Single Umbilical Stoma for Bilateral Ureterostomy after Radical Cystectomy.

PURPOSE: Cutaneous ureterostomy after radical cystectomy is less preferred compared with other permanent urinary diversions due to bilateral stomas. Single umbilical stoma for bilateral ureterostomy (SUSBU) may be a choice, in this study we reviewed the outcomes of SUSBU in seventeen patients who underwent radical cystectomy. METHODS AND MATERIALS: This was a case-series study conducted from April 2016 to Dec 2017. Seventeen male patients with confirmed PT2 bladder urothelial carcinoma who were not suitable for performing conduit or orthotopic urinary diversion, including those with high-risk patients underwent single umbilical stoma for bilateral ureterostomy after radical cystectomy. All patients were prospectively followed up for 24 months ± 2 months, this study was done in a teaching center mainly by senior residents. RESULTS: The mean age of patients was 68.6 ± 6.41 years. The mean length of operation time was 176.7 ± 15.1 minutes (from intubation to extubation from anesthesia). Sixteen patients were diagnosed with PT2 and one patient had a PT4 diagnosis. The decrease in hemoglobin level after surgery was 1.72 mg/dl ± 0.35 and creatinine increased by 0.15 ± 0.05 mg/dl. None of our patients had oliguria. One case developed constipation and no gas passing, with the suspicion of obstruction, underwent abdominal exploration, however, no obstruction or urine leakage was found and the patient was treated conservatively. One patient developed a fever during admission, in which atelectasis was identified as the cause. One patient underwent a second operation because of fascia dehiscence. CONCLUSION: It seems that this technique is suitable for high-risk patients with acceptable operating time, surgical complications, and fast recovery after the operation and one ureterostomy bag instead of two one's comparing to bilateral cutaneous ureterostomy.

Salvage autologous fascial sling after failed anti-incontinence surgeries: Long term follow up.

OBJECTIVE: To evaluate long term outcomes of autologous pubovaginal fascial sling (AFPVS) as a salvage procedure following different types of failed anti-incontinence surgeries. MATERIALS AND METHODS: We retrospectively reviewed medical records of patients who had undergone salvage AFPVS after any kind of anti-incontinence surgery from 2005-2015 at our medical center. Patients were contacted by telephone. Revised Urinary Incontinence Scale (RUIS) was used to determine the success rate. RESULTS: A total of 40 patients out of 51 were successfully contacted. Mean patient age was 50.8± 9.8 years (range30-75) and mean follow up was 62.6±32.4 months (range12-120). Of 40 patients, 14(35%) had pure SUI and 26(65%) complained of mixed urinary incontinence. A total of 15(37.5%) patients had a failed Burch colposuspention, 5(12.5%) TVT, 8(20%) TOT, 3 (7.5%) AFPVS and five (12.5%) patients had history of failed mini-sling procedure. Four (10%) patients had undergone more than one anti incontinence surgeries. Overall success rate was 65% in our study. New onset urge urinary incontinence was detected in 25% of patient which was negatively associated with satisfaction and recommendation.  There was no statistically significant correlation between mixed urinary incontinence, type or number of previous failed surgeries with success however presence of pure SUI had a strongCOCLUSION: Autologous pubovaginal fascial sling might be considered as a safe and efficacious salvage surgical option following failed midurethral slings, Burch colposuspention and even AFPVS itself. It will provide reasonable long term results with no major complications.

Laparoscopic Pyelolithotomy in Children Less Than Two Years Old with Large Renal Stones: Initial Series.

PURPOSE: Treatment of pediatric urolithiasis is still on debate. This study was designed to evaluate the safety and efficacy of laparoscopic pyelolithotomy in five children less than two years old. MATERIALS AND METHODS: Five children (less than two years old) with large kidney stones underwent laparoscopic pyelolithotomy. All patients underwent laparoscopic pyelolithotomy via a transperitoneal approach. After medial mobilization of colon and once renal pelvis and ureteropelvic junction were exposed, a longitudinal or circular incision was made on the renal pelvis, depending on the location and shape of the stone. Stones were extracted using an Endobag. Demographic data, size of stones, operation time, duration of hospital stay and stone free rate were assessed. RESULTS: Four boys and a one girl were included in this study. The mean age of patients was 17.6 (range: 13-22) months and the mean duration of operation was 130 (range: 115-145) minutes. The mean size of stone was 24.6 (range: 22-27) mm and the mean duration of hospital stay was 4.4 (range: 4-5) days. Stone free rate was 100%. There was no major complication. CONCLUSION: Even with a small number of patients, our results seem to show that laparoscopic pyelolithotomy could be a treatment option for selected cases of young pediatric cases with large renal stones. We believe that transperitoneal laparoscopic pyelolithotomy is feasible and it introduces a novel approach for managing kidney stones in pediatric population. .

Titanium elastic nailing versus hip spica cast in treatment of femoral-shaft fractures in children.

BACKGROUND: There is no consensus on treatment of closed femoral-shaft fractures in children. We compared hip spica cast with titanium elastic nailing (TEN) in the treatment of femoral-shaft fractures in children. MATERIALS AND METHODS: Forty-six children, 6-12 years old, with simple femoral-shaft fractures were randomized to receive skeletal traction followed by hip spica cast (n = 23) or TEN (n = 23). Length of hospital stay, time to start walking with aids, time to start independent walking, time absent from school, parent satisfaction, and range of knee motion were compared between the two groups 6 months after injury. RESULTS: The two groups were similar in background characteristics. Compared with the children treated with spica cast, those treated with TEN had shorter hospital stay (P < 0.001) and took a shorter time to start walking with support or independently (P < 0.001), returned to school sooner (P < 0.001), and had higher parent satisfaction (P = 0.003). Range of knee motion was 138.7 ± 3.4° in the spica cast group and 133.5 ± 13.4° in the TEN group (P = 0.078). Three patients (13.0%) in the spica cast group compared with none in the TEN group had malunion (P = 0.117). Postoperative infection was observed in three patients (13.0%) in the TEN group. CONCLUSIONS: The results showed significant benefits of TEN compared with traction and hip spica cast in the treatment of femoral-shaft fractures in children. Further trials with longer follow-ups and comparison of TEN with other methods, such as external fixation, in children's femoral fractures are warranted.