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CASE REPORTS
Low-grade liquid silicone injections as a penile enhancement procedure: Is bigger better?
Ramesh Sasidaran, Mohd Ali Mat Zain, Normala Hj Basiron
September-December 2012, 4(3):181-186
DOI:10.4103/0974-7796.102672  PMID:23248528
To report our experience with 5 cases of complications of penile enhancement procedures secondary to liquid silicone injections and our method of management of its debilitating effects. All five patients were treated with excision of penile shaft skin down to buck's fascia followed by resurfacing with split thickness skin grafting. We conclude that penile enhancement procedures with liquid silicone by non-medical personnel could result in devastating consequences. We also demonstrate that a simple method of excision of the entire penile shaft skin and resurfacing with split skin grafting showed improvement in cosmetic as well as functional outcome.
  86,546 732 -
ORIGINAL ARTICLES
Removal of foreskin remnants in circumcised adults for treatment of premature ejaculation
Mohammad Reza Namavar, Boroomand Robati
May-August 2011, 3(2):87-92
DOI:10.4103/0974-7796.82175  PMID:21747599
Background and Aim : Premature ejaculation (PE) is the most prevalent sexual dysfunction in every country. There are many types of treatment, but the main limitation of medical treatment for premature ejaculation is recurrence after withdrawal of medicine. The prepuce is a specific erogenous zone that contains a rich and complex network of nerves. Circumcision radically desensitizes the penis, but incomplete circumcision may cause premature ejaculation. We evaluate the effect of removal of foreskin remnants in adults on PE. Materials and Methods : The sensitive area of penile skin and the remaining parts of foreskin in adult men were recognized in 47 selective patients. Under local anesthesia, the remnant parts of foreskin were incised and removed. They were asked to fill the investigating questionnaire about the changes of intravaginal latency ejaculatory time (IVELT), patients and their sexual partners' satisfaction with sexual life, control over ejaculation, and penile sensitivity, before and after treatment. Results : There were no signs of inflammation and no serious adverse reactions in all cases after operation. IVELT significantly increased from 64.25 before surgery to 731.49 sec after surgery (P<0.001). The percentage of postoperative satisfaction in both the patient and his partner significantly increased (P<0.001). After surgery, 95.7% of men had better control over their ejaculation. This surgery significantly decreased sensitivity of penis (P<0.001), but it did not change glans penis insensitivity. Conclusions : These results indicate that removal of foreskin remnants in adults is an effective modality in selective patients of PE.
  43,575 818 9
The efficacy and safety of topical EMLA cream application for minor surgery of the adult penis
Kostis I Gyftopoulos
September-December 2012, 4(3):145-149
DOI:10.4103/0974-7796.102658  PMID:23248519
Background and Objectives : A variety of surgical procedures of the penis can be performed under local anesthesia. We evaluated the efficacy and safety of EMLA cream anesthetic in such procedures. Materials and Methods : In total 330 adult patients were subjected to minor penile surgery including: Complete circumcision (73), short frenulum plasty (168), meatotomy (14), fulguration of penile warts (56) and fulguration of urethral (meatal) warts (19). The level of anesthesia obtained by EMLA cream application along with any adverse effects was recorded. Results: The use of EMLA on mucosal lesions provided excellent level of local anesthesia in almost all patients (245/246, 99.5%). Anesthesia of skin lesions was in part influenced by the site of application. Circumcision patients showed the lowest efficacy of the EMLA cream as the majority (~80%) required some form of further anesthesia until the completion of the procedure. No significant adverse effects were noted. A transient erythema was present in almost all mucosal applications. Conclusions: The topical anesthetic EMLA cream is a useful, efficient and safe tool for minor surgical procedures of the penis at the office setting, with the exception of circumcision, where an additional type of anesthesia is likely to be necessary. Side effects can be kept to a minimum when the suggested doses are respected (especially at mucosal application) and the time allowed for action is carefully tailored to the site of application and the type of procedure.
  35,081 783 -
False fracture of the penis: Different pathology but similar clinical presentation and management
Adel Kurkar, Ahmad A Elderwy, Elderwy Orabi
January-March 2014, 6(1):23-26
DOI:10.4103/0974-7796.127015  PMID:24669117
Introduction: Penile fracture is the most common presentation of acute penis. Rupture of the superficial dorsal penile vein (s) may mimic penile fractures with similar clinical presentation but with intact corporeal bodies. Our aim of the study is to highlight superficial dorsal penile vein (s) injury as true emergency with better prognosis. Subjects and Methods: Sixty-eight patients with suspected penile fractures presented to our hospital between June 2007 and January 2013. Out of these, 11 patients showed intact tunica albuginea on exploration with injured dorsal penile vein (s) identified. Records of such 11 cases were reviewed regarding age, etiology, symptoms, physical signs, findings of surgical exploration and post-operative erectile function. Results: All 11 patients were injured during sexual intercourse and presented with penile swelling and ecchymosis and gradual detumescence. Mild penile pain was encountered in 5 cases and the "snap" sound was noted in 2 cases. Examination revealed no localized tenderness, or tunical defect. All the patients regained penile potency without deformity after surgical ligation of the severed vessels. One patient developed penile hypoesthesia. Conclusion: Although the classic "snap" sound and immediate detumescence are usually lacking in the symptomology of dorsal penile vein rupture, its clinical presentation can be indistinguishable from true penile fracture. Surgical exploration is still required to avoid missing tunical tear with possible future complications. The long-term outcome and prognosis are excellent.
  17,187 345 -
CASE REPORTS
Paraurethral Skene's duct cyst in a newborn
Serdar Moralioglu, Oktav Bosnali, Aysenur Cerrah Celayir, Ceyhan Sahin
July-September 2013, 5(3):204-205
DOI:10.4103/0974-7796.115754  PMID:24049387
Paraurethral or Skene's duct cysts are rare causes of interlabial masses in neonates. The diagnosis of Skene's duct cysts in the neonatal period is based on its location, in relation to the urethra, and the demonstration of transitional epithelium in the cyst wall. The distinguishing features of paraurethral cysts are the displacement of urethral meatus by the mass and a cyst containing milky fluid. Thus, we report a case of a Skene's duct cyst in a newborn which was treated by incision and drainage.
  15,600 372 -
Spontaneous subcapsular renal hematoma: A case report and review of literature
Ramen Kumar Baishya, Divya R Dhawan, RB Sabnis, Mahesh R Desai
January-April 2011, 3(1):44-46
DOI:10.4103/0974-7796.75852  PMID:21346835
Spontaneous subcapsular renal hematoma is not a common entity. We report a 38-year-old lady presenting with sudden onset right flank pain with uncontrolled hypertension and she was found to have subcapsular collection in the right kidney on ultrasonography. Finding was confirmed on computed tomography. Except hypertension, no particular cause for the condition could be found. Symptoms and size of the collection decreased on conservative treatment. They completely disappeared on ultrasonography at 6 months follow-up. She was asymptomatic at 18 months follow-up.
  11,868 797 5
Simple cyst of urinary bladder
Yang Bo
July-September 2014, 6(3):244-246
DOI:10.4103/0974-7796.134288  PMID:25125900
Simple cysts are rare in the urinary bladder and can pose a diagnostic dilemma to both the urologist and the histopathologist. No case study was found in the database of Elsevier Science Direct, Spring-Link, or PubMed. We present two cases of subserous cyst in the bladder and discuss the diagnosis and treatment of the condition. The cystic lesion at bladder dome was detected by radiologic examination and confirmed by cystoscopy. In case 1, transurethral resection was first performed which was followed by partial cystectomy; In case 2, the cyst was removed with the urachus using laparoscopic surgery. The patients recovered uneventfully and the histopathology showed cysts in subserous layer of urinary bladder. The bladder cyst should be distinguished from urachal tumor, and laparoscopic partial cystectomy is the preferred operative procedure.
  11,327 278 -
Management of pelvic lymphoceles following robot-assisted laparoscopic radical prostatectomy
Omer A Raheem, Wassim M Bazzi, J Kellogg Parsons, Christopher J Kane
May-August 2012, 4(2):111-114
DOI:10.4103/0974-7796.95564  PMID:22629010
Pelvic lymphocele is a potential complication of radical prostatectomy. Although lymphoceles often regress spontaneously, many may progress, precipitate clinical symptoms, and ultimately require intervention. To date, the best treatment of pelvic lymphoceles has not yet been fully defined. However, laparoscopic marsupialization is a definitive and efficacious surgical alternative to percutaneous drainage. It is effective, results in minimal patient morbidity, and allows for rapid recovery. We report our experience with management of clinically symptomatic pelvic lymphoceles following robotic-assisted prostatectomy using laparoscopic marsupialization.
  10,791 494 2
Prolonged priapism following single dose administration of sildenafil: A rare case report
Sachit Sharma, Sabyasachi Panda, Shilpa Sharma, Santosh K Singh, Amlesh Seth, Narmada Gupta
July-December 2009, 1(2):67-68
DOI:10.4103/0974-7796.56041  
A case of priapism following the consumption of a single dose of sildenafil is reported. A 25-year-old unmarried healthy man consumed non-prescribed 50 mg sildenafil purchased over the counter. He developed painful priapism 30 min after the drug intake that had lasted for 4 days (96 h) when he sought medical advice as an emergency. The corpus spongiosum and glans was soft and the corpus cavernosa was rigid. Winter's shunt was done. Fifteen milliliters of dark blood was aspirated with 16 G needle. Detumescence was achieved within 30 min. He was discharged after 12 h. On one month follow-up, he had normal morning erections. A genetic basis with cross-reactivity of PDE-3 in addition to PDE-5 resulting in a cumulative erection effect may be possible elucidation for this unwanted side effect in rare cases. However, the number of cases reported with this side effect is still too less to draw further conclusions.
  10,065 681 -
ORIGINAL ARTICLES
Transobturator tape for female stress incontinence: A day surgery case
Waleed Al Taweel
July-December 2009, 1(2):44-46
DOI:10.4103/0974-7796.56042  
Aim: To evaluate the effectiveness of transobturator vaginal tape (TOT) in the treatment of female stress urinary incontinence (SUI) and to analyze functional results and quality of life after12 months follow up. Materials and Methods : All women with SUI who underwent TOT procedure from outside to inside under general or regional anesthesia from December 2004 to January 2007 were included in the study. All must have had a minimal follow up of one year. The patients were prospectively evaluated with history including pads use/day, physical examination - pelvic examination, urinalysis, urogenital distress inventory (UDI-6), and analog global satisfaction scale - and urodynamic studies - filling cystometry, pressure-flow studies, and Valsalva leak point pressure. Results: Sixty two consecutive patients who fulfilled the inclusion criteria underwent TOT procedure by one surgeon. The mean age was 52 ± 9 years (range, 34-70 years) and minimal follow up was one year (12-24 months). The mean operative time was 17 ± 4 minutes (15-31) with average amount of bleeding 62 ± 22 cc. We found objectively 89% cure or improvement rate after one year. Conclusion: The out-in transobturator approach is a very effective treatment of SUI with low morbidity and high success rate. However, longer follow up in larger populations should assess the long-term reliability of this attractive procedure.
  9,038 1,247 -
CASE REPORTS
Genital self-amputation or the Klingsor syndrome: Successful non-microsurgical penile replantation
Y El harrech, N Abaka, O Ghoundale, D Touiti
October-December 2013, 5(4):305-308
DOI:10.4103/0974-7796.120309  PMID:24311919
Self-mutilations of the external genitals in psychiatric patients also known as Klingsor syndrome is a rare urologic trauma. Men with religious conflicts, low self-esteem, unresolved transsexual issues and feelings of guilt are the most vulnerable. This condition requires immediate surgical intervention. Currently replantation involves meticulous microsurgery and has become the primary method for managing these patients. In this paper, we report a case of self amputation of penis in a patient with a psychiatric history significant for schizopfrenia. Because of the unavailability of a microscope in our department, a non-microsurgical replantation without microscopic magnification was attempted. After surgery, normal appearance and function including a good normal voiding, sensation, and erections were observed.
  8,375 307 1
ORIGINAL ARTICLES
Chordee without hypospadias: Operative classification and its management
Sunita Singh, Jiledar Rawat, Shiv Narayan Kureel, Anand Pandey
April-June 2013, 5(2):93-98
DOI:10.4103/0974-7796.110005  PMID:23798865
Context: Developing countries. Aims: To propose a operative classification of Chordee without hypospadias (CWH) with its management. Settings and Design: Tertiary referral centre; Retrospective study from January 2000 to January 2011. Materials and Methods: Total 26 patients were classified peroperatively into sixtypes (A: Cutaneous chordee→ Degloving skin and dartos (1/26); B: Fibrous chordee→ chordectomy (4/26);C: Corporocavernosalchordee→ Corporoplasty ± Urethral mobilization (4/26); D: Urethral tethering with Hypoplastic urethra→ Urethral mobilization ± urethral reconstruction because of hypoplastic urethra (14/26); E: Congenital short urethra→ excision of urethra from the meatus and urethroplasty (2/26); and F: Complex chordee→ Degloving ± Corporoplasty ± urethroplasty (1/26 patients).The follow-up over 6 months to 9 years were analyzed. Statistical Analysis : SPSS soft ware version 17.0 for Windows. Results: The mean age of surgery was 5.33 ± 0.11 years. The success rate defined on uroflowmetry and voiding cystourethrography was 65.6%. The coronal urethra-cutaneous fistula developed in 26.9% (7/26) {including 7.7% (3/26) of associated metal stenosis}. The urethral stricture developed in 3.8% (1/26). Conclusions: CWH needs stepwise surgical management. The operative classification may help in better understanding and management of this difficult entity. Meticulous tissue handling and urethroplasty is needed for good and promising results.
  7,629 647 -
The influence of urine cytology on our practice
Mahmoud Alameddine, Anmar Nassir
May-August 2012, 4(2):80-83
DOI:10.4103/0974-7796.95550  PMID:22629001
Objective: Bladder cancer is a common malignancy. It is ranked ninth among male population in Saudi Arabia. Urine cytology is used by some physicians routinely in the workup for diagnosis and follow-up of patients with urothelial cancer. Our objective is to determine whether urine cytology is still essential in the work up of suspected urothelial cancer patients and to measure its cost-effectiveness. Materials and Methods: We reviewed all urine cytology reports that were performed over a period of five years from 2006 to 2010 in the International Medical Center in Jeddah, Saudi Arabia. The medical records of patients with cytology reports of both positive for malignant cells and atypical cells suspicious of malignancy were retrospectively, studied for age, sex, nationality, cystoscopic findings, imaging results, and total cost. Results: A total of 563 urine cytology tests were done on 516 patients. Two patients were positive for malignant cell and 10 showed atypical cells suspicious of malignancy. All 12 patients underwent imaging and/or cystoscopy as part of their complete work up for hematuria. The two patients with positive cytology had a cystoscopic confirmation of bladder tumor. In the 10 patients with atypical cells, bladder tumor was identified in seven using cystoscopy and/or imaging. The mean age was 54.6±16 year (range 15-95). The total cost was 140,750 SR (37,533 USD) for a yield of 0.3% positive results and 2% atypical cytology. Conclusion: Routine urine cytology did not affect the diagnostic strategy for urothelial cancer. It should be only used in selected patients.
  7,462 620 2
REVIEW ARTICLE
Robot-assisted urologic surgery in 2010 - Advancements and future outlook
Paurush Babbar, Ashok K Hemal
January-April 2011, 3(1):1-7
DOI:10.4103/0974-7796.75853  PMID:21346825
Robotic surgery is a cutting edge and minimally invasive procedure, which has generated a great deal of excitement in the urologic community. While there has been much advancement in this emerging technology, it is safe to say that robotic urologic surgery holds tremendous potential for progress in the near future. Hence, it is paramount that urologists stay up-to-date regarding new developments in the realm of robotics with respect to novel applications, limitations and opportunities for incorporation into their practice. Robot-assisted surgery provides an enhanced 3D view, increased magnification of the surgical field, better manual dexterity, relatively bloodless field, elimination of surgeon's tremor, reduction in a surgeon's fatigue and mitigation of scattered light. All these factors translate into greater precision of surgical dissection, which is imperative in providing better intraoperative and postoperative outcomes. Pioneering work assessing the feasibility of robotic surgery in urology began in the early 2000's with robot-assisted radical prostatectomy and has since expanded to procedures such as robot-assisted radical cystectomy, robot-assisted partial nephrectomy, robot-assisted nephroureterectomy and robot-assisted pyeloplasty. A MEDLINE search was used to identify recent articles (within the last two years) and publications of specific importance, which highlighted the recent developments and future direction of robotics. This review will use the aforementioned urologic surgeries as vehicles to evaluate the current status and future role of robotics in the advancement of the field of urology.
  6,609 1,200 17
ORIGINAL ARTICLES
Minimally-invasive management of prostatic abscess: The role of transrectal ultrasound
Punit Bansal, Aman Gupta, Ritesh Mongha, Maloy Bera, K Ranjit, Anup K Kundu
July-December 2009, 1(2):56-60
DOI:10.4103/0974-7796.56047  
Context and Aim: Prostatic abscess is an unusual condition. The prevalence of prostatic abscess is about 0.5% of all prostatic diseases. The purpose of the study is to present and discuss the role of transrectal ultrasound (TRUS) in the management of prostatic abscess. Settings and Design: Retrospective study. Materials and Methods: We retrospectively reviewed the medical records of all eight patients diagnosed and treated for prostatic abscess in the last threeyears. TRUS was used for diagnosis in all cases. Four patients had TRUS guided aspiration for management of prostatic abscess. Data collected regarding etiology, clinical features, investigations and treatment was compared with the available literature. Results: The age of patients ranged from 18-65 yrs (mean 47.12 yrs). Out of the eight patients, six were diabetics. TRUS revealed one or more hypoechoic areas within the prostate in all the patients. Successful treatment of prostatic abscess with TRUS guided needle aspiration was done in all fourpatients in whom it was used. Mean hospitalization time was 9.4 days, and most frequent bacterial agent was S. aureus. Conclusions: TRUS is useful in diagnosis as well as in guidance for aspiration of such abscesses. TRUS guided needle aspiration is an effective method for treating prostatic abscess. Most of the patients are diabetics and usually grow Staphaureus. So an antibiotic with staphylococcal coverage should be used empirically.
  7,053 752 -
CASE REPORTS
Giant adrenal myelolipoma: Incidentaloma with a rare incidental association
Nisar Ahmad Wani, Tasleem Kosar, Ijaz A Rawa, Abdul Qayum
September-December 2010, 2(3):130-133
DOI:10.4103/0974-7796.68865  PMID:20981204
Adrenal myelolipoma is an unusual, benign and biochemically inactive tumor that is composed of mature adipose and hematopoietic tissue. It is usually diagnosed accidentally and nowadays much more frequently because of widespread use of ultrasonography, computed tomography (CT) and magnetic resonance imaging. Adrenal myelolipoma is usually unilateral and asymptomatic, though known to be associated with obesity, hypertension, endocrinological disorders and some malignancies. We report herein two cases of right-sided giant adrenal myelolipoma diagnosed by multidetector-row CT. One patient was symptomatic because of a large mass in the right upper abdomen, which on imaging with CT was seen to be right adrenal myelolipoma. Another patient had a large left side Bochdalek hernia and right adrenal myelolipoma was incidentally discovered on CT.
  7,227 510 1
ORIGINAL ARTICLES
Effect of caffeine on bladder function in patients with overactive bladder symptoms
Supatra Lohsiriwat, Muthita Hirunsai, Bansithi Chaiyaprasithi
January-April 2011, 3(1):14-18
DOI:10.4103/0974-7796.75862  PMID:21346827
Objectives: To evaluate the effect of caffeine at the dose of 4.5 mg/kg on bladder function in overactive bladder (OAB) adults. Materials and Methods: Nine women and three men aged 21-40 years with OAB symptoms were included. Each subject drank 8 ml/kg of water with and without caffeine at two separate sessions. Cystometry and uroflowmetry were performed 30 minutes after each drink. The effects of caffeine on urodynamic parameters were compared. Results: After caffeine ingestion, the mean volume at bladder filling phase decreased at first desire to void and normal desire to void (P<0.05), compared to the mean volume after taking water (control) drink. The mean volume at strong desire to void, urgency and maximum cystometric capacity also tended to decrease. No change in the detrusor pressure at filling phase was found. At voiding phase, the maximal flow rate, average flow rate and voided volume were increased (P<0.05). The urine flow time and time to maximal flow rate were not changed. Conclusion: Caffeine at 4.5 mg/kg caused diuresis and decreased the threshold of sensation at filling phase, with an increase in flow rate and voided volume. So, caffeine can promote early urgency and frequency of urination. Individuals with lower urinary tract symptom should avoid or be cautious in consuming caffeine containing foodstuffs.
  6,688 857 21
CASE REPORTS
Perinephric abscess caused by ruptured retrocecal appendix: MDCT demonstration
Nisar Ahmad Wani, Mir Farooq, Tariq Gojwari, Tasleem Kosar
January-April 2010, 2(1):29-31
DOI:10.4103/0974-7796.62923  PMID:20842255
Acute appendicitis may occasionally become extraordinarily complicated and life threatening yet difficult to diagnose. One such presentation is described in a 60-year-old man who was brought to the hospital due to right lumbar pain and fever for the last 15 days. Ultrasonography showed a right perinephric gas and fluid collection. Abdominal computed tomography with multidetector-row CT (MDCT) revealed gas-containing abscess in the right retroperitoneal region involving the perinephric space, extending from the lower pole of the right kidney up to the bare area of the liver. Inflamed retrocecal appendix was seen on thick multiplanar reformat images with its tip at the lower extent of the abscess. Laparotomy and retroperitoneal exploration were performed immediately and a large volume of foul smelling pus was drained. A ruptured retrocecal appendix was confirmed as the cause of the abscess.
  6,928 582 1
MONTI as continent catheterized stoma using serosal-lined trough "Ghoneim Abolenin" technique in ileocystoplasty
Mohammed T Sammour, Abdulbari Bin Ajjaj
January-April 2011, 3(1):33-35
DOI:10.4103/0974-7796.75863  PMID:21346831
It is a great challenge to select and perform continent mechanism in a stoma for urinary reservoir. A new technique by combining MONTI ileal conduit with the serosal lined trough in order to achieve continent catheterizable stoma to the umbilicus as a part of augmentation ileocystoplasty. We applied serosal-lined trough as a continent mechanism with MONTI ileal tube in 12 years smart girl underwent ileocystoplasty for neuropathic bladder due to meylomeningocele in whom continence failed to be achieved by using Mitrofanoff with submucosal tunnel of the bladder as continent mechanism before, also the previous operation included left to right transuretero-ureterostomy, ureterocystoplasty and reimplantation of the right ureter. The patient became completely continent; she was able to do self-catheterization easily through the umbilical stoma using 16-French catheter and was able to wash the mucous easily. The capacity of the augmented bladder was 300ccs. She became independent from her mother and stopped using diapers, anticholinergic and antibiotics. Combining MONTI conduit with serosal-lined extramural valve trough (The Ghoneim technique) is an effective continent technique and gives wider channel for catheterization and washing out the mucous.
  7,085 380 -
ORIGINAL ARTICLES
Endoscopic placement of double-J ureteric stents in children as a treatment for primary obstructive megaureter
Daniel Carroll, Harish Chandran, Ashwini Joshi, Liam S. L. McCarthy, Karan Parashar
September-December 2010, 2(3):114-118
DOI:10.4103/0974-7796.68860  PMID:20981199
Aim: To determine the efficacy and potential complications of double-J ureteric stents in the treatment of persistent or progressive primary obstructive megaureter in pediatric patients within our institution. Materials and Methods: A retrospective case-note review of all patients with double-J ureteric stents, between 1997 and 2004, was performed. In all, 38 stents were inserted in 31 patients aged between 2 months and 15 years of age. Complications and results of follow-up investigations and the need for follow-up investigations were recorded. Patients were followed up clinically and radiologically for a minimum of 2 years following stent insertion. Results: Endoscopic placement of double-J ureteric stents in childhood is straightforward and complications are uncommon (8/38 insertions). In non-resolving or progressive primary non-refluxing megaureter, double-J ureteric stenting alone is effective with resolution of primary non-refluxing megaureter in 66% of cases (25/38 insertions). Conclusions: Ureteric stenting provides an alternative to early surgery in patients with primary non-refluxing megaureter. The youngest patient in our series was 2 months old at the time of endoscopic ureteric double-J stent insertion. Endoscopic placement of ureteric double-J stents should be considered as a first-line treatment in the management of persistent or progressive non-refluxing megaureter leading to progressive hydronephrosis or pyonephrosis.
  6,649 773 6
CASE REPORTS
New compression mechanism in penile-scrotal lymphedema and sexual rehabilitation
Jose Maria Pereira de Godoy, Fernando Nestor Facio, Eleni Cássia Matias de Carvalho, Maria de Fatima Guerreiro Godoy
January-March 2014, 6(1):88-90
DOI:10.4103/0974-7796.127025  PMID:24669133
The objective of this study is to describe a new compression mechanism in the treatment of lymphedema of the penis and scrotum and the ensuing sexual rehabilitation. The patient, a 58-year-old man, had edema of the penile and scrotal region as a result of surgery of the pancreas and spleen and chemotherapy. The patient complained of pain, discomfort, and difficulties to walk and urinate. A clinical diagnosis of lymphedema of the penis and scrotum was reached. Treatment involved the continuous use of a cotton-polyester compression garment for the region together with thorough hygiene skin care. The swelling reduced significantly within a week to almost a normal aspect which was accompanied by clinical improvements of the symptoms. The reduction in penile edema allowed sexual rehabilitation even though erectile dysfunction required the use of a specific medication (sildenafil). In conclusion, simple and low-cost options can improve lymphedema of the penis and scrotum and allow sexual rehabilitation.
  6,993 310 -
Anterior bladder flap neo urethra as treatment for stress urinary incontinence due to developmental urogenital anomaly
N Rajamaheswari, Sugandha Agarwal, Archana Bharti Chhikara, K Seethalakshmi
July-September 2013, 5(3):215-217
DOI:10.4103/0974-7796.115745  PMID:24049391
Congenital anomalies that involve the distal segment of urogenital sinus (giving rise to female urethra and vagina) may lead to abnormal urethral development ranging from absent to markedly deficient urethra. The abnormal division may also cause a short and patulous urethra. Sphincteric defects are likely to be associated and when combined with the short urethral length is a cause for severe urinary incontinence. Urinary incontinence due to a congenital cause requiring repeated urethral reconstruction to relieve symptoms is presented. A 15 year old girl was referred for bothersome urinary incontinence due to a short, wide, patulous urethra with defective sphincteric mechanism as part of urogenital sinus developmental anomaly. She was initially managed by reconstruction of bladder neck and proximal urethra with sphincter augmentation using autologous pubovaginal sling. Persistent urinary incontinence demanded a second urethral reconstruction using tubularised anterior bladder flap (modified Tanagho). Surgical reconstruction of the urethra achieved socially acceptable continence.
  7,084 207 -
ORIGINAL ARTICLES
Laparoscopic ureteroneocystostomy for management of lower ureteric strictures
Aman Gupta, Punit Bansal, MK Bera, Anup Kumar Kundu, Aradhana Kalra, Mukesh Kumar Vijay, Arindham Dutta, Suresh Singla, Punit Tiwari
July-December 2009, 1(2):47-51
DOI:10.4103/0974-7796.56044  
Aim: We assessed the results of laparoscopic transperitoneal ureteroneocystostomy with or without a psoas hitch for management of lower ureteral strictures. Materials and Methods: Between October 2005 and August 2008, 16 patients with lower ureteric strictures underwent laparoscopic ureteroneocystostomy with or without a psoas hitch. Etiology of strictures was gynecological surgery in 11, surgery for stone disease in 3, ureterovaginal fistula in 1 and primary obstructive megaureter in 1. Transperitoneal 3- or 4-port laparoscopic ureteroneocystostomy was performed with or without psoas hitch. Results: All operations were successfully completed without any need for conversion to open. Mean operative time was 171.56 min (range 130 to 260 min), mean blood loss was 93.44 cc (range 30 to 200 cc) and total hospital stay was 3.73 days (range 3 to 6 days). Mean time to resume oral intake was 12.5 h (range 8 to 22 h). Mean follow-up period was 21.83 months (range 6-39 months). Postoperative follow-up investigations revealed successful outcome in all 16 patients, success being defined as relief of symptoms and radiological improvement, irrespective of the refluxing status. Non-refluxing status was achieved in 15 out of 16 patients as determined by micturition cystography. Conclusions: Laparoscopic ureteroneocystostomy is a safe and effective procedure, with inherent advantages of laparoscopic surgery.
  6,462 707 -
CASE REPORTS
Subcapsular renal hematoma after ureterorenoscopy: An unknown complication of a known procedure
Ujjwal Bansal, Ajit Sawant, Jayesh Dhabalia
September-December 2010, 2(3):119-121
DOI:10.4103/0974-7796.68861  PMID:20981200
Renal subcapsular hematoma is not an uncommon complication after extracorporeal short wave lithotripsy, trauma, renal angiographic procedures and spontaneously in patients of malignancy and in patients on anticoagulation. We present a patient who developed renal subcapsular hematoma after ureterorenoscopy, which has not been mentioned in literature ever. Clinical spectrum varies from spontaneous resolution through acute renal failure to Page kidney. Page kidney is the external compression of a kidney usually caused by a subcapsular hematoma associated with high blood pressure and occasional renal failure. It is named after Dr. Irvin Page who first demonstrated in 1939 that wrapping cellophane tightly around animal kidneys could cause hypertension. Various management options are mentioned in literature and depend upon the severity of hematoma. Percutaneous drainage is a successful option for the management of subcapsular hematoma in hemodynamic stable patients.
  6,474 530 4
ORIGINAL ARTICLES
Antibiotic susceptibility pattern in urinary isolates of gram negative bacilli with special reference to AmpC β-lactamase in a tertiary care hospital
Mitesh H Patel, Grishma R Trivedi, Sachin M Patel, Mahendra M Vegad
January-April 2010, 2(1):7-11
DOI:10.4103/0974-7796.62915  PMID:20842250
Introduction: Resistance to higher antimicrobial agent is commonly seen in gram negative bacilli. This issue is a challenging problem to the medical practitioners in addition to it is financial impact on the health care system. Objectives: To document the prevalence of multi drug resistant gram negative bacilli isolated from urine of patients attending the Urology Department of Tertiary care Hospital of western India in year 2008. Results: Out of total 328 isolates, 118 (35.98%) E.coli, 72 (21.95 %) Klebsiella, 64 (19.51%) Pseudomonas aeruginosa, 30 (9.15%) Acinetobacter, 18 (5.49%) Proteus vulgaris, 18 (5.49%) Proteus mirabilis, 6 (1.83%) Providencia rettgerii, 2 (0.61%) Citrobacter freundii. Out of these isolates, 228 (69.51%) were b-lactamase positive, while 100 (30.51%) were β-lactamase negative. Out of 228 β-lactamase positive, 104 (45.61%) were AmpC β-lactamase positive. Conclusions: Stringent protocol such as Antibiotic policy and Hospital infection control program are mandatory to curb these microbes in a tertiary care hospital.
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