ABSTRACT
OBJECTIVE@#To describe the technique and report the first transurethral buccal mucosal graft ventral inlay (Nikolavsky Technique) urethroplasty done in the Philippines, in a patient who had a fossa navicularis stricture extending to the distal penile urethra.@*METHODS@#Reported here is a case of a twenty-seven-year-old male who had a 40% distal urethral mucosal tear, as seen on initial cystoscopy, following traumatic catherization. The urethral tear was initially managed with a foley catheter maintained for a month. However, the patient eventually developed a 4 cm stricture extending from the fossa navicularis to the distal penile urethra. A ventral buccal mucosal graft was placed on the denuded urethral plate as an inlay patch via the transurethral route. No skin incisions nor penile degloving was done@*RESULTS@#Total operative time was four hours, including graft harvest time, with approximately 400 ml blood loss. The patient was sent home on the 3rd postoperative day. The urethral catheter was removed after 14 days. Post-operative follow-up was performed at 0-, 3- 6- and 12-months. A repeat voiding cystourethrogram was performed at 4 weeks showing no narrowing at the prior stricture site. On 12 months follow-up, uroflowmetry showed a Q-max of 20ml/sec with minimal residual urine. LUTS symptom scoring was at 7 and IIEF-5 score of 25@*CONCLUSION@#Repair of distal urethral strictures can be done using transurethral ventral buccal mucosa graft inlay urethroplasty. It can be challenging for longer strictures (>4 cm) but easily reproducible for shorter ones. The technique demonstrated good results on medium term follow-up. To the authors’ knowledge, this is the first reported case that utilized this technique in the Philippines.
ABSTRACT
@#The current standard in the management of large burden renal stones is conventional percutaneous nephrolithotomy. Mini-percutaneous nephrolithotomy (mini-PCNL) is a procedure developed to decrease complications of standard PCNL by decreasing the size of access. Recent studies have shown high stone free rates with minimal complications in utilizing mini-PCNL in larger stones. @*OBJECTIVE@#This study aims to assess the safety and efficacy of mini-PCNL for stones with sizes 2 cm and above versus standard PCNL.@*METHODS@#This is a meta-analysis comparing mini-PCNL and standard PCNL in the management of renal stones 2 cm and above. A PUBMED search was done to acquire randomized controlled trials (RCTs), prospective and retrospective studies of mini-PCNL and standard PCNL assessing large burden renal stones, defined as 2 cm and above. Two authors independently assessed the studies for selection. Comparison of mini-PCNL and standard PCNL was done according to following parameters: stone-free rate, operative time, postoperative decrease in hemoglobin levels, length of hospital stay, rate of transfusion, occurrence of fever, postoperative pain scores, and occurrence of urine leakage.@*RESULTS@#Results of this meta-analysis showed that standard percutaneous nephrolithotomy has an advantage over mini percutaneous nephrolithotomy only in terms of having a shorter operative time for larger stones (MD: 8.44 min, 95% CI 6.36 – 10.52 min, p < 0.00001). No difference was found in the outcomes of postoperative pain scores (MD 0.19 VAS score, %CI 0.16 – 0.54, p = 0.29), occurrence of postoperative fever (OR 0.33, 95% CI 0.18 – 0.61, p = 0.06) and the stone-free rate (OR 0.97, 95% CI 0.67 – 1.41, p = 0.88). Mini-percutaneous nephrolithotomy has advantage over standard percutaneous nephrolithotomy for large-burden stones in terms of shorter length of postoperative hospital stay (MD 1.44 day, 95% CI 1.22-1.66, P <0.00001), lower hemoglobin drop (MD 0.48 mg/dl, 95% CI 0.39–0.66, p < 0.00001), lower rate of transfusion (OR 0.40, 95% CI 0.20 – 0.99, p = 0.01), urine leakage (OR 0.11, 95% CI 0.03 – 0.39, p = 0.0008) and an overall lower occurrence of complications (OR 0.42, 95% CI 0.28 – 0.62, p < 0.0001).@*CONCLUSION@#Mini-percutaneous nephrolithotomy is a safe and effective intervention in large-burden stones 2 cm in size and above.