ABSTRACT
Background: Computed tomography of the kidneys, ureters and bladder (CT-KUB) is increasingly used for urinary lithiasis. Its higher sensitivity in detecting small, radiolucent calculi with the avoidance of intravenous contrast media is very beneficial and replacing the traditional intravenous urography. Materials and methods: A Prospective study at Gandhi Hospital, Hyderabed was conducted from August 2013 to January 2016. Study Group I: calculus CT density less than 900 HU and study Group II: calculus CT density more than 900 HU. Results: Most of the stones were located in lower calix, followed by renal pelvis in both the groups. Hematuria persisted more than 24 hours among 6 (6%) patients in group 1 while18 (22.5%) in group 2. Steinstrasse was seen in 8 patients among group 1 which was managed medically in 6 patients where as ureteric stenting required in 2 patients .Where it was 3 patients in group 2 among them 1 required ureteric stenting, which appears to be significantly low but it was not when calculated among successful fragmentation as it is secondary complication to fragmented caliculi drainage. Conclusion: In patients with CT density <900 HU the ESWL was successful in 88%, with 58% of the patients required only one session and two or three ESWL sessions in remaining; with mean no 1.58 ESWL sessions are required. In patients CT density >900 HU, ESWL was successful in fewer than half of the patients (44%), only13% of them in a single session, and 76% requiring three sessions with failure rate of 80% in that group.
ABSTRACT
Background: Vesicovaginal fistula (VVF) is an abnormal opening between the bladder and the vagina that results in continuous and unremitting urinary incontinence. It is the most distressing complications of gynecologic and obstetric procedures. Materials and methods: It was a prospective study conducted at Gandhi Medical College and Hospital in Department of Urology from February 2014 to July 2015 for a period of 18 months. All cases were subjected to clinical examination, ultrasonography, IVP, cystoscopy, vaginoscopy, and cystogram for confirmation of diagnosis. All cases were managed surgically by different modalities and results were analyzed. Results: Our study included the patients in the age group of 18 to 56 years. 22 patients presented with continuous urine leak with voiding and 13 patients presented with voiding in addition to incontinence of urine. Out of 35 cases 25 were secondary to Gynecological surgeries and 10 were of Obstetric fistulas. Conclusion: The diagnosis of VVFs has traditionally been based on clinical methods and dye testing. The best chance of a successful repair is at the first attempt. The arguments about the most appropriate route for repair continue and are not clarified by the publications so far. However, the role of interposition grafts at both abdominal and vaginal repairs is viewed positively.
ABSTRACT
Background: Benign prostatic hyperplasia (BPH) is the commonest urological condition affecting men over 50 years of age. Medical therapy is usually the first line management of BPH. Finasteride is a 5-alpha reductase inhibitor (5ARI), which blocks the conversion of testosterone into the more potent dihydrotestosterone (DHT). Materials and methods: We prospectively enrolled 54 BPH patients with prostate size ranging from 30-60 gm based on ultrasound, who were undergoing elective TURP at Gandhi Hospital for a period of 2 years from January 2013 to Jan 2015. BPH patients with hematuria, bothersome symptoms and refractory retention were included in the study. Results: Totally 54 BPH patients were enrolled in our study, 30 were randomized to finasteride group and 24 to controlled group. There was significantly less (p value <0.01) mean blood loss in irrigation fluid in the finasteride group compared to the control group (54.27 gm in finasteride group Vs 82.45gms in the control group; p value < 0,01) for each transurethral resection of prostate. Conclusion: Finasteride give daily for 2 weeks before transurethral prostate resection decreased bleeding preoperatively, thereby decreasing the requirement of blood transfusions, post operative episodes of hematuria and clot retention.
ABSTRACT
Introduction: Urethral stricture is a common condition with varying etiology and management, determined by cause, site and length of stricture. Materials and methods: We presented here a randomized prospective trial comparing dorsal onlay buccal mucosa graft and penile skin flap urethroplasty at our institute over 3 years period. Results: Total 22 patients underwent substitution urethroplasty during this period. The mean age and follow up was 31.31 years and 9 months respectively. The most common cause of stricture urethra was post inflammatory (40.90%) followed by traumatic (36.36%) and balanitis xerotica obliterence (22.72%). Majority had combined penobulbar stricture (45.45%), followed by penile (31.81%) and bulbar (22.7%). The average size of the urethral stricture was 6.81 cm. The most common symptom of presentation of stricture urethra was thin stream (100%) followed by dysuria (80%), frequency (71.42%) and dribbling (30%). Most of the patients underwent surgical procedure prior to presentation; urethral dilatation done in 13 (59.05%) patients followed by visual internal urethrotomy 7 (31.81%) patients and suprapubic cystostomy in 4 (18.18%) patients. Of 22 patients, 10 (45.45%) underwent local flap and 12 (54.54%) patients buccal mucosal graft. Out of 10 local flap technique, 8 (36.36%) patients underwent ventral longitudinal flap and 2 (9.09%) underwent Quartey flap. Out of 12 buccal mucosal graft technique, 5 (22.72%) patients underwent ventral onlay graft, 5 (22.72%) dorsal onlay and 2 (9.09%) tube circumferential graft. Total success rate was 72.72%. Success rate was higher with buccal mucosal graft (83.33%) compared to local flap technique (60%). Among local G. Mallikarjuna, N. Ramamurthy, G. Ravichander, Ravi Jahagirdar, Jagadeeshwar. Substitution urethroplasty: Buccal mucosal graft Vs local flaps - A prospective randomized study. IAIM, 2016; 3(10): 162-173. Page 163 flap technique, ventral longitudinal flap (62.5%) had better results than quartey flap (50%). Among buccal mucosal graft dorsal onlay graft had best (100%) results followed by ventral onlay (80%) and then tube circumferencial graft (50%). Patients with smaller stricture length (2.5-7.5 cm) had better (75%) results. Patients with combined penobulbar (90%) and BXO as etiology (80%) also had better results. Conclusion: The success rate of buccal mucosal free graft substitution urethroplasty is better than local penile skin flaps in patients with anterior urethral strictures.