Bulbar substitution urethroplasty by use of tubularized ventral and dorsal onlay buccal mucosal grafts

We report our experience and evaluation of the outcome in men undergoing bulbar urethral reconstruction with tubulanzed neourethra from ventrally and dorsally situated buccal mucosal onlay grafts. Twelve patients with urethral stricture underwent substitution bulbar urethroplasty with buccal mucosal grafts. Preoperative evaluation was performed with complete urine analysis with culture and sensitivity tests, uroflow, retrograde and voiding cystourethrogram and urethral sonography. Complete excision of the stricture area was performed with preservation of the healthy corpus spongiosum intact as a separate vascular layer. Harvesting of 2 buccal mucosal grafts was done from cheek. The 1[st] graft was fixed dorsally onto the corporeal bodies. The 2[nd] graft was fixed ventrally to the undersurface of corpus spongiosum. Fashioning of the grafts was performed as a tube over a 14 Fr catheter. Three months after catheter removal; urinary flow rate, AUA symptom scores and retrograde urethrogram were performed. The average age of our patients was 33.5 years. Average follow up was 12 months. Of strictures, 2 patients [16.7%] were idiopathic in origin, 4 [33.3%] were traumatic, 4 [33.3%] were infectious and 2 [16.7%] were iatrogemc. The average stricture length was 3 cms. The average operative time was 165 mm. The average estimated blood loss was 214 ml. Hospital stay averaged 3.2 days. Peak unnary flow rates improved from an average of 7.9ml/second to 30.4 ml/second [p < 0.001]. AUA symptom scores decreased from an average of 20.5 preoperatively to 43 postoperatively [p < 0.001]. There were 2 early postoperative complications, 1 had a postoperative febrile UTIs and another patient had prolonged penurethral leakage which heal spontaneously. The overall success rate was 91.7%. Three to 6 months after surgery, RGUG demonstrated small non symptomatic ventral sacculation in one patient and narrowing in another patient which required endoscopic incision. The creation of neourethra from modulation of ventrally and dorsally situated onlay buccal mucosal grafts after complete excision of strictured urethra is a new added reasonable and reconstructive option for management of long bulbar urethral strictures [>2cm.]. However, more efforts, researches and extended follow up are necessary to establish and explain the hidden secretes of improving the outcome of substitution urethroplasty with buccal mucosal grafts

Laparoscopic nephropexy for symptomatic nephroptosis: initial experience

To evaluate the efficacy of laparoscopic nephropexy as a minimally invasive procedure for treatment of cases with symptomatic nephroptosis. We have performed laparoscopic right nephropexy in 6 patients presenting with symptomatic nephroptosis documented by radiographic studies [IVU] and/or renal scans. Exposure of the kidney was achieved via a transperitoneal laparoscopic approach. For kidney fixation, the upper most part of the lateral border of the kidney was sutured to the overlying fascia of the quadratus lumborum muscle using ah intracorporeal suturing technique. In addition, the mid-portion of the renal capsule was sutured to the back muscle and its covering fascia using two or three running sutures thereby, creating a vertical and horizontal means of fixation. Laparoscopic right nephropexy was successfully accomplished in all 6 patients. The average operative time was 4 hours. All patients resumed oral intake during the first postoperative day; the average amount of parenteral analgesia required postoperatively was 42.7 mg of morphine sulphate or its equivelant. Hospital stay averaged 2.5 days; return to usual activities occurred on average at 2.5 weeks postoperatively. Postoperative imaging studies confirmed reduction or elimination of nephroptosis in all patients; all patients have remained asymptomatic during an average follow-up of 19 months [range: 3 to 33 months]. Laparoscopic nephropexy appears to be a feasible minimally invasive treatment option for patients with symptomatic, documented nephroptosis. It can be safely and effectively accomplished with satisfactory anatomical and clinical results

Laparoscopic nephropexy: initial experience

To evaluate the efficacy of laparoscopic nephropexy as a minimally invasive procedure for treatment of cases with symptomatic nephroptosis. We have performed laparoscopic right nephropexy in 6 patients presenting with symptomatic nephroptosis documented by radiographic studies [IW] and/or renal scans. Exposure of the kidney was achieved via a transperitoneal laparoscopic approach. For kidney fixation, the lateral border of the kidney was sutured to the overlying fascia of the quadratus lumborum muscle using an intracorporeal suturing technique; additionally, the anterior mid-portion of the renal capsule was sutured to the back muscle and its covering fascia using running sutures thereby, creating a vertical and horizontal means of fixation. Laparoscopic right nephropexy was successful accomplished in all 6 patients. The average operative time was 4 hours. All patients resumed oral intake during the first postoperative day; the average amount of parenteral analgesia required postoperatively was 42.7 mg of morphine sulphate or its equivelant. Hospital stay averaged 2.5 days; return to usual activities occurred on average at 2.5 weeks postoperatively. Postoperative imaging studies confirmed reduction or elimination of nephroptosis in all patients; all patients have remained asymptomatic during an average follow-up of 11 months [range: 3 to 24 months]. Laparoscopic nephropexy appears to be a feasible minimally invasive treatment option for patients with symptomatic, documented nephroptosis. It can be safely and effectively accomplished with satisfactory anatomical and clinical results