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 management of children with non-palpable testis

To show the advantages and limitations of laparoscopy in management of the non-palpable testis. Herein, we report our experience with diagnostic and interventional laparoscopic procedures in children with non-palpable testes. Between 1997 and 2001, 28 children underwent 30 laparoscopic procedures for evaluation and management of 36 non-palpable testes. Pneumoperitoneum was achieved using a Veress needle inserted infraumbilically in all cases. Examination of the abdomen and pelvis was performed with a 30°, 5 mm laparoscope. When intervention was deemed necessary, 2 to 3 additional 5 mm ports were inserted under direct visual control. For dissection, laparoscopic microscissors and electrosurgical dissection were used. The mean patient age was 3.6 years [12 months -14 years]. A total of 12 diagnostic procedures [localization] were performed on 12 patients and 15 inguinal exposures were done based on the laparoscopic findings [14 orchiopexy and 1 orchiectorny]. Tlie testes were absent in six more patients and farther surgery avoided. Twelve laparoscopic interventions were done on 10 patients: 9, one stage laparoscopically assisted orchiopexy, 1, two-staged orchiopexies, 1, laparoscopic Fowler-Stephen orchiopexy and, laparoscopic orchiectcmy. All procedures were performed on outpatient basis or with an overnight stay. There were 4 complications: injury of the spermatic vessels which did not affect the viability of the testis in one instance, two testes had atrophied at 4 weeks and 6 weeks follow-up, and one testis had retracted to the level of the pubic tubercle at 9 months. Laparoscopy is a useful tool in the management of the non-palpable testes. For an intracanalicular testis, an inguinal orchiopexy is recommended. For intra-abdominal testes, a laparoscopic orchiopexy is the technique of choice at our institution