Fistula repair after hypospadias surgery using buccal mucosal graft

The aim of this study was to evaluate the success rate of urethrocutaneous fistula repair using buccal mucosal graft in patients with a previous hyposadias repair. We reviewed records of our patients with urethrocutaneous fistula developed after hypspadias repair in whom buccal mucosal graft fistula repair had been performed. All of the patients had been followed up for 24 postoperative months. A successful surgical operation was defined as no fistula recurrence or urethral stricture. Retrograde urethrography and urethrocystoscopy would be performed in patients who had any history of decreased force and caliber of urine or any difficulty in urination. Fistula repair using buccal mucosa patch graft had been done in 14 children with urethrocutaneous fistula developing after hypospadias reconstruction. The mean age of the children was 8.70 +/- 1.00 years old [range, 4 to 11 years]. Seven fistulas were in the midshaft, 4 were in the penoscortal region, and 3 were in the coronal region. Repair of the fistulas was successful in 11 of 14 patients [78.6%]. In the remaining children, the diameter of the fistula was smaller than that before the operation, offering a good opportunity for subsequent closure. Our findings showed that fistula repair using buccal mucosal graft can be on the acceptable techniques for repairing fistulas developed after hypopadias repair

Clean intermittent catheterization with triamcinolone ointment following internal urethrotomy

Our aim was to evaluate clean intermittent catheterization [CIC] results in combination with triamcinolone ointment for lubrication of the catheter after internal urethrotomy. Seventy patients who underwent internal urethrotomy were assigned into 2 groups and performed CIC with either triamcinolone 1% ointment or a water-based gel [control] for lubrication of the catheter. They continued CIC regimen up to 6 month and were followed up for 12 months. Retrograde urethrography and urethrocystoscopy were done 6 and 12 months postoperatively. In case of obstructive symptoms or any difficulty in passing the urethral catheter, internal urethrotomy would be performed, if needed, and the same follow-up protocol would be started again. The recurrence rates after the first and second urethrotomy attempts were compared between the two groups. Thirty patients in the triamcinolone group and 34 in the control group completed the study. There were no significant differences in the baseline characteristics of the patients or the etiology of the stricture between the two groups. There was a 30.0% recurrence rate in the patients of the triamcinolone group versus 44.1% in those of the control group after the first internal urethrotomy [P = .24]. Following the second internal urethrotomy, the urethra was stabilized in 88.9% of the patients in the triamcinolone group and 60.0% those in the control group [P = .15]. Administration of triamcinolone ointment in patients on CIC regimen after internal urethrotomy only slightly decreased the stricture recurrence rate, and its possible effects should be more investigated

Diagnostic application of flexible cystoscope in pelvic fracture urethral distraction defects

The aim of this study was to evaluate the diagnostic value of antegrade flexible cystoscopy in pelvic fracture urethral distraction defects [PFUDD]. Between 1999 and 2004, a total of 111 patients with PFUDD were evaluated by antegrade flexible cystoscopy. The flexible cystoscope was introduced into the posterior urethra and the area was evaluated for any probable fistula, false passages, or displacement of the posterior urethra. For preventing misalignment, flexible cystoscope was also used during the urethroplasty to open the posterior urethra at its exact distal point. Posterior urethra ended distal to the external sphincter in 16 patients [14.4%]. Five [4.5%] and 9 [8.1%] patients had severe displacement of the posterior end of the urethra and bladder neck false passage, respectively. Prostatic urethrorectal fistula was detected in 1 patient. Another 1 patient had bladder rhabdomyoma. Flexible cystoscopy is a valuable procedure in the evaluation of the bladder, the bladder neck, and the posterior urethra in patients with urethral distraction defects and complements voiding cystography before the surgery. It is also helpful for showing the exact distal point of the proximal urethra during urethroplasty in cases with displaced posterior urethra