Purpose: Complete urethral mobilization may endanger the lateral vascularity of the urethra in buccal mucosal graft (BMG) urethroplasty in stricture urethral disease. The present study aimed to evaluate the outcomes of BMG urethroplasty by dorsolateral onlay technique in patients with anterior urethral stricture. Materials and Methods: This was a prospective interventional study conducted at the Department of Urology at PSG Institute of Medical Sciences and Research between January 2015 and December 2018. Patients diagnosed with anterior urethral stricture who underwent dorsolateral onlay urethroplasty were included in this study. Results were considered satisfactory with the Qmax between 8 mL/s and 15 mL/s. Failed outcome was defined as persistent lower urinary tract symptoms, stricture on retrograde urethrogram, Qmax <8 mL/s, and requiring repeated urethra intervention. Results: A total of 54 patients underwent BMG urethroplasty by dorsolateral onlay graft with a mean age of 47.6 years. The patients with a range of stricture length 3–14 cm were included in this study. Short-term success rate (Qmax >15 mL/s) was achieved in 42 patients, while satisfactory results (Qmax 8–15 mL/s) were observed in nine patients and failure (Qmax <8 mL/s) occurred in three patients. Oral and perineal complications were treated conservatively with oral antibiotics and analgesia. None of the patients in this study had a postoperative perineal hematoma, graft infection, and scrotal swelling. Conclusion: Overall observations suggest that dorsolateral onlay BMG urethroplasty with unilateral urethral mobilization for an anterior urethral stricture is a feasible and effective option with favorable outcomes.

Purpose: To assess the clinical outcomes following dorsal buccal mucosal graft urethroplasty (BMGU) in perimenopausal women (PMW) suffering from urethral stricture disease. Materials and Methods: PMW (40–65 years) presenting with urinary symptoms were evaluated with uroflowmetry, voiding cystourethrogram (VCUG), and urethral calibration. PMW with maximum flow rate (Qmax) less than 10 ml/s or postvoid residual (PVR) volume greater than 50 ml, VCUG showing evidence of urethral stricture, and failure to calibrate with 14 Fr Foley catheter were included in the study. Patients with underactive bladder, carcinoma cervix, pelvic trauma, and oral submucosal fibrosis were excluded from the study. Patients satisfying inclusion and exclusion criteria underwent dorsal BMGU. Outcomes of the surgery were assessed by uroflowmetry at 3-monthly intervals. Results: The number of patients satisfying the inclusion and exclusion criteria between March 2014 and March 2020 was eight. The mean age of the patients was 52.1 years. The mean stricture length was 1.9 cm. The mean preoperative Qmax and PVR were 4.2 ml/s and 110 ml, respectively. The mean postoperative Qmax and PVR at 6 months were 15.4 ml/s and 39.1 ml, respectively. One patient had a recurrent stricture and underwent dilatation. Donor site complications were minor. The overall success rate of the procedure was 87%. Conclusion: Dorsal BMGU in females for urethral stricture disease offers successful urethral reconstruction and the advantage of least disruption of continence mechanism and resilience to hormonal changes in PMW.

Introduction: Urosepsis is a systemic reaction of the body to a bacterial infection of the urogenital organs with the risk of lifethreatening complications including septic shock. Aim: To assess the profile of patients with urosepsis and to analyse outcomes in patient management at a tertiary care centre. Materials and Methods: A retrospective, single-centre study was conducted between January 2015 and December 2019 including patients of either sex, aged ≥20 to <80 years, with a confirmed diagnosis of urosepsis. Clinical report forms were reviewed to obtain patient characteristics (including age, sex, co-morbid conditions and clinical data). Blood, pus, urine culture data were evaluated to identify the source of infection. Details of upper and lower urinary tract symptoms and their imaging and urological intervention done were also recorded. Results: A total of 582 patients with urosepsis were included in this study. The majority of patients belonged to the age group of 41 to 60 years (n=315). The most frequent radiological diagnosis was infected hydronephrosis with calculus disease (n=237). The associated co-morbid conditions contributing to the perpetuation of urosepsis were Type II Diabetes Mellitus (T2DM), systemic hypertension, chronic kidney disease, decompensated liver disease, neurological disease, and coronary artery disease. Escherichia coli was the most commonly observed uropathogen (57.90%) in this study. Bilateral Double-J (DJ) stenting was usually preferred in patients with infected hydronephrosis and acute pyelonephritis (n=85, 76.58%). The insertion of a suprapubic catheter was more frequent among patients with obstructive lower urinary tract symptoms. Multivariate analysis showed that urosepsis with emphysematous pyelonephritis, uncontrolled diabetes, and persistent hypotension inspite of inotropic agents had a prolonged intensive care unit and higher mortality rate. Conclusion: Renal salvage is achievable in majority of cases with early surgical intervention, either DJ stenting or percutaneous nephrostomy. Suprapubic catheterisation is indicated in urosepsis patients with predominant lower urinary tract symptoms. An early diagnosis and an appropriate treatment can reduce the costs of hospitalisation, morbidity, mortality and better outcome.