Use of penile skin flap in complex anterior urethral stricture repair: our experience

Objective: To present our experience of treatment of complex anterior urethral strictures using penile skin flap

Study Design: Descriptive, case series

Place and Duration of Study: Department of urology Combined Military Hospital Malir Cantonment, Karachi and Armed Forces Institute of Urology, Rawalpindi from Jan 2012 to Feb 2014

Material and Methods: Total 18 patients with complex anterior urethral strictures and combined anterior and bulborurethral strictures were included. Patients underwent repair using Orandi or circularfacio-cutaneous penile skin flap depending upon the size and site of stricture. First dressing was changed after two days and an in dwelling silicone two way foleycatheter was kept in place for three weeks. Graft was assessed with regards to local infection, fistula formation and restricturing. Re-stricture was assessed by performing uroflowmetery at 6 months and 1 year. Ascending urethrogram was reserved for cases with less than 10 ml/sec Q max on uroflowmetery. Repair failure was considered whenthere was a need for any subsequent urethral procedure asurethral dilatation, dorsal visual internal urethrotomy, or urethroplasty

Results: Overall success rate was 83.3%. Of all the patients operated 1[5.6%] had infection with loss of flap, 3[16.7%] had urethral fistula and none had re stricture confirmed by uroflowmetery

Conclusion: In our study the excellent results of the penile skin flap both in anterior urethral strictures and combined anterior and bulbar urethral strictures are quite encouraging. It is easy to harvest and seems anatomically more logical

audit to evaluate the image quality of magnetic resonance of knee at radiology department of a tertiary care hospital

Objective: To evaluate the quality of MRI scans of knee, performed at Radiology Department of Jinnah Hospital in the light of recommendations of ACR

Study Design: A clinical audit

Place and Duration of Study: Department of Radiology, Jinnah Hospital, Lahore, from August 2015 to February 2016

Methodology: Scans of 20 patients who underwent MRI of knee in August 2015 were studied retrospectively to assess the quality of images obtained in the first audit. Based on the findings of this audit, recommendations were made and re audit was done 6 months later in February 2016 to look for improvement in local practice

Results: In the first audit, images were acquired in all the three necessary planes and the sagittal and coronal images had appropriate slice thickness, interslice gap as well as adequate anatomical coverage in all the patients. However, FOV [field of view] was appropriately set in 66% of cases in axial plane, 5% in sagittal plane, and 0% in coronal plane. Also, the anatomical coverage was not upto the mark in axial plane with 13 studies [66%] having adequate superior coverage, and 16 cases [80%] having recommended inferior anatomical coverage. The re audit performed 6 months later showed improvement with 100% compliance to standards

Conclusion: The first audit showed many shortcomings in acquiring of MRI data in patients undergoing knee MRI with FOV requiring a decrease in all planes and anatomical coverage increase in axial plane. These recommendations were made in departmental meetings and re-audit was done after 6 months. This second audit showed 100 % compliance

Inguinal hernia repair: a comparison of lichtenstein and darn techniques

To compare the number of postoperative complications and early recurrence between Lichtenstein tension free hernioplasty and Darn repair, for inguinal hernia. The study was conducted at Department of Surgery, Combined Military Hospital Rawalpindi from 1st Jan 2001 to 30th Nov 2002 and included 100 patients. The study design was quasi experimental. A total of 100 patients were selected. 50 patients were treated with Lichtenstein tension free hernioplasty [Group A] and 50 with Darn repair [Group B]. Cases were followed up for one year. The male to female ratio was 46.5:1. Total no of postoperative complications were 7[14.58%] in Group A and 21 [44.68%] in Group B. Haematoma was the most common complication followed by urinary retention and wound infection in both the study groups. Complications like haematoma [8.33% versus 14.89%], urinary retention [2.08% versus 12.76%], wound infection [2.08% versus 8.51%], scar pain [2.08% versus 6.38%] and testicular atrophy [0% versus 2.13%] were significantly low in Lichtenstein tension free hernioplasty as compared to Darn repair [P<0.05]. The early recurrence rate in this study was significantly low in Group A [0] as compared to Group B [O versus 4] but this is statistically insignificant [P>0.05]. Depending upon the surgeon's skills, Lichtenstein tension free hernioplasty has a definite superiority over Darn repair

Surgical management and outcome in achalasia cardia

The objective of the evidence based clinical report was to assess the outcome of exramucosal modified Heller's cardiomyotomy in terms of effective palliation of dysphagia with minimum complications. Ten patients were included after exclusion of four patients due to poor follow-up. Due to the non-availability of manometry, barium swallow and endoscopy had to be relied upon for the definitive diagnosis. All patients underwent transabdominal modified Heller's myotomy coupled with anterior partial fundoplication [Dor Patch]. Median age of the patients treated was 42.5 years. Seven patients had grade III dysphagia, 2 had grade IV and one patient, an 8 years old child was having grade II dysphagia. In one patient, [10%], mucosa was perforated iatrogenically followed by wound infection. Another patient developed acute coronary syndrome on first postoperative day. In the rest of patients recovery was uneventful. Mean hospital stay was 7.1 days. Immediate relief of dysphagia was noted in all the patients. Mean follow-up was 7.2 months. There was significant improvement in dysphagia following surgery. Outcome was assessed devising a scoring system. Excellent outcome was observed in 80% of cases, good in 10% and fair in 10% of cases

Don't let me die Galactography the art is dying

The fancied and sophisticated investigations always catch the eye of the patient and the mind of clinicians. We are living in an era, which is certainly making headways in the field of medicine. The inventions like the state of art MRI, Computed Tomography and the newer modality of PET scanning certainly do help. For the sake of breast, the screening via mammography still remains the prime investigation but the frequently used method of investigating the ducts i.e; galactograhy or the commonly called Ductography is these days not the favorite of most clinicians these days. This article is a very limited study but it might be helpful in reviving the confidence of the clinicians in the art of Galactograhy