We describe our experience with 20 patients undergoing 1-stage correction of an anterior urethral stricture using a buccal mucosa patch graft. This technique was used for treatment of short strictures (1 to 2 cm.) that usually required a 2 to 4 cm. repair, making excision and end-to-end anastomosis impractical. Results were excellent in 18 patients, while 2 required revision for recurrent stricture. Urethrocutaneous fistulas and diverticulas were not encountered in our series. The buccal mucosa patch graft is hairless and, therefore, it can tolerate trauma and infection adequately. This technique represents a reasonable alternative when penile skin cannot be used or endoscopic manipulation is not indicated.
Objectives
to make a reliable correlation between the chemical composition of the urinary calculi and its Hounsfield unit on CT scan, upon which we can depend on it for prediction of the type of the urinary calculi. The prediction of the chemical structure of the stone would help us to reach a more efficient therapeutic and prophylactic plan.
Methods
A retrospective study was performed by interpretation of the preoperative CT scans for patients who were presented by urinary stones.
Identification of the chemical structure of the calculi was implemented using Fourier Transform Infrared Spectroscopy (FT-IR spectroscopy). The laboratory report revealed multiple types of stones either of pure or mixed composition. Afterwards, a comparison was done between Hounsfield units of the stones and the chemical structure.
Results
The chemical structure of the urinary stones revealed four pure types of stones (Uric acid, Calcium Oxalate, Struvite and Cystine) and two types of mixed stones (mixed calcium oxalate+ Uric, and mixed calcium oxalate+ calcium phosphate).
Uric acid stone had a mean Hounsfield Unit (HU) density of428 ± 81, which was quite less than the other stones, followed by struvite stones with density ranging about 714 ± 38.
Mixed calcium oxalate stones could be differentiated from other types of stones like uric acid, pure calcium oxalate and struvite stones by the Hounsfield unit of Computed Tomography (the mean Hounsfield Unit was 886 ± 139 and 1427 ± 152 for mixed calcium oxalate + uric stone and mixed calcium oxalate + calcium phosphate stones respectively). Moreover, pure calcium oxalate stones were easily differentiated from all other stones using the mean Hounsfield density as it was 1158 ± 83. It was challenging only when it was compared to cystine stones, as they were quiet similar to HU value (997 ± 14).
The variation of Hounsfield values among the previously mentioned stones, was statistically significant (p < 0.001).
Conclusion
The study proved that the Hounsfield Unit of CT scanning is a convenient measure to predict the chemical structure of urinary calculi.
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