S. N. Wadhwa

MANAGEMENT OF OBLITERATIVE POSTTRAUMATIC POSTERIOR URETHRAL STRICTURES AFTER FAILED INITIAL URETHROPLASTY

PURPOSE We evaluate the problems encountered during surgery and assess the results of different endoscopic and open surgical methods following failed urethroplasty for posttraumatic posterior urethral stricture. MATERIALS AND METHODS Since 1992 we have treated 23 patients in whom urethroplasty for posterior urethral strictures failed. Of these patients, 3 had undergone 2 previous repairs and 6 had additional complicating factors, such as fistula, periurethral cavity and false passage. End-to-end anastomosis was done in 14 patients via a transperineal (7) or transpubic (7) approach. In 1 patient substitution urethroplasty using a radial artery based forearm free flap was performed. In 3 patients a 2-stage urethroplasty was done, 4 underwent core-through optical internal urethrotomy and 1 underwent endoscopic marsupialization of a false passage. RESULTS At 1 to 5-year followup 3 of the 23 patients had restenoses (13%), including 2 in whom previous treatment failed. The remaining 87% of the patients void well and are continent, and there is no worsening of the preexisting potency status. CONCLUSIONS Previous failed urethral stricture repair complicates management due to fibrosis, impaired vascularity and limited urethra available for mobilization. Recurrent strictures less than 1.5 cm. can be managed successfully with core-through internal urethrotomy. End-to-end anastomosis is possible in the majority with generous use of inferior pubectomy or the transpubic approach with certain modifications. When residual inflammation or long strictures are present a 2-stage procedure is a safer option. Overall, reoperation can offer a successful outcome for the majority of these complex strictures.

Complications and Management of “Neglected” Renal Stones

In developed countries, with better facilities for medical and surgical treatment of urolithiasis, calculi usually are not “neglected” although even from affluent countries, there are reports of patients in whom surgery was advised, but they have failed to take advantage of it. This study of 50 patients with renal/ureteric stone “neglected” by the patients so far as orthodox treatment is concerned have been collected from the records of patients admitted to the Institute Hospital during the period from January 1, 1979, to March 31, 1980. The reason for neglect has been most often patient fear of and unwillingness to undergo surgery, but to nearly an equal extent it has been due to claims by practitioners of “folk lore” medicine or rival system of medicine that they had some medicine to dissolve the stone. Ninety percent of the stones have contained calcium and 10% contained uric acid. There have been no cystine stones in this group.