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OBJECTIVES: The aims of this study were: (1) To evaluate the urethral orifice cross‐section size immediately and 12 days post‐operatively following a perineal urethrostomy procedure. (2) To assess the correlation between the cross‐section size and stricture formation during a 6‐month period following the perineal urethrostomy. ANIMALS: Twenty‐four male cats with feline lower urinary tract disease that failed to respond to medical treatment and underwent perineal urethrostomy. MATERIALS AND METHODS: The urethral orifice cross‐section size was estimated by the largest size of the urinary catheter that was possible to insert facilely through the urethrostomy site. The urethral orifice cross‐section size was measured in three different times: Pre‐operative (LUCpr), immediately post‐operative (LUCi) and 12 days post‐operative (LUCp). Urinary obstruction recurrence and urethrostomy site stricture formation were documented for 6 months after the surgical procedure. The probabilities for obstruction recurrence in cases of LUCi ≤ 8Fr and LUCi > 8Fr were calculated. RESULTS: Urinary obstruction and urethrostomy site stricture occurred in 5 of 24 (~20%) of the operated cats at an average of 92 ± 25 days post‐perineal urethrostomy. LUCi ranged from 6 to 10 (median 10) Fr and the LUCp ranged from 4 to 10 (median 8) Fr. There was a significant decrease of 0.15 ± 0.09 mm² of the urethral orifice cross‐section area 12 days post‐operative compared to the measurements taken immediately post‐operative. The probabilities for post‐operative urinary obstruction of the LUCi ≤ 8Fr cases (intra‐operative urethral orifice cross‐section area equal or larger than 5.5 mm²) and in the LUCi > 8Fr cases were 44 and 6%, respectively. Recurrence of obstruction was documented in all cases (three cats) in which LUCi was 6Fr. CONCLUSION AND CLINICAL SIGNIFICANCE: The largest size of the urinary catheter that is possible to insert during surgery is a simple method to evaluate urethrostomy cross‐section size. Contraction of the urethral orifice diameter is expected during the wound healing phase. Post‐operative urinary obstruction is more likely in cases where LUCi

Embolization of arterial supply of tumor and pelvic metastatic tissue has been widely used as an elective modality as an adjunct to chemotherapy in the management of gynecological tumors. It can be a rescue life-saving procedure in heavily pouring masses and also treatment modality so as to reduce the size of mass by endovascular methods. This is specifically remarkable in cases where other measures of hemorrhage control fail or are inapplicable. Here we report the case of 27-year-old lady with vaginal metastasis of choriocarcinoma with uncontrollable bleeding that was managed by emergent embolization. Coil embolization of bilateral internal iliac arteries by transfemoral route was done to control bleeding from vaginal metastatic growth of choriocarcinoma, which was in close proximity to urethral orifice. Emergent embolization proved to be a successful rescue modality of bleeding control from vaginal metastatic lesion of choriocarcinoma. Embolization has an emergent and elective role of in the management of choriocarcinoma. Intervention radiology is of immense importance not only in regular elective cases, it also can be used as an emergent measure. If the process is expedited, and the avoidable delays are somehow overcome, it can be used for emergent control of gynecological hemorrhage.

Urethral coitus is a rarely reported cause of female urinary incontinence and has been most commonly described in women with vaginal and hymenal anomalies. Herein, we report a 41-year-old woman with a complex obstetric history, who presented with continuous urinary incontinence. On evaluation, she was found to have an abnormally dilated urethral orifice and vaginal stenosis suggestive of chronic urethral coitus. She underwent a reduction urethroplasty with autologous sling insertion and a vaginoplasty using vaginal flaps. This case highlights the fact that urethral coitus, though rare, should be considered as a cause of urinary incontinence in women with history of obstetric vaginal trauma.

Introduction:. Genital herpes is one of the most common sexually transmitted infections worldwide. Most genital herpes occur on the genitalia, perineum, buttocks, upper thighs, or perianal areas. However, there were reports of rare cases of genital herpes on urethral orifice. Herein, we report a case of a patient who was diagnosed with urethral orifice genital herpes, a place likely to be ignored. Case presentation:. A 53-year-old woman presented with vagina pruritus at first, with subsequent burning sensation around urethra. Mycostatin and mycospor were administered for the treatment of the pruritus. Then levofloxacin was prescribed. Finally, the patient was given treatment with acyclovir. Different from other cases, the investigation showed herpes simplex virus type 1 DNA positive and herpes simplex virus type 2 DNA negative by PCR. The patient was therefore diagnosed with genital herpes. Discussion:. Most genital herpes happen on the genitalia, perineum, buttocks, upper thighs, or perianal areas. Few cases have been reported that genital herpes occurred on urethral orifice till now. Conclusion:. If there is no typical symptoms that patient present with herpes simplex virus type 1 or 2 positive, urethral orifice genital herpes should be considered.

Objectives The aim of this study is to develop a method to evaluate the fluid dynamics of urine flow in the lower urinary tract (LUT), especially that of vorticity. Materials and methods This investigation included three sub-studies to demonstrate urine flow in the entire LUT. First, we attempted to observe vorticity generation in the urinary bladder during spontaneous voiding using transabdominal color Doppler ultrasonography (CDUS). Second, we performed transrectal CDUS to evaluate the vorticity of urine flow in the prostatic urethra. Patients with prostate cancer were enrolled before robotic surgery and divided into the vorticity and non-vorticity groups based on CDUS findings for comparisons of longitudinal urethral diameter and prostatic urethral angle. Third, the vorticity of the voided urine stream was observed using a high-speed video-camera. Micturition was done in a standing position while synchronously monitored for urine flow using uroflowmetry. Results Vorticity formation could be dynamically demonstrated in the urinary bladder and prostatic urethra using CDUS. The prostatic urethral angle of the vorticity group was more than that of the non-vorticity group. High-speed video recording could clearly capture vorticity and spiral shape generation in voided urine. The distance from the external urethral orifice to the first twist changed in accordance with urine flow rate. Conclusions In a series of sub-studies, this investigation proved vorticity generation in the LUT and voided urine. Vorticity was detectable in the LUT and in voided urine using CDUS and a high-speed video-camera. Vorticity generation might be associated with urethral morphology.

Introduction: The aim of this research was to provide a detailed description of the morphology, topography, and histometry of rabbit accessory genital glands. Material and Methods: Seven male New Zealand White rabbits, 3–4 months of age and weighing 2.1–3 kg were used for the study. The whole urethra from the urinary bladder to the external urethral orifice accompanied by accessory genital glands was sliced at intervals of 1 mm. The serial sections were prepared with haematoxylin-eosin (H&E) and Movat–Russell modified pentachrome stain. Results: A detailed description of the morphology and morphometry was provided. The topography of the organs was explained on the basis of characteristic cross-sections on histological slides. The inconsistent nomenclature and descriptions of these glands by different authors were also discussed. Conclusion: The morphometric analysis indicated that some of the glands described have similar dimensions in different individuals, while others like paraprostates revealed high diversity in the number of lobes, their size, and their structure. The accessory glands are also good topographic markers which precisely define the segment of the urethra. The terms “proprostate”, “prostate”, and “paraprostates” as the nomenclature of the prostate complex reflect the location of these glands well and indicate their common origin and function.

BACKGROUND No studies have focused on the prevalence and clinical manifestations of penile gonococcal cutaneous and accessory gland infections in men with gonorrhea. METHODS We enrolled patients with penile gonococcal cutaneous and accessory gland infections and patients with urethral gonorrhea from January 2014 to February 2020. Demographic data, occurrence sites, and manifestations of all patients were recorded. RESULTS Fifty-one patients with penile gonococcal cutaneous and accessory gland infections were observed among 1994 (2.6%; 95% confidence interval, 1.9%-3.4%) patients with urethral or penile gonorrhea. Lesions were present at the external urethral orifice in 22 (43%) patients, at the glans in 11 (21%), in the side of the frenulum of the prepuce in 7 (14%), in the penile raphe in 5 (10%), in the inner plate of the prepuce in 1 (2%), in the external urethral orifice and side of the frenulum of the prepuce in 3 (6%), and in the glans and side of the frenulum of the prepuce in 2 (4%). The lesions manifested as sinus-like lesions in 22 (43%) patients, abscesses in 14 (27%), nodules in 10 (20%), pustules in 3 (6%), nodules with sinus tracts in 1 (2%), and ulcers in 1 (2%). CONCLUSIONS Penile gonococcal cutaneous and accessory gland infections in men probably are more common than previously understood. They mainly involve the paraurethral duct, glans, Tyson's gland, and penile raphe. Lesions mainly present as sinus-like lesions, abscesses, and nodules.

BACKGROUND: To identify the factors related to the effectiveness of retrograde removal of double J ureteral stents using a simple snare technique in female patients. METHODS: It was a retrospective observational study. From 2012 to 2017, 128 female patients underwent fluoroscopy-guided, retrograde double J stent removal with or without replacement using a simple snare technique. The position of the tip of the double J stent in the urinary bladder was classified according to position types A, B, C, and D, corresponding to the ipsilateral lateral, ipsilateral medial, contralateral medial, and contralateral lateral quadrants of the urinary bladder, respectively. The factors influencing the fluoroscopy time upon removal of the double J stent were analyzed. RESULTS: Technical success rate of 312 procedures performed was 97.44% (304/312) with the mean fluoroscopy time of 12.68±7.34 minutes. Eight double J stent removal procedures failed, and all of these occurred in the position type D patients. The position type and the number of curls of the double J stent had a significant influence on the fluoroscopy time (P

Summary:. Although primary vulvovaginal reconstruction after vulvectomy has high potential to improve patients’ outcomes, flap reconstruction is not an established part of the current standard treatment for vulvar cancer. We report a patient with successful secondary vulvar reconstruction 3 years after radical vulvectomy with direct wound closure. A 69-year-old woman presented with chronic, burning vulvar pain 3 years after radical vulvectomy without reconstruction for stage IB vulvar cancer. Her urethral orifice had everted because of the direct wound closure, which resulted in severe pain on contact. We performed secondary vulvar reconstruction using bilateral 14 × 5 cm2 gluteal fold flaps. Postoperative pain management and overall aesthetic outcomes were satisfactory. Secondary vulvar reconstruction with gluteal fold flaps can avoid the sequelae resulting from inadequate direct wound closure after radical vulvectomy. Thus, we strongly advocate immediate vulvar reconstruction to prevent such situations.

OBJECTIVE: To explore whether opening the external urethral orifice in the coronal sulcus can reduce the incidence of epididymitis after operating on hypospadias with a prostatic cyst connected to the vas deferens.MATERIALS AND METHODS: Three patients (group A) (average age = 3.3 years old) with severe hypospadias and prostatic cyst underwent cystostomy, hypospadias correction and urethroplasty, along with relocation of the external orifice of urethra. Group B consisted of 4 patients (average age = 6.9 years old) presenting with epididymitis after hypospadias surgery and Unsuccessful conservative treatment. Patients underwent urethral dilatation along with urethral catheterization, cutting of the original corpus cavernosum that encapsulated the urethra, and extension of the position of the external urethral orifice to the coronal sulcus. RESULTS: In group A, 3 children underwent bladder fistula removal 2 weeks after operation. All patients were followed up for 5-7 years. The vulva developed normally without any complications. Four children in group B underwent stent removal 12 weeks after operation, and one patient was still stenosed and dilated again. All patients were followed up for 2-12 years without epididymitis recurrence. Penile erection and ejaculation were normal in adulthood. CONCLUSION: For hypospadias patients experiencing complications due to the presence of a prostatic sac, especially those with prostatic sac connected to the vas deferens, the positioning of the external urethral orifice in the coronary sulcus would be helpful to reduce the occurrence of epididymitis.

Background: In this study, cases with suspected urethral condylomata acuminata were examined by dermoscopy, in order to explore an effective method for clinical. Objective: To study the application of dermoscopy image analysis technique in clinical diagnosis of urethral condylomata acuminata. Methods: A total of 220 suspected urethral condylomata acuminata were clinically diagnosed first with the naked eyes, and then by using dermoscopy image analysis technique. Afterwards, a comparative analysis was made for the two diagnostic methods. Results: Among the 220 suspected urethral condylomata acuminata, there was a higher positive rate by dermoscopy examination than visual observation. Study limitations: Dermoscopy examination technique is still restricted by its inapplicability in deep urethral orifice and skin wrinkles, and concordance between different clinicians may also vary. Conclusion: Dermoscopy image analysis technique features a high sensitivity, quick and accurate diagnosis and is non-invasive, and we recommend its use.

Summary This report describes the repair of an iatrogenic phallectomy that occurred during an attempted castration of a horse that was discovered to be a unilateral cryptorchid (inguinal testis). Use of a modification of a described phallectomy and sheath ablation technique allowed penile retroversion to be avoided, decreasing excessive dissection and post-operative morbidity, despite the urethral orifice being positioned more caudally than previously reported.

Cloacal malformations are rare anomalies which occur in one in 50,000 live births. Anatomically these anomalies are defined by the presence of a single perineal orifice. There is however a substantial range in their complexity. Defining these differences is key to surgical planning and timely referral of selected cases to centers with the capabilities to manage the most challenging cases. Traditionally the common channel length as measured during cysto-vaginoscopy has been used to differentiate between patients that can be repaired with a reproducible operation and those requiring a more complex repair. The quality and range of imaging available has advanced and thus a more detailed anatomic picture is now possible to help with pre-operative planning. Cross sectional imaging with 3D reconstruction has enhanced the understanding of the anatomic variations in these patients. In addition, the sacral ratio, previously thought to only have an influence on long term continence predictions, has been shown to not only forecast the presence of urological anomalies, but also the complexity of the malformation. In principle, cloacal malformations have two major components to the reconstruction. First, the rectum needs to be separated from the urogenital tract and second, the urogenital sinus needs to be managed to create a urethral orifice and vaginal introitus. The length of the urethra has been shown to be vital in deciding between the two main surgical maneuvers; a total urogenital mobilization (TUM) and a urogenital separation. The technical demands of a urogenital separation are significant and discussed here in detail. The need for vaginal replacement adds further complexity to the care of these patients and has also been shown to be related to the length of the urethra. Predicting complexity in an accurate and non-invasive way will facilitate the care of the most complex cloacal malformations and improve outcomes.

Urethral coitus is a rare type of sexual practice, usually due to vaginal agenesis or hymeneal anomalies. We report a case of urethral coitus in a healthy couple who were evaluated for infertility. The female partner had cribriform hymen and dilated urethral orifice but did not report any problems except infertility and her genital anatomy was normal. The male partner reported concerns over his penile size but was otherwise healthy. After incision of hymen, they were able to have vaginal coitus and successfully conceived. While urethral coitus is rare, it should be suspected in women presenting with infertility and a dilated urethral orifice.

Objective To provide a summary of the possible challenges we may face in managing patients with hypospadias from birth to adulthood, as the treatment of hypospadias is full of challenges not because of the operation technique itself but because of other factors such as delayed diagnosis, continuation of regular long-term follow-up, and relatively high rate of complications. Methods Collection of personal experience and literature regarding hypospadias management and its challenges with some suggestions of how to deal with these challenges in better ways. Many known surgical procedures have been established for hypospadias. The selection of the right procedure for each patient is an individual decision that varies with the location of the urethral orifice, other associated problems, and the centres experience, and this decision is usually taken intraoperatively. The management of these patients should also include the psychosocial aspect and the continued education of the patient and family. Results It is valuable that every surgeon dealing with hypospadias is aware of these challenges and how to manage them. The management of other aspects like psychosocial support should be considered. Conclusion A comprehensive knowledge of these challenges and their management is necessary for every surgeon dealing with such patients. Management of hypospadias is not only the surgical procedure, but it includes at the same time the long-term follow-up, psychosocial support, and continuous patient and family education.

A 20 years old woman had an external urethral orifice mass and received an excision operation. Seven years later, she complained a tumor with pain that was similar to the previous tumor. She underwent the tumor removal. Pathological diagnosis was a urethral angiomyomatous leiomyoma in the new concept of estrogen receptor-positive smooth muscle tumors.

A 29-year-old male exhibited progressive extrusion of the distal end of ventriculoperitoneal (VP) shunt through his urethral orifice within 10 d. The distal end of VP shunt was pulled out from the urethral orifice without bladder repairment, a new VP shunt assisted with ventriculoscope and laparoscope was performed and the distal end of VP shunt was fixd to the suprahepatic space. We first report a chronic complication of VP shunt with bladder perforation and extrusion through the urethral orifice in an adult male patient. To avoid this complication, the length of the distal end of VP shunt should be kept as short as possible in adults and we recommend that the distal end of VP shunt should be fixed to the suprahepatic space assisted with laparoscope in adult patients.

Obstructive urolithiasis is the retention of urine subsequent to lodgment of calculi anywhere in the urinary conduct from up to urethral orifice. The disease results in heavy economic losses to the livestock industry as it is attributed the fifth most prevalent cause of death in feedlot. Obstructive urolithiasis is a serious, potentially fatal condition, most commonly causing symptoms in castrated male animals, but also occurring in breeding males. Many surgical approaches and techniques for the diagnosis and the treatment of the disease have been described with their relative merits and demerits in the literature. [Vet World 2013; 6(4.000): 233-238]

Background Urinary tract infection (UTI) is the most common cause of fever in children. Less frequent disposable diaper changing is thought to be a cause ofUTI in children. While wearing a diapei; the perinea! area becomes damp with urine allowing bacteria to migrate from the anus to the external urethral orifice. Objective To assess for an association between the frequency of disposable diaper changing and urinary tract infections in children. Methods This cross-sectional study was conducted in the children's outpatient clinic of Haji Adam Malik Hospital from April to June 2010. Urine culture was performed in children with suspected UTI who wore disposable diapers every day. Subjects' ages ranged from 2 months to 2 years 6 months, with samples matched and collected by consecutive sampling. Diagnosis ofUTI was based on urine cultures with bacterial count 2:: 105/mL. Eighty children were followed in this study and divided into two groups: positive (n=40) and negative (n=40) urine cultures. Chi square test was use d to analyze the association between the frequency of daily disposable diapers changing during a one week period and the urine culture results. Results The frequency of daily disposable diapers changing in 80 subjects was as follows: < 4 times (22.5%), 4-5 times (40%), and 2::6 times (37.5%) . The frequency of daily disposable diaper changing in children with positive urine culture was as fo llows: < 4 times (1 8 out of 40), 4-5 times (22 out of 40), and 2::6 times (O out of 40); (P < 0.0001). The most common bacterial species found in urine cultures was Escherichia coli. Conclusion Lower frequency of daily disposable diaper changing is significantly associated with higher UTI incidence in children.

Male genitalia reconstruction in patients with exstrophy-epispadias complex often leads to secondary hypospadias, thus requiring additional surgery and resulting in possible complications. We describe a technique of male epispadias repair to prevent resultant hypospadias.The complete penile disassembly technique is modified by multiple Z-plasties, which enable creation of a funnel-like bladder neck and urethral plate lengthening. A total of 29 patients 2 months to 12 years old presenting with pure epispadias and bladder exstrophy were treated with this technique between 2004 and 2011. These patients were compared to 19 patients 1 day to 11 years old with exstrophy-epispadias treated with the standard penile disassembly technique between 2000 and 2004.Outcome measures were urethral orifice position, penile length and complications. There was no statistically significant difference between the 2 groups regarding penile length or complications. In the study group the urethra reached the tip of the glans in all patients, whereas the creation of intentional hypospadias was necessary in 6 patients (31.5%) in the control group (p0.05).The modified technique was effective in obtaining appropriate meatal location without decreasing the penile length. The complication rate was not changed. Creation of resultant hypospadias at genitalia reconstruction in male epispadias should strongly be prevented.

The aim of this report is to evaluate clinical findings and treatment of infected scrotal wounds and traumatic urethral rupture in two dogs. The material of this report consists of two Kopay breed hunting dogs, aged 3.5 and 8, brought to the Adnan Menderes University, Faculty of Veterinary Medicine Surgery Clinic. In both cases, the wounds had been caused by a wild boar and an open, infected wound with seromucous discharge was present. The wound had laid both testes bare in the first dog, while in the second dog, only the right testis was present, the left without testis. It was detected that the urethra was ruptured in the scrotal area when a urinary catheter sent through external urethral orifice came out of the wound. Both cases underwent surgery to repair the urethra and to perform wound revision. In both cases, the catheters were left in place postoperatively until the postoperative 10 th d. Follow-up examination indicated that both animals could urinate without any problems.

Purpose: We developed a method for ureteral stent exchange in female patients under fluoroscopic guidance using a crochet hook technique (CHEX). Patients and Methods: A total of 45 female patients (51 stents) underwent exchange of ureteral stents. In these patients, 21 ureteral stents were exchanged using CHEX. All procedures were carried out with the patients under conscious sedation. At the time of the procedures, we extracted the ureteral stent from the external urethral orifice using CHEX under fluoroscopic guidance and inserted the new stent under fluoroscopic guidance without cystoscopy. Results: 20 of the 21 stents (95.2%) were successfully exchanged. Ureteral stent exchange using CHEX was unsuccessful in 1 patient, including migration to the ureter. Conclusions: Ureteral stent exchange using a crochet hook is easy, safe and cost-effective. This technique was also easy to learn.

Anopenile urethral fistula (APUF) is not rare, but there are only a few detailed reports regarding its surgical treatment. We describe a patient with APUF who had no anal opening, and meconium was discharged from the external urethral orifice. The patient was treated with a staged operation.

Aims/objectives: Although both the tension-free vaginal tape (TVT) and the transobturator suburethral tape (TOT) have a high success rate in the treatment of stress urinary incontinence (SUI), both techniques have complications. In this study, we investigated the hypothesis that the approximation of the two ischiocavernosus muscles (ICMs) over the mid-urethra would effect a cure for the SUI. Methods: The technique was performed in 68 women with SUI who had a mean age of 54.3 ± 11.2 years. Inclusion criteria was comprised of a clinical and urodynamic diagnosis of SUI, a positive stress test, and a cystoscopy procedure. A transverse incision was performed below the external urethral orifice. The flaps of the incision were undermined laterally to expose both ICMs. The exposed ICMs and the underlying crus clitoridis (CC) were approximated and sutured together over the exposed mid-urethra. Results: A cure of SUI was achieved in 64 patients (94.1%). Four failures were the result of a gaping of the suture line; ...

Five-year old male patient was brought to the emergency service about four hours ago with the complaints of sudden inability to void and pain in the penis. A calculus was observed to occlude totally the external urethral orifice in the physical examination of the patient (Figure 1). A pediatric surgeon was consulted about the situation of the patient, and the calculus was removed under sedation. Oral antibiotic was administered to the patient and he was discharged from the hospital under suggestions. It should be remembered that calculus in external urethral orifice may be observed in the patients applying to the emergency service with the complaints of inability to void and pain in the penis. Figure 1: Appearance of the calculus in external urethral orifice. Arrows show the calculus

Virtual cystoscopy is a promising new technique based on computer-simulated rendering of the inner surface of the urinary bladder using volumetric magnetic resonance (MR) imaging data, thus enabling maneuvers that normally are not possible with conventional cystoscopy. Due to several distinct advantages over conventional cystoscopy such as minimal invasiveness, evaluation of the urethral orifice from a cranial point of view and an opportunity to observe diverticula formations and the inner urethral space, gadolinium-enhanced MR cystoscopy has a great potential for competing with conventional cystoscopy under some clinical circumstances. The recent improvement in MR scanners has significantly facilitated virtual cystoscopic evaluation of the urinary bladder lumen by MR imaging. Volumetric data associated with powerful postprocessing procedures allow imaging of the inner urinary bladder surface with excellent detail. In this article, imaging techniques and clinical applications of gadolinium-enhanced virtual MR cystoscopy are presented.

The procedure described demonstrates the feasibility of reliable implantation of an artificial sphincter system in female patients via a paraurethral access between the urethral orifice and the clitoris following radical cystectomy with continent, orthotopic urinary diversion and postoperatively developed urinary stress-incontinence. The technique presented avoids the more invasive transperitoneal or transvaginal approaches which jeopardize the neobladder-neck and increase the risk for infections or fistulas.

A 24 year old young patient presented in the emergency department of Shaheed Monsur Ali Medical College Hospital, Uttara, Dhaka with swollen, curved and flaccid penis after forceful bending of his erect penis. The patient was anxious with normal vital sign. Rolling sign was positive. There was no bleeding at external urethral orifice, scrotum & testicle were found normal. On the above facts, penile fracture was diagnosed clinically. The penis was degloved upto the root of the penis & after evacuation of the haematomas, transverse tears were detected in Bucks fascia & tunica albugenia of the left corpus cavernosum, which were repaired by interrupted suture. In the post operative period sedative was given & recovery was uneventful. The aim of this case report is to increase the awareness of the condition which should be regarded seriously and treated expeditiously and to draw attention to its possible complications. DOI: http://dx.doi.org/10.3329/jss.v16i1.14448 Journal of Surgical Sciences (2012) Vol. 16 (1) : 44-46

Gonococcal inflammation of paraurethral glands around the external urethral orifice is a local complication of gonorrhoea in men. To investigate the risk factors for this complication we compared prepuce factors, Chlamydia trachomatis infection, demographic data and behavioural indicators of gonorrhoeal patients with and without this complication. Results showed that a prolonged disease course of gonorrhoea, sexual intercourse during gonorrhoea, repeated squeezing of the penis and a redundant prepuce were risk factors for this complication.

Infections caused by bacteria strike primarily the prostate and vesical glands, and secondarily the epididymis. Essential first is to give evidence of bacteria in germ numbers exceeding 10(5) pro ml ejaculate. In addition, the diagnosis of prostatitis requires the demonstration of other signs of infection, for example increased numbers of leukocytes in the ejaculate, in the prostatic secretion and in the urine; the clinical symptoms in relation to these indicators are not necessarily characteristic. It is essential for the microbiological diagnostic, that evidence of all the germs be found in native material. It is therefore necessary to first disinfect the external urethral orifice and the glans penis, in order to avoid super-imposition of germs from the surroundings. Every demonstration of bacteria must be connected with a determination of resistance. The relationships between the ejaculate parameters which deviate from the norm, and evidence of bacteria in ejaculate are unclear. Reports about disturbances in spermatozoa motility or morphology during infections of the adnexa of man are to be evaluated with care.

We operated on an 87-year-old female suffering from a giant bladder stone. Her chief complaint was fever and lower abdominal pain, which was caused by lodgement in the urethra. The stone was easily removed in one piece without breakage or injury to the urethral orifice and urethra using forceps normally used for grasping bones in orthopedics. The stone measured 75×50×45 mm and was composed of magnesium ammonium phosphate. To our knowledge, this is the largest bladder and/or urethral stone that was transurethrally removed without being broken. Thus, forceps that are normally used for grasping bones in orthopedics can be used to remove giant bladder stones without leaving stone fragments.

Hypospadias is the commonest congenital urological anomaly, occurring in 1–3 per 1,000 live births. The spectrum of hypospadias anomalies include an abnormal urethral orifice on the ventral aspect of the penis, chordee (ventral curvature of the penis), an incomplete prepuce, an abnormal looking globular glans, rotation of the penis, abnormal raphe, and a disorganised corpus spongiosum and penile fascia.

A 52-year-old woman was admitted because of a vaginal-wall tumor adjacent to the external urethral orifice. The tumor had been causing disturbances in micturition for the past year. Magnetic resonance imaging and computed tomography images indicated a 6 x 3 cm solid mass in the anterior vaginal wall. The tumor was enucleated surgically through a median longitudinal incision of the anterior vaginal wall. Micturitional disturbances were rectified after surgery. Histologically, the tumor was a mixture of a high-cellularity area with a mitosis rate of 7 per 30 high-power fields, and a less cellular area without mitosis. Immunohistochemical staining was performed for both areas. The prognostic implications of the tumor are discussed.

We describe the novel use of a rectus abdominis myocutaneous flap for reconstruction of the female urethra following an oncological pelvic resection. Reconstruction of the female urethra from the bladder neck to external urethral orifice was successfully performed, avoiding the need for a urostomy. To our knowledge, the myocutaneous flap has never been described for complete urethral reconstruction.

The urethra, which carries urine from the urinary bladder to the external urethral orifice for excretion and provides the conduit for semen in males, may be involved by a broad spectrum of both neoplastic and nonneoplastic diseases, which may produce very similar clinical symptoms. This chapter reviews the clinical and pathologic features of urethral diseases organized by clinical setting: urethral stricture, male urethral cancer, female urethral cancer, and female urethral diverticulum.

Summary 1. Superficial ulceration and coarctation of the urethral orifice has been observed in forty-one cases. 2. Its etiology has been discussed, and in all cases but two, congenital shortening of the anterior-posterior diameter of the external meatus has been found. 3. Contributing skin factors are: (a) most frequently, ammonia dermatitis, (b) a dermatitis of unknown origin affecting only glans and the periphery of the meatus, (c) herpes simplex. 4. The dangers of obstructive uropathy caused by this disorder have been stressed. 5. Treatment of the disorder has been suggested.

The urethra is a tubular structure through which urine is expelled after accumulating in the physiological reservoir called the bladder. In men, this canal is also used by the seminal ducts and carries the sperm from the veru montanum all the way to the external urethral orifice.

A 30-year-old female was admitted in emergency with acute urinary retention due to bladder tumour prolapsed from the external urethral orifice. The patient underwent immediate endoscopic surgery via suprapubic percutaneous approach. The histological examination confirmed a superficial highly differentiated transitional cell bladder carcinoma. During the 6-year follow-up no evidence of local recurrence or metastatic tumor spread was revealed. The comprehensive Medline search confirmed that this is the fourth case of bladder tumor prolapsed from the external urethral orifice, reported so far. The case deserves the interest of practicing urologists because of the exceptional rarity of the entity and the unconventional treatment approach which involves using a percutaneous suprapubic endoscopic technique. Based on the results achieved, we can recommend this unconventional endoscopic approach as specifically indicated in certain situations. .

Hermaphroditism was identified in a 3-year-old American Cocker spaniel with an enlarged os clitoridis that was shown as reddish finger-like structure protruding from the vulva. The urethral orifice was located cranially to the base of the os clitoridis. The gonads were situated caudal to the kidneys at the cranial tips of the uterine horns, and were composed mainly of seminiferous tubules and interstitial cells and had ovarian follicles in the cortices. The uterus was enlarged and revealed pyometra. Gross and histopathological findings of the dog suggested hermaphroditism with bilateral ovotestes and pyometra.

This clinical case report described a three-month-old mongrel dog that had the urethral orifice opening 3 cm from the tip of the penis and lacked a completely formed preputial sheath. It was presented to the clinic with an exposed penile shaft that was dry. The dog had urinary incontinence that was not of neurological origin. It also had unilateral agenesis of the right testicle. The preputial sheath was successfully reconstructed. Urinary incontinence stopped soon after surgery, suggesting that it had been probably due to an ascending urethritis. A large preputial opening was left because of the location of the urethral opening.

Two surgical techniques were used to evert the bladder into the vagina for observation and repair of bladder tears that were associated with parturition. One technique involved an incision through the vaginal floor into the peritoneal cavity just caudal to the cervix, and prolapse of the bladder into the vagina. The second technique involved a 3-cm incision through the urethra, 5 cm cranial to the urethral orifice, and digital exploration of the tear and finger traction to evert the bladder through the urethral incision. In both mares, the bladder defects were repaired in two layers, with use of 2-0 polyglycolic acid in a simple continuous pattern. After repositioning, the vaginal and urethral incisions were closed in single layers using absorbable suture material. A standing vaginal approach eliminates the need for general anesthesia and allows excellent observation and repair of bladder tears in adult mares. ©Copyright 1999 by The American College of Veterinary Surgeons

The results of vaginoplasty by inversion of penile and scrotal skin in male-to-female transsexuals, in general, are satisfying. Cosmetic and functional considerations dictate the construction of a neoclitoris ventral to the urethral orifice. Embryologically, the glans penis and clitoris are homologues and mutual substitution seems to be the logical approach. In this paper, the long-term results in the first 60 patients using the pedicled sensate neoclitoroplasty according to Brown are presented and discussed. It has proven to be a safe technique that leads to satisfying cosmetic and functional results in nearly all patients. It should be considered state of the art in primary gender-confirming surgery for male-to-female transsexuals.

Paraurethral or Skene's duct cysts in the newborn period and early childhood are readily identified by their characteristic appearance —round, yellow- or orange-coloured swellings beside and distorting the urethral orifice. Clinical examination should be followed by sonography of the urinary tract. Natural resolution is the likely outcome and early surgery is not necessary.