Penile autotransplantation in rats: an animal model

Penile allotransplantation might be a viable option for patients who need penile reconstruction. A successful autotransplantation rat model is the first step toward proceeding for allotransplantation. We here in evaluate autotransplantation following transaction of the rat penis just distal to the urethral bulb. Experimental animal study. Five Sprague-Dawely rats weighing 520 g [SD 19] were used. Utilizing a magnification of 6-40, transection and immediate anastomosis of the tunica albuginea, urethra, dorsal vein and nerves were carried out. Vesicostomy was made to divert urine. The glandular skin was sutured to the perineum and the abdominal wall was closed in layers. Descriptive statistics. Average surgery time was 8 h. The first two rats had no vesicostomy and died in the first postoperative day from retention. Three rats tolerated well the procedure and survived to the end point. One rat was sacrificed at day 10 and histopathology showed 30-50% necrosis of the implanted penis. Another rat was sacrificed at day 20 and showed normal cavernous tissue. The fifth rat was sacrificed 3 months postoperatively and showed evidence of moderate corporal fibrosis. Urethral fistula and necrosis of corpus spongiosum, dorsal nerve necrosis and dorsal vein occurred in all animals. Penile autotransplantation in rats is feasible and provides the basis for evaluation of the corpora cavernosa in an allotransplantation model. Long-term urethral continuity and dorsal neurovascular bundle survival in this model is difficult to establish

Long term outcome of genital reconstruction of middle eastern women with congenital adrenal hyperplasia

There is a paucity of data on the long-term outcome of genital reconstruction of female children with congenital adrenal hyperplasia [CAH] as they become adult women. We report on the surgical outcome general condition and marriage status We reviewed the medical records of women 20 years or older with CAH who had genital reconstruction. We interviewed married patients utilizing the female sexual function index [FSFI-6] questionnaire and compared them to age-matched controls. We identified 43 women with CAH with a median age of 24.2 +/- 3.9 years and a median follow-up of 23.4 +/- 4.6 years. Salt wasting and the severity of virilization affected most patients, parents were commonly cousins, children were reared as boys for a protracted period and surgical reconstruction was usually complex. Only five women had married. Compared with single women, married women had significantly more frequent normal menses, emergency hospital admissions and number of repeated reconstructive surgery. There was no significant difference in FSFI score between patients and controls. Four women conceived and three gave birth to one healthy child. There was no significant difference in the number of children between patients and controls. CAH has a significant impact on adult women in our region. Most of the patients remain single. Few women get married and these are able to lead a nearly normal sexual life and give birth to healthy children

Role of percutaneous drainage in management of emphysematous pyelonephritis: a changing concept

To present the outcome of percutaneous drainage in cases of emphysematous pyelonephritis [EPN] and feasibility of avoiding nephrectomy in such patients with poor general condition. EPN was diagnosed in seventeen patients by computerized tomography [CT]. All patients received intravenous fluids and antibiotics. Emergency nephrectomy was carried out in two patients. Three patients died before any surgical intervention due to cerebrovascular stroke, uremia and diabetic coma. Percutaneous drainage was carried out for the remaining 12 patients. Kidney could be saved in 3 and subsequent nephrectomy was done in 9 patients. Two patients who underwent emergency nephrectomy survived. Of the evaluable 12 patients [10 diabetic and 2 nondiabetic]; percutaneous drainage was carried out. Resolution of inflammatory process was found in 3 cases and kidney recovered and preserved. Percutaneous drainage was unsuccessful in 9 patients; thus, secondary nephrectomy was necessary but in a better general condition of the patients. The pathogenic organism was Escherichia coli in 9, klebsiella pneumoniae in 2 and proteus mirabilis in 1. Percutaneous drainage may be considered as an alternative to immediate nephrectomy in emphysematous pyelonephritis. It could be the only treatment required and the affected kidney could be preserved. On the other hand when nephrectomy is inevitable percutaneous drainage can delay it until the general condition of the patient becomes better and the technical difficulties become minimal