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Pain control in outpatient rigid cystoscopy is often achieved via the application of intraurethral lidocaine jelly. This clinical trial was designed to test the effectiveness and safety of a new method to provide local anesthesia, transperineal urethrosphincteric block (TUSB), prior to rigid cystoscopy.Male patients posted for outpatient rigid cystoscopy were randomized to receive TUSB (group A) using 10-20 ml of 1% lidocaine, intraurethral 30 ml of 2% lidocaine jelly (group B) or intraurethral 30 ml of neutral jelly (group C) as a method of pain control. Following the procedure, plasma concentrations of lidocaine were measured in group A patients. Outcome assessments included mean urethral and sphincteric numerated pain scores (0-10), overall discomfort level (0-4) and plasma lidocaine levels.One hundred and fifty patients were recruited, 50 in each group. When the three groups were compared, the ratio of group A patients with sphincteric pain scoreor=2 was significantly the least. Also, the ratio of group A patients with discomfort levelor=2 was significantly less than the same ratio in either group B or C. Plasma lidocaine concentrations were within nontoxic levels and never exceeded 2.83 microg/ml in 39 subjects.This study demonstrates that TUSB is an effective and safe method in significantly relieving the pain associated with outpatient rigid cystoscopy. TUSB may offer urologists and anesthetists an alternative way to achieve pain control besides intraurethral lidocaine jelly during rigid cystoscopy.

Introduction: Many surgical procedures have been proposed for treatment of stress urinary incontinence (SUI) but none of them has proved completely successful. The aim of this study is to compare the efficacy and safety of tension free vaginal tape (TVT) with Burch colposuspension in the treatment of SIU. Patients and Methods: Fifty female patients, presenting with SUI were randomly divided into two equal groups. SUI was confirmed using urodynamic study in all patients. Group 1 (n=25) patients underwent Burch colposuspension while Group 2 (n=25) underwent TVT. Patients with high grade cystocele, previous surgical failure for SUI, uninhibited detrusor contraction during bladder filling on urodynamic study and incompetent internal sphincters were excluded from this study. A patient was declared cured of SUI, if 3–6 months after surgery she had no SUI. The procedure was judged to be a failure if 3–6 months after surgery, patient had SUI. Results: In group 1 patients, 72% were completely cured, 16% improved and 12% showed no improvement. In group 2 patients, 72 were completely cured, 20% improved and only 8% showed no improvement. There was no difference between the two groups in terms of cure rates. Operative time for TVT was significantly less compared to Burch. Postoperative pain was less in TVT than Burch. Return to normal activity was earlier in TVT compared to Burch group. Intra operative perforation of the urinary bladder occurred in 8% of patients in group 2. Urine retention occurred in 12% of patients in group 1 compared to 20% in group 2. This was successfully managed conservatively. De novo urgency developed in 12% in group I and 8% in group II and was successfully managed by medical treatment. Conclusion: The success rates of TVT and Burch colposuspension in the treatment of SUI in our experience are very similar. However, TVT is associated with less morbidity. We recommend TVT procedure for females with genuine SUI.

Objective: To investigate the changing pattern in incidence, aetiological factors and the effect of early diagnosis and surgical treatment on the outcome of iatrogenic ureteric injuries in our Urology Unit over a 5 year period. Patients/Methods: All patients with ureteric injuries caused as a result of any surgical procedures (iatrogenic ureteric injuries) were studied during a 5 year period (1998–2002). Data collected and analysed included yearly incidence of injury, aetiological factors, modalities of treatment and the outcome of management of the injuries. During the study period, our general surgical colleagues had a policy of requesting “J” stent insertion prior to major abdominopelvic surgical procedures. During the same period, in nearly all difficult cases of ureteroscopy (URS) + lithoclast lithotripsy±Dormia basket, a ureteric catheter or “J” stent was prophylactically inserted by urological surgeons. Results: There were 82 iatrogenic ureteric injuries in 75 patients over the 5 year period. The total number of iatrogenic ureteric injuries declined from 26 (31.7%) in 1998 to 10 (11.8%) in 2002. Urological, obstetrics and gynaecological and general surgical procedures were involved in 69(84.1%), 7(8.7%), and 4(4.9%) of the injuries respectively. The commonest types of injuries encountered were; injury to ureteric mucosa post URS or lithoclast calculi disintegration 34 (41.5%), complete ureteric perforation 15 (18.3%) and false passage 15 (18.3%). The most severe complications encountered were complete ureteric avulsions 3 (3.75%) and loss of ureteral segment 2 (2.4%). The commonest treatment options used were “J” stent insertion or ureteric catheter placement (48, 59.4%), percutaneous nephrostomy (17, 20.7%), laparotomy and removal of suture on tied ureters (5, 6.1%). Two (2.4%) nephrectomies were performed because of poor renal function in one patient and severe damage to a functioning renal unit during a difficult retroperitoneal surgery in another patient. Recognition and treatment of ureteric injuries at the time of surgery was associated with less morbidity compared to those in whom the diagnosis was delayed. The overall successful resolution of ureteric injuries in this series was 77/82 (93.9%). There was no mortality attributable to these ureteric injuries. Conclusion: In our Unit, the incidence of significant iatrogenic ureteric injuries has shown a decline over a 5-year period. We attribute this trend to the prophylactic use of “J” stents or ureteric catheter placement and good surgical technique during major abdomino-pelvic surgeries in our hospital. Endourological procedures are the commonest causes of ureteric injuries. Prompt diagnosis and institution of appropriate corrective surgical procedures often result in a very satisfactory outcome in about 94% of cases.

Background/Purpuse:To review the outcome oftubularized incised plate (TIP) urethroplastyin the primary treatment of penile hypospadiaswith minimal chordee and to describe ourexperience with the lateral flap used to coverthe urethroplasty.Methods: The charts of all patients withpenile hypospadias who underwent primary TIPrepair in our hospital between 1996 and 2001were examined and pre as well as postoperativebiodata were recorded. We used the lateral flapto cover the repair rather than a flapharvested from preputual skin as in theoriginal description.Results: 94 patients were identified butonly 83 were suitable for analysis. The meanage of the evaluable patients was 2.67 years(range 1–10). The mean of follow-up was 17.49months (range 1–54). The preoperative meatalposition was coronal in 50 (60.2%), distalshaft in 28 (33.7%) and mid shaft in 5 (6.1%)patients. The mean length of the urethral platewas 8 mm (range 5–15) while the mean width ofthe plate was 6 mm (range 4–8). In 30 patients(36.14%) chordee was present preoperatively.All patients were admitted to the hospitalfollowing the TIP urethroplasty with a urethralstent in place. The lateral flap was used tocover the repair in 70 patients. The stent wasleft for an average of 7.83 days (7–10). Theaverage hospital stay was 8.83 days (7–11). Acosmetically normal vertically orientedslit-like meatus was seen in 78 (94%)patients. The TIP repair revealed an apicalmeatus in 82 (98.8%) and a conical glanularconfiguration in 79 (95.20%) patients. Theparents observed that the urinary stream andthe penile shaft were straight in 75 (90.4%)and 82 (98.8%) patients respectively. Sevenpatients (8.4%) developed meatal stenosisrequiring repeated dilatations; four patients(4.8%) developed urethrocutaneous fistula andone (1.2%) had postoperative bleedingrequiring transfusion. Of the 70 patients whohad the lateral flap, 3 (4.28%) developedurethrocutaneous fistula.Conclusion: Our experience indicates thatthe TIP repair gives a good cosmetic andfunctional outcome with minimal complications.Urethroplasty coverage using the lateral flapis associated with a low incidence ofurethrocutaneous fistulae.