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Urethral prolapse is a rare condition not frequently encountered by gynecologists. However, patients with urethral prolapse occasionally visit gynecologists initially because the most common early symptom is genital bleeding. In this study, we report the case of a postmenopausal woman with severe urethral prolapse that could not be diagnosed by inspection alone but was successfully diagnosed by magnetic resonance imaging (MRI). An 89-year-old postmenopausal woman who complained of genital bleeding and incontinence had an erosive 3-cm vulvar mass. Because inspection alone was insufficient for diagnosis, MRI was performed. MRI revealed that the mass was not a tumor but protruding edematous urethral mucosa. We suspected urethral prolapse based on MRI results, and surgical excision was performed by urologists at another hospital. The excised tissue was composed of normal urethral mucosa under a microscope, and the diagnosis of urethral prolapse was pathologically confirmed. Her symptoms resolved after surgery with no recurrence. It is difficult for gynecologists to diagnose severe urethral prolapse by inspection alone. However, as described here, MRI can resolve this problem and is useful in eliminating diagnoses such as malignant vulvar tumor and condyloma. When inspection alone is insufficient to diagnose vulvar masses, MRI can be used as a supplemental investigative modality to aid in correct diagnosis.

A 23-year-old Falabella gelding kept in Tochigi, Japan, for more than 20 years presented with a recurrent mass of the glans penis that was first noticed about a year earlier. Partial phallectomy was performed with no adjunctive therapy for local regrowth of the mass. The horse was euthanized 3 months after surgery for urinary retention due to suspected regrowth. The resected mass affected the genital and urethral mucosa of the glans penis, and was diagnosed as equine sarcoid by histopathology and identification of bovine papillomavirus (BPV) DNA. Phylogenetic analysis of the BPV genome of the sarcoid showed high sequence homology to BPV type 1 (BPV-1) from Hokkaido, Japan, suggesting a geographical relationship for BPV-1 in Japan.

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...

Objective: To report the clinical outcome of urethral reconstruction by cultured urothelial or oral mucosa cells for tissue-engineered urethroplasty. Methods: We systematically searched for studies reporting the use of tissue-engineered techniques for hypospadias and urethral stricture repair in humans in PubMed and Embase (OvidSP) through January, 1990 to June, 2018. We excluded studies based on titles that clearly were not related to the subject, studies in which tissue-engineered biomaterial were used only in laboratory or experimental animals, and in the absence of autologous cultured epithelial cells. Studies were also excluded if they were not published in English, had no disease background and adequate follow-up. Finally, we search all relevant abstract presented at two of the main urological meetings in the last 10 years: European Association of Urology (EAU) and American Urological Association (AUA). Results: A total of six articles, reporting the clinical use of tissue-engineered techniques in humans, were fully reviewed in our review. The epithelial cells were harvested from the urethra (10 patients), the bladder (11 patients) and the mouth (104 patients). The tissue-engineered grafts were used in children for primary hypospadias repair in 16 cases, and in adults for posterior and anterior urethral strictures repair in 109 cases. Tissue-engineered grafts were showed working better in children for primary hypospadias repair than in adults for urethral strictures repair. Conclusion: One hundred and twenty-five patients received tissue-engineered urethroplasty using cultured epithelial cells for primary hypospadias or urethral strictures repair. The studies demonstrate a high degree of heterogeneity respect to epithelial cells (from urethra, bladder, and mouth), type of scaffold, etiology, site of urethral stricture, number of patients, follow-up and outcomes. Keywords: Urethra, Urethroplasty, Tissue engineering, Urethral mucosa, Oral mucosa, Surgical technique

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 Vessel-sparing anastomotic repair (vsAR) has been developed as a less traumatic alternative to transecting anastomotic repair (tAR) to treat isolated short bulbar urethral strictures. This vessel-sparing technique could result in improved functional outcomes without jeopardizing the excellent surgical outcome after (transecting) anastomotic repair. The purpose of this study is to directly compare vsAR and tAR for both surgical and functional outcomes. Methods This trial is a prospective, interventional, multi-center, single-blinded, 1:1 randomized, controlled, non-inferiority, phase II trial. Sample size calculation resulted in a required sample size of 100 patients (50 patients per arm). Trial participants will be randomized by an independent third party using a computer-based random sequence generator with permuted blocks of variable size. The primary objective of this trial is to show that vsAR is non-inferior to tAR in terms of failure-free survival after 24 months of follow-up, considering a non-inferiority limit of 10%. Failure is defined as the inability to pass a 16-Fr flexible cystoscope through the reconstructed area without damaging the urethral mucosa. Secondary end-points mainly include differences in postoperative complications and changes in functional outcome parameters, which will be assessed with validated questionnaires. All participants are scheduled for follow-up at 3, 12, and 24 months postoperatively. Discussion This trial will provide level Ib evidence about the differences in both surgical and functional outcome between vsAR and tAR, which may importantly scape the future of bulbar urethral reconstruction. Depending on the trial results, this phase II trial may generate a larger phase III trial with more statistical power and a lower alpha value. Trial registration This trial is registered at clinicaltrials.gov (NCT03572348) and in the Belgian Clinical Trial Registry (B670201837335). The trial was registered prospectively. Registered on 28 June 2018.

Objective A urethral diverticulum (UD) is a localised evagination of the urethral mucosa that forms a herniation that is continuous with the lumen of the urethra. We report of a patient who presented with a persistent UD during consecutive pregnancies and present a review of the current literature of other cases of UD during pregnancy. Methods A literature search was undertaken to identify previous research and case reports on the clinical presentation and management of UD in pregnancy using the search terms “pregnancy” and “urethral diverticulum”. Medline, PubMed and Cinahl were used as search engines. Results Six publications that described UD in pregnancy were identified with a total of nine cases documented within the literature. The articles reviewed showed that UD during pregnancy can be managed conservatively with expectant management, antibiotics and incision and drainage if required. Conclusion Overall, it is important for clinicians treating women in pregnancy to be aware of the rare diagnosis of UD, especially in those women who present with vague urinary symptoms refractory to other treatments. Brief Summary A case presentation of UD and literature review of UD in pregnancy., Highlights • A urethral diverticulum is an evagination of the urethral mucosa that forms a herniation that is continuous with the lumen of the urethra. • We report the case of a patient who presented with a persistent urethral diverticulum during consecutive pregnancies. • A literature search identified six publications that described urethral diverticulum in pregnancy, with a total of nine cases. • It is important for clinicians treating women in pregnancy to be aware of the rare diagnosis of urethral diverticulum.

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.

Dysuria and/or hematuria are common and worrisome symptoms for most parents. Dysuria results from excessive bladder muscle contraction and peristaltic activity of the edematous and inflamed urethral mucosa. Though urinary tract infection remains the commonest cause for dysuria, non-infectious causes should also be kept in mind. Equating all cases of dysuria to urinary infection is not incorrect. Hematuria can be both macroscopic and microscopic and an important sign of genitourinary tract disease. However, systemic causes like bleeding disorder or malignancy can also present with hematuria. A thorough history and physical examination is important for arriving at a diagnosis. The investigations for both the symptoms and the urgency with which the tests are required are dictated by the patient's clinical presentation.

A 23 year old Ugandan, Black, Mukiga, mother of two presented to us one year after delivery with severe lower abdominal pain, failure to pass urine, slight vaginal bleeding and a mass protruding from her vagina. Vaginal examination revealed she had a prolapsed urethral mucosa which was undergoing ischemic necrosis. Her condition was successfully treated by surgical excision of the prolapsed mucosa. The patient had no urinary, genital or other symptoms at 6 weeks, 6 months and at one and half years follow up. Keywords: Urethral, Mucosa, Prolapse, Post-partum patient

A urethral caruncle is a benign lesion of the distal urethra. Urethral prolapse occurs when the urethral mucosa is everted circumferentially all the way around the urethral meatus. In contrast, with a urethral caruncle, there is only partial eversion of the distal urethra. Often the terms urethral prolapse and urethral caruncle are incorrectly used interchangeably. Caruncles occur most commonly in low estrogen states and are treated with topical estrogen if they are causing symptoms.

The study for quantitation of TLR2, TLR4 and HBD-1 gene expression in urethral mucosal epithelium from women with chronic bacterial cystitis and healthy females. Materials and methods: RNA was extracted from the samples of urethral mucosa followed by RT-PCR. Results: increased expression of TLR2, TLR4 (respectively, 6.9-, 2.6-fold), along with 13.6-fold decrease in HBD-1 was revealed in women with chronic bacterial cystitis, as compared with appropriate parameters in normal women. Six months later, after combined therapy with autologous immunopeptide complex, TLR2, TLR4 и HBD1 expression levels proved to be near-normal in the patients, being similar to those in healthy females. Conclusion: Imbalanced expression of genes controlling innate immunity was revealed in urethral mucosa of the patients with chronic cystitis, thus increasing risk for urinary tract infections.

Urethral prolapse is a disease of prepubertal black girls and postmenopausal women with an unknown cause. It may be congenital in origin or an acquired condition. It has never been reported in males. We report a 10-year-old Caucasian boy who presented because of recurrent right undescended testis. He had been operated on for bilateral undescended testes 7 years ago in another hospital, and circumcision was done during the same operation. The boy complained of a weak urinary stream during voiding. The physical examination was consistent with recurrent right undescended testis. Penile examination showed a circumferential urethral prolapse around the meatus. The urethral meatal appearance was apparent right after the circumcision. An orchiopexy operation as well as circumferential excision of the perimeatal urethral tissue with primary repair was done. The pathological examination of the specimen revealed keratinized stratified squamous epithelium consistent with urethral mucosa. The postoperative course was uneventful, and the patient urinates normally at the 8 postoperative month with a normal uroflowmetry study. This is the first report of urethral prolapse in a male. Because circumcision is a widely employed practice in many cultures, it is unlikely to be a predisposing factor. It is a benign condition that can be cured with simple resection and anastomosis.

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...

Urethral catheters should satisfy variety of requirements connected to the specific application. Besides antifouling and antimicrobial properties, they should meet optimal mechanical properties, which are mostly related to the comfort during use. The comfort is extremely important since it is a direct indication of possible damage to the urethral mucosa.

A urethral foreign body is usually found as a part of sexual misadventure mostly in a young male. The literature has described items like a fork, battery, wire and other things in the urethra which almost always required a surgical procedure for its removal. Here we present the case of self-insertion of a hairpin in the male urethra with the open pointed end of hairpin facing distally. The hairpin despite being “stuck” inside the urethra due to its sharp end embedded in urethral mucosa was successfully removed with simple manipulation techniques with no complication in follow-up. This case highlights the point that when faced with the situation of an uncommon object in the urethra, the treatment has to be individualized according to the type of object, age and sex of the patient and sometimes common unorthodox technique can save the patient from operative procedure.

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 To explore the method of building a stable urethral stricture (US) model in New Zealand white rabbits. Methods Through 10× magnification optical microscope, a resection of 1.0 cm urethral mucosa was made in 6 male rabbits and other 6 male rabbits were controlled. After 60 days, the rabbits were evaluated with urethrography, urethral pressure profile (UPP) and histology. Result Urethrography demonstrated a stricture with narrow lumen and discontinuous mucosa in the resection group. The urethras of the control animals were all normal. UPP showed that the urethral pressure on operative site in the controlled group was 14.67 ± 2.16 cm H 2 O, and 27.83 ± 3.71 cm H 2 O in the resection group. There was significant statistical difference between the two groups ( p Conclusions We establish the way to build a stable urethral stricture model of New Zealand rabbits by the microsurgical technique, which is a good laboratory model to research all kinds of urethral stricture. Urethrography and histology combined UPP are the reliable methods to identify the urethral stricture.

Long considered a disease of elderly women, urethral prolapse is increasingly found in girls, mostly African. It is a rare disease which causes eversion of the urethral mucosa through the meatus. Such pathophysiology, still debated, contrasts with the purely clinical diagnosis in the presence of genital bleeding or vulva swelling more or less painful, and bleeding when touched. Surgical treatment gives excellent results. We hereby give details of our experience across three cases of urethral prolapse supported surgically with good results.

The aim of this study is to present a novel use of Dextranomer/hyaluronic acid copolymer (Deflux) for the treatment of a complicated iatrogenic chronic urethral injury. A 12-year-old boy with a neuropathic bladder presented a groove in the urethral mucosa due to chronic clean intermittent catheterizations (CICs) and suffered a posterior urethral injury during a failed catheterization for a routine examination. The defect on the urethral wall was repaired using Deflux, a technique that is not described in the literature. After the intervention the patient is continuing CICs without further complications.

Prolapse of urethral mucosa in prepubescent girls is an uncommon entity and most often seen among native Africans. Management of these cases is controversial. Some would adopt initial medical treatment and others prefer surgical treatment as primary modality with a very few recurrences. Though urethral mucosal prolapse has been managed successfully with surgery in many African girls, the role of medical management and its success cannot be overlooked. Authors present a case of urethral mucosal prolapse in a prepubescent Indian girl who was successfully treated with medical management with no recurrence on follow up.

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.

X-ray contrast imaging of the urethra, retrograde as urethrogram (UG) or antegrade as part of the miction cystourethrogram (MCU), has proved successful as a standard examination in urological diagnosis. The article presents a sonography technique enabling three-dimensional morphological and functional imaging the entire male urethra by real-time sonography. Advantages over x-ray film methods are the repeatability at any time, low invasiveness, absence of exposure to x-rays, and lesions of the urethral mucosa by catheters, as well as the avoidance of iodine-induced contrast medium reactions. Miction urethrosonography (MUS) is suitable for screening diagnosis of urethral stricture in miction difficulties, for excluding an iatrogenic of congenital urethral diverticulum, and for control after urethral surgery (internal urethrotomy, urethroplasty).

To prevent terrorism during anti-terror war, we developed a reproducible animal model for the induction of a urethral stricture in a war wound rabbit, and to evaluate the feasibility and effect of using a biodegradable urethral stent in the prophylaxis and treatment of urethral strictures in a war wound (or traumatic) rabbit urethral model. The urethral stricture rabbit model was successfully performed by a self-control explosion destructor. New biodegradable urethral stents were placed in the urethras of 20 war wound (traumatic) rabbits, but no stent was used in the 8 rabbits which formed the control group. Follow-up investigation included assessment of procedure success, stent changes, urethrascopy and retrograde urethrography, and histological findings were obtained after sacrifice at 4, 6, 8 and 12 weeks after stent placement. The urethral stricture model owing to a war wound (trauma) was tested by tissue reactions and urethroscopy. The length of the urethral strictures was 5-10 mm; the coarctation of the urethral lumen was more than 50%. Biodegradable stent placement was technically successful in 20 rabbits. Urethral specimens obtained from the 4 week stent placement group showed diminished inflammatory cell infiltration and decreased thickness of the papillary projections of the epithelium. There was a strong tendency towards regression of the papillary projections and regeneration of urethral mucosa epithelium in the 8 week group. In particular, the injured urethra has recovered completely in the biodegradable stent groups compared with the control group at 12 weeks. The biodegradable urethral stent seems feasible for treating and preventing urethral strictures owing to a war wound (or traumatic) urethra. There are distinct advantages in terms of safe, effective and less-invasive treatment for the reconstruction of post-traumatic urethral strictures.

Penile cysts are rare benign lesions. Their clinical or pathological diagnosis is extremely difficult. Less than 200 cases have been reported in literature. Most of them are asymptomatic and present since birth, but usually they are only detectable in adolescence or adulthood. These lesions rarely interfere with sexual function. These cysts most likely arise from ectopic urethral mucosa sequestered in the penile skin during embryologic development. We report a rare case of a 55-year-old man with a 4.5 × 4 cm nodule on the prepuce (ventral surface), which appeared two years ago and interfered with his sexual function. The nodule was excised by circumcision and a histopathological examination revealed a mucoid cyst of penis with squamous metaplasia. No recurrence was observed at a one year follow-up and the patient’s sexual function returned to normal.

Background: Urethral Prolapse is a rare benign condition that is often misdiagnosed by clinicians. Objectives: To report the clinical presentations and outcomes of urethral prolapse in Nigerian pre-menarcheal girls and to review the literature. Methods: This retrospective study was undertaken from February 21, 2015 back to January 1st, 2010. The clinical presentations and outcomes of cases of urethral prolapse managed in Enugu with complete surgical excisions were reviewed. Results: There were five cases of pre-menarcheal urethral prolapses. Their ages ranged from 2 to 10 years with a mean age of 6.6 years. The case presentations were mass in the vagina (4/5, 80%), asymptomatic (3/5, 60%), bleeding per vagina (1/5, 20%), and dysuria (1/5, 20%). Four cases (4/5, 80%) were misdiagnosed with the parents suspecting sexual assault in 3 (3/5, 60%) children. The outcomes of the surgical excisions were uneventful in four (4/5, 80%) cases. One child (1/5, 20%) had postoperative acute retention of urine. There was no urinary incontinence or recurrence of urethral prolapse after the excisions. Conclusions: Urethral prolapse is rare and often misdiagnosed by clinicians. The outcomes of complete surgical excisions were uneventful in most cases.

Urethral prolapse is a complete eversion of the distal urethral mucosa through the external meatus. It occurs primarily in prepubertal, primarly Black girls. Its pathophysiology has not been clearly identified. We report a case of a 5-year-old girl who came to the Emergency Department with a 1-day history of genital pain and "vaginal bleeding". Early recognition makes differential diagnosis with sexual abuse and staging allows prompt management under general anesthesic like prolapse reduction or surgical excision.

Urethra mucosa prolapse is a benign condition in which there is a circular protrusion of the distal urethra through the external urethra meatus. It is more commonly seen in prepubertal black girls and postmenopausal white women. It is rare in the reproductive age group. This case describes the presentation and management of an 18-year-old adolescent with urethra mucosa prolapse.

Objective— To confirm in vivo optimal laser energy settings previously determined in vitro for lithotripsy, to develop a technique for Ho:YAG laser lithotripsy, and to evaluate acute and chronic tissue effects of laser lithotripsy. Study design— Prospective, randomized preclinical trial. Animals or Sample Population— Nineteen intact, adult male dogs. Methods— Via cystotomy, a single urolith was inserted into the urethra to the level of the base of the os penis to simulate obstruction. Uroliths (calcium oxalate, urate, or magnesium ammonium phosphate) were fragmented by Ho:YAG laser, in contact mode through a 320 μ optic fiber, passed through the operating channel of a 2.8 mm flexible endoscope. The time and total energy to fragmentation were recorded. Dogs were euthanatized immediately after lithotripsy (3 dogs) or at 3 days (7 dogs), and urethral lesions and any stone remnants were evaluated. Urethral integrity was also evaluated in 9 other dogs by endoscopy on day 10; these were also monitored clinically for 30 days. Results— The mean time for adequate fragmentation was 166.7 seconds (range, 47–494.5 seconds). The mean±SD energy used was 1418±851.2 J. In part 1, 2 dogs were obstructed with urolith fragments at necropsy. Eight dogs had minimal (

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.

Urethral prolapse is the abnormal protrusion of the urethral mucosa through the external urethral meatus. It is a rarely diagnosed condition as most cases will be misdiagnosed as sexual abuse. If diagnosed, however, medical treatment with follow-up will usually suffice. If this fails, or in the presence of complications, surgical management may be employed. The most common presenting feature is urogenital bleeding. Genital bleeding in a pre-pubertal child is alarming to parents. Their first impression is that of a sexual abuse resulting in the suspicion of all adult males in the surrounding environment. The condition is worsened by a scenario in which the child is either too little to give an account or where she points accusing fingers to some adults. We report a case of bleeding from the vulva from urethral prolapse masquerading as suspected sexual abuse from an unknown adult.

Urethral prolapse (UP) is a circular complete eversion of the distal urethral mucosa through the external meatus. It is a rare condition seen mostly in African-American premenarcheal girls. Both a medical and a surgical approach to this condition have been described. We present a case of a spontaneous urethral prolapse in a 60-year-old postmenopausal Caucasian woman, who failed medical management and underwent successful surgical management. The patient is asymptomatic 18 months following the procedure.

A male neutered Staffordshire bull terrier presented for evaluation of urethral haemorrhage of three days duration. A urethral mass was identified on contrast radiography, ultrasonography and urethroscopy. An open excisional biopsy was performed and the mass appeared to arise from the vascular tissue beneath the urethral wall. Histopathology revealed evidence of ulceration and granulation; coupled with the clinical findings the mass appeared to be a herniation of corpus spongiosum through a defect in the urethral mucosa. Removal and closure of the urethral defect, along with postoperative propranolol, effected a clinical resolution. To the author9s knowledge, a urethral mucosal defect as a cause of urethral haemorrhage has not been previously described in the dog.

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.