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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...

Most congenital or acquired urethral diseases are usually accompanied by corpus spongiosum (CS) defects. However, Substitution urethroplasty can only reconstruct urethral lumen, not the CS. Many long-term complications occur due to the lack of protection from CS. Is CS a kind of tissue that cannot be repaired by regeneration and self-healing? In this study, the CS defect with urethral mucosa intact model was established in rabbits by removing the ventral CS tissue. Based on this model, three groups of different CS defect sizes, with lengths of 0.5 cm (Group A), 1.0 cm (Group B) and 1.5 cm (Group C), were then constructed, respectively, to assess the potential regeneration ability of CS. Three months later, the entire urethra, including the CS defect, was assessed by histological staining. Results showed that the vascular sinusoids were completely removed from urethral mucosa. The rabbit model of CS defect was established successfully. Three months post-operatively, the CS defects in all the 3 groups were replaced by disordered collagen instead of regenerating typical sinusoid-like vascular structure, which is significantly different from the normal CS rich in vascular sinusoids. The CS defects could not be repaired through self-healing. The potential regeneration ability of CS is extremely poor.

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

Background and objectives The pathophysiology of female stress urinary incontinence (SUI) is far from unraveled. Capturing all aspects of this bothersome condition in one theory remains challenging. The well-known Hammock and Integral theories, both from the early 90's, were successful in explaining a large proportion of the observations made in clinical practice. Nevertheless, some (pre)clinical observations cannot be explained by the current understanding. One of the issues concerns the pressure transmission. Is this process really a passive mechanical action, or is an additional active mechanism responsible for urethral closure? The finding that an increase in urethral pressure sometimes precedes and exceeds the increase in intravesical pressure suggests the latter. This concept has never been incorporated in one of the existing theories describing SUI. This is remarkable as a lot of evidence has been generated in recent years that proves involvement of active components. This review aims to provide an additional theory in which an active reflex closure mechanism of the urethra is incorporated. Methods Recent as well as older publications from clinical and animal studies are included to support the hypothesis. Results The smooth muscles of the urethra, the vascular bed, and the estrogen-influenced urethral mucosa, combined with striated muscle tone, contribute to the intra-urethral pressure. A passive transmission of force to the urethra exists only in the abdominal proximal third of the urethra. In the distal two thirds of the urethra an active closure mechanism is present, dependent on sufficient urethral support in the proper anatomical position. This active closure mechanism is generated by reflex contraction of striated muscles of the urethra and the pelvic floor. Conclusion Continence is a result of passive as well as active urethral closure mechanisms. The most important factor in female continence seems to be the proper functioning of an active reflex urethral closing mechanism.

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.

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...

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.

Female urethral reconstruction via the traditional routes can be limiting for various reasons. Current literature on the use of acellular biologic grafts derived from viscera for female urethral reconstruction is limited. We present two cases of women with complete loss of their posterior urethra presenting for urethral reconstruction. Two cases of urethral reconstruction using acellular porcine urinary bladder matrix (UBM), along with labial fat pad transposition and biologic pubovaginal sling are presented. In both cases the UBM graft showed successful conversion to what appeared to be normal urethral mucosa. One woman showed significant improvement in continence and the other showed complete continence. Female urethral reconstruction using acellular porcine UBM is a viable option for patients who have lost a significant portion of their urethra. Both cases demonstrated transition of the graft into the posterior wall of the urethra with significant improvement in continence. Further studies are needed to confirm that acellular porcine UBM can transform to urethral mucosa in women requiring urethral reconstruction.

Objective: The aim of this study was to investigate the impact of thioglycolic acid on normal urethral mucosa. Methods: Twenty-four rats were used. Three control and three study groups were formed each consisting of 4 rats. Controls groups were given 0.9% NaCl and study groups received thioglycolic acid instillation. The groups were allocated according to the time of urethral resection and the number of thioglycolic acid instillations (2, 4 or 8 instillations). The urethras of the rats were resected and examined under a light microscope in control and study groups 1, 2 and 3 on days 15, 30 and 60. Results: There was no difference in the urethral mucosa of rats in the study or control groups, and no differences were found when the study groups were compared to each of the other groups at the microscopic level. Conclusion: The application of thioglycolic acid is an easy and inexpensive way of clearing urethral hair and does not cause pathological changes in the normal urethral mucosa.

Purpose: Apart from the urethral sphincters, the electric activity of the urethra has not been fully addressed in the literature. We investigated the hypothesis that also the non-sphincteric part of the urethra possesses electric activity which may have clinical significance.Materials and methods: Urethral electric activity was studied in 24 healthy volunteers (mean age 40.6 ±: 13.6 years, 14 women). Two electrodes in women and three in men were applied to the urethral mucosa distal to the striated urethral sphincter. A manometric catheter was placed into the penile urethra in men and distal to the striated sphincter in women.Results: Monophasic negatively deflected slow waves were recorded. Their frequency, amplitude and conduction velocity were identical in the electrodes of the individual subject and were reproducible. The slow waves were followed or superimposed by fast activity spikes or action potentials which occurred randomly and were associated with urethral pressure rise. The pattern of electric activity was stable in the same subject on all test sessions.Conclusions: A normal electrourethrogram could be identified. It consisted of slow waves and action potentials. The waves had a regular rhythm. The action potentials appear to have a motor activity and are suggested to clear the urethra of the residual urine and secretions that may exist in the urethra after micturition. The clinical significance and diagnostic role of the electrourethrogram need to be further investigated.

Objective: To evaluate the current range of hydrophilic-coated catheters for intermittent self-catheterization, focusing on the adherence of the catheter to the urethral mucosa at the end of catheterization. Subjects and methods: In a prospective randomized study, 61 community-based men tested each of four different hydrophilic-coated catheters available in the UK at the time. Subjects used each of the four test catheters for 1 week in a random order, and were provided with the number and size of catheter they normally used. To assess the products, the subjects: (i) timed seven catheterizations using a stop-watch to determine the time taken from extracting the catheter from the water-filled package, to removing the catheter from the penis, having emptied the bladder; (ii) recorded the severity of 'sticking' on catheter removal on a three-point scale (not at all, a little, a lot); and (iii) completed a product-performance questionnaire. Results: There were no significant differences in ratings of 'sticking' between the 'Easicath' and 'Lofric' (P > 0.05), but there were significant differences between these two products and the 'Aquacath' and the 'Silky', which were found to 'stick' more (P Conclusions: Adherence to the urethral mucosa on catheter removal was a common problem, occurring with all catheters, but two products were significantly more likely to stick than the other two. The clinical importance of 'sticking' and the long-term implications are currently unknown. The relative 'sticking' of uncoated catheters has also not been established.

In this retrospective study covering a nine-year period, 65 cases have been analyzed of prolapse of the urethral mucosa in young girls (aged between six weeks and 14 years) from the Ivory Coast. The aim of this study was to describe the etiology of this disorder, and to demonstrate the utility of ambulatory surgery. The main reason for the detection of this disorder was mild genital hemorrhage in 37 cases, which was related to rape in eight instances and to other types of trauma in nine cases, thereby raising serious medico-legal problems. Various forms of treatment were used (medical and/or surgical). The medical approach consisted of antibiotic and antiinflammatory treatment, combined with a local antiseptic. Two surgical approaches were adopted, either the Doria method in which the necrosed tissue is spontaneously eliminated after three to five days, or surgical excision under general anesthesia of the prolapsed mucosa followed by seromucosal stitching. The results were satisfactory in all cases, and in the surgically operated cases no complications or recurrence were noted at one-year follow-up.

The introduction of the tension free vaginal tape over a decade ago heralded the adoption of sub-urethral sling placement under the mid-urethra rather than the proximal urethra. This paper reviews the literature which led to the change in practice and also looks at which factors concerning tape position influence surgical outcome with particular reference to the position along the urethra. There is conflicting evidence on the importance of the mid-urethral position and there is also evidence that other factors such as the configuration of the tape under the urethra at rest and under strain and the proximity of the tape to the urethral mucosa may be as important in influencing outcome. Further research is required.

A rare complication after tension-free vaginal tape (TVT; including TVT-O) procedure is erosion of the tape through the urethral wall. In the literature, different methods to remove this intra-urethral tape are described. Most authors used the transvaginal approach with urethrotomy. In the cases described in this article, the transurethral approach is applied and proposed as the optimal method, being minimally invasive and less damaging to the urethral wall A transurethral catheter can be removed shortly after surgery to enable optimal tissue healing of the urethral mucosa.

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.

Self-inserted foreign bodies in the lower urinary tract are rare among children. The treatment of foreign bodies in the urethra is determined by their type, size, location, shape, and mobility. We describe here a 13-year-old boy who had self-inserted a needle into his urethra out of curiosity. Initial attempts to remove the needle from the urethra by inserting a cystoscope failed due to the weak biting force of the forceps and because the needle was trapped in the urethral mucosa. We successfully used a laparoscopic needle holder to remove the needle through the perineum.

Urethral prolapse is a rare condition that results in the eversion of the urethral mucosa through the distal urethra. Management is divided into two categories: conservative and surgical treatment. We present a case of urethral prolapse with severe symptoms that were minimally responsive to topical estrogen. Surgical excision was achieved with resection of the redundant urethral mucosa. This video highlights surgical techniques that can be used for the excision of urethral prolapse. The management of urethral prolapse should be individualized based on symptom severity, anatomical compromise, and surgical morbidity. Surgical management should be considered in cases of vascular compromise or failed medical management.

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.

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

The injection of bulking agents into the urethral submucosa is designed to create artificial urethral cushions that can improve urethral coaptation and hence restore continence. Ideally, a urethral bulking agent should be non-immunogenic and biocompatible, leading to minimal inflammatory and fibrotic response. The authors present a case report of a granulomatous reaction leading to urethral prolapse, 3 months after the transurethral injection of calcium hydroxylapatite. To our knowledge, this is the first granulomatous reaction described after calcium hydroxylapatite injection.

Summary Forty-two cases of urethral mucosal prolapse were reviewed in Trinidad, West Indies. The main presenting symptom was vaginal bleeding; 31% of patients had associated infection and 97% belonged to social classes III to V; 33% had conservative management and 67% had surgical treatment. It was concluded that treatment should be medical rather than surgical and it is suggested that this is a disease of the low socio-economic group.

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 hydrogel-coated urinary catheter is a novel formulation in which the coating hydrogel polymer is claimed to reduce the level of cytotoxicity frequently associated with the use of latex catheters. This study was undertaken to measure cytotoxicity using in vivo techniques. Twelve first generation and 5 second generation hydrogel-coated latex catheters were evaluated in vivo using canine urethras. The results showed all catheters to cause minimal inflammatory changes of the urethral mucosa (toxicity score 0-1.2/6).

For the reconstruction of urethra-vesical anastamosis after radical prostatectomy and for neobladder reconstruction, taking adequate sutures to include the urethral mucosa is vital. Due to the retraction of the urethra and unfriendly pelvis, the process of taking satisfactory urethral sutures may be laborious. Here, we describe a simple method by which we could overcome similar technical problems during surgery using Foley catheter as the guide for the suture.

A woman who was treated for intrinsic urethral sphincteric deficiency with periurethral injection of glutaraldehyde cross-linked collagen had prolapse of the urethral mucosa and recurrence of incontinence. She subsequently required surgical resection and a fascia lata sling. This is the first known occurrence of this postinjection complication.

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.

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.

A scanning electron microscopic investigation of the urethral mucosa of altogether ten men and women subjected to cystourethrectomy because of urothelial cancer of the urinary bladder was performed. The mucosal cells were found to be polygonal and characterized by the presence of microvilli and microridges. No sex difference could be demonstrated. Although a higher number of cells carrying microridges was found in the proximal part of the urethra, no statistical difference in the number of cells with various surface topography was found in different parts of the urethra. The micrographs revealed that the number of urethral cells to which bacteria were attached, was low, also in patients with proven preoperative infection. The bacteria, mainly cocci, seemed to exhibit a preferential adherence to a subpopulation of urethral cover cells, as indicated by the observation that the organisms were not attached randomly. The possibility that different cell surface properties may explain this distribution is considered.

Urethral prolapse, the circumferential protrusion of urethral mucosa through the urethral meatus, often presents in the premenarchal female as a large, friable mass. Some traditional therapies have included excision or cautery. A series of 13 premenarchal females presented with urethral prolapse and were treated medically at the Chicago Lying-in Hospital. All patients had resolution of signs and symptoms within 4 weeks of initiation of therapy. No relapses or recurrences were noted. Medical therapy of urethral prolapse in the premenarchal female is a safe and successful alternative to surgery.

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.

Prolapse of redundant urethral mucosa into the vestibule is an uncommon cause of “vaginal” bleeding in prepubertal girls. In this age group, the lesion is limited almost exclusively to Negroes. Cystourethrographic findings, not previously reported, consist of a mass in the vestibule with the urethral orifice at its center. It is suggested that the hymen is a normally visualized structure on cystourethrography.

SUMMARY Radiographs are shown demonstrating a copious and unexpected flooding of the venous circulation with opaque fluid through direct absorption from the urethra. It is contended that these films reveal a degree of permeability of the urethral mucosa which is of significance in the transmission of drugs and bacteria from the urethral lumen to the blood stream.

Bacterial adherence to urinary tract mucosal surfaces is thought to be the initiating event in ascending urinary tract infection. To study this process, we have developed a physiologic, quantitative, in vivo assay for bacterial adherence to the urethra. The effect of local (vaginal mucosa) immunization on the adherence of E. coli to the urethra was studied. Local immunization with a formalinized E. coli vaccine significantly reduced the capacity of viable cells of the immunizing strain to adhere to the urethra. Immunization-induced decrease in bacterial adherence to urethral mucosa is in agreement with our previous observations that immunization of the vaginal mucosa decreases the adherence of E. coli to the rat bladder. These data provide further evidence of a protective effect from local immunization against ascending urinary tract infection. No obvious change in indigenous urethral flora occurred after mucosal immunization.

Summary— Seventeen patients who developed urethral strictures following catheterisation have been studied; 14 of these (82%) were catheterised for standard monitoring purposes during and after major heart surgery, which was a coronary artery bypass graft (CABPG) in 12 cases. The possible aetiological mechanisms for the development of this complication are discussed. Animal experiments were designed and carried out to compare the effects of different catheter materials on the urethral mucosa. Silicone catheters provoked the least inflammation and rubber the most. A further experiment determined the flow rates through catheters of different sizes. From our results, we suggest that the careful insertion of a small silicone catheter, distally fixed, is least likely to induce stricture formation.

A study of 28 patients with mucoid cysts of the penile skin is reported. The lesions were seldom diagnosed correctly, either clinically or pathologically. The distinctive histologic features of the cysts include a lining of stratified columnar epithelium, often associated with intra-epithelial mucous cells and/or mucous glands. These cysts most likely arise from ectopic urethral mucosa sequestered in the penile skin during embryologic development.

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.

A small resectoscope loop, sans scope, has been used to obtain tissue from the male urethral mucosa for diagnostic and therapeutic purposes