Tricholithobezoar: An Unusual Late Complication of Neourethral Reconstruction in Aphallia

An 18-year-old man born with aphallia had undergone phallic reconstruction in childhood followed by total urethral reconstruction with a buccal mucosal graft and groin-based pedicle (Singapore) flap urethroplasty at 13 years of age. The patient presented with obstructive voiding symptoms lasting 6 months followed by acute urinary retention. The results of a voiding cystourethrogram showed a filling defect in the distal urethra that had been reconstructed by use of the skin flap. On urethroscopy, a 3 cmx2 cm sized tricholithobezoar was seen in the distal urethra. Pneumatic lithotripsy followed by bulbar urethrolithotomy was performed in the same operation to extract the bezoar. The remaining hairs were mechanically epilated. The patient has been doing well for 6 months of follow-up.

Leiomyosarcoma, a Nonurothelial Bladder Tumor: A Rare Entity With Therapeutic Diversity

A 22-year-old young woman presented with dysuria and lower urinary tract symptoms that had persisted for 6 months. She was diagnosed with a tumor near the bladder neck. Transurethral resection was done under anaesthesia. The histopathological examination with immunohistochemical staining showed the tumor to be a low-grade leiomyosarcoma. Adjuvant chemoradiation was given, and the patient has been doing well for 12 months of follow-up. Nonurothelial tumors of the bladder are rare and consensus is lacking regarding their definitive treatment. Furthermore, little is known about the natural history and prognosis of this type of bladder sarcoma. We present a minimally invasive treatment for this relatively rare tumor in which bladder preservation was achieved with no evidence of local or distant recurrences during the follow-up to date.

Leiomyosarcoma, a Nonurothelial Bladder Tumor: A Rare Entity With Therapeutic Diversity

A 22-year-old young woman presented with dysuria and lower urinary tract symptoms that had persisted for 6 months. She was diagnosed with a tumor near the bladder neck. Transurethral resection was done under anaesthesia. The histopathological examination with immunohistochemical staining showed the tumor to be a low-grade leiomyosarcoma. Adjuvant chemoradiation was given, and the patient has been doing well for 12 months of follow-up. Nonurothelial tumors of the bladder are rare and consensus is lacking regarding their definitive treatment. Furthermore, little is known about the natural history and prognosis of this type of bladder sarcoma. We present a minimally invasive treatment for this relatively rare tumor in which bladder preservation was achieved with no evidence of local or distant recurrences during the follow-up to date.

Ventral bulbar augmentation. a new technical modification of oral mucosa graft urethroplasty for stricture of the proximal bulbar urethra

Complication rates with ventral onlay technique of oral mucosa graft urethroplasty have been attributed to the poor ventral support for the graft. We herein describe a new technique which overcomes these problems and also discuss the short-term follow-up. In a prospective study conducted between January 2006 and June 2008, 13 patients with proximal stricture of the bulbar urethra underwent ventral bulbar augmentation. In this technique, the graft was sutured only to the bulbar urethra and the rest of spongiosal tissue was closed superficially. Longitudinal incisions were given in the partial depth of the bulb, adjacent to the suture line and were sutured together over the first suture line. The mean follow-up period was 16.4 months [range, 6 to 30 months]. Two of the patients developed restricture; one at the proximal anastomosis of the graft with native urethra and one at the distal anastomosis. Remaining 11 patients have satisfactory postoperative uroflow rates and are doing well. The success rate at the last follow-up was 84.6%. This technique exploits the local bulbar anatomy by successfully moving the lateral bulbar tissue medially, below the ventrally placed mucosal graft. This results in a thicker ventral bulbar platform which provides enhanced support to the graft

Andropause in Indian men: a preliminary cross-sectional study

The purpose of this study was to determine the frequency of androgen decline in the aging male [ADAM] in a group of Indian men working in the health sector. A free medical health checkup camp was organized for the male workers aged between 40 and 60 years employed in surgical departments of our hospital. Of 180 listed male workers, 170 attended this camp 157 eligible men participated in the study. After clinical history and systemic inquiry, the participants were requested to complete the Saint Louis University's ADAM questionnaire, and their serum levels of free and total testosterone were measured. Symptomatic andropause was found in 106 men [67.5%] on the basis of their responses to the questionnaire, of whom 41 [38.7%] had low serum free testosterone levels and 32 [30.2%] had low serum levels of total testosterone. Fifty-one men were asymptomatic according to the questionnaire and in this group, 11 [21.6%] had low serum free testosterone levels and 6 [11.8%] of these had low total testosterone levels. The frequency of andropause was 33.1% on the basis of low serum free testosterone levels and it was 26.1% when both symptoms and low serum free testosterone levels were taken into account. In our study, the high frequency of symptoms related to ADAM was unusual. This might be due to the nature of the questionnaire itself. Serum free testosterone measurement may be a better single test for diagnosis of hypogonadism than serum total testosterone measurement