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Abstract: Objective: To investigate the clinical and radiological parameters of posterior urethral valve (PUV) patients with residual valve or strictures after primary valve ablation. Patients and methods: A total of 127 PUV patients were treated in our clinic between 1986 and 2009. We retrospectively reviewed the records of 101 patients, who had at least 1 year of follow-up data, regarding the presence of valve remnants or urethral strictures after PUV ablation. Results: A total of 21 patients (20.8%) underwent repeat-urethroscopy and, of these, residual valve leaflets or stricture were detected in 10 patients (10/101, 9.9%). In 2 of these 10 (20%), the urethra had been found to be normal on the first voiding cystourethrogram following ablation. However, these two boys underwent re-urethroscopy due to persistent vesicoureteral reflux in one and persistent hydroureteronephrosis in the other, and valve remnants were detected. The remaining 8 cases had radiological signs consistent with persistent infravesical obstruction in the early period. Obstruction was due to urethral stricture and residual valve remnants in 2 and 6 cases, respectively. Conclusions: There was clinical suspicion of residual valve in about 20% of the cases and in half of these the urethra was found to be normal on urethroscopy. The possible presence of residual valve remnants after primary valve ablation should be confirmed by careful clinical, radiological and endoscopic evaluation. [Copyright &y& Elsevier]

Abstract: Objective: We report additional technical modifications and extended application of proximal TIP hypospadias repair in consecutive patients operated by a single surgeon. Materials: During a 39-month period, 36 patients underwent primary proximal hypospadias surgery, with 26 undergoing TIP and 10 two-stage repair for a thin urethral plate (UP) (1) or ventral penile curvature (VC) requiring UP transection (9). Of the TIP repairs, 16 had UP elevation from the corpora cavernosa to facilitate VC straightening while maintaining the UP for urethroplasty. All TIP patients underwent two-layer urethroplasty with tunica vaginalis coverage over the neourethra. Results: With mean follow up of 12 months (2–38) in 24 TIP patients, 16 had calibration and 11 urethroscopy 6–12 months postoperatively. Complications occurred in three (13%), glans dehiscence (2) and neourethral stricture (1), which represents a significant reduction versus our prior reports. Non-randomized preoperative testosterone in 8/24 with follow up did not influence complication rates. TIP incision of the elevated UP did not divide it into separate strips, or impair vascularity. Conclusions: Dissection of the UP from the corpora facilitates correction of VC while preserving the plate, without increasing TIP urethroplasty complications. Overall, complication rates for TIP have significantly diminished with technical modifications and experience. The role for neoadjuvant hormonal therapy remains unclear. Despite straightening VC preserving the UP, intraoperative assessment deemed it unsuitable for TIP in one case (4%). [ABSTRACT FROM AUTHOR]

Abstract: Here we present a case of successful non-operative management of an iatrogenic recto-urethral fistula in a 13-year-old boy. The fistula was created when urethroscopic repair of a urethral stricture was attempted. Due to the anatomy of the lesion and previous urinary diversion, it was deemed possible to spare this patient diverting colostomy or surgical repair of the fistula. The result was successful closure of the fistula, which was confirmed on retrograde urethrogram. While we do not support the routine use of non-operative management for recto-urethral fistulas we have demonstrated that there are circumstances where it can be safely applied. [Copyright &y& Elsevier]

Abstract: Urethral hair and diverticula are well described long-term complications following urethroplasty or hypospadias repair. Endoscopic laser ablation is an uncommonly reported treatment option for a symptomatic hair-bearing urethra, and holmium laser hair epilation has not been previously reported in the literature. We report the first case of urethroscopic holmium laser ablation of urethral diverticular hair follicles and the outcome. [Copyright &y& Elsevier]

Purpose: Prostatic utricle comes from an incomplete regression of the MÜllerian structures. Only those that are symptomatics presenting UTI or incontinence, should be considered for surgery. We present our experience with the laparoscopic approach for prostatic utricle resection in 5 patients with a mean age of 9.5 y.o (5-16). Material and Methods: The procedure begins with a cystourethroscopy and catheterization of the utricle with a Fogharty or a cystoscope, that is left inside the prostatic utricle to facilitate subsequent identification and mobilization during the procedure. Laparoscopy was conducted via a 10 mm port inserted through an umbilical incision. Two more 5 mm working ports were inserted at the right and left mid-abdomen. Resection of the utricle is done by electric monopolar cautery hook. Results: In all five boys resection was satisfactory except in one case that needed open conversion due to bleeding. Mean operative time was 165 min (120-240). Conclusions: Laparoscopic resection is a minimally invasive approach and cystocopy offers a good help and safe dissection of the utricule. [Copyright &y& Elsevier]

Purpose: Urethral duplication is a rare congenital anomaly. We report the clinical presentation, imaging findings and surgical treatment in a patient with Y-type duplicated urethra. Material and Methods: 2 years old boy presented to our clinic with voiding through his anus and urine dribbling from the urethral meatus at the center of the glans. He had an urethral meatus and a second anal urinary meatus on physical examination . Retrograde and voiding cystourethrograms and cystourethroscopy showed the Y-type urethral duplication with stenosis of the dorsal orthotopic urethra and a ventral dominat urethra placed in the anal opening that was functionally normal. The patient was treated with 2-stage urethral reconstruction. At first, ventral dominant anal urethra was transposed to the perineum followed by urethroplasty 6 months later. Proximal to distal steps of the urethroplasty were; 2 cm penile skin tubularization, 4cm preputial island flap tubularization, marsupialization of the dorsal orthotopic urethra, 2cm preputial inlay grefting between the incised dorsal urethral plate, preputial onlay flap to augment the dorsal urethral plate and finally tubularization of all parts to form ‘Thiersch type’ neourethra. Results: After 1 year of follow-up, no urethrocutaneous fistula developed and the patient now voids spontaneously through a meatus located normally at the tip of the glans. Conclusions: While the ideal surgical management of urethral duplication anomalies remains uncertain, we used a combination of surgical techniques to correct this severe malformation. [Copyright &y& Elsevier]

Purpose: It might be diffucult to evaluate the clinically significant residual valve remnants and strictures, and make a judgement for the re-operation after the ablation of posterior urethral valve. In this research, clinical and radiological parameters are examined in cases with residual valve remnants. Material and Methods: Between 1986-2009, a total of 127 valve patients were treated in our clinic and the records of 101 patients, who had regular follow-up, were included to the study. Of these 101 children, the records of 10 patients, who were found to have residual valve or stricture after ablation, were reviewed retrospectively. Results: Endoscopic intervention due to the residual valve remnants or stricture was performed after a mean period of 7.25±4.7 months following the first ablations. In 2 (20%) of the cases, urethra has been found to be normal in the first radiological evaluation (voiding cystourethrography). Of these 2 children, urethroscopy was conducted due to the recognition of the valve remnants in the follow-up of vesicoureteral reflux in one case and during evaluation of persistent hydroureteronephrosis in the other case. Two out of 8 cases who had the radiological appearance of obstruction in the early period, were found to have strictures. In the other 6 cases, the residual valve remnants were incisized. In the follow-up, endoscopy was re-conducted on the 2 out of 8 cases due to strictures. Conclusions: In our series, almost 10% of the cases were found to have residual valve or strictures. Although about one fifth of the cases were seen to be normal in the first radiological examination, valve remnants were found in the clinical follow-up evaluations due to the persistent hydrourethronephrosis and vesicoureteral reflux. For this reason, the operation decision should be given in the light of the clinical and radiological evaluations together to find the significant valve remnants and strictures following valve ablation. [Copyright &y& Elsevier]

Purpose: Judging the significance of valve remnants at check cystourethroscopy after ablation of posterior urethral valves (PUV) can be difficult. In November 2006, our Department adopted a policy of performing a repeat micturating cystourethrogram (MCUG) prior to check cystourethroscopy three months after primary PUV ablation. The aim of this study is to determine the predictive value of repeat MCUG for further valve resection at check cystourethroscopy. Material and Methods: We retrospectively reviewed the operative notes and MCUG (performed by Consultant Paediatric Radiologists) of all 31 boys with PUV who had a check cystourethroscopy with pre-operative MCUG between November 2006 and October 2008. Results: Repeat MCUG indicated remnant valves in ten boys, but no residual leaflets could be identified at subsequent endoscopy in four. In 21 boys, the PUV appeared completely ablated on MCUG. However, on cystourethroscopy, valve leaflets thought to necessitate resection were present in nine. Taking the degree of persistent posterior urethral dilatation on MCUG into consideration did not improve the test''s ability to anticipate residual valve leaflets at check cystourethroscopy. The positive predictive value of repeat MCUG for subsequent resection of valve remnants is 60%; the negative predictive value is 57%. Conclusions: Repeat MCUG after primary PUV ablation portends further resection of valve remnants at subsequent check cystourethroscopy in only 60%. Importantly, where complete PUV ablation is shown radiologically, remnant leaflets deemed significant are found on endoscopy in 43%. We recommend check cystourethroscopy three months after PUV ablation; pre-operative repeat MCUG is unprofitable. [Copyright &y& Elsevier]