[show abstract] [hide abstract]
ABSTRACT: We present our preliminary experience in the management of inflammatory anterior urethral strictures with a dorsally/dorsolaterally placed penile/preputial vascularized flap and discuss the distinct advantages of this procedure over a traditional ventrally placed flap.
Twelve patients (age, 20-66 years; mean age, 40.5 years) with recurrent inflammatory strictures of the penile and/or bulbar urethra (penile, 2; bulbar, 5 and bulbopenile, 5) were treated with dorsally/dorsolaterally placed penile/preputial (penile skin, 5; prepuce, 7) vascularized flap substitution urethroplasty. Prior to surgery, 7 patients had suprapubic cystostomy for acute urinary retention and 5 had a mean peak flow rate of 6.2 ml/sec. Inferior pubectomy was performed as an adjunct in two patients to facilitate proximal placement of the flap. Follow-up (5 to 24 months; mean, 15.5) included uroflowmetry and retrograde urethrograms at 6, 12 and 18 months, and thereafter as required.
The mean stricture length was 5.8 cm (range, 3 to 12 cm) and all strictures were associated with dense spongifibrosis. Temporary urethral fistulae, which healed spontaneously, occurred in 4 patients. The clinical and radiological outcome during the mean follow up of 15.5 months was gratifying. The mean peak flow rate improved to 24.2 ml/sec. No stricture recurrence has been noted to date. Sacculation of the flap, diverticulum formation and post-void dribble have not been encountered. None of the patients developed chordee or erectile dysfunction.
Dorsal onlay preputial/penile flap urethroplasty is a versatile procedure in the treatment of inflammatory anterior urethral strictures. The dorsal pedicle flap may be anatomically and functionally more logical as compared to the traditional ventrally placed flap.
Archivos españoles de urología 10/2001; 54(7):749-55.
[show abstract] [hide abstract]
ABSTRACT: To evaluate the efficacy of a semirigid mini-endoscope and the Swiss Lithoclast compared with a conventional rigid endoscope and ultrasound, the results of transurethral ureteroscopic lithotripsy in 147 patients over a period of 30 months were analyzed according to the type of ureteroscope (rigid v semirigid) and energy (ultrasound v Lithoclast) used. In the initial 25 cases (Group I), a conventional rigid ureteroscope and ultrasound were used. The latter 122 patients (Group II) were subjected to ureteroscopic lithotripsy using a miniscope and the Lithoclast. The results were superior in Group II with respect to the overall success rate (p = 1.6 x 10[-2]), first-attempt success rate (p = 2.9 x 10[-4]), and the need for ureteral dilation (P = 1.0 x 10[-6]) compared with Group I. There were no major complications. Overall, minor complications (hematuria and urinary tract infection) were observed in 25% of the cases. Further, the results of ureteroscopic lithotripsy in Group II were comparable to those of SWL in situ for upper ureteral calculi and better than for those located in the iliac and lower ureter as reported previously. Our results demonstrate that the Swiss Lithoclast provides effective fragmentation of even hard and smooth stones without increasing the complication rate. This lithotripter is reliable, safe, and simple to operate. In addition, the cost of maintenance is almost nil.
Journal of Endourology 11/1997; 11(5):327-30. · 2.07 Impact Factor
The National medical journal of India 11(4):158-9. · 0.91 Impact Factor