Meatotomy using topical anesthesia: a painless option

Urethral meatotomy is an office procedure often done under local anesthesia with or without penile block or under short general anesthesia. Whatever may be the method, the patient has to bear the pain of injection. To avoid painful injections, in the present study, topical anesthesia in the form of eutectic mixture of prilocaine and lidocaine anesthetics [EMLA/Prilox] has been used to perform such procedures and its effectiveness determined.A total of 48 consecutive patients with meatal stenosis who attended urology outdoor were enrolled in this study. After exclusion, in 32 patients, 3-4 g of Prilox cream was applied over the glans and occlusive covering was maintained for 45 min before the procedure. Meatotomy was done in a standard manner with hemostat application at the stenosed segment for 2-3 min followed by ventral incision at meatus. The patient's pain perception was measured using visual analog score. Out of 32, only one patient that had inappropriate application of cream, had a perception of pain during the procedure. Rest all the patient had no discomfort during the procedure. Mean visual analog score was 1.8 which is not a significant percepted pain level. No patient had any major complication. Use of topical anesthesia in form of Prilox [EMLA] cream for meatotomy is safe and effective method that avoids painful injections and anxiety related to it and should be considered in most of such patients as an alternative of conventional penile blocks or general anesthesia

Penile Fracture: Our Experience in a Tertiary Care Hospital

PURPOSE: Penile fracture is rare, but it is a urological emergency that always requires immediate attention. Moreover, penile fracture has been reported more frequently in recent years. It may have devastating physical, functional, and psychological consequences if not properly managed in time. MATERIALS AND METHODS: The objective of this study was to highlight the causes, clinical presentation, and outcomes of cases of penile fracture. This was a prospective observational study extending from November 2012 to November 2014. Each patient underwent a thorough clinical evaluation and received proper treatment. RESULTS: Twenty patients with penile fracture, aged 19 to 56 years (mean, 28 years) were evaluated in this study. Vaginal intercourse was the most common mechanism of injury. Most of the patients (95%) were diagnosed clinically with a proper history and clinical examination. Nineteen patients were treated surgically. The patients underwent six months of follow-up, and were evaluated with local examinations, questionnaires, and colour Doppler ultrasonography as necessary. CONCLUSIONS: Although penile fracture is an under-reported urological emergency, its incidence is increasing. It is usually diagnosed based on a clinical examination, but ultrasonography can be very helpful in diagnosis. Especially in cases where treatment is delayed, surgery is preferable to conservative management, because it is associated with better outcomes and fewer long-term complications.

Laparoscopic ureteroneocystostomy for management of lower ureteric strictures

We assessed the results of laparoscopic transperitoneal ureteroneocystostomy with or without a psoas hitch for management of lower ureteral strictures. Between October 2005 and August 2008, 16 patients with lower ureteric strictures underwent laparoscopl uretroeocystostomy with or without a psoas hitch. Etiology of strictures was gynecological surgery in 11, surgery for stone disease in 3, ureterovaginal fistula in 1 and primary obstructive megaureter in 1. Transperitoneal 3- or 4-port laparoscopic ureteroneocystostomy was performed with or without psoas hitch. 1. All operations were successfully completed without any need for conversion to open. Mean operative time was171.56 min [range 130 to 260 min], mean blood loss was 93.44 cc [range 30 to 200 cc] and total hospital stay was 3.73 days [range 3 to 6 days]. Mean time to resume oral intake was 12.5 h [range 8 to 22 h]. Mean follow-up period was 21.83 months [range 6-39 months]. Postoperative follow-up investigations revealed successful outcome in all 16 patients, success being defined as relief of symptoms and radiological improvement, irrespective of the refluxing status. Non-refluxing status was achieved in 15 out of 16 patients as determined by micturition cystography. Laparoscopic ureteroneocystostomy is a safe and effective procedure, with inherent advantages of laparoscopic surgery