Transobturator vaginal tape in comparison to tension-free vaginal tape: A prospective trial with a minimum 12 months follow-up.

BACKGROUND: The tension-free vaginal tape (TVT) procedure is based on the integral theory that the midurethra has an important role in the continence mechanism. Transobturator vaginal tape (TOT) is the same in concept as TVT but it differs from TVT in that, rather than passing through the retropubic space, sling materials are drawn through the obturator foramina. We prospectively compared TVT with TOT with respect to operation-related morbidity and surgical outcomes at a minimum follow up of 12 months. MATERIALS AND METHODS: A total of 36 women with stress urinary incontinence (SUI) were alternatively assigned to the TVT group (18) or the TOT group. Preoperative evaluation included urodynamic study and I-QOL questionnaire. One year after operation the surgical result, patient satisfaction, incontinence quality-of-life questionnaire, long-term complications, and uroflowmetry were evaluated in both groups. RESULTS: The patient characteristics in both the TVT and TOT group were similar. Mean operating time was significantly shorter in the TOT group likened to the TVT group. CONCLUSIONS: Both the TVT and TOT procedures are minimally invasive and similar in operation-related morbidity. TOT appears to be as effective as TVT, and safer than TVT for the surgical treatment of SUI in women at 12 months follow-up.

Genitourinary tuberculosis in pediatric urological practice.

OBJECTIVE: Genitourinary tuberculosis is a form of secondary tuberculosis with vague symptoms and presentation, and is rare in children. Antitubercular therapy is the cornerstone of treatment, although surgical intervention is required in a minority of the cases. We retrospectively evaluated our series of children with this disease, with special emphasis on the role of surgery. MATERIALS AND METHODS: Case records of 17 children diagnosed and admitted with genitourinary tuberculosis at our center were reviewed. Clinical features, organ involvement, investigations, treatment and outcome of therapy were studied. RESULTS: There were 11 male and six female children with a mean age of 11.6 years, admitted during the period July 1990 to June 2005. The most common presentation was storage lower urinary tract symptoms. The most commonly involved organ was the ureter in seven (41%) cases. Mycobacterium tuberculosis was identified on urinary examination in only five (29%) cases. A total of 28 procedures, including 15 endoscopic, four ablative and five reconstructive, were performed with some children requiring more than one procedure. Renal functional parameters stabilized or improved in four of five children (80%) in whom they were deranged at presentation. CONCLUSIONS: Genitourinary tuberculosis presents with a wide variety of clinical features and pathological lesions. Diagnosis is often delayed because of late presentation and many children present with cicatrization sequelae. Antitubercular drug therapy and judicious application of surgery achieve satisfactory results in the majority of cases. With improved drug therapy and experience with the use of bowel segments in the urinary tract, more reconstructive procedures are being performed with satisfactory outcomes. Children undergoing surgical procedures and reconstruction in particular need to be followed up rigorously.

Posterior urethral injury in male children: long-term follow up.

OBJECTIVE: Owing to the immature pelvis and the relative intra-abdominal position of the child's bladder, children with a posterior urethral injury differ from adults. We report our experience in the management of such injuries in male children. PATIENTS AND METHODS: Children with suspected urethral injury underwent retrograde urethrography once their clinical condition was stable. Children with complete urethral injury underwent primary urethral realignment either endoscopically or by open surgical technique. Suprapubic cystostomy was performed in other children who were unfit to undergo primary realignment or in whom the management of other injuries took precedence over that of urethral injury. Children referred from elsewhere for further management of urethral injury and those with initial suprapubic cystostomy underwent delayed urethroplasty. RESULTS: Twenty-two children with mean age of 11.3 years were treated at our centre for urethral injury. Seven children underwent primary endoscopic urethral realignment, five open surgical realignment and 10 initial suprapubic cystostomy followed by delayed urethroplasty. Six of the 12 children undergoing primary urethral realignment required additional endoscopic urethrotomy for managing the stricture, and three of these six children eventually underwent urethroplasty. Of the 10 children undergoing delayed urethroplasty, three required additional sessions of endoscopic urethrotomy and two of these required further correction graft urethroplasty. CONCLUSION: Most male children with posterior urethral injuries need immediate realignment to prevent long-term complications.

Use of LMA Stonebreaker as an intracorporeal lithotrite in the management of ureteral calculi.

BACKGROUND AND PURPOSE: LMA Stonebreaker is a new type of ballistic intracorporeal lithotrite that does not need external electric power or access to compressed air. It is small and portable. This study aims to evaluate the efficacy, safety, and cost-effectiveness of this lithotrite in the management of ureteral calculi. MATERIALS AND METHODS: A total of 110 patients with ureteral calculi necessitating intracorporeal lithotripsy were prospectively included in the study. The size of the stone, position of the stone, number of shocks needed to fragment the stone to effect complete clearance, and degree of retropulsion were documented in each case, and any evidence of urothelial trauma was noted. RESULTS: All stones were fragmented, and all patients were rendered stone free. The mean number of shocks needed to fragment the stones was eight. The incidence of retropulsion was 6.36%. There was no evidence of urothelial trauma noted in any patient. CONCLUSION: LMA Stonebreaker is a safe, effective, cost-effective, robust, and portable device for intracorporeal lithotripsy.