients [26.1%] in the stress group and 3 patients [33.3%] in the urge group [Improvement]. The cumulative success rate [cure +improvement] for stress and urge incontinence was 65.2% and 77.7%, respectively. The frequency of leak episodes per day was reduced in stress group from 3.2 +/- 2.4 [median 2.5] to 1.7 +/- 2.4 [median 1.0] [p=0.001] before and after treatment respectively and in urge group from 4.8 +/- 2.3 to 2.1 +/- 2.2 episodes per 24 hour [p =0.001]. Pad weight was reduced from 14.5 +/- 11.0 to 5.6 +/- 7.2 g in stress group [p=0.000]; and from 12.4 +/- 7.3 to 4.6 +/- 5.2 g in the urge group [Improvement] [p=0.001]. Eight patients in stress group and two patients in the urge group did not benefit from ExMI treatment. On urodynamic study, the mean bladder capacity increased from 356 +/- 120 to 397 +/- 123 after treatment but this deference was not significant. The present finding demonstrate that ExMI [PCK CHAR] is an effective, non invasive and painless treatment for stress and urge incontinence, can easily applied and acceptable by the patients. Further long term follow up are needed to evaluate the long-term efficacy of this treatment