Management of post traumatic posterior urethral sticture; internal urethrotomy versus perennial urethroplasty

To compare the efficacy and cost effectiveness of cold knife optical internal urethrotomy with perineal urethroplasty [excision and end to end anastomosis] in the management of post traumatic short posterior urethral stricture. Design: an observational prospective study. Place and duration of study: the study was performed in the department of urology and kidney transplantation Services hospital/post graduate medical institute Lahore, from September 1997 to December 1999. Patients and methods: Forty male patients of post traumatic posterior urethral stricture revealed by their urethrogram were included in the study. Patients were divided in two groups randomly [group A and group B]. After complete evaluation, patients of group A were managed by internal uretherotomy, while those of group B by perineal urethroplasty. Follow up was done at 1,3,6,9 and 12 months. age range of the patients was 20 to 59 years with the mean age of 35.5 years. Road traffic accident was the main cause [82.5%]. After facing the traumatic urethral injury, there was history of attempted Foley catheterization [47.5%], bouginage [15%] and intervention by rail road technique in 10% of the patients. All patients were with supra pubic catheter because of failure to void. The length of stricture varied from 0.5 to 2.0 cm [mean 1.4 cm]. Clinical response at the end of the study in group A and B was "good" in 58.82% and 66.66%, "satisfactory" in 23.52% and 22.22% and "poor" in 17.64% and 11.11% respectively. The mean cost of operation, hospital stay and loss of working hours were less in group A as compared to that of group B. The results of perineal urethroplasty are comparatively better than optical urethrotomy. The other differences of the two procedures lie in operative time cost of the operation and mean hospital stay. It is concluded that optical urethrotomy is an acceptable alternative to urethroplasty in patients with short post traumatic posterior urethral stricture

diagnosis and management of the urological complications of renal transplantation: a series of 1100 patients

To analyse the Urological Complications after Renal Transplantation and their management. A retrospective analysis of 1150 consecutive live donor renal transplants was performed. The study period extended from December 1995 to December 2004. The surgical procedure for ureteral reimplantation was modified Lich anastomosis. Ultrasonography, renal scanning, antegrade pyelography, retrograde pyelography and cystography were the diagnostic tools. Overall, 68 primary urological complications [5.9%] were identified during the 15-year experience in 65 patients. The Urological Complications in our series included 35 ureteral obstruction [3.0%], 25 ureteral or bladder leaks [2.17%], 05 out flow obstruction, 02 cases of vesicoureteral reflux and 01 case of ureteral stone. The incidence of Urological Complications in our study is 5.9%. Early exploration of the ureteric leaks and timely intervention to obstructed kidney reduced the morbidity and improves graft su rvival. The causes of these complications and techniques for their prevention are discussed in this study

Diagnosis and management of uric acid nephrolithiasis

The aim is to provide an account of the diagnosis and management of uric acid stones. Material and methods: A search was made on the topic of uric acid stones with regard to the diagnosis and management of uric acid stones. The incidence of uric acid stones varies between countries and account for 5% to 40% of all urinary calculi. Uric acid stone cannot be seen on x-ray. Intra venous uroghraphy, CT scan or sonoghraphy is required for their diagnosis. This is the only stone that can be reliably dissolved by urinary alkalization with alkali [Bicarbonates, citrate]. This medical treatment is highly effective resulting in dissolution of existing stones and prevention of stones. Extracorporeal shock wave lithotripsy and percutaneous nephrolithotripsy can be used successfully for uric acid stones. Open surgery is still performed especially for large complicated staghorn stones. Medical management with urinary alkalization for uric acid stone dissolution and prevention of recurrence is effective

Ureteral injuries: a complication of hysterectomy

Ureteric injury is an important complication following hysterecotomy which a General surgeon or Urologist is called upon to deal with. A prospective study of nine such patients referred to the authors for management is presented. The mean age of patients was 36 years. Commonest [66.7%] presentation was postoperative anuria, the rest [33.3%] presented with urinary fistulae. All these injuries followed either elective abdominal or caesarian hysterectomies. Majority [89%] of these were operated by relatively junior gynaecologists. All these patients were operated upon. In five patients who had suture entrapment of both ureters, delegation with or without stenting was done. In four patient ureteroneocystostomy was done for ureteric transection. All patients were cured and discharged from the hospital with a mean stay of 11 days

Low dose BCG in the management of superficial transitional cell carcinoma of urinary bladder

76 patients with recurrent superficial bladder tumor were treated with low dose intravesical BCG therapy [20 mg] between July 1987 to March 1995. Low dose BCG therapy prevented recurrence of superficial bladder tumors in 78.9% at one year and 64.4% at 5 years follow up period. One patient developed distant metastasis in bone although there was no local recurrence after BCG in 3 years