A challenging surgery relieves a man years of suffering
Our patient, a 36-year old male, presented to Dr. Faizal S., MBBS, MS, MCh., DNB (Urology) at the department of urology with a long history (10 years) of slow urination and mild penile skin changes. He was investigated and diagnosed to have extensive urethral stricture due to BXO (Balanitis xerotica obliterans).
A urethral stricture is a scar in or around the urethra, which can restrict the flow of urine. Imagine a narrowing or kink in a garden hose which will slow the stream of water. This patient had previously undergone multiple procedures elsewhere over a period of years with no improvement. So we planned for a major urethral reconstructive surgery. The choice of surgical procedure depends on the length and location of the stricture. The surgical repair in our patient was very challenging because the stricture was too long involving the whole of the anterior urethra with unhealthy mucosa. Unlike in short segment stricture where the strictured area can be removed and the two ends simply reconnected, here the diseased segment of urethra had to be reconstructed with tissue transferred from elsewhere in the body. In case of stricture due to BXO use of skin graft (which can be harvested easily) yields poor results due to involvement of the skin with the inflammatory process. So in our patient we used a long strip (15 cm) of buccal mucosa (lining inside the cheek), to augment the entire narrow segment of anterior urethra – Barbagli urethroplasty .This procedure is performed only in very few centres. The urinary catheter was retained for three weeks to ensure proper healing. On removing the catheter he could void normally with a good urinary stream and tests of urine flow confirmed the same.
A 2-½ year old child’s thick Empyema Peel removed at Paalana.
We successfully operated a case of thick Empyema at our Hospital by our Paediatric Surgeon, Dr. G. Lakshmi Devi, MBBS, DNB, MRCS, M.Ch. (Paediatric surgery).
At Paalana, we managed a 2-½ year old female child referred with right empyema thoracis, which is collection of pus around the lung with thickening of pleura (tissue covering the lung) preventing adequate expansion of the involved lung. Treatment of the condition is drainage of pus and decortication (removing the thickened covering of the lung). VATS (Video Assisted Thoracoscopic Surgery) and decortication was done for this patient, which hastened the recovery in this girl with very minimal post operative pain. She was active and playing at discharge after a hospital stay of only 6 days. We have been doing minimally invasive procedures on adult and Paediatric patients from the start, but thoracoscopy was done for the first time. This patient has escaped a very painful open surgery on the chest, a bad scar, a prolonged recovery time at hospital and in the long term, a chest wall deformity which we often see in growing children after open surgery.
This Super-Speciality Department is functioning with an excellent track record from its beginning.