Congenital anterior urethral diverticulum in an adolescent boy with obstructive urinary symptoms

A case of anterior urethral diverticulum in a 12 years old boy who presented with obstructive urinary symptoms is described. The diagnosis was made on retrograde urethrography. Open diverticulectomy and urethroplasty was done with complete excision of obstructing anterior valve. The clinical presentation, diagnosis, and management of this rare condition is discussed.     

前尿道内支架管在治疗前尿道狭窄中的应用

目的:观察在前尿道狭窄患者中留置前尿道支架管的临床疗效。方法:选取2005年1月至2008年5月在本院住院治疗及进行门诊尿道扩张的患者共38例作为治疗组,并将同期在本院采取尿道扩张器扩张的患者38例纳入对照组,通过最大尿流率(Qmax)及扩张次数等指标对两组的临床疗效进行对比分析。结果:尿流率检测表明留置支架管后所有患者的Qmax均较术前明显增加,对拔管后6个月随访结果进行分析,治疗组Qmax>15ml/s的患者显著多于对照组(P<0.05)。结论:采用前尿道内留置支架管治疗前尿道狭窄不但显著减少扩张次数,减轻患者的经济负担,也显著改善患者的生活质量,前尿道狭窄患者中留置前尿道内支架管不失为临床上一种较好的治疗手段,并取得了良好的预期效果,简单易行,效果确切,值得推广。     

A case of female large urethral diverticulum treated by electrofulguration

Female urethral diverticulum is not an uncommon disease. We report a case of female urethral diverticulum which caused severe urethral pain, but for which the diagnosis had not been obtained at many hospitals for many years. Transurethral electrocauterization of the diverticulum was very effective in this case.     

Giant anterior urethral diverticulum in a neonate

Congenital anterior urethral diverticulum is an uncommon condition that tends to present in older children with signs of chronic urinary problems. A neonate presented following recurrent collapse, and cystography revealed a giant urethral diverticulum. The diverticulum was incised at cystoscopy, leading to a full recovery.     

Acquired posterior urethral diverticulum following surgery for anorectal malformations

Purpose

Despite significant advances in the surgical management of anorectal malformations (ARMs), many children still experience significant debilities from potentially avoidable complications. One complication, the posterior urethral diverticulum, may have untoward consequences if not recognized and treated.

Methods

A retrospective cohort review was undertaken of male patients who presented to us with persistent problems after being operated on elsewhere for ARM. Twenty-nine patients presented with a urethral diverticulum. Their charts were reviewed for the type of malformation, prior repair, presentation, treatment, and postoperative follow-up.

Results

Twenty-nine patients were identified that fit the criteria for this study. To date, 28 patients have been managed with reoperation. Urinary complaints were the most common presenting symptoms. All patients were repaired using a posterior sagittal approach. Pathology of the diverticulum in one patient revealed a well-differentiated mucinous adenocarcinoma.

Conclusion

The incidence of acquired posterior urethral diverticulum has decreased with the popularization of the posterior sagittal incision. There is a theoretical concern that the incidence may increase with the use of laparoscopy for the treatment of ARMs especially those where the fistula is below the peritoneal reflection. Once detected, the diverticulum should be excised.     

Adenocarcinoma of the female urethral diverticulum treated by multimodality therapy

A 75-year-old female presented with a 7-month history of intermittent macrohematuria and urinary retention. Physical examination revealed a firm, round mass on the anterior vaginal wall. The diagnosis by urethroscopy and radiological evaluation was localized urethral diverticular tumor. Pathological examination of the biopsy specimen revealed adenocarcinoma. The patient received two courses of intra-arterial and systemic chemotherapy using cisplatin, 5-fluorouracil and leucovorin, followed by radiation to the urethra. The tumor shrunk markedly after chemotherapy. The patient underwent total urethrectomy and vesicostomy. Two years after the operation, she had no evidence of recurrence. Adenocarcinoma of the female urethral diverticulum is rare and has been treated by surgery and/or radiation. The present case is the first case of it being treated by multimodality therapy including chemotherapy.     

前尿道狭窄的病因和治疗

前尿道狭窄的发生率有增高趋势,如治疗不当,会进一步加重尿道损伤而造成复杂性前尿道狭窄,难于处理。近年来在其治疗上取得了很大进步,但多数泌尿外科医师对此病认识不足,治疗上存在差异,可能导致并发症的发生。     

先天性男性前尿道憩室的临床诊治

目的总结先天性男性前尿道憩室的临床诊断和治疗特点。方法回顾性分析1996年1月1日至2009年9月1日收治的4例先天性男性前尿道憩室的临床资料,包括临床表现、影像学检查、手术方法、术后随访等。结果 4例患者年龄3个月～3岁,均为出生后即有尿路梗阻症状,包括排尿困难,尿后滴沥等,排尿时阴茎根部至阴囊可见包块鼓起,均行了排泄性膀胱尿路造影、超声及尿道镜检,1例行MRI检查,均可于术前明确诊断。4例患者都行了开放性前尿道憩室切除和尿道整形术。术后随访15～99个月,患者均恢复好,排尿通畅,未见尿道狭窄和尿道憩室复发病例。结论对出生后出现尿路梗阻的男性患者要考虑到先天性前尿道憩室的可能性而进一步做检查明确诊断,同时要注意与尿道憩室并存的泌尿系统畸形。对先天性前尿道憩室建议开放手术,即憩室切除同时行尿道整形,手术效果好。     

Double breasting repair of urethral fistula in a patient with perineal abscess secondary to a large urethral stone

We report here a case of urethral fistula managed successfully following incision and drainage for the urethral abscess secondary to a large urethral stone leading to a large diverticulum (another rare condition) by using the technique of double breasting, where we used the redundant urethra and overlying skin.     

An anterior urethral stitch improves urinary incontinence following radical prostatectomy

OBJECTIVE: To determine the effects of an anterior urethral stitch, referred to as an endopelvic anterior urethral stitch (EAUS), in reducing recovery time for post-prostatectomy urinary incontinence. METHODS: The urinary continence recovery time for 24 patients, who received a retropubic radical prostatectomy with the EAUS procedure, was compared to that of a historical control series of 22 patients without EAUS. The EAUS is a simple 2-0 polyglactin stitch placed between the bunched dorsal vein complex and the anterior urethra. This procedure was performed at the time of urethro-vesical anastomosis. Continence recovery time was defined as the day after removal of the urethral catheter when the patient no longer required pads for incontinence. RESULTS: A significantly shorter time for continence recovery (median 8.5 days) was obtained in EAUS patients compared with that of the control series (median 72 days) (P < 0.0001). Early recovery of continence was observed in 12/24 patients (50%) within 1 week and 18/24 patients (75%) within 1 month in EAUS patients. No adverse effects or complications were observed in the EAUS patients. CONCLUSION: A surgical procedure, the EAUS, has been developed that reduces urinary incontinence in patients who have undergone a radical prostatectomy. This procedure is simple and quick and improves recovery of continence without any side-effects.     

Anterior urethral valves in children: A possible association between anterior urethral valves and Cowper''s duct cyst

To elucidate the pathophysiology of congenital obstruction of the anterior urethra and to investigate the association between anterior urethral valves and syringocele. Three boys with congenital obstruction of the anterior urethra diagnosed at our department between 1997 and 2004 were analyzed retrospectively. All three boys had congenital obstruction in the bulbar urethra. The presenting symptoms and age of each patient were varied. Whereas continuity between Cowper's duct and the diverticulum was not demonstrated radiographically in all of the boys, it was speculated endoscopically in all. Our series has suggested a possible association between anterior urethral valves (diverticulum) and syringocele. These congenital anomalies of the anterior urethra should be considered in the differential diagnosis of obstructive lesions of the urinary tract.     

'Pseudospongioplasty' in the repair of a urethral diverticulum

OBJECTIVES: To describe a technique for repairing urethral diverticula which includes neourethral reconstruction and increasing the mechanical support of the neourethra. PATIENTS AND METHODS: Between February 1995 and May 2000, 267 patients with proximal hypospadias underwent a one-stage penile skin longitudinal flap urethroplasty. The overall postoperative complication rate was 20%; a diverticulum formed in 24 patients (9%) and in all it was repaired. Diverticulectomy was carried out by de-epithelialization of excess diverticular skin, so that two subcutaneous vascularized tissue wings could be created. After re-establishing distal urethral patency and neourethral closure, the de-epithelialized diverticular wings were folded and overlapped to form a mechanical support for the neourethral ventral wall; this procedure was termed 'pseudospongioplasty'. RESULTS: There were no recurrences of diverticulum or any fistula formation. The only complication was urethral stenosis in two cases, which was successfully resolved by internal urethrotomy. CONCLUSION: Re-establishing patency and providing mechanical support are essential when repairing a urethral diverticulum. Our technique with pseudospongiosal tissue reconstruction during the repair represents a good alternative or addition to other techniques.     

Dorsal inlay buccal mucosal graft (Asopa) urethroplasty for anterior urethral stricture

Asopa described the inlay of a graft into Snodgrass’s longitudinal urethral plate incision using a ventral sagittal urethrotomy approach in 2001. He claimed that this technique was easier to perform and led to less tissue ischemia due to no need for mobilization of the urethra. This approach has subsequently been popularized among reconstructive urologists as the dorsal inlay urethroplasty or Asopa technique. Depending on the location of the stricture, either a subcoronal circumferential incision is made for penile strictures, or a midline perineal incision is made for bulbar strictures. Other approaches for penile urethral strictures include the non-circumferential penile incisional approach and a penoscrotal approach. We generally prefer the circumferential degloving approach for penile urethral strictures. The penis is de-gloved and the urethra is split ventrally to exposure the stricture. It is then deepened to include the full thickness of the dorsal urethra. The dorsal surface is made raw and grafts are fixed on the urethral surface. Quilting sutures are placed to further anchor the graft. A Foley catheter is placed and the urethra is retubularized in two layers with special attention to the staggering of suture lines. The skin incision is then closed in layers. We have found that it is best to perform an Asopa urethroplasty when the urethral plate is ≥1 cm in width. The key to when to use the dorsal inlay technique all depends on the width of the urethral plate once the urethrotomy is performed, stricture etiology, and stricture location (penile vs. bulb).     

Transvaginal ultrasound for the diagnosis of urethral diverticulum

PURPOSE: We reviewed our experience with urethral diverticula and transvaginal ultrasound to evaluate female patients with this condition. MATERIALS AND METHODS: All female patients who underwent transvaginal ultrasound during evaluation for urethral diverticulum at our institution between May 1995 and April 2002 were identified by searching a data base. We reviewed the diagnostic evaluation and compared diagnostic techniques with transvaginal ultrasound for diagnosing urethral diverticulum. RESULTS: Of the 25 patients with suspected urethral diverticulum who underwent transvaginal ultrasound as a diagnostic procedure 10 (40%) were diagnosed with urethral diverticulum, including 10 in whom it was confirmed by surgery or other diagnostic procedures. Transvaginal ultrasound was less expensive than the other diagnostic modalities and in no case did it miss a urethral diverticulum that was identified by another diagnostic technique. Urethral diverticulum was detected on 1 of 3 voiding cystourethrograms (33%) and this study missed the diagnosis in 1 case that was diagnosed by transvaginal ultrasound. Three cases of urethral diverticulum were noted on transvaginal ultrasound after they were missed by cystoscopy. Videourodynamics were unable to diagnose urethral diverticulum. CONCLUSIONS: Transvaginal ultrasound is effective for evaluating patients with suspected urethral diverticulum. It is less expensive and may identify diverticula missed by other diagnostic modalities.     

Multiple Urethral Calculi in Children: Report of Two Cases

(Received for publication on June 16, 1997; accepted on Jan. 6, 1998)