Lingual versus buccal mucosa graft urethroplasty for anterior urethral stricture: a prospective comparative analysis.

OBJECTIVE: To compare lingual and buccal mucosa graft urethroplasty for anterior urethral stricture with respect to intraoperative, postoperative parameters and urethroplasty outcome. METHODS: From January 2011 to December 2011, a total of 30 patients with anterior urethral stricture whereas group 2 underwent dorsal onlay buccal mucosa graft urethroplasty. Patients were evaluated for postoperative, tongue protrusion, oral opening, and difficulty in speech and swallowing pain score. Surgical outcome was evaluated with pre- and postoperative work-up involving retrograde urethrogram, uroflow and urethroscopy. RESULTS: Mean age, stricture length and overall pain score were comparable in two groups. All the patients were mostly pain free by postoperative day 7. Group 1 patients had significant difficulty in speech and delayed return to normal diet as compared with group 2. The group 2 patients had a significant reduction in oral opening for the first week after surgery. In group 1, approximately 20% patients (with bilateral lingual grafts and stricture length >7 cm) complained of a change in speech character with restricted tongue movement in the long term, whereas there was no significant long-term morbidity in group 2. At mean follow up of 14.5 months, urethroplasty outcome was comparable in the two groups with one failure in group 1, and two failures in group 2. CONCLUSION: Lingual mucosa graft urethroplasty provides outcomes equivalent to those of buccal mucosa graft urethroplasty. Postoperative morbidity and long-term change in speech make it a second choice for strictures >7 cm, only for cases where buccal mucosa graft is unavailable.

A quantitative comparison between free uroflow variables and urodynamic data, and the effect of the size of urodynamic catheters on its interpretation.

OBJECTIVE: To assess the effect of the urodynamic catheter on the urinary flow rate and residual volume in various urodynamic diagnoses, and compare the outcome when using a smaller catheter, as the effect of this catheter on free uroflow variables is mostly studied in patients with bladder outlet obstruction (BOO) and little is known about its effect in other urodynamic diagnoses. PATIENTS AND METHODS: In all, 319 men undergoing a pressure-flow study (PFS) with a 5 F filling and 5 F measuring bladder catheter were subdivided into three groups based on a urodynamic diagnosis, i.e. normal PFS (group 1), BOO (group 2) and detrusor underactivity (DU, group 3). Another group (4) comprised 61 patients who had a PFS with the filling catheter removed before the voiding phase. The effect of the catheters on the maximum urinary flow rate (Qmax) and the postvoid residual volume (PVR) was analysed statistically and compared among the groups. We also compared the free-flow variables with the clinical and urodynamic variables. RESULTS: Groups 1-3 (with two catheters) had a significantly lower Qmax and higher PVR than those voiding with one catheter (group 4). The reduction in Qmax was highest in group 3 (41.9%) and least in group 2 (21%). Group 4 showed no significant change in Qmax in cases with BOO and a normal PFS but a significant decline in those with DU (19.6%). The PVR was positively associated with the bladder capacity and negatively with detrusor contractility, but no association with a urodynamic diagnosis of BOO or any specific symptom. CONCLUSION: Detrusor contractility was the strongest predictor of the obstructive effect caused by the catheter. This study justifies the use of a single 5 F catheter at the time of voiding, although that can also cause a reduction in flow in patients with DU.

Analysis of short-term results of monsieur's tunica albuginea urethroplasty as a definitive procedure for pan-anterior urethral stricture.

CONTEXT: Long anterior urethral strictures are fairly common in developing world and the treatment is equally challenging. AIM: To assess the results and efficacy of Monsieur's Tunica Albuginea Urethroplasty (TAU) for anterior urethral stricture. SETTINGS AND DESIGN: We analyzed the results in 10 consecutive patients with pan-anterior urethral stricture, who underwent Monsieur's urethroplasty. MATERIALS AND METHODS: 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 to the tunica of corporal bodies with catheter in situ. Results were assessed postoperatively 3, 6, 9 and 12 months. Patients were categorized as success and failure by comparative analysis of patient satisfaction along with urethroscopy, retrograde urethrogram, uroflowmetry. All patients were taken for post-operative urethroscopic analysis at 6 months to allow better understanding of both successful and failed cases. RESULTS: Mean follow-up of 15.2 (11-19) months showed an 80% success rate. Mean uroflow rate showed Qmax 24.5 cc/sec with 8 cases showing no residual or recurrent stricture. Two cases failed and required intervention. Urethroscopic visualization of the reconstruction site showed wide, patent and distensible neourethra appearing epithelized over roof formed by tunica albuginea of the corpora cavernosa in successful cases. CONCLUSION: Monsieur's TAU is effective technique in treatment of anterior urethral stricture especially cases with unavailable buccal mucosa, with results fairly acceptable at the end of one year.

A case of solitary fibrous tumor of the kidney.

A solitary fibrous tumor (SFT) is an unusual spindle cell neoplasm that usually occurs in the pleura but has recently been described in diverse extrapleural sites. Urogenital localization is rare and to our knowledge, only 39 cases of SFT of the kidney have been described. Although SFT of the kidney is extremely rare, this tumor must be included in the differential diagnosis, whenever a renal tumor consisting of mesenchymal elements is encountered. We report a case of a large SFT of the right kidney which was clinically and radiologically thought to be renal cell carcinoma and a final diagnosis of SFT was made only after immunohistochemical study.