OpenUCT :: Browsing by Department "Division of Urology"

Browsing by Department "Division of Urology"

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Open Access
Bone metabolism abnormalities in children with epilepsy at Red Cross War Memorial Children's Hospital, Cape Town, South Africa
(2017) Kija, Edward Nkingwa
Introduction: Epilepsy is the most common neurological condition worldwide. Literature on the antiepileptic medications and biochemical markers of bone metabolism has revealed inconsistent results. Most of these studies were undertaken in Europe and America where the burden and the associated comorbidities are different to the ones in Africa. Methods: A hospital based case control study was undertaken at Red Cross War Memorial Children's Hospital where children were recruited from a dedicated Epilepsy clinic and controls were obtained from a day surgical ward. Blood and urine samples were taken for the assessment of markers of bone metabolism. Results: Seventy-five cases and 75 controls were recruited. The median age for the children with epilepsy was 9 years with a range of 1 to 17 and controls 3 years with a range of 1 to 12. Vitamin D deficiency was present in 11(16.2%) of children with epilepsy compared to 6(8.8%) in the control group. Vitamin D insufficiency was present in 30(44.1%) in children with epilepsy compared to 27(39.7%) in the control group. Children with epilepsy on enzyme inducing AEDs had lower mean Vitamin D levels (24.67±11.4 vs 30.72±7.4, p=0.08), lower mean Vitamin D2 (0.25±0.07 vs 0.4±0.17,p=0.0018),lower mean Vitamin D3 (1.61±1.06 vs 2.58±0.86,p=0.004), lower mean serum phosphate levels (1.39±0.2 vs 1.76±0.7,p=0.000) and a higher mean parathyroid hormone levels (4.47±2.33 vs 2.7±0.97, p=0.03) compared to the control group. Children with Epilepsy on enzyme inhibitors had higher mean Vitamin D2 (0.44±0.37 vs 0.25±0.07,p=0.000004) and mean Vitamin D3 (2.26±0.86 vs 1.61±1.06,p=0.028) compared to children on enzyme inducers. Dietary intake and ancestry did not influence Vitamin D levels between the cases and controls. Conclusion and Recommendations: Vitamin D deficiency is common in children with epilepsy on AEDs. Children on enzyme inducing AEDs should be investigated for vitamin D deficiency and managed accordingly.
Open Access
Do percutaneous nephrostomies for malignant obstructive uropathy improve renal function six months post intervention?
(2019) De Wet, Christiaan Ernst; Kaestner, Lisa-Ann
Background and purpose Malignant conditions of the pelvis and/or abdomen can cause ureteric obstruction and associated impaired renal function, which can be managed by performing percutaneous nephrostomy (PCN) tube insertion. Nephrostomy tubes are associated with prolonged hospital stay which affects quality of life. The main objective of this study was to assess the changes in estimated glomerular filtration rate (eGFR) over the first six months following percutaneous nephrostomy for malignant ureteric obstruction. We also explored the role of UTIs in the changes of eGFR following PCN. Materials and Methods We performed a retrospective folder review of patients who had PCN procedures at Groote Schuur Hospital for malignant obstructive uropathy from January 2015 to 31 December 2017. For each included patient, eGFR was recorded at baseline pre-PCN, and at its best and worst value in the first six months after PCN. The timing of baseline, best and worst values were also recorded. Other data collected included demographic data, type of malignancy, laterality of nephrostomy and presence of confirmed UTI at least one week post PCN. Results/main findings A total of 90 patients fulfilled our inclusion criteria. The most common cancers in men were bladder 59% (n=32), prostate 20% (n=11), lymphoma 7% (n=4), and colorectal 4% (n=2). The most common cancers in women were cervix 64% (n=23), bladder 19% (n=7), lymphoma 6% (n=2), colorectal 6% (n=2) and endometrial 6% (n=2). Men were of higher age, median (IQR), 60 (56, 67) years, compared to women, 48 (40, 67). 64% of patients (n=58) had bilateral PCN procedures (as opposed to a unilateral procedure). 52% (n=47) of patients developed at least one episode of UTI post PCN during the six-month observation period. Median (IQR) timepoint of pre-PCN eGFR measurement was 1.0 (2.0, 0) day pre PCN. The best post-PCN eGFR measurement was 13.0 (6.0, 26.0) days post PCN. The worst post-PCN measurement was 33.5 (14.0, 92.5) days post PCN. Pre-PCN eGFR, median (IQR), was 9 (5, 26). Post-PCN eGFR improved to 48 (30, 75) before deteriorating to 23 (9, 44) within the six-month follow-up window. Compared to patients who do not develop UTI post-PCN, those who develop one or more post-PCN UTI(s) have a 6.15 (95% CI: 0.87, 11.43) unit lower eGFR at their worst eGFR measurement. There are also markedly fewer deteriorations in chronic kidney disease (CKD) stages between best and worst post-PCN interval in those without UTI (42%, 18/43), compared to those with at least one post-PCN UTI (72%, 34/47). Conclusions Our study confirmed a similar renal function trend post-PCN for malignant ureteric obstruction across different demographics. It is clear that although most patients’ renal function initially improve post-PCN, the general trend for the majority of patients is to deteriorate towards pre-PCN eGFR and CKD stage values. Our data suggest that urinary tract infections play an important role in poor renal function response within six months post-PCN. Future studies should explore whether the development of UTI following PCN is an independent and modifiable risk factor for poor renal outcome.
Open Access
Genetic basis of human disorders of gonadal development
(2018) Maison, Patrick Opoku Manu; Lazarus, John
South Africa is unique in the arena of Intersex, in that for unknown reasons we have a very high percentage of ovotesticular DSD (True Hermaphrodite). Whereas ovotesticular DSD is the least common cause of hermaphroditism in other parts of the world, it is the most common cause of hermaphroditism in South Africa. There have been several studies in the past to determine the cause of ovotesticular DSD in our population but none of these studies found appropriate answers. The current state of understanding implicates signaling and signal transduction molecules and transcription factors suggesting that it is likely not all of the genetic factors involved have already been identified. It was hypothesized that exome sequencing of individuals with DGDs will identify new mutations and genes for these conditions. Therefore, this study aims to identify additional genes that are associated with ovotesticular DSD. By using a whole-genome sequencing approach we expected to be able to identify rare variants with this condition and determine the prevalence of mutations in these genes in the ovotesticular DSD population. After obtaining informed consent, blood specimen was obtained from eleven out of fifteen patients who had histological diagnosis of Ovotesticular DSD at the Red Cross War Memorial Hospital over a 10 year period. Blood specimen was also obtained from the biological parents of these children and sent to the Ostrer laboratory for whole genome sequencing and analysis. At the Ostrer laboratory, high quality DNA was extracted from blood for all of subjects and lymphoblastoid cell lines were created. Following sample preparation using the Illumina library preparation kit, sequencing was accomplished using paired-end sequencing technology on an Illumina HiSeq2000 sequencer. The data from the Illumina sequencers was analyzed first using the Illumina sequencing data analysis pipeline for quality control. Paired end reads were aligned to the Human Reference Genome (NCBI Build 36) using the BWA software. Each alignment was assigned a mapping quality score by BWA, which is the Phredscaled probability that a read is misaligned. The basic functional annotation of SNPs/Indels is performed by ANNOVAR. The clinical features of these patients was consistent with those found by other studies on Ovotesticular DSD in South Africa and it also showed the same pattern of variation to the clinical features of Ovotesticular DSD from other parts of the world. Similar to previous South African studies, this study found no convincing gene mutations as the possible etiology of Ovotesticular DSD in South Africa. Whiles gene mutations such as duplication of SOX 9 have been found in patients with XX Ovotesticular DSD from outside South Africa, this study could not identify any such mutations. This further adds to the suspicion that the unique features of Ovotesticular DSD in South Africa suggests a different etiology from that of other parts of the world. In conclusion, the etiology of Ovotesticular DSD in South Africa still remains elusive. It is however possible that a genetic mutation may be found from a more critical analysis of the genome of the patients and their parents.
Open Access
Gunshot wounds to the male external genitalia
(2007) Van der Merwe, André; Barnes, R D; Pontin, A R
This is a retrospective study of male patients that suffered gunshot wounds to the extental genitalia from August 1997 to September 2006. This study also reviews the literature and compares treatment methods locally and internationally.
Open Access
Investigating racial differences in clinical and pathological features of prostate cancer in South African men
(2016) Dewar, Malcolm James; Kaestner, Lisa-Ann; Lazarus, John
The aim of this project is to study the clinical and pathological features of prostate cancer in men from different racial groups in the Western Cape in an attempt to define the characteristics of the disease locally. Specifically we wanted to compare black with coloured and white patients.
Open Access
Is ethnicity a risk for high grade prostate cancer?
(2010) Kaestner, Lisa-Ann
To assess the association between ethnicity and grade of prostatic adenocarcinoma, prostatespecific antigen (PSA) and age, and to determine whether Africans of African descent (AAD) have higher grade cancers than other ethnic groups.
Open Access
Is The Learning Curve In Robotic Assisted Laparoscopic Radical Prostatectomies (RALP) in South Africa Comparable to International Standards?
(2020) de Jager, Simon; Howlett, Justin
Background and purpose Prostate cancer (PCa) is the second most common cancer in men, and the sixth leading cause of cancer death among men worldwide (1). Radical Prostatectomy (RP) is widely considered a gold standard treatment for clinically significant localized PCa. Robotic assisted laparoscopic radical prostatectomy (RALP) represents a modern minimally invasive technique for performing a RP. The aim of the study is to demonstrate a progression in the learning curve of two South Africa based urologists, as each embarks on their first series of RALP cases between September 2014 to July 2019. An audit of peri-operative outcomes for each surgeon's first uninterrupted series of RALP's has been undertaken. We also compare our results to international series to assess if local South African outcomes are similar to these. Materials and Methods We performed a retrospective audit of all patients who had a RALP with our two urologists between the dates of September 2014 to May 2019. Patients were only excluded if critical data could not be collected. For each included patient we collected peri-operative data. Pre-operative data collected was required for risk stratification grouping of patients according the D'Amico Risk group classification. Post-operative data included operative details (such as console time and blood loos), functional outcomes (such as potency and continence rates), and pathological outcomes (such a T-staging and positive surgical margin rates). The total number of patients for each of the two surgeons have been divided into a series of consecutive groups. The first 100 have been divided into groups of 25, and the subsequent patients into groups of 50. Results/main findings Our two surgeons have been designated Surgeon-X and Surgeon-Y. A total of 700 patients met our inclusion criteria, 400 and 300 cases for Surgeons-X and -Y respectively. Our study demonstrates that in a South Africa setting, for the parameters of median console time (CT), estimated blood loss (EBL), length of hospital stay (LOS), and positive surgical margins (PSM), there were notable improvements between the first and last groups of each surgeon's series. Although each parameter tends to fluctuate around a median value, there is a general trend towards improved outcomes. For the parameters of post-operative continence and potency our study failed to show a statistically significant improvement in outcomes between the first and last groups in each surgeon's series. Conclusions This study demonstrates that, similar to internationally published data, notable improvements in perioperative outcomes can be observed as each of our two surgeons gain experience in this relatively new operative approach to managing men with localized prostate cancer. The overall picture is one of improved outcomes with each consecutive group analysed and that when individually assessed, these outcomes display differing rates of improvement depending on which is being assessed. When analysing our outcomes of CT, EBL, PSM rate and LOS, we see that our results compare favourably to other internationally published data. For all intents and purposes our learning curve and peri-operative results are on par with our overseas counterparts and in some cases bette
Open Access
Motor neuron disease in an African population: A review of current literature and a case series of the flail arm variant in the Western Cape
(2018) Cross, Helen; Heckmann, Jeannine M
Background: Motor neuron disease (MND) is a devastating neurodegenerative disorder, with recognised phenotypic subtypes. Although prevalent in all parts of the world, little is described in the literature with regards motor neuron disease as it occurs in African populations. Aims: This study had two main aims: to conduct a systematic review of the current available literature on motor neuron disease in persons of African genetic descent, and to describe the clinical phenotype in a subgroup of MND patients with the flail arm (FA) variant seen at Groote Schuur Hospital MND clinic. Methods: In order to identify the current published knowledge of motor neuron disease in African populations, a systematic literature review was conducted using Pubmed and Google Scholar. For the case series description, patients presenting to the Groote Schuur Hospital MND clinic with a phenotype of restricted proximal upper limb, lower motor neuron involvement for at least 12 months after symptom onset, during the time period of March 2014 to September 2016, were considered for inclusion. A full clinical description of each case, including history, examination and electrophysiological findings, was conducted. Results: Review of the available literature on MND as it occurs in persons with African ancestry revealed that little is well described. Although there are a few original studies, all are small and most are out-dated. Some trends emerged, including younger age at onset of disease, tendency to longer survival, and possibly more frequent presentation with bilateral upper limb involvement. Six cases of FA variant of MND, representing 13% of the MND clinic cohort seen over the 2.5 years given time period, all with African genetic ancestry by self-categorization, are reported illustrating the various previously described features of this phenotype. Even within these few cases, there is variation in presentation and disease course. Conclusions: More research is required on African populations to address the questions surrounding MND as it occurs in Africans, including phenotypic and genetic similarities or differences to other populations. Although controversy surrounding exact case definition of the FA variant of MND remains, it does represent a unique phenotype, and seems to occur in patients of African genetic ancestry in a similar manner to that described in Caucasian populations.
Open Access
Near-fatal TURP syndrome associated with similarities in irrigant fluid packaging appearance
(2008) Lazarus, John; Batty, Dee; Moolman, Conray
We describe a case of severe iatrogenic transurethal resection of the prostate (TURP) syndrome associated with confusing irrigant fluid packaging. TURP syndrome is described, as well as steps taken to request industry to alter the packaging.
Open Access
Non-operative versus operative management of penetrating kidney injuries : a prospective audit
(2011) Moolman, Conray; Barnes, R D
To date there is little data on conservative management of penetrating renal trauma. The aim of this study was to review the management and outcome of a large patient cohort presenting with penetrating renal trauma to a tertiary referral centre in South Africa. All patients presenting with penetrating abdominal trauma and haematuria admitted to the Trauma Centre at Groote Schuur Hospital over a 19-month period was prospectively evaluated. Patients demographics, mechanism of injury, microscopic versus macroscopic haematuria, grade of injury, management decision (non-operative, laparotomy for other reasons without renal exploration or true renal surgery with Gerotas fascia opened), nonsurgical success rate, complications, hospital stay, transfusion requirements and nephrectomy rate were analysed.
Open Access
Pseudotumor cerebri (with special reference to visual loss)
(1988) Bryer, Alan; Philcox, D
AIMS OF STUDY: 1. To analyse the patients . who have been treated at Groote Schuur Hospital over the last seven years for Pseudotumor Cerebri. 2. To document the clinical features of this group of patients. 3. To determine the visual prognosis of this group. 4. To assess the forms of treatment that have been used in this group. 5. To review the literature with regard to: a) a comparison of the results of other studies with the present one. b) the pathophysiology of the condition. c) treatment of the syndrome. d) the visual prognosis of the syndrome.
Open Access
Retrospective review of open versus laparoscopic radical cystectomy for the treatment of bladder cancer: complications and oncological outcome
(2015) Cassim, Farzana; Sinha, S; Lazarus, JM
Objective: Radical cystectomy with extended lymphadenectomy and urinary diversion remains the standard of care for muscle-invasive urothelial carcinoma. Our centre (Groote Schuur Hospital) has been performing laparoscopic radical cystectomies since 2009. We aimed to audit our data regarding complications and oncological outcome and compare it to data obtained from patients undergoing open radical cystectomy by the same surgeon since 2007. The two procedures will be compared in terms of operative duration, intra-operative blood loss, peri-operative blood transfusion requirements, post-operative complications (using the Clavien Classification) and differences in pre- vs. post-operative staging. Patients and Methods: All adult patients (>18 years) that underwent open and laparoscopic radical cystectomy from 2007 to 2013 have been included in the study. Data on demographics, operative time, intra-operative blood loss, post-operative complications (as per Clavien-Dindo Classification), margin positivity, and lymph nodes (number obtained and number of positive nodes) was obtained retrospectively by means of folder review. Extracted data was collected on a Microsoft Excel spreadsheet. Only folders with complete data sets were included f or statistical analysis. Patients undergoing laparoscopic radical cystectomy converted to open were analysed on an intention-to-treat basis. Data was analysed using bivariate statistics and survival analysis was performed to compare mortality rate. Results: Physician's choice of surgical modality was associated with clinical disease staging with 59% of participants who underwent ORC presented with a palpable mass on examination under anaesthesia (EUA) compared to 36% of participants in the LRC arm. This association was confirmed on pathological staging. Participants undergoing ORC experienced shorter operative duration (301 minutes versus 382 minutes; p-value < 0.0001), increased blood loss (1376ml versus 778 ml; p-value = 0.00 2 3) and transfusion requirement (2 units versus 0; p-value = 0.071) in contrast to LRC. Post-operative complications were more prevalent in the ORC arm compared to the LRC arm (61% versus 43%) and this trend was reflected in the Clavien classification. The only complication that differed in its occurrence between the two arms was wound complications (18% for LRC versus 44% for ORC) with the main type being sepsis. Patients with a past medical history were at higher risk of experiencing post-operative complications (p-value = 0.04; Risk Ratio: 1.6). Margin positivity was comparable between the two arms. A trend was observed when comparing the number of lymph nodes sampled using the two techniques and this trend was maintained irrespective of the area sampled, whereby a higher number of nodes was sampled by the laparoscopic technique in this study (overall p-value = 0.07 ). Conclusion: Laparoscopic radical cystectomy is associated with longer operative times, decreased blood loss, and equivalent oncological outcomes when compared to open radical cystectomy. Laparoscopic RC is a feasible option in our setting. LRC affords patients a lower risk of requiring transfusion, with minimal risk of post-operative ileus and a lower risk of wound complications. Given the increasing number of laparoscopic procedures being performed at GSH, a prospective trial would be possible in order to confirm these findings.
Open Access
Retrospective review of radical cystectomies at GSH 1993-2007
(2010) Govender, Prenevin; Barnes, R D
The objective of the thesis was to look at the epidemiology of patients needing this procedure, clinical presentation and investigation, pathology, complications related to the procedure, adjuvant and neoadjuvant treatment, and survival.
Open Access
A review of transrectal ultrasound guided prostate biopsies is there still a role for finger-guided prostate biopsies?
(2012) Jehle, Karlheinz; Barnes, RD; Lazarus, JM
Prostate cancer is the most common male malignancy amongst black males in South Africa and the second commonest amongst white males (1,2). Prostate biopsy, via the rectum, is an essential part of diagnosing and treating this disease. Traditionally needle biopsies of the prostate were performed blindly by digital palpation of the gland per rectum.
Open Access
South African guideline for management of ischaemic stroke and transient ischaemic attack 2010: A guideline from the South African Stroke Society (SASS) and the SASS Writing Committee
(2010) Bryer, A; Connor, M D; Haug, P; Cheyip, B; Staub, H; Tipping, B; Duim, W; Pinkney-Atkinson, V
Background. Stroke is a leading cause of death and disability in South Africa. An increase in the burden of stroke is predicted as the population is undergoing a rapid epidemiological transition with increased exposure to, and development of, stroke risk factors, together with aging of the population. Objective. The objective was to update the guideline published in 2000, to place the recommendations within the current South African context, and to grade evidence according to the level of scientific rigour. Recommendations. Ideally, all patients with acute stroke should be managed in a dedicated stroke unit. There is ample evidence that protocol-driven multidisciplinary stroke unit care within a hospital improves recovery from stroke. Treatment in a stroke unit has been shown to reduce mortality as well as reduce the likelihood of dependency after stroke. An effective stroke service requires the establishment of a seamless network consisting of acute stroke units, post-acute care and rehabilitation, and further care in the community. Primary preventive measures reduce stroke incidence and should be universally available and actively promoted at all levels of health care in South Africa. Successful care of a stroke patient begins with recognition by the public and health professionals that stroke should be considered an emergency. Avoiding delay should be the major aim of the prehospital phase of acute stroke care. Acute stroke or transient ischaemic attack (TIA) should be treated as a medical emergency and evaluated with minimum delay. General supportive treatment is emphasised and is directed at maintaining homeostasis and the treatment of complications. Intravenous thrombolytic therapy with recombinant tissue plasminogen activator (tPA) is an accepted therapy for acute ischaemic stroke within 4.5 hours of onset of symptoms, but can only be administered at centres with specific resources. Awareness and treatment of the neurological and systemic complications of acute stroke are an integral part of management. Patients with suspected TIA and minor stroke with early spontaneous recovery should be evaluated as soon as possible after an event. Brain imaging is recommended, and non-invasive imaging of the cervicocephalic vessels should be performed urgently and routinely as part of the evaluation. Carotid endarterectomy (CEA) is recommended for patients with severe (70 - 99%) ipsilateral stenosis, and the procedure should be performed as soon as possible after the last ischaemic event – ideally within 2 weeks – in centres with a peri-operative complication rate (all strokes and death) of less than 6%. Survivors of a TIA or stroke have an increased risk of another stroke, which is a major source of increased mortality and morbidity. Secondary prevention strategies are aimed at reducing this risk. Stroke rehabilitation is a goal-orientated process that attempts to obtain maximum function in patients who have had strokes and who suffer from a combination of physical, cognitive and language disabilities.
Open Access
The spectrum of acute and subacute myelopathy
(1984) Silber, Michael H
Acute and subacute diseases causing intrinsic spinal cord damage are confusing and poorly defined clinically and pathologically. of this study is: The purpose 1. To analyse the spectrum of conditions responsible for acute and subacute myelopathy in South Africa. 2. To categorise the clinical presentations and prognosis of the illnesses and to correlate these with aetiology. 3. To assess the validity of diagnostic criteria for acute and subacute myelopathy in general and for the different aetiological groups. 4. To review the literature and to correlate previous studies with the present one. Thirty-four patients fulfilling strict criteria nave been identified over a seven-and-a-half-year period using the Groote Schuur Hospital computer retrieval system. Although the study was essentially retrospective, 11 of these patients were seen personally during their acute illnesses. All these patients have suffered from illnesses causing spinal cord dysfunction in the absence of trauma, physical agents or any extrinsic pressure such as might be caused by tumours or spondylosis. Maximum disability was reached in less than 8 weeks. In 17 patients no cause was identified. The clinical features, laboratory findings and courses have been analysed. Among the results, a high percentage of patients with Brown-Sequard Syndromes were found with possible significance for the pathogenesis of the illness. Seven patients with meningovascular syphilis were analysed as well as 2 additional patients with spinal cord syphilis not fulfilling the strict criteria of the study. Although well known before the penicillin era, this entity is not well described in modern neurological literature. Four patients had myelopathy associated with pulmonary tuberculosis in the absence of tuberculous meningitis or spinal disease. Three of these 4 patients also developed optic neuropathy. The association of these conditions has previously been described in only a very few patients. Two patients had Epstein-Barr virus infections and 1 had an infection with Mycoplasma pneumoniae. Two had systemic lupus erythematosus and 1 had an acute cord infarct following an aortic aneurysm repair. The literature is reviewed and the findings of this study correlated with previous ones. Conclusions regarding terminology, criteria for diagnosis, investigations, course and prognosis are discussed.
Open Access
The excretion of calcium and phosphorus by the human kidney
(1957) Dowdle, Eugene Bernard Davey
In this thesis I have attempted to assemble in some coherent form the fruits of two years' research into the renal handling of calcium and phosphorus.
Open Access
"The porphyrias in South Africa" A study of the excreted porphyrins
(1963) Sweeney, George Douglas
Study of the diseases of porphyrin metabolism has formed a major part of the work of the C.S.I.R.- U.C.T. Renal metabolic Research Group since 1959. The scope of the activities of this Group has been wide; this thesis concerns but one aspect, the excreted porphyrins. This is essentially a laboratory study but it is a study that would have lost much of its significance had it not been closely linked to the clinical studies of other members of the group, in particular Prof. L. Eales. The unit has formed a stimulating environment in which to pursue these investigations and it is a. pleasure to acknowledge the contributions to this thesis of all members of the group.
Open Access
The urological management of children with spinal dysraphism
(1990) Jee, Larry Donald
This project was undertaken with the following aims: 1) To generate a data base concerning the management of children with congenital spinal anomalies, who are known to form a significant proportion of the patients being treated in the Department of Paediatric Urology at Red Cross Hospital. 2) To assess the results of the management of these children, with special attention to the goals of therapy, namely preservation of renal function, establishment of urinary continence and protection from urinary tract infection. 3) To compare the treatment methods and results obtained to those reported in the literature. 4) To evaluate critically the treatment methods and results obtained with a view to identifying areas where improvements are possible.
Open Access
The use of SurgiSIS, an acellular collagen matrix, in endoscopic urethroplasty
(2003) Le Roux, Pieter Johannes; Naudè, JH
To evaluate small intestinal submucosa (SurgiSIS) as a substitute for skin in endoscopic urethroplasty performed as treatment for inflammatory and iatrogenic stricutres of the male bulbar urethra and in the early treatment of bulbumembranous urethral injuries associated with recent pelvic fractures. The tissue integration and epithelialisation of surgiSIS used in endoscopic urethroplasty is assessed. The long term maintenance of urethral patency following this treatment from is assessed.