Objective: The diagnosis and treatment of female urethral stricture disease (FUSD) are practiced variably due to the scarcity of data on evaluation, variable defi nitions, and lack of long-term surgical outcomes. FUSD is diffi cult to rule out solely on the basis of a successful calibration with 14F catheter. In this study, we have tried to characterize the variable clinical presentation of FUSD, the diagnostic utility of calibration, videourodynamic study(VUDS), and urethroscopy in planning surgical management. Materials and Methods: A retrospective review of records of 16 patients who underwent surgical management of FUSD was analyzed. The clinical history, examination fi ndings, and the results of all the investigations (including urofl owmetry, VUDS fi ndings, urethroscopy) they underwent, the procedures they had undergone ,and the follow-up data were studied. Results: A total of 16 patients underwent surgical management of FUSD. 13 out of 16 patients had successful calibration with 14F catheter on the initial presentation. These 13 patients on VUDS demonstrated signifi cant BOO and had variable stigmata of stricture on urethroscopy. The mean IPSS, fl ow rate, and PVR at presentation and after urethroplasty were 23.88±4.95, 7.72±4.25mL/s, 117.06±74.46mL and 3.50±3.44, 22.34±4.80mL/s, and 12.50±8.50mL, respectively. (p <0.05). The mean fl ow rate after endo dilation(17F) (n=12) was 11.4±2.5mL/s while after urethroplasty improved to 20.30±4.19mL/s and was statistically signifi cant(p <0.05). Conclusions: An adept correlation between clinical assessment, urethroscopy fi ndings, and VUDS is key in objectively identifying FUSD and planning surgical management. A good caliber of the urethra is not suffi cient enough to rule out a signifi cant obstruction due to FUSD. Early urethroplasty provides signifi cantly better outcomes in patients who have failed dilation as a treatment.
In the developed nations, temporary ileostomies are usually made in order to protect a distal anastomosis after cancer surgery. However, in India and the neighbouring countries ileal perforation is the most common indication for creating a temporary ileostomy after emergency laparotomy. It seems logical to perform a contrast study when a stoma that was made to protect a bowel anastomosis is being reversed in order to check for anastomosis healing, leak or stenosis. Although we do not know precisely when and why we started this practice, it is customary at our institute to do a contrast study before reversal of a temporary ileostomy. At some institutes a routine contrast study is never done. The utility of this practice has not previously been studied at our institute. This study tries to correlate the surgeon's clinical and operative findings with the contrast study report in order to see if it may be reasonable to reverse the stoma without a routine contrast study in selected patients where the surgeon has clearly documented absence of any gross disease in the distal bowel and who have had an uneventful post-operative period. To our knowledge this appears to be the first such attempt from our country.
Background: Renal angiomyolipoma is the most common benign tumor of kidney. It is often associated with pulmonary lymphangioleiomyomatosis specially when it is associated with tuberous sclerosis. This association is often missed and the patient bears the risk of hyperinflation lung injuries during or after the treatment of renal angiomyolipoma. Case Report: We hereby report a patient with pain and swelling in left side of the abdomen suggestive of a renal mass. She underwent left simple nephrectomy which eventually came out to be renal angiomyolipoma. She had other characteristics of tuberous sclerosis for which computed tomography of thorax and guided biopsy was done which revealed the presence of pulmonary lymphangioleiomyomatosis.
Conclusion:We should be aware of the co-existence of both renal angiomyolipoma and pulmonary lymphangiomyomatosis specially when other features of tuberous sclerosis are present. We should ensure regular follow-up and treat both the diseases to ensure the complete recovery of the patient.
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