The Effect of Hyaluronic Acid in Preventing Recurrence of Anterior Urethral Stricture after Endoscopic Internal Urethrotomy- A Single Centre, Randomised Controlled, Single Blind Study

BACKGROUNDHyaluronidase instillation during OIU may decrease the incidence of urethral stricture recurrence.13 The exact mechanism is not known in urethral stricture, but it is used as antifibrotic agent in hypertrophic scar, keloid, and pulmonary fibrosis. Intralesional injection decreases fibroblast proliferation, collagen, and glycosaminoglycan synthesis and suppresses proinflammatory mediators in wound healing process.14 This study was conducted to see the benefits of HA for preventing recurrence of anterior urethral stricture after urethrotomy.METHODSAfter obtaining the clearance from ethical committee, 70 patients satisfying the inclusion criteria were recruited & randomly divided into 2 groups: Group A (35 patients, experimental group) received hyaluronic acid (HA) instillation & Group B (35 patients, Control group) received lubricant lignocaine after EIU. Each patient was evaluated at 4 weeks (V1), 12 weeks (V2), & 24 weeks (V3) after surgery. The recurrence rate was evaluated by protocol analysis based on number of patients who completed the study. Preoperative characteristics, including the site & length of urethral stricture, were evaluated by intent-to-treat analysis. RESULTSAmong 70 patients, only 30 patients in group A & 30 patients in group B had completed the study. Significant improvement noted in both groups after surgery in every parameter with recurrence in Group A 9.43% & in Group B 22.92% (p <0.05) at V3. IPSS score at V3 were obstructive: Group A - 4.03±0.65, Group B – 5.16±1.84 (p=0.0024), Irritative: group A – 2.8±0.60, Group B – 3.33±1.19 (p=0.033). At V3 follow up Qmax: Group A – 22.40±3.21, Group B – 18.13±3.56 (p=0.0001); Qavg: Group A – 11.43±1.72, Group B – 10.43±2.2 (p=0.048); PVRV: Group A – 10.16 ± 13.81, Group B – 19.33±15.90 (p=0.020); Degree of satisfaction: Group A – 2.11 ± 0.38, Group B – 1.76±0.49 (p=0.0031).CONCLUSIONSHA instillation during EIU decreases the incidence of urethral stricture recurrence & improves degree of satisfaction in long term follow up without any side effect.

Complications after prone PCNL in pediatric, adult and geriatric patients - a single center experience over 7 years

ABSTRACT Introduction CROES-Clavien system (CCS) for grading complications in percutaneous nephrolithotomy (PCNL) is a step towards standardization of outcomes. We categorized complications based on CCS and predicted risk factors across the entire cohort and individually for pediatric (P: ≤18 years), adult (A: 19-65 years) and geriatric (G: ≥65 years) subgroups to assess the risk factors in each subset. We assessed association of complications with length of hospitalization (LOH) and operation time (OT). Materials and Methods Retrospective record review of unilateral PCNL performed between January 2009-September 2015 at a tertiary care center in India, performing around 150 PCNL per year. Results Out of 922 (P=61; A=794; G=67) PCNL, 259 (28.09%) complications occurred with CCS I, II, III and IV constituting 152 (16.49%), 72 (7.81%), 31 (3.36%) and 4 (0.43%) respectively and its distribution was similar across the subsets and majority (224; 24.3%) were minor (CCS-1, 2). Placement of a nephrostomy (47.4%; 18/38) in Group P, supracostal access, ≥2 punctures, higher GSS, nephrostomy, staghorn stones, ≥2 stones, stone size in Group A and hydronephrosis and prolonged OT in Group G were significantly associated with complications. On logistic regression, need of nephrostomy (adj. OR - 4.549), OT (adj. OR - 1.364) and supracostal access (adj. OR - 1.471) significantly contributed to complications in the study population. LOH was found to be significantly associated with complications (p<0.001). Conclusions Contrary to the belief that extremes of ages are associated with complications of prone PCNL, we found age does not alter the incidence or grade of complications and LOH.

Incidence of De Novo Erectile Dysfunction after Urethroplasty: A Prospective Observational Study

PURPOSE: De novo erectile dysfunction (ED) is a known complication after urethroplasty. Incidence and natural history of de novo ED after urethroplasty is underreported. We assessed the incidence of de novo ED after urethroplasty. MATERIALS AND METHODS: Consecutive consenting urethroplasty (n=48) patients aged 21 to 50 years from February 2014 to July 2016 with normal preoperative erectile function as determined by an International Index of Erectile Function-5 (IIEF-5) score ≥22 were included and interviewed at 3, 6, and 12 months. RESULTS: In patients with anterior stricture (n=40), substitution urethroplasty (SU) was performed in 22 patients (55.0%) and end-to-end anastomotic urethroplasty (EEAU) in 18 patients (45.0%). Their mean IIEF-5 score was 24.15±0.8 preoperatively, 20.10±4.2 at 3 months (p<0.001), 22.70±2.3 at 6 months (p=0.0012), and 23.70±1.7 at 12 months (p=0.03), showing a recovery of erectile function with time. All 8 patients with pelvic fracture urethral injury (PFUI) underwent progressive perineal urethroplasty. Their mean IIEF score was 24.0±1.2 preoperatively, 18.8±5.4 at 3 months (p=0.002), 20.9±3.5 at 6 months (p=0.37), and 22.0±1.5 at 12 months (p=0.427). The incidence of ED was similar at 1 year postoperatively between patients with anterior stricture and PFUI and between patients who underwent EEAU or SU for anterior stricture. CONCLUSIONS: Incidence of ED at 1 year after PFUI is similar to that after surgery for anterior stricture in patients with normal preoperative erectile function. Among the cases of anterior stricture, recovery was better with SU at 3 months and was similar between SU and EEAU at 1 year.