Treatment of retained encrusted ureteral Double-J stent.

OBJECTIVES: We conducted this study to evaluate patients with retained encrusted ureteral stents, identify the predisposing factors and present our experience in the management of such challenging problem. MATERIALS AND METHODS: This prospective study was carried out in the period from May 2007 to February 2011 at the Urology and Nephrology Center, Al-Thawra General Hospital, Sana'a, Yemen. 40 patients with retained encrusted ureteric stents were treated at our center. All patients were initially evaluated with a radiographic imaging for assessment of stent encrustation and stone burden. Treatment decisions were based on the site and severity of encrustations in the renal pelvis, ureter and bladder and on our technical situation and availability of instrumentations. Multi-modal approaches ranging from extracorporeal shock wave lithotripsy (ESWL) to endourological and open urologic procedures were used to achieve stent removal. RESULTS: A total of 90 urological procedures were performed to render all 40 patients stent and stone free. The average duration of stent remained indwelling was 24.2 months (range 4 months -16 years). All patients were managed either by minimally or more invasive multi-modal endourological approaches. For upper coil encrustation percutaneous nephrolithotripsy was performed in eight patients, pyelolithotomy in two patients and ESWL in three patients. Encrustation of the body was treated initially by ESWL, followed by retrograde ureteroscopic manipulation in 12 patients. Lower coil encrustation was successfully managed by cystolitholapaxy in seven patients and one patient required cystolithotomy. Cystolithotomy, pyelolithotomy and ureterolithotomy were carried out in two patients. Two patients who had large burden bladder and kidney stones with loss of kidney function underwent nephrectomy and cystolithotomy. CONCLUSIONS: The retrieval of severely encrusted retained ureteral stent and its associated stone burden poses a real management challenge for urologists due to the need for multimodal procedures and the lack of standardized treatment plan.

Gunshot wound injuries to the male external genitalia.

OBJECTIVE: To identify the patterns of civilian gunshot wound (GSW) injuries to the male external genitalia, and to present our experience in the management of such injuries. METHODS: This descriptive study was carried out in the Urology and Nephrology Center, Al-Thawra Modern General and Teaching Hospital, Sanaa, Yemen from June 2005 to April 2008, and included 20 men that presented with GSW injuries to the external genitalia. After clinical and radiological evaluation with retrograde urethrography when indicated, early surgical repair was undertaken for all patients with evident, or suspected deep genito-urinary wounds. RESULTS: The mean age of the patients was 33.2 years. In 15 (75%) patients, injuries were inflicted by high-velocity weapons, and in 5 by low-velocity pistols, and 18 (90%) patients had other associated injuries. The penis was involved alone in 10 (50%), scrotum in 4 (20%), and the penis and scrotum in combination in 6 (30%) patients. In 5 patients, the lesions were superficial. Corporeal injuries were detected in 13 patients, and urethral injuries were detected in 6 patients. In post-repair, mild curvature during erection was experienced by 5 patients, severe angulation by one, and sexual dysfunction by 2 patients. We encountered 9 testicular ruptures, and our testicular salvage rate was 45.5%. CONCLUSION: Although the dominant inflicting weapons were high-velocity automatic rifles, the severity of injuries and their related outcomes were almost comparable to other low-velocity series. This is possibly due to the primary involvement of nearby bulky muscles in 90% of cases, which may absorb the blasts effect of the projectiles on the genitalia.

Management of penile fractures.

OBJECTIVE: To present our experience with surgical and conservative management of penile fracture. METHODS: This prospective study was carried out in the Urology and Nephrology Center, at Al-Thawra Modern General and Teaching Hospital, Sana'a, Yemen from June 2003 to September 2007, and included 30 patients presenting with penile fracture. Diagnosis was made clinically in all our patients. Six patients with simple fracture were treated conservatively while 24 patients with more severe injuries were operated upon. RESULTS: Patients' ages ranged from 24-52 years (mean 31.3 years), 46.7% of patients were under the age of 30 years and 56.7% were unmarried. Hard manipulation of the erect penis for example during masturbation was the most frequent mechanism of fracture in 53.3% of patients. Solitary tear was found in 22 patients and bilateral corporal tears associated with urethral injury were found in 2 patients. Corporal tears were sutured with synthetic absorbable sutures and urethral injury was repaired primarily. All operated patients described full erection with straight penis except 3 of the 8 patients who were managed by direct longitudinal incision, in whom mild curvature during erection was observed. The conservatively treated patients described satisfactory penile straightness and erection. CONCLUSION: The optimal functional and cosmetic results are achieved following immediate surgical repair of penis fracture. Good results can also be obtained in some selected patients with conservative management.