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Chen YT, Wang TM, Cheng CT, Tee YS, Liao CH, Hsieh CH, Fu CY. Timing of male urethral injury treatment in patients with polytrauma: A retrospective study. Injury 2024; 55:111339. [PMID: 38575396 DOI: 10.1016/j.injury.2024.111339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/01/2024] [Accepted: 01/14/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Male urethral injuries are uncommon, and the ideal timing of the definitive treatment remains controversial. This study aimed to compare the outcomes of early and delayed interventions (1 month or more after the injury) for male urethral injuries. PATIENT AND METHODS We conducted a retrospective review of the medical records of 67 male patients with urethral injuries treated at our institution between 2011 and 2020. We examined patient age, injury severity score (ISS), abbreviated injury scale, mechanism, location and severity of injury, presence of pelvic fractures, surgical interventions, timing of treatment, and complications. We analysed factors associated with urinary complications based on the location of urethral injury. Additionally, we performed a subset analysis of patients with severe injuries (ISS≥16) to assess the impact of delayed surgery. RESULTS Overall, 47 %, 37 %, and 27 % of patients in the delayed treatment group (N = 30) had urethral stricture (US), erectile dysfunction (ED), and/or urinary incontinence (UI). These rates were greater than the 22 % US, 3 % ED, and 11 % UI rates in the early treatment group (N = 37). The subgroup analysis revealed that patients with anterior urethral injury (AUI) who underwent delayed treatment (N = 18) tended to be more severely injured (ISS, 19 vs 9, p = 0.003) and exhibited higher rates of US (44% vs 21 %, p = 0.193) and ED (39% vs 0 %, p = 0.002) than those who received early treatment (N = 24). In the case of posterior urethral injury (PUI), the delayed treatment group (N = 13) had higher rates of US (50% vs 23 %, p = 0.326), ED (33% vs 8 %, p = 0.272), and UI (42% vs 0 %, p = 0.030) than the early treatment group. Regarding study limitations, more than 45 % of the enrolled patients were severely injured (ISS≥16), which may have potentially influenced the timing of urethral injury repair. CONCLUSIONS The treatment of male urethral injuries may be delayed due to concurrent polytrauma and other associated injuries. However, delayed treatment is associated with higher rates of urinary complications. Early treatment of urethral injuries may be beneficial to male patients with urethral trauma, even in cases of severe injury.
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Affiliation(s)
- Yu-Ting Chen
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.
| | - Ta-Min Wang
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Chi-Tung Cheng
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Yu-San Tee
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC.
| | - Chien-Hung Liao
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Chi-Hsun Hsieh
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
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Hamill MM, Onzia A, Parkes-Ratanshi RM, Kyambadde P, Mande E, Nakate V, Melendez JH, Gough E, Manabe YC. Antibiotic overuse, poor antimicrobial stewardship, and low specificity of syndromic case management in a cross section of men with urethral discharge syndrome in Kampala, Uganda. PLoS One 2024; 19:e0290574. [PMID: 38489281 PMCID: PMC10942085 DOI: 10.1371/journal.pone.0290574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/11/2023] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE High prevalence of sexually transmitted infections (STIs) combined with poor antimicrobial stewardship are drivers of STI antimicrobial resistance (AMR) especially in resource-limited settings where syndromic case management (SCM) is the norm. We characterized patterns of antibiotic use prior to clinic attendance and study enrollment in Ugandan men with urethral discharge syndrome (UDS), evaluated in-clinic prescribing, and the performance characteristics of SCM. METHODS Participants were recruited from government clinics participating in an existing gonococcal surveillance program in Kampala, Uganda. Questionnaires including antimicrobial use prior to attendance, prior episodes of UDS, penile swabs, and blood samples were collected. Bivariable and multivariable logistic regression models were used to estimate odds ratios (OR) for preselected factors likely to be associated with antibiotic use. In-clinic antibiotic treatment data were extracted from clinical notes, and the performance of SCM against laboratory-based STI diagnoses was evaluated. FINDINGS Between October 2019 and November 2020, 100(40%) of 250 men with UDS reported taking antibiotics in the 14days prior to attending the clinic. Of these 210(84%) had at least one curable STI and 20% had a reactive point-of-care HIV test. Multivariable analysis demonstrated significant associations between recent antimicrobial use and duration of UDS symptoms <6 days (OR 2.98(95%CI 1.07,8.36), p = 0.038), and sex with women only (OR 0.08(95%CI 0.01,0.82),p = 0.038). The sensitivity of SCM ranged from 80.0% to 94.4%; specificity was low between 5.6% and 33.1%. The positive predictive value of SCM ranged from 2.4(95%CI 0.7,6.0) for trichomoniasis to 63.4(95%CI 56.5,69.9) for gonorrhea. CONCLUSION Pre-enrollment antibiotic use was common in this population at high risk of STI and HIV. Combined with the poor specificity of SCM for male UDS, extensive antibiotic use is a likely driver of STI-AMR in Ugandan men. Interventions to improve antimicrobial stewardship and deliver affordable diagnostics to augment SCM and decrease overtreatment of STI syndromes are required.
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Affiliation(s)
- Matthew M. Hamill
- Division of infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Annet Onzia
- Infectious Disease Institute, Kampala, Uganda
| | | | - Peter Kyambadde
- Ministry of Health, National Sexually Transmitted Infections Control Program, Kampala, Uganda
| | | | | | - Johan H. Melendez
- Division of infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Ethan Gough
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Yukari C. Manabe
- Division of infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
- Infectious Disease Institute, Kampala, Uganda
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Kusin SB, Carroll TF, Alhalabi F, Christie AL, Zimmern PE. Long-term Outcomes With Macroplastique in Women With Stress Urinary Incontinence Secondary to Intrinsic Sphincter Deficiency. Urology 2024; 185:36-43. [PMID: 38199277 DOI: 10.1016/j.urology.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To evaluate the long-term outcomes of polydimethylsiloxane (Macroplastique (MPQ)) in women with stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD) using validated questionnaires. METHODS Following IRB approval, charts of non-neurogenic women with SUI secondary to ISD who underwent MPQ injection were reviewed from a prospectively maintained database. ISD was defined as positive stress test with a well-supported urethra and low Valsalva leak point pressure when available. Excluded were women with follow-up <5years. Baseline data included validated questionnaire scores (UDI-6 question 3 (0-3), VAS Quality of Life, Incontinence Impact Questionnaire (IIQ-7)) and urodynamic study findings. Patients were followed with same questionnaires and three-dimensional ultrasound evaluating volume/configuration of MPQ. All three-dimensional ultrasound measurements were performed by the same imaging team blinded to clinical outcomes. Outcomes were evaluated in four groups based on prior SUI treatment. Success was defined as UDI-6 question 3 score of 0-1 and not requiring additional anti-incontinence therapy at the last visit after the last MPQ injection. RESULTS From April 2011-December 2016, 106 patients (median age 67) met study criteria. Median follow-up time was 7.4years. Median MPQ injected was 5 mL. Overall success was 43%, with 54% successful after one injection and 46% requiring ≥2 injections. Across all groups, patients had improvement in Quality of Life and IIQ-7 Question 7 (frustration). Among the failure group, 17% opted for a secondary autologous sling procedure. CONCLUSION MPQ demonstrated long-term favorable outcomes in a subset of women with SUI secondary to ISD.
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Affiliation(s)
- Samuel B Kusin
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Timothy F Carroll
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Feras Alhalabi
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Alana L Christie
- Simmons Comprehensive Cancer Center Biostatistics, University of Texas, Southwestern Medical Center, Dallas, TX
| | - Philippe E Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
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Zaragoza MR, Moorman M, Chew L. Ultra Long-term Follow-up of the Autologous Pubovaginal Sling for Stress Incontinence: Results at 23 Years. Urology 2024; 185:44-48. [PMID: 38101581 DOI: 10.1016/j.urology.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To examine the efficacy, safety, and long-term durability of the autologous pubovaginal sling for stress incontinence over a 29-year period. METHODS A total of 192 consecutive female patients with stress urinary incontinence who underwent autologous pubovaginal sling from 1993 through 1999 were analyzed over a 29-year period. Intermediate and ultra long-term follow-up were obtained at a mean of 4 and 23 years, respectively. A total of 51 patients had sufficient data at both time intervals and were evaluated using a standardized questionnaire for resolution of stress incontinence, the primary endpoint, as well as resolution of urge incontinence, overall dryness, and voiding dysfunction. RESULTS At intermediate-term follow-up (mean 45.3 months), 96% of 51 patients reported no stress incontinence. In addition, 76% of patients experienced resolution of their preoperative urge incontinence. Overall dryness occurred in 84%. At ultra long-term follow-up (mean 22.9 years), 84% reported no stress incontinence and an overall dryness rate of 53%. Postoperative voiding dysfunction included de novo urge incontinence (3 patients) and persistent urinary obstruction requiring urethrolysis (1 patient). CONCLUSION The autologous pubovaginal sling is effective, safe, and durable at a mean of 23 years, the longest known follow-up in the literature. Given the U.S. Food and Drug Administration (FDA) warnings regarding transvaginal mesh and growing concerns with the synthetic midurethral sling, the autologous pubovaginal sling should be offered as an option to those women seeking treatment for stress urinary incontinence.
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Affiliation(s)
| | | | - Lauren Chew
- Case Western Reserve University/University Hospitals, Cleveland, OH
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Overland MR, Srinivasan AK. Case of Urethral Hypoplasia in Prune Belly Syndrome Successfully Managed With Vesicoamniotic Shunts and a Progressive Augmentation by Dilation Urethra Anterior Procedure. Urology 2024; 185:84-87. [PMID: 38215914 DOI: 10.1016/j.urology.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Abstract
Urethral atresia is a rare but clinically significant cause of congenital lower urinary tract obstruction. Initial management options include urinary diversion until definitive urethral reconstruction or progressive urethral dilation. Given the overall rarity of the condition, there are no evidence-based guidelines for the immediate and long-term management of urethral atresia, and clinical practice varies widely. We present an illustrative case managed with progressive urethral dilation alongside urinary diversion to highlight key factors in shared clinical decision making. Ultimately, pooled multi-institutional long-term outcomes data are needed to better guide practice for these patients and their families.
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Affiliation(s)
- Maya R Overland
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Arun K Srinivasan
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
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Kim H, Kim JH, Jeong SJ. Mid-term results of ReMEEX sling system in female stress urinary incontinence with various indications and feasibility of readjustment. Investig Clin Urol 2024; 65:157-164. [PMID: 38454825 PMCID: PMC10925739 DOI: 10.4111/icu.20230283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/09/2023] [Accepted: 12/06/2023] [Indexed: 03/09/2024] Open
Abstract
PURPOSE To examine efficacy and safety of ReMEEX implantation in patients with female stress urinary incontinence (SUI) associated with detrusor underactivity (DU), recurrence, or intrinsic sphincter deficiency (ISD). MATERIALS AND METHODS Retrospective cohort study included 303 females who underwent ReMEEX system (March 2008 to May 2021). Patients were stratified into three groups by purpose of surgery (SUI with DU, reoperation, and SUI with ISD) and evaluated with following criteria: cure (absence of subjective complaint of leakage and objective leakage in the stress test), improvement (rare leakage subjectively, but satisfaction regardless of stress test), and failure. Primary outcome was success rate of surgery assessed through patient interviews and a stress test. Surgical outcomes and complications were evaluated. RESULTS Mean follow-up was 34.4 months (range, 6.0-145.0 months). At the final follow-up visit, 42.9% and 49.2% of patients were cured and improved. Twenty-one point five percent required tension readjustment (mean number, 1.2). The total complication rate was 19.5% (none for grade ≥4). Preoperative Qmax was significantly higher in the ISD group (p<0.001) and preoperative total International Prostate Symptom Score (IPSS) score was significantly higher in the DU group (p=0.044). Moreover, at postoperative 1 year, both total IPSS score and IPSS quality of life score were significantly higher in the DU group (both p=0.001). CONCLUSIONS The success rate of ReMEEX system was 92.1% at mean follow-up of 34.4 months in female SUI with DU, reoperation, or ISD. It also enabled postoperative readjustment of sling tension, as needed, up to 130 months after surgery.
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Affiliation(s)
- Hwanik Kim
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jin Hyuck Kim
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seong Jin Jeong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
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Richter J, Rickard M, Good H, Kim JK, Shannon P, Dos Santos J, Chua ME, Lorenzo AJ, Van Mieghem T, Shinar S. Pathological Findings in Fetuses Terminated for Suspected Lower Urinary Tract Obstruction: Experience From a High-Risk Fetal Center in Canada. J Urol 2024; 211:305-312. [PMID: 37922376 DOI: 10.1097/ju.0000000000003777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/27/2023] [Indexed: 11/05/2023]
Abstract
PURPOSE Pregnancies complicated by prenatally suspected lower urinary tract obstruction (LUTO) can be associated with high rates of terminations due to potentially poor outcomes. Herein, we assessed autopsy findings of fetuses terminated for suspected LUTO to evaluate the prenatal diagnostic accuracy and spectrum of underlying pathologies. MATERIALS AND METHODS We performed a retrospective review of all pregnancies referred to a high-risk fetal center in a universal access to care health care system for suspected LUTO that opted for termination of pregnancy between 2009 and 2022. Ultrasound features, genetic investigations, placental findings, and distribution of postmortem diagnoses were assessed. RESULTS Of a total of 190 pregnancies with suspected LUTO evaluated during the study period, 79 (42%) were terminated. We excluded 35 fetuses with incomplete data, resulting in 44 available for analysis. Pregnancies were terminated at a mean gestation of 22 ± 5 weeks. A LUTO diagnosis was confirmed in 37 (84.1%) fetuses (35 males, 2 females), and the remaining 7 showed other pathologies. Pulmonary hypoplasia was found in 62.2% (n = 23) and placental pathologies in 56.8% of confirmed LUTO compared to 33.4% and 71.4% in non-LUTO cases, respectively. Overall, a total of 31 fetuses underwent additional prenatal investigations with genetic anomalies detected only in fetuses with a confirmed LUTO diagnosis (13.6%). CONCLUSIONS In our health care system, almost half of prenatally suspected LUTO pregnancies are terminated. The sonographic diagnostic accuracy for LUTO is reasonable at 84%. However, the remaining 16% still had significant pathologies. Genetic abnormalities are uncommon and rarely the trigger for pregnancy terminations.
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Affiliation(s)
- Juliane Richter
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mandy Rickard
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hayley Good
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jin K Kim
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Shannon
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael E Chua
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Urology, St Luke's Medical Center, Manila, Philippines
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tim Van Mieghem
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shiri Shinar
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Hoselton AS, Finup J, Roedel M, Davidson E, Farhat W. A Case of Urethral Atresia: Emphasizing the Role of Parental Engagement. Urology 2024; 184:e243-e245. [PMID: 37956764 DOI: 10.1016/j.urology.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023]
Abstract
Congenital urethral atresia is generally considered to be incompatible with life unless there is either a patent urachus or vesicoamniotic shunt. Here we present the case of a male neonate with anhydramnios detected at 28weeks gestation due to urethral atresia, who was born without evidence of either a patent urachus or vesicoamniotic shunt, who has survived and is not requiring respiratory support at age 5months. While this is a thought-provoking clinical case, it also highlights the importance of early and effective parental engagement in cases of complex congenital anomalies of the urinary tract.
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Affiliation(s)
| | - Jennika Finup
- University of Wisconsin - Madison, Department of Urology, Madison, WI
| | - Megan Roedel
- University of Wisconsin - Madison, Department of Urology, Madison, WI
| | - Emily Davidson
- University of Wisconsin - Madison, Department of Urology, Madison, WI
| | - Walid Farhat
- University of Wisconsin - Madison, Department of Urology, Madison, WI
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Allred RP, Nguyen J, Agopian AJ, Canfield MA, Shumate CJ. An epidemiologic study of penoscrotal transposition by maternal characteristics using data from the Texas birth defects registry. Birth Defects Res 2024; 116:e2270. [PMID: 37929661 DOI: 10.1002/bdr2.2270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Penoscrotal transposition (PST) is an uncommon urogenital malformation in which the penis is mal-positioned to be inferior to the scrotum. The purpose of this study was to explore PST risk by maternal characteristics and to describe co-occurring congenital abnormalities in the Texas Birth Defects Registry (TBDR). METHODS We conducted a population-based descriptive study examining occurrence of PST in the TBDR between 1999 and 2019. The primary outcome variable was PST diagnosis during infancy. Descriptive variables included maternal age, education, and race/ethnicity. Prevalence ratios (PRs) were calculated within each maternal variable category using Poisson regression. Counts and percentages of cases with select co-occurring congenital abnormalities were also calculated. RESULTS Overall, 251 infants had PST, providing a prevalence of 0.61/10,000 live male births (95% CI: 0.53-0.68). PST prevalence was significantly lower among infants of mothers who had lower educational attainment (high school), who were younger (<25 vs. 25-34), and who were Hispanic (vs. non-Hispanic White) and was significantly higher among older mothers (35+ vs. 25-39). Hypospadias was the most common co-occurring genitourinary anomaly, affecting close to 70% of cases. CONCLUSIONS To our knowledge, this is the first investigation exploring the prevalence of PST in a population-based birth defects registry. Our findings help to understand the risk for PST among select maternal demographic characteristics and may assist in generating hypotheses about the underlying etiology of this condition for future work.
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Affiliation(s)
- Rachel P Allred
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - Joanne Nguyen
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - A J Agopian
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas, USA
| | - Mark A Canfield
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas, USA
| | - Charles J Shumate
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
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Quaresma V, Magalhães F, Marconi L, Lima J, Lopes M, Ferreira AM, Nunes P, Figueiredo A. National consensus survey on management approaches for upper urinary tract obstruction: A comparative analysis of retrograde ureteric stent and percutaneous nephrostomy. Arch Ital Urol Androl 2023; 95:12118. [PMID: 38193221 DOI: 10.4081/aiua.2023.12118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/02/2023] [Indexed: 01/10/2024] Open
Abstract
To the Editor, Upper urinary tract obstruction (UUTO) is a common scenario in clinical practice, and it is caused by a variety of diseases. Lithiasis, tumours and strictures are some of the principal aetiologies. Multiple factors may influence both the need for decompression of the obstructed collecting system and the urgency of procedure...
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Affiliation(s)
- Vasco Quaresma
- Urology Department, Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine of the University of Coimbra.
| | | | - Lorenzo Marconi
- Urology Department, Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine of the University of Coimbra.
| | - João Lima
- Urology Department, Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine of the University of Coimbra.
| | - Manuel Lopes
- Urology Department, Centro Hospitalar e Universitário de Coimbra.
| | | | - Pedro Nunes
- Urology Department, Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine of the University of Coimbra.
| | - Arnaldo Figueiredo
- Urology Department, Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine of the University of Coimbra.
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Cousin T, Peyronnet B, Bentellis I, Lasri S, Taha F, Hermieu N, Boileau A, Zelmar A, Ciolek C, Dubois A, Leon P, Hermieu JF, Brierre T, Gamé X, Tricard T, Saussine C, Lecoanet P, Vidart A, Bruyère F, Cornu JN, Monsaint H, Biardeau X, Capon G. Which revision strategy is the best for non-mechanical failure of male artificial urinary sphincter? World J Urol 2023; 41:3663-3669. [PMID: 37902863 DOI: 10.1007/s00345-023-04670-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/26/2023] [Indexed: 11/01/2023] Open
Abstract
PURPOSE Persistence or recurrence of stress urinary incontinence (prSUI) after artificial urinary sphincter (AUS) implantation may be secondary to non-mechanical failure (NOMECA). It have for long been assumed to result from urethral atrophy. Its existence is now debated. As the pathophysiology of NOMECA is not elucidated, the most appropriate management remains unclear. We aimed to compare the several revision techniques for NOMECA of AUS in men. METHODS NOMECA was defined as prSUI, with normally functioning device, no erosion, infection or fluid loss. Exclusion criteria were neurogenic SUI, revision or explantation for other causes. From 1991 to 2022, 143 AUS revisions for NOMECA, including 99 cuff DOWNSIZING, 10 cuff repositioning (RELOC), 13 TANDEM-CUFF placement, 18 cuff changing (CHANGE), three increasing balloon pressure (BALLOON-UP), were performed in 10 centers. BALLOON-UP patients weren't included in comparative analysis due to small sample size. All components could be changed during the revision. Patients were also categorized in COMPLETE-CHANGE vs. PARTIAL-CHANGE of the device. RESULTS The three-months complete continence rate was 70.8% with a significant difference between RELOC and DOWNSIZING groups (p = 0.04). COMPLETE CHANGE was significantly associated with complete continence status at three months in multivariate analysis (83.3% vs. 63.3%, OR = 2.7; CI 95% [1.1-7.1], p = 0.03). Estimated five-year reoperation-free and explantation-free survival were respectively 63.4% and 75.9% (p = 0.16; p = 0.30). Those were significantly longer in COMPLETE-CHANGE vs PARTIAL-CHANGE (82.2% vs. 69.6%, p = 0.03); (71.2% vs. 58.2%, p = 0.047). CONCLUSIONS AUS revision for prSUI due to NOMECA yields satisfactory outcomes regardless of the technique used. We observed better functional outcomes when repositioning the new cuff. COMPLETE-CHANGE may improve functional outcomes, explantation-free and reoperation-free survivals.
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Affiliation(s)
- Tiffany Cousin
- Department of Urology, University of Bordeaux, Bordeaux, France.
| | | | | | - Sami Lasri
- Department of Urology, University of Lille, Lille, France
| | - Fayek Taha
- Department of Urology, University of Reims, Reims, France
| | | | - Adrien Boileau
- Department of Urology, University of Toulouse, Toulouse, France
| | - Augustin Zelmar
- Department of Urology, University of Strasbourg, Strasbourg, France
| | - Clement Ciolek
- Department of Urology, University of Nancy, Nancy, France
| | | | - Priscilla Leon
- Department of Urology, University of Reims, Reims, France
| | | | | | - Xavier Gamé
- Department of Urology, University of Toulouse, Toulouse, France
| | - Thibault Tricard
- Department of Urology, University of Strasbourg, Strasbourg, France
| | | | | | - Adrien Vidart
- Department of Urology, Foch Hospital, Suresnes, France
| | - Franck Bruyère
- Department of Urology, University of Tours, Tours, France
| | | | | | | | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
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Adriaenssens M, De Boe V. Congenital lower urinary tract obstruction with spontaneous fetal bladder rupture due to posterior urethral valves: a case report. J Med Case Rep 2023; 17:445. [PMID: 37875965 PMCID: PMC10598892 DOI: 10.1186/s13256-023-04163-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/04/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Congenital lower urinary tract obstruction (LUTO) is a rare but significant condition affecting fetal urinary tract development. LUTO has a range of etiologies, with posterior urethral valves (PUV) being the most common cause. The prenatal diagnosis of LUTO plays a crucial role in recognizing the condition and guiding management decisions. Prenatal ultrasound serves as the primary tool for identifying LUTO, with key findings including megacystis, bladder wall thickening, oligohydramnios, hydronephrosis, and the 'keyhole sign' indicating dilatation of the posterior urethra. We present a case of congenital LUTO with a rare complication of spontaneous fetal bladder rupture and urinary ascites, treated by peritoneo-amniotic shunt placement. CASE PRESENTATION A 27-year-old pregnant Caucasian women was referred at 28 weeks of pregnancy due to the presence of megacystis and bilateral hydronephrosis on routine ultrasound and suspicion of LUTO. Repeat ultrasound at 29 weeks showed significant fetal ascites, oligohydramnios and resolution of megacystis and hydronephrosis, after which diagnosis of spontaneous bladder rupture was made. Despite ascites aspiration and amnio-infusion, there was persistent ascites and oligohydramnios. A peritoneo-amniotic shunt was placed with resolution of ascites and normalization of the amniotic fluid volume. At 35 weeks, relapse of the megacystis was observed with bilateral pyelectasis and oligohydramnios, possibly due to healing of the bladder rupture, after which elective cesarean section was planned. Cystography confirmed spontaneous healing of the bladder rupture and the presence of posterior urethral valves, which were resected in the neonatal period with cold knife incision. Total follow-up of 8 years continued to show positive ultrasonographic results and good renal function, but the child suffers from bladder dysfunction, manifesting as overactive bladder disease. CONCLUSIONS LUTO might lead to important renal dysfunction and pulmonary hypoplasia in case of increasing disease severity. Spontaneous bladder rupture might improve renal prognosis, acting as a pop-off mechanism by decompression of the urinary tract. However, fetal bladder rupture is rare and only few cases have been reported. Prenatal intervention can be considered for moderate or severe LUTO, but the benefit for long-term outcome remains uncertain and further studies are needed.
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Affiliation(s)
- Max Adriaenssens
- Department of Urology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
| | - Veerle De Boe
- Department of Urology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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13
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Faure A, Haddad M, Pinol J, Merrot T, Guys JM, Michel F, Karsenty G. Initial experience with ACT™ periurethral adjustable balloons to treat urinary incontinence due to intrinsic sphincter deficiency in the pediatric population. World J Urol 2023; 41:2767-2774. [PMID: 37642679 DOI: 10.1007/s00345-023-04550-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/21/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE To present our initial experience with periurethral adjustable continence therapy (ACT™) for urinary incontinence due to intrinsic sphincter deficiency (ISD) in children. METHODS This is an approved prospective non-randomized pilot study (NCT03351634) aiming to treat children born with spinal dysraphism (SD) or exstrophy epispadias complex (EEC) with ACT™. Endpoints were patient-reported changes in daily pad count, 24-h Pad test and complications. RESULTS Since April 2018, 13 children (six girls, seven boys) were implanted at the median age of 12 years (5-16). The etiology of incontinence was neurogenic ISD (7/13, 54%) and EEC (6/13, 46%). After ACT™ implantation, continence (no pad or 1 security pad/day) was achieved in 9(69%) patients (5/7 SD, 4/6 EEC). Additionally, two (15%) patients had a significant improvement (decreasing Pad test from 1049 to 310 g at 3 months). One patient (7%) had no improvement. Results were stable at 21 months (6-43) of follow-up. Mean final balloon volume was 2.89 ml (± 0.85) with a median of 3 fillings to obtain continence. We had four revisions due to cutaneous port erosion (n = 3) and balloon migration (n = 1) and two definitive explantations. PinQ score was significantly improved (47 vs 40.5 with balloon, p = ns). Neither degradation of the upper urinary tract nor cystomanometric changes have been observed at 6 and 12 months postoperatively. CONCLUSION Urinary incontinence due to ISD owing to EEC or SD can be successfully treated with ACT™ periurethral balloons. Given the minimal invasiveness of this therapy, it might be a first-line option treatment in children with complex stress urinary incontinence.
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Affiliation(s)
- Alice Faure
- APHM, Department of Pediatric Urology, CHU Timone Enfants, Marseille, France.
- Medicine Faculty, Aix-Marseille University, Marseille, France.
| | - Mirna Haddad
- APHM, Department of Pediatric Urology, CHU Timone Enfants, Marseille, France
| | - Jessica Pinol
- APHM, Department of Pediatric Urology, CHU Timone Enfants, Marseille, France
- Medicine Faculty, Aix-Marseille University, Marseille, France
| | - Thierry Merrot
- APHM, Department of Pediatric Urology, CHU Timone Enfants, Marseille, France
- Medicine Faculty, Aix-Marseille University, Marseille, France
| | - Jean-Michel Guys
- APHM, Department of Pediatric Urology, CHU Timone Enfants, Marseille, France
- Medicine Faculty, Aix-Marseille University, Marseille, France
| | - Floriane Michel
- APHM, Department of Adult Urology and Kidney Transplantation, CHU La Conception, Marseille, France
- Medicine Faculty, Aix-Marseille University, Marseille, France
| | - Gilles Karsenty
- APHM, Department of Adult Urology and Kidney Transplantation, CHU La Conception, Marseille, France
- Medicine Faculty, Aix-Marseille University, Marseille, France
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14
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Kanematsu A. Editorial Comment to "Does primary urethral realignment improve the outcome of pediatric pelvic fracture urethral injury? A randomized controlled trial". Int J Urol 2023; 30:929-930. [PMID: 37563920 DOI: 10.1111/iju.15272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Affiliation(s)
- Akihiro Kanematsu
- Department of Urology, Hyogo Medical University, Nishinomiya, Hyogo, Japan
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15
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Favorito LA. Editorial Comment: Penile revascularization utilizing the lateral femoral circumflex artery after pelvic fracture urethral injury. Int Braz J Urol 2023; 49:644-645. [PMID: 37506036 PMCID: PMC10482457 DOI: 10.1590/s1677-5538.ibju.2023.05.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 07/30/2023] Open
Affiliation(s)
- Luciano A. Favorito
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
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16
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Guérin S, Khene ZE, Peyronnet B. Adjustable Continence Therapy Balloons in Female Patients with Stress Urinary Incontinence: A Systematic Review. Urol Int 2023; 107:653-665. [PMID: 37271125 DOI: 10.1159/000529712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/06/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The aim of this study was to perform a systematic review of studies reporting the outcomes of ACT® balloons in female patients with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). METHODS In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) standards, a systematic search of the PubMed (Medline) and Scopus electronic database was performed in June 2022. Terms used for the query were ("female" or "women") and ("adjustable continence therapy" OR "periurethral balloons"). RESULTS Thirteen studies were included. All were retrospective or prospective case series. The success rates ranged from 13.6% to 68% and the improvement rates from 16% to 83%. The intraoperative complication rate ranged from 3.5 to 25% and consisted of urethral, bladder, or vaginal perforations. The rate of postoperative complications varied from 11 to 56% without major complications. Between 6% and 38% of ACT® balloons were explanted and subsequently reimplanted in 15.2-63% of cases. CONCLUSION ACT® balloons can be considered as an option to treat SUI due to ISD in female patients with a relatively modest success rate and quite a high complication rate. Well-designed prospective studies and long-term follow-up data are needed to fully elucidate their role.
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Affiliation(s)
- Sonia Guérin
- Department of Gynecology Obstetrics, Rennes University Hospital, Rennes, France
| | | | - Benoit Peyronnet
- Departement of Urology, Rennes University Hospital, Rennes, France
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17
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Nnabugwu II, Obadaseraye OR, Anyimba SK, Nnabugwu CA, Anikwe ON. Epidemiology of posterior urethral injury among adults with traumatic pelvic ring disruptions: a 10-year retrospective review from a trauma care centre in Southeast Nigeria. Pan Afr Med J 2023; 45:43. [PMID: 37575524 PMCID: PMC10422031 DOI: 10.11604/pamj.2023.45.43.34603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 03/15/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction posterior urethral injuries can occur in polytrauma settings, and may contribute to morbidity post-trauma. The aim of this study is to determine the occurrence of pelvic fracture urethral injury (PFUI) in adult polytrauma patients who were successfully stabilized and to appraise the nature of associated injuries. Methods the medical records of stabilized polytrauma patients≥ 18 years of age from January 2010 to December 2019 were retrospectively reviewed focusing on those presenting with bony pelvis disruptions. Injuries were categorized using the injury severity scale (ISS) while bony pelvis disruptions were classed according to the Young-Burgess classification. Data on the demography of the patient, mechanism of injury, nature, and severity of injuries, class of pelvic fracture-disruption, and urethral integrity were collected and analyzed accordingly. Results of 111 patients with bony pelvis disruptions, 95 of them had adequate information and were included in our analysis. The mean age of participants was 37.3 ± 11.8 years and most of them were males (87.4%). Blunt pelvic trauma occurred in 96.8%. Lateral compression pelvic injuries were prevalent at 39.0%. In 54.7% of the patients, the injury severity score (ISS) was ≥ 27. At 25.3% and 24.2% respectively, the abdomen and the lower extremities most frequently sustained a grade ≥ 3 injuries (abbreviated injury scale (AIS) ≥3). At a rate of 2.1%, spinal cord injury was the least observed. In the 10 years, there were 6 PFUI among 83 stabilized polytraumatized men with mean ISS of 35.5 ± 8.3. The incidence rate of PFUI was 0.6 per 8.3 pelvic disruptions in men per year. Symphysis pubis disruption or fracture of the pubis or both was consistently seen in all PFUI. Higher ISS significantly relates to PFUI (p <0.001). The mechanism of bony pelvis disruption and the class of bony pelvis injury are determined by the severity and trajectory of the impact apparently relates to PFUI only through fracture-disruption of the pubic symphysis or the pubis. Conclusion about 7.2% of men presenting with traumatic disruption of the bony pelvis in polytrauma setting sustain PFUI. In polytrauma settings, PFUI should be suspected in cases of fracture-disruption of the pubis or symphysis pubis from any mechanism.
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Affiliation(s)
- Ikenna Ifeanyi Nnabugwu
- Urology Unit, Department of Surgery, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | | | - Solomon Kenechukwu Anyimba
- Urology Unit, Department of Surgery, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Chinwe Andrea Nnabugwu
- Department of Orthopaedics and Trauma, National Orthopaedic Hospital Enugu, Enugu, Nigeria
| | - Obinna Nnabuife Anikwe
- Urology Unit, Department of Surgery, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
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18
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Maigaard T, Trip MB. [Not Available]. Ugeskr Laeger 2023; 185:V09220574. [PMID: 37057693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
This review summarises the principles for diagnosing and treating acute urological trauma. Renal trauma can be life threatening, although most injuries are self-limiting. Development in imaging and non-operative measures allows for a more conservative and nephron-sparing approach. Pelvic fracture urethral injury is often associated with multiple injuries. Strategy for intervention depends on whether the injury is partial or complete, anterior or posterior. Penile fracture is a rare but acute urological condition. Surgical treatment is necessary to minimize risk of complications. If handled accordingly, the functional outcome is good.
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Affiliation(s)
- Thomas Maigaard
- Urinvejskirurgisk Afdeling, Aarhus Universitetshospital
- Urinvejskirurgisk Afdeling, Aalborg Universitetshospital
| | - Mia Børsmose Trip
- Urinvejskirurgisk Afdeling, Aarhus Universitetshospital
- Urinvejskirurgisk Afdeling, Aalborg Universitetshospital
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19
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Ii Y, Gao G, Liao X, Yang J, Ye R, Zheng X. Intermittent urethral infusion of dimethylsulfoxide for urethral amyloidosis: a case report and literature review. Aging Male 2022; 25:180-184. [PMID: 35815465 DOI: 10.1080/13685538.2022.2097220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Urethral amyloidosis (UA) is a very rare condition. We here report the case of a 63-year-old male patient who was admitted to our outpatient department due to aggravating dysuria, frequent urination, pain during intercourse, and a gradually enlarging mass at the ostium of his urethra, which he first notice one year earlier. Pathological tissue biopsy of urethral ostium mass confirmed UA. Intermittent urethra infusion of dimethyl sulfoxide was performed and the treatment effect is satisfactory.
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Affiliation(s)
- Yunzhi Ii
- Beijing University of Chinese Medicine, Beijing, PR China
| | - Guojing Gao
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, PR China
| | - Xiaoxing Liao
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, PR China
| | - Jianghua Yang
- Beijing Aerospace General Hospital, Beijing, PR China
| | - Rongzhen Ye
- Beijing Aerospace General Hospital, Beijing, PR China
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20
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Saint-Jacques C, Uzan A, Marechal E, Frochot V, Haymann JP, Traxer O, Daudon M, Letavernier E. The Case | An 80-year-old man with obstructive uropathy. Kidney Int 2022; 102:1197-1198. [PMID: 36272748 DOI: 10.1016/j.kint.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Camille Saint-Jacques
- Assistance Publique des Hôpitaux de Paris, Service des Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Paris, France
| | - Audrey Uzan
- Assistance Publique des Hôpitaux de Paris, Service d'Urologie, Hôpital Tenon, Paris, France
| | - Elise Marechal
- Assistance Publique des Hôpitaux de Paris, Service des Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Paris, France
| | - Vincent Frochot
- Assistance Publique des Hôpitaux de Paris, Service des Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Paris, France
| | - Jean-Philippe Haymann
- Assistance Publique des Hôpitaux de Paris, Service des Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Paris, France; Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche UMR S 1155, Sorbonne Université, Paris, France
| | - Olivier Traxer
- Assistance Publique des Hôpitaux de Paris, Service d'Urologie, Hôpital Tenon, Paris, France; Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche UMR S 1155, Sorbonne Université, Paris, France
| | - Michel Daudon
- Assistance Publique des Hôpitaux de Paris, Service des Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Paris, France
| | - Emmanuel Letavernier
- Assistance Publique des Hôpitaux de Paris, Service des Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Paris, France; Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche UMR S 1155, Sorbonne Université, Paris, France.
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21
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Morais M, Moura M, Correia A, Fan Y. Urinary tract obstruction in the second trimester: a report of an incarcerated gravid uterus. BMJ Case Rep 2022; 15:15/9/e249986. [PMID: 36175041 PMCID: PMC9528483 DOI: 10.1136/bcr-2022-249986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Incarceration of the gravid uterus (IGU) is a rare obstetric disorder that may lead to pregnancy-related complications. Acute urinary retention (AUR) is one of the associated symptoms in IGU and it is mostly observed in the first semester and early second trimester. A case of a woman, in her 30s, is described, who presented AUR and lower abdominal pain in the early second trimester. The diagnosis was confirmed upon pelvic examination, and abdominal and transvaginal ultrasound. Management included long-term bladder catheterisation, manual reduction manoeuvres and passive positioning manoeuvres at home. At 24 weeks of gestation, the uterus returned in its correct polarity, the Foley catheter was removed and the patient was able to void spontaneously. A healthy infant was delivered vaginally at term. No specific guidelines have been published for IGU treatment. However, prompt diagnosis and tight follow-up of these patients are essential to define strategies, reduce complications and prevent recurrences.
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Affiliation(s)
- Mariana Morais
- Obstetrics and Gynecology, Centro Hospitalar de Trás-os-montes e Alto Douro EPE, Vila Real, Portugal
| | - Mário Moura
- Obstetrics and Gynecology, Centro Hospitalar de Trás-os-montes e Alto Douro EPE, Vila Real, Portugal
| | - Ana Correia
- Obstetrics and Gynecology, Centro Hospitalar de Trás-os-montes e Alto Douro EPE, Vila Real, Portugal
| | - Yida Fan
- Obstetrics and Gynecology, Centro Hospitalar de Trás-os-montes e Alto Douro EPE, Vila Real, Portugal
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吴 永, 胡 杨, 王 寿, 徐 波, 徐 延, 陈 海. [Effectiveness of penis up transfer method for penoscrotal transposition in children]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2022; 36:776-780. [PMID: 35712938 PMCID: PMC9240851 DOI: 10.7507/1002-1892.202201010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate the effectiveness of penile up transfer method in the treatment of penoscrotal transposition (PST) in children. METHODS A clinical data of 46 children with PST admitted between January 2015 and March 2021 and met selective criteria was retrospectively analyzed. The M-shaped scrotal flap method was adopted in 21 cases (group A), and the penile up transfer method was adopted in 25 cases (group B). There was no significant difference in age and PST typing between the two groups ( t=0.491, P=0.626; χ 2=0.710, P=0.790). The operation time and postoperative complications of the two groups were recorded and compared, and the correction effect of PST was evaluated. RESULTS All operations were successfully completed, and no urethral injury occurred during operation. The operation time was significantly less in group B than in group A [(70.36±9.76) minutes vs. (96.62±13.18) minutes; t=7.553, P=0.000]. All children were followed up 6-33 months (mean, 13.2 months). There were 5 cases (23.8%) of skin necrosis and 6 cases (28.6%) of scar hyperplasia in group A, and 1 case (4.0%) of skin necrosis and 1 case (4.0%) of scar hyperplasia in group B. The incidence of complication was significantly lower in group B than in group A ( χ 2=3.949, P=0.047; χ 2=5.341, P=0.021). In the evaluation of PST correction at 6 months after operation, there were 15 cases of complete correction and 6 cases of incomplete correction in group A, 24 cases of complete correction and 1 case of incomplete correction in group B, and the difference was significant ( χ 2=5.341, P=0.021). CONCLUSION The penis up transfer method is not only easy to correct PST, but also can correct scrotal separation at the same time, with fewer postoperative complications and satisfactory correction effect of penile scrotal appearance.
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Affiliation(s)
- 永隆 吴
- 厦门大学附属妇女儿童医院(厦门市妇幼保健院)小儿外科(福建厦门 361003)Department of Pediatric Surgery, Affiliated Women and Children’s Hospital, Xiamen University, Xiamen Fujian, 361003, P. R. China
| | - 杨 胡
- 厦门大学附属妇女儿童医院(厦门市妇幼保健院)小儿外科(福建厦门 361003)Department of Pediatric Surgery, Affiliated Women and Children’s Hospital, Xiamen University, Xiamen Fujian, 361003, P. R. China
| | - 寿福 王
- 厦门大学附属妇女儿童医院(厦门市妇幼保健院)小儿外科(福建厦门 361003)Department of Pediatric Surgery, Affiliated Women and Children’s Hospital, Xiamen University, Xiamen Fujian, 361003, P. R. China
| | - 波 徐
- 厦门大学附属妇女儿童医院(厦门市妇幼保健院)小儿外科(福建厦门 361003)Department of Pediatric Surgery, Affiliated Women and Children’s Hospital, Xiamen University, Xiamen Fujian, 361003, P. R. China
| | - 延波 徐
- 厦门大学附属妇女儿童医院(厦门市妇幼保健院)小儿外科(福建厦门 361003)Department of Pediatric Surgery, Affiliated Women and Children’s Hospital, Xiamen University, Xiamen Fujian, 361003, P. R. China
| | - 海琛 陈
- 厦门大学附属妇女儿童医院(厦门市妇幼保健院)小儿外科(福建厦门 361003)Department of Pediatric Surgery, Affiliated Women and Children’s Hospital, Xiamen University, Xiamen Fujian, 361003, P. R. China
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23
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Bereźniak M, Palczewski P, Sułkowska K, Gołębiowski M. Unilateral "white pyramid" sign in acute urinary tract obstruction. Abdom Radiol (NY) 2022; 47:2277-2278. [PMID: 35394155 DOI: 10.1007/s00261-022-03505-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Marlena Bereźniak
- Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Palczewski
- Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland.
| | - Katarzyna Sułkowska
- Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Marek Gołębiowski
- Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
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24
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Streltsova OS, Boldyreva MN, Kiseleva EB, M MA, Lazukin VF. [Study of the structure and microflora of urethral tissues in urethral pain syndrome]. Urologiia 2021:41-49. [PMID: 34743430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
UNLABELLED Urethral pain syndrome (UPS) is characterized by the occurrence of persistent or recurrent pain in the urethra in the absence of a confirmed infection and other obvious local pathological changes. The study of its pathogenetic aspects is important first of all for understanding the causes of the disease, to prescribe effective treatment, specific recommendations for the prevention and treatment of this disease are also absent. This paper presents the advanced experience of our research group on the study of the urethral state by the in vivo cross-polarization optical coherence tomography (CP OCT) method, and also the results of the microbiota analysis in the urethral tissues. The purpose of the study is to search for the risk factors for UPS and the character of changes in the urethral tissues, using the data of: 1) concomitant pathology, 2) structural changes in the urethral wall in UPS in comparison with chronic cystitis of bacterial etiology 3) studying the microbiota of urethral tissues. MATERIALS AND METHODS The condition of the urethra was studied in 109 patients: 55 of them with UPS (group "US"), without clinical manifestations of inflammation; 41 - with chronic inflammation of the lower urinary tract of various origins (group "Inf"); in 14 patients with stones of the upper urinary tract without pyelonephritis, the urethra was taken as the norm (group "N"). All performed a clinical minimum of studies, also cystoscopy with the study of the bladder triangle, the neck of the bladder and the urethra by the method of in vivo tissue imaging - CP OCT. The device "OCT-1300U" with wavelength of 1300 nm is used. To determine the possible role of UPS disease background, the analysis of concomitant pathology preceding the development of UPS was performed. To analyze the relationship of changes in the urethral tissues with the composition of its microbiota, a PCR study of biopsies from the proximal segment of the urethra was performed in 13 patients with UPS. RESULTS Qualitative comparison of the thickness and character of the OCT signal of the urethral wall layers observed using CP OCT in the studied groups of patients allowed us to establish that the state of the epithelium and connective tissue structures of the mucous membrane in patients with UPS is not the norm, changes are similar to those in chronic inflammation. Changes in the character of the OCT signal were recorded in all parts of the urethra, but in the middle third they are most pronounced and most critical. In UPS, there is a brightly pronounced reorganization of the connective tissue stroma components. Pronounced fibrosis of subepithelial structures (increased signal brightness in the cross-channel compared to the norm) with their thickening was recorded in 48.2% of cases, and thinning/lack of visualization of the epithelial layer was detected in 20.5%, and in chronic inflammation 55.5% and 40.6% of cases, respectively. According to the results of PCR, only one patient had significant total bacterial contamination of the biopsy (TB=104.7). In all other cases, the total bacterial mass of the biopsies was at the level of negative control. CONCLUSIONS In patients with UPS, the presence of several concomitant, often chronic, diseases was revealed, which may be a premorbid background and one of the risk factors for the occurrence and maintenance of UPS. Pilot PCR studies of biopsies from the proximal segment of the urethra indicate that low values of bacterial contamination in the majority of patients with UPS do not exclude the possible role of bacteria in the development of the disease in some patients. The CP OCT method used in this study is currently the only one in vivo method of visualization of the urethral mucosa, which provides real-time images of structural changes in the epithelial (atrophy or hyperplasia) and connective tissue (active or latent inflammation with cellular infiltration or fibrosis) layers of the urethra, allowing better understanding of the pathogenesis of the disease and monitoring of therapy.
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Affiliation(s)
- O S Streltsova
- Federal State Budgetary Educational Institution of Higher Education Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation
- Nizhniy Novgorod, Russia
- National Research Centre Institute of Immunology FMBA of Russia, Moscow, Russia
| | - M N Boldyreva
- Federal State Budgetary Educational Institution of Higher Education Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation
- Nizhniy Novgorod, Russia
- National Research Centre Institute of Immunology FMBA of Russia, Moscow, Russia
| | - E B Kiseleva
- Federal State Budgetary Educational Institution of Higher Education Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation
- Nizhniy Novgorod, Russia
- National Research Centre Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Molvi A M
- Federal State Budgetary Educational Institution of Higher Education Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation
- Nizhniy Novgorod, Russia
- National Research Centre Institute of Immunology FMBA of Russia, Moscow, Russia
| | - V F Lazukin
- Federal State Budgetary Educational Institution of Higher Education Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation
- Nizhniy Novgorod, Russia
- National Research Centre Institute of Immunology FMBA of Russia, Moscow, Russia
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Ramiro Pérez C, Manuel Vázquez A, Latorre Fragua R, Sanz Miguelañez JL, Ramia Ángel JM. [Parastomal hernia in Bricker urinary diversion as a reversible cause of obstructive uropathy: An exceptional complication.]. ARCH ESP UROL 2021; 74:796-799. [PMID: 34605420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Parastomal hernia in patientswith ileal urinary diversion is insufficiently described in theliterature, and among its complications, the presence ofurinary obstruction is not usually reported. METHODS: We present a 74-year-old male with a Brickertype urinary diversion. He presented urinary infections withCT scan showing hydronephrosis with obstruction of theileal conduit probably related to a parastomal hernia. Thehernia growth runs in parallel to the ureterohydronephrosis,so we performed a hernioplasty to solve the obstruction. CTat 6 months shows no urinary obstruction and no hernia recurrence.No hydronephrosis in the follow-up at 14 months. RESULTS: We reviewed the literature and we only foundthree articles that related parastomal hernia in Bricker toureterohydronephrosis, although none of them proved thisrelationship with the correction of the urinary obstructionafter hernia surgery. CONCLUSIONS: Parastomal hernia should be consideredin the differential diagnosis of obstructive uropathy in patientswith ileal urinary diversion.
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Affiliation(s)
- Carmen Ramiro Pérez
- Servicio de Cirugía General y del Aparato Digestivo. Hospital Universitario de Guadalajara. España
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Lo TS, Ng KL, Lin YH, Hsieh WC, Kao CC, Tan YL. Impact of intrinsic sphincter deficiency on mid-urethral sling outcomes. Int Urogynecol J 2021; 33:887-896. [PMID: 34003308 DOI: 10.1007/s00192-021-04757-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Our primary objective was to study outcomes of patients with intrinsic sphincter deficiency (ISD) following mid-urethral slings (MUS) at 1-year. Our secondary objective was to delineate factors affecting success in these patients. METHODS Six hundred eighty-eight patients who had MUS between January 2004 and April 2017 were reviewed retrospectively; 48 women were preoperatively diagnosed with ISD. All completed urodynamic studies and validated quality-of-life (QOL) questionnaires at baseline and 1 year. Primary outcomes were objective and subjective cure of stress incontinence, defined as no involuntary urine leakage during filling cystometry and 1-h pad test < 2 g and negative response to Urogenital Distress Inventory-6 Question 3. Ultrasound was performed to determine tape position, urethral mobility and kinking at 1 year. RESULTS Women with ISD had significantly lower objective and subjective cure rates of 52.1% and 47.9%, respectively, compared to an overall of 88.2% and 85.9%. QOL scores significantly improved in those with successful surgeries. The sling type did not make a difference. Multivariate logistic regression identified reduced urethral mobility [OR 2.11 (1.24-3.75)], lower maximum urethral closure pressure (MUCP) [OR 1.61 (1.05-3.41)] and tape position [OR 3.12 (1.41-8.71)] to be associated with higher odds of failed slings for women with ISD. CONCLUSIONS Although there are good overall success in women undergoing MUS, those with ISD have significantly lower cure rates at 1 year. Factors related to failure include reduced urethral mobility, low MUCP and relative tape position further away from the bladder neck. Optimal management of patients with ISD and reduced urethral mobility remains challenging.
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Affiliation(s)
- Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsin Street, Kwei-shan, Tao-Yuan City, Taiwan, 333, Republic of China.
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China.
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei Medical Center, Taipei, Taiwan, Republic of China.
- Chang Gung University, School of Medicine, Taoyuan, Taiwan, Republic of China.
| | - Kai Lyn Ng
- Department of Obstetrics & Gynecology, National University Hospital of Singapore, Singapore, Singapore
| | - Yi-Hao Lin
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsin Street, Kwei-shan, Tao-Yuan City, Taiwan, 333, Republic of China
- Chang Gung University, School of Medicine, Taoyuan, Taiwan, Republic of China
| | - Wu-Chiao Hsieh
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsin Street, Kwei-shan, Tao-Yuan City, Taiwan, 333, Republic of China
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China
- Chang Gung University, School of Medicine, Taoyuan, Taiwan, Republic of China
| | - Chuan Chi Kao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China
| | - Yiap Loong Tan
- Department of Obstetrics and Gynecology, Kuching Specialist Hospital, Sarawak, Malaysia
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Kutia SA, Radkovskij VA, Astafurov DD, I LA, Yarovaya OY. [Modern ideas about bulbourethral glands]. Urologiia 2021:128-134. [PMID: 33960172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Bulbourethral glands are the accessory glands of the male reproductive system, the leading function of which is associated with ejaculation and includes both the neutralization of the acidic urine residues and environment of the female vagina, and friction reduction during the sexual intercourse. These glands play the role of immune barrier for urogenital infections, and also synthesize important autocrine and paracrine factors for the male urogenital system development. Glands pathologies usually have a subclinical course, however they can also lead to the functional disorders of the human urogenital system. The list of the most common diseases include cuperitis and syringocele. Usually their duration is asymptomatic and they are nearly impossible to diagnose; as a consequence, it is quite difficult to evaluate the real incidence of morbidity and importance of the bulbourethral gland pathology. In recent years, the vast majority of the bulbourethral glands researches are dedicated to the features of X-ray diagnostics and pathology detection, as well as to the description of rare clinical cases. Authors have analyzed the various available scientific data in order to review of morphological, physiological and clinical aspects of the Cowpers glands.
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Affiliation(s)
- S A Kutia
- V.I. Vernadsky Crimean Federal University, Simferopol, Republic of Crimea, Russia
| | - V A Radkovskij
- V.I. Vernadsky Crimean Federal University, Simferopol, Republic of Crimea, Russia
| | - D D Astafurov
- V.I. Vernadsky Crimean Federal University, Simferopol, Republic of Crimea, Russia
| | - Lugin A I
- V.I. Vernadsky Crimean Federal University, Simferopol, Republic of Crimea, Russia
| | - O Ya Yarovaya
- V.I. Vernadsky Crimean Federal University, Simferopol, Republic of Crimea, Russia
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Tikhonova LV, Kasyan GR, Stroganov AB, Mukhtarov ST, Sheripbaev RB, Dyakov VV, Pushkar DY. [Diagnostic nomograms for the treatment of urogenital fistula]. Urologiia 2021:13-20. [PMID: 33818929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIM Studies on non-obstetric urogenital fistula provide limited information on predictive factors. The aim of our study was to specify and to analyze the predictors for long-term anatomical and functional results in women with non-obstetric urogenital fistula. MATERIALS AND METHODS A cross-section study of surgical repair for non-obstetric urogenital fistula repairs was carried out. From 2012 to 2018, a total of 446 patients with urogenital fistulas were treated in two tertiary centers. Patients with vesicovaginal and urethrovaginal fistulas with at least 12 months of follow-up were identified and contacted by phone and/or examined in the clinic. Anatomical outcome was assessed by resolution of symptoms and/or results of clinical examination. Urinary distress inventory (UDI-6) was used for the measurement of functional outcomes. The nomogram is based on a multiple regression equation, the solution of which is performed using a computer. The nomogram is presented as a set of scales, each of which corresponds to a certain variable. The baseline parameter is assigned certain points, depending on its value, then the sum of all parameters is calculated. As a result, it is possible to determine the risk using a couple or three scales. RESULTS Overall, 169 patients were studied (mean age of 49.2, mean follow-up of 34 months). The most common cause of fistulas included hysterectomy (69.4%), followed by pelvic radiotherapy (18.9%). Only 64% of cases were primary fistula. Closure rate was 90.7% (98/108). Anatomical success depended on the surgical approach. For transvesical procedure, success rate was 89.4% (42/47), compared to 84% (89/106) and 87.5% (14/16), respectively for transvaginal and transabdominal success rate. According to Clavien-Dindo, complications were grade 1 (11.8%) and grade 2 (4.7%). As UDI-6 showed, the most common symptoms were frequency (62%), urgency (50%), incontinence (73%), pain (55%) and voiding symptoms (27%). Fistula size > 3.0 cm, pelvic radiation, and previous vaginal surgeries were associated with a higher risk of failure or more severe lower urinary tract symptoms. A high number of re-do cases and complex fistulas could be a limitation of this study. Factors for successful non-obstetric urogenital fistula closure were fistula size less than 3.0 cm, absence of pelvic radiation, and previous vaginal surgeries. CONCLUSION According to our results, only fistula size > 3 cm, previous vaginal procedures and pelvis irradiation were unfavorable predictors for anatomic success of fistula repair. In addition, our results allow to determine the predictors for successful repair and risk of recurrence lower urinary tract symptoms postoperatively.
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Affiliation(s)
- L V Tikhonova
- Department of Urology of A. I. Evdokimov Moscow State University of Medicine and Dentistry
- AO European Medical Center, urologic clinic, Moscow, Russia
| | - G R Kasyan
- Department of Urology of A. I. Evdokimov Moscow State University of Medicine and Dentistry
| | - A B Stroganov
- Department of Urology of A. I. Evdokimov Moscow State University of Medicine and Dentistry
| | - S T Mukhtarov
- Republican Specialized Center of Scientific and Practical Urology, Tashkent, Uzbekistan
| | - R B Sheripbaev
- Republican Specialized Center of Scientific and Practical Urology, Tashkent, Uzbekistan
| | - V V Dyakov
- Department of Urology of A. I. Evdokimov Moscow State University of Medicine and Dentistry
| | - D Yu Pushkar
- Department of Urology of A. I. Evdokimov Moscow State University of Medicine and Dentistry
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Gvozdev MY, Arefyeva OA, Vasilyeva MA, Dzhuraeva MD. [Urethral diverticulum in female]. Urologiia 2020:94-97. [PMID: 32597594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Urethral diverticulum is one of the rarest female urological diseases, which is characterized by various manifestations, ranging from an asymptomatic to severe urinary disorders, pain and dyspareunia. The aim of this work is to present a clinical observation of female urethral diverticulum with a description and discussion of its etiology, diagnosis, and treatment. Clinical observation is dedicated to 40-year-old woman with complaints of pain in the urethral area. The patient underwent ureteral stenting followed by a diverticulectomy. Vaginal diverticulectomy is the gold standard for treatment. The specialist performing such interventions should be aware for possible intraoperative complications. It seems appropriate to perform the surgical treatment of female urethral diverticulum in specialized centers with an experience in female urethral reconstruction.
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Affiliation(s)
- M Yu Gvozdev
- Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - O A Arefyeva
- Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - M A Vasilyeva
- Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - M D Dzhuraeva
- Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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Popov SV, Orlov IN, Gadjiev NK, Obidnyak VM, Sytnik DA, Kulikov AY, Akopyan GN, Gadzhieva ZK, Spiridonov NY. [Conservative management of rectourethral fistula: modern treatment]. Urologiia 2019:44-47. [PMID: 32003166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION & Objectives. Rectal injury and recto-urethral fistula (RUF) formation are severe complications after surgical treatment of prostate cancer . There are various surgical techniques as well as conservative methods for the treatment of RUF. Nonsurgical approach can be used in nontoxic, minimally symptomatic patients. MATERIALS & METHODS From 2012 to 2016, 825 patients (mean age 68y) with LPR to be performed were recruited in the study. Postoperatively RUF developed in 7 patients (0.8%) in average in 10 days after surgery. Five cases were uncomplicated presented with pneumaturia, dysuria or urine per rectum. Two patients with fecaluria and previous history of radiotherapy or androgen deprivation were excluded from the study group. Conservative management include: 1)bowel rest 2)broad-spectrum antibiotics after urine culture 3) fully absorbable diet (combination of parenteral and enteral nutrition) 4) bladder drainage (urethral catheter or suprapubic tube). Duration of conservative treatment was 4 weeks. After treatment all patients underwent a voiding cystourethrogram. RESULTS During the treatment one patient has developed severe UTIs and surgical treatment were perfomed. The remaining 4 patients had spontaneous healing of the fistula and normal cystourethrogram. With the median follow up of 24 month after RUF treatment all 4patients had no fistula signs and they were fully continent. Overall RUF closure using nonsurgical treatment was successful in 4 of 5 cases (80%). CONCLUSIONS Conservative management of RUF is a highly effective option which can be used to avoid major surgery and temporary colostomy. Nonsurgical treatment is a feasible method in selected patients with RUF.
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Affiliation(s)
- S V Popov
- St. Petersburg Clinical Hosital named after St Luka, Sankt Peterburg, Saint-Petersburg, Russia
- Department of Urology Saint Petersburg Pavlov State Medical University, Saint-Petersburg, Russia
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- medical clinic MedClub, Saint-Petersburg, Russia
| | - I N Orlov
- St. Petersburg Clinical Hosital named after St Luka, Sankt Peterburg, Saint-Petersburg, Russia
- Department of Urology Saint Petersburg Pavlov State Medical University, Saint-Petersburg, Russia
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- medical clinic MedClub, Saint-Petersburg, Russia
| | - N K Gadjiev
- St. Petersburg Clinical Hosital named after St Luka, Sankt Peterburg, Saint-Petersburg, Russia
- Department of Urology Saint Petersburg Pavlov State Medical University, Saint-Petersburg, Russia
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- medical clinic MedClub, Saint-Petersburg, Russia
| | - V M Obidnyak
- St. Petersburg Clinical Hosital named after St Luka, Sankt Peterburg, Saint-Petersburg, Russia
- Department of Urology Saint Petersburg Pavlov State Medical University, Saint-Petersburg, Russia
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- medical clinic MedClub, Saint-Petersburg, Russia
| | - D A Sytnik
- St. Petersburg Clinical Hosital named after St Luka, Sankt Peterburg, Saint-Petersburg, Russia
- Department of Urology Saint Petersburg Pavlov State Medical University, Saint-Petersburg, Russia
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- medical clinic MedClub, Saint-Petersburg, Russia
| | - A Y Kulikov
- St. Petersburg Clinical Hosital named after St Luka, Sankt Peterburg, Saint-Petersburg, Russia
- Department of Urology Saint Petersburg Pavlov State Medical University, Saint-Petersburg, Russia
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- medical clinic MedClub, Saint-Petersburg, Russia
| | - G N Akopyan
- St. Petersburg Clinical Hosital named after St Luka, Sankt Peterburg, Saint-Petersburg, Russia
- Department of Urology Saint Petersburg Pavlov State Medical University, Saint-Petersburg, Russia
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- medical clinic MedClub, Saint-Petersburg, Russia
| | - Z K Gadzhieva
- St. Petersburg Clinical Hosital named after St Luka, Sankt Peterburg, Saint-Petersburg, Russia
- Department of Urology Saint Petersburg Pavlov State Medical University, Saint-Petersburg, Russia
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- medical clinic MedClub, Saint-Petersburg, Russia
| | - N Y Spiridonov
- St. Petersburg Clinical Hosital named after St Luka, Sankt Peterburg, Saint-Petersburg, Russia
- Department of Urology Saint Petersburg Pavlov State Medical University, Saint-Petersburg, Russia
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- medical clinic MedClub, Saint-Petersburg, Russia
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Dorado M, Molina R, Álvarez M, Paéz Á. Urethral prolapse, is surgical treatment necessary? ARCH ESP UROL 2019; 72:619-620. [PMID: 31274130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Montserrat Dorado
- Servicio Urología. Hospital Universitario de Fuenlabrada. Madrid. España
| | - Roberto Molina
- Servicio Urología. Hospital Universitario de Fuenlabrada. Madrid. España
| | - Manuel Álvarez
- Servicio Urología. Hospital Universitario de Fuenlabrada. Madrid. España
| | - Álvaro Paéz
- Servicio Urología. Hospital Universitario de Fuenlabrada. Madrid. España
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Inama M. Use of biological mesh in trans-anal treatment for recurrent recto-urethral fistula. Int Urol Nephrol 2017; 49:2169. [PMID: 28918524 DOI: 10.1007/s11255-017-1704-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 09/11/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Marco Inama
- General Surgery Unit, Hospital "Dott. Pederzoli", Via Monte Baldo 24, Peschiera del Garda, 37019, Verona, Italy.
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Wang C, Liu S, Chen Z, Li L, Zheng W. [Efficacy evaluation of laparoscopic surgery for children with persistent cloaca]. Zhonghua Wei Chang Wai Ke Za Zhi 2016; 19:1389-1394. [PMID: 28000197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To explore the feasibility and efficacy of laparoscopic surgery in the treatment of children with persistent cloaca. METHODS Clinical data of 26 female children with high type persistent cloaca undergoing operation in the Capital Pediatric Institution between November 2005 and February 2015 were retrospectively analyzed. Mean age of these children was (1.4±1.6) years old. Distal end of rectum locating in the superior border of pubis was the standard of diagnosis. Laparoscopy-assisted anorectoplasty (LAARP), vaginoplasty and urethroplasty were performed in 17 cases (LAARP group), including 3-port laparoscopy in 12 cases and single-port laparoscopy in 5 cases. Abdominoperineal pull through (APPT), vaginoplasty and urethroplasty were performed in the other 9 cases (APPT group). Sacral ratio (SR), length of common channel, intraoperative blood loss, operation time, postoperative hospital stay, postoperative complications and bowel function were compared between two groups. Postoperative defecation was evaluated by the Krickenbeck standard. RESULTS Operations were successfully performed in all patients and no case in LAARP group was transferred to open abdominal operation. There were no significant differences in SR value, length of common channel and age at operation between the two groups. As compared to APPT group, the mean operative time was shorter [(124.1±4.9) minutes vs. (131.8±3.2) minutes, P=0.000], the intraoperative blood loss was less [(10.5±2.1) ml vs. (16.2±2.7) ml, P=0.000], and the postoperative hospital stay was shorter [(5.7±0.5) days vs. (9.2±0.4) days, P=0.000] in LAARP group. In LAARP group, there were no significant differences in operation time, intraoperative blood loss and postoperative hospital stay between 3-port and single-port laparoscopic surgery (all P>0.05). The mean follow-up period was (4.0±2.8) months in LAARP group and (6.0±2.3) months of APPT group. There is one case have wound infection in ARRT patients. The rates of voluntary bowel movement, soiling, constipation (grade 1, 2, 3) were similar in both groups, however, the overall bowel function after LAARP was better than that of ARRT according to the Krickenbeck classification (10.7±0.2 vs. 9.7±1.2, P=0.047). Postoperative rectal mucosa prolapse was found in 2 cases of LAARP group and 1 case in APPT group. One case of APPT group developed wound infection. No urethrovaginal fistula relapse, anal stenosis or urethral stricture was found in all the cases. CONCLUSIONS The LAARP is safe and feasible in the treatment of persistent cloaca.
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Affiliation(s)
- Chen Wang
- Department of Colorectum Surgery, Qingdao Municipal Hospital, Qingdao 266011, China
| | - Shuli Liu
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing 100020, China
| | - Zhen Chen
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing 100020, China
| | - Long Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing 100020, China.
| | - Wei Zheng
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing 100020, China
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Gazali ZA, Singal AK. Hair Thread Tourniquet Syndrome of Penis Causing Urethral Fistula. Indian Pediatr 2015; 52:538. [PMID: 26121743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Zarine A Gazali
- Rowhouse D1 Goldmine, Plot no. 138, Sector- 21, Nerul east, Navi-Mumbai, Maharashtra, India.
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Bazi T, El-Hout Y. Re: Distal intramural urethral pathology in women: A. N. Romman, F. Alhalabi and P. E. Zimmern J Urol 2012; 188: 1218-1223. J Urol 2013; 189:2395-6. [PMID: 23328577 DOI: 10.1016/j.juro.2013.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2013] [Indexed: 11/30/2022]
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Komiakov BK, Idrisov SN, Kim VE. [Urethral amyloidosis]. Urologiia 2011:71-72. [PMID: 21870489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Artibani W, Novara G. The International Continence Society terminology for the lower urinary tract: the importance of standardization. ACTA ACUST UNITED AC 2005; 2:576-7. [PMID: 16474526 DOI: 10.1038/ncpuro0348] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Accepted: 10/12/2005] [Indexed: 11/08/2022]
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Affiliation(s)
- S Kulkarni
- Department of Urology, Royal Free Hospital, Hampstead, London.
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Ichiyanagi N, Shibata T, Matsumura T, Ishimaru H, Sakai K. Immunohistochemical identification of prostate-specific antigen in a parameatal urethral cyst of the glans penis. Br J Urol 1998; 81:170-1. [PMID: 9467501 DOI: 10.1046/j.1464-410x.1998.00353.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- N Ichiyanagi
- Department of Urology, Tsuchiura Kyodo Hospital, Ibaraki, Japan
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Abstract
Mycoplasma genitalium was sought in synovial fluids from 13 patients, of whom five had Reiter's syndrome, four had rheumatoid arthritis, and one each had systemic lupus erythematosus, psoriatic arthritis, rheumatic fever and undefined arthritis. The mycoplasma was detected by a PCR assay in the knee joint of a 25-year-old man with Reiter's syndrome, from whom urethral ureaplasmas were isolated and whose synovial fluid mononuclear cells responded to ureaplasmal antigens in a proliferation assay. Mycoplasma genitalium was also detected in the knee joint during an exacerbation of arthritis in a 58-year-old man who had had seronegative juvenile polyarthritis that had evolved to seronegative rheumatoid arthritis.
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Affiliation(s)
- D Taylor-Robinson
- MRC Sexually Transmitted Diseases Research Group, St. Mary's Hospital, Paddington, London, UK
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45
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Mishina T, Watanabe K. [Thirteen cases of female urethral diverticula]. Hinyokika Kiyo 1988; 34:343-50. [PMID: 3132031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We report 13 cases of female urethral diverticula which were diagnosed at the Mishina Urological Office between July, 1984 and June, 1987. The 8 cases among them were discovered between July, 1986 and June, 1987 in the office, because the positive pressure urethrography has been energetically performed to detect female urethral diverticulum since November, 1985. The number of female outpatients in this period was 285, and the occurrence rate of the female urethral diverticula was 2.8%. Transvaginal diverticulectomy was performed in 5 of the 13 cases, using methylene blue-coagulum as an adjunct to the surgery. Postoperative course was uneventful in all cases. We herein reviewed the literature on this disease in addition to 65 cases including our cases since 1980.
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Affiliation(s)
- T Mishina
- Department of Urology, Kyoto Saiseikai Hospital
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46
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Abstract
Primary amyloidosis of the lower urinary tract is a rare condition with an excellent prognosis in most cases. Three patients with this condition are described. In the cases of localized amyloidosis of the urethra and urinary bladder, the clinical presentation mimicked cancer of the respective sites. This was also true in the case of primary systemic amyloidosis involving the bladder. If significant associated systemic or local disease can be excluded, management is symptomatic and expectant.
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Affiliation(s)
- R Grainger
- Department of Urology, St. Vincent's Hospital, Dublin, Ireland
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Hara M, Kanamori S, Kondo Y, Nishimura T, Akimoto M. [A case of large diverticular stone of the anterior urethra]. Hinyokika Kiyo 1987; 33:1125-7. [PMID: 3120523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A case of large diverticular stone of anterior urethra is reported. A 70-year-old man was admitted for dysuria, miction pain and hard mass beneath the scrotal skin. Retrograde urethrogram revealed a large stone in anterior urethral diverticulum and extravasation of contrast medium through the fistula from diverticulum. Open resection of diverticulum was performed and the stone was removed. Three months after the operation, the urethrogram showed no abnormal findings. The stone was 40 x 19 x 17 mm in size, weighed 16 g and was mainly composed of calcium phosphate.
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Affiliation(s)
- M Hara
- Department of Urology, Nippon Medical School
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Abstract
A 19-year-old white male with Crohn's disease, who complained of passing urine per rectum and having retrograde ejaculations, was noted to have a urethroperineal-rectal fistula. The fistulous communication remained patent despite pharmacologic therapy, a diversion ileostomy, and a total proctocolectomy. A fistulectomy and definitive urethral repair finally resulted in resolution of the problem.
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50
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Gupta SC, Kumar S, Srivastava A. Urethral myiasis. Trop Geogr Med 1983; 35:73-4. [PMID: 6612774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A case of urethral myiasis is reported. The authors are not aware of any such reference in the literature.
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