Does urge incontinence contraindicates surgery for stress urinary incontinence?

Urge incontinence is commonly associated with female stress urinary incontinence [SUI]. Many surgeons hesitate to operate for SUI if associated with urgency. Our aim is to define whether urge incontinence contraindicates surgery for SUI or not. This study was conducted on 35 female patients complaining of mixed incontinence [Urge and stress]. Patients with uninhibited detrusor contractions in cystometrogram [CMG] excluded from the study. All patients underwent preoperative assessment by history, physical examination, oblique cystogram, urodynamics [CMG, flowmetry and Valsalva leak point pressure [VLPP]] and cystoscopy. All patients were managed with fascial patch sling either from anterior rectus sheath or fascia lata [in patients with previous suprapubic incision or scarring]. All patients were followed up for one year with the same preoperative parameters. SUI was cured in 34 patients [97.1%] while urge incontinence was cured in 25 patients [71.4%] and persisted in 10 patients [28.6%]. In conclusion, patients complaining of mixed incontinence with urodynamically proved signs of urethral relaxation, as the main component of urge incontinence, will benefit significantly from surgery of SUI

Pubo-scrotal incision for repair of penile fractures

Fracture penis is a urologic emergency, which should be managed with prompt exploration and repair of the tunical tear. In this study we have evaluated a puboscrotal incision for the repair of penile fractures. Between Feb. 1995 till Dec. 2000, 42 cases of fracture penis were operated upon for repair using a puboscrotal incision. Patients presented at the emergency room and outpatient clinic of our department Full history, clinical examination and preoperative cavernosogram were done to all the patients to delineate the sites of Tunical tear. If urethral injury was suspected urethrography was performed. All cases included in this study presented to our department within 3-72 hours from injury. Their ages ranged from 18 to 44 years [mean 27.5 +/- 6.95 years]. Urethral injury was found in 5 cases [12%]. The follow-up of cases ranged from 12 to 34 months [average was 18 months]. The puboscrotal incision gave almost no complications in 30 cases [62.5%] and complications when happened were minimal and self-limiting. They included wound infection in one case [2.4%], residual fibrotic area in 3 cases [7.1%] minimal penile curvature in 2 cases [4.8%], painful erection during coitus in one case [2.4%], hematoma formation [small] in 2 cases [4.8%] and finally weak erection that resolved after 3 months postoperative in one case [2.4%]. In conclusion the puboscrotal incision is a good exposure of the penis with satisfactory repair of penile fractures and concomitant urethral injury. It avoids incision into markedly edematous penile skin