Bilateral testicular gangrene: does it occur in Fournier’s gangrene?

Fournier’s gangrene (FG) is an infective necrotizing fascitis of the perineum, genital and perianal area leading to gangrene of the overlying skin and subcutaneous tissue. Testis and epididymis tend to be spared. We report a case of a young male with bilateral gangrene of the testis.     

Reconstructive surgery for tuberculous contracted bladder: experience of a center in northern India

Objective  

To document the management of tuberculous cicatrized urinary bladder by incorporating bowel segment and the long-term follow-up after the reconstructive surgery.     

Spinal cord injury: A rare complication following thoracic epidural anesthesia for percutaneous nephrolithotomy

Herein, we report a rare instance of paraplegia following percutaneous nephrolithotomy under thoracic epidural anesthesia in a conscious patient. The possible factors include low body mass index, chronic renal failure, and multiple “in and out” needle passes during the procedure. Direct cord trauma with epidural bloody collection resulted in the neurological damage. However, the patient did not show signs of spinal cord trauma during the needle injury, possibly due to a prior accidental subarachnoid block. This not only delayed the recognition of the disorder, but also delayed treatment, consequently resulting in permanent paraplegia. Careful monitoring after epidural blocking should be undertaken in order to allow the early detection of mismanagement and limit the extent of neurologic injury.     

Dorsal onlay buccal mucosal graft urethroplasty in female urethral stricture disease: a single-center experience

Introduction and hypothesis

The aim of this report is to present our initial, short-term experience with dorsal onlay buccal mucosal graft urethroplasty (DBMGU) in women with urethral stricture.

Methods

Between May 2011 and April 2013, eight women with moderate to severe bothersome lower urinary tract symptoms due to mid- or distal urethral stricture underwent DBMGU. All women were evaluated preoperatively with the American Urological Association (AUA) symptom score, uroflowmetry with post-void residual volume (PVR) estimation, urodynamic study, calibration with 14 F catheter, and voiding cystourethrography. Postoperatively, the women were followed at regular intervals with AUA symptom score, uroflowmetry, and PVR estimation. Increase in AUA symptom score, maximum flow rate (Q_max)?<?12 ml/s, and failure to calibrate with 18 F catheter were considered as recurrence of the disease.

Results

The mean age of the patients was 40.6 years. The mean follow-up period was 14.8 months. All women voided successfully after catheter removal. One patient was lost to follow-up after 3 months. There was significant improvement in AUA symptom score and Q_max and reduction in PVR (p?<?0.0001) at 3, 6, and 9 months. Two women had recurrence of stricture at 12 months, while another had recurrence at 18 months which was treated by urethral dilatation followed by a self-dilatation protocol. The limitations of the study include the small number of cases with short follow-up.

Conclusions

DBMGU is a simple and safe method of urethroplasty in women with unsatisfactory results. Large size studies with long-term follow-up are desirable to document the success rates.     

Cystographic images of Youssef syndrome: flower on top of the bladder

Vesicouterine fistula after obstructed labor is very rare. Hysterosalpingography is the investigation of choice. Cystography primarily does not demonstrate the fistula because the intrauterine pressures are higher than the vesical pressure. A 38-year-old woman presented to us with vecisovaginal fistula and vesicouterine fistula that had developed 13 years earlier after obstructed labor and vaginal delivery of a stillborn neonate. She was found to have normal renal function, but she had developed small capacity bladder and the cystogram performed with Foley catheter showed contrast spilling into the uterus. She was managed by continent urinary diversion.