Modified MAGPI for coronal hypospadias

A total of 10 boys underwent modification of MAGPI procedure. The main features of this technique are excision of a bell-shaped penile skin area covering the distal urethra and wide glandular dissection in order to get tension free urethral advancement and glanduloplasty. Details of the technique are mentioned and discussed. All boys had excellent cosmetic result which was persistent in the follow up of 8 boys which ranged from 3 months to 2 years

In situ ultrasonic guided extracorporeal shock wave lithotripsy of ureteric stones

From July 1989 to December 1993 182 patients with symptomatic ureteric calculi were treated, 160 in the upper ureter and 22 in the lower ureter, by using in situ extracorporeal shock wave lithotripsy [ESWL]. The lithotriptor used is "Sonolith 3000", it is ultrasound guided spark gap unit. Transverse diameter of the stones ranged from 5 to 16 mm. A total of 139 patients underwent a single treatment and 43 needed multiple treatment sessions. Successful fragmentation was obtained in 148 and in 19 patients with upper and lower ureteric stones, respectively. Stone fragmentation failed in 15 patients, 12 with upper ureteric stones and 3 with lower ureteric stones. 9 of the 12 non-fragmented upper ureteric stones has a large transverse diameter [>10 mm]. Local anesthesia and IV sedation were used in 145 patients, while general anesthesia was needed for 37 patients. There were no major complications. Steinstrasse and severe renal colic occurred in 20 and 42 patients, respectively. Ureteroscopy was the only ancillary procedure needed, it was successful in 13 of 15 patients. After 3 months 58 patients were lost to follow up, 118 patients of the remaining 124 evaluable patients were stone-free. In view of these results, it is suggested that ESWL in situ is the primary treatment of upper ureteric stones and selected subgroup of lower ureteric stones

Ureteroscopy: results and complications

In the period from July 1989 to December 1993, a total of 272 ureteroscopic procedures were performed in 258 patients. Indications of ureteroscopy included ureteric stones in 243 patients and ureteric strictures in 15. Successful stone removal or fragmentation was obtained in 216 patients [88.8% of stone group]. Failure occurred in 27 patients, failure to pass the ureteroscope via the ureteric orifice in 3 patients, stone migration in 7 patients, second session procedure in 14 and ureterovesical reimplantation in 3. Complications occurred in 37 patients, 8 major and 29 minor. Major complications included severe ureteric trauma requiring immediate surgery in 3 and delayed ureteric strictures in 5. Ureteric stricture was treated by transureteroscopic lateral or medial ureterotomy followed by balloon dilatation. The later procedure was successful in 7 patients [46.6% of the stricture group]. One patient had total anuria, 2 weeks postureterotomy. These results indicated that ureteroscopy is very valuable tool to urologists, particularly if complete set up of lithotriptors and ureteroscopes are available

Management of infection in vascular procedures

This study included 31 patients with septic wound problems following various vascular procedures. Staphylococcus aureus was the commonest causative organism cultured from 60% of cases. The presentation of infection was variable, the commonest being superficial wound infection [41.9%] successful management depended upon the early detection and interference before the infection reached the graft or the suture line as well as the proper choice of the lines of therapy. For superficial infections conservative measures were sufficient. However, in deep infections, graft removal was indicated in cases where the graft was bathed in pus thrombosed or when secondary hemorrhage occurred. Extra anatomical bypasses were done following graft excision only when limb threatening ischemia occurred. Attempts at saving the graft was done when it was patent not bathed in pus and not chronically inflamed. In these cases, timely wound excision and flap coverage proved to be the most successful form of therapy