Introduction: This study aimed to describe single-stage urethroplasty and to determine factors associated with urethrocutaneous fistula after the procedure at our institution. Methods: All hypospadias patients without any prior surgery who underwent single-stage urethroplasty from July 2010 to January 2018 were included. In total, 179 patients were followed for at least one year postoperatively. Information on types of hypospadias, operation techniques, chordee degree, preoperative pyuria (urine white blood cell count >5/HPF), urethral defect length and urethrocutaneous fistula formation was collected. Results: We obtained 103 cases of posterior (57.5%), middle (57 cases) and anterior (19 cases) hypospadias on whom onlay preputial island flap (71 cases), tubularized incised plate (46 cases) and Duckett’s transverse preputial island flap (35 cases) were conducted. After 47.1±25.8 months of follow-up, urethrocutaneous fistula were found in 23 (12.8%) patients associated with posterior hypospadias occurrence ( p=0.025), longer urethral defect ( p=0.007) and preoperative pyuria ( p<0.001). Chordee degree ( p=0.886) and age ( p=0.187) were not significant factors associated with urethrocutaneous fistula formation. Conclusion: Single-stage urethroplasty is a versatile procedure for various hypospadias cases, with a urethrocutaneous fistula rate of 12.8%. Posterior hypospadias, preoperative pyuria and longer urethral defect were associated with urethrocutaneous fistula formation. Level of evidence Level 2B.
Background ESWL is still considered as the first favorable therapeutic option for urinary stone disease with acceptable effectivity. However, factors associated with favorable outcome have not been widely studied in pediatrics due to the small number of urinary stone prevalence. The aim of this study is to evaluate the factors associated with the success rate of pediatric ESWL in our center according to immediate stone-free rate and 3-month stone-free rates. Methods This is a retrospective cohort study of children less than 18 years who had ESWL for urolithiasis from January 2008 until August 2015. Patient’s characteristics including age, gender, BMI, stone location, stone length, stone burden, stone opacity, and number of ESWL sessions were gathered from the medical record. Nutritional status was determined according to the Centers for Disease Control and Prevention BMI curve. The outcome of this study was the factors related to the success rate in pediatric ESWL. Results Extracorporeal shock wave lithotripsy was done for 36 patients and 39 renal units (RUs) with mean age of 13.7 ± 4.3 years old, height of 1480 ± 16.0 cm, and BMI of 20.0 ± 3. Of 36 patients included, 39 renoureteral units (RUs) and 46 ESWL sessions were recorded. The mean overall treatment was 1.2 ± 0.5 sessions with mean stone length of 11.1 ± 6.3 mm and stone burden of 116.6 ± 130.3 mm2. Within 3 months of follow-up, we recorded that the overall 3-month success rate was 100%, while the overall 3-month stone-free rate was 66.7%. Stone length (p < 0.001 and p < 0.001), stone perpendicular length (p < 0.001 and p < 0.001), and stone burden (p < 0.001 and p = 0.001) were found to be significantly associated with immediate success and 3-month stone-free status, respectively. Conclusions ESWL is an effective and safe modality to treat pediatric urolithiasis cases. Stone length, stone perpendicular length, and stone burden were found to be associated with immediate success and 3-month stone-free status after pediatric ESWL treatment.
Introduction: Eosinophilic ureteritis is a very rare etiology of ureteric obstruction that leads to hydroureteronephrosis. We have only so far discovered a few case reports discussing eosinophilic ureteritis and the exact cause of this condition is poorly understood. Clinical findings: we report a very interesting case of a 71-year-old patient presenting with general weakness and oliguria, computed tomography (CT) scan found bilateral hydroureteronephrosis caused by recurring ureteric strictures. Diagnosis, interventions, and outcomes: ureterorenoscopy (URS) to extract a specimen for biopsy and laser fulguration to relieve ureteral strictures was performed. Double-J (DJ) stents were inserted both in the left and right ureters to overcome the ureteric strictures. Microscopy of the excised specimen revealed dominant eosinophilic infiltration. Therefore, diagnosis of eosinophilic ureteritis was made. In addition to stenting, Meropenem and Mirabegron was given to the patient. After a week of observation, the patient made a full recovery with no signs of initial symptoms. Conclusion: It is important to consider eosinophilic ureteritis in the differential diagnosis of any ureteric stricture because it is a highly uncommon entity with variable clinical characteristics. The gold standard procedure, which should be utilized to make the diagnosis, is a histological examination.
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