Problem of fused kidneys – Our observations

Genitourinary tract tops the list of developmental anomalies – 30-40% of malformed individuals. These developmental anomalies comprise a diversity of abnormalities ranging from complete absence to aberrant location

orientation

shape

form

fusion

number and vascular attachments. Amongst these wide range of anomalies

fusion anomalies are not uncommon. Horseshoe kidney is the commonest fusion anomaly which accounts for about 0.25% of the population. Unilateral fused kidney with inferior ectopia is the next most common fusion anomaly with an incidence of 1:1000. The other fusion anomalies are Sigmoid or S – shaped kidney

Lump kidney

L shaped kidney

Disc or doughnut kidney and Unilateral fused kidney with superior ectopia. These fusion anomalies are clinically important because they are malrotated

abnormally placed with anomalous blood supply. They are predisposed to various complications like hydronephrosis

infection

urolithiasis and neoplasm. This is a study of 10 patients who presented with fusion anomalies

in the department of Osmania Hospital

Afzalgunj during the period of 2013-2015. The clinical presentations

modalities of arriving at diagnosis

associated complications and the management are discussed.

A study of primary megaureter Our experience

Amongst the congenital anomalies of the Ureter, Megaureter is one of the commonest, next only to the various types of duplications. Though every dilated and large ureter can be described as Megaureter, Primary obstructive megaureter is the entity wherein the dilated ureter is associated with a short, juxtavesical, narrow, adynamic segment and is not associated with reflux. This is a study of 8 patients who presented with primary obstructive megaureter in the department of urology, Osmania General Hospital, Afzalgunj during 2013-2015. Apart from the clinical presentation of this disorder, the modalities of arriving at the Diagnosis, the associated complications and the management are discussed

Dorsal onlay buccal mucosal graft urethroplasty in inflammatory stricture of urethra – Our experience

Urethral stricture is a common disease with changing etiology and changing practices in management. Management options were grossly determined by cause, site, length of stricture and also by other factors like prior attempts of repair and local genital skin condition. Treatment options vary from dilatation, optical urethrotomy to various types of urethroplasty. Substitution urtethroplasty is done using various types of graft materials like skin, buccal mucosa, bladder mucosa or colonic mucosa. Over the past 10-15 years buccal mucosa grafts have been increasingly used in the urethral reconstruction. Barbagli technique (Dorsal onlay technique) has the advantages of no sacculation which is seen with ventral onlay grafts, good neovascularity and less shrinkage (10%) rate. We have presented the results and complications of doral onlay buccal mucosa graft urethroplasty (Barbagli technique) in 20 cases performed over a period of 30 months in our institution. Our study showed a success rate of 80% at the end of 2yrs follow up, comparable with other studies, with a restructure rate of 20%. None of our patients developed urethrocutaneous fistula and urethral diverticulum.

Our experience with ileocystoplasty for augmentation of tuberculous bladders

Augmentation cystoplasty has traditionally been used in the treatment of low capacity, poorly compliant or contracted bladders. Various bowel segments can be used for augmentation with its own advantages and disadvantages like ileum, sigmoid, cecum, ileo cecal, stomach etc. The surgical technique involves detubularisation and reconfiguration of bowel to create a patch. A successful clinical outcome depends on creating a large capacity, low pressure reservoir to store urine. Present study was retrospective study conducted from November 2010 to March 2014 on 7 patients (5 men, 2 women with mean age 32 years). Early complications: wound infection in 3 cases, wound dehiscence in 2 cases, urinary leakage in 1 case. Late complications: recurrent UTI in 2 cases, increased mucus production in one case, bladder stone formation in one case. All were grade I to III according to Clavien- Dindo classification. No major (grade IV or V) complications. As in our experience ileocystoplasty for augmentation of tuberculous bladder is a safe and effective procedure.