Intraoperative breakage of Sachse's knife blade: A rare complication of optical internal urethrotomy (one case managing experience)

ABSTRACT Optical internal urethrotomy (OIU) is the most common procedure performed for short segment bulbar urethral stricture worldwide. This procedure most commonly performed using Sachse’s cold knife. Various perioperative complications of internal urethrotomy have been described in literature including bleeding, urinary tract infection, extravasation of fluid, incontinence, impotence, and recurrence of stricture. Here we report a unique complication of breakage of Sachse knife blade intraoperatively and its endoscopic management.

Urological surgery in epidermolysis bullosa: tactical planning for surgery and anesthesia

Epidermolysis bullosa (EB) is characterized by extreme fragility of the skin and mucosae. Anesthetic and surgical techniques have to be adapted to those children and routine practice may not be adequate. Urological problems are relatively common, but surgical techniques adapted to those children have not been well debated and only low evidence is available to this moment. Herein we discuss the specifics of anesthetic and surgical techniques chosen to treat a six year old EB male presenting with symptomatic phimosis.

Minimal Hydrocelectomy with the aid of scrotoscope: a ten-year experience

Background Since hydrocelectomy remains the choice of surgical treatment of hydrocele and standard surgical procedures may cause postoperative discomfort and complications, a new minimal surgery procedure is needed. The scrotoscope was used for the diagnosis and treatment of intrascrotal lesions. The aim of the study is to illustrate a new minimal hydrocelectomy with the aid of scrotoscope, in an effort to decrease complications. Materials and Methods: Between 2002 and 2012, 65 patients underwent hydrocelectomy with the aid of a scrotoscope. Before carrying out hydrocelectomy, the scrotoscopy was first used to examine the intrascrotal contents to exclude any pathological lesions. After determining the condition of testis, epididymis and spermatic cord and excluding any other secondary causes of hydrocele, a 2.0cm scrotal incision was performed. The parietal tunica vaginalis was then grasped out of scrotum, and the mobilized tunica was excised. The scrotoscopy was then performed again to inspect the intrascrotal contents. Results Mean operative time was 35.4 minutes. No major complications occurred during the post-operative follow-up period. Of these 65 patients, 61 underwent scrotoscopy and minimal hydrocelectomy, two patients underwent open hydrocelectomy because thickening of hydrocele wall was identified; two patients with acute inflammation only underwent scrotoscopy. Pathological changes were observed among eight patients. All patients were satisfied with the outcomes. Conclusions Minimal hydrocelectomy shows commendable results and fewer complications. The combination of minimal hydrocelectomy and scrotoscopy seems to be an encouraging technique. This novel surgical procedure proves to be a viable option for the diagnosis and treatment of hydrocele. .

Parachute technique for partial penectomy

PURPOSE: Penile carcinoma is a rare but mutilating malignancy. In this context, partial penectomy is the most commonly applied approach for best oncological results. We herein propose a simple modification of the classic technique of partial penectomy, for better cosmetic and functional results. TECHNIQUE: If partial penectomy is indicated, the present technique can bring additional benefits. Different from classical technique, the urethra is spatulated only ventrally. An inverted "V" skin flap with 0.5 cm of extension is sectioned ventrally. The suture is performed with vicryl 4-0 in a "parachute" fashion, beginning from the ventral portion of the urethra and the "V" flap, followed by the "V" flap angles and than by the dorsal portion of the penis. After completion of the suture, a Foley catheter and light dressing are placed for 24 hours. CONCLUSIONS: Several complex reconstructive techniques have been previously proposed, but normally require specific surgical abilities, adequate patient selection and staged procedures. We believe that these reconstructive techniques are very useful in some specific subsets of patients. However, the technique herein proposed is a simple alternative that can be applied to all men after a partial penectomy, and takes the same amount of time as that in the classic technique. In conclusion, the "parachute" technique for penile reconstruction after partial amputation not only improves the appearance of the penis, but also maintains an adequate function.

Early catheter removal after anterior anastomotic (3 days) and ventral buccal mucosal onlay (7 days) urethroplasty

INTRODUCTION: Physicians who perform urethroplasty have varying opinions about when the urinary catheter should be removed post-operatively, but research on this subject has not yet appeared in the literature. We performed voiding cystourethrogram (VCUG) on our anterior urethroplasty patients on days 3 (anastomotic) and 7 (buccal) in an effort to determine the earliest day for removal of the urethral catheter. MATERIALS AND METHODS: Retrospective chart review of 29 urethroplasty patients from October 2002 - August 2004 was performed at two reconstructive urology centers. 17 patients had early catheter removal (12 anastomotic and 5 ventral buccal onlay urethroplasty) and were compared to 12 who had late removal (7 anastomotic and 5 buccal). RESULTS: Of those with early catheter removal, 2/12 (17 percent) of anastomotic urethroplasty patients had extravasation, which resolved by the following week and 0/5 (0 percent) of the buccal mucosal urethroplasty patients had extravasation. Patients with late catheter removal underwent VCUG 6-14 days (mean 8 days) after anastomotic urethroplasty and 9-14 days (mean 12 days) after buccal mucosal urethroplasty. 0 percent of the anastomotic urethroplasty had leakage after the late VCUG and 1/5 (20 percent) of the buccal patients had extravasation after the VCUG. Recurrences were low in all patient groups. CONCLUSION: Catheter removal after anastomotic and buccal mucosal urethroplasty can be safely attempted on the 3rd and 7th post-operative days respectively, with a low rate of extravasation on VCUG. Eliminating the catheter as soon as possible should improve patient comfort without harming results and decrease the overall negative impact of surgery on the patient.

Longitudinal urethral sling with prepubic and retropubic fixation for male urinary incontinence

OBJECTIVE: Description and early results of a new urethral sling technique for treatment of postprostatectomy urinary incontinence, which combines efficacy, low cost and technical simplicity. MATERIALS AND METHODS: From May 2003 to April 2004, 30 patients with moderate or total urinary incontinence, following radical prostatectomy or endoscopic resection of the prostate, underwent the new technique. The technique is based on the placement of a longitudinal-shaped sling in the bulbar urethra, measuring 4 cm in length by 1.8 cm in width, made of Dacron or polypropylene mesh, fixed by 4 sutures on each side, with 2 sutures passed with Stamey-Pereira needle by retropubic approach and 2 by prepubic approach, which are then tied over the pubis. Pressure control was determined by interrupting the loss of infused water through a suprapubic cystostomy 60 cm from the pubis level. RESULTS: Pre-operative assessment excluded vesical instability, urethral stenosis and urinary infection. Suprapubic cystostomy was removed when the patient was able to satisfactorily void with urinary residue lower than 100 mL, which occurred in 29 of the 30 cases. In 2 cases, there was infection of the prosthesis, requiring its removal. In 3 cases, there was the need to adjust the sling (increasing the tension), due to failure of the urinary continence. Overall, 20 of 30 (66.7 percent) operated patients became totally continent, and did not require any kind of pads. Four of 30 (13.3 percent) patients achieved partial improvement, requiring 1 to 2 pads daily and 6 of 30 (20 percent) patients had minimal or no improvement. There was no case of urethral erosion. CONCLUSION: This new sling technique has shown highly encouraging preliminary results. Its major advantage over other surgical techniques for treatment of moderate or severe stress urinary incontinence is the simplicity for its execution and low cost. A long-term assessment, addressing maintenance of continence, detrusor function and preservation of the upper urinary tract, is still needed.