A policy in the management of urethral fistula.

Our experience with repair of urethral fistula in 33 patients over a 5-year period is reviewed. The ages ranged from 2 to 12 years with an average of 8 years. Meatal advancement and glanuloplasty (MAGPI) were performed in five patients; there was no recurrence. A layered repair was used in 26 patients; of these, 12 recurred. Twelve patients needed a second operation and, of these, one had urethral dilatation with spontaneous cure of the fistula and the remaining 11 had a layered repair with a recurrence in five. Five patients had a third repair with further recurrence in three. Suprapubic urinary division was used in 13 cases with a failure rate of 77% (10 cases), while transurethral drainage was used in 31 cases with a failure rate of 35% (11 cases). Three of the cases with a MAGPI procedure had no urinary division. It is concluded that the MAGPI principle should be used in the repair of coronal and some subcoronal urethral fistulae as it carries a good healing rate with a short hospital stay. Transurethral bladder drainage should be used more frequently.

The pattern of intussusception in Kuwait. A review of 244 cases.

Two-hundred and thirty-three patients with 244 intussusceptions were treated in the Department of Paediatric Surgery, Ibn Sina Hospital, Kuwait, with only one death. Our incidence was around 25 per year. The age for idiopathic intussusception fits that reported in Western countries. Kuwaitis have a lower incidence of intussusception than other nationalities living in Kuwait. Diarrhea seems to precede intussusception in about 19.1% of cases; leading points were found in 8.2%, and recurrences in 4.5% of cases, most of them following barium reduction. Our complications were high, particularly in the operated group. Barium enema has become our first line of management and it has greatly reduced complications and shortened hospitalization times. Those who present early and late are more prone to operative treatment.