Urethral meatus preserving ventral onlay augmentation urethroplasty for female urethral stricture: our technique with initial experience

Background Female urethral stricture (FUS) is an uncommon cause of lower urinary tract symptoms (LUTS) in women. Reconstructive techniques are being increasingly used for strictures resistant to the more conservative form of management. Most forms of reconstruction require cutting open of urethral meatus, thereby resulting in some loss of the meatus function. We hereby describe the technique of urethral meatus sparing ventral onlay mucosal graft augmentation urethroplasty with our initial experience. Methods We performed this procedure in 10 cases of FUS with normal meatus and prospectively studied the outcomes over a period of 6 months follow-up. Results There was 90 percent success rate with one recurrence. The mean Qmax increased from 7.2 to 19.5 ml/s, mean post-void residual urine (PVRU) decreased from 96.5 to 22.7 ml and the mean IPSS decreased from 26.1 to 5.7. There were no major complications noted and the patients demonstrated significant subjective and objective improvement of symptoms in the follow-up period. Conclusion The technique of meatus sparing ventral onlay augmentation graft urethroplasty is a promising approach with good outcomes, is reproducible and has minimal complication rate.

A novel Levator Ani Midurethral Support Via Single Vaginal Incision to Treat Stress Urinary Incontinence: Case Report

IntroductionA novel native tissue midurethral support procedure, Levator Ani Midurethral Support via single vaginal incision, to treat patients with stress urinary incontinence is introduced in this case report. After mesh controversy, there is a need for a minimal invasive native tissue surgical procedure to treat stress urinary incontinence with minimal complication.Case PresentationA 51-year-old female with stress urinary incontinence had three mesh midurethral slings and one autologous fascia sling with severe infection that failed. She developed recurrent stress urinary incontinence and coital incontinence. After she was referred to our care, she was initially treated with urethral bulking injections which also failed. There were few alternatives left after failure of three mesh midurethral slings, one autologous fascia sling with severe infection and urethral bulking injections. The patient was successful treated with our novel native tissue midurethral support procedure, Levator Ani Midurethral Support via single vaginal incision. She remains continent 23 months after the Levator Ani Midurethral Support via single vaginal incision and her coital incontinence has also resolved. She reported she has no pelvic pain or dyspareunia. ConclusionsAfter further study, this novel native tissue midurethral support procedure, Levator Ani Midurethral Support via single vaginal incision may meet the need for a minimal invasive native tissue surgical procedure for the treatment of stress urinary incontinence with minimal complication.

A Case on Fracture of Os Penis and Partial Penectomy in a Raccoon

The os penis is a unique structure existing in some placental mammals, however it predisposes the organ to fracture. Partial penectomy is an incomplete penile amputation which is carried out when the transection site needed. In this report, a clinical case of partial penectomy in a raccoon was described. A 20-month-old, male albino raccoon (Procyon lotor) was referred to University Veterinary Hospital in Universiti Putra Malaysia with the penile prolapse. Preliminary therapeutic plan included prescription of broad-spectrum antibiotic and anti-inflammatory. Partial penectomy was arranged in this case. Postoperative treatment prescribed were fluoroquinolone antibiotic and analgesics. The prognosis was good due to minimal complication. The clinical symptoms on fracture of os penis, complications of partial penectomy, and options for treatment on fracture of os penis were discussed in this report. Castration can be an alternative preventive method to prevent trauma related to the fracture of masturbation os penis.

Squamous-cell carcinoma due to mesh infection after umbilical hernia operation: third case of the literature

Introduction Polypropylene (PP) meshes are safe synthetic products used for hernia repairs and associated with minimal complication. Chronic inflammation is thought to play a pathophysiological role in the development of cancer. Case presentation: We present a 67-year-old female case of squamous cell-cancer (SCC) that developed due to mesh after umbilical hernia operation. The mass in the anterior abdominal wall was totally resected. Pathology was reported as T2N0, moderately differentiated acantholytic type SCC. No recurrence or complication was detected in the fourth-month follow-up. Conclusion Cancer development after mesh is very rare and our case is the third case in the literature. Cancer development should be kept in mind in patients presenting with ulcerated masses if do not regress with infection treatment after mesh application.

Biologic restoration: A successful treatment option for immediate esthetics – A case report

Crown fractures mainly in the anterior region are the most common outcome of traumatic injuries. The common cause is ascribed to falls, motor vehicle accidents, and contact sports. Out of all the dental trauma injuries, dentoalveolar trauma contributes to about 25%, which may vary from simple crown fracture of enamel and/or dentin to complicated crown root fractures. In this case report, an undergraduate dental student reported with a fractured crown due to a fall an hour earlier. The clinical and radiographic assessment leads to the diagnosis of an uncomplicated crown fracture. Fracture line was extending obliquely till the middle third of the crown involving enamel and dentin. Tooth segment adaptation was evaluated, and decision was made to attempt for reattachment procedure. The tooth was isolated using rubber dam and tooth fragment was reattached using flowable composite. Follow up period was noted for 6 months. Tooth segment reattachment is a minimally invasive procedure with immediate aesthetic and it is not time consuming. This procedure has a predicable long-term prognosis with minimal complication due to advances in adhesive technique. Various factors should be taken into consideration for maximizing the benefits. Thus, this simple procedure is an alternative to the other complex restorative procedure for restoring tooth function, form, and esthetics. Recent advances in flowable composites can be used for a much more predictable result pertaining to strength and aesthetics.

Analysis of Port Site Complications & Measures to Prevent them

Background: Port site complications following elective laparoscopic surgeries are rare. Port site infection is the most common complication. Objectives: The study was conducted to analyze port site complications occurring in the patients undergoing laparoscopic surgeries and measures to prevent them. Patients and Methods: Total 408 patients who underwent various laparoscopic surgeries were included in the study. Follow up was done for 3 months postoperatively. Port site was examined for any complication. Result: Out of 408 patients 24 patients (5.88%) developed port site complications. 14 patients developed post site infection, 4 patients had port site discharge with sinus formation, 4 patients developed port site bleeding and 2 patients had port site hernia. No case of port site metastasis or visceral injury while port insertion were found. No patient had port site omental entrapment. Conclusion: Minimally invasive surgery is a safe and effective with minimal complication.

Clearance of Renal Stone in PCNL Under Spinal Anaesthesia

Objective: To evaluate the Outcome of PCNL under spinal Anaesthesia. Material and Method: A total of 74 patients with renal stone disease were treated by PCNL under spinal anasthesia. Total study period was from January 2013 to October 2019. Pre operative and post operative variables and complications were recorded. Result: Age range from 25 years to 65 years, mean 41.37 ± 33 yrs. Male female ratio was 6.4:1 stone size ranges from 15mm to 40mm, majority was 21.33mm. Mean operative time was 69±4.2 min. Total stone clearance was 15.60%. Only 10.82% patients were suffering from grade I complications and mean hospital stay was 3.1±0.6 days. Conclusion: Percutaneous nephrolithotomy is effective and safe under spinal anesthesia with shorter hospital stay and minimal complication. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.154-157

MODIFIED KSHARSUTRA TECHNIQUE IN COMPLEX FISTULA IN ANO - A CASE STUDY

Fistula in ano is an anorectal disorder in which two openings are present. One is located near perianal re-gion and another is at anal canol or rectum. Fistula in ano is itself a challenging disease for patients because of mortality is not associated but daily routine life of patients become crushed. Ayurveda also said about Bhagandar (fistula in ano) that it is Kashta Shadhya Vyadhi i.e. difficult to treat because its take time and recurrence rate is also associated. But Ayurveda has described the Kshar sutra therapy for the treatment of fistula in ano which have high success rate, but time taken. With time, revolution has also come in Ayurve-dic treatment modalities for anorectal fistulas. A modified Ksharsutra technique is new technique for treatment of complex fistula in ano. The name of this technique is interception of fistulous tract and appli-cation of Ksharsutra (IFTAK). This technique has high success rate with minimal complication, early re-covery and there is no recurrence is associated. Cosmetically, this technique is good.

Combined approach for management of gynecomastia: Subcutaneous mastectomy and liposuction

Introduction: There are different modalities for the treatment of gynecomastia. Open surgical techniques have become less popular with the advent of liposuction and its variants, including power-assisted and ultrasound-assisted liposuction. Methodology: This is a descriptive study done to observe the combined approach of liposuction and subcutaneous mastectomy for the treatment of gynecomastia and to evaluate aesthetic aspects using Surgeon’s evaluation score for size, shape, scarring, overall outcome and patient satisfaction score by using visual analogue scale. Inclusion criteria consist of all the patients with bilateral or unilateral gynecomastia using Simon Grade I and II. , Exclusion criteria consist of patients having pseudogynecomastia, pathological and with Simon Grade III gynecomastia. Frequency analysis was done using Statistical Package for Social Sciences version 20.0. Results: Twenty-one patients were included in the study, out of which there were 12 (57%) cases of bilateral, six (29%) cases of right and three (14%) cases of left sided gynecomastia. Mean age was 23.8 years range (14-32) years, mean body mass index 22.52 kg/m2 (18-26) kg/m2 mean volume of fat removal through liposuction 136.43 ml (40-300) ml, and mean resected breast tissue was 89.29 gm (40-150) gm. In our study 33.3% cases were of Simon Grade I and 66.7 % cases were of Grade II gynecomastia with one (4.7%) case had post-operative hematoma. With combined approach liposuction and subcutaneous mastectomy results showed overall excellent patient satisfaction, minimal complication, less scarring and cost effective. Conclusions: Management of gynecomastia with subcutaneous mastectomy and liposuction can be a combined approach with less complication and overall excellent patient satisfaction.

Should a fistula first policy be revisited in elderly haemodialysis patients?

Life-sustaining haemodialysis requires a durable vascular access (VA) to the circulatory system. The ideal permanent VA must provide longevity for use with minimal complication rate and supply sufficient blood flow to deliver the prescribed dialysis dosage. Arteriovenous fistulas (AVFs) have been endorsed by many professional societies as the VA of choice. However, the high prevalence of comorbidities, particularly diabetes mellitus, peripheral vascular disease and arterial hypertension in elderly people, usually make VA creation more difficult in the elderly. Many of these patients may have an insufficient vasculature for AVF maturation. Furthermore, many AVFs created prior to the initiation of haemodialysis may never be used due to the competing risk of death before dialysis is required. As such, an arteriovenous graft and, in some cases, a central venous catheter, become a valid alternative form of VA. Consequently, there are multiple decision points that require careful reflection before an AVF is placed in the elderly. The traditional metrics of access patency, failure and infection are now being seen in a broader context that includes procedure burden, quality of life, patient preferences, morbidity, mortality and cost. This article of the European Dialysis (EUDIAL) Working Group of ERA-EDTA critically reviews the current evidence on VA in elderly haemodialysis patients and concludes that a pragmatic patient-centred approach is mandatory, thus considering the possibility that the AVF first approach should not be an absolute.