Giant calculus of the posterior urethra following recurrent penile urethral stricture

A case of an unusually large, proximal urethral calculus located very close to the external sphincter and caused by recurrent urethral stricture is presented.     

Prolapsing congenital polyp of posterior urethra and urethral duplication associated with imperforate anus

We report the first case of a boy with a prolapsing congenital polyp of the posterior urethra associated with urethral duplication and imperforate anus.     

Complete tear of ventral penile skin and penile urethra: A rare infective complication of chronic urethral catheterization

We report the case of a 93-year-old paraplegic male patient who presented with complete tear of penile urethra and ventral penile skin due to indwelling urethral catheter. Therefore, debilitating patients with chronic indwelling urethral catheters should be in surveillance and caregivers of these patients should be alerted for such potential complications.     

Observations upon techniques for reconstruction of the urethral meatus, the hypospadiac glans deformity and the penile urethra

Many minimal defects of the terminal urethra may be left untreated; others may be considerably improved by a simple one-stage extension to a terminal position by one of the many one-stage "flap-strip" procedures. Patients with a marked ventriflexed glans are much better treated by the "kippered-glans" procedure; undertaken as a two-stage procedure, the functional and the cosmetic results of this procedure are extremely good and reliable. The results of one-stage procedures reflect the experience and the judgement of the surgeon but they tend to be less perfect and furthermore there is always an element of "double or quits" inasmuch as complications may require revision procedures. Thus a minor surgical dilemma arises because both the cosmetic and the functional results of a two-stage "kippered-glans" procedure for severe hypospadiac deformities tend to be better than those achieved for minor deformities by one-stage flap-strip or glans-flap procedures.     

Transmission of penile cuff pressure to the penile urethra.

PURPOSE: We developed a noninvasive method to measure voiding bladder pressure by inflating a penile cuff to interrupt flow. We tested the underlying assumption that cuff pressure is transmitted to the penile urethra. MATERIALS AND METHODS: In 35 men we simultaneously recorded penile cuff and urethral pressure during 2 experimental protocols for 6 cuffs of various widths and manufactures. Initially a urethral pressure transducer was placed at the mid point of the cuff and urethral pressure was continuously recorded during cuff inflation. In experiment 2 cuff pressure was set at 120 cm. water and the urethral pressure profile was measured by withdrawing the urethral transducer through the cuff width. RESULTS: There was excellent agreement of cuff with urethral pressure over the range of 0 to 200 cm. water for cuffs 37 to 54 mm. wide. Narrower cuffs showed wider variation with less efficient transmission of cuff pressure to the urethral lumen. Similarly maximum pressure in the urethral pressure profile showed best agreement for cuffs 38 and 46 mm. wide. Wider cuffs produced higher and narrower cuffs produced lower transmitted pressure within the urethra. Cuff performance was also related to penile size. Results had good within-subject repeatability. CONCLUSIONS: We demonstrated that pressure transmission from cuff to urethra is optimal at a cuff width of 40 to 50 mm. and recommended this width for other investigations of noninvasive bladder pressure measurement.     

Hypospadias and the embryogenesis of the penile urethra

The findings of a histological study of a rare specimen of a human hypospadias penis are presented. These findings suggest that distal pits are due to arrested development of the glandar urethra. The present findings also indicate that accessory urethrae and possibly the ventral position of the urethral meatus are the result of an intrinsic abnormality of the urethral plate.     

Iatrogenic urethral strictures of the male urethra

The iatrogenic aetiology of urethral stricture appears to be increasing in frequency. Transurethral catheterization and endourethral manipulation are the principal aetiologic factors. Prevention is based essentially upon a greater respect of the urethra when an endoscopic exploration is necessary and the use of suprapubic catheterization whenever bladder drainage is necessary.     

On the morphology and pathology of the internal urethral orifice

Basing his observations on the arrangement of the vesical musculature, author outlines the physiological phenomena occurring in the vicinity of the internal urethral orifice. He has found that the proximal portion of the posterior part of the urethra suffices to ensure continence at rest, while on exertion urine escapes if the external sphincter is defective. All morphological alterations accompanying disturbances of vesical innervation occur in the neighbourhood of the internal orifice. Endoscopy supplies information about the cause of nervous disorders. It is important that examinations of this kind be performed during micturition and not only when the bladder is at rest. by doing so it is possible to distinguish between urinary phenomena due to higher (cervical, cerebral) and lower (thoracic) neural lesions.     

Congenital rectovesical fistula in the absence of imperforate anus

Two neonates with multiple congenital anomalies presented with contamination of the urinary tract with fecal organisms. Both patients had normal anorectal areas but in both, a work-up of the urinary tract infection including cystogram and barium enema revealed a rectovesical fistula. This is highly unusual and as far as can be determined, no reports similar to this could be found. Patient 1 succumbed from severe cardiovascular disease after colostomy so that no further diagnostic or therapeutic measures could be taken. Patient 2 underwent sigmoid colostomy to divert the fecal contamination of the bladder. He then underwent successful surgical division of the rectovesical fistula from an abdominal approach and subsequently had his colostomy closed. Intraoperatively, a catheter placed in the fistula via the rectum was quite helpful in identification of the fistula. This very unique lesion in this second patient was one of a constellation of anomalies including megalourethra, epispadiac urethral fistula, undescended testes, bilaterally, a floppy lower abdominal wall, and absent left kidney. This patient could be construed as a variant of the prune belly syndrome.     

Case of male accessory urethra with orifice in the scrotal skin

A 67-year-old male had an innate fistular orifice at the scrotal skin. In spite of occasional pus discharge from the orifice, no treatment had been performed for the fistula because it improved spontaneously. Due to increasing pus discharge, the fistula was resected at a dermatology clinic, but a persistent fistula tract was confirmed postoperatively by MRI. The fistula adjoined the bulbar urethra and was considered an accessory urethra. We performed resection of the fistula to resolve the frequent pus discharge and pain due to infection of the fistula. The isolated fistula did not communicate with the urethra and the proximal edge ended blindly. Pathological examination showed that the proximal end consisted of transitional epithelium and the distal end consisted of stratified squamous epithelium which meant an accessory urethra. Accessory urethra is not a rare condition, but cases like this one with an orifice that opened at the scrotal skin are extremely rare. As the treatment for the fistula, complete resection should be indicated.     

尿道置三根硅胶管治疗骨盆骨折后尿道断裂及炎性尿道狭窄

为改进探讨骨盆骨折后尿道断裂、炎性尿道狭窄新的治疗方法,作者对骨盆骨折后尿道断裂会师术后７～１０天患者６６例、炎性尿道狭窄患者１５例强行扩张术后,尿道内置三根２．５ｍｍ硅胶管,留置３个月。结果：骨盆骨折后尿道断裂６６例,治愈率８７．９％,良好率３．０％,失败率９．１％;炎性尿道狭窄１５例,全部治愈。本组８１例总治愈率９２．６％,失败率７．４％。作者认为,该术式操作简单、安全、有效,并且能显著地降低尿道感染及狭窄。     

延长尿道口-阴道口间距治疗女性尿道综合征50例

目的：探讨治疗女性尿道综合征的手术方法及可行性。方法：对50例女性尿道综合征患者采用延长尿道口-阴道口间距进行治疗。结果：除5例失随访外，余45例(90％)全部得到随访，痊愈者38例(84％)，好转4例(9％)，差3例(7％)，痊愈38例中，术后3个月内痊愈者8例，4--6月13例，7-12月12例，1--2a 5例，平均8月，总有效率达到93％。结论：此术式治疗女性尿道综合征，简单，安全、可行，疗效满意。     

Distal urethrectomy for localized penile squamous carcinoma in situ extending into the urethra: an updated series

Introduction

The presence of squamous carcinoma in situ (CIS) of the distal penis extending into the urethral meatus is generally considered a contraindication for glans-sparing procedures. Distal urethrectomy with subsequent reconstruction can provide an alternative approach toward urethral resection while providing penile preservation in select cases. Unfortunately, long-term oncologic outcomes with this approach are ill-defined.

Materials and methods

Between 1988 and 2012, five patients at Indiana University Medical Center underwent distal urethrectomy with reconstruction for penile squamous CIS extending into the urethral meatus. This cohort was retrospectively reviewed to evaluate functional and oncological outcomes.

Results

Of the five patients, four presented with glanular lesions and were initially managed with Mohs procedure in three cases, and local excision in one. The final patient presented with extensive urethral disease and was managed with primary urethrectomy. Reconstruction was performed with penile skin pedicle grafts in four patients and perineal urethrostomy in one. Final pathologic stage was T1 in one patient and Tis in the remaining four. Follow-up ranged from 6 to 96 months. One local recurrence was verified; however, it occurred outside the urethral area. This was confirmed in the pathologic analysis after the patient underwent a partial penectomy. Meatal dilation was necessary in two patients 12 and 7 months after the procedure.

Conclusion

Distal urethrectomy for penile squamous CIS extending into the urethral meatus is a valid alternative to achieve negative surgical margins while preserving a penile function. Oncologic outcomes appear acceptable but larger series are still warranted to confirm our findings.