Urethroplasty for long anterior urethral strictures report of long term results

We reviewed the long-term outcome of substitution urethroplasty with skin flaps for anterior urethral strictures, comparing 1-stage with 2-stage repairs. A total of 45 patients with urethral strictures, 2.5 cm or longer, had undergone skin flap urethroplasty. A 1-stage surgical operation had been done in 10 patients [Orandi and bilateral pedicle island of penile skin] and a 2-stage surgical repair had been performed in 35 using the Johanson technique. They were followed up by retrograde urethrography for 1 to 10 years. The mean age of the patients was 46.3 +/- 17.1 years. Etiology of the stricture was instrumentation in 33.3% of the patients, urethritis in 28.9%, trauma in 13.3%, and unknown in 24.5%. At the first postoperative year, the success rate was 75.6%. This rate was 71.4% and 90% for the 1-stage and 2-stage operations, respectively [P = .23]. There were 1 [10%] and 10 [28.6%] cases of recurrent structure and 1 [10%] and 3 [8.6%] cases of fistula in the patients with the 1-stage and 2-stage operations within the first year, respectively. During the 5 postoperative years, 70% of the patients with the 1-stage repair, 57.1% with the 2-stage repair, and 60% in total had no complications. Based on the previous studies and our experience, we recommend skin flap urethroplasty. However, some measures such as proper tailoring of the flap and the extension of the incision onto the intact segments should be considered for achieving a better outcome

Comparison of snodgrass and mathieu surgical techniques in anterior distal shaft hypospadias repair

To compare the outcomes of Mathieu and Snodgrass techniques in the repair of anterior distal shaft hypospadias. From 2001 to 2003, 33 patients with the mean age of 7.06 +/- 3.44 [range 2 to 12] years suffering from anterior distal shaft hypospadias, were assessed. Inclusion criteria were anterior distal shaft hypospadias, and exclusion criteria were association with chordee, circumcision, and surgical repair history. Fifteen patients underwent surgical repair using Snodgrass technique and 18 patients, using Mathieu technique. Surgeries were performed by one single surgeon, acquainted with both techniques. Patients were examined 1 week, 1 month, and 6 months after discharge. Data including duration of the surgery, stenting time, duration of hospitalization, and any kind of complications such as break down, meatal stenosis, and fistula formation were collected. Also, success rate was calculated for every single patient and accordingly, the two groups were compared. Mean operative time, stenting duration, and hospital stay were 94 +/- 26.06 minutes, 5.06 +/- 1.31 days, and 3.93 +/- 1.86 days in Mathieu group and 106.11 +/- 23.04 minutes, 5.11 +/- 1.56 days, and 4.55 +/- 1.29 days in Snodgrass group, respectively [P >0.05]. The rate of break down, meatal stenosis, and fistula formation were 0%, 0%, and 5.55% in Mathieu group and 0%, 6.66%, and 13.32% in Snodgrass group, respectively [P >0.05]. Success rate was 80.02% in Snodgrass group and 94.45% in Mathieu group [P >0.05]. In spite of some reports about preference for Snodgrass technique, we concluded that these techniques are as acceptable and as effective as each other for hypospodias repairing, regardless of cosmetic outcomes; however, we need further studies and larger sample sizes to determine which is the superior technique

Effect of antibiotic therapy on asymptomatic bacteriuria in kidney transplant recipients

Asymptomatic bacteriuria is a very common complication after kidney transplantation and the need for antibiotic therapy is controversial. The aim of this study was to evaluate the effect of antibiotic therapy on the clinical course of asymptomatic bacteriuria in renal transplant recipients. In the present study, 88 kidney transplant recipients with asymptomatic bacteriuria were divided into two groups of cases and controls. The patients had been selected from among those with at least 1 year follow-up. In the case group, asymptomatic bacteriuric episodes were treated with antibiotics, and in control group, they were followed without antibiotic therapy. The follow-up period was 9 to 12 months. Bacteriuric episodes, symptomatic urinary tract infection [UTI] episodes, and changes in plasma creatinine level were recorded and compared between the two groups. The rate of bacteriuric episodes and symptomatic UTIs were not significantly different between the two groups [P >0.05]. In addition, level of plasma creatinine did not increase significantly in neither of the groups during the study [P >0.05]. It seems that treatment of asymptomatic bacteriuria in kidney recipients does not decrease the rate of UTI episodes afterwards. Asymptomatic bacteriuria does not affect renal function in short term. Thus, we can abandon antibiotic therapy, subject to careful follow-up