Skin bridge a new operation for coronal urethrocutaneous fistula [Al Gyoushy operation]

To evaluate our novel reconstructive technique to solve the problems of coronal and juxta-coronal penile fistula. Eleven patients 5 to 22 years old [mean age 14 years] underwent one stage skin bridge operation for repair of coronal urethrocutaneous fistula of different etiologies between 1998 and 2002.The size of fistula ranged from 4 to 20 mm in maximum diameter. Result of follow up revealed that nine of 11 patients [82%] had complete healing with good urine stream. One patient developed small fistula and was treated by simple closure while another patient failed due to graft infection. One stage Skin bridge operation is a highly successful option for repairing coronal urethrocutaneous fistulae even recurrent ones, whatever their etiology and size

Diagnostic and therapeutic applications of ureteroscopy in upper urinary tract filling defects

To evaluate diagnostic and therapeutic uses of ureteroscopy [URS] in upper urinary tract filling defects. Fourty patients with upper urinary tract filling defects underwent Ureterorenoscopy [URS], their age ranged from 38 to 83 years [Mean 68 yrs]. Clinical presentation included: gross hematuria [20 cases], flank pain [13 cases], microscopic hematuria [5 case], and fever [2 cases]. Radiological studies [intravenous urography and/or retrograde urography], revealed filling defects in the renal pelvis [4 cases], upper ureter [16 cases], middle ureter [one cases], and lower ureter [19 cases]. Introduction of ureteroscopy was done without preliminary ureteral dilation in 60% of the cases. The procedure was completed in 38 cases and aborted in 2 cases because of inability to engage the ureter [one case], and perforation with extravasations [one case]. Diagnosis was established by direct endoscopic visualization in 26.3% of patients while 57.9% of patient's required additional biopsy. These procedures revealed that 34.2% of patients had malignant urothelial tumors, 18.4% had radiolucent stones. Benign ureteral polyps were found in 10.5% of patients, ureteritrs cystica in 7.9%, blood clots in 7.9% and papillary necrosis in 5.3% of patients. No abnormalities were detected in 6 patients [15.8%] by URS, further angiography's identified vascular anomaly in only one patient. In conclusion, URS proved to be of value in dealing with upper urinary tract filling defects. This procedure, whenever the lesion is accessible, can add in diagnosis and treatment of the underlying lesion causing a pelvic or ureteric filling defect. URS can disclose the nature of these lesions, and extensive surgery can be avoided