Immediate endoscopic management of complete iatrogenic anterior urethral injuries: A case series with long-term results

BACKGROUND: Urethral injury produces partial or complete disruption of the urethral integrity. Advances in endourology have made endoscopic management of most of these injuries feasible without greatly compromising the final result. We report our institutional experience of immediate endoscopic realignment of complete iatrogenic anterior urethral injury. METHODS: From May 1997 to May 2003, seven patients with complete anterior urethral disruption were managed by immediate endoscopy guided splinting of urethra. Retrograde urethroscopy, combined with fluoroscopic guidance and in some cases antegrade cystoscopy through a suprapubic stab cystostomy was performed. A guide wire was negotiated across the disruption. Later, a 16 F Foley catheter was placed for 1–3 weeks. Patients were followed up at 1, 3, 6 and 12 months and then yearly to assess the long-term outcome of endoscopic management. RESULTS: Immediate endoscopic realignment was achieved in all patients. Three patients developed recurrence at six months; that was treated by optical urethrotomy. Only one patient developed multiple recurrences over an average follow-up of 49.2 months (range 7 to 74 months). He was offered open end-to-end urethroplasty at twenty months after third recurrence. Thus immediate endoscopic realignment avoided any further intervention in four patients (57.14%); while after an additional optical urethrotomy, urethroplasty could be avoided in six patients (87.2%). CONCLUSION: Immediate endoscopic realignment of traumatic urethral disruption is a feasible, safe and effective treatment modality for management of patients with iatrogenic complete anterior urethral injuries

Benign Prostate Hyperplasia and Bladder Stones: An Update

Bladder calculi in elderly are thought to be commonly associated with presence of bladder outlet obstruction. However there is a role of systemic factors in pathogenesis of calculi. It is clear that enlarged prostate may be an innocent bystander in many elderly patients having bladder calculi. There are varieties of options available for management of both these conditions. The present review is focused on understanding of pathogenesis of bladder calculi in elderly male. It also provides an overview of various treatment modalities described in literature for management of this condition. Approach in each case should be individualized based on the patient's clinical criteria and his choice, availability of various endourological gadgets, surgical expertise and experience

In-situ holmium laser lithotripsy for impacted urethral calculi

Urethral calculi usually present as acute retention of urine. The issues in this rare clinical problem are its emergency management scenario, small urethral caliber, and long-term risk of stricture formation. In this retrospective study, the positive experience with the safety and efficacy of holmiumlaser lithotripsy for ureteral calculi was applied to the management of urethral calculi, and the initial results were analyzed. From October 1999 to June 2003, 42 patients presented with symptomatic urethral calculi. Under anesthesia, an attempt was made to push the calculus back in the bladder using lidocaine jelly. In 18 patients in whom this attempt failed, in-situ intracorporeal holmium lasertripsy was performed under cystourethroscopic guidance. All the patients were rendered stone free after a single endoscopic procedure. There were no intraoperative or postoperative complications. At a mean follow-up of 22.28 months (range 5-35 months), 17 of the patients having lasertripsy were asymptomatic with no evidence of development of urethral stricture. Intracorporeal intraurethral holmium lasertripsy is a feasible, safe, and effective minimally invasive alternative for the treatment of impacted male urethral calculi

Genitourinary Tuberculosis; An Update

Genitourinary tuberculosis remains a disease that has significant consequences. Due to its regional preponderance, knowledge and suspicion is key to early diagnosis in patients living in the western hemisphere. The present overview highlights varied presentation of genitourinary tuberculosis and its current treatmentmodalities. It provides review of minimally invasive techniques that have reduced the morbidity of surgical therapy in these patients. Disease remains lethal in immune compromised patients and in those withmulti-drug resistant tuberculosis

Are titanium clips for control of the renal hilar vessels as unsafe as generally presumed?

Controlled ligation and division of renal vessels is a critical step during any nephrectomy procedure. It is generally been presumed that titanium clip ligation of renal vessels is risky and insecure. We report our experience over 5 years with ligaclips 10-mm titanium clips for secure ligation of renal hilum during laparoscopic nephrectomy. Titanium clips of 10 mm were used to secure renal vessels in 86 patients. We managed to get across the entire width of renal vein with a 10-mm titanium clip by crimpling the vein with the help of the clip applicator before firing the clips. In all except 2 cases ligaclips alone were enough to ensure secure occlusion of renal hilum. There was no incidence of slippage or dislodgement of clips applied on renal vessels. On cost analysis, it was found that the Hem-o-lok clip and gastrointestinal anastomosis stapling device were approximately 6-fold and 12-fold costlier than ligaclips. We also reviewed literature on different modalities available for renal hilar control during laparoscopic nephrectomy