Laser epilation of luminal hair following skin graft urethroplasty for hypospadias: the hair snare

2021 ◽  
Vol 14 (9) ◽  
pp. e244123
Author(s):  
Siddharth Kumar ◽  
Ankur Mittal ◽  
Vikas Kumar Panwar ◽  
Arup Kumar Mandal
Keyword(s):  
Perioperative Complications ◽  
Urethral Diverticulum ◽  
Hair Follicles ◽  
Urethral Reconstruction ◽  
Internal Urethrotomy ◽  
Ho:Yag Laser ◽  
Micturating Cystourethrogram ◽  
Retrograde Urethrogram ◽  
Laser Epilation

A 66-year-old man, who underwent urethral reconstruction using skin grafts for hypospadias five decades earlier as a 13-year-old child, presented with burning micturition and recurrent UTI. A retrograde urethrogram along with micturating cystourethrogram revealed a bulbar urethral stricture and broad neck distal penile urethral diverticulum. On a cystourethroscopic examination, a urethral diverticulum was seen just proximal to the hypospadiac external urethral meatus with 12–15 hair follicles inside the diverticulum and a 1 cm long mid-bulbar stricture. Visual internal urethrotomy for the bulbar stricture, a diverticular neck incision, laser epilation and hair follicle photocoagulation was performed using a 30 W Ho:YAG laser. The depilated hair tufts were extracted. The process was repeated again in 6 months due to recurrent symptoms. A patent urethra with a wide open diverticulum without any residual hair follicles was confirmed. No perioperative complications noted and the patient is doing well on 1 month of follow-up.

scholarly journals Congenital anterior urethral diverticulum in male child

2018 ◽  
Vol 7 (1) ◽  
pp. 45-47
Author(s):  
Mohammad Afzalur Rahman
Keyword(s):  
Renal Function ◽  
Normal Renal Function ◽  
Urethral Diverticulum ◽  
Male Child ◽  
Urinary Symptoms ◽  
Urethral Reconstruction ◽  
Retrograde Urethrogram ◽  
Uncommon Condition ◽  
Anterior Urethral Diverticulum

Congenital anterior urethral diverticulum is an uncommon condition in males. In my series a 15 years old boy with congenital anterior urethral diverticulum was presented with urinary symptoms and ventral penile swelling. The diagnosis was made on retrograde urethrogram (RGU) and micturiting cystourethrogram (MCU). The patient had normal renal function. Open diverticulectomy and primary urethral reconstruction was carried out uneventfully. CBMJ 2018 January: Vol. 07 No. 01 P: 45-47

scholarly journals Is anastomotic urethroplasty is really superior than BMG augmented dorsal onlay urethroplasty in terms of outcomes and patient satisfaction: Our 4-year experience

2015 ◽  
Vol 9 (1-2) ◽  
pp. 22 ◽  
Author(s):  
Anil Kumar Choudhary ◽  
Nawal K. Jha
Keyword(s):  
Patient Satisfaction ◽  
Skin Flap ◽  
Short Segment ◽  
Buccal Mucosa Graft ◽  
Micturating Cystourethrogram ◽  
Retrograde Urethrogram ◽  
Dorsal Onlay ◽  
End To End ◽  
Anastomotic Urethroplasty

Introduction: We analyzed the outcomes of augmented buccal mucosa graft (BMG) dorsal onlay urethroplasty and anastomotic urethroplasty in the management of urethral stricture.Methods: Patients having a stricture length more than 2 cm were treated by augmented BMG dorsal onlay urethroplasty; patients with a stricture length less than 2 cm were managed by excision and end-to-end anastomotic urethroplasty. The postoperative retrograde urethrogram, micturating cystourethrogram, and uroflowmetry were compared to preoperative values. The postoperative subjective symptoms and complications were recorded and analyzed.Results: In total, 90 patients were included in this study. Forty-five patients had an average stricture length of 5.9 cm; they underwent BMG augmented dorsal onlay urethroplasty. Of these, 7 (15.55%) patients came with recurrence, while 38 (84.44%) were asymptomatic, in the average follow-up period of 32.8 months. The next 45 patients underwent excision of the stricture and end-to-end anastomosis. Of these, 6 (13.33%) failed on therapy and the remaining 39 (86.66%) were asymptomatic during the average follow-up period of 28.4 months.Conclusion: The technique of BMG dorsal onlay is easy to do, it is very reliable, has high success rate, less postoperative complications and better patient satisfaction compared to anastomotic urethroplasty. Our study has its limitations. Recurrent cases of urethroplasty and hypospadias were excluded from this study. Recurrent stricture cases were eliminated to overcome bias. Cases of hypospadias are still best treated by axial or random penile skin flap as BMG augmentation cannot create a long urethral tube. Based on our 4-year experience, we recommend BMG augmented urethroplasty long and short segment stricture of the urethra.

EVALUATION OF LONGO’S HEMORRHOIDECTOMY AT HUE UNIVERSITY HOSPITAL

2012 ◽  
pp. 79-85
Author(s):  
Van Lieu Nguyen ◽  
Doan Van Phu Nguyen ◽  
Thanh Phuc Nguyen
Keyword(s):  
Hospital Stay ◽  
Perioperative Complications ◽  
University Hospital ◽  
Anal Pain ◽  
Stapled Hemorrhoidectomy ◽  
Fourth Degree ◽  
Duration Of Hospital Stay ◽  
The Mean ◽  
Good For

Introduction: Since Longo First described it in 1998, Stapled Hemorrhoidectomy has been emerging as the procedure of choice for symtomatic hemorrhoid. Several studies have shown it to be a safe, effective and relative complication free procedure. The aim of this study was to determine the suitability of (SH) as a day cas procedure at Hue University Hospital. Methods: From Decembre 2009 to April 2012, 384 patients with third- degree and fourth-degree hemorrhoids who underwent Stapled Hemorrhoidectomy were included in this study. Parameters recorded included postoperative complications, analegic requirements, duration of hospital stay and patient satisfaction. Follow-up was performed at 1 month and 3 months post-operative. Results: Of the 384 patients that underwent a Stapled Hemorrhoidectomy 252 (65,7%) were male and 132 (34,3%) were female. The mean age was 47,5 years (range 17-76 years. Duration of hospital stay: The mean day was 2,82 ± 1,15 days (range 1-6 days). There were no perioperative complications. There was one case postoperative complication: hemorrhage; Follow-up after surgery: 286 (74,4%) patients had less anal pain, 78 (20,3%) patients had moderate anal pain, 3 (0,8%) patients had urinary retention; Follow-up after one month: good for 325 (84,6%) patients, average for 59 (15,4%) patients; Follow-up after three months: good for 362 (94,3%) patients, average for 22 (5,7%) patients. Conclusion: Our present study shows that Stapled Hemorrhoidectomy is a safe, reduced postoperative pain, shorter hospital stay and a faster return to unrestricted daily activity

A propensity-adjusted comparison of endoscopic endonasal surgery versus transcranial microsurgery for pediatric craniopharyngioma: a single-center study

2021 ◽  
pp. 1-10
Keyword(s):  
Perioperative Complications ◽  
Single Center ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Adjusted Analysis ◽  
Significant Difference ◽  
Csf Leakage ◽  
Hypothalamic Function

OBJECTIVE When comparing endoscopic endonasal surgery (EES) and transcranial microsurgery (TCM) for adult and mixed-age population craniopharyngiomas, EES has become an alternative to TCM. To date, studies comparing EES and TCM for pediatric craniopharyngiomas are sparse. In this study, the authors aimed to compare postoperative complications and surgical outcomes between EES and TCM for pediatric craniopharyngiomas. METHODS The data of pediatric patients with craniopharyngiomas who underwent surgery between February 2009 and June 2021 at a single center were retrospectively reviewed. All included cases were divided into EES and TCM groups according to the treatment modality received. The baseline characteristics of patients were compared between the groups, as well as surgical results, perioperative complications, and long-term outcomes. To control for confounding factors, propensity-adjusted analysis was performed. RESULTS Overall, 51 pediatric craniopharyngioma surgeries were identified in 49 patients, among which 35 were treated with EES and 16 were treated with TCM. The proportion of gross-total resection (GTR) was similar between the groups (94.3% for EES vs 75% for TCM, p = 0.130). TCM was associated with a lower rate of hypogonadism (33.3% vs 64.7%, p = 0.042) and a higher rate of growth hormone deficiency (73.3% vs 26.5%, p = 0.002), permanent diabetes insipidus (DI) (60.0% vs 29.4%, p = 0.043), and panhypopituitarism (80.0% vs 47.1%, p = 0.032) at the last follow-up. CSF leakage only occurred in the EES group, with no significant difference observed between the groups (p > 0.99). TCM significantly increased the risk of worsened visual outcomes (25.0% vs 0.0%, p = 0.012). However, TCM was associated with a significantly longer median duration of follow-up (66.0 vs 40.5 months, p = 0.007) and a significantly lower rate of preoperative hypogonadism (18.8% vs 60.0%, p = 0.006). The propensity-adjusted analysis revealed no difference in the rate of recurrence, hypogonadism, or permanent DI. Additionally, EES was associated with a lower median gain in BMI (1.5 kg/m2 vs 7.5 kg/m2, p = 0.046) and better hypothalamic function (58.3% vs 8.3%, p = 0.027) at the last follow-up. CONCLUSIONS Compared with TCM, EES was associated with a superior visual outcome, better endocrinological and hypothalamic function, and less BMI gain, but comparable rates of GTR, recurrence, and perioperative complications. These findings have indicated that EES is a safe and effective surgical modality and can be a viable alternative to TCM for pediatric midline craniopharyngiomas.

scholarly journals Tubularized proximally-incised plate in distal/midshaft hypospadias repair

2017 ◽  
Vol 39 (2) ◽  
Author(s):  
Antonio Marte ◽  
Lucia Pintozzi
Keyword(s):  
Perioperative Complications ◽  
Foley Catheter ◽  
Case Series ◽  
Functional Results ◽  
Inclusion Criteria ◽  
Urethral Plate ◽  
Age At Surgery ◽  
Long Term Follow Up

The aim of this study was to verify the validity, feasibility, and the functional results, by uroflowmetry, of Tubularized proximallyincised plate technique in selected case of distal/midshaft hypospadias. Out of 120 patients scheduled to undergo TIP (or Snodgrass) procedure, 23 were selected between January 2013 and January 2016 (19.1%). This case series comprised 16 patients with distal and 7 with midshaft hypospadias. Mean age at surgery was 2.9 years. The inclusion criteria were a deep and wide glandular groove and a proximal narrow urethral plate. The procedure was carried out as described by Snodgrass but the incision of the urethral plate, including the mucosal and submucosal tissue, was made only proximally, between the original meatus and the glandular groove in no case extending to the entire length of the plate. Postoperatively a foley catheter was left in place from 4 to 7 days. Uroflowmetry was performed when the patients age ranged from 2.5 to 5.7 years (mean age 3.11 years and mean follow-up 1.8 years, body surface 2). No patient presented fistulas nor perioperative complications. At uroflowmetry, eighteen patients presented values above the 25<sup>th</sup> percentile and 5 showed a borderline flow. All patients in this group remained stable without urinary symptoms. In selected cases, the tubularized proximally-incised plate yields satisfactory cosmetic and functional results for the treatment of midshaft proximal hypospadias. A long-term follow-up study is needed for further evaluation. Patient selection is crucial for the success of this technique.

scholarly journals Measurement of operative femoral anteversion during cementless total hip arthroplasty and influencing factors for using neck-adjustable femoral stem

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jingyang Sun ◽  
Bohan Zhang ◽  
Lei Geng ◽  
Qingyuan Zheng ◽  
Juncheng Li ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Influencing Factors ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Demographic Data ◽  
Univariate Analysis ◽  
Femoral Stem ◽  
Femoral Anteversion ◽  
Total Hip

Abstract Background Placement of femoral stem in excessive anteversion or retroversion can cause reduced range of motion, prosthetic impingement, and dislocation. The aim of this study was to assess the operative femoral anteversion in patients treated with total hip arthroplasty (THA) and analyze the need of adjusting stem anteversion. Methods We retrospectively included 101 patients (126 hips) who underwent cementless THA with a manual goniometer to determine the femoral anteversion between October 2017 and December 2018. The operative femoral anteversion we measured was recorded during THA. We further divided those hips into three subgroups based on the range of operative femoral anteversion: group 1 (<10°), group 2 (10–30°), and group 3 (>30°) and compared the differences of their demographic data. Univariate and multivariate logistic regression were used to identify the influencing factors for the need of neck-adjustable femoral stem. The clinical and radiographic outcomes were also assessed. Perioperative complications were recorded. Results After THA, the Harris hip scores improved from 52.87 ± 15.30 preoperatively to 90.04 ± 3.31 at the last follow-up (p < 0.001). No implant loosening, stem subsidence, and radiolucent lines were observed on radiographs. No severe complications occurred and no components needed revision at the latest follow-up. The mean operative femoral anteversion was 14.21° ± 11.80° (range, −9 to 60°). Patients with femoral anteversion more than 30° were about 10 years younger than others. Femoral anteversion >30° was more common in patients with developmental dysplasia of the hip (DDH). There were totally 14 hips treated with the neck-adjustable femoral stem. From the univariate analysis, we can observe that female sex, diagnosis of DDH (compared with osteonecrosis), and higher operative femoral anteversion and its value >30° (compared with <10°) are associated with higher rates of using the neck-adjustable femoral stem. However, all these factors were no longer considered as independent influencing factors when mixed with other factors. Conclusions This study highlighted the significance of operative femoral anteversion. Identification of abnormal femoral anteversion could assist in adjusting stem anteversion and reduce the risk of dislocation after THA.

532 OUTCOME OF QUILICI’S HEPATIC SHOULDER PROCEDURE TO AUGMENT LAPAROSCOPIC HIATOPLASTY IN LARGE OR RECURRENT HIATAL HERNIA

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Johannes Zacherl ◽  
Viktoria Kertesz ◽  
Cordula Höfle ◽  
Lisa Gensthaler ◽  
Bernhard Eltschka ◽  
...  
Keyword(s):  
High Risk ◽  
Hernia Repair ◽  
Hiatal Hernia ◽  
Laparoscopic Hernia Repair ◽  
Perioperative Complications ◽  
Recurrent Hernia ◽  
Hernia Recurrence ◽  
Hiatal Hernia Repair ◽  
Laparoscopic Hiatal Hernia Repair

Abstract   Laparoscopic hiatoplasty and fundoplication is the gold standard of surgical treatment of GERD and hiatal hernia. However, the main drawback of laparoscopic hiatal hernia repair is a substantial recurrence rate. Hence, prosthetic meshs have been used to reduce the risk for recurrence. But meshs may cause major complications. As a consequence we adopted the hepatic shoulder plasty described by Quilici to augment the hiatal hernia repair in patients with a high risk for hernia recurrence. Methods Patients with large (&gt;4 cm) axial hiatal hernia, giant paraesophageal or with recurrent hernia consecutively underwent laparoscopic hernia repair with crural sutures and hepatic shoulder plasty. A Toupet or a floppy Nissen fundoplication was added. In patients with giant paraesophageal hernia the hernia sack was resected. Perioperative complications were recorded. Follow-up comprised endoscopy and/or radiography and QoL-evaluation with the Eypasch score (GIQLI). Results Between 2012 and 2018 51 patients (mean age 71 years, 65% female) underwent Quilici’s procedure. Among them 33,3% had one or more previous hiatal hernia repair. There were no conversions. Postoperative complication rate was 7.8%. At follow-up after 2 years 6 recurrences (12%) were encountered, 4 of them were symptomatic (8%). One patient underwent reoperation due to hernia recurrence. In 84% QoL was significantly improved at follow-up. Conclusion In patients with high risk of recurrence, biological augmentation of the hiatal closure with the left lobe of the liver may be a valuable alternative to prosthetic reinforcement. We observed no complication attributable to liver lobe transposition.

scholarly journals The Effects of Hyaluronic Acid in Preventing Recurrence of Urethral Stricture after Visual Internal Urethrotomy

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H H G Hasan ◽  
M K A Tolba ◽  
M M M Shalaby
Keyword(s):  
Hyaluronic Acid ◽  
Recurrence Rate ◽  
Urethral Stricture ◽  
Large Scale ◽  
Control Group ◽  
Urethral Reconstruction ◽  
Internal Urethrotomy ◽  
Randomized Controlled ◽  
Voiding Symptoms ◽  
Number Of Patients

Abstract Background Many urologists prefer Visual internal urethrotomy (VIU)because of its ease to perform, short hospital stay, low cost, and perceived low complication rate. They may repeat VIU several times to avoid complex urethral reconstruction, because it requires significant surgical experience. Because of its effectiveness and simplicity, VIU is the primary treatment option for urethral stricture disease. However, the recurrence rate is high and the success rate is low. Aim of the Work To evaluate the effect of hyaluronic acid (HA) instillation during visual internal urethrotomy (VIU) for decreasing the incidence of recurrent urethral stricture. Patients and Methods A total of 50 patients who were treated by Visualized internal uretherotomy for urethral stricture between February 2017 and January 2019 were invited to participate in the present study. This study is a multicenter,prospective, randomized controlled, single-blinded study. Results In this study the experimental group had a better voiding symptoms than the control group six months after the surgery,The present study showed that the instillation of hyaluronic acid into the urethra during visualized internal urethrotomy didn’t significantly reduced the recurrence of urethral stricture after the operation although the number of patients who had recurrence after hyaluronic acid instillation were less than recurrence rate in the control group. The hyaluronic acid had no observed side effects and helped to improve the pain and quality of life after the surgery. Conclusion The instillation of hyaluronic into the urethra during VIU reduced postoperative pain and improved voiding symptoms in the study group , but it didn’t significantly reduce the recurrence of urethral stricture after the operation. we suggest that a large-scale, randomized controlled trial be conducted in a larger number of patients with long-term follow-up .

scholarly journals Durability of Smoking Cessation for Elective Lower Extremity Orthopaedic Surgery

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0039
Author(s):  
Danica H. Smith ◽  
Michael F. McTague ◽  
Michael J. Weaver ◽  
Jeremy T. Smith
Keyword(s):  
Smoking Cessation ◽  
Lower Extremity ◽  
Orthopaedic Surgery ◽  
Perioperative Complications ◽  
Smoking History ◽  
Secondary Outcome ◽  
Impaired Wound Healing ◽  
Patient Reported ◽  
The Impact

Category: General Health Introduction/Purpose: Smoking tobacco is a risk factor for impaired wound healing, infection, delayed fracture healing, and prolonged hospital stay. Smoking cessation prior to surgery has shown a 40% relative risk reduction in total perioperative complications. The primary purpose of this study is to evaluate the impact of preoperative smoking cessation on long-term smoking habits in patients undergoing elective lower extremity orthopaedic surgery. The secondary outcome is patient-reported effectiveness of smoking cessation method. Methods: A retrospective cohort study was performed by identifying all patients who were smokers that were required to quit and subsequently had a normal nicotine/cotinine serum test prior to lower extremity orthopaedic surgery. Attempts were made to contact all patients and administer a survey inquiring about demographics, medical history, smoking history, smoking cessation process, and current smoking status. Results: Of 36 eligible patients, 23 completed the survey. Eleven patients identified as current non-smokers (48%) at the time of survey follow-up (mean follow-up 55 months with a range of 12 to 88 months). Of these 11, 82% said they were very likely to continue to refrain from smoking. Twelve patients identified as current smokers at the time of survey, over half of whom ceased smoking for at least three months perioperatively. The reasons for resuming smoking were “stress” (45%), ”falling back into the habit” (37%), and due to “friends who smoke” (18%). The majority of smoking patients (92%) decreased the number of cigarettes they smoked regularly. The most effective smoking cessation techniques were ”cold turkey”, “non-nicotine medication”, and ”trans-dermal nicotine patches”. Conclusion: Elective surgery offers a unique opportunity for smoking cessation. Of 23 patients required to quit smoking prior to surgery, 48% maintained smoking cessation at least one year postoperatively. Of the 12 patients who relapsed, 55% stated that they did not resume smoking until at least three months postoperatively, suggesting that this particular period may be an important time for intensified smoking cessation counseling.

Neoglottis Reconstruction Following Total Laryngectomy: The Emory Experience

1982 ◽  
Vol 90 (5) ◽  
pp. 569-575 ◽  
Author(s):  
Fred M.S. McConnel ◽  
John Teichgraeber
Keyword(s):  
Medical School ◽  
Revision Surgery ◽  
Total Laryngectomy ◽  
Perioperative Complications ◽  
Vocal Rehabilitation ◽  
Early Results ◽  
Emory University ◽  
Long Term Follow Up

A number of studies over the last decade have reported on a viability of the primary neoglottis reconstruction after total laryngectomy. Early results have been encouraging, although operative and perioperative complications are higher than with a classic laryngectomy. This article reports on a series of 13 neoglottis reconstructions performed at Emory University Medical School using the techniques developed by Mario Staffiert, MD. During the course of the study, the overall success rate has fallen from 80% at three years to 54% at five years. With each succeeding year there has been an increasing need for revision surgery. The series emphasizes the need for long-term follow-up in any vocal rehabilitation procedure.

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