ABSTRACT
Various surgical procedures were described for the correction of the external genitalia in male-to-female transsexualism. In all these methods complications such as vaginal stenosis, unpleasant appearance of external genitalia and lack of consent are seen. This paper describes a method of surgery for repair of these complications and success rate of this surgery. Reconstructive surgery was performed by one surgeon in 16 patients from 2009 to 2011 in Imam Reza Hospital of Mashhad. Mean age 25.75 years of age from 21 to 31 years. Due to the condition of each patient appropriate reconstructive surgery was performed. These surgeries include: clitoroplasty, inverted U flap, labioplasty, urethroplasty, removal of excess skin and increasing depth of vagina. After the surgery, the patients admitted for complete bed rest up to 5 days. They received postoperative prophylaxis medication for anti-thromboembolic events. Only 3 complications were seen in all 16 patients. One hematoma of surgery site, one infection of surgery site and a blood transfusion. Eleven patients had history of vaginoplasty using small intestine and 10 patients with penile and perineal skin. From 3 to 24 months follow up after discharge were done, no patient had a major complication in long-term follow up and were generally satisfied with their sexual intercourse. This study has some limitations. Follow-up of the patients was performed for about one year that longer follow-up for these patients is favorable. Also, evaluation of patients' satisfaction from their intercourse was not performed as systematically with using an standard questionnaire and by a person who is blind to the study. Using this method of restoring external genitalia in the hands of expert surgeon, aesthetic and functional result would be expected very well
ABSTRACT
Background: Percutaneous nephrolithotomy [PCNL] is less invasive treatment for kidney stones. This technique is preferred in patients with a history of open nephrolithotomy surgery due to fewer side effects. In this study, bleeding complication was compared in patients with and without history of open kidney surgery
Materials and Methods: In this cross sectional study, PCNL was performed in 73 patients 17 patients with a history of open nephrolithotomy surgery [group 1] and 56 patients without any history of surgery [group 2] referring to Imam Reza Hospital, Mashhad, between 2010-2011. Serum hematocrit [Hct] before and after surgery, irrigation fluid volume used in operation room, and Hct of irrigation fluid were considered as a measure of bleeding. Obtained data were statistically analyzed in SPSS software, version 15, using independent-sample T-test, Man- Whitney U test and Pearson test. A P<0.05 was considered significant
Results: The irrigation fluid used in group 1 was 14.8 liters, while this was 7.9 liters in another group [p<0.001]. Decrease in hematocrit level was 10 in group 1 and 4.05 in group 2. This difference was statistically quite significant [P<0.001]. Mean blood loss volume was 405.7cc and 103.2cc in group 1 and 2, respectively [P<0.001]
Conclusion: The results of this study showed that the PCNL bleeding complications is seen more in patients with a history of open kidney surgery. Irrigation fluid hematocrit may be considered as a reliable index for the bleeding measurement of patient, independent of serum intake and hydration