Outcome Analysis of Redo Urethroplasty for Large and Multiple Urethrocutaneous Fistula

Background: Urethrocutaneous fistula is the most common complication of hypospadias surgery. Due to the poor surrounding tissue quality, surgical treatment of these patients represents a complex problem. Objectives: Present study aimed to determine a better procedure of salvage urethroplasty for failed hypospadias, caused by persistent large (>4mm) or multiple -small (<4mm) fistulae, by a randomized comparison.Methods: This interventional study was performed in a single institute over a period of five years. Comparisons were made among three procedures of salvage urethroplasty using substitution of dorsal skin flap, Flip flap, or buccal mucosal graft in a controlled situation. Outcomes were assessed by means of objective scoring system. Results: Refistula rate, devascularization of flap and grafts and wound dehiscence rate were significantly less in Buccal mucosal graft than flip flap and dorsal transposition flap. This led to a higher success rate and better patient compliance in buccal mucosal graft. Though mean duration of hospital stay was significantly longer in buccal mucosal graft compared to other methods, it did not negatively affect patient satisfaction due to overall higher success rate. The objective scoring evaluation revealed that score gain of BM group was significantly higher than that of dorsal transposition flap and flip flap. Conclusion: Staged redo urethroplasty for large or multiple-small fistulae using substitution of buccal mucosal graft revealed as an better option for urethral reconstruction than dorsal transposition flap and flip flap procedures (group A˃ group B ˃group C).

In silico analysis of indole-3-carbinol and its metabolite DIM as EGFR tyrosine kinase inhibitors in platinum resistant ovarian cancer vis a vis ADME/T property analysis.

Epidermal Growth Factor Receptor (EGFR) is one of the four members of the Human Epidermal Receptor (HER) family, which is deregulated and over expressed in platinum resistant ovarian cancer. Thus, targeting EGFR receptor along with platinum drugs is one of the major strategies to increase the platinum drug sensitivity. That‟s why, in this study, we aimed to investigate the inhibitory activity and binding site analysis of indole-3-carbinol and its active metabolite 3,3'-diindolylmethane by using molecular simulation studies, also metabolic profile had been investigated by SOM prediction. The 3,3'-diindolylmethane showed significant inhibitory activity and binding energy comparing to indole-3-carbinol, also it processed lower toxicity and will undergo aromatic hydroxylation due its high intrinsic activity and Fe accessibility. Though our research study supports previous reports of EGFR inhibition, further in vivo study is necessary for validation of toxicological and pharmacokinetic study. However, the current work tries to address most of the variables in the dynamic drug design process by In silico study in order to boost the potentiality of the selected molecule to serve as good leads in terms of optimum pharmacokinetic and toxicological attributes.