Extended Boari-flap reconstruction in isolated tuberculous pan-ureteral stricture.

A 53-year-old female presented with left loin pain and imaging showed left pan-ureteral stricture secondary to tuberculosis. The renal unit was salvaged by percutaneous nephrostomy. She was planned for ileal ureteric replacement. An extended Boari flap was constructed for her as the bladder capacity was good and Boari bladder flap reached the renal pelvis without tension. Follow-up nephrostogram revealed wide pyelovesical junction with prompt drainage. She completed antituberculous treatment. Extended Boari flap is rarely used for upper ureteric reconstruction. It should be considered as an option for complete ureteric reconstruction in the unilateral pan-ureteral stricture in selected cases.

Non Transecting Dorsal Onlay and Ventral Inlay Buccal Mucosal Substitution Urethroplasty for Obliterative Bulbar Urethral Strictures.

BACKGROUND: Dorsal or ventral single layer repair can be impractical when there is an inadequate strip of urethra. Staged urethroplasty and non-transecting bilayer substitution urethroplasty are the other alternatives. OBJECTIVES: To assess the safety and outcome of non-transecting dorsal onlay and ventral inlay buccal mucosal substitution urethroplasty technique. METHOD: Between January 2014 and December 2018, 21 patients underwent non-transecting, double-layer, buccal mucosal urethroplasty for inflammatory bulbar urethral strictures. Four weeks after surgery, foley catheters were removed and voiding trial was given. Clinical examination and uroflowmetry (UFM) were done at 1, 3, and 6 months after surgery. Annual follow-up with flow rate and post-void residual assessment were also recorded. Failure was defined as a condition when there was flow rate deterioration (<15 mL/s) or when there is stricture recurrence (<20 Fr). RESULTS: The mean age was 49.5 years. There was no significant difference in comorbidities among the patients. The mean duration of operative time was 259 min. The mean blood loss was 190 mL. The follow-up duration ranged from 12 to 66 months. The average length of stricture was 3.9 cm. The mean diameter of stricture segment was 1.96 mm. Comparison of UFM trend during follow-up was statistically significant (p = 0.05). One patient had Clavien-dindo grade 1, while 2 patients had grade 3b complications. Two patients had soft anastomotic site stricture and were treated successfully with endoscopic internal urethrotomy. The success rate was 90.47%. CONCLUSIONS: Non-transecting bilayer substitution urethroplasty is safe and has better short-term outcome in case of obliterative inflammatory urethral strictures.

Bipolar Transurethral Resection of Bladder Tumor Provides Better Tissue for Histopathology But Has No Superior Efficacy and Safety: A Randomized Controlled Trial.

BACKGROUND AND PURPOSE: Bipolar transurethral resection of bladder tumors (TURBTs) has been claimed to have lesser complications and better specimen quality, but recent studies have contradictory results, and hence, we conducted this study to compare the clinical efficacy and safety of monopolar and bipolar electrosurgical modalities in TURBTs. MATERIALS AND METHODS: A total of 287 patients were enrolled in the study and underwent TURBTs between July 2015 and September 2016. Patients undergoing surgery under general anesthesia and restage procedure were excluded from the study. Patient demographic profile, tumor characteristics, and complications of the procedures such as obturator jerk, bladder perforation, blood loss, need for resurgery, and transurethral resection syndrome were recorded. Tumor specimens were analyzed for stage, grade, deep muscle invasion, and quantity and quality of thermal artifacts. RESULTS: A total of 160 patients were block randomized and analyzed with 80 patients in either group. Patient demographics and tumor characteristics were comparable between the groups. Change in hemoglobin levels and incidence of bladder perforation were comparable between the groups. A higher proportion of patients in bipolar group had obturator jerk compared with those in monopolar group, however, it was not statistically significant (24% vs 14%; p = 0.23). A higher proportion of patients in bipolar group did not have thermal artifacts when compared with monopolar group (27.5% vs 5%; p < 0.0001). CONCLUSIONS: The operative risks of bipolar TURBT such as obturator jerk, bladder perforation, and blood loss are comparable with monopolar resection. However, less thermal artifacts in tissue samples obtained with bipolar resection may be helpful to the pathologist in interpretation of histopathologic findings.

A neglected reddish penile patch: A wolf in sheep's clothing.

Microinvasive squamous cell carcinoma (SCC) is a known premalignant lesion of carcinoma cervix. It is also reported from other sites such as the oral cavity, larynx, and vulva. Microinvasive SCC is very rarely reported from the penis. We report the occurrence of microinvasive SCC in a long-standing erythematous lesion of glans penis in a patient, with extensive metastasis. We emphasize the need for awareness among patients and urologists about the premalignant lesions of penis and prompt treatment of such lesions to prevent possible spread of the disease.

Retrograde Pyelogram during intended Cystogram: A Rare complication of a common procedure.

Inadvertent placement of the urinary catheter into the ureter can cause several complications. We describe a rare complication during cystogram due to unrecognized inadvertently placed urinary catheter in ureter, resulting in a life-threatening situation. A 47-year-old multiparous female underwent total laparoscopic hysterectomy for adenomyosis. During early postoperative period, she developed vesicovaginal fistula and transvaginal repair of fistula was done. During filling cystography done at 2 weeks, she developed right loin pain and urosepsis. Contrast extravasation was seen in the right renal subcapsular space with Foley's catheter inside the right ureter. Subsequently, she recovered well.

Castleman's Disease Presenting as Localized Abdominal Mass and Paraneoplastic Pemphigus.

Castleman's disease is a rare, benign lymphoproliferative disorder of unknown origin. Paraneoplastic pemphigus is a common association which presents as oral mucosal ulcerations. Abdominal and retroperitoneal Castleman's disease present either as a localized disease or as a systemic disease. We hereby present a 15-year-old male patient with oral mucosal lesions with localized vague right lower abdominal mass who was diagnosed to have Castleman's disease with paraneoplastic pemphigus which was surgically excised.