<b><i>Introduction:</i></b> This study was carried out to identify the predictors of urethral stricture recurrence after dorsal onlay buccal mucosal graft (BMG) urethroplasty. <b><i>Materials and Methods:</i></b> The medical records of patients with anterior urethral stricture who underwent dorsal onlay BMG urethroplasty at a single tertiary medical center during the period from March 2010 to January 2018 were reviewed. Only patients with ≥2-year follow-up were included. Data regarding patient demographics, clinical characteristics, stricture characteristics, postoperative course, and adverse events were recorded. Kaplan-Meier analysis was used to assess the recurrence-free survival and likelihood of stricture recurrence. Cox regression analysis was used to identify potential independent predictors of stricture recurrence. <b><i>Results:</i></b> This study included 266 patients with a mean age of 37.71 years and a mean follow-up period of 49.77 months. From the overall study cohort, 34 (12.8%) reported stricture recurrence and 232 (87.2%) were not. The mean recurrence-free time was 79.93 months and mean time to recurrence was 21.59 months. On multivariate analysis, obesity (hazard ratio (HR): 6.02; 95% conference interval (CI): 1.91, 19.03: <i>p</i> = 0.002), inflammatory aetiology (HR: 9.13; 95% CI: 3.50, 23.81; <i>p</i> < 0.001), prior urethroplasty (HR: 8.81; 95% CI: 3.26, 23.86; <i>p</i> < 0.001), penile stricture location (HR: 3.09; 95% CI: 1.10, 8.71; <i>p</i> = 0.033), and stricture length >4.5 cm (HR: 6.83; 95% CI: 1.69, 27.62; <i>p</i> = 0.007) were the significant independent predictors of stricture recurrence. <b><i>Conclusions:</i></b> Dorsal onlay BMG urethroplasty has a reasonable recurrence-free rate with acceptable postoperative complications. Obesity, inflammatory etiology, prior urethroplasty, penile stricture location, and longer stricture were the factors associated with urethral stricture recurrence.
To compare the outcomes of miniaturised percutaneous nephrolithotomy (mini-PCNL) and extracorporeal shockwave lithotripsy (ESWL) in the management of 10-20 mm, non-lower pole, renal stones.
Patients and MethodsThis prospective randomised double-arm trial was conducted at a tertiary care hospital in Egypt from February to December 2020. Adult patients with single, non-lower pole, high-density (≥1000 HU) renal stones were randomised to receive mini-PCNL or ESWL. The stone-free rate (SFR); operative, fluoroscopy and hospitalisation times; blood loss; auxiliary procedures; retreatment; unscheduled hospital readmission; and complications were compared between the groups.
ResultsThe primary analysis included 34 patients in the mini-PCNL group and 33 in the ESWL group. Overall, the SFR was 97.1% in the mini-PCNL group vs 30.3% in the ESWL group (P < 0.001). All patients in the ESWL group required retreatment, and none of them were stone-free after the first ESWL session. None of the patients in the mini-PCNL group required retreatment. The overall operative time, fluoroscopy time, auxiliary procedure, retreatment, and unscheduled hospital readmission were significantly higher in the ESWL group. The hospital stay and decrease in the haemoglobin level were significantly higher in the mini-PCNL group. The groups were comparable for the overall complication rate.
ConclusionsMini-PCNL is more effective than ESWL for treating 10-20 mm, high-density, non-lower pole renal stones. Mini-PCNL has the advantages of a high SFR and abolishing the need for retreatment and re-hospitalisation.
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