Ureterocalycostomy can be performed in patients in whom desired methods of treating secondary PUJ (Pelvi-Ureteric Junction) obstructions either failed or could not be used.In our study, one child and two adults in whom one redo-ureterocalycostomy and two ureterocalycostomies were performed for severely scarred PUJ. The causes for secondary PUJ obstruction were post-pyelolithotomy in one case, post-pyeloplasty and ureterocalycostomy for PUJ obstruction in the second patient and the third patient had long upper ureteric stricture post-ureteropyeloplasty due to tuberculosis. In all these cases ureterocalycostomy proved to be salvage/final resort for preserving functional renal unit.
Objective: Urethrocutaneous fistula, which occurs after hypospadias surgery, is often a baffling problem and its treatment is challenging. The study aimed to evaluate the results of the simple procedure (Durham Smith vest-over-pant technique) for this complex problem (post-hypospadias repair fistula). Methods: During the period from 2011 to 2015, 20 patients with post-hypospadias repair fistulas underwent Durham Smith repair. Common age group was between 5 and 12 years. Site wise distribution of fistula was coronal 2 (10%), distal penile 7 (35%), mid-penile 7 (35%), and proximal-penile 4 (20%). Out of 20 patients, 15 had fistula of size <5 mm (75%) and 5 patients had fistula of size >5 mm (25%). All cases were repaired with Durham Smith vest-over-pant technique by a single surgeon. In case of multiple fistulas adjacent to each other, all fistulas were joined to form single fistula and repaired. Results: We have successfully repaired all post-hypospadias surgery urethrocutaneous fistulas using the technique described by Durham Smith with 100% success rate. Conclusion: Durham Smith vest-over-pant technique is a simple solution for a complex problem (post hypospadias surgery penile fistulas) in properly selected patients.
Purpose:We evaluate here our experience with modified Cantwell–Ransley technique described by Gearhart for correction of isolated continent epispadias in adults with respect to its long-term functional outcome and complications.Introduction:Isolated male epispadias is a rare anomaly with a reported incidence of 1 in 11,700 males. Many surgical techniques with various modifications described to correct epispadias as treatment are debatable and challenging. The majority of the cases are treated at childhood as clinical presentation is striking at birth; hence, presentation in adulthood is extremely rare.Materials and Methods:During the past 5 years, modified Cantwell–Ransley technique described by Gearhart was performed in five cases of isolated continent epispadias which includes two cases of proximal penile, two distal penile and one penopubic. All cases were fresh except one had prior failed repair. Corporal rotation was done by delayed absorbable sutures without incision and anastomosis and suprapubic diversions placed in all the cases.
Results:All cases followed up ranging from 6 months to 5 years and were having horizontal and downwards angled penis. No case had urethrocutaneous fistula or stricture. One case had superficial skin infection which healed by secondary intention did not require any secondary procedure. All cases maintained erection post-operatively too. Catheterisation with soft tube revealed easily negotiable channel in all cases on follow-up.Conclusion:Modified Cantwell–Ransley repair described by Gearhart has excellent cosmetic, functional and anatomical results in isolated continent epispadias in the adult.
Aim: Aim of our study is to demonstrate that modified O'Connor's technique is possible and feasible for all types of postobstetric and gynecological procedures vesicovaginal fistula (VVF).
Materials and methods:The study of 38 patients includes 34 primary and four recurrent (operated primarily elsewhere) type of VVF treated by modified O'Connor technique with omental flap interposition between January 2009 to June 2016 by a single surgeon. Patients were followed postoperatively at 3 weeks, 3 monthly for 6 months and later depending on symptoms.Results: Common age group in our study between 30 years and 40 years (50%). Twenty-eight patients had simple fistula while 10 had a complex fistula. Fistula size ranges from 5 mm to 4 cm with the most common size ranges between 1 cm and 3 cm (28 patients). Thirty-three patients had a single fistula and 5 had two fistulae includes one patient of asymptomatic vesicoperitoneal fistula. The most common cause of fistula was posthysterectomy, for benign diseases (25 cases). the most common site was supratrigonal (28 cases) and in 10 cases involving either trigone or infratrigonal area. All patients were dry following catheter removal. The success rate of the technique was 100%. There was no perioperative complication except one patient had mild stress urinary incontinence (SUI), one had recurrent urinary tract infection and three had storage lower urinary tract symptoms (LUTS).
Conclusion:Modified O'Connor repair is safe and gives excellent functional results in postobstetrics and gynecological procedures related to VVF. Selection of technique should depend on experience and preference of surgeon which gives maximum success rate.
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