BACKGROUND Urethral stricture is a condition that often develops with trauma and results in narrowing of the urethral lumen.Although endoscopic methods are mostly used in its treatment,it has high recurrence rates.The...BACKGROUND Urethral stricture is a condition that often develops with trauma and results in narrowing of the urethral lumen.Although endoscopic methods are mostly used in its treatment,it has high recurrence rates.Therefore,open urethroplasty is recommended after unsuccessful endoscopic treatments.AIM To investigate the risk factors associated with urethral stricture recurrence.METHODS The data of male patients who underwent internal urethrotomy for urethral stricture between January 2017 and January 2023 were retrospectively analyzed.Demographic data,comorbidities,preoperative haemogram,and biochemical values obtained from peripheral blood and operative data were recorded.Patients were divided into two groups in terms of recurrence development;recurrence and non-recurrence.Initially recorded data were compared between the two groups.RESULTS A total of 303 patients were included in the study.The mean age of the patients was 66.6±13.6 years.The mean duration of recurrence development was 9.63±9.84(min-max:1-39)months in the recurrence group.Recurrence did not occur in non-recurrence group throughout the follow-up period with an average time of 44.15±24.07(min-max:12-84)months.In the comparison of both groups,the presence of diabetes mellitus(DM),hypertension(HT),and multiple comorbidi-ties were significantly higher in the recurrence(+)group(P=0.038,P=0.012,P=0.013).Blood group,postoperative use of non-steroidal anti-inflammatory drugs,preoperative cystostomy,cause of stricture,iatrogenic cause of stricture,location and length of stricture,indwelling urinary cathater size and day of catheter removal did not differ between the two groups.No statistically significant difference was observed between the two groups in terms of age,uroflowmetric maximum flow rate value,hemo-gram parameters,aspartate aminotransferase(AST),alanine aminotransferase(ALT),fasting blood sugar,creati-nine,glomerular filtration rate,neutrophil-lymphocyte ratio,platelet-lymphocyte ratio,lymphocyte-monocyte ratio,monocyte-lymphocyte ratio and AST/ALT ratios.CONCLUSION In patients with urethral stricture recurrence,only the frequency of DM and HT was high,while inflammation marker levels and stricture-related parameters were similar between the groups.展开更多
Urethral duplication is a rare congenital anomaly, mainly involving boys, although cases in girls have been reported. The majority of duplications of the urethra are asymptomatic and the discovery of this malformation...Urethral duplication is a rare congenital anomaly, mainly involving boys, although cases in girls have been reported. The majority of duplications of the urethra are asymptomatic and the discovery of this malformation can be done at any age. Diagnosis and determination of its type are based on urethrocystography with mid-void images, which helps to guide the surgical approach. The treatment is not yet well codified and the therapeutic attitude varies from one author to another. We report a clinical observation of a urethral duplication with a calculus in a six-year-old boy who underwent a partial urethrectomy of the supernumerary urethra in whom a lithotomy and a urethrectomy were performed via a suspension approach. This observation illustrates the possibility of urinary stone formation after partial urethrectomy of the supernumerary urethra.展开更多
The aim is to highlight the epidemiological, clinical and therapeutic aspects of iatrogenic urethral strictures. Methodology: This was a retrospective study, descriptive type, 6 years from January 1<sup>st</s...The aim is to highlight the epidemiological, clinical and therapeutic aspects of iatrogenic urethral strictures. Methodology: This was a retrospective study, descriptive type, 6 years from January 1<sup>st</sup> 2012, to December 31<sup>st</sup> 2017 carried out in the Urology-Andrology department of the National Hospital Ignace Deen of Conakry. All records of patients carrying the Diagnosis of iatrogenic urethral stricture were included in this study. Results: We collected 30 cases of iatrogenic urethral stricture, with a frequency of 2.5%. The average age of the patients was 62.33 years. The most affected age group is from 71 to 80 years (33.33%). Dysuria was the main reason for consultation. Retrograde urethrocystography plus voiding cystourethrography (RUC-VCU) allowed us to make the diagnosis. The treatment was essentially surgical and several techniques were used. Endoscopic internal urethrotomy alone was the most performed surgical technique, followed by segmental uretrectomy associated with end-to-end urethrography. Conclusion: Iatrogenic urethral stricture is easy to diagnose but difficult to manage due to the frequency of recurrences. Improving the quality of care, in particular urethral catheterizations and transurethral endoscopic maneuvers, makes it possible to prevent it.展开更多
The objective of this case report was to highlight the characteristics of posterior urethral valves observed in a 3-year-old patient and to describe their management. The case of a 4-year-old patient treated for a pos...The objective of this case report was to highlight the characteristics of posterior urethral valves observed in a 3-year-old patient and to describe their management. The case of a 4-year-old patient treated for a posterior urethral valve with bilateral renal cortical atrophy was reviewed. The diagnosis was confirmed by abdominal ultrasound, cystography and abdominal CT. He was referred to Martinique (a tertiary health establishment) for effective support. From the acute situation to the fortuitous discovery, its understanding must be deepened because of the potential immediate symptomatic impact in the form of renal colic which can be associated with sepsis, as well as in the long term on renal function. This observation is intended to help the attending physician to initiate his diagnosis and treatment.展开更多
Background: Male urethral stricture is as yet considered one of the very popular and defying dilemmas to the urologist. Treatment modalities include dilation, endoscopic urethrotomy and urethroplasty, however internal...Background: Male urethral stricture is as yet considered one of the very popular and defying dilemmas to the urologist. Treatment modalities include dilation, endoscopic urethrotomy and urethroplasty, however internal optical urethrotomy displays rapid cure, lower scarring, and minimal hazard of infection. Purpose: To evaluate the efficacy of internal optical urethrotomy in the treatment of patients with urethral stricture. Patients & Methods: This study was carried out at Al-Yermouk Teaching Hospital/Baghdad/Iraq in the period between January 2015 and January 2018. A group of 75 male patients (16 - 25 years of age) presented with urethral strictures had been treated with internal optical urethrotomy. Follow-up period ranged from 1 - 3 months. Outcome was graded as good, fair and poor. Results: Out of 75 patients, 28 (37.3%) were (21 - 30) years of age. Trauma was the most popular source of stricture found in 40 (53.3%) and the most widespread presenting feature was poor urinary flow in 32 (42.6%) patients. Stricture in the bulbous urethra in 48 (64%) cases was found to be the most prevalent area followed by penile urethra in 16 (21.3%) cases. Overall response rate was good in 52 (69.3%) patients. Eleven (14.6%) patients exhibited only minor bleeding postoperatively with no other considerable complications. Conclusion: Internal optical urethrotomy is a dependable and effective procedure in treating urethral stricture.展开更多
Paraurethral cysts are a rare congenital abnormality seen in female neonates. We present the case of a female newborn with a paraurethral cyst resulting in urinary obstruction. Surgical intervention was chosen as a re...Paraurethral cysts are a rare congenital abnormality seen in female neonates. We present the case of a female newborn with a paraurethral cyst resulting in urinary obstruction. Surgical intervention was chosen as a result of the obstruction.展开更多
We report here the history and evolution of the use of oral mucosa in reconstructive urethral surgery since it was first used for urethroplasty in 1894.Since that time,many authors have contributed to develop,improve ...We report here the history and evolution of the use of oral mucosa in reconstructive urethral surgery since it was first used for urethroplasty in 1894.Since that time,many authors have contributed to develop,improve and popularize the use of oral mucosa as a substitute material.Paediatric urologists should be considered pioneers on the use of oral mucosa as they used it to repair primary and failed hypospadias.The use of oral mucosa to repair penile and bulbar urethral strictures was described,for the first time,in 1993.Important evolutions in the technique for harvesting oral mucosa from the cheek were reported in 1996.Today,oral mucosa is considered the gold standard material for any type of anterior urethroplasty in a one-or two-stage repair due to its biological and structural characteristics that make it a highly versatile that is adaptable to any environment required by the reconstructive urethral surgery.As the future approaches,tissue engineering techniques will provide patients with new materials originating from the oral epithelial mucosal cells,which are cultured and expanded into a scaffold.However,the path to reach this ambitious objective is still long and many difficulties must be overcome along the way.展开更多
BACKGROUND Clear cell adenocarcinoma of the urethra is a rare type of aggressive cancer with a poor prognosis.Clear cell carcinoma of the urethra represents less than 0.02%of all malignancies in women.Adenocarcinomas ...BACKGROUND Clear cell adenocarcinoma of the urethra is a rare type of aggressive cancer with a poor prognosis.Clear cell carcinoma of the urethra represents less than 0.02%of all malignancies in women.Adenocarcinomas account for 10%of female urethral carcinomas,of which 40%are the clear cell variant.Determining the presence or absence of certain mutations through genetic testing may predict whether a patient with cancer may benefit from a particular chemotherapy regimen.CASE SUMMARY A 40-year-old woman presented with a 3-year history of slow urinary flow and a 3-mo history of urinary urgency and frequency as well as gross hematuria.An abdominal and pelvic computed tomography scan demonstrated enlarged lymph nodes in the abdomen and pelvis.A biopsy of a left inguinal lymph node microscopically confirmed a metastatic adenocarcinoma of the urethra.Specialized genetic testing determined personalized chemotherapy.She was treated successfully with a non-platinum-based chemotherapy consisting of paclitaxel and bevacizumab.Following 3 cycles of paclitaxel and bevacizumab,she attained significant clinical improvement,and response by FDG-Positron emission tomography(PET)imaging showed a definite improvement in size and metabolic activity.She achieved complete response after 6 cycles of therapy by PET scan.The patient concluded 11 cycles of paclitaxel and bevacizumab,and a subsequent PET scan confirmed progression of metastatic disease.The patient was then treated with two cycles of doxorubicin after which a PET scan revealed a mixed response to the treatment.CONCLUSION We report the first case of a patient with metastatic clear cell adenocarcinoma of the urethra who underwent personalized chemotherapy after testing for cancer gene alterations.Our unique case represents the safe and effective use of nonplatinum-based chemotherapy in clear cell adenocarcinoma of the urethra.展开更多
Aim: Describe the clinical, radiological and management of patients with posterior urethral valves. Materials and Methods: This was a retrospective descriptive study over a period going from January 2011 to December 2...Aim: Describe the clinical, radiological and management of patients with posterior urethral valves. Materials and Methods: This was a retrospective descriptive study over a period going from January 2011 to December 2016, reviewing 12 cases of patients treated for valves of the urethra posterior to the medical surgical center of urology in Cameroon at Douala. The variables studied were clinical, paraclinical, therapeutic and evolutionary. Results: In 5 years, we had diagnosed and treated 12 cases of posterior urethral valves, an average of 2.4 per year. The average age of patients was 41.6 months with extrems of 3 and 156 months. The reason for consultation was dominated by urinary tract infections. Urethrocystography and echography were performed in all patients and allowed to objectify a bilateral ureterohydronephrosis, a diverticular bladder in 9 cases and 4 cases of vesico-ureteral reflux, including a grade 4 according to the classification of Cendron, 8 patients suffered from acute urinary failure. Renal scintigraphyrealised on 3 patients had as objective in 1 patient the existence of a disfunctioning kidney. The treatment consisted of an endoscopic incision of the valves (n = 8), a vesicostomy (n = 3) and an iterative urethral dilatation with double J catheter placement (n = 1). The evolution was favorable (n = 7), and 5 cases of death were recorded. Conclusion: The endoscopic incision is the gold-standard of the treatment of the valves of the posterior urethra. The vesicostomy is an alternative in the absence of adequate technical platform. Despite adequate support, the prognosis remains burdened with significant mortality.展开更多
Penile fracture is a rare urological emergency. It occurs mainly in young adults during sexual intercourse. In many instances, one of the corpora carvanosus is involved though bilateral injuries with or without corpus...Penile fracture is a rare urological emergency. It occurs mainly in young adults during sexual intercourse. In many instances, one of the corpora carvanosus is involved though bilateral injuries with or without corpus spongiosus involvement is not uncommon. However, isolated injury to corpus spongiosus is extremely rare. We report a case of isolated rupture of corpus spongiosum secondary to penile injury during coitus in a 43-year-old man that presented to University Hospital Souro Sanou of Bobo Dioulasso. He presented with history of persistence bleeding per urethra following penile injury during sexual intercourse. The Retrograde urethrography (RUG) showed a partial rupture of urethra, Moore type 3. Complementary penile ultrasound revealed extensive contusion of the urethra with circumferential hematoma and rupture of the distal 1/3 of the corpus spongiosus. He had gentle per urethral catheterization which was left for one month. Penile ultrasound sound done after removal of catheter showed residual injury and narrowing of the urethra.展开更多
Introduction: The urethral diverticulum or urethrocele corresponds to a saccular dilation of a portion of the urethral wall. Our objective was to report the clinical aspects, investigations and therapeutic aspects of ...Introduction: The urethral diverticulum or urethrocele corresponds to a saccular dilation of a portion of the urethral wall. Our objective was to report the clinical aspects, investigations and therapeutic aspects of three cases of congenital urethrocele. Observations: They were three male patients aged 11, 20 and 42 years, two of whom had consulted for terminal dribbling. The diagnosis of urethrocele was made for all patients with retrograde and voiding cystouretrography. Treatment consisted of resection of the urethrocele followed by urethroplasty for both cases. Conclusion: Diagnostic of congenital urethrocele must always be assessed when there is a persistent terminal dribbling, and systematically ask for a retrograde and voiding cystourethrography to confirm it.展开更多
<strong>Aim:</strong> To improve management of the posterior urethral valve (PUV) in children in a hospital environment. <strong>Patients and Methods:</strong> This was a retrospective descript...<strong>Aim:</strong> To improve management of the posterior urethral valve (PUV) in children in a hospital environment. <strong>Patients and Methods:</strong> This was a retrospective descriptive study that covered a sixteen (16) years period, from January 1, 2002 to December 31, 2017, In pediatric surgery and urology departments of our teaching hospital, 26 cases of posterior urethral valve (PUV) were involved. The diagnosis was made by retrograde urethrocystography and micturition, supplemented by ultrasound. <strong>Results:</strong> During this period, 26 patients (1.7%) had a PUV. The mean age of the patients was 73, 2 months with extremes ranging from 6 to 180 months. Fifteen patients consulted for dysuria, 8 for complete retention of urine. Only one patient had a history of rolling the valves to the benign ones. The main complications found were urinary tract infection in 15 children, urolithiasis in 3 children and renal failure in 2 children. Two children had serum creatinine values of 50 and 58 mg/L. The lamination of the posterior urethral valves was performed in all patients. In our series, we had one death from chronic renal failure in a 6-year-old child with a bilateral mute kidney at IVU. <strong>Conclusion:</strong> The valve diagnosis of the posterior urethra is made late because the diagnosis is still postnatal.展开更多
Background: Urethral stricture is a disabling condition that remains prevalent due to the upsurge of sexually transmitted infections and traumatic lesions of the urethra during trauma of the pelvis in humans. Objectiv...Background: Urethral stricture is a disabling condition that remains prevalent due to the upsurge of sexually transmitted infections and traumatic lesions of the urethra during trauma of the pelvis in humans. Objective: Describe the epidemiological, clinical and radiological presentations of male urethral strictures. Method: It was a cross-sectional and descriptive study during a one-year period from January to December 2017 including all male patients presenting for a urethrocystography examination, at the Ngaoundere Radiology and Medical Imaging Center who agreed to participate. The urethrocystography technique depended on patient’s condition and was either retrograde, anterograde, or following intravenous urography. The examinations were performed with GE X-ray equipment using Kodak Dry View CRs. The interpretation was performed by a radiologist with at least five years of experience. The variables studied were age, clinic, history, uretrocystography technique and results. The data were collected using a previously established data sheet and processed with Sphinx Plus2 V5 and Microsoft Excel 2010 software. Results: 39 patients were enrolled in this study;the average age of our patients was 43.8 years with extremes of 4 and 76 years. The 50 - 60 age group (30.7%) was the most affected. Infection (53.9%) and trauma (23.1%) were the most common etiologies;dysuria (38.5%) and diminution of urinary flow (30.8%) were the most patient’s complaint. Retrograde urethrocystography (66.7%) was the most performed technic. Minimal bleeding in 46.2% of patients was the most common incident during urethrocystography;76.9% of patients had a difficult urination and 7.7% an impassable urethral meatus. After interpretation, 84.6% of patients had urethral stenosis, which was associated with bladder diverticula (23%) and fistulas (15.3%). The stenosis was seated on membranous urethra (81.8%), tight type (45.4%), short (66.7%) and single (81.8%). The post-void residue was significant in 84.6% of cases and not significant in 15.4% of cases. 15.3% of the urethrocystographies were normal. Conclusion: Urethral stenosis in Ngaoundere mainly affects young adult;the main etiology is infectious, very often unique, short, and tight and the membranous urethra is the seat of predilection. Hence, to reduce the extent of pathology with its functional consequences and its impact on the socio-professional life in our context, the focus should be on sexually transmitted infectious.展开更多
Purpose: To conduct a study of epidemiological, diagnostic and therapeutic aspects of urethral strictures at Yalgado Ouedraogo University Teaching Hospital. Patients and methods: It was about a retrospective and descr...Purpose: To conduct a study of epidemiological, diagnostic and therapeutic aspects of urethral strictures at Yalgado Ouedraogo University Teaching Hospital. Patients and methods: It was about a retrospective and descriptive study conducted in the urology division of Yalgado Ouedraogo Hospital from October 1st 2009 to September 30th 2014. All the patients, included in this study, had a urethral stricture confirmed by the voiding retrograde cystourethrogram (VCUG) or during surgical intervention with useful surgical report and medical file. Results: During the period of study, 127 complete medical records were found. The hospital prevalence was 10.1%. The average age of the patients was 50.5 (from 3 to 80 years). 55.6% of the patients were from rural areas. Dysuria and urinary retention were the major causes of consultation with respectively 66.7% and 33.3%. The aetiology of urethral stricture was infectious in 71.4% of the cases. The VCUG permitted to objectify the characteristics of the stenosis. The urethral stenoses were single in the majority of the cases, about 88.8% of cases. The bulbar urethral stricture was the major location. Escherichia coli was isolated in 77.7% of the urinary infections. The majority of patients (61.9%) had undergone open surgery including 39.7% end to end anastomosis. No endoscopic treatment was recorded. Conclusion: The urethral stenosis is frequent in our division. Its major aetiology is infectious. The treatment is dominated by open surgery in our context.展开更多
<strong>Aim:</strong> To compare and analyze dose constraints and target coverage results and to reduce Bladder Wall (B<sub>wall</sub>) V<sub>18.12</sub> for prostate Stereotactic-B...<strong>Aim:</strong> To compare and analyze dose constraints and target coverage results and to reduce Bladder Wall (B<sub>wall</sub>) V<sub>18.12</sub> for prostate Stereotactic-Body Radiation Therapy (SBRT) when Seminal Vesicles (SSVV) are included or not. Several indicators based on intersection volumes are obtained to predict constraint fulfillment. <strong>Background:</strong> Due to prostate’s low alpha-beta ratio and the possibility of increasing the therapeutic ratio several moderate and extreme hypofractionation schemes have been proposed. The scheme selected was a fivefraction urethra-sparing prostate SBRT. <strong>Materials and Methods:</strong> 150 patients divided into two groups according to the inclusion of SSVV in PTV or not were analyzed. Histograms, average values, standard deviations and degrees of fulfillment were obtained for each constraint or goal and group. A possible reduction of the B<sub>wall</sub> V<sub>18.12</sub> was addressed by re-optimizing fifty randomly chosen patients. Predictors of constraint fulfilling were obtained by using the intersections of B<sub>wall</sub> and Rectum Wall (R<sub>wall</sub>) with the PTV. <strong>Results:</strong> Significant differences in R<sub>wall</sub> V<sub>32.62</sub> and V<sub>29</sub> were obtained when evaluating the influence of SSVV inclusion. A reduction of 12% in the B<sub>wall</sub> V<sub>18.12</sub> constraint was achieved without compromising coverage and OARs doses. No dependence on the inclusion of SSVV was found. <strong>Conclusions:</strong> Statistically significant differences have been found in R<sub>wall</sub> intermediate-dose constraint when SSVV was included. A reduction of 12% in the B<sub>wall</sub> V<sub>18.12</sub> constraint has been achieved without compromising the PTV coverage and the rest of OARs constraints. Constraint fulfillment predictors could be useful to evaluate the feasibility of prostate SBRT prior to the planning process for every single patient.展开更多
Inverted urothelial papilloma is a rare benign tumour and represents one of the urothelial lesions with inverted morphology. Accurate diagnosis and differentiation from other inverted lesions is important because its ...Inverted urothelial papilloma is a rare benign tumour and represents one of the urothelial lesions with inverted morphology. Accurate diagnosis and differentiation from other inverted lesions is important because its proper clinical management and expected clinical outcomes are distinctly different. Here we describe a case of a large inverted urothelial papilloma of the prostatic urethra and a synchronous non-invasive low-grade papillary urothelial carcinoma of the bladder in a 60 year-old man. We focus on the differential diagnosis of inverted urothelial papilloma.展开更多
Primary urethral malignant melanoma is an extremely rare malignancy with early metastasis and often delayed diagnosis, resulted in poor prognosis. Literature on this entity, especially with regard to urinary cytology ...Primary urethral malignant melanoma is an extremely rare malignancy with early metastasis and often delayed diagnosis, resulted in poor prognosis. Literature on this entity, especially with regard to urinary cytology is limited. We report here an extremely rare case of primary urethral malignant melanoma (MM) developed in a 95-year-old Japanese woman. A urinalysis showed macrophages containing brown granular pigments, and the urinary cytology was positive for atypical cells containing brown pigments suggestive of MM. Pathological examination of the biopsy specimen from the tumor revealed MM of the urethra. Immunohistochemically, the tumor cells showed strong cytoplasmic reactivities against antibodies, HMB-45 and Malan-A. Melanoma cells were immunohistochemically positive for c-Kit in their cytoplasm and cell membrane, although mutations in BRAF V600E and N/K-RAS were not detected. The urinary cytology and immunohistochemistry were useful for the rapid and accurate diagnosis for the urethral MM.展开更多
A foreign body in the urethra is the presence of an object in the urethra. They are often secondary, either to an erotic curiosity, <span style="white-space:nowrap;">û</span> or to psych...A foreign body in the urethra is the presence of an object in the urethra. They are often secondary, either to an erotic curiosity, <span style="white-space:nowrap;">û</span> or to psychiatric disorders. The diagnosis remains clinically aided by imagery. Treatment is most often endoscopic, but in some cases the use of open surgery is necessary. We reported the case of an 80-year-old man with no history of behavioral disorders;a wooden rod was inserted into the urethra to empty his bladder. The care consisted of a meatoplasty under locoregional anesthesia. Upon discharge, the patient had a good urine flow.展开更多
<strong>Background:</strong> The aim of this study was to evaluate the outcomes of stricture treatment using endoscopic internal urethrotomy in the male urethra. <strong>Patients and Methods:</str...<strong>Background:</strong> The aim of this study was to evaluate the outcomes of stricture treatment using endoscopic internal urethrotomy in the male urethra. <strong>Patients and Methods:</strong> We conducted a retrospective study from 2012 to 2017 at the Urology and Andrology Department of the University Hospital in Brazzaville, Congo. Medical records of 30 patients who underwent endoscopic internal urethrotomy for urethral stricture were analyzed. We studied the following variables: frequency of urethral stricture, age of patient, onset, cause and location of urethral stricture, duration of bladder catheterization, duration of hospitalization, and postoperative complications. The treatment outcome was assessed after a follow-up of 2.6 years (extreme: 2 and 4 years). Outcomes were considered successful or good when the patients had a normal urine flow and an unobstructed urethra at the Retrograde Urethrogram (RUG). <strong>Results:</strong> The mean age was 47.5 ± 9.7 years (range: 17 to 83 years). Dysuria was the most common symptom reported. We found that urethral stricture was mostly caused by infectious diseases (20 patients). The urethral stricture was located at the membranous urethra in 4 patients, the bulbar urethra in 25 patients, and the penile urethra in 1 patient. The mean duration of the bladder catheterization was 2.3 days. Hospitalization duration was 36 hours. We observed the following complications: urethrorrhagia in 3 patients, acute orchiepididymitis. We achieved good results in 23 patients. <strong>Conclusion:</strong> In our context where the practice of endoscopic internal urethrotomy is recent, it provides satisfactory results for the treatment of short urethral male stricture.展开更多
Introduction: To investigate if potty training from infancy can affect bladder dysfunction in boys with posterior urethral valves (PUV). Subjects and Methods: The voiding pattern and emptying ability were followed usi...Introduction: To investigate if potty training from infancy can affect bladder dysfunction in boys with posterior urethral valves (PUV). Subjects and Methods: The voiding pattern and emptying ability were followed using the 4-hour voiding observation method in 17 Vietnamese boys with PUV aged 3 months to 4 years who had been potty-trained from infancy. This group was compared with a group of healthy Vietnamese boys. Results: In the boys with PUV, the bladder volume increased according to age, and interrupted voiding was rare. However, when comparing boys with PUV with healthy boys, a significant difference was noted with more frequent voidings and lower voided volumes in the age group 0 - 1 year (P < 0.001). Despite the minimum amount of residual urine, average 8 ml or less in the boys with PUV, the age groups 1 - 2 and 2 - 4 years had significantly higher residual volumes compared with those of the healthy boys (P The findings from the 4-hour voiding observation showed few signs of dysfunctional bladder in the Vietnamese boys with PUV, including residual urine, even if there were signs of dysfunction compared with the healthy Vietnamese boys. Potty training from infancy could favor early bladder rehabilitation in boys with PUV.展开更多
文摘BACKGROUND Urethral stricture is a condition that often develops with trauma and results in narrowing of the urethral lumen.Although endoscopic methods are mostly used in its treatment,it has high recurrence rates.Therefore,open urethroplasty is recommended after unsuccessful endoscopic treatments.AIM To investigate the risk factors associated with urethral stricture recurrence.METHODS The data of male patients who underwent internal urethrotomy for urethral stricture between January 2017 and January 2023 were retrospectively analyzed.Demographic data,comorbidities,preoperative haemogram,and biochemical values obtained from peripheral blood and operative data were recorded.Patients were divided into two groups in terms of recurrence development;recurrence and non-recurrence.Initially recorded data were compared between the two groups.RESULTS A total of 303 patients were included in the study.The mean age of the patients was 66.6±13.6 years.The mean duration of recurrence development was 9.63±9.84(min-max:1-39)months in the recurrence group.Recurrence did not occur in non-recurrence group throughout the follow-up period with an average time of 44.15±24.07(min-max:12-84)months.In the comparison of both groups,the presence of diabetes mellitus(DM),hypertension(HT),and multiple comorbidi-ties were significantly higher in the recurrence(+)group(P=0.038,P=0.012,P=0.013).Blood group,postoperative use of non-steroidal anti-inflammatory drugs,preoperative cystostomy,cause of stricture,iatrogenic cause of stricture,location and length of stricture,indwelling urinary cathater size and day of catheter removal did not differ between the two groups.No statistically significant difference was observed between the two groups in terms of age,uroflowmetric maximum flow rate value,hemo-gram parameters,aspartate aminotransferase(AST),alanine aminotransferase(ALT),fasting blood sugar,creati-nine,glomerular filtration rate,neutrophil-lymphocyte ratio,platelet-lymphocyte ratio,lymphocyte-monocyte ratio,monocyte-lymphocyte ratio and AST/ALT ratios.CONCLUSION In patients with urethral stricture recurrence,only the frequency of DM and HT was high,while inflammation marker levels and stricture-related parameters were similar between the groups.
文摘Urethral duplication is a rare congenital anomaly, mainly involving boys, although cases in girls have been reported. The majority of duplications of the urethra are asymptomatic and the discovery of this malformation can be done at any age. Diagnosis and determination of its type are based on urethrocystography with mid-void images, which helps to guide the surgical approach. The treatment is not yet well codified and the therapeutic attitude varies from one author to another. We report a clinical observation of a urethral duplication with a calculus in a six-year-old boy who underwent a partial urethrectomy of the supernumerary urethra in whom a lithotomy and a urethrectomy were performed via a suspension approach. This observation illustrates the possibility of urinary stone formation after partial urethrectomy of the supernumerary urethra.
文摘The aim is to highlight the epidemiological, clinical and therapeutic aspects of iatrogenic urethral strictures. Methodology: This was a retrospective study, descriptive type, 6 years from January 1<sup>st</sup> 2012, to December 31<sup>st</sup> 2017 carried out in the Urology-Andrology department of the National Hospital Ignace Deen of Conakry. All records of patients carrying the Diagnosis of iatrogenic urethral stricture were included in this study. Results: We collected 30 cases of iatrogenic urethral stricture, with a frequency of 2.5%. The average age of the patients was 62.33 years. The most affected age group is from 71 to 80 years (33.33%). Dysuria was the main reason for consultation. Retrograde urethrocystography plus voiding cystourethrography (RUC-VCU) allowed us to make the diagnosis. The treatment was essentially surgical and several techniques were used. Endoscopic internal urethrotomy alone was the most performed surgical technique, followed by segmental uretrectomy associated with end-to-end urethrography. Conclusion: Iatrogenic urethral stricture is easy to diagnose but difficult to manage due to the frequency of recurrences. Improving the quality of care, in particular urethral catheterizations and transurethral endoscopic maneuvers, makes it possible to prevent it.
文摘The objective of this case report was to highlight the characteristics of posterior urethral valves observed in a 3-year-old patient and to describe their management. The case of a 4-year-old patient treated for a posterior urethral valve with bilateral renal cortical atrophy was reviewed. The diagnosis was confirmed by abdominal ultrasound, cystography and abdominal CT. He was referred to Martinique (a tertiary health establishment) for effective support. From the acute situation to the fortuitous discovery, its understanding must be deepened because of the potential immediate symptomatic impact in the form of renal colic which can be associated with sepsis, as well as in the long term on renal function. This observation is intended to help the attending physician to initiate his diagnosis and treatment.
文摘Background: Male urethral stricture is as yet considered one of the very popular and defying dilemmas to the urologist. Treatment modalities include dilation, endoscopic urethrotomy and urethroplasty, however internal optical urethrotomy displays rapid cure, lower scarring, and minimal hazard of infection. Purpose: To evaluate the efficacy of internal optical urethrotomy in the treatment of patients with urethral stricture. Patients & Methods: This study was carried out at Al-Yermouk Teaching Hospital/Baghdad/Iraq in the period between January 2015 and January 2018. A group of 75 male patients (16 - 25 years of age) presented with urethral strictures had been treated with internal optical urethrotomy. Follow-up period ranged from 1 - 3 months. Outcome was graded as good, fair and poor. Results: Out of 75 patients, 28 (37.3%) were (21 - 30) years of age. Trauma was the most popular source of stricture found in 40 (53.3%) and the most widespread presenting feature was poor urinary flow in 32 (42.6%) patients. Stricture in the bulbous urethra in 48 (64%) cases was found to be the most prevalent area followed by penile urethra in 16 (21.3%) cases. Overall response rate was good in 52 (69.3%) patients. Eleven (14.6%) patients exhibited only minor bleeding postoperatively with no other considerable complications. Conclusion: Internal optical urethrotomy is a dependable and effective procedure in treating urethral stricture.
文摘Paraurethral cysts are a rare congenital abnormality seen in female neonates. We present the case of a female newborn with a paraurethral cyst resulting in urinary obstruction. Surgical intervention was chosen as a result of the obstruction.
文摘We report here the history and evolution of the use of oral mucosa in reconstructive urethral surgery since it was first used for urethroplasty in 1894.Since that time,many authors have contributed to develop,improve and popularize the use of oral mucosa as a substitute material.Paediatric urologists should be considered pioneers on the use of oral mucosa as they used it to repair primary and failed hypospadias.The use of oral mucosa to repair penile and bulbar urethral strictures was described,for the first time,in 1993.Important evolutions in the technique for harvesting oral mucosa from the cheek were reported in 1996.Today,oral mucosa is considered the gold standard material for any type of anterior urethroplasty in a one-or two-stage repair due to its biological and structural characteristics that make it a highly versatile that is adaptable to any environment required by the reconstructive urethral surgery.As the future approaches,tissue engineering techniques will provide patients with new materials originating from the oral epithelial mucosal cells,which are cultured and expanded into a scaffold.However,the path to reach this ambitious objective is still long and many difficulties must be overcome along the way.
文摘BACKGROUND Clear cell adenocarcinoma of the urethra is a rare type of aggressive cancer with a poor prognosis.Clear cell carcinoma of the urethra represents less than 0.02%of all malignancies in women.Adenocarcinomas account for 10%of female urethral carcinomas,of which 40%are the clear cell variant.Determining the presence or absence of certain mutations through genetic testing may predict whether a patient with cancer may benefit from a particular chemotherapy regimen.CASE SUMMARY A 40-year-old woman presented with a 3-year history of slow urinary flow and a 3-mo history of urinary urgency and frequency as well as gross hematuria.An abdominal and pelvic computed tomography scan demonstrated enlarged lymph nodes in the abdomen and pelvis.A biopsy of a left inguinal lymph node microscopically confirmed a metastatic adenocarcinoma of the urethra.Specialized genetic testing determined personalized chemotherapy.She was treated successfully with a non-platinum-based chemotherapy consisting of paclitaxel and bevacizumab.Following 3 cycles of paclitaxel and bevacizumab,she attained significant clinical improvement,and response by FDG-Positron emission tomography(PET)imaging showed a definite improvement in size and metabolic activity.She achieved complete response after 6 cycles of therapy by PET scan.The patient concluded 11 cycles of paclitaxel and bevacizumab,and a subsequent PET scan confirmed progression of metastatic disease.The patient was then treated with two cycles of doxorubicin after which a PET scan revealed a mixed response to the treatment.CONCLUSION We report the first case of a patient with metastatic clear cell adenocarcinoma of the urethra who underwent personalized chemotherapy after testing for cancer gene alterations.Our unique case represents the safe and effective use of nonplatinum-based chemotherapy in clear cell adenocarcinoma of the urethra.
文摘Aim: Describe the clinical, radiological and management of patients with posterior urethral valves. Materials and Methods: This was a retrospective descriptive study over a period going from January 2011 to December 2016, reviewing 12 cases of patients treated for valves of the urethra posterior to the medical surgical center of urology in Cameroon at Douala. The variables studied were clinical, paraclinical, therapeutic and evolutionary. Results: In 5 years, we had diagnosed and treated 12 cases of posterior urethral valves, an average of 2.4 per year. The average age of patients was 41.6 months with extrems of 3 and 156 months. The reason for consultation was dominated by urinary tract infections. Urethrocystography and echography were performed in all patients and allowed to objectify a bilateral ureterohydronephrosis, a diverticular bladder in 9 cases and 4 cases of vesico-ureteral reflux, including a grade 4 according to the classification of Cendron, 8 patients suffered from acute urinary failure. Renal scintigraphyrealised on 3 patients had as objective in 1 patient the existence of a disfunctioning kidney. The treatment consisted of an endoscopic incision of the valves (n = 8), a vesicostomy (n = 3) and an iterative urethral dilatation with double J catheter placement (n = 1). The evolution was favorable (n = 7), and 5 cases of death were recorded. Conclusion: The endoscopic incision is the gold-standard of the treatment of the valves of the posterior urethra. The vesicostomy is an alternative in the absence of adequate technical platform. Despite adequate support, the prognosis remains burdened with significant mortality.
文摘Penile fracture is a rare urological emergency. It occurs mainly in young adults during sexual intercourse. In many instances, one of the corpora carvanosus is involved though bilateral injuries with or without corpus spongiosus involvement is not uncommon. However, isolated injury to corpus spongiosus is extremely rare. We report a case of isolated rupture of corpus spongiosum secondary to penile injury during coitus in a 43-year-old man that presented to University Hospital Souro Sanou of Bobo Dioulasso. He presented with history of persistence bleeding per urethra following penile injury during sexual intercourse. The Retrograde urethrography (RUG) showed a partial rupture of urethra, Moore type 3. Complementary penile ultrasound revealed extensive contusion of the urethra with circumferential hematoma and rupture of the distal 1/3 of the corpus spongiosus. He had gentle per urethral catheterization which was left for one month. Penile ultrasound sound done after removal of catheter showed residual injury and narrowing of the urethra.
文摘Introduction: The urethral diverticulum or urethrocele corresponds to a saccular dilation of a portion of the urethral wall. Our objective was to report the clinical aspects, investigations and therapeutic aspects of three cases of congenital urethrocele. Observations: They were three male patients aged 11, 20 and 42 years, two of whom had consulted for terminal dribbling. The diagnosis of urethrocele was made for all patients with retrograde and voiding cystouretrography. Treatment consisted of resection of the urethrocele followed by urethroplasty for both cases. Conclusion: Diagnostic of congenital urethrocele must always be assessed when there is a persistent terminal dribbling, and systematically ask for a retrograde and voiding cystourethrography to confirm it.
文摘<strong>Aim:</strong> To improve management of the posterior urethral valve (PUV) in children in a hospital environment. <strong>Patients and Methods:</strong> This was a retrospective descriptive study that covered a sixteen (16) years period, from January 1, 2002 to December 31, 2017, In pediatric surgery and urology departments of our teaching hospital, 26 cases of posterior urethral valve (PUV) were involved. The diagnosis was made by retrograde urethrocystography and micturition, supplemented by ultrasound. <strong>Results:</strong> During this period, 26 patients (1.7%) had a PUV. The mean age of the patients was 73, 2 months with extremes ranging from 6 to 180 months. Fifteen patients consulted for dysuria, 8 for complete retention of urine. Only one patient had a history of rolling the valves to the benign ones. The main complications found were urinary tract infection in 15 children, urolithiasis in 3 children and renal failure in 2 children. Two children had serum creatinine values of 50 and 58 mg/L. The lamination of the posterior urethral valves was performed in all patients. In our series, we had one death from chronic renal failure in a 6-year-old child with a bilateral mute kidney at IVU. <strong>Conclusion:</strong> The valve diagnosis of the posterior urethra is made late because the diagnosis is still postnatal.
文摘Background: Urethral stricture is a disabling condition that remains prevalent due to the upsurge of sexually transmitted infections and traumatic lesions of the urethra during trauma of the pelvis in humans. Objective: Describe the epidemiological, clinical and radiological presentations of male urethral strictures. Method: It was a cross-sectional and descriptive study during a one-year period from January to December 2017 including all male patients presenting for a urethrocystography examination, at the Ngaoundere Radiology and Medical Imaging Center who agreed to participate. The urethrocystography technique depended on patient’s condition and was either retrograde, anterograde, or following intravenous urography. The examinations were performed with GE X-ray equipment using Kodak Dry View CRs. The interpretation was performed by a radiologist with at least five years of experience. The variables studied were age, clinic, history, uretrocystography technique and results. The data were collected using a previously established data sheet and processed with Sphinx Plus2 V5 and Microsoft Excel 2010 software. Results: 39 patients were enrolled in this study;the average age of our patients was 43.8 years with extremes of 4 and 76 years. The 50 - 60 age group (30.7%) was the most affected. Infection (53.9%) and trauma (23.1%) were the most common etiologies;dysuria (38.5%) and diminution of urinary flow (30.8%) were the most patient’s complaint. Retrograde urethrocystography (66.7%) was the most performed technic. Minimal bleeding in 46.2% of patients was the most common incident during urethrocystography;76.9% of patients had a difficult urination and 7.7% an impassable urethral meatus. After interpretation, 84.6% of patients had urethral stenosis, which was associated with bladder diverticula (23%) and fistulas (15.3%). The stenosis was seated on membranous urethra (81.8%), tight type (45.4%), short (66.7%) and single (81.8%). The post-void residue was significant in 84.6% of cases and not significant in 15.4% of cases. 15.3% of the urethrocystographies were normal. Conclusion: Urethral stenosis in Ngaoundere mainly affects young adult;the main etiology is infectious, very often unique, short, and tight and the membranous urethra is the seat of predilection. Hence, to reduce the extent of pathology with its functional consequences and its impact on the socio-professional life in our context, the focus should be on sexually transmitted infectious.
文摘Purpose: To conduct a study of epidemiological, diagnostic and therapeutic aspects of urethral strictures at Yalgado Ouedraogo University Teaching Hospital. Patients and methods: It was about a retrospective and descriptive study conducted in the urology division of Yalgado Ouedraogo Hospital from October 1st 2009 to September 30th 2014. All the patients, included in this study, had a urethral stricture confirmed by the voiding retrograde cystourethrogram (VCUG) or during surgical intervention with useful surgical report and medical file. Results: During the period of study, 127 complete medical records were found. The hospital prevalence was 10.1%. The average age of the patients was 50.5 (from 3 to 80 years). 55.6% of the patients were from rural areas. Dysuria and urinary retention were the major causes of consultation with respectively 66.7% and 33.3%. The aetiology of urethral stricture was infectious in 71.4% of the cases. The VCUG permitted to objectify the characteristics of the stenosis. The urethral stenoses were single in the majority of the cases, about 88.8% of cases. The bulbar urethral stricture was the major location. Escherichia coli was isolated in 77.7% of the urinary infections. The majority of patients (61.9%) had undergone open surgery including 39.7% end to end anastomosis. No endoscopic treatment was recorded. Conclusion: The urethral stenosis is frequent in our division. Its major aetiology is infectious. The treatment is dominated by open surgery in our context.
文摘<strong>Aim:</strong> To compare and analyze dose constraints and target coverage results and to reduce Bladder Wall (B<sub>wall</sub>) V<sub>18.12</sub> for prostate Stereotactic-Body Radiation Therapy (SBRT) when Seminal Vesicles (SSVV) are included or not. Several indicators based on intersection volumes are obtained to predict constraint fulfillment. <strong>Background:</strong> Due to prostate’s low alpha-beta ratio and the possibility of increasing the therapeutic ratio several moderate and extreme hypofractionation schemes have been proposed. The scheme selected was a fivefraction urethra-sparing prostate SBRT. <strong>Materials and Methods:</strong> 150 patients divided into two groups according to the inclusion of SSVV in PTV or not were analyzed. Histograms, average values, standard deviations and degrees of fulfillment were obtained for each constraint or goal and group. A possible reduction of the B<sub>wall</sub> V<sub>18.12</sub> was addressed by re-optimizing fifty randomly chosen patients. Predictors of constraint fulfilling were obtained by using the intersections of B<sub>wall</sub> and Rectum Wall (R<sub>wall</sub>) with the PTV. <strong>Results:</strong> Significant differences in R<sub>wall</sub> V<sub>32.62</sub> and V<sub>29</sub> were obtained when evaluating the influence of SSVV inclusion. A reduction of 12% in the B<sub>wall</sub> V<sub>18.12</sub> constraint was achieved without compromising coverage and OARs doses. No dependence on the inclusion of SSVV was found. <strong>Conclusions:</strong> Statistically significant differences have been found in R<sub>wall</sub> intermediate-dose constraint when SSVV was included. A reduction of 12% in the B<sub>wall</sub> V<sub>18.12</sub> constraint has been achieved without compromising the PTV coverage and the rest of OARs constraints. Constraint fulfillment predictors could be useful to evaluate the feasibility of prostate SBRT prior to the planning process for every single patient.
文摘Inverted urothelial papilloma is a rare benign tumour and represents one of the urothelial lesions with inverted morphology. Accurate diagnosis and differentiation from other inverted lesions is important because its proper clinical management and expected clinical outcomes are distinctly different. Here we describe a case of a large inverted urothelial papilloma of the prostatic urethra and a synchronous non-invasive low-grade papillary urothelial carcinoma of the bladder in a 60 year-old man. We focus on the differential diagnosis of inverted urothelial papilloma.
文摘Primary urethral malignant melanoma is an extremely rare malignancy with early metastasis and often delayed diagnosis, resulted in poor prognosis. Literature on this entity, especially with regard to urinary cytology is limited. We report here an extremely rare case of primary urethral malignant melanoma (MM) developed in a 95-year-old Japanese woman. A urinalysis showed macrophages containing brown granular pigments, and the urinary cytology was positive for atypical cells containing brown pigments suggestive of MM. Pathological examination of the biopsy specimen from the tumor revealed MM of the urethra. Immunohistochemically, the tumor cells showed strong cytoplasmic reactivities against antibodies, HMB-45 and Malan-A. Melanoma cells were immunohistochemically positive for c-Kit in their cytoplasm and cell membrane, although mutations in BRAF V600E and N/K-RAS were not detected. The urinary cytology and immunohistochemistry were useful for the rapid and accurate diagnosis for the urethral MM.
文摘A foreign body in the urethra is the presence of an object in the urethra. They are often secondary, either to an erotic curiosity, <span style="white-space:nowrap;">û</span> or to psychiatric disorders. The diagnosis remains clinically aided by imagery. Treatment is most often endoscopic, but in some cases the use of open surgery is necessary. We reported the case of an 80-year-old man with no history of behavioral disorders;a wooden rod was inserted into the urethra to empty his bladder. The care consisted of a meatoplasty under locoregional anesthesia. Upon discharge, the patient had a good urine flow.
文摘<strong>Background:</strong> The aim of this study was to evaluate the outcomes of stricture treatment using endoscopic internal urethrotomy in the male urethra. <strong>Patients and Methods:</strong> We conducted a retrospective study from 2012 to 2017 at the Urology and Andrology Department of the University Hospital in Brazzaville, Congo. Medical records of 30 patients who underwent endoscopic internal urethrotomy for urethral stricture were analyzed. We studied the following variables: frequency of urethral stricture, age of patient, onset, cause and location of urethral stricture, duration of bladder catheterization, duration of hospitalization, and postoperative complications. The treatment outcome was assessed after a follow-up of 2.6 years (extreme: 2 and 4 years). Outcomes were considered successful or good when the patients had a normal urine flow and an unobstructed urethra at the Retrograde Urethrogram (RUG). <strong>Results:</strong> The mean age was 47.5 ± 9.7 years (range: 17 to 83 years). Dysuria was the most common symptom reported. We found that urethral stricture was mostly caused by infectious diseases (20 patients). The urethral stricture was located at the membranous urethra in 4 patients, the bulbar urethra in 25 patients, and the penile urethra in 1 patient. The mean duration of the bladder catheterization was 2.3 days. Hospitalization duration was 36 hours. We observed the following complications: urethrorrhagia in 3 patients, acute orchiepididymitis. We achieved good results in 23 patients. <strong>Conclusion:</strong> In our context where the practice of endoscopic internal urethrotomy is recent, it provides satisfactory results for the treatment of short urethral male stricture.
文摘Introduction: To investigate if potty training from infancy can affect bladder dysfunction in boys with posterior urethral valves (PUV). Subjects and Methods: The voiding pattern and emptying ability were followed using the 4-hour voiding observation method in 17 Vietnamese boys with PUV aged 3 months to 4 years who had been potty-trained from infancy. This group was compared with a group of healthy Vietnamese boys. Results: In the boys with PUV, the bladder volume increased according to age, and interrupted voiding was rare. However, when comparing boys with PUV with healthy boys, a significant difference was noted with more frequent voidings and lower voided volumes in the age group 0 - 1 year (P < 0.001). Despite the minimum amount of residual urine, average 8 ml or less in the boys with PUV, the age groups 1 - 2 and 2 - 4 years had significantly higher residual volumes compared with those of the healthy boys (P The findings from the 4-hour voiding observation showed few signs of dysfunctional bladder in the Vietnamese boys with PUV, including residual urine, even if there were signs of dysfunction compared with the healthy Vietnamese boys. Potty training from infancy could favor early bladder rehabilitation in boys with PUV.
