Bladder and buccal mucosa graft in urethral stricture reconstruction

Purpose.

Our aim was to determine the success of urethroplasty using a free graft of buccal or bladder mucosa for the treatment of complex anterior urethral stricture in adults.

Materials and Methods.

From October 2000 to February 2005, 11 patients with complex anterior urethral stricture underwent substitution urethroplasty, using mucosal grafts, 6 buccal and 5 bladder.

Results.

The mean follow-up time was 50 months for 8 out of 11 patients (range 24 to 72). The procedure was successful for 6 patients (75%). Urethral stricture recurred in 2 patients (25%) and was treated by urethrotomy or meatoplasty with positive outcomes.

Conclusion.

Our limited experience with the reconstruction of a complex stricture of the anterior urethra confirmed that buccal and bladder mucosa grafts are excellent materials for substitution urethroplasty but that case selection is important.

Bladder and buccal mucosa graft in urethral stricture reconstruction

Purpose. Our aim was to determine the success of urethroplasty using a free graft of buccal or bladder mucosa for the treatment of complex anterior urethral stricture in adults. MATERIALS AND METHODS. From October 2000 to February 2005, 11 patients with complex anterior urethral stricture underwent substitution urethroplasty, using mucosal grafts, 6 buccal and 5 bladder. RESULTS. The mean follow-up time was 50 months for 8 out of 11 patients (range 24 to 72). The procedure was successful for 6 patients (75%). Urethral stricture recurred in 2 patients (25%) and was treated by urethrotomy or meatoplasty with positive outcomes. CONCLUSION. Our limited experience with the reconstruction of a complex stricture of the anterior urethra confirmed that buccal and bladder mucosa grafts are excellent materials for substitution urethroplasty but that case selection is important.

Cryptococcosis

A case of cryptococcosis is presented in this review: its prostatic localization is considered to be extremely unusual.

The relevant diagnostic course and therapeutic treatment are discussed, taking into account the fact that this mycotic infectious disease occurs in immunodepressed subjects.

Complete pyelo-calyceal avulsion as a result of blunt abdominal trauma

We present a rare case of complete avulsion of the kidney collecting system as a result of blunt abdominal trauma. Emergency celiotomy precluded radiographic studies. Perinephric hematoma was mild, the lesion was not detected and this later led to a nephrectomy. Pelvis disruption diagnosis is frequently delayed, and this compromises surgical reconstruction.

[T1G3 bladder tumors: our experience]

T1 G3 bladder carcinoma are classified as superficial tumours and treatment results are included in low stage tumour groups. A review of survival rates shows that there is a high risk of progression about 50-70%. The grade is by now considered the most significant prognostic factor and many other prognostic biological tests have been suggested. We treated 41 cases of T1G3 bladder tumours with a first therapeutic TUR and second staging TUR two months later. Subsequently a group of 15 has had "wait" and see" endoscopic follow-up with bad results, a group of 7 underwent "early cystectomy", a group of 12 has been treated with adjuvant cytotoxic chemotherapy with poor results on recurrence and good results on progression percentages, a group of 6 radiotherapy with poor results. We got confirmation of high risk of progression, 4 cases with high stage from beginning, 3 with precocious metastatic disease. Apart the cases with precocious metastases, the best survival rates are achieved with early cystectomy.

Leiomioma renale gigante. Descrizione di un caso: Giant renal leiomyoma: Case report

Giant renal leiomyoma is a rare benign tumour with a prevalently smooth muscular component; its clinical aspect and radiological and histological aspects are described. Renal leiomyoma should always be considered in differential diagnosis of a renal mass and surgical exploration is necessary to obtain the histological evidence.

Erectile Impotence from Veno-Occlusive Dysfunction: Our Experience and Present Diagnostic-Therapeutic Indications

The authors evaluate erectile impotence from veno-occlusive dysfunction, concentrating on diagnostic techniques, both invasive and non-invasive, and appropriate treatment. In particular dynamic testing is reviewed, where a vasoactive drug, Papaverine or more recently PGE1, is injected into one of the corpora cavernosa. Measurement of blood flow velocity with Doppler ultrasonography allows a functional evaluation, while radiographic images during cavernosography give an anatomical view of the erectile abnormality. A review of case histories and partial follow-up of patients has confirmed the actual precision of the diagnostic methods and various therapeutic approaches.

[Anesthesia and perioperative care in radical cystectomy]

The results of anesthesia and perioperative assistance on a series of 84 patients who underwent since 1982 to 1990 a one-stage radical cystectomy and urinary diversion are reported. Reduction of the high risk of operation is particularly dependent on preoperative preparation, use of a safe anesthesia technique with continuous evaluation of vital signs, control of blood loss and use of low dose of heparin for prevention of venous thromboembolism. The complication rate was low, 7.1% for the early one, 16.6% for late one. General mortality of 5.9% is dependent on the high average age of the patients and on the fact all the cases were deeply invasive cancer.

[Complications of endoscopic bladder resection for neoplasia]

The improvement of the endoscopic strumentation and technique has permitted a large diffusion of the transurethral resection of the vesical (TURV) for malignant neoplasms. We report the complications of this method described in literature and a review of the cases observed at the Urological Division of Niguarda Hospital in Milan from January 1985 to December 1989 has presented. The adequate treatment of the complications permits to minimize the damage for the patient.