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Aim: To evaluate the long-term effects on hypospadias repair with cultured autologous urothelial cells. Methods: From 2000 to 2002, six patients with scrotal or perineal hypospadias and pronounced chordee were treated surgically with cultured autologous urothelial cell transplants. All patients were evaluated at 6-8 years postoperatively, that is, in the prepubertal period. The outcome was assessed with respect to cosmetic appearance, voiding function, urinary flow, artificial erection, urethroscopy and biopsies. Results: Median follow-up time was 7.25 years. Up to date, all patients present with a good cosmetic appearance. One of the boys prefers a sitting voiding position. Urinary flow curves are bell-shaped in all but one. All have straight erections, urethroscopy reveals an even, non-hair-bearing surface on the transplanted side and 2/6 present with urothelial cells in biopsies. Limitations of this follow-up study include a small group of patients and lack of controls. However, patients with severe hypospadias have high complication rates, and our results are equal or better than expected for the phenotype. Conclusion: Tissue engineering for severe hypospadias repair can be performed in a safe manner. The method is feasible for treatment of a selected group of hypospadias, where pronounced chordee and shortage of preputial and penile skin complicates the creation of a neourethra. [ABSTRACT FROM AUTHOR]

Study Type – Therapy (RCT) Level of Evidence 1b OBJECTIVE To assess whether real-time cysto-urethroscopy (CUS) performance improves by simulator-based training (criterion or predictive validity), addressing the research question ‘Does practical skills training on the URO Mentor (UM, Simbionix USA Corp., Cleveland, OH, USA) virtual-reality simulator improve the performance of flexible CUS in patients’. SUBJECTS AND METHODS Participants (71 interns from Catharina Hospital Eindhoven, CHE, and 29 from University Medical Centre Groningen, UMCG) were randomized to carry out CUS in a patient after training on the UM (UM-trained, 50) or without training on UM (control, 50). The assessment of real-time performance consisted of scoring on a Global Rating Scale (GRS) by supervisors unaware of training status. Data were analysed using stepwise multiple linear regression. The effect size (ES) indication for correlations was used to interpret the magnitude of a standard regression coefficient (β); an ES of 0.10, 0.30 and 0.50 were considered small, moderate and large, respectively. The study was approved by the Medical Review Ethics Committees of the participating hospitals. RESULTS Overall, the group that received training performed significantly better than the controls ( P ≤ 0.003, β range 0.30–0.47). There was no effect of training for participants with a specific preference for a surgical speciality in two of five GRS scores. Participants from CHE obtained higher GRS 3 scores than those from UMCG. Significantly more UMCG trainees indicated having had stress than those from CHE ( P < 0.001). CONCLUSIONS The results showed that interns who had trained on UM outperformed controls for a CUS procedure in a patient. Training for CUS on the UM is to be recommended for learning to respect tissue, procedural knowledge, flow of procedure and forward planning. Use of the UM to train interns with a specific interest in a surgical speciality in handling instruments, and time and motion, seems to be of limited value. [ABSTRACT FROM AUTHOR]

Study Type – Therapy (case control) Level of Evidence 3b OBJECTIVE To assess the construct validity of the URO MentorTM (Simbionix Corp., Cleveland, OH, USA) virtual reality training model for several variables of skills training in cysto-urethroscopy, addressing two research questions: (i) Does training on the URO Mentor significantly improve novices’ performance in terms of time, trauma, areas inspected and Global Rating Scale (GRS) score?; (ii) is discrimination between different levels of expertise possible using the URO Mentor? METHODS Thirty experts and 50 novices performed seven tasks on the URO Mentor during one training session. The first, fourth and seventh tasks were ‘test tasks’ to evaluate participants’ performance. The simulator recorded procedure time and trauma; a supervisor scored which areas were inspected and gave scores on the GRS. A two-way analysis of variance with repeated-measures test was used to analyse experts’ and novices’ performances, with P < 0.05 considered to indicate statistical significance. Effect sizes (ES) were calculated to quantify the practical significance of the results; ES of 0.10, 0.30, and 0.50 were considered small, medium and large, respectively. RESULTS Novices’ performances showed a significant improvement with large ES in time (linear trend of learning curve P < 0.001, ES 0.66) and mean GRS score (linear trend P < 0.001, ES 0.84, quadratic trend P = 0.018, ES 0.24). There was a medium improvement for trauma (linear trend P < 0.001, ES 0.40) and a small improvement in areas inspected (linear trend P = 0.032, ES 0.21). That the 95% confidence intervals of the measures on the first task of experts and novices did not coincide indicates that differentiation between experts and novices on the four variables measured can be achieved using the URO Mentor. CONCLUSIONS Training on the URO Mentor appears to result in a medium to large improvement of novices’ performances for time, trauma, areas inspected and GRS scores. Moreover, discrimination between different levels of expertise is possible using this simulator. [ABSTRACT FROM AUTHOR]

Background A 34-year-old, captive-born, vasectomized male chimpanzee ( Pan troglodytes) presented with lethargy and scrotal swelling. Methods Urethral obstruction was diagnosed via urethroscopy. Results Removal of the grass stem foreign body resolved the obstruction. Scrotal and preputial ulceration developed from urine scald, which was managed with surgical debridement and antibiotics. Conclusions After 7 weeks, the animal was reintroduced to its troup and has been healthy for 11 months. [ABSTRACT FROM AUTHOR]

Intracorporeal treatment of urolithiasis is characterized by continuous technological evolution. In this review we present updated data upon the use of ureteroscopy for the management of urolithiasis. Novel digital flexible ureteroscopes are used in clinical practice. Ureteroscopic working tools are revolutionized resulting in safer and more efficient procedures. Special categories of stone patients such as pregnant women, children and patients on anticoagulation medication can now undergo uneventful ureteroscopy. Routine insertion of stents and access sheaths as well as bilateral ureteroscopy is still a controversial issue. Future perspectives include smaller and better instruments to visualize and treat a stone, while robotic ureteroscopy is becoming a fascinating reality. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy of tunica albuginea urethroplasty (TAU) for anterior urethral strictures. Methods: We assessed 206 patients with anterior urethral strictures who underwent TAU. 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 with a silicon catheter in situ. Thus in neourethra, the roof is formed by tunica albuginea of the urethral groove. Results were assessed at 6, 12, 24 and 36 months by comparative analysis of patient satisfaction along with retrograde urethrogram, urethrosonogram, uroflowmetry, and were categorized as good, fair and poor. Good and fair results were considered as successful. Thirty patients were taken for postoperative urethroscopic analysis to allow better understanding of both successful and failed cases. Results: Postoperative evaluation at 6 months showed a 96.6% success rate, which decreased to 94.7% at 1 year, 93.2% at 2 years and over 90% at the end of 3 years. The overall failure rate was 9.2%, which required revision surgery. Urethroscopic visualization of the reconstruction site showed wide, patent and distensible neourethra uniformly lined by urothelium over roof formed by tunica albuginea of the corpora cavernosa in successful cases. Failure cases showed diffuse fibrotic narrowing or circumferential scarring. Conclusion: Tunica albuginea is a locally available distensible tissue, sufficient to maintain the patency of the neourethra, without any graft or flap. TAU is easier and useful when patients have unhealthy oral mucosa due to tobacco chewing. [ABSTRACT FROM AUTHOR]

OBJECTIVE To describe the prevalence of sexual dysfunction and evaluate risk factors in patients just diagnosed with non-muscle-invasive bladder cancer (NMI UC), who have the prospect of an intensive surveillance scheme by cysto-urethroscopy to detect tumour recurrences. PATIENTS AND METHODS We conducted a cross-sectional survey on 150 patients just diagnosed with primary or recurrent NMI UC. Patients were participating in a randomized clinical multicentre trial (CEFuB), comparing two surveillance schemes. Patients were asked to complete questionnaires at study entry 3 months before the start of the study-surveillance scheme (demographic characteristics, a validated visual analogue scale, and validated subset of questions on sexual function and performance derived from QLQ-BLS-24). The results were compared with those from an age-and gender-matched healthy population. RESULTS The response rate was 95% (142/150); 61% (87/142) of the respondents were sexually active in the previous 4 weeks after diagnosis, 66% (70/105) of men and 46% (17/37) of women. Although libido was not negatively affected, 54% (47/87) of the patients had a sexual dysfunction, and 23% (17/73) were afraid to inflict harm on their partner by sexual contact. Sexually active patients perceived a higher state of general health ( P = 0.03). CONCLUSIONS The prevalence of sexual dysfunction in patients with NMI UC is very high (54%) compared with an age- and gender-matched healthy population (20–45%). No predictors for sexual dysfunction were found. These patients and partners would benefit from proper sexual information in the outpatient clinic. [ABSTRACT FROM AUTHOR]

The bladder neck fascial sling may become a more popular procedure if surgical modifications could ensure more rapid postoperative voiding, yet not compromising the 85% long-term cure rate. In a study of 80 women, we found that increasing the distance from the Prolene knot to the rectus fascia, while simultaneously observing the closure of the bladder neck with a cystoscope, resulted in 92% of women voiding the same day and 93% experiencing no stress incontinence at 1 year. [ABSTRACT FROM AUTHOR]

To report and describe the diagnosis and treatment of female paraurethral cysts. Twenty-five cases of cysts of the external female genitalia were diagnosed over a 7-year period, using a physical examination, routine blood tests, urine analysis, abdominal ultrasonography and cysto-urethroscopy in all. The cysts were incised, drained and marsupialized; no attempt was made to excise or remove the internal wall of the cyst and it remained in situ. All patients responded to simple marsupialization, with no recurrence of the cyst. Cysto-urethroscopy and a limited laboratory and imaging evaluation were enough for the diagnosis. [ABSTRACT FROM AUTHOR]

Background: Candylomata acuminata is one of the commonest sexually transmitted diseases. The urethra is involved in up to 30% of cases. Case report: A case of intraurethral condylomata acuminata is presented as an illustration of diagnosis and therapy. Comment: Mealoscopy allows direct visualisation of meatal condylomata. Ascending urethrogram or contrast voiding cysturethrography can show tilling defects suspicious of condylomata acuminata: urethroscopy is diagnostic. In the author's opinion, Laser therapy is the treatment of choice. [ABSTRACT FROM AUTHOR]

Abstract A 75-year-old female presented with a 7-month history of intermittent macrohematuria and urinary retention. Physical examination revealed a firm, round mass on the anterior vaginal wall. The diagnosis by urethroscopy and radiological evaluation was localized urethral diverticular tumor. Pathological examination of the biopsy specimen revealed adenocarcinoma. The patient received two courses of intra-arterial and systemic chemotherapy using cisplatin, 5-fluorouracil and leucovorin, followed by radiation to the urethra. The tumor shrunk markedly after chemotherapy. The patient underwent total urethrectomy and vesicostomy. Two years after the operation, she had no evidence of recurrence. Adenocarcinoma of the female urethral diverticulum is rare and has been treated by surgery and/or radiation. The present case is the first case of it being treated by multimodality therapy including chemotherapy. [ABSTRACT FROM AUTHOR]

Abstract Background: A 21-year-old man presented with a sudden onset of miction pain and post-void dribbling. The diagnosis was Cowper's syringocele due to the findings of retrograde urethrography and urethroscopy. Methods/Results: The patient underwent transurethral unroofing of the syringocele. The present case is of interest because Cowper's syringocele is usually diagnosed in male infants and children and is rarely found in adults. Conclusion: This lesion should be included in the differential diagnosis of voiding disturbances in adults. [ABSTRACT FROM AUTHOR]

Abstract Background: We describe a rare case of malignant melanoma originating from the male urethra. Methods/Results: This case, which presented a tan-colored lesion at the distal urethra on urethroscopy, was considered as transitional cell carcinoma by transurethral biopsy. Pathologic examination of widely resected urethra revealed scattering cells, which included melanin granules in cytoplasm, and then immunohistochemical stains established the diagnosis as amelanotic melanoma. Although partial penectomy and inguinal lymph node dissection were subsequently performed, 7 months later, total cystourethrectomy was required because of multifocal recurrence at the residual urethra. Conclusions: In cases of amelanotic melanoma, it should be noted that a lack of melanin granules in tumor cells may lead pathologists and urologists to a misdiagnosis due to the histologic non-specific appearance. With respect to surgical management, of significance is the fact that malignant melanoma may progress multifocally along the total urethra; therefore, total urethrectomy should be considered as radical surgery for the primary site, even if the tumor is confined to the distal urethra. [ABSTRACT FROM AUTHOR]

The author reflects on lower urinary tract symptoms. Topics discussed include prostatic urethral lift therapy, compression and tethering of prostatic glandular tissue to the outer prostatic capsule to open prostatic urethra, and the UroLift technology of Neotract Inc. Also discussed are the implantation and effect of Urolift implants.

The author discusses various researches which aim to develop urine markers for optimal bladder cancer (BC) identification. The author says that the markers being developed possess lower specificity and higher sensitivity than conventional cytology. Furthermore, he relates the study by Ashish M. Kamat and colleagues which reveals cystourethroscopy (CUS) as the most cost-effective surveillance strategy for the diagnosis of non-muscle-invasive BC (NMIBC).

Examines an insertional hernia after suprapubic catheter insertion. Identification of a tight bladder neck stricture by flexible urethroscopy; Influence of a persistent bladder outlet obstruction on hernia development; Complication of herniation.

Introduction: Disorders of sex development (DSD), defined as congenital condition associated with atypical development of chromosomal, gonadal, and phenotypic sex abnormalities, is a social burden for the neonatal period, yet there's still limited data on the incidence, diagnostic and management of DSD. Materials and Methods: Data were collected from medical records of patients with DSD managed by urologist, pediatric endocrinologist, and reproductive gynaecologist at CiptoMangunkusumo Hospital from January 2005 to July 2014. The 2006 International Intersex Consensus Conference Participant (IICCP) classification was used as classification. The profile and management of DSD were evaluated. Results: Out of 182 DSD cases, type 46 XX DSD had the highest incidence (46%) with majority of CAH, followed by 46 XY DSD (33%) with majority of AIS. Most cases were diagnosed at = 1 year of age (41%) and = 11 years (31%). As many as 83% of 46 XY DSD cases were raised as male, and 83% of 46 XX DSD cases were raised as female. Genitography had been used in 11 cases, urethroscopy and colposcopy used in 7 case, and diagnostic laparoscopy in 13 case. thirty persent of 46XY cases raised as a female having cross gender assignment, while 3/14 of 46 XX cases raised as male having cross gender assignment. Medical treatment was the most common treatment for Turner syndrome and CAH, while AIS was mostly treated with orchidopexy, and a total of 73 surgeries were done in all case. Conclusion: Most cases of DSD in CiptoMangunkusumo Hospital were CAH and AIS. Genitography, urethroscopy and colposcopy, and diagnostic laparoscopy have been used in the diagnosis of DSD. Forty percentof all DSD cases were treated with surgical treatment. [ABSTRACT FROM AUTHOR]