Purpose: We aim to present our experience for the repair of vesicovaginal fistula (VVF) with special reference to surgical approach. Materials and Methods: From January 1999 to June 2005, 52 VVF patients with mean age of 32 years underwent operative treatment. Fistulas were divided into two groups, simple and complex, depending on site, size, etiology and associated anomalies. Simple VVFs were approached through the vaginal route and complex VVFs via the transabdominal route. Patients were evaluated at two to three weeks initially, three-monthly twice and later depending on symptoms. Results: Thirty-two (61.5%) had simple fistulas and 20 (38.5%) complex fistulas. The most common etiology was obstetric trauma in 31 (59.6%) patients, while the second most common cause was post hysterectomy VVF. Thirty-two (61.5%) patients were managed by transvaginal route, of which 17 had supratrigonal and 15 trigonal fistulas. Twenty (38.5%) patients with complex fistulas were managed by abdominal route. The mean blood loss, postoperative pain and mean hospital stay were shorter in transvaginal repair. Eleven (21.2%) patients required ancillary procedures for various other associated anomalies at the time of fistula repair. Three patients failed repair giving a success rate of 94.2%. At a mean follow-up of three years 48 women were sexually active, of these 10 (19.2%) complained of mild to moderate dyspareunia. Conclusion: Most of the simple fistulas irrespective their locations are easily accessible transvaginally while in complex fistulas we recommend the transabdominal approach. Depending on the clinical context both the approaches achieved comparable success rates.

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Vesicovaginal fistula (VVF) has been a social and a surgical problem for centuries and remains a challenge to surgeons. Though advances have been made in the understanding of the etiology, diagnostic procedures and management of these fistulae, controversies still exist over the ideal approach and time to repair. This review was undertaken to look into the recent literature with regard to the timing and surgical approach to VVF repair. The literature search was done using the Medline database with keywords: vesicovaginal fistula, laparoscopy and robotic repair filtered for the last 5 years.

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Objective: To understand role of mitochondrial (mt) mutations in genes regulating oxidative phosphorylation (OXPHOS) in pathogenesis of male infertility. Infertility affects approximately 15% of couples trying to conceive. Infertility is frequently attributed to defects of sperm motility and number. Mitochondrion and mitochondrial DNA (mtDNA) play an important role in variety of physiological process. They control the oxidative energy supply and thus are central to growth, development and differentiation. Mitochondrial function is controlled by a fine-tuned crosstalk between mtDNA and nuclear DNA (nDNA). As mitochondria supply energy by OXPHOS, any mutation in mtDNA disrupts adenosine triphosphate (ATP) production and thus result in an impaired spermatogenesis and impaired flagellar movement. As sperm midpiece has few mtDNA copies, thus enhanced number of mutant mtDNA results in early phenotypic defect which manifest as spermatogenic arrest or asthenozoospermia. Oxidative stress and mtDNA mutations are positively correlated and mutations in mitochondrial genome (mt genome) are implicated in the lowered fertilising capacity of the sperm and affects the reproductive potential of an individual. Materials and Methods: A thorough review of articles in the last 15 years was cited with reference to the below-mentioned keywords. The articles considered discuss the role of mt genome in the normal functioning of sperm and the factors associated with mt mutations and impact of these mutations on the reproductive potential. Results: Sperm motility is a very important factor for the fertilisation of ova. The energy requirements of sperm are therefore very critical for sperm. Mutations in the mitochondrial genes as COX II, ATPase 6 and 8 play an important role and disrupts ATP production affecting the spermatogenesis and sperm motility. Therefore, the aberrations in mt genome are an important etiopatholgy of male infertility. Conclusion: In the context of male infertility, mt mutations, generation of reactive oxygen species and lowered antioxidant capacity are interlinked and constitute a unified pathogenic molecular mechanism. In the era of assisted reproduction technique (ART), it is very important to distinguish between mutations in nuclear and mitochondrial genomes in sperm, as mtDNA mutations are better diagnostic and prognostic markers in infertile men opting for ART.

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Percutaneous nephrolithotomy (PNL) is the procedure of choice for large renal stones. Since its introduction in 1976, many aspects of the operative technique and the endoscopic equipments have had constant evolution, increasing the success rates of the procedure. We performed a literature search using Entrez Pubmed from January 2000 to July 2007 concerning PNL and many aspects related to all steps of the procedure. We could verify that PNL in supine position has been proved as an acceptable option, but more worldwide experience is necessary. Urologists must be trained to gain their own renal tract access. Minipercutaneous PNL still needs equipments improvements for better results. Tubeless PNL is increasing in popularity and different tract sealants have been studied. Medical prevention is proved to be effective against stone recurrence and should be always used after PNL. Although the evolution of the technique in the last 20 years, urologists must continue to improve their skills and develop new technologies to offer to the patients more and more a safe and effective option to treat large renal stones.

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Objectives: To report the advances in laparoscopic partial nephrectomy (LPN) for renal masses with emphasis on technically challenging cases. Methods: Literature in the English language was reviewed using the National Library of Medicine database using the key words kidney, renal, tumor, nephron sparing surgery, and laparoscopic partial nephrectomy, for the period between 1993 and 2009. Over 500 articles were identified. A total of 50 articles were selected for this review based on their relevance to the evolution of the technique and outcomes, as well as expanding indications for LPN. Results: In expert hands, LPN is safe and effective for central tumors, completely intrarenal tumors, hilar tumors, tumor in a solitary kidney, large tumors requiring heminephrectomy, cystic tumors, multiple tumors, obese patients, and even incidental stage ≥ pT2 tumors. Perioperative outcomes and 5-year oncologic outcomes after LPN are comparable to open partial nephrectomy (OPN). Conclusions: In experienced hands indications for LPN have expanded significantly. In 2009, advanced LPN remains a skill-intensive procedure that can nevertheless provide excellent outcomes for patients with renal tumors.

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Background: Small cell bladder carcinoma is an uncommon tumor. In this retrospective study we report our experience dealing with this disease at the Leon-Berard Cancer Centre. Materials and Methods: We retrospectively analyzed various characteristics of small cell bladder carcinoma: patient demographics, histological diagnosis, disease stage, treatment effects and outcome, in 14 non-metastatic small cell bladder carcinoma patients treated at our institution between 1995 and 2006. Results: The mean age at diagnosis was 60 years (range, 45-77). All patients were male. Seventy-five per cent were smokers. All had locally advanced disease. Ten patients (71.4%) were treated by cystoprostatectomy and bilateral pelvic lymph node resection, one by cystoprostatectomy alone. Two patients received neoadjuvant chemotherapy and four received adjuvant chemotherapy. One patient was treated by radiotherapy with concomitant cisplatin after transurethral resection of bladder tumor (TURBT). One patient refused surgery and was treated by chemotherapy alone. One patient was lost to follow-up after TURBT. After 49-month median follow-up, 12 patients had relapsed. Disease-free survival was 5.7 months. The most frequent sites of relapse were the retroperitoneal lymph node (seven patients) and the liver (three patients). Nine patients died of metastasis. Median overall survival was 29.5 months. Survival probability at two years was 58%. Median overall survival was 34 months in the mixed small carcinoma group, as compared with 9.5 months in the pure small cell carcinoma group (P=0.01). Mean overall survival was 27.2 months for all patients and 38.6 months for patients treated with cystectomy and adjuvant chemotherapy. Conclusion: To date, the optimal treatment for locally advanced small cell bladder carcinoma is not clear. Cystectomy with neoadjuvant or adjuvant chemotherapy appears as a viable option.

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Purpose: To assess the effects of transplant renal artery stenosis (TRAS) on blood pressure, renal function, and graft survival. To assess the usefulness of Doppler in predicting the clinical significance of TRAS and also to identify the predictive factors in Doppler that correlated with clinical features of TRAS. Materials and Methods: A prospective study was done on consecutive renal allograft recipients at Christian Medical College, over a period of 66 months from January 2002. All recipients underwent Doppler ultrasound (DUS) evaluation on the fifth post-operative day. Subsequent evaluation was done if the patients had any clinical or biochemical suspicion of TRAS. Angiogram was done in case of a high index of suspicion of significant stenosis or before angioplasty and stenting. The clinical and radiological outcomes of the patients with symptomatic or asymptomatic TRAS were analyzed. Results: Five hundred and forty three consecutive renal allograft recipients were analyzed, of whom, 43 were found to have TRAS. Nine recipients (21%) were detected to have TRAS on first evaluation. All had a high peak systolic velocities (PSV) recorded while 25 of them had other associated features. Patients with only high PSV required no further intervention and were followed up. They had a pretransplant mean arterial pressure (MAP) of 107.83 mmHg (SD = 13.32), ranging from 90 to 133 mm Hg and a posttransplant MAP of 106.56 mmHg (SD =16.51), ranging from 83 to 150 mm Hg. Their mean nadir serum creatinine was 1.16 mg% (SD = 0.24), at detection was 1.6 mg% (SD = 1.84) and at 6 months follow-up was 1.26 mg% (SD=0.52). Of the remaining 25 patients with other associated Doppler abnormalities, 11 required further intervention in the form of re-exploration in 2, angioplasty in 3 and stenting in 6 patients. One patient in the group of patients intervened, expired in the immediate post-operative period due to overwhelming urosepsis and consumption coagulopathy. The mean creatinine clearance (Cockroft-Gault method) in this group of remaining 10 patients, before and after intervention was 44.75 ml/min (SD=17.85) and 68.96 ml/min (SD = 10.56), respectively, with a mean increase by 24.21 ml/min (P=0.000). The mean arterial pressure before and after intervention in this group were 132.80 mm Hg (SD = 13.22) and 102 mm Hg (SD = 10.55), with a decline in the MAP by 30.80 mmHg (P=0.017). The haemoglobin levels also increased from 11.72 (SD=2.13) to 12.48 gm% (SD = 1.75), with a mean increase by 0.76 gm% (P=0.05). Conclusions: Patients with isolated high PSV do not have a significant alteration of blood pressure or allograft function and required no intervention. Although high PSV with associated Doppler anomalies are more suggestive of significant TRAS, the decision regarding surgical intervention is largely based on clinical assessment.

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This retrospective analysis was done on 48patients who had undergone a dry fulguration for the treatment of posterior urethral valves (PUV) over the past 23 years. The patients were evaluated for the effectiveness of treatment and complications, particularly stricture formation. 31 (64.5 percent) patients had a vesicostomy and 17 (35.5 percent) patients had bilateral (B/L) ureterostomies at the time of fulguration. Only 2 patients developed urethral stricture (42 percent). Of these 2 patients, 1 suffered urethral injury during attempted valve destruction at 3 months' age; the procedure was abandoned and a vesicostomy fashioned. He subsequently underwent fulguration at 1 year age. The other patient had undergone a dry fulguration at 10 months' ageand had no apparent reason for the stricture. We believe that although dry fulguration of PUV should be avoided, it can be performed safely and effectively and need not be accompanied with a simultaneous undiversion procedure.

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Introduction: Various grafts have been used in the treatment of urinary incontinence and pelvic prolapse. Autologous materials such as muscle and fascia were first utilized to provide additional anatomic support to the periurethral and pelvic tissues; however, attempts to minimize the invasiveness of the procedures have led to the use of synthetic materials. Complications such as infection and erosion or extrusion associated with these materials may be troublesome to manage. We review the literature and describe a brief overview of grafts used in pelvic floor reconstruction and focus on the management complications specifically related to synthetic materials. Materials and Methods: We performed a comprehensive review of the literature on grafts used in pelvic floor surgery using MEDLINE and resources cited in those peer-reviewed manuscripts. The results are presented. Results: Biologic materials provide adequate cure rates but have associated downfalls including potential complications from harvesting, variable tissue quality and cost. The use of synthetic materials as an alternative graft in pelvic floor repairs has become a popular option. Of all synthetic materials, the type I macroporous polypropylene meshes have demonstrated superiority in terms of efficacy and fewer complication rates due to their structure and composition. Erosion and extrusion of mesh are common and troublesome complications that may be managed conservatively with observation with or without local hormone therapy, with transvaginal debridement or with surgical exploration and total mesh excision, dependent upon the location of the mesh and the mesh type utilized. Conclusions: The ideal graft would provide structural integrity and durability with minimal adverse reaction by the host tissue. Biologic materials in general tend to have fewer associated complications, however, the risks of harvesting, variable integrity of allografts, availability and high cost has led to the development and use of synthetic grafts. Synthetic grafts have a tendency to cause higher rates of erosion and extrusion; however, these complications can be managed successfully.

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Many classifications of hypospadias have been published, mainly based on the position of the ectopic meatus, which is an insufficient criterion to define the severity of this malformation. What really marks the proximal landmark of this malformation is the level of division of the corpus spongiosum, which is always proximal to the ectopic meatus. In this article, we will focus on the most severe forms of hypospadias which include those with a proximal division of corpus spongiosum (below the midshaft), important chordee and a poor development of the ventral radius, reflecting a marked hypovirilization of the genital tubercle, and cripple hypospadias resulting from several previous failed surgical procedures. The principle of hypospadias surgery will be reviewed together with the outcome of the current surgical techniques. Furthermore, common complications will be outlined. There is no minor or major hypospadias and all forms require a solid experience of the surgeon, as minor looking hypospadias may turn out to be far more complex to repair than they appear once the ventral radius of the penis has been dissected.

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Purpose: To determine the impact of age and gender on the clinicopathological characteristics of histologically confirmed bladder cancer in India. Materials and Methods: From January 2001 to June 2008, records of patients with bladder cancer were evaluated for age and gender at presentation, clinical symptoms, cystoscopic finding, history of smoking, and histopathological characteristics. A total of 561 patients were identified from the computer-based hospital information system and the case files of patients. Results: A total of 97% of the patients presented with painless hematuria. The mean age was 60.2 ± 4.4 years old (range: 18-90 years old) and the male to female ratio was 8.6:1. Transitional cell carcinoma (TCC) was the most common histological variety, which was present in 97.71% (470 of 481) of the patients. A total of 26% of the patients had muscle invasive disease at the time of presentation. However, 34.5% (166 of 481) of the patients did not show any evidence of detrusor muscle in their biopsy specimen. In patients with nonmuscle-invasive bladder carcinoma, 55% had p Ta while 45% had p T1. Overall, 44.7% (215 of 481) of the patients had low-grade disease. Among patients younger than 60 years old, low-grade (51.0% vs. 38.1%; P = 0.006) and low-stage (77.1% vs. 70.8%; P = 0.119) disease were more prevalent than in patients older than 60 years old. The incidence of smoking was much higher among males compared with females (74% vs. 22%). Conclusion: TCC is the predominant cancer, with significant male preponderance among Indian patients. Younger-aged patients have low-grade disease. Hematuria is the most common presentation and greater awareness is needed not to overlook bladder cancer.

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The legislation called the Transplantation of Human Organ Act (THO) was passed in India in 1994 to streamline organ donation and transplantation activities. Broadly, the act accepted brain death as a form of death and made the sale of organs a punishable offence. With the acceptance of brain death, it became possible to not only undertake kidney transplantations but also start other solid organ transplants like liver, heart, lungs, and pancreas. Despite the THO legislation, organ commerce and kidney scandals are regularly reported in the Indian media. In most instances, the implementation of the law has been flawed and more often than once its provisions have been abused. Parallel to the living related and unrelated donation program, the deceased donation program has slowly evolved in a few states. In approximately one-third of all liver transplants, the organs have come from the deceased donor program as have all the hearts and pancreas transplants. In these states, a few hospitals along with committed NGOs have kept the momentum of the deceased donor program. The MOHAN Foundation (NGO based in Tamil Nadu and Andhra Pradesh) has facilitated 400 of the 1,300 deceased organ transplants performed in the country over the last 14 years. To overcome organ shortage, developed countries are re-looking at the ethics of unrelated programs and there seems to be a move towards making this an acceptable legal alternative. The supply of deceased donors in these countries has peaked and there has been no further increase over the last few years. India is currently having a deceased donation rate of 0.05 to 0.08 per million population. We need to find a solution on how we can utilize the potentially large pool of trauma-related brain deaths for organ donation. This year in the state of Tamil Nadu, the Government has passed seven special orders. These orders are expected to streamline the activity of deceased donors and help increase their numbers. Recently, on July 30, 2008, the Government brought in a few new amendments as a Gazette with the purpose of putting a stop to organ commerce. The ethics of commerce in organ donation and transplant tourism has been widely criticized by international bodies. The legal and ethical principles that we follow universally with organ donation and transplantation are also important for the future as these may be used to resolve our conflicts related to emerging sciences such as cloning, tissue engineering, and stem cells.

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Objectives : To assess the accuracy of Gleason grading/scoring on preoperative needle core biopsy (NCB) compared to the radical prostatectomy (RP) specimen. Materials and Methods : Data of NCB and RP specimens was analyzed in 193 cases. Gleason grade/scoring was done on both NCB and RP specimens. Sixteen cases were excluded for various reasons. The Gleason scores of the two sets of matched specimens were compared and also correlated with the PSA, age, and number of needle biopsy cores. The overall change was also correlated with the initial score on NCB. Results : The mean age and PSA were 63.3 ± 2(5.27) years and 18.48 ± 2(28.42) ng/ml, respectively. The average Gleason score increased from 5.51 ± 2(1.52) to 6.2 ± 2(1.42) (P < 0.02). The primary grade increased in 57 (32.2%) cases. Overall, 97 (54.8%) cases had an increase in Gleason score. Five other cases had a change from 3 + 4 = 7 to 4 + 3 = 7. Change in Gleason score was significantly more if the score on NCB was ≤6 or number of needle cores was ≤6. Besides, 28 cases had perineural invasion, 16 had capsular invasion (pT3 _a ), and 4 had vascular invasion on RP specimen. Conclusions : There is a significant upgrading of Gleason score on RP specimens when compared with NCB. This trend may be correlated positively with lower initial Gleason score on preoperative biopsy and the lower number of cores taken.

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Introduction: We present our eight-year experience with open nephron-sparing surgery (NSS) in renal tumors with contralateral normal kidney to assess its oncological efficacy and safety. Materials and Methods: Thirty-six patients undergoing open NSS for small localized renal tumors with normal contralateral kidney from January 1998 to August 2006 were studied regarding demographic, clinical and pathological characteristics along with long-term follow-up. Results: The mean age was 48.28 ± 9.5 years. The mean tumor size was 3.72 cm (range 1.5-6). The following surgeries were performed: Wedge resection-13, partial polar nephrectomy-15, segmental resection-eight. The following techniques were used for vascular control: clamping and cooling-eight, warm ischemia-12, a novel technique of serial encirclage-16. The mean warm ischemia time was 23.2 ± 3.2 min. The mean operating time was 190.07 ± 11.3 min. The mean estimated blood loss was 331 ± 17.4 ml. The majority of renal tumors were renal cell carcinoma (97.22%). There were no positive surgical margins. There were no major intraoperative and postoperative complications. The mean follow up was 52.1 months (range 4-80) with no case showing progression to renal insufficiency (defined as serum creatinine > 2 mg/dl). There was only one local recurrence. However, four distant metastases were reported. The five-year cancer-specific survival, recurrence-free survival and overall survival were 94.4%, 88.88% and 86.11% respectively. Conclusions : In patients with solitary, small localized, unilateral renal tumors with normal contralateral kidney, elective open NSS is feasible, safe and provides excellent long-term local control and oncological efficacy with functional benefits.

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Although they may present with significant morbidity, pelvic organ prolapse and stress urinary incontinence are mainly afflictions that affect quality of life. To appropriately treat these entities, comprehension of the various theories of the pathophysiology is paramount. Utilizing a Medline search, this article reviews recent data concerning intrinsic (i.e., genetics, postmenopausal status) and extrinsic factors (i.e., previous hysterectomy, childbirth) leading to organ prolapse or stress incontinence.

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Vesicoureteral reflux is a common clinical entity and is one of the keystones of the establishment of pediatric urology as a urological subspeciality. There has been continued evolution in the management of vesicoureteral reflux as new insights are gained on its role in renal damage. The optimal treatment algorithm remains controversial. This review aims to highlight the current literature on VUR and its association with urinary tract infections and renal damage. The protocol of management of a child with VUR followed at The Hospital for Sick Children, Toronto is described.

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Genitourinary tuberculosis (GUTB) occurs in 15-20% cases of pulmonary tuberculosis with a prevalence of 400 per 100,000 population. Reconstructive surgery for GUTB is required for cases with grossly distorted and dysfunctional anatomy that are unlikely to regress with chemotherapy alone. In the recent past, there has been a tremendous increase in the variety of reconstructive procedures for the urinary bladder, used in the management of GUTB. Augmentation cystoplasty includes the goals of increasing bladder capacity, while retaining as much of bladder as possible. Various bowel segments (from the stomach to the sigmoid colon) have been used for bladder reconstruction. The choice of material for reconstruction is purely the surgeon's prerogative--his skill, the ease, the mobility and length of mesentery (allowing bowel to reach the bladder neck without tension and maintaining an adequate blood supply). The presence or absence of concomitant reflux is of considerable importance. In the former, an ileocystoplasty with implantation of ureter to the proximal end of the isolated ileal loop and anastomosis of the distal end of the ileal loop to the bladder neck and trigone is advocated. In the latter case, the ureterovesical valve is preserved and colocystoplasty is preferred, wherein the sigmoid colon on being opened along its antimesentric border is joined to the trigone and bladder neck and then to itself to form a capacious pouch. Gastrocystoplasty reduces the risk of acidosis but is associated with complications like hypochloremic alkalosis and 'hematuria-dysuria' syndrome. Orthotopic neobladder reconstruction is a feasible option, suitable in cases of tubercular thimble bladder with a markedly reduced capacity (as little as 15 ml), where an augmentation alone may be associated with anastomatic narrowing or poor relief of symptoms. In this article, we review the various bladder reconstruction options used for the surgical management of GUTB, along with their indications and complications.

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The bladder agenesis is an extremely rare congenital genitourinary anomaly; only 60 cases have been reported in the English literature and only 19 of these were noted in viable neonates. ^[1] Our case represents the 20th live birth with bladder agenesis. The triad of bladder agenesis with solitary kidney and ectopic ureter is seldom compatible with life due to associated anomalies. ^[2,3] Successful treatment and the long-term prognosis are usually poor because of the associated abnormalities. In our case, function of left solitary kidney was good and child did not have associated life-threatening disorder. Hence child was successfully managed with continent urinary diversion with good quality of life.

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The past several decades have seen multiple advances in the surgical reconstruction for girls born with Disorders of Sexual Differentiation. This surgery can be technically very demanding, and must be individualized for each patient, as the degree of virilization and level of confluence of the vagina and urogenital sinus will dictate the surgical approach. In this manuscript we present our approach and experience in the surgical options for girls born with Congenital Adrenal Hyperplasia, with special attention regarding clitoroplasty, urogenital mobilization, and vaginoplasty.

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Bladder cancer has an incidence of 15 cases per 100,000 persons in the global population and is the most common tumor of the urinary tract. Imaging techniques, cytoscopy, and cytology are either invasive or not sufficiently accurate to detect early stage tumors, and the need for new diagnostic markers still remains. Among the markers most recently proposed to improve diagnostic accuracy and especially sensitivity, increasing attention has been focused on the role of the ribonucleoprotein, telomerase. Relevant papers on the etiology, diagnosis, and evaluation of bladder cancer using telomerase in urine were searched for and considered. The PubMed search was performed using the text terms "bladder cancer", "diagnosis", and "telomerase". Previous studies have shown that the quantitative Telomerase Repeat Amplification Protocol (TRAP) assay performed in voided urine is an important non-invasive tool for the diagnosis of bladder tumors since it has very high sensitivity and specificity, even for early stage and low grade tumors. The main limitation of this test is the rate of false positive results due to the presence of inflammatory or non-tumor cells (i.e., epithelial cells from the lower genital tract), which express telomerase activity (TA). Consequently, an in situ analysis would seem to be important to identify the nature of telomerase-positive cells. Immunocytochemical detection of the hTERT subunit by a specific antibody seemed to open up the possibility to identify different cellular components of urine. However, the lack of a strict relationship between hTERT protein expression and telomerase activity has, to a certain extent, made this approach less relevant. In conclusion, telomerase activity in urine determined by TRAP seems to be marker of great potential, even more advantageous in cost/benefit terms when used in selected symptomatic patients or professionally high-risk subgroups.

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Objective: To prospectively compare the postoperative morbidity of closure versus non closure of the buccal mucosal graft (BMG) harvest site. Methods: Patients who underwent BMG harvest for urethroplasty were randomized into 2 groups; in group 1 donor site was closed and in group 2 it was left open. Self made questionnaires were used to assess post-operative pain, limitation to mouth opening, loss of sensation at graft site. The time to resumption of liquid and solid diet were also noted. Results: Fifty patients were studied, 25 in each group from July 2003 to July 2005. BMG was harvested from single cheek in most of the patients. Mean post operative pain score was 4.20 and 3.08 at day 1 in group 1 and group 2, respectively (P < 0.05). Return to oral intake in terms of liquid and solid diet was comparable between the groups. Difficulty with mouth opening was maximal during the first week with no difference among the two groups. Two patients in group 1 and one in group 2 had persistent peri-oral numbness at 6 months. None of the patients in both the groups had changes in salivation or retention cysts. Conclusion: Pain appears to be worse in the immediate post operative period with suturing of the harvest site. There is no difference in long term morbidity whether the graft site is closed or left open. It may be best to leave buccal mucosa harvest sites unsutured.

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Context: For management of long segment anterior urethral stricture, dorsal onlay urethroplasty is currently the most favored single-stage procedure. Conventional dorsal onlay urethroplasty requires circumferential mobilization of the urethra, which might cause ischemia of the urethra in addition to chordee. Aims: To determine the feasibility and short-term outcomes of applying a dorsolateral free graft to treat anterior urethral stricture by unilateral urethral mobilization through a perineal approach. Settings and Design: A prospective study from September 2005 to March 2008 in a tertiary care teaching hospital. Materials and Methods: Seventeen patients with long or multiple strictures of the anterior urethra were treated by a dorsolateral free buccal mucosa graft. The pendulous urethra was accessed by penile eversion through the perineal wound. The urethra was not separated from the corporal bodies on one side and was only mobilized from the midline on the ventral aspect to beyond the midline on the dorsal aspect. The urethra was opened in the dorsal midline over the stricture. The buccal mucosa graft was secured on the ventral tunica of the corporal bodies. Statistical Analysis Used: Mean and median. Results: After a follow-up of 12-30 months, one recurrence developed and 1 patient needed an internal urethrotomy. Conclusions: A unilateral urethral mobilization approach for dorsolateral free graft urethroplasty is feasible for panurethral strictures of any length with good short-term success.

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Antiplatelet agents like aspirin and clopidogrel are widely used for indications ranging from primary and secondary prevention of myocardial infarction or stroke to prevention of coronary stent thrombosis after percutaneous coronary interventions. When patients receiving antiplatelet drugs are scheduled for surgery, urologists commonly advise routine periprocedural withdrawal of these drugs to decrease the hemorrhagic risks that may be associated if such therapy is continued in the perioperative period. This approach may be inappropriate as stopping antiplatelet drugs often exposes the patient to a more serious risk, i.e. the risk of developing an arterial thrombosis with its potentially fatal consequences. Moreover, it has been seen that the increase in perioperative bleeding if such drugs are continued is usually of a quantitative nature and does not shift the bleeding complication to a higher risk quality. We, in this mini review, look at the physiological role and pathological implications of platelets, commonly used antiplatelet therapy and how continuation or discontinuation of such therapy in the perioperative period affects the hemorrhagic and thrombotic risks, respectively. Literature on the subject between 1985 and 2008 is reviewed. The consensus that seems to have emerged is that the policy of routine discontinuation of antiplatelet drugs in the perioperative period must be discouraged and risk stratification must be employed while making decisions regarding continuation or temporary discontinuation of antiplatelet therapy. Although antiplatelet drugs may be discontinued in patients at a low risk for an arterial thrombotic event, they must be continued in patients where the risks of bleeding and complications related to excessive bleeding are less than the risks of developing arterial thrombosis.

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Objectives : To review the evidence-based literature on the causes, characteristics, and options to manage double J stent-related symptoms. Methods : We performed a Medline database assessment on papers that investigated the prevalence, mechanisms, risk factors, bothersome and management of double-J stent-related symptoms. Articles in English were reviewed and summarized. Results : Stent-related symptoms have a high prevalence and may affect over 80% of patients. They include irritative voiding symptoms including frequency, urgency, dysuria, incomplete emptying; flank and suprapubic pain; incontinence, and hematuria. Assessment tools are important to determine their intensity and allow for comparisons between different points in the timeline. The Urinary Stent Symptom Questionnaire (USSQ) is the most proper tool used for this purpose. Management should be focused on the prevention and management of symptoms. In this sense, research has focused on new materials and stent designs that would be more compatible to the physiologic properties of the urinary tract and medications that can ameliorate the sensitivity and motor response of the bladder. Conclusions : Stent-related symptoms are very common in the Urological clinical setting. It is of major importance for the urologist to understand their physiopathology and to be familiar with ways to avoid or manage them.

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