Outcome of fistula repair after hypospadias surgery

To evaluate the outcome of urethrocutaneous fistula [UCF] repair after hypospadias surgery and to determine the role of the fistula characteristics on the outcome of repair. One hundred twenty patients with a mean age of 7.6 [range 2.5-20] years underwent repair of UCF after hypospadias surgery at Sohag University Hospital, Sohag, Egypt between April 1995 and April 2006. The fistulas were small [< 2 mm] in 55 cases and large [> 2 mm] in 65 cases. They were coronal in 20, distal penile in 40, mid-penile in 30 and posterior penile in 30 cases. The interval between primary hypospadias repair and the first attempt at fistula repair was 6-9 months. Small fistulas were repaired using multiple-layer simple closure. Large coronal fistulas were changed into complete hypospadias, then managed by re-do tubularised incised plate [TIP] repair with or without incised plate and covered by dartos flap. Small coronal fistulas were covered with a "trap-door" flap. Large penile fistulas were repaired using a rotational skin flap. Recurrent fistulas after repair were covered either with a dartos fascia flap or a tunica vaginalis flap. The parameters studied included the size, site and number of fistulas, the type of repair and whether it was a primary on secondary repair. The Pearson chi-squane test and Fisher's exact test were used for statistical analysis with p<0.05 considered statistically significant. The overall success rate of repair was 70% [84/120 cases]. The relationship between the success of repair and the site, size, number of fistulas and primary and secondary correction was not statistically significant. Recurrent fistulas occurred in 30% [36/120] of the cases. Their repair using a tunica vaginalis flap yielded a success rate of 100% [12/12 cases] compared to a success rate of 54.2% [13/24 cases] achieved with the dartos fascia flap [P<0.05]. Recurrent fistulas after dartos fascia flap were treated by tunica vaginalis flap with a success rate of 100%. The size and number of fistulas as well as the number of operations seemed to have no effect on the success rate. Therefore, choosing the right technique for repair is the most important factor for success

Long-term outcome of orthotopic neobladder reconstruction after radical cystectomy - Sohag experience

To assess the long-term outcome of neobladder reconstruction after radical cystectomy. In this retrospective study we evaluated the records of 90 patients [70 males and 20 females] subjected to radical cystectomy and orthotopic neobladder reconstruction at Sohag University Hospital, Sohag, Egypt, between January 1999 and January 2006. The age of the patients ranged from 35 to 70 years with a median age of 42 years. All patients had invasive bladder carcinoma; squamous cell carcinoma in 55, transitional cell carcinoma in 33 and adenocarcinoma in 2 patients. Thirty-five patients had a W-neobaldder with serous-lined extramural ureteral reimplantation, 35 patients had Studer pouch and 20 patients had colonic [sigmoid] neobladder reconstruction. After surgery all patients were followed up for a period of 6 to 84 months [median 45 months] in order to evaluate the functional and oncological outcome. Thirty [33.3%] patients developed early complications [defined as within 30 days from surgery]. Chest infection and wound infection occurred in 3 [3.3%] and 5 [5.6%] and 5 [5.6%] patients, respectively, and was treated with antibiotics. Eight patients developed paralytic ileus which was managed with naso-gastric tube drainage. Re-operation was required in 8 patients; 3 required re-suturing of the abdominal incision, bleeding occurred in 2, while 2 developed intestinal obstruction and one ureteriointestinal leakage. Pouch leakage was observed in 6 patients. Late complications occurred in 18 [20%] patients. Re-operation was necessary in 15 cases: 4 with stone formation in the neobladder, 3 with incisional hernia, 5 with a stricture at the ureterovesical junction, one with vesicourethral stricture and 2 with vesicovaginal fistula. Complete continence during day and night was achieved in 63 patients [70%]. The daytime continence rate was 86.6% [87 patients], while 24 patients [26.7%] had nocturnal incontinence and 3 patients [3.3%] were fully incontinent. Four patients [4.4%] used clean intermittent self-catheterization. Twenty-seven [30%] patients developed recurrence of cancer within 4 to 30 months from surgery, among them 3 with urethral recurrence, 20 with local pelvic recurrence and 4 with distant metastases. All patients died from causes not related to the operation. Orthotopic neobladder reconstruction provides acceptable continence rates and has an acceptable early and late complication rate. We therefore recommend that all suitable patients undergoing cystectomy should have an option of orthotopic neobladder reconstruction

Long- term outcome of orthotopic neoblader reconstruction after radical cystectomy

To assess the long- term outcome of neobladder reconstruction after radical cystectomy. In this retrospective study we evaluated the records of 90 patients [70 males and 20 females] subjected to radical cystectomy and orthotopic neobladder reconstruction at Sohag University Hospital, Sohag, Egypt, between January 1999 and January 2006. The age of the patients ranged from 35 to70 years with a median age of 42 years. All patients had invasive bladder carcinoma: squamous cell carcinoma was found in 55, transitional cell carcinoma in 33 and adenocarcinoma in 2 patients. Thirty-five patients had a W-neobladder with serous-lined extramural ureteral reimplantation, 35 patients had Studer pouch and 20 patients had colonic [sigmoid] neobladder reconstruction. After surgery all patients were followed up for a period of between 6 and 84 months [median 45 months] in order to evaluate the functional and oncological outcome. Thirty [33.3%] patients developed complications within 30 days from surgery, defined as early complications. Chest infection and wound infection which was found in 3 [3.3%] and 5 [5.6%] patients, respectively, was treated with antibiotics. Eight patients developed paralytic ileus which was managed with NGT. Re-operation was required in 8 patients: 3 of them required re-suturing of the abdominal incision, bleeding occurred in 2 cases, while 2 cases developed intestinal obstruction and one patient ureterointestinal leakage. Pouch leakage was observed in 6 patients. Late complications occurred in 18 [20%] patients. Re-operation was necessary in 15 cases: 4 cases with stone formation in the neobladder, 3 cases with incisional hernia, 5 cases with a stricture at the ureterovesical junction, one case with vesicourethral stricture and 2 cases of vesicovaginal fistula. Complete continence during day and night was achieved in 63 [70%] patients, while 24 patients [26.7%] had nocturnal incontinence and 3 patients [3.4%] were fully incontinent. The daytime continence rate was 86.6% [87 patients] with 4 patients [4.4%] using clean self-intermittent catheterization. Twenty-seven [30%] patients developed recurrence of cancer within 4 to 30 months from surgery, among them 3 with urethral recurrence, 20 with local pelvic recurrence and 4 with distant metastases. Orthotopic neobladder reconstruction provides excellent continence rates and has an acceptable early and late complication rate. Therefore we recommend neobladder reconstruction for all patients undergoing cystectomy