Outcome of urethro cutaneous fistula repair

To evaluate the outcome of urethro cutaneous fistula repair. This was a prospective study conducted in department of urology Jinnah Postgraduate Medical Centre [JPMC], Karachi. Seventeen cases with urethrocutaneous fistulas were enrolled in this study. In 12 [75%] we did the simple repair and second layer with dartos, in 03 [16.7%] OIU and silicone catheterization was done, but they recurred then repair with tunica vaginalis cover was performed and 02 [8.3%] patient underwent OIU plus simple repair with dartos. The mean age was 25.58 +/- 6.2 years, in 11 post hypospadiasis was the cause of urethrocutaneous fistula. Recurrence was observed in four patients. Two patients after post hypospadias repair; one after stricture peno-scrotal and one after post infection, boil at base of penis had recurrence. Two patients with simple repair and 2[nd] layer with dartos had recurrence, two patients treated with OIU had recurrence and after that repair with tunica vaginalis cover was performed with no recurrence and none of the patients treated with OIU plus simple repair with dartos had recurrence. Circumferential incision around the fistula opening, tension free closure with fine PDS suture is the key for successful treatment of urethral fistula

Fournier's gangrene and its management

To find out major causes of Fournier's gangrene and evaluate its management. A retrospective study was done at Department of Urology JPMC, Karachi, and records of all 32 patients with Fournier's Gangrene over 4 years' period i.e. from December 2001 till 2005 were reviewed. Mean age was 48 years, all being male. All presented with an average delay of 2-10 days. Involvement was typical, with 70% extending to lower abdominal wall, and 10% to perianal region. 37.5% presented with septic shock. Cause being urological in most of the cases [78.13%], followed by anorectal in 6.2% and idiopathic in 15.6%. Associated diseases were diabetes mellitus in 37.5%, uraemia in 12.5% and hepatic failure in 6.25%. 25% patients died due to multiorgan failure in our study. Aggressive surgical debridment with supportive measures remained the key to success