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Introduction: Internal urethrotomy (IU) in patients with urethral contracture following perineal repair of pelvic fracture urethral injuries (PRPFUI) is troublesome. We evaluated the clinical factors affecting the surgical outcome of IU for urethral contracture after PRPFUI.Materials and Methods: We retrospectively reviewed the records of 35 patients who underwent IU for urethral contracture after PRPFUI between March 2004 and June 2013. Ages of patients ranged from 18 to 50, and their follow-up duration was more than 1year after IU. The urethral contracture was confirmed by retrograde urethrogram or cysto-urethroscopy. Success was defined as greater than 15mL/s of peak urinary flow rate at 1year after IU without any clinical evidence of urethral contracture. Success rates were investigated according to the number of IU. Age, body mass index, urethral defect length before PRPFUI, time interval between the original urethral injury and the PRPFUI or between a previous operation and the PRPFUI, time interval between the PRPFUI and the urethral contracture, number of PRPFUI performed, and the type of urethral lengthening procedure were compared between patients with and without success according to the number of IU.Results: Among the 35 patients, the overall success rate of IU was 37% (13/35) during the mean follow-up period of 53 months (range: 17-148 months). There were 8 and 5 patients with success in first and second IU, respectively. However, there was no success after third IU. Urethral defect length before PRPFUI was significantly shorter in patients with success who underwent first and second IU (p<0.05). There were significant differences of success between patients with and without previous repeated failures of PRPFUI in first and second IU (p<0.05).Conclusions: Short urethral defect length and no previous surgical failures before PRPFUI are good prognostic factors for IU following PRPFUI. Only one or two IUs will be helpful in patients with urethral contracture following PRPFUI. [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]

Objective: To assess the current etiology, features, and natural history of urethral stricture disease in the developed world. Materials and Methods: We analyzed the data from 1439 male patients with urethral stricture, who had undergone surgical treatment in our referral urethral center from 2000 to 2010. The preoperative evaluation included a detailed clinical history of stricture, uroflowmetry, retrograde and voiding cystourethrography, and urethroscopy. Statistical analysis was done for the stricture site, length, and etiology, patient age, and previous treatments. Results: Strictures were posterior in 112 (7.8%) and anterior in 1327 (92.2%). In the anterior group, 439 were penile (30.5%), 675 bulbar (46.9%), 71 penile plus bulbar (9.9%), and 142 panurethral (4.9%). The main causes were iatrogenic in 556 (38.6%), unknown in 515 (35.8%), lichen sclerosus in 193 (13.4%), and trauma in 156 (10.8%). The main iatrogenic strictures were from catheterization in 234 (16.3%), hypospadias repair in 176 (12.2%), and transurethral surgery in 131 (9.1%). The stricture distribution increased until about 45years and then decreased. Strictures were uncommon in those <20 and >70years old. The mean length was 4.15cm; longer strictures were found in those with lichen sclerosus (7.45cm) or after hypospadias repair (4.42cm) and catheterization (4.40cm). The mean length was also greater in the pretreated (4.34cm) than in the untreated (3.64cm) strictures. Conclusion: Urethral stricture in developed countries mainly involves the anterior urethra, in particular the bulbar tract. The most common cause was iatrogenic. Hypospadias repair and lichen sclerosus represent emerging important causes. Finally, urethral stricture is not a disease of the elderly but involves all ages. [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]

Urethral stricture disease in men has traditionally been investigated with ascending and voiding cystourethrography as well as urethroscopy. The main emphasis during the preoperative assessment is on establishing the exact extent of the disease process in order to plan appropriate management. We describe a technique that represents a novel approach to the assessment of proximal urethral stricture and in selected cases would be of immense help in defining its precise nature and planning definitive treatment. [ABSTRACT FROM AUTHOR]

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

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

Purpose: It might be diffucult to evaluate the clinically significant residual valve remnants and strictures, and make a judgement for the re-operation after the ablation of posterior urethral valve. In this research, clinical and radiological parameters are examined in cases with residual valve remnants. Material and Methods: Between 1986-2009, a total of 127 valve patients were treated in our clinic and the records of 101 patients, who had regular follow-up, were included to the study. Of these 101 children, the records of 10 patients, who were found to have residual valve or stricture after ablation, were reviewed retrospectively. Results: Endoscopic intervention due to the residual valve remnants or stricture was performed after a mean period of 7.25±4.7 months following the first ablations. In 2 (20%) of the cases, urethra has been found to be normal in the first radiological evaluation (voiding cystourethrography). Of these 2 children, urethroscopy was conducted due to the recognition of the valve remnants in the follow-up of vesicoureteral reflux in one case and during evaluation of persistent hydroureteronephrosis in the other case. Two out of 8 cases who had the radiological appearance of obstruction in the early period, were found to have strictures. In the other 6 cases, the residual valve remnants were incisized. In the follow-up, endoscopy was re-conducted on the 2 out of 8 cases due to strictures. Conclusions: In our series, almost 10% of the cases were found to have residual valve or strictures. Although about one fifth of the cases were seen to be normal in the first radiological examination, valve remnants were found in the clinical follow-up evaluations due to the persistent hydrourethronephrosis and vesicoureteral reflux. For this reason, the operation decision should be given in the light of the clinical and radiological evaluations together to find the significant valve remnants and strictures following valve ablation. [Copyright &y& Elsevier]

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]

Abstract: Association of the anterior and posterior urethral valve is a rare congenital anomaly which can lead to various urinary tract symptoms. An 8-year-old boy was referred by his primary care physician for urinary dribbling, straining at micturition, and recurrent febrile urinary tract infection since the age of 2 years. Clinically, the bladder was palpable; both testes were normal, and, in addition, he had a subcoronal hypospadias. Diagnosis was confirmed by retrograde urethrogram and voiding cystourethrogram (micturating cystourethrogram) and urethroscopy. Cystoscopic ablation of both valves was done by electrocautery hook using low current at 5 o''clock and 7 o''clock directions. He voided with good flow and to completion. Urinary dribbling had completely subsided and renal function was normal at a follow-up period of 36 months with freedom from recurrent urinary tract infection. Both the anterior and posterior urethral valves develop from different embryological sources; thus, this association is rare. A case with this association has not been reported previously in the literature. [Copyright &y& Elsevier]