Search

Introduction To investigate the role of trans-labial ultrasound study in detection of female urethral stenosis (FUS) compared to former cysto-urethroscopy as the currently available definitive diagnostic modality. Material and methods In this cross-sectional study, 60 consecutive patients with bladder outlet obstruction diagnosed by clinical symptoms and urodynamic study, were included from 2019 to 2022. For additional assessment, all these patients underwent gel-Infused trans-labial ultrasound (GITLUS) and cystourethroscopy. Trans-labial real-time ultrasonography was performed following the insertion of 20 ml steady stream viscous jelly into the urethral meatus to assess the length of the urethra and exact location and length of the probable narrowing, as well as the presence of peri-urethral fibrosis (PUF). Results In GITLUS evaluation, urethral stricture was found in 27 patients. Mean urethral length and stricture length were 35.63 ±4.78 and 17.04 ±10.59, respectively. All these stenosis were confirmed via cysto-urethroscopy. PUF was found in 20 of 27 patients. In cysto-urethroscopy, urethral stricture was confirmed in 40 patients: 13 in urethral meatus and 27 in other parts or pan-urethra. GITLUS could not reveal urethral stricture in 13 patients with meatal stenosis, confirmed with cystoscopy. GITLUS detected FUS less accurately when it involves pure distal urethra compared to other parts of urethra or pan-urethral stenosis (p value = 0.002). Conclusions GITLUS is a safe, non-invasive, and valuable technique for detecting FUS. The location and the length of the stricture and probable peri-urethral fibrosis can be identified by this method. However, in meatal or pure short-length distal urethral strictures, this method should be used with caution. [ABSTRACT FROM AUTHOR]

Endoscopic procedures in urology are safe although simple and impossible. We report a rare catastrophic complication of cystolitholapaxy in a patient with severe urethral stenosis. Despite laparotomy one day after cystolitholapaxy because of peritonitis and loop colostomy, the patient died. Hence, the principles of prevention and extra-care and time especially in the abnormal urethra are emphasized. [ABSTRACT FROM AUTHOR]

This document is a video abstract from the Central European Journal of Urology titled "Penile urethrostomy for recurrent long-segment strictures of the penile urethra: step-by-step surgical technique." The video presents a surgical technique for performing a penile urethrostomy as an alternative to augmentation urethroplasty for patients with recurrent long-segment urethral strictures. The procedure involves creating an opening in the penile urethra to allow for urination while standing. The video provides a detailed description of the surgical steps involved in performing a penile urethrostomy and highlights its aesthetic outcome. The authors suggest that penile urethrostomy can be considered as an equivalent alternative to perineal urethrostomy for patients who prefer to urinate while standing. [Extracted from the article]

Amyloidosis is characterized by the deposition of fibrillar proteins by either plasma cells or derived from circulating proteins, the former especially involved in pathogenesis of localised amyloidosis. We describe a case of primary localised amyloidosis involving the urethra, in a 54-year-old diabetic patient, presenting with symptoms of stricture. Though a rare cause, in a patient with clinical diagnosis of urethral stricture, one of the differential diagnosis to be ruled out is primary urethral amyloidosis.

Stress urinary incontinence is a common medical problem among women. The urethral closure complex and/or the supportive mechanisms are responsible for incontinence in the majority of patients. Several surgical procedures with different degrees of invasiveness and outcomes have been reported to treat the problem. Although most of these procedures are reasonably effective, a general trend towards the study of natural and biocompatible tissues is emerging over popular synthetic materials. Here we report our experience of autologous adipose-derived stem cells transplantation into the periurethral region as a new method of stress urinary incontinence treatment. Ten women with symptoms of stress urinary incontinence were treated by injections of autologous adipose-derived stem cells into the periurethral region via transurethral and transvaginal approach under urethroscopic observation. This report presents the short-term outcome of the patients. The outcome measured by pad test results, ICIQ-SF scores, and Qmax. The mean age of the participants was 45.8±8.7 years. Urinary incontinence significantly decreased through the first two, 6 and 24 weeks after the injection therapy. The difference was significant in pad test results (P<0.001) and ICIQ-SF scores (P<0.001), especially comparing results between 2 and 6 weeks and among 6 and 24 weeks, but not for 2 and 6 weeks compared to each other. Surprisingly, Qmax showed improvement after the study period (means 32.6 vs. 35.7; P=0.002). This study showed that injection of the autologous adipose-derived stem cells to the periurethral region is a safe, yet short-term effective treatment option for stress urinary incontinence. Further studies with longer follow up are needed to confirm its long term efficacy. [ABSTRACT FROM AUTHOR]

OBJECTIVE To determine whether passive ureteral dilation (PUD) would occur after an indwelling ureteral stent was left in place in healthy dogs for 2 or 6 weeks, urererosropy would he posdhle ar the rime of stent removal, and PUD would he reversible after Stent removal. ANIMALS 5 healthy adult female Beagles. PROCEDURES A ureteral stent was cystoscoplcally placed in each ureter of each dog with fluoroscopic guidance (week 0) One stent was removed from I ureter in each dog after 2 week; (ureter group I), and the other was removed after 6 weeks(ureter group 2); removal timing was randomized. Computed tomographic excretory urography was performed pvery 1 week;enfrom weeks 0 through 10 to measure ureteral diameters. Urethroscopy was attempted at the time of ureteral stent removal In each group. Ureteral diameters were compared among measurement points. RESULTS The degree of PUD was significant after 2 and 6 weeks of stent placement in both ureter groups. Mean diameter of the midportion of the ureter In both groups prior to stent placement was 170 mm (range, 1.3 to 2.7 mm). At stent removal, mean diameter of the midportion of the ureter wns 2.86 mm (range, 2.4 to 3.1 mm) in group I and 2.80 mm (range. 2.1 to 3.4 mm) in group 2. Ur etcroscopy was successfully performed in all dogs up to the renal pelvis. Compared with week 0 values for diameter of the midportion of the ureter, the degree of PUD induced by stent placement had reversed by week 8 in group I (mean diameter, 2.00 mm [range. I.£ to 2.3 mm]), CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that ureteral stent plnrement for 2 weeks would result in sufficient PUD in healthy dogs to allow ureteroscopy at the time of stent removal and that the original ureteral diameter would eventually be restored. Additional research is needed to determine whether findings would be similar for dogs with urinary tract disease. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe the signalment, clinical features, and outcome for male horses with urethral rents following perineal urethrotomy (PU) or corpus spongiotomy (CS). DESIGN: Retrospective case series. ANIMALS: 33 horses. PROCEDURES: Medical records of male horses examined because of hematuria or hemospermia caused by urethral rents that underwent PU or CS at a referral hospital between 1989 and 2013 were reviewed. Data regarding signalment, clinical features, urethroscopic findings, surgical treatment, and outcome were recorded. Long-term follow-up information was obtained by telephone interviews. RESULTS: Age of the study population ranged from 3 to 18 years. Nineteen geldings and I stallion were examined because of hematuria, of which 13 and 7 underwent PU and CS, respectively, at a mean of 56 days after onset of clinical signs. Thirteen stallions were examined because of hemospermia, of which 7 and 6 underwent PU and CS, respectively, at a mean of 193 days after onset of clinical signs. Hematuria resolved following I surgical procedure in all 17 horses for which long-term information was available. Of the 12 stallions for which long-term information was available, 7 had resolution of hemospermia after I PU or CS and 5 developed recurrent hemospermia that required additional PUs or CSs (n = 3) or primary closure of the urethral rent (2). CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that PU and CS were reliable treatments for resolution of hematuria in male horses with urethral rents; stallions with urethral rents may require multiple PUs or CSs or primary closure of the rent for resolution of hemospermia. [ABSTRACT FROM AUTHOR]

Amyloidosis is characterized by the deposition of fibrillar proteins by either plasma cells or derived from circulating proteins, the former especially involved in pathogenesis of localised amyloidosis. We describe a case of primary localised amyloidosis involving the urethra, in a 54-year-old diabetic patient, presenting with symptoms of stricture. Though a rare cause, in a patient with clinical diagnosis of urethral stricture, one of the differential diagnosis to be ruled out is primary urethral amyloidosis. [ABSTRACT FROM AUTHOR]

To evaluate efficacy of “U” shaped prostatobulbar anastamosis [USPBA] in a posterior urethral stricture along with its urethroscopic evaluation to let us assess the process of neourethrisation in successful cases as well as pathogenesis of restricture in failure cases. Methods: We analysed results of “U” shaped prostato-bulbar anastamosis in 132 patients with posterior urethral stricture, preoperatively and postoperatively with a retrograde urethrogram, urethrosonogram, uroflowmetry and patient satisfaction (based on symptoms). With comparative analysis, results were categorised as good, fair and poor. Twenty patients were randomly selected for urethroscopic evaluation to directly visualise the anastomotic site. Results: Good and fair results were counted as successful. On immediate postoperative evaluation the success rate was 96.2%, which remained almost the same at 6 months but decreased to 92.42% at 12 months and 90.9% at 24 months. Urethroscopy showed mucosal covering at the area of the roof of neourethra in patients having good results with patent and distensible lumen. Cases with fair results showed similar findings except for some narrowing at places and mucosal irregularities. Poor result cases mostly showed dense fibrosis with collapsed lumen or circumferential scarring leading to constricting stricture. Conclusion: USPBA lacks disadvantages of ring anastamosis and is an effective option for posterior urethral strictures.

Objective: To describe the safety, feasibility and outcome of redo buccal mucosal graft urethroplasty in patients presenting with recurrent anterior urethral stricture following previous failed BMG urethroplasty. Materials and Methods: This was a retrospective chart review of 21 patients with recurrent anterior urethral stricture after buccal mucosal graft urethroplasty, who underwent redo urethroplasty at our institute between January 2008 to January 2014. All patients underwent preoperative evaluation in the form of uroflowmetry, RGU, sonourethrogram and urethroscopy. Among patients with isolated bulbar urethral stricture, who had previously undergone ventral onlay, redo dorsal onlay BMG urethroplasty was done and vice versa (9+8 patients). Three patients, who had previously undergone Kulkarni-Barbagli urethroplasty, underwent dorsal free graft urethroplasty by ventral sagittal urethrotomy approach. One patient who had previously undergone urethroplasty by ASOPA technique underwent 2-stage Bracka repair. Catheter removal was done on 21st postoperative day. Follow-up consisted of uroflow, PVR and AUA-SS. Failure was defined as requirement of any post operative procedure. Results: Idiopathic urethral strictures constituted the predominant etiology. Eleven patients presented with stricture recurrence involving the entire grafted area, while the remaining 10 patients had fibrotic ring like strictures at the proximal/distal graft-urethral anastomotic sites. The success rate of redo surgery was 85.7% at a mean follow-up of 41.8 months (range: 1 yr-6 yrs). Among the 18 patients who required no intervention during the follow-up period, the graft survival was longer compared to their initial time to failure. Conclusion: Redo buccal mucosal graft urethroplasty is safe and feasible with good intermediate term outcomes. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to evaluate results of urethroscopic management of iatrogenic urethral injuries due to gynecological operations. Materials and Methods: From November 2001 till November 2003, 12 iatrogenic urethral injuries which were managed with mean time 12 hours (Range= 6-72) after gynecological operations were included in this study. 3 months after urethroscopy and distending, patients were evaluated with IVP. Mean time of clinical follow up was 12 months (range= 4-29). Results: 7 patients with urethral stricture were found and considering fluoroscopy guided urethral dilatation with balloon in 2 of them, urethroscopy and distending was successful in 6 patients (85/7%). In 5 patients with complete dissection of urethra, urethroscopy and distending was successful only in 1 of them (20%). All patients were discharged after 24 hours and in follow up IVP after 3 months. Results were satisfactory in 6 of 7 patients. One of patients needed re-distending due to stricture. Conclusion: Urethroscopic approach as first step in management of iatrogenic urethral injuries seems reasonable and cost benefit, specially in ligating lesions.

Purpose: To examine the value of surveillance urethro-cystoscopy in patients with neurogenic lower urinary tract dysfunction (NLUTD) in regard to the conflicting literature as it is generally agreed that patients with NLUTD are at increased risk for bladder cancer. Materials and Methods: In a cross-sectional study, a consecutive series of 129 patients (50 females, 79 males, mean age 51, range 18–88) suffering from NLUTD for at least 5 years was prospectively investigated using urethro-cystoscopy and bladder washing cytology at a single university spinal cord injury (SCI) center. Results: Due to suspicious urethro-cystoscopy and/or bladder washing cytology findings, 13 (10%) of 129 patients underwent transurethral resection of the bladder lesion and/or random bladder biopsies. Overall, 9 relevant histological findings were found in 5% (7/129) of our patients: bladder melanosis (n = 1), nephrogenic adenoma (n = 3), keratinizing squamous metaplasia (n = 1), intestinal metaplasia (n = 3), and muscle-invasive adenocarcinoma of the bladder (n = 1). Conclusions: Using surveillance urethro-cystoscopy, we found relevant histological findings in 5% of our patients suffering from NLUTD for at least 5 years. Thus, surveillance urethro-cystoscopy might be warranted, although the ideal starting point and frequency remain to be determined in further prospective studies. [ABSTRACT FROM AUTHOR]

Purpose: The bladder outlet obstruction index (BOOI), also known as the Abrams-Griffiths (AG) number, is the most widely used index for predicting BOO. However, the obstructed prostatic urethra determined by the BOOI is often inconsistent with endoscopically-proven obstruction. We assessed abdominal straining pattern as a novel parameter for improving the prediction of BOO. Materials and Methods: We retrospectively reviewed the pressure-flow studies (PFS) and cystourethroscopy in 176 BPH/LUTS patients who were unresponsive to medical therapy. During PFS, some groups of patients tried to urinate with abdominal straining, which can increases intravesical pressure and underestimate BOOI theoretically. Accordingly, the modified BOOI was defined as (PdetQmax+ΔPabd)-2Qmax. Results: Ultimately, 130 patients were eligible for the analysis. In PFS, ΔPabd (PabdQmax-initial Pabd) was 11.81±13.04 cmH2O, and it was 0–9 cmH2O in 75 (57.7%), 10–19 cmH2O in 23 (17.7%) and ≥20 cmH2O in 32 (24.6%) patients. An endoscopically obstructed prostatic urethra in 92 patients was correctly determined in 47 patients (51.1%) by the original BOOI versus 72 patients (78.3%) based on the modified BOOI. Meanwhile, an “unobstructed” urethra according to the original BOOI was present in 11 patients (12.0%), whereas according to the modified BOOI, only 2 (2.1%) would be labeled as “unobstructed”. In receiver operating characteristic curves, the area under the curve was 0.906 using the modified BOOI number versus 0.849 in the original BOOI (p<0.05). Conclusions: The change in abdominal pressure was correlated with endoscopically-proven obstruction. Our simple modification of the BOOI on the basis of this finding better predicted bladder outlet obstruction and, therefore, should be considered when evaluating BOO in patients with LUTS/BPH. [ABSTRACT FROM AUTHOR]

Purpose: To determine the efficacy of mitomycin C in reducing the recurrence of anterior urethral stricture after internal optical urethrotomy (IOU). Materials and Methods: This was a randomized controlled trial conducted in the Department of Urology at the Institute of Kidney Diseases Peshawar from March 2011 to December 2013. A total of 151 patients who completed the study were divided into two groups by the lottery method. Group A (cases) comprised 78 patients in whom mitomycin C 0.1% was injected submucosally in the stricture after conventional IOU. Group B (controls) comprised 73 patients in whom IOU only was performed. Self-clean intermittent catheterization was not offered in either group. All patients were regularly followed up for 18 months. Recurrence was diagnosed by use of retrograde urethrogram in all patients and flexible urethroscopy in selected cases. Data were collected on a structured pro forma sheet and were analyzed by SPSS. Results: The mean age of the patients in group A was 37.31±10.1 years and that in group B was 40.1±11.4 years. Recurrence of urethral stricture was recorded in 11 patients (14.1%) in group A and in 27 patients (36.9%) in group B (p=0.002). The mitomycin group also showed a delay in recurrence compared with the control group (p=0.002). Conclusions: Recurrence of urethral stricture is high after optical urethrotomy. Mitomycin C was found to be highly effective in preventing the recurrence of urethral stricture after IOU. [ABSTRACT FROM AUTHOR]

Background: To measure the effects of real-time visualisation during urethrocystoscopy on pain in patients who underwent ambulatory urethrocystoscopy. Methods: An observational study was designed. From June 2012 to June 2013 patients who had ambulatory urethrocystoscopy participated in the study. In order to measure pain perception we used a numeric rating scale (NRS) 0 to 10. Additional data was collected including gender, reason for intervention, use of a rigid or a flexible instrument and whether the patient had had urethrocystoscopy before. Results: 185 patients were evaluated. 125 patients preferred to watch their urethrocystoscopy on a real-time video screen, 60 patients did not. There was no statistically relevant difference in pain perception between those patients who watched their urethrocystoscopy on a real-time video screen and those who did not (p = 0.063). However, men who were allowed to watch their flexible urethrocystoscopy experienced significantly less pain, than those who did not (p = 0.007). No such effects could be measured for rigid urethrocystoscopy (p = 0.317). Furthermore, women experienced significantly higher levels of pain during the urethrocystoscopy than men (p = 0.032). Conclusions: Visualisation during urethrocystoscopy procedures in general does not significantly decrease pain in patients. Nevertheless, men who undergo flexible urethrocystoscopy should be offered to watch their procedure in real-time on a video screen. To make urethrocystoscopy less painful for both genders, especially for women, should be subject to further research. [ABSTRACT FROM AUTHOR]

Background: Urinary tract tumours represent only 0.5-1% of neoplasms in dogs, and transitional cell carcinoma (TCC) is the most common. It is most common to find TCCs in the trigone region. Diagnosis can be made with image analysis, cytology or histology. With non-infiltrative lesions in the early stages, it is possible to obtain a biopsy by endoscopy. Surgical resection is the treatment option of choice for this tumour. Dogs with poor response to chemotherapy or at an advanced stage of the disease are candidates for palliative treatment. This paper reports an special case of TCC located in the distal urethra of a female dog, obtaining the diagnosis through endoscopy, cytology and immunohistochemistry. Case: A nine-year old, female, neutered Golden Retriever was referred for examination after suffering vaginal bleeding. Vaginal palpation revealed an apparent mass on the vaginal floor. Cytology by imprinting the mass revealed a carcinoma. A vaginoscopy was performed on the patient. An endoscopic examination showed normal vaginal mucosa, but, through the urethra, a mass was observed in the urethral lumen, with thickening and dilatation of the urinary meatus. A tissue biopsy was obtained. Episiotomy was performed to remove the tumour. Histopathological studies diagnosed the mass as transitional cell carcinoma with incomplete surgical margins. An immunohistochemistry analysis of the tumour was performed. Discussion: The location of the tumour in the distal urethra makes this case unusual, as this rarely occurs. There are few reports of this location in bitch dogs and they are usually diagnosed at necropsy. This shows the great advantages of endoscopy for the diagnosis of tumours in the urinary tract. There are few cases of this type of tumour being described at this site, and they are usually diagnosed at necropsy. This report shows the great advantages of urethroscopy for the diagnosis of neoplasias of the urinary tract. In this report, owing to the location of the tumour, cytologic diagnosis (carcinoma) could be made quickly by an impression smear. However, we were unable to determine the precise tumour type, because there were no cells with vacuolated basophilic cytoplasm or signet-ring-shaped cells. Distinguishing TCC from other malignant tumours by cytology is complicated, as they are caused by immaturity and there is a lack of differentiation; so, biopsy is suggested. Endoscopy is the most effective method to obtain biopsies of TCC in the urinary tract. An endoscopic examination can be performed with a rigid or flexible endoscope. In the present case, a videoendoscope with a diameter of 9.2 mm was used, owing to the large dilatation of the urinary meatus. The majority of vesical tumours are diagnosed by contrast and negative double-contrast cystography; however, in this case, they did not reveal the presence of a tumour in the bladder. Immunohistochemistry was positive for monoclonal antibodies for TAG-72 in the present case; this is a common finding in 53% of reported cases. Conventional surgery was performed to resect the tumour, because electrosurgical transurethral resection of TCCs in females can cause some surgical complications. This animal had a favourable response after administering NSAIDs (piroxicam). Treatment was still challenging, owing to the difficulties in surgical resection and the poor response to conventional chemotherapy. [ABSTRACT FROM AUTHOR]

Background. Vaginal stones may form in the setting of mesh exposure with urinary incontinence. This report serves to help understand the presentation, evaluation, and management of vaginal urinary stones. Case. A 68-year-old female presented with a vaginal calculus. She had a history of anterior and posterior polypropylene mesh placement for prolapse 7 years earlier and urinary incontinence. The stone was identified on a portion of exposed mesh and removed in office. Pathology confirmed urinary etiology. The exposed mesh resolved with topical estrogen. Cystourethroscopy excluded urinary fistula and bladder mesh erosion. Conclusions. When identified, a vaginal calculus should be removed and evaluated for composition. Cystourethroscopy should be performed to assess potential urinary tract fistulas and mesh erosion. Additional imaging should be considered. [ABSTRACT FROM AUTHOR]

Background. Synthetic mid-urethral mesh slings are the most common primary surgical treatment for stress urinary incontinence (SUI) and have been designated as the standard of care by the American Urogynecologic Society. In recent years, synthetic mesh has come under increased scrutiny by the Federal Drug Administration (FDA) due to concerns over patient safety. This has led to more surgeons and patients preferring Burch colposuspension to treat SUI. Case. We discuss two cases of suture erosion into the urethra and bladder. They presented with irritative voiding symptoms and recurrent urinary tract infections. Both were discovered years after a Burch colposuspension. Conclusion. As reported in the literature as early as 1999, erosion is a complication associated with many types of incontinence surgery and not unique to mesh based sling operations. Burch colposuspension should not be favored solely to avoid erosion and patients should be counseled accordingly. Teaching Point. Cystourethroscopy performed intraoperatively or postoperatively is essential for early diagnosis and treatment of complications related to incontinence surgery. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical usefulness of preoperative CT voiding cystourethrography (CT-VCUG) using 16-multidetector computed tomography for female urethral diverticula. Materials and Methods: Preoperative CT-VCUG was performed in 15 consecutive patients who underwent urethral diverticulectomy from May 2004 to December 2012. The result of preoperative cystourethroscopy and surgical findings were recorded by a single surgeon and CT-VCUG findings including the location of osita were retrospectively reviewed by another urologist who was blinded to the surgical finding. The location of the ostium detected on CT-VCUG was compared descriptively with the intraoperative surgical and preoperative cystourethroscopic findings. Results: A total of 14 consecutive patients who underwent preoperative CT-VCUG and urethral diverticulectomy were included in the analysis. Ostia were detected on CT-VCUG in all cases, whereas ostia were identified in 10 patients (71.4%) by cystourethroscopy. Ostia were located between the 4 and 8 o’clock direction. Mean distance from the bladder neck to the ostium was 24.2 mm. Circumferential and horseshoe shaped diverticula were observed in 6 and 4 patients, respectively. The surgical findings correlated well with the CT findings. Conclusions: Preoperative CT-VCUG can be useful in identifying the ostia of urethral diverticula in patients scheduled for urethral diverticulectomy and can provide structural information, useful to establish surgical strategy. [ABSTRACT FROM AUTHOR]

Background Urethral metastatic adenocarcinoma is extremely rare. Moreover, only 9 previous cases with metastases from colorectal cancer have been reported to date, and not much information on urethral metastases from colorectum is available so far. Case presentation We report our experience in the diagnosis and the management of the case with urethral metastasis from a sigmoid colon cancer. A 68-year-old man, who underwent laparoscopic sigmoidectomy for sigmoid colon carcinoma four years ago, presented gross hematuria with pain. Urethroscopy identified a papillo-nodular tumor 7 mm in diameter in the bulbar urethra. CT-scan imaging revealed the small mass of bulbous portion of urethra and solitary lung metastasis. Histological examination of the tumor obtained by transurethral resection showed moderately differentiated adenocarcinoma, which was diagnosed as a metastasis of a sigmoid colon carcinoma pathologically by morphological examination. Immunohistochemical analysis of the urethral tumor revealed the positive for cytokertin 20 and CDX2, whereas negative for cytokertin 7. These features were consistent with metastatic adenocarcinoma of the sigmoid colon cancer. As the management of this case with urethral and lung metastasis, 6-cycle of chemotherapy with fluorouracil with leucovorin plus oxaliplatin was administered to the patient, and these metastases were disappeared with no recurrence of disease for 34 months. Conclusion Urethral metastasis from colorectal cancer is a very rare occurrence. However, in the presence of urinary symptoms, the possibility of the urethral metastasis should be considered. [ABSTRACT FROM AUTHOR]

Background Hem-o-lok clips are widely used during robot-assisted and laparoscopic radical prostatectomy to control the lateral pedicles. There are a few reports of hem-o-lok clip migration into the bladder or vesico-urethral anastomosis and only four cases of hem-o-lok clip migration resulting into bladder neck contracture. Herein, we describe the first case, to our knowledge, of hem-o-lok clip migration leading to severe bladder neck contracture and subsequent stress urinary incontinence. Case presentation A 62-year-old Caucasian man underwent robot-assisted laparoscopic radical prostatectomy for a T1c Gleason 8 prostate cancer. One month after surgery the patient was fully continent; however, three months later, he presented with acute urinary retention requiring suprapubic drainage. Urethroscopy showed a hem-o-lok clip strongly attached to the area between the vesico-urethral anastomosis and the urethral sphincter and a severe bladder neck contracture behind it. Following cold-knife urethral incision and clip removal, the bladder neck contracture was widely resected. At 3-month follow-up, the patient voided spontaneously with a peak flow rate of 9.5 ml/sec and absence of post-void residual urine, but leaked 240 ml urine at the 24-hour pad test. To date, at 1-year follow-up, his voiding situation remains unchanged. Conclusions The present report provides further evidence for the risk of hem-o-lok clip migration causing bladder neck contracture, and is the first to demonstrate the potential of such complication to result into stress urinary incontinence. [ABSTRACT FROM AUTHOR]

Bladder cancer represents a considerable issue in Egypt and the Middle East. Radical cystectomy and orthotopic neobladder represent the standard of care for managing cases with invasive bladder tumour. There are few cases reported in the literature considering the urothelial recurrence in the urethra, connected to neobladder. We are presenting a rare case of a young female patient, with an aggressive urothelial tumour, recurring 13-year post-radical cystectomy, and the Studer neobladder. Our case was managed by urethrectomy and conversion of the neobladder into continent reservoir, with good short-term oncological and functional outcomes. We can conclude that bladder cancer cases should be followed thoroughly throughout their life. Follow-up urethroscopy and cytology should be done for all cases of post-radical cystectomy, regardless of patients' symptoms. [ABSTRACT FROM AUTHOR]

We describe the case of a patient who presented with ocular symptoms (chemosis, proptosis, increased intra-ocular pressure, impaired visual acuity) eight months after the transvenous coil occlusion of an ipsilateral sigmoid sinus dural arteriovenous fistula (dAVF). Digital substraction angiography revealed a partial occlusion of the left sigmoid sinus with coils Since the connection from the sigmoid sinus to the internal jugular vein was obliterated by coils without interrupting the arteriovenous shunt, the venous drainage was redirected into the inferior petrosal sinus, the cavernous sinus and the superior ophthalmic vein. The transjugular access to the inferior petrosal sinus was obstructed by a large coil mass in the jugular bulb. Several attempts to remove these coils with an Alligator retrieval device and a goose neck snare failed. The coil mass was withdrawn via a direct access to the internal jugular vein using flexible cysto-urethroscopy grasping forceps, an urological device designed for the removal of kidney `stones After establishing anterograde drainage, the now accessible inferior petrosal sinus was occluded with fibered coils and the dAVF was completely obliterated. The ocular symptoms resolved within ten days. [ABSTRACT FROM AUTHOR]

Ureteral stents are widely used to ensure good urinary drainage and to relieve obstruction, pain and infection during urologic procedures. However, long-term indwelling ureteral stents can cause various complications, such as encrustation, hematuria and infection. Here, the case of an 88-year-old man who had undergone simultaneous radical resection of sigmoid colon cancer and partial resection of the bladder 6 years prior is presented. The patient complained of urinary frequency and urgency, dysuria and intermittent fever. A kidney ureter bladder X-ray examination revealed the presence of an entire coiled double-J stent with calculi from the kidney to the bladder. A computed tomography scan revealed mild hydronephrosis of the left kidney and one J end of the stent in the bladder. The stent was removed successfully by cystourethroscopy and holmium laser lithotripsy. This report describes the clinical experience of the removal of a long-term stent by endoscopic manipulation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate efficacy of “U” shaped prostatobulbar anastamosis [USPBA] in a posterior urethral stricture along with its urethroscopic evaluation to let us assess the process of neourethrisation in successful cases as well as pathogenesis of restricture in failure cases. Methods: We analysed results of “U” shaped prostato-bulbar anastamosis in 132 patients with posterior urethral stricture, preoperatively and postoperatively with a retrograde urethrogram, urethrosonogram, uroflowmetry and patient satisfaction (based on symptoms). With comparative analysis, results were categorised as good, fair and poor. Twenty patients were randomly selected for urethroscopic evaluation to directly visualise the anastomotic site. Results: Good and fair results were counted as successful. On immediate postoperative evaluation the success rate was 96.2%, which remained almost the same at 6 months but decreased to 92.42% at 12 months and 90.9% at 24 months. Urethroscopy showed mucosal covering at the area of the roof of neourethra in patients having good results with patent and distensible lumen. Cases with fair results showed similar findings except for some narrowing at places and mucosal irregularities. Poor result cases mostly showed dense fibrosis with collapsed lumen or circumferential scarring leading to constricting stricture. Conclusion: USPBA lacks disadvantages of ring anastamosis and is an effective option for posterior urethral strictures. [Copyright &y& Elsevier]

We report the second case of prolapsing anterior urethral polyp, which was diagnosed on urethral ultrasonography and was confirmed on cystourethroscopy, successfully treated by transurethral resection.

In the modern era, the incidence of rectourethral fistula (RUF) has been on a rise due to an increasing number of surgeries being performed for prostatic carcinoma. Other causes of this condition still remain rare and their management differs from that of post prostatectomy RUF. We report a rare case of a young man who presented with leakage of urine per rectum 4 weeks after injection sclerotherapy for haemorrhoids. A Micturating Cystourethrogram/Retrograde Cystourethrogram revealed the presence of RUF arising at the level of prostrato-membranous urethra and the urine examination did not show any fecal contamination of urine. A fistula at the level or verumontanum along with stricture of the distal penile urethra was demonstrated on urethroscopy. The patient was successfully managed by dilatation of the stricture segment and urethral catheterization. RUF can rarely result from injection sclerotherapy and must be thoroughly evaluated. Cases which present early and have minimal contamination of urine by fecal contents can be conservatively managed with a simple Foleys catheterization for 4-6 weeks after ruling out any obstruction distal to the fistulous tract. [ABSTRACT FROM AUTHOR]

An intravesical exposed mesh may result from an unrecognized bladder perforation or from bladder erosion after a mid-urethral sling procedure performed to treat a stress urinary incontinence. Introduction of trans-obturator tape and tension-free vaginal tape-obturator techniques have minimized, but not eliminated, the risk of bladder injury. The suggested management of the above complication is removal of the polypropylene mesh from the bladder. Herein, we describe a case of partial intravesically-exposed sling, first diagnosed by trans-labial ultrasound, confirmed by cystourethroscopy and successful treated with endoscopic transurethral resection. [ABSTRACT FROM AUTHOR]

Congenital obstruction of the male urethra is usually caused by posterior urethral valves. Anterior urethral valves (AUV) represent a rare anomaly with a wide spectrum of presentation varying from mild voiding difficulties to end-stage renal disease. Prompt diagnosis and appropriate treatment is essential to prevent renal impairment. We report the case of a 13 month-old boy who presented with deterioration of kidney function caused by unrecognized AUV disorder. Temporary cutaneous vesicostomy was necessary to protect the upper urinary tract from further damage and to stabilize renal function. Even though a voiding cystourethrogram (VCUG) demonstrated obstruction of distal urethra, AUV were initially overlooked but finally diagnosed on additional VCUG followed by urethroscopy. [ABSTRACT FROM AUTHOR]

A 14-year-old girl presented with continuous dribbling of urine along with normal voiding pattern since childhood. Cystourethroscopy showed absence of right ureteric opening, and vaginoscopy showed right ureter opening into vaginal vault. Radiological images showed small right kidney with normal excretory function with single-system ectopic ureter. Patient underwent laparoscopic transperitoneal extravesical ureteric reimplantation. At 3 months' follow-up, intravenous urography (IVU) and micturating cystourethrogram (MCU) showed no obstruction and reflux. [ABSTRACT FROM AUTHOR]

Flexible retrograde ureteroscope is now being widely used in endoscopic management of the urinary calculi. We report technique of supine ante grade flexible ureteroscopy in treating impacted upper and mid ureteric calculi in a pediatric patient. A six year-old boy with a history of acute right ureteric colic was investigated and found to have right upper and middle impacted ureteric calculi. He was planned for ureteroscopy, but the intramural part of the ureter could not be dilated. Hence, a decision was taken to do an antegrade flexible ureteroscopy in the supine position. An antegrade renal access was established in the supine position using ultrasound- guided puncture, a 22 Fr Amplatz was placed after serial dilatation of the tract and the stones were accessed using a flexible ureteroscope. The stones were then disintegrated using holmium laser. The ureter was stented at the end of the procedure. IVU done after six months revealed normal right kidney. [ABSTRACT FROM AUTHOR]

The article focuses on the use of 3D printed bladder model to simulate the urethrovesical anastomosis (UVA) task during a minimally invasive prostatectomy. It discusses the evolution of the 3D printed bladder model, the process of performing a UVA task on the 3D printed bladder model, and the positive outcome of the bladder model on UVA.

Background: Cysto-urethroscopy or cystoscopy is an important tool for the practicing urologist for both therapeutic and diagnostic purposes. The indications for cystoscopy vary widely from centre to centre. We describe our experience with this tool. Materials and Methods: We reviewed retrospectively the medical records of patients who had rigid cystoscopy at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Symbol specialist hospital, Nnewi and Borromeo specialist hospital Onitsha, all in Anambra State, Southeast,Nigeria in the period January 2004 to December 2009. All indications were as reported in the initial diagnosis for all the patients. Results: A total of one hundred and eleven patients had cystoscopy during the study period. Most of the patients who had cystoscopy were in the seventh48 (43.3%) and fifth26 (23.4%) decades of life. The male to female ratio was 2:1. The commonest indication for cystoscopy was for investigation of bladder tumors in 50(45.0%) of the patients. Other indications were for the investigation of hematuria in 31(28.0%) patients, hydronephrosis in 13(11.8%), urethral stricture 9(8.1%), cystitis 2(1.8%), bladder calculi 3(2.7%), prostatitis 1( 0.9%), bladder fistula 1(0.9%), and urinary incontinence 1(0.9%). Conclusion: The indications for Cystoscopy vary from centre to centre. In our experience, the most common indication is for bladder tumors. The procedure is well tolerated by patients with a low incidence of morbidity. Studies have shown that the flexible cystoscope offers more advantage in that it is less invasive and can be done under local anaesthesia. [ABSTRACT FROM AUTHOR]

Primary genitourinary melanoma accounts for less than one per cent of all cases of melanoma. Most cases attributed to the prostate actually originate from the prostatic urethra. Due to its infrequency, primary malignant melanoma of the genitourinary tract presents a difficult diagnostic and management challenge. We report a case of primary malignant melanoma of the prostate found during transurethral resection of the prostate. [ABSTRACT FROM AUTHOR]

We report a case of acute urinary retention in a 13-month-old boy, secondary to a perforate Cowper's syringocele. Diagnosis was established with voiding cystourethrogram, transperineal ultrasound and urethroscopy; definitive management involved endoscopic unroofing of the syringocele and resolution of the patient's obstructive signs and symptoms followed. Although novel diagnostic and therapeutic options have been reported, standard urethrographic imaging and endoscopic management is appropriate for the majority of symptomatic Cowper's syringoceles. [ABSTRACT FROM AUTHOR]

We report the second case of prolapsing anterior urethral polyp, which was diagnosed on urethral ultrasonography and was confirmed on cystourethroscopy, successfully treated by transurethral resection. [ABSTRACT FROM AUTHOR]

The article presents a case study regarding the congenital prostato-urethral fistula caused by persistence of the mesonephric duct that developed in an adult with a lifelong history of perianal urinary leakage on voiding. This disease was developed when he was four months old. Though urethroscopy showed a normal bladder, prostate and urethra, an antegrade cystourethrogram demonstrated a fistula between the prostatic urethra and the anal verge.

Vesicoureteral reflux (VUR) affects ∼1% of children. We present an unusual case of urinary retention secondary to an obstructing urethral stone, underlying reflux, and its management. A 7-year-old boy presenting with acute urinary retention had a palpable penile shaft swelling and patent urethral meatus on examination. Cysto-urethroscopy with a 6.6Fr ureteroscope, due to unavailability of paediatric instruments, revealed an obstructing calculus impacted in the navicular fossa. This was laser fragmented and extracted. Cystoscopy revealed multiple bladder calculi with a patulous right ureteric orifice. Post-operative investigations revealed a small, scarred right kidney (ultrasound), bilateral ureteric reflux (micturating-cystourethrogram), 4 cm by 0.8 cm right ureteric calculus (CT-KUB) and 4% right split renal function (DMSA). Right laparoscopic nephroureterectomy was subsequently performed. Our case highlights the variety with which VUR can present and the effectiveness of a ureteroscope in an emergency setting as an alternative to a paediatric cystoscope to visualize the urethra and the bladder. [ABSTRACT FROM AUTHOR]

Introduction: To report our experience of laparoscopic excision of symptomatic prostatic utricles in children. Methods: five males were treated from February 2002 to February 2007. Age at surgery was between 3 and 12 years (mean 7.6). four patients showed severe hypospadias. Three patients presented with urogenital infections. Laparoscopic procedures were performed using a 12 mm umbilical trocar for the camera and 3, 5 mm trocars for instruments placed in the suprapubic region and iliac fossa bilaterally. Cysto-urethroscopy and cannulation of the prostatic utricle was initially undertaken with a cystoscope that was left in situ inside the prostatic utricle to facilitate subsequent identification and mobilization during the laparoscopic procedure in the first patien. The remnants were ligated with endoscopic loops or Hem-O-Lock. Results: Laparoscopic excision of the prostatic utricle was successful in all five patients. The urethral defect was closed by intracorporeal suturing in three patients while the defect was small enough to be adequately closed by ultrasonic coagulation in two. The mean (range) operative duration was 108 (80.140) min. All five patients recovered uneventfully with no complications. Conclusions: Laparoscopic excision is effective for symptomatic prostatic utricles, offering a good surgical view and decreases surgical risk and operative time. [ABSTRACT FROM AUTHOR]

Introduction: The high recurrence rate is still the major complication of internal urethrotomy. Our institutes have a protocol to performe urethral dilatation post internal urethrotomy. The aim is to evaluate the effect urethral dilatation on anterior urethral stricture recurrence after internal urethrotomy. Methods: We classified into 2 groups which are urethral dilatation and observation. Data were collected from 2 public hospital and 3 private hospital. All stricture was anterior, single, and partial obstruction. Urethral dilatation was using a metal sound urethral dilatation and performed every 1-2 weeks for first and second month and once a month after that or if there is any voiding complaints or maximal urine flow rate< 10 mL/s. The criteria for recurrence were indicating the need for urethroscopy, DVIU or open surgery, and/or impossible dilatation. We follow up at least 1 month after DVIU. Results: A total 204 cases can be reviewed, which are 188 had urethral dilatation procedure and only 16 had observation. In urethral dilatation group, we found 4 recurrent cases (2,1%) with mean time of recurrence was 4.3 month. In observation group, we found 9 recurrent cases (56,3%) with mean time of recurrence was 10 month. There was no significant differences in time of recurrence between two groups (P = 0,503). By Kaplan Meier survival analysis, urethral dilatation group had better and longer mean recurrent time. Conclusions: We found a urethral dilatation post internal urethrotomy had beneficial effect for decreasing recurrent complication. [ABSTRACT FROM AUTHOR]

Introduction: To report our long term results of reconstruction of extended recurrent urethral strictures with buccal mucosal graft. Methods: From 04/1997 till 12/2007, 374 reconstructions of recurrent urethral strictures were done. 360 of them were reconstructed with buccal mucosal graft. In all the patients, graft was placed ventrally by onlay technique. Patients were aged from 5-88 years (mean 50). Stricture length ranged from 1-25 cm (mean 10.1). Number of prior operative treatments were 1-24 (mean 4.7). The data were prospectively recorded by patients reported questionnaires evaluating uroflow and residual urine every 3 month in the first year and 6 monthly thereafter. In cases of uroflow less than 20ml, residual urine more than 100ml or infections,we performed urethroscopy and or urethrography. Mean follow up was 37 months (range 3-121). Results: 26 of these patients (7.2%) developed a recurrence between 8 and 74 months (mean 33) with the highest risk during first 2 years and after 5 years, postoperatively. The follow up analysis shows that 60% recurrences occur within 2 years and about 40% after 5 years. The age of patients with recurrence was between 31-79 years. Conclusions: Buccal mucosal graft implanted by onlay technique on the ventral aspect of the urethra is an excellent material for reconstruction of extended recurrent urethral strictures. Long term results are very satisfying. Recurrences also occur after 5 years postoperatively hence a long term follow up is necessary. [ABSTRACT FROM AUTHOR]

Introduction: Higher complication rate with ventral onlay buccal mucosa graft urethroplasty as compared to dorsal placement of the mucosal graft has been mainly attributed to poor ventral support for the graft. We herein describe a technique to augment the thickness of ventral portion of the bulb that forms the base of the ventral graft in an attempt to decrease this complication rate. Materials and Methods: In a pilot study conducted between Jan 2007 and July 2007, 5 patients with proximal bulbar urethral stricture underwent ventral onlay buccal mucosal graft urethroplasty. After the graft was sutured with the mucosal edges of the stricture defect, a continuous 4-0 monofilament poliglecaprone-25 suture was applied taking thin bites through the superficial portion of the bulb. The inverted raw edges of the bulb form a large vascularized bed for the buccal mucosal graft. Approximately 5mm on either side of this suture line, parasagittal incisions were given in partial depth of bulb and medial edges were sutured together over the first suture line. The lateral edges of incision were then sutured as a third layer. It is desired to separate fibrofascial adhesions that adhere lateral aspect of bulb to undersurface of perineal membrane by blunt dissection to permit medial advancement of bulbar tissue. The technique described exploits local bulbar anatomy and successfully moves the lateral bulbar tissue medially below the ventrally placed mucosal graft. Postoperative urethroscopy and pericatheteric urethrograms was done to document healing. A retrograde urethrogram was done at three months follow up. Results: Mean patient age was 38.7 years. Mean follow up period is 10 months. Postoperatively all patients were symptom free. None developed a graft pseudodiverticulum. The described technique of VBA leads to a thicker bulb ventrally to provide a sound, wider and vascularized base for the mucosal graft. Conclusion: With ventral bulbar augmentation following buccal mucosal graft urethroplasty, a thicker ventral bulbar platform results which provides enhanced support to the graft. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the clinical relevance of MRI urethrogram in diagnosing stricture urethra and comparing the investigation with the conventional urethrogram. Materials and Methods: Patients with stricture urethra who came to our institution between Jan 2007 and Aug 2007 were investigated with conventional RUG and multiformat MR urethrogram. All the patients underwent urethroscopy under anesthesia and later subjected to definitive endoscopic or open surgical intervention. The accuracy of both these investigations in assessing the stricture length and the advantages of MR urethrogram over RUG were analysed. Conclusion: MR urethrogram is a promising investigation which provides additional data regarding stricture characteristics like the size of the stricture and the extent of spongiofibrosis which cannot be obtained in our RUG, to decide on the treatment approach. [ABSTRACT FROM AUTHOR]