Sample records for human urethral rhabdosphincter

  1. Neural control of the female urethral and anal rhabdosphincters and pelvic floor muscles (United States)

    de Groat, William C.


    The urethral rhabdosphincter and pelvic floor muscles are important in maintenance of urinary continence and in preventing descent of pelvic organs [i.e., pelvic organ prolapse (POP)]. Despite its clinical importance and complexity, a comprehensive review of neural control of the rhabdosphincter and pelvic floor muscles is lacking. The present review places historical and recent basic science findings on neural control into the context of functional anatomy of the pelvic muscles and their coordination with visceral function and correlates basic science findings with clinical findings when possible. This review briefly describes the striated muscles of the pelvis and then provides details on the peripheral innervation and, in particular, the contributions of the pudendal and levator ani nerves to the function of the various pelvic muscles. The locations and unique phenotypic characteristics of rhabdosphincter motor neurons located in Onuf's nucleus, and levator ani motor neurons located diffusely in the sacral ventral horn, are provided along with the locations and phenotypes of primary afferent neurons that convey sensory information from these muscles. Spinal and supraspinal pathways mediating excitatory and inhibitory inputs to the motor neurons are described; the relative contributions of the nerves to urethral function and their involvement in POP and incontinence are discussed. Finally, a detailed summary of the neurochemical anatomy of Onuf's nucleus and the pharmacological control of the rhabdosphincter are provided. PMID:20484700

  2. Urethritis (United States)

    ... Sensitivity to the chemicals used in spermicides or contraceptive jellies, or foams Sometimes the cause is unknown. Risks for urethritis include: Being a female Being male, ages 20 to 35 Having many sexual partners ...

  3. Urethritis (United States)

    ... urethritis. Organisms—such as Neisseria gonorrhoeae , which causes gonorrhea —can spread to the urethra during sexual intercourse ... Sometimes people have no symptoms. In men, when gonorrhea or chlamydia is the cause, there is usually ...

  4. Electrospun Poly(l-lactide/Poly(ethylene glycol Scaffolds Seeded with Human Amniotic Mesenchymal Stem Cells for Urethral Epithelium Repair

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    Xiaokui Lv


    Full Text Available Tissue engineering-based urethral replacement holds potential for repairing large segmental urethral defects, which remains a great challenge at present. This study aims to explore the potential of combining biodegradable poly(l-lactide (PLLA/poly(ethylene glycol (PEG scaffolds and human amniotic mesenchymal cells (hAMSCs for repairing urethral defects. PLLA/PEG fibrous scaffolds with various PEG fractions were fabricated via electrospinning. The scaffolds were then seeded with hAMSCs prior to implantation in New Zealand male rabbits that had 2.0 cm-long defects in the urethras. The rabbits were randomly divided into three groups. In group A, hAMSCs were grown on PLLA/PEG scaffolds for two days and then implanted to the urethral defects. In group B, only the PLLA/PEG scaffolds were used to rebuild the rabbit urethral defect. In group C, the urethral defect was reconstructed using a regular urethral reparation technique. The repair efficacy was compared among the three groups by examining the urethral morphology, tissue reconstruction, luminal patency, and complication incidence (including calculus formation, urinary fistula, and urethral stricture using histological evaluation and urethral radiography methods. Findings from this study indicate that hAMSCs-loaded PLLA/PEG scaffolds resulted in the best urethral defect repair in rabbits, which predicts the promising application of a tissue engineering approach for urethral repair.

  5. Disposition of the striated urethral sphincter and its relation to the prostate in human fetuses

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    Luciano A. Favorito


    Full Text Available OBJECTIVE: To describe the arrangement of the muscle fibers of the striated urethral sphincter and its relationship with the prostate during the fetal period in humans. MATERIALS AND METHODS: We analyzed 17 prostates from well preserved fresh human fetuses ranging in age from 10 to 31 weeks postconception (WPC. Transversal sections were obtained and stained with Gomori's trichrome and immunolabeled with anti alpha-actin antibody. RESULTS: We found that the urethral striated sphincter (rabdosphincter is located on the periphery of the smooth muscle and there was no merge between striated and smooth muscle fibers in any fetal period. In the prostate apex, the striated sphincter shows a circular arrangement and covers completely the urethra externally, whereas adjacent to verumontanum, it looks like a "horseshoe" and covers only the anterior and lateral surfaces of the urethra. Near the bladder neck, in fetuses younger than 20 WPC, we have found striated muscle fibers only at the anterior surface of the prostate, while in fetuses older than 20 WPC, the striated muscle covers the anterior and lateral surfaces of the prostate. CONCLUSIONS: The urethral sphincter muscle covers the anterior and lateral surfaces of the urethra in all fetuses older than 20 WPC, close to the bladder neck and at the distal prostate. In the region of the prostate apex, the urethral sphincter covers completely the urethra circularly. The knowledge of the normal anatomy of the urethral sphincter in fetuses could be important to understand its alterations in congenital anomalies involving the base of the bladder, the bladder neck and the proximal urethra.

  6. Tissue Engineering for Human Urethral Reconstruction : Systematic Review of Recent Literature

    NARCIS (Netherlands)

    de Kemp, Vincent; de Graaf, Petra; Fledderus, Joost O.; Bosch, JLHR; de Kort, Laetitia


    Background Techniques to treat urethral stricture and hypospadias are restricted, as substitution of the unhealthy urethra with tissue from other origins (skin, bladder or buccal mucosa) has some limitations. Therefore, alternative sources of tissue for use in urethral reconstructions are

  7. Human amniotic fluid stem cell injection therapy for urethral sphincter regeneration in an animal model

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    Kim Bum


    Full Text Available Abstract Background Stem cell injection therapies have been proposed to overcome the limited efficacy and adverse reactions of bulking agents. However, most have significant limitations, including painful procurement, requirement for anesthesia, donor site infection and a frequently low cell yield. Recently, human amniotic fluid stem cells (hAFSCs have been proposed as an ideal cell therapy source. In this study, we investigated whether periurethral injection of hAFSCs can restore urethral sphincter competency in a mouse model. Methods Amniotic fluids were collected and harvested cells were analyzed for stem cell characteristics and in vitro myogenic differentiation potency. Mice underwent bilateral pudendal nerve transection to generate a stress urinary incontinence (SUI model and received either periurethral injection of hAFSCs, periurethral injection of Plasma-Lyte (control group, or underwent a sham (normal control group. For in vivo cell tracking, cells were labeled with silica-coated magnetic nanoparticles containing rhodamine B isothiocyanate (MNPs@SiO2 (RITC and were injected into the urethral sphincter region (n = 9. Signals were detected by optical imaging. Leak point pressure and closing pressure were recorded serially after injection. Tumorigenicity of hAFSCs was evaluated by implanting hAFSCs into the subcapsular space of the kidney, followed two weeks later by retrieval and histologic analysis. Results Flow activated cell sorting showed that hAFSCs expressed mesenchymal stem cell (MSC markers, but no hematopoietic stem cell markers. Induction of myogenic differentiation in the hAFSCs resulted in expression of PAX7 and MYOD at Day 3, and DYSTROPHIN at Day 7. The nanoparticle-labeled hAFSCs could be tracked in vivo with optical imaging for up to 10 days after injection. Four weeks after injection, the mean LPP and CP were significantly increased in the hAFSC-injected group compared with the control group. Nerve regeneration and

  8. Urethral Injuries (United States)

    ... include pelvic fractures and straddle injuries to the perineum. The perineum is the area between the anus and the ... tissues of the penis, scrotum, abdominal wall, or perineum. Complications that can result from urethral injuries include ...


    African Journals Online (AJOL)


    Two (16%) of the 12 patients, had had some form of female genital mutilation. Of the 9 patients that had urine culture in their ... is associated with good outcome. Keywords:Urethral prolapse, children, Female genital mutilation, UTI. Introduction .... Furthermore, the campaign and awareness on the dangers of FGM should be.

  10. Bladder and urethral repair - slideshow (United States)

    ... 100002.htm Bladder and urethral repair - series—Normal anatomy To use the sharing features on this page, ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated: ...

  11. [Association between penoscopy data and urethral cytology among men with partners who had cervical lesions associated with human papilloma virus]. (United States)

    Alarcón-Herrera, América; Cervantes-Sánchez, Abraham; Meneses-Miranda, Teresa; Castillejos-López, Manuel; Astudillo-de la Vega, Horacio; Tena-Suck, Martha Lilia


    The aim of this study was to identify human papillomavirus lesions in a group of men whose sexual partners had cervical intraepithelial lesions associated with low-grade HPV confirmed by PCR-DNA. We carried out a correlation between urethral cytology penoscopy data and PCR-DNA results. We studied 100 male volunteers with an age range of 21-45 (median 30 years) and divided them into two groups according to the identified virus; two groups were conformed, a high risk and a low risk virus. For the penoscopy data we included the following: type of hirsutoide papillomatosis in 40 (40%) cases, common warts in 24 (24%) cases, papillomatosis in plaque in 6 (6%) and 47% displayed an urethra with a foamy appearance. In urethral cytology we did not find evidence of koilocytes in 58% and 42% showed no koilocytes. Inflammation was observed in 44 cases; an added infection was noted among 60 cases. Depending on the type of infection we found non-specific bacteria in 8%, bacillary in 10%, mixed infection in 12%, changes suggestive of Gardnerella vs 24%, and Chlamydia treatment in 6%. Dyskeratosis was noted in 47% of study participants. 67 patients were treated with imiquimod cream 5% and 33% received non-specific treatment. Regarding improvement we noted that 67 (67%) cases showed 46/67 hypochromic stains after treatment with imiquimod. Disappearance of the lesions in the penis were observed among 65 cases and only 35 remained with lesions. Regarding high-risk HPV we found a significant difference in odor (p = .004, phi = .004), urethral discharge (p = .007), pearly papules in raphe (p = .023), with inflammation, dyskeratosis and added infection (p = .000 respectively). We also noted hypochromic spots or skin discoloration after treatment with imiquimod among 5% of subjects (p = .046). In our study we observed that high-risk HPV is associated with increased penile lesions and frank evidence of koilocytes in urethral cytology. We recommend that sexual partners of women with

  12. Smooth Muscle Progenitor Cells Derived From Human Pluripotent Stem Cells Induce Histologic Changes in Injured Urethral Sphincter. (United States)

    Li, Yanhui; Wen, Yan; Wang, Zhe; Wei, Yi; Wani, Prachi; Green, Morgaine; Swaminathan, Ganesh; Ramamurthi, Anand; Pera, Renee Reijo; Chen, Bertha


    : Data suggest that myoblasts from various sources, including bone marrow, skeletal muscle, and adipose tissue, can restore muscle function in patients with urinary incontinence. Animal data have indicated that these progenitor cells exert mostly a paracrine effect on the native tissues rather than cell regeneration. Limited knowledge is available on the in vivo effect of human stem cells or muscle progenitors on injured muscles. We examined in vivo integration of smooth muscle progenitor cells (pSMCs) derived from human pluripotent stem cells (hPSCs). pSMCs were derived from a human embryonic stem cell line (H9-ESCs) and two induced pluripotent stem cell (iPSC) lines. pSMCs were injected periurethrally into urethral injury rat models (2 × 10(6) cells per rat) or intramuscularly into severe combined immunodeficiency mice. Histologic and quantitative image analysis revealed that the urethras in pSMC-treated rats contained abundant elastic fibers and thicker muscle layers compared with the control rats. Western blot confirmed increased elastin/collagen III content in the urethra and bladder of the H9-pSMC-treated rats compared with controls. iPSC-pSMC treatment also showed similar trends in elastin and collagen III. Human elastin gene expression was not detectable in rodent tissues, suggesting that the extracellular matrix synthesis resulted from the native rodent tissues rather than from the implanted human cells. Immunofluorescence staining and in vivo bioluminescence imaging confirmed long-term engraftment of pSMCs into the host urethra and the persistence of the smooth muscle phenotype. Taken together, the data suggest that hPSC-derived pSMCs facilitate restoration of urethral sphincter function by direct smooth muscle cell regeneration and by inducing native tissue elastin/collagen III remodeling. The present study provides evidence that a pure population of human smooth muscle progenitor cells (pSMCs) derived from human pluripotent stem cells (hPSCs) (human

  13. Urethral Plugs in Dogs


    Stiller, A.T.; LULICH, J.P.; Furrow, E.


    Background Crystalline?matrix urethral plugs have not been previously reported in dogs. Hypothesis/Objectives To report the composition of urethral plugs in dogs, describe clinical features of the disease, and identify overrepresented breeds. Methods Retrospective case series. A Minnesota Urolith Center (MUC) record search was performed for urethral plugs in dogs submitted during a 6?year period. The composition of the plugs and signalment of affected dogs were recorded. Breed risk analysis w...

  14. A Giant Urethral Calculus. (United States)

    Sigdel, G; Agarwal, A; Keshaw, B W


    Urethral calculi are rare forms of urolithiasis. Majority of the calculi are migratory from urinary bladder or upper urinary tract. Primary urethral calculi usually occur in presence of urethral stricture or diverticulum. In this article we report a case of a giant posterior urethral calculus measuring 7x3x2 cm in a 47 years old male. Patient presented with acute retention of urine which was preceded by burning micturition and dribbling of urine for one week. The calculus was pushed in to the bladder through the cystoscope and was removed by suprapubic cystolithotomy.

  15. Ultrasound evaluation of the striated urethral sphincter as a predictive parameter of urinary continence after radical prostatectomy

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    Lucio Dell’Atti


    Full Text Available Objectives: The purpose of this study was to evaluate preoperatively the results of transrectal ultrasound (TRUS in the detection of morphological, vascularization status of urethral rhabdosphincter (RS and evaluate the correlation with urinary continence after radical prostatectomy (RP. Methods: 211 patients who underwent RP were prospectively studied using TRUS scan of the RS thickness. At the end of the examination a study was performed with the use of colour-Doppler for the assessment of the RS vascularity pattern. The level of continence was graded on a 5 point scale as: 1 = complete continence, 2 = 1 pad daily, 3 = 2-3 pads daily, 4 = 4 or more pads daily, and 5 = complete incontinence. Results: It was possible to visualize the rhabdosphincter and its vascularity in all patients. Patients with normal continence (level 1 and 2 showed a sphincter-muscle thickness of 3.5 mm (± 0.4 and a hypoechoic ultrasound pattern. With respect to the other levels 3, 4 and 5 of urinary incontinence RS thickness was 2.8 mm (± 0.5, 2.1 mm (± 0.6, 1.7 (± 0.7 respectively. Incontinence after RP (≥ 3 level was associated with urethral sphincter deficiency in the great majority of patients. Statistical significant differences were observed in the vascularity between continent and incontinent men in all measured vascularity variables (p < 0.005. Conclusions: This study suggests that RS integrity is a good predictor of urinary continence after RP and this information can be important during the preoperative phase as part of the informed consent.

  16. False urethral anastomosis

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    M Kumar Prabhu


    Full Text Available We present images of three cases with false urethral anastomosis following urethroplasty. The likely causes are inadequate posterior urethral dissection and blind use of Hey Grove dilator. We recommend use of antegrade flexible cystoscopy to prevent this complication.

  17. Familial bulbar urethral strictures (United States)

    Jindal, Tarun; Pal, Partha; Sinha, Rajan Kumar; Karmakar, Dilip


    Strictures are commonly encountered in the urological practice. The most common aetiologies are infection, trauma and iatrogenic events. Familial occurrence of urethral stricture is exceptionally rare. We present a case in which bulbar urethral strictures developed in a father and his two sons. PMID:24591388

  18. Unusual Giant Prostatic Urethral Calculus

    African Journals Online (AJOL)


    Jun 29, 2010 ... They are typically asymptomatic and may be associated with benign prostatic hyperplasia, and prostatic cancer.[1] Primary prostatic urethral calculi are usually associated with urethral strictures, posterior urethral valve or diverticula. Acute urinary retention might result secondary to a large urethral calculus.

  19. Urethral discharge culture (United States)

    Culture of urethral discharge; Genital exudate culture; Culture - genital discharge or exudate ... 2015:chap 109. Craft AC, Woods GL. Specimen collection and handling for diagnosis of infectious diseases. In: ...

  20. Urethral plugs in dogs. (United States)

    Stiller, A T; Lulich, J P; Furrow, E


    Crystalline-matrix urethral plugs have not been previously reported in dogs. To report the composition of urethral plugs in dogs, describe clinical features of the disease, and identify overrepresented breeds. Retrospective case series. A Minnesota Urolith Center (MUC) record search was performed for urethral plugs in dogs submitted during a 6-year period. The composition of the plugs and signalment of affected dogs were recorded. Breed risk analysis was performed using a control group without plugs from the Veterinary Medical Center, University of Minnesota (VMC UMN). Breed risk was also calculated for a group of dogs with struvite (plugs and uroliths). Medical records for the subset of plug cases from the VMC UMN were reviewed and described. Between 2006 and 2011, 42 urethral plugs from dogs were submitted to the MUC. All came from male dogs, and the mineral component of the majority (83%) was struvite. Thirty (71%) samples were from Pugs. Pugs were overrepresented in plug submissions (OR 179; CI 88-389; P Pugs. None of these cases had bacteriuria or positive urine cultures, and no underlying cause of plug formation was identified. When evaluating dogs with urethral obstruction, plugs need to be considered, especially in male Pugs. Further investigation into the underlying cause of plug formation in dogs is warranted. Copyright © 2014 by the American College of Veterinary Internal Medicine.

  1. The role of membranous urethral afferent autonomic innervation in the continence mechanism after nerve sparing radical prostatectomy: a clinical and prospective study. (United States)

    Catarin, Marcos Vinicius Guarnieri; Manzano, Gilberto Mastrocola; Nóbrega, João A M; Almeida, Fernando G; Srougi, Miguel; Bruschini, Homero


    We evaluated the somatic and autonomic innervation of the pelvic floor and rhabdosphincter before and after nerve sparing radical retropubic prostatectomy using neurophysiological tests and correlated findings with clinical parameters and urinary continence. From February 2003 to October 2005, 46 patients with prostate cancer were enrolled in a controlled, prospective study. Patients were evaluated before and 6 months after nerve sparing radical retropubic prostatectomy using the UCLA-PCI urinary function domain and neurophysiological tests, including somatosensory evoked potential, and the pudendo-urethral, pudendo-anal and urethro-anal reflexes. Clinical parameters and urinary continence were correlated with afferent and efferent innervation of the membranous urethra and pelvic floor. We used strict criteria to define urinary continence as complete dryness with no leakage at all, not requiring any pads or diapers and with a UCLA-PCI score of 500. Patients with a sporadic drop of leakage, requiring up to 1 pad daily, were defined as having occasional urinary leakage. Two patients were excluded from study due to urethral stricture postoperatively. We evaluated 44 patients within 6 months after surgery. The pudendo-anal and pudendo-urethral reflexes were unchanged postoperatively (p = 0.93 and 0.09, respectively), demonstrating that afferent and efferent pudendal innervation to this pelvic region was not affected by the surgery. Autonomic afferent denervation of the membranous urethral mucosa was found in 34 patients (77.3%), as demonstrated by a postoperative increase in the urethro-anal reflex sensory threshold and urethro-anal reflex latency (p motor pudendal innervation to this specific pelvic region did not change after nerve sparing radical retropubic prostatectomy. Significant autonomic afferent denervation of the membranous urethral mucosa was present in most patients postoperatively. Impaired membranous urethral sensitivity seemed to be associated with

  2. Unusual Giant Prostatic Urethral Calculus

    African Journals Online (AJOL)


    Jun 29, 2010 ... associated with benign prostatic hyperplasia, and prostatic cancer.[1] Primary prostatic urethral calculi are ... Giant vesico-prostatic urethral calculus is uncommon. Urethral stones rarely form primarily in the urethra, ... Prostatic calculi associated with hypertrophy of the gland. Group III. Prostatic calculi that ...

  3. Soap induced urethral pain in boys

    African Journals Online (AJOL)

    external urethral meatus before each soap bath satisfactorily controlled the urethral pains. Conclusion: “Idiopathic urethral pain in boys” may be due to soap induced chemical urethritis and responds well to application of bland petroleum jelly to the external urethral meatus before each soap bath with appropriate antibiotics.

  4. Suppression of reflex urethral responses by sacral dermatome stimulation in an acute spinalized feline model (United States)

    Mariano, Timothy Y.; Bhadra, Narendra; Gustafson, Kenneth J.


    Aims Reflex contractions of the external urethral sphincter (EUS) are a major component of voiding dysfunction after neurological injury or disease. Aberrant urethral reflexes can prevent voiding and cause serious medical complications. Characterizing these urethral reflexes during genitourinary studies is necessary for evaluating novel pharmacological or neuroprosthetic approaches. The objectives of the present study were to generate urethral reflexes in the acute spinal feline, to quantify these reflexes, and to suppress them with electrical stimulation of the sacral dermatomes. Methods This study comprised eight male cats. Anaesthesia was maintained with alpha-chloralose or sodium pentobarbital. The spinal cord was transected between T10 and T12, and nerve cuff electrodes were placed on the extradural S2 sacral roots to provide bladder activation. Bladder and urethral pressures were recorded during and after bladder contractions. Electrical stimulation was applied non-invasively to the sacral dermatomes with commercial surface electrodes. Results Urethral reflexes were elicited consistently in six cats. The corresponding urethral pressure spikes were quantified. Putative metrics of urethral reflex activity such as the rate and average magnitude of reflex pressure spikes correlated significantly with standard urodynamic variables. Electrical stimulation of the sacral dermatomes suppressed urethral reflexes in three cats. Conclusions These findings in an acute spinal feline preparation demonstrate a non-invasive means of suppressing undesirable urethral reflexes. Translation of this work to clinical use could improve neuroprostheses for restoring bladder function and enhance treatment of aberrant urethral reflexes in humans. PMID:19283867

  5. Female urethral dilation. (United States)

    Bazi, Tony; Abou-Ghannam, Gael; Khauli, Raja


    The aim of this manuscript is to review the subject of urethral dilation (UD) in female patients and to conduct a critical appraisal of the available evidence for its use. We used an online search of electronic databases. UD has been cited as a treatment option for various conditions that do not share common etiologies and that affect the lower urinary tract in female patients. Outcome measurement was not consistent, even when performed for the same conditions. A total of six randomized controlled trials failed to prove any benefit for UD in repetitive urinary tract infections (UTI), urethral syndrome, and overactive bladder. Conflicting results and diverse opinions have characterized the use of UD until present time. Professional societies are urged to attend to this issue, and to identify possible areas where UD could be potentially investigated.

  6. Anterior Urethral Valves

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    Vidyadhar P. Mali


    Full Text Available We studied the clinical presentation and management of four patients with anterior urethral valves; a rare cause of urethral obstruction in male children. One patient presented antenatally with oligohydramnios, bilateral hydronephrosis and bladder thickening suggestive of an infravesical obstruction. Two other patients presented postnatally at 1 and 2 years of age, respectively, with poor stream of urine since birth. The fourth patient presented at 9 years with frequency and dysuria. Diagnosis was established on either micturating cystourethrogram (MCU (in 2 or on cystoscopy (in 2. All patients had cystoscopic ablation of the valves. One patient developed a postablation stricture that was resected with an end-to-end urethroplasty. He had an associated bilateral vesicoureteric junction (VUJ obstruction for which a bilateral ureteric reimplantation was done at the same time. On long-term follow-up, all patients demonstrated a good stream of urine. The renal function is normal. Patients are continent and free of urinary infections. Anterior urethral valves are rare obstructive lesions in male children. The degree of obstruction is variable, and so they may present with mild micturition difficulty or severe obstruction with hydroureteronephrosis and renal impairment. Hence, it is important to evaluate the anterior urethra in any male child with suspected infravesical obstruction. The diagnosis is established by MCU or cystoscopy and the treatment is always surgical, either a transurethral ablation or an open resection. The long-term prognosis is good.

  7. [Urethral substitution with synthetic material]. (United States)

    Da Silva, E A; Zungri Telo, E


    In spite of the numerous surgical techniques described, management of urethral stenosis continues to be an unresolved problem. Free graft urethroplasty is indicated in selected cases and several organic and synthetic materials have been described for this use. Our group reviews the synthetic alloplasts used for partial or total replacement of the male urethra. The search for an appropriate alloplast for urethral replacement has been rather frustrating. Complication rates are still too high to allow routine usage. The most encouraging results are those with new absorbable materials which cause minimal inflammatory reactions of a foreign body type. These are readily available and allow urethral replacement using tissues regenerated from removed ends.

  8. Urethritis due to Corynebacterium glucuronolyticum. (United States)

    Galan-Sanchez, Fátima; Aznar-Marin, Pilar; Marin-Casanova, Pilar; Garcia-Martos, Pedro; Rodriguez-Iglesias, Manuel


    We describe a case of urethritis in a young man caused by Corynebacterium glucuronolyticum. This bacterium is a synonym of Corynebacterium seminale, a known agent of non-gonococcal urethritis, that cannot be regarded as commensal flora in the urogenital region when is isolated in a symptomatic clinical context. Accuracy in diagnosis and correct treatment is important for avoiding probable complications, for example prostatitis. Bacterial isolation is convenient, and an antimicrobial susceptibility test should be conducted to discover antimicrobial resistance. In our case the patient was successfully treated with fluoroquinolones and was symptom-free in 2 weeks.

  9. Biodegradable urethral stent in the treatment of post-traumatic urethral strictures in a war wound rabbit urethral model

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    Fu Weijun [Department of Urology, Chinese People' s Liberation Army General Hospital, Military Postgraduate Medical College, No.28 Fuxing Road, Hai dian District, Beijing 100853 (China); Zhang Binghong [Department of Urology, Chinese People' s Liberation Army General Hospital, Military Postgraduate Medical College, No.28 Fuxing Road, Hai dian District, Beijing 100853 (China); Gao Jiangping [Department of Urology, Chinese People' s Liberation Army General Hospital, Military Postgraduate Medical College, No.28 Fuxing Road, Hai dian District, Beijing 100853 (China); Hong Baofa [Department of Urology, Chinese People' s Liberation Army General Hospital, Military Postgraduate Medical College, No.28 Fuxing Road, Hai dian District, Beijing 100853 (China); Zhang Lei [Department of Urology, Chinese People' s Liberation Army General Hospital, Military Postgraduate Medical College, No.28 Fuxing Road, Hai dian District, Beijing 100853 (China); Yang Yong [Department of Urology, Chinese People' s Liberation Army General Hospital, Military Postgraduate Medical College, No.28 Fuxing Road, Hai dian District, Beijing 100853 (China); Meng Bo [Biomaterials Lab, School of Materials Science and Engineering, Tsinghua University, Beijing (China); Zhu Ning [Biomaterials Lab, School of Materials Science and Engineering, Tsinghua University, Beijing (China); Cui Fuzhai [Biomaterials Lab, School of Materials Science and Engineering, Tsinghua University, Beijing (China)


    To prevent terrorism during anti-terror war, we developed a reproducible animal model for the induction of a urethral stricture in a war wound rabbit, and to evaluate the feasibility and effect of using a biodegradable urethral stent in the prophylaxis and treatment of urethral strictures in a war wound (or traumatic) rabbit urethral model. The urethral stricture rabbit model was successfully performed by a self-control explosion destructor. New biodegradable urethral stents were placed in the urethras of 20 war wound (traumatic) rabbits, but no stent was used in the 8 rabbits which formed the control group. Follow-up investigation included assessment of procedure success, stent changes, urethrascopy and retrograde urethrography, and histological findings were obtained after sacrifice at 4, 6, 8 and 12 weeks after stent placement. The urethral stricture model owing to a war wound (trauma) was tested by tissue reactions and urethroscopy. The length of the urethral strictures was 5-10 mm; the coarctatetion of the urethral lumen was more than 50%. Biodegradable stent placement was technically successful in 20 rabbits. Urethral specimens obtained from the 4 week stent placement group showed diminished inflammatory cell infiltration and decreased thickness of the papillary projections of the epithelium. There was a strong tendency towards regression of the papillary projections and regeneration of urethral mucosa epithelium in the 8 week group. In particular, the injured urethra has recovered completely in the biodegradable stent groups compared with the control group at 12 weeks. The biodegradable urethral stent seems feasible for treating and preventing urethral strictures owing to a war wound (or traumatic) urethra. There are distinct advantages in terms of safe, effective and less-invasive treatment for the reconstruction of post-traumatic urethral strictures.

  10. Unusual giant prostatic urethral calculus | Bello | Journal of Surgical ...

    African Journals Online (AJOL)

    Giant vesico-prostatic urethral calculus is uncommon. Urethral stones rarely form primarily in the urethra, and they are usually associated with urethral strictures, posterior urethral valve or diverticula. We report a case of a 32-year-old man with giant vesico-prostatic (collar-stud) urethral stone presenting with sepsis and ...

  11. Prevalence and morbidity of urethral Trichomonas vaginalis in Japanese men with or without urethritis. (United States)

    Seike, Kensaku; Maeda, Shin-Ichi; Kubota, Yasuaki; Tamaki, Masayoshi; Yasuda, Mitsuru; Deguchi, Takashi


    Trichomonas vaginalis is one of the pathogens causing sexually transmitted infections. This microorganism is a common pathogen among women, but its significance as a cause of morbidity among men remains uncertain. We sought to determine the prevalence and morbidity of T. vaginalis infection in Japanese men with and without urethritis. We examined urine specimens from 215 men with urethritis and 98 men without urethritis for the presence of urethral T. vaginalis by PCR assay. Only four patients-one with gonococcal urethritis, one with non-gonococcal chlamydial urethritis, one with non-gonococcal non-chlamydial urethritis and one without urethritis-were positive for T. vaginalis. The prevalence of T. vaginalis was 1.4% in men with urethritis and 1.0% in men without urethritis. A possible relation between the appearance of T. vaginalis and clinical symptoms was not confirmed. In the present study, the incidence of urethral T. vaginalis infection appears to be rare in Japanese men with or without urethritis, and T. vaginalis may be an uncommon pathogen in male urethritis in Japan.

  12. Familial recurrence of urethral stenosis/atresia. (United States)

    Siebert, Joseph R; Walker, Martin P R


    We report the familial recurrence of urethral stenosis/atresia in two sibling fetuses with bladder outlet obstruction, severe oligohydramnios, and pulmonary hypoplasia. Urethral obstruction in the fetus, when severe, results in a dilated urinary bladder (megacystis) and associated urinary anomalies (hydroureter, hydronephrosis, renal dysplasia). Distention of the fetal abdomen, the result of megacystis or urinary ascites, leads to stretching and eventually hypoplasia or even absence of abdominal muscles. This constellation of findings, known by a variety of terms including "prune belly" syndrome, is associated with a variety of urethral changes, including posterior urethral valves and urethral stenosis/atresia. One fetus manifested unilateral postaxial polydactyly of the left hand. A microdeletion of 6p25.3, identified in mother and one fetus, is not associated with a gene known to be involved in urethral development and therefore of unknown significance. (c) 2009 Wiley-Liss, Inc.

  13. Gonococcal urethritis due to fellatio. (United States)

    Soendjojo, A


    Of 609 male patients seen for sexually transmitted disease, 94 (15.4%) admitted to having had orogenital intercourse; 30 (5%) had practiced it during their last contact. Ten of the 30 patients admitting to fellatio during their last exposure had gonococcal urethritis. Three of these men practiced fellatio exclusively with prostitutes, and their cases demonstrate the inherent risk of oral-to-genital transfer of sexually transmitted disease. All three patients responded favorably to therapy with ampicillin and probenecid.

  14. Editorial comment on “Etiology of male urethral strictures ...

    African Journals Online (AJOL)

    Etiology of male urethral strictures—Evaluation of temporal changes at a single center, and review of the literature”. Guido Barbagli. ∗. Professor of Urology, Head of the Center for Reconstructive Urethral Surgery. Center for Reconstructive Urethral ...

  15. A Method for Recording Urethral Pressure Profiles in Female Rats.

    Directory of Open Access Journals (Sweden)

    Shengfei Xu

    Full Text Available Urethral pressure profile (UPP and leak-point pressure (LPP measurements as well as external urethral sphincter (EUS electromyography (EMG and videourodynamic analyses are the primary methods for evaluating urethral function in humans. However, UPP recording in female rats, a widely used animal model, is challenging due to their small body sizes. This study reports a novel method for recording UPP in female rats.Seventeen anesthetized female rats were studied. LPP data for 14 rats were included. The other 3 rats were excluded because of death or abnormal urogenital organs. UPP curves were recorded using a modified water-perfusion catheter system, with the lateral hole facing the 3-, 6-, 9-, and 12-o'clock positions in a randomized sequence. LPP, functional urethral length (FUL and maximum urethral closure pressure (MUCP were analyzed.The mean LPP was 64.39 ± 20.29 cm H2O. The mean FUL and MUCP values at the 3-, 6-, 9-, and 12-o'clock positions were 12.90 ± 1.20, 16.70 ± 1.95, 13.90 ± 2.42, and 11.60 ± 0.97 mm, respectively, and 38.70 ± 11.85, 33.90 ± 11.82, 37.40 ± 11.95, and 71.90 ± 23.01 cm H2O, respectively. The FUL at the 6-o'clock position and MUCP at the 12-o'clock position were significantly greater than those at the other 3 positions. The FUL and MUCP of repeated UPP recordings were not significantly different than those of the first recordings.UPP recording using a modified method based on a water-perfusion catheter system is feasible and replicable in female rats. It produces UPP curves that sensitively and appreciably reflect detailed pressure changes at different points within the urethra and thus provides opportunity to evaluate urethral structures, especially the urethral sphincter, in detail. These results may enhance the utility of female rat models in research of urinary sphincter mechanisms.

  16. Autologous Bone Marrow-Derived Cells Regenerate Urethral Sphincters. (United States)

    Imamura, Tetsuya; Ishizuka, Osamu; Nishizawa, Osamu


    Regenerative medicine based on tissue engineering and/or stem cell therapy techniques has the potential to improve irreversibly damaged tissues. Surgical injury to the lower urinary tract can occur as a result of radical prostatectomy or bladder neck surgery. Regeneration of urethral sphincters could be an effective treatment for post-surgical intrinsic sphincter deficiency (ISD)-related urinary incontinence. The replacement, enhancement, and/or recovery the urethral sphincter striated and smooth muscles could increase urethral closure pressure to help patients regain continence. Stem cells from muscle-derived satellite or adipose-derived mesenchymal cells provide temporary improvement in urethral closure pressure but do not reconstruct the muscle layer structures. Our strategy to accomplish regeneration of urethral sphincters is the utilization of autologous bone marrow-derived cells. We have developed a freeze injury model of ISD in rabbits. Freezing of the urinary sphincter causes loss of the majority of striated and smooth muscle cells, and causes a significant decrease in leak point pressure. In this review, we show that the autologous bone marrow-derived cells implanted within the freeze-injured sphincters differentiate into striated or smooth muscle cells. These cells then develop to reconstitute muscle layer structures within the sphincter. Furthermore, the leak point pressure of cell-implanted rabbits is significantly higher than that of cell-free injected controls. We conclude that implantation of autologous bone marrow-derived cells could be an effective treatment for human post-surgical ISD-related urinary incontinence. © 2012 Blackwell Publishing Asia Pty Ltd.

  17. Bladder exstrophy associated with complete urethral duplication ...

    African Journals Online (AJOL)

    J.E. Mensah · Case report. Bladder exstrophy associated with complete urethral duplication: Bladder can be augmented with dorsal urethral mucosa. J.E. Mensaha,∗. , K.N. Ampadua, M.Y. Kyeia, B. Edusieb.

  18. Hydraulic urethral dilatation after optical internal urethrotomy ...

    African Journals Online (AJOL)

    Objectives: To determine the rate of early recurrence of urethral stricture in the first six months in patients who perform hydraulic urethral dilatation(HUD) after optical internal urethrotomy (OIU) and compare the early recurrence Fate in patients who perform HUD after OIU with the recurrence rates in patients reported in the ...

  19. Anterior urethral diverticulum: A rare presentation

    Directory of Open Access Journals (Sweden)

    Annavarupu Gopalkrishna


    Full Text Available Congenital anomalies of the urogenital tract are the most common anomalies found in the foetus, neonates and infants, but anterior urethral valves and diverticula are rare. Here, we present a case with congenital anterior urethral diverticulum associated with patent ductus arteriosus and polydactyly.

  20. Podophyllin induced urethral stricture in a young Nigerian male

    African Journals Online (AJOL)

    P.O. Areo

    2015 Pan African Urological Surgeons' Association. Production and hosting by Elsevier B.V. All rights reserved. Introduction. Urethral stricture is an abnormal narrowing or loss of distensi- bility due to fibrosis in the peri-urethral tissues. Common causes include gonococcal urethritis, urethral injury from instrumentation,.

  1. Multiple Urethral Stones Causing Penile Gangrene

    Directory of Open Access Journals (Sweden)

    Michael J. Ramdass


    Full Text Available Penile urethral stones are a rare occurrence resulting from a number of causes including migration of stones within the urinary tract, urethral strictures, meatal stenosis, and obstructing tumours such as adenomatous metaplasia of the uroepithelium, hypospadias, urethral diverticulum, and very rarely primary fossa navicularis calculi. We report the case of a 54-year-old male presenting with penile gangrene and sepsis resulting from impaction of multiple stones within the penile urethra. This paper summarises the topic and discusses the pathophysiology of this unusual condition.

  2. Primary urethral reconstruction results in penile fracture. (United States)

    Barros, R; Silva, Mis; Antonucci, V; Schulze, L; Koifman, L; Favorito, L A


    Objective This study assessed primary urethral reconstruction results in patients with a penile fracture. Materials and methods Between January 2005 and April 2016, patients who underwent primary urethral reconstruction due to penile fracture were called for a follow-up. Epidemiological and clinical presentation data and operative findings were reviewed retrospectively. Partial urethral lesions were primarily treated with interrupted absorbable sutures over urethral catheter. In cases of complete urethral lesion, tension-free end-to-end anastomosis was performed. From the third month after surgery, all patients were interviewed using the International Prostate Symptom Score questionnaire and uroflowmetry. Retrograde urethrocystography was used in patients with urinary symptoms or altered uroflowmetry to rule out or confirm urethral stenosis. Results Of 175 patients with penile fractures, 27 (15.4%) had associated urethral injury. All patients were diagnosed with penile fracture by means of clinical history and physical examination. No subsequent examinations were conducted. Ages varied from 30 years to 58 years old (mean 39.2 years). All fractures resulted from sexual activity. Reported sexual positions were 'doggy style' position in eight cases (61.5%) and with the 'man on top' in five cases (38.4%). Ten patients (76.9%) experienced haematuria, ten (76.9%) had urethral bleeding and four (30.7%) suffered urinary retention. Unilateral and bilateral injury of the corpus cavernosum was observed in four (30.7%) and nine (69.2%) patients, respectively; partial injury was found in nine cases (69.3%) and complete urethral injury was noticed in four cases (30.7%). All cases of complete urethral injury were associated with bilateral lesion of the corpus cavernosum. Six patients who had uroflowmetry with maximum urinary flow rate below 15 ml/s and/or had IPSS above 7 underwent retrograde urethrocystogram, and this was normal in all cases, excluding the possibility of

  3. Urethral Strictures and Artificial Urinary Sphincter Placement. (United States)

    Myers, Jeremy B; Brant, William O; Hotaling, James N; Lenherr, Sara M


    Patients undergoing artificial urinary sphincter (AUS) placement often have complex medical and surgical histories, such as radical prostatectomy, endoscopic treatment of urethral strictures, previous AUS placement, and prior open urethral surgery. Urethral strictures at the bladder neck, membranous urethra, or site of a previous AUS erosion are problems that profoundly affect the timing and treatment success of AUS placement. Understanding the complexities and outcomes in this subset of patients is the only way to inform shared decision making about treatment of urinary incontinence. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Urethral syndrome” in women

    Directory of Open Access Journals (Sweden)

    Sławomir Dutkiewicz


    Full Text Available A contemporary overview of knowledge is presented on the subject of the so-called urethral syndrome in women, the causes of which have yet to be clearly identified. For practical reasons, the following three forms of the syndrome have been distinguished: interstitial cystitis, the “infectious” form and the “clean” form. In women who do not show symptoms of inflammation of the reproductive organs, bacterial urethritis should be distinguished from the urethral syndrome by evaluating the symptoms, the bacteriological tests and the risk of infection.

  5. Posterior Urethral Valves with Severe Unilateral Vesicoureteral ...

    African Journals Online (AJOL)


    Aug 10, 2004 ... urinary catheter drainage, with no pedal oedema. There ... In patients with posterior urethral valves (PUV), severe unilateral vesicoureteral reflux (VUR) is one ... evaluation of urinary tract infection (UTI), voiding dysfunction, or ...

  6. Acute urethritis caused by Neisseria meningitidis. (United States)

    Kanemitsu, Noriyuki; Hayashi, Issei; Satoh, Nodoka; Hayakawa, Takahiro; Mitsuya, Hideo; Hayase, Yosimasa; Hiramoto, Ken; Kojima, Munekado


    A 48-year-old heterosexual Japanese man visited the outpatient clinic of Nagoya Urology Hospital, complaining of burning pain at voiding and pus discharge from the urethral orifice. These symptoms appeared the day following oral-genital contact (fellatio) with a commercial sex worker. On the basis of the presumptive clinical diagnosis of gonorrhea because of the microscopic detection of diplococci in the urethral discharge, he was treated with levofloxacin (300 mg per day) for 7 days. His symptoms responded quickly and urinalysis taken 7 days later was normal. Microbiological examinations isolated Neisseria meningitidis in the urethral discharge by culture with the use of enzymatic profiles. Further prevalence of sexually transmitted diseases (STD) through oral-genital contact would lead to an increase in meningococcal urethritis.

  7. Current management of urethral stricture disease

    Directory of Open Access Journals (Sweden)

    Thomas G Smith


    Conclusions: Progress is being made toward consistent terminology, and nomenclature which will, in turn, help to standardize treatment within the field of urology. Treatment for urethral stricture and stenosis remains inconsistent between reconstructive and nonreconstructive urologists due to varying treatment algorithms and approaches to disease management. Tissue engineering appears to be future for reconstructive urethral surgery with reports demonstrating feasibility in the use of different tissue substitutes and grafts.

  8. Transperineal Ultrasonographic findings of female urethral diverticulum

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Jin Han; Koo, Bong Sik; Nam, Ki Dong; Choi, Jong Cheol; Park, Byeong Ho; Nam, Kyung Jin; Kweon, Heon Young [Dong-A University College of Medicine, Pusan (Korea, Republic of)


    The purpose of the study was to explore the role of sonography for women with a suspected urethral diverticulum and to evaluate the transperineal ultrasonographic findings of female urethral diverticulum. Eight women (mean age, 44 years) who presented with urethral symptoms and clinically suspected urethral diverticula underwent transperineal ultrasonography; sagittal and coronal images were obtained. Sonography was done with either a 7-5 MHz curved array transducer or 10-5 MHz linear transducer, placed on the perineum at the level of the urethra. Ultrasonograms were assessed for the presence, size, location, shape, echogenicity, and septum. Five patients underwent voiding cystourethrography (VCUG). Results of the sonograms and VCUGs were compared with each other and with surgical findings. Longitudinally, all lesions were located in a middle third of the urethra. In axial plane, 4 diverticula wrapped around 50-100% of the urethra. 3 cases located posteriorly, and 1 case laterally. Seven diverticula contained echogenic debris. Three cases have septa in the diverticulum. The outer margin of the diverticula was smooth in 2 patients and was lobulated in 6 patients. In 3 of 5 cases who underwent VCUG, diverticula were filled with contrast, and appeared to be smaller than those of ultrasonography. In addition, all were single diverticulum in VCUG. Most urethral diverticulum were located in a middle third of the urethra, wrapped around the urethra or round posteriorly. Many cases appear unilocular or multilocular with echogenic debris. Transperineal ultrasonography is easy to operate and accurate for showing urethral diverticulum, and it may be useful for diagnosing this group of women with urethral symptoms and suspected urethral diverticulum. It provides information on the extent and location of the diverticulum, which are important in surgical excision.

  9. Total bladder and posterior urethral reconstruction: salvage technique for defunctionalized bladder with recalcitrant posterior urethral stenosis. (United States)

    Patil, Mukul B; Hannoun, Donald; Reyblat, Polina; Boyd, Stuart D


    Recalcitrant posterior urethral stenosis is a challenging disease. When combined with a defunctionalized bladder, cutaneous urinary diversion is the most common surgical option. We present a novel technique of total lower urinary tract reconstruction, combining salvage cystectomy, ileal neobladder formation and urethral pull-through, as an orthotopic alternative in patients with a defunctionalized bladder and recalcitrant posterior urethral stenosis. We completed a retrospective review of 8 patients who underwent salvage cystectomy, orthotopic ileal neobladder formation and urethral pull-through. Artificial urinary sphincter placement was performed in a staged fashion. Six patients received prostate cancer treatment including radiation therapy, 1 had urethral disruption after robotic radical prostatectomy, and 1 experienced bladder rupture and urethral distraction injury during a motorcycle accident. Patient demographics, operative variables and postoperative outcomes were examined. No high grade complications were observed after salvage cystectomy, orthotopic neobladder formation and urethral pull-through. After staged artificial urinary sphincter placement, a median of 2 revision surgeries (range 0 to 4) was required to establish social continence. All patients maintained functional urinary storage, urethral patency and social continence at a median followup of 58 months. No patient had complications related to orthotopic neobladder formation, including ureteroileal anastomotic stricture or pyelonephritis, and no patient required cutaneous diversion. Total lower urinary tract reconstruction with cystectomy, ileal neobladder formation and urethral pull-through offers an orthotopic alternative for patients with recalcitrant posterior urethral stenosis and defunctionalized bladders. Although it requires staged placement of an artificial urinary sphincter, this approach can offer functional urinary storage, durable urethral patency and avoidance of cutaneous urinary

  10. Chlamydia trachomatis in non-specific urethritis. (United States)

    Terho, P


    Chlamydia trachomatis was isolated from 58.5% of 159 patients with non-specific urethritis (NSU) using irradiated McCoy cell cultures. Patients with persistent Chlamydia-positive NSU remained Chlamydia-positive each time they were examined before treatment and patients with Chlamydia-negative NSU remained Chlamydia-negative during the course of the illness. Neither the duration of symptoms of urethritis nor a history of previous urethritis affected the chlamydial isolation rate significantly. Of 40 patients with severe discharge 30 (75%) harboured C. trachomatis. One-third of the Chlamydia-positive patients had a severe urethral discharge, while this was present in only 15% of Chlamydia-negative patients. Complications--such as conjunctivitis, arthritis, and epididymitis--were more severe in men with Chlamdia-positive NSU than in those with Chlamydia-negative NSU. Of 64 men matched for sexual promiscuity but without urethritis, none harboured C. trachomatis in his urethra. This differs significantly (P less than 0.001) when compared with patients with NSU. C. trachomatis was isolated from the urogenital tract in 24 (42%) out of 57 female sexual contacts of patients with NSU. The presence of C. trachomatis in the women correlated significantly (P less than 0.001) with the isolation of the agent from their male contacts. These findings give further evidence for the aetiological role of C. trachomatis in non-specific urethritis and its sexual transmission. PMID:678958

  11. Radiological findings of congenital urethral valves

    Energy Technology Data Exchange (ETDEWEB)

    Yeon, Kyung Mo; Kook, Shin Ho [Seoul National University College of Medicine, Seoul (Korea, Republic of)


    Congenital urethral valve is the common cause of hydronephrosis in newborn infants and the most common cause of bladder outlet obstruction in male children. We reviewed and analysed radiological findings and associated anomalies of 16 cases of congenital urethral valve which were examined during the period from January 1985 to December 1989. The most frequent age was under one year old (56%). The main symptoms were urinary dribbing (37.5%), weak stream (25%) and urinary frequency and incontinence (25%). Anterior urethral valve (AUV) was 5 cases (31%) and posterior urethral valve (PUV) was 11 cases(69%), in which 10 cases were Type I and one case was Type III. Bladder wall thickening was seen in all cases and its severity was partly correlated with the degree of vesicoureteral reflux (VUR). VUR was observed in 12 cases (75%), and relatively severe in older age group. The degree of VUR was milder in AUV than PUV. Hydronephrosis was more severe in PUV than in anterior one, and its degree was correlated with the severity of VUR. Associated anomalies were ectopic urethral opening (2 cases), PDA (1 case), congenital megacolon (1 case) and patent urachus (1 case) in PUV. So early diagnosis and treatment of congenital urethral valve is essential to the prevention of renal damage.

  12. Safer urethral catheters: how study of catheter balloon pressure and force can guide design. (United States)

    Wu, Alex K; Blaschko, Sarah D; Garcia, Maurice; McAninch, Jack W; Aaronson, David S


    To better define urethral catheter balloon pressures and extraction forces during traumatic placement and removal of urethral catheters. To help guide design for safer urethral catheters. Measurements of balloon pressure were made upon filling within the urethra vs the bladder. Extraction forces were measured upon removal of a catheter with a filled balloon from the bladder. Models for the bladder and urethra included an ex vivo model (funnel, 'bladder', attached to a 30 F tube, 'urethra') and fresh human male cadavers. The mean (SEM) balloon pressures and extraction forces were calculated. In the ex vivo model, the mean (SEM) pressures upon filling the balloon with 10 mL were on average three-times higher within the ex vivo'urethra' (177 [6] kPa) vs 'bladder' (59 [2] kPa) across multiple catheter types. In the human cadaver, the mean balloon pressure was 1.9-times higher within the urethra (139 [11] kPa) vs bladder (68 [4] kPa). Balloon pressure increased non-linearly during intraurethral filling of both models, resulting in either balloon rupture (silicone catheters) or 'ballooning' of the neck of the balloon filling port (latex catheters). Removal of a filled balloon per the ex vivo model 'urethra' and cadaveric urethra, similarly required increasing force with greater balloon fill volumes (e.g. 9.34 [0.44] N for 5 mL vs 41.37 [8.01] N for 10 mL balloon volume). Iatrogenic complications from improper urethral catheter use is common. Catheter balloon pressures and manual extraction forces associated with urethral injury are significantly greater than those found with normal use. The differences in pressure and force may be incorporated into a safer urethral catheter design, which may significantly reduce iatrogenic urethral injury associated with catheterization. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  13. Urethralism concomitant with amphetamine abuse

    Directory of Open Access Journals (Sweden)

    Bang-Ping Jiann


    Full Text Available Urethralism is a paraphilia disorder in which a person exhibits the habitual self-insertion of a foreign body into the urethra to achieve sexual gratification. We report a patient who habitually inserted a foreign body into his urethra and abused amphetamines to cope with stress. A 48-year-old man presented at the emergency room because of urine leakage from the penile base. Prior to this incident, he had been admitted to hospital 10 times from 2000 to 2005 for the removal of foreign bodies from the lower urinary tract. The patient also reported repeatedly inhaling a high dose of amphetamine to reach a “high” status prior to inserting a foreign body into his urethra. After the successful removal of the foreign bodies, the patient was referred to a psychiatrist for management in coping with stress and illicit drug withdrawal. Psychiatric support and treatment appeared to have a beneficial effect on his sexual behavior. In the management of a case involving recurrent insertion of a foreign body into the lower urinary tract, clinicians should enquire about a history of drug abuse and consult the psychiatry department regarding stress management and drug abstinence.

  14. Urethral pressure reflectometry in women with pelvic organ prolapse

    DEFF Research Database (Denmark)

    Khayyami, Yasmine; Lose, Gunnar; Klarskov, Niels


    INTRODUCTION AND HYPOTHESIS: The mechanism of continence in women with pelvic organ prolapse (POP) before and after surgery remains unknown. Urethral pressure reflectometry (UPR) separates women with stress urinary incontinence (SUI) from continent women by measuring urethral opening pressure...

  15. Minimally invasive surgical approach to treat posterior urethral diverticulum (United States)

    Alsowayan, Ossamah; Almodhen, Fayez; Alshammari, Ahmed


    Urethral diverticulum is a localized saccular or fusiform out-pouching of the urethra. It may occur at any point along the urethra in both male and females. Male urethral diverticulum is rare, and could be either congenital or acquired, anterior or posterior. The mainstay treatment of posterior urethral diverticulum (PUD) is the open surgical approach. Here we discuss our minimally invasive surgical approach (MIS) in managing posterior urethral diverticulum. PMID:25834967

  16. Minimally invasive surgical approach to treat posterior urethral diverticulum

    Directory of Open Access Journals (Sweden)

    Ossamah Alsowayan


    Full Text Available Urethral diverticulum is a localized saccular or fusiform out-pouching of the urethra. It may occur at any point along the urethra in both male and females. Male urethral diverticulum is rare, and could be either congenital or acquired, anterior or posterior. The mainstay treatment of posterior urethral diverticulum (PUD is the open surgical approach. Here we discuss our minimally invasive surgical approach (MIS in managing posterior urethral diverticulum.

  17. Minimally invasive surgical approach to treat posterior urethral diverticulum


    Ossamah Alsowayan; Fayez Almodhen; Ahmed Alshammari


    Urethral diverticulum is a localized saccular or fusiform out-pouching of the urethra. It may occur at any point along the urethra in both male and females. Male urethral diverticulum is rare, and could be either congenital or acquired, anterior or posterior. The mainstay treatment of posterior urethral diverticulum (PUD) is the open surgical approach. Here we discuss our minimally invasive surgical approach (MIS) in managing posterior urethral diverticulum.

  18. The detection of microorganisms related to urethritis from the oral cavity of male patients with urethritis. (United States)

    Le, Phuong Thi; Hamasuna, Ryoichi; Matsumoto, Masahiro; Furubayashi, Keiichi; Hatanaka, Masayuki; Kawai, Shuichi; Yamaguchi, Takamasa; Uehara, Kazutaka; Murakami, Norihiko; Yoshioka, Masaru; Nakayama, Ken; Shiono, Yutaka; Muraoka, Keisuke; Suzuki, Masahiko; Fujimoto, Naohiro; Matsumoto, Tetsuro


    To investigate the presence of microorganisms related to urethritis in the oral cavity of male patients with urethritis and the efficacies of antimicrobials for urethritis on microorganisms in the oral cavity. Ninety-two male patients with urethritis and 17 male controls participated to this study at 12 urology clinics in Japan between March 2014 and March 2015. The first voided urine (FVU) and oral wash fluid (OWF) specimens were collected from the participants. The microorganisms in both FVU and OWF specimens were detected by nucleic acid amplification tests at the first and follow-up visit. The efficacies of antimicrobials were evaluated after 1-4 weeks treatment completion. In a total of 92 male patients with urethritis, Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum, Ureaplasma parvum, Trichomonas vaginalis and Gardnerella vaginalis were detected from OWF specimens of 12%, 3%, 9%, 0%, 12%, 3%, 3% and 15% patients, respectively. From control males, no microorganism was detected from OWF specimens. Among 46 patients who could be evaluated for antimicrobial efficacies at the follow-up visit, 5 in FVU specimens failed by azithromycin (AZM), and 10 failed in OWF specimens (7 by AZM, 2 by tetracycline, 1 by spectinomycin; p = 0.002). Especially, a high prevalence of G. vaginalis remained positive after treatment for urethritis in the oral cavity. Microorganisms related to urethritis were detected in the oral cavity of male patients with urethritis. Antimicrobials that focused on urethritis, especially AZM regimen seem to be less effective for microorganisms in the oral cavity. Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  19. Urethral catheterization:The need for adequate undergraduate ...

    African Journals Online (AJOL)

    E.V. Ezenwa


    Dec 26, 2016 ... The component of the questionnaire included questions on knowledge of urethral catheterization procedure and ... Table 1. Response to questions on the steps of the procedure. Steps of the procedure assessed ... In a polish study [4], 32.9% of urethral trauma was associated with urethral catheterization, ...

  20. Childhood urethral mucosa prolapse in Port Harcourt, Nigeria: An 11 ...

    African Journals Online (AJOL)

    Background: Childhood urethral mucosal prolapse occurs in girls between the ages of six months and eight years. It can be associated with significant morbidity with resultant urethral loss especially with poor management. Objectives: To review our experiences of managing urethral mucosal prolapse in children over an ...

  1. 21 CFR 876.4590 - Interlocking urethral sound. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Interlocking urethral sound. 876.4590 Section 876...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4590 Interlocking urethral sound. (a) Identification. An interlocking urethral sound is a device that consists of two metal sounds...

  2. Post-TURP obliterative urethral stricture: Unusual treatment and ...

    African Journals Online (AJOL)


    [8] Shanberg A, Bagholassarian R, Tansey L, Sawyer D. KTP 532. Laser in the treatment of urethral strictures. Urology 1988;32: 517–20. [9] Dogra PN, Nabi G. Core-through urethrotomy using the Neodymium: YAG laser for obliterative urethral strictures after traumatic urethral disruption and/or distraction defects: long-term ...

  3. Management of advanced primary urethral carcinomas. (United States)

    Dayyani, Farshid; Hoffman, Karen; Eifel, Patricia; Guo, Charles; Vikram, Raghu; Pagliaro, Lance C; Pettaway, Curtis


    Primary urethral carcinoma (PUC) is a rare malignancy accounting for modes of presentation. Clinical evaluation includes cystourethroscopy with biopsy and examination under anaesthesia. Magnetic resonance imaging provides a highly effective method to image the primary tumour while defıning the potential involvement of surrounding structures. Most tumours are localised, with regional metastases to nodal sites seen in up to 30% of cases in both genders, while distant metastases at presentation are rare (0-6%), but occur in up to 40% of cases with recurrent disease. Among men, the two most important prognostic factors are disease location and stage. Low-stage tumours (T1-2) and tumours involving the fossa navicularis or the penile urethra have a better prognosis than higher stage tumours (>T2 or N+) and lesions involving the bulbomembranous urethra. In women, in addition to stage and location, the size of the tumour has also prognostic implications. While surgery and radiation therapy (RT) are of benefit in early stage disease, advanced stage PUC requires multimodal treatment strategies to optimise local control and survival. These include induction chemotherapy followed by surgery or RT and concurrent chemoradiation with or without surgery. The latter strategy has been used successfully to treat other human papillomavirus-related cancers of the vagina, cervix and anus and may be of value in achieving organ preservation. Given the rarity of PUC, prospective multi-institutional studies are needed to better define the optimal treatment approach for this disease entity. © 2014 The Authors. BJU International © 2014 BJU International.


    African Journals Online (AJOL)

    Urine diversion was done via suprapubic cystostomy. The patient was scheduled for excision of the diverticulum and urethroplasty. Unfortunately he has not yet reported for definitive treatment due to financial reasons. DISCUSSION. By classification, urethral diverticula may ei- ther be congenital or acquired. Most cases are.

  5. Incomplete urethral duplication in an adult male.

    LENUS (Irish Health Repository)

    Davis, N F


    Urethral duplication is a rare congenital anomaly with less than 200 cases reported. It predominantly occurs in males and is nearly always diagnosed in childhood or adolescence. It is defined as a complete second passage from the bladder to the dorsum of the penis or as an accessory pathway that ends blindly on the dorsal or ventral surface.


    African Journals Online (AJOL)

    tients (90%) had no evidence of recurrent stric- ture. Randomized studies comparing the dorsal and ventral approaches for buccal mucosa graft urethroplasty have not been published so far. Andrich et al.9 treated 71 patients with bul- bar urethral strictures with buccal mucosa patch urethroplasty. The approach was dorsal.

  7. Male Urethral Diverticulum Having Multiple Stones

    African Journals Online (AJOL)

    The patients are counseled regarding decompression of the UD by external manual urethral pressure following the act of micturition and precaution to prevent urinary tract infection. Complicated diverticula invariably require surgical intervention that can be open or endoscopic. Endoscopic deroofing of the diverticular sac, ...

  8. Predictors for success of internal urethrotomy in patients with urethral contracture following perineal repair of pelvic fracture urethral injuries. (United States)

    Hong, Young-Kwon; Choi, Kyung-Hwa; Lee, Young-Tae; Lee, Seung-Ryeol


    Internal urethrotomy (IU) in patients with urethral contracture following perineal repair of pelvic fracture urethral injuries (PRPFUI) is troublesome. We evaluated the clinical factors affecting the surgical outcome of IU for urethral contracture after PRPFUI. We retrospectively reviewed the records of 35 patients who underwent IU for urethral contracture after PRPFUI between March 2004 and June 2013. Ages of patients ranged from 18 to 50, and their follow-up duration was more than 1year after IU. The urethral contracture was confirmed by retrograde urethrogram or cysto-urethroscopy. Success was defined as greater than 15mL/s of peak urinary flow rate at 1year after IU without any clinical evidence of urethral contracture. Success rates were investigated according to the number of IU. Age, body mass index, urethral defect length before PRPFUI, time interval between the original urethral injury and the PRPFUI or between a previous operation and the PRPFUI, time interval between the PRPFUI and the urethral contracture, number of PRPFUI performed, and the type of urethral lengthening procedure were compared between patients with and without success according to the number of IU. Among the 35 patients, the overall success rate of IU was 37% (13/35) during the mean follow-up period of 53 months (range: 17-148 months). There were 8 and 5 patients with success in first and second IU, respectively. However, there was no success after third IU. Urethral defect length before PRPFUI was significantly shorter in patients with success who underwent first and second IU (psuccess between patients with and without previous repeated failures of PRPFUI in first and second IU (p<0.05). Short urethral defect length and no previous surgical failures before PRPFUI are good prognostic factors for IU following PRPFUI. Only one or two IUs will be helpful in patients with urethral contracture following PRPFUI. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. EAU guidelines on primary urethral carcinoma. (United States)

    Gakis, Georgios; Witjes, J Alfred; Compérat, Eva; Cowan, Nigel C; De Santis, Maria; Lebret, Thierry; Ribal, Maria J; Sherif, Amir M


    The European Association of Urology (EAU) Guidelines Group on Muscle-Invasive and Metastatic Bladder Cancer prepared these guidelines to deliver current evidence-based information on the diagnosis and treatment of patients with primary urethral carcinoma (UC). To review the current literature on the diagnosis and treatment of patients with primary UC and assess its level of scientific evidence. A systematic literature search was performed to identify studies reporting urethral malignancies. Medline was searched using the controlled vocabulary of the Medical Subject Headings database, along with a free-text protocol. Primary UC is considered a rare cancer, accounting for guidelines document on primary UC is the first publication on this topic by the EAU. It aims to increase awareness in the urologic community and provide scientific transparency to improve outcomes of this rare urogenital malignancy. Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  10. [Urethral reconstruction using buccal mucosa transplants]. (United States)

    Engel, O; Ahyai, S; Rink, M; Eichelberg, C; Dahlem, R; Fisch, M


    Buccal mucosa is the ideal material for urethral reconstruction because it is easy to harvest, is accustomed to permanent moisture and can be used at any location in the urethra. Stricture length and local conditions of the urethra have to be considered to decide which technique is required to reconstruct the urethra. Open urethroplasty with buccal mucosa has a success rate over 85% and should be used after unsuccessful internal urethrotomy and primarily in longer strictures.

  11. Pediatric pelvic fracture urethral distraction defect causing complete urethrovaginal avulsion. (United States)

    Singh, Ritesh Kumar; Kaushal, Devashish; Khattar, Nikhil; Nayyar, Rishi; Manasa, T; Sood, Rajeev


    Pelvic fracture with urethral injury in girls is an uncommon entity that is usually associated with concomitant vaginal lacerations. Management options vary from immediate exploration and urethral anastomosis to delayed urethroplasty. We report our experience of managing a 10-year old girl presenting 6 months after a pelvic fracture with urethrovaginal injury and a completely obliterated urethral meatus managed successfully with a single-stage bladder tube repair.

  12. Polypoidal Intestinal Metaplasia and Dysplasia of the External Urethral Meatus

    Directory of Open Access Journals (Sweden)

    Mary Mathew


    Full Text Available Urethral mucosa with intestinal metaplasia and dysplasia is a rare occurrence. To date only a single case has been reported in a male with long-standing urethral stricture. We present a 33-year-old female with polypoid intestinal metaplasia and dysplasia of the external urethral meatus in the absence of an inciting factor. Intestinal metaplasia of the urethral mucosa may undergo dysplasia, emphasizing the necessity of a high degree of clinical suspicion and vigilant pathological examination of these lesions.

  13. [Acute urethritis caused by Neisseria meningitidis and Chlamydia trachomatis]. (United States)

    Yagihashi, Yusuke; Kawase, Norio; Kurita, Izumi; Fukuzawa, Shigeki


    A 16-year-old heterosexual man presented to our hospital with a purulent urethral discharge and pain at voiding. These symptoms began seven days after oral-genital contact (fellatio) with his partner. A Gram-stained smear from the urethral discharge showed Gram-negative diplococci, and the antigen of Chlamydia trachomatis from urine was positive. We initially made a diagnosis of urethritis caused by Neisseria gonorrhoeae and C. trachomatis. However, N. meningitidis was isolated by culture. Clinicians should pay attention to the possibility of N. meningitidis infection in all cases resembling gonococcal urethritis.

  14. The urethral closure function in continent and stress urinary incontinent women assessed by urethral pressure reflectometry. (United States)

    Saaby, Marie-Louise


    Stress urinary incontinence (SUI) occurs when the bladder pressure exceeds the urethral pressure in connection with physical effort or exertion or when sneezing or coughing and depends both on the strength of the urethral closure function and the abdominal pressure to which it is subjected. The urethral closure function in continent women and the dysfunction causing SUI are not known in details. The currently accepted view is based on the concept of a sphincteric unit and a support system. Our incomplete knowledge relates to the complexity of the closure apparatus and to inadequate assessment methods which so far have not provided robust urodynamic diagnostic tools, severity measures, or parameters to assess outcome after intervention. Urethral Pressure Reflectometry (UPR) is a novel method that measures the urethral pressure and cross-sectional area (by use of sound waves) simultaneously. The technique involves insertion of only a small, light and flexible polyurethane bag in the urethra and therefore avoids the common artifacts encountered with conventional methods. The UPR parameters can be obtained at a specific site of the urethra, e.g. the high pressure zone, and during various circumstances, i.e. resting and squeezing. During the study period, we advanced the UPR technique to enable faster measurement (within 7 seconds by the continuous technique) which allowed assessment during increased intra-abdominal pressure induced by physical straining. We investigated the urethral closure function in continent and SUI women during resting and straining by the "fast" UPR technique. Thereby new promising urethral parameters were provided that allowed characterization of the closure function based on the permanent closure forces (primarily generated by the sphincteric unit, measured by the Po-rest) and the adjunctive closure forces (primarily generated by the support system, measured by the abdominal to urethral pressure impact ratio (APIR)). The new parameters enabled

  15. Congenital anterior urethral valves and diverticula: Diagnosis and ...

    African Journals Online (AJOL)

    The present study highlights the clinical approach in identifying the condition and its treatment options, especially for those, presenting with urethral diverticula. Materials and Methods: We have studied children with congenital anterior urethral valves and diverticula. Six patients of AUVs with diverticula were admitted during ...

  16. A rare case of congenital Y-type urethral duplication

    Directory of Open Access Journals (Sweden)

    Charu Tiwari


    Full Text Available Duplication of urethra is a rare congenital anomaly. We report a case of Y-type of urethral duplication with the accessory urethra arising from posterior urethra and opening in the perineum. The orthotopic urethra was normal. The accessory urethral tract was cored, transfixed and divided. At 1 year of follow-up, the patient has no urinary complaints

  17. Female Urethral Anomalies in Pediatric Age Group: Uncovered ...

    African Journals Online (AJOL)

    Female urethral anomalies such as epispadias and hypospadias have been rarely reported in the literature. Clinical diagnosis of female urethral anomalies is significant for management. Diagnosis may be missed leading to mismanagement of the clinical condition. Herein, we report a case of female epispadias and ...

  18. Acquired Urethral Diverticulum Following Hypospadias Repair: A Case Report

    Directory of Open Access Journals (Sweden)

    Onur Dede


    Full Text Available Summary: Urethral diverticulum is a rare condition in men. Patients often presented with voiding symptoms and mass with related urethra. In this study, diverticula did not detected after result of ultrasound, MRI and physical examination, Retrograde urethrography was performed and diverticulum and 2.5 cm stone was detected in diverticula. The exision of urethral diverticula and urethroplasty were performed.

  19. Anterior Urethral Advancement in Repair of Hypospadias: A ...

    African Journals Online (AJOL)


    Background/Purpose: Anterior Urethral advancement as one stage technique for hypospadias repair was first described by. Ti – Shang Cheng in 1984. It was used for repair of distal and midpenile hypospadias. It was also used for treating secondary cases and urethral fistulae. Stricture, fistulae and ventral curvature were ...

  20. Anterior Urethral Advancement in Repair of Hypospadias: A ...

    African Journals Online (AJOL)

    Background/Purpose: Anterior Urethral advancement as one stage technique for hypospadias repair was first described by Ti – Shang Cheng in 1984. It was used for repair of distal and midpenile hypospadias. It was also used for treating secondary cases and urethral fistulae. Stricture, fistulae and ventral curvature were ...

  1. Physician Knowledge and Practices of Urethral Catheterization in ...

    African Journals Online (AJOL)

    We sought to find out the knowledge and practice patterns of physicians regarding urethral catheterization. Methodology: Self-administered questionnaires aimed at elucidating knowledge of the indications of urethral catheterization and precautionary measures effective against catheter-associated urinary tract infection ...

  2. A microbiological study therapy for gonococcal of failed urethritis ...

    African Journals Online (AJOL)

    thritis in patients who, having received procaine penicillin plus probenicid therapy for gonococcal urethritis, returned with persistent urethral discharge. Patients and methods. A total of 75 black men were investigated during the period. July - September 1987. All patients had returned-to the. Sexually Transmitted Diseases ...

  3. Deferred endoscopic urethral realignment: Role in management of ...

    African Journals Online (AJOL)

    M.A. Elgammal

    a Department of Urology, Assiut University Hospital and School of Medicine, Assiut University, Assiut, Egypt b Department of Urology, Qena University Hospital and School of Medicine, Qena University, Egypt. Received 27 December ..... posterior urethral injury and early realignment using magnetic urethral catheters. J Urol.

  4. Histopathological findings in post-inflammatory urethral strictures ...

    African Journals Online (AJOL)

    The predominant risk factor for recurrence of urethral stricture after surgical treatment is the extent of scarring and other related pathological findings in the affected segment of the urethra. In this study, 107 patients with post inflammatory urethral strictures aged between 23-79 years seen between 1996 and 1998 underwent ...

  5. Aetiology of Urethral Strictures at Moi Teaching and Refferal Hospital

    African Journals Online (AJOL)

    process (1). Earlier studies indicated sexually transmitted diseases to be still common in the age group 15 to 50 years in developing countries. (2).This trend is reported to have changed with gonorrhea ,the historical cause of urethral stricture having been replaced by urethral instrumentation and external trauma as the most ...

  6. Urethral Stricture as seen in Dar es Salaam, Tanzania.

    African Journals Online (AJOL)


    surgery.2011;16(2). 16. Figueroa JC, Hoenig DM. Use of flexible paedriatic cystoscope in the staging and management of urethral stricture disease. J Endourol.2004; 18(1):119-21. 17. Webster GD, Koefoot RB, Sihelnik SA. Urethroplasty management in 100 cases of urethral strictures: a rationale for procedure selection.

  7. Direct vision internal urethrotomy in 459 urethral stricture patients at ...

    African Journals Online (AJOL)

    Four hundred and fifty nine patients seen with simple urethral strictures between 1990 and 1998 underwent direct vision urethrotomy.. The procedure was successful in 441 patients and failed in only 18 patients. Postoperative complications included fever in 31 patients, urethral bleeding in 14 and epididymitis in 17 patients.

  8. Urethral diverticulum with massive lithiasis presenting as a scrotal mass. (United States)

    Labanaris, Apostolos P; Zugor, Vahudin; Witt, Jorn H; Nützel, Reinhold; Kühn, Reinhard


    Urethral diverticula in men are uncommon clinical entities. Their clinical manifestations include urinary tract infection, hematuria, irritative or obstructive voiding symptoms, ventral bulging and displacement of the penile shaft. Male urethral diverticulum with massive lithiasis presenting as a scrotal mass with stress urinary incontinence as the main symptom is extremely rare. Herein, we present such a case. Copyright © 2011 S. Karger AG, Basel.

  9. Urethral hemangioma: case report and review of the literature ...

    African Journals Online (AJOL)

    ... from the terminal urethra (urethral hemangioma). We performed surgical resection of the tumor, along with bladder drainage. The postoperative course was simple. We update through a review of the literature aspects of the diagnostic and therapeutic care of the urethral hemangioma. Pan African Medical Journal 2016; 23 ...

  10. A descriptive study of urethral discharge among men in Fiji. (United States)

    Gaunavinaka, Lavenia; Balak, Dashika; Varman, Sumanthla; Ram, Sharan; Graham, Stephen M


    Urethral discharge is a common presentation of sexually transmitted infection (STI) in men and known pathogens include Neisseria gonorrhoeae and Chlamydia trachomatis. There are no published data of the burden of urethral discharge among men in Fiji. To evaluate urethral discharge among men to determine the incidence, the frequency of recurrence and reported at-risk behaviour. We conducted a retrospective, descriptive study of clinical records of all men presenting with urethral discharge to two major reproductive health clinics. Data collected included self-reported at-risk behaviours, results of abnormal syphilis serology and antibiotics prescribed. The frequency of recurrence in the following 1-2 years of initial presentation was determined along with microbiological findings from urethral swab in this group. A total of 748 males presented with urethral discharge to the clinic in one year. This represents an incidence rate of at least 295 per 100,000 adult males per year in the study population. Within the next 1-2 years of the initial presentation, 102 (14%) of these re-presented out of which 42 had urethral swab taken for etiological diagnosis. The commonest isolate was Neisseria gonorrhoeae. Results of syphilis tests were available for 560 (75%) of patients and 29 (5%) were positive. Recurrence was not associated with self-reported at-risk behaviours. The incidence of urethral discharge among males in Fiji is very high and prevention strategies are urgently needed.

  11. Post TURP obliterative urethral stricture: Unusual presentation and ...

    African Journals Online (AJOL)

    A. Bhageria

    [8] ShanBerg A, Bagholassarian R, Tansey L, Sawyer D. KTP 532 laser in the treatment of urethral strictures. Urology 1988;32:517–20. [9] Dogra PN, Nabi G. Core through urethrotomy using the neodymium: YAG laser for obliterative urethral strictures after traumatic utrethral disruption and or distraction defects: long term ...

  12. Pelvic fracture urethral injuries revisited: A systematic review ...

    African Journals Online (AJOL)

    Purpose: We attempted to determine the unresolved controversies about pelvic fracture urethral injuries and to present a treatment plan for this lesion. Materials and methods: A systematic review was conducted on all contemporary pelvic fracture urethral injury articles published in the last 60 years. Studies were eligible ...

  13. Pelvic fracture urethral injuries revisited: A systematic review

    African Journals Online (AJOL)

    Mamdouh M. Koraitim


    Jul 12, 2011 ... Abstract Purpose: We attempted to determine the unresolved controversies about pelvic fracture urethral injuries and to present a treatment plan for this lesion. Materials and methods: A systematic review was conducted on all contemporary pelvic fracture urethral injury articles published in the last 60 years ...

  14. Histopathological findings in post-inflammatory urethral strictures ...

    African Journals Online (AJOL)

    The predominant risk factor for recurrence of urethral stricture after surgical treatment is the extent of scarring and other related pathological findings in the affected segment of the urethra. In this study, 107 patients with post inflammatory urethral strictures aged between 23-79 years seen between 1996 and. 1998 underwent ...

  15. Management of Urethral Strictures After Hypospadias Repair. (United States)

    Snodgrass, Warren T; Bush, Nicol C


    Strictures of the neourethra after hypospadias surgery are more common after skin flap repairs than urethral plate or neo-plate tubularizations. The diagnosis of stricture after hypospadias repair is suspected based on symptoms of stranguria, urinary retention, and/or urinary tract infection. It is confirmed by urethroscopy during anticipated repair, without preoperative urethrography. The most common repairs for neourethra stricture after hypospadias surgery are single-stage dorsal inlay graft and 2-stage labial mucosa replacement urethroplasty. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Aetiology of male urethritis in patients recruited from a population with a high HIV prevalence

    NARCIS (Netherlands)

    Sturm, P.D.J.; Moodley, P.; Khan, N.; Ebrahim, S.; Govender, K.; Connolly, C.E.; Sturm, A.W.


    The aetiology of urethritis, the significance of potential pathogens and the relation of urethritis to HIV infection were determined in 335 men (cases) with and 100 men (controls) without urethral symptoms. Urethral swab specimens were tested for different organisms by PCR or by culture for

  17. Endoscopic repair in 154 cases of urethral occlusion: the promise of guided optical urethral reconstruction. (United States)

    al-Ali, M; al-Shukry, M


    We determined whether optical urethral reconstruction, with the use of a Béniqué bougie in the proximal urethra and transrectal digital guidance, is effective for the treatment of long and severe urethral occlusions. However, with some skill the procedure can be done without the bougie for the treatment of short occlusions. During a 9-year period 154 men with complete urethral occlusion underwent core through optical urethrotomy via transrectal digital guidance, using the Béniqué bougie in 89 (58%). A total of 400 urethrotomies was performed. All lesions were in the posterior urethra except 8 in the pendulous portion. There were 64 war related injuries (41.6%). Combined voiding and retrograde urethrography was not useful to measure the length of the occlusion due to failure of proximal urethral filling. Guided optical urethral reconstruction consisted of optical urethrotomy performed with a Béniqué bougie introduced proximally through the suprapubic catheter site and into the proximal urethra with the index finger of the operator in the rectum. The same procedure was performed blindly without use of the bougie in 65 patients (42%), and in 43 with lesions shorter than 1 cm. and 4 with multiple annular lesions. We also used the blind technique successfully to reestablish 18 occlusions longer than 1 cm. For optimal epithelialization of the urethral tract we suggest leaving a silicone catheter indwelling for 3 months. No prophylactic antibiotics were given. Of the patients 54 (35%) were cured after 1 procedure, whereas the remaining 100 (65%) required 1 to 9 additional urethrotomies (mean 3). Patients with an uninstrumented urethra who were treated initially with suprapubic catheterization required 1 to 6 urethrotomies (mean 2), compared to 1 to 10 (mean 3) for those who had undergone a prior procedure. Hematuria occurred in 9% of the patients, symptomatic urinary tract infection in 7% and slight extravasation in 3.2%. One patient had stress incontinence. Our

  18. Adult Urethral Stricture Disease after Childhood Hypospadias Repair

    Directory of Open Access Journals (Sweden)

    Richard A. Santucci


    Full Text Available Background. Adult patients with urethral stricture after childhood hypospadias surgeries are infrequently discussed in the literature. We report our experience in treating such patients. Materials and Methods. A retrospective chart review was performed. From 2002 through 2007, nine consecutive adult patients who had current urethral stricture and had undergone childhood hypospadias surgeries were included. All adult urethral strictures were managed by a single surgeon. Results. Mean patient age was 38.9 years old. The lag time of urethral stricture presentation ranged from 25 to 57 years after primary hypospadias surgery, with an average of 36 years. Stricture length ranged from 1 to 17 cm (mean: 10.3 cm. Open graft-based urethroplasties were performed in 4/9 cases. Salvage perineal urethrostomy was performed in 2/9 cases. Another 3 cases chose to undergo repeat urethrotomy or dilatations—none of these patients was cured by such treatment. Complications included one urethrostomy stenosis and one urinary tract infection. Conclusion. Urethral stricture may occur decades after initial hypospadias surgery. It can be the most severe form of anterior urethral stricture, and may eventually require salvage treatment such as a perineal urethrostomy. Patients undergoing hypospadias surgery should receive lifelong follow-up protocol to detect latent urethral strictures.

  19. Does patterned afferent stimulation of sacral dermatomes suppress urethral sphincter reflexes in individuals with spinal cord injury? (United States)

    McCoin, Jaime L; Bhadra, Narendra; Brose, Steven W; Gustafson, Kenneth J


    Dyssynergic contractions of the external urethral sphincter prevent efficient bladder voiding and lead to numerous health concerns. Patterned electrical stimulation of the sacral dermatomes reduces urethral sphincter spasms and allows functional bladder emptying in cats after chronic SCI. Reflex suppression in animals is strongly dependent on stimulus location and pattern. The purpose of this study was to determine whether the stimulation patterns and locations effective in animals suppress urethral sphincter spasms in humans with SCI. Ten subjects with chronic SCI underwent bladder filling to elicit distention-evoked contractions. During reflex contractions patterned electrical stimulation was applied to the S2 or S3 dermatome in random 25-sec intervals. Bladder and sphincter pressures were simultaneously recorded and compared between control and afferent stimulation periods. Six of the 10 subjects demonstrated both reflex bladder and sphincter contractions with bladder filling. No significant reduction in urethral pressure was observed during stimulation for any stimulus locations and patterns tested. Stimulation parameters and locations effective in SCI animals did not suppress reflex sphincter activity in these human subjects. It is likely that a broader set of stimulus patterns and dermatome locations will need to be tested to find the effective combination in humans. © 2014 Wiley Periodicals, Inc.

  20. Congenital dorsal urethral diverticulum: A rare case report

    Directory of Open Access Journals (Sweden)

    Samir Gupta


    Full Text Available Urethral diverticulum in males can be congenital or acquired (secondry to stricture, stenosis. Congenital urethral diverticulae of male urethra are rare. Most of them occur ventral to the native urethra, arising from the cystic dilatation of the Cowper′s gland ducts. Ours is the report of urethral diverticulum, which was present on the dorsal side of the urethra, with splaying of the two corpora cavernosa and thinning of the corpus spongiosum. The diverticulum was excised and urethroplasty was done. Postoperatively there was a marked improvement in the symptoms, with good cosmesis

  1. Xenograft iterposition in female urethral diverticulum surgery. (United States)

    Tolosa Eizaguirre, Egoitz; Robles Garcia, J E; Barba Abad, J; Saiz Sansi, A; Pascual Piedrola, J I


    To describe the use collagen xenograft as adjuvant therapy in the surgical treatment of female urethral diverticulum (FUD) and to perform a bibliographic review. We performed a surgical approach to remove the diverticulum and repair the remaining dead space with a porcine collagen mesh to avoid fistulas. Monitoring is done by MRI. After two years of follow up the patient improved considerably, disappearing the previous symptoms. Follow-up MRI showed no abnormality: There was no inflammatory reaction or encapsulation of any kind. We recognize that the flap or the use of a xenograft are not always necessary, but due to its technical simplicity and effectiveness, it is an important tool for diverticulum surgery. However, more experience is needed to assess the appropriateness of this method.

  2. The effect of single oral doses of duloxetine, reboxetine, and midodrine on the urethral pressure in healthy female subjects, using urethral pressure reflectometry

    DEFF Research Database (Denmark)

    Klarskov, Niels; Cerneus, Dirk; Sawyer, William


    AIMS: To evaluate the effect on urethral pressure of reference drugs known to reduce stress urinary incontinence symptoms by different effect size and mechanisms of action on urethral musculature under four test conditions in healthy female subjects using urethral pressure reflectometry. METHODS...

  3. Evaluating the cost of iatrogenic urethral catheterisation injuries. (United States)

    Bhatt, N R; Davis, N F; Addie, D; Flynn, R; McDermott, T E D; Manecksha, R P; Thornhill, J A


    Technique is vital to prevent urethral trauma during urethral catheterisation (UC). Education programmes are helpful but are not compulsory and safe UC remains operator dependent. Traumatic UC is associated with increased morbidity, length of stay, resource utilisation and surgical intervention. To determine the cost of iatrogenic urethral injuries managed in a tertiary referral centre over a 6-month period. A 6-month prospective study monitored iatrogenic urethral injuries secondary to traumatic UC. Included were referrals from district hospitals and inpatient consultations relating to urethral injury caused by traumatic UC. The added cost of management was estimated. Thirteen iatrogenic urethral injuries were recorded in 6 months. Management included open surgery for a ruptured bladder (n = 1), flexible cystourethroscopy (n = 10), suprapubic catherisation (n = 4), 3-way catheterisation (n = 4) and catheter re-insertion under direct vision (n = 6). The cost of acute management of these injuries was approximately €50,000 including theatre costs, ambulance transfer, hospital stay, procedural and equipment costs and short-term follow-up care. Iatrogenic injuries during UC represent a significant cost burden to the healthcare system. Training programmes should be compulsory for all healthcare professionals routinely involved in catheterisation procedures.

  4. Difficult male urethral catheterization: a review of different approaches

    Directory of Open Access Journals (Sweden)

    Carlos Villanueva


    Full Text Available PURPOSE: To review and compare the different methods for difficult male urethral catheterization described in selected literature. MATERIALS AND METHODS: A PubMed search was done with the terms "difficult", "failed", or "complications" and "urethral catheterization", "transurethral catheterization", "Foley catheter", "urethral catheter" or "filiforms and followers". All articles addressing the issue of difficult adult male urethral catheterization were included. RESULTS: Six main approaches were identified on the 14 articles included for review: 1 Passage of either a Glidewire, guide wire or filiform under direct vision; 2 Blind passage of a filiform, guide wire, Glidewire or hydrophilic catheter; 3 "The Peel-away® sheath placed on a cystoscope/resectoscope technique"; 4 "The rigid ureteroscope placed inside the 22F Foley technique"; 5 Suprapubic catheterization; and 6 "The instillation of 60 cc of saline through the catheter as it is advanced technique". CONCLUSION: There is a paucity of prospective data comparing the benefits, risks, success rates and complications of the different approaches for difficult Foley catheter placement. Our suggested approach starts with the initial attempt at urethral catheterization with an 18F coude and a 12F silicone catheter. If these fail, using a flexible cystoscope or the blind Glidewire technique are reasonable alternatives. If dilatation of a stricture is necessary, ureteric dilatators or a urethral balloon dilatator are recommended.

  5. Urethral obstruction from dislodged bladder Diverticulum stones: a case report

    Directory of Open Access Journals (Sweden)

    Okeke Linus I


    Full Text Available Abstract Background Secondary urethral stone although rare, commonly arises from the kidneys, bladder or are seen in patients with urethral stricture. These stones are either found in the posterior or anterior urethra and do result in acute urinary retention. We report urethral obstruction from dislodged bladder diverticulum stones. This to our knowledge is the first report from Nigeria and in English literature. Case presentation A 69 year old, male, Nigerian with clinical and radiological features of acute urinary retention, benign prostate enlargement and bladder diverticulum. He had a transurethral resection of the prostate (TURP and was lost to follow up. He re-presented with retained urethral catheter of 4months duration. The catheter was removed but attempt at re-passing the catheter failed and a suprapubic cystostomy was performed. Clinical examination and plain radiograph of the penis confirmed anterior and posterior urethral stones. He had meatotomy and antegrade manual stone extraction with no urethra injury. Conclusions Urethral obstruction can result from inadequate treatment of patient with benign prostate enlargement and bladder diverticulum stones. Surgeons in resource limited environment should be conversant with transurethral resection of the prostate and cystolithotripsy or open prostatectomy and diverticulectomy.

  6. Transurethral resection of fibrotic scar tissue combined with temporary urethral stent placement for patients with in anterior urethral stricture

    Directory of Open Access Journals (Sweden)

    Cheol Yong Yoon


    Full Text Available Introduction Fibrotic scar formation is a main cause of recurrent urethral stricture after initial management with direct vision internal urethrotomy (DVIU. In the present study, we devised a new technique of combined the transurethral resection of fibrotic scar tissue and temporary urethral stenting, using a thermo-expandable urethral stent (MemokathTM 044TW in patients with anterior urethral stricture. Materials and Methods As a first step, multiple incisions were made around stricture site with cold-cutting knife and Collins knife electrode to release a stricture band. Fibrotic tissue was then resected with a 13Fr pediatric resectoscope before deployment of a MemokathTM 044TW stent (40 – 60mm on a pre-mounted sheath using 0° cystoscopy. Stents were removed within 12 months after initial placement. Results We performed this technique on 11 consecutive patients with initial (n = 4 and recurrent (n = 7 anterior urethral stricture (April 2009 – February 2013. At 18.9 months of mean follow-up (12-34 months, mean Qmax (7.8±3.9ml/sec vs 16.8 ± 4.8ml/sec, p < 0.001, IPSS (20.7 vs 12.5, p = 0.001 , and QoL score (4.7 vs 2.2, p < 0.001 were significantly improved. There were no significant procedure-related complications except two cases of tissue ingrowth at the edge of stent, which were amenable by transurethral resection. In 7 patients, an average 1.4 times (1-5 times of palliative urethral dilatation was carried out and no patients underwent open surgical urethroplasty during the follow-up period. Conclusion Combined transurethral resection and temporary urethral stenting is a effective therapeutic option for anterior urethral stricture. Further investigations to determine the long-term effects, and safety profile of this new technique are warranted.

  7. SIU/ICUD Consultation on Urethral Strictures: Dilation, internal urethrotomy, and stenting of male anterior urethral strictures. (United States)

    Buckley, Jill C; Heyns, Chris; Gilling, Peter; Carney, Jeff


    Male urethral stricture is one of the oldest known urologic diseases, and continues to be a common and challenging urologic condition. Our objective was to review all contemporary and historial articles on the topic of dilation, internal urethrotomy, and stenting of male anterior urethral strictures. An extensive review of the scientific literature concerning anterior urethral urethrotomy/dilation/stenting was performed. Articles were included that met the criteria set by the International Consultation on Urological Diseases (ICUD) urethral strictures committee and were classified by level of evidence using the Oxford Centre for Evidence-Based Medicine criteria adapted from the work of the Agency for Health Care Policy and Research as modified for use in previous ICUD projects. Using criteria set forth by the ICUD, a committee of international experts in urethral stricture disease reviewed the literature and created a consensus statement incorporating levels of evidence and expert opinion in regard to dilation, internal urethrotomy, and stenting of male anterior urethral strictures. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Endoscopic removal of a proximal urethral stent using a holmium laser: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Francisco Botelho


    Full Text Available Urethral stents were initially developed for the management of urethral strictures and obstructive voiding disorders in select patients. Urethral stent complications are common and may require stent explantation, which is often quite challenging. We present our experience with endoscopic removal of an encrusted UroLume proximal urethral stent in a 72-year-old male using a holmium laser. The literature on various management options and outcomes for urethral stent removal is reviewed. Endoscopic removal of proximal urethral stents is feasible and safe and should be considered as the primary treatment option in patients requiring stent extraction.

  9. [Role of Chlamydia trachomatis in male urethritis. Analysis of 2,000 cases of male urethritis]. (United States)

    Pastorini, E; Pastorini, P; Chevallier, D; Amiel, J; Toubol, J


    A study involving of 2,000 cases of urethritis revealed the presence of Chlamydia trachomatis in 44% of patients. Following a pathophysiological review, the strongly suggestive clinical picture of infection by this microorganism is emphasized. This study stresses two precise points by dealing with: firstly, the importance of the choice of technique for demonstration of the presence of the bacteria, and its reliability; secondly, the value of bacteriological evidence of the infection in order to treat not only the patient but also the partner(s) and to subsequently confirm the treatment as being effective.

  10. Long anterior urethral stricture: Reconstruction by dorsally quilted penile skin flap

    Directory of Open Access Journals (Sweden)

    Mohammad Sayed Abdel-Kader


    Conclusion: Free penile skin flaps offer good results (functional and cosmetic in long anterior urethral stricture. Meticulously fashioned longitudinal, circular or spiral penile skin flaps could bridge urethral defects up to 15 cm long.

  11. Urethral duplication: a rare cause of urinary incontinence in a female child


    Khandelwal, Atul; Gupta, Sanjay; Tiwari, Rajesh; Kumar, Vijoy; Singh, Mahendra


    Female urethral duplication is a rare congenital anomaly. We report a case of complete urethral duplication along with horseshoe kidney in a four-years-old female child presenting with incontinence since childhood.

  12. “Close-loop” urethral obstruction: Clinico-radiological features and ...

    African Journals Online (AJOL)


    features and management consideration in a resource- constraint environment. A.A. Ajapea,∗ ... “Close-loop” urethral obstruction management consideration. 27 radiographies included dilated prostatic urethral, .... practise in our unit, without strict adherence to the above consider- ations for failed urethral catheterization, ...

  13. Urethral triplication with meatuses terminating on the penis: a rare case presenting with bifid urinary stream

    Energy Technology Data Exchange (ETDEWEB)

    Hirselj, Daniel A.; Jayanthi, Venkata R. [Nationwide Children' s Hospital, Department of Pediatric Urology, Columbus, OH (United States); Lowe, Gregory K. [The Ohio State University Medical Center, Department of Urology, Columbus, OH (United States)


    Urethral duplication is an uncommon clinical finding, and classification systems have been described to explain the clinical findings. Urethral triplication is an extremely uncommon diagnosis, with few published case reports. We present the rare case of an infant noted to have a bifid urinary stream and found to have urethral triplication on voiding cystourethrography. (orig.)

  14. Passive urethral resistance to dilation in healthy women

    DEFF Research Database (Denmark)

    Bagi, P; Thind, P; Nordsten, M


    at equilibrium, P alpha and P beta express the decline in pressure, and tau alpha and tau beta are time constants. The size of the pressure response proved highly dependent on velocity and size of dilation as well as urethral site of measurement, with the maximum values in the high pressure zone. The time......The dynamic urethral pressure response to a simulated urine ingression was studied at the bladder neck, in the high pressure zone, and in the distal urethra in 10 healthy female volunteers. The pressure response was characterised by a steep pressure increase simulataneous with the urethral dilation......, followed by a decay during the next seconds until a new equilibrium pressure was reached. The pressure decay could be described by a double exponential function in the form Pt = Pequ + P alpha e-t/tau alpha + P beta e-t/tau beta, where Pt represents the pressure at the time t, Pequ represents the pressure...

  15. Bleomycin induced urethral stricture in Hodgkin′s disease

    Directory of Open Access Journals (Sweden)

    Ritesh Tapkire


    Full Text Available Bleomycin is a glycoprotein that is extensively used in combination with other anti-cancer agents because of its relative lack of hematological and gastrointestinal toxicity. However, pulmonary toxicity is common with bleomycin and limits its therapeutic utility. Urethral stricture as a result of bleomycin toxicity has not been reported in literature. In this case report, a young male patient who developed urethral stricture after bleomycin-based chemotherapy is described and the possible effects of bleomycin on the urethra are discussed.

  16. Bedside ultrasound diagnosis of urethral calculus in emergency depar tment

    Directory of Open Access Journals (Sweden)

    Umut Cakir


    Full Text Available A 22-year-old boy presented to the emergency department with penile pain and acute urinary retention. The patient had a tender and painful mass along the distal volar surface of the penis, 5 cm away from the external urethral meatus. Bedside ultrasound was performed in the emergency department. Revealing penile urethral calculus in the emergency department with bedside sonography allowed a prompt diagnosis for the patient without additional invasion or radiation exposing diagnostic modalities such as Xray, CT or retrograde urethrography.

  17. Posterior colporrhaphy does not affect the urethral closure mechanism

    DEFF Research Database (Denmark)

    Khayyami, Yasmine; Lose, Gunnar; Klarskov, Niels


    INTRODUCTION AND HYPOTHESIS: Studies have suggested that a posterior vaginal wall prolapse might compress the urethra and mask stress urinary incontinence (SUI), much like an anterior vaginal wall prolapse. A recent study with urethral pressure reflectometry (UPR) has shown that the urethral...... International Consultation on Incontinence-Urinary incontinence (ICIQ-UI) short forms. The sample size was 18, with a power of 99.9% and a level of significance of 5%. Parameters were compared using paired t tests or Fisher's exact test, where appropriate; p values

  18. Effect of fesoterodine on urethral closure function in women with stress urinary incontinence assessed by urethral pressure reflectometry

    DEFF Research Database (Denmark)

    Klarskov, Niels; Darekar, Amanda; Scholfield, David


    INTRODUCTION AND HYPOTHESIS: The aim was to evaluate, using urethral pressure reflectometry (UPR), the effect of fesoterodine on urethral function in women with stress urinary incontinence (SUI). METHODS: Women aged 18 to 65 years were eligible for this randomised, double-blind, placebo......-controlled, crossover study if they had had clinically significant SUI or SUI-predominant mixed urinary incontinence for >3 months. Each participant received fesoterodine 4 mg, fesoterodine 8 mg, and placebo once daily for 7 days, with a 7- to 10-day washout between treatments. UPR was performed at baseline and 4 to 8...... variables (total urinary incontinence, SUI, or urgency urinary incontinence episodes per 24 h). Adverse events were reported by 8 participants taking fesoterodine 4 mg, 17 taking fesoterodine 8 mg, and 8 taking placebo. CONCLUSIONS: Fesoterodine did not affect urethral pressure or significantly decrease...

  19. The urethral closure function in continent and stress urinary incontinent women assessed by urethral pressure reflectometry

    DEFF Research Database (Denmark)

    Saaby, Marie-Louise


    , the parameters showed highly significant negative correlation with ICIQ-SF, pad test and the number of incontinence episodes per week and are therefore valid as urodynamic severity measures. UPR in SUI women before and after TVT demonstrated a more efficient urethral closure function after the operation. The Po......-rest was unchanged suggesting that the sphincteric unit was virtually unaltered and hence the permanent closure forces unchanged. However, the resting opening elastance increased by 18% indicating that at the resting state the TVT somewhat improves the closure function by providing increased resistance against...... the dilation of the urethra, which probably explains the decreased maximum urine flow rate found after TVT in this and previous studies. The APIR increased in all patients after TVT suggesting that the support system was re-established and thus the adjunctive closure forces improved, regardless of the type...

  20. Dorsolateral onlay urethroplasty for anterior urethral strictures by a unilateral urethral mobilization approach

    Directory of Open Access Journals (Sweden)

    Bhupendra P Singh


    Settings and Design: A prospective study from September 2005 to March 2008 in a tertiary care teaching hospital. Materials and Methods: Seventeen patients with long or multiple strictures of the anterior urethra were treated by a dorsolateral free buccal mucosa graft. The pendulous urethra was accessed by penile eversion through the perineal wound. The urethra was not separated from the corporal bodies on one side and was only mobilized from the midline on the ventral aspect to beyond the midline on the dorsal aspect. The urethra was opened in the dorsal midline over the stricture. The buccal mucosa graft was secured on the ventral tunica of the corporal bodies. Statistical Analysis Used: Mean and median. Results: After a follow-up of 12-30 months, one recurrence developed and 1 patient needed an internal urethrotomy. Conclusions: A unilateral urethral mobilization approach for dorsolateral free graft urethroplasty is feasible for panurethral strictures of any length with good short-term success.

  1. Quantitative Evaluation of Electrodes for External Urethral Sphincter Electromyography during Bladder-to-Urethral Guarding Reflex (United States)

    Steward, James E.; Clemons, Jessica D.; Zaszczurynski, Paul J.; Butler, Robert S.; Damaser, Margot S.; Jiang, Hai-Hong


    Purpose Accuracy in the recording of external urethral sphincter (EUS) electromyography (EMG) is an important goal in the quantitative evaluation of urethral function. This study aim was to quantitatively compare electrode recordings taken during tonic activity and leak point pressure (LPP) testing. Methods Several electrodes, including the surface electrode (SE), concentric electrode (CE), and wire electrode (WE), were placed on the EUS singly and simultaneously in six female Sprague-Dawley rats under urethane anesthesia. The bladder was filled via a retropubic catheter while LPP testing and EUS EMG recording were done. Quantitative baseline correction of the EUS EMG signal was performed to reduce baseline variation. Amplitude and frequency of one-second samples of the EUS EMG signal were measured before LPP (tonic activity) and during peak LPP activity. Results The SE, CE, and WE signals demonstrated tonic activity before LPP and an increase in activity during LPP, suggesting that the electrodes accurately recorded EUS activity during tonic activity and during the bladder-to-EUS guarding reflex, regardless of the size or location of detection areas. SE recordings required significantly less baseline correction than both CE and WE recordings. The activity in CE-recorded EMG was significantly higher than that of the SE and WE both in single and simultaneous recordings. Conclusions These electrodes may be suitable for testing EUS EMG activity. The SE signal had significantly less baseline variation and the CE detected local activity more sensitively than the other electrodes, which may provide insight into choosing an appropriate electrode for EUS EMG recording. PMID:19680661

  2. Impacted calculus within a urethral stent: A rare cause of urinary retention

    Directory of Open Access Journals (Sweden)

    Shanmugasundaram Rajaian


    Full Text Available An elderly male presented to the emergency department with acute urinary retention. He had poor flow of urine associated with serosanguinous discharge per urethra for 3 days duration. Earlier he underwent permanent metallic urethral stenting for post TURP bulbar urethral stricture. Plain X-ray of Pelvis showed an impacted calculus within the urethral stent in bulbar urethra. Urethrolitholapaxy was done with semirigid ureteroscope. Urethral stent was patent and well covered. Subsequently he had an uneventful recovery. We describe a unique case of acute urinary retention due to calculus impaction within a urethral stent.

  3. Measurement of urethral closure function in women with stress urinary incontinence

    DEFF Research Database (Denmark)

    Klarskov, N; Scholfield, D; Soma, K


    , double-blind, placebo controlled, crossover study 17 women with stress urinary incontinence or mixed urinary incontinence received 4 mg esreboxetine or placebo for 7 to 9 days followed by a washout period before crossing over treatments. Urethral pressure reflectometry and urethral pressure profilometry......, and had a positive and clinically relevant effect on urethral closure function and symptoms of stress urinary incontinence....... esreboxetine patients had significantly fewer incontinence episodes and reported a treatment benefit (global impression of change) compared to placebo. CONCLUSIONS: The opening pressure measured with urethral pressure reflectometry was less variable compared to the parameters measured with urethral pressure...

  4. In-vivo laser induced urethral stricture animal model for investigating the potential of LDR-brachytherapy (United States)

    Sroka, Ronald; Lellig, Katja; Bader, Markus; Stief, Christian; Weidlich, Patrick; Wechsel, G.; Assmann, Walter; Becker, R.; Fedorova, O.; Khoder, Wael


    Purpose: Treatment of urethral strictures is a major challenge in urology. For investigation of different treatment methods an animal model was developed by reproducible induction of urethral strictures in rabbits to mimic the human clinical situation. By means of this model the potential of endoluminal LDR brachytherapy using β-irradiation as prophylaxis of recurrent urethral strictures investigated. Material and Methods: A circumferential urethral stricture was induced by energy deposition using laser light application (wavelength λ=1470 nm, 10 W, 10 s, applied energy 100 J) in the posterior urethra of anaesthetized New Zealand White male rabbits. The radial light emitting fiber was introduced by means of a children resectoscope (14F). The grade of urethral stricture was evaluated in 18 rabbits using videourethroscopy and urethrography at day 28 after stricture induction. An innovative catheter was developed based on a β-irradiation emitting foil containing 32P, which was wrapped around the application system. Two main groups (each n=18) were separated. The "internal urethrotomy group" received after 28days of stricture induction immediately after surgical urethrotomy of the stricture the radioactive catheter for one week in a randomized, controlled and blinded manner. There were 3 subgroups with 6 animals each receiving 0 Gy, 15 Gy and 30 Gy. In contrast animals from the "De Nuovo group" received directly after the stricture induction (day 0) the radioactive catheter also for the duration of one week divided into the same dose subgroups. In order to determine the radiation tolerance of the urethral mucosa, additional animals without any stricture induction received a radioactive catheter applying a total dose of 30 Gy (n=2) and 15 Gy (n=1). Cystourethrography and endoscopic examination of urethra were performed on all operation days for monitoring treatment progress. Based on these investigation a classification of the stricture size was performed and

  5. The Pattern of Association of Urethral Stricture with Benign Prostatic ...

    African Journals Online (AJOL)

    The records of all patients treated for Being Prostatic Hyperplasia (BPH) with urethral stricture between January 1991 to December 2000 in the Urology Unit of Usmanu Danfodiyo University Teaching Hospital, (U.D.U.T.H.), Sokoto were reviewed. 69 patients with this association were studied. The mean age was 62.5 years, ...

  6. Bulbar Urethral Diverticulum after Blunt Perineal Trauma: A Case ...

    African Journals Online (AJOL)

    Partial injury of the urethra might lead to diverticulum formation and present in a delayed fashion with obstructive voiding symptoms. Herein, we present the case of an 18 year male who presented with urethral diverticulum. He was examined properly, evaluated thoroughly and managed by modified excision of the ...

  7. Short Segment Bulbar Urethral Strictures: Review of 48 Cases ...

    African Journals Online (AJOL)


    Sep 14, 2017 ... Anger JT, Scott VCS, Sevilla C, Wang M, Yano EM. Patterns of management of urethral stricture disease in the veterans affairs system. Urology 2011;78:454-8. 26. McDermott DW, Bates RJ, Heney NM, Althausen A. Erectile impotence as complication of direct vision cold knife urethrotomy. Urology 1981 ...

  8. Female Urethral Duplication: Rare Anomaly with Unusual Presentation

    African Journals Online (AJOL)

    near its confluence into the vagina [Figure 2a]. The ventral urethra was dissected till communication to the vaginal. CASE. REPORT. Department of Pediatric Surgery, Indira Gandhi Institute of. Child Health Hospital, Bengaluru, Karnataka, India. ABSTRACT. Urethral duplication (UD) in females is a rare congenital anomaly ...

  9. Management of Posterior Urethral Valves in Rural Kenya

    African Journals Online (AJOL)

    obstructive sleep apnea syndrome. Pediatrics. 2002;109:704-12. 11. Bomalaski MD, Anema JG, Coplen DE, et al. Delayed. Presentation of Posterior Urethral Valves: A Not. So Benign Condition. J Urol. 1999;162:2130. 12. 12. World Health Organization. Global Database on Child Growth and Malnutrition. Geneva: Who.

  10. Management of Posterior Urethral Valves at Kilimanjaro Christian ...

    African Journals Online (AJOL)

    Fifty percent of patients presented with urine retention while vesicoureteral reflux was found in 23.2%. Of the valves seen 96.9% were type I. Initial treatment comprised of vesicostomy (42.9%), initial valve ablation (51.8%) and urethral catheterization 5.3%. Electrofulguration was the mainstay of definitive treatment of PUV ...

  11. Case Report: Posterior Urethral Valves with Severe Unilateral ...

    African Journals Online (AJOL)

    In patients with posterior urethral valves (PUV), severe unilateral vesicoureteral reflux (VUR) is one of the three conditions associated with preservation of renal function. Others are urinary ascites or urinoma in newborns and large congenital bladder diverticula. These conditions most likely provide a pop-off mechanism ...

  12. Anterior Urethral Advancement in Repair of Hypospadias: A ...

    African Journals Online (AJOL)


    Results: The usual complications of the technique (ventral curvature of the penis, urethral fistula and meatal stenosis) were avoided. Conclusion: This study represents certain modifications that helped to a great extent in improving the results and prevented stricture and fistula formation. Index Word: Hypospadias, fistula, ...

  13. Contralateral Fracture of the Penis with Concomitant Urethral Injury ...

    African Journals Online (AJOL)



    Mar 16, 2009 ... ABSTRACT. Penile refracture is a rare urological emergency, more so on the side contralateral to the previous fracture. A 55-year-old male was referred 70 hours after sudden detumescence during sexual intercourse, with a history of blood at the urethral meatus. The patient had had a fracture of the penis ...

  14. Contralateral Fracture of the Penis with Concomitant Urethral Injury ...

    African Journals Online (AJOL)

    Penile refracture is a rare urological emergency, more so on the side contralateral to the previous fracture. A 55-year-old male was referred 70 hours after sudden detumescence during sexual intercourse, with a history of blood at the urethral meatus. The patient had had a fracture of the penis four years previously.

  15. Original article The Treatment of Complex Urethral Strictures Using ...

    African Journals Online (AJOL)

    Objectives: To compare the outcome of free onlay Buccal Mucosa Graft (BMG) with onlay penile Skin Island Flap (SIF) urethroplasty ... Key Words: Urethral stricture, Urethroplasty, Buccal mucosa graft, Skin island flap. Corresponding Author: Dr. .... Heinke et al, reported that BMG can be used as a ventral patch with favorable.

  16. current concepts in the management of anterior urethral strictures

    African Journals Online (AJOL)


    Buccal mucosa is now the established materials of choice for patch repair of the bulbar urethra 68. The technique of BMG repair has, gradually, outmoded the use of bladder mucosa or appendix for anterior urethral repair. Potential Buccal mucosa donor site are the inner check, the lower lip and under surface of the tongue.

  17. Results of tubularized urethral plate urethroplasty in Megameatus Intact Prepuce

    Directory of Open Access Journals (Sweden)

    Amilal Bhat


    Conclusions: Surgical correction of MIP in the era of increased cosmetic awareness is justified. Excellent results are obtained with TUPU and along with spongioplasty and frenuloplasty because of availability of wide urethral plate and well-developed spongiosum in these patients. TUPU should be the preferred procedure in cases of MIP.

  18. clean intermitent catheterisation in the management of urethral ...

    African Journals Online (AJOL)


    Nov 11, 2007 ... use of clean intermittent self-catheterisation in the management of recurrent urethral strictures. Setting: Kenyatta National ..... money. Fifteen untreated fistula patients had visited health institutions for the fistula problem while the rest 24 had not visited health facilities for this problem. Of those who visited ...

  19. Urethral advancement procedure in the treatment of primary distal ...

    African Journals Online (AJOL)

    corpora cavernosa for a distance of B4 : 1. The urethra was ... We included in this study all patients presenting with primary distal ..... evaluation of results. The urethral mobilization technique has two main limitations. First, its use in proximal hypospadias is not feasible. It is not advised to use this technique in cases where the ...

  20. Congenital prepubic sinus – A variant of urethral duplication

    African Journals Online (AJOL)

    J.S. Aihole


    Aug 2, 2016 ... the anatomical variations of the course of the sinus tract will help in complete excision and hence avoiding ... Association. one of the variations of the dorsal urethral duplication. They usually present with discharge from the sinus. Excision of the sinus tract is ... Histology of the tract showed urothelium.

  1. Management of anterior urethral strictures with buccal mucosa: Our ...

    African Journals Online (AJOL)

    Abdelwahab Elkassaby


    Mar 2, 2016 ... Association. skin [2]. Again the results were unsatisfactory till 1995, when Duck- ett et al. successfully used buccal mucosa for urethral reconstruction ... subdivided into three categories (based on function and histology);. Masticatory, Lining and ... anatomy should be accurately determined. The location and ...

  2. Case report Bladder exstrophy associated with complete urethral ...

    African Journals Online (AJOL)

    The mucosa of the dorsal urethral plate was transected at the corona and mobilised proximally to augment the bladder. The ventral urethra was preserved and the bladder closed. At 14 months follow up he is voiding normally, has adequate bladder capacity and a normal penis. Post operative voiding cystogram shows ...

  3. Review: Management of anterior urethral strictures with buccal ...

    African Journals Online (AJOL)

    Urethral stricture management is a challenging surgery. Multiplicity of techniques means that none of them is ideal. No single technique is appropriate for all situations and the successful surgeon should have a store of operations to choose from according to each specific case. This review aims to provide an update on the ...

  4. The Treatment of Complex Urethral Strictures Using Ventral Onlay ...

    African Journals Online (AJOL)

    Objectives: To compare the outcome of free onlay Buccal Mucosa Graft (BMG) with onlay penile Skin Island Flap (SIF) urethroplasty in the treatment of complex urethral strictures. Patients and Methods: A prospective comparative study was conducted at the Universitas Academic Hospital in Bloemfontein, South Africa.

  5. Treatment Options and Outcomes of Urethral Stricture in Dar Es ...

    African Journals Online (AJOL)

    Length, patient's age and co morbid factors play significant roles in the choice of treatment. Therefore ... (cic) were adopted as modes of treatment of patients with urethral stricture seeking urological services at Muhimbili National hospital and Tumaini hospital in Dar es Salaam, DVIU being the commonest mode treatment.

  6. Clinical presentation and treatment of urethral stricture: Experience ...

    African Journals Online (AJOL)

    O.N. Ekeke


    Aug 23, 2016 ... Acquired urethral strictures may arise from iatrogenic cases follow- ing catheterization, surgery or instrumentation; traumatic strictures from straddle injuries or pelvic fractures and infectious or inflam- matory strictures caused by gonorrhoea or lichen sclerosis [6–8]. A multitude of treatment modalities have ...

  7. Female Urethral Duplication: Rare Anomaly with Unusual Presentation

    African Journals Online (AJOL)


    Aug 19, 2016 ... scrotal or labial structures were present and the perineum appeared flat and fused [Figure 1]. On further evaluation, ... genitalia and urinary incontinence) along with a review of pertinent literature. Key words: Ambiguous genitalia, female pseudohermaphroditism, urethral duplication. How to cite this article: ...

  8. Post-TURP obliterative urethral stricture: Unusual treatment and ...

    African Journals Online (AJOL)

    shanker Short communication. Post-TURP obliterative urethral stricture: Unusual treatment and favourable result. A. Bhageria. ∗. , B. Nayak , P.K. Rai , P.N. Dogra. Department of Urology, All India Institute of Medical Sciences, New Delhi 110029, India. Received 9 September 2012; received in revised form ...

  9. Single-dose trospectomycin for chlamydial urethritis in men. (United States)

    Keefer, M C; Menegus, M A; Nasello, M A; Reid, J A; Long, M; Reichman, R C


    Trospectomycin is an aminocyclitol analog of spectinomycin with significant in vitro activity against Chlamydia trachomatis. A single 1-g intramuscular dose was administered to 10 men with symptomatic, culture-positive chlamydial urethritis. Trospectomycin was well tolerated but failed to eradicate chlamydial infection, as determined by cultures obtained approximately 1 week after treatment. PMID:1830196

  10. Urethral cavernous hemangioma in a female patient: a rare entity ...

    African Journals Online (AJOL)

    Genitourinary hemangiomas are rare entities of the urinary system. We reported a female patient who suffered dyspareunia and intermitant hematuria that was proved as urethral cavernous hemangioma. Despite its benign nature, hemangiomas may recur due to incomplet excision. Pan African Medical Journal 2015; 22 ...

  11. Female Urethral Anomalies in Pediatric Age Group: Uncovered

    African Journals Online (AJOL)

    urinary tract infection, trauma or operative interventions. The child had normal developmental milestones. ... showed a defect in symphysis pubis [Figure 2]. Ultrasonography was done to rule out upper tract disease .... a case of female hypospadias rather than sinus urogenitalis. CONCLUSION. Diagnosis of female urethral ...

  12. posterior urethral valves in childhood: experience in a

    African Journals Online (AJOL)

    well on varying lengths of continuous bladder drainage either by indwelling urethral catheter, suprapubic cystostomy or a vesicostomy, and therefore did not require ureterostomy or nephrostomy. Different methods of valve ablation have been described, including ablation of the valves under imaging control3 and bouginage ...

  13. Posterior urethral valves and Down syndrome | Lazarus | African ...

    African Journals Online (AJOL)

    The broad range of renal and urinary tract abnormalities associated with Down syndrome are not well known. We present two cases from a single institution of posterior urethral valves associated with Down syndrome. The cases illustrate the potential for delayed diagnosis and the management challenges. The literature is ...

  14. Knowledge and experience of medical students with male urethral ...

    African Journals Online (AJOL)

    Sixty-nine (54.3%) students said xylocaine jelly should be used as lubricant.. Ninety four (74%) students said that they will inflate the balloon of the catheter when the Y junction gets to the tip of the penis. Forty-nine (38.6%) students said they are very confident about male urethral catheterization, 61 (48.0%) said reasonably ...


    Directory of Open Access Journals (Sweden)



    Full Text Available AIM OF THE STUDY: Effectiveness of Transpubic urethroplasty in recurrent (failed urethral strictures due to pelvic fracture urethral distraction defects. INTRODUCTION: Urethral distraction injuries occur upto 10% of pelvic fracture cases. The principle indication of Transpubic urethroplasty is length >3 c ms, recur rent (failed repairs of posterior urethral stricture. Though other procedures like primary anastomotic urethroplasty, rerouting of the urethra under the corporal body, urethral substitution with tubularised flaps, two stage urethroplasty are described, Tr anspubic urethroplasty is said to produce the best results especially when repeat procedures are required. MATERIALS & METHODS: This is a prospective study from 2004 to 2014 consisting of 17 patients having recurrent stricture urethra secondary to pelvic f racture urethral distraction defects (PFUDD. All the patients were males and their age ranged from 15year to 45 years. Pre - op evaluation included X - ray KUB, Ultrasound abdomen & pelvis, retrograde urethrogram (RGU, micturating cystourethrogram (MCU, up and down Cystoscopy, urine culture and renal biochemical parameters. Urethra was approched through progressive perineal and abdominal approach with total pubectomy, followed by excising fibrosed stricture and tension free end to end anastomosis. Post opera tively pericatheteral RGU was carried out after 4 weeks and Catheter removed if there was no leak. RGU, MCU uroflowmetry and PVR were done one month after removal of catheter. Subsequently UFR, PVR and obstructive symptoms were assessed periodically. RESUL TS: All 17 Cases were followed up for a period of 3 - 11 years. Out of 17patients, 14(80% patients maintained good uroflow (UFR and insignificant PVR and procedure was considered successful. In 3 patients procedure failed, of which 2 patients had pericathe ter leak and reduced urinary flow with significant PVR and were followed up with CIC and 1 patient remained on permanent

  16. Ventral free oral mucous membrane graft for bulbar urethral stricture. (United States)

    Haque, M E; Rahman, M A; Islam, M F; Siddique, F H; Uddin, M M; Khondoker, M I; Kaiser, I; Siddiqui, O; Karim, M M; Saha, P; Salam, M A


    The use of oral mucous membrane graft onlay urethroplasty represents the most widespread method of bulbar urethral stricture repair. We investigated the short term result of oral mucous membrane graft placed on the ventral surface for management of bulbar urethral stricture. Patients with Bulbar urethral stricture of any length, infection free urinary tract and informed consent for oral mucosa harvesting and urethroplasty were selected for study. We enrolled 108 cases of bulbar urethral stricture patients from January 2004 to July 2009. The mean ± SD preoperative maximum flow rate of 5.2 ± 2.6 ml/sec and mean ± SD PVR 87 ± 58.3 ml were treated by substitution urethroplasty with oral mucous membrane by a single surgical team in a private hospital. Causes of stricture were trauma 26(24.1%), infection 58(53.7%), catheter induced 8(7.4%), post TURP 11(10.2%) and unknown 5(4.6%). Oral mucous membrane was harvested from the cheek or from the inner side of lower lip. Defect of the urethra displayed by longitudinal ventral urethrotomy and the graft was sutured over the edges of the incised urethral mucosa over a 14 Fr latex Foley's catheter. Spongiosum tissue was closed over the graft. Pericatheter urethrogram was performed in all cases to check for the anastomotic leakage and the Catheter was removed after 2 weeks of the procedure. After removal of catheter uroflowmetry & ultrasound scan of bladder were performed to estimate the maximum flow rate and post voidal residue. The patient was followed-up every 3 months with uroflowmetry & ultrasonography. The median (range) age of the patients was 32(21-72) years. Mean follow up period was 36 months (range 12-54). Mean ± SD stricture length was 3.7 ± 2.6 cm. The overall success rate was 91.7%. Mean ± SD flow rate was 23 ± 4.2 ml/sec, mean ± SD post void residue was 25 ± 15.5 ml and patient quality of life (QOL) was excellent in almost all patients. Overall complications were seen in 9(8.3%) cases. Of which

  17. Acquired urethral diverticulum in a man with paraplegia presenting with a scrotal mass: a case report

    Directory of Open Access Journals (Sweden)

    El Ammari Jalal Eddine


    Full Text Available Abstract Introduction Male urethral diverticula are rare. Patients with paraplegia may present with acquired diverticula as a result of prolonged catheterization. Diverticula may be asymptomatic or lead to lower urinary tract symptoms. Rarely, the diverticulum may initially present as a scrotal mass. Case presentation We report the case of a male 45-year-old Arab with paraplegia who presented with a mass in the peno-scrotal junction. He had in his medical history iterative prolonged urethral catheterizations associated with urine leakage through the urethral meatus upon applying compression. Diagnosis confirmation of urethral diverticula is obtained by retrograde urethrography. The patient underwent a diverticulectomy with urethroplasty. Conclusion Male acquired urethral diverticula can be found in patients who have a spinal cord injury because of prolonged urethral catheterization. Clinical presentations are different and sometimes can be misleading. Retrograde urethrography is the key to diagnosis and open surgery is the treatment of reference.

  18. Aphallia with urethrorectal fistula, bladder and urethral calculi

    Directory of Open Access Journals (Sweden)

    M Movarrekh


    Full Text Available Introduction: Aphallia is a very rare urogenital anomaly with incidence rate of 1 in 30,000,000. It usually coexists with other anomalies such as cardiovascular anomalies which are incompatible with normal life, and therefore infants are delivered stillbirth or live for a very short period of time. Methods: We present an 18 months old boy with aphallia associated with congenital urethrorectal fistula, bladder and urethral stones. All stones were removed endourologically, recto-urethral fistula was repaired and perincal urethrostomy was performed. Results: The stones were composed of calcium phosphate colonized by klebiella pneumonia and proteus mirabilis. Urethrorectal fistula repairment was confirmed by cystography. Patient was discharged without a urinary catheter. Conclusion: In developed countries, management of such patients is to raise them as females. However, we must consider socio-cultural conditions, parents preference and patients tendency in management of aphallia.

  19. Comparative Efficacy of Penicillin and Doxycycline in Gonococcal Urethritis

    Directory of Open Access Journals (Sweden)

    Vinod K Sharma


    Full Text Available Ninety two episodes of gonococcal urethritis treated with one of the following regimens viz: (A 3 m. u. of fortified procaine penicillin made by adding 1 m.u. of crystalline penicillin to 2 m.u. of fortified procaine penicillin intramuscularly with one gram of probenecid orally, (B 3 m.u. of above fortified procaine penicillin intramuscularly alone, and (C 400 mg single oral dose of doxycycline produced success rates of 95,76.2 and 66.7% respectively. Post gonococcal urethritis was detected in 37% patients. Thirty four (45.94% of the 74 isolates of N. gonorrhoeae were relatively resistant (MIC 0. 12 units ml to penicillin. None of the 74 Neisseria gonorrhoeac strains was beta lactamase producing.

  20. Prostatic urethral lift vs transurethral resection of the prostate

    DEFF Research Database (Denmark)

    Gratzke, Christian; Barber, Neil; Speakman, Mark J


    OBJECTIVES: To compare prostatic urethral lift (PUL) with transurethral resection of the prostate (TURP) with regard to symptoms, recovery experience, sexual function, continence, safety, quality of life, sleep and overall patient perception. PATIENTS AND METHODS: A total of 80 patients with lowe...... in statistically significant improvement in sleep. CONCLUSION: PUL was compared to TURP in a randomised, controlled study which further characterized both modalities so that care providers and patients can better understand the net benefit when selecting a treatment option.......OBJECTIVES: To compare prostatic urethral lift (PUL) with transurethral resection of the prostate (TURP) with regard to symptoms, recovery experience, sexual function, continence, safety, quality of life, sleep and overall patient perception. PATIENTS AND METHODS: A total of 80 patients with lower...... function preservation, continence preservation and safety. Additional evaluations of patient perspective, quality of life and sleep were prospectively collected, analysed and presented for the first time. RESULTS: Significant improvements in International Prostate Symptom Score (IPSS), IPSS quality of life...

  1. Prevention of urethral stricture recurrence using clean intermittent self-catheterization

    DEFF Research Database (Denmark)

    Kjaergaard, B; Walter, S; Bartholin, J


    year following Sachse's operation for urethral stricture and 22 patients formed the control group after the same operation. All had an objective examination for urethral stricture every 2 months after surgery. RESULTS: Significantly fewer (P ... within the first postoperative year in the CIC group (n = 4) compared with the control group (n = 15). No CIC complications were seen, and patients who completed the CIC programme considered the method fully acceptable. CONCLUSION: Weekly CIC is a simple method of reducing the frequency of urethral...

  2. [Results of urethral reconstruction in adults after multiple hypospadias repairs]. (United States)

    Gamidov, S I; Shneiderman, M G; Pushkar, D Yu; Vasil'ev, A O; Govorov, A V; Ovchinnikov, R I; Popova, A Yu; Dusmukhamedov, R D


    To improve treatment results in patients after multiple hypospadias repairs by optimizing the postoperative management. Eighty-two patients (mean age 48.1+/-15.3 years) with urethral strictures secondary to failed hypospadias repairs underwent staged graft urethroplasty using oral mucosa (cheek, lip, tongue) as a grafting material. In 62 patients, at the end of surgery the bladder was drained with a standard Foley catheter. In twenty patients the bladder was drained with a modified silicone urethral catheter, which had an additional channel for delivering drugs and removing the urethral wound effluent, and a second additional channel for inflating a balloon fixed to the catheter tube at different parts of the catheter. The mean length of the stricture was 5.4+/-1.2 cm (from 1 to 16 cm). Twenty-eight patients had postoperative complications. Using the modified catheter resulted in statistically significantly (phypospadias repair. The proposed modification of the catheter ensures the timely delivery of drugs to the surgical site, evacuation the wound effluent from the urethra and helps prevent strictures by periodically inflating the adjustable balloon-dilator.

  3. Quality and length of life, money and urethral stricture disease. (United States)

    Jackson, Matthew J; Ivaz, Stella L


    This article walks through some of the ideas behind patient-reported outcome measurement and quality of life research against the backdrop of urethral stricture disease and conditions of the lower urinary tract more generally, why measurement matters at all, future areas for research and development and potential opportunities for misuse and manipulation. It is the authors' opinion that only one published study has substantially advanced our understanding of the way men with urethral stricture disease manage this condition in the real world, and, in turn, the outcomes those men seek when they consent to surgery and its associated risks. There is, however, almost certainly greater acceptance now by reconstructive urologists of the utility of patient-reported outcome measures in audit; surgical performance evaluation; clinical research; and fair, logical and transparent healthcare resource allocation at a population level. This is evidenced by the recent proliferation of studies incorporating patient-reported outcomes, which appear today to be on parity at least with those that surgeons historically gave priority to. The next frontier in urethral stricture disease outcomes research is a better understanding of the impact of this condition on men's daily lives. That level of insight is likely to be gained through a mixture of qualitative and quantitative research methods applied to collaborative research ventures with men with the condition who, as those that have the most to gain and lose, must be majority stakeholders in this process.

  4. [Urethral diverticulum. Our casuistic and the literatura review]. (United States)

    Ramírez Backhaus, M; Trassierra Villa, M; Broseta Rico, E; Gimeno Argente, V; Arlandis Guzmán, S; Alonso Gorrea, M; Jiménez Cruz, J F


    The possible etiopathogenic factors, symptoms, diagnostic methods, surgical management and complications of the urethral diverticula are reviewed. A retrospective study of the clinical charts with urethral diverticula diagnosis during the period 1986-2006 was carried out. In the last 20 years a total of 19 patients have been treated for this pathology: 15 females and 4 males. Five of the females started with a sensation of vaginal mass; the rest were diagnosed of micturitional (irritative) syndrome, urinary incontinence or urinary infection. In the case of males, 3 of them had a palpable tumour in the penis. The most used diagnostic method was retrograde and voiding cystourethrography; urethrography with double-occlusion balloon catheter was used in 5 cases and urethroscopy in 4 patients; other techniques of image diagnosis like magnetic resonance imaging were necessary for the most complex cases. The treatment was the excision of the diverticulum, except for one of the females who rejected the treatment. The evolution in all treated women was successful, according to follow up 2 years after the treatment. In males, two of them had complex recurrent diverticula. Urethral diverticula are nosologic entities of difficult diagnosis, due to their low prevalence and their unspecific clinic, therefore diagnosis is sometimes incidental. The etiopathogenity is acquired in most cases and its surgical treatment is more challenging in males than in females probably linked to the fact that diverticula appear in urethras with previous surgery, endourologic manipulation or associated injuries.

  5. Cost-effectiveness of microscopy of urethral smears for asymptomatic Mycoplasma genitalium urethritis in men in England. (United States)

    Sutton, Andrew J; Roberts, Tracy E; Jackson, Louise; Saunders, John; White, Peter J; Birger, Ruthie; Estcourt, Claudia


    The objective was to determine whether or not the limited use of urethral microscopy to diagnose asymptomatic and symptomatic non-chlamydial, non-gonococcal urethritis (NCNGU) in men is a cost-effective strategy to avert pelvic inflammatory disease (PID), ectopic pregnancy or infertility in female partners. Outputs from a transmission dynamic model of NCNGU in a population of 16-30 year olds in England simulating the number of consultations, PID cases and patients treated over time amongst others, were used along with secondary data to undertake a cost-effectiveness analysis carried out from a health care provider perspective. The main outcome measure was cost per case of PID averted. A secondary outcome measure was cost per major outcome averted, where a major outcome is a case of symptomatic PID, ectopic pregnancy, or infertility. Offering a limited number of asymptomatic men urethral microscopy was more effective than the current practice of no microscopy in terms of reducing the number of cases of PID with an incremental cost-effectiveness ratio of £15,700, meaning that an investment of £15,800 is required to avert one case of PID. For major outcomes averted, offering some asymptomatic men urethral microscopy was again found to be more effective than no microscopy, but here an investment of £49,900 is required to avert one major outcome. Testing asymptomatic men for NCNGU in a small number of genitourinary medicine settings in England is not cost-effective, and thus by maintaining the current practice of not offering this patient group microscopy, this continues to make savings for the health care provider.

  6. Signal processing in urodynamics: towards high definition urethral pressure profilometry. (United States)

    Klünder, Mario; Sawodny, Oliver; Amend, Bastian; Ederer, Michael; Kelp, Alexandra; Sievert, Karl-Dietrich; Stenzl, Arnulf; Feuer, Ronny


    Urethral pressure profilometry (UPP) is used in the diagnosis of stress urinary incontinence (SUI) which is a significant medical, social, and economic problem. Low spatial pressure resolution, common occurrence of artifacts, and uncertainties in data location limit the diagnostic value of UPP. To overcome these limitations, high definition urethral pressure profilometry (HD-UPP) combining enhanced UPP hardware and signal processing algorithms has been developed. In this work, we present the different signal processing steps in HD-UPP and show experimental results from female minipigs. We use a special microtip catheter with high angular pressure resolution and an integrated inclination sensor. Signals from the catheter are filtered and time-correlated artifacts removed. A signal reconstruction algorithm processes pressure data into a detailed pressure image on the urethra's inside. Finally, the pressure distribution on the urethra's outside is calculated through deconvolution. A mathematical model of the urethra is contained in a point-spread-function (PSF) which is identified depending on geometric and material properties of the urethra. We additionally investigate the PSF's frequency response to determine the relevant frequency band for pressure information on the urinary sphincter. Experimental pressure data are spatially located and processed into high resolution pressure images. Artifacts are successfully removed from data without blurring other details. The pressure distribution on the urethra's outside is reconstructed and compared to the one on the inside. Finally, the pressure images are mapped onto the urethral geometry calculated from inclination and position data to provide an integrated image of pressure distribution, anatomical shape, and location. With its advanced sensing capabilities, the novel microtip catheter collects an unprecedented amount of urethral pressure data. Through sequential signal processing steps, physicians are provided with

  7. Is the impaired flow after hypospadias correction due to increased urethral stiffness?

    NARCIS (Netherlands)

    T. Idzenga (Tim); D.J. Kok (Dirk); J.J.M. Pel (Johan); R. van Mastrigt (Ron); K.P. Wolffenbuttel (Katja)


    textabstractPurpose: A low flow rate without clinical symptoms is commonly found in boys after hypospadias correction. Urethral calibration usually shows no abnormalities. We investigated whether this flow rate impairment might be caused by increased neo-urethral wall-stiffness. Methods: From

  8. Long-term outcome of posterior urethral valves ablation using the ...

    African Journals Online (AJOL)

    Problems noticed on follow-up include recurrent urinary tract infections in 35% of the cases, acute and chronic renal failure in 5% and 15% respectively, rickets, anaemia, malnutrition and urethral stricture. Conclusion: Children who had posterior urethral valves ablated should be followed up much beyond the immediate ...

  9. Moraxella catarrhalis associated with acute urethritis imitating gonorrhoea acquired by oral-genital contact. (United States)

    Abdolrasouli, A; Amin, A; Baharsefat, M; Roushan, A; Hemmati, Y


    A case of heterosexual transmission of Moraxella catarrhalis by fellatio, which resulted in acute purulent urethritis mimicking gonorrhoea in the male partner, is described. In male patients with urethritis due to M. catarrhalis, orogenital contact with a sexual partner carrying the organism in his/her oropharynx is the probable route of transmission.

  10. The impact of tension-free vaginal tape on the urethral closure function

    DEFF Research Database (Denmark)

    Saaby, Marie-Louise; Klarskov, Niels; Lose, Gunnar


    AIM: To investigate if the tension-free vaginal tape (TVT) works by increasing the abdominal to urethral pressure impact ratio (APIR). METHODS: Twenty one women with urodynamically proven stress urinary incontinence (SUI) were assessed by ICIQ-SF, pad-weighing test, incontinence diary and Urethral...... Pressure Reflectometry (UPR) before and after TVT. UPR was conducted during resting and increased intra-abdominal pressure (P(Abd)) by straining. Related values of P(Abd) and urethral opening pressure (P(o)) were plotted into an abdomino-urethral pressuregram. Linear regression of the values was conducted......, and the slope of the line was found. The slope expresses the ratio of pressure increase in the urethra compared to the pressure increase in the abdomen and was called APIR. RESULTS: The urethral opening pressure at rest (P(o-rest)) was unchanged after TVT, while APIR increased in all women (from 0.7 to 1.4, P...

  11. Four cases of lowered urethral pressure in canine ectopic ureter. (United States)

    Koie, H; Yamaya, Y; Sakai, T


    To evaluate the function of the constrictor urethrae of dogs that had urinary incontinence and were diagnosed as having ectopic ureter, the urethral pressure profile (UPP) was measured by means of a microchip catheter transducer. The UPPs (14.5 +/- 3.3 mmHg) of the four dogs suffering from ectopic ureter were much lower (pdogs (35.3 +/- 5.7 mmHg). In the cases of ectopic ureter, it was shown that the UPP was lowered, and it was suggested that this would lead to the expression of urinary incontinence.

  12. Urethral duplication with unusual cause of bladder outlet obstruction

    Directory of Open Access Journals (Sweden)

    Vivek Venkatramani


    Full Text Available A 12-year-old boy presented with poor flow and recurrent urinary tract infections following hypospadias repair at the age of 3 years. The evaluation revealed urethral duplication with a hypoplastic dorsal urethra and patent ventral urethra. He also had duplication of the bladder neck, and on voiding cystourethrogram the ventral bladder neck appeared hypoplastic and compressed by the dorsal bladder neck during voiding. The possibility of functional obstruction of the ventral urethra by the occluded dorsal urethra was suspected, and he underwent a successful urethro-urethrostomy.

  13. Válvula de uretra anterior Anterior urethral valves

    Directory of Open Access Journals (Sweden)

    Silvio Tucci Jr.


    Full Text Available Objetivo: apresentar os aspectos clínicos, diagnósticos e terapêuticos de pacientes portadores de válvula da uretra anterior. Descrição: em dois neonatos, o diagnóstico presuntivo de patologia obstrutiva do trato urinário foi sugerido pela ultra-sonografia realizada no período pré-natal, confirmando-se o diagnóstico de válvula de uretra anterior pela avaliação pós-natal. Os pacientes foram submetidos a tratamento cirúrgico paliativo, com vesicostomia temporária e, posteriormente, definitivo, pela fulguração endoscópica das válvulas. Ambos evoluíram com função renal normal. Comentários: a válvula da uretra anterior é anomalia rara que deve ser considerada em meninos com quadro radiológico pré-natal sugestivo de obstrução infravesical, secundariamente à hipótese mais comum de válvula da uretra posterior. Ressaltamos a utilização da vesicostomia como derivação urinária temporária nestes casos, prevenindo potenciais complicações pela manipulação da uretra do recém-nascido.Objective: to discuss clinical signs, diagnostic tools and therapeutics of anterior urethral valves, an obstructive anomaly of the urinary system in males. Description: signs of urinary tract obstruction were identified on pre-natal ultrasound in two male fetuses and the diagnosis of anterior urethral valves was made through post-natal evaluation. As an initial treatment, vesicostomy was performed in both patients. Later, the valves were fulgurated using an endoscopic procedure. During the follow-up period both patients presented normal renal function. Comments: anterior urethral valves are a rare form of urethral anomaly that must be ruled out in boys with pre-natal ultrasound indicating infravesical obstruction. Vesicostomy used as an initial treatment rather than transurethral fulguration may prevent potential complications that can occur due to the small size of the neonatal urethra.

  14. Effectiveness of syndromic management for male patients with urethral discharge symptoms in Amazonas, Brazil. (United States)

    Menezes Filho, Jonas Rodrigues de; Sardinha, José Carlos Gomes; Galbán, Enrique; Saraceni, Valéria; Talhari, Carolina


    Urethral discharge syndrome (UDS) is characterized by the presence of purulent or mucopurulent urethral discharge.The main etiological agents of this syndrome are Neisseria gonorrhoeae and Chlamydia trachomatis. To evaluate the effectiveness of the syndromic management to resolve symptoms in male urethral discharge syndrome cases in Manaus, Amazonas, Brazil. Retrospective cohort of male cases of urethral discharge syndrome observed at a clinic for sexually transmitted disease (STD) in 2013. Epidemiological and clinical data, as well as the results of urethral swabs, bacterioscopy, hybrid capture for C.trachomatis, wet-mount examination, and culture for N.gonorrhoeae, were obtained through medical chart reviews. Of the 800 urethral discharge syndrome cases observed at the STD clinic, 785 (98.1%) presented only urethral discharge syndrome, 633 (79.1%) returned for follow-up, 579 (91.5%) were considered clinically cured on the first visit, 41(6.5 %) were considered cured on the second visit, and 13(2.0%) did not reach clinical cure after two appointments. Regarding the etiological diagnosis, 42.7% of the patients presented a microbiological diagnosis of N.gonorrhoeae, 39.3% of non-gonococcal and non-chlamydia urethritis, 10.7% of C.trachomatis and 7.3% of co-infection with chlamydia and gonococcus. The odds of being considered cured in the first visit were greater in those who were unmarried, with greater schooling, and with an etiological diagnosis of gonorrhea. The diagnosis of non-gonococcal urethritis reduced the chance of cure in the first visit. A study conducted at a single center of STD treatment. Syndromic management of male urethral discharge syndrome performed in accordance with the Brazilian Ministry of Health STD guidelines was effective in resolving symptoms in the studied population. More studies with microbiological outcomes are needed to ensure the maintenance of the syndromic management.

  15. Three-dimensional spiral computed tomographic cysto-urethrography for post-traumatic complex posterior urethral strictures associated with urethral-rectal fistula. (United States)

    Sa, Ying Long; Xu, Yue Min; Feng, Chao; Ye, Xu Xiao; Song, Lu Jie


    To evaluate the value of three-dimensional spiral computed tomography/cysto-urethrography (CTCUG) in diagnosing posterior urethral strictures associated with urethrorectal fistulas (URF). Between June 2008 and March 2012, 38 patients with posterior urethral strictures associated with URFs were examined by CTCUG, retrograde urethrography (RUG) and cysto-urethrography (CUG). Urethral reconstruction was undertaken and URFs were surgically repaired in all patients. The length of the urethral defect, location and size of URFs were recorded. Data from radiological examinations were compared with surgical findings. No statistically significant difference was found in the length of stricture measured using CTCUG (4.31 ± 2.28 cm) or conventional urethrography (4.02 ± 3.12 cm; p > 0.05), However, the accuracy in determining the location of the stricture was higher with CTCUG (93.12%) than with conventional urethrography (70.59%; p < 0.05). CTCUG identified URFs in all 38 patients (100%), whereas URFs were only observed in 27 patients (71%) using conventional urethrography. In conclusion, CTCUG was more accurate, safer and provided more details of URFs and urethral defects than conventional urethrography in patients with posterior urethral strictures associated with URFs.

  16. The meatal/urethral width in healthy uncircumcised boys. (United States)

    Orkiszewski, Marek; Madej, Joanna


    Knowledge of normal meatal/urethral width in a growing boy is important to create a neourethra of adequate size to correct hypospadias. Thus far, normal size values have been based on the study of circumcised, awake boys. The aim of this study was to measure normal urethral width in healthy uncircumcised boys under general anesthesia to provide a tool to create a neourethra of adequate size. Sixty healthy uncircumcised boys, aged 5 months through 16 years, were examined. Measurements were carried out under general anesthesia with Hegar dilators, size 1-8mm. Care was taken not to dilate or injure the urethra. The patients were divided into age groups similar to those in the literature and those recommended for hypospadias surgery. The data were analyzed in relation to age, body length and weight. With minimum size 3.5mm and maximum 7.5mm, the mean width was significantly larger in the age groups 5 months-2 years and 2-4 years than in the literature (P<0.001). This study presents a practical tool for surgeons involved in hypospadias repair. Standardization of procedure may result in better assessment of results and education. Copyright © 2009 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  17. Urethral dysfunction in female mice with estrogen receptor β deficiency.

    Directory of Open Access Journals (Sweden)

    Yung-Hsiang Chen

    Full Text Available Estrogen has various regulatory functions in the growth, development, and differentiation of the female urogenital system. This study investigated the roles of ERβ in stress urinary incontinence (SUI. Wild-type (ERβ(+/+ and knockout (ERβ(-/- female mice were generated (aged 6-8 weeks, n = 6 and urethral function and protein expression were measured. Leak point pressures (LPP and maximum urethral closure pressure (MUCP were assessed in mice under urethane anesthesia. After the measurements, the urethras were removed for proteomic analysis using label-free quantitative proteomics by nano-liquid chromatography-mass spectrometry (LC-MS/MS analysis. The interaction between these proteins was further analysed using MetaCore. Lastly, Western blot was used to confirm the candidate proteins. Compared with the ERβ(+/+ group, the LPP and MUCP values of the ERβ(-/- group were significantly decreased. Additionally, we identified 85 differentially expressed proteins in the urethra of ERβ(-/- female mice; 57 proteins were up-regulated and 28 were down-regulated. The majority of the ERβ knockout-modified proteins were involved in cell-matrix adhesion, metabolism, immune response, signal transduction, nuclear receptor translational regelation, and muscle contraction and development. Western blot confirmed the up-regulation of myosin and collagen in urethra. By contrast, elastin was down-regulated in the ERβ(-/- mice. This study is the first study to estimate protein expression changes in urethras from ERβ(-/- female mice. These changes could be related to the molecular mechanism of ERβ in SUI.

  18. Anti-fibrotic function of Cu-bearing stainless steel for reducing recurrence of urethral stricture after stent implantation. (United States)

    Zhao, Jing; Ren, Ling; Liu, Meixia; Xi, Tong; Zhang, Bingchun; Yang, Ke


    Recurrent stenosis is the main reason inducing the failure of urethral stricture treatment. Our previous study has found that the 316L type Cu bearing stainless steel (316L-Cu SS) showed antimicrobial activity and anti-encrustation performance when it was used for relieving urethral obstructer. However, whether it can reduce the occurrence of fibrosis or not, we need further investigation to compare the cellular and molecular responses of human urethral scar fibroblast cells (USFCs) on 316L-Cu SS and medical grade 316L stainless (316L SS, as a control). [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4- sulfophenyl)- 2H-tetrazolium (MTS) and Transwell were used to assess the cellular responses, which confirmed that 316L-Cu SS could inhibit proliferation and migration of USFCs. Molecular expressions of fibrosis were evaluated by western blot, real-time quantitative polymerase chain reaction (qPCR), and Cu/Zn superoxide dismutase (CuZnSOD) measurement. The results indicated that up-regulating of CuZnSOD attenuated the transforming growth factor-β1 expression and phosphorylation of Smad3 after exposure to 316L-Cu SS. Besides, the content of collagen type I (COL1) and collagen type III (COL3) secreting into the culture medium measured by enzyme-linked immunosorbent assay were in accord with the results of messenger ribonucleic acids. Both of them exhibited lower levels of COL1/COL3 exposure to 316L-Cu SS, demonstrating the inhibitory performance of 316L-Cu SS against fibrosis. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2017. © 2017 Wiley Periodicals, Inc.

  19. Incidence of Urethral Stricture in Patients with Adult Acquired Buried Penis. (United States)

    Liaw, Aron; Rickborn, Lanette; McClung, Christopher


    Introduction. Concealed-buried penis is an acquired condition associated with obesity, challenging to both manage and repair. Urethral stricture is a more common disorder with multiple etiologies. Lichen sclerosus is a significant known cause of urethral stricture, implicated in up to 30%. We hypothesize that patients with buried penis have a higher rate of urethral stricture and lichen sclerosus than the general population. Methods. We retrospectively reviewed a single surgeon's (CM) case logs for patients presenting with a buried penis. All patients were evaluated for urethral stricture with cystoscopy or retrograde urethrogram either prior to or at the time of repair for buried penis. Those that had surgical repair or biopsy were reviewed for presence of lichen sclerosus. Results. 39 patients met inclusion criteria. Of these, 13 (33%) had associated stricture disease. The location of the strictures was bulbar urethra (38%), penile urethra (15%), and meatus or fossa navicularis (62%). Five patients had lichen sclerosus and urethral stricture disease, while 3 had lichen sclerosus without stricture. 11/13 stricture patients were treated. Six underwent dilation, 3 underwent meatotomy, and 2 underwent urethroplasty. No significant recurrences of stricture were seen. Conclusion. Patients with a concealed penis are more likely than the general population to have a urethral stricture and/or LS. Patients presenting with concealed penis should also be evaluated for a urethral stricture.

  20. Urethral Reconstruction Using Everted Saphenous Vein Graft in a Rabbit Model: One-Year Outcomes. (United States)

    Xu, Yujie; Shen, Zhou; Liu, Gang; Liu, Bing; Hua, Xiaoliang; Xiang, Yechen; Dong, Chuanjiang; Li, Bing


    To investigate the efficacy of using everted saphenous vein graft for urethral reconstruction. Thirty-five adult male rabbits were divided into 7 groups randomly: experimental group A, B, C, D, E, stricture control group and normal control group (n = 5). In experimental groups and the stricture control group, a urethral mucosa defect (1.5 × 0.8 cm) was created in each rabbit. In experimental groups, a 2-cm long saphenous vein graft was harvested and incised longitudinally and urethral reconstruction was carried out using the everted saphenous vein patch. Rabbits in experimental group A-E were killed respectively at 1 week, 2 weeks, 1 month, 3 months, and 1 year postoperatively, and the specimens were obtained for histo-pathological examination. Retrograde urethrography was performed to evaluate urethral patency before sacrifice in group D and the stricture control group. In the histo-pathological study, the vein grafts were visible within first week. The vein graft was completely covered by epithelium 1 month postoperatively. Retrograde urethrograms showed the urethral caliber of experimental rabbits were similar to those of normal. While the stricture control group showed a narrow urethral lumen and urothelium defect. For urethral reconstruction, everted saphenous vein graft can be an ideal substitute material because of its longer survival time and rapid epithelization capacity. © 2017 S. Karger AG, Basel.

  1. Parameatal urethral cyst of glans penis in children – a report of three cases

    Directory of Open Access Journals (Sweden)

    Mrinal Gupta


    Full Text Available Parameatal urethral cysts are a rare benign condition usually seen in males. They are usually asymptomatic but may produce symptoms like difficulty in micturition, pain during intercourse, urinary retention and distortion of the urinary stream. We report three cases of parameatal urethral cyst in young males presenting as a spherical clear fluid filled cystic lesions over the external urethral meatus, causing distortion of the urinary stream and poor cosmesis. Histological examination of the excised cyst showed a monolocular cyst lined with pseudo-stratified epithelium with no evidence of inflammation. Complete surgical excision of the cysts was done and no recurrence was observed at follow-up.

  2. An Urethral Stone Mimicking Urinary Tract Infection in a Twenty-six-month-old Boy

    Directory of Open Access Journals (Sweden)

    Mehmet Giray Sönmez


    Full Text Available A 26-month-old boy, who was misdiagnosed with urinary tract infection, was admitted to our hospital with increasing complaints of uneasiness, vomiting and nausea. On physical examination, a urethral stone was suspected and was confirmed by plain urinary tract x-ray. In children, the clinical features of a urethral stone may be overlooked because children are not able to express their complaints fully. Therefore, a detailed and careful physical examination is of great importance. In this paper, we present the rare case of urethral stone in a child and a review of the literature.

  3. Effect of urethral wall injection of replication-defective herpes simplex virus-mediated gene transfer of kynurenine aminotransferase on urethral pressure in spinal cord-injured rats. (United States)

    Wang, Zhaoxia; Liao, Limin


    We determined whether or not replication-defective herpes simplex virus vector-mediated kynurenine aminotransferase II (HSVrd-KAT II) suppressed the tonic activity of the urethral sphincter in spinal cord-injured (SCI) rats. Thirty-six adult female Sprague-Dawley rats were used to produce a spinal cord injury model. One week after spinalization, HSVrd-KAT II was injected into the urethral wall of rats and another two groups of SCI rats were treated with saline and HSVrd as controls. Three weeks after viral injection, the urethral pressure profile (UPP), continuous cystometry, and gene expression in the L6-S1 spinal cords were evaluated in all three groups. In the HSVrd-KAT II group, the maximum urethral closure pressure (Pclo.max) and maximum voiding pressure were significantly decreased (23.6-24.9% and 31.6-30.9%, respectively), in addition to an increase in voiding efficiency(48.8-76%), compared with the sham and HSVrd groups. The KAT II protein and mRNA levels were significantly increased in HSV-KAT II group compared with the HSVrd group. KAT II gene therapy effectively reduced the urethral pressure, improving detrusor-sphincter dyssynergia (DSD), and detrusor overactivity (DO), probably by blocking the N-methyl-D-aspartate receptor (NMDAr) in the L6-S1 spinal cord. Neurourol. Urodynam. 36:1046-1051, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  4. Female Urethral Malignant Melanoma With Vesical Invasion: A Case Report

    Directory of Open Access Journals (Sweden)

    Alpaslan Akbas


    Full Text Available We report a 75-year-old female with a primary urethral malignant melanoma. A mass protruding from inside the urethra was detected on physical examination. Abdominopelvic magnetic resonance imaging revealed a mass extending from the urethra with dimensions of 4 × 2 cm, and periurethral heterogenous fatty planes consistent with infiltration. The histopathologic examination was consistent with HMB45(+ malignant melanoma. We performed cystourethrectomy and bilateral inguinal and pelvic lymphadenectomy in one session. The pathology report revealed primary malignant melanoma of the urethra invading the inferior bladder wall. The patient received no adjuvant therapy because of cardiopulmonary morbidities and the presence of multiple pulmonary metastases. The patient eventually died 13 months after surgery.

  5. Urethral dysontogenic metaplasia in cat with bilateral renal dysplasia

    Directory of Open Access Journals (Sweden)

    Carolina da Fonseca Sapin


    Full Text Available This paper to describe a case of dysontogenic urethral metaplasia in a one month old mongrel feline who also had bilateral renal dysplasia. Dysontogenic metaplasia in cats are scarce and this change may be associated with renal dysplasia and/or lower urinary tract. The animal had history of abdominal enlargement since birth and dysuria, eliminating urine only dropwise. Due to the poor prognosis we opted for euthanasia. At necropsy was observed enlarged and distended bladder, reduced kidneys and dilated and tortuous ureters. The urethra was thickened, hard to cut, and histologically, was replacing the connective tissue, cartilage and endochondral ossification areas, which features dysontogenic metaplasia. Both kidneys presented primitive appearance featuring dysplasia. Dysontogenic metaplasia in urinary tract feline with renal dysplasia, has not been described.

  6. Urethral masturbation and sexual disinhibition in dementia: a case report. (United States)

    Rosenthal, Michal; Berkman, Pinhas; Shapira, Adi; Gil, Israel; Abramovitz, Jancu


    Urethral masturbation and sexual disinhibition as manifestations of behavioral and psychological symptoms of dementia (BPSD) are described in a 90-year-old patient who repeatedly self-inserted foreign bodies into his urethra. A diagnosis was made of late onset sexual disinhibition and hypersexuality in a patient with Dementia of the Alzheimer Type. Significant reduction of his sexual behavior was achieved with low doses of haloperidol. Similar symptoms are noted in Pick's disease, other fronto-temporal lesions, mania and following a seizure or treatment of Parkinson's disease, and have been described as Kluver-Busy-type. Clinicians should consider this diagnosis when investigating dysuria, cystitis, haematuria and urinary tract infections even in the very old.

  7. Urethral polyp in a 1-month-old child

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    Beluffi, Giampiero [Department of Radiodiagnosis, IRCCS Policlinico S. Matteo, Section of Paediatric Radiology, Piazzale Golgi, 2, I-27100, Pavia PV (Italy); Berton, Francesca; Gola, Giada [University of Pavia, IRCCS Policlinico S. Matteo, Institute of Radiology, Pavia (Italy); Chiari, Giorgio; Romano, Piero; Cassani, Ferdinando [IRCCS Policlinico S. Matteo, Division of Paediatric Surgery, Pavia (Italy)


    Urethral polyps are a rare finding in children, particularly in the very young. They are suspected by the presence of various clinical signs such as obstruction, voiding dysfunction and haematuria. There is an association with other urinary tract congenital anomalies. They are usually benign fibro-epithelial lesions with no tendency to recur and are treated by surgical ablation, fulguration or laser therapy. We report a 1-month-old boy with an antenatally diagnosed left ectopic pelvic kidney, postnatal urinary tract infection and no clinical signs of obstruction. Voiding cystourethrography to exclude vesico-ureteric reflux showed a trabeculated bladder and a mobile filling defect in the posterior urethra. Owing to its large size, cystotomy was necessary to remove the polyp successfully. (orig.)

  8. Xanthogranulomatous urethritis and cystitis: a rare clinical and pathological entity

    Directory of Open Access Journals (Sweden)

    Lewkowicz Dorota


    Full Text Available Xanthogranulomatous inflammation of the urethra and the urinary bladder is a very rare pathological condition characterized by a chronic inflammatory infiltration composed mainly of foamy macrophages, with the presence of multinucleated giant cells. In a clinical examination, it can mimic urinary bladder carcinoma. This report presents the extremely rare case of a co-existing xanthogranulomatous urethritis and cystitis in a 64-year-old woman with recurrent dysuria, and with the suspicion of malignancy - as indicated on the basis of a cystoscopic examination. The standard treatment of this disorder is surgical resection, but in the presented case, only a diagnostic biopsy was performed. Because of the persistence of clinical symptoms, a cystoscopic examination and biopsy was repeated three times in a two year period. There was no malignancy seen in the repeated biopsies.

  9. Female urethral diverticulum associated with a large urinary calculus

    Directory of Open Access Journals (Sweden)

    Alexandre Oliveira Rodrigues


    Full Text Available The diverticula of female urethra are very uncommon, but more frequently found between the third and fifth decade of life. Diverticula area mostly relate to repeated urinary infections of the periurethral glands or urethra’s trauma. The diverticula may cause infection, calculus formation and rarely endometriosis or cancer. A case of a 65-year old Caucasian female with vaginal mass over six months is herein reported. There was no urinary loss, urethral secretion or urinary symptoms.    A cystourethrography showed diverticula with calculus inside. The patient was submitted to surgery and dismissed from the hospital on the first postoperative day. The pathologic examination revealed no malignancy. In six months of follow-up, the patient was continent with no complaints.

  10. Uretritis meningocóccica masculina Male meningococcal urethritis

    Directory of Open Access Journals (Sweden)

    Federico Díaz González


    Full Text Available

    Se presenta el caso de un hombre de 39 años que tuvo uretritis ocho días después de relación orogenital (felatio con una prostituta; de la secreción uretral se aisló Neisseria meningitidis, clasificada como del grupo B; la cepa no producía β lactamasa. El paciente fue tratado con ciprofloxacina y respondió satisfactoriamente; los controles ocho días después de terminar el tratamiento fueron negativos para Neisseria. La inmunofluorescencia para C. trachomatis fue negativa. Se hace una discusión del significado de la N. meningitidis en infecciones genitales.

    We report on the case of a 39 year-old white male who developed urethritis eight days after orogenital contact (fellatio with a prostitute. Group B N. meningitidis was recovered from the urethral secretion; the strain was negative for β lactamase production. Response to cyprofloxacin treatment was satisfactory. Control cultures for Neisseriawere negative eight days after completing treatment. At that moment direct immunofluorescence for Chlamydia trachomatis antigens were also negative. The significance of N. meningitidis in genital tract infections is discussed.

  11. Characterization of bulbospongiosus muscle reflexes activated by urethral distension in male rats

    National Research Council Canada - National Science Library

    Tanahashi, Masayuki; Karicheti, Venkateswarlu; Thor, Karl B; Marson, Lesley


    .... The UGR is evoked by distension of the urethra and activation of penile afferents. The current study compares two methods of elevating urethral intraluminal pressure in spinalized, anesthetized male Sprague-Dawley rats (n = 60...

  12. Remote discovery of an asymptomatic bowel perforation by a mid-urethral sling. (United States)

    Elliott, Jason E; Maslow, Ken D


    Bowel perforation is a rare complication of mid-urethral sling procedures and is usually reported shortly after the surgery. We report a remotely discovered asymptomatic bowel injury found at the time of subsequent surgery. The patient with a history of several prior pelvic surgeries underwent an uneventful retropubic mid-urethral sling placement. Five years later, during an abdominal sacrocolpopexy procedure, mesh from the mid-urethral sling was found perforating the wall of the cecum and fixating it to the right pelvic sidewall. Cecal wedge resection was performed to excise the sling mesh. Asymptomatic bowel perforation by mid-urethral sling mesh has not been previously reported. Pelvic and abdominal surgeons should be aware of the possibility of finding this injury in patients with prior sling surgeries.

  13. Primary Clear Cell Adenocarcinoma of a Urethral Diverticulum Treated with Multidisciplinary Robotic Anterior Pelvic Exenteration

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    Dane Scantling


    Full Text Available Primary urethral carcinoma is extremely rare and is marked by a variety of clinical symptoms. Primary carcinoma of a urethral diverticulum is still rarer and clear cell adenocarcinoma of the urethra is particularly uncommon (Swartz et al., 2006. Such infrequency has led to inadequate management guidance in the literature for a disease that is often late in presentation and carries substantial morbidity and mortality. This treatable but grave disease deserves definitive curative treatment. We present the first published instance in which it was treated with robotic anterior exenteration. In our case, a 47-year-old female was referred to the urology service for investigation of recurring urinary tract infections. During the workup, the patient was found to have an advanced clear cell urethral adenocarcinoma originating in a urethral diverticulum. We discuss the natural history of this condition, its consequences, and the first instance of its treatment using robotic anterior pelvic exenteration.

  14. Sexually transmitted diseases in men who have sex with men. Acquisition of gonorrhea and nongonococcal urethritis by fellatio and implications for STD/HIV prevention. (United States)

    Lafferty, W E; Hughes, J P; Handsfield, H H


    Despite trends toward safer sex practices in homosexually active men, some such people remain at high risk for acquiring sexually transmitted diseases (STD). This study was designed to assess behavioral and demographic determinants of STD acquisition in men who have sex with men (MSM), to guide prevention interventions. A cross-sectional medical record review was undertaken of MSM who attended an urban STD clinic from January, 1993 through December, 1994. Gonorrhea, chlamydial infection, Chlamydia-negative nongonococcal urethritis (NGU), and newly documented human immunodeficiency virus (HIV) infection were analyzed in relation to demographic and behavioral variables. Among 1,253 MSM, 196 (15.6%) had nonchlamydial NGU, 105 (8.4%) had gonorrhea, 31 (2.5%) had chlamydial infection, and 162 (12.9%) had known or newly documented HIV infection. Known HIV infection was an independent predictor of urethral gonorrhea (odds ratio [OR] 2.3, 95% confidence interval [CI95] 1.2-4.8). Oral insertive intercourse was independently associated with urethral gonorrhea (OR 4.4, CI95 1.4-13.4) and nonchlamydial NGU (OR 2.2, CI95 1.3-3.7), and receptive anal intercourse was associated with newly documented HIV infection (OR 2.6, CI95 1.3-4.9). Neither number of sex partners nor condom use was associated with any incident STD outcome, including new HIV infection. MSM who attend STD clinics represent a subgroup of homosexually active men who remain at high risk for STDs, including HIV infection. Fellatio, commonly thought to be a "safe" sexual practice, is an independent risk factor for urethral gonorrhea and nonchlamydial NGU. A history of consistent condom use or of few sex partners should not dissuade clinicians from performing screening tests for HIV and other STDs. Repeated STD screening and counseling about safer sex are indicated for many HIV-infected MSM.

  15. Artificial urinary sphincter revision for urethral atrophy: comparing single cuff downsizing and tandem cuff placement

    Directory of Open Access Journals (Sweden)

    Brian J. Linder

    Full Text Available ABSTRACT Objective To compare outcomes for single urethral cuff downsizing versus tandem cuff placement during artificial urinary sphincter (AUS revision for urethral atrophy. Materials and Methods We identified 1778 AUS surgeries performed at our institution from 1990-2014. Of these, 406 were first AUS revisions, including 69 revisions for urethral atrophy. Multiple clinical and surgical variables were evaluated for potential association with device outcomes following revision, including surgical revision strategy (downsizing a single urethral cuff versus placing tandem urethral cuffs. Results Of the 69 revision surgeries for urethral atrophy at our institution, 56 (82% were tandem cuff placements, 12 (18% were single cuff downsizings and one was relocation of a single cuff. When comparing tandem cuff placements and single cuff downsizings, the cohorts were similar with regard to age (p=0.98, body-mass index (p=0.95, prior pelvic radiation exposure (p=0.73 and length of follow-up (p=0.12. Notably, there was no difference in 3-year overall device survival compared between single cuff and tandem cuff revisions (60% versus 76%, p=0.94. Likewise, no significant difference was identified for tandem cuff placement (ref. single cuff when evaluating the risk of any tertiary surgery (HR 0.95, 95% CI 0.32-4.12, p=0.94 or urethral erosion/device infection following revision (HR 0.79, 95% CI 0.20-5.22, p=0.77. Conclusions There was no significant difference in overall device survival in patients undergoing single cuff downsizing or tandem cuff placement during AUS revision for urethral atrophy.

  16. Effects of multiple simulated birth traumas on urethral continence function in rats. (United States)

    Yoshikawa, Satoru; Sumino, Yasuhiro; Kwon, Joonbeom; Suzuki, Takahisa; Kitta, Takeya; Miyazato, Minoru; Yoshimura, Naoki


    Multiple vaginal parities have been reported to be an important risk factor for stress urinary incontinence (SUI). Simulated birth trauma with single vaginal distention (VD) has been used to induce the SUI condition in animals; however, the effect of multiple simulated birth traumas on the urethral continence function has not been well characterized. Therefore, we examined the effects of multiple VDs on urethral functions in vivo and the changes in gene expressions of several molecules in the urethra using female SD rats, which were divided into three groups; sham, VD-1 (single VD), and VD-3 groups (3 times of VDs every 2 wk). Two weeks after the final VD, leak point pressure (LPP) and urethral responses during sneezing were evaluated. Also, changes in mRNA levels of urethral molecules were quantified with RT-PCR. The VD-1 group did not show any change in LPP with only a tendency of decrease in amplitudes of the urethral responses during sneezing (A-URS); however, the VD-3 group showed a significant decrease in LPP and urethral responses such as baseline urethral pressure and A-URS accompanied with SUI episodes during sneezing. Nicotinic receptor subtypes and transforming growth factor (TGF)-β1 were significantly increased in both VD-1 and VD-3 groups while TNF receptor (TNFR)-1, IL-6, collagens, and matrix metalloproteinases-9 were significantly increased only in the VD-3 group. These data indicate that rats with multiple simulated birth traumas exhibit profound impairment of the urethral continence function and that these functional changes are associated with those in cytokines, extracellular matrix molecules, and nicotinic receptor subtypes in the urethra. Copyright © 2017 the American Physiological Society.

  17. Artificial urinary sphincter revision for urethral atrophy: Comparing single cuff downsizing and tandem cuff placement. (United States)

    Linder, Brian J; Viers, Boyd R; Ziegelmann, Matthew J; Rivera, Marcelino E; Elliott, Daniel S


    To compare outcomes for single urethral cuff downsizing versus tandem cuff placement during artificial urinary sphincter (AUS) revision for urethral atrophy. We identified 1778 AUS surgeries performed at our institution from 1990-2014. Of these, 406 were first AUS revisions, including 69 revisions for urethral atrophy. Multiple clinical and surgical variables were evaluated for potential association with device outcomes following revision, including surgical revision strategy (downsizing a single urethral cuff versus placing tandem urethral cuffs). Of the 69 revision surgeries for urethral atrophy at our institution, 56 (82%) were tandem cuff placements, 12 (18%) were single cuff downsizings and one was relocation of a single cuff. When comparing tandem cuff placements and single cuff downsizings, the cohorts were similar with regard to age (p=0.98), body-mass index (p=0.95), prior pelvic radiation exposure (p=0.73) and length of follow-up (p=0.12). Notably, there was no difference in 3-year overall device survival compared between single cuff and tandem cuff revisions (60% versus 76%, p=0.94). Likewise, no significant difference was identified for tandem cuff placement (ref. single cuff) when evaluating the risk of any tertiary surgery (HR 0.95, 95% CI 0.32-4.12, p=0.94) or urethral erosion/device infection following revision (HR 0.79, 95% CI 0.20-5.22, p=0.77). There was no significant difference in overall device survival in patients undergoing single cuff downsizing or tandem cuff placement during AUS revision for urethral atrophy. Copyright® by the International Brazilian Journal of Urology.

  18. Urethral pressure reflectometry before and after tension-free vaginal tape

    DEFF Research Database (Denmark)

    Saaby, Marie-Louise; Klarskov, Niels; Lose, Gunnar


    Urethral pressure reflectometry (UPR) is a new method for measuring pressure and cross-sectional area in the urethra. Our aim was to investigate if the UPR parameters at rest and during squeeze were unchanged after TVT.......Urethral pressure reflectometry (UPR) is a new method for measuring pressure and cross-sectional area in the urethra. Our aim was to investigate if the UPR parameters at rest and during squeeze were unchanged after TVT....

  19. Palliative Surgery for Rare Cases of Anterior Urethral Metastasis in Prostate Cancer

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    Enrique Gómez Gómez


    Full Text Available Penis metastasis from prostate cancer is very rare, and its management varies from case to case as there are very few cases reported in the literature. We describe a patient with prostate cancer treated with radiotherapy and androgen deprivation therapy who presented with urethral bleeding as a symptom of anterior urethral metastasis during followup. We propose a way to manage this and review the literature.

  20. History and evolution of the use of oral mucosa for urethral reconstruction


    Barbagli, Guido; Balò, Sofia; Montorsi, Francesco; Sansalone, Salvatore; Lazzeri, Massimo


    We report here the history and evolution of the use of oral mucosa in reconstructive urethral surgery since it was first used for urethroplasty in 1894. Since that time, many authors have contributed to develop, improve and popularize the use of oral mucosa as a substitute material. Paediatric urologists should be considered pioneers on the use of oral mucosa as they used it to repair primary and failed hypospadias. The use of oral mucosa to repair penile and bulbar urethral strictures was de...

  1. Urethral infection of male monkeys by Mycoplasma hominis and Ureaplasma urealyticum. (United States)

    Stipkovits, L; Marantidi, A N; Dzikidze, E K; Krylova, R I; Csütörtöki, V


    Seven male Macaca nemestrina, eight male Macaca mulatta and three male Papio hamadrias were infected with M. hominis or U. urealyticum separately or simultaneously into the urethra. Animals of the first two species exhibited moderate infection and mild clinical urethritis characterized by increased number of PMNL in the urethral discharge and colonization and lymphocytic infiltration of the mucous membrane of the urethra and urinary bladder. Animals of the third species proved to be less sensitive.

  2. Role of tissue engineered buccal mucosa for treatment of urethral stricture

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    Vaddi S


    next challenge awaiting researchers in the urogenital tissue engineering field. Genitalia reconstruction is also possible with cell therapy. Engineered penile prosthesis can be reconstructed by culturing autologous chondrocytes which are seeded onto a Poly-glycolic acid scaffold and then implanting the scaffold into the corporal space of penis [6]. Microencapsulated Leydig cells in animal studies have been used to replace or supplement testosterone in testicular failure [7]. Cell therapy techniques are also used for treatment of urinary incontinence, vesicoureteric reflux by injecting cultured myoblasts or adipocytes [5]. The major limitation in engineering solid organs is the vascularisation of the regenerated tissue. Recent developments in angiogenesis research [8] may provide answer to this complex problem and accomplish the goal. Most of the research to date in urological tissue engineering is done in animals. Before these engineering techniques can be applied to humans, further studies need to be performed. Buccal Mucosal Epithelium for repair of the short segment urethral stricture: Urethral stricture is the narrowing of the lumen of the urethra which occurs as a terminal event secondary to many etiologies. Patients present with difficulty in voiding urine. There are endoscopic and open surgical reconstructive procedures to treat this disorder. Endoscopic treatment is often temporary and eventually results in recurrence of the disease. Many open surgical procedures have been described but none of the procedures offer permanent cure. The use of buccal mucosal grafts for stricture repair is in practice [9,10] with considerable success. However the donor site morbidity and complications like stricture recurrence with the present techniques [11,12] warrant the advent of novel techniques. The use of buccal mucosal cells which can be obtained by harvesting a 2mm x 2mm tissue bit compared to that of 5-6cm tissue usually harvested in conventional techniques for a graft

  3. Acquired urethral obstruction in New World camelids: 34 cases (1995-2008). (United States)

    Duesterdieck-Zellmer, K F; Van Metre, D C; Cardenas, A; Cebra, C K


    Document the clinical features, short- and long-term outcomes and prognostic factors in New World camelids with acquired urethral obstruction. Retrospective case study. Case data from medical records of 34 New World camelids presenting with acquired urethral obstruction were collected and follow-up information on discharged patients was obtained. Associations with short- and long-term survival were evaluated using Wilcoxon rank-sum tests, exact-logistic regressions and Kaplan-Meier survival curves. Of the 34 New World camelids 23 were intact males and 11 were castrated; 4 animals were euthanased upon presentation, 7 were treated medically and 23 surgically, including urethrotomy, bladder marsupialisation, tube cystostomy alone or combined with urethrotomy, urethrostomy or penile reefing. Necrosis of the distal penis was found in 4 animals and all were short-term non-survivors. Short-term survival for surgical cases was 65%, and 57% for medical cases. Incomplete urethral obstruction at admission and surgical treatment were associated with increased odds of short-term survival. Of 14 records available for long-term follow-up, 6 animals were alive and 8 were dead (median follow-up 4.5 years, median survival time 2.5 years). Recurrence of urethral obstruction was associated with long-term non-survival. Surgically treated New World camelids with incomplete urethral obstruction have the best odds of short-term survival and those with recurrence of urethral obstruction have a poor prognosis for long-term survival. © 2014 Australian Veterinary Association.

  4. Urethral injection therapy for urinary incontinence in women. (United States)

    Kirchin, Vivienne; Page, Tobias; Keegan, Phil E; Atiemo, Kofi Om; Cody, June D; McClinton, Samuel; Aluko, Patricia


    statistical significance if an intention-to-treat analysis was used.Eight trials compared different agents and all results had wide confidence intervals. Silicone particles, calcium hydroxylapatite, ethylene vinyl alcohol, carbon spheres and dextranomer hyaluronic acid combination gave improvements which were not shown to be more or less efficacious than collagen. Dextranomer hyaluronic acid compound treated patients appeared to have significantly higher rates of injection site complications (16% with the hyaluronic acid compound versus none with collagen; RR 37.78, 95% CI 2.34 to 610.12) and this product has now been withdrawn from the market.A comparison of periurethral and transurethral methods of injection found similar outcomes but a higher (though not statistically significant) rate of early complications in the periurethral group. One trial of 30 women showed a weak (but not clinically significant) advantage for patient satisfaction (data not suitable for analysis in RevMan) after mid-urethral injection in comparison to bladder neck injection but with no demonstrable difference in continence levels. The available evidence base remains insufficient to guide practice. In addition, the finding that placebo saline injection was followed by a similar symptomatic improvement to bulking agent injection raises questions about the mechanism of any beneficial effects. One small trial comparing silicone particles with pelvic floor muscle training was suggestive of benefit at three months but it is not known if this was sustained, and the treatment was associated with high levels of postoperative retention and dysuria. Greater symptomatic improvement was observed with surgical treatments, though the advantages need to be set against likely higher risks. No clear-cut conclusions could be drawn from trials comparing alternative agents, although dextranomer hyaluronic acid was associated with more local side effects and is no longer commercially available for this indication. There

  5. Rapid evaluation of gonococcal and nongonococcal urethritis in men with Limulus amoebocyte lysate and a chromogenic substrate.


    Prior, R B; Spagna, V A


    A chromogenic substrate was used with Limulus amoebocyte lysate (LAL) and compared by parallel testing with the traditional gelation LAL method for the rapid evaluation of exudative urethritis in 125 male patients. Of these patients, 67 had positive cultures for Neisseria gonorrhoeae and 58 were negative. The corresponding prevalence of gonococcal urethritis was 53.6%. For assay, diluted urethral samples and chromogenic substrate were added directly to single-test LAL vials, and objective col...

  6. Monti’s procedure as an alternative technique in complex urethral distraction defect

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    Jalil Hosseini


    Full Text Available PURPOSE: Pelvic fracture urethral distraction defect is usually managed by the end to end anastomotic urethroplasty. Surgical repair of those patients with post-traumatic complex posterior urethral defects, who have undergone failed previous surgical treatments, remains one of the most challenging problems in urology. Appendix urinary diversion could be used in such cases. However, the appendix tissue is not always usable. We report our experience on management of patients with long urethral defect with history of one or more failed urethroplasties by Monti channel urinary diversion. MATERIALS AND METHODS: From 2001 to 2007, we evaluated data from 8 male patients aged 28 to 76 years (mean age 42.5 in whom the Monti technique was performed. All cases had history of posterior urethral defect with one or more failed procedures for urethral reconstruction including urethroplasty. A 2 to 2.5 cm segment of ileum, which had a suitable blood supply, was cut. After the re-anastomosis of the ileum, we closed the opened ileum transversely surrounding a 14-16 Fr urethral catheter using running Vicryl sutures. The newly built tube was used as an appendix during diversion. RESULTS: All patients performed catheterization through the conduit without difficulty and stomal stenosis. Mild stomal incontinence occurred in one patient in the supine position who became continent after adjustment of the catheterization intervals. There was no dehiscence, necrosis or perforation of the tube. CONCLUSION: Based on our data, Monti’s procedure seems to be a valuable technique in patients with very long complicated urethral defect who cannot be managed with routine urethroplastic techniques.

  7. Mirabegron relaxes urethral smooth muscle by a dual mechanism involving β3 -adrenoceptor activation and α1 -adrenoceptor blockade. (United States)

    Alexandre, E C; Kiguti, L R; Calmasini, F B; Silva, F H; da Silva, K P; Ferreira, R; Ribeiro, C A; Mónica, F Z; Pupo, A S; Antunes, E


    This article is commented on by Michel, M. C., pp. 429-430 of this issue. To view this commentary visit Mirabegron is the first β3 -adrenoceptor agonist approved for treatment of overactive bladder syndrome. This study aimed to investigate the effects of β3 -adrenoceptor agonist mirabegron in mouse urethra. The possibility that mirabegron also exerts α1 -adrenoceptor antagonism was also tested in rat smooth muscle preparations presenting α1A - (vas deferens and prostate), α1D - (aorta) and α1B -adrenoceptors (spleen). Functional assays were carried out in mouse and rat isolated tissues. Competition assays for the specific binding of [(3) H]prazosin to membrane preparations of HEK-293 cells expressing each of the human α1 -adrenoceptors, as well as β-adrenoceptor mRNA expression and cyclic AMP measurements in mouse urethra, were performed. Mirabegron produced concentration-dependent urethral relaxations that were shifted to the right by the selective β3 -adrenoceptor antagonist L-748,337 but unaffected by β1 - and β2 -adrenoceptor antagonists (atenolol and ICI-118,551 respectively). Mirabegron-induced relaxations were enhanced by the PDE4 inhibitor rolipram, and the agonist stimulated cAMP synthesis. Mirabegron also produced rightward shifts in urethral contractions induced by the α1 -adrenoceptor agonist phenylephrine. Schild regression analysis revealed that mirabegron behaves as a competitive antagonist of α1 -adrenoceptors in urethra, vas deferens and prostate (α1A -adrenoceptor, pA2  ≅ 5.6) and aorta (α1D -adrenoceptor, pA2  ≅ 5.4) but not in spleen (α1B -adrenoceptor). The affinities estimated for mirabegron in functional assays were consistent with those estimated in radioligand binding with human recombinant α1A - and α1D -adrenoceptors (pKi  ≅ 6.0). The effects of mirabegron in urethral smooth muscle are the result of β3 -adrenoceptor agonism together with α1A and α1D -adrenoceptor

  8. Mid-urethral slings in female incontinence: Current status

    Directory of Open Access Journals (Sweden)

    Ryan M Krlin


    Full Text Available The advent of the mid-urethral sling (MUS 15 years ago has drastically changed the surgical management of stress urinary incontinence (SUI. Both retropubic and transobturator MUS can be placed in the ambulatory setting with excellent results. The tension-free vaginal tape (TVT sling has the most robust and long-term data, but more recent literature suggests that the transobturator tape sling may offer comparable efficacy in appropriately selected patients. Single incision sling (SIS is the newest addition to the MUS group and was developed in an attempt to minimize morbidity and create an anti-incontinence procedure that could be performed in the office. The efficacy of SIS remains unknown as the current literature regarding SIS lacks long-term results and comparative trials. The suprapubic arc sling appears to have equally effective outcomes in at least the short-term when compared with TVT. Although evolution of the SIS has led to a less invasive procedure with decreased post-op pain and reduced recovery time, durability of efficacy could be the endpoint we are sacrificing. Until longer-term data and more quality comparison trials are available, tailoring one′s choice of MUS to the individual patient and her unique clinical parameters remains the best option.

  9. Forensic implications in self-insertion of urethral foreign bodies. (United States)

    Boscolo-Berto, Rafael; Iafrate, Massimo; Viel, Guido


    A 54-year-old Caucasian male presented to our emergency department because he had self inserted a transparent plastic and flexible tube into the urethral meatus, during erotic games. A plain pelvic x-ray film and an abdominal ultrasound were executed to determine the size, shape, orientation and location of the foreign body, and any eventually associated visceral injuries or complications. As results, a long tube of about 50 cm was described entering the urethra and reaching the bladder cavity in which the tube was folded and wrapped, in absence of any visceral complication. The patient underwent an urgent urethrocystoscopy resulting in the retrieval of both the two recognized foreign bodies by an endoscopic basket extraction. To complete the therapeutic approach, we focused also on the possible psychiatric implications of the self insertion of a foreign body into the urethra, and the initial evaluation reached the diagnosis of depression. The self introduction of a foreign body into the urinary tract represents an index of potentially harmful "self-destructive" behaviors. If the self destructive and/or suicidal ideations are not recognized in the clinical setting and the patient subsequently self inflicts an injury or commits suicide, the urologist may face legal problems related to the lack of diagnosis and treatment, potentially interpretable as a medical error, and thus as a reckless conduct.

  10. Balloon Cell Urethral Melanoma: Differential Diagnosis and Management

    Directory of Open Access Journals (Sweden)

    M. McComiskey


    Full Text Available Introduction. Primary malignant melanoma of the urethra is a rare tumour (0.2% of all melanomas that most commonly affects the meatus and distal urethra and is three times more common in women than men. Case. A 76-year-old lady presented with vaginal pain and discharge. On examination, a 4 cm mass was noted in the vagina and biopsy confirmed melanoma of a balloon type. Preoperative CT showed no distant metastases and an MRI scan of the pelvis demonstrated no associated lymphadenopathy. She underwent anterior exenterative surgery and vaginectomy also. Histology confirmed a urethral nodular malignant melanoma. Discussion. First-line treatment of melanoma is often surgical. Adjuvant treatment including chemotherapy, radiotherapy, or immunotherapy has also been reported. Even with aggressive management, malignant melanoma of the urogenital tract generally has a poor prognosis. Recurrence rates are high and the mean period between diagnosis and recurrence is 12.5 months. A 5-year survival rate of less than 20% has been reported in balloon cell melanomas along with nearly 20% developing local recurrence. Conclusion. To the best of our knowledge, this case is the first report of balloon cell melanoma arising in the urethra. The presentation and surgical management has been described and a literature review provided.

  11. Gonococcal urethral stricture and watering-can perineum. (United States)

    Osoba, A O; Alausa, O


    A total of sixteen patients with urethral stricture and/or perineal urinary fistulae (water-can perineum) complicating gonorrhoea were seen at the Special Treatment Clinic, University College Hospital, Ibadan, Nigeria. The patients were aged between 25 and 80 years, and the latent period between the time of original attack of gonococcal infection and the development of complications varied from 4 to 50 years. The rate of divorce or marital separation is high among these patients with late sequelae of gonorrhoea. The factors responsible for the present higher incidence of early and late complications of gonorrhoea among patients in Nigeria and other tropical countries compared with their counterparts in Europe and North American include: (a) Lack of medical facilities in most rural areas; (b) Inadequate treatment of veneral diseases, including the urban areas where self-medication is practised on a large scale by the general population; (c) Illiteracy and ignorance of venereal diseases. The cases of watering-can perineum reported here, and the subsequent chronic pyelonephritis and hypertension, reinforce the plea for early and energetic treatment of acute gonorrhoea in Africa as well as large-scale control measures by the health authorities. Images PMID:1009418

  12. Urethral Pain Among Prostate Cancer Survivors 1 to 14 Years After Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Pettersson, Niclas, E-mail: [Department of Physics and Biomedical Engineering, Sahlgrenska University Hospital, Goeteborg (Sweden); Olsson, Caroline [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Goeteborg (Sweden); Tucker, Susan L. [Department of Bioinformatics and Computational Biology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Alsadius, David; Wilderaeng, Ulrica [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Goeteborg (Sweden); Johansson, Karl-Axel [Department of Physics and Biomedical Engineering, Sahlgrenska University Hospital, Goeteborg (Sweden); Steineck, Gunnar [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Goeteborg (Sweden)


    Purpose: To investigate how treatment-related and non-treatment-related factors impact urethral pain among long-term prostate cancer survivors. Methods and Materials: Men treated for prostate cancer with radiation therapy at the Sahlgrenska University Hospital in Goeteborg, Sweden from 1993 to 2006 were approached with a study-specific postal questionnaire addressing symptoms after treatment, including urethral burning pain during urination (n=985). The men had received primary or salvage external-beam radiation therapy (EBRT) or EBRT in combination with brachytherapy (BT). Prescribed doses were commonly 70 Gy in 2.0-Gy fractions for primary and salvage EBRT and 50 Gy plus 2 Multiplication-Sign 10.0 Gy for EBRT + BT. Prostatic urethral doses were assessed from treatment records. We also recruited 350 non-pelvic-irradiated, population-based controls matched for age and residency to provide symptom background rates. Results: Of the treated men, 16% (137 of 863) reported urethral pain, compared with 11% (27 of 242) of the controls. The median time to follow-up was 5.2 years (range, 1.1-14.3 years). Prostatic urethral doses were similar to prescription doses for EBRT and 100% to 115% for BT. Fractionation-corrected dose and time to follow-up affected the occurrence of the symptom. For a follow-up {>=}3 years, 19% of men (52 of 268) within the 70-Gy EBRT + BT group reported pain, compared with 10% of men (23 of 222) treated with 70 Gy primary EBRT (prevalence ratio 1.9; 95% confidence interval 1.2-3.0). Of the men treated with salvage EBRT, 10% (20 of 197) reported urethral pain. Conclusions: Survivors treated with EBRT + BT had a higher risk for urethral pain compared with those treated with EBRT. The symptom prevalence decreased with longer time to follow-up. We found a relationship between fractionation-corrected urethral dose and pain. Among long-term prostate cancer survivors, the occurrence of pain was not increased above the background rate for prostatic urethral

  13. MR urethrogram versus combined retrograde urethrogram and sonourethrography in diagnosis of urethral stricture

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    El-ghar, Mohamed Abou, E-mail: [Radiology Department, Urology and Nephrology center, Mansoura University (Egypt); Osman, Yasser [Urology Department, Urology and Nephrology Center, Mansoura University (Egypt); Elbaz, Elsayed; Refiae, Huda; El-Diasty, Tarek [Radiology Department, Urology and Nephrology center, Mansoura University (Egypt)


    Objectives: To compare the accuracy of magnetic resonance (MR) urethrogram versus combined RUG and sonourethrography (SUG) in diagnosis urethral stricture with evaluation of their impact in management choice. Material and methods: From March 2006 through February 2007; 30 male patients (mean age, 45 {+-} 18 years, range 15-75) with clinically suspected urethral stricture. All patients underwent RUG, SUG and MR urethrogram. Results: The final diagnosis of the 30 cases included in our study, after endoscopy and surgical management, was classified into two main groups either isolated stricture (20 cases) or associated with other pathologies (9 cases). There was one case with normal urethral caliber at endoscopy. For the anterior stricture the sensitivity, specificity and overall accuracy of RUG was 91%, 90% and 90%, respectively and for the posterior stricture it was 89%, 91.7% and 90%, respectively. At SUG, all cases of anterior were detected with 100% accuracy while for cases of posterior stricture, the overall accuracy was 60%. MR urethrogram diagnosed all the cases of anterior and posterior stricture with exact delineation of its length except one case of normal caliber was diagnosed falsely at MR as anterior short segment urethral with 100% sensitivity, 91.7% specificity and 95% overall accuracy. Conclusion: MR urethrogram has comparable results with the combined RUG and SUG in diagnosing the anterior and posterior urethral strictures as regard the site and extension and degree of spongiofibrosis but MR is superior in diagnosis of associated pathologies with stricture.

  14. Early Primary Endoscopic Realignment of Posterior Urethral Injury- Evaluation and Follow-Up

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    Prasad Mylarappa


    Full Text Available Background: The management of complete orpartial posterior urethral disruption is contro-versial and much debate continues regarding theimmediate, early and delayed definitive therapy.Objective: We report our institutional experi-ence and long term result of early endoscopicrealignment of traumatic posterior urethral in-jury. Method and Materials: Between Septem-ber 1996 and March 2012, ninety six men witheither complete (84 or partial (12 posteriorurethral injury secondary to blunt trauma (11or pelvic fractures (85, presented to our insti-tution and these patients underwent immediatesuprapubic cystostomy followed by early pri-mary endoscopic realignment done 3-8 daysafter injury. Result: Seventy four patients(92.5% were continent after catheter removal.Urethral stricture was seen in seventy two pa-tients (90% of which fifty patients (69.4%had simple urethral stricture who were managedby urethral dilatation on outpatient basis. Four-teen patients (19.4% developed short stric-tures which were successfully treated with vi-sual internal urethrotomy. Eight patients(11.1% required anastomotic urethroplasty fordense stricture. Potency was retained in sev-enty five patients (93.75%. Urinary flow mea-surements at follow-up evaluation were satis-factory.Conclusion:Early primary endoscopic realign-ment in our experience reduces time to spon-taneous voiding, decrease the need for majorreconstructive surgery and long term supra pub-lic urinary diversion.

  15. Etiology of male urethral strictures-Evaluation of temporal changes at a single center, and review of the literature

    Directory of Open Access Journals (Sweden)

    C.F. Heyns


    Conclusions: Over the past 15 years there was an increase in education levels, illegal drug usage and number of sex partners in men with urethral strictures. There was a decrease in urethritis and external trauma, and an increase in iatrogenic trauma as stricture etiology.

  16. [Urethral stricture rate after prostate cancer radiotherapy : Five-year data of a certified prostate cancer center]. (United States)

    Kranz, J; Maurer, G; Maurer, U; Deserno, O; Schulte, S; Steffens, J


    urethral stricture is a scar of the urethral epithelium which can cause obstructive voiding dysfunction with consequential damage of the upper urinary tract. Almost 45% of all strictures are iatrogenic; they develop in 2-9% of patients after radical prostatectomy, but can also occur after prostate cancer radiotherapy. This study provides 5‑year data of a certified prostate cancer center (PKZ) in terms of urethral strictures. Between 01/2008 and 12/2012 a total of 519 men were irradiated for prostate cancer (LDR and HDR brachytherapy as well as external beam radiation). The entire cohort was followed-up prospectively according to a standardized protocol (by type of irradiation). Short segment urethral strictures were treated by urethrotomy, recurrent and long segment stenosis with buccal mucosa urethroplasty. A total of 18 of 519 (3.4%) patients developed a urethral stricture post-therapeutically, which recurred in 66% of cases after the first operative treatment. The largest risk for developing a urethral stricture is attributed to the HDR brachytherapy (8.9%). Urethral strictures after prostate cancer radiotherapy should be diagnosed and treated in time for long-term preservation of renal function. The rate of radiogenic urethral strictures (3.4%) is equivalent to those after radical prostatectomy. Due to a high rate of recurrences, urethrotomy has a limited importance after irradiation.

  17. Urethral Stenting for Obstructive Uropathy Utilizing Digital Radiography for Guidance: Feasibility and Clinical Outcome in 26 Dogs. (United States)

    Radhakrishnan, A


    Urethral stent placement is an interventional treatment option to alleviate urethral outflow obstruction. It has been described utilizing fluoroscopy, but fluoroscopy is not as readily available in private practice as digital radiography. To describe the use of digital radiography for urethral stent placement in dogs with obstructive uropathy. Twenty-six client-owned dogs presented for dysuria associated with benign and malignant causes of obstructive uropathy that underwent urethral stent placement. Retrospective study. Causes of obstructive uropathy included transitional cell carcinoma, prostatic carcinoma, hemangiosarcoma, obstructive proliferative urethritis, compressive vaginal leiomyosarcoma, and detrusor-sphincter dyssynergia. Survival time range was 1-48 months (median, 5 months). All dogs were discharged from the hospital with urine outflow restored. Intraprocedural complications included guide wire penetration of the urethral wall in 1 dog and improper stent placement in a second dog. Both complications were successfully managed at the time of the procedure with no follow-up problems noted in either patient. Urethral stent placement can be successfully performed utilizing digital radiography. The complications experienced can be avoided by more cautious progression with each step through the procedure and serial radiography. The application of digital radiography may allow treatment of urethral obstruction to become more readily available. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  18. Posterior urethral valves: determinants of outcome in a developing country. (United States)

    Okafor, Henrietta U; Ekenze, Sebastian O; Uwaezuoke, Samuel N


    This study aims to evaluate posterior urethral valve (PUV) in a developing country with focus on the profile of the disease, determinants of outcome and the challenges of management. Analysis of data collected prospectively from 31 patients managed for PUV at the University of Nigeria Teaching Hospital, Enugu from January 2008 to December 2009. The median age at presentation was 2.5 years (range 2 weeks-15 years). Only two (6.5%) had pre-natal diagnosis. Twenty-six (83.9%) had one or more complications of the disease at presentation. The mean estimated glomerular filtration rate was 39.5 mL/min/1.73 m(2) (range 4.4-116.0). There was hydronephrosis involving 50 renal units, and vesicoureteral reflux involving 22 renal units. Eight cases required upper tract diversion and four required dialysis prior to definitive catheter ablation. After average follow-up of 12.6 months (range 3-22 months), 18 (58.1%) cases had clinical and radiological improvement, 9 (29%) had persisting poor renal function and 4 (12.9%) died from acute renal failure and end-stage renal disease. Associated pulmonary hypoplasia in neonates, presentation at adolescent age, bilateral vesicoureteral reflux and estimated glomerular filtration rate <10.0 at presentation adversely affected outcome. Delayed diagnosis, dearth of facilities and resource deficiency remain a challenge. Significant cases of PUV present late with complications in our setting and have high morbidity and mortality. The poor outcome may be related to delayed diagnosis, poor renal function at presentation and poor renal support. Improving time to diagnosis and renal support may lead to better outcome. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  19. Obliterative urethral stricture: MR urethrography versus conventional retrograde urethrography with voiding cystourethrography. (United States)

    Sung, Deuk Jae; Kim, Yun Hwan; Cho, Sung Bum; Oh, Yu Whan; Lee, Nam Joon; Kim, Jung Hyuk; Chung, Kyoo Byung; Moon, Du Geon; Kim, Je Jong


    Institutional review board approval and informed consent were obtained. The purpose of the study was to prospectively evaluate magnetic resonance (MR) urethrography for the depiction of obliterative urethral stricture. Twelve patients with obliterative urethral stricture were examined preoperatively with T2-weighted, T1-weighted, and contrast material-enhanced T1-weighted MR imaging of a urethra distended with sterile lubricating jelly. Ten of the 12 patients were examined with conventional retrograde urethrography (RGU) combined with voiding cystourethrography (VCUG) prior to MR imaging. Each imaging result was compared with either a surgical specimen or a description of the surgical findings to determine which method allowed accurate estimation of stricture length. MR measurements of stricture length demonstrated significantly lower errors (P .05, respectively). MR imaging of the urethra distended with sterile lubricating jelly is an effective tool for evaluating obliterative urethral strictures. (c) RSNA, 2006.

  20. Urethral obstruction malformation complex: a cause of abdominal muscle deficiency and the "prune belly". (United States)

    Pagon, R A; Smith, D W; Shepard, T H


    Abdominal muscle deficiency with a "prune belly" abdomen as been a major feature of the so-called prune belly syndrome, which has been regarded as a specific entity, although the etiology and developmental pathology are not understood. We present evidence that abdominal muscle deficiency is an etiologically nonspecific anatomic defect which is secondary to fetal abdominal distention of various causes. One of the more common causes is urethral obstruction with consequent early bladder distention, causing abdominal distention and other anomalies, a constellation of findings which we have termed the urethral obstruction malformation complex. This interpretation of the etiology of most cases of prune belly syndrome accounts for the male predominance, the observed variability in severity, and the lack of a defined mode of inheritance. Recurrence risk figures need to be redefined for each specific obstructing lesion of the urethra. The possibility of early prenatal diagnosis and management of fetuses with urethral obstruction needs further study.

  1. Delayed vaginal and urethral mesh exposure: 10 years after TVT surgery. (United States)

    Khanuengkitkong, Siwatchaya; Lo, Tsia-Shu; Dass, Anil Krishna


    Delayed mesh exposure after tension-free vaginal tape (TVT) procedure is rare. We report a case of mesh exposure into the vagina and urethra that developed 10 years after TVT surgery. A 58-year-old postmenopausal woman presented with mixed urinary incontinence. She was investigated, and her stress urinary incontinence was cured with a TVT procedure 10 years ago. She was then scheduled follow-up annually. Two years postsurgery, a granulation tissue was observed and excised at the vaginal incision site. Vaginal examination 10 years postsurgery showed vaginal mesh erosion 0.5 cm from urethral meatus. Cystoscopy revealed concomitant urethral erosion at the posterior urethral wall. Mesh excision was performed, and urethra and vagina were repaired in layers. Postoperative recovery was uneventful. This finding shows that, although rare, complications can occur even after 10 years of TVT surgery.

  2. Urethral Caruncle Presented as Premature Menarche in a 4-Year-Old Girl

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    Manori Gamage


    Full Text Available Urethral caruncle (UC is a benign fleshy outgrowth at the urethral meatus. It was first described by Samuel Sharp in 1750 and occurs mainly at the posterior lip of the urethra, and the exact aetiology is still uncertain. More often it was seen in the postmenopausal women, and only few cases are reported in young girls. Patients may be asymptomatic and could find this as an incidental finding or they may present with symptoms such as dysuria, bleeding per vagina, haematuria, a mass protruding through vagina, and acute retention of urine. Here, we report the case history of a 4-year-old girl presented with vaginal bleeding which was taken as she has attended menarche and found to have urethral caruncle which was the cause for bleeding. Histology confirmed the diagnosis, and girl was completely cured following surgical excision.

  3. Dorsal buccal mucosal graft urethroplasty for anterior urethral stricture by Asopa technique. (United States)

    Pisapati, V L N Murthy; Paturi, Srimannarayana; Bethu, Suresh; Jada, Srikanth; Chilumu, Ramreddy; Devraj, Rahul; Reddy, Bhargava; Sriramoju, Vidyasagar


    Buccal mucosal graft (BMG) substitution urethroplasty has become popular in the management of intractable anterior urethral strictures with good results. Excellent long-term results have been reported by both dorsal and ventral onlay techniques. Asopa reported a successful technique for dorsal placement of BMG in long anterior urethral strictures through a ventral sagittal approach. To evaluate prospectively the results and advantages of dorsal BMG urethroplasty for recurrent anterior urethral strictures by a ventral sagittal urethrotomy approach (Asopa technique). From December 2002 to December 2007, a total of 58 men underwent dorsal BMG urethroplasty by a ventral sagittal urethrotomy approach for recurrent urethral strictures. Forty-five of these patients with a follow-up period of 12-60 mo were prospectively evaluated, and the results were analysed. The urethra was split twice at the site of the stricture both ventrally and dorsally without mobilising it from its bed, and the buccal mucosal graft was secured in the dorsal urethral defect. The urethra was then retubularised in one stage. The overall results were good (87%), with a mean follow-up period of 42 mo. Seven patients developed minor wound infection, and five patients developed fistulae. There were six recurrences (6:45, 13%) during the follow-up period of 12-60 mo. Two patients with a panurethral stricture and four with bulbar or penobulbar strictures developed recurrences and were managed by optical urethrotomy and self-dilatation. The medium-term results were as good as those reported with the dorsal urethrotomy approach. Long-term results from this and other series are awaited. More randomised trials and meta-analyses are needed to establish this technique as a procedure of choice in future. The ventral sagittal urethrotomy approach is easier to perform than the dorsal urethrotomy approach, has good results, and is especially useful in long anterior urethral strictures.

  4. The role of bladder-to-urethral reflexes in urinary continence mechanisms in rats. (United States)

    Kamo, Izumi; Cannon, Tracy W; Conway, Deirdre A; Torimoto, Kazumasa; Chancellor, Michael B; de Groat, William C; Yoshimura, Naoki


    Urethral closure mechanisms during passive increments in intravesicular pressure (P(ves)) were investigated using microtip transducer catheters in urethane-anesthetized female rats. After a block of reflex bladder contractions by spinal cord transection at T8-T9, abruptly raising P(ves) to 20, 40, or 60 cmH(2)O for 2 min induced a bladder pressure-dependent contractile response in a restricted portion of the middle urethra (12.5-15 mm from the urethral orifice) that was abolished by cutting the pelvic nerves bilaterally. In pelvic nerve-intact rats, the bilateral transection of either the pudendal nerves, the nerves to the iliococcygeous/pubococcygeous muscles, or the hypogastric nerves significantly reduced (49-74%) the urethral reflex response induced by passive P(ves) increases, and combined transection of these three sets of nerves totally abolished the urethra-closing responses. In spinal cord-intact rats, similar urethral contractile responses were elicited during P(ves) elevation (20 or 40 cmH(2)O) and were also eliminated by bilateral pelvic nerve transection. After spinal cord and pelvic nerve transection, leak point pressures, defined as the pressure inducing fluid leakage from the urethral orifice during passive P(ves) elevation by either bladder pressure clamping in 2.5-cmH(2)O steps or direct compression of the bladder, were significantly lowered by 30-35% compared with sham-operated (spinal cord-transected and pelvic nerve-intact) rats. These results indicate that 1) passive elevation of P(ves) can elicit pelvic afferent nerve-mediated contractile reflexes in the restricted portion of the urethra mediated by activation of sympathetic and somatic nerves and 2) bladder-to-urethral reflexes induced by passive P(ves) elevation significantly contribute to the prevention of stress urinary incontinence.

  5. Risk Factors for Urinary Tract Infection following Mid Urethral Sling Surgery. (United States)

    Vigil, Humberto R; Mallick, Ranjeeta; Nitti, Victor W; Lavallée, Luke T; Breau, Rodney H; Hickling, Duane R


    Mid urethral sling surgery is common. Postoperative urinary tract infection rates vary in the literature and independent risk factors for urinary tract infection are not well defined. We sought to determine the incidence of and risk factors for urinary tract infection following mid urethral sling surgery. A retrospective cohort of females who underwent sling surgery was captured from the 2006 to 2014 NSQIP® (National Surgical Quality Improvement Program®) database. Exclusion criteria included male gender, nonelective surgery, totally dependent functional status, preoperative infection, prior surgery within 30 days, ASA® (American Society of Anesthesiologists®) Physical Status Classification 4 or greater, concomitant procedure and operative time greater than 60 minutes. The primary outcome was the incidence of urinary tract infection within 30 days of mid urethral sling surgery. Risk factors for urinary tract infection were assessed by examining patient demographic, comorbidity and surgical variables. Logistic regression analyses were performed to estimate the ORs of individual risk factors. Multivariable logistic regression was then performed to adjust for confounding. A total of 9,022 mid urethral sling surgeries were identified. The urinary tract infection incidence was 2.6%. Factors independently associated with an increased infection risk included age greater than 65 years (OR 1.54, 95% CI 1.07-2.22), body mass index greater than 40 kg/m2 (OR 1.89, 95% CI 1.23-2.92) and hospital admission (OR 2.06, 95% CI 1.37-3.11). Mid urethral sling surgery performed by urologists carried a reduced risk of infection compared to the surgery done by gynecologists (OR 0.52, 95% CI 0.40-0.69). The urinary tract infection risk following mid urethral sling surgery in NSQIP associated hospitals is low. Novel patient and surgical factors for postoperative urinary tract infection have been identified and merit further study. Copyright © 2017 American Urological Association

  6. Urethral pressure variation: a neglected contributing factor in patients with overactive bladder syndrome?

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    Ruth Kirschner-Hermanns

    Full Text Available ABSTRACT Objective To study urethral pressure variations during the whole filling phase among different groups of patients. Material and Methods We investigated 79 consecutive patients from January 2011 to June 2012. All patients were recruited within our routine practice in our continence clinic and were evaluated with urodynamic exam according to the standards of the International Continence Society (ICS with an additional continuous measurement of the urethral pressure profile (cUPP that was done in a supine position. Patients with genital prolapse >grade I, as well as patients with impaired cognitive function or neurogenic disorders were excluded. Bacteriuria at the time of investigation was excluded by urine analysis. Urethral pressure changes higher than 15cmH2O were considered as ‘urethral instability’. Results From 79 investigated patients, 29 were clinically diagnosed with OAB syndrome, 19 with stress urinary incontinence (SUI and 31 with mixed (OAB and SUI incontinence. The prevalence of ‘urethral instability’ as defined in this study was 54.4% (43/79. The mean Δp in patients with OAB (36.5cmH2O was significantly higher (p<0.05 than in groups with pure stress (14.9cmH2O and mixed urinary incontinence (19.3cmH2O. Conclusions Etiology of ‘urethral instability’ is unknown, but high prevalence among patients with overactive bladder syndrome, especially concomitant with detrusor activity can raise a fair question and direct further diagnostic as well as treatment efforts.

  7. Urethral pressure reflectometry; a novel technique for simultaneous recording of pressure and cross-sectional area

    DEFF Research Database (Denmark)

    Aagaard, Mikael; Klarskov, Niels; Sønksen, Jens


    in several studies. But the technique, which was based on the field gradient principle, was never implemented in the clinical setting because of technical limitations. In 2005, urethral pressure reflectometry was introduced as a new technique in female urodynamics. The technique has been shown to be more...... reproducible than conventional urethral pressure profilometry, when measuring incontinence in women. In 2010 it was also introduced as a new measuring technique in the anal canal. This study, adds a new and interesting technique to the field of male urodynamics. For the first time, sound waves have been used...

  8. Results of Multiplex Polymerase Chain Reaction Assay to Identify Urethritis Pathogens

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    Mehmet Sarıer


    Full Text Available Objective: The purpose of this study was to evaluate the results of multiplex polymerase chain reaction (PCR test applied to identify the pathogens in male patients who attended our urology clinic with a pre-diagnosis of urethritis related with sexual intercourse. Materials and Methods: In this study, we included a total of 91 male patients, who sought medical advice in our clinic between August 2015 and October 2016 due to complaints of urethral discharge, dysuria and urethral itching, having a visible urethral discharge during the physical examination or a positive leukocyte esterase test (Combur-Test®-Roche in the first urine sample. In the urethral swab samples of these patients, urethritis pathogens were searched with a multiplex PCR test. The multiplex PCR kit, which is able to identify nine pathogens and produced by PathoFinder® (Holland, was used in the process. The pathogens that could be detected by the kit were Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum, Gardnerella vaginalis, Trichomonas vaginalis, Treponema pallidum, and Candida albicans. Results: The average age of the subjects was 35.1 (19-57 years. Sixty one out of 91 patients (67% were found to have a pathogen in the urethral swab sample. In 45 patients (49.4%, only one pathogen, in 12 (13.1% - two different pathogens and in 4 (4.3% patients, 3 different pathogens were detected. The pathogens found were as follows: Ureaplasma urealyticum in 22 patients (27.1%, Gardnerella vaginalis in 15 (18.6%, Neisseria gonorrhoeae in 13 (16.1%, Mycoplasma genitalium (10 patients; 12.3%, Mycoplasma hominis (8 patients; 9.9%, Chlamydia trachomatis (8 patients; 9.9%, Trichomonas vaginalis (3 patients; 3.8%, and Candida albicans (2 patients; 2.4%. None of the patients were identified with Treponema pallidum. None of the pathogens were identified in 30 patients (32.9% whose samples were examined by PCR method. Conclusion

  9. Long-term follow-up after urethral injection with polyacrylamide hydrogel for female stress incontinence

    DEFF Research Database (Denmark)

    Mouritsen, Lone; Lose, Gunnar; Møller-Bek, Karl


    Urethral injection therapy for treatment of stress urinary incontinence has been in use for years, but only a few long-term follow-up studies have been published. Twenty-five women, injected with polyacrylamide hydrogel 8 years earlier, were invited for follow-up. Twenty-four could be contacted; 15...... had had no further treatment, seven had been re-operated with placement of mid-urethral slings, and two had been re-injected with polyacrylamide hydrogel. Eleven women attended for objective examination; all non-attenders were interviewed by telephone. Subjectively, in 44% the stress incontinence...

  10. Traumatic posterior urethral fistula to hip joint following gunshot injury: a case report

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    Rezaee Ahmad


    Full Text Available Abstract Introduction Urinary system fistula to the hip joint is a rare complication. We report a case of delayed posterior urethral fistula to the hip joint following penetrating gunshot wound injury. Case presentation A 37-year-old Iranian Balochi male was shot with a firearm in the superior part of his right pelvis. He underwent primary closure on the same day. Ten months later, he developed urinary retention. He underwent retrograde urethrography and antegrade cystography which showed a stricture measuring 5 cm in length. There was also a history of progressive pain in the right hip joint accompanied by low grade fever which started 2 months after the initial injury. Hip X-ray showed evidence of an acetabular cavity and femoral head destruction diagnostic of complicated septic arthritis. The patient subsequently underwent reconstructive surgery for the urethral stricture and urethral fistula via a transperineal approach followed by total hip arthroplasty. Conclusion Hip joint contamination with urine following a urethro-acetabular fistula can lead to severe and disabling complications such as septic arthritis. We recommend that every clinician should keep these fistulas in mind as a complication of penetrating urethral injury and every attempt should be made for their early diagnosis and prompt treatment.

  11. Technical features of the system used to perform multichannel urethral pressure profilometry

    NARCIS (Netherlands)

    Messelink, E. J.; Dobbe, I.; Kools, C.; Dabhoiwala, N. F.; Dijkhuizen, T.; Schneider, P.; Lettinga, K. P.; Kurth, K.


    Multichannel Urethral Pressure Profilometry (MCUPP) is a method used to get more information on the pressure distribution within the female urethra. This information may be of value in the diagnostic work up of women with urinary incontinence. Different systems are used for this technique. The pump

  12. A Study Of The Results Of "Urethral Advancement And Glanuloplasty" (UAGP In Repairing Anterior Hypospadias

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    Sadeghipottr roodsari S


    Full Text Available Background: In this study, the results of "Urethral Advancement & Glanuloplasty" in repairing anterior hypospadias were considered. Hypospadias is a common urethral anomaly in boys. More than 65 percent of hypospadias cases are anterior (glanular, coronal and distal penil shaft. More than two hundreds original techniques have been applied to correct hypospadias. Each of these techniques has some complications. The most common complications of hypospadias repairing are fistula and meatal stenosis."nMaterials and Methods: A total of 74 boys with anterior hypospadias underwent the procedure of "Urethral Advancement and Glanuloplasty" (UAGP in our medical centers from March 1994 to April 1999. The procedure included: degloving, correction of chordee, urethral mobilization and glans plasty. Cosmetic results were excellent in most patients. There was no fistula, and also meatal stenosis was not observed after applying V-Flap of the glans."nResults & Conclusions: In a 1 - 6 year follow - up (mean 3.15 years, SD ± 1.79 the results functionally and cosmetically, were satisfactory in all cases with no long-tem complication or chordee.

  13. Role of tubularization of urethral plate in development of urethrocutaneous fistula post hypospadias repair

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    Basim S Alsaywid


    Conclusion: Incision of the urethral plate did not affect the fistula rate. In comparison to international literature, the incidence of fistula was significantly higher which could be explained by the fact that one-third of those patients had a previous hypospadias repair.

  14. Posterior urethral valves in children: A review of 28 cases in ...

    African Journals Online (AJOL)

    . A Chiabi, F Angwafo, MT Obama, V Takou, J Kanyi Zoung. Abstract. We reviewed the files of 28 children treated or followed up for posterior urethral valves (PUV) from 1st January 1985 to the 31st of December 1996 in the University Teaching ...

  15. Perspectives by patients and physicians on outcomes of mid-urethral sling surgery

    NARCIS (Netherlands)

    Houwert, R.M.; van Munster, D.N.; Roovers, J.P.W.R.; Venema, P.L.; Dijkgraaf, M.G.W.; Bruinse, H.W.; Vervest, H.A.M.


    Introduction and hypothesis: The aim of this study is to determine patient expectations regarding wanted and unwanted sequels of mid-urethral sling (MUS) procedures and to identify mismatches during the physician-patient information exchange prior to MUS procedures. Methods: A patient preference

  16. Prune belly syndrome associated with bilateral multicystic dysplastic kidneys and urethral obstruction: A case report

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    Arzu Akdag


    Full Text Available Prune belly syndrome is a rare congenital disorder defined by a characteristic clinical triad: Abdominal muscle deficiency, severe urinary tract abnormalities, and bilateral cryptorchidism. We describe a preterm neonate of Prune Belly syndrome who had abdominal muscle deficiency, multicystic dysplastic kidney, urethral hypoplasia and pulmonary hypoplasia. We presented this rare case with the data gathered from the literatüre.

  17. An experimental model of urethral stricture in rabbits using holmium laser under urethroscopic direct visualization. (United States)

    Hu, Wei-Feng; Li, Cui-Ling; Zhang, Hui-Ping; Li, Ting-Ting; Zeng, Xiao-Yong


    To establish an experimental rabbit model of urethral stricture using holmium laser under direct urethroscopic visualization. Sixteen adult male New Zealand rabbits were divided into equally-sized control and experimental groups. All rabbits underwent retrograde urethrography and transurethral endoscopy with a 7.5 F urethroscope after intramuscular anesthetic injection. We used a holmium:YAG laser to injure the distal urethra in all rabbits in the experimental group under direct visualization. Thirty days after surgery, all animals were evaluated with retrograde urethrography and urethroscopy. The flow rate of the isolated urethras was measured to evaluate urethral stricture formation. One rabbit in the experimental group (12.5%) died of infection 4 days after surgery. Thirty days after surgery, retrograde urethrography and urethroscopy revealed strictures in all seven surviving rabbits (87.5%) in the experimental group. The mean flow rate of the isolated urethras was significantly lower in the experimental group than in the control group. A rabbit model of urethral stricture can be successfully established using holmium laser under direct urethroscopic visualization, providing an ideal object for research concerning the pathogenesis and molecular biology of urethral strictures. © 2014 S. Karger AG, Basel.

  18. Urethral atrophy after artificial urinary sphincter placement: is cuff downsizing effective? (United States)

    Saffarian, Amir; Walsh, Kilian; Walsh, Ian K; Stone, Anthony R


    We reviewed the outcome of cuff downsizing with an artificial urinary sphincter for treating recurrent incontinence due to urethral atrophy. We analyzed the records of 17 patients in a 7-year period in whom clinical, radiological and urodynamic evidence of urethral atrophy was treated with cuff downsizing. Cuff downsizing was accomplished by removing the existing cuff and replacing it with a 4 cm. cuff within the established false capsule. Incontinence and satisfaction parameters before and after the procedure were assessed by a validated questionnaire. Mean patient age was 70 years (range 62 to 79). Average time to urethral atrophy was 31 months (range 5 to 96) after primary sphincter implantation. Mean followup after downsizing was 22 months (range 1 to 64). Cuff downsizing caused a mean decrease of 3.9 to 0.5 pads daily. The number of severe leakage episodes decreased from a mean of 5.4 to 2.1 The mean SEAPI (stress leakage, emptying, anatomy, protection, inhibition) score decreased from 8.2 to 2.4. Patient satisfaction increased from 15% to 80% after cuff downsizing. In 1 patient an infected cuff required complete removal of the device. Patient satisfaction and continence parameters improved after cuff downsizing. We believe that this technique is a simple and effective method of restoring continence after urethral atrophy.

  19. [Penis-preserving surgery in patients with primary penile urethral cancer]. (United States)

    Maek, M; Musch, M; Arnold, G; Kröpfl, D


    Primary urethral cancer in males is a rare entity with only approximately 800 cases described, which is why it is difficult to formulate evidence-based guidelines for treatment. For tumors in the pT2 stage with a localization distal to the membranous urethra, a penis-preserving operation can be carried out. In the period from November 2006 to February 2014 a total of 4 patients with primary urethral cancer underwent a penis-preserving urethral resection. The tumor characteristics and treatment results were collated retrospectively. Of the four patients one had a transitional cell carcinoma of the mid-penile urethra in stage pT2 G2. In two out of the four patients a squamous cell carcinoma (PEC) was present in the mid-penile urethra in stages pT2 G2 and pT2 G3, respectively, with concomitant carcinoma in situ (CIS). The fourth patient had a PEC of the fossa terminalis in stage pT2 G2. Initially all patients underwent a penis-preserving resection. In one case, despite an initial R0 resection a local recurrence occurred and a complete penectomy was performed. Irradiation and lymphadenectomy were not carried out. At a mean follow-up of 37 months all patients are currently in complete remission. Primary penile urethral cancer can be treated by a penis-preserving operation. Close follow-up is essential because recurrence can arise despite an initial R0 resection.

  20. Treatment of male urethral strictures – possible reasons for the use ...

    African Journals Online (AJOL)

    urethrotomy did not improve the cumulative success rate.8,9. A prospective randomised study performed at our hospital during the period January 1991 - January 1994 compared filiform dilatation (n=106 patients) with optical urethrotomy (n=104) as treatment for male urethral strictures.10 The study compared the stricture ...

  1. Pressure/cross-sectional area probe in the assessment of urethral closure function. Reproducibility of measurement

    DEFF Research Database (Denmark)

    Lose, G; Schroeder, T


    -pressure zone and distally in the urethra. The in vitro study showed that cross sectional areas of 13-79 mm2 were determined with a SD of 1.4 mm2. In vivo measurements revealed that the urethral parameters: elastance, hysteresis, pressure and power of contraction during coughing and squeezing were fairly...

  2. Urethral mucosal prolapse in young girls: A report of nine cases in ...

    African Journals Online (AJOL)

    This condition may be confused with tumour or sexual abuse in girls. This study aims at reporting the pathology presentation and therapeutic options of ... acute urine retention and one had recurrence that was treated successfully without operation. All the nine girls are cured. Conclusion: Urethral prolapse is a disease of the ...

  3. Urethral mucosal prolapse in young girls: A report of nine cases in Cotonou

    Directory of Open Access Journals (Sweden)

    Fiogbe M


    Full Text Available Background: Urethral mucosal prolapse is rare. This condition may be confused with tumour or sexual abuse in girls. This study aims at reporting the pathology presentation and therapeutic options of urethral prolapse in girls. Materials and Methods: A retrospective study was undertaken from January 2000 to December 2008. Authors analysed the clinical features and the treatment options. Results: There were nine cases of urethral prolapse. The ages ranged from 2.5 to 10 years (mean age: 5.08 years. The main presentation was vaginal bleeding (five cases. Physical examination revealed a soft, non-tender mass that bleeds on touch (six cases, with a length ranging from 0.75 to 1 cm. Urine culture in four patients revealed urinary infection that yielded Escherichia coli in three cases and the Staphylococcus aureus in one case. Six patients had surgical treatment while three had medical treatment. In those who had surgery, one had acute urine retention and one had recurrence that was treated successfully without operation. All the nine girls are cured. Conclusion: Urethral prolapse is a disease of the prepubertal girls of low socio-economic group. Diagnosis is clinical. The treatment of choice is surgical.

  4. Management of complex urethral stricture disease: Algorithm and experience from a single institute

    Directory of Open Access Journals (Sweden)

    Yu-Hua Shau


    Conclusion: Complex urethral strictures can be managed by a variety of surgical techniques according to specific stricture locations. However, a careful postoperative follow-up for recurrences is mandatory, since ∼40% of patients undergoing buccal mucosal graft-augmented urethroplasties were expected to have additional procedures after the index urethroplasty.

  5. Comparison of Perineal Sonographically Measured and Functional Urodynamic Urethral Length in Female Urinary Incontinence

    Directory of Open Access Journals (Sweden)

    Laila Najjari


    Full Text Available Objectives. To detect the anatomical insufficiency of the urethra and to propose perineal ultrasound as a useful, noninvasive tool for the evaluation of incontinence, we compared the anatomical length of the urethra with the urodynamic functional urethral length. We also compared the urethral length between continent and incontinent females. Methods. 149 female patients were enrolled and divided into four groups (stress, urge, or mixed incontinence; control. Sonographically measured urethral length (SUL and urodynamic functional urethral length (FUL were analyzed statistically. Standardized and internationally validated incontinence questionnaire ICIQ-SF results were compared between each patient group. Results. Perineal SUL was significantly longer in incontinent compared to continent patients (p<0.0001. Pairwise comparison of each incontinent type (stress, urge, or mixed incontinence with the control group showed also a significant difference (p<0.05. FUL was significantly shorter in incontinent patients than in the control group (p=0.0112. But pairwise comparison showed only a significant difference for the stress incontinence group compared with the control group (p=0.0084 and not for the urge or mixed incontinent group. No clear correlation between SUL, FUL, and ICIQ-SF score was found. Conclusions. SUL measured by noninvasive perineal ultrasound is a suitable parameter in the assessment of female incontinence, since incontinent women show a significantly elongated urethra as a sign of tissue insufficiency, independent of the type of incontinence.

  6. The effect of oral and intraurethral trimetazidine use on urethral healing

    Directory of Open Access Journals (Sweden)

    Ali Ayyildiz


    Conclusion: TMZ increased urinary total oxidant level; while increasing serum TAC levels in the long-term. It also reduced serum TAC levels in urethral use and caused an increase in serum TOC levels with minimal effects on DNA injury and repair. No effect was detected on IL1 α and TNF, but partially reduced the effect on IL-1 β levels.

  7. Cost-effective Strategies for the Management and Treatment of Urethral Stricture Disease. (United States)

    Osterberg, E Charles; Murphy, Gregory; Harris, Catherine R; Breyer, Benjamin N


    Following failed endoscopic intervention, the most cost-effective strategy for recurrent urethral stricture disease (USD) is urethroplasty. Inpatient hospital costs associated with urethroplasty are driven by patient comorbidities and postoperative complications. Symptom-based surveillance for USD recurrence will reduce unnecessary diagnostic procedures and cost. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Anterior Urethral Stricture Disease Negatively Impacts the Quality of Life of Family Members

    Directory of Open Access Journals (Sweden)

    Jonathan R. Weese


    Full Text Available Purpose. To quantify the quality of life (QoL distress experienced by immediate family members of patients with urethral stricture via a questionnaire given prior to definitive urethroplasty. The emotional, social, and physical effects of urethral stricture disease on the QoL of family members have not been previously described. Materials and Methods. A questionnaire was administered prospectively to an immediate family member of 51 patients undergoing anterior urethroplasty by a single surgeon (SBB. The survey was comprised of twelve questions that addressed the emotional, social, and physical consequences experienced as a result of their loved one. Results. Of the 51 surveyed family members, most were female (92.2%, lived in the same household (86.3%, and slept in the same room as the patient (70.6%. Respondents experienced sleep disturbances (56.9% and diminished social lives (43.1%. 82.4% felt stressed by the patient’s surgical treatment, and 83.9% (26/31 felt that their intimacy was negatively impacted. Conclusions. Urethral stricture disease has a significant impact on the family members of those affected. These effects may last decades and include sleep disturbance, decreased social interactions, emotional stress, and impaired sexual intimacy. Treatment of urethral stricture disease should attempt to mitigate the impact of the disease on family members as well as the patient.

  9. In vitro fertilizing potential of urethral and epididymal spermatozoa collected from domestic cats (Felis catus). (United States)

    Prochowska, S; Niżański, W


    The aim of this study was to provide a comparative analysis of in vitro fertilizing potential of frozen-thawed urethral and epididymal feline spermatozoa. Both types of semen were collected from 7 cats and cryopreserved in liquid nitrogen. To perform in vitro fertilization, both urethral and epididymal samples from the same individual were thawed and spermatozoa were co-incubated with in vitro matured cat oocytes. Obtained embryos were cultured in vitro for 7 days in a commercial medium. Cleavage rate, morula rate and blastocyst rate were calculated. Experiment was run in 10 replicates. The examined parameters showed no significant differences between urethral and epididymal spermatozoa (p>0.05). Cleavage rate and embryo's development were highly variable between replicates, even for the different sperm samples collected from one individual. There was no significant correlation between fertilizing capacity of two types of spermatozoa collected from the same male. In this study we confirmed that cryopreserved urethral spermatozoa have equally good fertilizing potential as epididymal ones, and both can be successfully used for in vitro fertilization in cats with the use of commercial medium.

  10. Urethral diverticulum in the female: a meta-analysis of modern series. (United States)

    Cameron, Anne P


    Urethral diverticula are a complex problem for the female pelvic surgeon. Given the rarity of the condition most published series are small and single institutional. This is a review article and a meta-analysis including all case series of female urethral diverticulum from the year 2000 to 2015 including only those case series with a minimum of ten subjects. Twenty-five articles were included and data was sufficient to perform a meta-analysis on patient age, symptoms at presentation, physical exam findings, location of diverticulum, diverticular size, radiological findings, pathology, complications, and recurrence rates. Urethral diverticulum have variable symptom presentation and can mimic many other common conditions, but often present with a palpable urethral mass. Surgical diverticulectomy is the most commonly performed procedure, but does put the patient at risk for de novo stress incontinence and recurrent diverticula are not rare. Patients with pre-existing stress incontinence can be safely offered concomitant autologous pubovaginal sling at the time of diverticulectomy. Pathology is benign 97% of the time but one must have a high degree of suspicion in the case of a firm mass or if MRI indicates a mass within the diverticula. Physicians need to have a high degree of suspicion particularly in those patients whose symptoms do not resolve with standard treatment and pelvic MRI is the investigation of choice.

  11. Treatment of male urethral strictures – possible reasons for the use ...

    African Journals Online (AJOL)

    Treatment of male urethral strictures – possible reasons for the use of repeated dilatation or internal urethrotomy rather than urethroplasty. ... Statistical analysis was performed using Student's t-test and Fisher's exact test (p<0.05 statistically significant). Results: The mean age of the 125 men was 49.9 years (range 12.8 ...

  12. Acute urethritis due to Neisseria meningitidis group A acquired by orogenital contact: case report.


    Wilson, A. P.; Wolff, J; Atia, W


    A case of heterosexual transmission of Neisseria meningitidis group A by fellatio, which resulted in acute purulent urethritis in the male partner, is presented. The emotional impact of a mistaken diagnosis of gonococcal infection and the need to treat asymptomatic throat carriage in sexual contacts makes early recognition of meningococcal infection important in this unusual circumstance.

  13. Acute urethritis due to Neisseria meningitidis group A acquired by orogenital contact: case report. (United States)

    Wilson, A P; Wolff, J; Atia, W


    A case of heterosexual transmission of Neisseria meningitidis group A by fellatio, which resulted in acute purulent urethritis in the male partner, is presented. The emotional impact of a mistaken diagnosis of gonococcal infection and the need to treat asymptomatic throat carriage in sexual contacts makes early recognition of meningococcal infection important in this unusual circumstance. PMID:2502493

  14. Mesonephroid adenocarcinoma in urethral diverticulum treated with diverticulectomy. Case report and review of the literature

    DEFF Research Database (Denmark)

    Jacobsen, F; Sørensen, Flemming Brandt; Nielsen, J B


    A case of mesonephroid adenocarcinoma in an urethral diverticulum treated with diverticulectomy in a 53 year old female is reported. To our knowledge 26 cases of similar tumours have been reported in the literature. A review of symptoms, management and possible relationship to nephroid metaplasia...

  15. Painless Urethral Bleeding During Penile Erection in an Adult Man With Klippel-Trenaunay Syndrome: A Case Report. (United States)

    Lei, Hongen; Guan, Xing; Han, Hu; Qian, Xiaosong; Zhou, Xiaoguang; Zhang, Xiaodong; Tian, Long


    Klippel-Trenaunay syndrome (KTS) is a rare congenital vascular disorder characterized by a triad of cutaneous port wine capillary malformations, varicose veins, and hemihypertrophy of bone and soft tissues. To report on a rare case of KTS in an adult man manifested by painless urethral bleeding during penile erection briefly review the clinical presentation and management of the genitourinary forms of this syndrome. On presentation, the clinical features of this patient, including medical history, signs and symptoms, and imaging examinations, were recorded. After diagnosis and initial treatment, a literature review of the urethral features of KTS was performed and is discussed in this report. A 35-year-old man with KTS presented with painless urethral bleeding during penile erection that was associated with posterior urethral vascular malformations. The coagulation method was used to treat the malformation, and no urethral bleeding or gross hematuria occurred during a postoperative follow-up period of 6 months. This case demonstrates that coagulation therapy and careful follow-up can be adequate treatment approaches for urethral features of KTS. However, the long-term efficacy of coagulation for this disorder should be investigated further. Lei H, Guan X, Han H, et al. Painless Urethral Bleeding During Penile Erection in an Adult Man With Klippel-Trenaunay Syndrome: A Case Report. Sex Med 2018;X:XXX-XXX. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  16. microRNA expression profiles of scar and normal tissue from patients with posterior urethral stricture caused by pelvic fracture urethral distraction defects. (United States)

    Zhang, Kaile; Chen, Jun; Zhang, Dongliang; Wang, Lin; Zhao, Weixin; Lin, David Yun-Te; Chen, Rong; Xie, Hong; Hu, Xiaoyong; Fang, Xiaolan; Fu, Qiang


    Pelvic fracture urethral distraction defect (PFUDD) seriously affects the quality of life of patients. At present, there are few effective drug treatments available for PFUDD‑induced urethral stricture, which is associated with fibrosis and scar formation in urethra lumen. Emerging evidence suggests that microRNAs (miRNAs/miRs) may be involved in the regulation of fibrosis, and analysis of miRNA expression profiles in urethral scar and normal urethra tissues may therefore benefit the discovery of novel treatments for urethral stricture with micro invasive procedures. In the present study, miRNA sequencing and quantitative polymerase chain reaction (qPCR) validation using paired scar and normal tissues from patients with PFUDD, and functional analysis of the miRNAs involved in the fibrosis associated signaling pathway was performed. A total of 94 differentially expressed miRNAs were identified in the scar tissue of patients with PFUDD. Among them, 26 miRNAs had significantly altered expression in the scar tissue compared with the normal tissue from the same patient. qPCR validation confirmed that miR‑129‑5p was overexpressed in scar tissue. The TGF‑β pathway‑associated functions of a total of 5 miRNAs (hsa‑miR‑129‑5p, hsa‑miR‑135a‑5p, hsa‑miR‑363‑3p, hsa‑miR‑6720‑3p and hsa‑miR‑9‑5p) were further analyzed, as well as their key molecular targets and functional mechanisms in signaling regulation. To conclude the miRNA sequencing indicated a significantly altered expression of hsa‑miR‑129‑5p, hsa‑miR‑135a‑5p, hsa‑miR‑363‑3p, hsa‑miR‑6720‑3p and hsa‑miR‑9‑5p in patients with PFUDD. These miRNAs and their potential target genes were associated with fibrosis in several diseases, and the data from the present study may help explore potential miRNA targets for future precision treatments for urethral stricture.

  17. Difference between urethral circumference and artificial urinary sphincter cuff size, and its effect on postoperative incontinence. (United States)

    Rothschild, Jennifer; Chang Kit, Laura; Seltz, Lara; Wang, Li; Kaufman, Melissa; Dmochowski, Roger; Milam, Douglas F


    We assessed whether a difference between intraoperative urethral circumference and artificial urinary sphincter cuff size affects postoperative outcomes. We evaluated the medical records of 87 males who underwent implantation of an artificial urinary sphincter between January 2006 and May 2010. A validated questionnaire was completed by 59 patients for long-term followup. The difference between urethral circumference and artificial urinary sphincter cuff size was calculated. Incontinence was recorded as daily pad use. The primary outcome variable was the postoperative decrease in incontinence. Multivariable linear regression was used to model the effect on postoperative incontinence of the difference between urethral circumference and cuff size. Mean long-term followup was 4.2 years. Median preoperative incontinence was 8 pads per day and median abdominal leak point pressure was 50 cm H2O. Median urethral circumference was 38 mm and the median difference between urethral circumference and artificial urinary sphincter cuff size was 2.5 mm. Median postoperative incontinence was 1 pad per day. A 1 mm increase in the difference between urethral circumference and cuff size resulted in a 1.6% increase in incontinence by 4.5 months postoperatively (95% CI -3.1-6.2, p = 0.487). Paradoxically, each 1 mm increase improved postoperative continence at long-term followup by 29% (95% CI -15-56, p = 0.162). At 4.5-month followup there was no statistical difference in pad use or patient satisfaction when the difference between urethral circumference and artificial urinary sphincter cuff size was less than 4 mm vs 4 mm or greater. However, at long-term followup the 4 mm or greater group reported statistically significantly better continence and satisfaction than the less than 4 mm group. This study does not support efforts to improve continence by minimizing cuff size but rather suggests that modestly up-sizing the cuff may produce improved long-term outcomes. Copyright © 2014

  18. A 10-year review of urethral stricture management in Irrua, Nigeria

    Directory of Open Access Journals (Sweden)

    Eshiobo Irekpita


    Full Text Available Background: Several authors have demonstrated regional and temporal changes in the demographics of urethral stricture and its management. Objectives: To assess the changes in the demographics of the patients and the evolution of the management of urethral stricture in this institution. Subjects and Methods: This is a retrospective study. The files of all the men who were diagnosed with urethral stricture from May 2006 to April 2016 were retrieved from the database of the records department of the hospital. The predictor variables assessed included age at presentation, occupation, etiology, presenting symptoms, stricture site, length of stricture, treatment method, year of treatment, complications of treatment, result of urine microscopy and sensitivity, comorbidities, and social habits of the patients. The outcome variables were the proportion of men in relation to the predictor variables and the test of correlation (P = 0.05 and below significant. Analysis was done using the Statistical Package for the Social Sciences (SPSS version 21. Results: Forty-six patients were diagnosed as having urethral stricture within the study period. All were males. The mean age was 53.11 years (standard deviation 17.63852 with a range from 19 to 96. There were 4 (8.7% students, 11 (23.9% civil servants, 4 (8.7% businessmen, 3 (6.5% military men, and 24 (52.2% others who were essentially artisans. Majority of them (68.9% presented with lower urinary tract symptoms while Escherichia coli was the most commonly cultured organism from their urine (17.4%. The most common single etiology was urethritis (30.4%. From 2013 onward, there was an abrupt transition from conservative treatment using dilatation which dropped from 38.9% to 17.9%. More complex surgeries such as buccal mucosal graft urethroplasty for bulbar strictures and two-stage repair for penile strictures increased from 11.1% to 57.1%. Conclusion: Urethritis is still the most common single etiological factor

  19. Combined cystometrography and electromyography of the external urethral sphincter following complete primary repair of bladder exstrophy. (United States)

    Borer, Joseph G; Strakosha, Ruth; Bauer, Stuart B; Diamond, David A; Pennison, Melanie; Rosoklija, Ilina; Khoshbin, Shahram


    Concern in patients with bladder exstrophy after reconstruction regarding potential injury to pelvic neurourological anatomy and a resultant functional deficit prompted combined (simultaneous) cystometrography and electromyography after complete primary repair of bladder exstrophy. We determined whether complete primary repair of bladder exstrophy would adversely affect the innervation controlling bladder and external urethral sphincter function. Complete primary repair of bladder exstrophy was performed via a modified Mitchell technique in newborns without osteotomy. Postoperative evaluation included combined cystometrography and needle electrode electromyography via the perineum, approximating the external urethral sphincter muscle complex. Electromyography was done to evaluate the external urethral sphincter response to sacral reflex stimulation and during voiding. Nine boys and 4 girls underwent combined cystometrography/electromyography after complete primary repair of bladder exstrophy. Age at study and time after complete primary repair of bladder exstrophy was 3 months to 10 years (median 11.5 months). Cystometrography revealed absent detrusor overactivity and the presence of a sustained detrusor voiding contraction in all cases. Electromyography showed universally normal individual motor unit action potentials of biphasic pattern, amplitude and duration. The external urethral sphincter sacral reflex response was intact with a normal caliber with respect to Valsalva, Credé, bulbocavernosus and anocutaneous (bilateral) stimulation. Synergy was documented by abrupt silencing of external urethral sphincter electromyography activity during voiding. After complete primary repair of bladder exstrophy combined cystometrography/electromyography in patients with bladder exstrophy showed normal neurourological findings, including sacral reflex responses, sustained detrusor voiding contraction and synergic voiding, in all patients postoperatively. These findings

  20. Urethral and penile war injuries: The experience from civil violence in Iraq (United States)

    Al-Azzawi, Issam S.; Koraitim, Mamdouh M.


    Objective To determine the incidence, mechanism of injury, wounding pattern and surgical management of urethral and penile injuries sustained in civil violence during the Iraq war. Patients and methods In all, 2800 casualties with penetrating trauma to the abdomen and pelvis were received at the Al-Yarmouk Hospital, Baghdad, from January 2004 to June 2008. Of these casualties 504 (18%) had genitourinary trauma, including 45 (8.9%) with urethral and/or penile injuries. Results Of 45 patients, 29 (64%) were civilians and 16 (36%) were Iraqi military personnel. The injury was caused by an improvised explosive device (IED) in 25 (56%) patients and by individual firearms in 20 (44%). Of the patients, 24 had penile injuries, 15 had an injury to the bulbar urethra and six had an injury to the posterior urethra. Anterior urethral injuries were managed by primary repair, while posterior urethral injuries were managed by primary realignment in five patients and by a suprapubic cystostomy alone in one. An associated injury to major blood vessels was the cause of death in eight of nine patients who died soon after surgery (P < 0.001). Conclusion Urethral and penile injuries were caused by IEDs and individual firearms with a similar frequency. Most of the casualties were civilians and a minority were military personnel. Injuries to the anterior urethra can be managed by primary repair, while injuries to the posterior urethra can be managed by primary realignment. An associated trauma to major blood vessels was the leading cause of death in these casualties. PMID:26019940

  1. Evaluation of anterior urethral stricture using thick slab SSFSE MR urethrography

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    Park, Byung Kwan; Kim, Chan Kyo (Dept. of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul (Korea)), e-mail:; Lee, Sung Won (Dept. of Urology, Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul (Korea))


    Background: Magnetic resonance urethrography (MRU) can be used for depicting not only anterior urethral strictures but also periurethral anatomy in order to produce a management plan. Purpose: To determine if thick slab single-shot fast spin echo (SSFSE) MRU is useful for evaluating anterior urethral stricture compared to fast recovery fast spin echo (FRFSE) MRU. Material and Methods: Ten patients with benign anterior urethral stricture underwent both thick slab SSFSE MRU and FRFSE MRU using sterile jelly for urethral distension before retrograde urethrography. The glans penis was tied at the time of MRU. The two types of MR image were compared regarding stricture length, scan time, and image quality. We also determined whether or not both of the two MR sequences could display an entire anterior urethra on one image. Results: The stricture length on thick slab SSFSE and FRFSE MRU ranged from 4.0 to 71.3 mm (36.4 {+-} 21.8 mm) and from 4.0 to 67.5 mm (35.7 {+-} 20.8 mm), respectively (P > 0.05). The mean scan time for thick slab SSFSE and FRFSE sequences was 2 s and 194 s, respectively (P < 0.05). However, regarding image quality, thick slab SSFSE MRU was inferior to FRFSE MRU (P < 0.05). All the thick slab SSFSE MRU displayed the entire anterior urethra on one image, while only five FRFSE MRU did so (P < 0.05). Conclusion: Thick slab SSFSE MRU can provide a concordant stricture length when compared to the FRFSE MRU and imaging of the entire length of the anterior urethral stricture with subjective reduced image quality and scan time.

  2. Surgical procedures for urethral diverticula in women in the United States, 1979-1997. (United States)

    Burrows, Lara J; Howden, Nancy L S; Meyn, Leslie; Weber, Anne M


    The objective of this study was to describe national rates of surgery for urethral diverticula in women. Data from the National Hospital Discharge Survey (NHDS), a federal database that samples inpatient hospitals in the United States, were analyzed from 1979 to 1997 for diagnosis and procedure codes using the ICD-9-CM classification system. The difference between the median age-adjusted rates from 1979 to 1988 and 1989 to 1997 were evaluated using the Mann-Whitney U test since the yearly rates fluctuated in a nonlinear fashion. Data from the National Statistics for Ambulatory Surgery (NSAS) database were analyzed from 1994 to 1996 in a similar fashion. The average age of women undergoing surgery for urethral diverticula increased from 41.6+/-15.1 years from 1979 to 1988 to 49.4+/-14.8 years from 1989 to 1997 (p=0.02). The average length of hospital stay decreased from 8.4+/-5.0 days in 1979 to 3.2+/-1.7 days in 1997 (p=0.007). Approximately 27,000 inpatient procedures were performed for the repair of urethral diverticula in the United States over a 19-year period, ranging from an estimated 500 to 3400 cases per year. The median age-adjusted rate of procedures decreased from 14.2 per 1 million women from 1979 to 1988 to 6.4 per 1 million women from 1989 to 1997 (p=0.009). Data from the NSAS indicated that an average of 6.7 surgeries per 1 million women per year were performed in the outpatient setting from 1994 to 1996. Age-adjusted rates of inpatient surgery for urethral diverticula were threefold higher for black compared to white women. Inpatient surgical repair of urethral diverticula is three times as high in black as compared to white women. These procedures are infrequent and rates appear to have decreased over time.

  3. Evaluation of anterior urethral stricture using thick slab SSFSE MR urethrography. (United States)

    Park, Byung Kwan; Kim, Chan Kyo; Lee, Sung Won


    magnetic resonance urethrography (MRU) can be used for depicting not only anterior urethral strictures but also periurethral anatomy in order to produce a management plan. to determine if thick slab single-shot fast spin echo (SSFSE) MRU is useful for evaluating anterior urethral stricture compared to fast recovery fast spin echo (FRFSE) MRU. Ten patients with benign anterior urethral stricture underwent both thick slab SSFSE MRU and FRFSE MRU using sterile jelly for urethral distension before retrograde urethrography. The glans penis was tied at the time of MRU. The two types of MR image were compared regarding stricture length, scan time, and image quality. We also determined whether or not both of the two MR sequences could display an entire anterior urethra on one image. the stricture length on thick slab SSFSE and FRFSE MRU ranged from 4.0 to 71.3 mm (36.4 ± 21.8 mm) and from 4.0 to 67.5 mm (35.7 ± 20.8 mm), respectively (P > 0.05). The mean scan time for thick slab SSFSE and FRFSE sequences was 2 s and 194 s, respectively (P slab SSFSE MRU was inferior to FRFSE MRU (P slab SSFSE MRU displayed the entire anterior urethra on one image, while only five FRFSE MRU did so (P slab SSFSE MRU can provide a concordant stricture length when compared to the FRFSE MRU and imaging of the entire length of the anterior urethral stricture with subjective reduced image quality and scan time.

  4. The effect of urethral transection on erectile function after anterior urethroplasty. (United States)

    Haines, Trevor; Rourke, Keith F


    To prospectively assess the effect of urethral transection on erectile function after anterior urethroplasty. From February 2012 to December 2014, 104 patients were enrolled in a prospective study assessing erectile function (EF) after anterior urethroplasty. Participants completed the International Index of Erectile Function (IIEF) questionnaire preoperatively and 6 months postoperatively. Outcome measures were the incidence of erectile dysfunction (ED) defined by ≥5-point change in EF and mean change in the EF domain. Factors examined were urethral transection, stricture location, patient age and other demographics. Fisher's exact test, Student's t test and linear regression were used to evaluate associations when appropriate. Seventeen patients were excluded because of poor EF, leaving 87 patients for analysis. Twenty-two patients (25.3 %) had urethral transection during urethroplasty, while 65 underwent non-transecting techniques (74.7 %). For the entire cohort, IIEF scores remain unchanged (20.16 versus 20.14; p = 0.98). Eighteen patients (20.7 %) developed ED, while 15 (17.2 %) experienced an improvement in EF. Urethral transection was not associated with ED (p = 0.22) or mean change in EF (-0.8 versus +0.2; p = 0.71). Stricture location was not associated with ED, but patient age ≥50 was associated with a decrease in mean postoperative EF (-2.84 versus +1.85; p = 0.04). On linear regression analysis patient age remained independently associated with adverse change in EF (p = 0.05). Urethroplasty can result in a decline in erectile function in some patients but overall is associated with minimal change in erectile function. Urethral transection is not associated with adverse change in erectile dysfunction after urethroplasty however, advanced patient age is.

  5. An Indwelling Urethral Catheter Knotted Around a Double-J Ureteral Stent: An Unusual Complication after Kidney Transplantation

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    E. G. Warmerdam


    Full Text Available Urethral catheterization is a common procedure with a relatively low complication rate. Knotting of an indwelling urethral catheter is a very rare complication, and there are only a few case reports on knotted catheters, most of them concerning children. We report an especially rare case where a urethral catheter formed a knot around a double-J ureteral stent after a kidney transplantation. We will discuss the various risk factors for knotting of a catheter and the methods to untangle a knot.

  6. Urethral (indwelling or intermittent) or suprapubic routes for short-term catheterisation in hospitalised adults. (United States)

    Kidd, Emily A; Stewart, Fiona; Kassis, Nadine C; Hom, Emily; Omar, Muhammad Imran


    Indwelling urethral catheters are often used for bladder drainage in hospital. Urinary tract infection is the most common hospital-acquired infection, and a common complication of urinary catheterisation. Pain, ease of use and quality of life are important to consider, as well as formal economic analysis. Suprapubic catheterisation can also result in bowel perforation and death. To determine the advantages and disadvantages of alternative routes of short-term bladder catheterisation in adults in terms of infection, adverse events, replacement, duration of use, participant satisfaction and cost effectiveness. For the purpose of this review, we define 'short-term' as intended duration of catheterisation for 14 days or less. We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process,, WHO ICTRP and handsearching of journals and conference proceedings (searched 26 February 2015), CINAHL (searched 27 January 2015) and the reference lists of relevant articles. We included all randomised and quasi-randomised trials comparing different routes of catheterisation for short-term use in hospitalised adults. At least two review authors extracted data and performed 'Risk of bias' assessment of the included trials. We sought clarification from the trialists if further information was required. In this systematic review, we included 42 trials.Twenty-five trials compared indwelling urethral and suprapubic catheterisation. There was insufficient evidence for symptomatic urinary tract infection (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.61 to 1.69; 5 trials, 575 participants; very low-quality evidence). Participants with indwelling catheters had more cases of asymptomatic bacteriuria (RR 2.25, 95% CI 1.63 to 3.10; 19 trials, 1894 participants; very low quality evidence) and more participants reported pain (RR 5.62, 95% CI

  7. Toxic catheters and urethral strictures: A concern about types of catheters used in resource-poor countries

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    A.A. Popoola


    Full Text Available Various reports in the literature have confirmed urethral toxicity caused by the use of catheters, mostly latex catheters and their coated versions, resulting in long-segment urethral strictures or strictures located in multiple areas of the urethra. Most catheters used in resource-poor countries, such as Nigeria, are latex catheters with various coatings, such as silicone. The reasons for the widespread use of these potentially toxic catheters are mainly non-availability and/or the high cost of less toxic catheters. We report three cases of urethral strictures following the use of siliconized latex catheters in order to highlight the potential urethral toxicity associated with the use of latex catheters and to draw the authorities’ attention to the need to regulate the types of catheters used in the country.

  8. Trichomonas vaginalis infection: How significant is it in men presenting with recurrent or persistent symptoms of urethritis? (United States)

    Ng, Andrea; Ross, Jonathan D C


    Persistent or recurrent non-gonococcal urethritis has been reported to affect up to 10-20% of men attending sexual health clinics. An audit was undertaken to review the management of persistent or recurrent non-gonococcal urethritis in men presenting at Whittall Street Clinic, Birmingham, UK. Detection of Trichomonas vaginalis infection was with the newly-introduced nucleic acid amplification test. A total of 43 (8%) of 533 men treated for urethritis re-attended within three months with persistent or recurrent symptoms. Chlamydia trachomatis infection was identified in 13/40 (33%), T. vaginalis in 1/27 (4%) and Mycoplasma genitalium in 6/12 (50%). These findings suggest that the prevalence of T. vaginalis infection remains low in our clinic population and may not contribute significantly to persistent or recurrent non-gonococcal urethritis. © The Author(s) 2015.

  9. In-vivo performance of high-density collagen gel tubes for urethral regeneration in a rabbit model.

    NARCIS (Netherlands)

    Micol, L.A.; Arenas da Silva, L.F.; Geutjes, P.J.; Oosterwijk, E.; Hubbell, J.A.; Feitz, W.F.J.; Frey, P.


    Congenital malformations or injuries of the urethra can be treated using existing autologous tissue, but these procedures are sometimes associated with severe complications. Therefore, tissue engineering may be advantageous for generating urethral grafts. We evaluated engineered high-density

  10. A case of clear cell adenocarcinoma arising from the urethral diverticulum: Utility of urinary cytology and immunohistochemistry

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    Shin-ichi Nakatsuka


    Full Text Available Carcinomas rarely arise from the urethral diverticulum. In this report, we present a case of clear cell adenocarcinoma arising from the urethral diverticulum. A 42-year-old woman complained of bloody discharge and lower back pain. Imaging studies showed a tumor involving the region surrounding the urethra and cystourethroscopy showed papillary and villous tumors in the urethral diverticula. Cytology of the urine sediment showed papillary or spherical clusters of atypical cells, some of which had clear abundant cytoplasm and formed mirror ball-like clusters, suggesting adenocarcinoma. Although histological diagnosis was indeterminate by biopsy and transurethral resection (TUR because of absence of stromal invasion, surgically resected specimen via cysturethrectomy revealed that the tumor was clear cell carcinoma. Urinary cytological findings and immunohistochemical analysis for CD15, Ki-67, and p53 might be useful for accurate diagnosis of clear cell adenocarcinoma that arises from the urethral diverticulum when sufficient materials are not available by biopsy and TUR.

  11. External urethral sphincter dilation for the management of high risk myelomeningocele: 15-year experience. (United States)

    Park, J M; McGuire, E J; Koo, H P; Schwartz, A C; Garwood, C K; Bloom, D A


    We investigate the long-term outcome using external urethral sphincter dilation for high risk myelomeningocele. Since 1984 external urethral sphincter dilation was performed in 25 patients with myelomeningocele who demonstrated passive leak point pressure greater than 40 cm. H2O and/or poor bladder compliance. Mean followup from the first dilation was 8.4 years. Overall 2.4 dilations were performed per patient (range 1 to 8). Cystometrography, imaging study and continence status were evaluated retrospectively. Overall external urethral sphincter dilation produced durable improvements in mean leak point pressure (60.9 versus 34.4 cm. H2O), capacity (119.8 versus 233.3 ml.), initial compliance (11.5 versus 28.4 ml./cm. H2O) and terminal compliance (1.1 versus 7.7 ml./cm. H2O). Categorical analysis revealed 3 groups in terms of outcome. Group 1 consisted of 11 patients (44%) who demonstrated durable improvements in urodynamic parameters as well as preservation of the upper tracts. These patients demonstrated a 2-step compliance pattern on pre-dilation cystometrography, in which elevated leak point pressure was associated with excellent initial compliance. Group 2 consisted of 5 patients (20%) who failed to maintain safe leak point pressure and whose upper tracts deteriorated, including 4 who eventually underwent augmentation cystoplasty. This group demonstrated a 1-step hypertonicity in which elevated leak point pressure was associated with a steep pressure increase during early filling. Group 3 consisted of 9 patients (36%) who responded minimally in terms of leak point pressure reduction but whose upper tracts remained well preserved. They demonstrated a high pressure instability pattern associated with excellent baseline compliance. External urethral sphincter dilation provides an effective long-term solution for select high risk myelomeningocele cases. Those who demonstrate elevated leak point pressure and poor bladder compliance at the time of external urethral

  12. Congenital anterior urethral valves and diverticula: Diagnosis and management in six cases

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    Rawat Jiledar


    Full Text Available Background: Anterior urethral valves (AUVs are rare congenital anomalies causing lower urinary tract obstruction in children. Although they are referred to as valves, these obstructive structures often occur in the form of a diverticulum. The urethra in these cases shows saccular or bulbar dilatation known as anterior urethral diverticulum (AUD. They typically occur where there is a defect in the corpus spongiosum, leaving a thin-walled urethra. This segment of the urethra balloons out during voiding, simulating a mass that is sometimes visible along the ventral wall of the penis. The swelling is fluctuant and urine dribbles from the meatus on compression. The present study highlights the clinical approach in identifying the condition and its treatment options, especially for those, presenting with urethral diverticula. Materials and Methods: We have studied children with congenital anterior urethral valves and diverticula. Six patients of AUVs with diverticula were admitted during the period of 2000-2007 and were prospectively evaluated. The mean age of presentation was 16 months (15 days to 4 years. Straining at micturition and a palpable penile swelling were the most common presenting features. The diagnosis was established by voiding cystourethrogram (VCUG and supported by ultrasonography (USG. All patients were treated with single-stage open surgical excision except one who died preoperatively due to urosepsis. Initial lay opening of the penoscrotal urethra and delayed repair were done in one patient. Results: The surgical outcome was successful in all but one patient, who died of delayed presentation with severe back pressure changes, urinary ascitis and urosepsis. On long-term follow-up, all patients demonstrated good stream of urine. The renal functions were normal and the patients had no evidence of urinary infections. Conclusion: We propose that, the patients of AUVs, if not excessively delayed for treatment are otherwise well in terms

  13. Inhibitory role of the spinal cholinergic system in the control of urethral continence reflex during sneezing in rats. (United States)

    Yoshikawa, Satoru; Kitta, Takeya; Miyazato, Minoru; Sumino, Yasuhiro; Yoshimura, Naoki


    The urethral continence reflex during stress conditions such as sneezing or coughing is an important mechanism preventing stress urinary incontinence (SUI). Although the spinal noradrenergic and serotonergic pathways are known to modulate this reflex activity, the role of spinal cholinergic pathways in the control of urethral continence reflex has not been elucidated. We therefore investigated the effect of intrathecal administration of an acetylcholine esterase (AChE) inhibitor, which increases ACh in synaptic terminals, and anti-cholinergic agents on the sneeze-induced urethral reflex in rats. Female SD rats were anesthetized with urethane. Urethral function was evaluated during sneezing induced by insertion of the rat whisker into the nostril. Effects of an AChE inhibitor, neostigmine, and muscarinic or nicotinic receptor antagonists administered at the level of L6-S1 spinal cord were examined. Neostigmine dose-dependently and significantly decreased the amplitude of urethral responses during sneezing (A-URS) with an approximately 70% reduction at 3 nmol, without changing urethral baseline pressure. The neostigmine-induced decrease in A-URS was significantly reversed by pretreatment with atropine (nonselective muscarinic receptor antagonist), methoctramine (M2 receptor antagonist) or 4-DAMP (M3 receptor antagonist), but not with pirenzepine (M1 receptor antagonist), tropicamide (M4 receptor antagonist), or mecamylamine (nicotinic receptor antagonist). These results indicate that an increase in endogenous ACh in the lumbosacral spinal cord inhibits the sneeze-induced urethral continence reflex via activation of M2 and/or M3-muscarinic receptors, implying the inhibitory role of spinal cholinergic pathways in the control of urethral continence reflex under stress conditions such as sneezing. © 2013 Wiley Periodicals, Inc.

  14. Fournier’s Gangrene in a Heterosexual Man: A Complication of Neisseria meningitidis Urethritis

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    Tariq A. Khemees


    Full Text Available A 55-year-old heterosexual male presented to the emergency department with a symptomatology consistent with urethritis and Fournier’s gangrene. Urethral swab and operative tissue cultures were positive for coagulase-negative Staphylococcus and an intracellular Gram-negative diplococcus. The latter was initially thought to be Neisseria gonorrhea; however, DNA sequencing technique confirmed it to be Neisseria meningitidis. The patient required three separate surgical debridements to control widespread necrotizing infection. Following documentation of sterile wound healing with appropriate antibiotics, four reconstructive surgeries were necessary to manage the resultant wound defects. To our knowledge, Neisseria meningitidis as a causative organism in Fournier’s gangrene has not been reported in the literature.

  15. Prevalence of genital Chlamydia in Iranian males with urethritis attending clinics in Mashhad. (United States)

    Ghanaat, J; Afshari, J T; Ghazvini, K; Malvandi, M


    Chlamydia trachomatis is a common cause of sexually transmitted disease which can cause severe consequences. Effective prevention requires knowledge of prevalence of infection in order to target interventions in a cost-effective manner. To determine the prevalence of chlamydial infection in Mashhad, northeastern Islamic Republic of Iran, this study was performed among male patients with urethritis. Urethral discharge was collected from 150 patients. Cell culture was established for diagnosis of Chlamydia in genital specimens. Cell culture showed that 9.3% of patients in this study were infected with Chlamydia. This study provides strong evidence that prevalence of Chlamydia in our region is quite high, which necessitates screening and treatment for the infection.

  16. [Congenital urethral polyps. A rare cause of obstructive uropathy in childhood]. (United States)

    Schäfer, J; Porkolab, L; Pinter, A


    Congenital urethral polyps are an extremely rare cause of obstructive uropathy in childhood. Obstructing polyps arise on the seminal colliculus or the floor of the prostatic urethra. They are pedunculated, and the stalk can be several centimetres in length. Primarily they are composed of connective tissue covered by epithelium. Additionally, smooth muscles and islands of glandular cells and even nerve tissue have been found. We present three cases of children with congenital posterior urethral polyps causing severe infravesical obstruction. In two cases the polyps were excised at open cystotomy and in one case, transurethrally. The follow-up investigations confirmed a good prognosis of these patients: micturition behaviour had normalized and the symptoms of urinary obstruction had either markedly improved or completely disappeared. Dilatation of the upper urinary tract and loss of function resulting from recurrent urinary tract infection remained stable after relief of the obstruction by polypectomy.

  17. A giant dumbbell shaped vesico-prostatic urethral calculus: a case report and review of literature. (United States)

    Prabhuswamy, Vinod Kumar; Tiwari, Rahul; Krishnamoorthy, Ramakrishnan


    Calculi in the urethra are an uncommon entity. Giant calculi in prostatic urethra are extremely rare. The decision about treatment strategy of calculi depends upon the size, shape, and position of the calculus and the status of the urethra. If the stone is large and immovable, it may be extracted via the perineal or the suprapubic approach. In most of the previous reported cases, giant calculi were extracted via the transvesical approach and external urethrotomy. A 38-year-old male patient presented with complaints of lower urinary tract symptoms. Further investigations showed a giant urethral calculus secondary to stricture of bulbo-membranous part of the urethra. Surgical removal of calculus was done via transvesical approach. Two calculi were found and extracted. One was a huge dumbbell calculus and the other was a smaller round calculus. This case was reported because of the rare size and the dumbbell nature of the stone. Giant urethral calculi are better managed by open surgery.

  18. Usefulness of an injectable anaesthetic protocol for semen collection through urethral catheterisation in domestic cats. (United States)

    Pisu, Maria Carmela; Ponzio, Patrizia; Rovella, Chiara; Baravalle, Michela; Veronesi, Maria Cristina


    Objectives Although less often requested in comparison with dogs, the collection of semen in cats can be necessary for artificial insemination, for semen evaluation in tom cats used for breeding and for semen storage. Urethral catheterisation after pharmacological induction with medetomidine has proved to be useful for the collection of semen in domestic cats. However, most of the previously used protocols require the administration of high doses of medetomidine that can increase the risk of side effects, especially on the cardiovascular system. In routine clinical practice, one safe and useful injectable anaesthetic protocol for short-term clinical investigations or surgery in cats involves premedication with low intramuscular doses of dexmedetomidine with methadone, followed by intravenous propofol bolus injection. We aimed to assess the usefulness of this injectable anaesthetic protocol for semen collection, via urethral catheterisation, in domestic cats. Methods The study was performed on 38 purebred, adult cats, during the breeding season, and semen was collected via urethral catheterisation using an injectable anaesthesia protocol with methadone (0.2 mg/kg) and dexmedetomidine (5 µg/kg) premedication, followed by induction with propofol. Results The anaesthetic protocol used in the present study allowed the collection of large-volume semen samples, characterised by good parameters and without side effects. Conclusions and relevance The results from the present study suggest that the injectable anaesthetic protocol using methadone and dexmedetomidine premedication, followed by induction with propofol, could be suitable and safe for the collection of a good-quality semen sample, via urethral catheterisation, in domestic cats. It can therefore be used as an alternative to previous medetomidine-based sedation protocols.

  19. Urethral Hairballs as a Long-Term Complication of Hypospadias Repair: Two Case Reports

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    Spyridon Kampantais


    Full Text Available Many times hair-bearing urethral grafts have been used inadvertently in the treatment of hypospadias. This can be accompanied with numerous troublesome long-term complications such as formation of stones, diverticula, and hairballs. We report two cases of men with a history of hypospadias repair being affected by such complications. We also discuss about their management and the effect of thioglycolic acid instillation to stop hair growth in the urethra mucosa in the second case.

  20. Urethral Stricture Outcomes After Artificial Urinary Sphincter Cuff Erosion: Results From a Multicenter Retrospective Analysis. (United States)

    Gross, Martin S; Broghammer, Joshua A; Kaufman, Melissa R; Milam, Douglas F; Brant, William O; Cleves, Mario A; Dum, Travis W; McClung, Christopher; Jones, LeRoy A; Brady, Jeffrey D; Pryor, Michael B; Henry, Gerard D


    To evaluate the influence of both repair type and degree of cuff erosion on postoperative urethral stricture rate. Sparse literature exists regarding patient outcomes after artificial urinary sphincter (AUS) cuff erosion. Surgeons from 6 high-volume male continence centers compiled a comprehensive database of post-erosion patients to examine outcomes. This retrospective multi-institution study included 80 patients treated for AUS cuff erosions. Seventy-eight patients had specific information regarding post-cuff erosion urethral strictures. Erosion patients were categorized into 1 of 3 repair types at the time of explant surgery: catheter only, single-layer capsule-to-capsule repair (urethrorrhaphy), and formal urethroplasty. Operative notes and available medical records were extensively reviewed to collect study data. Twenty-five of 78 patients manifested a urethral stricture after AUS cuff erosion (32%). More strictures occurred among patients who underwent urethrorrhaphy (40% vs 29% for catheter only and 14% for urethroplasty). Stricture rates did not vary significantly by repair type (P = .2). Strictures occurred significantly more frequently in patients with complete cuff erosions (58%) as compared to partial erosions (25%, P = .037). A trend was detected regarding increased percentage of erosion correlating with increased stricture rate, but this did not reach statistical significance (P = .057). Partially eroded patients were more likely to undergo urethrorrhaphy repair (60%, P = .002). Urethral stricture was more likely to occur after complete cuff erosion as opposed to partial erosion in this multicenter retrospective population. Repair type, whether catheter only, urethrorrhaphy, or formal urethroplasty, did not appear to influence postoperative stricture rate. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Urethroplasty by superficial membranous fascia for long urethral strictures: a new approach. (United States)

    Onu, P E


    36 patients has single-stage repair of severe bulbar urethral strictures using a superficial membranous fascia tubed flap. The length of follow-up varied from 9 months to 2 years (mean 15 months). Recurrence occurred in 1 case. Urodynamic studies in 35 cases before and after urethroplasty showed a marked improvement in urinary flow and voiding postoperatively. This procedure is safe, simple, economically preferable and has a no higher risk than other 1- and 2-stage procedures.

  2. A posterior sagittal pararectal approach for repair of posterior urethral distraction injuries. (United States)

    Abdalla, Medhat Ahmed


    To report our initial experience with the posterior sagittal pararectal approach as an alternative in the treatment of complicated urethral distraction defect after pelvic trauma. Twenty-four patients with posttraumatic pelvic fracture urethral distraction defects (PFUDDs) underwent urethroplasty in our department from March 2003 to June 2006. In 7 of those patients, the posterior sagittal pararectal approach was utilised. Of the 7 patients, 5 had failed previous transperineal repair, whereas the other 2 had long-distance urethral distraction defect. Follow-up included retrograde urethrography (RUG) and uroflowmetry, which were done postoperatively at 3 wk and 3, 12, and 18 mo, and thereafter when needed. Clinical outcome was considered a success at the time that no postoperative procedure was needed. Of the 7 patients, 5 were in the paediatric group with ages ranging from 9 to 14 yr, whereas 2 patients were adults (21 and 50 yr). The aetiology of PFUDDs in all patients was road traffic accident. Median length of the stricture was 5 cm. The median operative time was 240 min, whereas the median hospital stay was 10 d. Postoperatively, 1 patient developed gluteal abscess that was successfully managed conservatively. Follow-up period ranged from 7 to 32 mo (median: 13 mo). All patients showed criteria of success including satisfactory uroflowmetry (median Qmax: 18 ml/s), patent RUG, and subjective improvement in the voiding pattern. Only 1 patient developed difficulty 1 mo postoperatively and was successfully managed by urethral dilation. This technique is a good alternative approach for repair of complicated PFUDDs. It is safe and has the advantage of better visualisation of the apex of the prostate and surgical field, with subsequent good outcomes without immediate or remote effects on the sphincteric function of the rectum or bladder. Further studies with larger cohort of patients are needed to justify the specific indications of this approach.

  3. Risk factors for urethritis in heterosexual men. The role of fellatio and other sexual practices. (United States)

    Schwartz, M A; Lafferty, W E; Hughes, J P; Handsfield, H H


    Nonchlamydial nongonococcal urethritis (NGU) is a common sexually transmitted disease (STD) in heterosexual men. Prior studies have suggested that NGU may be acquired by insertive oral sex. To assess the association of oral sex and other sexual practices with nonchlamydial NGU in heterosexual men in order to better understand this syndrome and to guide its prevention and treatment. Risk factors for urethral gonorrhea and chlamydial infection were explored to contrast with NGU. A retrospective case-control study was conducted among heterosexual men attending as STD clinic during 1993 and 1994. The study included 4,848 men who were sexually active within the prior 2 months and had urethral specimens obtained for Gram's stain, culture for Neisseria gonorrhoeae, and culture for Chlamydia trachomatis. Insertive oral sex was not shown to be an independent risk factor for NGU. Independent predictors of nonchlamydial NGU by multivariate analysis included African-American race (odds ratio [OR] 3.71, 95% confidence interval [95% CI] 3.06 to 4.50) and having > or = two sex partners in the prior 2 months (OR 1.45, 95% CI 1.20 to 1.75). History of using condoms "always" was negatively associated with NGU (OR 0.59, 95% CI 0.43 to 0.79), gonorrhea (OR 0.31, 95% CI 0.17 to 0.56), and chlamydial infection (OR 0.67, 95% CI 0.44 to 1.03). This study supports the sexually transmitted nature of nonchlamydial NGU but did not confirm an association with oral sex. However, the analysis was compromised by the rarity of insertive oral sex as patients' only sexual exposure. Consistent condom use protects against all causes of sexually acquired urethritis.

  4. Current concepts in the management of pelvic fracture urethral distraction defects

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    Ramanitharan Manikandan


    Full Text Available Objectives : Pelvic fracture urethral distraction defect (PFUDD may be associated with disabling complications, such as recurrent stricture, urinary incontinence, and erectile dysfunction. In this article we review the current concepts in the evaluation and surgical management of PFUDD, including redo urethroplasty. Materials and Methods : A PubMedTM search was performed using the keywords "pelvic fracture urethral distraction defect, anastomotic urethroplasty, pelvic fracture urethral stricture, pelvic fracture urethral injuries, and redo-urethroplasty." The search was limited to papers published from 1980 to March 2010 with special focus on those published in the last 15 years. The relevant articles were reviewed with regard to etiology, role of imaging, and the techniques of urethroplasty. Results : Pelvic fracture due to accidents was the most common etiology of PFUDD that usually involved the membranous urethra. Modern cross-sectional imaging, such as sonourethrography and magnetic resonance imaging help assess stricture pathology better, but their precise role in PFUDD management remains undefined. Surgical treatment with perineal anastomotic urethroplasty yields a success rate of more than 90% in most studies. The most important complication of surgical reconstruction is restenosis, occurring in less than 10% cases, most of which can be corrected by a redo anastomotic urethroplasty. The most common complication associated with this condition is erectile dysfunction. Urinary incontinence is a much rarer complication of this surgery in the present day. Conclusions : Anastomotic urethroplasty remains the cornerstone in the management of PFUDD, even in previously failed repairs. Newer innovations are needed to address the problem of erectile dysfunction associated with this condition.

  5. Cefonicid as Therapy for Uncomplicated Gonococcal Urethritis Caused by Penicillinase-Producing Neisseria gonorrhoeae


    Sanchez, Philip L.; Lancaster, Danny J.; Berg, S. William; Kerbs, Sharon B. J.; Harrison, William O.


    Young men with uncomplicated gonococcal urethritis were treated with 1 gram of cefonicid given intramuscularly plus 1 gram of probenecid by mouth. Of 53 evaluable patients, 33 (62%) had penicillinase-producing Neisseria gonorrhoeae. All but one of these patients were cured. All men who had penicillin-sensitive infections were cured. Cefonicid was highly effective in the treatment of both penicillin-sensitive and penicillin-resistant N gonorrhoeae. Other than moderate pain at the site of injec...

  6. Management of iatrogenic recto-urethral fistula by transanal rectal flap advancement. (United States)

    Joshi, H M N; Vimalachandran, D; Heath, R M; Rooney, P S


    Recto-urethral fistulas are an uncommon, but devastating complication following rectal or urinary tract surgery. Repair is often difficult, and the optimal approach is unclear. We report our recent experience using an endorectal advancement flap. A case note review of all patients undergoing repair of recto-urethral fistula in our institution was undertaken. Data on aetiology of the fistula, patient demographics, operative procedure and outcome both clinically and radiologically were extracted. Between 2002 and 2008, six transanal rectal advancement flaps in five patients were carried out. Four had undergone a laparoscopic radical prostatectomy, without any radiotherapy. Two types of fistula (type 1 associated with severe intra-abdominal sepsis and type 2 associated with localized sepsis) were found, with faecal diversion being less likely with the latter. Four (80%) patients underwent successful primary repair, with one patient requiring a second procedure. Postoperative cystography confirmed closure of the fistula in all five patients, and no recurrence has been observed at a mean follow-up time of 11 months. Rectal advancement flap is a simple, effective technique for iatrogenic recto-urethral fistula with minimal morbidity. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

  7. Removal of retrievable self-expandable urethral stents: experience in 58 stents

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    Shin, Ji Hoon; Song, Ho-Young; Kim, Jin Hyoung; Ko, Heung-Kyu; Kim, Yong Jae; Woo, Chul-Woong; Kim, Tae-Hyung; Ko, Gi-Young; Yoon, Hyun-Ki; Sung, Kyu-Bo [Asan Medical Center, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul (Korea); Park, Hyungkeun [Asan Medical Center, Department of Urology, University of Ulsan College of Medicine, Seoul (Korea)


    The purpose of this study was to retrospectively evaluate the safety and efficacy of removing retrievable self-expandable urethral stents using a retrieval hook wire. Under fluoroscopic guidance, the removal of 58 polyurethane or PTFE (polytetrafluoroethylene)-covered stents was attempted in 33 patients using a retrieval hook wire. Indications for removal were elective removal (n=21), stent migration (n=19), formation of tissue hyperplasia around or inside of the stent (n=14), stent deformity (n=3), and severe pain (n=1). The mean time the stents remained in place was 64.8{+-}42.9 days (range, 1-177 days). Fifty-six (97%) of the 58 stents were successfully removed using the retrieval hook wire despite the following difficulties; hook wire disconnection (n=2), untied drawstrings (n=3), and polyurethane membrane disruption/separation (n=4). The removal procedure using a retrieval hook wire failed in two stents (3%) which had migrated into the urinary bladder. One of the two stents with migration into the urinary bladder was removed using a snare through the cystostomy route. The overall complication rate was 14% (seven hematuria cases and one urethral tear case), and all were minor and spontaneously resolved without further treatment. In conclusion, removal of retrievable urethral stents using a retrieval hook wire was safe and effective despite some technical difficulties. It is a useful method for allowing temporary stent placement and solving various complications of stent use. (orig.)

  8. Management of Anterior Urethral Strictures in Adults: A Survey of Contemporary Practice in Germany. (United States)

    Rosenbaum, Clemens M; Reiss, C Philip; Borgmann, Hendrik; Salem, Johannes; Fisch, Margit; Huber, Johannes; Schmid, Marianne; Ahyai, Sascha A


    Treatment methods of anterior urethral strictures in adults have undergone considerable changes in the recent past. Our goal was to determine national practice patterns among German urologists and to compare results with the results of prior international surveys. We conducted a survey on the management of urethral strictures among German urologists. Eight hundred forty-five urologists, representing about 14.6% of German urologists, answered the survey. Most common procedures were direct vision internal urethrotomy (DVIU; 87.2%), blind internal urethrotomy (57.5%), dilatation (56.3%), ventral buccal mucosa graft urethroplasty (31.6%) and excision and primary anastomosis (28.9%). In case of a 3.5-cm bulbar stricture and in the case of a 1-cm bulbar stricture after 2 failed DVIUs, a consecutive urethroplasty was significantly more often favoured compared to transurethral treatment options (44.9 vs. 21.3% and 59.4 vs. 8.3%, both p < 0.001). Open urethral reconstruction reveals to be a more common method in practice nowadays. Adherence to recommended treatment algorithms improved in comparison to prior surveys. © 2017 S. Karger AG, Basel.

  9. History and evolution of the use of oral mucosa for urethral reconstruction. (United States)

    Barbagli, Guido; Balò, Sofia; Montorsi, Francesco; Sansalone, Salvatore; Lazzeri, Massimo


    We report here the history and evolution of the use of oral mucosa in reconstructive urethral surgery since it was first used for urethroplasty in 1894. Since that time, many authors have contributed to develop, improve and popularize the use of oral mucosa as a substitute material. Paediatric urologists should be considered pioneers on the use of oral mucosa as they used it to repair primary and failed hypospadias. The use of oral mucosa to repair penile and bulbar urethral strictures was described, for the first time, in 1993. Important evolutions in the technique for harvesting oral mucosa from the cheek were reported in 1996. Today, oral mucosa is considered the gold standard material for any type of anterior urethroplasty in a one- or two-stage repair due to its biological and structural characteristics that make it a highly versatile that is adaptable to any environment required by the reconstructive urethral surgery. As the future approaches, tissue engineering techniques will provide patients with new materials originating from the oral epithelial mucosal cells, which are cultured and expanded into a scaffold. However, the path to reach this ambitious objective is still long and many difficulties must be overcome along the way.

  10. Using transurethral Ho:YAG-laser resection to treat urethral stricture and bladder neck contracture (United States)

    Bo, Juanjie; Dai, Shengguo; Huang, Xuyuan; Zhu, Jing; Zhang, Huiguo; Shi, Hongmin


    Objective: Ho:YAG laser had been used to treat the common diseases of urinary system such as bladder cancer and benign prostatic hyperplasia in our hospital. This study is to assess the efficacy and safety of transurethral Ho:YAG-laser resection to treat the urethral stricture and bladder neck contracture. Methods: From May 1997 to August 2004, 26 cases of urethral stricture and 33 cases of bladder neck contracture were treated by transurethral Ho:YAG-laser resection. These patients were followed up at regular intervals after operation. The uroflow rate of these patients was detected before and one-month after operation. The blood loss and the energy consumption of holmium-laser during the operation as well as the complications and curative effect after operation were observed. Results: The therapeutic effects were considered successful, with less bleeding and no severe complications. The Qmax of one month postoperation increased obviously than that of preoperation. Of the 59 cases, restenosis appeared in 11 cases (19%) with the symptoms of dysuria and weak urinary stream in 3-24 months respectively. Conclusions: The Ho:YAG-laser demonstrated good effect to treat the obstructive diseases of lower urinary tract such as urethral stricture and bladder neck contracture. It was safe, minimal invasive and easy to operate.

  11. Hypothesis That Urethral Bulb (Corpus Spongiosum Plays an Active Role in Male Urinary Continence

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    Peter Rehder


    Full Text Available The proximal urethral bulb in men is enlarged, surrounds the bulbous urethra, and extends dorsally towards the perineum. During intercourse engorgement takes place due to increased blood flow through the corpus spongiosum. Antegrade ejaculation is facilitated by contraction of the bulbospongiosus muscles during climax. Micturition during sexual stimulation is functionally inhibited. Supporting the bulb may indirectly facilitate continence in a certain subset of patients with postprostatectomy incontinence. During physical activity with increased abdominal pressure, reflex contraction of the pelvic floor muscles as well as the bulbospongiosus muscles occurs to support sphincter function and limit urinary incontinence. Operations to the prostate may weaken urinary sphincter function. It is hypothesized that the distal urinary sphincter may be supported indirectly by placing a hammock underneath the urethral bulb. During moments of physical stress the “cushion” of blood within the supported corpus spongiosum helps to increase the zone of coaptation within the sphincteric (membranous urethra. This may lead to urinary continence in patients treated by a transobturator repositioning sling in patients with postprostatectomy incontinence. This paper describes the possible role of the urethral bulb in male urinary continence, including its function after retroluminal sling placement (AdVance, AdVance XP® Male Sling System, Minnetonka, USA.

  12. Morphology and urodynamics after longitudinal urethral plate incision in proximal hypospadias repairs: long-term results. (United States)

    Orkiszewski, M; Leszniewski, J


    To determine whether longitudinal neourethra incision disturbs the healing and growth of the neourethra, and to see how it affects the urine flow after proximal hypospadias repairs. Nine patients were examined, in whom longitudinal incision had been performed 9 - 15 years earlier, after previous penis lengthening operations. Calibration, urethrography, endoscopy, and urodynamics were carried out in all patients. In all but 1 patient the external meatus had steadily been growing in width, and in 8 out of 9 it was within the normal size range. Urethroscopy showed single hairs growing into the lumen in 3 patients. No scarring was demonstrated in any patient. Saccular dilatation of the neourethra was found in 6 out of 9, urethral stricture was shown in only 1 patient. Peak flow rate was within 2 SD in 5 patients, and below 2 SD in 3. Average flow rate was below 2 SD in 6 patients and in all patients it was markedly low. In the patient with urethral stricture both peak flow rate and average flow rate were well below normal. Although longitudinal neourethra incision allows for easy and safe closure, longitudinal incision may result in functional meatal stenosis with formation of a wide neourethra. This may be due to disproportional low resistance of the urethral wall, compared with external meatus, to urine flow.

  13. Ruptured urinary bladder attributable to urethral compression by a haematoma after vertebral fracture in a bull. (United States)

    Braun, Ueli; Trösch, Luzia; Sydler, Titus


    In male cattle, rupture of the urinary bladder is usually associated with urethral obstruction by uroliths. Less common causes include urethral compression or stricture. This case report describes the findings in a young Limousion breeding bull with rupture of the urinary bladder because of urethral compression by a haematoma after coccygeal fracture. The bull had been introduced into a 40-head Red-Holstein herd one week before being injured. One week after introduction to the herd, the bull had an acute onset of anorexia and he was referred to the clinic. There was marked abdominal distension, reduced skin turgor and enophthalmus. The serum concentration of urea and creatinine was increased. Ultrasonographic examination revealed severe ascites and abdominocentesis yielded clear yellow fluid with high urea and creatinine concentrations, which supported a diagnosis of uroperitoneum. The bull was euthanatized because of a poor prognosis. Postmortem examination revealed a comminuted fracture of the first two coccygeal vertebrae associated with a massive haematoma that obstructed entire pelvic cavity. The haematoma compressed the urethra thereby preventing outflow of urine, which resulted in a 5-cm tear ventrally at the neck of the bladder. It was assumed that the newly-introduced bull had sustained the vertebral fractures when he was mounted by a cow. The present case study serves to expand the differential diagnosis of urinary bladder rupture. Therefore, in addition to obstructive urolithiasis, compression and stricture of the urethra might be considered in male cattle with uroperitoneum.

  14. Rat animal model for preclinical testing of microparticle urethral bulking agents. (United States)

    Mann-Gow, Travis K; Blaivas, Jerry G; King, Benjamin J; El-Ghannam, Ahmed; Knabe, Christine; Lam, Michael K; Kida, Masatoshi; Sikavi, Cameron S; Plante, Mark K; Krhut, Jan; Zvara, Peter


    To develop an economic, practical and readily available animal model for preclinical testing of urethral bulking therapies, as well as to establish feasible experimental methods that allow for complete analysis of hard microparticle bulking agents. Alumina ceramic beads suspended in hyaluronic acid were injected into the proximal urethra of 15 female rats under an operating microscope. We assessed overall lower urinary tract function, bulking material intraurethral integrity and local host tissue response over time. Microphotographs were taken during injection and again 6 months postoperatively, before urethral harvest. Urinary flow rate and voiding frequency were assessed before and after injection. At 6 months, the urethra was removed and embedded in resin. Hard tissue sections were cut using a sawing microtome, and processed for histological analysis using scanning electron microscopy, light microscopy and immunohistochemistry. Microphotographs of the urethra showed complete volume retention of the bulking agent at 6 months. There was no significant difference between average urinary frequency and mean urinary flow rate at 1 and 3 months postinjection as compared with baseline. Scanning electron microscopy proved suitable for evaluation of microparticle size and integrity, as well as local tissue remodeling. Light microscopy and immunohistochemistry allowed for evaluation of an inflammatory host tissue reaction to the bulking agent. The microsurgical injection technique, in vivo physiology and novel hard tissue processing for histology, described in the present study, will allow for future comprehensive preclinical testing of urethral bulking therapy agents containing microparticles made of a hard material. © 2015 The Japanese Urological Association.

  15. [Local injection of gentamycin for female urethral syndrome: a clinical study]. (United States)

    Ding, Xin-Min; Jiang, Guo-Hua; Wen, Hong-Bo; He, Jin-Yuan; Chen, Guan-Hao; Wang, Wei


    To observe the therapeutic effect of local antibiotic injection into the female prostate on female urethral syndrome (FUS), and search for an effective treatment for this disease. This study included 163 FUS patients treated in the out-patient department between July 2009 and December 2010. According to the visiting order, the patients were randomly assigned to Groups A (n = 58), B (n = 55) and C (n = 50). All underwent routine treatment. Inaddition Group A received local injection of 2 ml of 80 000 U gentamycin + 2 ml of lidocaine, and Group B 2 ml of normal saline + 2 ml of lidocaine, both injected into the distal segment of the urethral back wall where the female prostate is located, twice a week for 3 weeks. The therapeutic effects were evaluated according to the changes of the patients' independent symptom scores at 2 and 4 weeks after the treatment. Disappearance of the symptoms was considered as "curative" , > 1/2 reduction in the symptom score as "obviously effective", 1/2 - > 1/4 reduction in the symptom score as "effective", and 0.05). At 4 weeks, the total effectiveness rate of Group A was slightly decreased, but still remarkably higher than that of group B or C (P gentamycin into the female prostate is effective for the treatment of female urethral syndrome.

  16. Can separation of the scrotal sac in proximal hypospadias reliably predict the need for urethral plate transection? (United States)

    Arnaud, Alexis; Ferdynus, Cyril; Harper, Luke


    One of the main challenges in proximal hypospadias repair is correcting curvature. The best technique to achieve this remains the object of debate. Indeed, some authors believe the urethral plate should be kept and used as often as possible. In some cases, however, even after extensive mobilization and dorsal plication, significant curvature remains and it is necessary to transect the urethral plate. Having a reliable pre-dissection marker of the need for urethral transection would be useful in choosing a technique.We wanted to determine if presence of marked separation of the scrotal sac (SSS), also referred to as bifid scrotum, could reliably predict the need for urethral plate transection. We prospectively enrolled a series of boys with proximal hypospadias. We noted age, degree of hypospadias, meatal position, presence of cryptorchidism, and presence or absence of SSS. During surgery we fully degloved the penile shaft, freeing all ventral tissues, and radically dissected the more proximal bulbar urethra. We then performed an erection test. If there was residual curvature 30° we transected the urethral plate. Twenty-nine patients were included, of whom 18 presented SSS. The average age was comparable in both groups, as was type of hypospadias and meatal position. We estimated transection of the urethral plate to be necessary in 15 out of the 18 children with SSS, and 2 out of the 11 children without SSS. The relative risk for requiring urethral plate transection in case of SSS in this series was 4.58. Techniques that commit to urethral plate transection are criticized because they preclude using the urethral plate. In our study presence of SSS was predictive for the need to transect the plate. Obviously one can decide to keep the urethral plate at all cost, and mobilize it more than we did, or accept more residual curvature, but in reality our aim was to determine a preoperative marker allowing us to define a patient category. We believe presence of SSS is a

  17. Successful treatment of a 67-year-old woman with urethral adenocarcinoma with the use of external beam radiotherapy and image guided adaptive interstitial brachytherapy

    DEFF Research Database (Denmark)

    Mujkanovic, Jasmin; Tanderup, Kari; Agerbæk, Mads


    Primary urethral cancer (PUC) is a very rare disease. This case report illustrates a successful treatment approach of a 67-year-old woman with a urethral adenocarcinoma selected for an organ preserving treatment with external beam radiotherapy (EBRT) and interstitial brachytherapy (BT) boost, usi...... in EQD23. At 24 months follow-up, the patient was recurrence free and without treatment related side effects.......Primary urethral cancer (PUC) is a very rare disease. This case report illustrates a successful treatment approach of a 67-year-old woman with a urethral adenocarcinoma selected for an organ preserving treatment with external beam radiotherapy (EBRT) and interstitial brachytherapy (BT) boost, using...

  18. External urethral sphincter electromyography in asymptomatic women and the influence of the menstrual cycle. (United States)

    Tawadros, Cecile; Burnett, Katherine; Derbyshire, Laura F; Tawadros, Thomas; Clarke, Noel W; Betts, Christopher D


    To investigate by electromyography (EMG), the presence of complex repetitive discharges (CRDs) and decelerating bursts (DBs) in the striated external urethral sphincter during the menstrual cycle in female volunteers with no urinary symptoms and complete bladder emptying. Healthy female volunteers aged 20-40 years, with regular menstrual cycles and no urinary symptoms were recruited. Volunteers completed a menstruation chart, urinary symptom questionnaires, pregnancy test, urine dipstick, urinary free flow and post-void ultrasound bladder scan. Exclusion criteria included current pregnancy, use of hormonal medication or contraception, body mass index of >35 kg/m(2) , incomplete voiding and a history of pelvic surgery. Eligible participants underwent an external urethral sphincter EMG, using a needle electrode in the early follicular phase and the mid-luteal phase of their menstrual cycles. Serum oestradiol and progesterone were measured at each EMG test. In all, 119 women enquired about the research and following screening, 18 were eligible to enter the study phase. Complete results were obtained in 15 women. In all, 30 EMG tests were undertaken in the 15 asymptomatic women. Sphincter EMG was positive for CRDs and DBs at one or both phases of the menstrual cycle in eight (53%) of the women. Three had CRDs and DBs in both early follicular and mid-luteal phases. Five had normal EMG activity in the early follicular phase and CRDs and DBs in the mid-luteal phase. No woman had abnormal EMG activity in the early follicular phase and normal activity in the luteal phase. There was no relationship between EMG activity and age, parity or serum levels of oestradiol and progesterone. CRDs and DB activity in the external striated urethral sphincter is present in a high proportion of asymptomatic young women. This abnormal EMG activity has been shown for the first time to change during the menstrual cycle in individual women. CRDs and DBs are more commonly found in the luteal

  19. Application of novel optical diffuser for urethral stricture treatment (Conference Presentation) (United States)

    Nguyen, Trung Hau; Rhee, Yun-Hee; Ahn, Jin-Chul; Kang, Hyun Wook


    Optical fibers have frequently been used for photothermal laser therapy due to its efficiency to deliver laser energy directly to tissue. The aim of the current study was to develop a diffusing optical fiber to achieve radially uniform light irradiation for endoscopically treating urethral stricture. The optical diffuser was fabricated by micro-machining helical patterns on the fiber surface using CO2 laser light at 5 W. Visible light emission (632 nm) and spatial emissions (including polar, azimuthal, and longitudinal emissions) of the fiber tip were evaluated to validate the performance of the fabricated diffuser. Prior to tissue tests, numerical simulation on heat distribution was developed to estimate the degree of tissue coagulation depth during interstitial coagulation. Due to a high absorption coefficient by tissue water, 1470 nm laser was used for photothermal therapy treatment of urethral stricture to obtain a more precise depth profile. For in vitro tissue tests, porcine liver tissue was irradiated with three different power levels (3, 6, and 9 W) at various irradiation times. Porcine urethral tissue was also tested with the diffuser for 10 sec at 6 W to validate the feasibility of circumferential photothermal treatment. The treated tissue was stained with hematoxylin and eosin (H and E) and then imaged with an optical transmission microscope. The spatial emission characteristics of the diffusing optical fiber presented an almost uniform power distribution along the diffuser tip (less than 10% deviation) and around its circumference (less than 5% deviation). The peak temperature in simulation model at the tissue interface between the glass-cap and the tissue was 373 K that was higher than that at the distal end. The tissue tests showed that higher power levels resulted in lower coagulation thresholds (e.g., 1 sec at 9 W vs 8 sec at 3 W). Furthermore, the coagulation depth was approximately 20% thinner than the simulation results (p<0.001). The extent of

  20. Sex-related penile fracture with complete urethral rupture: A case report and review of the literature

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    Marco Garofalo


    Full Text Available Objective: To present the management of a patient with partial disruption of both cavernosal bodies and complete urethral rupture and to propose a non-systematic review of literature about complete urethral rupture. Material and method - Case report: A 46 years old man presented to our emergency department after a blunt injury of the penis during sexual intercourse. On physical examination there was subcutaneous hematoma extending over the proximal penile shaft with a dorsal-left sided deviation of the penis and urethral bleeding. Ultrasound investigation showed an hematoma in the ventral shaft of the penis with a discontinuity of the tunica albuginea of the right cavernosal corporum. The patient underwent immediate emergency surgery consisted on evacuation of the hematoma, reparation the partial defect of both two cavernosal bodies and end to end suture of the urethra that resulted completely disrupted. Results: The urethral catheter was removed at the 12-th postoperative day without voiding symptoms after a retrograde urethrography. 6 months postoperatively the patients was evaluated with uroflowmetry demonstrating a max flow rate of 22 ml/s and optimal functional outcomes evaluated with validated questionnaires. 8 months after surgery the patients was evaluated by dynamic magnetic resonance (MRI of the penis showing only a little curvature on the left side of the penile shaft. Conclusion: Penile fracture is an extremely uncommon urologic injury with approximately 1331 reported cases in the literature till the years 2001. To best of our knowledge from 2001 up today, 1839 more cases have been reported, only in 159 of them anterior urethral rupture was associated and in only 22 cases a complete urethral rupture was described. In our opinion, in order to prevent long term complications, in case of clinical suspicion of penile fracture, especially if it is associated to urethral disruption, emergency surgery should be the first choice of treatment.

  1. Urethral duplication II-A Y type with rectal urethra: ASTRA approach and tunica vaginalis flap for first stage repair

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    Antonio Macedo Jr


    Full Text Available INTRODUCTION: Urethral duplication is a rare congenital anomaly affecting mainly boys. Generally, the duplication develops on the sagittal plane; the accessory urethra may run dorsally or ventrally to the orthotopic one. We present a patient with urethral duplication in which the orthotopic urethra was patent in the penile segment but atresic in the bulbar and prostatic segment. The patient had urinary flow from the rectum and the ectopic urethra could be well identified by anal examination. MATERIALS AND METHODS: Age at surgery was 13 months. The procedure consisted of an ASTRA (anterior sagittal trans-ano-rectal approach for dividing the urethra and rectum and was successful to move the urethra up to the perineal area. The rectum was reconstructed and the patient placed into a lithotomy position. A urethral catheter inserted in the penile urethra oriented us were the atresic urethra in bulbar area started. The scrotum was opened in the middle and the distance between the two urethral stumps proximal and distal defined the extension of no urethral tissue that consisted of 5 cm. We opened the right scrotal space and a tunica vaginalis flap was obtained and attached to the bulbar tissue for a two-stage urethroplasty strategy. RESULTS: Patient had a nice healing and the tunica vaginalis was nicely incorporated to the adjacent tissue, having the two urethral stumps well delineated. CONCLUSIONS: ASTRA approach in combination with a two-stage urethroplasty with tunica vaginalis dorsal flap proved to be an excellent combination for a rare case of urethral Y duplication having the main urethra into the rectum.

  2. Suppression of ERK activation in urethral epithelial cells infected with Neisseria gonorrhoeae and its isogenic minD mutant contributes to anti-apoptosis. (United States)

    Liu, GuanQun L; Parti, Rajinder P; Dillon, Jo-Anne R


    In gonococci-infected transduced human urethral epithelial cells (THUEC), the role of ERK, a mitogen-activated protein kinase (MAPK), in apoptosis is unknown. We observed lowering of ERK activation in THUEC following infection with anti-apoptosis-inducing Neisseria gonorrhoeae strain CH811. An isogenic cell division mutant of this strain, Ng CJSD1 (minD deficient), which is large and abnormally shaped, reduced ERK phosphorylation levels even more than its parental strain in THUEC. This led to higher anti-apoptosis in mutant-infected cells as compared to the parental strain-infected cells. Our results suggest that N. gonorrhoeae infection reduces ERK activation in THUEC contributing to anti-apoptosis. Copyright © 2015 Institut Pasteur. Published by Elsevier Masson SAS. All rights reserved.

  3. Aggressive diagnosis and treatment for posterior urethral valve as an etiology for vesicoureteral reflux or urge incontinence in children

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    Hideo Nakai


    Full Text Available Vesicoureteral reflux (VUR is one of the most common diseases in pediatric urology and classified into primary and secondary VUR. Although posterior urethral valve (PUV is well known as a cause of the secondary VUR, it is controversial that minor urethral deformity recognized in voiding cystourethrography represents mild end of PUV spectrum and contributes to the secondary VUR. We have been studying for these ten years congenital urethral obstructive lesions with special attention to its urethrographic and endoscopic morphology as well as therapeutic response with transurethral incision. Our conclusion to date is that congenital obstructive lesion in the postero-membranous urethra is exclusively PUV (types 1 and 3 and that severity of obstruction depends on broad spectrum of morphological features recognized in PUV. Endoscopic diagnostic criteria for PUV are being consolidated.

  4. Nanoparticle Albumin-Bound-Paclitaxel in the Treatment of Metastatic Urethral Adenocarcinoma: The Significance of Molecular Profiling and Targeted Therapy

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    Yasmin M. Abaza


    Full Text Available Primary urethral cancer is rare and accounts for only 0.003% of all malignancies arising from the female genitourinary tract. Due to the rarity of this disease, no consensus exists regarding the optimal therapeutic approach. Nanoparticle albumin-bound-paclitaxel has been shown to be effective in the treatment of a number of malignancies including metastatic breast, pancreatic, and bladder cancer. We present a 67-year-old woman with advanced metastatic urethral adenocarcinoma resistant to two lines of chemotherapy (ifosfamide/paclitaxel/cisplatin and irinotecan/5-fluorouracil/leucovorin that showed a dramatic response to nanoparticle albumin-bound-paclitaxel. This is the first case report to document the use and efficacy of nanoparticle albumin-bound-paclitaxel in the treatment of unresectable metastatic urethral cancer.

  5. Non sex-related subtotal rupture of the corpus cavernosum without urethral injury: A case report and literature review

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    Zeki Bayraktar


    Full Text Available Although penile fracture is a rare case, it is a well-described urologic emergency. It results from the rupture of the tunica albuginea of corpora cavernosa by blunt strain that commonly mandates immediate surgical exploration. Urethral injury may also accompany penile fracture. An ideal anamnesis and a special physical examination were determinant to achieve a correct diagnosis. It is usually diagnosed based on clinical examination, but ultrasonography can be very helpful in diagnosis. The treatment is based on the presence of associated urethral injury. Early surgery is preferable to conservative management, because it is associated with better outcomes and fewer long-term complications. The surgical repair of cavernous body can produce good results, with a favorable prognosis and minimal rate of complications. We present a penile fracture case of 34-year-old with subtotal rupture of the right corpus cavernosum without urethral injury who treated by early surgery and good results.

  6. Development of a rabbit's urethral sphincter deficiency animal model for anatomical-functional evaluation

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    M. Skaff


    Full Text Available OBJECTIVE: The aim of the study was to develop a new durable animal model (using rabbits for anatomical-functional evaluation of urethral sphincter deficiency. MATERIALS AND METHODS: A total of 40 New Zealand male rabbits, weighting 2.500 kg to 3.100 kg, were evaluated to develop an incontinent animal model. Thirty-two animals underwent urethrolysis and 8 animals received sham operation. Before and at 2, 4, 8 and 12 weeks after urethrolysis or sham operation, it was performed cystometry and leak point pressure (LPP evaluation with different bladder distension volumes (10, 20, 30 mL. In each time point, 10 animals (8 from the study group and 2 from the sham group were sacrificed to harvest the bladder and urethra. The samples were evaluated by H&E and Masson's Trichrome to determine urethral morphology and collagen/smooth muscle density. RESULTS: Twelve weeks after urethrolysis, it was observed a significant decrease in LPP regardless the bladder volume (from 33.7 ± 6.6 to 12.8 ± 2.2 cmH2O. The histological analysis evidenced a decrease of 22% in smooth muscle density with a proportional increase in the collagen, vessels and elastin density (p < 0.01. CONCLUSIONS: Transabdominal urethrolysis develops urethral sphincter insufficiency in rabbits, with significant decrease in LPP associated with decrease of smooth muscle fibers and increase of collagen density. This animal model can be used to test autologous cell therapy for stress urinary incontinence treatment.

  7. Early Realignment Versus Delayed Urethroplasty in Management of Pelvic Fracture Urethral Injury: A Meta-analysis

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    Rama Firmanto


    Full Text Available Aim: this meta-analysis study will evaluate the incidence of urethral stricture as a successfull parameter in the management of PFUI through early realignment, compared with delayed urethroplasty. Long-term complications such as erectile dysfunction and incontinence on both methods will also be evaluated. Methods: online literature was sourced from Pubmed, Embase, Cochrane, and Google Scholar. The incidence of stricture was evaluated from the entire study group of ER and DU. Stricture of the urethra is diagnosed by the symptoms such as the obstruction that felt by the patient, uroflowmetry examination, and urine residual post micturition that supported by urethrography examination at regular interval. In some cases the incidence of stricture also diagnosed by urethroscopy. The patient is assessed as not having stricture when it is no longer needed to do urethral dilatation or advanced urethrotomy. The rate of incontinence was assessed subjectively from the patient’s complaints. The erectile function assessed subjectively; decreased of tumesen’s degree, reduced the duration of erection, and penetration failure diagnosed as erection dysfunction. The data were processed as dichotomy data to calculate the risk ratio using Review Manager 5.1. Results: five relevant literatures reviewed in this study. The incidence of urethral strictures are statistically significant lower in early realignment group (RR=0.70, 95% CI 0.50-0.99, P<0.05. There were no statistically significant differences between both treatment groups on the incidence of erectile dysfunction (RR=0.72, 95% CI 0.39-1.34 nor the incidence of incontinence (RR=0.74, 95% CI 0.36-1.51. Conclusion: early realignment decrease the occurrence of stricture on PFUI treatment compared to delayed urethroplasty method. Between the two methos, the complications such as erectile dysfunction and incontinence; however, there was no significant difference.


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    Nischal Prasad Reddy


    Full Text Available OBJECTIVES: T he most common congenital anomaly is Posterior Urethral valve (PUV and has as incidence of 1 in 8000 male births. It is the most common obstructive cause of end stage renal disease in children. Vesicoureteric reflux, recurrent UTI, voiding dysfunction and late onset renal failure are the long term major problems in these children. There are few long term outcome studies of children with PUV from India. These studies mainly concentrate on the surgical aspects. The study is aimed to assess the long term impact of PUV on renal function and th e growth of these children. METHODS: The study was conducted at AJ hospital, Mangalore between July 2010 - June 2011. Thirty children, with posterior urethral valve, five years or more post - surgery were included in the study. The details of children were obtained from records regarding age, presenting symptoms serum creatinine, presence of or absence of vesicoureteric reflux. Outcomes measured were stunting, renal failure (GFR, tubular functions and bladder functions. Results were analysed. RESULTS: Thirt y children were analysed. The age at presentation varied from antenatal detection to six years. About 46.6% of patients presented between 0 - 1 month, 36.6% between one month to one year, 16.8% between one to six years. The median age at presentation was thr ee months. Primary surgery done in the neonatal period in 33% children. Of the 28 children who had antenatal ultrasound, 20 had normal USS and eight had antenatally detected hydronephrosis (28.6%. Five out of eight had associated oligohydramnios. All thes e five children had GFR <90 m/m/1.73m 2 at follow up. CONCLUSION: Poor bladder function was seen in one - third of patients. Interventions as and when needed on follow - up are important in the management of all children with posterior urethral valve. Comprehen sive care should be the rule by a team comprising paediatrician, pediatric surgeon and pediatric nephrologists

  9. Urinary and sexual functions after surgical treatment of penile fracture concomitant with complete urethral disruption

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    Ali Abdel Raheem


    Full Text Available Objectives: Penile fracture with concomitant complete urethral disruption is an uncommon urologic disorder. Data about the treatment and outcome measurements of this condition are scarce in the literature. The aim of the present study is to evaluate the long term urinary and sexual functions of patients with penile fracture associated with complete urethral injury after immediate surgical reconstruction. Patients and methods: Twelve patients met our inclusion criteria and were included in this retrospective case series study; however, one was lost during follow-up. Patient's medical records were reviewed and all patients were interviewed for clinical evaluation. Urinary function was assessed by history, uroflometry and retrograde urethrography, while, sexual function was assessed by questionnaire (Sexual Health Inventory for Men and penile Doppler for patients with erectile dysfunction. Results: Patients’ mean age was 32.3 ± 7.5 years (range 21-43 and the mean follow-up period was 72.6 ± 45.4 months (range 14-187. Vigorous sexual intercourse was the main cause in 91% of our patients. No serious long term complications was found. Only 1 patient (9% suffered from anterior urethral stricture, 1 patient (9% complained of weak erection, 3 patients (27% had a palpable fibrosis and 2 patients (18% reported a slight penile curvature during erection. Ninety one percent of all our patients maintained their normal urinary and sexual functions. Conclusion: On the long term follow-up, most of the patients maintained their normal erectile and voiding functions with no harmful long-term complications. We advocate immediate surgical intervention and reconstruction of both corpora cavernous and urethra as a first line treatment for those patients.

  10. Histopathological evaluation of the effect of vitamin E on rat kidney after complete unilateral urethral obstruction

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    G.h Mousavi


    Full Text Available Vitamin E is an important antioxidant, which plays a vital role in preventing free radical induced reperfusion injuries. Any disorder in the normal urinary flow is termed obstructive nephropathy which could ultimately lead to hydronephrosis, atrophy and complete impairment of renal function. The aim of this study was to determine the effect of vitamin E on renal tissue following complete unilateral urethral obstruction in the rat. In this experimental study, 30 adult male Sprague-Dawley rats were randomly divided into three groups each containing 10 rats. The first group was considered as the control group. Following Unilateral urethral obstruction (UUO, rats in the second group received olive oil intraperitoneally for 15 days starting one day before surgery. Group three rats were given 50 Iu/kg of Vitamin E intraperitoneally for 15 days starting one day before unilateral obstruction (UUO-Vit E. Rats were euthanized at day 14 after surgery for histopathological evaluation and their left kidneys were collected and fixed in formalin and stained with Hematoxylen and Eosin, Trichrome-masson and Periodic Acid Schiff techniques. Histopathological evaluation revealed dilation of the Bowman’s capsule, severe glomerular and tubular atrophy, periglomerular sclerosis, interstitial infiltration of mononuclear cells, severe diffuse tubular degeneration, epithelial thickening of Bowman’s capsule, perivascular edema, interstitial fibrosis, hemorrhage and sub capsular fibrosis in the UUO group. Vitamin E administration in the UUO-Vit E group significantly decreased renal tissue lesions and fibrosis. The result of the present study indicated that urethral obstruction leads to severe renal fibrosis and tissue damage and concurrent administration of Vitamin E decreases tissue lesions and fibrosis resulting from the obstruction.

  11. A case report of ureteral cast stone and giant urethral stone, respectively

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    Song, Ho Yung; Rhee, Song Joo; Choi, Ki Chul [School of Medicine, Jeongbug National University, Jeonju (Korea, Republic of)


    Urinary lithiasis is one of the most common disease of the urinary tract. It occurs more frequently in men than in women but rare in children and in blacks; a familial predisposition is often encountered. Ureteral stones originate in the kidney. Gravity and peristalis contribute to spontaneous passage into and down the ureter. Ureterovesical junction is the most frequent lodging site of stone. In our hospital one case of ureteral cast stone and giant urethral stone were found respectively and they were confirmed by radiological examination and surgery on Aug. 1978 and Jan. 1979. Ureteral cast stone which had been introduced and named first by Kiyonobu Tari and Kikjiro So in 1972 was very giant unusually. It may be the only one till now. Our patient was 36 years old female who has been suffered from intermittent right flank pain for 10 years. On KUB giant cylindrical radiopaque shadow was shown on RLQ extended to right minor pelvis and this was confirmed as a stone by retrograde ureteral catheterization. A stone measured 13cm x 1.5cm was found above the ureterovesical junction during operation. Follow up excretory urogram one year after operation showed no functional improvement of right kidney. Urethral stone is also unusual urinary lithiasis. This 60 years old male patient was been suffered from non-tender palpable hard mass on scrotal area and intermittent urinary retention. When urinary retention was occurred it was relieved by manipulation of the mass by himself. On plain film oval shaped giant radiopaque shadow was shown on cavernous urethral region. On urethrocystogram anterior urethra was opacified, but posterior urethra and bladder were not opacified and multiple fistulous leakage was identified. A stone measured 6.5cm x 3.5cm was found in cavernous urethra during operation.

  12. Longitudinal urethral sling with prepubic and retropubic fixation for male urinary incontinence

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    Carlos H. Schaal


    Full Text Available OBJECTIVE: Description and early results of a new urethral sling technique for treatment of postprostatectomy urinary incontinence, which combines efficacy, low cost and technical simplicity. MATERIALS AND METHODS: From May 2003 to April 2004, 30 patients with moderate or total urinary incontinence, following radical prostatectomy or endoscopic resection of the prostate, underwent the new technique. The technique is based on the placement of a longitudinal-shaped sling in the bulbar urethra, measuring 4 cm in length by 1.8 cm in width, made of Dacron or polypropylene mesh, fixed by 4 sutures on each side, with 2 sutures passed with Stamey-Pereira needle by retropubic approach and 2 by prepubic approach, which are then tied over the pubis. Pressure control was determined by interrupting the loss of infused water through a suprapubic cystostomy 60 cm from the pubis level. RESULTS: Pre-operative assessment excluded vesical instability, urethral stenosis and urinary infection. Suprapubic cystostomy was removed when the patient was able to satisfactorily void with urinary residue lower than 100 mL, which occurred in 29 of the 30 cases. In 2 cases, there was infection of the prosthesis, requiring its removal. In 3 cases, there was the need to adjust the sling (increasing the tension, due to failure of the urinary continence. Overall, 20 of 30 (66.7% operated patients became totally continent, and did not require any kind of pads. Four of 30 (13.3% patients achieved partial improvement, requiring 1 to 2 pads daily and 6 of 30 (20% patients had minimal or no improvement. There was no case of urethral erosion. CONCLUSION: This new sling technique has shown highly encouraging preliminary results. Its major advantage over other surgical techniques for treatment of moderate or severe stress urinary incontinence is the simplicity for its execution and low cost. A long-term assessment, addressing maintenance of continence, detrusor function and preservation

  13. Clinical usefulness of the transobturator sub-urethral tape in the treatment of stress urinary incontinence in female patients with spinal cord lesion. (United States)

    Pannek, Juergen; Bartel, Peter; Gocking, Konrad


    To evaluate the clinical usefulness of transobturator sub-urethral tapes for the treatment of stress urinary incontinence in women with spinal cord injury. Chart review for all female patients with spinal cord injury who underwent implantation of a transobturator sub-urethral tape for treatment of stress urinary incontinence at our institution. Nine women, median age 45.1 years, received a sub-urethral transobturator tape in the period November 2007 to September 2010. Four patients had paraplegia and five had tetraplegia. Seven women performed intermittent catheterization. At follow up, three of the nine patients were either cured or vastly improved. One major late complication (urethral erosion) occurred. Five of the six patients without treatment success underwent second-line treatment (artificial sphincter or urinary diversion). In our case series, implantation of transobturator sub-urethral tapes in women with stress urinary continence due to intrinsic sphincter deficiency and a low leak point pressure led to unfavorable results.

  14. Algorithm for Optimal Urethral Coverage in Hypospadias and Fistula Repair: A Systematic Review. (United States)

    Fahmy, Omar; Khairul-Asri, Mohd Ghani; Schwentner, Christian; Schubert, Tina; Stenzl, Arnulf; Zahran, Mohamed Hassan; Gakis, Georgios


    Although urethral covering during hypospadias repair minimizes the incidence of fistula, wide variation in results among surgeons has been reported. To investigate what type of flap used during Snodgrass or fistula repair reduces the incidence of fistula occurrence. We systematically reviewed published results for urethral covering during Snodgrass and fistula repair procedures. An initial online search detected 1740 reports. After exclusion of ineligible studies at two stages, we included all patients with clear data on the covering technique used (dartos fascia [DF] vs tunica vaginalis flap [TVF]) and the incidence of postoperative fistula. A total of 51 reports were identified involving 4550 patients, including 33 series on DF use, 11 series on TVF use, and seven retrospective comparative studies. For distal hypospadias, double-layer DF had the lowest rate of fistula incidence when compared to single-layer DF (5/855 [0.6%] vs 156/3077 [5.1%]; p=0.004) and TVF (5/244, 2.0%), while the incidence was highest for single-layer DF among proximal hypospadias cases (9/102, 8.8%). Among repeat cases, fistula incidence was significantly lower for TVF (3/47, 6.4%) than for DF (26/140, 18.6%; p=0.020). Among patients with fistula after primary repair, the incidence of recurrence was 12.2% (11/90) after DF and 5.1% (5/97) after TVF (p=0.39). The absence of a minimum follow-up time and the lack of information regarding skin complications and rates of urethral stricture are limitations of this study. A double DF during tubularized incised plate urethroplasty should be considered for all patients with distal hypospadias. In proximal, repeat, and fistula repair cases, TVF should be the first choice. On the basis of these findings, we propose an evidence-based algorithm for surgeons who are still in their learning phase or want to improve their results. We systematically reviewed the impact of urethral covering in reducing fistula formation after hypospadias repair. We propose an

  15. Eccentric circummeatal based flap with limited urethral mobilization: An easy technique for distal hypospadias repair. (United States)

    Ekinci, Saniye; Çiftçi, Arbay Özden; Karnak, İbrahim; Şenocak, Mehmet Emin


    Hypospadias is a common congenital anomaly. Over 300 techniques have been described for repairing hypospadias. Eccentric circummeatal based flap with combined limited urethral mobilization technique (ECMB-LUM) is a simple procedure to repair distal hypospadias with minimal complication rate. This study presents results of this technique, highlighting surgical pitfalls to achieve the best result. Medical records of patients with distal hypospadias operated on using the same technique between 1998 and 2011 were reviewed retrospectively. Age at surgery, position of meatus preoperatively and postoperatively, duration of urethral catheterization and hospitalization, early and late complications, previous hypospadias repairs, and secondary surgical interventions were evaluated. In the surgical technique an eccentric circummeatal based flap is outlined. The proximal part of the flap is dissected from the underlying urethra and Buck's fascia. If the flap is not long enough, the distal urethra is mobilized a few millimeters (Figure). The eccentric flap is sutured to the tip of the glans. The glans wings are approximated in the midline. A urethral catheter of 6 Fr or 8 Fr is passed and left in the bulbous urethra or the urinary bladder. Diverged limbs of corpus spongiosum are approximated on the urethra, then, the glans and skin of the penile shaft are sutured. Of the 171 consecutive patients operated on using the ECMB-LUM technique; 115 had coronal, 47 had subcoronal, and nine had glanular meatus. The mean age at surgery was 4.5 (1-17) years. Patients were hospitalized for 2.2 ± 0.7 days. Mean duration of urethral catheterization was 2.3 ± 0.5 days. All but eight patients had ECBF-LUM as primary repair. There were no early complications such as bleeding, hematoma, and wound infection. All patients voided spontaneously after catheter removal. Late complications were meatal stenosis, urethrocutaneous fistula, meatal regression, and glandular dehiscence (Table). These

  16. [Usefulness of urethral endoprosthesis in the management of urinary retention after brachytherapy for localized prostate cancer]. (United States)

    Kerkeni, W; Chahwan, C; Lenormand, C; Dubray, B; Benyoucef, A; Pfister, C


    Brachytherapy is a possible treatment for localized low risk prostate cancer. Although this option is minimally invasive, some side effects may occur. Acute retention of urine (ARU) has been observed in 5% to 22% of cases and can be prevented in most cases by alpha-blocker treatment. Several alternatives have been reported in the literature for the management of ARU following brachytherapy: prolonged suprapubic catheterization, transurethral resection of the prostate and also intermittent self-catheterization. The authors report an original endoscopic approach, using urethral endoprosthesis, with a satisfactory voiding status. Copyright © 2013. Published by Elsevier Masson SAS.

  17. Recreational urethral sounding is associated with high risk sexual behaviour and sexually transmitted infections. (United States)

    Breyer, Benjamin N; Shindel, Alan W


    What's known on the subject? and What does the study add? Most of the medical literature regarding recreational urethral sounding pertains to foreign body retrieval. Very little is known about men who perform sounding and do not require medical attention. Of >2000 men, who responded to a urinary and sexual wellness survey, 10% had a history of recreational urethral sounding. Compared with men who did not sound, men who did reported higher risk sexual behaviours such as multiple sexual partners, sex with strangers and reported more sexually transmitted infections. Men who seek medical attention for complications resulting from sounding should be counselled regarding the hazards of the practice. Realistic strategies for risk reduction should be discussed with men who engage in recreational sounding. To determine whether men who perform recreational sounding are at increased risk of engaging in unsafe sexual behaviours, developing sexually transmitted infections (STIs) and lower urinary tract symptoms (LUTS). In a cross-sectional, international, internet-based survey of the sexual practices of >2000 men who have sex with men, subjects were asked if they had engaged in urethral sounding for sexual gratification. We compared ethnodemographic and health-related variables between the sounding and non-sounding populations. The International Prostate Symptom Score and a modified validated version of the International Index of Erectile Function were used to quantify LUTS and erectile dysfunction (ED) in both populations. There were 2122 respondents with complete data, 228 (10.7%) of whom had engaged in recreational sounding. Men who had engaged in sounding were more likely to report certain high risk sexual behaviours (e.g. multiple sexual partners and sex with partners who were not well known) and had increased odds of reporting STIs. Men who had engaged in sounding had a slight but statistically significant increase in LUTS but no significant difference in prevalence of ED

  18. Urethral Stone Disease Leading to Retention After Hair-bearing Neophalloplasty

    Directory of Open Access Journals (Sweden)

    Robert Viviano


    Full Text Available A 35-year-old male patient with a past history of traumatic penile amputation and subsequent penile reconstruction with a radial artery free flap phalloplasty presented to the urology clinic for urinary retention and complaint of a firm penile mass. The patient had been lost to follow-up for 2 years before this presentation. Patient had a suprapubic tube in place from initial surgery, with imaging showing 2 large uroliths encrusted around the end. Urethral stricture was suspected in the patient. On cystoscopy, an additional obstructing urolith was found in penile urethra, appearing to have formed in situ.

  19. Adenovirus urethritis and concurrent conjunctivitis: a case series and review of the literature. (United States)

    Liddle, Olivia Louise; Samuel, Mannampallil Itty; Sudhanva, Malur; Ellis, Joanna; Taylor, Chris


    We present eight cases and review the literature of concurrent urethritis and conjunctivitis where adenovirus was identified as the causative pathogen. The focus of this review concerns the identification of specific sexual practices, symptoms, signs and any serotypes that seem more commonly associated with such adenovirus infections. We discuss the seasonality of adenovirus infection and provide practical advice for clinicians to give to the patient. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  20. A case of penile fracture at the crura of the penis without urethral involvement: Rare entity

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    B V Srinivas


    Full Text Available Penile fracture is a rare injury, most commonly sustained during sexual intercourse. We report the case of a 29-year-old man who presented with bilateral rupture of the crura of the cavernosa without urethral injury. This is the first case in the literature to present with this unique finding. Urgent surgical exploration was performed and the injuries repaired primarily. At follow-up, the patient reported satisfactory erectile function. This case highlights the importance of early diagnosis with unusual presentation and early surgical repair for better outcome.

  1. Female urethral diverticulum containing a giant calculus: a CARE-compliant case report. (United States)

    Dong, ZhiLong; Wang, Hanzhang; Zuo, LinJun; Hou, MingLi


    Urethral diverticula with calculi have a low incidence as reported in the literature. Diverticulum of female urethra is rare, often discovered due to associated complications. We report a case of diverticulum of the female urethra containing giant calculi in a 62-year-old multiparous woman. She consulted with our office due to dysuria and a hard, painful periurethral mass in the anterior vagina wall. The diverticulum was approached surgically by a vaginal route, and local extraction of the calculi and subsequent diverticulectomy successfully treated the condition.Diagnosis of a complicated diverticulum can be easily achieved if one possesses a high degree of clinical symptoms.

  2. A Danish national survey of women operated with mid-urethral slings in 2001

    DEFF Research Database (Denmark)

    Ammendrup, Astrid Cecilie; Jørgensen, Anette; Sander, Pia


    OBJECTIVE: To perform a national survey on self-reported cure, satisfaction and complications four years after mid-urethral sling (MUS) for urinary stress incontinence in Danish women operated in 2001. DESIGN: A postal questionnaire survey. POPULATION: All Danish women who received an MUS operation...... in 2001 extracted from the Danish National Patient Register. METHODS: The women received a validated postal questionnaire in 2005. The questionnaire included questions about subjective cure, satisfaction, complications and a Danish version of International Consultation on Incontinence Questionnaire...

  3. Surgical Repair of Mid-shaft Hypospadias Using a Transverse Preputial Island Flap and Pedicled Dartos Flap Around Urethral Orifice. (United States)

    Liang, Weiqiang; Ji, Chenyang; Chen, Yuhong; Zhang, Ganling; Zhang, Jiaqi; Yao, Yuanyuan; Zhang, Jinming


    To evaluate the effects, particularly the incidence of anastomotic fistula, of a pedicled dartos flap around the urethral orifice in the treatment of urethroplasty of mid-shaft hypospadias. A total of 46 cases of congenital mid-shaft hypospadias were included in this study. The patients ranged in age from 0.7 to 25.4 years and the average was 5.8 years. The patients received penis chordee correction. A transverse preputial island flap was developed for urethral reconstruction. The proximal dartos of the urethral orifice was used to develop a pedicled dartos flap, which was transposed to cover and strengthen neourethral anastomosis. The ventral penile skin defect was repaired by another flap. The 46 patients were examined during follow-up visits for 6 months to 3 years. An anastomotic fistula was observed in one case (2.2 %). Scar healing without fistula was observed in another patient due to poor blood supply to part of the ventral penile skin. No other incidences of fistula, urethral rupture, flap necrosis, wound infections, urinary tract (meatal) stenosis, or urethral diverticulum were observed in the patients. A pedicled dartos flap around the urethral orifice can take advantage of well-vascularized local tissue to add a protective layer to the proximal aspect of the neourethral anastomosis for reducing the incidence of anastomotic fistula in mid-shaft hypospadias repair using a transverse preputial island flap. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .

  4. Efficacy and perioperative safety of synthetic mid-urethral slings in obese women with stress urinary incontinence

    DEFF Research Database (Denmark)

    Weltz, V; Guldberg, R; Lose, G


    INTRODUCTION AND HYPOTHESIS: Obesity is associated with an increased prevalence of female stress urinary incontinence (SUI). Mid-urethral polypropylene sling is considered the surgical gold standard for treatment of SUI. We reviewed the current literature on efficacy at 1 year (or more......) and perioperative safety of synthetic mid-urethral sling procedures for SUI in obese women. METHODS: A systematic search of PubMed, Embase and the Cochrane databases was performed using the MeSH terms "Stress urinary incontinence", "Overweight", "Obesity" and "Surgery". We included 13 full-text papers published...

  5. A novel highly potent autotaxin/ENPP2 inhibitor produces prolonged decreases in plasma lysophosphatidic acid formation in vivo and regulates urethral tension.

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    Hiroshi Saga

    Full Text Available Autotaxin, also known as ectonucleotide pyrophosphatase/phosphodiesterase 2 (ENPP2, is a secreted enzyme that has lysophospholipase D activity, which converts lysophosphatidylcholine to bioactive lysophosphatidic acid. Lysophosphatidic acid activates at least six G-protein coupled recpetors, which promote cell proliferation, survival, migration and muscle contraction. These physiological effects become dysfunctional in the pathology of cancer, fibrosis, and pain. To date, several autotaxin/ENPP2 inhibitors have been reported; however, none were able to completely and continuously inhibit autotaxin/ENPP2 in vivo. In this study, we report the discovery of a highly potent autotaxin/ENPP2 inhibitor, ONO-8430506, which decreased plasma lysophosphatidic acid formation. The IC50 values of ONO-8540506 for lysophospholipase D activity were 6.4-19 nM for recombinant autotaxin/ENPP2 proteins and 4.7-11.6 nM for plasma from various animal species. Plasma lysophosphatidic acid formation during 1-h incubation was almost completely inhibited by the addition of >300 nM of the compound to human plasma. In addition, when administered orally to rats at a dose of 30 mg/kg, the compound demonstrated good pharmacokinetics in rats and persistently inhibited plasma lysophosphatidic acid formation even at 24 h after administration. Smooth muscle contraction is a known to be promoted by lysophosphatidic acid. In this study, we showed that dosing rats with ONO-8430506 decreased intraurethral pressure accompanied by urethral relaxation. These findings demonstrate the potential of this autotaxin/ENPP2 inhibitor for the treatment of various diseases caused by lysophosphatidic acid, including urethral obstructive disease such as benign prostatic hyperplasia.

  6. Complex epithelial remodeling underlie the fusion event in early fetal development of the human penile urethra. (United States)

    Shen, Joel; Overland, Maya; Sinclair, Adriane; Cao, Mei; Yue, Xuan; Cunha, Gerald; Baskin, Laurence

    We recently described a two-step process of urethral plate canalization and urethral fold fusion to form the human penile urethra. Canalization ("opening zipper") opens the solid urethral plate into a groove, and fusion ("closing zipper") closes the urethral groove to form the penile urethra. We hypothesize that failure of canalization and/or fusion during human urethral formation can lead to hypospadias. Herein, we use scanning electron microscopy (SEM) and analysis of transverse serial sections to better characterize development of the human fetal penile urethra as contrasted to the development of the human fetal clitoris. Eighteen 7-13 week human fetal external genitalia specimens were analyzed by SEM, and fifteen additional human fetal specimens were sectioned for histologic analysis. SEM images demonstrate canalization of the urethral/vestibular plate in the developing male and female external genitalia, respectively, followed by proximal to distal fusion of the urethral folds in males only. The fusion process during penile development occurs sequentially in multiple layers and through the interlacing of epidermal "cords". Complex epithelial organization is also noted at the site of active canalization. The demarcation between the epidermis of the shaft and the glans becomes distinct during development, and the epithelial tag at the distal tip of the penile and clitoral glans regresses as development progresses. In summary, SEM analysis of human fetal specimens supports the two-zipper hypothesis of formation of the penile urethra. The opening zipper progresses from proximal to distal along the shaft of the penis and clitoris into the glans in identical fashion in both sexes. The closing zipper mechanism is active only in males and is not a single process but rather a series of layered fusion events, uniquely different from the simple fusion of two epithelial surfaces as occurs in formation of the palate and neural tube. Copyright © 2016 International Society

  7. Urethral advancement technique for repair of distal penile hypospadias: A revisit

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    Awad Mohamed


    Full Text Available Background: Numerous ingenious methods have been described to repair hypospadias with variable results. The anterior urethral advancement technique reported by Chang[1] to repair distal hypospadias has shown encouraging results. We have reevaluated this technique with some modifications to improve its results. Materials and Methods: This study was done on 72 patients, 19 cases with glanular hypospadias, 20 cases with coronal hypospadias, 22 cases of subcoronal hypospadias,and 11 cases with anterior penile hypospadias in the period between September 1999 and October 2003. The patients′ age ranged from two years to twenty five years (median age 5.6 years. All the patients were operated using Chang′s technique with our modifications. Results: There were no major complications in any of our patients, no postoperative fistulae or urethral stricture. Three patients had meatal stenosis and preputial edema occurred in 83.3% in non-circumcised patients. Conclusion: Modifications of the anterior advancement technique has produced excellent Results. It is easy to do and learn and also offers good cosmetic and functional results.

  8. A rare complication: misdirection of an indwelling urethral catheter into the ureter. (United States)

    Ishikawa, Tsutomu; Araki, Motoo; Hirata, Takeshi; Watanabe, Masami; Ebara, Shin; Watanabe, Toyohiko; Nasu, Yasutomo; Kumon, Hiromi


    We report 3 patients with the rare complication of an indwelling urethral catheter misdirected into the ureter. This is the largest series to date. Patients were referred to us for a variety of reasons following exchange of their chronic indwelling urinary catheters. CT in all cases demonstrated the urinary catheters residing in the left ureter. The ages of the patients were 37, 67 and 81 years old. All patients suffered from neurogenic bladder. Two patients were female, one was male, and 2 of the 3 had a sensory disorder inhibiting their pain response. The catheters were replaced with open-end Foley catheters. Extensive follow-up CT scans were obtained in one case, demonstrating improvement of hydronephrosis and no evidence of ureteral stenosis. Cystoscopy in this patient demonstrated normally positioned and functioning ureteral orifices. Although the placement of an indwelling urethral catheter is a comparatively safe procedure, one must keep in mind that this complication can occur, particularly in female patients with neurogenic bladder. CT without contrast is a noninvasive, definitive diagnostic tool.

  9. Urodynamic assessment of bladder and urethral sphincter function before and after robot-assisted radical prostatectomy. (United States)

    Barnoiu, O S; Vozmediano-Chicharro, R; García-Galisteo, E; Soler-Martinez, J; del Rosa-Samaniego, J M; Machuca-Santacruz, J; Baena-Gonzalez, V


    Affectation of the bladder after open prostatectomy is demonstrated. Decrease in bladder capacity and bladder compliance, detrusor hyper-or hypo-activity and voiding dysfunction are observed. We propose to investigate the effects of robotic surgery on bladder and sphincter function through the comparative study of preoperative and postoperative urodynamic values 3 months after prostatectomy. Prospective study of 32 consecutive patients undergoing robotic prostatectomy. They all underwent urodynamic study one month before the intervention and 3 months after the radical prostatectomy. Twenty five percent of patients undergoing robotic prostatectomy showed detrusor hyperactivity accompanied by a decrease in bladder compliance of 30.2 to 21.8 ml/cmH2O. Urethral profile showed diminished functional length of 67 to 44 mm and decreased maximum urethral pressure of 48.5 to 29.3 cmH2O. After robotic prostatectomy 21.8% of patients had detrusor hypoactivity, obstruction decreased between 28.1% to 12.5%. Decreased bladder compliance, detrusor hypo- or hyperactivity and obstruction improvement observed in the study of the flow pressure have been associated with sphincter involvement. It is part of the complex of lower urinary tract dysfunction that occurs after robotic prostatectomy. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  10. Impact of castration with or without alpha-tocopherol supplementation on the urethral sphincter of rats

    Directory of Open Access Journals (Sweden)

    Mirian Kracochansky


    Full Text Available OBJECTIVE: To analyze the impact of low levels of testosterone induced by orchiectomy and the effect of alpha-tocopherol supplementation on oxidative stress in the urethral sphincter. MATERIALS AND METHODS: Forty male Wistar rats weighing 250-300g were divided into four groups with 10 each: Sham group; Orchiectomy group: bilateral orchiectomy; Orchiectomy-pre-Tocopherol group: bilateral orchiectomy preceded by alpha-tocopherol supplementation for four weeks; Orchiectomy-full-Tocopherol group: bilateral orchiectomy with alpha-tocopherol supplementation for four weeks preceding the procedure and for eight weeks afterwards. At the protocol end, animals were euthanized and had the sphincter analyzed stereologically focusing on collagen and muscle fibers percentage. Oxidative stress levels were determined using 8-epi-PGF2. RESULTS: The 8-epi-PGF2 levels were statistically higher (p < 0.0003 in the Orchiectomy group compared to others groups while Sham and Orchiectomy-full-Tocopherol groups presented statistically similar values (p = 0.52. Collagen volumetric densities were significantly lower in Sham and Orchiectomy-full-Tocopherol groups (p < 0.022. Sham group presented statistically greater muscle fiber percent. CONCLUSION: Castration caused oxidative stress in the urethral sphincter complex, with increased collagen deposition. Alpha-tocopherol had a protective effect and its supplementation for twelve weeks provided the greatest protection.

  11. Microwave prostatic hyperthermia: Interest of urethral and rectal applicators combination -- Theoretical study and animal experimental results

    Energy Technology Data Exchange (ETDEWEB)

    Despretz, D.; Camart, J.C.; Michel, C.; Fabre, J.J. [Univ. des Sciences et Technologies de Lille, Villeneuve D`Ascq (France); Prevost, B. [Centre Oscar Lambret, Lille (France); Sozanski, J.P. [INSERM, Lille (France); Chive, M. [Univ. des Sciences et Technologies de Lille, Villeneuve D`Ascq (France)]|[INSERM, Lille (France)


    Microwave thermotherapy systems used for benign prostatic hyperplasia treatment generally operate with urethral or rectal applicator to deliver the microwave energy in the prostate. This technique does not allow an efficient heating of all the gland particularly in the case of large adenoma or when the treatment is limited to only one heating session. A solution to this problem is given by using simultaneously the rectal and urethral applicators. A complete 915-MHz microwave thermotherapy system is presented with two applicators which can operate independently or simultaneously to deliver the microwave energy in the prostate. Electromagnetic and thermal modeling have been developed for the applicator antenna optimization, to calculate the specific absorption rate (SAR) and the thermal pattern in the prostate for each applicator alone and when they operate together in phase. Different canine experiments have been performed to prove the interest of using the two applicators simultaneously as compared when they operate alone. Histological examination cuts of the prostate gland after heating have been carried out.

  12. Urethral pressure reflectometry in women with pelvic organ prolapse: a study of reproducibility. (United States)

    Khayyami, Yasmine; Lose, Gunnar; Klarskov, Niels


    The mechanism of continence in women with pelvic organ prolapse (POP) before and after surgery remains unknown. Urethral pressure reflectometry (UPR) separates women with stress urinary incontinence (SUI) from continent women by measuring urethral opening pressure at an abdominal pressure of 50 cmH2O (P O-Abd 50). UPR can help identify women with POP at risk of postoperative de novo SUI. The aim of this study was to investigate the reproducibility of UPR in women with POP. Women with anterior or posterior vaginal wall prolapse were recruited for this prospective, observational study from our outpatient clinic. The women were examined with UPR on two occasions. Measurements were done at rest, and during squeezing and straining. Statistical analyses were performed using SAS 9.4. A Bland-Altman analysis with limits of agreement and coefficients of variation was used to determine the level of agreement between measurements. Paired t tests were used to estimate the difference; a two-tailed P value of pressures at rest or during squeezing or in the values of P O-Abd 50. P O-Abd 50 showed limits of agreement of 15.3 cmH2O and a coefficient of variation of 9.9 %. UPR was found to be a highly reproducible method in women with POP. UPR may be used in future studies to help reveal urodynamic features predictive of postoperative de novo SUI in women with POP.

  13. Conditioning stimulus can influence an external urethral sphincter contraction evoked by a magnetic stimulation. (United States)

    Wefer, Bjoern; Reitz, André; Knapp, Peter A; Bannowsky, Andreas; Juenemann, Klaus-Peter; Schurch, Brigitte


    To study the effect of a conditioning stimulus on an external urethral sphincter (EUS)contraction evoked by a magnetic stimulation at different time intervals. Seven healthy male volunteers underwent EUS pressure measurement. At baseline, magnetic stimulation of the lumbosacral spinal cord above the motor threshold was performed and evoked EUS pressure responses were recorded. The lumbosacral magnetic stimulation was repeated with same intensity, while a selective electrical dorsal penile nerve stimulation below the bulbocavernosus reflex (BCR) threshold was preceding at five different intervals (10, 20, 30, 50, 100 msec). The protocol was performed with empty and full bladder (BLA), and baseline responses were statistically compared to those with combined stimulation. When the dorsal penile nerve electrical stimulation preceded the lumbosacral magnetic stimulation by 20 msec (P=0.0048), 50 msec (P=0.0039), or 100 msec (P=0.0002), the amplitudes of the EUS pressure response with empty BLA were significantly reduced compared to lumbosacral magnetic stimulation alone. With a filled BLA, the amplitudes of the EUS were significantly reduced only at an interval of 50 msec (Pstimulation seems to have the capacity to inhibit the external urethral sphincter contraction induced by a magnetic stimulation. The inhibitory effect seems to depend on the latency between the peripheral and lumbosacral stimulation as well as on the degree of BLA filling. It remains to be proved if the neuromodulative effect of the conditional stimulus occurs at a spinal or supraspinal level. Copyright (c) 2005 Wiley-Liss, Inc.

  14. Etiology and STI/HIV coinfections among patients with urethral and vaginal discharge syndromes in South Africa. (United States)

    Mhlongo, Sakhile; Magooa, Precious; Müller, Etienne E; Nel, Noel; Radebe, Frans; Wasserman, Elizabeth; Lewis, David A


    This study was undertaken to establish the etiology of the male urethral discharge (MUDS) and vaginal discharge (VDS) syndromes, to determine the prevalence of other sexually transmitted infections (STI) and human immunodeficiency virus (HIV) coinfections, and to examine associations between STIs and HIV serostatus among STI patients in South Africa. A total of 507 MUDS and 300 VDS patients were recruited in Cape Town (CPT) and Johannesburg (JHB). A multiplex polymerase chain reaction assay detected Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and Mycoplasma genitalium infections. Bacterial vaginosis and candidiasis were detected by microscopy. Sera were screened for syphilis, HSV-2, and HIV antibodies. Etiological diagnoses were made for 92% of MUDS patients and 85% of VDS patients. Gonorrhoea accounted for 85% (CPT) and 71% (JHB) of MUDS presentations. Chlamydia was the second most frequently detected MUDS pathogen (CPT, 13%; JHB, 24%). Among VDS patients, bacterial vaginosis was the most common cause (CPT, 46%; JHB, 36%) and trichomoniasis the most frequently detected STI pathogen (CPT, 19%; JHB, 34%). Few patients (4%) had serological evidence of syphilis. The HSV-2 and HIV seroprevalence were higher in Johannesburg compared to Cape Town and among women compared to men. HIV infection was statistically significantly associated with HSV-2 seropositivity at both sites and with the presence of N. gonorrhoeae and absence of C. trachomatis in Cape Town MUDS patients. Gonorrhoea and bacterial vaginosis were confirmed as the most frequent causes of MUDS and VDS. The high HIV seroprevalence in STI patients emphasizes the need to address HIV testing among this population.

  15. Long-term bladder dysfunction and renal function in boys with posterior urethral valves based on urodynamic findings

    NARCIS (Netherlands)

    Ghanem, MA; Wolffenbuttel, KP; De Vylder, A; Nijman, RJ

    Purpose: Posterior urethral valves are the most common cause of congenital obstructive uropathy leading to renal failure in childhood. We investigate the influence of bladder dysfunction on renal function impairment. Materials and Methods: We retrospectively reviewed the records of 116 patients with

  16. A rare case of male pelvic squamous cell carcinoma of unknown primary origin presenting as perineal abscess and urethral stenosis

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    Massimiliano Creta


    Full Text Available Carcinomas of unknown primary origin (CUP represent a diagnostic and therapeutic challenge. Squamous cell CUP located in the male pelvis are very rare. We describe a case of a locally advanced squamous cell CUP occurring in the male pelvis presenting as perineal abscess and urethral stenosis and diagnosed by means of transperineal needle biopsy.

  17. Avoidable iatrogenic complications of urethral catheterization and inadequate intern training in a tertiary-care teaching hospital.

    LENUS (Irish Health Repository)

    Thomas, Arun Z


    To examine the magnitude of potentially avoidable iatrogenic complications of male urethral catheterization (UC) within a tertiary-care supra-regional teaching hospital, and to evaluate risk factors and subjective feeling of interns in our institution on the adequacy of training on UC.

  18. Urethral pressure reflectometry, a novel technique for simultaneous recording of pressure and cross-sectional area in the prostatic urethra

    DEFF Research Database (Denmark)

    Aagaard, Mikael; Klarskov, Niels; Sønksen, Jens


    OBJECTIVE: Urethral pressure reflectometry (UPR) was introduced in 2005, for simultaneous measurement of pressure and cross-sectional area in the female urethra. It has shown to be more reproducible than conventional pressure measurement. Recently, it has been tested in the anal canal...

  19. Short- and long-term transfer of urethral catheterization skills from simulation training to performance on patients

    DEFF Research Database (Denmark)

    Todsen, Tobias; Henriksen, Mikael V; Kromann, Charles B


    Inexperienced interns are responsible for most iatrogenic complications after urethral catheterization (UC). Although training on simulators is common, little is known about the transfer of learned skills to real clinical practice. This study aimed to evaluate the short- and long-term effects of UC...

  20. Clinical Efficacy of a Single Two Gram Dose of Azithromycin Extended Release for Male Patients with Urethritis

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    Satoshi Takahashi


    Full Text Available To clarify the clinical efficacy of a single oral 2 g dose of azithromycin extended-release for heterosexual male patients with urethritis, and the current antimicrobial sensitivity of Neisseria gonorrhoeae to azithromycin, a prospective clinical trial was conducted from 2011–2013. In patients with gonococcal urethritis, the eradication rate was 90.9% (30 of 33. The susceptibility rates of isolated Neisseria gonorrhoeae strains to ceftriaxone, spectinomycin, cefixime and azithromycin were 100%, 100%, 95.3% (41/43 and 37.2% (16/43, respectively. In the patients with nongonococcal urethritis, the eradication rate was 90.0% (45 of 50. The microbiological eradication rates for the pathogens were 90.9% (30/33 for Neisseria gonorrhoeae, 91.5% (43/47 for Chlamydia trachomatis, 71.4% (5/7 for Mycoplasma genitalium, and 100% (13/13 for Ureaplasma urealyticum. The main adverse event was diarrhea and its manifestation rate was 35.2% (32 of 120. The symptom of diarrhea was mostly temporary and resolved spontaneously. The conclusion was that the treatment regimen with a single oral 2 g dose of azithromycin extended-release would be effective for patients with urethritis. However, the antimicrobial susceptibilities of Neisseria gonorrhoeae and Mycoplasma genitalium should be carefully monitored because of possible treatment failure.

  1. Transobturator vaginal tape inside out for treatment of urethral sphincter mechanism incompetence: preliminary results in 7 female dogs. (United States)

    Claeys, Stéphanie; de Leval, Jean; Hamaide, Annick


    To evaluate the clinical efficacy of the transobturator vaginal tape inside-out (TVT-O) in incontinent female dogs affected with urethral sphincter mechanism incompetence (USMI) and to determine its urodynamic and morphologic effects. Case series. Incontinent spayed female dogs (n=7). TVT-O tape was inserted in 7 incontinent female dogs diagnosed with USMI. Urethral pressure profilometry (UPP) and vaginourethrograms were performed preoperatively, and 1 and 3 months postoperatively. Clinical efficacy of the technique was evaluated and complications reported. Follow-up information was evaluated by a telephone questionnaire. All dogs were continent immediately after the procedure. Incontinence recurred 2 months after surgery in 1 dog and was treated by phenylpropanolamine administration. At mean follow-up time of 11.3 months, 6 of 7 dogs were continent. An iatrogenic urethral tear occurred intraoperatively in 1 dog. No postoperative complications were encountered. The postoperative UPPs showed significantly increased maximal urethral closure pressure and integrated pressure. Postoperative vaginourethrograms were unremarkable. The surgical procedure did not modify the location of the urinary bladder neck in dogs with a "pelvic urinary bladder" preoperatively. TVT-O was efficient in maintaining short term continence in 6 of 7 dogs affected with USMI. © Copyright 2010 by The American College of Veterinary Surgeons.

  2. Injectable biomaterials for the treatment of stress urinary incontinence: their potential and pitfalls as urethral bulking agents.

    LENUS (Irish Health Repository)

    Davis, Niall F


    Injectable urethral bulking agents composed of synthetic and biological biomaterials are minimally invasive treatment options for stress urinary incontinence (SUI). The development of an ideal urethral bulking agent remains challenging because of clinical concerns over biocompatibility and durability. Herein, the mechanical and biological features of injectable urethral biomaterials are investigated, with particular emphasis on their future potential as primary and secondary treatment options for SUI. A literature search for English language publications using the two online databases was performed. Keywords included "stress urinary incontinence", "urethral bulking agent" and "injectable biomaterial". A total of 98 articles were analysed, of which 45 were suitable for review based on clinical relevance and importance of content. Injectable biomaterials are associated with a lower cure rate and fewer postoperative complications than open surgery for SUI. They are frequently reserved as secondary treatment options for patients unwilling or medically unfit to undergo surgery. Glutaraldehyde cross-linked bovine collagen remains the most commonly injected biomaterial and has a cure rate of up to 53 %. Important clinical features of an injectable biomaterial are durability, biocompatibility and ease of administration, but achieving these requirements is challenging. In carefully selected patients, injectable biomaterials are feasible alternatives to open surgical procedures as primary and secondary treatment options for SUI. In future, higher cure rates may be feasible as researchers investigate alternative biomaterials and more targeted injection techniques for treating SUI.

  3. Fundamentals and clinical perspective of urethral sphincter instability as a contributing factor in patients with lower urinary tract dysfunction—ICI‐RS 2014 (United States)

    Anding, Ralf; Rosier, Peter; Birder, Lori; Andersson, Karl Erik; Djurhuus, Jens Christian


    Aims Urethral pathophysiology is often neglected in discussions of bladder dysfunction. It has been debated whether “urethral sphincter instability,” referred to based on observed “urethral pressure variations,” is an important aspect of overactive bladder syndrome (OAB). The purpose of this report is to summarize current urethral pathophysiology evidence and outline directions for future research based on a literature review and discussions during the ICI‐RS meeting in Bristol in 2014. Methods Urethral pathophysiology with a focus on urethral pressure variation (UPV) was presented and discussed in a multidisciplinary think tank session at the ICI_R meeting in Bristol 2014. This think tank session was based on collaboration between physicians and basic science researchers. Results Experimental animal studies or studies performed in clinical series (predominantly symptomatic women) provided insights into UPV, but the findings were inconsistent and incomplete. However, UPV is certainly associated with lower urinary tract symptoms (likely OAB), and thus, future research on this topic is relevant. Conclusions Future research based on adequately defined clinical (and urodynamic) parameters with precisely defined patient groups might shed better light on the cause of OAB symptoms. Further fundamental investigation of urethral epithelial–neural interactions via the release of mediators should enhance our knowledge and improve the management of patients with OAB. Neurourol. Urodynam. 35:318–323, 2016. © 2016 The Authors. Neurourology and Urodynamics published by Wiley Periodicals, Inc. PMID:26872575

  4. Can bipolar vaporization be considered an alternative energy source in the endoscopic treatment of urethral strictures and bladder neck contracture?

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    Erem K. Basok


    Full Text Available OBJECTIVE: We evaluated the outcome of bipolar energy by using PlasmaKinetic™ cystoscope instruments in the treatment of urethral stricture and bladder neck contracture. MATERIALS AND METHODS: Twenty-two male patients with urethral stricture and five with bladder neck contracture were treated by endoscopic bipolar vaporization. The most common etiology for stricture formation was iatrogenic (85.2% and the mean stricture length was 12.2 mm. All patients were evaluated with urethrography and uroflowmetry one month and 3 months after surgery. Urethroscopy was routinely performed at the end of the first year. Preoperative mean maximum flow rate (Q max was 4.9 mL/s for urethral stricture and mean Q max was 3.4 mL/s for bladder neck contracture. The results were considered as "successful” in patients where re-stenosis was not identified with both urethrography and urethroscopy. Minimum follow-up was 13.8 months (range 12 to 20. RESULTS: Tissue removal was rapid, bleeding was negligible and excellent visualization was maintained throughout the vaporization of the fibrotic tissue. Postoperative mean Q max was 14.9 mL/s and the success rate was 77.3% for urethral stricture at mean follow-up time of 14.2 months. The success rate was 60% with a mean follow-up time of 12.2 months for bladder neck contracture and the mean Q max was 16.2 mL/s, postoperatively. CONCLUSIONS: The study suggests that bipolar vaporization is a safe, inexpensive and reliable procedure with good results, minimal surgical morbidity, negligible blood loss, and thus, it could be considered as a new therapeutic option for the endoscopic treatment of urethral stricture and bladder neck contracture.

  5. Causative Role of Ureaplasma Urealyticum and other Sexually Transmitted Infections in the Urethral Meatus Polyp Development in Women

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    Tatyana S. Taranina


    Full Text Available The objective of this study was the investigation of the influence of ureaplasmal infection on the development of urethral meatus polyps in women. The article presents the results of the examination of women with chronic cystitis and urethritis over a 0.5- to 5-year duration, complicated by the presence of urethral meatus polyps and associated with concomitant Ureaplasma urealyticum and other sexually transmitted infections (STI. This was based on the culture analysis of the cervical and urethral content, and PCR-diagnostics of STI, as well as a complex pathomorphologic study of the resected polyps, including electron microscopy. In this study, 98 women between 45 and 60 years (52.5±4.9 years were examined, who had undergone radiowave resection of the polyps: 52 women were infected by STI, including Ureaplasma urealyticum, Mycoplasma genitalium, Mycoplasma hominis, Chlamydia trachomatis and Trichomonas vaginalis, while the remaining 46 women had been diagnosed as not having STI. According to the culture results in the women with STI, U. urealyticum was identified as a monoinfection in 69% of cases, while in the remaining 31% of cases it was evident in the form of mixed infections, mainly in association with Mycoplasma hominis (17.5% and Trichomonas vaginalis (13.5%. Pathomorphological examination of the urethral meatus polyps of the women with U. urealyticum and other STI demonstrated the proliferative character of the remodeling of the surface epithelium with hyperplasia, acanthosis, and keratinization of the stratified squamous epithelium and synchronous changes in the underlying connective tissue - impaired microcirculation and the diffuse inflammatory cell infiltrates with transepithelial leukopedesis. Using electron microscopy in the fibroblasts and plasma cells of the resected polyps the markers of U. urealyticum were detected in patients with negative results of the bacteriological diagnostic methods.

  6. Notes from the Field: Increase in Neisseria meningitidis-Associated Urethritis Among Men at Two Sentinel Clinics - Columbus, Ohio, and Oakland County, Michigan, 2015. (United States)

    Bazan, Jose A; Peterson, Amy S; Kirkcaldy, Robert D; Briere, Elizabeth C; Maierhofer, Courtney; Turner, Abigail Norris; Licon, Denisse B; Parker, Nicole; Dennison, Amanda; Ervin, Melissa; Johnson, Laura; Weberman, Barbara; Hackert, Pamela; Wang, Xin; Kretz, Cecilia B; Abrams, A Jeanine; Trees, David L; Del Rio, Carlos; Stephens, David S; Tzeng, Yih-Ling; DiOrio, Mary; Roberts, Mysheika Williams


    Neisseria meningitidis (Nm) urogenital infections, although less common than infections caused by Neisseria gonorrhoeae (Ng), have been associated with urethritis, cervicitis, proctitis, and pelvic inflammatory disease. Nm can appear similar to Ng on Gram stain analysis (gram-negative intracellular diplococci) (1-5). Because Nm colonizes the nasopharynx, men who receive oral sex (fellatio) can acquire urethral Nm infections (1,3,5). This report describes an increase in Nm-associated urethritis in men attending sexual health clinics in Columbus, Ohio, and Oakland County, Michigan.

  7. Posterior urethral valves: Morphological normalization of posterior urethra after fulguration is a significant factor in prognosis

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    Menon Prema


    Full Text Available Aim: To assess the changes in urethral morphology 3 months post fulguration of posterior urethral valves (PUVs on micturating cystourethrogram (MCUG and correlate these changes with the overall clinical status of the patient. Materials and Methods: A total of 217 children, managed for PUVs during a period of 6 years in a single surgical unit were prospectively studied. The ratio of the diameters of the prostatic and bulbar urethras (PU/BU was calculated on the pre- and post-fulguration MCUG films. They were categorized into three groups based on the degree of normalization of posterior urethra (post-fulguration PU/BU ratio. Results: Group A: Of the 133 patients, 131 had normal urinary stream and 4 (3% had nocturnal enuresis. Vesicoureteral reflux (VUR, initially seen in 83 units (31% units, regressed completely at a mean duration of 6 months in 41 units (49%. Of the 152 non-VUR, hydroureteronephrosis (HUN units, 11 were poorly functioning kidneys. Persistent slow but unobstructed drainage was seen in 23 units (16% over a period of 1.5-5 years (mean 2.5 years. Group B: All the 11 patients had a normal stream. Four (36.4% had daytime frequency for a mean duration of 1 year and one (9% had nocturnal enuresis for 1 year. Grade IV-V VUR was seen in five patients (three bilateral, which regressed completely by 3 months in five units (62.5%. In the non-VUR, HUN patients, slow (but unobstructed drainage was persistent in two units (14% at 3 years. Group C: Of the 16 patients, only 5 (31.3% were asymptomatic. Six patients (nine units had persistent VUR for 6 months to 3 years. Of the 20 units with HUN, 17 (85% were persistent at 1-4 years (mean 2 years. Eight patients (50% required a second fulguration while 3 (18.7% required urethral dilatation for stricture following which all parameters improved. Conclusions: Adequacy of fulguration should be assessed by a properly performed MCUG. A postop PU/BU ratio >3 SD (1.92 should alert to an incomplete

  8. Correlation of gross urine color with diagnostic findings in male cats with naturally occurring urethral obstruction. (United States)

    Brabson, Tamera L; Bloch, Christopher P; Johnson, Justine A


    Seventy-five male cats with urethral obstruction were prospectively enrolled to evaluate gross urine color at urinary catheter placement for correlation with diagnostic findings. Cats with darker red urine were more likely to be azotemic (serum creatinine concentration >2.0 mg/dl [177 µmol/l]), and urine color correlated well with serum creatinine and serum potassium concentrations. Darker urine color was negatively correlated with urine specific gravity. Urine color was not associated with the presence or absence of lower urinary tract stones on radiographs or ultrasound. Cats with darker red urine at the time of urinary catheter placement are likely to have more significant metabolic derangements and may require more aggressive supportive care. © ISFM and AAFP 2014.

  9. Effect of posture on bladder and urethral function in normal pregnancy. A preliminary report. (United States)

    Clow, W M


    25 pregnant women, 15 of whom developed stress incontinence in pregnancy, have been investigated by cystometry and urethrometry in both erect and supine posture. The resting bladder pressure rises throughout pregnancy in both erect and supine positions. Those who are not incontinent have normal bladder and urethral function. Incontinent patients show no residual urine, normal bladder capacity, and either detrusor instability and/or sphincter weakness. The stress of change of posture makes both bladder dysfunction and sphincter weakness more evident. Although the results of this investigation are not yet complete, there is a suggestion that detrusor instability may be produced by pregnancy in some patients and that in some instances recovery to normal bladder function occurs after delivery. It is postulated that these patients may be the ones who, in later life, develop stress incontinence due to bladder dysfunction.

  10. Prospective, Randomized, Multinational Study of Prostatic Urethral Lift Versus Transurethral Resection of the Prostate

    DEFF Research Database (Denmark)

    Sønksen, Jens; Barber, Neil J; Speakman, Mark J


    BACKGROUND: Transurethral resection of the prostate (TURP) is considered the gold standard for male lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). However, TURP may lead to sexual dysfunction and incontinence, and has a long recovery period. Prostatic urethral...... lift (PUL) is a treatment option that may overcome these limitations. OBJECTIVE: To compare PUL to TURP with regard to LUTS improvement, recovery, worsening of erectile and ejaculatory function, continence and safety (BPH6). DESIGN, SETTING, AND PARTICIPANTS: Prospective, randomized, controlled trial...... at 10 European centers involving 80 men with BPH LUTS. INTERVENTION: PUL or TURP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The BPH6 responder endpoint assesses symptom relief, quality of recovery, erectile function preservation, ejaculatory function preservation, continence preservation...


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    Full Text Available INTRODUCTION: Mid Urethral Slings is the main stay of therapy in the management of stress urinary incontinence in the female, w e evaluated the effect of TVT on sexual function in women who are from the rural backward districts of Rayalaseema districts of Andhra Pradesh. MATERIALS & METHODS: 30 Women with a mean age of 44 yrs with SUI were evaluated before TVT procedure and then every 3months for 1yr for sexual health using NSF - 9 questionnaire . RESULTS: The sexual function in all the domains including desire, frequency ar ousal , orgasm remained the same as before surgery in more than 80% pts. The satisfaction rate was better in pts who were leaking during sex before surgery in six out of ten patients. CONCLUSIONS: TVT surgery does not have any significant impact on sexual function Sexual function is not an important issue for the female beyond the age of 40 yrs in the perimenopau s e/ post menopause period

  12. Impact of castration with or without alpha-tocopherol supplementation on the urethral sphincter of rats. (United States)

    Kracochansky, Mirian; Reis, Leonardo Oliveira; Lorenzetti, Fabio; Ortiz, Valdemar; Dambros, Miriam


    To analyze the impact of low levels of testosterone induced by orchiectomy and the effect of alpha-tocopherol supplementation on oxidative stress in the urethral sphincter. Forty male Wistar rats weighing 250-300 g were divided into four groups with 10 each: Sham group; Orchiectomy group: bilateral orchiectomy; Orchiectomy-pre-Tocopherol group: bilateral orchiectomy preceded by alpha-tocopherol supplementation for four weeks; Orchiectomy-full-Tocopherol group: bilateral orchiectomy with alpha-tocopherol supplementation for four weeks preceding the procedure and for eight weeks afterwards. At the protocol end, animals were euthanized and had the sphincter analyzed stereologically focusing on collagen and muscle fibers percentage. Oxidative stress levels were determined using 8-epi-PGF2. The 8-epi-PGF2 levels were statistically higher (p Alpha-tocopherol had a protective effect and its supplementation for twelve weeks provided the greatest protection.

  13. [Two Cases of Urethral Clear Cell Adenocarcinoma with Suspected Recurrence of Uterine Cancer]. (United States)

    Okuno, Masato; Kusuda, Yuji; Taguchi, Isao; Kawabata, Gaku


    Herein, we report two cases of urethral clear cell carcinoma in two patients who had previously undergone radical hysterectomyfor utetine cancer. Case 1 presented with bloodyvaginal discharge and case 2 presented with acute urinaryretention. Magnetic resonance imaging revealed a periurethral tumor in both cases. Both cases were suspected to be recurrence at first. However, pathological findings of the transurethral resection-biopsyshowed clear cell adenocarcinoma in both cases. Subsequentlyradical cystourethrectomy and pelvic lymphadenectomy were performed in both cases. Surgical findings showed tumor invasion of the vaginal muscularis in case 1 and invasion of the anterior wall of the vagina and bladder neck in case 2. Although adjuvant postoperative therapywas not performed, there has been no evidence of recurrence to date.

  14. Three year results of the prostatic urethral L.I.F.T. study. (United States)

    Roehrborn, Claus G; Rukstalis, Daniel B; Barkin, Jack; Gange, Steven N; Shore, Neal D; Giddens, Jonathan L; Bolton, Damien M; Cowan, Barrett E; Cantwell, Anthony L; McVary, Kevin T; Te, Alexis E; Gholami, Shahram S; Moseley, William G; Chin, Peter T; Dowling, William T; Freedman, Sheldon J; Incze, Peter F; Coffield, K Scott; Borges, Fernando D; Rashid, Prem


    To report the three year results of a multi-center, randomized, patient and outcome assessor blinded trial of the Prostatic Urethral Lift (PUL) in men with bothersome lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). At 19 centers in North America and Australia, 206 subjects = 50 years old with International Prostate Symptom Score (IPSS) ≥ 13, peak flow rate (Qmax) ≤ 12 mL/s, and prostate volume between 30 cc-80 cc were randomized 2:1 to the PUL procedure or sham control. PUL involved placing permanent UroLift implants into the lateral lobes of the prostate to enlarge the urethral lumen. After randomized comparison at 3 months, PUL patients were followed to 3 years. LUTS severity (IPSS), quality of life, Qmax, sexual function, and adverse events were assessed throughout follow up. The therapeutic effect of PUL regarding IPSS was 88% greater than sham at 3 months. Average improvements from baseline through 3 years were significant for total IPSS (41.1%), quality of life (48.8%), Qmax (53.1%), and individual IPSS symptoms. Symptomatic improvement was independent of prostate size. There were no de novo, sustained ejaculatory or erectile dysfunction events and all sexual function assessments showed average stability or improvement after PUL. Fifteen of the 140 patients originally randomized to PUL required surgical reintervention for treatment failure within the first 3 years. PUL offers rapid improvement in voiding and storage symptoms, quality of life and flow rate that is durable to 3 years. Patients demonstrated a level of symptom relief that is associated with significant patient satisfaction. PUL, a minimally invasive procedure, is very effective in treating bothersome LUTS secondary to benign prostatic obstruction (BPO) and is unique in its ability to preserve total sexual function while offering a rapid return to normal physical activities.

  15. Compliance With Guideline Statements for Urethral Catheterization in an Iranian Teaching Hospital

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    Negar Taleschian-Tabrizi


    Full Text Available Background It is believed that healthcare staff play an important role in minimizing complications related to urethral catheterization. The purpose of this study was to determine whether or not healthcare staff complied with the standards for urethral catheterization. Methods This study was conducted in Imam Reza teaching hospital, Tabriz, Iran, from July to September 2013. A total of 109 catheterized patients were selected randomly from surgical and medical wards and intensive care units (ICUs. A questionnaire was completed by healthcare staff for each patient to assess quality of care provided for catheter insertion, while catheter in situ, draining and changing catheter bags. Items of the questionnaire were obtained from guidelines for the prevention of infection. Data analysis was performed with SPSS 16. Results The mean age of the patients was 50.54 ± 22.13. Of the 109 patients, 56.88% were admitted to ICUs. The mean duration of catheter use was 15.86 days. Among the 25 patients who had a urinalysis test documented in their hospital records, 11 were positive for urinary tract infection (UTI. The lowest rate of hand-washing was reported before bag drainage (49.52%. The closed drainage catheter system was not available at all. Among the cases who had a daily genital area cleansing, in 27.63% cases, the patients or their family members performed the washing. In 66.35% of cases, multiple-use lubricant gel was applied; single-use gel was not available. The rate of documentation for bag change was 79%. Conclusion The majority of the guideline statements was adhered to; however, some essential issues, such as hand hygiene were neglected. And some patients were catheterized routinely without proper indication. Limiting catheter use to mandatory situations and encouraging compliance with guidelines are recommended.

  16. Biomechanical study on the bladder neck and urethral positions: simulation of impairment of the pelvic ligaments. (United States)

    Brandão, Sofia; Parente, Marco; Mascarenhas, Teresa; da Silva, Ana Rita Gomes; Ramos, Isabel; Jorge, Renato Natal


    Excessive mobility of the bladder neck and urethra are common features in stress urinary incontinence. We aimed at assessing, through computational modelling, the bladder neck position taking into account progressive impairment of the pelvic ligaments. Magnetic resonance images of a young healthy female were used to build a computational model of the pelvic cavity. Appropriate material properties and constitutive models were defined. The impairment of the ligaments was simulated by mimicking a reduction in their stiffness. For healthy ligaments, valsalva maneuver led to an increase in the α angle (between the bladder neck-symphysis pubis and the main of the symphysis) from 91.8° (at rest) to 105.7°, and 5.7 mm of bladder neck dislocation, which was similar to dynamic imaging of the same woman (α angle from 80° to 103.3°, and 5mm of bladder neck movement). For 95% impairment, they enlarged to 124.28° and 12 mm. Impairment to the pubourethral ligaments had higher effect than that of vaginal support (115° vs. 108°, and 9.1 vs. 7.3mm). Numerical simulation could predict urethral motion during valsalva maneuver, for both healthy and impaired ligaments. Results were similar to those of continent women and women with stress urinary incontinence published in the literature. Biomechanical analysis of the pubourethral ligaments complements the biomechanical study of the pelvic cavity in urinary incontinence. It may be useful in young women presenting stress urinary incontinence without imaging evidence of urethral and muscle lesions or organ descend during valsalva, and for whom fascial damage are not expected. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. A new material to prevent urethral damage after implantation of artificial devices: an experimental study

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    Salvador Vilar Correia Lima

    Full Text Available ABSTRACT Objective To validate the application of the bacterial cellulose (BC membrane as a protecting barrier to the urethra. Materials and Methods Forty female Wistar rats (four groups of 10: Group 1 (sham, the urethra was dissected as in previous groups and nothing applied around; Group 2, received a 0.7cm strip of the BC applied around the urethra just below the bladder neck; Group 3, received a silicon strip with the same dimensions as in group 2; Group 4, had a combination of 2 and 3 groups being the silicon strip applied over the cellulosic material. Half of the animals in each group were killed at 4 and 8 months. Bladder and urethra were fixed in formalin for histological analysis. Results Inflammatory infiltrates were more intense at 4 months at lymphonodes (80% Grade 2, statistically different in the group 2 compared with groups 1 (p=0.0044 and 3 (p=0.0154. At 8 months, all samples were classified as grade 1 indicating a less intense inflammatory reaction in all groups. In group 2, at 8 months, there was a reduction in epithelial thickness (30±1μm when com-pared to groups 1 (p=0.0001 and 3 (p<0.0001. Angiogenesis was present in groups 2 and 4 and absent in group 3. In BC implant, at 4 and 8 months, it was significant when comparing groups 4 with 1 (p=0.0159. Conclusion BC membrane was well integrated to the urethral wall promoting tissue remodeling and strengthening based on morphometric and histological results and may be a future option to prevent urethral damage.

  18. Modified one-stage dorsal-inlay buccal mucosa graft technique for ventral penile urethral and penile skin erosion: A step-by-step guide


    Van Putte, Lennert; De Win, Gunter


    Objective To demonstrate the use of a modified single-stage technique for the repair of a ventral penile urethral erosion with involvement of the penile skin, as penile urethral erosion is a rare but potential complication of chronic indwelling catheterisation with a lack of available recommendations for reconstructive options. Patient and methods A 44-year-old male with paraplegia, neurogenic bladder dysfunction and chronic sacral decubitus, presented with a large mid-penile erosion of the v...

  19. AB037. Role of nocturnal penile erection test on response to daily sildenafil in patients with erectile dysfunction due to pelvic fracture urethral disruption


    Lin, Jian; Peng, Jing; Zhang, Zhichao; Cui, Wanshou; Yuan, Yiming; Gao, Bing; Song, Weidong; Tang, Yan; Xin, Zhongcheng


    Objective To evaluate the results of nocturnal penile erection test and response to daily sildenafil in patients with erectile dysfunction (ED) due to pelvic fracture urethral disruption. Methods In the past three years, we included 38 patients with ED due to pelvic fracture urethral disruption. The mean age was 33.1 years (range, 22-49 years). All were evaluated subjectively and objectively by the International Index of Erectile Function-5, nocturnal penile tumescence and rigidity (NPTR) tes...

  20. IGF-1 as an Important Endogenous Growth Factor for Recovery from Impaired Urethral Continence Function in Rats with Simulated Childbirth Injury. (United States)

    Sumino, Yasuhiro; Yoshikawa, Satoru; Mori, Ken-Ichi; Mimata, Hiromitsu; Yoshimura, Naoki


    We examined the functional role of endogenous IGF-1 (insulin-like growth factor-1) in the recovery phase of stress urinary incontinence induced by simulated childbirth trauma using an IGF-1 receptor inhibitor. Simulated birth trauma was induced by vaginal distension in female Sprague Dawley® rats. The IGF-1 receptor antagonist JB-1 (10 and 100 μg/kg per day) or vehicle was continuously delivered from 1 day before vaginal distension for 7 days using subcutaneous osmotic pumps. Seven, 14 and 21 days after vaginal distension the effect of JB-1 treatment was examined by functional analyses, including leak point and urethral baseline pressure, and urethral responses during passive increments in intravesical pressure, as well as molecular analyses in urethral tissues, including phosphorylation of Akt, apoptotic changes and peripheral nerve density using Western blot and immunohistochemistry. On functional analyses vehicle treated rats with vaginal distension had significantly decreased leak point and urethral baseline pressure, and urethral responses at 7 days, which recovered to the normal level 14 and 21 days after vaginal distension. In the JB-1 treated vaginal distension group leak point and urethral baseline pressure, and urethral responses were still significantly reduced 21 days after vaginal distension. On molecular analyses JB-1 treatment increased apoptotic cells, induced a significant decrease in phosphorylated Akt and prolonged the decrease of peripheral nerve density in urethral tissues. Suppression of endogenous IGF-1 activity delayed recovery from stress urinary incontinence induced by simulated childbirth trauma in rats. Thus, IGF-1 is likely to be an important endogenous mediator for functional recovery from childbirth related stress urinary incontinence. This suggests that IGF-1 could be an effective target for treating stress urinary incontinence in women. Copyright © 2016 American Urological Association Education and Research, Inc. Published by

  1. Impacted anterior urethral calculus complicated by a stone-containing diverticulum in an elderly man: outcome of transurethral lithotripsy without resection of the diverticulum. (United States)

    Zhou, Tie; Chen, Guanghua; Zhang, Wei; Peng, Yonghan; Xiao, Liang; Xu, Chuangliang; Sun, Yinghao


    The prevalence of lower urinary tract symptoms (LUTS) is about 20% in men aged 40 or above. Other than benign prostatic hyperplasia (BPH), urethral diverticulum or calculus is not uncommon for LUTS in men. Surgical treatment is often recommended for urethral diverticulum or calculus, but treatment for an impacted urethral calculus complicated by a stone-containing diverticulum is challenging. An 82-year-old man had the persistence of LUTS despite having undergone transurethral resection of prostate for BPH. Regardless of treatment with broad spectrum antibiotics and an α-blocker, LUTS and post-void residual urine volume (100 mL) did not improve although repeated urinalysis showed reduction of WBCs from 100 to 10 per high power field. Further radiology revealed multiple urethral calculi and the stone configuration suggested the existence of a diverticulum. He was successfully treated without resecting the urethral diverticulum; and a new generation of ultrasound lithotripsy (EMS, Nyon, Switzerland) through a 22F offset rigid Storz nephroscope (Karl Storz, Tuttingen, Germany) was used to fragment the stones. The operative time was 30 minutes and the stones were cleanly removed. The patient was discharged after 48 hours with no immediate complications and free of LUTS during a 2 years follow-up. When the diverticulum is the result of a dilatation behind a calculus, removal of the calculus is all that is necessary. Compared with open surgery, ultrasound lithotripsy is less invasive with little harm to urethral mucosa; and more efficient as it absorbs stone fragments while crushing stones.

  2. A comparison of surgical outcomes of perineal urethrostomy plus penile resection and perineal urethrostomy in twelve calves with perineal or prescrotal urethral dilatation

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    M.A. Marzok


    Full Text Available The clinical diagnosis, ultrasonographic findings, surgical management, outcome, and survival rate of perineal or prescrotal urethral dilatation in 12 male calves are described. All calves were crossbred and intact males. The most noticeable clinical presentations were perineal (n= 10 or prescrotal (n= 2 swellings and micturition problems. The main ultrasonographic findings were oval shaped dilatation of the urethra in all animals with dimensions of 40-75 X 30-62 mm. The calves with perineal urethral dilatation were treated by perineal urethrostomy (n= 4 and partial penile transection including the dilated urethra and urethral fistulation (n= 6. Prescrotal urethral dilatations were treated by penile transection proximal to the dilatation site (n= 2. Cystitis and stricture of the urethra were recorded postoperatively for two of the calves that underwent perineal urethrostomy. Nine animals were slaughtered at normal body weight approximately 6-8 months after the surgical treatment. Three animals were slaughtered after approximately three to four months, two of them having gained insufficient body weight. Our study shows that ultrasonography is a useful tool for the diagnosis of urethral dilatation in bovine calves. Our study also shows that the partial penile transection may be a suitable and satisfactory choice of surgical treatment for correcting the urethral dilatation in bovine calves.

  3. Evaluation of crural release and ischial osteotomy for relief of tension in the repair of large segmental urethral defects in male cats. (United States)

    Zemer, Orly; Benzioni, Hadas; Kaplan, Rotem; Zineman, Shelly; Kelmer, Efrat; Shipov, Anna; Milgram, Joshua


    To examine if the tension at the site of a urethral anastomosis can be relieved by performing either a crural release technique or an ischial osteotomy technique. Cadaveric study and 2 case reports. Adult male cat cadavers (n = 18). Cats were divided into 2 groups; crural release (n = 9) and ischial osteotomy (n = 9). In each group, 20%, 25%, and 30% of the pelvic urethra was excised in 3 cats. The length of the urethral defect was measured after excision of the urethral segment, and after approximation, before and subsequent to the tension relieving technique performed. Two clinical cases are described. Both crural release and ischial osteotomy were effective in relieving the tension encountered at the urethral anastomosis after removal of 20% of the urethral length. In the ischial osteotomy group, apposition without tension after removing up to 30% of the intrapelvic urethral length was easily achieved. A similar technique was successfully used in 2 clinical cases. Crural release and ischial osteotomy techniques allow approximation and tension free anastomosis of large segmental defects of the pelvic urethra in cats. © Copyright 2013 by The American College of Veterinary Surgeons.

  4. Macrolide and quinolone-resistant Mycoplasma genitalium in a man with persistent urethritis: the tip of the British iceberg? (United States)

    Soni, Suneeta; Parkhouse, Andy; Dean, Gillian


    There is growing concern worldwide for macrolide resistance in M. genitalium following liberal use of 1 g azithromycin to treat non-gonococcal urethritis and confirmed C. trachomatis infection. Moxifloxacin is the second-line treatment for M. genitalium and still has excellent efficacy against it. However, recent reports indicating that quinolone resistance is more prevalent than previously thought are worrying. Routine testing of symptomatic men and women for M. genitalium is not currently recommended in BASHH guidelines, and attempts to implement such testing have been hampered by a lack of commercially available assays. We present a case of M. genitalium urethritis which failed to respond to four different antibiotic regimens, resulting in multiple visits to the clinic and anxiety for the patient. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  5. A Case of Urethral Metastasis from Sigmoid Colon Cancer Diagnostically and Prognostically Indicated by F 18 FDG PET/CT

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    Seo, Han Seok; Kim, Eun Sil; Kim, Soyon; Im, Su Jin; Park, Yong Hyun; Lee, Ju Hyoung; Hur, So Chong [National Police Hospital, Seoul (Korea, Republic of)


    Urethral metastasis from colorectal cancer is rare and is known to have a poor prognosis. A 72 year old man with a history of colectomy and colostomy due to sigmoid colon cancer was admitted to the emergency room with bowel distension, rectal bleeding and urinary symptoms. Computed tomography of the abdominopelvis showed sigmoid colon cancer with multiple metastases involving the liver. Positron emission tomography with F 18 fluorodeoxyglucose (FDG) showed multiple hypermetabolic foci in the liver, penis and pubic bone, which otherwise could not be diagnosed. The lesions revealed no improvement with chemotherapy and urological surgery on follow up F 18 FDG PET/CT. We present a case of urethral metastasis of sigmoid colon cancer diagnostically and prognostically indicated by F 18 FDG PET/CT.

  6. Penile fracture: A rare case of simultaneous rupture of the one corpus cavernosum and complete urethral rupture

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    Nale Đorđe


    Full Text Available Introduction. Penile fracture is a traumatic rupture of tunica albuginea and the tumescent corpora cavernosa due to the nonphysiological bending of the penile shaft, presenting with or without rupture of corpus spongiosum and urethra. The incidence of concomitant injury of the urethra is 0-38%. Complete urethral rupture is rare, but it is almost always associated with bilateral corporeal injury. Case report. We presented a patient with complete urethral rupture, and rupture of the right cavernous body. According to the available literature, this case is extremely rare. Conclusion. Fracture of the penis is relatively uncommon and is considered a urologic emergency. Prompt surgical exploration and repair can preserve erectile and voiding function.

  7. Urethral versus suprapubic catheter: choosing the best bladder management for male spinal cord injury patients with indwelling catheters. (United States)

    Katsumi, H K; Kalisvaart, J F; Ronningen, L D; Hovey, R M


    Bladder management for male patients with spinal cord injury (SCI) challenges the urologist to work around physical and social restrictions set forth by each patient. The objective of this study was to compare the complications associated with urethral catheter (UC) versus suprapubic tube (SPT) in patients with SCI. A retrospective review of records at Long Beach Veterans Hospital was carried out to identify SCI patients managed with SPT or UC. Chart review identified morbidities including urinary tract infection (UTI), bladder stones, renal calculi, urethral complications, scrotal abscesses, epididymitis, gross hematuria and cancer. Serum creatinine measurements were evaluated to determine whether renal function was maintained. In all, 179 patients were identified. There was no significant difference between the two catheter groups in any areas in which they could be compared. There were catheter-specific complications specific to each group that could not be compared. These included erosion in the UC group and urethral leak, leakage from the SPT and SPT revision in the SPT group. Average serum creatinine for the UC and SPT groups was 0.74 and 0.67 mg per 100 ml, respectively. SCI patients with a chronic catheter have similar complication rates of UTIs, recurrent bladder/renal calculi and cancer. Urethral and scrotal complications may be higher with UC; however, morbidity from SPT-specific procedures may offset benefits from SPT. Serum creatinine was maintained in both groups. Overall, bladder management for patients with chronic indwelling catheters should be selected on the basis of long-term comfort for the patient and a physician mind-set that allows flexibility in managing these challenges.

  8. Comparison of TVT and TOT on urethral mobility and surgical outcomes in stress urinary incontinence with hypermobile urethra. (United States)

    Cavkaytar, Sabri; Kokanalı, Mahmut Kuntay; Guzel, Ali Irfan; Ozer, Irfan; Aksakal, Orhan Seyfi; Doganay, Melike


    To compare the change of urethral mobility after midurethral sling procedures in stress urinary incontinence with hypermobile urethra and assess these findings with surgical outcomes. 141 women who agreed to undergo midurethral sling operations due to stress urinary incontinence with hypermobile urethra were enrolled in this non-randomized prospective observational study. Preoperatively, urethral mobility was measured by Q tip test. All women were asked to complete Urogenital Distress Inventory Short Form (UDI-6) and Incontinence Impact Questionnaire Short Form (IIQ-7) to assess the quality of life. Six months postoperatively, Q tip test and quality of life assessment were repeated. The primary surgical outcomes were classified as cure, improvement and failure. Transient urinary obstruction, de novo urgency, voiding dysfunction were secondary surgical outcomes. Of 141 women, 50 (35. 5%) women underwent TOT, 91 (64.5%) underwent TVT. In both TOT and TVT groups, postoperative Q tip test values, IIQ-7 and UDI-6 scores were statistically reduced when compared with preoperative values. Postoperative Q tip test value in TVT group was significantly smaller than in TOT group [25°(15-45°) and 20° (15-45°), respectively]. When we compared the Q-tip test value, IIQ-7 and UDI-6 scores changes, there were no statistically significant changes between the groups. Postoperative urethral mobility was more frequent in TOT group than in TVT group (40% vs 23.1%, respectively). Postoperative primary and secondary outcomes were similar in both groups. Although midurethral slings decrease the urethtal hypermobility, postoperative mobility status of urethra does not effect surgical outcomes of midurethral slings in women with preoperative urethral hypermobility. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  9. Concentric needle electrodes are superior to perineal surface-patch electrodes for electromyographic documentation of urethral sphincter relaxation during voiding. (United States)

    Mahajan, Sangeeta T; Fitzgerald, Mary Pat; Kenton, Kimberly; Shott, Susan; Brubaker, Linda


    To compare interpretations of electromyographic (EMG) recordings from perineal surface patch electrodes (PSPEs) to those from urethral concentric needle electrodes (CNEs) during voiding. Consenting women underwent urodynamic testing with a 30 G, 3.8 cm CNE at the 12 o'clock position in the striated urethral sphincter muscle, and with PSPEs placed at the 2 and 10 o'clock positions around the anus. Pressure-flow studies were conducted with simultaneous input from both EMG electrodes. Representative, de-identified paper copies of EMG signals were assembled by chronology and electrode type. Six examiners unaware of the patient details were asked to determine if the tracings were interpretable and whether there was quiescence of the urethral sphincter motor unit during voiding. The agreement between the interpretations of each tracing was assessed using McNemar and kappa statistics. Twenty-two women undergoing urodynamic testing for incontinence (16), voiding dysfunction (two) or urinary retention (four) participated in this study. CNE tracings were consistently more interpretable than PSPE tracings (mean 89% vs 67%). When tracings were interpretable, a significantly higher percentage of CNE EMG tracings (mean 79%) had urethral sphincter motor unit quiescence than PSPE EMG tracings (mean 28%). The kappa values for agreement among the reviewers' interpretations were highly variable and none were statistically significant. Reviewers unanimously agreed on only 12 of the 44 tracings, and 11 of these showed quiescence when using a CNE. CNEs are more often interpretable than PSPEs for determining motor unit quiescence during voiding. CNE EMG appears to have greater clinical utility for central reading than PSPEs.

  10. [Effect of epidermal growth factor and testosterone on androgen receptor activation in urethral plate fibroblasts in hypospadias]. (United States)

    Lin, Junshan; Xie, Cheng; Chen, Ruiqing; Li, Dumiao


    To investigate androgen receptor (AR) expression and the effect of epidermal growth factor (EGF) and testosterone on AR expression level.
 EGF or different concentrations of testosterone were incubated with the primary urethral plate fibroblasts from patients with hypospadias. The levels of AR expression in the fibroblasts were detected by immunocytochemical assays and graphical analysis.
 There was no significant difference in AR activation under physiological concentrations (3×10(-8) mol/L) of testosterone between the control and the distal hypospadias group (P>0.05). However, there was a significant decrease in AR activation in the proximal hypospadias group compared to that in the control group (Pdistal hypospadias group>proximal hypospadias group, Phypospadias was improved most obviously when EGF and physiological concentration of testosterone were employed in the urethral plate fibroblasts from hypospadias patients (Phypospadias group than that in the control group (P=0.02).
 AR expression and activation in the urethral plate fibroblasts from hypospadias patients are abnormal. EGF can be used to improve AR activation in fibroblasts from different types of hypospadias, especially in the proximal type.

  11. Electrical stimulation of sacral dermatomes can suppress aberrant urethral reflexes in felines with chronic spinal cord injury. (United States)

    McCoin, Jaime L; Bhadra, Narendra; Gustafson, Kenneth J


    Uncoordinated reflex contractions of the external urethral sphincter (EUS) are a major component of voiding dysfunction after neurologic injury. Patterned stimulation of sacral afferent pathways can reduce abnormal EUS reflexes after acute spinal cord injury (SCI); however, effectiveness following chronic SCI is unknown. Four adult male cats were implanted with bilateral extradural sacral root electrodes to allow bladder activation and underwent subsequent spinal transection (T10-12). Nine weeks after SCI urethral and bladder pressures were recorded with and without sacral afferent stimulation. Surface electrodes were applied to sacral and lumbar dermatomes and stimulus amplitude set below the muscle fasciculation threshold. The stimulation pattern was varied by on/off times of fixed frequency at each location. Reflexive EUS contractions were observed in all animals after chronic SCI. Patterned sacral dermatome stimulation reduced EUS reflex rate and amplitude in two of four cats. Suppression was dependent on both the stimulus location and pattern. Sacral locations and a stimulation pattern of (0.75 sec on, 0.25 sec off, 20 Hz) were effective in both responder animals. Patterned sacral dermatome stimulation can reduce abnormal urethral reflexes following chronic SCI. Reflex suppression is dependent on both the stimulation location and stimulus pattern. Reduction of reflexive EUS activity after chronic SCI with this non-destructive and non-invasive approach may provide an advance for the treatment of detrusor-sphincter-dyssynergia. Copyright © 2012 Wiley Periodicals, Inc.

  12. Dosimetric analysis of radiation therapy oncology group 0321: the importance of urethral dose. (United States)

    Hsu, I-Chow; Hunt, Daniel; Straube, William; Pouliot, Jean; Cunha, Adam; Krishnamurthy, Devan; Sandler, Howard


    Radiation Therapy Oncology Group 0321 is the first multi-institutional cooperative group high-dose-rate (HDR) prostate brachytherapy trial with complete digital brachytherapy dosimetry data. This is a descriptive report of the data and an analysis of toxicity. Patients are treated with external beam radiation therapy at 45 Gy and 1 HDR implant with 19 Gy in 2 fractions. Implants are done with transrectal ultrasound guidance, and computed tomography (CT)-compatible nonmetallic catheters. HDR planning is done on ≤3-mm-thick CT slices. The "mean DVH" (dose-volume histogram) of the planning target volume (PTV), implanted volume (IP), and organs at risk are calculated. This includes the mean and standard deviation (SD) of the volume at 10-percentage-point intervals from 10% to 200% of the prescribed dose. The conformal index (COIN), homogeneity index (HI), catheters per implant, and patients per institution are calculated. Multivariate analysis and hazard ratios calculation of all the variables against reported grade ≥2 (G2+) genitourinary (GU) adverse events (Common Terminology Criteria for Adverse Events, version 3) are performed. Dosimetry data are based on 122 eligible patients from 14 institutions. The mean of PTV, IP, catheters per implant, and patients per institution are 54 cc, 63 cc, 19 and 9, respectively. The mean of %V100PTV, V80Bladder, V80Rectum, and V120Urethra were 94%, 0.40 cc, 0.15 cc, and 0.25 cc, respectively. There are too few G2+ gastrointestinal adverse event (GI AE) for correlative analysis; thus, the analysis has been performed on the more common G2+ GU AE. There are positive correlations noted between both acute and late G2+ GU AE and urethral dose at multiple levels. Positive correlations with late AE are seen with PTV and IP at high-dose levels. A negative correlation is seen between HI and acute AE. A higher patient accrual rate is associated with a lower rate of G2+ acute and late AE. Higher urethral dose, larger high-dose volumes, and

  13. Structural and functional evaluation of oxygenating keratin/silk fibroin scaffold and initial assessment of their potential for urethral tissue engineering. (United States)

    Lv, XiangGuo; Li, Zhe; Chen, ShiYan; Xie, MinKai; Huang, JianWen; Peng, XuFeng; Yang, RanXing; Wang, HuaPing; Xu, YueMin; Feng, Chao


    In this study, we report a new type of oxygen-generating scaffold, composed of human keratin, silk, gelatin and calcium peroxide (CPO). After mixing the silk/keratin (60:40) with 2% gelatin and 20% CPO, the film demonstrated excellent mechanical properties, non-cytotoxicity and oxygen-generative ability. The detailed structure of scaffold was revealed by confocal laser and electronic scanning microscopy. The gelatin formed the network structure, which mixed with silk fibroin and keratin. The CPOs were embedded into scaffold. A shell-core structure was formed in the CPO particles, in which the CPO was located in the core and the gelatin was mainly wrapped around the CPO. Furthermore, the oxygen-release test showed that scaffold was able to steadily release high level of oxygen over two weeks in vitro. In addition, the anti-bacterial function was also proved in the scaffold. Films with CPO enhanced the repair in dog urethral defect models, resulting in patent urethra. Improved organized muscle bundles and epithelial layer were observed in animals treated with CPO films compared with those treated with non-CPO films. This study suggests that this biomaterial could be suitable for tissue engineered urinary tract reconstruction. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Outcome analysis of urethral wall stent insertion with artificial urinary sphincter placement for severe recurrent bladder neck contracture following radical prostatectomy. (United States)

    Magera, James S; Inman, Brant A; Elliott, Daniel S


    We present outcome and quality of life analyses for the treatment of post-radical prostatectomy bladder neck contracture with urethral wall stent insertion and subsequent artificial urinary sphincter placement. A retrospective analysis from June 2001 to September 2007 identified 25 consecutive men who underwent urethral wall stent placement for severe, recurrent bladder neck contracture despite aggressive transurethral resection after radical prostatectomy. Assessment of symptoms and quality of life impact from urinary incontinence was conducted with a self-administered, standardized questionnaire. Nonparametric testing was used for comparing covariates among groups. Univariate Cox proportional hazards modeling was used to assess predictors of treatment failure. P values are double-sided and are considered statistically significant if bladder neck contracture was radical prostatectomy in all patients. Concurrent severe stress incontinence before treatment of bladder neck contracture was noted in 23 of 25 patients (92%). Before urethral wall stent insertion a median of 3 (IQR 2 to 5) failed endoscopic treatments were performed. Bladder neck contracture stabilization with insertion of 1 urethral wall stent was noted in 13 of 25 (52%) patients with a median followup of 2.9 years from last urethral wall stent insertion. Multiple urethral wall stent insertions (range 2 to 4) salvaged an additional 6 of 25 (24%) patients and failure to obtain patency was observed in 6 of 25 (24%). All patients responded to the questionnaire and quality of life improvement was noted in 23 of 25 patients (92%). Urethral wall stent and delayed artificial urinary sphincter placement for treatment of severe, recurrent bladder neck contracture and incontinence after radical prostatectomy is associated with improvement in quality of life. Long-term followup is required to further delineate the efficacy of this treatment approach.

  15. Urethral exudates of men with Neisseria gonorrhoeae infections select a restricted lipooligosaccharide phenotype during transmission. (United States)

    McLaughlin, Stephanie E; Cheng, Hui; Ghanem, Khalil G; Yang, Zhijie; Melendez, Johan; Zenilman, Jonathan; Griffiss, J McLeod


    Neisseria gonorrhoeae lipooligosaccharides (LOSs) induce immunoglobulin G that protects men from experimental infection. This raises the possibility that an LOS vaccine might prevent gonorrhea. Gonococci make different LOS molecules, depending on whether 3 genes, lgtA, lgtC, and lgtD, are in frame (IF) or out of frame (OOF). Mispairing of polymeric guanine (polyG) tracts within each gene determines its frame during replication. We amplified lgtA, lgtC, and lgtD from diagnostic slides of urethral exudates and sequenced their polyG tracts. We found that lgtA in exudative bacteria is IF and that lgtC is OOF. The frame of lgtD varied widely: it was OOF in most but not all cases. This genotype would result in synthesis of polylactosamine α chains that could be sialylated. Polylactosamine α chains would enhance virulence, and their sialylation would enable gonococci to survive within polymorphonuclear cells; however, an active LgtD in a few bacteria could provide a survival advantage in other sites of infection.

  16. The role of bladder neck suspension in the era of mid-urethral sling surgery. (United States)

    Rashid, T G; De Ridder, D; Van der Aa, F


    Mid-urethral slings are currently considered to be the gold standard for the surgical treatment of stress urinary incontinence, replacing bladder neck suspension techniques which previously occupied this position. In recent years, however, there have been concerns with regard to the use of synthetic material in vaginal surgery. We performed a review of the literature to discuss the role of bladder neck suspension techniques in the current clinical setting. Bladder neck suspension techniques consist of vaginal techniques, needle suspension techniques and retropubic techniques. The latter two techniques have been proven to offer durable outcomes for stress urinary incontinence. As compared to autologous slings, the long-term success rates may be considered inferior, but so is the rate of complication, resulting in higher patient satisfaction. Bladder neck suspension techniques may have a role in treating recurrent and/or persisting stress urinary incontinence after (failed) sling surgery and remain of particular interest in patients with stress urinary incontinence when performing concomitant surgery, for example for prolapse.

  17. One-stage anastomotic urethroplasty for traumatic urethral strictures. January 2004-January 2013

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    Charles Azuwike Odoemene


    Full Text Available Purpose: One-stage anastomotic urethroplasty is an attractive procedure for reconstructing the urethra following trauma. This prospective study highlights the advantages of the procedure and outcome of treatment. Materials and Methods : A total of 87 patients, age range 11-68 years with a mean of 35.4 years were included in the study. These patients were seen at two tertiary Institutions in South East Nigeria. The stricture lengths varied between 0.8 cm and 3.2 cm. All had suprapubic cystostomy initially followed by an end to end perineal anastomosis after thorough work up. Preoperatively 9 (10.3% patients had impotence from the trauma. Postoperatively the patients were assessed with peri-catheter retrograde urethrogram, micturating cystourethrogram, and uroflowmetery. Results : All the patients were males. At 6 months, 13 out of 21 (62% patients who had bulbo-prostatic anastomosis and 62 out of 66 (94% patients that had bulbo-membranous, bulbo-bulbar anastomosis had satisfactory micturition with urine flow rate >15 ml/s. Totally, 12 (13.8% patients had urine flow rate of <12 ml/s. At 1-year, there were 12 re-strictures, no urinary incontinence and four cases of a decrease in the strength of penile erection that needed no treatment. Conclusion : Delayed one-stage anastomotic urethroplasty provides for decreased incidence of postoperative morbidity, re-stricture, impotence and urinary incontinence for most short segment posttraumatic urethral strictures.

  18. Outcome of TVT operations in women with low maximum urethral closure pressure. (United States)

    Moe, Kjartan; Schiøtz, Hjalmar A; Kulseng-Hanssen, Sigurd


    (i) To establish whether low maximal urethral closure pressure (MUCP) is associated with a poorer prognosis after TVT-surgery, and if so to establish an MUCP cut-off value for poor outcome. (ii) To characterize the population with a low MUCP. Retrospective analysis of data from 6,646 women with stress/mixed urinary incontinence included in the Norwegian Female Incontinence Registry. Postoperative subjective (degree of satisfaction), objective (leakage on stress test) and composite cure according to preoperative MUCP were analyzed in unadjusted and adjusted analysis. Preoperative variables were compared between women having a low or normal MUCP. Non-parametric tests were used on continuous variables and χ 2 tests on categorical variables. Logistic regression was used for the adjusted analysis. Level of significance: P 20 cm H 2 O. In adjusted analysis MUCP ≤20 cm H 2 O was associated with neither objective, subjective, nor composite failure. Women with MUCP TVT-surgery compared to women with MUCP >20 cm H 2 O after adjusting for preoperative variables. Neurourol. Urodynam. 36:1320-1324, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  19. Challenging non-traumatic posterior urethral strictures treated with urethroplasty: a preliminary report

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    Nicolaas Lumen


    Full Text Available Introduction: Posterior urethral strictures after prostatic radiotherapy or surgery for benign prostatic hyperplasia (BPH refractory to minimal invasive procedures (dilation and/or endoscopic urethrotomy are challenging to treat. Published reports of alternative curative management are extremely rare. This is a preliminary report on the treatment of these difficult strictures by urethroplasty. Materials and Methods: Seven cases were treated: 4 cases occurred after open prostatectomy or transurethral resection of the prostate for BPH, one case after external beam irradiation and 2 after brachytherapy. The 4 cases after BPH-related surgery were in fact complete obstructions at the bladder neck and the membranous urethra with the prostatic urethra still partially patent. Anastomotic repair by perineal route was done in all cases with bladder neck incision in the BPH-cases and prostatic apex resection in the radiotherapy cases. Results: Mean follow-up was 31 months (range: 12-72 months. The operation was successful, with preserved continence, in 3 of the 4 BPH-cases and in 2 of the 3 radiotherapy cases. An endoscopic incision was able to treat a short re-stricture in the BPH-patient and a longer stricture at the bulbar urethra could be managed with a perineostomy in the radiotherapy-patient. Conclusion: Posterior non-traumatic strictures refractory to minimal invasive procedures (dilation/endoscopic urethrotomy can be treated by urethroplasty using an anastomotic repair with a bladder neck incision if necessary.

  20. Does penile tourniquet application alter bacterial adhesion to rat urethral cells: an in vitro study. (United States)

    Boybeyi-Turer, Ozlem; Kacmaz, Birgul; Arat, Esra; Atasoy, Pınar; Kisa, Ucler; Gunal, Yasemin Dere; Aslan, Mustafa Kemal; Soyer, Tutku


    To investigate the effects of penile tourniquet (PT) application on bacterial adhesion to urothelium. Fifty-six rats were allocated into control group (CG), sham group (SG), PT group (PTG). No intervention was applied in CG. A 5mm-length urethral repair was performed in SG and PTG. In PTG, a 10-min duration of PT was applied during the procedure and the tissue oxygenation monitor was used to adjust the same degree of ischemia in all subjects. Samples were examined for wound healing parameters and tissue levels of inflammatory markers, eNOS, e-selectin, and ICAM-1antibodies. The adhesion of Escherichia coli to urothelium was investigated with in vitro adhesion assay. Inflammation was higher and wound healing was worse in SG than CG and in PTG in comparison to CG and SG (pcaused endothelial corruption and prevented cell proliferation in cell culture. The PT application does not improve wound healing and increases bacterial adhesion molecules in penile tissue. The in vitro assays showed that PT causes severe endothelial damage and inhibits endothelial cell proliferation. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. MRI micturating urethrography for improved urethral delineation in prostate radiotherapy planning: a case study (United States)

    Rai, Robba; Sidhom, Mark; Lim, Karen; Ohanessian, Lucy; Liney, Gary P.


    Stereotactic ablative body radiotherapy is used in prostate cancer to deliver a high dose of radiation to the tumour over a small number of treatments. This involves the simulation of the patient using both CT and MRI. Current practice is to insert an indwelling catheter (IDC) during CT to assist with visualisation of the urethra and subsequently minimise dose to this highly critical structure. However, this procedure is invasive and has an associated risk of infection. This is a case study, which demonstrates our initial experience of using a real-time non-invasive MRI technique to replace the use of IDC for prostate cancer patients. The patient was scanned on a dedicated 3T MRI and was instructed to micturate in their own time whereupon a sagittal T2 weighted HASTE sequence was acquired every 5 s. This was subsequently followed by T2 weighted axial imaging at the level of mid prostate to provide improved urethral definition. Acquired images showed bladder voidance in real-time and an increase in signal intensity in the proximal urethra post voiding allowing for delineation of the urethra. The dimension and shape of the proximal urethra was well visualised and accumulation time of urine in the urethra was sufficient to enable optimum timing of the scanning technique. We have presented for the first time a micturating urethography technique using MRI, which has allowed us to visualise the urethra without contrast and with minimal invasiveness to the patient.

  2. Long-term risk of complications after mid-urethral sling IVS implantation

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    Grzegorz Surkont


    Full Text Available [b]Introduction[/b]. Results of short-term evaluation of multifilament microporous midurethral tape IVS differ a great deal. During the first year of implantation, erosions have been observed in 0%–26% of operated women. Long-term observations are rare. They suggest high risk of extrusion and infection even after years of implantation. [b]Objective[/b]. The purpose of the study was to evaluate long-term risk of complications after IVS implantation. Material and methods. Between 2001–2005, 72 women were operated on with the use of IVS mid-urethral tape. [b]Results[/b]. Two women had vaginal erosions during the first 3 months after the operation. Twelve women had vaginal erosions, purulent vaginal discharge, with IVS tape sticking out of the abdominal wall or vagina, and abdominal abscess. These complications were diagnosed between 9 months and 6 years after IVS implantation. The patients were operated on vaginally and open abdominally, 1–5 times because of complications after IVS implantation. [b]Conclusions[/b]. In the case of post-IVS complication, as much tape as possible should be excised. Long-term follow up on patients with IVS implantation should be recommended to the centres where IVS tape was used, even to patients after removal of the tape. Risk of erosion, extrusion and infection after midurethral multifilament microporous IVS tape implantation is too high – which is the reason it should no longer be used.

  3. Instrumented urethral catheter and its ex vivo validation in a sheep urethra (United States)

    Ahmadi, Mahdi; Rajamani, Rajesh; Timm, Gerald; Sezen, Serdar


    This paper designs and fabricates an instrumented catheter for instantaneous measurement of distributed urethral pressure profiles. Since the catheter enables a new type of urological measurement, a process for accurate ex vivo validation of the catheter is developed. A flexible sensor strip is first fabricated with nine pressure sensors and integrated electronic pads for an associated sensor IC chip. The flexible sensor strip and associated IC chip are assembled on a 7 Fr Foley catheter. A sheep bladder and urethra are extracted and used in an ex vivo set up for verification of the developed instrumented catheter. The bladder-urethra are suspended in a test rig and pressure cuffs placed to apply known static and dynamic pressures around the urethra. A significant challenge in the performance of the sensor system is the presence of parasitics that introduce large bias and drift errors in the capacitive sensor signals. An algorithm based on use of reference parasitic transducers is used to compensate for the parasitics. Extensive experimental results verify that the developed compensation method works effectively. Results on pressure variation profiles circumferentially around the urethra and longitudinally along the urethra are presented. The developed instrumented catheter will be useful in improved urodynamics to more accurately diagnose the source of urinary incontinence in patients.

  4. Grating-based tomography of human tissues (United States)

    Müller, Bert; Schulz, Georg; Mehlin, Andrea; Herzen, Julia; Lang, Sabrina; Holme, Margaret; Zanette, Irene; Hieber, Simone; Deyhle, Hans; Beckmann, Felix; Pfeiffer, Franz; Weitkamp, Timm


    The development of therapies to improve our health requires a detailed knowledge on the anatomy of soft tissues from the human body down to the cellular level. Grating-based phase contrast micro computed tomography using synchrotron radiation provides a sensitivity, which allows visualizing micrometer size anatomical features in soft tissue without applying any contrast agent. We show phase contrast tomography data of human brain, tumor vessels and constricted arteries from the beamline ID 19 (ESRF) and urethral tissue from the beamline W2 (HASYLAB/DESY) with micrometer resolution. Here, we demonstrate that anatomical features can be identified within brain tissue as well known from histology. Using human urethral tissue, the application of two photon energies is compared. Tumor vessels thicker than 20 μm can be perfectly segmented. The morphology of coronary arteries can be better extracted in formalin than after paraffin embedding.

  5. Further analysis of the Glans-Urethral Meatus-Shaft (GMS) hypospadias score: correlation with postoperative complications. (United States)

    Arlen, Angela M; Kirsch, Andrew J; Leong, Traci; Broecker, Bruce H; Smith, Edwin A; Elmore, James M


    The Glans-Urethral Meatus-Shaft (GMS) score is a concise and reproducible way to describe hypospadias severity. We classified boys undergoing primary hypospadias repair to determine the correlation between GMS score and postoperative complications. Between February 2011 and August 2013, patients undergoing primary hypospadias repair were prospectively scored using the GMS classification. GMS scoring included a 1-4 scale for each component: G - glans size/urethral plate quality, M - meatal location, and S - degree of shaft curvature, with more unfavorable characteristics assigned higher scores [Figure]. Demographics, repair type, and complications (urethrocutaneous fistula, meatal stenosis, glans dehiscence, phimosis, recurrent chordee and stricture) were assessed. Total and individual component scores were tested in uni- and multivariate analysis. Two-hundred and sixty-two boys (mean age 12.3 ± 13.7 months) undergoing primary hypospadias repair had a GMS score assigned. Mean GMS score was 7 ± 2.5 (G 2.1 ± 0.9, M 2.4 ± 1, S 2.4 ± 1). Mean clinical follow-up was 17.7 ± 9.3 months. Thirty-seven children (14.1%) had 45 complications. A significant relationship between the total GMS score and presence of any complication (p hypospadias (GMS 3-6) had a 2.4% fistula rate vs. 11.1% for moderate (GMS 7-9) and 22.6% for severe (GMS 10-12) hypospadias (p 60° ventral curvature) patients were 27 times more likely to develop a fistula than S1 (no curvature) boys (95% CI, 3.2-229). The GMS score is based on anatomic features (i.e. glans size/urethral plate quality, location of meatus, and degree of chordee) felt to most likely impact functional and cosmetic outcomes following hypospadias repair. We demonstrated a statistically significant increase in the likelihood of any postoperative complication with every unit increase in total GMS score. The concept that factors aside from meatal location affect hypospadias repair and outcomes is not novel, and degree of ventral

  6. Abnormal antenatal sonogram: an indicator of disease severity in children with posterior urethral valves

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    Harvie, S. [Peterborough Health Centre, Dept. of Radiology, Peterborough, Ontario (Canada); McLeod, L. [IWK Health Centre, Dept. of Obstetrics and Gynaecology, Halifax, Nova Scotia (Canada); Acott, P. [IWK Health Centre, Dept. of Nephrology, Halifax, Nova Scotia (Canada); Walsh, E. [Dr. Charles A. Janeway Children' s Health Centre, Dept. of Radiology, St. John' s, Newfoundland (Canada); Abdolell, M. [QE II Health Sciences Centre, Dept. of Radiology, Halifax, Nova Scotia (Canada); Macken, M.B., E-mail: [IWK Health Centre, Dept. of Diagnostic Imaging, Halifax, Nova Scotia (Canada)


    To review the association of an abnormal prenatal sonogram with most recent serum creatinine in patients with proven posterior urethral valves (PUV). Since 1992, all live-born patients between 1992-2004 with clinically proven PUV, with postnatally proven PUV, from 2 pediatric tertiary care centers, were reviewed for age at diagnosis, most recent serum creatinine, presence of chronic renal failure (CRF) (serum creatinine >2 standard deviations above normal for age), or end stage renal disease (dialysis or transplant). Available antenatal reports from the 2 centres and surrounding community hospitals were reviewed for gestational age (GA) at the time of ultrasound, volume of amniotic fluid, and urinary-tract abnormality. Thirty-four patients with proven PUV and prenatal sonograms were identified (1992-2004). Eighteen patients had abnormalities on their prenatal sonogram, with poor outcome in 5 (mean follow-up, 8 years [1-13 y]). No specific features were identified on prenatal sonogram. Sixteen patients had normal prenatal sonograms, with poor outcomes in 2 (mean follow-up, 8 years [3-13 y]). There is an increased risk of an abnormal serum creatinine among those patients with an abnormal prenatal study, odds ratio (OR) 2.6 (95% confidence interval, 0.35-32). PUV represents a spectrum of disease severity. A normal prenatal ultrasound does not preclude PUV. The majority of patients with a normal prenatal examination have good outcomes. The OR suggests that there may be increased risk for poor outcome in those with an abnormal prenatal examination. A multicenter study is necessary to obtain a larger sample size and more precise ORs. (author)

  7. Urethral sphincter EMG-controlled dorsal penile/clitoral nerve stimulation to treat neurogenic detrusor overactivity (United States)

    Opisso, E.; Borau, A.; Rijkhoff, N. J. M.


    The goal of this study was to investigate whether real-time external urethral sphincter (EUS) EMG-controlled dorsal genital nerve (DGN) stimulation can suppress undesired detrusor bladder contractions in patients with both neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD). Detrusor pressure (Pdet) and EUS EMG were recorded in 12 neurogenic patients who underwent two filling cystometries. The first one was without stimulation and was intended to confirm the NDO and DSD and to set the EMG detection threshold. The second one was with real-time EMG-controlled stimulation of DGNs. Two detection methods were analyzed to detect bladder contractions. The first method was a Kurtosis-scaled root mean square (RMS) detector and was used on-line. The second was a simple RMS detector and was used off-line. Of 12 patients included, 10 patients showed both NDO and DSD. In nine of these ten patients relevant EMG concomitant to detrusor activity was detected and stimulation could suppress at least one detrusor contraction. The second filling compared to the first one showed an increase of 84% in bladder capacity (p = 0.002) and a decrease of 106% in Pdet (p = 0.002). Nine false-positive detections occurred during the ten fillings with electrical stimulation. The mean increases of both time and Pdet between stimulation and bladder contraction onsets for method 1 were 1.8 s and 4 cmH2O and for method 2 were 0.9 s and 2 cmH2O, respectively. This study shows that EUS EMG can be used in real time to detect the onset of a bladder contraction. In combination with DGN stimulation has been shown to be feasible to suppress undesired bladder contractions and in turn to increase bladder capacity in subjects with both NDO and DSD.

  8. Long-term recording of external urethral sphincter EMG activity in unanesthetized, unrestrained rats. (United States)

    LaPallo, Brandon K; Wolpaw, Jonathan R; Chen, Xiang Yang; Carp, Jonathan S


    The external urethral sphincter muscle (EUS) plays an important role in urinary function and often contributes to urinary dysfunction. EUS study would benefit from methodology for longitudinal recording of electromyographic activity (EMG) in unanesthetized animals, but this muscle is a poor substrate for chronic intramuscular electrodes, and thus the required methodology has not been available. We describe a method for long-term recording of EUS EMG by implantation of fine wires adjacent to the EUS that are secured to the pubic bone. Wires pass subcutaneously to a skull-mounted plug and connect to the recording apparatus by a flexible cable attached to a commutator. A force transducer-mounted cup under a metabolic cage collected urine, allowing recording of EUS EMG and voided urine weight without anesthesia or restraint. Implant durability permitted EUS EMG recording during repeated (up to 3 times weekly) 24-h sessions for more than 8 wk. EMG and voiding properties were stable over weeks 2-8. The degree of EUS phasic activity (bursting) during voiding was highly variable, with an average of 25% of voids not exhibiting bursting. Electrode implantation adjacent to the EUS yielded stable EMG recordings over extended periods and eliminated the confounding effects of anesthesia, physical restraint, and the potential for dislodgment of the chronically implanted intramuscular electrodes. These results show that micturition in unanesthetized, unrestrained rats is usually, but not always, associated with EUS bursting. This methodology is applicable to studying EUS behavior during progression of gradually evolving disease and injury models and in response to therapeutic interventions. Copyright © 2014 the American Physiological Society.

  9. YouTube as an educational tool regarding male urethral catheterization. (United States)

    Nason, Gregory J; Kelly, Padraig; Kelly, Michael E; Burke, Matthew J; Aslam, Asadullah; Giri, Subhasis K; Flood, Hugh D


    Urethral catheterization (UC) is a common procedure carried out on a daily basis. The aims of this study were to assess the quality of YouTube as an educational tool regarding male UC and to assess the experience of newly qualified doctors regarding UC. YouTube was searched for videos containing relevant information about male UC. A checklist for evaluating content for male UC was devised. The top-ranked video was shown to interns and they were questioned regarding their experience of UC and the usefulness of the video. A total of 100 videos was screened and 49 unique videos were identified. The median length of video was 7 min 15 s (range 1 min 44 s to 26 min 44 s). Regarding the Safe Catheter Insertion Score, the mean score was 5.18 ± 1.64. 9 (18.4%) deemed useful, 24 (49%) somewhat useful and 16 (32.7%) not useful. There was no difference in the number of views (p = 0.487), duration of video (p = 0.364) or number of days online (p = 0.123) between those categorized as useful, somewhat useful and not useful. Twenty-six interns (89.7%) attended the UC teaching session. All reported the video to be a useful educational adjunct. Nine of the respondents (42.9%) had independently inserted a urinary catheter before the educational session. The quality of videos on YouTube regarding male UC is widely variable. Preselected videos are deemed useful by junior doctors regarding male UC and can be used as an educational adjunct before performing hands-on tasks.

  10. Internal urethrotomy in patients with recurrent urethral stricture after buccal mucosa graft urethroplasty. (United States)

    Rosenbaum, Clemens M; Schmid, Marianne; Ludwig, Tim A; Kluth, Luis A; Reiss, Philip; Dahlem, Roland; Engel, Oliver; Chun, Felix K-H; Riechardt, Silke; Fisch, Margit; Ahyai, Sascha A


    To determine the success rate of direct vision internal urethrotomy (DVIU) in the treatment of short stricture recurrence after buccal mucosa graft urethroplasty (BMGU). Patients who underwent DVIU for the treatment of short, "veil-like" recurrent urethral strictures (<1 cm) after BMGU between October 2009 and 2013 were retrospectively identified within our urethroplasty database. Stricture recurrence was defined as maximum flow rate (Q max) <15 ml/s and a consecutively verified stricture in a combined retro- and antegrade voiding cystography or cystoscopy at a follow-up visit. The success rate of DVIU was assessed by Kaplan-Meier analysis. Univariable Cox regression analyses evaluated risk factors for stricture recurrence following DVIU. Forty-three patients underwent DVIU for short stricture recurrence after BMGU for bulbar (81.3 %), penile (14.0 %) and membranous (4.7 %) strictures. Relapse had occurred proximally to the buccal mucosa graft in 28 (65.1 %) and distally in 12 (27.9 %) patients, respectively. At a mean follow-up of 11.7 (±9.7) months, stricture recurrence was observed in 48.8 % of our patients. Stricture recurrence was significantly associated with weak urinary stream (9.3 ml/s vs. no recurrence 19.5 ml/s) and patient dissatisfaction (66.7 % vs. no recurrence 18.1 %; both p < 0.001). The overall success rate was 60.5 % 15 months after DVIU. The main limitations of this study are its retrospective design, the small sample size and the short follow-up. DVIU after BMGU showed a moderate success rate and therefore might be a viable treatment option in selected patients with very short strictures after BMGU. However, longer follow-up is warranted to prove long-term effectiveness.

  11. Bladder injury and success rates following retropubic mid-urethral sling: TVT EXACT™ vs. TVT™. (United States)

    Thubert, Thibault; Canel, Virginie; Vinchant, Marie; Wigniolle, Ingrid; Fernandez, Hervé; Deffieux, Xavier


    Although placement of a retropubic mid-urethral slings (MUS) is one of the gold standard surgical treatments for stress urinary incontinence, new devices are poorly evaluated before marketing. We compared TVT-EXACT™ (TVT-E), a new device expected to reduce bladder injuries, with the historically described bottom-to-top TVT™ (TVT). This retrospective study compared TVT-E (n=49) and TVT (n=49). The main outcomes were the prevalence of complications (bladder injuries, immediate postoperative pain, perioperative complications, etc.) and the short-term success rate (no reported urinary leakage and negative cough test) of both MUSs. Minimum follow-up was 12 months. The characteristics of the two groups were comparable. The prevalence of bladder injury for TVT-E and TVT was 8% and 6%, respectively (p=1). The intensity of immediate postoperative pain (VAS/100) was lower following TVT-E than after TVT (8.0 vs. 15.9, p=0.01). The first post-void residual was increased in the TVT-E group (153.9 vs. 78.9mL, p=0.045), and there were more postoperative bladder outlet obstruction (BOO) symptoms in the TVT-E group (24% vs. 6%, p=0.02). However, there was no difference when considering only de novo BOO (14% vs. 4%, p=0.16). The prevalence of peri- and post-operative complications was equal in the two groups. The success rate was similar at 12 months of follow-up (80 vs. 82%, p=1). The prevalence of bladder injury was unchanged with TVT-EXACT™ compared with TVT™, but post-operative pain was decreased. The success rate of both retropubic MUSs was similar at 12 months of follow-up. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Urethral strictures after bipolar transurethral resection of prostate may be linked to slow resection rate

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    Guan Hee Tan


    Full Text Available Purpose: This study aimed to determine the urethral stricture (US rate and identify clinical and surgical risk factors associated with US occurrence after transurethral resection of the prostate using the bipolar Gyrus PlasmaKinetic Tissue Management System (PKTURP. Materials and Methods: This was an age-matched case-control study of US occurrence after PK-TURP. Retrospective data were collected from the hospital records of patients who had a minimum of 36 months of follow-up information. Among the data collected for analysis were prostate-specific antigen level, estimated prostate weight, the amount of prostate resected, operative time, history of urinary tract infection, previous transurethral resection of the prostate, and whether the PK-TURP was combined with other endourological procedures. The resection rate was calculated from the collected data. Univariate and multivariate analyses were performed to identify clinical and surgical risk factors related to US formation. Results: A total of 373 patients underwent PK-TURP between 2003 and 2009. There were 13 cases of US (3.5%, and most of them (10 of 13, 76.9% presented within 24 months of surgery. Most of the US cases (11 of 13, 84.6% occurred at the bulbar urethra. Multivariable logistic regression analyses identified slow resection rate as the only risk factor significantly associated with US occurrence. Conclusions: The US rate of 3.5% after PK-TURP in this study is comparable to contemporary series. A slow resection rate seems to be related to US occurrence. This should be confirmed by further studies; meanwhile, we must be mindful of this possibility when operating with the PK-TURP system.

  13. External urethral sphincter pressure measurement: an accurate method for the diagnosis of detrusor external sphincter dyssynergia?

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    Carlos H Suzuki Bellucci

    Full Text Available Combined pelvic floor electromyography (EMG and videocystourethrography (VCUG during urodynamic investigation are the most acceptable and widely agreed methods for diagnosing detrusor external sphincter dyssynergia (DESD. Theoretically, external urethral sphincter pressure (EUSP measurement would provide enough information for the diagnosis of DESD and could simplify the urodynamic investigation replacing combined pelvic floor EMG and VCUG. Thus, we evaluated the diagnostic accuracy of EUSP measurement for DESD. PATIENTS #ENTITYSTARTX00026;A consecutive series of 72 patients (36 women, 36 men with neurogenic lower urinary tract dysfunction able to void spontaneously was prospectively evaluated at a single university spinal cord injury center. Diagnosis of DESD using EUSP measurement (index test versus combined pelvic floor EMG and VCUG (reference standard was assessed according to the recommendations of the Standards for Reporting of Diagnostic Accuracy Initiative.Using EUSP measurement (index test and combined pelvic floor EMG and VCUR (reference standard, DESD was diagnosed in 10 (14% and in 41 (57% patients, respectively. More than half of the patients presented discordant diagnosis between the index test and the reference standard. Among 41 patients with DESD diagnosed by combined pelvic floor EMG and VCUR, EUSP measurement identified only 6 patients. EUSP measurement had a sensitivity of 15% (95% CI 5%-25%, specificity of 87% (95% CI 76%-98%, positive predictive value of 60% (95% CI 30%-90%, and negative predictive value of 56% (95% CI 44%-68% for the diagnosis of DESD.For diagnosis of DESD, EUSP measurement is inaccurate and cannot replace combined pelvic floor EMG and VCUR.

  14. Sperm evaluation and biochemical characterization of cat seminal plasma collected by electroejaculation and urethral catheterization. (United States)

    Zambelli, Daniele; Raccagni, Ramona; Cunto, Marco; Andreani, Giulia; Isani, Gloria


    This paper aimed to evaluate cat seminal plasma protein profile (with SDS-page) and determine differences in seminal plasma composition from ejaculates obtained using urethral catheterization after pharmacological induction (UrCaPI) and electroejaculation (EE). In addition, this study evaluates whether the recovery method affected seminal plasma protein and zinc concentrations. A single ejaculation was collected from 17 mixed-breed cats by EE (5/21) or UrCaPI (12/21), while 4/21 cats underwent four sperm collections once every four days using EE and UrCaPI techniques alternately. The semen parameters evaluated were: volume, percentage of motility and progressive motility, morphology, and sperm concentration. After centrifugation, the seminal plasma obtained was stored at -80 °C and later used to measure protein and zinc concentrations, and to determine protein profile by SDS-polyacrylamide gel electrophoresis (PAGE). The results obtained indicate that cat seminal plasma protein profile is characterized by many protein bands (>30) with a molecular weight ranging from 3.5 to 200 kDa, and that the recovery method influences the seminal plasma protein profile: EE is related to the absence of two proteins (P55 and P14), and alters three protein bands (P200, P80, P28). The collection technique also affected zinc concentration (mg/dL) and protein concentration (g/dL) which were significantly higher (P < 0.01) in samples collected by UrCaPI; on the contrary the total Zn and protein amount/ejaculate were not significantly different in samples collected by both technique (P < 0.05). Copyright © 2010 Elsevier Inc. All rights reserved.

  15. High-dose-rate interstitial brachytherapy for female peri-urethral cancer

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    Daya Nand Sharma


    Full Text Available Purpose: Peri-urethral cancer (PUC in females is a rare malignancy. Surgery is not usually contemplated due to associated morbidity. Radiation therapy (RT can be employed in the form of interstitial brachytherapy (IBT alone for early lesions, and external beam radiation therapy (EBRT with or without IBT for advanced lesions. We report our first experience in the literature to evaluate the role of high-dose-rate (HDR IBT in female PUC. Material and methods : Between 2008 and 2013, 10 female patients with PUC (5 primary and 5 recurrent were treated with HDR-IBT with or without EBRT at our center. Size of the lesion ranged from 1.5 cm to 5.0 cm. A 2-3 plane free-hand implant was performed using plastic catheters. The prescribed dose of HDR-IBT was 42 Gy in 14 fractions for brachytherapy alone (5 patients, and 18-21 Gy for the boost along with EBRT (5 patients. Patients were followed up regularly for assessment of disease control and toxicity. Results: At a median follow up of 25 months, six patients were disease free at their last follow up. Four patients developed recurrence: 2 at inguinal nodes, 1 at local site, and 1 at both local as well as inguinal nodes. Moist desquamation was the commonest acute toxicity observed in all 5 patients treated with IBT alone, which healed within 4 weeks’ time. Overall, grade II delayed complication rate was 30%. Conclusions : Though small sample size, the results of our study have shown that HDR-IBT provides good loco-regional control with acceptable toxicity for female PUC.

  16. A survey of primary care physician practices in antibiotic prescribing for the treatment of uncomplicated male gonoccocal urethritis

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    Blanchon Thierry


    Full Text Available Abstract Background The development of resistance to antimicrobial therapy by Neisseria gonorrhoeae causes on-going problems for individual case management of gonorrhoea. Surveillance data about N. gonorrhoeae have indicated an increase in the incidence of gonorrhoea in France in 2006. As a consequence of the development of antibiotic resistance in N. gonorrhoeae, French guidelines excluded fluoroquinolones as a standard treatment for N. gonorrhoeae. Ceftriaxone became the recommended treatment, associated with azithromycin for Clamydia trachomatis infection. Our aim was to describe the practice patterns of general practitioners (GPs in managing the antibiotic treatment of patients with symptoms suggestive of uncomplicated male urethritis. Methods We developed a clinical vignette describing a man with typical gonococcal urethritis symptoms to elicit questions about antibiotic treatment. We mailed the electronic questionnaire to a random sample of 1000 French GPs belonging to the Sentinelles Network. Results By the end of the survey period, 350 vignettes were received, yielding a response rate of 35%. Sixty-six GPs (20.2% prescribed the recommended antibiotics for the simultaneous treatment of N. gonorrhoeae and C. trachomatis infections, while 132 GPs (40.4% prescribed only non-recommended antibiotics, including ciprofloxacin in 69 cases (21.1%. General practitioners with less than 10 years in practice showed better compliance to guidelines than those with more years in practice (p Conclusions The results suggest a mismatch between the guidelines and the antibiotic treatment of male uncomplicated urethritis by French GPs, mostly among the subgroup of physicians who have been in practice longer. Educational approaches based on practice feedback need to be developed to improve these deficits in the quality of care.

  17. Intermittent urethral catheterisation: the reality of the lubricants and catheters in the clinical practice of a Brazilian service. (United States)

    Mazzo, Alessandra; Pecci, Gabriel Luiz; Fumincelli, Laís; Neves, Roberta Corsini; Dos Santos, Rachel Cristina Rodrigues; Cassini, Marcelo Ferreira; Tucci, Silvio


    To identify how catheters and lubricants have been used among patients using intermittent urinary catheterisation in rehabilitation. The clean intermittent urinary catheterisation technique is an invasive procedure can cause discomfort, pain and urethral traumas. The use of lubricants and lubricated urinary catheters reduces the friction between the catheter and the urethral mucosa, minimising the risks. A descriptive exploratory design was used. Quantitative and descriptive study developed at a rehabilitation centre of a University Hospital in the interior of the state of São Paulo, Brazil, at the Intermittent Urinary Catheterisation Outpatient Clinic, between June 2012-December 2014. After ethical approval, the data were collected through an interview with the support of a semistructured questionnaire, held during the nursing consultation. Among the users, patients using intermittent urinary catheterisation were interviewed, over 18 years of age and minors younger than eight years accompanied. Descriptive statistical analysis was applied. Most of 214 (100·0%) patients were interviewed were male, single, young adults and with a primary medical diagnosis of bone marrow injury and myelomeningocele. Most patients perform the urinary catheterisation between four and six times per day. For the procedure, the majority uses polyethylene (polyvinyl chloride) catheter and, as a lubricant, 2·0% lidocaine hydrochloride on the catheter itself. Many mention lack of sensitivity when passing the catheter. In the study sample, a risk of urethral traumas was evidenced, related to the inappropriate use of catheters and lubricants. For the patients' safety, the professionals need to acknowledge the importance of the appropriate use of lubricants and lubricated catheters to implement evidence-based practices that mobilise public policies. The use of evidences demonstrates that the appropriate use of lubricants for intermittent urinary catheterisation is fundamental for patient

  18. Psychometric validation of the Spanish version of the USS-PROM questionnaire for patients who undergo anterior urethral surgery. (United States)

    Puche-Sanz, I; Martín-Way, D; Flores-Martín, J; Expósito-Ruiz, M; Vicente-Prados, J; Nogueras-Ocaña, M; Tinaut-Ranera, J; Cózar-Olmo, J M


    To translate into Spanish and validate the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROM) questionnaire, assessing its psychometric properties and determining its suitability for clinical use in our community. We also assessed the potential changes in ejaculatory function using the Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD). A systematic translation of the British version was performed. Patients scheduled for anterior urethral stricture surgery between September 2014 and September 2015 were prospectively included in the study. All patients completed the questionnaire before and after the surgery. We conducted an in-depth psychometric study of the questionnaire. We assessed the responses of a total of 40 patients. The questionnaire showed its validity, presenting an excellent negative correlation between the voiding symptom scores and the maximum flow (r=-0.6, P<.001), and also showed significant improvement in the EQ5D-VAS (visual analogue scale) and the time trade-off. For internal consistency, the Cronbach's alpha was 0.701. For the test-retest reliability, the overall intraclass correlation coefficient (ICC) was 0.974, and the ICC for each item separately ranged from 0.799 to 0.980. We observed significant improvement in all items regarding urinary symptoms and health-related quality of life (P<.001), thereby demonstrating the response capacity to changing the questionnaire. There were no significant changes in the MSHQ-EjD. The Spanish version of the USS-PROM questionnaire is a valid instrument for quantifying changes in voiding symptoms and the health-related quality of life of patients undergoing anterior urethral surgery. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Urethral pressure reflectometry. A method for simultaneous measurements of pressure and cross-sectional area in the female urethra

    DEFF Research Database (Denmark)

    Klarskov, Niels


    A novel technique for simultaneous measurements of pressure and cross-sectional area (CA) in the female urethra, denoted Urethral Pressure Reflectometry (UPR), was devised. A very thin and highly flexible polyurethane-bag was placed in the urethra. A pump applied increasing and decreasing pressures...... to the polyurethane-bag and thereby opened and closed the urethra. Sound waves were continually sent into the polyurethane-bag and the cross-sectional area (CA) of the bag (urethra) could be measured from the reflections with Acoustic Reflectometry. The CA of the bag was measured for each mm of the bag and 10 times...

  20. Fabrication of Tissue-Engineered Bionic Urethra Using Cell Sheet Technology and Labeling By Ultrasmall Superparamagnetic Iron Oxide for Full-Thickness Urethral Reconstruction. (United States)

    Zhou, Shukui; Yang, Ranxin; Zou, Qingsong; Zhang, Kaile; Yin, Ting; Zhao, Weixin; Shapter, Joseph G; Gao, Guo; Fu, Qiang


    Urethral strictures remain a reconstructive challenge, due to less than satisfactory outcomes and high incidence of stricture recurrence. An "ideal" urethral reconstruction should establish similar architecture and function as the original urethral wall. We fabricated a novel tissue-engineered bionic urethras using cell sheet technology and report their viability in a canine model. Small amounts of oral and adipose tissues were harvested, and adipose-derived stem cells, oral mucosal epithelial cells, and oral mucosal fibroblasts were isolated and used to prepare cell sheets. The cell sheets were hierarchically tubularized to form 3-layer tissue-engineered urethras and labeled by ultrasmall super-paramagnetic iron oxide (USPIO). The constructed tissue-engineered urethras were transplanted subcutaneously for 3 weeks to promote the revascularization and biomechanical strength of the implant. Then, 2 cm length of the tubularized penile urethra was replaced by tissue-engineered bionic urethra. At 3 months of urethral replacement, USPIO-labeled tissue-engineered bionic urethra can be effectively detected by MRI at the transplant site. Histologically, the retrieved bionic urethras still displayed 3 layers, including an epithelial layer, a fibrous layer, and a myoblast layer. Three weeks after subcutaneous transplantation, immunofluorescence analysis showed the density of blood vessels in bionic urethra was significantly increased following the initial establishment of the constructs and was further up-regulated at 3 months after urethral replacement and was close to normal level in urethral tissue. Our study is the first to experimentally demonstrate 3-layer tissue-engineered urethras can be established using cell sheet technology and can promote the regeneration of structural and functional urethras similar to normal urethra.

  1. Comparison of preoperative and postoperative pressure transmission ratio and urethral pressure profilometry in patients with successful outcome following the vaginal wall patch sling technique. (United States)

    Mikhail, Magdy S; Rosa, Hector; Palan, Prabhudas; Anderson, Patrick


    We studied preoperative and postoperative pressure transmission ratio (PTR) and urethral pressure profilometry in patients undergoing the vaginal wall patch sling technique as a first surgical approach for genuine stress incontinence (GSI) with urethral hypermobility. The specific aims were to determine the exact urodynamic parameters, if any, that may be improved postoperatively and to report the urodynamic outcome of the vaginal wall patch sling technique in successful cases. Preoperatively, all patients had a positive standing stress test, urethral hypermobility on Q-tip testing, and normal postvoid residual volume. On urodynamics, all patients had equalization of maximum urethral closure pressure (MUCP) on cough profilometry, and absence of detrusor contractions on subtracted cystometry. The PTR for each cough was calculated. Cough spikes were assigned locations in the first, second, third, or fourth quartile of the functional urethral length (FUL). Urethral pressure profilometry was performed at bladder capacity in the sitting position. All urodynamic tests were repeated 3-6 months postoperatively. A two-tailed t-test was used for statistical analysis. Forty-eight patients demonstrated successful outcome at initial follow up and constituted the study population. There was a statistically significant increase in MUCP at stress as well as a statistical increase in PTR in the first, second, and third quartiles of the FUL postoperatively. The vaginal patch sling technique appears to restore continence both by buttressing the urethra at times of stress as well as repositioning the proximal urethra into the intra-abdominal pressure zone, thus, enhancing pressure transmission to the proximal urethra.

  2. Vesicostomy and Colostomy in a Premature Neonate With Posterior Urethral Valves, Bilateral Dysplastic Kidneys, and High Imperforate Anus: The Challenge of Stoma Placement. (United States)

    McGrath, Melissa; Alnaqi, Amar A A; Braga, Luis H


    Although anorectal malformations are often associated with urinary tract abnormalities, the association with posterior urethral valves is exceptionally rare. We report a unique case of a premature (35 gestational weeks) male neonate born with posterior urethral valves, bilateral dysplastic kidneys, and imperforate anus, successfully treated by Blocksom vesicostomy and left upper quadrant loop colostomy. The challenges involving placement of both stomas in a small abdominal wall of a 2200 g premature neonate are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Endoscopic treatment of vesical and urethral perforations after tension-free vaginal tape (TVT) procedure for female stress urinary incontinence. (United States)

    Baracat, Fabio; Mitre, Anuar Ibrahim; Kanashiro, Hideki; Montellato, Nelson Ileo Dias


    Stress urinary incontinence is a problem that is prevalent in women, and its treatment with minimally invasive techniques using synthetic materials has increased recently, although the procedure has also brought increased occurrence of specific complications such as vesical and urethral perforations. We describe 11 cases of endoscopic correction of vesical and urethral perforations due to the use of synthetic material for the treatment of stress urinary incontinence. Eleven patients were treated for complications after undergoing the TVT(R) (tension-free vaginal tape) procedure; 6 of them had the polypropylene tape inside the bladder, and 5 had erosion of the urethra. Endoscopic resection of the polypropylene tapes was performed on all patients. A 6-month follow-up with cystoscopic control showed that the procedures were successful with complete relief of the symptoms except for 1 patient who persisted with the polypropylene tape in the bladder. This patient underwent a new endoscopic resection, and the cystoscopic control exam was normal 3 months later. Endoscopic resection of intravesical and intraurethral synthetic tapes can be considered a good alternative for the treatment of complications resulting from the TVT procedure.

  4. Study of prognostic significance of antenatal ultrasonography and renin angiotensin system activation in predicting disease severity in posterior urethral valves

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    Divya Bhadoo


    Full Text Available Aims: Study on prognostic significance of antenatal ultrasonography and renin angiotensin system activation in predicting disease severity in posterior urethral valves. Materials and Methods: Antenatally diagnosed hydronephrosis patients were included. Postnatally, they were divided into two groups, posterior urethral valve (PUV and non-PUV. The studied parameters were: Gestational age at detection, surgical intervention, ultrasound findings, cord blood and follow up plasma renin activity (PRA values, vesico-ureteric reflux (VUR, renal scars, and glomerular filtration rate (GFR. Results: A total of 25 patients were included, 10 PUV and 15 non-PUV. All infants with PUV underwent primary valve incision. GFR was less than 60 ml/min/1.73 m 2 body surface area in 4 patients at last follow-up. Keyhole sign, oligoamnios, absent bladder cycling, and cortical cysts were not consistent findings on antenatal ultrasound in PUV. Cord blood PRA was significantly higher (P < 0.0001 in PUV compared to non-PUV patients. Gestational age at detection of hydronephrosis, cortical cysts, bladder wall thickness, and amniotic fluid index were not significantly correlated with GFR while PRA could differentiate between poor and better prognosis cases with PUV. Conclusions: Ultrasound was neither uniformly useful in diagnosing PUV antenatally, nor differentiating it from cases with non-PUV hydronephrosis. In congenital hydronephrosis, cord blood PRA was significantly higher in cases with PUV compared to non-PUV cases and fell significantly after valve ablation. Cord blood PRA could distinguish between poor and better prognosis cases with PUV.

  5. Can quantity of amniotic fluid reliably predict postnatal renal function in boys with posterior urethral valves: a decision curve analysis. (United States)

    Harper, Luke; Waubant, Alice; Vignes, Julien; Amat, Sara; Dobremez, Eric; Lefevre, Yan; Ferdynus, Cyril


    Prenatal management of male fetuses with suspected posterior urethral valves depends on reliable markers for postnatal long-term renal function. Whether ultrasound parameters, including the presence or absence of oligohydramnios, are reliable remains the subject of debate. We decided to evaluate the reliability of quantity of amniotic fluid to predict postnatal renal function using decision curve analysis (DCA), a method for evaluating the clinical utility of a diagnostic test. We analyzed retrospectively 51 male fetuses born with prenatally suspected posterior urethral valves between 2009 and 2012. We studied the relationship between quantity of amniotic fluid on prenatal ultrasound and the nadir creatinine during the first year of life as a proxy of postnatal renal function using DCA. Twelve fetuses presented with prenatal oligohydramnios. Thirty-one children had a normal nadir creatinine, of which one had prenatal oligohydramnios (3.2%). Thirteen had a nadir creatinine between 35 and 75 μmol/L, of which four had prenatal oligohydramnios (30.8%). Seven had a nadir creatinine >75 μmol/L, all of them had prenatal oligohydramnios. In this retrospective study, DCA confirms the relationship between prenatal quantity of amniotic fluid volume and postnatal renal function. © 2017 John Wiley & Sons, Ltd. © 2017 John Wiley & Sons, Ltd.

  6. Mid-urethral sling operations for stress urinary incontinence in women. (United States)

    Ford, Abigail A; Rogerson, Lynne; Cody, June D; Ogah, Joseph


    Urinary incontinence is a very common and debilitating problem affecting about 50% of women at some point in their lives. Stress urinary incontinence (SUI) is a contributory or predominant cause in 30% to 80% of these women. Mid-urethral sling (MUS) operations are a recognised minimally invasive surgical treatment for SUI. MUS involves the passage of a small strip of tape through either the retropubic or obturator space, with entry or exit points at the lower abdomen or groin, respectively. This review does not include single incision slings. To assess the clinical effects of mid-urethral sling (MUS) operations for the treatment of stress urinary incontinence (SUI), urodynamic stress incontinence (USI) or mixed urinary incontinence (MUI) in women. We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from CENTRAL, MEDLINE, MEDLINE in process, and handsearching of journals and conference proceedings (searched 26 June 2014), Embase and Embase Classic (January 1947 to Week 25 2014), WHO ICTRP (searched on 30 June 2014) and the reference lists of relevant articles. Randomised or quasi-randomised controlled trials amongst women with SUI, USI or MUI, in which both trial arms involve a MUS operation. Two review authors independently assessed the methodological quality of potentially eligible studies and extracted data from the included trials. We included 81 trials that evaluated 12,113 women. We assessed the quality of evidence for outcomes using the GRADE assessment tool; the quality of most outcomes was moderate, mainly due to risk of bias or imprecision.Fifty-five trials with data contributed by 8652 women compared the use of the transobturator route (TOR) and retropubic route (RPR). There is moderate quality evidence that in the short term (up to one year) the rate of subjective cure of TOR and RPR are similar (RR 0.98, 95% CI 0.96 to 1.00; 36 trials, 5514 women; moderate quality evidence) ranging from

  7. Management of stress urinary incontinence in spinal cord injured female patients with a mid-urethral tape - a single center experience. (United States)

    Sakalis, Vasileios I; Floyd, Michael S; Caygill, Philippa; Price, Chloe; Hartwell, Ben; Guy, Peter J; Davies, Melissa C


    Stress urinary incontinence (SUI) affects the quality of life of females with spinal cord injury (SCI), has a negative impact on functional independence and disturbs their psychosocial interaction. Our aim was to assess the efficacy of mid-urethral tapes (MUT) in managing stress urinary incontinence in this population. Retrospective cohort study. SCI females with upper motor neuron lesion and urodynamically proven stress or mixed urinary incontinence that was treated with a mid-urethral tape and followed up for at least 12 months. Mid-urethral tapes such TVT, TOT and mini-Arc. Patient reported outcomes based on the daily use of pads and ICIQ modular questionnaire scores. The primary endpoint was defined as the success rate of MUT surgery in managing stress incontinence at 12. The secondary endpoints included the improvement rate at 12 months, the complication rates and the need for additional treatments. 38 females were studied. At 12 months the overall patient reported success rate was 52.6%. 16% reported significant improvement. 68.4% felt the quality of life to improve. Nine patients develop tape related complications (five de novo urgency, one vaginal extrusion, one frequent dysreflexia and one worsening of incontinence). Mid-urethral tapes are effective in the management of stress urinary incontinence in female patients with spinal cord injury. There are demonstrable improvements in both continence and quality of life.

  8. Correction of Residual Ventral Penile Curvature After Division of the Urethral Plate in the First Stage of a 2-Stage Proximal Hypospadias Repair. (United States)

    Schlomer, Bruce J


    The first stage of a 2-stage proximal hypospadias repair involves division of the urethral plate and correction of any residual ventral penile curvature (VPC). Options to correct residual VPC include dorsal corporal shortening or ventral corporal lengthening techniques. This review discusses these options and suggests an approach to management. Recent reports of 2-stage proximal hypospadias repairs indicate low rates of recurrent VPC with either dorsal corporal shortening or ventral corporal lengthening. Dorsal corporal shortening with dorsal plication may be preferentially used for mild to moderate residual VPC after division of urethral plate and ventral corporal lengthening reserved for severe residual VPC. Ventral corporal lengthening with grafts has been associated with urethroplasty complications after the second stage hypospadias surgery. Ventral corporal lengthening with relaxing incisions of corpora has been reported, but concerns about adverse effects require longer term studies. Little guidance exists to choose the best technique for VPC correction during first stage hypospadias repair after division of urethral plate. Reported literature suggests good results with dorsal plication techniques and ventral corporal lengthening. A practical approach is to use dorsal plication techniques for mild to moderate residual VPC after division of urethral plate (45°).

  9. Partial urethral resection in the surgical treatment of vulvar cancer does not have a significant impact on urinary continence. A confirmation of an authority-based opinion

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    de Mooij, Y.; Burger, M. P. M.; Schilthuis, M. S.; Buist, M.; van der Velden, J.


    Partial resection of the urethra is sometimes necessary in the surgical treatment of locally advanced vulvar cancer. In this study, the frequency of urinary incontinence after partial urethral resection was compared with that of patients who were treated without partial resection of the urethra.

  10. Gracilis muscle interposition with primary rectal without urethral repair for moderate sized rectourethral fistula caused by brachytherapy for prostate cancer: a case report. (United States)

    Samalavicius, Narimantas Evaldas; Lunevicius, Raimundas; Gupta, Rakesh Kumar; Poskus, Tomas; Ulys, Albertas


    There is a 0.16% chance of a rectourethral fistula after prostate brachytherapy monotherapy using Palladium-103 or Iodine-125 implants. We present an unusual case report of a rectourethral fistula following brachyradiotherapy monotherapy for prostate adenocarcinoma. It was also associated with unusual management of the fistula. A 58-year-old Caucasian man underwent brachyradiotherapy monotherapy as definitive treatment for verified intracapsular prostate adenocarcinoma receiving 56 Iodine-125 implants using a transrectal ultrasound-guided technique. The patient started to complain of severe perineal pain and mild rectal bleeding 15Â months after brachyradiotherapy. A biopsy of mucosa of his anterior rectal wall was performed. A moderate sized rectourethral fistula was confirmed 23Â months after implantation of Iodine-125 seeds. Laparoscopic sigmoidostomy and suprapubic cystostomy were then performed. Long-term cortisone applications in combination with 30 sessions of hyperbaric oxygen therapy, and antibacterial therapies were initiated due to necrotic infection. A gracilis muscle interposition to create a partition between the patient's rectum and urethra in conjunction with primary rectal repair but without urethral repair were performed 6 months later. The 3cm rectal defect was repaired via a 3cm-long horizontal perineal incision. The 1.5cm urethral defect just below the prostate was not repaired. The patient underwent an optic internal urethrotomy 3Â months later for a 1.5cm-long urethral stricture. Several planned preventive urethral buginages were performed to avoid urethral stricture recurrence. At 12Â months postoperatively, there were no signs of a fistula and cancer recurrence. He now has a normal voiding and anal continence. Severe rectal pain, bleeding, and local anterior necrotic proctitis are predictors of a rectourethral fistula. Urinary and fecal diversion is the first-step operation. Gracilis muscle interposition in conjunction with primary

  11. Gracilis muscle interposition with primary rectal without urethral repair for moderate sized rectourethral fistula caused by brachytherapy for prostate cancer: a case report

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    Samalavicius Narimantas


    Full Text Available Abstract Introduction There is a 0.16% chance of a rectourethral fistula after prostate brachytherapy monotherapy using Palladium-103 or Iodine-125 implants. We present an unusual case report of a rectourethral fistula following brachyradiotherapy monotherapy for prostate adenocarcinoma. It was also associated with unusual management of the fistula. Case presentation A 58-year-old Caucasian man underwent brachyradiotherapy monotherapy as definitive treatment for verified intracapsular prostate adenocarcinoma receiving 56 Iodine-125 implants using a transrectal ultrasound-guided technique. The patient started to complain of severe perineal pain and mild rectal bleeding 15Â months after brachyradiotherapy. A biopsy of mucosa of his anterior rectal wall was performed. A moderate sized rectourethral fistula was confirmed 23Â months after implantation of Iodine-125 seeds. Laparoscopic sigmoidostomy and suprapubic cystostomy were then performed. Long-term cortisone applications in combination with 30 sessions of hyperbaric oxygen therapy, and antibacterial therapies were initiated due to necrotic infection. A gracilis muscle interposition to create a partition between the patient's rectum and urethra in conjunction with primary rectal repair but without urethral repair were performed 6 months later. The 3cm rectal defect was repaired via a 3cm-long horizontal perineal incision. The 1.5cm urethral defect just below the prostate was not repaired. The patient underwent an optic internal urethrotomy 3Â months later for a 1.5cm-long urethral stricture. Several planned preventive urethral buginages were performed to avoid urethral stricture recurrence. At 12Â months postoperatively, there were no signs of a fistula and cancer recurrence. He now has a normal voiding and anal continence. Conclusion Severe rectal pain, bleeding, and local anterior necrotic proctitis are predictors of a rectourethral fistula. Urinary and fecal diversion is the first

  12. Role of urethral plate and fossa navicularis biopsies in the detection of balanitis xerotica obliterans in boys undergoing redo hypospadias repair

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    Mohamed Sultan


    Full Text Available Objectives: To evaluate the presence of balanitis xerotica obliterans (BXO, clinically and pathologically, in the urethra of boys with failed previous hypospadias repair and where surgical management was planned. Patients and methods: Between February 2010 and March 2015, boys with failed distal penile hypospadias repair who were planned for surgical management were evaluated for the presence of clinical and pathological evidence of BXO. Samples were obtained from the urethral plate and fossa navicularis, after obtaining informed consent and ethical approval. The samples were fixed, sectioned, and haematoxylin and eosin stained for light microscopic examination. Results: In all, 157 boys were enrolled in our study, with a mean (SD age of 6.4 (2.8 years. All the boys had a history of failed hypospadias repair surgeries (once or more. The presentation was fistula in 34 boys (21.7%, meatal stenosis in 45 (28.7%, urethral stricture in 28 (17.8%, and total dehiscence in 50 (31.8%. BXO was detected clinically in 46 boys (29.3%. The total number of biopsies taken was 314, of which 124 (39.5% were pathologically BXO-positive samples. Of the 157 boys, BXO-positive cases were clinically associated with fistula in seven boys (4.5%, meatal stenosis in 18 (10.8%, urethral stricture in seven (4.5%, and total dehiscence in 15 (9.6%. Of the 314 pathological samples, pathologically BXO-positive samples were associated with fistula in 20 samples (6.4%, meatal stenosis in 40 (12.7%, urethral stricture in 22 (7%, and total dehiscence in 42 (13.4%. Conclusions: In failed hypospadias cases BXO should be considered, especially for cases with multiple failures, meatal stenosis, and total dehiscence. Urethral plate and fossa navicularis biopsies are important in planning a proper approach for subsequent repair. Keywords: Balanitis xerotica obliterans, Lichen sclerosus, Hypospadias

  13. Analysis of short-term results of monsieur′s tunica albuginea urethroplasty as a definitive procedure for pan-anterior urethral stricture

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    Adittya K Sharma


    Full Text Available Context: Long anterior urethral strictures are fairly common in developing world and the treatment is equally challenging. Aim: To assess the results and efficacy of Monsieur′s Tunica Albuginea Urethroplasty (TAU for anterior urethral stricture. Settings and Design: We analyzed the results in 10 consecutive patients with pan-anterior urethral stricture, who underwent Monsieur′s urethroplasty. Materials and Methods: The procedure involves mobilization of strictured urethra and laying it open with a dorsal slit. Edges of the slit-open urethra are sutured to edges of the urethral groove to the tunica of corporal bodies with catheter in situ. Results were assessed postoperatively 3, 6, 9 and 12 months. Patients were categorized as success and failure by comparative analysis of patient satisfaction along with urethroscopy, retrograde urethrogram, uroflowmetry. All patients were taken for post-operative urethroscopic analysis at 6 months to allow better understanding of both successful and failed cases. Results: Mean follow-up of 15.2 (11-19 months showed an 80% success rate. Mean uroflow rate showed Qmax 24.5 cc/sec with 8 cases showing no residual or recurrent stricture. Two cases failed and required intervention. Urethroscopic visualization of the reconstruction site showed wide, patent and distensible neourethra appearing epithelized over roof formed by tunica albuginea of the corpora cavernosa in successful cases. Conclusion: Monsieur′s TAU is effective technique in treatment of anterior urethral stricture especially cases with unavailable buccal mucosa, with results fairly acceptable at the end of one year.

  14. SU-E-T-767: Treatment Planning Study of Prostate Cancer by CyberKnife with Respect to the Urethral Dose

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    Mizuno, H; Mizuno, H; Sumida, I; Otani, Y; Yagi, M; Takashina, M; Suzuki, O; Yoshioka, Y; Koizumi, M; Ogawa, K [Osaka University, Suita, Osaka (Japan)


    Purpose: Hypo-fractionated stereotactic body radiation therapy (SBRT) with intensity modulated radiation therapy (IMRT) is nowadays one of the treatment strategies for prostate cancer. There are few reports on planning study of prostate cancer by CyberKnife with respect to the urethral dose because of the invisibility in CT. We have investigated a planning method using fixed collimators with considering dose homogeneity, conformity and urethral dose. Methods: Radiotherapy treatment planning of prostate cancer were under a clinical trial approved by the institutional review board. The prescription dose of 35 Gy were delivered to the PTV in five fractions with the urethral catheter. Urethra position was identified by pretreatment CT and catheter, which was inserted before treatment planning CT and released after the treatment. All plans agreed to the criteria as shown in table 1, and the following constraints were recommended as well: the prescribed iso-dose line should be from 70% to 90%; the total MU should be below 50,000 MU; the minimum MU per beam should be larger than 15 MU; the estimated delivery time (excluding patient setup time) by Multiplan with image time interval of 60 s should be less than 35 min. Collimator size and position were decided as shown in figure 1. Fixed collimator of 15 mm was positioned around urethra and PTV for avoiding high dose of urethra and achieving conformity, and fixed collimator of 30 or 40 were positioned around PTV for achieving dose homogeneity. Results: With this method, all constraints were achieved. (Table 1, Figure 2) Max dose of urethra was ranging from 103.9% to 114.2%, because urethra position was identified by pretreatment CT and urethral catheter. Conclusion: Hypo-fractionated SBRT with IMRT utilizing urethral catheter could be a promising new treatment option for prostate cancer. This work was supported by JSPS Core-to-Core program Number 23003.

  15. Reconstruction of the urethra with a Surgisis® onlay patch in urethral reconstructive surgery: two case reports

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    Ecke Thorsten H


    Full Text Available Abstract Introduction We present two case reports of patients with recurrent stricture of the urethra. We used Surgisis® for reconstruction. Case presentation In these two case reports, we show the positive results of reconstructive surgery with Surgisis® as an alternative surgical approach to common onlay patch surgery of the urethra performed on two Caucasian patients: a 48-year-old man and a 55-year-old man. Conclusion Compared to buccal mucosa flap or foreskin graft surgeries for urethral reconstruction, reconstructive surgery with Surgisis® is considered a relevant therapeutic alternative because of the shorter operation time and the preventable surgery of the buccal cavity or foreskin.

  16. Reduction of Image Artifacts in Mice by Bladder Flushing with a Novel Double-Lumen Urethral Catheter

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    Chad R. Haney


    Full Text Available In electron paramagnetic resonance imaging (EPRI, the accumulation of contrast agent in the bladder can create a very large source of signal, often far greater than that of the organ of interest. Mouse model images have become increasingly important in preclinical testing. To minimize bladder accumulation on mouse images, we developed a novel, minimally invasive, MRI/EPRI-friendly procedure for flushing a female mouse bladder. It is also applicable to other imaging techniques, for example, PET, SPECT, etc., where contrast agent accumulation in the bladder is also undesirable. A double-lumen urethral catheter was developed, using a standard IV catheter with a silicone tube extension, having a polyethylene tube threaded into the IV catheter. Flushing of the bladder provides a substantial reduction in artifacts, as shown in images of tumors in mice.

  17. Multicenter Analysis of Urinary Urgency and Urge Incontinence in Patients with Anterior Urethral Stricture Disease before and after Urethroplasty. (United States)

    Hampson, Lindsay A; Elliott, Sean P; Erickson, Bradley A; Vanni, Alex J; Myers, Jeremy B; McClung, Christopher; Breyer, Benjamin N; Smith, Thomas G; Hagedorn, Judith C; Voelzke, Bryan B


    Little published data exist on the impact of urethral stricture surgery on urinary urgency. We evaluated urinary urgency and urge incontinence before and after anterior urethroplasty. Male patients who underwent 1-stage anterior urethroplasty were retrospectively identified at 8 centers. Patients with preoperative and 2-month or greater postoperative subjective urinary urgency assessments were included in study. Patients who received anticholinergic medications preoperatively were excluded. Univariate and multivariate analysis was done to analyze the association of patient characteristics with preoperative and postoperative symptoms as well as improvement or worsening of symptoms after surgery. Symptom and followup data on urgency and urge incontinence were available in in 439 and 305 patients, respectively. Preoperatively 58% of the men reported urgency and 31% reported urge incontinence. Postoperatively this decreased to 40% of men for urgency and 12% for urge incontinence (each p incontinence. Few of those without preoperative symptoms showed worse symptoms, including urgency in 9% and urge incontinence in 5%. New urgency was more likely to develop in men with a higher body mass index (OR 1.09, p = 0.02). Men with stricture recurrence were less likely to show improvement in urgency (OR 0.24, p = 0.03). Older men were more likely to have new urge incontinence (OR 1.06, p = 0.01) and less likely to notice improvement in urge symptoms (OR 0.92, p incontinence in male patients with anterior urethral stricture is high. The majority of men experience symptom stability or improvement in urinary urge symptoms following anterior urethroplasty. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  18. Dose perturbation due to the presence of a prostatic urethral stent in patients receiving pelvic radiotherapy: an in vitro study. (United States)

    Gez, E; Cederbaum, M; Yachia, D; Bar-Deroma, R; Kuten, A


    Temporary metallic intraprostatic stent is a new alternative treatment for patients with urinary obstructive syndrome caused by prostate cancer. Definitive radiotherapy is a treatment of choice for localized prostate cancer. This study evaluates in vitro the effect of a urethral intraprostatic metallic stent on the dose absorbed by the surrounding tissue. The study was designed to mimic the conditions under which the prostatic stent is placed in the body during pelvic irradiation. A urethral stent composed of a 50% nickel-50% titanium alloy (Uracoil-InStent) was imbedded in material mimicking normal tissue (bolus) at a simulated body depth of 10 cm. The distribution of the absorbed dose of irradiation was determined by film dosimetry using Kodak X-Omat V film. Irradiation was done in a single field at the isocenter of a 6 MV linear accelerator with a field size of 7 x 7 cm. The degree of film blackening was in direct proportion to the absorbed dose. The measurements showed an increase in dose of up to 20% immediately before the stent and a decrease of up to 18% immediately after the stent. These changes occurred within a range of 1-3 mm from both sides of the stent. In practice, irradiation in prostate cancer is given by two pairs of opposed co-axial fields; a total of four fields (Box Technique). The dose perturbations are partly cancelled in a pair of opposed beams resulting in a net variation of +/- 4%; therefore, the presence of the intraprostatic stent should not influence radiotherapy planning for prostate cancer.

  19. A Randomized Study of Intraoperative Autologous Retropubic Urethral Sling on Urinary Control after Robotic Assisted Radical Prostatectomy. (United States)

    Nguyen, Hao G; Punnen, Sanoj; Cowan, Janet E; Leapman, Michael; Cary, Clint; Welty, Christopher; Weinberg, Vivian; Cooperberg, Matthew R; Meng, Maxwell V; Greene, Kirsten L; Garcia, Maurice; Carroll, Peter R


    We evaluated whether placement of a retropubic urethral sling fashioned from autologous vas deferens during robotic assisted radical prostatectomy would improve recovery of continence. In a phase 2, single blind trial age stratified patients were randomized to undergo robotic assisted radical prostatectomy by multiple surgeons with or without sling placement. The outcomes were complete continence (0 urinary pads of any type) and near continence (0, an occasional or 1 pad per day) at 6 months, which was assessed by the Fisher exact test and logistic regression. The Kaplan-Meier method and the log rank test were used to evaluate time to continence. EPIC-UIN (Expanded Prostate Cancer Index Composite-Urinary Inventory) and I-PSS (International Prostate Symptom Score) 1, 3 and 6 months after catheter removal were evaluated by mixed models for repeated measures. Of 203 patients who were recruited 95 and 100 were randomized to undergo sling and no sling placement, respectively, and completed postoperative interviews. Six months after surgery the proportions reporting complete and near continence (66% and 87%, respectively) and times to complete and near continence were similar in the groups. Younger age was associated with a higher likelihood of complete continence (OR 1.74 per decreasing 5-year interval, 95% CI 1.23-2.48, p <0.01) and near continence (OR 2.18 per decreasing 5-year interval, 95% CI 1.21-3.92, p <0.01) adjusting for clinical, urinary and surgical factors. Adjusted EPIC-UIN and I-PSS scores changed with time but did not differ between the groups. No serious adverse events were observed. This trial failed to demonstrate a benefit of autologous urethral sling placement at robotic assisted radical prostatectomy on early return of continence at 6 months. Continence was related to patient age in adjusted models. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  20. Intraoperative maximal urethral closing pressure measurement: a new technique of tape tension adjustment in transobturator sling surgery?

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    Myung Beum Kang


    Full Text Available PURPOSE: Tape tension adjustment is an essential procedure in mid-urethral sling surgery. The goal of this study was to determine if intraoperative maximal urethral closing pressure (MUCP elevation could be used as a reference value for adequate tape tension adjustment and predict transobturator (TOT sling surgery outcome. MATERIALS AND METHODS: A prospective study was performed using MUCP measurements just before tape insertion and just after tension adjustment during surgery. Clinical data including preoperative urodynamic results were collected. The cure rate was determined by questionnaire. Patients were divided into two groups. The MUCP elevation group included patients with a MUCP elevation of more than 10 cmH2O before tape insertion; the others were regarded as the non-elevation group. The cure rate and pre- and postoperative clinical variables were compared between the two groups. RESULTS: A total of 48 patients had TOT surgery. The MUCP elevation group (n=19 and the non-elevation group (n=29 were similar with regard to patient characteristics and the preoperative parameters including age, mixed incontinence prevalence, Q-tip angle, peak flow rate, MUCP and the valsalva leak point pressure (VLPP. The mean follow-up period was nine months. The cure rate was significantly higher in the group with MUCP elevation than in the non-elevation group (84% vs. 52%, p=0.02. There was no significant difference in the mean postoperative peak flow rate between the two groups and there was no retention episode. CONCLUSIONS: MUCP elevation of more than 10 cmH2O just after tape insertion was a prognostic factor.

  1. Successful treatment of a 67-year-old woman with urethral adenocarcinoma with the use of external beam radiotherapy and image guided adaptive interstitial brachytherapy

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    Jasmin Mujkanovic


    Full Text Available Primary urethral cancer (PUC is a very rare disease. This case report illustrates a successful treatment approach of a 67-year-old woman with a urethral adenocarcinoma selected for an organ preserving treatment with external beam radiotherapy (EBRT and interstitial brachytherapy (BT boost, using the GEC-ESTRO target concept originally designed for locally advanced cervical cancer (LACC. Treatment included EBRT with 45 Gy in 25 fractions followed by image guided adaptive interstitial BT (IGABT with a pulsed-dose-rate (PDR BT boost with 30 Gy in 50 hourly pulses. The D 90 for CTV HR was 79.1 Gy in EQD23. At 24 months follow-up, the patient was recurrence free and without treatment related side effects.

  2. Successful treatment of a 67-year-old woman with urethral adenocarcinoma with the use of external beam radiotherapy and image guided adaptive interstitial brachytherapy. (United States)

    Mujkanovic, Jasmin; Tanderup, Kari; Agerbæk, Mads; Bisgaard, Ulla; Høyer, Søren; Lindegaard, Jacob Christian; Fokdal, Lars


    Primary urethral cancer (PUC) is a very rare disease. This case report illustrates a successful treatment approach of a 67-year-old woman with a urethral adenocarcinoma selected for an organ preserving treatment with external beam radiotherapy (EBRT) and interstitial brachytherapy (BT) boost, using the GEC-ESTRO target concept originally designed for locally advanced cervical cancer (LACC). Treatment included EBRT with 45 Gy in 25 fractions followed by image guided adaptive interstitial BT (IGABT) with a pulsed-dose-rate (PDR) BT boost with 30 Gy in 50 hourly pulses. The D 90 for CTV HR was 79.1 Gy in EQD2 3 . At 24 months follow-up, the patient was recurrence free and without treatment related side effects.

  3. A national population-based cohort study of urethral injection therapy for female stress and mixed urinary incontinence: the Danish Urogynaecological Database, 2007-2011

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    Hansen, Margrethe Foss; Lose, Gunnar; Kesmodel, Ulrik Schioler


    Introduction and hypothesis Urethral injection therapy (UIT) has been performed since the early 20th century and a variety of agents have been launched. In 2006, polyacrylamide hydrogel (PAGH) was introduced and is now widely used as an agent. The objective was to evaluate the efficacy of PAGH ba....... A surgeon learning curve for UIT was indicated, as was assigning interventions to fewer hands to improve the surgical training value and consequently the cure rate for women with UIT....

  4. Prevention of Urethral Retraction with Stay Sutures (PURS) During Robot-Assisted Radical Prostatectomy Improves Early Urinary Control: A Prospective Cohort Study. (United States)

    Argun, Omer Burak; Tuna, Mustafa Bilal; Doganca, Tunkut; Obek, Can; Mourmouris, Panagiotis; Tufek, Ilter; Erdogan, Sarper; Cetinel, Bulent; Kural, Ali Rıza


    To evaluate early continence rates with a novel modified vesicourethral anastomosis technique based on prevention of urethral retraction using anastomosis sutures as stay sutures (PURS) during robot-assisted radical prostatectomy. Sixty patients operated by a single surgeon were enrolled and data collected prospectively. This cohort was compared with another consecutive 60 patients operated with standard anastomosis. The new technique is based on preventing urethral retraction of the posterior urethra with two anastomosis sutures being used as stay sutures. The outcomes were prospectively followed and groups compared regarding early continence. International Consultation on Incontinence Questionnaire Short Form was used to assess incontinence and its impact on the quality of life. Pad use (yes or no pads) was evaluated as a more stringent criterion. Preoperative patient characteristics were similar between the two groups. Anastomosis was completed faster in PURS group (15.1 vs 18.5 min, p = 0.05). At postoperative week 1 and month 1, the severity and bother of incontinence were significantly less in the PURS group (12.7 vs 4.1 and 10.1 vs 2.6, p < 0.001). PURS cohort reported significantly superior pad-free rates at both postoperative month 1 (73% vs 35%, p < 0.0001) and month 3 (83% vs 53%, p = 0.0004). On multivariable analysis, younger age and the new anastomosis technique were two independent predictors to improve early continence. Four patients in modified anastomosis group (4/60) and 1 in standard anastomosis group (1/60) necessitated temporary urethral recatheterization because of urinary retention. We describe a simple and time-efficient modified urethrovesical anastomosis technique by using anastomosis sutures as stay sutures to prevent perineal retraction of the urethral stump. Our results demonstrated that the technique is an independent factor impacting early recovery of urinary continence. Future randomized controlled studies would be

  5. Squamous Cell Carcinoma Penis in a Case of Urethral Stricture Due to Lichen Sclerosus Balanitis Xerotica Obliterans: A Case Report and Review of Literature. (United States)

    Taneja, Yogesh; Ram, Priyatama; Dhaked, Santosh Kumar; Sen, Tridib Kumar


    Penile carcinoma is considered a delayed sequel of lichen sclerosus. It is important to recognize this not so uncommon complication in time as survival of patients with Squamous Cell Carcinoma (SCC) depends on early diagnosis and treatment. We describe a case of a 49-year-old male presenting with urethral stricture due to lichen sclerosus. He was treated for stricture disease and later on developed SCC penis after ten years of presentation.

  6. Charles Richard de Beauregard and the treatment of blennorrhagic urethral stenosis in Madrid in the 18th century: Advertising, secrecy and deception. (United States)

    Gómiz, J J; Galindo, I


    Describe the introduction of the treatment for blennorrhagic urethral stenosis in the city of Madrid in the 18th century by the French surgeon Charles de Beauregard, the formulations employed in the preparation of his personal «bougies», the advertising in the press, their marketing and distribution. Nonsystematic review of the Madrid newspaper Gaceta de Madrid y Diario curioso, erudito, económico y comercial (Madrid Gazette, curious, erudite, financial and commercial) between 1759 and 1790. Review of the medical literature of the 18th century preserved in the Fondo Antiguo of the Biblioteca Histórica of Universidad Complutense de Madrid (Historical Resource of the Historical Library of the Complutense University of Madrid). A Google search of «Charles Richard de Beauregard». Charles de Beauregard focused his professional work mainly on the treatment of the urethral sequela of blennorrhagia, phimosis and paraphimosis. He introduced to 18th century Spanish society (with purported originality and clear commercial interests) therapeutic methods based on lead acetate that had already been developed in France by Thomas Goulard. The urethral sequela of diseases such as blennorrhagic urethritis, stenotic phimosis and paraphimosis were highly prevalent in 18th century Madrid and required complex solutions for the practice of urology of that era. Charles de Beauregard introduced innovative but not original treatments that were invasive but not bloody and that provided him with fame and social prestige. He advertised his professional activity and marketed his therapeutic products through advertisements submitted to the daily press (Madrid Gazette, Gaceta de Madrid). Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Epidemiology and laboratory characteristics of Trichomonas vaginalis infection in Croatian men with and without urethritis syndrome: a case-control study. (United States)

    Sviben, Mario; Missoni, Emilija Mlinarić; Meštrović, Tomislav; Vojnović, Gordana; Galinović, Gordana Mlinarić


    The main objective of this study is to determine the prevalence of trichomoniasis in men with and without symptoms of urethritis, with concomitant analysis of sociodemographic and behavioural specificities of both groups. Also, the objective is to evaluate laboratory methods used in the diagnostics of this parasitic disease. A total of 500 men with and 200 without urethritis symptoms were included in the study. Every respondent filled out a questionnaire asking for some general data, specific information about habits, sexual behaviour and symptoms. Sediment of first void urine was analysed by wet mount microscopy, cultivation in Diamond's medium and real-time PCR. In the symptomatic group, Trichomonas vaginalis infection was documented in 2.4% of respondents by wet mount microscopy, in 4.8% by cultivation and in 8.2% by real-time PCR. In the asymptomatic group, infection was proven using the same methods in 1.0%, 1.5% and 2.0% of the respondents, respectively. Trichomoniasis prevalence was statistically significantly higher in the respondents manifesting urethritis symptoms when cultivation (χ2=4.20, p=0.041) and real-time PCR (χ2=9.20, p=0.002) were used. Several epidemiological risk factors were identified, and greater sensitivity of real-time PCR was found in comparison with microscopy and culture. Trichomonas infection was statistically more frequent in men with urethritis syndrome. Assuming that the samples found positive by any laboratory technique are truly positive, it can be concluded that the real-time PCR showed the greatest sensitivity of all the methods used in this study. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  8. Comparison between transurethral ultrasound and conventional urethrography in male urethral stricture; Uretrosonografia. Comparacion con la uretrografia convenctional en la estenosis de uretra masculina

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    Fernandez, G. C.; Rivas, C.; Rivas, B.; Perez, M.; Peasqueira, D.; Tardaguila, F. [Hospital Povisa. Vigo. Pontevedra (Spain)


    To define the role of transurethral ultrasound in the study of male urethral structure. A prospective study was carried out in 19 consecutive patients with male urethral structure, diagnosed by means of conventional urethrography, who subsequently underwent transurethral ultrasound. The latter study consisted of the introduction of a Foley catheter (8 or 10 F) and gradual inflation of the balloon within the navicular fossa. Sterile saline solution was then slowly and continuously infused while the ultrasound was carried out by placing the transducer on the ventral aspect of the penis and in the perineal region to identify the different portions of the urethra. The location and extension of the structure were determined by both radiological techniques, and adjacent areas of fibrosis (spongiofibrosis) were detected by ultrasound. The results correlated with the pathological findings in 10 case. There was good agreement between the two techniques in the localization of the structure (kappa=0.81). However, there were statistically significant differences in the measurements of the extension (p=0.01). Transurethral ultrasound revealed areas of spongiofibrosis adjacent to the structure that presented a different echogenicity. The results of the measurement of their extension were not significantly different from those found in the pathological study. Transurethral ultrasound is more effective than conventional urethrography in the study of urethral structure since it permits the precise measurement and localization of the structure and the visualization of the zone of spongiofibrosis, a determining factor in surgical planning. (Author) 11 refs.

  9. The effectiveness of otis urethrotomy combined with six weeks urethral dilations until 40 Fr in the treatment of bladder outlet obstruction in women: a prospective study. (United States)

    Grivas, Nikolaos; Tsimaris, Ioannis; Makatsori, Aikaterini; Hastazeris, Konstantinos; Kafarakis, Vasillios; Stavropoulos, Nikolaos E


    To evaluate the effectiveness of Otis urethrotomy combined with six weekly urethral dilations until 40 French (Fr) in the treatment of women with urodynamic diagnosis of bladder outlet obstruction (BOO). Women diagnosed with lower urinary tract symptoms underwent urodynamic evaluation. Severity of symptoms and quality of life were assessed with international prostate symptom score (IPSS) and quality of life (QoL) questionnaires. Bladder outlet obstruction was defined as the presence of two or more of the following: maximum flow rate (Qmax) 50 cmH2O and urethral resistance factor (URF) greater than 0.2. Ten out of 25 women diagnosed with BOO met the criteria. All women underwent Otis urethrotomy to 40 F and six-week urethral dilations until 40 F. After six months all patients underwent free uroflowmetry. Moreover post voiding residual (PVR), IPSS-QoL were recorded. Six months post-operatively there was a significant improvement in all parameters: IPSS = 13.5 vs. 22.5 (P = .001), QoL = 3 vs. 5 (P = .001), voided volume = 312 mL vs. 216 mL (P = .055), Qmax = 27.5 mL/s vs. 12 mL/s (P = .001), and PVR = 27.5 mL vs. 170 mL (P = .005). Five women had close follow up during an average of 82 months. They maintained improved QoL (P women with evidence of BOO not related to detrusor sphincter dyssynergia or obvious functional and anatomical pathology.

  10. For reliable urine cultures in the detection of complicated urinary tract infection, do we use urine specimens obtained with urethral catheter or a nephrostomy tube? (United States)

    Dede, Gülay; Deveci, Özcan; Dede, Onur; Utanğac, Mazhar; Dağgulli, Mansur; Penbegül, Necmettin; Hatipoğlu, Namık Kemal


    The aim of this study was to compare the results of urine cultures obtained either from urethral, and percutaneous nephrostomy (PCN) catheters. This study included 328 consecutive patients that underwent PCN at our institution with complicated urinary tract infections (UTIs) between July 2010 and April 2015. Results of urine cultures obtained from the urethral and nephrostomy catheters were compared. This study included 152 male and 176 female patients. Mean age of the patients was 46.2±24.3 years. The main indications were obstructive uropathy due to urolithiasis complicated with pyonephrosis 145 (44%), malignant disease (n=87; 26%), pregnancy (n=26; 8%), and anatomical abnormality (n=23; 7%). One hundred and twenty three patients had diabetes mellitus. The most common causative organisms were Escherichia coli , Klebsiella pneumoniae , and Pseudomonas aeruginosa . Blood cultures showed the same results for the PCN and bladder urine cultures. The bladder urine culture was positive in 304 patients, while the PCN urine culture in 314 patients. PCN is an important treatment for the management of pyonephrosis. Cultures from the PCN yield valuable information that is not available from urethral urine cultures, and is a guiding tool for antibiotic therapy selection.

  11. A modified vaginal wall patch sling technique as a first-line surgical approach for genuine stress incontinence with urethral hypermobility: long-term follow up. (United States)

    Mikhail, Magdy S; Rosa, Hector; Packer, Paul; Palan, Prabhudas; Lazarou, George


    We describe our long-term outcome for patients with genuine stress incontinence (GSI) and urethral hypermobility using a modified vaginal wall patch sling technique. Fifty-three patients were studied. Preoperatively, all patients had a positive standing stress test and urethral hypermobility on Q-tip testing. On urodynamics, all patients had absence of detrusor contractions on subtracted cystometry. The mean age of the patients was 45+10.2 years. Forty-four patients demonstrated complete symptomatic and urodynamic improvement. Five patients had a noticeable failure observed within the first 12 months of follow up and four patients developed later recurrence despite initial success. The overall success rate after 5 years of follow up was 83% (n=44/53). The modified vaginal wall patch sling technique appears to have a good long-term success rate with low operative morbidity and minimal postoperative voiding dysfunction. The patch sling can be used as a first-line surgical approach for GSI with urethral hypermobility and be combined with other vaginal surgery.

  12. Isolation of Chlamydia trachomatis from men with urethritis: relative value of one vs. two swabs and influence of concomitant gonococcal infection. (United States)

    Singal, S S; Reichman, R C; Graman, P S; Greisberger, C; Trupei, M A; Menegus, M A


    Two successive urethral swabs were used to obtain specimens for culture of Neisseria gonorrhoeae and Chlamydia trachomatis from 136 heterosexual men with urethritis. The first swab was used to culture N. gonorrhoeae and then C. trachomatis; the second was used to culture C. trachomatis only. C. trachomatis cultures from the second swab were positive more often (30 of 31 pairs) than were cultures from the first swab (22 of 31 pairs) (P less than .05). In addition, cultures from swab 2 had greater numbers of inclusions per coverslip more frequently (23 of 31 pairs) than did cultures from the first swab (six of 31 pairs) (P = .003). Numbers of chlamydial inclusions per coverslip were lower in specimens positive for both C. trachomatis and N. gonorrhoeae than in specimens positive for C. trachomatis only (P less than .02). In addition, the presence of N. gonorrhoeae in a specimen adversely affected the quality of the McCoy cell monolayer. In 17 of 21 instances of monolayer toxicity, cultures for N. gonorrhoeae were positive (P less than .01). These results demonstrate that when specimens from men with urethritis are cultured for N. gonorrhoeae and C. trachomatis, use of a second swab will improve rates of recovery of C. trachomatis. Material present in specimens that contain N. gonorrhoeae may adversely affect rates of isolation of C. trachomatis.

  13. Urethroplasty with dorsal buccal mucosa graft. Is it still the method of choice in long term urethral stenosis?

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    Carlo Pavone


    Full Text Available The aim of our work was to evaluate the long-term changes in symptoms (median 42 months and to analyze data for any negative predictive factors for the application of the procedure, in patients who underwent to urethroplasty with dorsal buccal mucosa graft. During the period from 2010 to 2015 27 patients were examined. Than they underwent urethroplasty using dorsal buccal mucosa graft (graft of 4 x 2.5 cm. The evaluation of symptoms has been addressed through the application of the IPSS Quality of Life Questionnaire (International Prostatic Symptoms Score and the evaluation of urinary flow has been carried out by a comparative analysis between the pre- and post-operative uroflowmetry. As our study has shown, data obtained by the screening tests in the post-operative follow-up indicate that there is an increase in the maximum flow of urine until 1 month after surgery. The results in the long-term follow-up are different because they show a partial reduction of the maximum flow although it is maintained around an average value of 23 ml/s being still higher than the maximum flow in the pre-operative period. According to our results it follows that there is a low failure rate of the procedure after a median of 42 months. Only in patients with urethral stenosis longer than 2 cm, a lower long term success is achieved. From what we could observe, this length of the stenosis seems to be the only negative predictive factor for long-term maintenance of a good Quality of Life in patients undergoing the procedure. The results obtained from our study confirm literature data according to which, the gold standard for 2-cm long bulbar urethral stricture whose lumen is well preserved with circumferential spongiofibrosis limited to 1-2 mm is the dorsal graft urethroplasty with buccal mucosa that in our study showed success rates higher of 80% after a median follow up of 42 months and a percentage of relapse-free patients of 82.1% ( median 3.5 years.

  14. Detecção de Mycoplasma genitalium, M. fermentans e M. penetrans em pacientes com sintomas de uretrite e em indivíduos infectados pelo HIV-1 no Brasil Detection of Mycoplasma genitalium, M. fermentans and M. penetrans in patients with symptoms of urethritis and in HIV-1 infected persons in Brazil

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    Caio Mauricio Mendes de Cordova


    Full Text Available Neste trabalho investigamos a prevalência de três espécies de micoplasma recém-identificadas como patógenos humanos, M. genitalium, implicado em casos de uretrite não-gonocócica, e M. fermentans e M. penetrans, isolados de pacientes imunodeprimidos, e das duas espécies mais freqüentes no trato geniturinário, M. hominis e U. urealyticum. Foram estudados 110 pacientes com sintomas de uretrite (grupo A e 106 indivíduos infectados pelo HIV-1 (grupo B. M. genitalium foi detectado em 10,9% das amostras de raspado uretral do grupo A, e em 1,9% das amostras de raspado uretral e 0,9% das amostras de urina do grupo B. M. fermentans foi detectado em 0,9% e 5,7% das amostras de raspado uretral dos grupos A e B, respectivamente. M. penetrans foi detectado em 6,6% das amostras de urina somente do grupo B. M. hominis e U. urealyticum tiveram taxas de infecção de 0,9% e 14,5% no grupo A, e de 7,5% e 18,9% no grupo B, respectivamente. A relevante prevalência da infecção por estas novas espécies, em comparação aos micoplasmas mais conhecidos do trato urogenital, sugere que a magnitude do papel destes microrganismos no âmbito das doenças sexualmente transmissíveis (DST e da infecção pelo HIV pode estar sendo subestimada em nossa população.In this work the prevalence of three mycoplasma species recently identified as human pathogens was investigated: M. genitalium, involved in cases of non-gonococcal urethritis, and M. fermentans and M. penetrans, isolated from immunosupressed individuals, and the 2 species more frequently isolated from the urogenital tract: M. hominis and U. urealyticum. Studied groups were composed by 110 patients with symptoms of urethritis (group A and 106 HIV-1-infected individuals (group B. M. genitalium was detected in 10.9% of the urethral swab samples from the group A, and in 1.9% of the urethral swab samples and 0.9% of the urine samples from the group B. M. fermentans was detected in 0.9% and 5.7% of the

  15. Improved semen collection method for wild felids: urethral catheterization yields high sperm quality in African lions (Panthera leo). (United States)

    Lueders, I; Luther, I; Scheepers, G; van der Horst, G


    For wild and domestic felids, electroejaculation (EE) is the most common semen collection method. However, the equipment is expensive, there is a risk of urine contamination and animals usually show strong muscular contraction despite general anesthesia. Accordingly, we tested the feasibility of a different approach using urethral catheterization (UC) in seven African lions, previously described for domestic cats only. After general anesthesia with the α2-agonist medetomidine (which also stimulates semen release into the urethra) and ketamine, a transrectal ultrasound was performed to locate the prostate. A commercial dog urinary catheter (2.6 or 3.3 mm in diameter) was advanced approximately 30 cm into the urethra to allow semen collection into the lumen of the catheter by capillary forces. After retraction, sperm volumes between of 422.86 ± 296.07 μl yielded motility of 88.83 ± 13.27% (mean ± SD) with a mean sperm concentration of 1.94 × 10(9)/ml. Here we describe a simple, field friendly and effective method to attain highly concentrated semen samples with excellent motility in lions and potentially other wild felid species as an alternative to electroejaculation. Copyright © 2012 Elsevier Inc. All rights reserved.

  16. Increase of the perirectal and perivesical fat tissue in the chronic urethral obstructive disease. Evaluation by CT scan

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    Kushihashi, Tamio; Takenaka, Hiroki; Gokan, Takehiko; Komatsu, Takashi; Munechika, Hirotsugu; Hishida, Toyohiko; Fujii, Noriteru; Imamura, Kazuo


    The perirectal space (sacro-rectal distance=PS value) and perivesical space (acetabulo-vesical distance=PV value) were evaluated by CT in 56 patients, of which 22 had no particular intrapelvic diseases and 34 had prostatic hypertrophy or prostatic carcinoma. In the former group of patients, the mean PS and PV value were 0.72 cm and 0.25 cm respectively. PS value over 1.0 cm was seen in 18% of the patients. On the other hand, in the latter group of patients, the mean PS and PV value were 1.45 cm and 0.62 cm respectively. PS value over 1.0 cm was seen in 73% of the patients. The CT attenuation value of these spaces indicated to be filled with the fatty tissue. It should be concluded from these results that the chronic urethral obstruction was one of the causes to produce accumulation of the fatty tissue in the intrapelvic space. (author).

  17. The Outcome of Repeated Mid Urethral Sling in SUI Treatment after Vaginal Excisions of Primary Failed Sling: Preliminary Study

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    Jacek Kociszewski


    Full Text Available Mid urethral sling is the standard in SUI treatment. Nevertheless, the risk of reoperation reaches 9%. There is no consensus as to the best treatment option for complications. A question is raised: what is the optimal way to achieve the best result in patients after primary failure? The aim of the study was to evaluate the outcomes of repeat MUS surgery in patients after excision of the sling with recurrent SUI. We compared its effectiveness with uncomplicated cases treated with TVT. 27 patients who underwent the repeated MUS and 50 consecutive patients after primary TVT were enrolled in the study. After 6 months, we have found that 24 (88.46% patients from repeat sling group and 48 (96% patients after primary sling were dry (1-hour pad test, 2 g or less. The difference between groups was not significant. We showed statistically significant improvement of quality of life in both groups. In conclusion, we showed that repeated sling after MUS excision is almost as effective as primary MUS. We postulate that sling excision and repeated MUS may be the best option for persistent SUI and/or complications after MUS procedures. Further multicenter observations are ongoing as to provide results on bigger group of cases.

  18. Supraspinal control of motoneurons innervating the striated muscles of the pelvic floor including urethral and anal sphincters in the cat. (United States)

    Holstege, G; Tan, J


    The nucleus of Onuf (ON) in mammals contains motoneurons innervating the pelvic floor muscles including the external urethral and anal sphincters. Recently, direct pathways from the dorsolateral pons to the ON, probably involved in supraspinal micturition control, have been reported (Holstege et al., 1986). Since the pelvic floor muscles are involved not only in micturition but also in various other functions (e.g., coughing, vomiting, defaecation, parturition), an attempt has been made to establish whether, in the cat, there exist other direct brainstem pathways to the ON motoneurons. Our results indicate that specific projections to the ON are derived from 3 different areas: (1) the ipsilateral paraventricular hypothalamic nucleus; (2) the ipsilateral caudal pontine lateral reticular formation; and (3) the contralateral caudal nucleus retroambiguus. More diffuse projections (to all motoneuronal cell groups in the spinal cord including the ON) are derived from (1) neurons in the area of the nucleus subcoeruleus in the dorsolateral pontine reticular formation, (2) the nucleus raphe pallidus, and (3) the ventral part of the medullary medial reticular formation. Possible functional implications of these pathways are discussed.

  19. Cateterismo Uretral: un tema para la reflexión Urethral catheterism: A subject for the reflection

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    Bertha Ligia Diez M.


    Full Text Available El presente artículo trata del cateterismo uretral inspirado en acciones de prevención y de cuidado integral a la persona. Se propone una guía técnica para el procedimiento con aportes de otras guías basadas en evidencia, además invita a la reflexión a partir del análisis de los riesgos que implica, especialmente los que tienen que ver con la infección urinaria, importante causa de la infección intrahospitalaria. De esta manera se quiere problematizar el papel y la responsabilidad del profesional de enfermería frente a este procedimiento, subrayando la necesidad de practicarlo de manera consciente, con un conocimiento profundo de las indicaciones, riesgos, manejo y medidas alternas que facilitan la eliminación urinaria. Se hace énfasis en los principios éticos de beneficencia no maleficencia como garantes de la calidad del cuidado de enfermería, expresada en el bienestar integral del paciente y su familia.This article deals with urethral catheterism and it is inspired by the actions for the preventive and integral care of the persons. A technical guide for the procedure is proposed with contributions of others evidence based guides. The analysis of the implicated risks is taken into account, particularly those related to urinary infection which is an important cause of interhospitalary infection. Accordingly the problems related with the role and the nurses professional responsibility in this procedure are considered stressing how has to be practiced in the utmost conscious manner, with the deepest knowledge of the instructions, risks, handling and alternative procedures helping urinary elimination.The beneficial ethical principles are stressed to warrant the quality of the nursing care to ensure the patient and his family integral well-being.

  20. Ablation of posterior urethral valves in the newborn using Fogarty balloon catheter: A simple method for developing countries. (United States)

    Kyi, A; Maung, M; Saing, H


    The aim of this study was to review the efficacy and safety of using a Fogarty balloon catheter to ablate posterior urethral valves (PUV) in the newborn in a developing country. Five newborn babies weighing 1.4 to 3.9 kg (mean, 2.08 kg; with 4 weighing less than 2.0 kg) who had severe obstructive uropathy caused by PUV were subjected to valve ablation using a size 6F Fogarty balloon catheter in the radiology department without anesthesia. The ages ranged from 10 to 61 days (mean, 26.4 days) at the time of valve ablation. Successful ablation of PUV was achieved in 4 of 5 (80%) patients after one attempt at ablation. There was failure to ablate the PUV in 1 patient despite 2 attempts to do so. All 4 patients with successful ablation of PUV had grade IV vesicoureteric reflux (VUR) before valve ablation. Postablation micturating cystourethrogram (MCU) showed complete disappearance of VUR in one child. In 2, VUR improved to grade III and II immediately after valve ablation, and further improved to grade I and 0, respectively, at MCU repeated 3 months later. In one child, grade IV VUR persisted during the postablation VUR and remained at that grade 3 months later. Fogarty balloon catheter ablation of PUV is an effective, economic, and simple alternative to endoscopic valve fulguration in very sick and small neonates. It is particularly suitable for use in developing countries in which expensive endoscopes may not be readily available. Copyright 2001 by W.B. Saunders Company.

  1. Continuous urethral pressure measurements; measurement techniques; pressure variations; clinical interpretations; and clinical relevance. A Systematic Literature Analysis. (United States)

    Kummeling, Maxime T M; Rosier, Peter F W M; Elzevier, Henk W; Groenendijk, Pieter M


    The clinical relevance of urethral pressure variations (UPV) in the pathophysiology of over active bladder syndrome (OAB) has remained controversial to date. Some studies report an association with OAB and/or detrusor over activity (DO). Recently the International Consultation on Incontinence-Research Society recommended new clinical research to be performed on this subject. We provide a systematic review of the literature to specify this recommendation. Literature search was performed in PubMed, Embase, Web of Science, Cochrane, Central, Cinahl, Academic Science Premier, Science Direct, and Wiley Online using a sensitive search string combination. All authors independently reviewed and scored full text papers and consensus about methodological quality was obtained according to Oxford Level of Evidence (LoE). Four hundred eighty seven abstracts were screened, 25 papers met all predefined inclusion selection criteria. Incidence figures of UPV varied between 2% and 95%. Studies are of poor methodological quality with Oxford LoE scores of 3B and 4. Measurement methods and techniques show a large variety. The above mentioned association of DO/OAB with UPV is however frequently reported. There exists a phenomenon of UPV, apart from DO, which may be a separate entity within OAB syndrome. Large variation in measurement techniques and patient populations hinders fundamental research as well as clinical progress. Clinical relevance of UPV and consequences for treatment therefore are yet to be established. Future prospective research with well-defined patient population and standardised urodynamic measurement techniques is needed. Results of standardized and objective evaluations should be compared to clinical signs and symptoms by validated questionnaires. Neurourol. Urodynam. 36:51-56, 2017. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  2. Suprapubic tube versus urethral catheter drainage after robot-assisted radical prostatectomy: a systematic review and meta-analysis. (United States)

    Jian, Zhongyu; Feng, Shijian; Chen, Yuntian; Wei, Xin; Luo, Deyi; Li, Hong; Wang, Kunjie


    Prostate cancer is one of the most common cancers in the elderly population. The standard treatment is radical prostatectomy (RARP). However, urologists do not have consents on the postoperative urine drainage management (suprapubic tube (ST)/ urethral catheter (UC)). Thus, we try to compare ST drainage to UC drainage after robot-assisted radical prostatectomy regarding to comfort, recovery rate and continence using the method of meta-analysis. A systematic search was performed in Dec. 2017 on PubMed, Medline, Embase and Cochrane Library databases. The authors independently reviewed the records to identify studies comparing ST with UC of patients underwent RARP. Meta-analysis was performed using the extracted data from the selected studies. Seven studies, including 3 RCTs, with a total of 946 patients met the inclusion criteria and were included in our meta-analysis. Though there was no significant difference between the ST group and the UC group on postoperative pain (RR1.73, P 0.20), our study showed a significant improvement on bother or discomfort, defined as trouble in hygiene and sleep, caused by catheter when compared two groups at postoperative day (POD) 7 in ST group (RR2.05, P 0.006). There was no significant difference between the ST group and UC group on urinary continence (RR0.98, P 0.74) and emergency department visit (RR0.61, P 0.11). The rates of bladder neck contracture and other complications were very low in both groups. Compared to UC, ST showed a weak advantage. So it might be a good choice to choose ST over RARP.

  3. Does MRI help in the pre - operative evaluation of pelvic fracture urethral distraction defect? - a pilot study

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    Rajadoss Muthukrishna Pandian

    Full Text Available ABSTRACT Objectives To study the usefulness of MRI in preoperative evaluation of PFUDD. Can MRI provide additional information on urethral distraction defect (UDD and cause of erectile dysfunction (ED? Materials and Methods In this prospective study, consecutive male patients presenting with PFUDD were included from Feb 2011 till Dec 2012. Those with traumatic spinal cord injury and pre-existing ED were excluded. Patients were assessed using IIEF questionnaire, retrograde urethrogram and micturating cystourethrogram (RGU+MCU and MRI pelvis. Primary end point was erectile function and secondary end point was surgical outcome. Results Twenty patients were included in this study. Fourteen patients (70% were ≤40years; fifteen patients (75% had ED, seven patients (35% had severe ED. MRI findings associated with ED were longer median UDD (23mm vs. 15mm, p=0.07, cavernosal injury (100%, p=0.53, rectal injury (100%, p=0.53, retropubic scarring (60%, p=0.62 and prostatic displacement (60%, p=0.99. Twelve patients (60% had a good surgical outcome, five (25% had an acceptable outcome, three (15% had a poor outcome. Poor surgical outcome was associated with rectal injury (66.7%, p=0.08, cavernosal injury (25%, p=0.19, retropubic scarring (18.1%, p=0.99 and prostatic displacement (16.7%, p=0.99. Five patients with normal erections had good surgical outcome. Three patients with ED had poor outcome (20%, p=0.20. Conclusions MRI did not offer significant advantage over MCU in the subgroup of men with normal erections. Cavernosal injury noted on MRI strongly correlated with ED. Role of MRI may be limited to the subgroup with ED or an inconclusive MCU.

  4. Remarkable increase of Neisseria gonorrhoeae with decreased susceptibility of azithromycin and increase in the failure of azithromycin therapy in male gonococcal urethritis in Sendai in 2015. (United States)

    Yasuda, Mitsuru; Ito, Shin; Hatazaki, Kyoko; Deguchi, Takashi


    The antimicrobial resistance of Neisseria gonorrhoeae is a serious problem worldwide. In this study, we examined the susceptibility of N. gonorrhoeae isolated from male gonococcal urethritis in Sendai in 2014 and 2015. Furthermore, of all cases, we investigated the clinical efficacy of a single 2-g dose of extended-release azithromycin (AZM-SR) in the treatment of male gonococcal urethritis retrospectively. Sixty N. gonorrhoeae strains in 2014 and 54 strains in 2015 were isolated from male gonococcal urethritis and stored each year. The MIC of AZM was ≥1 mg/L in 4 strains (6.7%) in 2014 and in 13 strains (24.1%) in 2015 and the number of strains having ≥1 mg/L MIC increased significantly (P = 0.016). Microbiological efficacy was evaluated in 32 and 29 of these patients, and the rates of treatment success were 93.8% and 79.3%, respectively. All of the treatment failures were caused by strains having a MIC of AZM of ≥0.5 mg/L. In particular, the increase in the isolates having a MIC of AZM of ≥1 mg/L was remarkable. Therefore, it was thought that the increase in these strains was the reason for the increase in treatment failures in 2015. Because no other drug is effective, it is currently necessary to use AZM-SR to treat gonococcal infections caused by ceftriaxone-resistant strains or patients allergic to ceftriaxone. To prevent a further increase in resistance to AZM, we should not use AZM-SR to treat normal cases of gonococcal infection. Copyright © 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  5. Urodynamic assessment of bladder and urethral function among men with lower urinary tract symptoms after radical prostatectomy: A comparison between men with and without urinary incontinence. (United States)

    Lee, Hansol; Kim, Ki Bom; Lee, Sangchul; Lee, Sang Wook; Kim, Myong; Cho, Sung Yong; Oh, Seung-June; Jeong, Seong Jin


    We compared bladder and urethral functions following radical prostatectomy (RP) between men with and without urinary incontinence (UI), using a large-scale database from SNU-experts-of-urodynamics-leading (SEOUL) Study Group. Since July 2004, we have prospectively collected data on urodynamics from 303 patients with lower urinary tract symptoms (LUTS) following RP at three affiliated hospitals of SEOUL Study Group. After excluding 35 patients with neurogenic abnormality, pelvic irradiation after surgery, or a history of surgery on the lower urinary tract, 268 men were evaluated. We compared the urodynamic findings between men who had LUTS with UI (postprostatectomy incontinence [PPI] group) and those who had LUTS without UI (non-PPI group). The mean age at an urodynamic study was 68.2 years. Overall, a reduced bladder compliance (≤20 mL/cmH2O) was shown in 27.2% of patients; and 31.3% patients had idiopathic detrusor overactivity. The patients in the PPI group were older (p=0.001) at an urodynamic study and had a lower maximum urethral closure pressure (MUCP) (p<0.001), as compared with those in the non-PPI group. Bladder capacity and detrusor pressure during voiding were also significantly lower in the PPI group. In the logistic regression, only MUCP and maximum cystometric capacity were identified as the related factor with the presence of PPI. In our study, significant number of patients with LUTS following RP showed a reduced bladder compliance and detrusor overactivity. PPI is associated with both impairment of the urethral closuring mechanism and bladder storage dysfunction.

  6. Azithromycin 1.5g Over 5 Days Compared to 1g Single Dose in Urethral Mycoplasma genitalium: Impact on Treatment Outcome and Resistance. (United States)

    Read, Tim R H; Fairley, Christopher K; Tabrizi, Sepehr N; Bissessor, Melanie; Vodstrcil, Lenka; Chow, Eric P F; Grant, Mieken; Danielewski, Jennifer; Garland, Suzanne M; Hocking, Jane S; Chen, Marcus Y; Bradshaw, Catriona S


    We evaluated the impact of extended azithromycin (1.5g over 5 days) on selection of macrolide resistance and microbiological cure in men with Mycoplasma genitalium urethritis during 2013-2015 and compared this to cases treated with azithromycin 1g in 2012-2013. Microbiological cure was determined for men with M. genitalium urethritis treated with azithromycin 1.5g using quantitative polymerase chain reaction specific for M. genitalium DNA on samples 14-100 days post-treatment. Pre- and post-treatment macrolide resistance mutations were detected by sequencing the 23 S gene. There was no difference in proportions with microbiological cure between azithromycin 1.5g and 1g: 62/106 (58%; 95% confidence interval [CI], 49%, 68%) and 56/107 (52%; 95%CI 42-62%), P = .34, respectively. Also, there was no difference in the proportion of wild-type 23 S rRNA (presumed macrolide sensitive) infections cured after 1.5g and azithromycin 1g: 28/34 (82%; 95%CI 65-92%) and 49/60 (82%; 95%CI 70-90%), P=1.0, respectively. There was no difference between 1.5g and 1g in the proportions of wild-type infections with post-treatment resistance mutations: 4/34 (12%; 95%CI 3-27%) and 11/60 (18%; 95%CI 10-30%), respectively, P = .40. Pre-treatment resistance was present in 51/98 (52%; 95%CI 42-62%) cases in 2013-2015 compared to 47/107 (44%; 95%CI 34-54%) in 2012-2013, P = .25. Extended azithromycin 1.5g was no more effective than a single 1g dose at achieving cure of M. genitalium urethritis and importantly did not reduce the selection of macrolide resistance. Nonmacrolide and new approaches for the treatment of M. genitalium urethritis are required. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail

  7. Haemophilus parainfluenzae causing sexually transmitted urethritis. Report of a case and evidence for a beta-lactamase plasmid mobilizable to Escherichia coli by an Inc-W plasmid. (United States)

    Facinelli, B; Montanari, M P; Varaldo, P E


    A multiple antibiotic resistance, beta-lactamase-producing strain of Haemophilus parainfluenzae was isolated from a patient with sexually transmitted urethritis that was contracted in Northwest Africa. The strain was found to harbor a small (3.2 megadaltons) plasmid encoding for beta-lactamase production, which was successfully mobilized to Escherichia coli in triparental mating experiments by means of a broad host-range Inc-W conjugative plasmid. Since H. parainfluenzae is believed to be a source and reservoir for the spread of beta-lactamase plasmids to other bacterial species, such a plasmid mobilization may suggest a new possible means for resistance plasmid dissemination.

  8. Penile fracture with disruption of both cavernosal bodies and complete urethral rupture in a 15-years-old male: Delayed surgical approach

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    Carolina Talini


    Full Text Available Penile fracture is defined as the traumatic rupture of the tunica albuginea of the corpus cavernosa usually associated to trauma during sexual intercourse or masturbation. Historically penile fracture has been managed conservatively, but contemporary management includes early surgical exploration. The case presents a 15-year-old male who suffered a blunt penile trauma and was first managed with cystostomy and no penile exploration. Five months after trauma was submitted to definitive surgical correction of both, urethral rupture and bilateral corporal fracture. The proposed surgical techinique was a diamond-shape corpora anastomosis. Surgery did well and after 3 years he presented no late complications.

  9. A Case of Urethral Duplication Arising from the Posterior Urethra to the Scrotum with Urinary Stone in a 6-Year-Old Male

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    Kenichi Mori


    Full Text Available Urethral duplication is a rare congenital anomaly. We report a 6-year-old male with type IIA2 (Y-type using Effmann’s classification. The accessory urethra, in which a urinary stone existed, arose from the posterior urethra to the scrotum. Because of recurrent urinary tract infection and urinary discharge from the accessory urethra, surgical removal of the accessory urethra through a scrotal incision was performed. At 7-month postoperative follow-up the patient was completely free from urinary incontinence and urinary tract infection.

  10. [Fever, Hepatic Dysfunction and Interstitial Pneumonia Caused by Intravesical Bacillus Calmette-Guerin (BCG) Instillation after Urethral Bougie : A Case Report]. (United States)

    Nitta, Satoshi; Sakka, Shotaro; Endo, Tsuyoshi; Komine, Manabu; Tsutsumi, Masakazu; Nishiyama, Hiroyuki


    A 60-year-old man had a past history of urothelial carcinoma of the left renal pelvis treated with laparoscopic left total nephroureterectomy in October 2004. He underwent transurethral resection of the bladder tumor (TUR-Bt) twice for recurrence of urothelial carcinoma in the bladder in April 2014 and February 2015, and subsequently received intravesical Bacillus Calmette-Guerin (BCG) instillation at weekly intervalsfor prevention of recurrence. In November 2016, a year and a half after BCG induction, he received BCG therapy after urethral bougie to dilate the urethral stricture. After BCG therapy, he exhibited a continuously high fever. Immediate antituberculosis drug therapy in consideration of BCG sepsis failed to improve the symptoms, and all cultures from urine and blood were negative for mycobacterium tuberculosis. Serum liver enzyme was markedly elevated and chest CT showed diffuse interstitial shadows in both lower lungs. Thus, we considered that these symptoms were caused by a hypersensitivity reaction to BCG and started pulse steroid therapy. After pulse steroid therapy, body temperature, and hepatic function became normal and interstitial pneumonia subsided.

  11. Factors that influence the outcome of open urethroplasty for pelvis fracture urethral defect (PFUD): an observational study from a single high-volume tertiary care center. (United States)

    Fu, Qiang; Zhang, Yu-meng; Barbagli, Guido; Zhang, Jiong; Xie, Hong; Sa, Ying-long; Jin, San-bao; Xu, Yue-min


    To report the clinical features of pelvic fracture urethral injury (PFUI) and assess the real effect of factors that are believed to have adverse effects on delayed urethroplasty. An observational descriptive study in a single urological center examined 376 male patients diagnosed with PFUI who underwent open urethroplasty from 2009 to 2013. Analyzed factors included patient age at the time of injury, etiology of PFUI, type of emergency treatment, concomitant injuries, length and position of stricture, type of urethroplasty and the outcome of surgery. Univariate and multivariate logistic regression analyses were applied, together with analytical statistic methods such as t test and Chi-square test. The overall success rate of delayed urethroplasty was 80.6 %. Early realignment was associated with reduced stricture length and had beneficial effect on delayed surgery. Concomitant rectum rupture, strictures longer than 1.6 cm and strictures closer than 3 cm to the bladder neck were indicators of poor outcome. Age, type of injury, urethral fistula and bladder rupture were not significant predicators of surgery outcome. Failed direct vision internal urethrotomy and urethroplasty had no significant influence on salvage operation. The outcome of posterior urethroplasty is affected by multiple factors. Early realignment has beneficial effect; while the length and position of stricture and its distance to bladder neck plays the key role, rectum rupture at the time of injury is also an indicator of poor outcome. The effect of other factors seems insignificant.

  12. Ureaplasma parvum and Mycoplasma genitalium are found to be significantly associated with microscopy-confirmed urethritis in a routine genitourinary medicine setting. (United States)

    Cox, Ciara; McKenna, James P; Watt, Alison P; Coyle, Peter V


    Inflammation of the urethra defined by an excess of polymorphonuclear leukocytes in the absence of sexually transmitted Chlamydia trachomatis and Neisseria gonorrhoeae is called non-chlamydial non-gonococcal urethritis (NCNGU). Although Mycoplasma genitalium is now recognised as causing a sexually transmitted infection, the clinical significance of the other Mollicute species is less clear. This study used specific real-time quantitative polymerase chain reaction assays to detect and quantify four Mollicute species, M. genitalium, M. hominis, Ureaplasma urealyticum and U. parvum, in urine specimens from men with and without NCNGU. A total of 165 urine specimens from male patients attending a genitourinary medicine clinic were eligible for the study, with microscopy-confirmed (≥5 polymorphonuclear leukocytes in urethral swab) NCNGU in 75 (45.5%) and non-confirmed NCNGU in 90 (54.5%). Chi-squared statistical analysis indicated a significantly higher prevalence of U. parvum (17.3% vs. 5.6%; p = 0.03) and M. genitalium (12% vs. 0%; p < 0.001) in NCNGU. In a subset analysis, M. genitalium was also significantly (p = 0.03) higher in men who have sex with men (MSM; 13.5%) compared to non-MSM (3.1%). No significant associations were reported for U. urealyticum and M. hominis In conclusion, this study supports a clinically significant role in NGNCU for both U. parvum and M. genitalium. © The Author(s) 2015.

  13. Role of nocturnal penile erection test on response to daily sildenafil in patients with erectile dysfunction due to pelvic fracture urethral disruption: a single-center experience. (United States)

    Peng, Jing; Zhang, Zhichao; Cui, Wanshou; Yuan, Yiming; Gao, Bing; Song, Weidong; Xin, Zhongcheng


    To evaluate the results of nocturnal penile erection test and response to daily sildenafil in patients with erectile dysfunction (ED) due to pelvic fracture urethral disruption. From January 2010 to January 2012, we included 38 patients with ED due to pelvic fracture urethral disruption. The mean age was 33.1 years (range, 22-49 years). All were evaluated subjectively and objectively by the International Index of Erectile Function-5, nocturnal penile tumescence and rigidity (NPTR) test, and penile Doppler ultrasonography. Patients received daily sildenafil 50 mg for 3 months. Thirty-one patients were followed up: 54.8% showed response to sildenafil defined as reporting successful vaginal penetration and intercourse. Patients with neurogenic, arterial, and venous EDs did not differ in efficiency rates (P = .587). However, the penile erectile rigidity recorded by NPTR test affected efficiency significantly (P = .046). Patients with tip rigidity >40% had the highest response rate (76.9%), but the response rate for patients with tip rigidity erectile function in patients with ED due to trauma and is significant for selecting pharmacologic treatment as optimal therapy. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Congenital duplication of the urethra with urethral diverticulum: a case report [v1; ref status: indexed,

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    Darshan H Shah


    Full Text Available Duplication of the urethra is a rare congenital anomaly. Urethral duplication with the presence of diverticulum is a rare combination and to the best of our knowledge has  not been previously reported. We report a case of a 16 month old male child with duplication of the urethra and diverticulum arising from the ventral urethra. We also cover the intricacies and challenges in the management of such a case. The opening of the narrowed accessory dorsal urethra at the verumontanum was cauterized and gradually the dorsal urethra became atrophied. The ventral urethral diverticulum was excised. This case is unique due to: The unusual presentation of swelling over the dorsum of the penis, together with duplication of the urethra with diverticulum. The use of cauterization as a treatment modality. Cauterization of the ventral urethra with a Bugbee electrode and diverticulectomy was performed. A glidewire helped in identifying the small opening of the dorsal urethra at the level of the verumontanum. The case also highlights the importance of endoscopic management of this clinical entity.

  15. Structural alterations of foreskin caused by chronic smoking may explain high levels of urethral reconstruction failure using foreskin flaps

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    João P. Rosado


    Full Text Available OBJECTIVES: The aim of the present study was to perform a stereological and biochemical analysis of the foreskin of smoker subjects. MATERIALS AND METHODS: Foreskin samples were obtained from 20 young adults (mean = 27.2 years old submitted to circumcision. Of the patients analyzed, one group (n = 10 had previous history of chronic smoking (a half pack to 3 packs per day for 3 to 13 years (mean = 5.8 ± 3.2. The control group included 10 nonsmoking patients. Masson's trichrome stain was used to quantify the foreskin vascular density. Weigert’s resorcin-fucsin stain was used to assess the elastic system fibers and Picrosirius red stain was applied to study the collagen. Stereological analysis was performed using the Image J software to determine the volumetric densities. For biochemical analysis, the total collagen was determined as µg of hydroxyproline per mg of dry tissue. Means were compared using the unpaired t-test (p < 0.05. RESULTS: Elastic system fibers of smokers was 42.5% higher than in the control group (p = 0.002. In contrast, smooth muscle fibers (p = 0.42 and vascular density (p = 0.16 did not show any significant variation. Qualitative analysis using Picrosirius red stain with polarized light evidenced the presence of type I and III collagen in the foreskin tissue, without significant difference between the groups. Total collagen concentration also did not differ significantly between smokers and non-smokers (73.1µg/mg ± 8.0 vs. 69.2µg/mg ± 5.9, respectively, p = 0.23. CONCLUSIONS: The foreskin tissue of smoking patients had a significant increase of elastic system fibers. Elastic fibers play an important role in this tissue’s turnover and this high concentration in smokers possibly causes high extensibility of the foreskin. The structural alterations in smokers’ foreskins could possibly explain the poor results in smoking patients submitted to foreskin fasciocutaneous flaps in urethral reconstruction surgery.

  16. Comparison between Two Different Two-Stage Transperineal Approaches to Treat Urethral Strictures or Bladder Neck Contracture Associated with Severe Urinary Incontinence that Occurred after Pelvic Surgery: Report of Our Experience

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    A. Simonato


    Full Text Available Introduction. The recurrence of urethral/bladder neck stricture after multiple endoscopic procedures is a rare complication that can follow prostatic surgery and its treatment is still controversial. Material and Methods. We retrospectively analyzed our data on 17 patients, operated between September 2001 and January 2010, who presented severe urinary incontinence and urethral/bladder neck stricture after prostatic surgery and failure of at least four conservative endoscopic treatments. Six patients underwent a transperineal urethrovesical anastomosis and 11 patients a combined transperineal suprapubical (endoscopic urethrovesical anastomosis. After six months the patients that presented complete incontinence and no urethral stricture underwent the implantation of an artificial urethral sphincter (AUS. Results. After six months 16 patients were completely incontinent and presented a patent, stable lumen, so that they underwent an AUS implantation. With a mean followup of 50.5 months, 14 patients are perfectly continent with no postvoid residual urine. Conclusions. Two-stage procedures are safe techniques to treat these challenging cases. In our opinion, these cases could be managed with a transperineal approach in patients who present a perfect operative field; on the contrary, in more difficult cases, it would be preferable to use the other technique, with a combined transperineal suprapubical access, to perform a pull-through procedure.

  17. Management of iatrogenic cystoscopic urethral lesion associated with sequela of cuff erosion in a patient after previous AMS 800 implantation. One-step technique with revision, without cuff explantation. (United States)

    Weibl, P; Rutkowski, M; Huebner, W


    Iatrogenic urethral lesion with subsequent cuff erosion during cystoscopy is a rare complication. The alternative surgical strategy with in situ urethroplasty while maintaining the open cuff left in situ will be presented. The authors report 3cases of iatrogenic urethral lesion with cuff erosion during cystoscopic evaluation to exclude stricture or cuff erosion due to new onset of obstructive lower urinary tract symptoms. All patients had a history of a AMS 800 implantation due to posprostatectomy incontinence. Rigid cystoscopy was performed, which revelaed no pathologies; however, iatrogenic small urethral lesion was identified during the removal of the cystoscope at the projection of the cuff. In situ urethroplasty was performed, and the cuff was left open in situ. Additionally a protection fat flap was placed around the urethra from the dorsolateral aspect, separating the cuff and urethra from the direct contact with each other. After 6 weeks the urethral defect was completely healed and via a primary perineal incision the cuff was readapted and closed. The device was fully functioning without any additional adjustments. Our modification should be considered in select cases with absence of infection as part of management strategy for cases of iatrogenic urethral lesions with subsequent cuff erosion. Thereby the original cuff can be spared and the possibly difficult preparation of the urethra during reoperation can be avoided. However, additional more cases should be presented in the world-wide literature, to confirm the utility of this surgical principle. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Stages of Urethral Cancer (United States)

    ... In men, the urethra also carries semen . Enlarge Anatomy of the male urinary system (left panel) and female urinary system (right panel) showing the kidneys, ureters, bladder, and urethra. Urine is made in the renal tubules and collects in the renal pelvis of ...

  19. MRI at the completion of chemoradiotherapy can accurately evaluate the extent of disease in women with advanced urethral carcinoma undergoing anterior pelvic exenteration. (United States)

    Gourtsoyianni, S; Hudolin, T; Sala, E; Goldman, D; Bochner, B H; Hricak, Hedvig


    To demonstrate the value of pelvic magnetic resonance imaging (MRI) in mapping tumour extension after chemoradiotherapy and before anterior pelvic exenteration in patients with primary carcinoma of the urethra. The Institutional Review Board approved and issued a waiver of informed consent for this retrospective study, which was compliant with the Health Insurance Portability and Accountability Act. Six women (median age 51 years, range 39-63 years) with histopathology-proven urethral carcinoma who underwent neoadjuvant chemoradiotherapy before anterior pelvic exenteration were included in the study. All had MRI performed at first presentation and after completion of chemoradiotherapy. MRI images were analysed by an experienced reader, who was blinded to the clinical data. The tumour location, signal intensity, size, local extension, and presence of enlarged lymph nodes were recorded for each patient at baseline and after chemoradiotherapy. Surgical histopathology constituted the reference standard. All tumours were locally advanced (stage T3) at baseline MRI. The mean maximum diameter of the tumour at baseline MRI was 3.7 cm (range 2.4-5 cm). After chemoradiotherapy, the mean reduction in maximum tumour diameter on MRI was 44% (range 13-67%), but only three cases were down-staged. MRI was accurate in the evaluation of tumour extension after completion of chemoradiotherapy in all cases. Persistence of bladder neck and anterior vaginal wall invasion was correctly identified in three cases. In women with advanced primary urethral cancer, MRI is an excellent tool for monitoring neo-adjuvant chemoradiotherapy changes and evaluating the extent of disease before exenterative surgery. Copyright © 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  20. MRI at the completion of chemoradiotherapy can accurately evaluate the extent of disease in women with advanced urethral carcinoma undergoing anterior pelvic exenteration

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    Gourtsoyianni, S.; Hudolin, T. [Department of Radiology, Memorial Sloan-Kettering Cancer Centre, 1275 York Avenue, New York, NY (United States); Sala, E. [Department of Radiology, Box 218, Addenbrooke' s Hospital, Hills Road, Cambridge (United Kingdom); Goldman, D. [Department of Radiology, Memorial Sloan-Kettering Cancer Centre, 1275 York Avenue, New York, NY (United States); Bochner, B.H. [Department of Urology, Memorial Sloan-Kettering Cancer Centre, 1275 York Avenue, New York, NY (United States); Hricak, Hedvig, E-mail: [Department of Radiology, Memorial Sloan-Kettering Cancer Centre, 1275 York Avenue, New York, NY (United States)


    Aim: To demonstrate the value of pelvic magnetic resonance imaging (MRI) in mapping tumour extension after chemoradiotherapy and before anterior pelvic exenteration in patients with primary carcinoma of the urethra. Materials and methods: The Institutional Review Board approved and issued a waiver of informed consent for this retrospective study, which was compliant with the Health Insurance Portability and Accountability Act. Six women (median age 51 years, range 39-63 years) with histopathology-proven urethral carcinoma who underwent neoadjuvant chemoradiotherapy before anterior pelvic exenteration were included in the study. All had MRI performed at first presentation and after completion of chemoradiotherapy. MRI images were analysed by an experienced reader, who was blinded to the clinical data. The tumour location, signal intensity, size, local extension, and presence of enlarged lymph nodes were recorded for each patient at baseline and after chemoradiotherapy. Surgical histopathology constituted the reference standard. Results: All tumours were locally advanced (stage T3) at baseline MRI. The mean maximum diameter of the tumour at baseline MRI was 3.7 cm (range 2.4-5 cm). After chemoradiotherapy, the mean reduction in maximum tumour diameter on MRI was 44% (range 13-67%), but only three cases were down-staged. MRI was accurate in the evaluation of tumour extension after completion of chemoradiotherapy in all cases. Persistence of bladder neck and anterior vaginal wall invasion was correctly identified in three cases. Conclusion: In women with advanced primary urethral cancer, MRI is an excellent tool for monitoring neo-adjuvant chemoradiotherapy changes and evaluating the extent of disease before exenterative surgery.

  1. What is the best choice for repair of distal penile hypospadias: The tubularized incised plate urethroplasty or anterior urethral advancement technique?

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    Awad Mohamed


    Full Text Available Background and Aim: Numerous ingenious methods have been introduced to repair hypospadias with variable results. We tried to evaluate the two techniques, tubularized incised plate urethroplasty (TIP and anterior urethral advancement (AUA for repair of distal hypospadias and choose the best method to treat the distal type of penile hypospadias with the least complications. Materials and Methods : A total of 140 boys with distal penile hypospadias were divided into two groups. Group A (68 patients was treated with TIP and Group B (72 patients was treated with AUA. All the patients had an average age of three years (2-19 with variable meatal sites coronal (44 sub coronal (53 and anterior penile hypospadias (43. There was no significant difference between both groups with respect to the age and meatal sites. Results: The fistula rate in Group A was 8.8% versus 1.3% in Group B. There was no urethral stricture in both procedures. Wound dehiscence did not occur in Group A versus one case in Group B (1.3%. In Group A, 26 cases (38.3% had mild glanular torsion and five (7.3% had moderate glanular torsion versus none in Group B postoperatively. No postoperative chordee or binding in Group A, versus four patients (5.5% in Group B. No significant difference was observed in both groups with respect to meatal stenosis (7.3% versus 5.5% respectively. There was a significant difference between both groups with regard to the operative time in favour of Group B. Good cosmetic appearance of the glans was achieved in both techniques. Conclusion: Both techniques can treat this anomaly with a high success rate but the modified AUA technique appears to be a good choice due to its simplicity, short operative time and less fistula rate with good cosmetic results.

  2. Psychometric validation of a German language version of a PROM for urethral stricture surgery and preliminary testing of supplementary ED and UI constructs. (United States)

    Kluth, Luis A; Dahlem, Roland; Becker, Andreas; Schmid, Marianne; Soave, Armin; Rosenbaum, Clemens; Ludwig, Tim A; Christ, Natalie; Rink, Michael; Reiss, Philip; Engel, Oliver; Riechardt, Silke; Chun, Felix K-H; Fisch, Margit; Ahyai, Sascha A


    To validate a German language version of the patient-reported outcome measurement (PROM) following urethral stricture surgery (USS) in a cohort of men undergoing one-stage buccal mucosa graft urethroplasty (BMGU) for urethral stricture. Furthermore, to explore the responsiveness of erectile function (EF) and urinary incontinence (UI) constructs in the context of this intervention. The USS-PROM captures voiding symptoms (ICIQ-MLUTS) and health-related quality of life (HRQoL) (EQ-5D). To evaluate EF and UI, the IIEF-5 and ICIQ-UI SF were included. Between March 2012 and April 2013, all patients undergoing BMGU at our institution were prospectively enrolled in this study. Psychometric assessment included internal consistency, test-retest reliability, criterion validity and responsiveness. Ninety-three men completed the USS-PROM before and 3 months after surgery, with 40 (43 %) also completing the USS-PROM 6 months after surgery to assess reliability. Internal consistency: for the ICIQ-MLUTS, Cronbach's α was 0.83. The test-retest intraclass correlation coefficient was 0.94. There was a negative correlation between change in ICIQ-MLUTS total score and change in Q max (r = -0.40). All values exceeded our predefined thresholds. Significant improvements of voiding symptoms and HRQoL demonstrate responsiveness to change (all p values 0.05), IIEF-5 scores improved significantly (p = 0.048). The German language USS-PROM shows similar psychometric properties to the English language version. This instrument can be improved by assessing EF by the use of IIEF-5. Further studies with larger patient cohorts are needed to evaluate the significance of measuring UI in urethroplasty patients.

  3. Bipolar plasma vaporization using plasma-cutting and plasma-loop electrodes versus cold-knife transurethral incision for the treatment of posterior urethral stricture: a prospective, randomized study

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    Wansong Cai


    Full Text Available OBJECTIVE: Evaluate the efficiency and safety of bipolar plasma vaporization using plasma-cutting and plasma-loop electrodes for the treatment of posterior urethral stricture. Compare the outcomes following bipolar plasma vaporization with conventional cold-knife urethrotomy. METHODS: A randomized trial was performed to compare patient outcomes from the bipolar and cold-knife groups. All patients were assessed at 6 and 12 months postoperatively via urethrography and uroflowmetry. At the end of the first postoperative year, ureteroscopy was performed to evaluate the efficacy of the procedure. The mean follow-up time was 13.9 months (range: 12 to 21 months. If re-stenosis was not identified by both urethrography and ureteroscopy, the procedure was considered “successful”. RESULTS: Fifty-three male patients with posterior urethral strictures were selected and randomly divided into two groups: bipolar group (n=27 or cold-knife group (n=26. Patients in the bipolar group experienced a shorter operative time compared to the cold-knife group (23.45±7.64 hours vs 33.45±5.45 hours, respectively. The 12-month postoperative Qmax was faster in the bipolar group than in the cold-knife group (15.54±2.78 ml/sec vs 18.25±2.12 ml/sec, respectively. In the bipolar group, the recurrence-free rate was 81.5% at a mean follow-up time of 13.9 months. In the cold-knife group, the recurrence-free rate was 53.8%. CONCLUSIONS: The application of bipolar plasma-cutting and plasma-loop electrodes for the management of urethral stricture disease is a safe and reliable method that minimizes the morbidity of urethral stricture resection. The advantages include a lower recurrence rate and shorter operative time compared to the cold-knife technique.

  4. Formação de cálculo uretral ao redor de um corpo estranho: relato de um caso Formation of an urethral calculus around a foreign body: a case report

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    João Ricardo Maltez de Almeida


    Full Text Available Os cálculos uretrais primários são raros no ocidente. O seu desenvolvimento freqüentemente está associado a alterações prévias do fluxo urinário, como divertículos uretrais, áreas de estenose ou corpos estranhos impactados. Os autores relatam um caso de um paciente de 77 anos de idade que se apresentou com queixa de retenção urinária aguda e dor na região genital. O diagnóstico de uretrolitíase foi feito e, mediante estudos radiográficos, um objeto estranho, cilindro de madeira, foi identificado no interior do cálculo.Primary urethral calculi are uncommon in the Western world. Stone formation is frequently associated with prior disorders affecting the urinary flow such as urethral diverticula, stenosis of the urethra and impacted foreign bodies. The authors report a case of a 77-year-old man, who complained of acute urinary retention and pain on the genital area. The diagnosis of urethral lithiasis was established and radiological studies revealed a wood cylindrical foreign body inside the stone.


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    Sathish Kumar G


    Full Text Available BACKGROUND Balanitis Xerotica Obliterans (BXO, also known as lichen sclerosus of penis is a chronic, progressive disease of the glans and prepuce that leads to phimosis and stricture of the urethra that can extend from the meatus and glanular urethra to the prostatic urethra. Urinary and sexual functions are affected and there is a severe reduction in quality of life. Many patients have been initially treated with tacrolimus or circumcision, when the disease has involved the prepuce and glans superficially, but conservative management has a limited role in this condition. Once stricture develops, surgical intervention in the form of grafts or flaps becomes necessary. We present our results with single-stage Ventral Onlay Buccal Mucosal Graft Urethroplasty (VOBMGU based on tunica vaginalis flap for BXO related strictures of meatus and fossa navicularis. MATERIALS AND METHODS From July 2014, six patients who underwent single stage Ventral Onlay Buccal Mucosal Graft Urethroplasty Graft (VOBMGU based on tunica vaginalis flap for BXO related strictures of urethral meatus and navicular fossa were included in the study. Patients presenting with BXO were clinically assessed for the extent of involvement as having BXO affecting the foreskin, glans, meatus, penile shaft, urethra and scrotum. They were radiologically assessed with a retrograde urethrogram and ultrasound abdomen. Outcome was assessed in terms of uroflowmetry, cosmetic appearance, stricture recurrence and complications. RESULTS Patients were reviewed every three months for over one year and six monthly. Only one patient had mild stenosis of the urethral meatus, as evidenced by change in flow, which was treated successfully with dilatation. One patient reported moderate splaying of urine, but this was mild in all other cases. All patients had a normal slit-like meatus, satisfactory voiding and sexual functions. CONCLUSION Isolated involvement of fossa navicularis and meatal stenosis stricture

  6. Visible and UVA light as a potential means of preventing Escherichia coli biofilm formation in urine and on materials used in urethral catheters. (United States)

    Vollmerhausen, T L; Conneely, A; Bennett, C; Wagner, V E; Victor, J C; O'Byrne, C P


    Catheter-associated urinary tract infections are the most common hospital-acquired infection, for which Escherichia coli is the leading cause. This study investigated the efficacy of 385nm and 420nm light for inactivation of E. coli attached to the silicone matrix of a urinary catheter. Using urine mucin media, inactivation of planktonic bacteria and biofilm formation was monitored using silicone coupons. Continuous irradiance with both 385nm and 420nm wavelengths with starting cell density population 10 3 CFU ml -1 reduced planktonic suspensions of E. coli to below the detection level after 2h and 6h, respectively. Bacterial attachment to silicone was successfully prevented during the same treatment. Inactivation by 385nm and 420nm was found to be dependent on media, cell density and oxygen, with less inhibition on planktonic suspensions when higher starting cell densities were used. In contrast to planktonic suspensions in PBS, continuous irradiance of pre-established biofilms showed a greater reduction in survival compared to urine mucin media after 24h. Enhanced inhibition for 385nm and 420nm light in urine mucin media was associated with increased production of reactive oxygen species. These findings suggest 385nm and 420nm light as a promising antimicrobial technology for the prevention of biofilm formation on urethral catheters. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. [A comparative study between two procedures of TVT retropubic mid-urethral sling placement for treatment of female stress urinary incontinence]. (United States)

    Sergent, F; Gay-Crosier, G; Resch, B; Pons, J-C; Marpeau, L


    To evaluate complications and functional outcomes at 1 year and more of a modified Tension-free Vaginal Tape (TVT) technique from that of classic TVT. Retrospective study comparing the two techniques. For the modified TVT technique, a peri-urethrovesical hydrodissection was performed. An 18-gauge hollow needle, in which a thread was introduced, was used as an ancillary for the placement of the sling. The sling was secured to the thread and then positioned with it. Bladder filling objectified perforations. An absorbable suture around the sling allowed its descent if necessary. One hundred and eighteen procedures were performed (54 classic TVT and 64 modified TVT). For the standard TVT and the modified TVT, the vesico-urethral perforation rates were respectively 7.4% and 1.5% (PTVT versus 88.2% and 90% for the modified TVT (NS). The dissatisfaction rate was lower for the modified TVT (PTVT, it is possible to reduce its complications while maintaining its efficacy. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  8. Urethral duplication in a dog: case report Duplicação uretral em cão: relato de caso

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    R. Stedile


    Full Text Available A male Brazilian Fila dog was referred because of a perineal orifice with urine stream during micturition. To determine the extent of the accessory channel, a contrasted retrograde urethrocystography was performed. A surgical correction was undertaken. Histological study showed the presence of the urethral channel lined by multilayer transitional epithelium. The patient recovered well and there was no evidence of complications one year after surgery.Um cão macho da raça Fila brasileiro foi atendido por apresentar, durante a micção, presença de jato de urina em orifício na região perineal. Uretrocistografia retrógrada contrastada foi realizada para determinar o trajeto do canal acessório. Fez-se a remoção cirúrgica da comunicação uretrocutânea. A avaliação histológica demonstrou a presença de um canal uretral revestido por epitélio de transição composta de várias camadas. O paciente teve boa recuperação, e após um ano, não havia apresentado complicações.

  9. Vesico-urethral anastomosis (VUA) evaluation of short- and long-term outcome after robot-assisted laparoscopic radical prostatectomy (RARP): selective cystogram to improve outcome. (United States)

    Tillier, C; van Muilekom, H A M; Bloos-van der Hulst, J; Grivas, N; van der Poel, H G


    The role of a cystogram to assess the vesico-urethral anastomosis (VUA) after robot-assisted laparoscopic radical prostatectomy (RARP) has been debated. Early catheter removal without cystogram was reported to be associated with a trend towards an increased risk of acute urinary retention (AUR). In two cohorts we studied the effects of VUA leakage on cystogram and functional outcome after RARP. Cohort A contained 1390 consecutive men that routinely underwent a cystogram after RARP. Transurethral catheter (TUC) was removed in the absence of VUA leakage or minimal leakage on subsequent repeat cystogram. Outcome was compared to a group of 120 men that underwent cystography 7-10 days after RARP but had the TUC removed independent of cystography findings (cohort B). Outcome was assessed by early clinical follow-up and quality of life (QOL) questionnaires at 6 months. Men in cohort B had an increased risk of AUR and 6 months voiding complaints when compared to cohort A. The incidence of AUR and voiding complaints was associated with grade 2-3 leakage on cystography in cohort B but not in cohort A. Grade 2-3 leakage on cystogram was more likely in men with larger prostates larger and preoperative voiding complaints. Selective cystogram in men with larger prostates and preoperative lower urinary tract symptoms (LUTS) may prevent early AUR and voiding complaints after RARP when prolonged TUC use is applied.

  10. Transobturator vaginal tape inside out for treatment of urethral sphincter mechanism incompetence in female dogs: cadaveric study and preliminary study in continent female dogs. (United States)

    Claeys, Stéphanie; Ruel, Hélène; de Leval, Jean; Heimann, Marianne; Hamaide, Annick


    (1) To describe a surgical technique adapted from the "transobturator vaginal tape inside-out" (TVT-O) used in women and to define the trajectory of the tape on canine cadavers, and (2) to determine the urodynamic and morphological effects of the TVT-O in continent bitches. Cadaveric and experimental in vivo study. Fresh female canine cadavers (n=12) and spayed female Beagle dogs (2). (1) TVT-O was inserted in 12 cadavers. Dissection was performed and distances between the tape and neighboring structures were recorded. (2) TVT-O was inserted in 2 continent female Beagle dogs. Urethral pressure profilometry and vaginourethrograms were performed preoperatively, immediately after surgery, and 2, 4, and 6 months postoperatively. Histopathology was performed 6 months after surgery. (1) TVT-O tape was consistently located in a perineal space before entering the obturator foramina and was located at a safe distance from major neurovascular structures including the femoral vessels and obturator nerve. (2) TVT-O was performed without any surgical or postoperative complications in 2 continent bitches. Histopathologic examination of the tissues surrounding the tape revealed a mild fibroblastic proliferation with a mild to minimal lymphoplasmacytic inflammatory infiltration. TVT-O is a feasible and accurate procedure that can be performed in continent bitches with a low risk of complications. © Copyright 2010 by The American College of Veterinary Surgeons.

  11. Myogenic potential of whole bone marrow mesenchymal stem cells in vitro and in vivo for usage in urinary incontinence.

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    Monica Gunetti

    Full Text Available Urinary incontinence, defined as the complaint of any involuntary loss of urine, is a pathological condition, which affects 30% females and 15% males over 60, often following a progressive decrease of rhabdosphincter cells due to increasing age or secondary to damage to the pelvic floor musculature, connective tissue and/or nerves. Recently, stem cell therapy has been proposed as a source for cell replacement and for trophic support to the sphincter. To develop new therapeutic strategies for urinary incontinence, we studied the interaction between mesenchymal stem cells (MSCs and muscle cells in vitro; thereafter, aiming at a clinical usage, we analyzed the supporting role of MSCs for muscle cells in vitro and in in vivo xenotransplantation. MSCs can express markers of the myogenic cell lineages and give rise, under specific cell culture conditions, to myotube-like structures. Nevertheless, we failed to obtain mixed myotubes both in vitro and in vivo. For in vivo transplantation, we tested a new protocol to collect human MSCs from whole bone marrow, to get larger numbers of cells. MSCs, when transplanted into the pelvic muscles close to the external urethral sphincter, survived for a long time in absence of immunosuppression, and migrated into the muscle among fibers, and towards neuromuscular endplates. Moreover, they showed low levels of cycling cells, and did not infiltrate blood vessels. We never observed formation of cell masses suggestive of tumorigenesis. Those which remained close to the injection site showed an immature phenotype, whereas those in the muscle had more elongated morphologies. Therefore, MSCs are safe and can be easily transplanted without risk of side effects in the pelvic muscles. Further studies are needed to elucidate their integration into muscle fibers, and to promote their muscular transdifferentiation either before or after transplantation.

  12. Surgimesh M-SLING(®) transobturator and prepubic four-arm urethral sling for post-prostatectomy stress urinary incontinence: clinical prospective assessment at 24 months. (United States)

    Le Portz, Benoit; Haillot, Olivier; Brouziyne, Majid; Saussine, Christian


    To assess tolerance and mid-term clinical outcomes of treatment, with a new four-arm mesh sling, of post-prostatectomy incontinence (PPI) in men. This was a French multicentre prospective study that included 93 patients who underwent radical prostatectomy at least 1 year before Surgimesh M-SLING(®) implantation for the treatment of PPI. Data were collected preoperatively, and patients were followed at 3, 12 and 24 months postoperatively. Objective outcome measures included number of pads per day, 24-h pad-test, maximum urinary flow rate (Qmax ) and urinary retention. We also analysed Urinary Symptom Profile (USP(®) ) score, degree of erectile dysfunction, patients' satisfaction level, postoperative pain and procedure complications. Length of catheterization and hospitalization periods were also recorded. Patients were considered cured if no protection was used and/or daily pad weight was 50%. Those not included in any of the aforementioned groups were assessed as unchanged or to have deteriorated, and were considered as treatment failures. The mean hospitalization period was 1.57 ± 0.70 days. All patients remained catheterized for 1.17 ± 0.48 days. Intention-to-treat analysis at 24 months showed that 34.4% of patients were cured, 27.1% had improved, and 19.4% were considered failures. Two patients experienced transient urinary retention. USP questionnaire scores showed a significant decrease in incontinence and prevalence of hyperactive bladder. There was a nonsignificant tendency for reduced severe erectile dysfunction (ED), and a shift towards moderate ED was observed. No severe complications occurred. The Surgimesh M-SLING transobturator and prepubic four-arm urethral sling represents an easy-to-deploy, safe and durable therapeutic alternative for mild to moderate PPI. Its implantation did not have a negative influence on sexual performance outcomes. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

  13. Risk factors associated with bladder and urethral injuries in female children with pelvic fractures: An analysis of the National Trauma Data Bank. (United States)

    Delaney, Kristen M; Reddy, Srinivas H; Dayama, Anand; Stone, Melvin E; Meltzer, James A


    Bladder and/or urethral injuries (BUIs) secondary to pelvic fractures are rare in children and are associated with a high morbidity. These injuries are much less likely to occur in females and are often missed in the emergency department. To help clinicians detect these injuries in female children, larger studies are needed to identify risk factors specific to this patient population. This study aimed to identify risk factors associated with BUI in female children with a pelvic fracture. We reviewed the National Trauma Data Bank for females younger than 16 years who sustained a pelvic fracture from 2010 to 2012. Patients with penetrating injuries were excluded. Variables including patient characteristics, mechanism of injury, and type of pelvic fracture were selected for bivariate analysis. Variables with an association of p fractures were identified. The median patient age was 12 years (interquartile range [IQR], 7-14 years). BUI was identified in 81 patients (3%). Patients with BUI had a significantly higher median Injury Severity Score (ISS) (25 [IQR, 17-34] vs. 13 [IQR, 6-22], p fractures (adjusted OR, 2.3; 95% CI, 1.3-3.9), and sacral spine injury (adjusted OR, 1.6; 95% CI, 1.0-2.6). In total, 62 patients (77%; 95% CI, 67-86%) with BUI had at least one of these findings. Female children who sustained a pelvic fracture and have a vaginal laceration, disruption of the pelvic circle, multiple pelvic fractures, or a sacral spine injury seem to be at highest risk for BUI. Prognostic/epidemiologic study, level III.

  14. Low-power holmium:YAG laser urethrotomy for urethral stricture disease: Comparison of outcomes with the cold-knife technique

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    Mustafa Atak


    Full Text Available In this prospective randomized clinical trial, we aimed to evaluate the safety and efficacy of endourethrotomy with holmium:yttrium-aluminium-garnet (HO:YAG laser and compare the outcomes with the conventional cold-knife urethrotomy. Fifty-one male patients with single, iatrogenic, annular strictures of the urethra were randomly divided into two groups; 21 patients who underwent direct-vision endoscopic urethrotomy with Ho:YAG laser (15 W; 1,200–1,400 mJ; 8–12 Hz at 12 o’clock position (laser group and 30 patients who underwent direct-vision endoscopic urethrotomy with cold-knife incision at 12 o’clock position (cold-knife group. The results obtained were analyzed and compared at 3 months, 6 months, 9 months, and 12 months postoperatively by clinical evaluation, uroflowmetry, and retrograde urethrographies. Variables were compared among groups using Fisher’s exact and Mann Whitney U tests. There were no differences between two groups in terms of patient age, preoperative Qmax value, stricture location, and length. Operative time was shorter in laser group (16.4±8.04 minutes when compared with cold-knife group (23.8±5.47 minutes (p<0.001. Recurrence-free rate at 3 months was similar between two groups (p=0.122. However, recurrence-free rates at 6 months, 9 months, and 12 months were significantly higher in laser group when compared with cold-knife group (p values were 0.045, 0.027, and 0.04, respectively. No intra- or postoperative complications were encountered. Use of Ho:YAG laser in the management of urethral stricture disease is a safe and effective method. In addition, it provides shorter operative time and lower recurrence rate when compared with the conventional technique.

  15. Gonococcal arthritis in human immunodeficiency virus-infected patients. Review of the literature. (United States)

    Sena Corrales, Gabriel; Mora Navas, Laura; Palacios Muñoz, Rosario; García López, Victoria; Márquez Solero, Manuel; Santos González, Jesús

    We report a case of gonococcal arthritis in a patient with human immunodeficiency virus (HIV) infection and review 17 previously published cases; only one patient presented urethritis, and blood cultures were positive in one case. Gonococcal arthritis is rare in HIV-infected patients and is not usually associated with other symptoms. It should be considered in the differential diagnosis of acute arthritis in patients with HIV infection. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  16. Alternative treatment of prostatic urethral obstruction secondary to benign prostatic hypertrophy. Non-surgical balloon catheter prostatic dilatation

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    Castaneda, F.; Letourneau, J.G.; Reddy, P.; Hulbert, J.; Hunter, D.W.; Castaneda-Zuniga, W.R.; Amplatz, K.


    Benign prostatic hypertrophy (BPH) produces symptoms that currently can only be treated surgically either by open or endoscopic prostatectomy. We have undertaken animal (1) and human studies to determine if invasive radiologic techniques utilizing balloon catheters could be applied to the treatment of this common ailment. We report a series of twelve patients treated by retrograde transurethral balloon catheter prostatic dilatation. The procedure is performed using topical anesthesia with a specially designed balloon catheter (Medi-Tech, Inc.). The procedure is done on an outpatient basis and is completed within approximately 15 minutes. Relatively long-term results have resulted in persistent relief of symptoms. No complications have been encountered. We anticipate that balloon dilatation of the prostatic urethra will have a major impact on the treatment of BPH based on the promising preliminary results. Transurethral resection of the prostate (TURP) is associated with moderate morbidity and significant cost which can be reduced by the proposed procedure.

  17. Comparison of the Abbott RealTime High Risk HPV with Genomica HPV Clinical Array for the detection of human papillomavirus DNA. (United States)

    Sias, Catia; Garbuglia, Anna Rosa; Piselli, Pierluca; Cimaglia, Claudia; Lapa, Daniele; Del Nonno, Franca; Baiocchini, Andrea; Capobianchi, Maria Rosaria


    Human papillomavirus (HPV) has been identified as the major cause of cervical cancer worldwide and HPV DNA testing is recommended in primary cervical cancer screening. Several molecular tests for detection/typing of HPV DNA with different sensitivity and specificity are commercially available. The present study compared the performance of the Abbott RealTime High Risk HPV assay and the Genomica HPV Clinical Array CLART2 in 78 specimens (63 cervical smears and 15 rectal/urethral swabs).The typing results of the Genomica assay were in absolute agreement with each of the four possible result categories of the Abbott assay (HPV16, HPV18, Other HR HPV, not detected) in 87.2% (68/78) of the samples, with a Cohen' kappa agreement coefficient for every HR type of 0.62 (95% CI: 0.39-0.85), higher in cervical swabs (k = 0.74, 95% CI: 0.50-0.99) than in rectal/urethral swabs (k = 0.36, 95% CI: 0.00-0.82). There was an excellent agreement of the Genomica results with those of Abbott in cervical samples harbored HPV single infection (100% agreement). Nonetheless, both methods may lose sensitivity for detecting HPV types in multiple infections, giving discordant results (10/78). This underlines the importance of establishing the analytical sensitivity in HPV type detection in single and multiple HPV infections. In rectal/urethral swabs, 5 of 15 (33%) discordant cases were observed, most of which became compatible when the Genomica assay was performed starting from nucleic acid extracted with the Abbott m2000sp system. These results suggest that nucleic extraction based on the magnetic beads technique is suitable for HPV DNA detection in urethral/rectal swabs. © 2013 The Authors APMIS © 2013 APMIS.

  18. Performance of self-collected penile-meatal swabs compared to clinician-collected urethral swabs for the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium by nucleic acid amplification assays. (United States)

    Dize, Laura; Barnes, Perry; Barnes, Mathilda; Hsieh, Yu-Hsiang; Marsiglia, Vincent; Duncan, Della; Hardick, Justin; Gaydos, Charlotte A


    Men were enrolled in a study to assess the performance and acceptability of self-collected penile meatal swabs as compared to clinician-collected urethral swabs for sexually transmitted infections (STIs). We expected penile-meatal swabs to perform favorably to urethral swabs for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), and Mycoplasma genitalium (MG) detection by nucleic acid amplification assays (NAATs). Of 203 swab pairs tested; for CT, penile-meatal swab sensitivity was 96.8% and specificity was 98.8%. NG sensitivity and specificity were 100% and 98.9%, respectively. For TV, sensitivity was 85.0% and specificity was 96.7%. For MG sensitivity and specificity were 79.3% and 99.4%, respectively. No significant statistical differences between sample type accuracy (CT: P=0.625; NG: P=0.248; TV: P=0.344; and MG: P=0.070) existed. Most men, 90.1%, reported self-collection of penile-meatal swabs as "Very Easy" or "Easy". Self-collected penile-meatal swabs appeared acceptable for NAAT STI detection and an acceptable collection method by men. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Acute Urinary Morbidity Following Stereotactic Body Radiation Therapy for Prostate Cancer with Prophylactic Alpha-Adrenergic Antagonist and Urethral Dose Reduction. (United States)

    Repka, Michael C; Guleria, Shan; Cyr, Robyn A; Yung, Thomas M; Koneru, Harsha; Chen, Leonard N; Lei, Siyuan; Collins, Brian T; Krishnan, Pranay; Suy, Simeng; Dritschilo, Anatoly; Lynch, John; Collins, Sean P


    Stereotactic body radiation therapy (SBRT) delivers high doses of radiation to the prostate while minimizing radiation to the adjacent critical organs. Large fraction sizes may increase urinary morbidity due to unavoidable treatment of the prostatic urethra. This study reports rates of acute urinary morbidity following SBRT for localized prostate cancer with prophylactic alpha-adrenergic antagonist utilization and urethral dose reduction (UDR). From April 2013 to September 2014, 102 patients with clinically localized prostate cancer were treated with robotic SBRT to a total dose of 35-36.25 Gy in five fractions. UDR was employed to limit the maximum point dose of the prostatic urethra to 40 Gy. Prophylactic alpha-adrenergic antagonists were initiated 5 days prior to SBRT and continued until resolution of urinary symptoms. Quality of life (QoL) was assessed before and after treatment using the American Urological Association Symptom Score (AUA) and the Expanded Prostate Cancer Index Composite-26 (EPIC-26). Clinical significance was assessed using a minimally important difference (MID) of one half SD change from baseline. One hundred two patients underwent definitive prostate SBRT with UDR and were followed for 3 months. No patient experienced acute urinary retention requiring catheterization. A mean baseline AUA symptom score of 9.06 significantly increased to 11.83 1-week post-SBRT (p = 0.0024) and 11.84 1-month post-SBRT (p = 0.0023) but returned to baseline by 3 months. A mean baseline EPIC-26 irritative/obstructive score of 87.7 decreased to 74.1 1-week post-SBRT (p big problem, and that proportion increased to 37.6% 1 week following completion of SBRT before returning to baseline by 3 months. Stereotactic body radiation therapy for localized prostate cancer with utilization of prophylactic alpha-adrenergic antagonist and UDR was well tolerated as determined by acute urinary function and bother, and symptoms were comparable to those

  20. Acute Urinary Morbidity Following Stereotactic Body Radiation Therapy for Prostate Cancer with Prophylactic Alpha-Adrenergic Antagonist and Urethral Dose Reduction

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    Michael Charles Repka


    Full Text Available Background: Stereotactic body radiation therapy (SBRT delivers high doses of radiation to the prostate while minimizing radiation to adjacent critical organs. Large fraction sizes may increase urinary morbidity due to unavoidable treatment of the prostatic urethra. This study reports rates of acute urinary morbidity following SBRT for localized prostate cancer with prophylactic alpha-adrenergic antagonist utilization and urethral dose reduction (UDR.Methods: From April 2013 to September 2014, 102 patients with clinically localized prostate cancer were treated with robotic SBRT to a total dose of 35-36.25 Gy in 5 fractions. UDR was employed to limit the maximum point dose of the prostatic urethra to 40 Gy. Prophylactic alpha-adrenergic antagonists were initiated five days prior to SBRT and continued until resolution of urinary symptoms. Quality of life (QoL was assessed before and after treatment using the American Urological Association Symptom Score (AUA and the Expanded Prostate Cancer Index Composite-26 (EPIC-26. Clinical significance was assessed using a minimally important difference (MID of one half standard deviation change from baseline.Results: 102 patients underwent definitive prostate SBRT with UDR and were followed for 3 months. No patient experienced acute urinary retention requiring catheterization. A mean baseline AUA symptom score of 9.06 significantly increased to 11.83 one-week post-SBRT (p = 0.0024 and 11.84 one-month post-SBRT (p = 0.0023 but returned to baseline by 3 months. A mean baseline EPIC-26 irritative/obstructive score of 87.7 decreased to 74.1 one-week post-SBRT (p < 0.0001 and 77.8 one-month post-SBRT (p < 0.0001 but returned to baseline at 3 months. EPIC-26 irritative/obstructive score changes were clinically significant, exceeding the MID of 6.0. At baseline, 8.9% of men described their urinary function as a moderate to big problem, and that proportion increased to 37.6% one week following completion of SBRT

  1. SU-F-J-131: Reproducibility of Positioning Error Due to Temporarily Indwelled Urethral Catheter for Urethra-Sparing Prostate IMRT

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    Hirose, K; Takai, Y [Hirosaki University, Hirosaki (Japan); Southern Tohoku BNCT Research Center, Koriyama (Japan); Sato, M; Hatayama, Y; Kawaguchi, H; Aoki, M; Akimoto, H [Hirosaki University, Hirosaki (Japan); Komai, F; Souma, M; Obara, H; Suzuki, M [Hirosaki University Hospital, Hirosaki (Japan)


    Purpose: The purpose of this study was to prospectively assess the reproducibility of positioning errors due to temporarily indwelled catheter in urethra-sparing image-guided (IG) IMRT. Methods: Ten patients received urethra-sparing prostate IG-IMRT with implanted fiducials. After the first CT scan was performed in supine position, 6-Fr catheter was indwelled into urethra, and the second CT images were taken for planning. While the PTV received 80 Gy, 5% dose reduction was applied for the urethral PRV along the catheter. Additional CT scans were also performed at 5th and 30th fraction. Positions of interests (POIs) were set on posterior edge of prostate at beam isocenter level (POI1) and cranial and caudal edge of prostatic urethra on the post-indwelled CT images. POIs were copied into the pre-indwelled, 5th and 30th fraction’s CT images after fiducial matching on these CT images. The deviation of each POI between pre- and post-indwelled CT and the reproducibility of prostate displacement due to catheter were evaluated. Results: The deviation of POI1 caused by the indwelled catheter to the directions of RL/AP/SI (mm) was 0.20±0.27/−0.64±2.43/1.02±2.31, respectively, and the absolute distances (mm) were 3.15±1.41. The deviation tends to be larger if closer to the caudal edge of prostate. Compared with the pre-indwelled CT scan, a median displacement of all POIs (mm) were 0.3±0.2/2.2±1.1/2.0±2.6 in the post-indwelled, 0.4±0.4/3.4±2.1/2.3±2.6 in 5th, and 0.5±0.5/1.7±2.2/1.9±3.1 in 30th fraction’s CT scan with a similar data distribution. There were 6 patients with 5-mm-over displacement in AP and/or CC directions. Conclusion: Reproducibility of positioning errors due to temporarily indwelling catheter was observed. Especially in case of patients with unusually large shifts by indwelling catheter at the planning process, treatment planning should be performed by using the pre-indwelled CT images with transferred contour of the urethra identified by

  2. Human papillomavirus infection in a male population attending a sexually transmitted infection service.

    Directory of Open Access Journals (Sweden)

    Marta Elena Álvarez-Argüelles

    Full Text Available OBJECTIVE: Human Papillomavirus (HPV infection in men may produce cancer and other major disorders. Men play an important role in the transmission of the virus and act as a reservoir. The aim of this study was to determine the HPV-genotypes and their prevalence in a group of men attending a Sexually Transmitted Infection service. PATIENTS AND SAMPLES: Between July 2002 and June 2011, 1392 balanopreputial, 435 urethral, 123 anal, and 67 condyloma lesions from 1551 men with a mean age of 35.8±11.3 years old (range: 17-87 were collected for HPV-DNA testing. METHODS: A fragment of the L1-gene and a fragment of the E6/E7-genes were amplified by PCR. Positive samples were typed by hybridization. RESULTS: The HPV genome was detected in 36.9% (486/1318 balanopreputial and in 24.9% (101/405 urethral (p35. HPV was found in 59.4% (104 of 165 men with lesions (macroscopic or positive peniscopy, and in 22.8% (61/267 without clinical alterations. HPV was also detected in 71.4% (40/56 men with condylomata and in 58.7% (64/109 of men with positive peniscopy. CONCLUSIONS: HPV prevalence in men was high and decreased with age. HPV was found more frequently in balanopreputial than in urethral swabs. There was a low rate of co-infections. Low-risk HPV vaccine genotypes were the most recurrent especially in younger. Although HPV has been associated with clinical alterations, it was also found in men without any clinical presentation. Inclusion of men in the national HPV vaccination program may reduce their burden of HPV-related disease and reduce transmission of the virus to non-vaccinated women.

  3. Frequency of herpes simplex virus, cytomegalovirus and human papillomavirus DNA in semen. (United States)

    Aynaud, Olivier; Poveda, Jean-Dominique; Huynh, Bernard; Guillemotonia, Aline; Barrasso, Renzo


    Herpes simplex virus (HSV-2) and cytomegalovirus (CMV) infections produce brain damage in the newborn, and human papillomavirus (HPV) plays a role in cervical carcinogenesis. To assess the frequency of herpes virus and HPV in semen and its role in transmission, semen from 111 male partners of women with histologically-detected genital HPV infection was analysed for HSV, CMV and HPV infection. We used cell culture to detect HSV and CMV, and polymerase chain reaction (PCR) for HPV. Virological findings in the sperm were correlated to the presence or absence of HPV-associated genital lesions and to the viral type. Viral cultures yielded HSV-2 DNA in 9% and CMV DNA in 6.3% of cases. No correlation was established with a history of clinically apparent infection for HSV. HPV-DNA was detected in 23.4% of semen by PCR techniques: in 48% of subjects with urethral lesions, in 22% of patients with penile lesions, in 2% of patients without HPV-associated lesions. HPV-DNA type 16 was detected in 3.6% of cases. Patients with a positive HPV semen sample and penile or urethral lesions had the same HPV type detected in the two specimens. The study shows a high detection of clinically inapparent HSV and CMV, but does not confirm high HPV prevalence in semen from men without detectable lesions. Our study also suggests that the mechanism for semen contamination by HPV is the exfoliation of infected cells from urethral lesions during semen ejaculation, and probably, by abrasion from penile lesions. This could result in the contamination of semen used in assisted reproductive technology.

  4. Predicting Risk of Chronic Kidney Disease in Infants and Young Children at Diagnosis of Posterior Urethral Valves: Initial Ultrasound Kidney Characteristics and Validation of Parenchymal Area as Forecasters of Renal Reserve. (United States)

    Odeh, Rakan; Noone, Damien; Bowlin, Paul R; Braga, Luis H P; Lorenzo, Armando J


    There is paucity of validated objective early imaging markers to help predict future renal deterioration in infants with posterior urethral valves. We evaluated the prognostic value of total renal parenchymal area, renal echogenicity and corticomedullary differentiation regarding future development of chronic kidney disease. We analyzed initial postnatal ultrasonographic images from serial posterior urethral valve cases seen at a single tertiary referral center using National Institutes of Health sponsored image processing software. Echogenicity and corticomedullary differentiation were objectively measured as ratios relative to the adjacent liver or spleen and between cortex and medulla. The primary study outcome, renal function at last followup, was dichotomized based on glomerular filtration rate and/or need for renal replacement therapy (dialysis or renal transplantation, stage 5 chronic kidney disease). A total of 75 patients were evaluated, of whom 16 had progression to stage 5 chronic kidney disease after a mean ± SD followup of 64.2 ± 38.9 months. Mean renal parenchymal area was 21.41 cm(2) in patients without and 16 cm(2) in patients with stage 5 chronic kidney disease (p <0.001), and mean corticomedullary differentiation was 1.77 and 1.21, respectively (p <0.001). Bilateral echogenic kidneys were significantly associated with development of stage 5 chronic kidney disease (p = 0.004). The performance of corticomedullary differentiation in predicting stage 5 chronic kidney disease was statistically significant (AUROC 0.881, 95% CI 0.776-0.987, p <0.001). Estimates of renal parenchyma quantity (total renal parenchymal area) and quality (corticomedullary differentiation and renal echogenicity) measured on initial postnatal ultrasound carry prognostic value in determining future risk of stage 5 chronic kidney disease in patients with posterior urethral valves. These data are promising for developing tools to risk stratify patients, counsel parents and

  5. Treatment Options for Urethral Cancer (United States)

    ... In men, the urethra also carries semen . Enlarge Anatomy of the male urinary system (left panel) and female urinary system (right panel) showing the kidneys, ureters, bladder, and urethra. Urine is made in the renal tubules and collects in the renal pelvis of ...

  6. Treatment Option Overview (Urethral Cancer) (United States)

    ... In men, the urethra also carries semen . Enlarge Anatomy of the male urinary system (left panel) and female urinary system (right panel) showing the kidneys, ureters, bladder, and urethra. Urine is made in the renal tubules and collects in the renal pelvis of ...

  7. General Information about Urethral Cancer (United States)

    ... In men, the urethra also carries semen . Enlarge Anatomy of the male urinary system (left panel) and female urinary system (right panel) showing the kidneys, ureters, bladder, and urethra. Urine is made in the renal tubules and collects in the renal pelvis of ...

  8. Untangling of knotted urethral catheters

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    Sambrook, Andrew J. [Aberdeen Royal Infirmary, Department of Radiology, Aberdeen (United Kingdom); Todd, Alistair [Raigmore Hospital, Inverness (United Kingdom)


    Intravesical catheter knotting during micturating cystourethrography is a rare but recognized complication of the procedure. We were able to untangle a knot utilizing a fluoroscopically guided vascular guidewire. Following this success, a small study was performed using a model. Various types of guidewires and techniques were tested for different diameters of knots in order to predict the likelihood of success in this type of situation. (orig.)

  9. Gram stain of urethral discharge (United States)

    ... What Abnormal Results Mean Abnormal results may indicate gonorrhea or other infections. Risks There are no risks. ... and the A.D.A.M. Editorial team. Gonorrhea Read more Sexually Transmitted Diseases Read more NIH ...

  10. Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in an STI population: performances of the Presto CT-NG assay, the Lightmix Kit 480 HT CT/NG and the COBAS Amplicor with urine specimens and urethral/cervicovaginal samples (United States)

    Schuurs, T A; Verweij, S P; Weel, J F L; Ouburg, S; Morré, S A


    Objectives This study assessed the performances of the Presto CT-NG assay, the Lightmix Kit 480 HT CT/NG and the COBAS Amplicor for Chlamydia trachomatis and Neisseria gonorrhoeae detection. Design A cross-sectional study design. Setting Izore, Centre for Diagnosing Infectious Diseases in Friesland, the Netherlands, tested samples sent from regional sexually transmitted infection (STI) outpatient clinics and regional hospitals from the province Friesland, the Netherlands. Participants Samples were collected from 292 men and 835 women. These samples included 560 urine samples and 567 urethral/cervicovaginal samples. Primary and secondary outcome measures The primary outcome measure is C trachomatis infection. No secondary outcome measures are available. Results The sensitivity, specificity, positive predicative value (PPV) and negative predictive value (NPV) for C trachomatis detection in urine samples using the Presto CT-NG assay were 100%, 99.8%, 98.1% and 100%, respectively; for the Lightmix Kit 480 HT CT/NG: 94.2%, 99.8%, 96.1% and 99.4%, respectively; for the COBAS Amplicor: 92.3%, 99.6%, 96% and 99.2%, respectively. The sensitivity, specificity, PPV and NPV for C trachomatis detection in urethral/cervicovaginal swabs using the Presto CT-NG assay and the COBAS Amplicor were 100%, 99.8%, 97.7% and 100%, respectively; for the Lightmix Kit 480 HT CT/NG: 100%, 99.6%, 97.7% and 100%, respectively. Calculations for N gonorrhoeae could not be made due to a low prevalence. Conclusions All three assays had a high sensitivity, specificity, PPV and NPV for C trachomatis, with best performance for the Presto CT-NG assay. PMID:24381252

  11. Comparison of three mid-urethral tension-free tapes (TVT, TVT-O, and TVT-Secur) in the treatment of female stress urinary incontinence: 1-year follow-up. (United States)

    Wang, Yi-jun; Li, Fei-ping; Wang, Qian; Yang, Sen; Cai, Xian-guo; Chen, Ying-he


    The purpose of the study was to evaluate and compare the clinical values of tension-free vaginal tape (TVT), tension-free vaginal tape-transobturator (TVT-O), or tension-free vaginal tape-Secur (TVT-Secur) as treatment for female stress urinary incontinence. The pre-operative and 1-year post-operative follow-up protocols for patients who were treated with serial mid-urethral tension-free tape procedures in two hospitals from October 2008 to December 2009 were prospectively studied. These patients were randomly allocated to TVT, TVT-O, or TVT-Secur. A total of 102 women participated. At the 1-year follow-up, complications were not statistically different across the three groups except for pain in the thigh, which was more common in the TVT-O group. The overall efficacy and cure rate were similar between the TVT and TVT-O groups, but were significantly lower in the TVT-Secur group. A comparison of the three procedures shows that TVT-O is easy to operate and is as safe as TVT-Secur, and it has similar long-term efficacy to TVT, though, as one of the third-generation mid-urethral tension-free tapes, TVT-Secur is still being evaluated. Basing on the outcome of our study, it had rare complications but unsatisfactory efficacy, and we suggest that TVT-Secur is not fit for severe cases. However, observation and comparison of these groups in a larger sample size on a longer term are needed.

  12. Sexually transmitted diseases in homosexual and bisexual males from a cohort of human immunodeficiency virus negative volunteers (Project Horizonte, Belo Horizonte, Brazil

    Directory of Open Access Journals (Sweden)

    Lignani Jr L


    Full Text Available Sexually transmitted diseases (STD are very frequent in the whole world. Males who do not use a condom during their sexual relations are at great risk. We report cases of STD during six months of observation, among homosexual/bisexual males who participate in the Project Horizonte. There were 16 cases of genital warts, 6 cases of human immunodeficiency virus infection, 24 cases of unspecific urethritis, 28 cases of herpes simplex virus infection, 30 cases of syphilis, 58 cases of gonorrhea and 84 cases of pediculosis. We concluded that a condom must be used in all sexual relations and new counseling techniques are needed, to avoid this situation.

  13. The long-term influence of body mass index on the success rate of mid-urethral sling surgery among women with stress urinary incontinence or stress-predominant mixed incontinence: comparisons between retropubic and transobturator approaches.

    Directory of Open Access Journals (Sweden)

    Seong Jin Jeong

    Full Text Available Mid-urethral sling (MUS surgery for the treatment of urinary incontinence has been widespread since the introduction of tension-free vaginal tape in the mid-1990s. The majority of studies with short-term follow-up <2 years found no differences in the surgical outcomes according to body mass index (BMI. However, considering the chronic influence of obesity on pelvic floor musculature, it is cautiously speculated that higher BMI could increase stress on pelvic floor and sub-urethral tape, possibly decreasing the long-term success rate in the obese population. We aimed to compare the long-term effects of BMI on the outcomes of MUS between women with retropubic and transobturator approaches.We performed a retrospective analysis on 243 consecutive women who received MUS and were followed up for ≥36 months. The influence of BMI on the success rates was separately estimated and the factors for treatment failure were examined using logistic regression in either approach.The mean follow-up was 58.4 months, and 30.5% were normal weight, 51.0% overweight, and 18.5% obese. Patients received either the retropubic (30.5% or transobturator (69.5% approach. The success rates (% under the transobturator approach differed according to the BMI groups (94.3, 88.6, and 78.6, respectively; P = 0.037 while those under the retropubic approach were not different according to the BMI groups. However, in multivariate models, only the presence of preoperative mixed urinary incontinence (MUI was proven to be the risk factor for treatment failure in the transobturator approach (OR 6.39, P = 0.003. The percent of subjects with MUI was higher in obese women than in non-obese women with the transobturator approach.BMI was not independently associated with failures in either approach. Higher success rates in women with lower BMI in the transobturator approach were attributed to the lower percent of preoperative MUI in those with lower BMI.

  14. Early Continence Recovery after Preservation of Maximal Urethral Length until the Level of Verumontanum during Radical Prostatectomy: Primary Oncological and Functional Outcomes after 1 Year of Follow-Up

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    Stavros Sfoungaristos


    Full Text Available Purpose. To investigate the effect of preventing maximal urethral length until the level of verumontanum during radical prostatectomy on both oncologic and functional outcomes. Patients and Methods. We recruited 329 patients, and they underwent an open radical prostatectomy by a single surgeon. The study cohort was randomized in 2 groups. A standard radical prostatectomy was performed in group A patients, while in group B the urethra was preserved until the level of verumontanum. Results. There was no statistically significant difference between the study groups in terms of positive surgical margins or biochemical relapse. Regarding the functional results, the incidence of incontinence, urgency, and nocturia at 1st month, statistically significant higher rates were seen in group A. In addition, there was a statistically significant difference in the number of pads/day in favor of group B at the 1st, 3rd, and 6th months after surgery. However, this difference was eliminated at 12 months postoperatively. Similar results were seen with the scores of the ICIQ-SF and IIQ-SF questionnaires. Conclusions. Without compromising the oncological outcome, our surgical modificated technique showed earlier recovery of continence in the first 6 months, having though the same rates of continence at 12 months.

  15. Multipotent Basal Stem Cells, Maintained in Localized Proximal Niches, Support Directed Long-Ranging Epithelial Flows in Human Prostates

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    Mohammad Moad


    Full Text Available Sporadic mitochondrial DNA mutations serve as clonal marks providing access to the identity and lineage potential of stem cells within human tissues. By combining quantitative clonal mapping with 3D reconstruction of adult human prostates, we show that multipotent basal stem cells, confined to discrete niches in juxta-urethral ducts, generate bipotent basal progenitors in directed epithelial migration streams. Basal progenitors are then dispersed throughout the entire glandular network, dividing and differentiating to replenish the loss of apoptotic luminal cells. Rare lineage-restricted luminal stem cells, and their progeny, are confined to proximal ducts and provide only minor contribution to epithelial homeostasis. In situ cell capture from clonal maps identified delta homolog 1 (DLK1 enrichment of basal stem cells, which was validated in functional spheroid assays. This study establishes significant insights into niche organization and function of prostate stem and progenitor cells, with implications for disease.

  16. Some Aspects Of Human Sparganosis In Korea. (United States)

    Cho, Seung Yull; Bae, Jong Hoa; Seo, Byong Seol


    Human sparganosis in Korea was discussed on the bases of five human cases experienced by the present authors and 58 case records already reported by many previous authors, in aspects of epidemiology and clinical features. Sparganosis is not infrequent tissue helminthiasis now in Korea and the incidence has been evidently increased during past 10 years. It might be interpreted that improved medical delivery system and health care exposed the hidden but prevalent disease. The distribution of sparganosis in Korea is apparently subdivided into three major endemic areas; Kyunggi Do, Kyungsang Do and Hamkyung Nam Do. Although scanty in other areas of Korea, the distribution of this disease is presumably throughout the whole peninsula of Korea except Cheju Do. The majority of human cases of sparganosis in Korea has revealed raw consuming of snakes for treatment of tuberculosis, syphilis and joint pain, for tonics and for the belief of special nutrition among very limited group of Korean population. Because of this kinds of mode of infection, comprising four fifths of all cases, the majority of cases detected were male adult consisting of about 70% of total cases. And drinking of untreated water in rural area where no protective, sanitary measures for water sources were provided in the past, seems another important causes of infection especially in women and children in Korea. Thus it may be concluded that sparganosis in Korea is concluded by eating of infective stages per os voluntarily or involuntarily, but not through the direct invasion. Clinically, subcutaneous mass or lump was the most frequent problem in those patients and those masses were associated with inflammatory signs. By the anatomical location of the lesion, some peculiar manifestations could be developed as in orbital, abdominal, urethral, ureteral and vertebral cases. And the lesions could be complicated by haemorrhage or abscess formations. The larval worms hitherto collected in Korea has been identified

  17. Ação do citrato de sildenafil sobre a função uretral de ratas com desnervação vesical Effect of sildenafil citrate in the urethral function in rats with denervated bladder

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    Haylton Jorge Suaid


    urethane at a dosage of 1.25mg/kg. All animals underwent cystostomy with a catheter P50 connected by a Y to an infusion pump and to a polygraph Narco-Biosystem. The cystometry was performed trice in each animal: right after the cystostomy, after surgical of bladder denervation and 1h after gastric infusion of 1mg/kg of sildenafil citrate. Maximum (MaP and minimum (MiP vesical pressure were compared in the following moments: I - before bladder denervation, II - after bladder denervation and III - after bladder denervation and sildenafil administration. Wilcoxon test was used for a level of significance of 5%. RESULTS: Mean values of MaP were: I - 86.6±10.1, II - 42.6±15.0 and III - 30.8±12.4. The corresponding values of MiP were: : I - 72.1±18.9, II - 31.1±9.8 and III - 14.5±9.5. The comparison between MaP and MiP in each moment showed difference only in moment III (p0.05 in IIxIII. For MiP the p values were <0.004 in IxII, <0.002 in IxIII and <0.01 in IIxIII. CONCLUSION: 1 Bladder denervation reduces maximum and minimum urethral pressure; 2 Sildenafil citrate reduces the minimum urethral pressure widening the interval between the peak and bottom pressures; and, 3 Sildenafil citrate does not interfere on the peak urethral pressure after bladder denervation.

  18. The York-Mason technique for recto-urethral fistulas Correção de fistula reto-uretral pela técnica de York-Mason

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    Alexandre Crippa


    Full Text Available OBJECTIVE: Recto-urethral fistula formation following radical prostatectomy is an uncommon but potentially devastating event. There is no consensus in the literature regarding the treatment of these fistulas. We present here our experiences treating recto-urethral fistulas. MATERIAL AND METHODS: We analyzed 8 cases of rectourethral fistula treated at our institution in the last seven years. Seven of the patients underwent repair of the fistula using the modified York-Mason procedure. RESULTS: The causes of the fistula were radical retropubic prostatectomy in five patients, perineal debridement of Fournier's gangrene in one, transvesical prostatectomy in one and transurethral resection of the prostate in the other patient. The most common clinical manifestation was fecaluria, present in 87.5% of the cases. The mean time elapsed between diagnosis and correction of the fistula was 29.6 (7-63 months. One spontaneous closure occurred after five months of delayed catheterization. Urinary and retrograde urethrocystography indicated the site of the fistula in 71.4% of the cases. No patient presented recurrence of the fistula after its correction with the modified York-Mason procedure. CONCLUSION: The performance of routine colostomy and cystostomy is unnecessary. The technique described by York-Mason permits easy access, reduces surgical and hospitalization times and presents low complication and morbidity rates when surgically correcting recto-urethral fistulas.OBJETIVO: As fístulas reto-uretrais são de acesso difícil e por vezes complexo, sendo seu fechamento espontâneo raro. Com o diagnóstico precoce e aumento do número de intervenções, principalmente a cirurgia por adenocarcinoma da próstata localizado, sua incidência apesar de rara vem crescendo. Nós demonstramos a nossa experiência dos casos de fístulas reto-uretrais entre 2000 a 2006 com uma serie de oito pacientes, sendo que sete realizaram correção da fístula pela Técnica de

  19. Human papillomavirus infection in a male population attending a sexually transmitted infection service. (United States)

    Álvarez-Argüelles, Marta Elena; Melón, Santiago; Junquera, Maria Luisa; Boga, Jose Antonio; Villa, Laura; Pérez-Castro, Sonia; de Oña, María


    Human Papillomavirus (HPV) infection in men may produce cancer and other major disorders. Men play an important role in the transmission of the virus and act as a reservoir. The aim of this study was to determine the HPV-genotypes and their prevalence in a group of men attending a Sexually Transmitted Infection service. PATIENTS AND SAMPLES: Between July 2002 and June 2011, 1392 balanopreputial, 435 urethral, 123 anal, and 67 condyloma lesions from 1551 men with a mean age of 35.8±11.3 years old (range: 17-87) were collected for HPV-DNA testing. A fragment of the L1-gene and a fragment of the E6/E7-genes were amplified by PCR. Positive samples were typed by hybridization. The HPV genome was detected in 36.9% (486/1318) balanopreputial and in 24.9% (101/405) urethral (pmen. Co-infections were present in 5.4% (80/1469) of cases. HPV was found in 43.9% (373/850) of men younger than 35 vs. 31.7% (187/589) of men aged >35. HPV was found in 59.4% (104) of 165 men with lesions (macroscopic or positive peniscopy), and in 22.8% (61/267) without clinical alterations. HPV was also detected in 71.4% (40/56) men with condylomata and in 58.7% (64/109) of men with positive peniscopy. HPV prevalence in men was high and decreased with age. HPV was found more frequently in balanopreputial than in urethral swabs. There was a low rate of co-infections. Low-risk HPV vaccine genotypes were the most recurrent especially in younger. Although HPV has been associated with clinical alterations, it was also found in men without any clinical presentation. Inclusion of men in the national HPV vaccination program may reduce their burden of HPV-related disease and reduce transmission of the virus to non-vaccinated women.

  20. More Human than Human. (United States)

    Lawrence, David


    Within the literature surrounding nonhuman animals on the one hand and cognitively disabled humans on the other, there is much discussion of where beings that do not satisfy the criteria for personhood fit in our moral deliberations. In the future, we may face a different but related problem: that we might create (or cause the creation of) beings that not only satisfy but exceed these criteria. The question becomes whether these are minimal criteria, or hierarchical, such that those who fulfill them to greater degree should be afforded greater consideration. This article questions the validity and necessity of drawing divisions among beings that satisfy the minimum requirements for personhood; considering how future beings-intelligent androids, synthezoids, even alternate-substrate sentiences-might fit alongside the "baseline" human. I ask whether these alternate beings ought to be considered different to us, and why this may or may not matter in terms of a notion of "human community." The film Blade Runner, concerned in large part with humanity and its key synthezoid antagonist Roy Batty, forms a framing touchstone for my discussion. Batty is stronger, faster, more resilient, and more intelligent than Homo sapiens. His exploits, far beyond the capability of normal humans, are contrasted with his frailty and transient lifespan, his aesthetic appreciation of the sights he has seen, and his burgeoning empathy. Not for nothing does his creator within the mythos term him "more human than human."