Rare case of ureteral endometriosis presenting as hydronephrotic kidney.

A 29-year-old woman presented with unilateral loin pain because of severely hydro-nephrotic kidney due to deposits of pelvic endometriosis. Double J-stent was placed beyond the obstruction and she was started on hormone therapy. The stent was removed after three months when back pressure changes had resolved. This case is being presented along with a short relevant discussion, due to rarity of ureteral involvement by endometriosis.

A rare case of primary solid intrarectal dermoid.

Primary rectal teratomas are rare and only few cases have been reported in the literature worldwide. These usually occur in females. These are usually cystic but very rarely solid variants may occur. We present a case of a solid intra-rectal dermoid arising primarily in rectum from postero-lateral wall. Excision biopsy was done per rectally. Histology revealed the presence of squamous epithelium, fat cells, hair follicles, cartilaginous material and columnar lining of glandular structures suggestive of mature teratoma. It is usually benign but may become malignant, therefore complete resection is advised.

Successful removal of an impacted metallic arrowhead penetrating up to the brainstem.

A case of impacted metallic arrowhead in the brain through an unusual route of the neck and behind the external carotid artery to the base of the skull up to the brainstem is reported. Review of the literature reveals no previous reports of this type of injury. A 35-year-old man was admitted to the hospital after 36 h of injury, being fully conscious and with partial facial palsy. The arrowhead was successfully removed by exploration of the entry wound, without any neurovascular complications. The patient not only survived the operation but was also discharged in an improved neurological condition.

Double dart technique of instillation of triamcinolone in ganglion over the wrist.

BACKGROUND: Ganglia are the most common benign cystic swellings found over both the dorsal and volar aspects of the wrist. In spite of technical advancement, both operative and non-operative interventions achieve more or less similar results. Complete evacuation of gelatinous fluid followed with intra cystic instillation of triamcinolone has given encouraging results. AIMS: To assess the efficacy and safety of drainage of cyst and instillation of triamcinolone in wrist ganglion. MATERIALS AND METHODS: A prospective study was conducted on patients with simple ganglion cysts on the wrist. Total of 219 patients underwent this study. Out of this, 105 patients underwent the aspiration of the cyst fluid followed by intracystic instillation of triamcinolone, and 114 patients underwent surgical excision of wrist ganglia. Two years follow up was done for recurrence. RESULTS: Most ganglia of wrist occurred in the extensor aspect. Complications noted among the surgically excised group were post operative pain and restricted mobility of wrist with a recurrence rate of 21.5%. Instillation of Triamcinolone into the ganglion yielded early resolution with a low recurrence of 8.4%. CONCLUSIONS: Intracystic instillation of triamcinolone after complete evacuation of cyst fluid is a simple and effective technique for treatment of ganglion.

Tunica albuginea urethroplasty for panurethral strictures.

PURPOSE: To assess the efficacy of tunica albuginea urethroplasty for pan urethral stricture management as an alternative approach to conventional dorsal buccal mucosal graft urethroplasty, especially in cases with unavailability of healthy buccal mucosa. MATERIALS AND METHODS: Eighty-six patients with panurethral strictures underwent tunica albuginea urethroplasty at our center with follow-ups at 6, 12, 24, and 36 months. Results were assessed by comparative analysis of preoperative and postoperative patient's satisfaction (based on symptoms) along with retrograde urethrography, urethrosonography, and uroflowmetry. Ten patients from the successful group underwent postoperative urethroscopic examination. RESULTS: Counting good and fair results as successful (satisfied and not requiring revision urethroplasty), success (good + fair) rate was 95.3% at immediate postoperative and at 6 months. Results reduced to 93% at 12 months, 90.7% at 24 months, and 89.5% at the end of 36 month follow-up. Failure (poor results requiring revision urethroplasty) rate was 10.5% at the end of the 3 years of follow-up. CONCLUSION: Tunica albuginea urethroplasty runs over the concept of urethral groove and the ease of procedure with adequately satisfactory results provides decent outcomes. Tunica albuginea urethroplasty gives advantage of local availability and achieving patent distensible urethra without any graft. Urethroscopy of these subjects, by direct visualization shows the area of roof formed by tunica appears well covered with urothelium, further substantiating its ability to maintain patency and distensibility of the urethra.

Rare asymptomatic presentations of schwannomas in early adolescence: three cases with review of literature.

INTRODUCTION: Schwannoma also known as Neurilemoma is a benign neoplasm of the Schwann Cells of the neural sheath. They are usually found to occur in the extremities, but can also be found in the trunk, head and neck, pelvis, and rectum. It is seldom painful and usually remains small. It has no potential for malignancy unless the patient has multi-neural tumours. It usually presents as a slowly enlarging painless nodule somewhat movable beneath the surface, rarely becomes larger than 2cm in diameter and is most frequently diagnosed in 25-55 yrs of age. PATIENTS AND METHODS: We report three rare, asymptomatic presentations of schwannomas at adolescent age, in the back, pancreas and in the cervical region with a review of the available literature. CONCLUSION: Despite the rarity of the presentations, as encountered by us, similar swellings in the adolescent age group can be schwannomas and can be adequately managed surgically alone. This is what should be borne in mind, for 'what the mind knows is what the eyes see'.

Degloving injury to the penis.

A case of reconstruction after penile skin avulsion is described in an eight-year-old boy. Penile coverage was gained by use of the avulsed skin flap itself, without a graft or local tissue flap. The procedure avoids any valuable time delay; thus, enhancing the chances to obtain adequate flap viability, avoids patient discomfort caused by perineal expansion, gives a satisfactory cosmetic appearance, and taking into account his age, avoids future psychosomatic and psychosexual problems.

Cystic lymphangioma of the breast in a 6-year-old boy.

Cystic lymphangiomas commonly occur in childhood, but breast involvement is an extremely rare entity that tends to be more common in adults, with only a few cases reported in children. We describe a 6-year-old boy who presented with a lump in the left breast that measured 4.5 x 3.5 x 2.5 cm. A local excision was performed, and a diagnosis of cystic lymphangioma was confirmed. There was no recurrence of the lesion after 18 months after surgical excision. A brief case description and review of the relevant literature is presented.

Tunica albuginea urethroplasty for anterior urethral strictures: a urethroscopic analysis.

OBJECTIVE: To assess the efficacy of tunica albuginea urethroplasty (TAU) for anterior urethral strictures. METHODS: We assessed 206 patients with anterior urethral strictures who underwent TAU. The procedure involves mobilization of strictured urethra and laying it open with a dorsal slit. Edges of the slit-open urethra are sutured to edges of the urethral groove with a silicon catheter in situ. Thus in neourethra, the roof is formed by tunica albuginea of the urethral groove. Results were assessed at 6, 12, 24 and 36 months by comparative analysis of patient satisfaction along with retrograde urethrogram, urethrosonogram, uroflowmetry, and were categorized as good, fair and poor. Good and fair results were considered as successful. Thirty patients were taken for postoperative urethroscopic analysis to allow better understanding of both successful and failed cases. RESULTS: Postoperative evaluation at 6 months showed a 96.6% success rate, which decreased to 94.7% at 1 year, 93.2% at 2 years and over 90% at the end of 3 years. The overall failure rate was 9.2%, which required revision surgery. Urethroscopic visualization of the reconstruction site showed wide, patent and distensible neourethra uniformly lined by urothelium over roof formed by tunica albuginea of the corpora cavernosa in successful cases. Failure cases showed diffuse fibrotic narrowing or circumferential scarring. CONCLUSION: Tunica albuginea is a locally available distensible tissue, sufficient to maintain the patency of the neourethra, without any graft or flap. TAU is easier and useful when patients have unhealthy oral mucosa due to tobacco chewing.

Comprehensive analysis and urethroscopic evaluation of "U" shaped prostatobulbar anastomotic urethroplasty.

OBJECTIVE: To evaluate efficacy of "U" shaped prostatobulbar anastamosis [USPBA] in a posterior urethral stricture along with its urethroscopic evaluation to let us assess the process of neourethrisation in successful cases as well as pathogenesis of restricture in failure cases. METHODS: We analysed results of "U" shaped prostato-bulbar anastamosis in 132 patients with posterior urethral stricture, preoperatively and postoperatively with a retrograde urethrogram, urethrosonogram, uroflowmetry and patient satisfaction (based on symptoms). With comparative analysis, results were categorised as good, fair and poor. Twenty patients were randomly selected for urethroscopic evaluation to directly visualise the anastomotic site. RESULTS: Good and fair results were counted as successful. On immediate postoperative evaluation the success rate was 96.2%, which remained almost the same at 6 months but decreased to 92.42% at 12 months and 90.9% at 24 months. Urethroscopy showed mucosal covering at the area of the roof of neourethra in patients having good results with patent and distensible lumen. Cases with fair results showed similar findings except for some narrowing at places and mucosal irregularities. Poor result cases mostly showed dense fibrosis with collapsed lumen or circumferential scarring leading to constricting stricture. CONCLUSION: USPBA lacks disadvantages of ring anastamosis and is an effective option for posterior urethral strictures.

Jejunal diverticulae: reports of two cases with review of literature.

INTRODUCTION: Jejunal diverticulosis (JD) is a rare disease of elderly people. Majority of diagnosed individuals are asymptomatic and found incidentally. The disease is clinically significant because of associated potential risk of serious complications. Due to the rarity and variable presentation of this clinical entity, diagnosis is often difficult and delayed, resulting in unnecessary morbidity and mortality. Clinical presentations, signs, diagnosis, complications and treatment of JD are discussed through a review of the literature and report of two cases. METHODS: A literature review was done for analysis of diagnosis, treatment and complications of JD. Two cases of JD diagnosed and treated in our institution are also presented. CONCLUSION: JD is a rare disease which has variable presentations and thus poses a challenge to our diagnostic skills. Awareness about complications and presentation of the condition is needed for early detection and avoiding unnecessary mortality.

U-shaped prostatobulbar anastomosis for urethral injury after pelvic trauma.

BACKGROUND: We describe a technique of U-shaped bulboprostatic anastomosis for urethral injury after pelvic trauma. METHODS: Sixty-eight male patients were included in our study. Suprapubic cystostomy was carried out initially, followed by U-shaped prostatobulbar anastomosis after 6-12 weeks. Follow ups were carried out at 6, 12 and 18 months by assessing patient satisfaction rates along with preoperative and postoperative urethrogram, uroflowmetry and labelled as good, fair and poor. The surgical technique used was as follows: after an inverted Y-shaped skin incision, subcutaneous tissue and Colle's fascia was opened. Bulbospongiosum was mobilized to gain access to the stricture membranous urethra, which was excised and the bulbar urethra freed. A sound was passed through the suprapubic cystostomy and complete resection of the scar over the tip of the sound was carried out. A silicon catheter was then passed into the bladder and the anastomosis was completed in a 'U' shape; that is, there were no stitches from the 10 to the 2 o'clock position. RESULTS: Good and fair results were considered as successful. Overall success rate was 97.05% immediately and after 6 months, but decreased to 95.6% at 12 months and 93.6% at 18 months. CONCLUSION: U-shaped end-to-end prostatobulbar anastomosis markedly decreases the chance of restenosis and impotence.