ABSTRACT
Vesicouterine fistula represents a rare urogenital fistula, accounting for approximately 1-4% of genitourinary fistulas. Iatrogenic reasons have been shown to be most common cause. Surgical excision is the mainstay of treatment. Less than 5% patients respond to conservative management. Authors report a case of successful conservative management of vesicouterine fistula.
ABSTRACT
Background: Authors describe their experience with dorsal onlay urethroplasty using Buccal mucosal graft or penile skin graft through dorsal sagittal urethrotomy for bulbar urethral stricture.Methods: From 2014 to 2017, 29 male patients with bulbar urethral stricture have been treated by one stage dorsal onlay substitution urethroplasty using buccal mucosal graft and penile skin graft. Patients with balanitis xerotica obliterans, unhealthy penile skin, oral mucosa pathology or those who had undergone more than one urethral dilation/internal urethrotomy or urethroplasty were excluded from study. Results were analyzed at 6th and 12th month follow up with clinical history and uroflowmetry. Clinical outcome was considered a failure when any postoperative instrumentation was needed, including dilation or optical internal urethrotomy.Results: A total of 16 men age between 21 to 56 years for buccal mucosa graft (BMG) urethroplasty and 13 men age between 18 to 59 years underwent dorsal onlay substitution urethroplasty using BMG and penile skin graft (PSG). Mean stricture length was 4.2 cm (3.8-6) for BMG urethroplasty and 4.1 cm (3.2-5) for PSG urethroplasty. Mean length and width of graft were 4.2 cm and 2.6 cm respectively in BMG urethroplasty while 4.6 cm and 2.5 cm in PSAG urethroplasty. Average follow up months were 13.4 months with overall success rate 87.5% in BMG urethroplasty while average follow up months were 14.6 months with overall success rate 82.3% in PSG urethroplasty.Conclusions: On short term follow up substitution urethroplasty using both penile skin and buccal mucosa graft have comparable results.
ABSTRACT
Background: Emphysematous pyelonephritis (EPN) is a urologic emergency caused by a life-threatening necrotizing infection of the kidney leading to an accumulation of gas in the renal parenchyma and perirenal tissue. we present the clinical details and outcome of twelve patients of managed at our institute and discuss their management and outcomes.Methods: Twelve consecutive patients with EPN were managed in our institute from July 2014 to July 2018. Data on demographic profile, clinical features, laboratory investigations, imaging studies, outcome of patients and follow up details were recorded.Results: Out of 12 patients with EPN, nine were female and three were male. Ten patients were diabetic (83%). All the diabetic patient had raised blood sugar at the time of admission ureteric stone was present in two nondiabetic patients. All the patients had fever at the time of presentation while localized flank pain was present in 6 (50%) patients. On examination, renal angle tenderness was present in ten patients while abdominal mass found in three patients. Pyuria was found in all patients while leukocytosis found in 10 patients. Two patients had thrombocytopenia while 4 had deranged renal parameters at the time of admission. Urine culture showed Escherichia coli in 8 patients and Klebsiella in two patients. Four patients required percutaneous drainage. Interval nephrectomy was done in one patient due to non-functioning kidney.Conclusions: Majority of patients diagnosed as emphysematous pyelonephritis were managed conservatively due to diagnosed at an early stage. Percutaneous drainage is successfully utilized in patients with more advanced disease.