Transpubic urethroplasty: a single center experience.

Objective. To evaluate the long-term results of transpubic urethroplasty for pelvic fracture urethral distraction defects. Patients and Methods. Sixteen patients who had undergone transpubic urethroplasty for posttraumatic complex posterior urethral disruptions between 2007 and 2013 were analyzed retrospectively and prospectively. Patients were followed up for a mean (range) of 24 (6-60) months by history, urinary flow rate estimate, retrograde urethrography, and voiding cystourethrography. Results. The mean age of the patients was 30.4 years. The estimated radiographic stricture length before surgery was 4.3 cm. Transpubic urethroplasty was successful in 14 out of 16 patients. Postoperative complications were recurrent stricture (12.5%), urethrocutaneous fistula (12.5%), incontinence (31.25%), impotence (25%), and wound infection (18.75%). Failed repairs were successfully managed endoscopically in one patient and by perineal anastomotic repair in the other, giving a final success rate of 100%. Five out of 16 patients were incontinent of which 3 of them resolved and 2 had permanent incontinence. Impotence was seen in 4 out of 16 patients. There were no reported complications of pubectomy in any of our patients. Conclusions. Though considered obsolete now, transpubic urethroplasty for complex posterior urethral disruptions is still a viable alternative with excellent results and minimal morbidity.

Single-stage preputial skin flap urethroplasty for long-segment urethral strictures: evaluation and determinants of success.

OBJECTIVE: To determine the overall efficacy and predictors of success of the penile preputial flap in the management of complex urethral strictures >2.5 cm in length. PATIENTS AND METHODS: We performed a retrospective and prospective study of 58 patients undergoing single-stage penile preputial flap urethroplasty for complex long-segment urethral strictures, without lichen sclerosus, repaired between May 2005 and April 2012 at our institution. For obvious reasons circumcised patients were excluded from the study. Results were assessed by univariate analysis of various patient characteristics, preoperative and postoperative patient satisfaction (based on symptoms), and urethral ultrasonography, retrograde urethrography and uroflowmetry. RESULTS: The median (range) follow-up was 42 (6-90) months, the median (range) intra-operative stricture length was 48.5 (26-85) mm and the median (range) operating time was 90 (85-125) min. A total of 87.93% of patients had a satisfactory outcome, with an overall success rate of 81.03%. Diabetes mellitus (relative risk [RR] 5.21, confidence interval [CI] 2.31-64.68, P = 0.003) and smoking (RR 4.19, CI 1.54- 45.0, P = 0.01) were predictors of failure, while postinfective aetiology (RR 2.19), panurethral stricture (RR 2.73), stricture length >70 mm (RR 3.25), previous urethroplasty (RR 2.4) and severe peri-urethral fibrosis (RR 2.37) were also associated with a higher risk of failure. CONCLUSIONS: A urologist should try to gain experience of all the methods of urethroplasty as the techniques may vary according to the circumstances. Single-stage preputial skin flap urethroplasty, in experienced and expert hands, has results equivalent to all other methods of urethroplasty in complex urethral strictures. We prefer this technique in this part of the world where buccal mucosa cannot be used because of dyskeratotic changes as a result of consumption of gutkha, tobacco, pan masala, betel nut.

Collagen dressing versus conventional dressings in burn and chronic wounds: a retrospective study.

OBJECTIVE: Biological dressings like collagen are impermeable to bacteria, and create the most physiological interface between the wound surface and the environment. Collagen dressings have other advantages over conventional dressings in terms of ease of application and being natural, non-immunogenic, non-pyrogenic, hypo-allergenic, and pain-free. This study aims to compare the efficacy of collagen dressing in treating burn and chronic wounds with that of conventional dressing materials. MATERIALS AND METHODS: The records of 120 patients with chronic wounds of varied aetiologies and with mean age 43.7 years were collected and analyzed. The patients had been treated either with collagen or other conventional dressing materials including silver sulfadiazine, nadifloxacin, povidone iodine, or honey (traditional dressing material). Patients with co-morbidities that could grossly affect the wound healing like uncontrolled diabetes mellitus, chronic liver or renal disease, or major nutritional deprivation were not included. For the purpose of comparison the patients were divided into two groups; 'Collagen group' and 'Conventional group', each having 60 patients. For assessment the wound characteristics (size, edge, floor, slough, granulation tissue, and wound swab or pus culture sensitivity results) were recorded. With start of treatment, appearance of granulation tissue, completeness of healing, need for skin grafting, and patients' satisfaction was noted for each patient in both groups. RESULTS: With two weeks of treatment, 60% of the 'collagen group' wounds and only 42% of the 'conventional group' wounds were sterile (P=0.03). Healthy granulation tissue appeared earlier over collagen-dressed wounds than over conventionally treated wounds (P=0.03). After eight weeks, 52 (87%) of 'collagen group' wounds and 48 (80%) of 'conventional group' wounds were >75% healed (P=0.21). Eight patients in the 'collagen group' and 12 in the 'conventional group' needed partial split-skin grafting (P=0.04). Collagen-treated patients enjoyed early and more subjective mobility. CONCLUSION: No significant better results in terms of completeness of healing of burn and chronic wounds between collagen dressing and conventional dressing were found. Collagen dressing, however, may avoid the need of skin grafting, and provides additional advantage of patients' compliance and comfort.

Large mucinous adenoma of pancreas presenting with recurrent pancreatitis.

Cystic pancreatic tumors are an unfamiliar and rare entity even after the advent of modern abdominal imaging. Mucinous pancreatic tumors presenting with features of pancreatitis is a rare phenomenon moreover it creates a diagnostic dilemma and can lead to mismanagement. We report here such a case of mucinous cyst adenoma presented as recurrent pancreatitis and mimicking as a pancreatic pseudocyst. The correct diagnosis was made only on CT scan and was successfully treated by surgical excision in the form of distal pancreatectomy with splenectomy.

Isolated renal artery thrombosis because of blunt trauma abdomen: report of a case with review of the literature.

BACKGROUND: Isolated renal trauma in case of blunt trauma abdomen (BTA) is not common. Renal artery occlusion by thrombosis in such cases is seen very rarely. These cases had been traditionally treated by early nephrectomy, but nowadays, renal preservation is considered whenever possible. Treatment options to do so are being developed. METHODS: Recently we came across one such case of isolated unilateral renal artery thrombosis (RAT) because of BTA. Relevant literature especially on various therapeutic techniques has been critically reviewed briefly along with case presentation. RESULTS: Isolated blunt traumatic RAT has an incidence of less than 1%. Only about 400 cases have been reported. It must be diagnosed and treated as soon as possible to avoid progressive permanent loss of renal function. Contrast-enhanced CT scanning is the preferred modality for evaluation and follow-up of RAT. Conservative treatment is reserved for unilateral cases. For bilateral cases and when RAT occurs in a solitary kidney, revascularization either surgically or more preferably by less invasive percutaneous techniques has been recommended. CONCLUSION: Renal arterial thrombosis because of blunt abdominal trauma is still an underreported entity, treatment for which has not yet been established. Both early nephrectomy and delayed revascularization are not justified treatment options.

Honey dressing versus silver sulfadiazene dressing for wound healing in burn patients: a retrospective study.

OBJECTIVE: The aim was to evaluate the effect of honey dressing and silver sulfadiazene (SSD) dressing on wound healing in burn patients. MATERIALS AND METHODS: We retrospectively reviewed the records of 108 patients (14-68 years of age), with first and second degree burns of less than 50% of the total body surface area admitted to our institution, over a period of 5 years (2004-2008). Fifty-one patients were treated with honey dressings and 57 with SSD. Time elapsed since burn, site, percentage, degree and depth of burns, results of culture sensitivity at various time intervals, duration of healing, formation of post-treatment hypertrophic scar, and/or contracture were recorded and analyzed. RESULTS: The average duration of healing was 18.16 and 32.68 days for the honey and SSD group, respectively. Wounds of all patients reporting within 1 h of burns became sterile with the honey dressing in less than 7 days while there was none with SSD. All wounds treated with honey became sterile within 21 days while for SSD-treated wounds, this figure was 36.5%. A complete outcome was seen in 81% of all patients in the "honey group" while in only 37% patients in the "SSD group." CONCLUSION: Honey dressings make the wounds sterile in less time, enhance healing, and have a better outcome in terms of hypertropic scars and postburn contractures, as compared to SSD dressings.

Urogenital fistulas in women: 5-year experience at a single center.

INTRODUCTION: Urogenital fistula is one of the most devastating complications that can result from labor or urogenital surgeries. It is still a frequent problem in the developing world. Urogenital fistulas can lead to devastating medical, social, and psychological problems; thus cause major impact on the lives of girls and women. However, these cases are still largely neglected in the developing world. We aimed to evaluate causative factors and discuss management of urogenital fistulas. MATERIALS AND METHODS: Forty-two cases of urogenital fistula developing within 5 to 38 days after delivery, pelvic surgery, and obstetric procedures were treated over a period of 5 years from 2003 to 2008. These included 37 vesicovaginal fistulas (88.1%), 4 uterovesical fistulas (9.5%), and 1 pure ureterovaginal fistula (2.4%). All of the patients were catheterized immediately on presentation and the catheter was left in situ for a minimum of 3 weeks before surgical intervention. RESULTS: The most common cause of vesicovaginal fistulas was obstructed labor, while other varieties of fistulas were mostly associated with pelvic surgery. Spontaneous closure occurred in 3 cases of vesicovaginal fistula. Surgical intervention needed in 39 patients. Peritoneal flap and Martius flap were interposed between suture lines in transabdominal and transvaginal approaches, respectively. Thirty-four fistulas (80.1%) were closed at the first attempt. There was no mortality from the surgical procedure. CONCLUSION: Vasicovaginal fistula is the most common urogenital fistula. Obstructed labor and its complications are still the leading cause of its development. Peritoneal flap interposition technique is a successful and effective treatment method for urogenital fistula.

Congenital fibrosarcoma of the chest wall: report of a case.

Congenital fibrosarcoma (CFS) is a rare soft tissue tumour that usually occurs before the age of 1, and involves the distal extremities. The literature regarding the precise diagnosis and treatment of these tumours is limited. We present and discuss a case of CFS which ended fatally due to lung metastasis after 2 years.

A rare case of primary mucinous cystadenoma of spleen.

UNLABELLED: Mucinous cystadenomas are relatively uncommon benign cystic tumors. Most of them are found in the ovary, pancreas, and appendix. Primary mucinous cystadenoma of spleen is extremely rare and only countable cases have been recorded. These are assumed to arise from heterotopic pancreatic tissue or invaginated spleenic capsular mesothelium. We present a rare case of primary mucinous cystadenoma of spleen without pancreatic tissue in it. Exact tissue of origin could not be determined. KEYWORDS: Cystadenoma; Splenic cyst; Pseudomyxoma peritonei.

Technique of anterior urethra urethroplasty using tunica albuginea of corpora cavernosa.

OBJECTIVE: Over previous years, urethral stricture has constantly created a great problem in efforts to find a permanent cure for it. We describe a technique of anterior urethroplasty using tunica albuginea of corpora cavernosa. METHODS: After a midline penoscrotal incision, the bulbar or penile urethra along with corpus spongiosum was dissected from the corpora cavernosa. Urethra was then rotated dorsally and the stricture was opened along its whole length. The walls of the slit urethra, along with the tunica albuginea of the corpus spongiosum, were sutured to the tunica albuginea of the corpora cavernosa at the 5 and 7 o'clock position after passing an all silicon catheter. We performed this technique on 79 male patients, having anterior urethral stricture, ranging 18-60 years of age (mean, 46 years). The etiology of stricture was trauma in 54, instrumentation in 12, infection in 10 and unknown in three. Follow ups were done at 4, 12 and 24 months by assessing patients' satisfaction rate along with a pre- and postoperative urethrogram, labeled as "good", "fair" and "poor". RESULTS: Good and fair results were considered as successful. The overall success rate was 94.9%. The success rate remained same at 4 months (64 + 11) and decreased to 93.7% (63 + 11) at 12 months and 89.9% (61 + 10) at 24 months. CONCLUSION: These observations show that anterior urethroplasty using tunica albuginea of corpora cavernosa have produced satisfactory results and are comparable with any other technique of urethroplasty. Thus, we strongly recommend the use of tunica albuginea of corpora cavernosa for anterior urethroplasty, which is histologically similar and anatomically located near the stricture.