Treatment of panurethral strictures using one side dissection dorsal onlay buccal mucosal graft urethroplasty

The management of panurethral stricture was still challenging and controversial. We presented a case of pan urethral strictures management by using a one-sided dissection of dorsal onlay buccal mucosal graft (BMG) urethroplasty (Kulkarni technique). A 53-years old man admitted with panurethral stricture who had previously undergone several procedures. Bipolar micturition cystourethrography procedure revealed 17 cm stricture length. One-sided dissection dorsal onlay buccal mucosal graft urethroplasty was performed. No drain was placed. The Foley catheter was removed four weeks after surgery, and the results of the micturition were favourable. No fistulae were found at a straight erection and meatus at a normal position. The postoperative flow rate (Qmax) was 24.9 ml/second. As a conclusion Kulkarni technique urethroplasty gained good outcome for panurethral stricture in our case.

Suprapubic Micturition Cystourethrography

Suprapubic micturition cystourethrography is performed by puncturing the bladder aseptically, in the midline, 1 to 2 cm above the symphysis pubis with an 18 to 21 gauge needle. The needle is pointed 10 to 15° cranially to avoid puncture of the trigonum and urethra. Anaesthesia, antibiotic protection, and diuretics are not necessary. In 225 examinations performed on 200 patients, the only complications noted were transient haematuria (1.5%) and slight extravasation of contrast medium through the puncture sites (8%). None required any therapeutic measures. In 4 patients puncturing of the bladder needed ultrasound guidance. The technique is ideal for the study of vesicoureteral reflux, neurogenic bladder, urethral strictures, posterior urethral valves and other urethral pathology. It is also useful in balloon catheter dilatation of urethral strictures. Suprapubic micturition cystourethrography is safe, efficient and time-saving. It is well accepted by the patients and carries little risk of urinary infection.

Excretory Urography for Evaluation of Enuresis

Enuresis is the involuntary discharge of urine occurring beyond the age when control of the urinary bladder should have been acquired.1 Eighty percent of children with enuresis have problems staying dry at night, 5% in the day, and 15% both day and night.2 The age at which children can be expected to stay dry at night is not well established and is often cause for extreme concern for parents and children alike. Most children are still not dry at night by age 2 years. In a study of 315 children, Klackenberg reported 87% dry by 3 years and 96% dry by 6 years. Essen and Peckham,4 reviewing the records of 12,000 children, found enuresis more prevalent in older ages. More than 10% of their patients were enuretic between ages 5 and 7 years and almost 5% were still having problems at 11 years of age. The etiology of enuresis is also difficult to define, and many different theories have been advanced. Bindelglas5 grouped these into five major categories: (1) organo-urogenic, including urologic malformations; (2) psychogenic; (3) developmental; (4) genetic; (5) environmental. The first of these categories must be of primary concern to the physician when confronted with an enuretic child, ie, could the symptoms possibly reflect a surgically correctable urologic abnormality? Radiologic procedures such as excretory urography and micturition cystourethrography are the studies usually relied on to exclude an underlying anatomic lesion. Because of the potential risk and expense of any radiologic procedure as well as the possible low yield in this condition, the Committee on Radiology examined the utility of these studies in the routine evaluation of enuresis.

Variations in Vesicoureteral Reflux

Micturition cystourethrography was performed with varying numbers of films exposed and the probability of missing a vesicoureteral reflux or underrating its severity was calculated for each series. It was concluded that a small number of exposures can give sufficiently accurate diagnosis.