No abstract

Aphallia is known to be a very rare congenital malformation, with an occurrence of 1 in every 30 million births; only 75 cases have been reported in the literature till recently (Hendren WH. J Urol 1997; 157: 1469-1474). Gender reassingnment is recommended for the affected newborns in infancy (Elder JS. In: Walsh PC, Retik AB, eds. Campbell's Urology. Philadelphia: Saunders: 12343-12344). We herewith report a patient of aphallia who presented at the age of 16 years and was treated with phallus reconstruction and urethral reconstruction.

Harvesting fascia lata with fascial stripper is a minimally invasive which is easy to learn and provides an excellent fascial strip with minimal morbidity.

The treatment of choice for a stone load of up to 3 cm is indubitably extracorporeal shock wave lithotripsy (SWL). However, for larger stones, and particularly staghorn calculi, the choice is not that clearcut. Our experience with percutaneous nephrolithotomy (PCNL) for a stone load larger than 3 cm in 878 renal units over 9 years has left us convinced that a well-planned and determined effort at percutaneous clearance is the best option for these difficult cases. Our overall complete clearance rate in this group is 93% and ranges from 98.5% for solitary calculi to 71% for complete staghorn calculi. These results are comparable to those reported by other workers with percutaneous monotherapy and are superior to those achieved by SWL monotherapy. The complication rate was acceptably low at 4%. We conclude that the expeditiousness and the better stone-free rates of PCNL justify the slightly higher morbidity that it entails when compared with SWL monotherapy. We also prefer to aim for total clearance percutaneously, leaving for SWL only those stones that defy our best efforts.

The results of this study indicate that LNU for a tuberculous nonfunctioning kidney is a safe, effective, and less invasive treatment modality. Comparing our results with those of nephroureterectomy for other, benign diseases shows that the procedure has similar safety and efficacy even for tuberculous kidneys. Tuberculosis should not be considered a contraindication for a laparoscopic approach. Laparoscopic nephroureterectomy should be offered as the treatment modality of choice to all patients with tuberculous nonfunctioning kidney whose disease involves the kidney and ureters.