Role of dorsal onlay buccal mucosal graft urethroplasty for long anterior urethral strictures

Background: Treatment of the urethral strictures is challenging and with appropriate evaluation preoperatively and surgery planning it is possible to achieve good results. The objective of the study was to evaluate the efficacy of dorsal onlay buccal mucosal graft urethroplasty in treating long anterior urethral strictures.Methods: Between August 2018 to July 2019 a total of 25 patients with anterior urethral stricture were treated with dorsal onlay buccal mucosal graft urethroplasty. Age, etiology of the stricture, stricture length (≤ 7 cm, and > 7 cm), and site of the stricture were assessed as the factors affecting the success rate.Results: The clinical outcome as Success was defined as the patient not needing any form of urethral instrumentation postoperatively. The mean follow-up period was 18 months. Of 25 patients, 22 (92%) were successful and 3 (8%) were a failure. There was no statistically significant difference between the age groups, etiology of the stricture and success rate (p=0.21 and p=0.444). The statistical difference was significant for the site and length of the stricture by means of success (p=0.005 and p=0.025).Conclusions: Our results show stricture length and localization are the most important variables for good success. Because of less failure rate, single-stage dorsal onlay buccal mucosal graft urethroplasty may be offered as an alternative to staged urethroplasty in case of long urethral strictures.

A PROSPECTIVE STUDY COMPARING TUBELESS MINI-PERCUTANEOUS NEPHROLITHOTOMY TO RETROGRADE INTRARENAL SURGERY FOR ≤2 CM RENAL STONES.

Objective: The present study aims to assess the safety and efficacy of tubeless mini-PCNL and RIRS in the management of renal stones of ⩽2 cm size. Patients and methods: This was a prospective study in 80 patients with renal stones of ⩽2 cm and were divided into two equal groups of patients choice: Group 1 were managed by tubeless mini-PCNL and Group 2 by RIRS using flexible ureteroscopy and laser. Intraoperative events like duration of surgery, stone clearance and complications were noted. Postoperative parameters taken into account were pain score, parenteral analgesic requirements, bleeding, need for blood transfusion, fever, hospital stay, cost of the procedure and number of days taken to return to normal work. Results: Both groups were comparable for preoperative parameters. Mean duration of surgery in group 1 and group 2 was 68.88 ± 7.20 minutes and 92.25 ± 14.62 minutes respectively (p<0.00001). The mean haemoglobin fall in group 1 and group 2 was 0.47±0.24 g/dl and in group 2 was 0.28±0.18 g/dl respectively (p=0.00013). In group 2, residual stones were present in 4 patients (on follow-up at 3 weeks), while in group 1 there was no residual stones. The cost of the treatment was more in the RIRS group with statistically significant difference (p<0.005). Conclusion: In a urological setup where LASER and flexible ureteroscope are not available, tubeless mini PCNL is a safe, efficacious and cost-effective option for the management of smaller (⩽ 2 cm) stones compared to RIRS procedure. Recommendations: Mini PCNL and RIRS are safe and feasible surgical options to manage ⩽ 2 cm renal stones. We recommend tubeless mini PCNL in a setup where LASER and flexible ureteroscope are not available

A comparative study between HoLEP and bipolar TURP in the treatment of benign prostatic hyperplasia

Introduction: Benign Prostatic Hyperplasia (BPH) is one of the most frequent diseases in men. The laser treatment for BPH has challenged TURP due to advances in laser technology, a better understanding of tissue-laser interactions and rowing clinical experience. Objective: To evaluate the safety and efficacy of HoLEP, comparing it to Bipolar TURP. Material and methods: This was a prospective study to evaluate the outcomes in BPH patients undergoing surgery by HOLEP and Bipolar TURP done between January 2018 to December 2019. A total of 80 Patients were enrolled, 40 undergoing HoLEP and the other 40 Bipolar TURP for BPH. The procedures were performed by a single surgeon. All patients with symptomatic BPH and who were candidates for surgical treatment were included. Patients with previous prostate surgery, urethral surgery, history of prostate cancer or neurogenic bladder were excluded. Results: Baseline parameters were almost similar between both the groups in terms of age, IPSS, QOL, Q max, PVR, and gland size. Operative time and resected gland weight were more in HoLEP arm (p<0.001). Catheter time and Hospital stay were significantly low in the HoLEP group (p<0.0001). Hemoglobin drop was not significant (p=0.148). IPSS at three months was similar in both groups (p=0.608). Qmax improved significantly in both groups, with 18.87 ml/s in TURP and 17.87 ml/s in HoLEP with a p-value of 0.261. PVR and QOL were similar between the two groups (P=0.914 and P=0.781). Conclusion: Both Bipolar TURP and HoLEP were effective in relieving BOO. HoLEP has equal efficacy compared to conventional bipolar TURP, with decreased hospital stay and catheter indwelling time. The learning curve of HoLEP is steep; however, it can be overcome gradually