Bastab Ghosh

Outcome and erectile function following treatment of priapism: An institutional experience

Introduction: Priapism has a devastating consequence on the sexual function of men if not promptly managed. We are presenting our experience of the treatment of priapism and the status of sexual function even following successful detumescence achieved after treatment. Materials and Methods: Nineteen patients, who presented with priapism from January 2012 to December 2014, were included in the study. After obtaining a detailed history; color Doppler ultrasonography of penis and blood gas analysis of the initial corporal aspirate were done to ascertain the type of priapism. Standard protocol in our institute for management of priaprism was to start with conservative treatment by corporal aspiration and intracorporeal injection (ICI) of phenylephrine. On the failure of conservative management, distal shunts were performed. Proximal shunts were performed on the failure of distal shunt procedures. Erectile function was evaluated with International Index of Erectile Function-5 questionnaire on admission and during follow-up. Results: All the patients had ischemic type priapism. Age of the patients ranged from 22 to 55 years. Duration of priapism varied from 20 to 480 h (mean 96.7). Etiologies attributed were; over-the-counter sildenafil use, chlorpromazine, opium intake and intracorporeal papaverine injection, chronic myeloid leukemia, and idiopathic. Five patients had preserved erectile function during follow-up. Preservation of normal erectile function following aspiration and ICI, proximal and distal shunt procedures were 66.7%, 18.1% and 20%, respectively. Conclusion: Patients with late presentation and those patients requiring higher treatment modalities (e.g., proximal shunts) for achieving detumescence will subsequently have a poor erectile function. These patients should be counseled about the early penile prosthesis placement during initial surgical management.

Direct visual internal urethrotomy: Is it a durable treatment option?

Objective: To evaluate the long-term success rate of direct vision internal urethrotomy as a treatment for anterior urethral strictures. Materials and Methods: We retrospectively analyzed the results for patients who underwent internal urethrotomy from January 2009 to January 2014 for anterior urethral strictures. Patients were followed till January 2016. Patients with complicated urethral strictures with a history of previous urethroplasty, hypospadias repair, or previous radiation were excluded from the study, as anticipated low success rate of direct visual internal urethrotomy (DVIU) in these patients. The Kaplan–Meier method was used to analyze stricture-free probability after the first, second, and third urethrotomy. Results: A total of 186 patients were included in this study. Stricture-free rates after first, second, and third urethrotomy were 29.66%, 22.64%, and 13.33%, respectively. Conclusions: Although DVIU may be a management option for anterior urethral stricture disease, it seems that long-term results are disappointing.

Laparoscopic Extravesical Lich-Gregoir Ureteroneocystostomy with Psoas Hitch for the Management of Ureterovaginal Fistula in Post-Hysterectomy Patients

Introduction: Most commonly ureterovaginal fistula occurs due to surgical injury inflicted to the distal ureter and because of gynaecological procedures. Open surgical repair is a standard procedure and commonly involves ureteroneocystostomy. Methods: We retrospectively reviewed data of 9 patients, who underwent laparoscopic extravesical Lich-Gregoir ureteroneocystostomy using the psoas hitch procedure for ureterovaginal fistulas following hysterectomy during the period December 2012-August 2014. Transperitoneal laparoscopic ureteroneocystostomy was performed in all cases. Results: The mean operative time was 212 min (range 170-310) and estimated blood loss was 108 ml (range 70-150). Average hospital stay was 5.7 days. Follow-up time was from 6 to 26 months. Postoperative intravenous urography was done after 3 months, which showed patent anastomosis in 8 patients except for 1 patient who had nonvisualization of the ipsilateral renal moiety. Voiding cystogram done at 3 months showed no leakage in all patients. In the postoperative period, 1 patient had recurrent ipsilateral pyelonephritis 2 weeks after surgery, while another patient had febrile UTI. Apart from these no major complications were observed. Conclusion: Laparoscopic ureteroneocystostomy with psoas hitch can be performed safely with a success rate compared to that of open surgery but with less morbidity and quick convalescence.

Comparative analysis of outcome between laparoscopic versus open surgical repair for vesico-vaginal fistula

Objective Vesicovaginal fistula (VVF) causes detrimental psychosomatic effects on a woman. It is repaired using open abdominal as well as laparoscopic approach. Here we compare a series of open versus laparoscopic VVF repairs done at a single centre. Methods Retrospectively data of patients undergoing VVF repair in our department between January 2011 to December 2014 was analyzed. Patients who had a single, primary, simple VVF following a gynaecological surgery were included in the study. 26 patients met all the criteria. Out of these, thirteen patients had undergone a laparoscopic VVF repair (group 1) while thirteen had undergone an open transabdominal VVF repair (group 2). Results Mean fistula size was 2.14±0.23 cm in group 1 and 2.18±0.30 cm in group 2, which was comparable. Mean blood loss was 58.69±6.48 mL in group 1 and 147.30±19.24 mL in group 2, which is statistically significant (P<0.0001). Mean hospital stay was 4 days in group 1 and 13 days in group 2 which is statistically significant (P<0.0001). The analgesic requirement (diclofenac) was 261.53±29.95 mg in group 1 and 617.30±34.43 mg in group 2, which is statistically significant (P<0.0001). Fistula repair was successful in all the patients in both the groups. Conclusion The present study shows that laparoscopic VVF repair results in reduced patient morbidity and shorter hospital stay without compromising the results. So laparoscopic repair may be a more attractive treatment option for patients with post gynecology surgery VVF.

Ectopic ureter draining into the uterus

We report a rare case of a 13-year-old female child with a right-sided duplex system with the upper moiety draining into the uterus. Only one such case has been reported in scientific literature in English, of ectopic ureter draining into the uterus has been reported in literature. The patient was managed with laparoscopic end-to-side ureteroureterostomy into the normal ureter of the lower moiety.

A comparative study of lingual mucosal graft urethroplasty with buccal mucosal graft urethroplasty in urethral stricture disease: An institutional experience.

Aims: A prospective study to compare the outcomes of lingual versus buccal mucosal graft urethroplasty in patients with long segment anterior urethral strictures disease. Materials and Methods: The study included 30 patients for buccal mucosal graft urethroplasty (group I) and 30 patients for lingual mucosal graft urethroplasty (group II) for treatment of long segment (>3 cm) incomplete anterior urethral stricture disease using single-stage dorsal onlay free oral mucosal graft urethroplasty by Barbaglis technique between February 2013 to September 2014. All patients underwent complete evaluation of the stricture including inspection of the oral cavity. Results: The results of urethroplasty in between two group were not significant (P > 0.05) in terms of Qmax (P = 0.63), mean postoperative AUA symptom score (P = 0.83), operative time (P = 0.302) intra operative blood loss (P = 0.708), duration of postoperative hospitalization (P = 0.83), but slurring of speech complications was seen in group II, but not in group I. Long-term complications of salivary disturbance, tightness of the mouth, persistent pain at graft site, perioral numbness, seen only in group I (BMGU). Conclusion: LMG urethroplasty is an excellent alternative to BMG urethroplasty with comparable results of urethroplasty and minimal donor site complications.

A randomized clinical trial comparing intracorpus spongiosum block versus intraurethral lignocaine in visual internal urethrotomy for short segment anterior urethral strictures

Objectives: The primary objective was to compare the effectiveness in pain relief of intracorpus spongiosum block (ICSB) versus intraurethral topical anesthesia (TA) using 2% lignocaine jelly for performing visual internal urethrotomy (VIU) for short segment anterior urethral strictures. Materials and Methods: It was a randomized, parallel group controlled trial. Participants are adult patients with a single anterior urethral stricture up to 2 cm in length. Patients were allocated to two intervention groups with thirty patients in each group. For anesthesia of the urethra, Group 1 patients received ICSB whereas Group 2 patients received intraurethral TA using 2% lignocaine jelly before VIU. Patient discomfort was assessed with visual analog scale (VAS) during the procedure and 1 h postprocedure. The increase in pulse rate and the change in systolic blood pressure (BP) during the procedure were recorded. The procedure was considered successful if there was absence of symptoms or signs of recurrent stricture and ability to pass freely 18Fr catheter during urethral calibration at last follow-up. Results: From March 2014 to June 2015, sixty patients were randomized into two groups of thirty patients each. The mean (±standard deviation) intraoperative VAS score was 2.8 ± 1.1 in Group 1, which was significantly less (P < 0.05) than the 5.6 ± 1.7 score in Group 2. The mean 1 h postoperative VAS score was also significantly lower in Group 1 patients (1.0 ± 1.0) than in Group 2 patients (3.2 ± 1.5). The change in pulse rate was significantly greater in Group 2 (21.3 ± 10.1 beats/min) than in Group 1 (10.6 ± 4.6 beats/min, P < 0.05). The change in systolic BP was also significantly higher in Group 2 (16.3 ± 8.6 mmHg) than in Group 1 (9.1 ± 4.4 mmHg, P < 0.05). The stricture-free rate at 6-month after VIU in Group 1 and Group 2 patients were 88.5% and 89.6%, respectively. Conclusions: ICSB has better pain control with similar complication and recurrence rate than intraurethral lignocaine jelly alone in VIU.

Urologic complications following obstetrics and gynecologicai surgery: Our experience in a tertiary care hospital

Introduction: Urinary tract injuries are a known complication of obstetrical and gynecological surgeries because of their anatomical proximity. Delayed diagnosis and improper management leads to high morbidity and even mortality. This is our three years experience of urological complications after obstetric and gynecological surgery, their treatment and follows up. Materials and Methods: We reviewed all cases of urological injuries managed in our department that were deemed to be of obstetric and gynecological origins. Results: Thirty seven women were treated in the department for urological complications secondary to obstetric and gynecological procedures from January 2012 to December 2014. The most common organ involved was urinary bladder, occurring in 54% patients followed by ureter in 35.13%. Vesicovaginal fistula (VVF) was the most common injury involving the bladder occurring in nineteen patients. Ureterovaginal fistula (UVF) occurred in nine patients and acute ureteric injury in three. Hysterectomy was the most common etiology occurring in 60% cases followed by obstetrical causes in 40% cases. All cases were successfully managed both with open surgery or laparoscopic surgery. Conclusion: Although obstetrical causes are still important in developing countries, gynecological procedures especially laparoscopic surgeries are on the rise. In these procedures the suspicion of urological injuries should be kept in mind and intra-operative detection and early repair should be attempted. Delayed diagnosis and improper treatment leads to severe complications.

Urethral foreign body in an adolescent boy: report of two rare cases and review of literature.

Abstract The presence of a foreign body in the urethra is uncommon. A wide variety of foreign bodies have been described in urethras, but they are often missed in physical examinations as the patient tries to hide the fact. We report two unusual cases of foreign bodies in the urethra in two adolescent boys suffering from psychiatric disorders. In the first case, a 12-year-old boy presented with introduction of sewing needle into the urethra 3 days back. The patient in that case suffered from a delusional disorder. In the second case, a 19 year old man introduced a metallic screw into his urethra for sexual gratification several times in the preceding 4 years. That patient suffered from schizophrenia. Although psychiatric illness is associated with urethral foreign body, such underlying psychiatric disorders are very rare.

Angiosarcoma of penis

A 29-year-old male patient presented with proliferative lesion in the glans penis without any inguinal lymphadenopathy. The biopsy showed a highly vascular malignant lesion. Subsequent metastasis work-up was negative. Partial amputation of the penis with close follow-up was performed. Final histopathology was consistent with angiosarcoma of the penis.