Female paraurethral cysts: experience of 25 cases.

OBJECTIVE: To report and describe the diagnosis and treatment of female paraurethral cysts. PATIENTS AND METHODS: Twenty-five cases of cysts of the external female genitalia were diagnosed over a 7-year period, using a physical examination, routine blood tests, urine analysis, abdominal ultrasonography and cysto-urethroscopy in all. The cysts were incised, drained and marsupialized; no attempt was made to excise or remove the internal wall of the cyst and it remained in situ. RESULTS: All patients responded to simple marsupialization, with no recurrence of the cyst. CONCLUSION: Cysto-urethroscopy and a limited laboratory and imaging evaluation were enough for the diagnosis.

Free bladder mucosal autograft in the treatment of complicated vesicovaginal fistula.

OBJECTIVE: To describe an effective and simple method for repairing complicated vesicovaginal fistula using a free bladder mucosal autograft. PATIENTS AND METHODS: The study included 14 patients with an iatrogenic vesicovaginal fistula after hysterectomy or prolonged obstructed labour. An initial fistula repair had been attempted in 12 patients. All patients were then repaired using a free bladder mucosal graft technique 3-24 months (mean 8) after the fistula was diagnosed. RESULTS: Of the 14 patients 12 had an immediately successful result, with no evidence of leakage, but two required prolonged catheter drainage. Thirteen patients remained dry at the follow-up 3-15 months later. Two patients had stress urinary incontinence and three patients had urinary tract infection. CONCLUSIONS: The free bladder mucosal autograft technique is a simple, effective and fast method for vesicovaginal fistula repair. The technique produces an excellent repair of complicated vesicovaginal fistula, and appears to be more physiological and easier to perform than other transabdominal techniques.

PCNL in the management of lower pole caliceal calculi.

INTRODUCTION: Several therapeutic methods are used in the management of lower pole caliceal calculi. This survey has been conducted to evaluate the safety and efficacy of percutaneous nephrolithotomy in the management of lower pole calculi. MATERIALS AND METHODS: Fifty-five patients, 43 males and 12 females with a mean age of 41.5 (range 11 to 75) years, who had suffered from lower pole caliceal calculi and treated by standard percutaneous nephrolithotomy (PCNL) between 1997 and 2001, were enrolled in this study. The stones were classified as follows: small (less than 25 mm), intermediate (25 to 34 mm) and large (more than 35 mm). Mean follow-up was 6.2 months (range 2 weeks to 34 months). RESULTS: The stones were completely extracted by one session PCNL in 43 patients (79%). Repeat PCNL was needed in one patient and another method was used for stone extraction in another patient. Regarding the size of stone, 88%, 79%, and 74% of small, intermediate, and large stones were completely extracted, respectively. No major complication was noted. CONCLUSION: PCNL has high success rate in patients with stones larger than 2 cm and its morbidity would be low, provided that it is performed by skilled surgeons.

A comparison between laparoscopic and open pyeloplasty in patients with ureteropelvic junction obstruction.

INTRODUCTION: Our aim was to compare clinical and radiological outcomes, complications, and hospital stay in laparoscopic and open pyeloplasty. MATERIALS AND METHODS: From February 2002 to February 2003, 69 patients with ureteropelvic junction obstruction (UPJO) were assigned into two groups. Thirty-seven patients underwent transperitoneal laparoscopic pyeloplasty and 32 underwent open surgical pyeloplasty. Clinical symptoms were assessed before and after surgery, subjectively. Radiological assessment was also done three months postoperatively. RESULTS: Mean operative time was 3.2 hours and 2.2 hours in laparoscopic and open pyeloplasty groups, respectively. Intraoperative bleeding was trivial in both groups and no complication or conversion to open surgery occurred. Postoperative complication rates were 24% and 6% in laparoscopic and open pyeloplasty groups, respectively. Mean hospital stay was similar (6.2 days) in the two groups. Mean follow-up was 16.5 months versus 11.4 months. Clinical and radiological success rates were 89% and 83.8% for laparoscopy group versus 96.5% and 87% for open pyeloplasty group. Due to recurrence of stricture, repeated surgery was performed in 4 patients of laparoscopy and 1 of open pyeloplasty groups. CONCLUSION: Laparoscopic pyeloplasty is a less invasive method with less pain, cosmetic advantages, no long incision, and outcome comparable with open surgery. Hospital stay is also not longer than that in open surgeries. Hence, laparoscopic pyeloplasty can be a substitute for skilled surgeons.