Laparoendoscopic single-site surgery in urology using conventional instruments: our initial experience.

PURPOSE: To present our initial experience with laparoendoscopic single-site (LESS) urologic surgery using conventional laparoscopic instruments and to assess its feasibility and safety. PATIENTS AND METHODS: In 20 patients, we performed LESS urologic surgery, which included simple nephrectomy in 9, nephroureterectomy in 1 for a refluxing nonfunctioning kidney, radical nephroureterectomy in 1, heminephroureterectomy in 1 for a nonfunctioning upper moiety in a complete duplex kidney, marsupialization of a renal cyst in 1, ureterolithotomy in 1, varicocelectomy in 2, pyeloplasty in 2, vesicovaginal fistula (VVF) repair in 1, and orchiopexy in 1. LESS was performed using a small periumbilical incision, inserting regular trocars, and using a conventional 30-degree laparoscope and laparoscopic instruments. Data were collected prospectively with respect to feasibility, intraoperative or postoperative complications, postoperative pain, analgesic requirement, and recovery. RESULTS: Since March, 2012, a total of 20 patients have undergone LESS for various urologic conditions. All cases were completed successfully, without conversion to a standard laparoscopic or open approach. The total operative time for the nephrectomy, nephroureterectomy, pyeloplasty, VVF repair, ureterolithomy, varicocelectomy, or orchiopexy was 134 ± 20.06, 186 ± 40, 135 ± 21, 180, 150, 55, and 60, minutes, respectively. The mean blood loss was 100 mL. No intraoperative complication occurred. The mean pain score on the visual analog scale was 8.35 ± 0.9 (8-10) on day 1, 4.8 ± 1.6 (2-8) on day 2, and 2 ± 1.2 (2-4) on day 3. Similarly, the mean analgesic requirement was 220 ± 41 mg, 85 ± 74 mg, and 30 ± 47 mg of intravenous tramadol, respectively. One patient had surgical emphysema of the abdomen and another had ileus for 4 days. The mean hospital stay was 2.9 ± 1.7 (2-7) days. CONCLUSION: In selected patients, LESS for urological indications using conventional laparoscopic instruments is safe and feasible with no added cost. Additional experience and continued investigation are warranted.

Simultaneous bladder and vaginal reconstruction using ileum in complicated vesicovaginal fistula.

OBJECTIVES: To discuss the outcome of surgical repair in complicated vesicovaginal fistula with simultaneous bladder and vaginal reconstruction using ileum. MATERIALS AND METHODS: Four female patients in the age group of 12-30 years are included. All the patients had complicated vesicovaginal fistula with vaginal stenosis secondary to obstetric hysterectomy (except one secondary to the genitourinary tuberculosis). Repair of vesicovaginal fistula with simultaneous bladder augmentation, ureteric reimplantation, and reconstruction of vagina using ileum was performed in all the cases. RESULTS: All the patients had successful repair of fistula. Vaginal reconstruction using ileum, resulted in capacious vagina. Adult patients resumed to normal sexual life. Mucus discharge was the only complaint in postoperative period. CONCLUSIONS: Malnutrition, anemia, obstructed labor, Intra uterine fetal death (IUFD), postpartum hemorrhage following forceps delivery in a rural setting followed by an emergency obstetric hysterectomy after a delay of 6-8 h (due to transfer to a tertiary center) were the few contributing factors leading to the formation of vesicovaginal fistula (VVF). Preoperative assessment of bladder capacity and vaginal capacity in such cases is mandatory. The small bowel is a readily available vascular tissue for restoring bladder and vaginal capacity.

Chronic urinary retention in eunuchs.

Eunuchs seek medical attention only when extremely distressed by symptoms. No scientific publication has highlighted the medical problems of eunuchs in India till date, probably because of lack of access to this community and their reluctance in seeking medical help. We evaluated four eunuchs in the last three years with chronic retention of urine due to urethral stenosis, caused by an incorrect method of amputation of the penis and urethra. Though the management of the problem is simple, the article highlights the traditional method of castration and penectomy which is practiced in Indian eunuchs which leads to urethral stenosis.