Guide wire-assisted urethral dilatation for urethral strictures in pediatric urology

Purpose: The aim of this study was to report the results of 32 cases of dilatation of urethral stricture using a guide wire and sheath dilator technique supplemented by clean intermittent catheterization if further stabilization of the urethral stricture was felt warranted.Methods: The procedure involves insertion of a straight flexi-tip lubricated guide wire through the urethral stricture under cystoscopic guidance followed by insertion of a series of sheath dilators. Dilatation was followed by insertion of a Foley catheter, which was left in situ for 1 to 3 days. Patients underwent repeat cystoscopy to evaluate the urethra for recurrent stricture and those with a recalcitrant stricture were commenced on clean intermittent catheterization (CIC) to stabilize the narrowing.Results: Thirty-two patients were included. They have been followed up for up to 2 years after their last cystoscopy (mean, 16 months). Thirteen of 32 patients had more than 4 dilatations under anesthesia. Twelve patients had undergone CIC postoperatively. Complications included a urinary tract infection in 3 boys and bladder spasms in one. No false passage or sepsis occurred with this approach.Conclusions: Guide wire-assisted urethral dilatation helps avoid risks associated with blind dilatation techniques and appears to be a safe and simple alternative for management of urethral strictures in pediatric urology.     

Microsurgery in clinical urology.

Microsurgery is not a new tool to the urologist. Transurethral resection is probably the most challenging type of microsurgery, and we do it daily. The manipulations of microvascular dissections and anastomoses may be more intricate, but the basic concept of performing delicate procedures while looking down a tube is "old hat" to us. The new techniques discussed here may extend the range of operative solutions to difficult clinical problems in urology perhaps as transurethral resection did in the thirties and forties.     

Anterior urethral valves. A case report

Anterior urethral valves are rare anomalies which cause obstructive uropathy in the lower urinary tract of young men. We discuss our illustrative case and review the English medical literature in order to analyze the clinicopathologic spectrum. We propose a hypothesis of embryology of this lesion and present guidelines for its management.     

Posterior urethral polyps in children. A case report]

Posterior urethral polyps are rare. A case is reported in a 7-year-old boy presenting with pain and burning micturition. Ultrasound and cystography revealed the diagnosis by showing a round solid structure in the bladder neck. Cystoscopy confirmed the diagnosis by showing its implantation base at the summit of the verumontanum. The polyp was removed by endoscopic resection and histological examination of the resection specimen showed a fibrous polyp. A brief review of the clinical features, diagnostic methods, natural history and treatment of this benign tumour is presented.     

Incomplete urethral duplication in a male. A case report

Urethral duplication is a rare congenital anomaly affecting mainly males and being usually diagnosed during paedriatric age. We report a 20 year old male complaining of double urethral meatus with double urinary stream. Physical examination confirmed and additional hypospadic meatus below a normally placed urethral meatus. Retrograde urethro-cystography and voiding cysto-urethrograms showed two distinct urethras originating from a common bladder neck and the diagnosis of Effmann type IIA2 incomplete urethral duplication was made. No treatment was felt to be applied after associated anomalies were ruled out.     

Urethroplasty for anterior urethral strictures in a community-based urology practice

Introduction The outcome of urethroplasty for the anterior urethral stricture is superior to internal urethrotomy. However, the excellent results are often reported by tertiary medical centres and most urologists in general urological practice do not offer urethroplasty. We review the results of our institution to ascertain whether equivalent results are achievable in a district hospital urology service. Methods Over a 22-month period, 26 urethroplasties were performed. Mean age was 44.2 years (range: 16–83 years) and median follow-up was 14.6 months (range: 0.6–40.2 months). Anastomotic repair was performed in five, substitution urethroplasty in 15 (nine flaps and six grafts) and␣staged urethroplasty in 6. Length of strictures ranged from less than 0.2 cm to greater than 10 cm. Results Stricture-free rate of 90.5% at 1 year was observed. Only two cases developed repeat stricture formation. Other minor complications included one epididymo-orchitis and one haematoma. Conclusion Good early outcome for urethroplasty for anterior urethral strictures is achievable in a district hospital practice. Keys to good outcome include having a dedicated team and a wide repertoire of urethral reconstructive techniques.     

A case of urethral malacoplakia associated with vesical disease.

A case of recurrent urethral malacoplakia with coexisting disease of the bladder is described. This is compared to the single previously reported case of involvement of this site.