Vaginal Graft Substitution Urethroplasty For Female Urethral Strictures: A Good Alternative To Lingual/Buccal Mucosal Graft

Post-menopausal sub meatal stenosis used to be common in elderly ladies, but urethral strictures were not so common. With more frequent urethral manipulations and indwelling catheterization incidence of stricture has increased. Lingual or buccal mucosal substitution urethroplasty has become standard treatment option for female urethral stricture with good long-term result. Acceptance of this procedure in female is guarded due to donor site morbidity.We used vaginal graft for substitution in 11 patients after thorough evaluation with follow-up ranging from 3 months to 2 years with satisfactory outcome and no donor site morbidity.

Complicated UTI – A Rare Cause of Spontaneous Perirenal Hematoma.

Spontaneous renal hemorrhage is an unusual complication of urinary tract infection. A 56-year-old man, diabetic with single functional kidney was admitted with fever and abdominal pain for one day. He had pyuria and an obstructed renal moiety due to a lower ureteric stone. On evaluation, he was found to have a left perirenal hemorrhage. Drainage of the obstructed system was performed and hemorrhage was managed conservatively; in the postoperative period patient remained stable and was discharged. In conclusion, complicated urinary tract infection is a rare cause of the spontaneous perirenal hematoma and needs a high vigilance for diagnosis and management.

Single stage Anterior Sagittal Anorectoplasty (ASARP) for Anorectal Malformations with Vestibular Fistula and Perineal Ectopic Anus in Females: A New Approach.

Introduction: Despite a better understanding of the embryology, anatomy of anorectal malformations and of the physiology of continence, the management of children born with imperforate anus continues to be a surgical challenge and is still fraught with numerous complications and often leads to less than perfect qualitative results. Pediatric patients with recto-vestibular fistula have good prognoses in terms of bowel function when properly treated. Aim & Objective: The study was designed to assess the surgical morbidity of single stage Anterior Sagittal Anorectoplasty (ASARP). Methodology: This prospective study was carried for a period of 26 months. It included a total of 48 female patients (aged 0 – 14 years) with diagnosis of Anorectal Malformations (ARM) with vestibular fistula or perineal ectopic anus. In ASARP, Patient in lithotomy position, the anterior portion of sphincter muscles were cut through a midline perineal skin incision, rectum was separated from the vagina & then rectum was pulled through the center of these muscles. The perineal body was reconstructed and the normal appearance of perineum was achieved. Results: Short-term surgical outcome was satisfactory in all cases. No one needed colostomy. Conclusion: Single-stage ASARP is a good approach in experience hands for ARM with vestibular fistula and perineal ectopic anus in females and thereby complications and time involved in staged procedures including colostomy can be avoided.

Effects of estradiol-17beta and 17alpha, 20beta-dihydroxy-4-pregnen-3-one on different phospholipids metabolism and histological changes in ovary during reproductive growth in the catfish, Heteropneustes fossilis (Bloch).

Effect of cumulative doses of estradiol -17beta (E2-7, 14 and 28 mg/kg body weight) and 17alpha, 20beta-dihydroxy-4-pregnen-3-one (17alpha,20betaP-7, 14 and 28 mg/kg body weight) on total phospholipids (TP) and various phospholipids- phosphatidylcholine (PC), phosphatidylserine (PS), phosphatidylinositol (PI) and phosphatidylethanolamine (PE) on liver plasma and ovary were investigated during the reproductively active preparatory and prespawning phases of the annual reproductive cycle in the freshwater female catfish, H. fossilis. The effect of E2 on TP was generally stimulatory and has pronounced effect than 17alpha,20betaP during both the phases. The levels of PC was promoted high during prespawning phase by E2 comparatively very less than by 17alpha, 20betaP in studied tissues during both the phases. The levels of PS after E2 treatments was maximum in all tissues during prespawning phase whereas 17alpha,20betaP was effective only in liver during this phase. The PI was elevated in liver during preparatory phase but its elevation was in all studied tissues during prespawning phase after E2 treatments. The levels of PI was most effective in ovary during preparatory phase in response to 17alpha,20betaP. The levels of PE was declined in liver but elevated in ovary after E2 treatments during both the phases. Treatments of E2 during preparatory phase showed greater number of vitellogenic oocytes as compared to 17alpha,20betaP treatments. The present finding has demonstrated that estradiol-17beta has more pronounced effects than the 17alpha,20beta P in regulation of different phospholipids and ovarian recrudescence during reproductively active phases and among the phospholipids the PC is the main phospholipids of vitellogenin/ovarian lipids in H. fossilis.

Dorsal onlay buccal mucosal graft urethroplasty in long anterior urethral stricture

OBJECTIVE: To assess the success of buccal mucosal graft (BMG) urethroplasty by the dorsal onlay technique in long anterior urethral stricture (> 2 cm long) through the midline perineal incision. MATERIALS AND METHODS: From January 1998 to December 2003, 43 patients with long anterior urethral strictures were managed by dorsal onlay BMG urethroplasty. After voiding trial, they were followed up at 3 months with uroflowmetry, retrograde urethrogram (RGU) and American Urological Association symptoms score (AUA symptoms scores). Successful outcome was defined as normal voiding with a maximum one attempt of VIU after catheter removal. Patients were further followed-up with uroflowmetry at 3 months interval and RGU every 6 months interval. RESULTS: Mean stricture length was 4.8 cm (range 3 to 9 cm) and mean follow up was 48 months (range 12 to 84 months). Only five patients were found to develop stricture at anastomotic site, during follow-up. Two of them voided normally after single attempt of VIU. Other three patients (6.9 percent) required further open surgery or repeat VIU during follow up and were considered as failure. CONCLUSION: Dorsal onlay BMG urethroplasty is a simple technique with good surgical outcome.

Fine needle aspiration cytology in the diagnosis of prostatic enlargements.

One hundred patients with enlarged prostate were subjected to fine needle aspiration cytology and histopathologic examination of prostate. The results have been found encouraging. The cytodiagnostic accuracy rate was 99 p.c. in identification of benign or malignant nature of the lesions and 94 p.c. in cytologic specific diagnosis (exactly similar to histopathologic diagnosis). The technique was simple, rapid, economical, reliable, easy to repeat and highly suitable for outpatients. The procedure can routinely be adopted in places where facilities for preparation of paraffin section do not exist or when quick diagnosis is required.