Results of buccal mucosal graft urethroplasty in complex hypospadias.

INTRODUCTION: Urethral reconstruction in complex hypospadias poses a significant challenge. We report our experience using buccal mucosa to repair complex hypospadias. MATERIALS AND METHODS: From February 2001 to September 2003, 16 urethral reconstructions were performed using buccal mucosal graft. Twelve of the patients had previously failed urethroplasties, while the other 4 had perineal or scrotal hypospadias. Grafts were harvested from the lower lip. Onlay grafts were used in 8 cases, and tubularized grafts were used for the others. RESULTS: After 14 to 27 months' follow-up, 11 of 16 (69%) patients developed complications, including meatal stenosis in 2 (12.5%), urethral stricture in 5 (31%), and urethrocutaneous fistula in 4 (25%). No oral complications were seen, and all of the urethroplasty complications were managed successfully. CONCLUSION: Urethroplasty using a buccal mucosal graft may be accompanied by a relatively high complication rate, which is more common in patients with tubularized graft; however, all complications can be managed successfully. We believe that urethroplasty using buccal mucosal graft in complex hypospadias is an acceptable treatment modality.

Efficacy of extracorporeal shock wave lithotripsy monotherapy in complex urolithiasis in the era of advanced endourologic procedures.

PURPOSE: It is believed that extracorporeal shock wave lithotripsy (ESWL) may be less effective than other modalities for treating stones in complex calculi. In this study, we investigated the efficacy of ESWL for treatment of complex stones. MATERIALS AND METHODS: Between September 2002 and October 2003, 250 complex cases of urolithiasis, including ureteral stones, staghorn stones, and stones in children, high risk patients, single kidneys, steinstrasse, and horseshoe kidneys were selected to be treated with Siemens Lithostar (Siemens AG, Munich, Germany) on an outpatient basis. Data were collected prospectively and the results of ESWL monotherapy on these complex patients were reviewed. RESULTS: The overall success rate was 91.2% for children and 77.7% for patients with single kidneys. Also, ESWL was efficient in the treatment of ureteral stones at the rate of 70.5% to 83.3%, depending on the location of the stone in the ureter and its size. The success rate of ESWL for patients with horseshoe kidneys, staghorn stones, and steinstrasse were marginal (66.6%, 66.0% and 33.3%, respectively). All of the cases were managed on outpatient basis and hospital admission was not required. CONCLUSION: Outpatient ESWL can be safely performed as a minimally invasive treatment after proper patient selection, even for complex patients. Its successfulness in children, patients with solitary kidney, and for almost all of ureteral stones is quite acceptable. However, its usage in patients with horseshoe kidneys or steinstrasse, and those with staghorn stones is questionable and should be done only in carefully selected cases. Thus, with appropriate patient selection, significant improvements in stone-free rates may also be achieved in these cases.