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OBJECTIVES: The aims of this study were: (1) To evaluate the urethral orifice cross‐section size immediately and 12 days post‐operatively following a perineal urethrostomy procedure. (2) To assess the correlation between the cross‐section size and stricture formation during a 6‐month period following the perineal urethrostomy. ANIMALS: Twenty‐four male cats with feline lower urinary tract disease that failed to respond to medical treatment and underwent perineal urethrostomy. MATERIALS AND METHODS: The urethral orifice cross‐section size was estimated by the largest size of the urinary catheter that was possible to insert facilely through the urethrostomy site. The urethral orifice cross‐section size was measured in three different times: Pre‐operative (LUCpr), immediately post‐operative (LUCi) and 12 days post‐operative (LUCp). Urinary obstruction recurrence and urethrostomy site stricture formation were documented for 6 months after the surgical procedure. The probabilities for obstruction recurrence in cases of LUCi ≤ 8Fr and LUCi > 8Fr were calculated. RESULTS: Urinary obstruction and urethrostomy site stricture occurred in 5 of 24 (~20%) of the operated cats at an average of 92 ± 25 days post‐perineal urethrostomy. LUCi ranged from 6 to 10 (median 10) Fr and the LUCp ranged from 4 to 10 (median 8) Fr. There was a significant decrease of 0.15 ± 0.09 mm² of the urethral orifice cross‐section area 12 days post‐operative compared to the measurements taken immediately post‐operative. The probabilities for post‐operative urinary obstruction of the LUCi ≤ 8Fr cases (intra‐operative urethral orifice cross‐section area equal or larger than 5.5 mm²) and in the LUCi > 8Fr cases were 44 and 6%, respectively. Recurrence of obstruction was documented in all cases (three cats) in which LUCi was 6Fr. CONCLUSION AND CLINICAL SIGNIFICANCE: The largest size of the urinary catheter that is possible to insert during surgery is a simple method to evaluate urethrostomy cross‐section size. Contraction of the urethral orifice diameter is expected during the wound healing phase. Post‐operative urinary obstruction is more likely in cases where LUCi

Embolization of arterial supply of tumor and pelvic metastatic tissue has been widely used as an elective modality as an adjunct to chemotherapy in the management of gynecological tumors. It can be a rescue life-saving procedure in heavily pouring masses and also treatment modality so as to reduce the size of mass by endovascular methods. This is specifically remarkable in cases where other measures of hemorrhage control fail or are inapplicable. Here we report the case of 27-year-old lady with vaginal metastasis of choriocarcinoma with uncontrollable bleeding that was managed by emergent embolization. Coil embolization of bilateral internal iliac arteries by transfemoral route was done to control bleeding from vaginal metastatic growth of choriocarcinoma, which was in close proximity to urethral orifice. Emergent embolization proved to be a successful rescue modality of bleeding control from vaginal metastatic lesion of choriocarcinoma. Embolization has an emergent and elective role of in the management of choriocarcinoma. Intervention radiology is of immense importance not only in regular elective cases, it also can be used as an emergent measure. If the process is expedited, and the avoidable delays are somehow overcome, it can be used for emergent control of gynecological hemorrhage.

Urethral coitus is a rarely reported cause of female urinary incontinence and has been most commonly described in women with vaginal and hymenal anomalies. Herein, we report a 41-year-old woman with a complex obstetric history, who presented with continuous urinary incontinence. On evaluation, she was found to have an abnormally dilated urethral orifice and vaginal stenosis suggestive of chronic urethral coitus. She underwent a reduction urethroplasty with autologous sling insertion and a vaginoplasty using vaginal flaps. This case highlights the fact that urethral coitus, though rare, should be considered as a cause of urinary incontinence in women with history of obstetric vaginal trauma.

Introduction:. Genital herpes is one of the most common sexually transmitted infections worldwide. Most genital herpes occur on the genitalia, perineum, buttocks, upper thighs, or perianal areas. However, there were reports of rare cases of genital herpes on urethral orifice. Herein, we report a case of a patient who was diagnosed with urethral orifice genital herpes, a place likely to be ignored. Case presentation:. A 53-year-old woman presented with vagina pruritus at first, with subsequent burning sensation around urethra. Mycostatin and mycospor were administered for the treatment of the pruritus. Then levofloxacin was prescribed. Finally, the patient was given treatment with acyclovir. Different from other cases, the investigation showed herpes simplex virus type 1 DNA positive and herpes simplex virus type 2 DNA negative by PCR. The patient was therefore diagnosed with genital herpes. Discussion:. Most genital herpes happen on the genitalia, perineum, buttocks, upper thighs, or perianal areas. Few cases have been reported that genital herpes occurred on urethral orifice till now. Conclusion:. If there is no typical symptoms that patient present with herpes simplex virus type 1 or 2 positive, urethral orifice genital herpes should be considered.

Objectives The aim of this study is to develop a method to evaluate the fluid dynamics of urine flow in the lower urinary tract (LUT), especially that of vorticity. Materials and methods This investigation included three sub-studies to demonstrate urine flow in the entire LUT. First, we attempted to observe vorticity generation in the urinary bladder during spontaneous voiding using transabdominal color Doppler ultrasonography (CDUS). Second, we performed transrectal CDUS to evaluate the vorticity of urine flow in the prostatic urethra. Patients with prostate cancer were enrolled before robotic surgery and divided into the vorticity and non-vorticity groups based on CDUS findings for comparisons of longitudinal urethral diameter and prostatic urethral angle. Third, the vorticity of the voided urine stream was observed using a high-speed video-camera. Micturition was done in a standing position while synchronously monitored for urine flow using uroflowmetry. Results Vorticity formation could be dynamically demonstrated in the urinary bladder and prostatic urethra using CDUS. The prostatic urethral angle of the vorticity group was more than that of the non-vorticity group. High-speed video recording could clearly capture vorticity and spiral shape generation in voided urine. The distance from the external urethral orifice to the first twist changed in accordance with urine flow rate. Conclusions In a series of sub-studies, this investigation proved vorticity generation in the LUT and voided urine. Vorticity was detectable in the LUT and in voided urine using CDUS and a high-speed video-camera. Vorticity generation might be associated with urethral morphology.

Introduction: The aim of this research was to provide a detailed description of the morphology, topography, and histometry of rabbit accessory genital glands. Material and Methods: Seven male New Zealand White rabbits, 3–4 months of age and weighing 2.1–3 kg were used for the study. The whole urethra from the urinary bladder to the external urethral orifice accompanied by accessory genital glands was sliced at intervals of 1 mm. The serial sections were prepared with haematoxylin-eosin (H&E) and Movat–Russell modified pentachrome stain. Results: A detailed description of the morphology and morphometry was provided. The topography of the organs was explained on the basis of characteristic cross-sections on histological slides. The inconsistent nomenclature and descriptions of these glands by different authors were also discussed. Conclusion: The morphometric analysis indicated that some of the glands described have similar dimensions in different individuals, while others like paraprostates revealed high diversity in the number of lobes, their size, and their structure. The accessory glands are also good topographic markers which precisely define the segment of the urethra. The terms “proprostate”, “prostate”, and “paraprostates” as the nomenclature of the prostate complex reflect the location of these glands well and indicate their common origin and function.

BACKGROUND No studies have focused on the prevalence and clinical manifestations of penile gonococcal cutaneous and accessory gland infections in men with gonorrhea. METHODS We enrolled patients with penile gonococcal cutaneous and accessory gland infections and patients with urethral gonorrhea from January 2014 to February 2020. Demographic data, occurrence sites, and manifestations of all patients were recorded. RESULTS Fifty-one patients with penile gonococcal cutaneous and accessory gland infections were observed among 1994 (2.6%; 95% confidence interval, 1.9%-3.4%) patients with urethral or penile gonorrhea. Lesions were present at the external urethral orifice in 22 (43%) patients, at the glans in 11 (21%), in the side of the frenulum of the prepuce in 7 (14%), in the penile raphe in 5 (10%), in the inner plate of the prepuce in 1 (2%), in the external urethral orifice and side of the frenulum of the prepuce in 3 (6%), and in the glans and side of the frenulum of the prepuce in 2 (4%). The lesions manifested as sinus-like lesions in 22 (43%) patients, abscesses in 14 (27%), nodules in 10 (20%), pustules in 3 (6%), nodules with sinus tracts in 1 (2%), and ulcers in 1 (2%). CONCLUSIONS Penile gonococcal cutaneous and accessory gland infections in men probably are more common than previously understood. They mainly involve the paraurethral duct, glans, Tyson's gland, and penile raphe. Lesions mainly present as sinus-like lesions, abscesses, and nodules.

BACKGROUND: To identify the factors related to the effectiveness of retrograde removal of double J ureteral stents using a simple snare technique in female patients. METHODS: It was a retrospective observational study. From 2012 to 2017, 128 female patients underwent fluoroscopy-guided, retrograde double J stent removal with or without replacement using a simple snare technique. The position of the tip of the double J stent in the urinary bladder was classified according to position types A, B, C, and D, corresponding to the ipsilateral lateral, ipsilateral medial, contralateral medial, and contralateral lateral quadrants of the urinary bladder, respectively. The factors influencing the fluoroscopy time upon removal of the double J stent were analyzed. RESULTS: Technical success rate of 312 procedures performed was 97.44% (304/312) with the mean fluoroscopy time of 12.68±7.34 minutes. Eight double J stent removal procedures failed, and all of these occurred in the position type D patients. The position type and the number of curls of the double J stent had a significant influence on the fluoroscopy time (P

Summary:. Although primary vulvovaginal reconstruction after vulvectomy has high potential to improve patients’ outcomes, flap reconstruction is not an established part of the current standard treatment for vulvar cancer. We report a patient with successful secondary vulvar reconstruction 3 years after radical vulvectomy with direct wound closure. A 69-year-old woman presented with chronic, burning vulvar pain 3 years after radical vulvectomy without reconstruction for stage IB vulvar cancer. Her urethral orifice had everted because of the direct wound closure, which resulted in severe pain on contact. We performed secondary vulvar reconstruction using bilateral 14 × 5 cm2 gluteal fold flaps. Postoperative pain management and overall aesthetic outcomes were satisfactory. Secondary vulvar reconstruction with gluteal fold flaps can avoid the sequelae resulting from inadequate direct wound closure after radical vulvectomy. Thus, we strongly advocate immediate vulvar reconstruction to prevent such situations.

OBJECTIVE: To explore whether opening the external urethral orifice in the coronal sulcus can reduce the incidence of epididymitis after operating on hypospadias with a prostatic cyst connected to the vas deferens.MATERIALS AND METHODS: Three patients (group A) (average age = 3.3 years old) with severe hypospadias and prostatic cyst underwent cystostomy, hypospadias correction and urethroplasty, along with relocation of the external orifice of urethra. Group B consisted of 4 patients (average age = 6.9 years old) presenting with epididymitis after hypospadias surgery and Unsuccessful conservative treatment. Patients underwent urethral dilatation along with urethral catheterization, cutting of the original corpus cavernosum that encapsulated the urethra, and extension of the position of the external urethral orifice to the coronal sulcus. RESULTS: In group A, 3 children underwent bladder fistula removal 2 weeks after operation. All patients were followed up for 5-7 years. The vulva developed normally without any complications. Four children in group B underwent stent removal 12 weeks after operation, and one patient was still stenosed and dilated again. All patients were followed up for 2-12 years without epididymitis recurrence. Penile erection and ejaculation were normal in adulthood. CONCLUSION: For hypospadias patients experiencing complications due to the presence of a prostatic sac, especially those with prostatic sac connected to the vas deferens, the positioning of the external urethral orifice in the coronary sulcus would be helpful to reduce the occurrence of epididymitis.

Background: In this study, cases with suspected urethral condylomata acuminata were examined by dermoscopy, in order to explore an effective method for clinical. Objective: To study the application of dermoscopy image analysis technique in clinical diagnosis of urethral condylomata acuminata. Methods: A total of 220 suspected urethral condylomata acuminata were clinically diagnosed first with the naked eyes, and then by using dermoscopy image analysis technique. Afterwards, a comparative analysis was made for the two diagnostic methods. Results: Among the 220 suspected urethral condylomata acuminata, there was a higher positive rate by dermoscopy examination than visual observation. Study limitations: Dermoscopy examination technique is still restricted by its inapplicability in deep urethral orifice and skin wrinkles, and concordance between different clinicians may also vary. Conclusion: Dermoscopy image analysis technique features a high sensitivity, quick and accurate diagnosis and is non-invasive, and we recommend its use.

Summary This report describes the repair of an iatrogenic phallectomy that occurred during an attempted castration of a horse that was discovered to be a unilateral cryptorchid (inguinal testis). Use of a modification of a described phallectomy and sheath ablation technique allowed penile retroversion to be avoided, decreasing excessive dissection and post-operative morbidity, despite the urethral orifice being positioned more caudally than previously reported.

Cloacal malformations are rare anomalies which occur in one in 50,000 live births. Anatomically these anomalies are defined by the presence of a single perineal orifice. There is however a substantial range in their complexity. Defining these differences is key to surgical planning and timely referral of selected cases to centers with the capabilities to manage the most challenging cases. Traditionally the common channel length as measured during cysto-vaginoscopy has been used to differentiate between patients that can be repaired with a reproducible operation and those requiring a more complex repair. The quality and range of imaging available has advanced and thus a more detailed anatomic picture is now possible to help with pre-operative planning. Cross sectional imaging with 3D reconstruction has enhanced the understanding of the anatomic variations in these patients. In addition, the sacral ratio, previously thought to only have an influence on long term continence predictions, has been shown to not only forecast the presence of urological anomalies, but also the complexity of the malformation. In principle, cloacal malformations have two major components to the reconstruction. First, the rectum needs to be separated from the urogenital tract and second, the urogenital sinus needs to be managed to create a urethral orifice and vaginal introitus. The length of the urethra has been shown to be vital in deciding between the two main surgical maneuvers; a total urogenital mobilization (TUM) and a urogenital separation. The technical demands of a urogenital separation are significant and discussed here in detail. The need for vaginal replacement adds further complexity to the care of these patients and has also been shown to be related to the length of the urethra. Predicting complexity in an accurate and non-invasive way will facilitate the care of the most complex cloacal malformations and improve outcomes.

Urethral coitus is a rare type of sexual practice, usually due to vaginal agenesis or hymeneal anomalies. We report a case of urethral coitus in a healthy couple who were evaluated for infertility. The female partner had cribriform hymen and dilated urethral orifice but did not report any problems except infertility and her genital anatomy was normal. The male partner reported concerns over his penile size but was otherwise healthy. After incision of hymen, they were able to have vaginal coitus and successfully conceived. While urethral coitus is rare, it should be suspected in women presenting with infertility and a dilated urethral orifice.

Objective To provide a summary of the possible challenges we may face in managing patients with hypospadias from birth to adulthood, as the treatment of hypospadias is full of challenges not because of the operation technique itself but because of other factors such as delayed diagnosis, continuation of regular long-term follow-up, and relatively high rate of complications. Methods Collection of personal experience and literature regarding hypospadias management and its challenges with some suggestions of how to deal with these challenges in better ways. Many known surgical procedures have been established for hypospadias. The selection of the right procedure for each patient is an individual decision that varies with the location of the urethral orifice, other associated problems, and the centres experience, and this decision is usually taken intraoperatively. The management of these patients should also include the psychosocial aspect and the continued education of the patient and family. Results It is valuable that every surgeon dealing with hypospadias is aware of these challenges and how to manage them. The management of other aspects like psychosocial support should be considered. Conclusion A comprehensive knowledge of these challenges and their management is necessary for every surgeon dealing with such patients. Management of hypospadias is not only the surgical procedure, but it includes at the same time the long-term follow-up, psychosocial support, and continuous patient and family education.

A 20 years old woman had an external urethral orifice mass and received an excision operation. Seven years later, she complained a tumor with pain that was similar to the previous tumor. She underwent the tumor removal. Pathological diagnosis was a urethral angiomyomatous leiomyoma in the new concept of estrogen receptor-positive smooth muscle tumors.

A 29-year-old male exhibited progressive extrusion of the distal end of ventriculoperitoneal (VP) shunt through his urethral orifice within 10 d. The distal end of VP shunt was pulled out from the urethral orifice without bladder repairment, a new VP shunt assisted with ventriculoscope and laparoscope was performed and the distal end of VP shunt was fixd to the suprahepatic space. We first report a chronic complication of VP shunt with bladder perforation and extrusion through the urethral orifice in an adult male patient. To avoid this complication, the length of the distal end of VP shunt should be kept as short as possible in adults and we recommend that the distal end of VP shunt should be fixed to the suprahepatic space assisted with laparoscope in adult patients.

The aim of this report is to evaluate clinical findings and treatment of infected scrotal wounds and traumatic urethral rupture in two dogs. The material of this report consists of two Kopay breed hunting dogs, aged 3.5 and 8, brought to the Adnan Menderes University, Faculty of Veterinary Medicine Surgery Clinic. In both cases, the wounds had been caused by a wild boar and an open, infected wound with seromucous discharge was present. The wound had laid both testes bare in the first dog, while in the second dog, only the right testis was present, the left without testis. It was detected that the urethra was ruptured in the scrotal area when a urinary catheter sent through external urethral orifice came out of the wound. Both cases underwent surgery to repair the urethra and to perform wound revision. In both cases, the catheters were left in place postoperatively until the postoperative 10 th d. Follow-up examination indicated that both animals could urinate without any problems.

Anopenile urethral fistula (APUF) is not rare, but there are only a few detailed reports regarding its surgical treatment. We describe a patient with APUF who had no anal opening, and meconium was discharged from the external urethral orifice. The patient was treated with a staged operation.

Five-year old male patient was brought to the emergency service about four hours ago with the complaints of sudden inability to void and pain in the penis. A calculus was observed to occlude totally the external urethral orifice in the physical examination of the patient (Figure 1). A pediatric surgeon was consulted about the situation of the patient, and the calculus was removed under sedation. Oral antibiotic was administered to the patient and he was discharged from the hospital under suggestions. It should be remembered that calculus in external urethral orifice may be observed in the patients applying to the emergency service with the complaints of inability to void and pain in the penis. Figure 1: Appearance of the calculus in external urethral orifice. Arrows show the calculus