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Aims: To evaluate the management and intermediate term follow up for post- traumatic posterior urethral strictures in children. Methods: From March 2000 to Nov 2006, the surgical records of 28 children (= 18yrs) were reviewed. Patients were followed up for a median of 36 months (3-58 months). The cause of trauma, extent of urinary tract injury, radiological examination, history of previous urethral manipulation (rail roading, urethral dilatation or optical urethrotomy) and failures were evaluated. The need for repeat dilatation, optical urethrotomy or secondary operation after anastomotic urethroplasty was considered a failure. Results: The mean age of the patients was 12.1 yrs (5-18 yrs) at the time of injury. The estimated radiographic stricture length before surgery was 3.41 cm (2-6 cm). Of the 28 patients, 27 were managed by transperineal urethroplasty and success was achieved in 20 (75%) cases. Failed (7 cases) repairs were successfully managed endoscopically in 4 patients and by redo urethroplasty in 3 patients. All failures were at anastomotic site and were with in the the first year of urethroplasty. Of the 28 patients, 15 patients with urethral manipulation before anastomotic urethroplasty had a satisfactory result of 80% Vs 69.3% in patients without previous surgical treatment. The difference was not statically significant. Conclusion: Post traumatic posterior urethral strictures in children can be managed successfully through Transperineal approach. Failures can be successfully managed by endoscopic urethral dilatation/ urethrotomy or redo urethroplasty. Initial urethral manipulations do not affect the intermediate term results of anastomotic urethroplasty. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the safety and efficacy of multiple tracts percutaneous nephrolithotomy. Methods: We retrospectively analyzed the data of 149 patients of staghorn calculi, who underwent percutaneous nephrolithotomy using multiple (≥2) access tracts, at our institute between Jan 1999 and Sep 2006. The data were analyzed with regard to stone burden, stone clearance, perioperative morbidity, complications and number of ancillary procedures. Results: Total 164 renal units of 149 patients [118 men, 31 women, mean age (range), 39.8 years (12- 65 years)] were treated. Of 164 renal units, 43 (26.2%) had complete staghorn, 85 (51.8%) had partial staghorn and 36 (21.9%) had borderline stone bulk. A total of 420 tracts were established in 164 renal units. The maximum number of tracts used in single renal unit was 6 (range, 2-6), majority of them required 3 tracts. Supracostal access was established in 98 (59.7%) renal units. Complications were blood transfusion (n = 28), pseudoaneurysm (n = 4), sepsis (n = 8), hydrothorax (n = 7), hemothorax (n = 1) and perinephric collection (n = 1). Complete stone clearance rate of 70.7% was achieved after single sitting of percutaneous nephrolithotomy which enhanced to 89% after second look procedure (n = 30) and ESWL (n = 16). Conclusion: An approach to staghorn calculi using multiple tracts is safe and effective in achieving higher stone clearance rate with acceptable morbidity. Supracostal approach may be used more often without increasing the risk of significant complications. [ABSTRACT FROM AUTHOR]