Duration Of Urethral Catheterization Research Articles

Clinical evaluation of enhanced recovery versus conventional care in the perioperative period for intradural extramedullary spinal tumors: a study protocol for a multicenter, randomized controlled trial

BackgroundThis randomized clinical trial protocol aimed to investigate the comparative efficacy of an enhanced recovery after surgery (ERAS) protocol versus traditional perioperative care programs in patients with intradural extramedullary spinal tumors.MethodsThe study included 180 patients aged 18–80 years, who were randomly assigned to two groups: Group A receiving traditional perioperative care and Group B receiving accelerated rehabilitation perioperative care. The nurse responsible for patient care was informed of the group assignment, but the patients themselves remained blinded to the intervention. The primary outcome measure was the Karnofsky Performance Scale score, which assessed functional status. The secondary outcomes included the Japanese Orthopedic Association Scale, Numeric Pain Rating Scale, length of postoperative hospital stay, duration of urethral catheterization, patient satisfaction questionnaire, and complication rates. Follow-up assessments were conducted telephonically 1 month, 3 months, and 6 months after the surgery.DiscussionThis study protocol provided a structured approach to assess the potential benefits of ERAS during the perioperative period for patients with intradural extramedullary tumors, aiming to improve patient outcomes and overall care efficiency.Trial registrationThis study has been registered with the China Clinical Trials Registry (Project No: ChiCTR2200063347). Registered on September 5 2022.

Pritchard's Regimen: The Effect of 12-Hour Versus 24-Hour Magnesium Sulphate Maintenance Regimen on the Occurrence of Seizures and Maternal Outcome in Women with Severe Features of Preeclampsia: A Triple-Blind Randomized Controlled Trial.

Magnesium sulphate (MgSO4) administered for twenty-four hours is the drug of choice for seizure prophylaxis in patients with preeclampsia with severe features. Due to its narrow therapeutic index, a reduction in the duration of MgSO4 administered in the postpartum period may not only prevent the occurrence of seizures but also reduce the adverse effects associated with this drug. This study aimed to compare the efficacy of the 12-hour and 24-hour Pritchard's MgSO4 maintenance regimen on the occurrence of seizures and maternal outcomes in patients with preeclampsia with severe features. A triple-blind randomized controlled trial was conducted among women with preeclampsia with severe features between 1st June 2022 and January 31st, 2023. The primary outcome measure was the occurrence of seizure in either arm of the study. One hundred and forty-six women were randomized into two groups, those who received a 12-hour MgSO4 regimen and placebo for the remaining twelve hours (Group I) and those who received a 24-hour MgSO4 regimen in the postpartum period (Group II). The collected data was coded and analyzed using Statistical Product and Service Solutions (SPSS) version 26 and p<0.05 was considered significant. There was no statistically significant difference between the two groups concerning the occurrence of seizures, the need to recommence MgSO4, clinical evidence of toxicity and adverse effects of MgSO4. There was also no statistically significant difference between the two groups in the total dose of MgSO4 administered, duration of urethral catheterization and duration of hospital admission. No maternal mortality was recorded in this study. The results of this study suggest that the 12-hour MgSO4 maintenance regimen is as efficacious as the traditional 24-hour regimen in preventing seizures without worsening maternal outcomes.

Effect of Duration of Catheterization on Recurrence after Endoscopic Urethrotomy

Purpose: The aim of the study was to analyze the effect of duration of catheterization on the recurrence of urethral stricture recurrence after endoscopic urethrotomy. Material and Methods: We retrospectively analyzed all patients who solely underwent endoscopic urethrotomy between January 2017 and June 2022. The effect of duration of catheterization and other clinical factors including weight, height, smoking, comorbid diseases, number, location, length and etiology of the strictures, presence of previous urethrotomies were analyzed. Results: Total of 231 patients were included in the data analyses. The locations of the strictures were bulbar urethra (76%), penile urethra (15%) and membranous urethra (9%). The etiology was mostly iatrogenic (77%). The maximum duration of catheterization was equal or less than two weeks in all patients. The mean duration of urethral catheterization was 4.5 ± 2.3 days. Thirty-nine percent of the patients had a recurrence. There were no statistically significant difference in terms of stricture location and recurrence but mean time to recurrence was longer in younger ones (21.63±17,50 months vs. 13.37±13,11 months; p=0.013). The duration of catheterization was found to be significantly longer in the group with iatrogenic etiology (5.38±3.22 days vs. 4.22±1.96 days; p=0.002). Conclusions: Endoscopic urethrotomy is still far away from being a definitive treatment with a higher recurrence rate. These rates seem to increase with elder age. Also, the surgeons have a tendency to lengthen the duration of urethral catheterization in iatrogenic ones.

The efficacy of STRATAFIX® spiral PDS for vesicourethral anastomosis during robot-assisted laparoscopic radical prostatectomy: a single-center retrospective study.

To investigate the efficacy of continuous suturing using barbed suture for vesicourethral anastomosis (VUA) during robot-assisted laparoscopic radical prostatectomy (RARP). Seventy-three consecutive patients who underwent RARP by a single surgeon between 2020 and 2022 were retrospectively divided based on the suture type used for VUA: group A, 3-0 poliglecaprone-25 RB-1 needle (Monocryl®), n = 46; group B, 3-0 spiral polydioxanone (PDS) barbed suture with RB-1 needle (STRATAFIX®), n = 27. There was no significant difference in patient background characteristics between groups, including age, body mass index, and clinical stage. However, group B had a significantly shorter operative time, console time, hospital stay, and duration of urethral catheterization. The VUA time was significantly shorter in group B than in group A (17.9min vs. 10.6min; p < 0.001). Only 1 case of minor leakage was observed during the intraoperative leak test (1 patient in group A). There was no significant difference in the number of pads used at 1, 3,6months and 1year postoperatively. There were no urethral strictures, and there was no significant difference in pathologic results or postoperative prostate-specific antigen progression between groups. Our study suggests that the use of barbed suture during VUA for RARP is associated with reduced VUA time.

A novel 12-hour versus 24-hour magnesium sulfate regimen in the management of eclampsia and preeclampsia in Ghana (MOPEP Study): A randomized controlled trial.

We compared the efficacy of a 12-h versus 24-h regimen of intramuscular magnesium sulfate in the management of eclampsia and preeclampsia. This is an open-labeled parallel randomized controlled trial conducted in Accra, Ghana from November 2018 to November 2020. Participants were adult pregnant women admitted to the Korle Bu Teaching Hospital (KBTH) with a diagnosis of antepartum, intrapartum, or postpartum eclampsia or preeclampsia with severe features, having received no more than a loading dose of magnesium sulfate prior to admission at KBTH. Participants in the standard 24-h group received a loading dose of magnesium sulfate 4g intravenous and 10g intramuscular (5g in each buttock) followed by six, 5g intramuscular maintenance doses over 24h. Participants in the 12-h intervention group received the same loading dose followed by three, 5g intramuscular maintenance doses over 12h. The primary outcome was occurrence of seizure after completion of the assigned magnesium sulfate regimen. Secondary outcomes were magnesium sulfate toxicity, magnesium sulfate side effects, maternal outcomes (mode of delivery, duration of inpatient admission, duration of urethral catheterization), maternal complications (pulmonary edema, acute kidney injury, intensive care unit admission, death), and neonatal outcomes. Among 1176 total participants, we found no difference in occurrence of seizure after completion of the assigned regimen in the 24-h group (n =5, 0.9%) versus the 12-h group (n =2, 0.3%), P =0.29; RR 0.40, 95% CI 0.08, 2.04), or in occurrence of seizure any time after enrollment (n =9, 1.5% vs. n =5, 0.9%, P =0.28, RR 0.55, 95% CI 0.19-1.64). Participants in the 12-h group had a shorter duration of inpatient admission (9.4± 8.8 vs. 7.7± 6.5 days, P =0.0009) and urethral catheterization (2.1± 1.0 vs. 1.9± 1.3 days, P <0.0001). Rates of side effects from magnesium sulfate were lower in the 12-h group: pain at the injection site (94.8% (n =548) vs. 91.5% (n =540), P =0.03), inflammation (62.2% (n =358) vs. 40.0% (n =237), P <0.0001), and bleeding or bruising at the injection site (25.1% (n =144) vs. 14.4% (n =85), P <0.0001). Compared with 24h, 12 h of intramuscular magnesium sulfate showed similar rates of seizures, with fewer side effects and shorter inpatient admission. Prospective registration was with Pan African Clinical Trial Registry (PACTR201811515303983): https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=4690.

A comparison of urethral catheterization duration - three weeks versus two weeks after bulbar urethroplasty

Objective To determine the incidence of bacteriuria, urinary tract infections (UTI), and significant extravasation of contrast on initial postoperative pericatheter retrograde urethrogram (pcRUG) after bulbar urethroplasty in relation to duration of urethral catheterization (DUC) of three weeks versus two weeks after surgery. Methods Retrospective chart review of 100 bulbar urethroplasty patients between January 2015 and November 2015 were compared with 50 prospective bulbar urethroplasty patients from June 2017 to February 2018 operated at the same university hospital. All patients in the retrospective cohort had catheter removal three weeks after surgery, while patients in the prospective cohort had catheter removal two weeks after surgery. Patient groups were compared using t-test and Fischer’s exact test. Results There was a higher incidence of UTI in patients with a DUC of three weeks after open urethroplasty compared to patients with two weeks DUC (p = 0.03). Occurrence of extravasation on initial pcRUG or asymptomatic bacteruria did not differ between the two groups. Conclusion The findings in this study suggest that a DUC of two weeks may be more favorable compared to a DUC of three weeks.

Open nerve-plane sparing radical hysterectomy in locally advanced cervical cancer: evaluation on efficacy and long-term survival outcomes

Objective: To evaluate the security and clinical outcomes of open nerve-plane sparing radical hysterectomy (NPSRH) for operable locally advanced cervical cancer, compared with conventional radical hysterectomy (CRH). Methods: All 389 cases with International Federation of Gynecology and Obstetrics (FIGO, 2009) stage Ⅰb2 and Ⅱa2 cervical cancer were retrospectively analyzed in Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences between January 2008 and December 2014. Of all the patients, 69 cases underwent laparotomic NPSRH, and other 320 cases underwent CRH. Patients' general characteristics and intraoperative parameters were evaluated between the two groups. Basic clinical and pathological informations between the two groups were matched. After median 82 months' follow-up,disease-free survival (DFS), overall survival (OS), and postoperative recovery of bladder function were compared between the two groups. Results: (1) Compared to CRH group, NPSRH group had less intraoperative bleeding [(366±302) vs (457±301) ml; t=2.305, P=0.022], and a little bit longer operation time [(262±51) vs (245±52) minutes; t=2.621, P=0.009]. (2) Compared to CRH group, NPSRH group had shorter duration of urethral catheterization [(11±9) vs (16±7) days; t=3.906, P<0.01], and better postoperative bladder sensation and function in one year (6.1% vs 16.0%; χ2=4.418, P=0.036). (3) The 5-year DFS rate and 5-year OS rate of all patients were 89.6% and 89.9%, respectively. Either preserving pelvic autonomic nerves or not had little effect on the 5-year DFS rate (NPSRH vs CRH: 90.9% vs 89.4%; P=0.714) or on 5-year OS rate (NPSRH vs CRH: 90.0% vs 89.9%; P=0.910) for locally advanced cervical cancer. Univariate analysis showed that lymphatic vascular space infiltration (LVSI) and pelvic lymphatic metastasis were significantly correlated with prognosis (P<0.05). Multivariate analysis showed that pelvic lymphatic metastasis was the independent prognostic factor of 5-year DFS rate (HR=1.31, 95%CI: 1.01-1.68, P=0.040) as well as 5-year OS rate (HR=1.30, 95%CI: 1.01-1.67, P=0.046) for locally advanced cervical cancer. Conclusion: Open NPSRH is feasible for patients with locally advanced cervical cancer, which could improve both short-term and long-term bladder function, and is not a risk factor for the prognosis of patients.

Deepithelialized glans reconfiguration (DeGRe) for distal hypospadias repair

Our objective was to present our experience with a novel technique for distal hypospadias repair consisting of deepithelialized glans reconfiguration. We reviewed the clinical data of all patients who underwent distal hypospadias using Deepithelialized Glans Reconfiguration between January 2015 and December 2019. We noted age at surgery, position of meatus, duration of urethral catheterization and hospitalization, as well as early and late complications. Standard postoperative care included follow-up examination at 1, 6 and 12 months. Successful repair was defined as a patient presenting with a straight penis with an apical meatus, no stricture nor fistula. Sixty-seven patients were included. Average age at surgery was 12.5 months (6-23 months). All patients presented distal hypospadias (3 glanular, 61 coronal, 3 subcoronal). 36% of patients were operated as day case surgery. No intra-operative complications were recorded. Eleven patients did not complete the designated follow up. They attended the post-operative appointment at six months but not the one-year visit. All patients presented satisfactory urinary streams according to the parents. All parents were satisfied with the cosmetic appearance of their child's penis. Two patients presented with glans dehiscence (3%). The mean HOPE score for the last 10 patients was 47.4±3.2 out of a maximum of 50. Deepithelialized Glans Reconfiguration is a simple technique with satisfactory results. Though it has similarities with existing techniques, it contains specific aspects not described previously. Contrary to the MAGPI technique, there is no meatal advancement, no rotation of the glans wings, and it is the glans lateral and proximal to the meatus which is approximated in the midline. As opposed to the GAP procedure, there is no closure of the ventral aspect of the urethra. We rely on secondary healing within the glans to reconstruct the missing ventral aspect of the urethra. We reserve this technique for coronal hypospadias with a wide, deep glanular groove. Deepithelialization favours rapid healing of the glans wings on the midline. There is no formal urethroplasty. The limits to this study include lack of long-term (>1 year) follow-up and uroflow. Though careful observation did not identify fistulas, the absence of functional stenosis has to be more clearly evaluated at a later age. Finally, this technique is not suitable for the completely flat glans as it relies on being able to approximate the glans ridges in the midline. Deepithelialized Glans Reconfiguration is a simple technique which achieves good cosmetic results, without complications associated with meatal or urethral advancement or formal urethroplasty.

The pattern and outcome of ureteroscopy in a tertiary health care facility, North-western Nigeria

Objective: To review the pattern and outcome of ureteroscopy in our institutionMaterials and Methods: A retrospective review of ureteroscopies performed at our hospital between January 2013 and December 2018 for patients aged ≥18 years. The following data were extracted from patients' case notes and operation register; patient demographics, symptoms, investigations, diagnosis, definitive treatment, hospital stay, surgical outcome, duration of urethral catheterization and ureteric stenting, complications and duration of follow up visits. SPSS version 20.0 for Windows was used in data analysis. The results are presented in simple frequencies and percentages.Result: Total of 32 ureteroscopies were performed on 32 patients aged between 20 to 65 years with modal age of 32 years (18.8%). The commonest presenting complaint is ureteric colic, 13(40.6%) while the commonest indication for ureteroscopy is ureteric calculi, 14(43.8%) and ureteral obstruction, 12(33.3%). Ureteroscopy, pneumatic lithotripsy and double J (DJ) stenting of the ureter is the definitive treatment in 14(43.8%) patients, making it the most common performed definitive treatment. Following treatment, 63% of the patients were symptom free while 27.2% have residual symptom. The mean hospital stay is 4.6 days, mean duration of DJ stenting of the ureter is 6.3 weeks and that of follow up is 10.4 months. The commonest complications recorded was Urinary tract infection, 12(37.5%)Conclusion: Ureteroscopy is an effective treatment modality for treating ureteric diseases such as calculus and strictures with no mortality recorded during the study period.Keyword: Ureteroscopy, lithotripsy, ureteric calculus, DJ stenting.Savannah Journal of Medical Research and Practice 2018;7(1):17-22

Fatores Preditivos de Retorno Hospitalar Inesperado Após Ressecção Transuretral de Tumor Vesical

Introdução: Pretende-se avaliar que fatores estão associados a um retorno hospitalar inesperado (RHI) após a realização de ressecção transuretral de tumor vesical (RTU-TV).&#x0D; Material e Métodos: Realizado estudo exploratório transversal de todas as RTU-TV realizadas entre 2015-2016.&#x0D; Resultados: Realizaram-se 499 RTU-TV em 389 doentes. Nos primeiros 30 dias após a cirurgia, ocorreu RHI em 16,8% dos casos, com necessidade de reinternamento em 4,2%. A principal causa de RHI foi infeção do trato urinário (ITU) (38,1%). Verificou-se um RHI significativamente superior nos casos de tumor primário, de dimensões tumorais superiores, de RTU-TV incompleta, de necessidade de realização de procedimentos endoscópicos adicionais, de maior duração da cirurgia e da cateterização uretral (CU) e de valores pré-operatórios mais altos de proteína C reativa (PCR) e mais baixos de hemoglobina. Na análise multivariada, verificou-se uma associação forte e independente entre a ocorrência de RHI e duração da cirurgia (OR = 1,016), duração da CU (OR = 1,059), e valores médios de PCR pré-operatória (OR = 1,131).&#x0D; Conclusão: Um RHI precoce após RTU-TV ocorreu em quase 17% dos casos, sobretudo devido a ITU. Por cada minuto de cirurgia adicional, por cada dia adicional de CU e por cada unidade adicional de PCR pré-operatória, existe um aumento do risco de RHI de 1,6%, 5,9% e 13,1%, respetivamente. Sendo a PCR uma variável não modificável, cabe ao cirurgião otimizar o tempo operatório e, sobretudo, a duração da CU de modo a reduzir a probabilidade de RHI.

Prostate shape significantly affects the HoLEP procedure time and energy usage: A retrospective pilot study

Introduction: In this study we evaluate the influence of longitudinal and transverse length of prostate size measured on the magnetic resonance imaging (MRI) scan on the overall outcomes of HoLEP.Material and methods: The patients were divided into two groups based on the shape of the prostate. Group 1 had a longitudinal shape with a longitudinal diameter greater than the transverse diameter, whereas group 2 had an oval shape with a transverse diameter greater than the longitudinal diameter. The pre-operative, peri-operative and the one-month post-operative data along with the urinary parameters were then evaluated.Results: The two groups were comparable with regard to their pre-operative values. While the median lobe enucleation time and morcellation time showed no difference, group 1 showed a significantly shorter (p < 0.01) operative time for lateral lobe enucleation, lower laser energy usage and better enucleation efficiency. However, there was no difference in the median lobe enucleation time, morcellation time, haemoglobin drop, duration of urethral catheterization and hospital stay. The groups were also comparable with regard to the improvement in urinary parameters and complications.Conclusion: Prostate shape plays a significant role in the surgical treatment of BPH.

Bidirectional Barbed Only vs Poliglecaprone Suture with Rhabdosphincter Reconstruction for Urethrovesical Anastomosis During Robotic Radical Prostatectomy: Does It Make Any Difference?

We investigated the use of bidirectional barbed suture only vs poliglecaprone suture with posterior rhabdosphincter reconstruction for urethrovesical anastomosis (UVA) during robot-assisted radical prostatectomy (RARP) on cystographic leakage, duration of catheterization, and early urinary continence. Bidirectional double-armed barbed suture only was used for UVA (n = 50) in Group 1. Two 3/0 poliglecaprone 25 sutures were tied to each other to form a double-armed suture used for UVA with posterior rhabdosphincter reconstruction in Group 2 (n = 50). Groups were similar regarding patient demographics and operative parameters. Groups were compared regarding leakage on cystography, duration of urethral catheterization after RARP, immediate urinary continence (continence at the time of urethral catheter removal), and continence rates at first and third-month follow-up. Leakage on cystography was detected in 4 (8%) and 10 (20%) of the patients in Group 1 and 2, respectively (p = 0.08). Urinary catheter removal duration was 7.8 and 8.5 days in Group 1 and 2, respectively (p = 0.1). Immediate urinary continence was achieved in 38 (76%) and 20 (40%) of the patients in Group 1 and 2, respectively (p = 0.002). Urinary continence in first-month follow-up was achieved in 46 (92%) and 38 (76%) of the patients in Group 1 and 2, respectively (p = 0.02). Urinary continence in third-month follow-up was achieved in 48 (96%) and 47 (94%) of the patients in Group 1 and 2, respectively (p = 0.64). Mean UVA time was 16.8 and 21.2 minutes, respectively, in Group 1 and 2 (p < 0.001). Because of our experience, use of a barbed suture for UVA during RARP seems to lead to better immediate and early (first month) urinary continence rates and a shorter UVA time.

Abstract No. 569 Interventional urethral realignment as a radical treatment in posterior urethral disruption accompanied by complex pelvic fracture

Unlike anterior urethral injury, posterior urethral rupture accompanied by complex pelvic fracture would have the distance between the ruptured urethra becoming wider due to pelvic hematoma, and thus, interventional urethral realignment would be expected to face similar difficulties as surgical urethral realignment. The purpose of this study was to evaluate the clinical efficacy of interventional urethral realignment as a radical treatment in patients with posterior urethral disruption. This retrospective study included 8 patients with traumatic posterior urethral disruptions who were treated with interventional urethral realignment between November 2016 and September 2017. All 8 patients were men with the mean age of 50.5 years. Reviewed results included patient demographics, technical success rate of interventional urethral realignment, fluoroscopic findings, manner of procedure, required procedure time, duration of urethral catheterization, and procedure-related complications. Interventional urethral realignment was technically successful in 6 of 8 patients (75.0%). The majority of patients were young male involved in motor vehicle crashes. In 5 patients, the catheter previously placed by retrograde urethrography was used as a landmark, and the antegrade guidewire was successfully navigated through the free space of urethra separated further by rupturing and exited through the outer urethral orifice by finding the true lumen of the distal urethra. In one patient, the rendezvous technique with a snare catheter in the free space was used. The mean procedure time was 51.2 minutes (range, 40–65 min). The mean duration of urethral catheterization after interventional urethral realignment was 63 days (range, 48–94 d). There were no immediate complications related to procedure, although all patients developed symptomatic urethral stenosis after urethral realignment. Interventional urethral realignment is a safe and minimally invasive procedure that can be performed in a patient with posterior urethral rupture accompanied by complex pelvic fracture. Thus, it can be viewed as a radical treatment that can reduce the frequency of invasive surgical procedures.

Re: Duration of Urethral Catheterization After Urethroplasty: How Long Is Enough?

Re: Duration of Urethral Catheterization After Urethroplasty: How Long Is Enough?

Comparative Analysis of the Duration of Urethral Catheterization for Caesarian Delivery

Comparative Analysis of the Duration of Urethral Catheterization for Caesarian Delivery

Duration of urethral catheterization after urethroplasty: how long is enough?

To report the impact of duration of urethral catheterization (DUC) on the rate of extravasation on voiding cysto-urethrography (VCUG) and the subsequent need of catheter replacement in urethroplasty. Two hundred nineteen consecutive patients undergoing urethroplasty between October 2010 and November 2014 were evaluated for the impact of DUC. Patients were divided into 2 groups, based on the scheduled DUC≤10 days (group 1, N.=86) or >10 days (group 2, N.=133). Fourteen patients (6.4%) had extravasation on VCUG with an additional period of catheter usage. In 10 of the 14 patients (71.4%) clinical signs of impaired wound healing were present. In group 1 (median DUC 8 days) 3 patients (3.5%) needed an additional period of urethral catheterization, compared to 11 patients (8.3%) in group 2 (median DUC 14 days). Strictures in group 2 were longer (4 vs. 2 cm, P<0.001) and more complex. Redo urethroplasty was needed in 9 of the 14 patients with extravasation. In uncomplicated cases of urethroplasty, the urethral catheter can be safely removed after 8 to 10 days postoperatively. Extravasation on VCUG occurs in around 6% of urethroplasties and is a prognostic factor for stricture recurrence and reoperation.

Results of a Two-stage Technique for Treatment of Proximal Hypospadias with Severe Curvature: Creation of a Urethral Plate Using a Vascularized Preputial Island Flap.

To present the results of a two-stage technique used for the treatment of proximal hypospadias with severe curvature. The medical records of children with proximal hypospadias and severe curvature were retrospectively analyzed. A 2-stage procedure was performed in 30 children. In the first stage, the release of chordee was performed, and a well-vascularized preputial island flap was created. The vascularized island flap was brought anteriorly and sutured over the ventral surface of the glans and degloved penile shaft. The second stage was performed 6-8 months later. A neourethra was reconstructed by the tubularization of the preputial-urethral plate utilizing the principles of Duplay technique. All surgical procedures were performed between 2005 and 2011. The mean age of the patients was 4.4 years (1-17 years). The mean duration of urethral catheterization was 6 days after the first stage and 10 days following the second stage. The flaps were viable in all of the children. There was no residual chordee. Following the second stage (n = 30), complications developed in 11 children (36%), namely, a fistula in 7, a pinpoint fistula in 3, and a diverticulum formation in 1. The cosmetic outcome was satisfactory. Uroflowmetry measurements were evaluated, and only one patient had a diverticulum formation at the late follow-up. Vascularized preputial island flap is an alternative to free grafts for the reconstruction of the urethra. The main advantage of this flap technique is the creation of a thick, healthy and well-vascularized urethral plate. The advantages of this technique include better aesthetic appearance, an acceptable complication rate, and a very low rate of diverticula formation.

Eccentric circummeatal based flap with limited urethral mobilization: An easy technique for distal hypospadias repair

Hypospadias is a common congenital anomaly. Over 300 techniques have been described for repairing hypospadias. Eccentric circummeatal based flap with combined limited urethral mobilization technique (ECMB-LUM) is a simple procedure to repair distal hypospadias with minimal complication rate. This study presents results of this technique, highlighting surgical pitfalls to achieve the best result. Medical records of patients with distal hypospadias operated on using the same technique between 1998 and 2011 were reviewed retrospectively. Age at surgery, position of meatus preoperatively and postoperatively, duration of urethral catheterization and hospitalization, early and late complications, previous hypospadias repairs, and secondary surgical interventions were evaluated. In the surgical technique an eccentric circummeatal based flap is outlined. The proximal part of the flap is dissected from the underlying urethra and Buck's fascia. If the flap is not long enough, the distal urethra is mobilized a few millimeters (Figure). The eccentric flap is sutured to the tip of the glans. The glans wings are approximated in the midline. A urethral catheter of 6 Fr or 8 Fr is passed and left in the bulbous urethra or the urinary bladder. Diverged limbs of corpus spongiosum are approximated on the urethra, then, the glans and skin of the penile shaft are sutured. Of the 171 consecutive patients operated on using the ECMB-LUM technique; 115 had coronal, 47 had subcoronal, and nine had glanular meatus. The mean age at surgery was 4.5 (1-17) years. Patients were hospitalized for 2.2 ± 0.7 days. Mean duration of urethral catheterization was 2.3 ± 0.5 days. All but eight patients had ECBF-LUM as primary repair. There were no early complications such as bleeding, hematoma, and wound infection. All patients voided spontaneously after catheter removal. Late complications were meatal stenosis, urethrocutaneous fistula, meatal regression, and glandular dehiscence (Table). These patients were treated using dilatation, fistula repair, meatoplasty, and secondary repair with the same technique, respectively. Eventually all patients had a vertical slit-like meatus on the tip of a natural looking glans. The most commonly used distal hypospadias repair techniques are glanular approximation, meatal advancement and glanuloplasty, Koff, Mathieu, Thiersch-Duplay procedure, tubularized incised plate repairs, and modifications of these techniques. Cosmetic and functional results and complication rates of ECMB-LUM technique are comparable with those of the commonly used techniques.

The Efficacy of Primary Interventional Urethral Realignment for the Treatment of Traumatic Urethral Injuries

PurposeTo evaluate the efficacy of primary interventional urethral realignment (PIUR) in patients with traumatic urethral injuries. Materials and MethodsThis retrospective study included 13 patients with traumatic urethral injuries who were treated with PIUR between September 2008 and February 2014. All 13 patients were men with the mean age of 56.3 years. Technical success rate of PIUR, time to PIUR, required procedure time, length of hospital stay, duration of urethral catheterization, and complications after PIUR were investigated. ResultsPIUR was technically successful in 12 of 13 patients (92.3%). The mean time from trauma to PIUR was 44 hours (range, 1–240 h). The mean procedure time was 20.2 minutes (range, 3–90 min). The median length of hospital stay was 15 days (range, 1–60 d). The mean duration of urethral catheterization after PIUR was 25 days (range, 9–65 d). There were no immediate complications related to PIUR, although 6 of 12 patients developed symptomatic urethral stricture after PIUR. The mean time to stricture development after PIUR was 4.3 months (range, 2–12 mo). Of the 6 patients, 2 were treated with endoscopic internal urethrotomy, and 4 were treated with interventional radiologic urethral balloon dilation. ConclusionsPIUR can be safe and effective for patients with traumatic urethral injuries. However, symptomatic stricture formation occurred in one-half of the successful realignment procedures.

Periprostatic Fat Area Is an Independent Factor That Prolonged Operative Time in Laparoscopic Radical Prostatectomy

To evaluate the effect of visceral obesity on surgical outcomes in laparoscopic radical prostatectomy (LRP). Visceral fat area (VFA) and periprostatic fat area (PPFA) were used as index of visceral obesity. In addition to VFA and PPFA, age, body mass index (BMI), prostate weight, cross-section area of Retzius space, history of previous abdominal surgery, repeated transrectal needle biopsy, and neoadjuvant hormone therapy were recorded. LRP was separated into 7 steps (1: port insertion and lymph node dissection, 2: endopelvic fascia incision, 3: dorsal vein complex ligation, 4: prostate dissection from bladder neck, 5: dissection of seminal vesicle and vas deferens, 6: prostate dissection from rectum, and 7: vesicourethral anastomosis). Potential factors that prolonged total operative time (OT), pneumoperitoneum time, and duration of each step were assessed by multivariate logistic regression analysis. The association between visceral obesity and other surgical outcomes was also evaluated. One hundred sixteen LRPs were performed by a single experienced surgeon. High PPFA and prostate weight were independent factors that prolonged total OT and pneumoperitoneum time. High BMI was not a factor. PPFA affected steps 1, 4, 5, and 6, and prostate weight affected prolonged steps 5 and 6. Estimated blood loss, duration of urethral catheterization, postoperative hospital stay, perioperative complications, and margin status were not affected by visceral obesity. PPFA was more useful to accurately predict prolonged OT than VFA or BMI. Safety and margin status were not compromised even in high PPFA group when operations were performed by an experienced surgeon.