Diabetic foot ulcers (DFUs) are a serious complication of diabetes that results in significant morbidity and mortality. Mortality rates associated with the development of a DFU are estimated to be 5% in the first 12 months, and 5-year morality rates have been estimated at 42%. The standard practices in DFU management include surgical debridement, dressings to facilitate a moist wound environment and exudate control, wound off-loading, vascular assessment, and infection and glycemic control. These practices are best coordinated by a multidisciplinary diabetic foot wound clinic. Even with this comprehensive approach, there is still room for improvement in DFU outcomes. Several adjuvant therapies have been studied to reduce DFU healing times and amputation rates. We reviewed the rationale and guidelines for current standard of care practices and reviewed the evidence for the efficacy of adjuvant agents. The adjuvant therapies reviewed include the following categories: nonsurgical debridement agents, dressings and topical agents, oxygen therapies, negative pressure wound therapy, acellular bioproducts, human growth factors, energy-based therapies, and systemic therapies. Many of these agents have been found to be beneficial in improving wound healing rates, although a large proportion of the data are small, randomized controlled trials with high risks of bias.

/pdf/update-on-management-of-diabetic-foot-ulcers-3t7shn41st.pdf

Update on management of diabetic foot ulcers.

The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. In conjunction with advice from internal and external reviewers and expert consultants in the field, this update is based on a systematic review of the literature centred on the following: the Population (P), Intervention (I), Comparator (C) and Outcomes (O) framework; the use of the SIGN guideline/Cochrane review system; and the 21 point scoring system advocated by IWGDF/EWMA. This has resulted in 13 recommendations. The recommendation on sharp debridement and the selection of dressings remain unchanged from the last recommendations published in 2016. The recommendation to consider negative pressure wound therapy in post-surgical wounds and the judicious use of hyperbaric oxygen therapy in certain non-healing ischaemic ulcers also remains unchanged. Recommendations against the use of growth factors, autologous platelet gels, bioengineered skin products, ozone, topical carbon dioxide, nitric oxide or interventions reporting improvement of ulcer healing through an alteration of the physical environment or through other systemic medical or nutritional means also remain. New recommendations include consideration of the use of sucrose-octasulfate impregnated dressings in difficult to heal neuro-ischaemic ulcers and consideration of the use of autologous combined leucocyte, platelet and fibrin patch in ulcers that are difficult to heal, in both cases when used in addition to best standard of care. A further new recommendation is the consideration of topical placental derived products when used in addition to best standard of care.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/dmrr.3283

Guidelines on use of interventions to enhance healing of chronic foot ulcers in diabetes (IWGDF 2019 update).

GENERAL PURPOSE:To provide background and examine evidence for the therapeutic application of light energy treatments for wound healing.TARGET AUDIENCE:This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wo

Photobiomodulation Therapy for Wound Care: A Potent, Noninvasive, Photoceutical Approach.

Gender dysphoria is estimated to occur in approximately 25 million people worldwide, and can have severe psychosocial sequelae Medical and surgical gender transition can substantially improve quality-of-life outcomes for individuals with gender dysphoria Individuals seeking to undergo female-to-male (FtM) transition have various surgical options available for gender confirmation, including facial and chest masculinization, body contouring, and genital surgery The World Professional Association for Transgender Health guidelines should be met before the patient undergoes surgery, to ensure that gender-confirming surgery is appropriate and indicated Chest masculinization and metoidioplasty or phalloplasty are the most common procedures pursued, and both generally result in high levels of patient satisfaction Phalloplasty, with a resultant aesthetic and sensate phallus along with implantable prosthetic, can take upwards of a year to accomplish, and is associated with a considerable risk of complications Urethral complications are most frequent, and can be addressed with revision procedures A number of scaffolds, implants, and prostheses are now in development to improve outcomes in FtM patients

An overview of female-to-male gender-confirming surgery

A Multi-institutional Evaluation of the Management and Outcomes of Long-segment Urethral Strictures.

Foot ulcers are serious complications of diabetes mellitus (DM) and are known to be resistant to conventional treatment. This study was conducted to evaluate the efficacy of low-level laser therapy (LLLT) for the treatment of diabetic foot ulcers in a tertiary care centre (Department of Surgery, Mahatma Gandhi Memorial Medical College and Maharaja Yashwantrao Hospital, A.B. Road, Indore). A total of 30 patients with type 2 DM having Meggitt-Wagner grade I foot ulcers of more than 6 weeks duration with negative culture were studied. Patients were randomized into two groups of 15 each. Patients in study group received LLLT (660 ± 20 nm, 3 J/cm2) along with conventional therapy and those in control group were treated with conventional therapy alone. The primary outcome measure was the absolute and relative wound size reduction at 2 weeks compared to the baseline parameter. Percentage ulcer area reduction was 37 ± 9% in the LLLT group and 15 ± 5.4% in the control group (p < 0.001). For ∼75% of wounds of the treatment group, wound area reduction of 30–50% was observed. In contrast, for the control group, ∼80% of wounds showed a wound area reduction of <20% on day 15. Further, the wounds with initial wound area 1000–2000 mm2 seems to have better final outcome than the groups with larger areas. The treated groups showed higher amount of granulation than the control group. The results suggest that LLLT is beneficial as an adjunct to conventional therapy in the treatment of diabetic foot ulcers.

Low-level laser therapy as an adjunct to conventional therapy in the treatment of diabetic foot ulcers

Objective

To determine the overall efficacy and predictors of success of the penile preputial flap in the management of complex urethral strictures >2.5 cm in length.




Patients and Methods

We performed a retrospective and prospective study of 58 patients undergoing single-stage penile preputial flap urethroplasty for complex long-segment urethral strictures, without lichen sclerosus, repaired between May 2005 and April 2012 at our institution.
For obvious reasons circumcised patients were excluded from the study.
Results were assessed by univariate analysis of various patient characteristics, preoperative and postoperative patient satisfaction (based on symptoms), and urethral ultrasonography, retrograde urethrography and uroflowmetry.




Results

The median (range) follow-up was 42 (6–90) months, the median (range) intra-operative stricture length was 48.5 (26–85) mm and the median (range) operating time was 90 (85–125) min.
A total of 87.93% of patients had a satisfactory outcome, with an overall success rate of 81.03%.
Diabetes mellitus (relative risk [RR] 5.21, confidence interval [CI] 2.31–64.68, P = 0.003) and smoking (RR 4.19, CI 1.54– 45.0, P = 0.01) were predictors of failure, while postinfective aetiology (RR 2.19), panurethral stricture (RR 2.73), stricture length >70 mm (RR 3.25), previous urethroplasty (RR 2.4) and severe peri-urethral fibrosis (RR 2.37) were also associated with a higher risk of failure.




Conclusions

A urologist should try to gain experience of all the methods of urethroplasty as the techniques may vary according to the circumstances.
Single-stage preputial skin flap urethroplasty, in experienced and expert hands, has results equivalent to all other methods of urethroplasty in complex urethral strictures.
We prefer this technique in this part of the world where buccal mucosa cannot be used because of dyskeratotic changes as a result of consumption of gutkha, tobacco, pan masala, betel nut.

Single-stage preputial skin flap urethroplasty for long-segment urethral strictures: evaluation and determinants of success.

Background: We describe a technique of U-shaped bulboprostatic anastomosis for urethral injury after pelvic trauma.

Methods:  Sixty-eight male patients were included in our study. Suprapubic cystostomy was carried out initially, followed by U-shaped prostatobulbar anastomosis after 6–12 weeks. Follow ups were carried out at 6, 12 and 18 months by assessing patient satisfaction rates along with preoperative and postoperative urethrogram, uroflowmetry and labelled as good, fair and poor. The surgical technique used was as follows: after an inverted Y-shaped skin incision, subcutaneous tissue and Colle’s fascia was opened. Bulbospongiosum was mobilized to gain access to the stricture membranous urethra, which was excised and the bulbar urethra freed. A sound was passed through the suprapubic cystostomy and complete resection of the scar over the tip of the sound was carried out. A silicon catheter was then passed into the bladder and the anastomosis was completed in a ‘U’ shape; that is, there were no stitches from the 10 to the 2 o’clock position.

Results:  Good and fair results were considered as successful. Overall success rate was 97.05% immediately and after 6 months, but decreased to 95.6% at 12 months and 93.6% at 18 months.

Conclusion:  U-shaped end-to-end prostatobulbar anastomosis markedly decreases the chance of restenosis and impotence.

U-shaped prostatobulbar anastomosis for urethral injury after pelvic trauma.

Aim: The aim of this study is to identify the common urinary problems in Indian females, their etiology and symtomatology. Material and Methods: This is a prospective epidemiological study of 703 female patients with urinary problems, who attended the surgery and gynecology OPD (outpatient department) in our institution which is a tertiary referral centre in central India. Result: 58% of patients were middle age (31 - 55) yrs. Burning micturition was the most common urinary complain (607 patients) followed by increased frequency of micturition (309 patients). 68% females took months or even years to take first consultation after appearance of their symptoms. 14% percent of patients suffered from urinary incontinence (stress, urge and mixed). 86% of women had education level below fifth standard. About 58% of females gave birth to 3 or more than 3 issues. About 254 (36%) patients had one or more unassisted delivery at home. Thirty eight percent of patients still remained undiagnosed. More than 50% of undiagnosed females lie in middle age group. 68% of undiagnosed patients took consultation months or years after their symptoms first appeared. Irritative symptoms are the most common presenting complains of these undiagnosed patients followed by pain in abdomen. Around 60% of patients had history of either mental distress, domestic violence or any neuropschiatric disease. This study only gives us an idea about the urinary problems faced by females and their probable causative factors. Many more studies need to be done involving multidisciplinary approach in order to benefit this section of our society.

/pdf/study-of-common-urinary-problems-of-females-at-a-government-4v522r2b3i.pdf

Study of Common Urinary Problems of Females at a Government Hospital in Central India

This study attempts to identify etiological factors responsible for urinary problems in females presenting to a tertiary setup in Central India. Urethra, being shorter in females than in males, is itself a predisposing factor while wider pelvis in females predisposes to pelvic floor weakness. Hormonal and physiological changes with increasing age predispose to voiding dysfunctions. The prevalence of lower urinary tract symptoms is more in females than in males (3;4). Socioeconomic status and poor urogenital hygiene are also responsible for increased incidence of all urinary problems.

Raj Kumar Mathur

Papers

Low-level laser therapy as an adjunct to conventional therapy in the treatment of diabetic foot ulcers

Single-stage preputial skin flap urethroplasty for long-segment urethral strictures: evaluation and determinants of success.

U-shaped prostatobulbar anastomosis for urethral injury after pelvic trauma.

Study of Common Urinary Problems of Females at a Government Hospital in Central India

Etiological correlation of common urinary problems in females in a tertiary care centre in central India