Use of autologous grafts in the treatment of acquired penile curvature: An experience of 33 cases.

AIM: The objective was to compare the use of autologous dermal and temporalis fascia grafts in the treatment of acquired penile curvatures. MATERIALS AND METHODS: It was a prospective observational study of 33 cases, conducted in Sher-i-Kashmir Institute of Medical Sciences, Srinagar from March 2007 to September 2013. All the patients had stable Peyronies disease (PD). Dorsal, dorsolateral and vental curvatures with good preoperative erections were included. PD index with visual analog scales for curvature was used preoperatively. An informed written consent was taken from all the patients with main emphasis on erectile dysfunction. RESULTS: After an average follow up of 2 years, complete straightening of penis was observed in all patients with satisfactory sexual intercourse in 30 patients (90%). Three patients (10%) required frequent use of type 5 phosphodiesterase inhibitors for adequate erections. Overall 91% of patients and partners were satisfied with the procedure and cosmetically donor site was better in temporalis fascia graft site. No rejection of any graft was noted and glans hypoesthesia was noticed in 4 patients (12%). None of the patients required penile prosthesis. Total operative time for harvesting and application of the graft was more in dermal grafts (>3 hrs) than for temporalis fascia graft (2 hrs). CONCLUSION: Tunical lengthening procedures by autologous free grafts represents a safe and reproducible technique. A good preoperative erectile function is required for tunical lengthening procedure. Temporalis fascia graft is thin, tough membrane and effective graft for PD with good cosmetic and functional results.

The ideal treatment of the typhoid enteric perforation - resection anastomosis.

Eighty-one cases of typhoid enteric perforation were studied prospectively after separating them into four groups. Group A patients were treated with resection anastomosis, group B by debridement of margins of the perforation/wedge excision and simple closure, group C by simple closure and group D by ileostomy of perforated ileum or simple peritoneal drainage. A copious lavage of the peritoneal cavity with normal saline was performed in all four groups. The complication and mortality rates for group A patients were 37.50% and 21.47%, respectively, very much less than that observed in the other three groups. The ideal treatment for typhoid enteric perforation was found to be resection-anastomosis with copious peritoneal lavage.

Comparative study of various forms of urinary diversion after radical cystectomy in muscle invasive carcinoma urinary bladder.

OBJECTIVE: To compare the three types of urinary diversion namely Ileal Conduit, MAINZ Pouch II and Ileal Neobladder in terms of patient preference, post-operative hospital stay, early and late complications, continence rates, quality of life and patient satisfaction. METHOD: From January 2003 to October 2007, 30 patients (28 males and 2 females) of muscle invasive carcinoma urinary bladder (mean age 57.7 years) were operated upon by radical cysto- prostatectomy or anterior pelvic exenteration and urinary diversion was performed by Ileal conduit, Mainz pouch II or Ileal neobladder. The patient preference for the type of diversion was determined pre-operatively after discussing all the three types of urinary diversions. Post-operative hospital stay, early and late complications, continence rates, quality of life and patient satisfaction with the type of diversion were evaluated on follow up. RESULTS: 60% of the patient's preferred Ileal neobladder, 10% preferred Ileal conduit and 10% preferred Mainz pouch II as their 1st choice diversion; 20% left the decision to the operating surgeon. The mean post-operative hospital stay was 15.0 days in Ileal conduit group, 17.8 days in Mainz pouch II group and 19.7 days in Ileal neobladder group. The mean follow up was 27.7 months. Early complications (within 1 month of surgery) were observed in 46.2% of patients in Ileal conduit group, 38.5% in Mainz pouch II group and 50.0% in Ileal neobladder group. Late complications (after 1 month of surgery) were seen in 61.5% of patients in Ileal conduit group, 46.2% in Mainz pouch II group and 50.0% in Ileal neobladder group. In Mainz pouch II group 92.3% of the patients achieved daytime continence and 84.6% achieved night time continence 3 to 6 months after surgery. In Ileal neobladder group, 75.0% patients achieved day time continence and 50.0% achieved night time continence 3 to 6 months after surgery. Patient satisfaction and overall quality of life was described 'Good' by majority of patients in Ileal conduit group and 'Very Good' by majority of patients in Mainz pouch II group and Ileal neobladder group. CONCLUSION: There are inherited advantages and disadvantages to each form of urinary diversion and patient selection is important to identify the most appropriate method of diversion for an individual.