Surgical interventions in female urethral strictures: a comprehensive literature review.

INTRODUCTION AND HYPOTHESIS: Female urethral stricture (FUS) is an uncommon entity. Although there is no clinical consensus on the best modality of treatment, several studies have been published describing different techniques of FUS management. We carried out a literature review of the different surgical techniques used in the management of FUS and their results. METHODS: We performed a systematic search of the PubMed and EMBASE databases and several cross-references. We grouped the data available from the studies into four general treatment categories. RESULTS: We reported 35 studies (488 patients) with outcome measures; 53.48% of cases were presumably idiopathic in origin. A history of prior intervention was described in 91.29% of cases. As a surgical intervention, urethral dilatation (UD) had the lowest success rate of only 41.25%. In contrast, local flaps performed better (92.54% success rate) than local or oral grafts (87.30% and 89.94%, respectively). Only 9.43% of patients experienced mild to moderate post-surgery de novo incontinence; most of them recovered with pelvic floor exercises. CONCLUSION: In practice, UD is tried first for FUS, at least once, before urethroplasty. In case of failure or short recurrence following UD, urethroplasty should not be delayed. In experienced hands, urethroplasty has a better outcome.

Same-day angiography and embolization in delayed hematuria following percutaneous nephrolithotomy: an effective, safe, and time-saving approach.

PURPOSE: To evaluate the results of prompt, same-day selective angiography and transcatheter angioembolization (TAE) on delayed post-percutaneous nephrolithotomy (PCNL) hematuria. MATERIALS AND METHODS: Between 2011 and 2017, 21 patients with a mean age of 37 years (range, 21-60 years; males, 18) underwent digital subtraction angiography (DSA) and TAE to control delayed gross hematuria following PCNL. Discharged patients who following an uneventful PCNL presented to the emergency room with gross, brisk hematuria were included in the study and taken up for prompt, same-day DSA and same-session TAE with N-butyl-2-cyanoacrylate glue, without resorting to any initial conservative measures. All patient data were retrieved from medical records. RESULTS: Angiography revealed vascular lesions in all the cases (pseudoaneurysms, 14 cases; arteriovenous fistula, 2; mixed lesions, 5). The mean time of onset of delayed hemorrhage was 10.10±2.67 days. The average time from onset of bleeding to TAE was 4.31±0.64 hours (range 3.5-5.5 hours). Bleeding was controlled in all the cases without any recurrence or the need for further embolization. There were no procedural complications except for transient elevation of serum creatinine in four cases. CONCLUSION: Primary DSA and TAE is a safe, effective, and time-saving alternative to conservative management for post-PCNL, delayed, gross hematuria.

Flank bulge following subcostal percutaneous nephrolithotomy.

Loss of tone of the anterolateral abdominal wall muscles due to denervation injury is quite common after open renal surgery by lumbotomy incision. Although rare, flank bulge following percutaneous nephrolithotomy (PCNL) after supracostal approach has been reported in literature. But pseudohernia after PCNL with subcostal access has not been reported yet. In this case report, we present the rare complication of an abdominal wall bulge that occurred after PCNL with a subcostal access. The index case had been operated for a partial staghorn calculus with lower calyceal extension. PCNL with subcostal approach was used. Complete stone-free status was achieved with an uneventful recovery. During the first follow-up after 1 week, an unsightly, painless flank bulge was noticed, which continued to persist till 9 months of periodic follow-up.