Spontaneous nephrocutaneous fistula: a rare complication of reflux nephropathy.

A rare case of nephrocutaneous fistula due to reflux nephropathy in a 4-year-old female child is presented here. No such case has been described previously in the English literature.

Unusual complication of suprapubic cystostomy. A case report.

An unusual case of inadvertent ureterostomy following suprapubic cystostomy is described. The case itself was unusual with unexpected obstruction at the bladder outlet.

Fracture of corpus cavernosum following penile venous surgery. A case report.

A rare complication of fracture of the corpus cavernosum following penile venous surgery is described here. Problems of diagnosis and management are briefly outlined.

Urethrocavernous fistula following sexual intercourse.

An unusual case of urethrocavernous fistula following blunt penile trauma sustained during sexual intercourse is described. The fistula was well outlined by cavernosography and responded successfully to conservative treatment.

Dynamic pharmacocavernosometry: a search for an ideal approach.

Of 141 patients attending the department with complaints of erectile dysfunction, 57 were diagnosed as having organic impotence. Of these 57 patients, 37 were found to have venogenic impotence. All 37 patients had normal Duplex Doppler ultrasound examination and nonvasculogenic factors were ruled out. Corporovenous leak (CVL) was diagnosed on careful workup of dynamic pharmacocavernosometry along with cavernosography. After giving 60 mg of papaverine intracavernosally, dynamic cavernosometry was performed on a Dantec 5000 Urodynamic machine. The vesical or abdominal pressure was taken as intracavernous pressure (ICP) and venous infusion as total intracavernosal flow, measured on a Special User Program. The pressure and maintenance flow criteria were used to diagnose CVL and to define the correlation. Concomitant cavernosography was performed in each case to have radiological evidence. The criteria used to define the leak were: (1) maintenance flow requirement of > or = 30 ml/min, and (2) a fall in ICP of > 40 cm/30 s after achieving full erection when flow is stopped. Apart from these 37 patients, 5 normal controls and 7 patients with psychogenic impotence were also evaluated by this method to establish normal criteria.

Experience with penile venous surgery.

Venogenic impotence was detected in 37 out of 141 patients who attended our clinic with a complaint of erectile dysfunction. Eighteen patients presented with primary impotence and the rest had progressive secondary impotence. All 37 patients have shown partial or poor response to 60 mg of intracavernosal papaverine. The corporovenous leak (CVL) was diagnosed on the careful workup of dynamic pharmacocavernosometry and cavernosography. Concomitant arterial cause was noted in 10% cases on the basis of penile duplex Doppler ultrasound study. 24 patients in the age group of 23-60 years underwent the penile venous surgery. The CVL was noted in the deep dorsal vein (23 cases), cavernous vein (16) and in the crural vein (2). The operation consisted of deep dorsal vein (DDV) ligation and excision with all tributaries (8 cases) or DDV ligation and excision+cavernous vein ligation (13 cases), through an infrapubic curvilinear incision. One patient had crural vein ligation and corporoplasty through a perineal incision, one had direct corporeal revascularization for associated arteriogenic impotence with venous leak and another had distal spongiolysis and closure of a corporospongiosal shunt. The results were excellent in 11 cases, improved in 6 and 7 had failures. Surgical intervention is effective in CVL in selected cases but limiting factors in the form of increasing age, concomitant arteriogenic cause, significant crural leak, missing tributaries, recurrent venous leak and unknown factors may also be present to prevent total cure.

Difficult urethral reconstruction.

A new technique using the pedicled island flap of penile skin for total urethral reconstruction is described. The technique consists of using a long, modified flap of more than 15 cm in length and was utilized in 6 cases of total urethral stricture. Four cases resulted in an excellent outcome, while 2 had fistula with anastomotic stricture. The technique is useful in reconstruction of the total urethra, but the utmost care is needed in the dissection to preserve the viability of the pedicle.

Anterior urethroplasty--changing concepts.

The management of complex anterior urethral strictures, not amendable to dilatation or internal urethromotomy, is difficult. Our experience of treating long strictures of anterior urethra with one-stage urethroplasty in 16 cases and two-stage Johanson's in 12 cases are reviewed here. The strictures had varied etiology and many were associated with fistula, diverticulum, etc. Three cases had concomitant posterior urethral strictures and were managed by one-stage anterior and posterior urethroplasty simultaneously. The one-stage repair was done using vascularized flap of longitudinal ventral penile skin in most cases. Transverse scrotal flap and Duckket's transverse preputial flap were utilized in 2 cases each. In one-stage repair success was 100% and in two-stage repair it was 75%. Our preference is now for one-stage repair irrespective of length and number of strictures.

Syndrome of inappropriate antidiuretic hormone following tuberculous epididymo-orchitis in renal transplant recipient: case report.

A rare case of the inappropriate antidiuretic hormone syndrome after tuberculous epididymoorchitis in a renal transplant recipient is described. Orchiectomy was performed because of a cold abscess, following which clinical improvement was noted.

Transvesical vesicovaginal fistula repair: a revival.

Vesicovaginal fistulae are usually traumatic in nature, following obstetric or gynecologic trauma. Here, our experience with vesicovaginal fistula repair in 68 cases, performed transvesically (58 cases) or transperitoneally-transvesically, with pedicled omental interposition in 10 cases over the last 8 years is described. The size of fistulae ranged from 1 to 5 cm, and most were situated near or above the trigone. Two cases required ureteric reimplantation. Recurrent fistulae were found in 4 cases. We attribute our success to the simple access, the construction of a vascularized flap, the tension-free grid-iron closure, and the utilization of Vicryl suture.

Ureteric substitution with Boari bladder flap.

Between 1986 and 1989, 12 patients underwent ureteric substitution with a Boari bladder flap at this Institute. The indications were ureteric injury following hysterectomy, difficult forceps delivery, difficult ureterolithotomy, ureteric strictures caused by a Dormia basket and previous ureteric surgery, tuberculosis, retroperitoneal fibrosis and a post-ureteric reimplantation fistula. There were 2 patients with a solitary kidney and 2 in acute renal failure. Double J stenting was carried out in 11 patients and the stent was removed 3 to 6 weeks post-operatively. Good results, with no morbidity or mortality, were achieved in all but 1 patient where a simple Silastic stent had migrated to the pelvis and required open surgery to remove it. We attribute our success to the tension-free anastomosis, a wide based posterior flap with preservation of its vascular supply, the use of a double J stent and vicryl suture material.