Objective. To present the results of reconstruction of long (>5 cm), penile, bulbar, and bulbopenile urethral strictures by penile skin flap as dorsal onlay in one-stage procedure. Patients and Methods. Between January, 1998 and December, 2004, 18 patients (aged from 28-65 years) presented with long urethral strictures, 5.6–13.2 cm (penile in 6, bulbar in 2 and combined in 10 cases), those were repaired utilizing long penile skin flaps placed as dorsal onlay flap in one stage (Orandi flap 6 cm in 6 cases, circular flaps 7–10 cm in 8, and spiral flaps 10–15 cm in 4). Followup of all patients after reconstruction included urine flow rate at weekly intervals, RUG at 6–12 weeks, and urethrocystoscopy at 12 and 18 months. Results. The urethral patency was achieved in 77% of patients. The complications were fistula in one patient (5.5%), restricture occurred in 3 patients (16.6%) that required visual internal urethrotomy and two patients (11%) showed curvature on erection that dose not interfere with sexual intercourse. Diverticulum (penile urethra) was seen in one patient (5.5%) containing stones and was excised surgically. There was penile skin loss in 3 patients (16.6%). All patients completed at least one-year followup period. Conclusion. Free penile skin flaps offer good results (functional and cosmetic) in long penile and/or bulbar urethral strictures. Meticulously fashioned longitudinal, circular or spiral penile skin flaps could bridge urethral defects up to 15 cm long.

Urolithiasis is a recognized precursor for renal deterioration. Moreover, if untreated, it can lead to renal failure. The prevalence of nephrolithiasis in patients with concomitant renal insufficiency is estimated to be 17.5%, it is a major public health problem and in the surgical setting not only are they at higher risk of anesthetic complications, but at greater risk of post-procedure complications (Kellett etal., 1991; Jones et al., 2017). In addition to achieving good stone clearance, surgical interventions employed in the treatment of stone disease must try to preserve maximal renal function (Kellett et al., 1991; Chandhoke et al1992). Management of nephrolithiasis in patients with renal insufficiency is therefore a difficult challenge for the endourologist as well as nephrologists and calls for careful consideration of the risks against the benefits, Multiple modularities can be used for various types of renal stones such as shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PNL), retrograde intrarenal surgery (RIRS) and laparoscopic and/or robotic approaches(Nasir et al., 2014). Gunasekaran et al compared the long-term effects of shock wave lithotripsy (SWL) and percutaneous nephrolithotomy (PNL) on renal function with a solitary kidney and/or Abstract: Background: The incidence of stone formation in patients with renal insufficiency 17.5%, complete clearance of stone in these patients need least invasive procedure with safety of kidney parenchyma and kidney function. Objectives:To analyze outcomes of percutaneous nephrolithotomy (PNL) and shock wave lithotripsy (SWL) and their effect on kidney function for patients with renal insufficiency. Materials and methods: 52 renal insufficiency patients with renal stones presented to our department randomized into two groups group A (25 patients) underwent PNL and group B (27 patients) underwent SWL and all results recorded and analyzed with Statistical Package for Social Science ® (SPSS) and Microsoft Excel 2010. Results: Stone free rate was about 84% of patients in group A (25 patients) and about 26.6% of patients in group B with first session, while it`s about 88.9% for all patients in group B (27 patients) with some degree of improvement of kidney function. Conclusion: This study shows that both PNL and SWL are safe on patients with renal insufficiency with improvement of kidney function.