Application of small intestinal submucosa graft for repair of complicated vesicovaginal fistula: a pilot study.

PURPOSE: Vesicovaginal fistula is a socially debilitating problem with important psychological and medicolegal implications. Complicated fistulas include large fistulas or those with failed prior repair attempts. The key to successful closure of such fistulas is the use of adjuncts such as a Martius, peritoneal or omental flap. Small intestinal submucosa is an acellular collagen matrix graft that is nonimmunogenic, biodegradable and ready to use off the shelf. We evaluated small intestinal submucosa as an interposition patch during complicated vesicovaginal fistula repair. MATERIALS AND METHODS: A total of 23 women with a mean age of 33.5 years who had a complicated vesicovaginal fistula were enrolled in this clinical trial. Complicating factors were failed primary repair in 9 cases, excessive perifistulous scarring in 4 patients and a fistula 1.5 cm or greater in the remainder. Transvaginal repair was done in 7 low fistula cases and transabdominal repair was done in the remainder with a high fistula. A small intestinal submucosa patch was interposed in all cases at classic abdominal or vaginal repair. All patients were evaluated 1, 3 and 6 months postoperatively. RESULTS: All patients who underwent vaginal repair were dry during followup. Of the 16 women who underwent transabdominal repair 14 were dry. The overall success rate was 91.3%. No reported allergic or inflammatory reactions were documented. CONCLUSIONS: Using small intestinal submucosa as an interposition layer at anatomical vaginal and/or transabdominal repair of complicated vesicovaginal fistulas seems to be a simple, feasible solution.

Laparoscopic pyelolithotomy in selected patients with ectopic pelvic kidney: a feasible minimally invasive treatment option.

BACKGROUND AND PURPOSE: Ectopic pelvic kidney is a rare congenital anomaly. It carries more risks for obstruction and stone formation than a normal located kidney. The treatment of renal stones in these patients is challenging. We present our experience with laparoscopic pyelolithotomy for treatment of selected patients with large and multiple renal stones in ectopic pelvic kidneys. PATIENTS AND METHODS: After insertion of a ureteral catheter, pneumoperitoneum was achieved by Veress needle, and the kidney was exposed. The renal pelvis was identified, dissected, and opened. The stones were extracted using laparoscopic forceps. The rigid nephroscope was used to extract any caliceal stones. The renal pelvis was sutured, and the stones were removed from the peritoneal cavity. The procedure was concluded after placement of an intraperitoneal drain. RESULTS: A total of 11 patients with large renal pelvic and/or multiple stones underwent laparoscopic transperitoneal pyelolithotomy. A transmesenteric approach was used in eight patients while the colon was mobilized off the kidney in three patients. All stones were removed except one that needed Double-J stent placement and one session of shockwave lithotripsy. After one auxiliary procedure, the stone-free rate was 100%. There were no major intraopertive or postoperative complications. Within a mean follow-up period of 23 months, no stone recurrence occurred. CONCLUSIONS: Laparoscopic pyelolithotomy for large and multiple stones in ectopic pelvic kidneys is a feasible minimally invasive treatment option. The technique allows removal of all the stones without fragmentation, which may decrease the possibility for rapid stone recurrence.

Right subclinical varicocele: how to manage in infertile patients with clinical left varicocele?

In this prospective study, we compared the results of bilateral varicocelectomy and left varicocelectomy for treatment of infertile patients with subclinical right and clinical left varicoceles with oligoasthenospermia. Because there was more improvement in semen parameters and pregnancy rate in patients who underwent the bilateral surgery, we concluded that right subclinical varicocele should be surgically treated in conjunction with the left one.

Analysis of risk factors for organic erectile dysfunction in Egyptian patients under the age of 40 years.

Many risk factors have been implicated in the pathogenesis of erectile dysfunction (ED), but it is not clearly evident which of these factors are more relevant among the young population. The aim of this project was to find the most significant risk factors for this disease in young patients. We included 434 patients with organic ED younger than 40 years and 272 age-matched controls. All participants had their complete history taken (including the International Index of Erectile Function-5 [IIEF-5]) and underwent physical examination and some laboratory investigations. Univariate analysis was then applied to study the significance of the following factors in the predisposition of ED: smoking, use of recreational drugs, obesity, dyslipidemia, diabetes mellitus, hypertension, coronary heart disease, and chronic pelvic pain syndrome. This analysis showed that smoking, use of recreational drugs, dyslipidemia, hypertension, and obesity were the significant factors (P < .05 for each factor). When these significant factors were studied in the multivariate model, the only factors that sustained the statistical significance were smoking (P < .05; odds ratio [OR], 1.78; 95% confidence interval [95% CI], 1.16-2.72) and use of recreational drugs (P < .05; OR, 3.18; 95% CI, 1.15-8.82). In addition, a negative correlation was detected between the smoking index of the impotent patients and their IIEF-5 score (r(2) = 0.67; P < .05). In conclusion, smoking and the use of recreational drugs are the most significant risk factors for organic ED in patients younger than 40 years.