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

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

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

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

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

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

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

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

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

Male genitalia reconstruction in patients with exstrophy-epispadias complex often leads to secondary hypospadias, thus requiring additional surgery and resulting in possible complications. We describe a technique of male epispadias repair to prevent resultant hypospadias.The complete penile disassembly technique is modified by multiple Z-plasties, which enable creation of a funnel-like bladder neck and urethral plate lengthening. A total of 29 patients 2 months to 12 years old presenting with pure epispadias and bladder exstrophy were treated with this technique between 2004 and 2011. These patients were compared to 19 patients 1 day to 11 years old with exstrophy-epispadias treated with the standard penile disassembly technique between 2000 and 2004.Outcome measures were urethral orifice position, penile length and complications. There was no statistically significant difference between the 2 groups regarding penile length or complications. In the study group the urethra reached the tip of the glans in all patients, whereas the creation of intentional hypospadias was necessary in 6 patients (31.5%) in the control group (p0.05).The modified technique was effective in obtaining appropriate meatal location without decreasing the penile length. The complication rate was not changed. Creation of resultant hypospadias at genitalia reconstruction in male epispadias should strongly be prevented.

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

A 24 year old young patient presented in the emergency department of Shaheed Monsur Ali Medical College Hospital, Uttara, Dhaka with swollen, curved and flaccid penis after forceful bending of his erect penis. The patient was anxious with normal vital sign. Rolling sign was positive. There was no bleeding at external urethral orifice, scrotum & testicle were found normal. On the above facts, penile fracture was diagnosed clinically. The penis was degloved upto the root of the penis & after evacuation of the haematomas, transverse tears were detected in Bucks fascia & tunica albugenia of the left corpus cavernosum, which were repaired by interrupted suture. In the post operative period sedative was given & recovery was uneventful. The aim of this case report is to increase the awareness of the condition which should be regarded seriously and treated expeditiously and to draw attention to its possible complications. DOI: http://dx.doi.org/10.3329/jss.v16i1.14448 Journal of Surgical Sciences (2012) Vol. 16 (1) : 44-46

Infections caused by bacteria strike primarily the prostate and vesical glands, and secondarily the epididymis. Essential first is to give evidence of bacteria in germ numbers exceeding 10(5) pro ml ejaculate. In addition, the diagnosis of prostatitis requires the demonstration of other signs of infection, for example increased numbers of leukocytes in the ejaculate, in the prostatic secretion and in the urine; the clinical symptoms in relation to these indicators are not necessarily characteristic. It is essential for the microbiological diagnostic, that evidence of all the germs be found in native material. It is therefore necessary to first disinfect the external urethral orifice and the glans penis, in order to avoid super-imposition of germs from the surroundings. Every demonstration of bacteria must be connected with a determination of resistance. The relationships between the ejaculate parameters which deviate from the norm, and evidence of bacteria in ejaculate are unclear. Reports about disturbances in spermatozoa motility or morphology during infections of the adnexa of man are to be evaluated with care.

We operated on an 87-year-old female suffering from a giant bladder stone. Her chief complaint was fever and lower abdominal pain, which was caused by lodgement in the urethra. The stone was easily removed in one piece without breakage or injury to the urethral orifice and urethra using forceps normally used for grasping bones in orthopedics. The stone measured 75×50×45 mm and was composed of magnesium ammonium phosphate. To our knowledge, this is the largest bladder and/or urethral stone that was transurethrally removed without being broken. Thus, forceps that are normally used for grasping bones in orthopedics can be used to remove giant bladder stones without leaving stone fragments.

Hypospadias is the commonest congenital urological anomaly, occurring in 1–3 per 1,000 live births. The spectrum of hypospadias anomalies include an abnormal urethral orifice on the ventral aspect of the penis, chordee (ventral curvature of the penis), an incomplete prepuce, an abnormal looking globular glans, rotation of the penis, abnormal raphe, and a disorganised corpus spongiosum and penile fascia.

A 52-year-old woman was admitted because of a vaginal-wall tumor adjacent to the external urethral orifice. The tumor had been causing disturbances in micturition for the past year. Magnetic resonance imaging and computed tomography images indicated a 6 x 3 cm solid mass in the anterior vaginal wall. The tumor was enucleated surgically through a median longitudinal incision of the anterior vaginal wall. Micturitional disturbances were rectified after surgery. Histologically, the tumor was a mixture of a high-cellularity area with a mitosis rate of 7 per 30 high-power fields, and a less cellular area without mitosis. Immunohistochemical staining was performed for both areas. The prognostic implications of the tumor are discussed.

The urethra, which carries urine from the urinary bladder to the external urethral orifice for excretion and provides the conduit for semen in males, may be involved by a broad spectrum of both neoplastic and nonneoplastic diseases, which may produce very similar clinical symptoms. This chapter reviews the clinical and pathologic features of urethral diseases organized by clinical setting: urethral stricture, male urethral cancer, female urethral cancer, and female urethral diverticulum.

Summary 1. Superficial ulceration and coarctation of the urethral orifice has been observed in forty-one cases. 2. Its etiology has been discussed, and in all cases but two, congenital shortening of the anterior-posterior diameter of the external meatus has been found. 3. Contributing skin factors are: (a) most frequently, ammonia dermatitis, (b) a dermatitis of unknown origin affecting only glans and the periphery of the meatus, (c) herpes simplex. 4. The dangers of obstructive uropathy caused by this disorder have been stressed. 5. Treatment of the disorder has been suggested.

The urethra is a tubular structure through which urine is expelled after accumulating in the physiological reservoir called the bladder. In men, this canal is also used by the seminal ducts and carries the sperm from the veru montanum all the way to the external urethral orifice.

A 30-year-old female was admitted in emergency with acute urinary retention due to bladder tumour prolapsed from the external urethral orifice. The patient underwent immediate endoscopic surgery via suprapubic percutaneous approach. The histological examination confirmed a superficial highly differentiated transitional cell bladder carcinoma. During the 6-year follow-up no evidence of local recurrence or metastatic tumor spread was revealed. The comprehensive Medline search confirmed that this is the fourth case of bladder tumor prolapsed from the external urethral orifice, reported so far. The case deserves the interest of practicing urologists because of the exceptional rarity of the entity and the unconventional treatment approach which involves using a percutaneous suprapubic endoscopic technique. Based on the results achieved, we can recommend this unconventional endoscopic approach as specifically indicated in certain situations. .

Hermaphroditism was identified in a 3-year-old American Cocker spaniel with an enlarged os clitoridis that was shown as reddish finger-like structure protruding from the vulva. The urethral orifice was located cranially to the base of the os clitoridis. The gonads were situated caudal to the kidneys at the cranial tips of the uterine horns, and were composed mainly of seminiferous tubules and interstitial cells and had ovarian follicles in the cortices. The uterus was enlarged and revealed pyometra. Gross and histopathological findings of the dog suggested hermaphroditism with bilateral ovotestes and pyometra.

This clinical case report described a three-month-old mongrel dog that had the urethral orifice opening 3 cm from the tip of the penis and lacked a completely formed preputial sheath. It was presented to the clinic with an exposed penile shaft that was dry. The dog had urinary incontinence that was not of neurological origin. It also had unilateral agenesis of the right testicle. The preputial sheath was successfully reconstructed. Urinary incontinence stopped soon after surgery, suggesting that it had been probably due to an ascending urethritis. A large preputial opening was left because of the location of the urethral opening.

Paraurethral or Skene's duct cysts in the newborn period and early childhood are readily identified by their characteristic appearance —round, yellow- or orange-coloured swellings beside and distorting the urethral orifice. Clinical examination should be followed by sonography of the urinary tract. Natural resolution is the likely outcome and early surgery is not necessary.

Female hypospadias is a rare anomaly in which the urethral orifice is located on the anterior vaginal wall close to the introitus. The condition is also associated with a neurogenic voiding disorder that is poorly understood [3]. We report two children aged 3 and 9 years who were managed with clean intermittent catheterization after a Mitrofanoff operation.

The sexual function of 82 patients treated for hypospadias was assessed. It was concluded that the sexual function in these patients was unsatisfactory only following incomplete or incorrect surgery. The aim of surgery should be to achieve a straight penis with an adequate urethral lumen and a urethral orifice situated at the tip of the glans. Proper assessment of chordee and meticulous care in surgical technique are the prerequisites for success. They are the only preventive measures of the physical, psychic, sexual and social handicaps to which hypospadiacs are subjected.

A case of a 66 years old female who had a nephrogenic adenoma recurring three times during a 6 months course of her illness is reported. With each recurrence, the lesion moved toward the urethral orifice, suggesting an intimate relationship between the recurrent process and physical stimuli to the mucosa. Electron microscopy revealed merely non-specific morphological features of epithelial cells in the lesion. There were no positive morphological clues in the lesion for supporting the lesion to resemble mesonephric and/or mesodermal tissue. The diagnostic term of tubular metaplasia for the lesion is preferable instead of nephrogenic adenoma.

All 117 boys circumcized for phimosis during one year at the Department of Pediatric Surgery in Lund were subject to a follow-up study five years postoperatively. In 45 cases the main operative indication was recurrent balanitis, in 25 cases scarring of the prepuce and in 41 cases an expressed ballooning at voiding. Early operative complications included 7 cases of postoperative haemorrhage which in 1 case necessitated reoperation. In 1 case there was a postoperative infection. 13/117 patients developed a stricture of the urethral orifice necessitating meatotomy. The study included a questionnaire which was answered by 97/117 patients, 92 of whom expressed complete satisfaction with the operation. The complaints of the others were cosmetic in nature. There was in no instance any sign of more severe psychological disorder than a certain shyness which was expressed in 8 cases. It is concluded that circumcision for phimosis in young boys is complicated by meatal stenosis in a certain frequency (13/117) but not loaded with serious complications. There seems to be no reason to fear psychological disturbances due to circumcision.

Radical vulvectomy is the accepted treatment for carcinoma of the vulva. The operative mortality is now very low and the 5 year survival rate of over 66 per cent is encouraging. The technique here described is based on a series of 125 cases. Emphasis is placed on the method of inguinal lymphadenectomy and also on the technique of transposing the urethral orifice to prevent stress incontinence. Residual disability is surprisingly small and vaginal delivery has been possible subsequently.

57 year-old man complaining of massive bleeding out of external urethral orifice was admitted to our department. X-ray findings and urethroscopy revealed a calculus in the posteior urethra and rectourethral fistula. Both the calculus and the fistula were surgically removed. The calculus, weighing 21g, measured 3.5 × 3.0 × 2.0cm. in size. The calculus showed a mixture of calcium phosphate and calcium carbonate under the ultrared spectrophotometric analysis.

Urethral extension was performed in 14 cows with clinical urovagina and infertility. Urovagina was corrected in nine cows (64%) and was reduced in the others. Formation of fistulas at the cranial end of the extension site was the most frequent complication (4 cows). In one cow, the urethral extension was not extended far enough caudally. Eleven cows (79%) returned to fertility after surgery. Severity of urine pooling, cranial displacement of the urethral orifice, and severe preoperative vaginitis may explain the failure of the urethral extension in some cows.

A HISTORY of urinary incontinence since infancy, associated with otherwise normal micturition, suggests ureteral ectopia. The ectopic orifice is usually in the midline just posterior to the urethral orifice (Fig. 1). Less commonly it opens into the upper vagina, the cervix or the uterus. The orifice may be obscured by local inflammatory reaction, and its identification and catheterization require anesthesia. The ectopic ureter, which nearly always originates from a duplicated upper renal segment, is often dilated as the result of cicatricial stenosis of the exposed ureteral orifice. The tissue of the anomalous renal segment may be hypoplastic, or it may . . .

I. H., male, aged 51 years, blacksmith, had for more than a year recurrent attacks of pain in the right iliac fossa, becoming more severe, so that five weeks before entering Bridgeton Hospital, for operation, he had been confined to the house for three weeks by an attack. The question of malignancy was considered, because his father had died of "cancer," and on tracing history of father's case, I find that the cecum was much thickened and softened, but no microscopic examination was made. I mention this because Hollender has recently stated that "cancer of intestine is apt to recur in families." Having opened the abdomen, by the usual incision, we found the appendix lying posterior of cecum, pointing upward and slightly outward, firmly adherent and bound down by results of previous inflammation. It was severed near the cecum, and peritoneum closed over stump by mattress sutures; the cecum did

A rare case of a cyst of the outer urethral orifice in a 35-year-old female is presented. The etiology is discussed.

It has been stated that a rounded or lobulated peniurethral collection of contrast material on a postvoid cystourethrogram is virtually diagnostic of urethral diverticulum [1 ]. A case of ureteral ectopia mimicking a urethral diverticulum, with a suggested explanation of this unusual presentation, is reported here. Differentiation of these two entities is important because the appropriate surgical procedure for a duplicated ectopic ureter is heminephroureterectomy rather than simple diverticulectomy. When a urethral diverticulum is diagnosed, the radiologist should be aware of the possibility of an unrecognized duplicated ureter with an ectopic urethral orifice. A preoperative diagnosis will be made by careful scrutiny of the patient’s excretory urogram for signs of a duplicated upper pole moiety.