scholarly journals Direct Vision Internal Urethrotomy (DVIU) and Regular Clean Self Intermittent Catheterization (CSIC) For Short Bulbar Urethral Strictures: A Durable Solution

2020 ◽  
Vol 3 (2) ◽  
pp. 13-16
Author(s):  
Pankaj Trivedi
Keyword(s):  
Tertiary Care ◽  
Study Data ◽  
Direct Vision ◽  
Hypospadias Repair ◽  
Internal Urethrotomy ◽  
Common Cause ◽  
Urethral Strictures ◽  
One Year ◽  
Good Success Rate

Background: To evaluate durability of DVIU results and recurrence of stricture if the CSIC was done regularly up to one year and weekly thereafter. Subjects and Methods: This retrospective study was conducted in the Department of Urology at tertiary care teaching hospital of Rajasthan, India. Files of all patients operated between January 2015 and July 2018 for single bulbar urethral strictures of less than 1-1.5cm size in length, iatrogenic, idiopathic, traumatic or inflammatory origins were evaluated. Patient with multiple or complicated strictures of post urethroplasty, post hypospadias repair, previous radiation or multiple DVIU were excluded from the study. Data of all patients who were on CSIC following direct vision internal urethrotomy were evaluated at 3, 6, 12 and 24 months. Results: Mean age of patients was 41.13 years with range in between 26-74 years. Most common cause of urethral strictures were idiopathic 66 (58.92%) followed by iatrogenic 27 (24.11%) causes. After 24 months of follow up 95 (84.82%) patients maintained urethral caliber up to 16 Fr. Failure or recurrence was found in 17 (15.18%) patients who required intervention. Conclusion: Direct vision internal urethrotomy (DVIU) with regular clean intermittent self-catheterization (CSIC) was found good success rate in bulbar urethral strictures upto 1 cm in selected patients.

scholarly journals Outcomes of Direct Vision Internal Urethrotomy for Bulbar Urethral Strictures: Technique Modification with High Dose Triamcinolone Injection

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Rishi Modh ◽  
Peter Y. Cai ◽  
Alyssa Sheffield ◽  
Lawrence L. Yeung
Keyword(s):  
Corticosteroid Injection ◽  
Direct Vision ◽  
High Dose ◽  
Internal Urethrotomy ◽  
High Dose Corticosteroid ◽  
Urethral Strictures ◽  
Significant Difference ◽  
Triamcinolone Injection ◽  
Dose Corticosteroid

Objective. To evaluate the recurrence rate of bulbar urethral strictures managed with cold knife direct vision internal urethrotomy and high dose corticosteroid injection.Methods. 28 patients with bulbar urethral strictures underwent direct vision internal urethrotomy with high dose triamcinolone injection into the periurethral tissue and were followed up for recurrence.Results. Our cohort had a mean age of 60 years and average stricture length of 1.85 cm, and 71% underwent multiple previous urethral stricture procedures with an average of 5.7 procedures each. Our technique modification of high dose corticosteroid injection had a recurrence rate of 29% at a mean follow-up of 20 months with a low rate of urinary tract infections. In patients who failed treatment, mean time to stricture recurrence was 7 months. Patients who were successfully treated had significantly better International Prostate Symptom Scores at 6, 9, and 12 months. There was no significant difference in maximum flow velocity on Uroflowmetry at last follow-up but there was significant difference in length of follow-up (p=0.02).Conclusions. High dose corticosteroid injection at the time of direct vision internal urethrotomy is a safe and effective procedure to delay anatomical and symptomatic recurrence of bulbar urethral strictures, particularly in those who are poor candidates for urethroplasty.

scholarly journals DIRECT VISUAL INTERNAL URETHROTOMY (DVIU) FOR UNTREATED BULBAR URETHRAL STRICTURES. A SOLUTION?

2021 ◽  
pp. 15-16
Author(s):  
Abhiyutthan Singh Jadaon ◽  
Chitra Champawat ◽  
Chandra Pal Singh
Keyword(s):  
Treatment Failure ◽  
Urethral Stricture ◽  
Cox Regression ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Care Hospital ◽  
Internal Urethrotomy ◽  
Urethral Strictures ◽  
Alternative Approach

Introduction :Urethral stricture diseases have been treated with numerous approaches. Though open urethroplasty is considered a one-time solution [1], The direct visual internal urethrotomy (DVIU) is still considered an alternative approach in the stepladder of treatment [2,3]. Here we report our experience at a tertiary care hospital with DVIU in a homogeneous series of patients with bulbar urethral stricture who underwent strict follow-up and present a multivariable analysis of the results to identify signicant predictors of treatment failure. We wish to offer new insights into DVIU. Materials and method: We performed a retrospective analysis of patients who underwent internal urethrotomy. Patients who underwent DVIU for untreated bulbar urethral strictures with minimum follow-up of 12 months were included. Patients with traumatic stricture and stricture length >4 cm were excluded.The primary outcome was treatment failure. Multivariable Cox regression analyses by Stata v.12.0 were used to test the association between predictors:- Stricture etiology, stenosis length, preoperative maximum ow [pQmax]) and treatment failure. Results: 215 patients were included. Median follow-up was 35 months. At 5-yr follow-up the failure-free survival rate was 54.4%. On multivariable analysis pQmax was the only signicant predictor of treatment failure. Conclusions: DVIU success rate for untreated bulbar urethral strictures was signicantly associated with preoperative maximum ow rate. The patients with a pre- operative maximum ow lesser than 6 ml/s have a low probability of success and may be considered for alternative treatments such as open urethroplasty, especially when affected by long urethral strictures.

scholarly journals Redo hypospadias repair: experience at a tertiary care children’s hospital

2012 ◽  
Vol 1 (1) ◽  
Author(s):  
Ahmed Al-Sayyad ◽  
John G. Pike ◽  
Michael P. Leonard
Keyword(s):  
Tertiary Care ◽  
Institutional Review Board ◽  
Hypospadias Repair ◽  
Urethral Plate ◽  
Institutional Review ◽  
Tubularized Incised Plate ◽  
Distal Shaft ◽  
The Status ◽  
Initial Severity

Objective: Treatment of patients with failed hypospadias repairs can be challenging.Our study aimed to determine the best type of redo repair dependingon the location and size of the urethral meatus, the status of the urethralplate and genital skin, the severity of residual chordee and the amount ofscar tissue.Methods: The Institutional Review Board approved our retrospective chart reviewof patients who had a redo hypospadias repair at our institution over the past6 years. We recorded the type and number of previous repair(s), the type andnumber of redo procedure(s),as well as the complications and functional outcomes.Results: There were 28 patients, aged 1–12 (mean 3.8) years, with failed hypospadiasrepairs. The initial severity of the hypospadias were as follows: perineal(1), penoscrotal (9), proximal shaft (1), mid-shaft (9), distal shaft (4), coronal(3) and mega-meatus (1). Of all the patients, 24 had 1 repair, 3 had 2 repairsand 1 had 3 repairs. The initial repairs comprised 11 tubularized island flaps(TIFs), 8 Snodgrass tubularized incised plate (TIP) techniques, 5 Mathieu repairs,1 Meatal Advancement and GlanuloPlasty Incorporated (MAGPI) technique,1 Pyramid, 1 Arap technique and 1 Thiersch-Duplay repair. Twenty-one of 28 patients had 1 redo operation, 5 had 2 redo operations, 1 had 3 redo operationsand 1 had 4 redo operations, for a total of 38 redo operations. Of these,26 were TIP techniques (68.4%), 3 were Mathieu (7.9%), 3 were TIF repairs(7.9%), 2 were onlay island flaps (5.3%) and 4 were buccal mucosal grafts(10.5%). Follow-up was 1–5 years (mean 3.5 yr). The final locations of urethralmeatus included glans (18), corona (6), mid-shaft (3) and penoscrotal (1).Complications after redo surgery comprised 4 urethrocutaneous fistulae, 2 meatalstenoses, 1 urethral stricture and 3 dehiscences. Sixteen patients were followedwith yearly uroflow with a Q-mean (mean uroflow) range of 3–14 mL/s (mean8.1 mL/s).Conclusion: The majority of hypospadias failures can be salvaged with one operation.The TIP repair is our procedure of choice in most cases. In the settingof a poor urethral plate, TIF or buccal mucosa may be necessary. Complicationsare not infrequent in redo procedures.

scholarly journals Successful treatment of pulmonary mucormycosis caused by Rhizopus microsporus with posaconazole

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
F. Yuan ◽  
J. Chen ◽  
F. Liu ◽  
Y. C. Dang ◽  
Q. T. Kong ◽  
...  
Keyword(s):  
Fungal Culture ◽  
Rhizopus Microsporus ◽  
Pulmonary Tissue ◽  
Case Presentation ◽  
Common Cause ◽  
Pulmonary Mucormycosis ◽  
Threatening Condition ◽  
Life Threatening ◽  
One Year

Abstract Background Mucormycosis is a rare fungal infection occurring chiefly in the lung or the rhino-orbital-cerebral compartment, particularly in patients with immunodeficiency or diabetes mellitus. Among Mucorales fungi, Rhizopus spp. are the most common cause of mucormycosis. Case presentation We report a case of pulmonary mucormycosis caused by Rhizopus microsporus in a young patient with diabetes but no other apparent risk factors. The diagnosis mainly relied on clinical manifestation, positive pulmonary tissue biopsy, and fungal culture. The patient was successfully treated with posaconazole oral suspension and remains asymptomatic at one-year follow-up. Conclusions Pulmonary mucormycosis is a life-threatening condition and posaconazole is an effective treatment for pulmonary mucormycosis caused by Rhizopus microspores.

scholarly journals Peritonea-vaginal canal pathologies at Regional Hospital Center of Lomé-Commune (Togo): Epidemiological, anatomoclinical and therapeutic aspects

2017 ◽  
Vol 3 (3) ◽  
pp. 10
Author(s):  
Simlawo Kpatékana ◽  
Tchangaï B ◽  
Kanassoua K ◽  
Boumé MA ◽  
Sakye A ◽  
...  
Keyword(s):  
Study Data ◽  
Regional Hospital ◽  
Average Hospital ◽  
Scrotal Hematoma ◽  
Scrotal Swelling ◽  
Vaginal Canal ◽  
One Year ◽  
The Right ◽  
Hospital Center

Objective: To describe epidemiological, anatomo-clinical and therapeutic aspects of peritoneo-vaginal canal pathologies (PVCP).Methods: We performed a retrospective and descriptive study on the files of PVCP cases operated in Lomé-Commune Regional Hospital (Togo). The study data concerned: the age, the occuring mode, anatomo-clinical classification, the side and treatment outcomes.Results: 107 files were collected from January 2011 to December 2015. The average age was 9.2 ± 8 years with a range from 16 months to 47 years. Twelve patients were less than 2 years and 14 patients were adults. The main consultation motive was an intermittent and painless inguinal or inguino-scrotal swelling in 89 cases (83.18%). The PVCP was in the right side in 66 patients (61.68%) and bilateral in 8 patients (7.47%). Concerning anatomo-clinical types, inguinal or inguino-scrotal hernia were more frequent (62.6%). The treatment was surgical in all cases and the average hospital stay was 2.1 days. The operative follow up was satisfactory in 94.3%. However, we noticed 4 cases of scrotal hematoma and 2 cases of parietal suppuration. The mortality rate after surgery was zero. One year back, we noticed two cases of testicular atrophy.Conclusions: Pathologies of the peritoneo-vaginal canal are frequent in our urological practice. Inguinal hernia and inguinoscrotal hernia are more represented. The surgical treatment results are successful.

Aluminium Splint Incorporated Fibreglass Cast Preserves Limb Function in Bovines with Olecranon Fracture

2020 ◽  
Vol 33 (06) ◽  
pp. 434-442
Author(s):  
Vandana Sangwan ◽  
Ganga P. Yadav ◽  
Ashwani Kumar
Keyword(s):  
Study Design ◽  
Traumatic Event ◽  
Weight Bearing ◽  
Olecranon Fracture ◽  
Limb Function ◽  
Common Cause ◽  
Olecranon Process ◽  
One Year ◽  
Olecranon Fractures

Abstract Objective Olecranon process fractures are rare in bovines. The aim of the study was to put on record satisfactory limb usage in cattle and buffaloes suffering from olecranon fractures and treated conservatively, primarily for carpal contracture or to prevent it, using aluminum splints incorporated within a fiberglass cast along with stall confinement. Study Design This one year study included 19 olecranon fractures in bovines (15 buffaloes and 4 cattle). Out of 19, 12 bovines (9 buffaloes and 3 cattle) were treated primarily to manage the associated carpal contracture, using external coaptation of aluminium splints incorporated within a fiberglass cast for 6 to 8 weeks. The owners of the remaining 7 bovines (6 buffaloes and 1 bullock) were only advised to keep their animal in stall-confinement, due to various reasons. Results Slipping and falling on hard surfaces was the primary aetiology of olecranon fractures (17/19). Most of the fractures (14/19) were presented more than 10 days after a traumatic event, with a mean duration of 24.0 ± 26.6 days. On follow up, all the treated bovines showed satisfactory limb usage whereas all stall-confined buffaloes showed no improvement. Conclusion Slipping and falling on hard surfaces is a common cause of olecranon fracture in bovines. Olecranon fractures associated carpal contracture can be successfully treated/prevented by applying full limb cast (if possible including elbow) along with aluminum splints leading to satisfactory limb usage in bovines. Further it is concluded that stall confinement alone is insufficient to prevent limb contracture (which usually develops with olecranon fracture in bovines) leading to permanent non-weight bearing disability.

Successful Treatment of Pulmonary Mucormycosis Caused by Rhizopus Microsporus With Posaconazole

2021 ◽  
Author(s):  
Fan Yuan ◽  
Jun Chen ◽  
Fang Liu ◽  
Yongchao Dang ◽  
Qingtao Kong ◽  
...  
Keyword(s):  
Fungal Culture ◽  
Rhizopus Microsporus ◽  
Pulmonary Tissue ◽  
Case Presentation ◽  
Common Cause ◽  
Pulmonary Mucormycosis ◽  
Threatening Condition ◽  
Life Threatening ◽  
One Year

Abstract Background: Mucormycosis is a rare fungal infection occurring chiefly in the lung or the rhino-orbital-cerebral compartment, particularly in patients with immunodeficiency or diabetes mellitus. Among Mucorales fungi, Rhizopus spp. are the most common cause of mucormycosis. Case presentation: We report the case of pulmonary mucormycosis caused by Rhizopus microsporus in a young patient with diabetes but no other apparent risk factors. The diagnosis has mainly relied on clinical manifestation, positive pulmonary tissue biopsy, and fungal culture. The patient was successfully treated with posaconazole oral suspension and remains asymptomatic at one-year follow-up.Conclusions: Pulmonary mucormycosis is a life-threatening condition and based on direct microscopy, histopathology, and culture for the diagnosis.

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