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Background: Multiple urethral anomalies are rare with its own challenges in diagnosis and management. The double urethral obstructions are often missed as proximal obstruction can mask the early diagnosis of distal obstruction. We present a rare case of concomitant posterior urethral valve (PUV) and anterior urethral valve (AUV) with a large anterior urethral diverticula (AUD) and hypospadias. Case Presentation: An 11-month-old male child after fulguration of PUVs continued to have urinary symptoms. He was subsequently found to have distal urethral obstruction because of AUV and large anterior urethral bulbar diverticula. He also had associated glanular hypospadias. He was managed with endoscopic ablation of AUV and diverticulectomy. Conclusion: Concomitant PUV, AUV, AUD, and hypospadias is a rare occurrence. The diagnosis and management can be challenging in such cases with multiple anomalies. To avoid a misdiagnosis, a high index of suspicion, proper assessment of urethrogram, and detailed cystourethroscopy is required.

Lower urinary tract (LUT) emergencies are common reasons for small animal patients to be presented to their veterinarians. Patient stabilization and management of life threatening problems is a priority in this population. Urethral obstruction is a common LUT emergency. Urethral stent placement has gained popularity over the past decade allowing for a minimally invasive, image-guided method for relief of urethral obstruction in some patient populations. This article focuses on candidate selection, diagnostic workup, stent placement technique, and the expected outcome and complications for patients undergoing urethral stent placement and addresses some additional strategies for interventional management of LUT emergencies.

Objective To (1) describe minimally invasive transurethral antegrade and retrograde techniques for the placement of self-expanding metallic stents (SEMS) to reestablish urethral patency in cats with non-urolith urethral obstructions and (2) to report the procedural complications, incontinence rates, and long-term effectiveness in maintaining a patent urethra. Study Design Case series. Animals Cats (n = 8). Methods Signalment, history, clinical signs, physical examination, severity of stranguria and incontinence, clinicopathologic data, diagnostic procedures performed, diagnosis, interventional technique, type and dimensions of stent placed, complications and final outcome of 8 cats treated with SEMS for the management of urethral strictures or masses are presented. Each cat was followed for ≥12 months. Follow-up information was obtained from the medical record or by telephone interview of the owner and/or referring veterinarian. Results Four cats were continent after stent placement, 2 were moderately incontinent, and 2 were severely incontinent. Long-term follow-up (median, 462 days) was available. At follow-up, 5 cats were alive and 3 had been euthanatized at 88, 233, and 305 days. Long-term outcome, as assessed by the authors, was good (1) to excellent (3) in 4 cats, and fair (2) to poor (2) in 4 cats. Owner reported outcomes were excellent in 3/8, good to excellent in 1/8, good in 2/8, and poor in 2/8. Conclusion Palliative stenting of urethral obstructions is a minimally invasive method to re-establish urethral patency in cats.

The first laser employment for the treatment of the cervico-urethral obstructions (CUO) dates back to the early '90s. This study begins with the analysis of laser basics in Medicine and has the purpose to weigh pros and cons (and limits as well) of laser use in CUO due to Benign Prostatic Hyperplasia (BPH). That is an ageing man's typical disease and there is a huge need of minimally invasive treatments, because people affected by this kind of illness suffer very often from comorbidities, and that could make traditional surgery quite risky.The target of this study is the in vivo experimentation of a brand new laser diode, crated to be specifically used in BPH, and to verify its efficacy and safety.The subject of the study is the whole laser diode supply, with its double-band laser source (980 nm + 1470 nm), which gains a 140 W-power and is equipped with Water-Free optical fibers of different kinds of tip. We have tested a conical tip fiber on a standard 24-26 F-resectoscope instead of a standard diathermic loop. The conic fiber optimizes the energy on the treated tissue. We recruited 14 patients with CUO caused by BPH, 56 to 70 years old, with a prostatic volume between 33 and 53 cc, and we treated them with laser surgery using the power of 100-110 W. We considered the operative time, the intra-surgery complications and the specific side effects such as hematuria, pain, catheter removal time and the presence or not of acute urinary retention, in order to evaluate the efficacy and safety of this new technique.The possibility of using the same resectoscope as the one used in transurethral resection of prostate (TURP) made everything more comfortable and easy because of the immediate feeling with the new instrument and the actual time of Light Vaporization between 30 and 40 minutes, which is more or less the same time of a standard TURP procedure.The idea of a double-band-emitting laser used with conical tip fibers appears to be a great solution in the BPH treatment: it uses the principle of low power density plasma in order to treat bigger prostatic tissue areas but never going in depth. In our clinical results, the efficacy of the double-band-emitting laser source (1470 nm + 980 nm) appears to be similar, but even potentially greater, to the actual surgical laser options (such as HoLEP with Ho:YAG laser and PVP with KTP laser), and it is also similar to traditional TURP.

OBJECTIVE To endoscopically study the Lacuna Magna (LM) and attempt to explain some of the anatomical, clinical and embryological issues pertaining to it. The LM, stated to be present in 30 to 50 percent of males and linked to congenital distal urethral obstructions, post-void bloody-spotting and dysuria in young boys, has few studies on its endoscopic characterization. In this study, its incidence, normal spectrum of appearance and variations have been endoscopically recorded and documented. METHODS The fossa navicularis of 50 consecutive male patients undergoing endourological procedures for non-meatal pathologies was examined for the presence of the LM and its endoscopic characteristics, and variations were video-recorded. The variants of the LM were classified into 4 groups. RESULTS The LM could be demonstrated in 98% of subjects. Group-wise percentage was 2%, 52%, 26%, and 20% in Type O, Type I, Type II, and Type III categories, respectively. Variations included "bi-channeled" LM and deviations in positions of the orifices off the commonest position at 12 o'clock. CONCLUSION The LM is a constant structural component of the fossa navicularis. The "valve" of Guerin (1864), described as a leaflet between the LM and the urethra has no valvular properties. Type III variant of the LM could be mistaken for a urethral stricture during ureteroscopy as well as act as a mechanical obstruction to contrast during retrograde urethrography. The LM is indemonstrable on a micturating cystourethrogram. Further studies could determine whether the location and disposition of the LM favor the development of submeatal post-instrumentation strictures.

An ageing general population, increase in average life span and prevailing benign prostatic hypertrophy bring an increasing number of elderly men to surgery for cervico-urethral obstruction. Given the small but significant morbidity of TURP, recently new mini-invasive techniques have been introduced for BPH, laser therapy being the most popular. The authors report on the different methods for delivering laser energy to the prostate, discussing the benefits and defects. They also present their personal experience with 44 patients aged over 75 years subjected to Nd:YAG laser prostatectomy from 1992 until today. In these patients transurethral laser evaporation, as suggested by Narayan and al., produced significant symptomatic and clinical results with low morbidity and invasiveness. The authors therefore believe that this kind of therapy may improve management of the elderly patient with BPH.

BackgroundBenign urethral obstructions (BUO) in dogs result in substantial morbidity because of challenges with conventional therapies. Treatment of malignant urethral obstructions with intraluminal urethral stents is reported to successfully relieve obstructions.Hypothesis/ObjectivesTo evaluate the efficacy and outcome of urethral stent placement for treatment of BUO in dogs.AnimalsEleven client-owned animals with urethral stents placed for treatment of BUO.MethodsRetrospective study in which medical records were reviewed in dogs diagnosed with BUO and treated with a metallic urethral stent. Data collected included signalment, cause of benign obstruction, procedure time, size and type of stent, complications, and short- and long-term outcome.ResultsEleven dogs with 15 urethral stents were included. Intraluminal urethral stent(s) relieved the obstructions in all dogs. Four dogs had 2 stents placed in separate procedures because of incomplete patency after treatment (n = 1), inadvertent compression of the stent (n = 1), or tissue ingrowth through the stent (n = 2). The median continence score after stent placement was 10 of 10 (range 3–10) with 6 dogs being continent, 3 mildly incontinent, and 1 each moderately and severely incontinent. All owners considered their dog to have an excellent long-term clinical outcome with long-term urethral patency. The median follow-up time was 24 months (range 4–48).Conclusions and Clinical ImportanceUrethral stents appear to be an effective treatment for benign urinary obstructions. Moderate to severe incontinence developed in a minority (12.5%) of dogs. Stents relieved obstructions in all dogs with an excellent long-term outcome.

The aim of this study is to help the doctors for diagnosis process of urinary system illnesses that causes obstruction in the urethra and the bladder. There are several reasons that cause obstructions in the urinary system. The common causes of these obstructions are prostate cancers, verimontanum hypertrophies, detrusor instabilities, urinary incontinence, the bladder cancer and malfunctions. This study is to help the specialist doctors about the evaluation process of the uroflowmetric measurements that are made to determine the intensity of the urinary obstructions. The average flowrate (ml) and the residual urine volume measured in the bladder are accepted as the input variables of the fuzzy logic system. The output variable is the urinary obstruction rate of the urethra. When the obstruction reaches the dangerous levels, it means that the severity of the obstruction in the urethra is high and this obstruction can easily give harm to the kidneys and at the advanced stages of the illness it can cause real failure. Matlab 7 Fuzzy Logic Toolbox is used for the simulation of the fuzzy logic urinary obstruction diagnosis system.

Objective—To evaluate use of balloon-expandable and self-expanding metallic stents in management of malignant urethral obstructions in dogs. Design—Original study. Animals—12 dogs with malignant urethral obstructions. Procedures—The extent and location of urethral obstructions and the diameter of adjacent unaffected luminal segments were determined by use of fluoroscopically guided wires and measuring catheters. Stents were chosen to extend approximately 1 cm proximal and distal to the obstruction. Stent diameters were chosen to be approximately 10% greater than the diameter of healthy portions of the urethra to prevent displacement. Stents were placed in the urethra under fluoroscopic guidance to restore luminal patency. Results—3 dogs received balloon-expandable metallic stents, and 9 dogs received self-expanding metallic stents. The placement procedures were rapid, safe, and effective at restoring luminal patency and were not associated with major complications. Complications included recurrent urethral obstruction secondary to blood clot formation and urethral edema in 1 dog and stent dislodgement into the urinary bladder in 1 dog. All dogs were able to urinate immediately after the procedure. Nine dogs (3/4 females and 6/8 males) were continent or mildly incontinent after stent placement. Of the remaining 3 dogs, 2 developed severe incontinence and 1 had an atonic bladder. Seven dogs were considered to have good to excellent outcome, 3 had fair outcome, and 2 had poor outcome. Conclusions and Clinical Relevance—Transurethral placement of metallic stents was a safe and effective palliative treatment option for dogs with malignant urethral obstructions.

Objective—To determine hospital proportional morbidity rates (HPMR) for urethral obstructions, urethral plugs or urethroliths, and urethrostomies in cats in veterinary teaching hospitals (VTH) in Canada and the United States between 1980 and 1999. Design—Epidemiologic study. Animals—305,672 cats evaluated at VTH. Procedures—Yearly HPMR were determined for cats with urethral obstructions, urethral plugs or urethroliths, or urethrostomies from data compiled by the Purdue Veterinary Medical Database. The test for a linear trend in proportions was used. Results—Urethral obstructions were reported in 4,683 cats. Yearly HPMR for urethral obstructions declined from 19 cases/1,000 feline evaluations in 1980 to 7 cases/1,000 feline evaluations in 1999. Urethral plugs or urethroliths affected 1,460 cats. Yearly HPMR for urethral plugs or urethroliths decreased from 10 cases/1,000 feline evaluations in 1980 to 2 cases/1,000 feline evaluations in 1999. A total of 2,359 urethrostomies were performed. Yearly HPMR for urethrostomies decreased from 13 cases/1,000 feline evaluations in 1980 to 4 cases/1,000 feline evaluations in 1999. Conclusions and Clinical Relevance—Frequency of feline urethrostomies performed at VTH in Canada and the United States declined during the past 20 years and paralleled a similar decline in frequency of urethral obstructions and urethral plugs or urethroliths. These trends coincide with widespread use of diets to minimize struvite crystalluria in cats, which is important because struvite has consistently been the predominant mineral in feline urethral plugs during this period. (J Am Vet Med Assoc 2002;221:502–505)

Summary— Congenital obstruction of the posterior urethra was first systematically classified by Young in 1919. Since then, no-one has seriously challenged the presence of both Type I and Type III “valves”, although the presence of Type II lesions has often been disputed. A review of Young's papers and more recent anatomical studies, together with endoscopic findings in our own patients, indicates that most congenital posterior urethral obstructions are anatomically similar. Consequently, Young's classification now seems redundant.

In girls there are three distinct morphological kinds of congenital distal urethral stenoses in the broad sense. Incomplete meatal stenoses are the most frequent of these. Calibration of the urethra appeared to be the most reliable diagnostic tool in revealing distal urethral obstructions. To relieve the urodynamically interfering urethral stenoses we developed a resecting surgical technique. In a retrospective study the follow-up after meatoplasty of 163 girls with recurrent urinary tract infections was analysed. The long-term success rate totals up to 83.5%.

Forty veal calves were fed milk replacers containing differing concentrations of Mg in a 16-w study. The concentrations were .1% (basal), .3%, .6% Mg, and .6% Mg plus 2% NaCl. The four groups were further subdivided into two groups fed reconstituted milk replacer at 14 or 17.9% DM. Weight gain was greater at the two lower concentrations of Mg. Calves fed .6% Mg or .6% Mg plus NaCl excreted significantly more Mg than calves fed .1 or .3% magnesium. The low water group (17.9% DM) excreted a more concentrated urine relative to Mg, Ca, and P than did the high water group (14% DM). No urethral obstructions were observed. Seventy percent of calves at .6% Mg and 30% of calves at .6% Mg plus NaCl had stones in their kidneys consisting primarily of calcium apatite and secondarily of struvite. Added NaCl reduced kidney and bladder calculi formation. When high amounts of water were fed, added NaCl prevented calculi formation completely. All calves fed the NRC level of .1% Mg performed normally.

Urodynamic evaluation consisting of urethral closure pressure profile (UCPP) and micturitional vesicourethral static pressure profile (MUPP) was carried out in male patients who had obstructive lower urinary tract symptoms. The studies revealed that 12 patients had varying degrees of anterior urethral constrictions. Seven from this group of patients had coexistent posterior urethral obstructions. All patients who demonstrated anterior urethral constrictions in the UCPP (resting state) had abnormal MUPP configurations during voiding.