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Urethral Trauma is a discontinuity of urethra which caused by external stress (pelvic fracture or straddle injury) or internal stress (catheter placement, urological procedures). There are several suitable techniques, including immediate exploration or urine diversion. The treatment used depend on the cause of the rupture, rupture length, as well as anatomical position of the rupture. A 46-year-old male suddenly presented with swollen penile and testicle after 1 day of hospitalization. One day before, patient suffers in high-speed motorcycle accident and sustains blunt trauma to the perineal area, hitting the handle bar of the motorcycle and brought to the emergency department. There was a palpable bladder distension during physical exam, with penis and scrotum enlargement. Laboratory findings show elevated WBC and elevated creatinine level. Urinalization test was within normal limit. Partial laceration found during urethroscopy approximately <1cm in size. Scrotal drainage and exploration are conducted due to scrotum being swollen progressively. There is uncertainty regarding these symptoms to be interpreted as a urethral injury because some of the classical symptoms are missing, although patient showed with palpable bladder distension. Due to the swollen penis and scrotum which are enlarged progressively, urethroscopy and scrotal exploration was performed. Small laceration on the bulbar area of the urethra is found, indicating anterior urethral rupture, the laceration is treated conservatively with the placement of transurethral catheter. Scrotal exploration then performed which pus and extravasation of urine is found within the scrotum. The precision on determining anterior urethral rupture as a diagnosis decides the management, prognosis and complication rate of anterior urethral rupture. Although, the initial urethral trauma management remains disputed, a bulbous urethral rupture with a complication of extravasation of urine into the penis and scrotum can be treated effectively with urine diversion and scrotal exploration. [ABSTRACT FROM AUTHOR]

The article focuses on the use of diagnostic flexible cysto-urethroscopy (FC) to investigate various symptoms including haematuria, lower urinary tract symptoms, (LUTS) and urinary tract infections in Great Britain. A study is conducted to examine if FC offers useful diagnostic information in young patients investigated for urological symptoms. It provides information regarding the results of the study.

Introduction and hypothesis: Our purpose was to assess the accuracy of history and physical, cystourethroscopy, and magnetic resonance imaging (MRI) in preoperative diagnosis of urethral diverticula. Methods: This was a retrospective review of all patients who underwent surgical excision of periurethral masses between 1998 and 2009. Presenting symptoms and examination and cystourethroscopic findings were noted. A single pathologist reviewed all cases and provided the reference standard for the diagnosis of a diverticulum. A single radiologist reviewed all preoperative MRI studies. Sensitivities, specificities, and positive and negative predictive values (PPV, NPV) were determined. Results: Diverticula were diagnosed in 36/60 (60 %) patients. Transurethral fluid expression on palpation and recurrent urinary tract infection (UTI) had high PPV. Sensitivity, specificity, PPV, and NPV, respectively, for cystourethroscopy were 33 %, 100 %, 100 %, and 42 %; for MRI, these were 100 %, 83 %, 92 %, and 100 %. Conclusion: These data reinforce the utility of transurethral fluid expression for preoperative evaluation of urethral diverticula. Additionally, MRI is an excellent adjunctive diagnostic tool and may assist in establishing the diagnosis when there is high clinical suspicion of a urethral diverticulum but nonconfirmatory findings on cystourethroscopy. [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 describe the prevalence of sexual dysfunction and evaluate risk factors in patients just diagnosed with non-muscle-invasive bladder cancer (NMI UC), who have the prospect of an intensive surveillance scheme by cysto-urethroscopy to detect tumour recurrences. PATIENTS AND METHODS We conducted a cross-sectional survey on 150 patients just diagnosed with primary or recurrent NMI UC. Patients were participating in a randomized clinical multicentre trial (CEFuB), comparing two surveillance schemes. Patients were asked to complete questionnaires at study entry 3 months before the start of the study-surveillance scheme (demographic characteristics, a validated visual analogue scale, and validated subset of questions on sexual function and performance derived from QLQ-BLS-24). The results were compared with those from an age-and gender-matched healthy population. RESULTS The response rate was 95% (142/150); 61% (87/142) of the respondents were sexually active in the previous 4 weeks after diagnosis, 66% (70/105) of men and 46% (17/37) of women. Although libido was not negatively affected, 54% (47/87) of the patients had a sexual dysfunction, and 23% (17/73) were afraid to inflict harm on their partner by sexual contact. Sexually active patients perceived a higher state of general health ( P = 0.03). CONCLUSIONS The prevalence of sexual dysfunction in patients with NMI UC is very high (54%) compared with an age- and gender-matched healthy population (20–45%). No predictors for sexual dysfunction were found. These patients and partners would benefit from proper sexual information in the outpatient clinic. [ABSTRACT FROM AUTHOR]

Abstract  Urethral erosion (UE) is an uncommon but potentially severe complication after suburethral synthetic slings. We aimed to identify the risk factors and diagnostic modalities of UE and also functional outcome after UE surgical management. We retrospectively analyzed eight cases of UE managed in our department between 1997 and 2007. The main presumptive risk factors of UE were excessive sling tensioning (six of eight) and postoperative urethral dilation (four of eight). The most frequent symptoms included voiding difficulties (five of eight), storage symptoms (three of eight), pain (three of eight), and recurrent stress incontinence (three of eight). UE diagnosis was accessible to introital ultrasound (five of five) and confirmed by urethroscopy (eight of eight). Surgical management was performed in seven cases and included transvaginal sling removal with urethral repair (two of seven), endoscopic transurethral sling resection (four of seven), and combined approach (one of seven). All the approaches provided good functional outcomes. Transurethral endoscopy is a mini-invasive treatment of UE and should be tried first in selected cases. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the reliability of subjective diagnoses of benign prostatic obstruction (BPO) using flexible cystourethroscopy as compared to the actual degree of bladder outlet obstruction as measured by a pressure-flow study (PFS), and to investigate the difference of subjective diagnoses among different urologists. Methods: A standardized PFS was done in 33 BPO patients. The degree of BPO (0∼VI) was determined by linear PURR. Flexible cystourethroscopy was also performed in order to evaluate the BPO by video recording. Nine urologists, who have served on the Japanese Board of Urology, diagnosed the degree of the BPO (0∼VI) by watching the video recordings. The degree of obstruction revealed by cystourethroscopy was dependent upon the subjective impression of each urologist who wrote their diagnoses on questionnaires. Results: A positive correlation was found between the results of the PFS and the subjective evaluations based on the cystourethroscopy video (p < 0.001), and the trained urologists arrived at a similar obstruction grade in most cases. However, relatively large gaps between linear PURR and cystoscopic finding were found in some cases. We suggest that these gaps could be caused by dynamic obstructions which cannot be detected by cystourethroscopy. Conclusions: Even though it is difficult to establish an objective measurement of the degree of a BPO using cystourethroscopy, our results show that it is a simple and reliable tool for the assessment of BPO in most cases.Copyright © 2000 S. Karger AG, Basel [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]

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]

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

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]

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: 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]

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]