ABSTRACT

Background: Currently, there is renewed controversy over which tissues and techniques are optimal for urethral replacement. Because surgical treatment of urethral stricture diseases is an evolving process, new technical refinements are continuously being suggested.

Objectives: To evaluate the efficacy and mid-term results of using lingual mucosal grafts (LMG) in management of long and recurrent strictures of the anterior urethra.

Patients and Methods: The study included 18 patients with long recurrent strictures of the anterior urethra. The recurrence arose in 14 patients after several visual internal urethrotomies, after hypospadias repair in 2, and after buccal mucosal graft (BMG) urethroplasty in 2. The strictures varied in length from 3 to 9 cm. Dorsal onlay of the LMGs was used in 12 patients, while ventral onlay was used in 6 patients. Follow-up lasted from 3 to 24 months. Postoperatively, all patients were followed by urethrography, uroflowmetry, and urethroscopy. Successful reconstruction criteria were a peak flow rate greater than 15 ml/sec and no need for postoperative dilatation.

Results: Out of 18 cases, 15 were successful (83.3%). Of the 3 failures, 1 patient had an urethrocutaneous fistula, and 2 patients developed recurrence in the stricture 3 months after urethroplasty.

Conclusion: The technique of substitution urethroplasty using lingual mucosal grafts has been shown to be easy, safe, and reproducible with good surgical and functional outcomes. The success rate is comparable to other techniques of substitution urethroplasty, especially BMGs, but with fewer donor site complications. Our mid-term results are satisfactory, but larger comparative studies with longer duration of follow-up are needed to confirm the durability of these results.

Keywords: LMG, BMG, Urethroplasty

Correspondence: Maged M Ragab, Urology Department, Tanta University Hospital, Tanta, Egypt, mmregy@yahoo.com

To Cite this Article: Ragab MM, Elgamal S, Farhat Y, Saber W, Hawas M, Elsharaby M. Urethroplasty with Lingual Mucosal Graft for Management of Long and Recurrent Strictures of the Anterior Urethra. UIJ. In Press. doi:10.3834/uij.1939-4810.2008.12.02

ABSTRACT

Objectives: We hypothesized that patients undergoing bilateral native nephrectomy have a better perioperative course and earlier recovery when renal transplantation is performed before nephrectomy rather than afterwards, since the anuric state is avoided.

Methods: Of 9 patients undergoing bilateral nephrectomy between November 2000 and December 2005, 5 had nephrectomy before renal transplant and 4 had nephrectomy after transplant. Hospital course and complications within 3 months of each operation were compared.

Results: Patients who underwent bilateral nephrectomy prior to transplantation spent more days in the hospital overall (mean = 25 days) than did patients who received their transplant before nephrectomy (mean = 14 days). Serum creatinine levels over the course of both operations were greater for the group maintained on dialysis, but both groups had similar values at the time of discharge from the second procedure and at 1-year follow-up. Major and minor complications were more frequent in those who underwent nephrectomy before transplant.

Conclusion: The order of operations for patients undergoing both bilateral nephrectomy and renal transplantation impacts perioperative course, especially in the first 3 months after the operations are completed. Bilateral native nephrectomy before renal transplantation is associated with a greater risk of complications and longer overall duration of hospitalization.

Keywords: Transplantation, Nephrectomy, Laparoscopy, Postoperative complications

Correspondence: J. Stuart Wolf Jr., Department of Urology, University of Michigan Health System, 1500 East Medical Center Drive, TC 3875, Ann Arbor, MI, 48109, wolfs@med.umich.edu

To Cite this Article: Kaplan JR, Sung RS, Wolf JS. Bilateral Native Nephrectomy: Before or After Renal Transplantation?. UIJ. In Press doi:10.3834/uij.1939-4810.2008.12.04

ABSTRACT

We present a 31-year-old man with transverse testicular ectopia of the left testis. He presented to our surgical outpatient department with right scrotal swelling, originally diagnosed as an obstructed hernia, and an impalpable testis in the left scrotum. We performed a right herniotomy on the patient and found a large lobulated left testis and normal right testis in the right scrotum. Diagnosis of transverse testicular ectopia was made on the operation table, as the man originally came for repair of obstructed right inguinal hernia. This is the first case of transverse testicular ectopia we have come across since 1966.

Keywords: Transverse testicular ectopia, Inguinal hernia, Urogenital anomalies

Correspondence: Abdulqadir Maghded Zangana, Erbil Teaching Hospital, PO Box 178, Erbil, Iraq, draqzangana@yahoo.com

ABSTRACT

Objective: To assess the performance of the NMP22^® BladderChek^® (NMP22-BC) urine test compared with cytological and histological findings for detecting bladder cancer recurrence in patients with a prior history of bladder cancer.

Methods: A prospective study was performed, evaluating a total of 112 urine samples from 67 patients. These samples were obtained prior to cystoscopy and were analyzed with the NMP22-BC. The results were compared against those of voided urine cytology (VUC) and cystoscopy.

Results: Of the 112 samples, there was a total of 27 recurrences (24.1%). The overall sensitivity of NMP22-BC alone was 33%, VUC with malignant or suspicious specimens alone was 37%, and the two methods combined was 46%. The specificity of NMP22-BC alone was 92%, VUC alone was 99%, and both methods combined was 92%. The detection rate of bladder cancer recurrence in high-grade tumors increased from 50% for NMP22-BC alone and 43% for VUC alone, to 64% when both tests were used in combination. The detection rate of recurrence for stages Ta, T2, and CIS was also significantly increased when NMP22-BC and VUC were used in combination. The overall positive and negative predictive values were 68% and 84% respectively. Inclusion of atypia as positive for recurrence (VUC+A) increased the overall sensitivity of cytology to 72% but decreased the specificity to 64%. However, in cases where atypical cytology was confirmed with positive NMP22-BC, the sensitivity of the combination was 46% and specificity was 100%.

Conclusion: NMP22^® BladderChek^® is a valuable addition to voided urine cytology for detection of high-risk lesions. Our study shows that once atypical cytology is confirmed by NMP22-BC, the specificity is 100%. Furthermore, the sensitivity of this combination is superior to that of malignant or suspicious cytology alone.

Keywords: Bladder cancer, NMP-22, Cytology, Urinary markers

Correspondence: Ravi Munver, Department of Urology, Hackensack University Medical Center, 360 Essex Street, Suite 403, Hackensack, NJ, 07601, rmunver@humed.com

ABSTRACT

Background: Intravesical foreign bodies are a reported problem with variable natures. Rarely, it is reported to be an intrauterine device (IUD) that perforates through both the uterine and the vesical walls to lie within the urinary bladder.

Objective: We report our experience with 6 cases of IUDs perforating into the urinary bladder.

Methods: Over 5 years, a total of 6 patients with IUDs perforating to the bladder presented to our facility complaining of LUTS and positive for microscopic hematuria of variable duration. Large, 4- to 5-cm stones were found in 2 patients and were removed via cystolithotomy. IUDs were removed from 3 patients via cystolitholapaxy and endoscopic extraction, and 1 partially perforating IUD with no stone formation was treated via extraction of the device per vagina.

Results: All procedures went well with no complications. Patients received urinary drainage for 1 week postoperatively.

Conclusion: IUD perforation to the bladder, with or without stone formation, is a rare event that can be diagnosed and treated easily with minor procedures and minimal complications, provided that the urologist kept the condition in mind.

Keywords: IUD, Bladder stone

Correspondence: Mohamed Ali A Ismail, Urology Department, Theodore Bilharz Research Institute, Giza, Egypt, mohadali@hotmail.com