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

Complications of percutaneous nephrolithotomy single center experience of 103 cases

Objective: To present our complications of percutaneous nephrolithotomy [PCNL] during initial one year using modified Calvien system

Study Design: Observational prospective cohort

Place and Duration of Study: Armed Forces Institute of Urology [AFIU] Rawalpindi from 1[st] January 2014 to 31[st] December 2014

Material and Methods: The study was conducted at AFIU, Rawalpindi from 1[st] January 2014 to 31[st] August 2014. All of the consecutive 103 patients who underwent PCNL were included. Single-stage PCNL was performed in all the cases under general anesthesia. Pneumatic and ultrasound probes [alone or in combination] were used to fragment the calculi. Stone fragments were removed using graspers. A 16 Fr Foley catheter was used as nehrostomy tube. It was clamped on the first postoperative day. Foley catheter and ureteric stent was removed one day later. Intravenous antibiotics were given during admission period, i.e. 3-5 days. The complications were classified according to modified Clavien system. The data was analysed using the Statistical Package for the Social Sciences [SPSS] version 16

Results: Sixty nine [67%] patients were males and thirty four [33%] were females. Their ages ranged from 7 years to 81 years with mean age 41.7 +/- 16.34 years. PCNL was performed on right side in 48 [46.6%] cases while 55 [53.4%] underwent PCNL on left side. Overall complication rate was 21.35%. Grade 1 complications in 7.7%, grade 2 in 7.8%, grade 3a in 2.8% and grade 4a complications in 2.9% were seen

Conclusion: PCNL is associated with low incidence of major complications even in the hands of beginners when carefully performed

Pneumatic lithotripsy for the treatment of ureteric calculi

Transureteral lithotripsy has emerged as a popular and standard treatment modality for the management of ureteric calculi. It can be used very effectively to treat ureteric calculi at all locations. In this study, fifty consecutive cases of ureteric calculi treated by ureteroscopy and pneumatic intracorporeal [Lithoclast] lithotripsy have been reviewed. The overall success rate was 92%. With the advent of and continuous refinements in minimally invasive techniques, open surgery is becoming a story of past in the management of ureteric calculi. The success rate for ureteroscopic stone retrieval depends upon the stone size, location and experience of the ureteroscopist. In our experience, ureteroscopic lithotripsy has been found to be a safe, effective and expeditious means of clearing ureteric calculi at all levels. It is tolerated well by the patient, associated with very low morbidity and recommended as a procedure of choice for all ureteric calculi