ABSTRACT
The recurrence of pediatric nephrolithiasis, the morbidity of repeated open surgical treatment as well as our experience in percutaneous nephrolithotomy [PNL] in adult patients, all derived us to shift to PNL for managing renal stones >1.5 cm in pediatric patients. Our aim of this study is to evaluate the safety and efficacy of PNL in pediatric patients. During the period of the month between May 2011 and April 2013, 38 children [47 renal units] underwent PNL for renal stones 1.5-5 cm in length. Patient demographics, stone characteristics, and clinical outcome were prospectively studied. Data of those who underwent conventional and tubeless PNL were compared. Median follow-up period was 12 months [range: 6-24]. The median age at presentation was 8-year [range: 3-12]. The operative time ranged from 30 to 120 min [median [0]. Overall stone clearance rate was [1.5% after single PNL. The median hospital stay was 3 days. Auxiliary procedures were successful for the remaining 4 patients [nephroscopic clearance in one and shockwave lithotripsy in 3]. Tubeless PNL was performed in 17 renal units with a comparable outcome to conventional ones. The perioperative complications were noted in 5/47 [10.6%] of all procedures [Clavien Grade II in 4 and Clavien Grade IIIa in 1] and were managed conservatively. Percutaneous nephrolithotomy for renal stones in pediatric patients is safe and feasible if performed by a well-experienced endourologist. Tubeless PNL is a better choice for children
ABSTRACT
We'd like to present our experience in treating long [>5 cm] anterior urethral stricture by penile skin flap as dorsal on-lay in one-stage procedure. Between January 1998 and December 2010, 18 patients [aged from 28-65 years] presented with long urethral stricture, 5.6-13.2 cm, [penile in 6, bulbar in 2, and combined in 10 cases], those were repaired utilizing long penile skin flaps placed as dorsal on-lay flap in one-stage [Orandi flap 6 cm in 6 cases, circular flaps 7-10 cm in 8, and spiral flaps 10-15 cm in 4]. Uroflowmetry and RUG were done following catheter removal and at 6 and 12 months. The urethral patency was achieved in 77% of patients. The complications were fistula in 1 patient [5.5%], re-stricture occurred in 3 patients [16.6%] that required visual internal urethrotomy [VIU], and 2 patients [11%] showed curvature on erection that did not interfere with sexual intercourse. Diverticulum [penile urethra] was seen in 1 patient [5.5%] containing stones and was excised surgically. There was penile skin loss in 3 patients [16.6%]. All patients completed at least one year follow-up period. Free penile skin flaps offer good results [functional and cosmetic] in long anterior urethral stricture. Meticulously fashioned longitudinal, circular or spiral penile skin flaps could bridge urethral defects up to 15 cm long.