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POS-01.43: Dorsal free buccal mucosal graft urethroplasty for recurrent anterior urethral strictures via ventral sagittal urethrotomy approach
UNMODERATED POSTER SESSIONS
with the two PCR protocols. The cultivation results were positive for 5 of them. We registered a woman with positive results for C. trachomatis obtained from the two PCRs and the cultivation method, but her partner‘s samples were completely negative for C. trachomatis. History of ectopic pregnancies in 3 women, tubal adhesions in 2 and salpingitis in 1, were the gynecological and obstetrical associations found among the female partners of C. trachomatis-positive men. Conclusions: Relatively high frequency (12,3%) of C. trachomatis infection was found in male partners of infertile couples at childbearing age. In approximately 66,7% of these couples C. trachomatis was present at the same tame in the two partners. It is most likely that infertility in the couples with proved chlamydial infection to be due to the microbiological pathogen but the search of other factors that can contribute to infertility must continue.
POS-01.42 A comparative study of two methods of perineal and genital skin antiseptic preparation prior to urological procedures in adult male patients Kehinde EO1, Ali Y1, Khodakhast F2, Jamal W2, Seshah M1, Rotimi VO2 1 Departments of Surgery (Division of Urology), 2Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait Introduction: The perineal route is increasingly being used in male urological patients for diagnostic and therapeutic procedures. The objective of this study is to compare two methods of perineal and genital skin antiseptic preparation in male urological patients. Methods: Adult male in-patients undergoing cystoscopic procedures were randomized into two groups for perineal and genital skin disinfection. In Group 1 the perineal and genital area was scrubbed three times using Savlon® (Chlorhexidinecetrimide mixture) only, while in Group 2 the area was initially scrubbed twice using Savlon® and a third time using Betadine® (povidone-iodine solution). Three sets of swab specimens, labeled A, B and C were taken from the perineum of the patients in the operating theatre. Specimen A was taken before cleaning and disinfection of the perineal and genital skin, specimen B after disinfection and draping and specimen C on completion of the operative procedure. The specimens were processed microbiologically for aerobic, anaerobic bacteria and yeasts using standard
laboratory media under appropriate incubation conditions. Results: There were 114 and 117 patients in Groups 1 and 2 respectively. Bacteria were isolated from 139/231 (60.2%) of specimen A in both groups. The commonest isolates in specimen A in both groups were Gram positive bacteria (89.2%) and Gram negative bacteria (10.8%). No yeasts were cultured from any of the specimens. The bacteria isolation rate from the two patient groups and specimens were: Group 1 specimens A ⫽ 35.1%, B ⫽ 7.1% and C ⫽ 11.4% compared to Group 2 specimens A ⫽ 63%, B ⫽ 5.1% and C ⫽ 2.6%. Thus, both methods of perineal and genital skin disinfection resulted in a significant reduction of bacterial isolates from specimen B compared to specimen A (p⬍0.001) although a lower rate of bacteria isolation from specimen B was obtained from Group 2 patients (p⫽NS). Furthermore, Group 2 patients had a significantly lower bacteria isolation rate from specimen C compared to Group 1 patients (p⬍0.001). Conclusion: These data demonstrate that the addition of Betadine® to the standard regimen of perineal and genital skin antiseptic preparation results in a more effective perineal and genital skin disinfection in adult male urological patients.
POS-01.43 Dorsal free buccal mucosal graft urethroplasty for recurrent anterior urethral strictures via ventral sagittal urethrotomy approach VLN Murthy P, Sriman P, Ramreddy C, Devraj R, Sagar V, Prasad N, Srikanth J, Suresh B Nizam’s Institute Of Medical Sciences, Hyderdad, India Introduction: The last word is not yet said about the definitive treatment of stricture urethra inspite of umpteen number of procedures described.The dorsal free buccal mucosal graft(BMG) augmentation urethroplasty described by Barbagli claimed excellent long term results. Recently Asopa reported good results with BMG urethroplasty using a ventral sagittal urethrotomy approach.Here no mobilisation of urethra is required dorsally, which not only preserves urethral blood supply coming through circumflex and perforating vessels ,but also simplifies the procedure.In the present series we used similar technique to place graft through a ventral
UROLOGY 70 (Supplment 3A), September 2007
urethrotomy. The objective is to evaluate the results and advantages of this technique. Methods: From December 2002 to December 2006 40 male patients (mean age:41) were operated by this technique for recurrent urethral strictures. The length of the stricture ranged from 3 to 17 cm(mean:6.24). A one stage urethroplasty with a dorsal onlay patchBMG through a ventral sagittal urethrotomy technique was used. The BMG was harvested from the inner cheek or both cheeks and also lower lip in cases of long strictures. The urethra was opened ventrally in the midline over the stricture after degloving the penile skin and or through a midline perineal incision. The dorsal urethra was incised in the midline and the incision was extended by 1cm. beyond the proximal and distal limits of the stricture and deeply up to the tunica albuginea. By mobilising the edges of the dorsally incised urethra, a wide elliptical area (up to 1.7 cm.) was obtained for the graft. The graft edges were sutured to the edges of the dorsally incised urethra and quilted to the floor. The ventral urethrotomy was closed with a continuous stitch over a 16F. Foley catheter. The catheter was removed at the end of 3 weeks after performing a pericatheter urethrogram to check the leaks. The patients were followed up at regular intervals (3,6 & 12 months) with urethrogram/urethroscopy/uroflowmetry. Results: Three patients developed fistulae following catheter removal and healed spontaneously. Six patients developed stricture and responded to optical urethrotomy. Two of them required self dilatation. The follow up period ranged from 3 to 48 months. No complications were observed at the donor site. Conclusion: Ventral sagittal urethrotomy approach avoids urethral mobilisation and preserves blood supply to the already diseased urethra. It is easier and gives straight and good access for dorsal augmentation. POS-01.44 Clinical study of male urethritis in Nagano Matsushiro General Hospital Nakagawa T Nagano Matsushiro General Hospital Objectives: From August 2002 to December 2006, the clinical features and etiology of consecutive symptomatic male patients with urethritis were studied in our urologic department, Nagano Matsushiro General Hospital.
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with the two PCR protocols. The cultivation results were positive for 5 of them. We registered a woman with positive results for C. trachomatis obtained from the two PCRs and the cultivation method, but her partner‘s samples were completely negative for C. trachomatis. History of ectopic pregnancies in 3 women, tubal adhesions in 2 and salpingitis in 1, were the gynecological and obstetrical associations found among the female partners of C. trachomatis-positive men. Conclusions: Relatively high frequency (12,3%) of C. trachomatis infection was found in male partners of infertile couples at childbearing age. In approximately 66,7% of these couples C. trachomatis was present at the same tame in the two partners. It is most likely that infertility in the couples with proved chlamydial infection to be due to the microbiological pathogen but the search of other factors that can contribute to infertility must continue.
POS-01.42 A comparative study of two methods of perineal and genital skin antiseptic preparation prior to urological procedures in adult male patients Kehinde EO1, Ali Y1, Khodakhast F2, Jamal W2, Seshah M1, Rotimi VO2 1 Departments of Surgery (Division of Urology), 2Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait Introduction: The perineal route is increasingly being used in male urological patients for diagnostic and therapeutic procedures. The objective of this study is to compare two methods of perineal and genital skin antiseptic preparation in male urological patients. Methods: Adult male in-patients undergoing cystoscopic procedures were randomized into two groups for perineal and genital skin disinfection. In Group 1 the perineal and genital area was scrubbed three times using Savlon® (Chlorhexidinecetrimide mixture) only, while in Group 2 the area was initially scrubbed twice using Savlon® and a third time using Betadine® (povidone-iodine solution). Three sets of swab specimens, labeled A, B and C were taken from the perineum of the patients in the operating theatre. Specimen A was taken before cleaning and disinfection of the perineal and genital skin, specimen B after disinfection and draping and specimen C on completion of the operative procedure. The specimens were processed microbiologically for aerobic, anaerobic bacteria and yeasts using standard
laboratory media under appropriate incubation conditions. Results: There were 114 and 117 patients in Groups 1 and 2 respectively. Bacteria were isolated from 139/231 (60.2%) of specimen A in both groups. The commonest isolates in specimen A in both groups were Gram positive bacteria (89.2%) and Gram negative bacteria (10.8%). No yeasts were cultured from any of the specimens. The bacteria isolation rate from the two patient groups and specimens were: Group 1 specimens A ⫽ 35.1%, B ⫽ 7.1% and C ⫽ 11.4% compared to Group 2 specimens A ⫽ 63%, B ⫽ 5.1% and C ⫽ 2.6%. Thus, both methods of perineal and genital skin disinfection resulted in a significant reduction of bacterial isolates from specimen B compared to specimen A (p⬍0.001) although a lower rate of bacteria isolation from specimen B was obtained from Group 2 patients (p⫽NS). Furthermore, Group 2 patients had a significantly lower bacteria isolation rate from specimen C compared to Group 1 patients (p⬍0.001). Conclusion: These data demonstrate that the addition of Betadine® to the standard regimen of perineal and genital skin antiseptic preparation results in a more effective perineal and genital skin disinfection in adult male urological patients.
POS-01.43 Dorsal free buccal mucosal graft urethroplasty for recurrent anterior urethral strictures via ventral sagittal urethrotomy approach VLN Murthy P, Sriman P, Ramreddy C, Devraj R, Sagar V, Prasad N, Srikanth J, Suresh B Nizam’s Institute Of Medical Sciences, Hyderdad, India Introduction: The last word is not yet said about the definitive treatment of stricture urethra inspite of umpteen number of procedures described.The dorsal free buccal mucosal graft(BMG) augmentation urethroplasty described by Barbagli claimed excellent long term results. Recently Asopa reported good results with BMG urethroplasty using a ventral sagittal urethrotomy approach.Here no mobilisation of urethra is required dorsally, which not only preserves urethral blood supply coming through circumflex and perforating vessels ,but also simplifies the procedure.In the present series we used similar technique to place graft through a ventral
UROLOGY 70 (Supplment 3A), September 2007
urethrotomy. The objective is to evaluate the results and advantages of this technique. Methods: From December 2002 to December 2006 40 male patients (mean age:41) were operated by this technique for recurrent urethral strictures. The length of the stricture ranged from 3 to 17 cm(mean:6.24). A one stage urethroplasty with a dorsal onlay patchBMG through a ventral sagittal urethrotomy technique was used. The BMG was harvested from the inner cheek or both cheeks and also lower lip in cases of long strictures. The urethra was opened ventrally in the midline over the stricture after degloving the penile skin and or through a midline perineal incision. The dorsal urethra was incised in the midline and the incision was extended by 1cm. beyond the proximal and distal limits of the stricture and deeply up to the tunica albuginea. By mobilising the edges of the dorsally incised urethra, a wide elliptical area (up to 1.7 cm.) was obtained for the graft. The graft edges were sutured to the edges of the dorsally incised urethra and quilted to the floor. The ventral urethrotomy was closed with a continuous stitch over a 16F. Foley catheter. The catheter was removed at the end of 3 weeks after performing a pericatheter urethrogram to check the leaks. The patients were followed up at regular intervals (3,6 & 12 months) with urethrogram/urethroscopy/uroflowmetry. Results: Three patients developed fistulae following catheter removal and healed spontaneously. Six patients developed stricture and responded to optical urethrotomy. Two of them required self dilatation. The follow up period ranged from 3 to 48 months. No complications were observed at the donor site. Conclusion: Ventral sagittal urethrotomy approach avoids urethral mobilisation and preserves blood supply to the already diseased urethra. It is easier and gives straight and good access for dorsal augmentation. POS-01.44 Clinical study of male urethritis in Nagano Matsushiro General Hospital Nakagawa T Nagano Matsushiro General Hospital Objectives: From August 2002 to December 2006, the clinical features and etiology of consecutive symptomatic male patients with urethritis were studied in our urologic department, Nagano Matsushiro General Hospital.
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