CONGENITAL SCAPHOID MEGALOURETHRA: REVISITING A RARE ANOMALY.

Megalourethra is an infrequent malformation of the anterior urethra that is caused by the lack of corpus sponigosum and in severe cases is accompanied by the lack of corpora cavernosa as well. We report a five-year-old boy presented to us with scaphoid variety of megalourethra having complaints of ballooning of urethra during voiding. He was investigated with urethrogram and cystoscopy and subsequently repaired with Nesbitt Longitudinal Reduction Urethroplasty. He had smooth recovery postoperatively with normal voiding stream on follow up.

Transurethral resection of prostate: early versus delayed removal of catheter.

BACKGROUND: Transurethral resection of prostate is the gold standard operation for bladder outflow obstruction due to benign prostatic enlargement. However, catheter removal day is variable. The objective of this study was to compare early and delayed catheter removal groups in terms of length of hospital stay, weight of resected prostate, duration of resection, peri-operative blood transfusion, and postoperative complications. METHODS: This randomized controlled trial was carried out in Urology Unit-B, Institute of Kidney Diseases Peshawar from 1st September 2009 to 31st July 2011. Patients were selected by simple random sampling technique after taking informed consent and divided into two groups: Group A-standard catheter removal group and Group B-early catheter removal group. The study excluded patients with large post-void urine volume, simultaneous internal urethrotomy and transurethral resection of prostate, co-morbidity and intra-operative complications. Patients were discharged after removal of catheter if they voided successfully. In Group-A the catheters were kept for more than one day according to the standard protocol of our ward. The data were analysed using SPSS-17. RESULTS: The study included 320 patients, 163 in Group-A and 157 in Group-B. Mean weight of resected tissue in Group-A was 46.67 ± 9.133 grams; it was 45.22 ± 7.532 grams in group B. Mean catheter removal day was 4.13 ± 1.65 days in Group-A; and 1.23 ± 0.933 days in Group-B. Mean length of hospital stay was 3.57 days ± 1.028 in Group-A and 1.29 days ± 1.030 in Group-B (p-value < 0.05). Length of hospital stay strongly correlated with the day of catheter removal. There was no significant difference between the two groups in terms of postoperative complications. CONCLUSION: Removal of catheter on first postoperative day after transurethral prostatectomy does not increase the postoperative complications and results in shorter hospital stay.

Ureteral trauma during open surgery: aetiology, presentation and management.

BACKGROUND: Ureteric injury during a surgical procedure is a serious complication with significant morbidity. The objective of this research was to study the aetiology, clinical features and management of iatrogenic ureteric injuries after open surgical procedures. METHODS: This descriptive study was carried out in the Urology and Transplant unit of Institute of Kidney Diseases, Peshawar, from 1st August 2008 to 30th April 2011. Patients with clinical diagnosis of ureteral trauma due to open surgical procedures were included in the study through convenient sampling after informed consent. Important variables under study were: aetiology of ureteric injury, presenting features, time from injury to diagnosis, type of ureteric injury, treatment options, and outcome of treatment. Follow up was at 1, 3, 6 and 12 months. RESULTS: The study included 43 patients; 33 (76.7%) were females and 10 (23.3%) males. Abdominal hysterectomy was the commonest cause 20 (46.5%) of ureteric injury. Common presenting features were urinary incontinence 13 (30.23%), flank pain 7 (16.3%) and anuria 10 (23.3%). Median time from ureteric injury to urological referral was 10 days. Distal ureter was most commonly injured. Percutaneous nephrostomy was carried out in 14 (32.5%) cases. Ureteroscopic ureteric stenting was successful in 5 (11.6%) cases. Ureteroneocystostomy was carried out 25 (58%) cases. Two (4.7%) cases presented very late with non-functioning kidneys and required nephrectomy. Patients developing ureteric stricture after ureteroneocystostomy were managed successfully by endo-urological procedures. Renal function remained stable in all the patients during follow-up and there was no mortality. CONCLUSION: Timely recognition of ureteric injury and its management is associated with good outcome and decreased morbidity.

Role of clean intermittent self catheterisation (CISC) in the prevention of recurrent urethral strictures after internal optical urethrotomy.

BACKGROUND: Urethral stricture is one of the oldest diseases Urethral dilatation Internal optical urethrotomy,were the only treatment. Clean Intermittent Self Catheterisation was introduced by Lapides has greatly decreased the recurrence of stricture. Objectives were to determine the role of Clean Intermittent Self Catheterisation (CISC) in the prevention of recurrence of urethral strictures after Internal Optical Urethrotomy and to study the frequency of any postoperative complications and tolerability for the patients associated with this procedure. METHODS: A randomised controlled study conducted in the department of urology and renal transplantation, Institute of Kidney Diseases Hayatabad Medical Complex, Peshawar from June 2007 to June 2010. Total of 60 patients with mean age 48 years (range 20-73) were selected and randomly divided into Treatment Group (30 patients) and Control Group (30 Patients). Eight "drop out" occurred in the treatment group and four "drop out" occurred in the controlled group. All the patients were treated with Internal Optical Urethrotomy using Sachse method followed by indwelling catheter for 5 days. The treatment group was then taught to perform Clean Intermittent Self Catheterisation by inserting a Classic Neleton Catheter (No. 16 or 18) twice a day for 1 week, then once a day for another 4 weeks and then once weekly continued for one year. All the patients were followed up regularly at 1 month intervals during the first 6 months and then every 2 months for the next 6 months. RESULTS: Total of 48 patients completed the study, 22 in the treatment group and 26 in the control group. Within the first year, 4 patients (22%) in the treatment group developed urethral stricture. In the control group, 12 patients (46%) developed urethral stricture within the first year, showing a significant difference (p < 0.01). In the treatment group four patients developed simple UTIs while in the control group three patients developed UTIs, one with concomitant epididymitis. No other complications were noted up to one year follow up. CONCLUSION: Clean Intermittent Self Catheterisation is a simple and effective way of reducing stricture recurrence after Internal Optical Urethrotomy and is associated with less morbidity and is cost effective. CISC is an important modality for maintaining the normal urethral calibre.