Deepa Kapoor

Dorsal onlay vaginal graft urethroplasty for female urethral stricture.

Introduction: Female urethral stricture is an underdiagnosed and overlooked cause of female bladder outlet obstruction. The possible etiologies may be infection, prior dilation, difficult catheterization with subsequent fibrosis, urethral surgery, trauma, or idiopathic. We present our technique and results of dorsal onlay full thickness vaginal graft urethroplasty for female urethral stricture. Materials and Methods: A retrospective review was performed on 16 female patients with mid-urethral stricture who underwent dorsal onlay vaginal graft urethroplasty from January 2007 to June 2011. Of these, 13 patients had previously undergone multiple Hegar dilatations, three had previous internal urethrotomies. The preoperative work up included detailed voiding history, local examination, uroflowmetry, calibration, and micturating cystourethrogram. Results: All patients had mid-urethral stricture. Mean age was 47.5 years. Mean Qmax improved from 6.2 to 27.6 ml/s. Mean residual volume decreased from 160 to 20 ml. Mean duration of follow-up was 24.5 months (6 months to 3 years). Only one patient required self-calibration for 6 months after which her stricture stabilized. None of the patient was incontinent. Conclusion: Dorsal vaginal onlay graft urethroplasty could be considered as an effective way to treat female urethral stricture.

Delivery after augmentation cystoplasty: Implications and precautions.

A young female with history of genitourinary tuberculosis with solitary functioning kidney became pregnant 1 year after augmentation cystoplasty (AC) with ureteric reimplantation. Throughout pregnancy she had two episode of febrile urinary tract infection. Her renal function remained normal. She was planned for cesarian section due to obstetric indications. Despite altered pelvic anatomy, we successfully did the lower segment cesarian section. We reviewed the literature regarding pregnancy in patients with AC to find that what the treating Urologist and Gynecologist should know about these rare cases. Various complications which should be anticipated and measures to prevent them are also discussed.

Maturation of permanent teeth in different facial types: A comparative study

BACKGROUND Accurate diagnosis of dental maturation help in diagnosis, treatment planning, and timing in orthodontics and dentofacial orthopedics. AIM AND OBJECTIVE The present study is undertaken to compare and correlate chronological age and dental age of patients with average, vertical, and horizontal facial types, and to find out any sex difference in dental age in different growth patterns and to evaluated the reliability of Willems method in Indian population. MATERIALS AND METHODS Subjects in the age group of 8-10 years were screened from Out Patients Department of Orthodontics and Dentofacial Orthopedics and from the various school of the City, were subjected to cephalometric radiography and orthopentomograms. Angular and linear measurements used included;-SN Go-Gn angle, J.R. (Jarabak ratio) and LAFH (lower anterior facial height), to group total sample of 150 children. Group 1 (average grower), Group 2 (vertical grower), and Group 3 (horizontal grower). Then dental age for each child in different group was calculated from OPG of each subject and compared with chronological age using Student t-test. RESULTS The results suggest a difference in dental age in subject with vertical and horizontal growers. Vertical grower showed earlier maturation compared to horizontal growth patterns. There was insignificant difference present when vertical grower and horizontal grower were compared with average growth pattern. Insignificant difference was found in dental age between males and females when compared to same growth pattern. CONCLUSION Subjects with vertical growth pattern matured early than having the horizontal growth pattern in the same chronological age.

Assessment of Sagittal Skeletal Discrepancy: A Cephalometric Study

Introduction: Sagittal discrepancies are more commonly encountered in day to day practice. Angular and linear measurements have been incorporated into various cephalometric analyses to help the clinician for diagnosing this anteroposterior discrepancy. The purpose of the study was to assess sagittal skeletal discrepancy with Beta angle and to compare and correlate the Beta angle with angular measurements—ANB angle, AFB angle and with linear measurements –AO-BO, AF-BF and App-Bpp. Materials and methods: Pretreatment lateral cephalograms of 100 young adults (50 men and 50 women) were divided into skeletal Class I, II and III. The data was subjected to statistical analysis using the statistical software namely SPSS 11.0 and Systat 8.0. Results: The results of the present study showed that the mean Beta angle is 32.54 ± 0.86. Significant negative correlation exists between Beta angle with other angular measurements (ANB angle, AFB angle) and with linear measurements (AO-BO, AF-BF and App-Bpp). Sex difference was statistically insignificant. Conclusion: Increase and decrease of Beta angle from normal demonstrate skeletal Class III and Class II discrepancy respectively. There was negative correlation between Beta angle and other linear and angular measurements for assessing sagittal skeletal discrepancy.

Ruptured ovarian endometrioma with an extreme rise in serum CA 125 level — A case report Ovarian endometrioma with very high CA-125 level

► CA 125 is the most useful tumor marker for epithelial ovarian carcinoma. ► Very high serum CA 125 level does not necessarily indicate ovarian malignancy. ► Rapidly rising and persistent levels of CA 125 may be consistent with benign disease.

Is modified Raz technique of midurethral sling a reliable and cost-effective method of treating stress urinary incontinence?

Objectives: We report our experience of pure stress urinary incontinence (SUI) treated by midurethral synthetic sling placement by modified Raz technique. Materials and Methods: Fifty-three patients with pure SUI operated at our institute between June 2003 and December 2008 were included in this study. Midurethral sling tape, fashioned from commercially available large pore synthetic mesh, was placed using the modified Raz technique. The technique consisted of placing the tape within retropubic space using double-pronged needle, which is passed under finger control through the fascia and retropubic space. Outcomes were assessed on the basis of patients interview in follow-up OPD. Results: Mean age was 57.68 (28–69) years. Forty-five (85%) patients were totally dry and eight (15%) socially dry at the end of the follow-up. Mean operative time was 46.5 + 11.3 minutes (35–80 minutes). None of the patients required blood transfusion or had bladder/bowel injury. Mean duration of hospital stay was 2.17 days (2–4 days). Mean duration of follow-up was 46.1 months (12–78 months). Conclusions: Modified Raz technique is safe and cost-effective for placing midurethral sling for genuine stress incontinence.

Intraoperative finding of Falope ring over ureter as a cause of nonfunctioning kidney during laparoscopic simple nephrectomy

Laparoscopic tubal ligation is one of the most common laparoscopic procedures performed worldwide. The incidence of associated ureteric injury is low and usually due to thermal injury. An interesting case of nonfunctioning kidney secondary to ureteral ligation by Falope ring is presented. A 46-year-old postmenopausal woman with no comorbidity presented with dull aching right flank pain for 4 months. She had history of laparoscopic tubal ligation 15 years previously. On ultrasonography, there was a severely hydronephrotic right kidney with a normal left kidney. Serum creatinine was 0.8 mg/dL with normal excreting left kidney on intravenous urogram (Figure 1). On ethyl cysteine scan, the right kidney was not visualizedwhereas the left kidney was normal. The patient underwent laparoscopic transperitoneal simple nephrectomy. Intraoperatively, there was a grossly dilated right kidney and ureter up to the right sacroiliac joint and a tubal ligation clip was identified over the right ureter (Figure 2). The ureter was removed up to the sacroiliac joint. The postoperative period was uneventful. Histopathology report revealed chronic pyelonephritis. At 3 months follow-up, the patient was doing well. Ever since laparoscopic surgery began in the 1960s, ureteric injuries have been associated with them. Laparoscopic hysterectomy is the most common laparoscopic procedure leading to ureteric injury with a reported rate from 0.5% to 14% [1]. Patients with delayed presentation have a variety of signs and symptoms

Trans-vaginal anterior vaginal wall prolapse repair using a customized tension-free bell-shaped prolene mesh: A single-center experience with long-term functional analysis.

Introduction: The existing literature shows that mesh reinforcement improves the anatomical success rate of cystocele repair. We report the long-term results of a custom bell-shaped mesh with simultaneous urethral support for the repair of cystocele. Materials and Methods: The present study was a single-center, single-surgeon case series of 36 patients. Only patients with Pelvic Organ Prolapse Quantification system (POP-Q) stage 2 and above were included in the study. Patients having rectocele or uterine/vault prolapse were excluded. Body of the mesh was used for reinforcement of the cystocele repair and two limbs were left tension free in the retropubic space. Patients were followed 3 monthly for the first year and yearly thereafter. Recurrence was defined as cystocele ≥stage 2 (Aa or Ba 0) any time after the first follow-up. Results: Mean patient age was 58.5 ± 6.2 years. The mean parity was 3.2 ± 1.6. Of 36 patients, 11 (30.5%) of the patients were POPQ stage 2, 15 (41.7%) were stage 3 and 10 (27.7%) were stage 4 cystocele. The mean follow-up period was 53.4 months, with 32 patients reporting for follow-up till date (88.9%). There was no bladder injury, no mesh erosion or infection. No patient required CIC (clean intermittent catheterization) or had stress urinary incontinence post-operatively at 5 years of follow-up. Conclusion: The bell-shaped mesh is a simple, effective and safe procedure in the surgical management of cystocele with excellent long-term outcome.

Trans-vaginal total pelvic floor repair using customized prolene mesh: A safe and cost-effective approach for high-grade pelvic organ prolapse.

Aims: To assess safety, efficacy, and cost-effectiveness of trans-vaginal total pelvic floor repair with customized prolene mesh in patients with high-grade pelvic organ prolapse. Materials and Methods: A total of 32 patients, who underwent trans-vaginal total pelvic floor repair using a customized prolene mesh from January 2007 to June 2010 for grade III and IV pelvic organ prolapse, were analyzed retrospectively. Prolapse was graded using Pelvic Organ Prolapse Quantification system of International Continence Society. Patients were evaluated for symptoms associated with prolapse pre- and postoperatively. Results: Of the 32 patients, 18 were grade IV uterine prolapse, 10 were grade III uterine prolapse, and 4 were grade IV vault prolapse. Twenty-eight patients underwent vaginal hysterectomy at the time of repair. All the patients had associated anterior and posterior prolapse of varying degree. Follow-up ranged from 6 to 42 months. All patients had symptomatic relief after surgery. There were no intraoperative rectal or bladder injuries. Early complications were perineal pain (30), de novo urgency (4), vaginal discharge (3), vaginal wall hematoma (2), and failure to void (2). Two patients had vaginal erosion of mesh. Conclusions: Trans-vaginal total pelvic floor repair using a customized prolene mesh is safe and effective treatment for comprehensive repair of high-grade pelvic organ prolapse. The use of this custom-made prolene mesh makes the procedure very cost-effective and affordable. The reduction in cost is about 25-30 times with the use of this mesh when compared with commercially available variety.

Influence of myofunctional therapy on oropharyngeal airway dimensions in skeletal class II cases - a cephalometric study

Skeletal Class II malocclusion is associated with a multitude of functional problems one of which is reduced oropharyngeal airway dimension. The airway is receiving renewed attention in recent literature regarding snoring and obstructive sleep apnoea syndrome especially as a retrognathic mandible is often implicated as its cause. The study was undertaken to investigate the myofunctional appliance (TWIN BLOCK) effects on the oropharyngeal airway dimensions in Skeletal Class II individuals in the average age of 11-13 years. This study also expresses the existence of any correlation between airway dimension and craniofacial morphology.