Background: Peyronie’s disease (PD) is a localized fibrosis of tunica albuginea, which causes the anatomical and functional changes to the penis. Corporoplasty with grafting is indicated in severe (>60°) and complex curvature. Buccal mucosa is the most favored autologous graft material nowadays. The ventrolateral aspect of lingual mucosa has similar histological features to the rest of the oral cavity. Methods: This study aimed to test the efficacy, safety, durability, and reproducibility of corporoplasty with lingual mucosal graft (LMG) in the surgical treatment of PD in terms of surgical outcome, sexual function, and donor site complications. This prospective study included 19 patients of PD with severe and complex curvature, who underwent corporoplasty with LMG. Surgical and functional outcomes were assessed at follow-up planned at 2 weeks, 3 months, 6 months, 1 year, and 2 years. Results: The mean operative time was 126.31 ± 21.45 min. Additional Nesbit’s plication to correct the residual deformity was required in 26% (5 / 19) of patients. Straightening of the penis (curvature <10°) was achieved in 89% (17 / 19) of patients. Increase in the penile length (>1 cm) postoperatively was achieved in 63% (12 / 19) of patients and a shortening of penis occurred in 5% (1 / 19) of patients. Newer onset erectile dysfunction developed in 11% (2 / 19) of patients, and patient and partner satisfaction rates were 89% (17 / 19) and 84% (16 / 19), respectively, in a mean follow-up of 20.66 ± 5.37 months. Donor site complications were minimal and no patient had any salivary changes or speech disturbances. Conclusion: LMG provided excellent short-term results in terms of deformity correction, improved sexual function, and minimal donor site morbidity. The method is simple and reproducible, and multicenter studies with larger number of cases with longer follow-up are required to confirm these favorable results.

Purpose: A modified Clavien classification system has been proposed to grade perioperative complications. We share our experience in grading the complications of percutaneous nephrolithotomy (PNL), according to this new classification. Methods: A total of 809 PNLs performed between 2010 and 2014 were reviewed retrospectively. The modified Clavien classification system, which classifies the perioperative complications into 5 grades, was applied. Grade wise comparison of complications between the patients with simple and complex calculi was done. We also carried out a univariate analysis of different predictors of complications after surgery. Results: A total of 253 perioperative complications were observed in 237 (29.29%) patients. Most complications were related to bleeding and urinary leakage. Patients with complex calculi had significantly more number of complications across all Clavien groups. In a univariate analysis, positive preoperative urine culture and multiple access for stone clearance were identified to be the independent predictors of complications. Conclusion: The modified Clavien system is a simplistic grading system for classification of postoperative complications. However, it suffers from various shortcomings. Therefore, till the proposition of a more comprehensive classification system, the modified Clavien system is useful for reporting the complications and short-term outcomes of PNL.

Objectives: The objective of this study was to predict the outcome of shock wave lithotripsy (SWL) on the basis of computed tomography (CT) morphodensitometry for ureteral and renal stones. We also assessed the possibility that Hounsfield unit (HU) values and the location of the stones could be used to predict the outcome of SWL. Material and methods: A prospective study was performed to measure stone size, location, composition, surface area, surface volume, stone burden, the skin-to-stone distance and the HU for solitary renal and ureteral stones by non-contrast CT studies (NCCT) from August 2013 to September 2015. Success of SWL was defined as: (1) being stone-free or (2) residual stone fragments < 4 mm by radiography/NCCT. Results: Of the 100 assessed patients, 68 patients (68%) were stone-free, 12 (12%) had residual stone fragments < 4 mm (clinically insignificant residual fragments) and 20 (20%) had residual stone fragments ≥ 4 mm/ancillary procedures. Multivariate analysis revealed that stone location and mean HU were significant predictors of SWL success. Receiver operating characteristic curves defined cut-off values for predicting treatment outcome. Treatment success rates were significantly higher for stones < 800 HU than with stones > 800 HU (p = 0.160). Conclusion: Evaluation of stone HU values and stone location prior to SWL can predict treatment outcome and aid in the development of treatment strategies. Level of evidence 2 & 4

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I1 Apr 2016PD16-05 LONG TERM RESULTS OF FEMALE URETHRAL RECONSTRUCTION USING DORSAL ONLAY LINGUAL MUCOSAL GRAFT Sameer Trivedi, Udai Shankar Dwivedi, Sartaj Wali Khan, V S Rathee, Pushpendra Shukla, and Aditya Kumar Singh Sameer TrivediSameer Trivedi More articles by this author , Udai Shankar DwivediUdai Shankar Dwivedi More articles by this author , Sartaj Wali KhanSartaj Wali Khan More articles by this author , V S RatheeV S Rathee More articles by this author , Pushpendra ShuklaPushpendra Shukla More articles by this author , and Aditya Kumar SinghAditya Kumar Singh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1157AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urethral strictures are an uncommon cause of bladder outlet obstruction in females and are treated empirically with various modalities like dilatation and internal urethrotomy with varying outcomes. Female urethroplasty utilizing a variety of tissues (Vaginal or labial grafts/flaps, oral mucosal grafts) has been described with variable degree of success in short term but long term data are lacking. In this study, we have analyzed long term results of dorsal onlay lingual mucosal graft (LMG) urethroplasty in management of female urethral stricture. METHODS Between Oct 2006 & Oct 2010, 40 female patients diagnosed as having urethral stricture underwent LMG urethroplasty. Mean age was 44 years (23 – 71 years). Pre-operative mean Qmax was 7.5 ml/s (2.2 – 13.4 ml/s) and urethral calibration revealed a urethral lumen of <14 Fr in all patients. Dorsal onlay LMG urethroplasty was performed using the technique previously described by us. After 15 days, patients underwent a trial of voiding and VCUG. Patients were then followed at 3, 12, 24, 36, 48 and 60 months with uroflowmetry and a detailed questionnaire. VCUG was advised at 6- and 12-month follow-ups and cystoscopy performed if required. Criteria for successful reconstruction were a Qmax of =15 mL/s with no postoperative instrumentation. RESULTS Mean urethral stricture and harvested graft length were 2.45 cm and 2.95 cm, respectively. All patients showed symptomatic improvement with mean Qmax increasing from 7.5 ml/s to 28.7ml/s at 3 months. At 3 months, 5 patients had a Qmax<15ml/sec and 4 of these patients required urethral dilatation while 1 patient had a urethral lumen > 14 Fr and reported significant improvement. At 1 year, all 36 successful patients were symptom free with mean Qmax of 27.6 ml/s (18.2 ml/s – 37 ml/s). At 3 and 5 years, 4 out of 36 patients were lost to attrition. In the remaining 32 patients, mean Qmax was 26.3 ml/s and 25.8 ml/s at 3 and 5 years respectively. None of these patients required any ancillary procedures. Overall success rate was 90% with 4 out of 40 patients requiring urethral dilatations postoperatively. None of the patients reported any urinary incontinence. CONCLUSIONS Dorsal onlay LMG urethroplasty is a simple, safe & effective surgical option with good long term results in the management of female urethral stricture with minimal risk of urinary incontinence & high success rates. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e395-e396 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Sameer Trivedi More articles by this author Udai Shankar Dwivedi More articles by this author Sartaj Wali Khan More articles by this author V S Rathee More articles by this author Pushpendra Shukla More articles by this author Aditya Kumar Singh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...