Surgical management of constrictive penile tie with urethrocutaneous and corporeal mutilation

Due to interference of non-medical personal in circumcision as well as abarrent psychosexual behavior complications in the form of constrictive penile tie with urethrocutaneous slough and variable degrees of corporeal wasting and mutilation was encountered. Since 1990-1997, 18 patients with such a condition has been surgically corrected. 14 patients presented as postcircumcision complication by traditional circumcisers while 4 patients had altered psychosexual behavior with self-induced genital mutilation. All patients had urethrocutaneous sloughing and corporeal wasting ranging from minor to severe. Seven patients had severe corporeal wasting in such a way that the distal penile segment and glans was hanging by a very narrowstrip of tissues. End to end urethral anastomosis and skin refashioning was done to all patients. Patients with severe degree of corporeal wasting were subjected to trimming and reaproximation of the corporeal bodies. Two patients developed stricture at site of anastomosis managed by endoscopic urethrotomy, one patient developed fistula that required repair and one patient had mild ventral skin chordee that required no intervention. All our patient had achieved satisfactory functional and cosmetic results

Use of sigmoid colon for vaginal reconstruction in patients with vaginal aplasia

There is a wide range of congenital abnormalities, the most severe is vaginal aplasia. Reconstruction of the vagina using part of the bowel is a well-established technique. In this study, vagina was reconstructed using 10-15 cm of the sigmoid colon. 14 patients with absent vagina were operated upon for vaginal reconstruction using 10-15 cm of the sigmoid colon. Six patients were genetically normal females with an absent vagina syndrome. In one patient, there was an associated vesico-vaginal fistula after an attempt of vaginal augmentation. In this group of patients, only vaginal reconstruction was performed. 8 patients were male pseudohermaphrodite who were brought up as females and had inadequate penis [phallus]. In this group, total female genital reconstruction is performed including reduction phalloplasty, labioplasty and colonic vaginal reconstruction. There had been no operative morbidity. In all patients, it was easy isolating a sigmoid segment for vaginal reconstruction. We could achieve excellent functional and cosmetic results in ten patients. In three patients marked stenosis at the anastomotic site occurred necessitating V-Y plasty in two patients and simple dilation under GA in one. One case developed total occlusion of the neovaginal opening and presented with acute abdomen due to rupture of the colonic vagina from accumulated mucous. Four patients got married and have successful sexual intercourse. Vaginal replacement with sigmoid colon is an easy and successful procedure. It gives much better functional results than using skin for reconstruction. These patients need regular manual dilation until they are engaged in sexual relation

Intracorporeal injection in impotent men: a double blind study using prostaglandin E[1] alone versus papaverine-prostaglandin E[1] injection therapy

A study comparing intra corporeal injection of prostaglandin E[1] [one drug solution] and papaverine plus prostaglandin E[1] [2 drug solution] for treatment of impotence. A total of 100 impotent patients with a median age of 54 years had intracorporeal injections of the one drug and 2-drug solution alternatively during 3 sessions, with the quality and duration of erections assessed in a randomized study using the rigiscan. 75% of patients developed a full erection with the 2-drug solution compared to 50% with the one-drug solution. The average duration of erections was 60 minutes and 45 minutes respectively. The complication rate was higher for the 2-drug solution. Papaverine plus prostaglandin E[1] is superior to prostaglandin E alone for treatment of impotence, but with a higher rate of complications. Intracavernous injection of vaso-active drugs is a very superior and important way for the treatment of impotence. Papaverine, prostaglandin E[1] had been used for treatment of importance alone or combined. A blind study was done to compare efficiency and complication rate of intracavernous injection of papaverine-prostaglandin E[1] [2 drug solution] with prostaglandin E[1] [alone]

Lithoclast disintegration versus cystolitholapaxy in management of vesical calculi

This study was conducted on 50 patients with vesical stones. We report our early experience with the Swiss lithoclast; a new simply constructed machine for endoscopic stone disintegration which uses compressed air [pneumatic lithotripsy]. The lithoclast was used to treat 25 patients of different ages having bladder calculi of variable sizes [10 through transurethral approach in adults and 15 through percutaneous suprapubic approach in children and adults]. Another 25 patients with bladder stones were subjected to mechanical disintegration with the visual lithotrite. Vesical stones in both groups were more than 1.5 cm in diameter. Immediate and prolonged follow up of the patients for 6-12 months was done to compare between the results of the two modalities. The Swiss lithoclast managed to crush all bladder stones successfully independent of their composition in short time without any bladder perforation, but only mucosal abrasions and echymosis in 2 cases. 1 patient developed urethral stricture. The visual lithotrite failed to crush 2 calculi, intraperitoneal perforation occurred in 1 patient and 3 patients developed urethral strictures. The Swiss lithoclast represents an attractive alternative to the other lithotriptors, due to its safety efficacy in treatment of all compositions of stories in short time with minimal complications and the feasibility of antegrade suprapubic lithotripsy in children and in adults with, secondary vesical stones

Value of ureteric visualization in management of patients with hydrouretero nephrosis

The surgical management of hydro-ureteronephrosis depends on many factors including the site and aetiology of obstruction as well as residual kidney function in a retrospection study of 80 cases of hydro-ureteronephrosis due to obstruction, simple strictures were found in 26 cases, stones in 50 cases and ureteral tumours in 4 patients. The value of visualizing the ureter in patients with poor kidney function or non-functioning kidneys is of utmost importance for proper management in these patients especially if the cause of obstruction is due to malignant aetiology