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S53 THE RESULTS OF TUBULARIZED INCISED PLATE URETHROPLASTY IN ADULTS WITH DISTAL HYPOSPADIAS
Introduction & Objectives: Urethral stricture is a narrowing of the caliber of the urethra mostly caused by the presence of a scar consequent on infection or injury. Balloon dilation and filiform and followers are used to dilate urethra. These methods however are effective but expensive and use of them is limited in many third world countries. To determine a new available and cost effective technique to dilate urethra under cystoscopy guidance in cases of urethral stricture.
Material & Methods: During 2001-2007, 104 patients with urethral stricture length of longer than 2 Cm which urethral lumen was relatively preserved involved in this study. The guide-wire is introduced through the urethra and advanced under cystoscopic vision. The tip of Nelaton urethral catheters incised and then advanced over the guide-wire from the smallest to the largest sizes. A Foley urethral catheter which tip was incised inserted at the end of procedure (figure1). The Foley catheter removed three weeks post dilatation, and patients underwent our arbitrary protocol of clean intermittent catheterization (CIC) [twice in a day in the first week, daily in the second week, twice a week and then weekly]. Results: A total number of 104 patients suffered from urethral stricture with the average stricture length of 0.7 ± 0.26 cm treated by nelaton dilatation technique. This procedure was successful in all attempts and no major complication occurred due to the technique. Overall, urethral stricture stabilized in 83.6% of patients with 1 or 2 dilations using this technique and 24% of patients showed decreased caliber and force of urination, in one year of follow up. Conclusions: This technique has been effective in overcoming urethral stricture and its safety and efficacy are comparable with filiforms and followers and balloon dilatators. Because filiforms and followers and balloons are expensive and not available easily, this cost-effective technique can be used in every urology department.
Lithotomy position related complications following posterior urethroplasty
S50
Hosseini, J., Kaviani, A., Mazloomfard, M.M. IRHRC, Reconstructive Urology, Tajrish Hospital, Shaheed Beheshti University MS, Dept. of Urology, Tehran, Iran Introduction & Objectives: Standard lithotomy is a favorable position, providing ample access to the perineum in posterior urethroplasty. Our aim was evaluation of risk factor associated with lithotomy position related complications in urethroplastic patients. Material & Methods: From 2000 to 2008, we retrospectively evaluated data from 370 male patients, aged 5 to 84 Years (Mean age of 23) on whom we performed perineal posterior urethroplasty. The medical records of all patients including their age, height, weight, duration of surgery, blood loss, stricture length, as well as lower extremities complications were evaluated. Results: A total of 370 perineal anastomotic urethroplasties for PFUDD were performed in our hospital, and have been followed for a mean of 52 months. Of 370 patients, 15 cases complained of pain or numbness in their lower extremity for which 2 cases of DVT, 2 compartment syndrome and eleven lower extremities neurapraxia were revealed. Mann-Whitney Test analysis, comparing two groups of normal and complicated cases, showed patient’s age (p = 0.001), length of stricture (p = 0.009), amount of blood loss (p <0.0001), and duration of surgery (p <0.0001) to be the statistically significant risk factors for lower extremity complications (Table 1).Table 1. Patients’ general data, operative procedures, and observed complications Patient
Age (Y)
BMI (Kg/m2)
Stricture length (Cm)
Previous urethral intervention
Time of operation (H)
Blood loss Lower (cc) extremity complication
1
71
26.7
3.5
Several IU
5.5
450
DVT
2
60
28.8
4
Failed U
6
800
DVT
3
50
30.3
4
Several IU
7
500
Compartment S.
4
45
29.3
4.5
Several IU
8
900
Compartment S.
5
40
26.4
4.5
Failed U
5
500
Neurapraxia
6
29
24.5
5
Several IU
5.5
600
Neurapraxia
7
12
19
3
Laparatomy and cystostomy
5
800
Neurapraxia
8
15
18.5
3
Laparatomy and cystostomy
5.5
750
Neurapraxia
9
26
29.5
5
Failed U
7.5
1200
Neurapraxia
10
25
25.3
3.5
Several IU
6
1000
Neurapraxia
11
16
23.3
3
Laparatomy and cystostomy
5
850
Neurapraxia
12*
67
30.1
3
Several IU
7
1400
Neurapraxia
13
42
27.7
5.5
Several IU
5
600
Neurapraxia
14
33
31.5
4
Failed U
7.5
450
Neurapraxia
15
39
24.1
4.5
Several IU
6.5
500
Neurapraxia
* The only Bilateral Neurapraxia; U: urethroplasty; IU: internal urethrotomy Conclusions: Position-related complications of the lower extremities such as compartment syndrome, rhabdomyolysis, and femoral and peroneal neuropathy could result in permanent disability and morbidity in patients. By minimizing the duration of lithotomy positioning, we could mitigate such complications.
S52
Urodynamic findings in children with high grade vesico-ureteral reflux
Karami H., Razi A., Mazloomfard M.M. Urology and Nephrology Research Center (UNRC), Shahid Beheshti University, Dept. of Urology, Tehran, Iran Introduction & Objectives: Different etiology explained for establishment of reflux including bladder dysfunction which is associated with high grade reflux. Urodynamic extremes also exist and predispose to VUR in the absence of overt neurologic pathology. The objective of this study was to determine the clinical symptoms and urodynamic characteristics among children with primary high grade vesicoureteral reflux. Material & Methods: We retrospectively reviewed clinical symptoms and urodynamic parameters of 147 consecutive patient ≤ 12 years old with idiopathic high grade vesicoureteral reflux (VUR) referred to our hospital. Results: From 147 patients with high grade VUR, 139 cases with mean age of 5.3 years met our inclusion criteria including 88.1% of female and 11.9% of male. The most common symptom was urgency (58.9%) followed by enuresis (31.6%) and frequency (26.6%). Normal urodynamic finding was observed in 23.02% of patients. Overactive bladder (74.1%), low compliance bladder (56.1%), and low bladder capacity (51.07%) were the most urodynamic reports in this study. Other urodynamic findings consisted of underactive bladder (1.43%), hypersensitive bladder (1.43%), hyposensitive bladder (2.87%) and high capacity bladder (2.15%). End filling detrusor pressure (EFDP) in 19.42% was more than normal. Conclusions: Vesicoureteral reflux is associated with urgency, enuresis and frequency and other sign and symptoms. Overactive bladder seems to be the primary factor for inducing reflux in primary high grade reflux among children.
S53
The results of tubularized incised plate urethroplasty in adults with distal hypospadias
Adayener C., Ateş F., Soydan H., Şenkul T., Karademir K., Baykal K. Gulhane Military Medical Faculty Haydarpasa Hospital, Dept. of Urology, Istanbul, Turkey Introduction & Objectives: We reviewed the medical records of the patients with distal hypospadias who had undergone tubularized incised plate urethroplasty for distal hypospadias. The success rate was evaluated due to operation tecnique which was used. Material & Methods: A total of 68 men out of 162 were undergone TIPU for their distal hypospadias between 1999 and 2010 in our clinic. The mean age of the patients were 21 (range 15-28). Sixty cases were primary and 8 of them were cripple. Meatal positions were coronal in 15, subcoronal in 48 and distal penile in 5 patients. Snodgrass’s TIPU technique was performed to all cases under local (42 cases) and spinal anesthesia (26 cases). Urinary diversion were done with cystostomy in 28 patients and urethral catheter was used in 40 patients. Results: The overall success rate was 77.9% (53 of the 68 patients). Fistula was seen in 10 patients and were primary repaired. Five of the 68 patients’ neourethra were detached and repaired with TIPU again. The success rate was 83.3% for primary cases and 62.5% for cripple patients. A significant higher success rates were achieved in patients who have cystostomy (89.2% to 70%) and in cases operated with regional anesthesia (88.4% to 71.4%). Better voiding function and
Eur Urol Suppl 2010;9(6):571
good cosmetic appearance was achieved in all patients. Conclusions: The success rate of TIPU technique for primary adult cases whith distal hypospadias is quite acceptable, but it is decreased in cripple patients. Patients operated with regional anesthesia and cases who have cystostomy for urinary diversion have significant higher success rates.
S54
Efficiency of urinary fistulas surgical treatment
Jovanovic M.D., Milovic N., Aleksic P., Bancevic V., Kosevic B., Campara Z., Nikolic I., Milosevic R., Spasic A. Military Medical Academy, Dept. of Urology, Belgrade, Serbia Introduction & Objectives: Urinary fistula can be defined as an abnormal passage communicating with the urinary tract. The most often urinary fistulas are vesicovaginal fistulas which appear in about 75% of cases. From the point of surgical solutions urinary fistulas can be divided into simple and complex. Treatment methods can be conservative and surgical. Material & Methods: In our retrospective clinical study on fistulas data of 50 patients were processed – 45 women and 5 men, that had been cured in period from 2000-2008 at our department. The patients were classified according to their sex, kind and localisation of the fistula, etiology, way of surgical treatment and the result of the treatment. Average time of the follow up was 2,62 years. Results: Average age of the patients in our study was 46,7 (min.32, max.79). 49 patients were treated surgically, and 1 woman patient was treated conservativelly beacuse of her extremelly bad general condition. The most fistulas in our series were vesicovaginal (60%) and vesicorectovaginal (20%) fistulas. All of the gynaecological and opsterical fistulas – 51,11% of all fistulas are primarily operated at some other institution. Average time of fistula arising after radiation was 3,15 years (from 4 months to 17 years, most frequently after 2,27 years). 87.75% of patients were successfully surgically treated. In the group of pelvic organs fistula, 86.87% of them were succesfully solved surgically. In the group of fistulas appeared after giving birth and after gynaecological operations, the percentage of successful treatment of vesicovaginal fistulas was 100% while that percentage with vesicovaginal fistulas appeared after radiation was 83% and percentage of successfulness of the surgical solutions with vesicorectovaginal fistulas in our series is 86%. In case of patients with vesicovaginal and vesicorectovaginal fistulas after radiation, bladder was succesfully preserved in 86.36% cases. With 13.64% of cases (6 patients) and mostly in the group with extensive communications of bladder, rectum, urethra and vagina we applied derivations of urine by orthotopic ileal pauch or ileal conduit. The greatest number of derivations were executed in the group of vescicorectovaginal fistulas (4 patients). Conclusions: In our series fistulas were solved surgically in 98% of cases. The most frequent approach that was used was transabdominal approach with interposition of omental flap and the best results were achieved in the area of fistulas arisen after obstetritical and gynaecological procedures without additional radiation.
S55
Optical internal urethrotomy in the management of urethral stenosis: Our experience
Belibasakis I., Nikas T., Kyriakopoulos M. 417 NIMTS Athens Army Veterans Hospital, Dept. of Urology, Athens, Greece Introduction & Objectives: Different therapeutic approaches have been employed for the management of urethral stenoses including urethral dilatation, optical internal urethrotomy (OIU) and urethroplasty. The aim of this study is to show our experience in patients treated with OIU as a primary treatment and evaluate its results and complications. Material & Methods: A retrospective analysis was performed of 78 patients who underwent OIU at the 417 NIMTS Athens Army Veteran’s Hospital from January 2005 to January 2007. Results: Urethroscopy was the commonest diagnostic procedure (96%), followed by urethrocystography (51%) and urine flow studies (10%). All patients had urethrotomy. The most common cause for the stenosis was iatrogenic postsurgery (52%), idiopathic (32%), inflammatory (12%) and traumatic (4%). The most frequent stenosis site was the bulbar urethra (64%), followed by the penile urethra (19%), membranous (9%) and meatal (8%). Patients received a mean follow-up of 32 months (3 – 60). 27 patients were stricture-free and clinical recurrence was observed in 14%, 40% and 65% after their first OIU at the 6, 12 and 24 months following treatment respectively. From the total of 51 patients who recurred, 41 of them (80%) underwent a repeat urethrotomy, 7 (14%) were managed with urethral dilatations and 4 (8%) underwent urethroplasty. The most frequent complications included post-operative bleeding in 4 (5%) patients, 7 (9%) urinary tract infection and 11 (14) persistent pain after catheter removal. % of patients free of stenosis 6 12 24
Eur Urol Suppl 2010;9(6):572
Months post-operatively 86 60 35
Conclusions: Urethral stricture is a challenging urological problem. Optical internal urethrotomy is a minimally invasive technique with variable results, In our study 36% of patients were free from disease with only one intervention whilst the rest were either re-operated or managed conservatively with good long-term results. The lack of adequate clinical evidence for the management of urethral strictures highlights the need for further research into this area.
S56
A versatile labia minora skin flap in severe vesicovaginal fistula repair
Bizic M., Kojovic V., Majstorovic M., Djordjevic M. University of Belgrade, Dept. of Urology, Belgrade, Serbia Introduction & Objectives: Vesicovaginal fistula (VVF) presents one of the most medically and socially devastating conditions for a patient, and therefore a great challenge for surgical repair. Complex VVF include those with large diameter, fistulas associated with previous unsuccessful closure or radiotherapy. Herein we describe our experience and evaluate availability and efficacy of labia minora skin flap for surgical repair of complex VVF. Material & Methods: Between January 2007 and June 2009, 14 patients, aged 37 to 64 years (mean 52) underwent surgical repair of complex VVF with labia minora flap. The fistulas were revealed after radiotherapy (7), hysterectomy (4), trauma (2), and prolonged delivery (1). Seven patients already underwent one or more unsuccessful fistula repair. The size of the fistula ranged from 11 to 43 mm (mean 29 mm). Transvaginal approach was used in all patients. Circumferential incision around fistula was made with 3mm margin. Labia minora flap with appropriate size was created from its inner surface. Outer surface was de-epithelialized to form long pedicle of the flap. The flap was transposed toward the defect area through the tunnel created under the vaginal wall laterally. The flap was sutured to the bladder wall defect. Abandoned pedicle was used to cover suture lines and to interpose between bladder and vaginal wall. Vaginal wall was mobilized and closed in nine cases. In remaining four patients with non-elastic vaginal wall, labia minora was fashioned as a double faced flap. Inner surface was used to close the bladder opening, while outer surface was sutured to the vaginal defect. Results: Follow-up ranged from 12 – 42 months (mean 25 months). All patients had uneventful recovery. Successful outcome was achieved in thirteen patients. One woman is planned for new fistula repair using transabdominal approach in the future. Conclusions: Complex VVF are usually difficult for direct closure without risk of either failure or vaginal stricture. Good position, mobility and abundance of labia minora enable simple harvesting of a very long flap that can be used for successful repair of severe VVF.
S57
Uroflow findings in older boys with tubularized incised-plate urethroplasty
Tuygun C., Bakırtaş H., Gücük A., Çakıcı H., İmamoğlu M.A. Diskapi Yildirim Beyazit Training and Research Hospital, Dept. of Urology, Ankara, Turkey Introduction & Objectives: To analyze uroflow findings in older boys with tubularized incised-plate urethroplasty (TIPU). Material & Methods: : Seventy-nine toilet-trained patients who had TIPU were evaluated by studying their voiding history, a physical examination, suprapubic ultrasound and uroflowmetry, both pre- and postoperatively. The obstructive urinary flow pattern (OUFP) was accepted as low maximum urinary flow rate with plateau, staccato or intermittent shape. Results: The mean age was 7 years (range 5-11). The mean follow-up was 30 months (range 6-36). Of the 79 patients, 70 recovered. A permanent OUFP was found in 10 of 63 patients, as follows: 7 were detected in the 6th month after operation, and 1 each in the 9th, 18th and 36th months.Ten patients had no voiding abnormality and significant residual urine. The mean interval from initial surgery to presentation with an OUFP was 10.5 months. Conclusions: An occult urethral obstruction develops in some asymptomatic children with TIPU and commonly occurres in the first year after operation.
S58
Rectosigmoid vaginoplasty: Our experience in 83 cases
Majstorovic M., Bizic M., Kojovic V., Djordjevic M. University of Belgrade, Dept. of Urology, Belgrade, Serbia Introduction & Objectives: Numerous techniques for creation of neovagina have been described. However, rectosigmoid segment seems to present the most natural substitute for vaginal tissue. Aims of this study are to present our refinements in rectosigmoid vaginoplasty and outcome in 83 patients. Material & Methods: Between May 2002 and September 2009, 83 patients, aged 14 to 57 years (mean 23) underwent rectosigmoid vaginoplasty. Indications were vaginal agenesis/Mayer-Rokitansky-Kuster-Hauser syndrome (42), male to female
Material & Methods: During 2001-2007, 104 patients with urethral stricture length of longer than 2 Cm which urethral lumen was relatively preserved involved in this study. The guide-wire is introduced through the urethra and advanced under cystoscopic vision. The tip of Nelaton urethral catheters incised and then advanced over the guide-wire from the smallest to the largest sizes. A Foley urethral catheter which tip was incised inserted at the end of procedure (figure1). The Foley catheter removed three weeks post dilatation, and patients underwent our arbitrary protocol of clean intermittent catheterization (CIC) [twice in a day in the first week, daily in the second week, twice a week and then weekly]. Results: A total number of 104 patients suffered from urethral stricture with the average stricture length of 0.7 ± 0.26 cm treated by nelaton dilatation technique. This procedure was successful in all attempts and no major complication occurred due to the technique. Overall, urethral stricture stabilized in 83.6% of patients with 1 or 2 dilations using this technique and 24% of patients showed decreased caliber and force of urination, in one year of follow up. Conclusions: This technique has been effective in overcoming urethral stricture and its safety and efficacy are comparable with filiforms and followers and balloon dilatators. Because filiforms and followers and balloons are expensive and not available easily, this cost-effective technique can be used in every urology department.
Lithotomy position related complications following posterior urethroplasty
S50
Hosseini, J., Kaviani, A., Mazloomfard, M.M. IRHRC, Reconstructive Urology, Tajrish Hospital, Shaheed Beheshti University MS, Dept. of Urology, Tehran, Iran Introduction & Objectives: Standard lithotomy is a favorable position, providing ample access to the perineum in posterior urethroplasty. Our aim was evaluation of risk factor associated with lithotomy position related complications in urethroplastic patients. Material & Methods: From 2000 to 2008, we retrospectively evaluated data from 370 male patients, aged 5 to 84 Years (Mean age of 23) on whom we performed perineal posterior urethroplasty. The medical records of all patients including their age, height, weight, duration of surgery, blood loss, stricture length, as well as lower extremities complications were evaluated. Results: A total of 370 perineal anastomotic urethroplasties for PFUDD were performed in our hospital, and have been followed for a mean of 52 months. Of 370 patients, 15 cases complained of pain or numbness in their lower extremity for which 2 cases of DVT, 2 compartment syndrome and eleven lower extremities neurapraxia were revealed. Mann-Whitney Test analysis, comparing two groups of normal and complicated cases, showed patient’s age (p = 0.001), length of stricture (p = 0.009), amount of blood loss (p <0.0001), and duration of surgery (p <0.0001) to be the statistically significant risk factors for lower extremity complications (Table 1).Table 1. Patients’ general data, operative procedures, and observed complications Patient
Age (Y)
BMI (Kg/m2)
Stricture length (Cm)
Previous urethral intervention
Time of operation (H)
Blood loss Lower (cc) extremity complication
1
71
26.7
3.5
Several IU
5.5
450
DVT
2
60
28.8
4
Failed U
6
800
DVT
3
50
30.3
4
Several IU
7
500
Compartment S.
4
45
29.3
4.5
Several IU
8
900
Compartment S.
5
40
26.4
4.5
Failed U
5
500
Neurapraxia
6
29
24.5
5
Several IU
5.5
600
Neurapraxia
7
12
19
3
Laparatomy and cystostomy
5
800
Neurapraxia
8
15
18.5
3
Laparatomy and cystostomy
5.5
750
Neurapraxia
9
26
29.5
5
Failed U
7.5
1200
Neurapraxia
10
25
25.3
3.5
Several IU
6
1000
Neurapraxia
11
16
23.3
3
Laparatomy and cystostomy
5
850
Neurapraxia
12*
67
30.1
3
Several IU
7
1400
Neurapraxia
13
42
27.7
5.5
Several IU
5
600
Neurapraxia
14
33
31.5
4
Failed U
7.5
450
Neurapraxia
15
39
24.1
4.5
Several IU
6.5
500
Neurapraxia
* The only Bilateral Neurapraxia; U: urethroplasty; IU: internal urethrotomy Conclusions: Position-related complications of the lower extremities such as compartment syndrome, rhabdomyolysis, and femoral and peroneal neuropathy could result in permanent disability and morbidity in patients. By minimizing the duration of lithotomy positioning, we could mitigate such complications.
S52
Urodynamic findings in children with high grade vesico-ureteral reflux
Karami H., Razi A., Mazloomfard M.M. Urology and Nephrology Research Center (UNRC), Shahid Beheshti University, Dept. of Urology, Tehran, Iran Introduction & Objectives: Different etiology explained for establishment of reflux including bladder dysfunction which is associated with high grade reflux. Urodynamic extremes also exist and predispose to VUR in the absence of overt neurologic pathology. The objective of this study was to determine the clinical symptoms and urodynamic characteristics among children with primary high grade vesicoureteral reflux. Material & Methods: We retrospectively reviewed clinical symptoms and urodynamic parameters of 147 consecutive patient ≤ 12 years old with idiopathic high grade vesicoureteral reflux (VUR) referred to our hospital. Results: From 147 patients with high grade VUR, 139 cases with mean age of 5.3 years met our inclusion criteria including 88.1% of female and 11.9% of male. The most common symptom was urgency (58.9%) followed by enuresis (31.6%) and frequency (26.6%). Normal urodynamic finding was observed in 23.02% of patients. Overactive bladder (74.1%), low compliance bladder (56.1%), and low bladder capacity (51.07%) were the most urodynamic reports in this study. Other urodynamic findings consisted of underactive bladder (1.43%), hypersensitive bladder (1.43%), hyposensitive bladder (2.87%) and high capacity bladder (2.15%). End filling detrusor pressure (EFDP) in 19.42% was more than normal. Conclusions: Vesicoureteral reflux is associated with urgency, enuresis and frequency and other sign and symptoms. Overactive bladder seems to be the primary factor for inducing reflux in primary high grade reflux among children.
S53
The results of tubularized incised plate urethroplasty in adults with distal hypospadias
Adayener C., Ateş F., Soydan H., Şenkul T., Karademir K., Baykal K. Gulhane Military Medical Faculty Haydarpasa Hospital, Dept. of Urology, Istanbul, Turkey Introduction & Objectives: We reviewed the medical records of the patients with distal hypospadias who had undergone tubularized incised plate urethroplasty for distal hypospadias. The success rate was evaluated due to operation tecnique which was used. Material & Methods: A total of 68 men out of 162 were undergone TIPU for their distal hypospadias between 1999 and 2010 in our clinic. The mean age of the patients were 21 (range 15-28). Sixty cases were primary and 8 of them were cripple. Meatal positions were coronal in 15, subcoronal in 48 and distal penile in 5 patients. Snodgrass’s TIPU technique was performed to all cases under local (42 cases) and spinal anesthesia (26 cases). Urinary diversion were done with cystostomy in 28 patients and urethral catheter was used in 40 patients. Results: The overall success rate was 77.9% (53 of the 68 patients). Fistula was seen in 10 patients and were primary repaired. Five of the 68 patients’ neourethra were detached and repaired with TIPU again. The success rate was 83.3% for primary cases and 62.5% for cripple patients. A significant higher success rates were achieved in patients who have cystostomy (89.2% to 70%) and in cases operated with regional anesthesia (88.4% to 71.4%). Better voiding function and
Eur Urol Suppl 2010;9(6):571
good cosmetic appearance was achieved in all patients. Conclusions: The success rate of TIPU technique for primary adult cases whith distal hypospadias is quite acceptable, but it is decreased in cripple patients. Patients operated with regional anesthesia and cases who have cystostomy for urinary diversion have significant higher success rates.
S54
Efficiency of urinary fistulas surgical treatment
Jovanovic M.D., Milovic N., Aleksic P., Bancevic V., Kosevic B., Campara Z., Nikolic I., Milosevic R., Spasic A. Military Medical Academy, Dept. of Urology, Belgrade, Serbia Introduction & Objectives: Urinary fistula can be defined as an abnormal passage communicating with the urinary tract. The most often urinary fistulas are vesicovaginal fistulas which appear in about 75% of cases. From the point of surgical solutions urinary fistulas can be divided into simple and complex. Treatment methods can be conservative and surgical. Material & Methods: In our retrospective clinical study on fistulas data of 50 patients were processed – 45 women and 5 men, that had been cured in period from 2000-2008 at our department. The patients were classified according to their sex, kind and localisation of the fistula, etiology, way of surgical treatment and the result of the treatment. Average time of the follow up was 2,62 years. Results: Average age of the patients in our study was 46,7 (min.32, max.79). 49 patients were treated surgically, and 1 woman patient was treated conservativelly beacuse of her extremelly bad general condition. The most fistulas in our series were vesicovaginal (60%) and vesicorectovaginal (20%) fistulas. All of the gynaecological and opsterical fistulas – 51,11% of all fistulas are primarily operated at some other institution. Average time of fistula arising after radiation was 3,15 years (from 4 months to 17 years, most frequently after 2,27 years). 87.75% of patients were successfully surgically treated. In the group of pelvic organs fistula, 86.87% of them were succesfully solved surgically. In the group of fistulas appeared after giving birth and after gynaecological operations, the percentage of successful treatment of vesicovaginal fistulas was 100% while that percentage with vesicovaginal fistulas appeared after radiation was 83% and percentage of successfulness of the surgical solutions with vesicorectovaginal fistulas in our series is 86%. In case of patients with vesicovaginal and vesicorectovaginal fistulas after radiation, bladder was succesfully preserved in 86.36% cases. With 13.64% of cases (6 patients) and mostly in the group with extensive communications of bladder, rectum, urethra and vagina we applied derivations of urine by orthotopic ileal pauch or ileal conduit. The greatest number of derivations were executed in the group of vescicorectovaginal fistulas (4 patients). Conclusions: In our series fistulas were solved surgically in 98% of cases. The most frequent approach that was used was transabdominal approach with interposition of omental flap and the best results were achieved in the area of fistulas arisen after obstetritical and gynaecological procedures without additional radiation.
S55
Optical internal urethrotomy in the management of urethral stenosis: Our experience
Belibasakis I., Nikas T., Kyriakopoulos M. 417 NIMTS Athens Army Veterans Hospital, Dept. of Urology, Athens, Greece Introduction & Objectives: Different therapeutic approaches have been employed for the management of urethral stenoses including urethral dilatation, optical internal urethrotomy (OIU) and urethroplasty. The aim of this study is to show our experience in patients treated with OIU as a primary treatment and evaluate its results and complications. Material & Methods: A retrospective analysis was performed of 78 patients who underwent OIU at the 417 NIMTS Athens Army Veteran’s Hospital from January 2005 to January 2007. Results: Urethroscopy was the commonest diagnostic procedure (96%), followed by urethrocystography (51%) and urine flow studies (10%). All patients had urethrotomy. The most common cause for the stenosis was iatrogenic postsurgery (52%), idiopathic (32%), inflammatory (12%) and traumatic (4%). The most frequent stenosis site was the bulbar urethra (64%), followed by the penile urethra (19%), membranous (9%) and meatal (8%). Patients received a mean follow-up of 32 months (3 – 60). 27 patients were stricture-free and clinical recurrence was observed in 14%, 40% and 65% after their first OIU at the 6, 12 and 24 months following treatment respectively. From the total of 51 patients who recurred, 41 of them (80%) underwent a repeat urethrotomy, 7 (14%) were managed with urethral dilatations and 4 (8%) underwent urethroplasty. The most frequent complications included post-operative bleeding in 4 (5%) patients, 7 (9%) urinary tract infection and 11 (14) persistent pain after catheter removal. % of patients free of stenosis 6 12 24
Eur Urol Suppl 2010;9(6):572
Months post-operatively 86 60 35
Conclusions: Urethral stricture is a challenging urological problem. Optical internal urethrotomy is a minimally invasive technique with variable results, In our study 36% of patients were free from disease with only one intervention whilst the rest were either re-operated or managed conservatively with good long-term results. The lack of adequate clinical evidence for the management of urethral strictures highlights the need for further research into this area.
S56
A versatile labia minora skin flap in severe vesicovaginal fistula repair
Bizic M., Kojovic V., Majstorovic M., Djordjevic M. University of Belgrade, Dept. of Urology, Belgrade, Serbia Introduction & Objectives: Vesicovaginal fistula (VVF) presents one of the most medically and socially devastating conditions for a patient, and therefore a great challenge for surgical repair. Complex VVF include those with large diameter, fistulas associated with previous unsuccessful closure or radiotherapy. Herein we describe our experience and evaluate availability and efficacy of labia minora skin flap for surgical repair of complex VVF. Material & Methods: Between January 2007 and June 2009, 14 patients, aged 37 to 64 years (mean 52) underwent surgical repair of complex VVF with labia minora flap. The fistulas were revealed after radiotherapy (7), hysterectomy (4), trauma (2), and prolonged delivery (1). Seven patients already underwent one or more unsuccessful fistula repair. The size of the fistula ranged from 11 to 43 mm (mean 29 mm). Transvaginal approach was used in all patients. Circumferential incision around fistula was made with 3mm margin. Labia minora flap with appropriate size was created from its inner surface. Outer surface was de-epithelialized to form long pedicle of the flap. The flap was transposed toward the defect area through the tunnel created under the vaginal wall laterally. The flap was sutured to the bladder wall defect. Abandoned pedicle was used to cover suture lines and to interpose between bladder and vaginal wall. Vaginal wall was mobilized and closed in nine cases. In remaining four patients with non-elastic vaginal wall, labia minora was fashioned as a double faced flap. Inner surface was used to close the bladder opening, while outer surface was sutured to the vaginal defect. Results: Follow-up ranged from 12 – 42 months (mean 25 months). All patients had uneventful recovery. Successful outcome was achieved in thirteen patients. One woman is planned for new fistula repair using transabdominal approach in the future. Conclusions: Complex VVF are usually difficult for direct closure without risk of either failure or vaginal stricture. Good position, mobility and abundance of labia minora enable simple harvesting of a very long flap that can be used for successful repair of severe VVF.
S57
Uroflow findings in older boys with tubularized incised-plate urethroplasty
Tuygun C., Bakırtaş H., Gücük A., Çakıcı H., İmamoğlu M.A. Diskapi Yildirim Beyazit Training and Research Hospital, Dept. of Urology, Ankara, Turkey Introduction & Objectives: To analyze uroflow findings in older boys with tubularized incised-plate urethroplasty (TIPU). Material & Methods: : Seventy-nine toilet-trained patients who had TIPU were evaluated by studying their voiding history, a physical examination, suprapubic ultrasound and uroflowmetry, both pre- and postoperatively. The obstructive urinary flow pattern (OUFP) was accepted as low maximum urinary flow rate with plateau, staccato or intermittent shape. Results: The mean age was 7 years (range 5-11). The mean follow-up was 30 months (range 6-36). Of the 79 patients, 70 recovered. A permanent OUFP was found in 10 of 63 patients, as follows: 7 were detected in the 6th month after operation, and 1 each in the 9th, 18th and 36th months.Ten patients had no voiding abnormality and significant residual urine. The mean interval from initial surgery to presentation with an OUFP was 10.5 months. Conclusions: An occult urethral obstruction develops in some asymptomatic children with TIPU and commonly occurres in the first year after operation.
S58
Rectosigmoid vaginoplasty: Our experience in 83 cases
Majstorovic M., Bizic M., Kojovic V., Djordjevic M. University of Belgrade, Dept. of Urology, Belgrade, Serbia Introduction & Objectives: Numerous techniques for creation of neovagina have been described. However, rectosigmoid segment seems to present the most natural substitute for vaginal tissue. Aims of this study are to present our refinements in rectosigmoid vaginoplasty and outcome in 83 patients. Material & Methods: Between May 2002 and September 2009, 83 patients, aged 14 to 57 years (mean 23) underwent rectosigmoid vaginoplasty. Indications were vaginal agenesis/Mayer-Rokitansky-Kuster-Hauser syndrome (42), male to female