ABSTRACT
INTRODUCTION: Oral mucosal graft (OMG) is the gold standard for urethral substitution but has poor results in long anterior urethral strictures and chronic tobacco-exposed oral mucosa. Saphenous vein has been recently described for long-segment anterior urethral stricture with successful initial results. Our objective was to compare the early outcomes of everted saphenous vein graft (eSVG) substitution urethroplasty in patients with tobacco-exposed oral mucosa and OMG urethroplasty in patients with nontobacco-exposed oral mucosa for long anterior urethral strictures. MATERIALS AND METHODS: 30 patients with long anterior urethral strictures underwent substitution urethroplasty using Dorsolateral onlay approach. Fifteen patients with healthy oral mucosa underwent OMG urethroplasty (Group 1) and 15 patients who had unhealthy oral mucosa due to chronic tobacco exposure underwent eSVG urethroplasty (Group 2). Outcomes were assessed with the International Prostate Symptom Score (IPSS); uroflowmetry; donor and recipient site complications at 1, 3, and 6 months; and symptomatic assessment thereafter. Retrograde urethrogram was done at 3 months in both the groups. Successful urethroplasty was defined as satisfactory voiding (Qmax>15 ml/s) and no need for endoscopic dilatation/direct vision internal urethrotomy in follow-up. RESULTS: Mean stricture and harvested graft length were 10.8 cm and 12.33 cm in Group 1, while in Group 2 were 13.6 cm and 15.73 cm, respectively. Nine of 13 patients in Group 1 (69.2%) and 11 of 14 in Group 2 (78.5%) with a minimum follow-up till 18 months had successful outcome at an average follow-up of 23.13 months. Donor and recipient site complications were comparable in both the groups. At 18 months, mean IPSS and Qmax in successful patients were 7.9 and 25.6 ml/s in Group 1, while in Group 2 were 8.0 and 22.6 ml/s. CONCLUSIONS: Outcomes of great saphenous vein graft urethroplasty are comparable to OMG, and it is an acceptable option in long-segment anterior urethral stricture patients with chronic tobacco-exposed oral mucosa.
ABSTRACT
In situations requiring an ileal segment for performing a Mitrofanoff cathetrisable urinary diversion, occasionally a "Double Monti" is needed to achieve a length for the cathetrisable channel to conveniently reach the abdomen of an adult. Casale's tube is an alternative where it can provide a jointless tube with adequate length. The video demonstrates the procedure in an adult with a neurogenic acontractile bladder who had developed a panurethral stricture because of years of self catheterization. "VQZ" technique of stoma formation is helpful in prevention of stenosis.
ABSTRACT
INTRODUCTION: Urologists tend to prefer retroperitoneal approach for open nephrectomy and transperitoneal route for laparoscopic nephrectomy. Urologists consider retroperitoneal laparoscopic approach difficult to learn and perform. There is a need to objectively define predictors of difficulty during laparoscopic retroperitoneal simple nephrectomy (LRSN) for the proper preoperative selection. To the best of our knowledge, this is the first study to prospectively assess the factors associated with difficulty during LRSN. MATERIALS AND METHODS: All adult patients of nonfunctioning kidneys (due to benign causes) planned for simple nephrectomies from November 2014 to January 2017 were included in the study. Various clinical and radiological parameters were noted along with intraoperative difficulty parameters (difficulty score, total operative time, and estimated blood loss). Renal and perirenal parameters were assessed and noted on computed tomography scan. Difficulty scale was calculated based on the three difficulty parameters and was used to objectively categorize the patients in easy and difficult group. RESULTS: A total of 44 patients were included in the study. There were 23 patients in Group I (Easy) and 21 patients in Group II (Difficult). Various preoperative clinical and radiological parameters were analyzed and compared between these two groups. History of pyonephrosis and presence of nephrostomy tube were the only two statistically significant factors associated with difficult cases (Group II). None of the factors were statistically significant in multivariate analysis. CONCLUSION: Based on the findings of our study, history of pyonephrosis and presence of nephrostomy are the most significant factors predicting difficulty during LRSN.
ABSTRACT
OBJECTIVE: To prospectively evaluate the feasibility and initial results of an everted saphenous vein graft (eSVG) as a dorsolateral onlay, in patients with long anterior urethral strictures and/or chronic tobacco users. PATIENTS AND METHODS: In all, 20 patients with long anterior urethral strictures (>7 cm) and/or chronic tobacco exposed oral mucosa were included in the study. The harvested SVG was hydro-distended, detubularised, and everted. Substitution urethroplasty using an eSVG was performed using a dorsolateral onlay technique. Symptoms were assessed using the International Prostate Symptom Score (IPSS) and uroflowmetry at 1, 3 and 6 months; and voiding and retrograde urethrograms, and urethroscopy were done at 3 months. Failure was defined as failure to void, need for interventions in form of direct-vision internal urethrotomy or endodilatation. RESULTS: Three patients were excluded because they underwent a staged urethroplasty. In all, 17 patients underwent eSVG substitution urethroplasty. The mean (SD, range) follow-up of our patients was 17.64 (5.23, 10-26) months. The mean (SD, range) length of the strictured segment was 14 (2.5, 10-18) cm and the length of the harvested SVG was 16.3 (2.7, 12-20) cm. The mean (SD) IPSS at 1, 3 and 6 months after catheter removal was 10 (2.8), 10 (3.4) and 10 (1.4) and the quality-of-life score was 1.76 (0.5), 2.05 (1.0) and 2.05 (1.0), respectively. Postoperatively, endodilatation was required in two patients. Complete failure occurred in one patient. CONCLUSIONS: An eSVG, as a dorsolateral onlay graft, is a promising and prudent option for long anterior urethral strictures, especially in patients with poor oral hygiene and chronic tobacco use.
