Comparative Analysis of Dorsal Onlay Buccal Mucosal Graft and Vaginal Wall Graft Urethroplasty for Female Urethral Stricture at a Tertiary Care Centre.

OBJECTIVE: To compare dorsal onlay Buccal Mucosal Graft (BMG) and Vaginal Wall Graft (VWG) urethroplasty in the management of Female Urethral Stricture (FUS). METHODS: A retrospective analysis was conducted on 33 women undergoing dorsal onlay urethroplasty using BMG (n = 17) and VWG (n = 16) for urethral stricture at a tertiary care centre. Data including patient demographics, comorbidities, stricture characteristics, preoperative, and postoperative Female Sexual Function Index (FSFI) scores and operative outcomes were analyzed. Their preoperative diagnosis was confirmed with uroflowmetry, micturating cystourethrogram, urethral calibration, and urethrocystoscopy. Per urethral catheter was removed after 3 weeks and patients were followed up at regular intervals with urine analysis, uroflowmetry and post void residual urine assessment. RESULTS: The overall mean age was 47 years (range: 21-75) and follow-up was 16 months (range: 6-26). The overall change in American Urological Association (AUA) symptom score was from 18 to 4, maximum flow rate (Q max) from 5 mL/s to 24 mL/s, Post Void Residual Urine (PVRU) from 110 mL to 10 mL, average operative time of 97 minutes (range: 80 to 118 minutes) with no statistical difference between the 2 groups. Other parameters showed no difference. The overall urethral patency rate was 93.9% with no statistical difference in these groups (0.862). None of the patients developed urinary incontinence. CONCLUSION: Dorsal onlay substitution with BMG and VWG shows equivalent outcomes with low complication rate. Substitution urethroplasty elicits a robust and enduring therapeutic response and should be offered to patients presenting with FUS to avoid the adversities of repeated urethral dilatations.

A rare occurrence of hepatic portal venous gas in emphysematous pyelonephritis.

Hepatic portal venous gas (HPVG) is an uncommon radiological sign and often portends significant underlying abdominal disease. A number of conditions may produce this sign and identifying the underlying etiology is essential for management. The advent of ultrasonography-color Doppler imaging and computerized tomography has led to more frequent recognition of this condition. This article describes the very rare association of HPVG in a patient with emphysematous pyelonephritis.

Clinically inapparent bilateral adrenal masses due to histoplasmosis.

Detection of bilateral adrenal masses in any patient often presents a management dilemma. Despite extensive imaging, positron emission tomography (PET) scanning, and fine needle aspiration biopsy (FNAB), a definite diagnosis may not be reached. We report an unusual case of bilateral adrenal mass diagnosed as histoplasmosis postoperatively and managed successfully by laparoscopy. Focus is placed on the role of laparoscopic adrenalectomy (LA) as a diagnostic and therapeutic tool in such patients.