Bilateral ureterocutaneostomy with modified stoma: long-term follow-up.

Ileal conduit and orthotopic bladder substitution have been the preferred options for urinary diversion after cystectomy. Self-catheterisation has revolutionised the management of neuropathic bladder. However, ureterocutaneostomy (cutaneous ureterostomy) described as a means of supravesical urinary diversion 40 years ago still has a definite role for both temporary and permanent diversion particularly in the developing countries. We present a small series of cutaneous ureterostomies performed in four children who have now grown up to become adults without being undiverted. We discuss the technique that we used to modify the stoma, which helped prevent stomal complications over the long term. Our results we believe will rekindle the interest in cutaneous ureterostomy as a viable option for permanent urinary diversion. Four children between ages 2 and 16 years had bilateral side-to-side single stoma tubeless end cutaneous ureterostomy as a primary procedure for permanent urinary diversion. The stoma was modified to prevent retraction and stenosis. Long-term follow-up is presented. All the children have grown up to become adults with their ureterocutaneostomies functioning very well. There have been no biochemical or mechanical complications. Only one out of four stomas had to be refashioned. A simple collection device has proved successful in maintaining a watertight drainage system without apparent problems. Bilateral side-to-side single stoma end cutaneous ureterostomy with modification of the stoma by a plastic surgical technique can help achieve a non-retracting stoma on which a collection device can snuggly fit. It is a viable option for permanent urinary diversion without any significant complications. It is simple, easy and highly practical way of managing urinary diversion especially in the developing countries.

Overgrafting for leukoderma of the lower lip: a new application of an already established method.

A case is reported where overgrafting was done for leukoderma of the lower lip. One and one-half year follow-up shows uniform color match of the overgrafted area.

Role of tensor fascia lata musculocutaneous flap in lymphedema of the lower extremity and external genitalia.

The tensor fascia lata (TFL) musculocutaneous flap has been used to cover raw areas resulting after block dissection of fungating cancerous glands in the groin. Postoperative lymphorrhea, a frequent serious problem after groin block dissection, was not seen. It was inferred that the TFL musculocutaneous flap absorbed lymph. This observation was used in treating patients with lymphedema of the lower extremity and genitalia. Groin block dissection was performed in 12 patients with tubercular and filarial lymphedema. By performing a groin block dissection, lymph was allowed to escape in the area of dissection and the TFL musculocutaneous flap absorbed the lymph. As a result a consistent reduction in the size and edema of the affected areas was noted. Wrinkling and suppleness of skin was seen in each patient within the first week. In 1 patient with congenital lymphedema, edema was restricted to the leg and foot. In this patient, groin block dissection was not performed. One end of the TFL musculocutaneous flap was transferred to the calf, and in second stage the proximal end with the whole flap was transferred to the back of the thigh and popliteal fossa. The TFL musculocutaneous flap here acted as a bridge between the area of congenital lymphedema (leg) and the area with normal lymphatic drainage (thigh).

Our experience of ventriculoatrial shunt using Upadhyaya valve in cases of hydrocephalus associated with tuberculous meningitis.

A small series of nine cases of tuberculous meningitis with hydrocephalus is presented in which a ventriculoatrial shunt was carried out. Upadhyaya valves were used. Four of these nine cases are doing well and are normal 1 1/2 to 2 years after surgery. Two of them remained spastic and athetotic and died within 15 months and 18 months after surgery. One child, who had recovered fully, died 2 1/2 months after surgery from an intercurrent infection. Another patient, though fully recovered, died on the 27th day after surgery. One child (case 9) did not show any improvement after surgery and died 1 2/2 months to 3 months after surgery. The Upadhyaya valve is an excellent device for treating hydrocephalus. The operation itself has been successful in all cases and there were no complications attributable to the Upadhyaya valve in this series. Sixty-five to seventy percent of cases of tuberculous meningitis in children fall in groups III, IV and V of the classification of neurological deficit, and hydrocephalus is a constant accompaniment of these cases. It is, therefore, advisable to insert a VA shunt using the Upadhyaya valve at a very early stage and in all cases that fall in groups III, IV and V of neurological deficit.