Search

Background: Benign prostatic hyperplasia (BPH) is a common disease in elderly men. Transurethral resection of the prostate (TURP) is still the standard treatment for BPH. However, postoperative uri...

Objective: To report the clinical outcome of urethral reconstruction by cultured urothelial or oral mucosa cells for tissue-engineered urethroplasty. Methods: We systematically searched for studies reporting the use of tissue-engineered techniques for hypospadias and urethral stricture repair in humans in PubMed and Embase (OvidSP) through January, 1990 to June, 2018. We excluded studies based on titles that clearly were not related to the subject, studies in which tissue-engineered biomaterial were used only in laboratory or experimental animals, and in the absence of autologous cultured epithelial cells. Studies were also excluded if they were not published in English, had no disease background and adequate follow-up. Finally, we search all relevant abstract presented at two of the main urological meetings in the last 10 years: European Association of Urology (EAU) and American Urological Association (AUA). Results: A total of six articles, reporting the clinical use of tissue-engineered techniques in humans, were fully reviewed in our review. The epithelial cells were harvested from the urethra (10 patients), the bladder (11 patients) and the mouth (104 patients). The tissue-engineered grafts were used in children for primary hypospadias repair in 16 cases, and in adults for posterior and anterior urethral strictures repair in 109 cases. Tissue-engineered grafts were showed working better in children for primary hypospadias repair than in adults for urethral strictures repair. Conclusion: One hundred and twenty-five patients received tissue-engineered urethroplasty using cultured epithelial cells for primary hypospadias or urethral strictures repair. The studies demonstrate a high degree of heterogeneity respect to epithelial cells (from urethra, bladder, and mouth), type of scaffold, etiology, site of urethral stricture, number of patients, follow-up and outcomes. Keywords: Urethra, Urethroplasty, Tissue engineering, Urethral mucosa, Oral mucosa, Surgical technique

Background Vessel-sparing anastomotic repair (vsAR) has been developed as a less traumatic alternative to transecting anastomotic repair (tAR) to treat isolated short bulbar urethral strictures. This vessel-sparing technique could result in improved functional outcomes without jeopardizing the excellent surgical outcome after (transecting) anastomotic repair. The purpose of this study is to directly compare vsAR and tAR for both surgical and functional outcomes. Methods This trial is a prospective, interventional, multi-center, single-blinded, 1:1 randomized, controlled, non-inferiority, phase II trial. Sample size calculation resulted in a required sample size of 100 patients (50 patients per arm). Trial participants will be randomized by an independent third party using a computer-based random sequence generator with permuted blocks of variable size. The primary objective of this trial is to show that vsAR is non-inferior to tAR in terms of failure-free survival after 24 months of follow-up, considering a non-inferiority limit of 10%. Failure is defined as the inability to pass a 16-Fr flexible cystoscope through the reconstructed area without damaging the urethral mucosa. Secondary end-points mainly include differences in postoperative complications and changes in functional outcome parameters, which will be assessed with validated questionnaires. All participants are scheduled for follow-up at 3, 12, and 24 months postoperatively. Discussion This trial will provide level Ib evidence about the differences in both surgical and functional outcome between vsAR and tAR, which may importantly scape the future of bulbar urethral reconstruction. Depending on the trial results, this phase II trial may generate a larger phase III trial with more statistical power and a lower alpha value. Trial registration This trial is registered at clinicaltrials.gov (NCT03572348) and in the Belgian Clinical Trial Registry (B670201837335). The trial was registered prospectively. Registered on 28 June 2018.

Objective A urethral diverticulum (UD) is a localised evagination of the urethral mucosa that forms a herniation that is continuous with the lumen of the urethra. We report of a patient who presented with a persistent UD during consecutive pregnancies and present a review of the current literature of other cases of UD during pregnancy. Methods A literature search was undertaken to identify previous research and case reports on the clinical presentation and management of UD in pregnancy using the search terms “pregnancy” and “urethral diverticulum”. Medline, PubMed and Cinahl were used as search engines. Results Six publications that described UD in pregnancy were identified with a total of nine cases documented within the literature. The articles reviewed showed that UD during pregnancy can be managed conservatively with expectant management, antibiotics and incision and drainage if required. Conclusion Overall, it is important for clinicians treating women in pregnancy to be aware of the rare diagnosis of UD, especially in those women who present with vague urinary symptoms refractory to other treatments. Brief Summary A case presentation of UD and literature review of UD in pregnancy., Highlights • A urethral diverticulum is an evagination of the urethral mucosa that forms a herniation that is continuous with the lumen of the urethra. • We report the case of a patient who presented with a persistent urethral diverticulum during consecutive pregnancies. • A literature search identified six publications that described urethral diverticulum in pregnancy, with a total of nine cases. • It is important for clinicians treating women in pregnancy to be aware of the rare diagnosis of urethral diverticulum.

Background: The effectiveness of microscopy of Gram-stained smear (GSS) for the detection of male urethral infection is debatable, especially in cases with low inflammation and no visible urethral discharge. This clinical study compared GSS samples collected with the conventional swab method and our new technique, the kissing slide method, together with polymerase chain reaction results to demonstrate the effectiveness of this new method in men with acute urethritis. Methods: The study included 64 men who presented to the urology outpatient clinic with complaints of acute urethritis between October 2019 and January 2020. Two GSS samples were collected from each patient, first using the kissing slide method (applying the slide directly to the urethral mucosa), followed by the conventional method. The results were compared with polymerase chain reaction findings. Results: The patients' mean age was 37.4 ± 7.8 years, and 68.7% had no visible urethral discharge on physical examination. At a GSS threshold of ≥5 polymorphonuclear leukocytes/high-power field, sensitivity values were 60% (95% confidence interval [CI], 42.32%-75.41%) for the kissing slide method and 23.33% (95% CI, 11.79%-40.93%) for the conventional method. At a threshold of ≥2 polymorphonuclear leukocytes/high-power field, sensitivity values with the kissing slide and conventional methods were 80% (95% CI, 62.69%-90.5%) and 50% (95% CI, 33.15%-66.85%) in all patients, and 66.67% (95% CI, 41.71%-84.82%) and 20% (95% CI, 7.047%-45.19%) in cases without visible urethral discharge, respectively. Conclusion: The new kissing slide method is a noninvasive alternative method that may have better sensitivity than the conventional GSS sampling method in the diagnosis of male acute urethritis. Randomized studies are needed to verify these findings. WOS:000574642100014 32649578 Q3

Primary carcinomas of the urethra are rare and poorly understood lesions; hence, their clinical and pathologic spectrum is not completely defined. We analyzed a series of 130 primary urethral tumors and classified 106 of them as primary urethral carcinomas. The age at diagnosis of patients with primary urethral carcinomas ranged from 42 to 97 years (mean, 69.4 years; median, 70 years). There were 73 male and 33 female patients with a ratio of 2.2:1. In male patients, the tumors most frequently developed in the bulbous-membranous segment of the urethra. In female patients, the entire length of the urethra was typically involved. Microscopically, they were poorly differentiated carcinomas with hybrid squamous and urothelial features and developed from precursor intraepithelial conditions such as dysplasia and carcinoma in situ, which were frequently present in the adjacent urethral mucosa. High-risk human papilloma virus infection could be documented in 31.6% of these tumors. Follow-up information was available for 95 patients. Twenty-three patients died of the disease with a mean and median survival of 39 and 21 months, respectively. Urethral carcinomas are aggressive tumors with a high propensity for regional and distant metastases with mean and median survival of 39 and 21 months, respectively. Our observations have important implications for the management of patients with primary carcinoma of the urethra by defining them as a unique entity linked to human papilloma virus infection.

Dysuria and/or hematuria are common and worrisome symptoms for most parents. Dysuria results from excessive bladder muscle contraction and peristaltic activity of the edematous and inflamed urethral mucosa. Though urinary tract infection remains the commonest cause for dysuria, non-infectious causes should also be kept in mind. Equating all cases of dysuria to urinary infection is not incorrect. Hematuria can be both macroscopic and microscopic and an important sign of genitourinary tract disease. However, systemic causes like bleeding disorder or malignancy can also present with hematuria. A thorough history and physical examination is important for arriving at a diagnosis. The investigations for both the symptoms and the urgency with which the tests are required are dictated by the patient's clinical presentation.

A urethral caruncle is a benign lesion of the distal urethra. Urethral prolapse occurs when the urethral mucosa is everted circumferentially all the way around the urethral meatus. In contrast, with a urethral caruncle, there is only partial eversion of the distal urethra. Often the terms urethral prolapse and urethral caruncle are incorrectly used interchangeably. Caruncles occur most commonly in low estrogen states and are treated with topical estrogen if they are causing symptoms.

INTRODUCTION AND OBJECTIVE:Iatrogenic injuries to urethral mucosa result in fibrosis, causing luminal constriction leading to scarring and stricture. The precise cellular and molecular mechanisms t...

A urethral foreign body is usually found as a part of sexual misadventure mostly in a young male. The literature has described items like a fork, battery, wire and other things in the urethra which almost always required a surgical procedure for its removal. Here we present the case of self-insertion of a hairpin in the male urethra with the open pointed end of hairpin facing distally. The hairpin despite being “stuck” inside the urethra due to its sharp end embedded in urethral mucosa was successfully removed with simple manipulation techniques with no complication in follow-up. This case highlights the point that when faced with the situation of an uncommon object in the urethra, the treatment has to be individualized according to the type of object, age and sex of the patient and sometimes common unorthodox technique can save the patient from operative procedure.

Objective Urethral prolapse (UP) is a complete eversion of the distal urethral mucosa through the external meatus. UP must be distinguished by examination from trauma, prolapsed ureterocele, tumors or sexual abuse. Its management remains controversial. The aim of the study was to promote the benefits of primary surgical management for UP. Methods A retrospective multicenter review of children who received surgery for UP between 1991 and 2011 was carried out. Non-complicated UP was primarily treated conservatively. A total of 19 patients were referred for complicated UP and underwent resection of the prolapsed urethral mucosa. Results The mean delay in diagnosis was 2.2 days (range 1–6) and the most common symptoms were vaginal spotting and bleeding. No predisposing factor was found, but most patients had a mean weight, height and BMI greater than the 50th percentile. All patients underwent surgery successfully. One patient experienced a complication, i.e., dysuria. There was no case of recurrence after a mean 28 months of follow-up. Conclusion Early detection is based on bedside examination. The first-line treatment strategy for uncomplicated UP should be conservative management. Surgical resection is safe and effective for patients with significant symptoms.

Objective To explore the method of building a stable urethral stricture (US) model in New Zealand white rabbits. Methods Through 10× magnification optical microscope, a resection of 1.0 cm urethral mucosa was made in 6 male rabbits and other 6 male rabbits were controlled. After 60 days, the rabbits were evaluated with urethrography, urethral pressure profile (UPP) and histology. Result Urethrography demonstrated a stricture with narrow lumen and discontinuous mucosa in the resection group. The urethras of the control animals were all normal. UPP showed that the urethral pressure on operative site in the controlled group was 14.67 ± 2.16 cm H 2 O, and 27.83 ± 3.71 cm H 2 O in the resection group. There was significant statistical difference between the two groups ( p Conclusions We establish the way to build a stable urethral stricture model of New Zealand rabbits by the microsurgical technique, which is a good laboratory model to research all kinds of urethral stricture. Urethrography and histology combined UPP are the reliable methods to identify the urethral stricture.

The aim of this study is to present a novel use of Dextranomer/hyaluronic acid copolymer (Deflux) for the treatment of a complicated iatrogenic chronic urethral injury. A 12-year-old boy with a neuropathic bladder presented a groove in the urethral mucosa due to chronic clean intermittent catheterizations (CICs) and suffered a posterior urethral injury during a failed catheterization for a routine examination. The defect on the urethral wall was repaired using Deflux, a technique that is not described in the literature. After the intervention the patient is continuing CICs without further complications.

X-ray contrast imaging of the urethra, retrograde as urethrogram (UG) or antegrade as part of the miction cystourethrogram (MCU), has proved successful as a standard examination in urological diagnosis. The article presents a sonography technique enabling three-dimensional morphological and functional imaging the entire male urethra by real-time sonography. Advantages over x-ray film methods are the repeatability at any time, low invasiveness, absence of exposure to x-rays, and lesions of the urethral mucosa by catheters, as well as the avoidance of iodine-induced contrast medium reactions. Miction urethrosonography (MUS) is suitable for screening diagnosis of urethral stricture in miction difficulties, for excluding an iatrogenic of congenital urethral diverticulum, and for control after urethral surgery (internal urethrotomy, urethroplasty).

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

Penile cysts are rare benign lesions. Their clinical or pathological diagnosis is extremely difficult. Less than 200 cases have been reported in literature. Most of them are asymptomatic and present since birth, but usually they are only detectable in adolescence or adulthood. These lesions rarely interfere with sexual function. These cysts most likely arise from ectopic urethral mucosa sequestered in the penile skin during embryologic development. We report a rare case of a 55-year-old man with a 4.5 × 4 cm nodule on the prepuce (ventral surface), which appeared two years ago and interfered with his sexual function. The nodule was excised by circumcision and a histopathological examination revealed a mucoid cyst of penis with squamous metaplasia. No recurrence was observed at a one year follow-up and the patient’s sexual function returned to normal.

We reviewed the available data on transurethral microwave thermotherapy in the treatment of patients with benign prostatic hyperplasia (BPH). Furthermore we provide a perspective of this minimally invasive treatment modality. To our knowledge all previously reported data from clinical trials of transurethral microwave thermotherapy for BPH are reviewed. Transurethral microwave thermotherapy was designed to apply microwave energy deep within lateral prostatic lobes while simultaneously cooling the urethral mucosa, thus enabling an outpatient based anesthesia-free procedure. Lower energy protocols using the Prostraton device provide significant symptomatic improvement and improvement in maximum flow of approximately 35% over baseline. Similar changes are being documented with other transurethral microwave thermotherapy devices. Higher energy protocols using the Prostatron device result in symptomatic improvement similar to that of lower energy protocols, while improvement in uroflowmetry is much more pronounced. However, the latter effect is achieved at the expense of increased morbidity. Second generation protocols have not yet been documented by users of the other thermotherapy devices. Numerous studies unequivocally support the efficacy and safety of transurethral microwave thermotherapy for treatment of symptomatic BPH. Significant improvement in objective and subjective parameters has been realized with transurethral microwave thermotherapy at multiple centers in the United States and Europe

If the urethral mucosa is replaced by another mucosa, urethral recurrence might decrease in patients who undergo neobladder construction for bladder cancer. We determined whether such replacement is possible.Six dogs underwent an operation consisting of a longitudinal urethral incision at its full length and immediate closure. In 6 other dogs, after the urethral mucosa was totally removed, a tubularized sublingual mucosa was closely set inside the urethral lumen. Postoperatively, the urinary stream and external meatus were observed every day. To measure urine leakage, a 10-minute pad test was performed once a month. All dogs were sacrificed 3 to 12 weeks after the operation for histological examination of the urethra. The excised urethras were examined with a 12F catheter for urethral patency.All dogs were continent postoperatively. The results of the 10-minute pad test showed no significant difference in the weight increase of the pad among the control, sham-operated and mucosa-replaced dogs. Urethral stricture developed in 1 mucosa-replaced dog. Histological examination revealed that all of the grafted oral mucosa survived in the urethra.These results indicate that the urethral mucosa can be replaced by oral mucosa without damaging the continence mechanism in female dogs.

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

Background Reactive arthritis (ReA) are sterile arthritis occurring after extra articular bacterial infection, mainly located in gut or genito urethral mucosa Objectives The aim of this study was to analyze, over 30 years, frequency as well as clinico-biological and therapeutic characteristics of ReA, comparing two periods. Methods In this retrospective monocentric study, the charts of all the patients followed in our unit between January 1st 1984 and April 2014 with the diagnosis or ReA, according to International Classification Criteria (1), were recorded and clinic biological features, management and outcome were analyzed, and compared between two periods: from January 1984 to December 1993, and from January 2004 to December 2013. Results 62 patients fulfilling international diagnosis criteria were analyzed. We found no significant differences (Table) between the two periods in incidence of new cases, clinical presentation (rheumatologic and extra articular features), biological and microbiological data or outcome. Change in therapeutic management was obvious with occurrence of anti TNF use in the recent period. Conclusions Reactive arthritis is still a current rheumatologic problem, with an apparently stable incidence in a developed country, with a need of early and tailored rheumatologic management. References Kingsley G, Sieper J. Third International Workshop on Reactive Arthritis. 23–26 September 1995, Berlin, Germany. Report and abstracts. Ann Rheum Dis. 1996;55:564–84. Disclosure of Interest None declared

Summary A case of mucinous hyperplasia in the right renal pelvis and ureter is reported in a 23-year-old, male, Quarter horse. The affected right renal pelvis was markedly distended and filled with inspissated yellowish-green mucous material compressing the adjacent cortical and medullary parenchyma. Multiple, similar masses were present protruding from the right urethral mucosa. Histologically, the masses were characterized by a cystic glandular and papillary hyperplasia of the mucosa of the renal pelvis and ureter. This is believed to be the first reported case in an equine species.

A single session of transurethral microwave thermotherapy using Prostatron (Technomed International, France) was performed in 20 patients with benign prostatic hyperplasia, and the clinical efficacy of this modality was evaluated by analysing the subjective and objective responses following the treatment. 1,296 MHz microwaves are delivered to the prostate by an antenna placed in a 20 Fr urethral balloon catheter equipped with a cooling system for preservation of the urethral mucosa. The treatment was performed in a single session for an hour on an outpatient basis. The clinical efficacy was evaluated by a total score of subjective symptoms and objective findings including residual urine and average flow rate, 8 weeks after the treatment. Reduction of subjective symptom score was observed in 26 cases (86.7%), and that of objective findings in 21 (70%). When 25% or more decrease of the total score was defined as good, the overall good result including subjective and objective responses was seen in 24 cases (80%). During the treatment and follow-up period, no severe adverse effect was detected. In conclusion, a single session of thermotherapy by Prostatron is a safe and useful modality as a non-surgical treatment performed on an outpatient basis for benign prostatic hyperplasia.

Inflammation of the urethral mucosa is very common, but most cases are easily treated and do not come to radiological attention. The three main causes are uncomplicated gonococcal urethritis, chalmydia trachomatis infection, and other nonspecific types of urethritis, due to ureaplasma urealyticum, trichomas vaginalis, and (rarely) herpes simplex virus. Some further simplify the classification into either gonococcal or nongonococcal urethritis. Another common cause is posttraumatic urethritis, for example after instrumentation or post urethral catherization, especially after the use of latex-based catheters. All these conditions seldom present for imaging, but if imaging is carried out in the acute stage, a subtle irregularity is seen related to the anterior urethra. An example is shown in Fig. 12.2. More chronic cases result in urethral strictures.

An unusual case of metastatic intraepithelial transitional cell carcinoma in situ to the vulvar epithelium resembling extramammary Paget’s disease is presented in a 75-year-old woman with a history of concurrent high-grade transitional cell carcinoma in situ of the bladder. Histologically and immunohistochemically, the tumor cells resembled the in situ bladder lesion. Epidermotropic spread of transitional cell carcinoma of the bladder is extremely rare, with lesions known to occur in urethral mucosa and around urethral meatus, representing an extramammary form of Paget’s disease. The present case represents previously unreported isolated intraepithelial metastasis of a urothelial carcinoma in situ to vulvar epithelium resembling extramammary Paget’s disease.

HYPOSPADIAS is a congenital defect in which the urethra terminates on the ventral surface of the penis. In about 20 percent of cases, the urethral meatus is at the base of the penis, and the anterior urethra is absent. Treatment in these cases requires extensive reconstruction of the anterior urethra, usually with autografts of flaps of contiguous skin or preputial skin transferred with a vascular pedicle.1 Split-thickness skin grafts from other parts of the body have also been used.1 , 2 The presence of pilosebaceous units in skin grafts can lead to problems, however, because of hair growth and sebaceous secretion. More . . .

OBJECTIVE To investigate the feasibility of urethral substitution using free lingual mucosa grafts (LMGs) in a dog model. MATERIALS AND METHODS The study included 10 female mongrel dogs in which a 4 × 1 cm2 section of urethral mucosa was excised. The defect was immediately repaired with a size-matched free LMG harvested from the inferior lateral surface of the tongue. A 12 F urethral catheter was kept inside the urethra for a mean of 7 days. At 3 months after the procedure, the patency of the urethra was assessed by both insertion of a 12 F catheter and by retrograde urethrography. Dogs were killed, the grafted areas excised, and evaluated by gross and histopathological examination. RESULTS All dogs survived the procedure and there were no tongue complications. One of the 10 dogs developed a slight urethral stricture near the proximal anastomosis. The remaining nine dogs voided spontaneously with no difficulty. Retrograde urethrography showed that no strictures or fistulas had formed. The LMGs shortened by 9.5% after surgery, from a mean (sd) of 4 (0.13) to 3.62 (0.11) cm (statistically significant, P

High-temperature thermal therapy for the treatment of prostate cancer is currently being applied as a minimally-invasive alternative over traditional forms of treatment. Catheter-based interstitial and transurethral ultrasound applicators are being developed for controlled and selective thermal ablation of prostaric tissues with concurrent MR thermal imaging. As part of this treatment strategy we have devised a transurethral cooling catheter and a cooling jacket to be placed over the endorectal MR imaging coil to protect the urethral mucosa and rectal wall from thermal damage during treatment. The cooling efficiencies and protective abilities of these devices were evaluated in vivo within three canine prostate glands. Invasive and MR derived temperature measurements within the prostate and rectal wall indicate that the protective influence of the endorectal cooling extends 5-10 mm from the rectal wall into the dorsal prostate. The urethral cooling extends approximately 5 mm from the cooling balloon. The protective capabilities were further verified with subsequent histological analysis with TTC stained tissue sections and contrast enhanced T1-weighted MR images post treatment. Both of these cooling devices are compatible with the MR thermometry and can be used to protect the urethral mucosa and rectal wall during prostate thermal ablation with interstitial and transurethral ultrasound devices.

We present a case of urethral mucosa prolapse in a postmenopausal woman. Transperineal gray-scale sonograms revealed a clover-shaped, hypoechoic mass protruding from the urethral meatus. Doppler studies revealed blood flow within the protruding mass. Detection of feeding arteries and draining veins contributed to exclude the possibility of necrosis and gangrene, thus allowing conservative medical treatment to be tried. The mucosal prolapse regressed after 1 week's treatment with topical estrogen and antibiotics and sitz baths. Follow-up sonograms showed a normal urethral configuration and diminished vascular flow when compared with the initial study. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:261–263, 2004; Published online in Wiley InterScience (www. interscience.wiley.com). DOI: 10.1002/jcu.20026

Urethral diverticulum is a sac-like outpouching of urethral mucosa. It may be anterior or posterior according to anatomical locations. It is less common in men than in women. It can be congenital or acquired. Anterior urethral diverticula are usually congenital as compared to majority of posterior diverticula which are acquired. The most common aetiologies of male acquired diverticula are stricture, abscess, trauma or post-hypospadias repair. We report a case of congenital giant anterior urethral diverticulum with a calculus which has been managed successfully with surgical excision and repair in two layers.

A 4 year old boy, who underwent 2 times of unsuccessful primary closure of the extrophied bladder at 7 days and 5 months after birth, was treated with construction of a rectal bladder with sigmoid-pull through by Duhamel procedure. Vas deference, seminal vesicles and prostate were not found at the cystectomy operation. Epispadias urethral mucosa was removed and phalloplasty was performed using the ventral hooded foreskin. The results were cosmetically and functionally excellent. He could keep continence and his upper urinary tract was normal at 6 months after the operation.

Background Urethral prolapse is an uncommon condition characterized by complete circular eversion of the urethral mucosa through the external meatus. Case We present the case of a 9-year-old Asian girl who presented with 3 days of vaginal spotting and a painless vulvar mass. After several unsuccessful attempts of manual reduction, surgery was performed. As a result, the patient had no recurrence or meatal stenosis at the 6-month follow-up. Conclusion Urethral prolapse can be clinically diagnosed without laboratory or radiographic evaluation by demonstrating edematous tissue that surrounds the meatus circumferentially. It should not be confused with other causes of vaginal bleeding, including sexual abuse.

The transurethral system for erection was developed to deliver vasoactive compounds to the urethral mucosa to treat men with erectile dysfunction. The urethral epithelium just beyond the fossa navicularis shifts from stratified squamous to complex columnar tissue where vasoactive compounds may be absorbed. Following absorption into the corpus spongiosum surrounding the urethra, medications may be subsequently transferred to the corpora cavernosa via collateral vessels.

SUMMARY The calcium channel antagonist nifedipine has shown efficacy in the treatment of interstitial cystitis and the urethral syndrome. The optimal daily dose of nifedipine can be determined with the use of a nifedipine titration test. To complete the repair of damaged bladder and/or urethral mucosa, nifedipine therapy should be used for a minimum of 3 months. Patients who do not respond well to nifedipine are those with the pelvic floor muscle spasm syndrome variant of interstitial cystitis.

We report the case of a 74-year-old man with ductal prostate cancer who had originally undergone radiotherapy but developed metastases to the anterior urethral mucosa. This is the fourth such case ever reported in English publications. We suspect the metastases developed from implantation after instrumentation, a common finding in the previously reported cases. Although no specific treatment regimen exists, we believe that local resection followed by androgen deprivation is the treatment of choice in these patients.

Urethrotomy was performed on 12 normal male dogs at the base of the os penis. The surgical site was allowed to heal by second intention in six dogs, and suture closure of the urethral mucosa, tunica albuginea, and subcuticular tissue was performed in six dogs. All dogs were maintained for 60 days postoperatively. Packed cell volume and serum total protein were measured before surgery and at 2, 4, 7, 14, and 60 days postoperatively. Suture closure of the urethra resulted in less hemorrhage during the postoperative recovery period. Urethral mucosal irregularity was seen in urethrograms performed on all operated dogs 60 days postoperatively. Urethral stricture was not observed in any of the dogs in this study.

Using a new type of nylon brush (Cytobrush) for sampling of cells, the state of the urethral mucosa was evaluated before and after oestrogen treatment in 10 patients suffering from urinary incontinence. In 4 other patients the results obtained were compared with those using the conventional cotton swab technique. The brush specimens were found to be much more cellular and consequently more informative than those obtained with the conventional technique. The cytologic examination based on brush samples also demonstrated that oestrogen treatment within 3 weeks induced a proliferation of the atrophic urethral mucosa in postmenopausal women suffering from urinary incontinence.

I can best round off my address bylisting do's and don'ts which summarize my main thoughts upon the problem of the vesicovaginal fistula. Don't despair of local closure of a vesicovaginal, or urethrovaginal, fistula. The great majority can be repaired by simple, direct methods. Don't attempt a transvesical or transabdominal operation, nor an extensive flap-splitting or grafting procedure, unless for very special reason. Don't use catgut for the repair unless it is of a very fine variety and is restricted to the tissues immediately adjacent to the bladder or urethral mucosa. Monofilament nylon is the best suture material for the vaginal wall. Don't forget to clear out all blood clot and debris from the bladder at the end of the operation, and to maintain constant drainage for fourteen days. Do make sure that there is no tension on the stitches at the end of the operation. If tension is present do not hesitate to make a relaxation incision on one or on both sides. Do make sure that there is not a second fistula present. Do make sure that there is not a bladder stone present. Do be careful of the ureters during repair.

Pseudopapillomata of the vesical and/or urethral mucosa were found in 195 patients among a total of 2046 patients at a Spinal Cord Injury Center. Of these, 169 cases were studied, and an incidence of

A new experimental model for the assessment of urethral catheters is described. Fifty catheters, comprising brands of latex, silicone, teflon-coated latex and polyvinylchloride (PVC) were assessed. The silicone, teflon-coated latex and PVC catheters were shown to cause minimal inflammatory change of the urethral mucosa, whereas the latex catheters showed variable and more marked changes. The model was simple to establish, and gave reproducible results.

Sections of 292 transurethral prostatic resection specimens and 52 intact prostatic urethral specimens from male patients 10 to 89 years old were examined for the presence of Brunn’s nests and glandular metaplasia in the urothelium of the supramontanal prostatic urethra. The complex pitted urethral mucosa at and below the verumontanum was not assessed. Either or both lesions were present focally in 211 transurethral prostatic resection specimens (72 per cent) and in 51 intact urethral specimens (97.5 per cent). Brunn’s nests and glandular metaplasia consisted chiefly of transitional cells but in 47 transurethral prostatic resection cases glandular metaplasia contained prostatic acinar-type cells and in 1 case intestinal-type goblet cells were noted. Brunn’s nests and glandular metaplasia were associated with inflammation in only 27 per cent of the cases and were not associated with dysplasia or urethral tumors except for 1 benign papilloma. We conclude that Brunn’s nests and glandular metaplasia are so common in the supramontanal prostatic urethra that they represent normal urothelial variants in this segment of the urinary tract.

Circular prolapse of the urethral mucosa in the elderly female is rarely reported in the literature, but is a common clinical entity. During the years 1972–1983 thirteen women with urethral prolapse were operated upon in our department, in all of whom differentiation of the benign lesion from malignancy could not be done on clinical grounds only. The following survey is meant to draw attention to the entity and its clinical implications.

Five cases of papillary adenocarcinomas of the prostate were studied for prostate-specific acid phosphatase, using the immunoperoxidase method, to determine the origin and histogenesis of these uncommon tumors. All five cases were prostatic-acid-phosphatase positive, whereas four cases showed in situ carcinoma involving large periurethral ducts. Positive immunohistochemical localization of prostate-specific acid phosphatase is useful in identifying papillary carcinoma of true prostatic origin and distinguishing them from prostatic-acid-phosphatase-negative carcinomas which may include tumors arising from periurethral glands or metaplastic urethral mucosa.

Acceptable results can be achieved in the treatment of hypospadias by the use of Denis Browne's method. However, the condition is not completely normalized, as the external orifice of the urethra is most frequently situated in the neighbourhood of the coronal sulcus and the orifice itself open. The distance to the normal urethral mucosa is thus short with the consequent increased risk of contamination. In order to ensure normalization of the condition, Denis Browne's method was supplemented by the construction of a fossa navicularis in 74 patients with hypospadias. The results of this construction were satisfactory in the great majority of cases.

Three cases of primary adenocarcinoma of the female urethra are presented. The tumour in the first case was associated with urethritis glandularis and is thought to arise from previous glandular metaplasia of the urethral mucosa. The tumour in the second case resembled the clear-cell carcinomas of the lower female genital tract and is thought to be of embryonic rest origin. The tumour in the third case is thought to arise from the paraurethral glands.

It is well known that the seminal vesicles may become involved during the course of a gonorrheal urethritis, and, if the process remains active in the vesicles, may prolong urethral infection in a most stubborn manner. The constant or intermittent feeding of new infection onto the prostatic urethra keeps active the inflammatory processes of the urethral mucosa, just as inflammatory processes in the vesical mucosa are activated by renal infections. It is probably not so universally recognized that the seminal vesicles, when the seat of a nongonorrheal or pyogenic infection, may result in prolonged suppuration of the posterior urethra and trigon. These infections may be even more stubborn than those of gonorrheal nature. To me it has been a new realization to find how many of these long-standing bacillary and coccal infections involving the posterior urethra and at times the bladder have been secondary to unsuspected vesiculitis. Every urologist is

No group of therapeutic substances has gained such rapid and universal utilization as have the sulfonamides. It is undoubted that their advent has been the important therapeutic accession of the decade and that the control of many diseases caused by infectious agents now has been brought within the physician's grasp. It is equally true that there has developed a degree of uncertainty relative to the specific indications for the use of the sulfonamides, and in no part of the literature is this more evident than in the discussions of the treatment of gonococcic infection in the male. Before the advent of the sulfonamides, how was gonorrhea cured? A host of chemicals and dyestuffs was given orally, first one and then another when the first seemed not to accomplish the desired result. A veritable flood of colored solutions was instilled onto the urethral mucosa or washed over its surface. Various vaccines

F. M., German, aged 19 years, machinist helper by trade, with poor general physical condition, and mentally below par, was given to frequent masturbation, and was of that type inwhich direct irritation of the urethral mucosa was necessary for complete sexual satisfaction. The chief complaint was general weakness and constant dribbling of urine. Three years before, while he was masturbating with a bougie molded from a piece of chewing gum, it accidentally went beyond his reach, entered the bladder and caused the subsequent cystitis. The patient kept on working as usual, until three weeks before I saw him (Sept. 15, 1914), when incontinence set in and a constant gripping pain began to annoy him at the neck of his bladder. He had not worked since the latter train of symptoms came on, but sat about all day, listless and dull, in clothes reeking with the odor of foul urine. He