Urethral stricture Yemen experience.

PURPOSE: In order to evaluate the etiology of urethral stricture in our society and outcome of different types of surgical reconstruction used to treat them. PATIENTS AND METHODS: This prospective study was carried out in the Urology and Nephrology Center, at Al-Thawra Modern General and Teaching Hospital, Sana'a, Yemen from July 2003 to July 2007 and included 62 male patients with complete urethral stricture whom underwent Urethral reconstructive surgery. The patients were evaluated by history, local and systemic physical examination, and radiological assessment according to each case. RESULTS: Patient's age ranged between 3 and 70 years (mean 25.31). Of 55 patients presented to the GER, 31 patients had car accident, 14 patients had gun shot injury, 9 patients fell from high, and one patient had bomb explosion. Five patients had history of traumatized catheterization and urethrocystoscopy, while two patients had history of urethritis. The site of the stricture was at the bulbomembranous area in 43 patients, in the penile urethra in 14 patients, and in bulbous urethra in 5 patients. The length of the urethral stricture was 10-30 mm in 39 patients (63%), <10 mm in 13 patients (21%) and of 30-70 mm in 10 patients (16%). A total of 15 patients (24%) with posterior urethral stricture of 10 mm or less (+2 patients with 1.2 and 1.5 cm), subjected to endoscopic treatment, 37 patients (60%) with stricture >10-30 mm, were underwent anastomotic urethral reconstruction and 10 patients (15%) with stricture >30 mm, were repaired utilizing tissue transfer technique. Follow-up period ranged from 3 months to 2 years (median 15 months), in which recurrent stricture was found in 11 patients (18%), wound dehiscence in 4 patients (6%) and fistula formation in 1 patient (1.5%), while no patient came with erectile dysfunction. CONCLUSION: Trauma is the commonest cause of urethral stricture in our country, therefore the control of it will decrease extremely the urethral stricture disease. No one technique is suitable for all types of the stricture, and the surgeon should be familiar with the different techniques and choose the most suitable one according to the case he deals with.

Tubeless percutaneous neprolithotomy: the new gold standard.

PURPOSE: We present our experience with tubeless percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: Between July 2004 and December 2006, 121 patients (82 males and 39 females) with 18-70 mm (mean 31.19 mm) renal stones underwent tubeless PCNL leaving only a 6 Fr externalized ureteric catheter. Their ages ranged between 4 and 80 years (mean 37.27). Two patients had bilateral disease, so a total of 123 renal units are included. The procedure was performed under general anesthesia in the prone (110 units) or supine position (13 units). A total of 133 punctures were performed. The punctures were single (114 units), double (8 units), or triple (1 unit). The approach was subcostal through the lower calyx (n=110) or middle calyx (n=10), or supracostal through the middle calyx (n=8) or upper calyx (n=5). RESULTS: Mean operative time was 46.30 min (range 15-100). Mean reduction in hemoglobin level was 1.57 g (range 0.3-4) with blood transfusion rate 4.13%. Complication rate was 9.9% in the form of perirenal collection (five patients), urinary leakage (two patients), fever (four patients), and hydrothorax (one patient). The ureteric catheter was left for 7-72 h (mean 45.67). Postoperative analgesia was required in 22 patients (18.2%) with mean 22.9 mg diclofenac sodium per patient. Mean hospital stay was 50.69 h (range 12-96) with 106 units (86.18%) rendered stone free, 13 (10.57%) with insignificant residuals, and four units (3.25%) were left with significant residual stones. CONCLUSIONS: Tubeless PCNL is a good option in non-complicated PCNL with the advantages of reduced hospital stay, low postoperative pain, and little need for postoperative analgesia.