Injuries of the female urethra

This study was performed with the aim of evaluating the alternative methods of treatment of female urethral injuries and determining the feasibility of 1 stage versus 2 stage management. This study comprised 11 female patients who had sustained different forms of urethral injuries. The most common cause was latrogenic [64%]. Two patients developed the injury after prolonged catheter drainage, one due to pelvic fracture and one due to urethra coitus. All the patients were managed by primary repair. Seven patients [64%] became totally continent after a single operative procedure and 3 [27.3%] required periurethral injection of macroplastique two months later. One patient, although not completely continent after the initial procedure, was satisfied with the result and refused further treatment. There were no complications related to the surgical repair in any of the patients. Most injuries can be successfully managed by primary repair through the vaginal route with excellent results and no complications. If the urethra is destroyed, a new urethra can be formed from a vaginal Flap. If continence is not obtained, an additional procedure can be employed such as periurethral injection of bulking agents

Ureteral meatotomy by endoscopic knife electrode in the management of large stones impacted in the intramural ureter

Transurethral meatotomy with knife electrode or Collings ' knife was done in 18 patients who either had a stone impacted in the intramural ureter and not suitable for ureteroscopic manipulations due to its large size [13] or when the dormia basket became impacted during attempts to extract the stone [5]. The stone was recurrent following open surgery in 10 of the 18 patients. This method resulted in successful endoscopic removal of the stones in all patients. Vesicoureteric reflux was detected in 10 patients at 1 month and in only 3 patients at 3 months. Follow up of these patients revealed no symptomatic upper tract infection or renal damage caused by this reflux. It was concluded that endoscopic ureteral meatotomy is recommended for the removal of impacted intramural ureteric stones not suitable for ureteroscopic manipulations or stones impacted in the dormia basket at the ureteric orifice, especially in recurrent cases