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Sample records for traumatic posterior urethral

  1. Evaluation of early endoscopic realignment of post-traumatic complete posterior urethral rupture

    PubMed Central

    Abdelsalam, Yaser M; Abdalla, Medhat A; Safwat, Ahmad S; ElGanainy, Ehab O

    2013-01-01

    Introduction: to report our experience with 41 patients treated by early endoscopic realignment of complete post-traumatic rupture urethra. Materials and Methods: The study includes patients presented to our institute, between May 2004 and April 2009, with post-traumatic complete posterior urethral disruption. Preoperative retrograde urethrography, voiding cystourethrography and abdominopelvic CT were performed to evaluate the urethral defect length, the bladder neck competence, the prostate position, and the extent of the pelvic hematoma. Within the first week after trauma, antegrade and retrograde urethroscopy were performed to identify both urethral ends and insert urethral catheter. Patients were followed up by pericatheter retrograde urethrogram monthly postoperatively till catheter removal on disappearance of extravasation. Retrograde urethrography, voiding cystourethrography and urethroscopy were performed 1 month after the removal of the catheter. Follow-up abdominal ultrasound and uroflowmetry monthly till 6 months, bimonthly till 1 year, and every 3 months thereafter were encouraged. Urinary continence and postoperative erectile dysfunction were assessed by direct patient interview. Results: Forty one patients in the age group 17-61 years (mean 37.9) were treated. Patients were followed up for Conclusions: Early endoscopic realignment for complete posterior urethral rupture is a feasible technique with no or minimal intraoperative complications. The technique is successful as the definitive line of therapy in reasonable number of patients and seems to render further future interventions for inevitable urethral stricture easier. PMID:24082438

  2. Posterior Urethral Strictures

    PubMed Central

    Gelman, Joel; Wisenbaugh, Eric S.

    2015-01-01

    Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty. PMID:26691883

  3. Posterior Urethral Strictures.

    PubMed

    Gelman, Joel; Wisenbaugh, Eric S

    2015-01-01

    Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty. PMID:26691883

  4. Gossypiboma mimicking posterior urethral stricture

    PubMed Central

    Kumar, Bindey; Kumar, Prem; Sinha, Sanjay Kumar; Sinha, Neelam; Hasan, Zaheer; Thakur, Vinit Kumar; Anand, Utpal; Priyadarshi, Rajiv Nayan; Mandal, Manish

    2013-01-01

    INTRODUCTION Foreign bodies in the urogenital tract are not uncommon. Hairpins, glass rods, umbilical tapes, ball point pen are described in lower urogenital tract. Retained gauze piece (gossypiboma) in posterior urethra may cause diagnostic dilemma. Symptoms and investigations may mimic stricture of posterior urethra. PRESENTATION OF CASE Two cases of retained gauze pieces in the urethra are described here. The micturating cystourethrogram was suggestive of posterior urethral stricture. DISCUSSION Two cases described here had retained gauze piece as a cause of filling defect and abnormal appearance in the micturating cystourethrogram. Gossypiboma may be a possibility where posterior urethral stricture are seen after previous surgery in paediatric age group. CONCLUSION In the setting of previous urogenital surgery gossypiboma should be kept in the differential diagnosis where posterior urethral stricture are seen in the paediatric age group. PMID:23500749

  5. Complex posterior urethral injury

    PubMed Central

    Kulkarni, Sanjay B.; Joshi, Pankaj M.; Hunter, Craig; Surana, Sandesh; Shahrour, Walid; Alhajeri, Faisal

    2015-01-01

    Objective To assess treatment strategies for seven different scenarios for treating complex pelvic fracture urethral injury (PFUI), categorised as repeat surgery for PFUI, ischaemic bulbar urethral necrosis (BUN), repair in boys and girls aged ⩽12 years, in patients with a recto-urethral fistula, or bladder neck incontinence, or with a double block at the bulbomembranous urethra and bladder neck/prostate region. Patients and methods We retrospectively reviewed the success rates and surgical procedures of these seven complex scenarios in the repair of PFUI at our institution from 2000 to 2013. Results In all, >550 PFUI procedures were performed at our centre, and 308 of these patients were classified as having a complex PFUI, with 225 patients available for follow-up. The overall success rates were 81% and 77% for primary and repeat procedures respectively. The overall success rate of those with BUN was 76%, using various methods of novel surgical techniques. Boys aged ⩽12 years with PFUI required a transpubic/abdominal approach 31% of the time, compared to 9% in adults. Young girls with PFUI also required a transpubic/abdominal urethroplasty, with a success rate of 66%. In patients with a recto-urethral fistula the success rate was 90% with attention to proper surgical principles, including a three-stage procedure and appropriate interposition. The treatment of bladder neck incontinence associated with the tear-drop deformity gave a continence rate of 66%. Children with a double block at the bulbomembranous urethra and at the bladder neck-prostate junction were all continent after a one-stage transpubic/abdominal procedure. Conclusion An understanding of complex pelvic fractures and their appropriate management can provide successful outcomes. PMID:26019978

  6. Cryptorchidism in boys with posterior urethral valves.

    PubMed

    Krueger, R P; Hardy, B E; Churchill, B M

    1980-07-01

    A review of 207 male children with poterior urethral valves revealed an over-all incidence of cryptorchidism of 12 per cent. This association of cryptorchidism in boys with posterior urethral valves has not been described previously. PMID:6106069

  7. Anterior urethral valve associated with posterior urethral valves.

    PubMed

    Kajbafzadeh, A M; Jangouk, P; Ahmadi Yazdi, C

    2005-12-01

    The association of anterior urethral valve (AUV) with posterior urethral valve (PUV) is rare. A 7-month-old infant was presented at a district hospital with episodes of acute pyelonephritis. He was treated medically and a voiding cystourethrogram (VCUG) confirmed bilateral vesico-urethral reflux. The presence of concomitant AUV and PUV was not recognized. He underwent several surgical procedures, which failed. He had reflux recurrence following two antireflux procedures. He had urinary retention after each operation, which was managed by vesicostomy and perineal urethrostomy. At the age of 3.5 years, he was referred to our paediatric urology clinic. Noticing the AUV and PUV in the past VCUG, the valves were fulgurated. Urodynamic study before and 3 months after valve ablation showed a high voiding pressure. VCUG 6 months following ablation showed no reflux, but several uroflowmetric studies showed a staccato and interrupted pattern. Empirical treatment with an alpha-blocker was started. One year after treatment, a repeat VCUG showed no reflux. Uroflowmetry and urodynamic studies returned to normal. The perineal urethrostomy was closed. The child was asymptomatic after 9 months of follow up. PMID:18947585

  8. Posterior Urethral Valve: An Unusual Cause of Primary Male Infertility

    PubMed Central

    Agbugui, Jude Orumuah; Omokhudu, Oisamoren

    2015-01-01

    Background Posterior urethral valve presenting in adulthood is uncommon. This can be an unusual cause of primary male infertility as a result of abnormalities in sexual function. Case Presentation This report describes a 40 year old man who presented to us on account of inability to impregnate his wife after 2 years of marriage. History revealed poor stream of urine since childhood and passage of scanty ejaculate during intercourse. A micturating cystourethrogram revealed dilated posterior urethra in keeping with posterior urethral valves. Endoscopic valve ablation was done with subsequent improvement in ejaculate volume and urine stream. His spouse achieved pregnancy thereafter. Conclusion In this report, it was found that adult posterior urethral valve though uncommon may be a cause of male infertility. Restoration of fertility potential can be achieved following valve ablation. PMID:25927029

  9. Fetoscopic transuterine release of posterior urethral valves: a new technique.

    PubMed

    Clifton, Matthew S; Harrison, Michael R; Ball, Robert; Lee, Hanmin

    2008-01-01

    Fetal urinary tract obstruction with oligohydramnios produces pulmonary hypoplasia and renal dysplasia. Decompression of the obstructed urinary tract may restore amniotic fluid and allow lung growth, but transabdominal catheter shunt decompression is often inadequate and does not allow for cycling of the bladder, while open procedures cause significant maternal morbidity. Disruption of the anatomic obstruction, usually posterior urethral valves in a male fetus, would be ideal but has proven technically difficult. Here we describe a new technique of percutaneous fetal cystoscopy and disruption of posterior urethral valves, and the case report of our first application of this technique. We pre-sent a case of a 17-week male fetus with posterior urethral valves which underwent fetal cystoscopy for mechanical disruption of posterior urethral valves. This minimally invasive approach to disruption of posterior urethral valves in a fetus is a novel method for decompressing the urinary tract. The technique offers a minimal degree of maternal morbidity and, if instituted early enough, can restore amniotic fluid volume, avert fatal pulmonary hypoplasia and may preserve renal function. PMID:18033963

  10. A case of hypospadias, anterior and posterior urethral valves.

    PubMed

    Carvell, James; Mulik, Roopa

    2013-01-01

    This report outlines the case of a 3-year-old boy whose initial presentation was that of asymptomatic hypertension (lowest recording 148/90), found at preoperative check prior to stage 2-correction surgery for distal hypospadias. Upon diagnosis of true hypertension, an ultrasound of the child's renal tract showed evidence of marked hydronephrosis and calyceal dilatation. On the background of deteriorating renal function (Urea 25.5 and Creatinine 188), a Micturating Cystourethrogram was performed, demonstrating posterior urethral dilatation. With difficulties controlling blood pressure, the child was transferred to Urology care, where resection of a posterior urethral valve (PUV) was undertaken. Despite this, renal function deteriorated further and re-cystoscopy identified an anterior urethral valve (AUV), which was also resected. Renal function, although improved, remains poor and blood pressure is controlled with two anti-hypertensives. To the publisher's knowledge, the association between hypospadias, PUVs and AUVs is as yet undocumented. PMID:24964414

  11. Posterior Urethral Valves: Renal Failure and Prenatal Treatment

    PubMed Central

    Casella, Daniel P.; Tomaszewski, Jeffrey J.; Ost, Michael C.

    2012-01-01

    Posterior urethral valves occur in 1 : 5000 live births. Despite the high prevalence, the few children that survive do poorly, with over 50% progressing to ESRD in 10 years. The gold standard for post-natal diagnosis is voiding cystourethrography, while pre-natal diagnosis is dependent on routine screening ultrasonography. Despite the ability to identify features of bladder outlet obstruction early in fetal development, there is no consensus on how to incorporate early detection into current screening protocols. There has yet to be a marker that allows prediction of obstruction in the absence of or prior to radiographic evidence of obstruction. With our current screening strategy, the majority of interventions are performed well after irreversible damage has occurred. Improved mortality and long term morbidity from posterior urethral valves and congenital bladder outlet obstruction will likely remain unchanged until it is possible to intervene prior to the onset of irreversible renal damage. New biologic markers and improved instrumentation will allow for more effective diagnosis and intervention at earlier stages of fetal development. PMID:21860792

  12. Anterior urethral valve associated with posterior urethral valves: report of 2 cases and review of the literature.

    PubMed

    Tran, Christine N; Reichard, Chad A; McMahon, Daniel; Rhee, Audrey

    2014-08-01

    Anterior urethral valve (AUV) associated with posterior urethral valves (PUVs) is an extremely rare congenital urologic anomaly resulting in lower urinary tract obstruction. We present our experience with 2 children with concomitant AUV and PUV as well as a literature review. The clinical presentation of concomitant AUV and PUV is variable. Successful endoscopic management can result in improvement in renal function, reversal of obstructive changes, and improvement or resolution of voiding dysfunction. PMID:24958476

  13. SIU/ICUD Consultation on Urethral Strictures: Posterior urethral stenosis after treatment of prostate cancer.

    PubMed

    Herschorn, Sender; Elliott, Sean; Coburn, Michael; Wessells, Hunter; Zinman, Leonard

    2014-03-01

    Posterior urethral stenosis can result from radical prostatectomy in approximately 5%-10% of patients (range 1.4%-29%). Similarly, 4%-9% of men after brachytherapy and 1%-13% after external beam radiotherapy will develop stenosis. The rate will be greater after combination therapy and can exceed 40% after salvage radical prostatectomy. Although postradical prostatectomy stenoses mostly develop within 2 years, postradiotherapy stenoses take longer to appear. Many result in storage and voiding symptoms and can be associated with incontinence. The evaluation consists of a workup similar to that for lower urinary tract symptoms, with additional testing to rule out recurrent or persistent prostate cancer. Treatment is usually initiated with an endoscopic approach commonly involving dilation, visual urethrotomy with or without laser treatment, and, possibly, UroLume stent placement. Open surgical urethroplasty has been reported, as well as urinary diversion for recalcitrant stenosis. A proposed algorithm illustrating a graded approach has been provided. PMID:24361008

  14. Vesicourethral fistula after retrograde primary endoscopic realignment in posterior urethral injury.

    PubMed

    Arora, Rajat; John, Nirmal Thampi; Kumar, Santosh

    2015-01-01

    A 22-year-old male patient presented with iatrogenic vesicourethral fistula after immediate retrograde endoscopic realignment of urethra after a posterior urethral injury associated with pelvic fracture. PMID:25440761

  15. Posterior urethral valve: Prognostic factors and renal outcome

    PubMed Central

    Bhadoo, Divya; Bajpai, Minu; Panda, Shasanka Shekhar

    2014-01-01

    Objective: The aim was to study the outcome of posterior urethral valve (PUV) cases treated by stepladder protocol and the prognostic factors affecting the outcome. Materials and Methods: Hospital records of all PUV patients treated by stepladder protocol between January 1992 and December 2013 were reviewed. The studied parameters were: Age at presentation, serum creatinine, types of surgical intervention, vesicoureteral reflux (VUR) on initial voiding cystourethrogram (VCUG), renal cortical scars, plasma renin activity (PRA), and glomerular filtration rate (GFR). Results: Of 396 PUV patients treated during the study period, 152 satisfied study criteria. The age at presentation ranged from 2 days to 15 years (mean 31.3 months). The mean follow-up period was 5 years (range: 2-18 years). Primary endoscopic valve ablation was the most common initial procedure. Chronic renal failure was seen in 42.7% patients at the last follow-up. Serum creatinine at presentation, initial PRA levels, initial GFR, and PRA levels at last follow-up were significant predictors of final renal outcome. Age at presentation (<1 vs. >1 year), presence/absence of VUR on initial VCUG and renal cortical scars had no significant correlation with ultimate renal function. Conclusion: Our study confirms the high prognostic significance of initial serum creatinine, PRA levels and GFR in cases with PUV. PRA also holds promise in long-term follow-up of these patients as a marker of progressive renal damage. PMID:25197189

  16. Posterior urethral valves: the scenario in a developing center.

    PubMed

    Chatterjee, S K; Banerjee, S; Basak, D; Basu, A K; Chakravarti, A K; Chatterjee, U S; Haque, J

    2001-01-01

    We have reviewed 233 patients with posterior urethral valves treated in a single center in Calcutta, India, over the last 20 years: 37 were neonates, 75 were between 1 and 12 months, 88 were between 1 and 5 years, and 33 were more than 5 years old when first seen. The clinical presentation and methods employed in diagnosis and assessment are described. Primary endoscopic valve ablation was performed in 140 patients (60%). One or other form of diversion was done in 100 (43%), 93 before and 7 either during or after valve ablation. The short- and long-term results have been studied. Eleven patients died during the initial hospitalization, 3 died subsequently, 15 are in end-stage renal disease, 17 are in poor health, and 18 have been totally lost to follow-up. The remaining 169 have been in good health for periods between 1 and 20 years. While our results of primary valve ablation in low-risk patients with responsible parents are as good as anywhere else in the world, we are concerned at our relatively high diversion rate and relatively poor long-term follow up; the methods being adopted to reduce these problems are discussed. PMID:11294260

  17. Rare copy number variants implicated in posterior urethral valves.

    PubMed

    Boghossian, Nansi S; Sicko, Robert J; Kay, Denise M; Rigler, Shannon L; Caggana, Michele; Tsai, Michael Y; Yeung, Edwina H; Pankratz, Nathan; Cole, Benjamin R; Druschel, Charlotte M; Romitti, Paul A; Browne, Marilyn L; Fan, Ruzong; Liu, Aiyi; Brody, Lawrence C; Mills, James L

    2016-03-01

    The cause of posterior urethral valves (PUV) is unknown, but genetic factors are suspected given their familial occurrence. We examined cases of isolated PUV to identify novel copy number variants (CNVs). We identified 56 cases of isolated PUV from all live-births in New York State (1998-2005). Samples were genotyped using Illumina HumanOmni2.5 microarrays. Autosomal and sex-linked CNVs were identified using PennCNV and cnvPartition software. CNVs were prioritized for follow-up if they were absent from in-house controls, contained ≥ 10 consecutive probes, were ≥ 20 Kb in size, had ≤ 20% overlap with variants detected in other birth defect phenotypes screened in our lab, and were rare in population reference controls. We identified 47 rare candidate PUV-associated CNVs in 32 cases; one case had a 3.9 Mb deletion encompassing BMP7. Mutations in BMP7 have been associated with severe anomalies in the mouse urethra. Other interesting CNVs, each detected in a single PUV case included: a deletion of PIK3R3 and TSPAN1, duplication/triplication in FGF12, duplication of FAT1--a gene essential for normal growth and development, a large deletion (>2 Mb) on chromosome 17q that involves TBX2 and TBX4, and large duplications (>1 Mb) on chromosomes 3q and 6q. Our finding of previously unreported novel CNVs in PUV suggests that genetic factors may play a larger role than previously understood. Our data show a potential role of CNVs in up to 57% of cases examined. Investigation of genes in these CNVs may provide further insights into genetic variants that contribute to PUV. PMID:26663319

  18. Posterior Urethral Polyp: First Holmium-YAG Laser Ablation on a 3-Month-Old Infant

    PubMed Central

    Keskin, Ercument; Yapanoglu, Turgut; Adanur, Senol; Ziypak, Tevfik; Altay, Mehmet Sefa; Aksoy, Yılmaz

    2016-01-01

    Abstract Background: Urethral polyps are rare benign pathologies seen in the male posterior urethra, more frequently originating from verumontanum. In this article, we aimed to discuss diagnosis and treatment of a urethral polyp causing hematuria and urinary infection in a 3-month-old male infant. This is the first case in the literature in which a urethral polyp is treated with Holmium yttrium-aluminum-garnet (YAG) laser. Case Presentation: The patient was a 3-month-old male infant, and complains were hematuria and crying during micturition. Ultrasonography and voiding cystourethrogram were used for diagnosis. Urethral polyp was observed on urethrocystoscopy. Ablation was performed with a newborn cystoscope. Conclusion: Urethral polyp can cause hematuria and urinary obstruction and should be considered in the differential diagnosis of pathologies such as posterior urethral valve and cecoureterocele that could cause infravesical obstruction. Holmium-YAG laser is a good choice of treatment with easy application possibilities using a newborn cystoscope, especially for newborns and infants who have thin urethra. PMID:27579428

  19. [Clinical practice guideline. Traumatic urethral stenosis in males].

    PubMed

    Serrano-Brambila, Eduardo Alonso; Moreno-Alcázar, Othón Martino; Neri-Páez, Edgar; Sánchez-Martínez, Luis Carlos; Hernández-Ordóñez, Octavio Francisco; Morales-Morales, Arturo; Basavilvazo-Rodríguez, M Antonia; Torres-Arreola, Laura del Pilar; Valenzuela-Flores, Adriana Abigail; Hernández-Valencia, Marcelino

    2013-01-01

    The incidence of urethral stenosis in Mexico had not been documented. At the Centro Médico Nacional La Raza, during the year 2010, 629 patients with urethral stenosis were attended as outpatient consultation: 85 % with previous urethral stenosis and 15 % with urethral treatment complication. Urethral stenosis is a chronic illness, with multiple etiological origins and the handling is controversial. It has a great negative impact for the patients and the recurrence reaches 85 %. The treatment consisted of an invasive approach (urethral dilations, endoscopy procedure) and open surgery (urethroplasty). The World Health Organization and World Alliance take the world challenge about the urinary tract infections associated with the attention of patients, focused on urethral stenosis. The objective of the following clinical guide is to offer to the health professional a clinical tool for making decisions in the handling of the hardship or masculine urethral stenosis, based on the best available evidence, carrying out in systematized form with bibliographical research using validated terms of the MeSH: urethral structures, in the databases Trip database, PubMed, Guideline Clearinghouse, Cochrane Library and Ovid. PMID:24021082

  20. Traumatic posterior dislocation of hip in children.

    PubMed

    Kutty, S; Thornes, B; Curtin, W A; Gilmore, M F

    2001-02-01

    Traumatic posterior dislocation of the hip joint in children is an uncommon injury. It constitutes a true orthopedic emergency. It makes up over 80% of pediatric hip dislocations. In children, it can occur as a result of minimal trauma, which is attributed to a soft pliable acetabulum and ligamentous laxity. In skeletally mature adolescents, a greater force is required to dislocate the hip joint. Delay in reduction is associated with long-term complications such as avascular necrosis and degenerative arthritis. Avascular necrosis is related to the duration of dislocation. A poorer prognosis is associated with delay in reduction beyond 6 hours, advanced skeletal maturity, or multiple traumas. Prompt reduction minimizes complications. We report two cases of traumatic posterior dislocation of hip in children aged 3 and 14 years. Both were reduced within 6 hours of dislocation, and review at 6 months revealed normal examination and no evidence of any post-traumatic changes. Post-reduction treatment remains without a consensus. This review highlights the clinical presentation, management, and time-sensitive complications of the injury. PMID:11265904

  1. Growth in boys and posterior urethral valves. Primary valve resection vs upper tract diversion.

    PubMed

    Krueger, R P; Hardy, B E; Churchill, B M

    1980-06-01

    Seventy-four patients with posterior urethral valves were evaluated for long-term growth potential and renal function. In those boy diagnosed and treated within the first year of life, initial treatment by temporary supravesical diversion (prior to valve resection) was associated with better growth potential and renal function than was treatment by primary valve resection alone. PMID:7404868

  2. Concomitant Anterior and Posterior Urethral Valves: A Comprehensive Review of Literature.

    PubMed

    Keihani, Sorena; Kajbafzadeh, Abdol-Mohammad

    2015-07-01

    Posterior urethral valves (PUVs) are the most common cause of infravesical obstruction in children, whereas anterior urethral valves and/or diverticula (AUV/D) are less commonly encountered. Concomitant AUV/D and PUV is believed to be very rare and may be missed on the initial evaluation. In this review, we provide brief information on embryology of AUV/D and PUV to explain the concurrent presence of these anomalies. We also summarize the information on published cases of concomitant AUV/D and PUV in the English literature with a special focus on diagnosis and the importance of both voiding cystourethrography and careful urethrocystoscopy. PMID:25863834

  3. Urethritis

    MedlinePlus

    ... Sensitivity to the chemicals used in spermicides or contraceptive jellies, creams, or foams Risks for urethritis include: Being a female in the reproductive years Being male, ages 20 to 35 Having many sexual partners ...

  4. [Significance of early diagnosis of posterior urethral valves in fetus for further development - own experience].

    PubMed

    Krzemień, Grażyna; Szmigielska, Agnieszka; Wawer, Zofia; Roszkowska-Blaim, Maria

    2013-01-01

    The incidence of posterior urethral valves is estimated to be from 3:1000 to 8:1000 and this is one of the most common causes of obstruction of urinary tract in boys. About 13-17% of children with posterior urethral valves develop end stage renal failure. We present a  6-month-old boy with late diagnosis of posterior urtehral valves. Antenatal ultrasound investigation of the urinary tract was normal. A small degree of oligohydramnios was found during delivery. At the age of six months the boy was admitted to hospital because of urinary tract infection, hypertension (130/90 mmHg) and acute kidney injury (urea - 46 mg/dL, creatinine - 1.1 mg/dL, GFR - 35.5 mL/min/1.73 m2 ). Bilateral hydronephrosis and megaureters, low-capacity bladder with hypertrophied wall were seen on ultrasound examination. Voiding cystourethrograhy revealed vesicoureteral refluxes (III/V), hypertrophy of the bladder wall with numerous diverticula and dilated posterior urethra. During urethroscopy urethral valves were resected. Increased intravesical pressure (leak point up to 305 cm H2 O) was found on urodynamic test. Renal scintigraphy (99mTc-EC) revealed decreased intake of isotope in the left kidney (5%), and the right kidney intake was 95% ERPF. The patient was qualified for left-sided nephrectomy, which was postponed because of high leak point and high risk of worsening of vesicoureteral reflux to right kidney after nephrectomy. Anticholinergic and α-blocker treatment was started. At the age of 11 months left-side nephrectomy was performed because of recurrent urinary tract infections. After 3.5-year follow-up blood pressure, physical development, kidney function tests, and urinalysis are normal. Additionally to this investigation the significance of early diagnosis including prenatal (PUV) for further development as well as further therapeutic procedure is discussed. PMID:24519771

  5. Use of Silodosin to Visualize the Posterior Urethra in Pelvic Floor Urethral Distraction Defect Patients

    PubMed Central

    Ranjan, Nikhil; Singh, Rana Pratap; Ahmed, Ahsan; Kumar, Vijoy; Singh, Mahendra

    2015-01-01

    Background: Retrograde urethrogram and voiding cystourethrogram are used to define length and location of urethral stricture prior to surgery. We used a single dose of silodosin prior to VCUG to relax the bladder neck and achieve visualization of posterior urethra. Objectives: To evaluate the efficacy of silodosin in visualization of posterior urethra during VCUG, and to compare the findings with a control group. Patients and Methods: Patients were divided into two groups A and B containing 20 and 15 patients, respectively. Patients in group A were given a single dose of silodosin prior to radiological studies. Results: In group A 19 out of 20 patients were able to achieve satisfactory bladder neck opening while in group B 10 out of 15 patients were able to achieve bladder neck opening. Conclusions: Silodosin use prior to VCUG confers a statistically significant increase in bladder neck opening and visualization of posterior urethra. PMID:26543831

  6. Renal Parenchymal Area and Risk of ESRD in Boys with Posterior Urethral Valves

    PubMed Central

    Pulido, Jose E.; Furth, Susan L.; Zderic, Stephen A.; Canning, Douglas A.

    2014-01-01

    Background and objectives Approximately 20% of boys with posterior urethral valves develop ESRD; however, few factors associated with the risk of ESRD have been identified. The objective of this study was to determine if renal parenchymal area, defined as the area of the kidney minus the area of the pelvicaliceal system on first postnatal ultrasound, is associated with the risk of ESRD in infants with posterior urethral valves. Design, setting, participants, & measurements A retrospective cohort of boys who were diagnosed with posterior urethral valves at less than 6 months of age between 1988 and 2011 and followed for at least 1 year at a free-standing children’s hospital was assembled. Cox proportional hazard regression and Kaplan–Meier analysis were used to estimate the association between renal parenchymal area and time to ESRD. Cox models were adjusted for age at presentation, minimum creatinine 1 month after bladder decompression, and vesicoureteral reflux. Results Sixty patients were followed for 393 person-years. Eight patients developed ESRD. Median renal parenchymal area was 15.9 cm2 (interquartile range=13.0–21.6 cm2). Each 1-cm2 increase in renal parenchymal area was associated with a lower risk of ESRD (hazard ratio, 0.64; 95% confidence interval, 0.42 to 0.98). The rate of time to ESRD was 10 times higher in boys with renal parenchymal area<12.4 cm2 than boys with renal parenchymal area≥12.4 cm2 (P<0.001). Renal parenchymal area could best discriminate children at risk for ESRD when the minimum creatinine in the first 1 month after bladder decompression was between 0.8 and 1.1 mg/dl. Conclusion In boys with posterior urethral valves presenting during the first 6 months of life, lower renal parenchymal area is associated with an increased risk of ESRD during childhood. The predictive ability of renal parenchymal area, which is available at time of diagnosis, should be validated in a larger, prospectively-enrolled cohort. PMID:24311709

  7. Spontaneous Rupture of Kidney Due to Posterior Urethral Valve–Diagnostic Difficulties

    PubMed Central

    Kiliś-Pstrusińska, Katarzyna; Pukajło-Marczyk, Agnieszka; Patkowski, Dariusz; Zalewska-Dorobisz, Urszula; Zwolińska, Danuta

    2013-01-01

    Background Spontaneous kidney rupture could develop in the course of posterior urethral valve (PUV), the most common cause of outflow urinary tract obstruction in male infants. However, urinary extravasation is a rare complication among this group of children. Case Presentation Our case report presents diagnostic difficulties connected with spontaneous kidney rupture due to PUV in a 6 week-old infant. Due to not equivocal images, thundery course of disease and rapid deterioration in the infant's condition, the patient required an urgent laparatomy. Conclusion This case showed that the investigation of renal abnormalities during early neonatal period, is very important specifically in PUV that can lead to kidney rupture. PMID:23795264

  8. A rare case of traumatic posterior phacocele with retinal detachment

    PubMed Central

    Sindal, Manavi D; Mourya, Deepesh

    2016-01-01

    Dislocation of crystalline lens into the anterior subconjunctival or subtenon's space is a rare but known complication of blunt trauma. Dislocation into the posterior subtenon's space is even rarer and can be associated with a complication such as occult scleral tear and retinal detachment. We report a case of traumatic posterior subtenon's dislocation of crystalline lens after blunt trauma and its successful surgical management. PMID:26953031

  9. The predictive value of ultrasonography in evaluation of infants with posterior urethral valves.

    PubMed

    Hulbert, W C; Rosenberg, H K; Cartwright, P C; Duckett, J W; Snyder, H M

    1992-07-01

    Between 1981 and 1989, 28 infants less than 6 months old with posterior urethral valves underwent ultrasound evaluation as part of the initial evaluation at our hospital. The single ultrasound feature that correlated with subsequent renal function was the status of corticomedullary differentiation. The presence of corticomedullary junctions in at least 1 kidney in 17 infants was always associated with a serum creatinine level of 0.8 mg./dl. or less in long-term followup. Of 11 patients with absent corticomedullary differentiation 7 had eventual creatinine levels of greater than 0.8 mg./dl. with 5 of them suffering clinically significant renal insufficiency. An association between vesicoureteral reflux and absent corticomedullary junctions was also found. PMID:1613850

  10. Management for Prostate Cancer Treatment Related Posterior Urethral and Bladder Neck Stenosis With Stents

    PubMed Central

    Erickson, Bradley A.; McAninch, Jack W.; Eisenberg, Michael L.; Washington, Samuel L.; Breyer, Benjamin N.

    2013-01-01

    Purpose Prostate cancer treatment has the potential to lead to posterior urethral stricture. These strictures are sometimes recalcitrant to dilation and urethrotomy alone. We present our experience with the Urolume® stent for prostate cancer treatment related stricture. Materials and Methods A total of 38 men with posterior urethral stricture secondary to prostate cancer treatment were treated with Urolume stenting. Stents were placed in all men after aggressive urethrotomy over the entire stricture. A successfully managed stricture was defined as open and stable for greater than 6 months after any necessary secondary procedures. Results The initial success rate was 47%. After a total of 31 secondary procedures in 19 men, including additional stent placement in 8 (18%), the final success rate was 89% at a mean ± SD followup of 2.3 ± 2.5 years. Four cases (11%) in which treatment failed ultimately requiring urinary diversion (3) or salvage prostatectomy (1). Incontinence was noted in 30 men (82%), of whom 19 (63%) received an artificial urinary sphincter a mean of 7.2 ± 2.4 months after the stent. Subanalysis revealed that irradiated men had longer strictures (3.6 vs 2.0 cm, p = 0.003) and a higher post-stent incontinence rate (96% vs 50%, p <0.001) than men who underwent prostatectomy alone but the initial failure rate was similar (54% vs 50%, p = 0.4). Conclusions Urolume stenting is a reasonable option for severe post-prostate cancer treatment stricture when patients are unwilling or unable to undergo open reconstructive surgery. Incontinence should be expected. The need for additional procedures is common and in some men may be required periodically for the lifetime of the stent. PMID:21074796

  11. Posterior Reversible Encephalopathy Syndrome Complicating Traumatic Pancreatitis

    PubMed Central

    Sigurtà, Anna; Terzi, Valeria; Regna-Gladin, Caroline; Fumagalli, Roberto

    2016-01-01

    Abstract We are reporting a case of posterior reversible encephalopathy syndrome (PRES) developed in an unusual clinical scenario without the presence of the most described symptoms. PRES is a neurological and radiological syndrome described in many different clinical conditions. In children it has been mostly reported in association with hematological and renal disorders. Our patient was a 15 years old boy, admitted to our intensive care unit for pancreatitis after blunt abdominal trauma. During the stay in the intensive care unit, he underwent multiple abdominal surgical interventions for pancreatitis complications. He had a difficult management of analgesia and sedation, being often agitated with high arterial pressure, and he developed a bacterial peritonitis. After 29 days his neurological conditions abruptly worsened with neuroimaging findings consistent with PRES. His clinical conditions progressively improved after sedation and arterial pressure control. He was discharged at home with complete resolution of the neurological and imaging signs 2 months later. The pathophysiology of PRES is controversial and involves disordered autoregulation ascribable to hypertension and endothelial dysfunction. In this case both hypertension and endothelial activation, triggered by sepsis and pancreatitis, could represent the culprits of PRES onset. Even if there is no specific treatment for this condition, a diagnosis is mandatory to start antihypertensive and supportive treatment. We are therefore suggesting to consider PRES in the differential diagnosis of a neurological deterioration preceded by hypertension and/or septic state, even without other “typical” clinical features. PMID:27258506

  12. Vesicostomy and Colostomy in a Premature Neonate With Posterior Urethral Valves, Bilateral Dysplastic Kidneys, and High Imperforate Anus: The Challenge of Stoma Placement.

    PubMed

    McGrath, Melissa; Alnaqi, Amar A A; Braga, Luis H

    2016-07-01

    Although anorectal malformations are often associated with urinary tract abnormalities, the association with posterior urethral valves is exceptionally rare. We report a unique case of a premature (35 gestational weeks) male neonate born with posterior urethral valves, bilateral dysplastic kidneys, and imperforate anus, successfully treated by Blocksom vesicostomy and left upper quadrant loop colostomy. The challenges involving placement of both stomas in a small abdominal wall of a 2200 g premature neonate are discussed. PMID:27015939

  13. Semen analysis in post-pubertal patients with posterior urethral valves: a pilot study.

    PubMed

    Puri, A; Gaur, K K; Kumar, A; Bhatnagar, V

    2002-03-01

    The issues of sexual function and fertility are becoming relevant in patients with posterior urethral valves (PUV), as more of them reach adulthood. To evaluate the semen of post-pubertal patients with PUV as a determinant of future fertility, all such patients (age >16 years) attending the follow-up urology clinic of our department from 1985 to December 1999 were contacted. Of the nine patients contacted, eight agreed to form the study group. All eight patients were asked to provide a post-masturbation semen sample and urine. Semen was analysed for pH, viscosity, liquefaction time, sperm morphology, sperm count, motility, and agglutination. The patients ages ranged from 16 to 21 years (mean 17.5 years). One patient with chronic renal failure awaiting a renal transplant refused to give a semen sample; two tried but failed to ejaculate on three consecutive visits. Their urine was negative for sperm. Of the five patients who gave semen, the liquefaction time was high in two. pH ranged from 7.2 to 8, sperm counts were 24-80 million. None of the patients had oligospermia. Abnormal sperm agglutination was present in four cases; a higher percentage of immotile sperm was also present in four. Semen abnormalities in the form of increased liquefaction time, abnormal sperm agglutination, and a high percentage of immotile sperm were thus seen in the present study. The bearing of these findings on subsequent sexual function and fertility remains a matter of speculation. PMID:11956780

  14. Impact of Posterior Urethral Plate Repair on Continence Following Robot-Assisted Laparoscopic Radical Prostatectomy

    PubMed Central

    Kim, Isaac Yi; Hwang, Eun A; Mmeje, Chinedu; Ercolani, Matthew

    2010-01-01

    Purpose The objective of this study is to evaluate the continence rate following reconstruction of the posterior urethral plate in robot-assisted laparoscopic radical prostatectomy (RLRP). Materials and Methods A retrospective analysis of 50 men with clinically localized prostate cancer who underwent RLRP was carried out. Twenty-five patients underwent RLRP using the reconstruction of the posterior aspect of the rhabdosphincter (Rocco repair). Results of 25 consecutive patients who underwent RLRP prior to the implementation of the Rocco repair were used as the control. Continence was assessed at 7, 30, 90, and 180 days following foley catheter removal using the EPIC questionnaire as well as a follow-up interview with the surgeon. Results There was no statistically significant difference between the two groups in any of the patient demographics. At 7 days, the Rocco experimental group had a continence rate of 19% vs. 38.1% in the non-Rocco control group (p = 0.306). At 30 days, the continence rate in the Rocco group was 76.2% vs. 71.4% in the non-Rocco group (p = 1). At 90 days, the values were 88% vs. 80% (p = 0.718), respectively. At 180 days, the pad-free rate was 96% in both groups. Conclusion Rocco repair offers no significant advantage in the time to recovery of continence following RLRP when continence is defined as the use of zero pads per day. On the other hand, Rocco repair was associated with increased incidence of urinary retention requiring prolonged foley catheter placement. PMID:20376897

  15. Posterior Iris Fixated Intraocular Lens for Pediatric Traumatic Cataract

    PubMed Central

    Kavitha, V.; Balasubramanian, Preethi; Heralgi, Mallikarjun M.

    2016-01-01

    Purpose: To evaluate the postoperative visual outcomes and complications of posterior iris fixated intraocular lens (IFIOL) implantation for pediatric traumatic cataract. Methods: A retrospective clinical audit was performed of all the pediatric traumatic cataract patients who underwent lens removal and iris fixated lens implantation due to inadequate capsular support with or without corneal tear repair between January 2009 and December 2013. Data were collected and analyzed on the preoperative and postoperative visual outcomes and complications. Results: Twenty-five children (25 eyes; 21 males and 4 females) were enrolled with the mean age of 11 ± 4.0 years. There were 72% of eyes that underwent primary cataract removal with IFIOL implantation. Twenty-eight percent of eyes underwent corneal tear repair prior to intraocular lens (IOL) implantation. Preoperative best corrected visual acuity (BCVA) was hand motion in 32% eyes, counting fingers in 24%, and perception of light in 44%. Postoperative BCVA of 0-0.2 logarithm of minimum angle of resolution was reported in the 64% of eyes. One eye developed secondary glaucoma, one eye underwent re-enclavation, and none developed retinal complications. Conclusion: Posterior IFIOL implantation resulted in an improved visual outcome, low incidence of postoperative complications, and is a good alternative to other IOL, in the cases of pediatric traumatic cataract without adequate capsular support. PMID:27162456

  16. Comparison of early neonatal valve ablation with vesicostomy in patient with posterior urethral valve

    PubMed Central

    Hosseini, Seyed Mohammad Vahid; Zarenezhad, Mohammad; Kamali, Mansour; Gholamzadeh, Saeed; Sabet, Babak; Alipour, Farzaneh

    2015-01-01

    Background: To compare the results of final renal function by two methods of treatment in patients diagnosed as posterior urethral valve (PUV) (valve ablation vs. vesicostomy). Materials and Methods: Fifty-four boys diagnosed with PUV participated in this study. They were divided into top two groups. Thirty-one of the total were treated with primary valve fulguration (Group 1) and 23 were treated with vesicostomy (Group 2). One-year-creatinine level and glomerular filtration rate (GFR) were measured. Also, they were taken ultrasonography detecting hydronephrosis. Data analysed in IBM SPSS21 with t-test and Chi-square test. Presented with 95% of confidence intervals. Results: Fifty-four boys diagnosed with PUV participated in this study. The mean age of patients in Group 1 was 3.8 ± 1.48 days and Group 2 was 4.7 ± 1.85 days. One-year Cr level was 1.57 ± 1.45 in Group 1 and 1.57 ± 1.45 in Group 2 which was not statistically significant (P < 0.8). Also 1-year GFR level was 31.1 ± 4.4 in Group 1 and 33 ± 4.7% in Group 2 (P < 0.10/23) in Group 2 (43.47%) had severe hydronephrosis and 14/31 (45.16%) in Group 1 had severe hydronephrosis. Graded ultrasound results were not significantly different (P = 0.24). Conclusion: The results showed no significant difference. Vesicostomy might be a more favourable method due to less complication and follow-up in early neonatal life. Hence, the condition of the patients and decision of the surgeon are effective parameters in choosing an optimal method in patients diagnosed with PUV. PMID:26712294

  17. Presentation, management, and outcome of posterior urethral valves in a Nigerian tertiary hospital

    PubMed Central

    Orumuah, Agbugui Jude; Oduagbon, Obarisiagbon Edwin

    2015-01-01

    Background: Posterior urethral valves (PUV) remain the most common cause of bladder outlet obstruction and renal insufficiency in male children. The aim of this study was to evaluate the presentation, management, challenges, and outcome of the disease in a Nigerian tertiary health institution. Patients and Methods: Retrospectively, medical records of male children with a diagnosis of PUVs over a 10 year period (2003-2012) were retrieved. All data in relation to the study objectives were recorded and analyzed. Results: A total of 44 patients was managed for PUV within the period. The mean age of presentation was 3.95 years with 56.8% of the patients presenting after the age of 1 year. Voiding dysfunction noted in 40 (91.0%) patients was the most common mode of presentation. The most common finding on physical examination was a palpable bladder while urinary tract infection noted in 23 (52.3%) patients was the most common complication noted. Abdominal ultrasonography revealed dilated posterior urethra in 16 (36.4%) cases, while micturating cystourethrogram revealed a dilated proximal urethra in all 35 cases in which it was done, diverticulum in 6 and vesicoureteric reflux in 9. The creatinine value at presentation ranged between 0.4 mg/dl and 4.0 mg/dl with a mean of 1.02 ± 0.93 mg/dl. Urethroscopy in 37 patients confirmed type I and type III PUV in 35 and 2 patients, respectively. Valve ablation with a diathermy bugbee electrode provided relief of obstructions in the 37 patients who underwent the procedure without any significant immediate complication. The period of follow-up ranged between 2 weeks and 3 years with a mean of 10.2 months. There was sustained improvement in urine stream, reduction in the mean creatinine concentration and incidence of UTI during follow-up. However, patients with significantly impaired renal function had a poorer outcome. Conclusion: Many patients with PUV presented late within the reviewed period. Valve ablation provided relief of

  18. Pelvic-fracture urethral injury in children

    PubMed Central

    Hagedorn, Judith C.; Voelzke, Bryan B.

    2015-01-01

    Objective To review paediatric posterior urethral injuries and the current potential management options; because urethral injury due to pelvic fracture in children is rare and has a low incidence, the management of this type of trauma and its complications remains controversial. Methods We reviewed previous reports identified by searching the PubMed Medline electronic database for clinically relevant articles published in the past 25 years. The search was limited to the keywords ‘pediatric’, ‘pelvic fracture’, ‘urethral injury’, ‘stricture’, ‘trauma’ and ‘reconstruction’. Results Most paediatric urethral injuries are a result of pelvic fractures after high-impact blunt trauma. After the diagnosis, immediate bladder drainage via a suprapubic cystotomy, or urethral realignment, are the initial management options, except for a possible immediate primary repair in girls. The common complications of pelvic fracture-associated urethral injury include urethral stricture formation, incontinence and erectile dysfunction. Excellent results can be achieved with delayed urethroplasty for pelvic fracture-associated urethral injuries. Conclusion Traumatic injury to the paediatric urethra is rare and calls for an immediate diagnosis and management. These devastating injuries have a high complication rate and therefore a close follow-up is warranted to assure adequate delayed repair by a reconstructive urologist. PMID:26019977

  19. Study of prognostic significance of antenatal ultrasonography and renin angiotensin system activation in predicting disease severity in posterior urethral valves

    PubMed Central

    Bhadoo, Divya; Bajpai, M.; Abid, Ali; Sukanya, Gayan; Agarwala, Sandeep; Srinivas, M.; Deka, Deepika; Agarwal, Nutan; Agarwal, Ramesh; Kumar, Rakesh

    2015-01-01

    Aims: Study on prognostic significance of antenatal ultrasonography and renin angiotensin system activation in predicting disease severity in posterior urethral valves. Materials and Methods: Antenatally diagnosed hydronephrosis patients were included. Postnatally, they were divided into two groups, posterior urethral valve (PUV) and non-PUV. The studied parameters were: Gestational age at detection, surgical intervention, ultrasound findings, cord blood and follow up plasma renin activity (PRA) values, vesico-ureteric reflux (VUR), renal scars, and glomerular filtration rate (GFR). Results: A total of 25 patients were included, 10 PUV and 15 non-PUV. All infants with PUV underwent primary valve incision. GFR was less than 60 ml/min/1.73 m2 body surface area in 4 patients at last follow-up. Keyhole sign, oligoamnios, absent bladder cycling, and cortical cysts were not consistent findings on antenatal ultrasound in PUV. Cord blood PRA was significantly higher (P < 0.0001) in PUV compared to non-PUV patients. Gestational age at detection of hydronephrosis, cortical cysts, bladder wall thickness, and amniotic fluid index were not significantly correlated with GFR while PRA could differentiate between poor and better prognosis cases with PUV. Conclusions: Ultrasound was neither uniformly useful in diagnosing PUV antenatally, nor differentiating it from cases with non-PUV hydronephrosis. In congenital hydronephrosis, cord blood PRA was significantly higher in cases with PUV compared to non-PUV cases and fell significantly after valve ablation. Cord blood PRA could distinguish between poor and better prognosis cases with PUV. PMID:25829668

  20. Unusual Giant Prostatic Urethral Calculus

    PubMed Central

    Bello, A.; Maitama, H. Y.; Mbibu, N. H.; Kalayi, G. D.; Ahmed, A.

    2010-01-01

    Giant vesico-prostatic urethral calculus is uncommon. Urethral stones rarely form primarily in the urethra, and they are usually associated with urethral strictures, posterior urethral valve or diverticula. We report a case of a 32-year-old man with giant vesico-prostatic (collar-stud) urethral stone presenting with sepsis and bladder outlet obstruction. The clinical presentation, management, and outcome of the giant prostatic urethral calculus are reviewed. PMID:22091328

  1. The Endoscopic Morphological Features of Congenital Posterior Urethral Obstructions in Boys with Refractory Daytime Urinary Incontinence and Nocturnal Enuresis.

    PubMed

    Nakamura, Shigeru; Hyuga, Taiju; Kawai, Shina; Kubo, Taro; Nakai, Hideo

    2016-08-01

    Purpose This study aims to evaluate the endoscopic morphological features of congenital posterior urethral obstructions in boys with refractory daytime urinary incontinence and/or nocturnal enuresis. Patients and Methods A total of 54 consecutive patients underwent endoscopy and were diagnosed with a posterior urethral valve (PUV) (types 1-4). PUV type 1 was classified as severe, moderate, or mild. A transurethral incision (TUI) was mainly performed for anterior wall lesions of the PUV. Voiding cystourethrography and pressure flow studies (PFS) were performed before and 3 to 4 months after TUI. Clinical symptoms were evaluated 6 months after TUI, and outcomes were assessed according to PFS waveform pattern groups (synergic pattern [SP] and dyssynergic pattern [DP]). Results All patients had PUV type 1 and/or 3 (i.e., n = 34 type 1, 7 type 3, and 13 types 1 and 3). There were severe (n = 1), moderate (n = 21), and mild (n = 25) cases of PUV type 1. According to PFS, SP and DP were present in 43 and 11 patients, respectively. TUI was effective in the SP group and symptoms improved in 77.4 and 69.3% of patients with daytime incontinence and nocturnal enuresis, respectively. Almost no effect was observed in the DP group. A significant decrease in the detrusor pressure was observed at maximum flow rate using PFS in the SP group. Conclusions PUV type 1 encompassed lesions with a spectrum of obstructions ranging from severe to mild, with mild types whose main obstructive lesion existed at the anterior wall of urethra occurring most frequently in boys with refractory daytime urinary incontinence and/or nocturnal enuresis. PMID:26378483

  2. Holmium laser core through internal urethrotomy with explantation of UroLume stent. An ideal approach for a complicated posterior urethral stricture.

    PubMed

    Gupta, N P; Ansari, M S

    2004-05-01

    Although the UroLume wallstent has been proven effective in the treatment of recurrent urethral stricture, obstruction may recur in some cases. A likely cause of obstruction is hyperplastic tissue reaction, which may necessitate the removal of the stent. The hyperplastic tissue reaction may be severe, resulting in a completely obliterative stricture. Stent removal with a completely obliterative stricture and the stent in situ is a tedious job, as there is no lumen in which to place the laser fiber to cut the stent wires. We report on a patient in whom a UroLume urethral stent was placed one year ago for post-traumatic recurrent bulbomembranous urethral stricture. The stricture recurred in spite of the stent in place and the lumen was finally completely obliterated. A holmium laser was used for core through internal urethrotomy and the explantation of the stent. PMID:15147555

  3. Traumatic bilateral posterior hip dislocation in 10 year old male child.

    PubMed

    Garg, Vipul; Singh, Ajay Pal; Singh, Arun Pal; Bajaj, P S

    2014-09-01

    Traumatic bilateral posterior hip dislocation in skeletally immature patient is reported very less in literature. We report a 10 yr old boy presented to us following farmyard injury with bilateral posterior hip dislocation, which was reduced manually under sedation with uneventful follow-up and complete hip range of motion at 2 year. PMID:25983489

  4. Posterior Urethral Valves in Children: Pattern of Presentation and Outcome of Initial Treatment in Ile-Ife, Nigeria

    PubMed Central

    Talabi, Ademola Olusegun; Sowande, Oludayo Adedapo; Etonyeaku, Amarachukwu Chiduziem; Salako, Abdulkadir A; Adejuyigbe, Olusanya

    2015-01-01

    Background: The management of posterior urethral valves (PUV) and its sequelae is still a challenge to most pediatric surgeons in our environment due to late presentation and inadequate facilities for long-term evaluation and treatment. Despite initial successful treatment about 40% would develop chronic renal failure. The aim is to describe the presentation, management and outcome of the initial treatment in boys with PUV. Materials and Methods: It is a retrospective analysis of PUV in boys 8 years and below over a 17 years period. Demographic characteristics, clinical features, investigations, and treatment outcome were reviewed. Results: Thirty-seven cases were analyzed. The median age was 5 months (range from birth to 8 years). Three (8.1%) patients had prenatal ultrasound diagnosis. The most common presentation was voiding dysfunction 37 (100%). Part of the preoperative investigation included micturating cystourethrogram (n = 31: 83.8%) and abdomino-pelvic ultrasonography (n = 37:(100%). The mean serum creatinine value of those who presented within the first 30 days of life and those who presented afterwards were 325 (±251) µmol/L and 141 (±100) µmol/L respectively, P = 0.003. Surgical interventions included trans-vesical excision of valves (n = 9: 28.1%), valvotomy (n = 10: 31.3%), balloon avulsion (n = 8: 25.0%), vesicostomy (n = 4: 12.5%) and endoscopic valve avulsion (n = 1: 3.1%). Seventeen (56.7%) patients had serum creatinine >70.4 µmol/L after 1-month of valve excision. Five (13.5%) patients had postrelief complications and 5 (13.5%) died on admission. Ninety percentage (27/30) of patients had poor prognostic indices. Conclusions: The initial treatment outcome was good but most had poor prognostic factors. PMID:26425072

  5. The unexpected with ankle fracture: traumatic tibialis posterior tendon dislocation: a case report and literature review.

    PubMed

    Al Khudairy, A; Zafar, M M; Padinjarathala, B A

    2013-12-01

    Traumatic dislocation of tibialis posterior is infrequently reported in the literature. It is rare but potential cause of persistent pain that can be easily missed. Concomitant ankle fracture may obscure the clinical picture and if unsuspected, consequences such as iatrogenic injury to tibialis posterior tendon while fixing the medial malleolus may occur. We report our experience in the management of a tibialis posterior tendon dislocation associated with ankle fracture. A review of all English literature had been carried with a focus on treatment options. PMID:24026087

  6. Judo-related traumatic posterior sternoclavicular joint dislocation in a child.

    PubMed

    Galanis, Nikiforos; Anastasiadis, Prodromos; Grigoropoulou, Foteini; Kirkos, John; Kapetanos, George

    2014-05-01

    Judo is a combat sport with high risk of injury. We present a rare case of traumatic left posterior sternoclavicular (SC) joint dislocation, inflicted to a 12-year-old boy during a judo contest. An extensive literature review did not reveal any case of posterior SC joint dislocation in judo. The patient was treated with closed reduction under general anesthesia. At 2-year follow-up, his left upper extremity had full range of motion, and he did not complain of any residual symptoms. He decided to discontinue judo training; however, he participates in other physically demanding sports. Although not often encountered, posterior SC joint dislocation is a challenging and critical medical problem that can be fatal if not promptly diagnosed and treated on time and should be considered in the differential diagnosis of trauma-related anterior chest pain. PMID:24172655

  7. Safety and efficacy of Intraurethral Mitomycin C Hydrogel for prevention of post-traumatic anterior urethral stricture recurrence after internal urethrotomy

    PubMed Central

    Moradi, Mahmoudreza; Derakhshandeh, Katayoun; Karimian, Babak; Fasihi, Mahtab

    2016-01-01

    Abstract: Background: Evaluation of the safety and efficacy of intraurethral Mitomycin C (MMC) hydrogel for prevention of post-traumatic anterior urethral stricture recurrence after internal urethrotomy. Methods: A thermoresponsive hydrogel base consisting of 0.8 mg MMC with 1cc water and propylene glycol to PF-127 poloxamer was used in theater. 40 male patients with short, non-obliterated, urethral stricture were randomized into 2 groups: control and MMC. After internal urethrotomy, the MMC group patients received the MMC-Hydrogel while the others were just catheterized. Both groups had their catheters for at least 1 week. After surgery, they were followed up by means of medical history and physical examination, monitoring voiding patterns and retrograde urethrogram at 1 month, 6 months and 1 year after surgery. Results: 40 male patients between 14 to 89 years old (Mean = 54.15) underwent internal urethrotomy. The average age for the control and MMC group was 54.55±21.25 and 53.75±24.75 respectively. In a comparison of age between the two groups, they were matched (P=0.574). Stricture length was 10.7±5.9 and 9.55±4.15 mm for the control and MMC group respectively. There were no statistically meaningful differences between the two groups (P=0.485). Fifteen patients had a history of one previous internal urethrotomy which in a comparison between the two groups meant there was no meaningful difference (P = 0.327). During postoperative follow up, total urethral stricture recurrence happened in 12 patients: 10 patients (50%) in control group and 2 patients (10%) in MMC group. The difference was statistically significant (P = 0.001). There were no significant complications associated with the MMC injection in our patients. Conclusions: Based on our results, MMC Hydrogel may have an anti-fibrotic action preventing post-traumatic anterior urethral stricture recurrence with no side effects on pre-urethral tissue. Due to our study limitations, our follow up time and the

  8. Ipsilateral Traumatic Posterior Hip Dislocation, Posterior Wall and Transverse Acetabular Fracture with Trochanteric Fracture in an adult: Report of First Case

    PubMed Central

    Sinha, Skand; Naik, Ananta k; Arya, Rajendra K; Jain, Vijay K

    2013-01-01

    Introduction: Posterior dislocation of the hip joint with associated acetabular and intertrochanteric fracture is a complex injury. Early recognition, prompt and stable reduction is needed of successful outcome. Case Report: 45 year old male patient presented with posterior dislocation of the hip with transverse fracture with posterior wall fracture of acetabulam and intertrochanteric fracture on the ipsilateral side. The complex fracture geometry was confirmed by CT scan. The patient was successfully managed by open reduction and internal fixation of intertrochanteric fracture was achieved with dynamic hip screw (DHS) plate fixation followed by fixation of acetabular fracture with reconstruction plate. Conclusion: Hip dislocation combined with acetabular fracture is an uncommon injury; this article presents a unique case of posterior wall and transverse fractures of ipsilateral acetabulum with intertrochanteric fracture in a patient who sustained traumatic posterior hip dislocation. Early surgical intervention is important for satisfactory outcomes of such complex fracture-dislocation injuries. PMID:27298928

  9. TRAUMATIC POSTERIOR DISLOCATION OF THE HIP IN CHILDREN:REPORT ON FIVE CASES

    PubMed Central

    Brandão, Gilberto Francisco; Américo, Luiz Renato Drumond; Soares, Cláudio Beling Gonçalves; Faria, Rodrigo Galinari Costa; Teixeira, Luiz Eduardo Moreira

    2015-01-01

    Objective: To evaluate a series of cases of traumatic posterior dislocations in children, with the treatment and results, and to review issues relating to the epidemiology, clinical and radiographic diagnosis, treatment, complications and prognosis of such cases. Methods: Five patients with traumatic hip dislocation, with a mean age of 4.6 ± 0.9 years and a follow-up period of 19.8 ± 7.0 months, were evaluated retrospectively. The time elapsed between dislocation and reduction, the type of treatment, the associated injuries and the subsequent complications were evaluated. Results: The initial treatment was closed reduction, which was performed on average 5.2 ± 3.6 hours after the initial trauma. All the patients underwent the reduction under anesthesia. The complementary treatment included plaster cast immobilization and traction. No need for additional surgery was observed and there were no long-term side effects. Conclusion: Traumatic dislocation of the hip should be treated quickly by means of closed reduction, with appropriate control over the reduction and rigorous observation in order to diagnose and treat late complications. PMID:27022542

  10. The spectrum of pelvic fracture urethral injuries and posterior urethroplasty in an Italian high-volume centre, from 1980 to 2013

    PubMed Central

    Barbagli, Guido; Sansalone, Salvatore; Romano, Giuseppe; Lazzeri, Massimo

    2014-01-01

    Objective To describe the emergency and delayed treatment of patients with pelvic fracture urethral injuries (PFUI) presenting to an Italian high-volume centre. Patients and methods In a retrospective, observational study we evaluated the spectrum of PFUI and posterior urethroplasty in an Italian high-volume centre, from 1980 to 2013. Patients requiring emergency treatment for PFUI and delayed treatment for pelvic fracture urethral defects (PFUD) were included. Patients with incomplete clinical records were excluded from the study. Descriptive statistical methods were applied. Results In all, 159 male patients (median age 35 years) were included in the study. A traffic accident was the most frequent (42.8%) cause of PFUI, and accidents at work were reported as the cause of trauma in 34% of patients. Agricultural accidents decreased from 24.4% to 6.2% over the course of the survey. A suprapubic cystostomy was the most frequent (49%) emergency treatment in patients with PFUI. The use of surgical realignment decreased from 31.7% to 6.2%, and endoscopic realignment increased from 9.7% to 35.3%. A bulbo-prostatic anastomosis was the most frequent (62.9%) delayed treatment in patients with PFUD. The use of the Badenoch pull-through decreased from 19.5% to 2.6%, and endoscopic holmium laser urethrotomy increased from 4.9% to 32.7%. Conclusions The spectrum of PFUI and subsequent treatment of PFUD has changed greatly over the last 10 years at our centre. These changes involved patient age, aetiology, emergency and delayed treatments, and were found to be related to changes in the economy and lifestyle of the Italian patients. PMID:26019976

  11. Urethral Injuries

    MedlinePlus

    ... Injuries Ureteral Injuries Urethral Injuries Injuries to the Penis and Scrotum Most urethral injuries occur in men. ... leakage of urine into the tissues of the penis, scrotum, abdominal wall, or perineum (the area between ...

  12. Traumatic Posterior Atlantoaxial Dislocation Without Associated Fracture but With Neurological Deficit: A Case Report and Literature Review.

    PubMed

    Xu, Yong; Li, Feng; Guan, Hanfeng; Xiong, Wei

    2015-10-01

    Posterior atlantoaxial dislocation without odontoid fracture is extremely rare and often results in fatal spinal cord injury. According to the reported literature, all cases presented mild or no neurologic deficit, with no definite relation to upper spinal cord injury. Little is reported about traumatic posterior atlantoaxial dislocation, with incomplete quadriplegia associated with a spinal cord injury.We present a case of posterior atlantoaxial dislocation without associated fracture, but with quadriplegia, and accompanying epidural hematoma and subarachnoid hemorrhage.The patient underwent gentle traction in the neutral position until repeated cranial computed tomography revealed no progression of the epidural hematoma. Thereafter, the atlantoaxial dislocation was reduced by using partial odontoidectomy via a video-assisted transcervical approach and maintained with posterior polyaxial screw-rod constructs and an autograft. Neurological status improved immediately after surgery, and the patient recovered completely after 1 year.Posterior fusion followed by closed reduction is the superior strategy for posterior atlantoaxial dislocation without odontoid fracture, according to literature. But for cases with severe neurological deficit, open reduction may be the safest choice to avoid the lethal complication of overdistraction of the spinal cord. Also, open reduction and posterior srew-rod fixation are safe and convenient strategies in dealing with traumatic posterior atlantoaxial dislocation patients with neurological deficit. PMID:26512572

  13. Pseudo-Acetabulum due to Heterotopic Ossification in a Child with Post Traumatic Neglected Posterior Hip Dislocation

    PubMed Central

    Pathak, Aditya C; Patil, Atul K; Sheth, Binoti; Bansal, Rohan

    2012-01-01

    Introduction: Traumatic neglected dislocations of hip in children are rare entity. Neglected traumatic dislocations of hip in children along with heterotopic ossification are still rare. Post traumatic neglected hip dislocations are to be diagnosed as early as possible and have to be treated with precision and aggression as the outcome of treatment for the same is not predictable. Case Report: 5 year female with post-traumatic neglected hip dislocation with heterotopic ossification forming a pseudoacetabulum postero-superiorly in which femur head was lodged. The girl was operated by open reduction using Moore’s Posterior approach and showed good results. Here is a mention of a rare case with a good 18 months follow up with no complication. Conclusions: Post-traumatic neglected posterior hip dislocation mostly requires open reduction and relocation of femoral head in original acetabulum with concentric reduction. Heterotopic ossification is a rare but known complication of traumatic dislocation of hip in children. Good results can be achieved in such cases and regular follow-up of patient is required post-operatively.

  14. Bipolar plasma vaporization using plasma-cutting and plasma-loop electrodes versus cold-knife transurethral incision for the treatment of posterior urethral stricture: a prospective, randomized study

    PubMed Central

    Cai, Wansong; Chen, Zhiyuan; Wen, Liping; Jiang, Xiangxin; Liu, Xiuheng

    2016-01-01

    OBJECTIVE: Evaluate the efficiency and safety of bipolar plasma vaporization using plasma-cutting and plasma-loop electrodes for the treatment of posterior urethral stricture. Compare the outcomes following bipolar plasma vaporization with conventional cold-knife urethrotomy. METHODS: A randomized trial was performed to compare patient outcomes from the bipolar and cold-knife groups. All patients were assessed at 6 and 12 months postoperatively via urethrography and uroflowmetry. At the end of the first postoperative year, ureteroscopy was performed to evaluate the efficacy of the procedure. The mean follow-up time was 13.9 months (range: 12 to 21 months). If re-stenosis was not identified by both urethrography and ureteroscopy, the procedure was considered “successful”. RESULTS: Fifty-three male patients with posterior urethral strictures were selected and randomly divided into two groups: bipolar group (n=27) or cold-knife group (n=26). Patients in the bipolar group experienced a shorter operative time compared to the cold-knife group (23.45±7.64 hours vs 33.45±5.45 hours, respectively). The 12-month postoperative Qmax was faster in the bipolar group than in the cold-knife group (15.54±2.78 ml/sec vs 18.25±2.12 ml/sec, respectively). In the bipolar group, the recurrence-free rate was 81.5% at a mean follow-up time of 13.9 months. In the cold-knife group, the recurrence-free rate was 53.8%. CONCLUSIONS: The application of bipolar plasma-cutting and plasma-loop electrodes for the management of urethral stricture disease is a safe and reliable method that minimizes the morbidity of urethral stricture resection. The advantages include a lower recurrence rate and shorter operative time compared to the cold-knife technique. PMID:26872076

  15. Candida albicans Fungaemia following Traumatic Urethral Catheterisation in a Paraplegic Patient with Diabetes Mellitus and Candiduria Treated by Caspofungin

    PubMed Central

    Vaidyanathan, Subramanian; Soni, Bakul; Hughes, Peter; Singh, Gurpreet

    2013-01-01

    A 58-year-old paraplegic male, with long-term indwelling urethral catheter, developed catheter block. The catheter was changed, but blood-stained urine was drained intermittently. A long segment of the catheter was seen lying outside his penis, which indicated that the balloon of Foley catheter had been inflated in urethra. The misplaced catheter was removed and a new catheter was inserted correctly. Gentamicin 160 mg was given intravenously; meropenem 1 gram every eight hours was prescribed; antifungals were not given. Twenty hours later, this patient developed distension of abdomen, tachycardia, and hypotension; he was not arousable. Computed tomography of abdomen revealed inflamed uroepithelium of right renal pelvis and ureter, 4 mm lower ureteric calculus with gas in right ureter proximally, and vesical calculus containing gas in its matrix. Urine and blood culture yielded Candida albicans. Identical sensitivity pattern of both isolates suggested that the source of the bloodstream infection was most likely urine. Both isolates formed consistently high levels of biofilm formation in vitro as assessed using a biofilm biomass stain, and high levels of resistance to voriconazole were observed. Both amphotericin B and caspofungin showed good activity against the biofilms. HbA1c was 111 mmol/mol. This patient was prescribed human soluble insulin and caspofungin 70 mg followed by 50 mg daily intravenously. He recovered fully from candidemia. PMID:24223316

  16. Current management of urethral stricture disease

    PubMed Central

    Smith, Thomas G.

    2016-01-01

    Introduction: Broadly defined, urethral strictures are narrowing of the urethral lumen that is surrounded by corpus spongiosum, i.e., urethral meatus through the bulbar urethra. Urethral stenosis is narrowing of the posterior urethra, i.e., membranous urethra through bladder neck/prostate junction, which is not enveloped by corpus spongiosum. The disease has significant quality of life ramifications because many times younger patients are affected by this compared to many other urological diseases. Methods: A review of the scientific literature concerning urethral stricture, stenosis, treatment, and outcomes was performed using Medline and PubMed (U.S. National Library of Medicine and the National Institutes of Health). Abstracts from scientific meetings were included in this review. Results: There is level 3 evidence regarding the etiology and epidemiology of urethral strictures, stenoses, and pelvic fracture urethral injuries. Outcomes data from literature regarding intervention for urethral stricture are largely limited to level 3 evidence and expert opinion. There is a single level 1 study comparing urethral dilation and direct vision internal urethrotomy. Urethroplasty outcomes data are limited to level 3 case series. Conclusions: Progress is being made toward consistent terminology, and nomenclature which will, in turn, help to standardize treatment within the field of urology. Treatment for urethral stricture and stenosis remains inconsistent between reconstructive and nonreconstructive urologists due to varying treatment algorithms and approaches to disease management. Tissue engineering appears to be future for reconstructive urethral surgery with reports demonstrating feasibility in the use of different tissue substitutes and grafts. PMID:26941491

  17. Traumatic posterior communicating artery-cavernous fistula, angioarchitecture, and possible pathogenesis: a case report and literature review

    PubMed Central

    Du, Bin; Zhang, Meng; Liu, Qing-Lin; Shen, Jie; Wang, Yun-Yan

    2016-01-01

    Carotid-cavernous fistulas (CCFs) are an abnormal vascular shunt between the carotid artery and the cavernous sinus, and were traditionally classified into four subtypes based on the detailed fistulas anatomy and arterial supply. CCFs are frequently encountered in patients with traumatic skull base fractures. In this report, we present one such case caused by two head traumas. Computed tomography and digital subtraction angiography confirmed that this CCF arose from posterior communicating artery of the internal carotid artery, which is not included in the traditional Barrow et al’s categorization. The possible mechanisms include laceration of dural mater of posterior clinoid process and laceration or pseudoaneurysm formation of posterior communicating artery. This case was successfully treated with endovascular coil embolization. PMID:27099501

  18. Massive rotator cuff tear associated with acute traumatic posterior shoulder dislocation: report of two cases and literature review.

    PubMed

    Luenam, Suriya; Kosiyatrakul, Arkaphat

    2013-12-01

    A massive rotator cuff tear in association with acute traumatic posterior glenohumeral dislocation is rare. To our knowledge, only four documented cases have been reported in the literature. We present two additional cases of such injury secondary to the traffic accident. The first patient had an unsuccessful closed reduction due to the posterior instability while the second developed the profound shoulder weakness following the reduction. From the findings of our cases together with the previous reports, every patient had a unique injury mechanism of high-energy directed axial loading on an outstretched, adducted, and internally rotated arm. The glenohumeral capsule and rotator cuff were uniformly avulsed from the humeral attachment, and the supraspinatus and infraspinatus were always involved. However, the clinical presentations were variable based on the severity of the associated rotator cuff tear. The outcomes of operative treatment in this type of injury with the open repair were favorable. PMID:22782426

  19. The Surgical Management of Traumatic Lower Cervical Spondylolisthesis with Posterior Percutaneous Pedicle Screw Fixation

    PubMed Central

    Luo, Peng; Ni, Wen-Fei; Wu, Yao-Sen; Wu, Ai-Min; Wang, Xiang-Yang; Xu, Hua-Zi

    2015-01-01

    We reported a technical report of traumatic lower cervical spondylolisthesisca used by bilateral pedicle fracture, without neurological compression. The patient was treated with the minimally invasive technique of percutaneous pedicle screw fixation. Fracture healing and normal cervical motion were confirmed by plain films and physical examinations on the 18-monthpostoperatively. The technique of percutaneous pedicle screw fixation might be an alternative strategy for the treatment of traumatic lower cervical spondylolisthesis with pedicle fracture. PMID:25901240

  20. Traumatic posterior shoulder dislocation with a large engaging Hill-Sachs lesion: splinting technique.

    PubMed

    Aldebeyan, Sultan; Aoude, Ahmed; Van Lancker, Hans

    2016-03-01

    Posterior shoulder dislocations are rare and are often associated with seizures, electrocution, and high-energy trauma. They can be missed and, therefore, left untreated. Early diagnosis and treatment can help avoid future complications and surgical intervention. PMID:26254506

  1. Urethral injury in laparoscopic-assisted abdominoperineal resection

    PubMed Central

    Stitt, Laurel; Flores, Francisco Avila; Dhalla, Sonny S.

    2015-01-01

    We present a 71-year-old man who underwent laparoscopic-assisted abdominoperineal resection for recurrence of rectal cancer, which was complicated by a urethral injury. Traumatic urinary catheter insertion was ruled out as an alternative etiology. This case highlights the importance of recognizing urethral injury as a possible complication of laparoscopic-assisted abdominoperineal resection surgery. PMID:26834902

  2. Giant urethral calculus

    PubMed Central

    Kotkar, Kunal; Thakkar, Ravi; Songra, MC

    2011-01-01

    Primary urethral calculus is rarely seen and is usually encountered in men with urethral stricture or diverticulum. We present a case of giant urethral calculus secondary to a urethral stricture in a man. The patient was treated with calculus extraction with end to end urethroplasty. PMID:24950400

  3. Posterior Reversible Encephalopathy Syndrome Complicating Traumatic Pancreatitis: A Pediatric Case Report.

    PubMed

    Sigurtà, Anna; Terzi, Valeria; Regna-Gladin, Caroline; Fumagalli, Roberto

    2016-05-01

    We are reporting a case of posterior reversible encephalopathy syndrome (PRES) developed in an unusual clinical scenario without the presence of the most described symptoms. PRES is a neurological and radiological syndrome described in many different clinical conditions. In children it has been mostly reported in association with hematological and renal disorders.Our patient was a 15 years old boy, admitted to our intensive care unit for pancreatitis after blunt abdominal trauma.During the stay in the intensive care unit, he underwent multiple abdominal surgical interventions for pancreatitis complications. He had a difficult management of analgesia and sedation, being often agitated with high arterial pressure, and he developed a bacterial peritonitis. After 29 days his neurological conditions abruptly worsened with neuroimaging findings consistent with PRES. His clinical conditions progressively improved after sedation and arterial pressure control.He was discharged at home with complete resolution of the neurological and imaging signs 2 months later.The pathophysiology of PRES is controversial and involves disordered autoregulation ascribable to hypertension and endothelial dysfunction. In this case both hypertension and endothelial activation, triggered by sepsis and pancreatitis, could represent the culprits of PRES onset. Even if there is no specific treatment for this condition, a diagnosis is mandatory to start antihypertensive and supportive treatment. We are therefore suggesting to consider PRES in the differential diagnosis of a neurological deterioration preceded by hypertension and/or septic state, even without other "typical" clinical features. PMID:27258506

  4. Anterior urethral stricture review

    PubMed Central

    Stein, Marshall J.

    2013-01-01

    Male anterior urethral stricture disease is a commonly encountered condition that presents to many urologists. According to a National Practice Survey of Board Certified Urologist in the United States most urologists treat on average 6-20 urethral strictures yearly. Many of those same urologists surveyed treat with repeated dilation or internal urethrotomy, despite continual recurrence of the urethral stricture. In point of fact, the urethroplasty despite its high success rate, is underutilized by many practicing urologists. Roughly half of practicing urologist do not perform urethroplasty in the United States. Clearly, the reconstructive ladder for urethral stricture management that was previously described in the literature may no longer apply in the modern era. The following article reviews the etiology, diagnosis, management and comparisons of treatment options for anterior urethral strictures. PMID:26816721

  5. Epidemiology of urethral strictures

    PubMed Central

    Blaschko, Sarah D.; McAninch, Jack W.; Breyer, Benjamin N.

    2014-01-01

    Urethral stricture disease is relatively common and is associated with a significant financial cost and potentially debilitating outcomes. Understanding urethral stricture epidemiology is important to identify risk factors associated with the etiology or progression of the disease. This understanding may lead to better treatments and preventative measures that could ameliorate disease severity, produce better health outcomes, and reduce expenditures. We performed a comprehensive review of urethral stricture disease based on available published case series, identified gaps in knowledge of this disease, and recommend future directions for research. PMID:26813256

  6. Approach to bulbar urethral strictures: Which technique and when?

    PubMed Central

    Joshi, Pankaj; Kaya, Cevdet; Kulkarni, Sanjay

    2016-01-01

    Bulbar urethra is the most common site of anterior urethral stricture and this stricture develops secondary to idiopathic (40%), iatrogenic (35%), inflammatory (10%), and traumatic (15%) causes. Various techniques and approaches with buccal mucosal graft have been described. We wanted to describe different techniques of repair with specific advantages. PMID:27274887

  7. Traumatic Dislodgement of Tibial Polyethylene Insert after a High-Flex Posterior-Stabilized Total Knee Replacement

    PubMed Central

    Astoul Bonorino, Juan Felix; Slullitel, Pablo Ariel Isidoro; Kido, Gonzalo Rodrigo; Bongiovanni, Santiago; Vestri, Renato; Carbó, Lisandro

    2015-01-01

    Many pathologic entities can produce a painful total knee replacement (TKR) that may lead to potential prosthetic failure. Polyethylene insert dissociation from the tibial baseplate has been described most frequently after mobile-bearing and cruciate-retaining TKRs. However, only 3 tibial insert dislocations in primary fixed-bearing High-Flex posterior-stabilized TKRs have been reported. We present a new case of tibial insert dislocation in a High-Flex model that shares similarities and differences with the cases reported, facilitating the analysis of the potential causes, which still remain undefined. PMID:26457215

  8. Synchronization between the anterior and posterior cortex determines consciousness level in patients with traumatic brain injury (TBI).

    PubMed

    Leon-Carrion, Jose; Leon-Dominguez, Umberto; Pollonini, Luca; Wu, Meng-Hung; Frye, Richard E; Dominguez-Morales, Maria Rosario; Zouridakis, George

    2012-10-01

    Survivors of traumatic brain injury (TBI) often suffer disorders of consciousness as a result of a breakdown in cortical connectivity. However, little is known about the neural discharges and cortical areas working in synchrony to generate consciousness in these patients. In this study, we analyzed cortical connectivity in patients with severe neurocognitive disorder (SND) and in the minimally conscious state (MCS). We found two synchronized networks subserving consciousness; one retrolandic (cognitive network) and the other frontal (executive control network). The synchrony between these networks is severely disrupted in patients in the MCS as compared to those with better levels of consciousness and a preserved state of alertness (SND). The executive control network could facilitate the synchronization and coherence of large populations of distant cortical neurons using high frequency oscillations on a precise temporal scale. Consciousness is altered or disappears after losing synchrony and coherence. We suggest that the synchrony between anterior and retrolandic regions is essential to awareness, and that a functioning frontal lobe is a surrogate marker for preserved consciousness. This article is part of a Special Issue entitled: Brain Integration. PMID:22534483

  9. Acute traumatic posterior fracture dislocation of the elbow in pediatric patients: impact of surgery time and associated fractures on outcome.

    PubMed

    Bilgili, Fuat; Dikmen, Goksel; Baş, Ali; Asma, Ali; Batibay, Sefa G; Şirikçi, Murat; Atalar, Ata Can

    2016-09-01

    This study assessed the effect of the time interval from initial injury to surgery and the presence of associated fracture on functional outcomes after acute posterior elbow fracture dislocation. Twenty-six pediatric patients were evaluated with respect to operation time point (within 24 h vs. later) and associated fracture retrospectively. The Mayo Elbow Performance Index (MEPI) score was used to assess functional results. The MEPI score was 91 (80-100) in patients with one associated fracture and 83 (75-95) (P=0.02) in patients with more than one associated fracture. The MEPI score in patients treated within 24 h was 90.3 (75-95) and in those treated later than 24 h, it was 88.6 (75-100) (P=0.6). Treatment time (within 24 h vs. later) does not affect outcomes, but increasing numbers of associated injuries affect outcomes negatively. Level of study: Level IV case series. PMID:26895289

  10. Steroid Treatment for Recurrent Epididymitis Secondary to Idiopathic Urethritis and Urethrovasal Reflux

    PubMed Central

    Ninan, G. K.; Bhishma, Preethi; Patel, Ramnik

    2013-01-01

    We describe a case of recurrent left-sided epididymitis secondary to severe idiopathic posterior urethritis extending to left seminal vesicle and vas deference with associated urethrovasal reflux (UVR). Cystourethroscopy and micturating cystourethrogram were essential for the diagnosis. Following cystourethroscopy, intravesical, and urethral instillation of topical steroid triamcinolone, patient had a full recovery. Idiopathic urethritis in association with veru montentitis, utriculitis leading to left-sided UVR, inflammation of the seminal vesicle, and vas deference causing secondary epididymitis is rare. We report the first such rare case presenting as recurrent acute scrotum and response to innovative treatment we used. PMID:25755955

  11. Urethral ultrasonography: A novel diagnostic tool for dysuria following bipolar transurethral plasma kinetic prostatectomy.

    PubMed

    Wang, Guang-Chun; Bian, Cui-Dong; Zhou, Ting-Ting; Liu, Min; Huang, Jian-Hua; Peng, Bo

    2016-04-29

    Urethral ultrasonography is non-invasive and able to indicate the urethral lumen clearly, as well as the surrounding tissues of the posterior urethra, without contrast agent or X-ray irradiation. In this paper, we evaluate the reliability of urethral ultrasonography in the diagnosis of dysuria following bipolar transurethral plasma kinetic prostatectomy (TUPKP). A total of 120 benign prostate hyperplasia (BPH) patients with dysuria undergoing TUPKP were enrolled in this study, with a mean age of 72.8 years. All the patients received urethral ultrasonography, urethroscopy and bladder neck urethra stenosis oulectomy. Among the 120 cases, there were 22 cases of bladder neck closure, 20 bladder orifice stricture, 60 urethral stricture, 10 prostate remnants, 2 calculi in prostatic urethra, 4 dysfunction of bladder detrusor muscle and 2 flap of internal urethral orifice. χ2-test was used for the comparison of ultrasonography and urethral cystoscopy in the diagnosis of dysuria following TRPKP, and no significant difference was found between two diagnostic tools (χ 2 = 0.94, P > 0.05). Urethral ultrasonography is a reliable and minimally invasive diagnostic tool for dysuria following TUPKP and is conducive to early treatment of dysuria following prostatectomy. PMID:27163308

  12. Aspects of urethrality in women.

    PubMed

    Bass, A

    1994-07-01

    It has long been noticed that women experience direct sexual stimulation from urethral practices that men do not. However, this empirical finding remains to be integrated with the general theory of female psychosexual development. An attempt is made to begin such an integration, with a focus on urethral perversions or perverse trends. PMID:7972586

  13. Current Management of Urethral Stricture

    PubMed Central

    Lee, Young Ju

    2013-01-01

    The surgical treatment of urethral stricture diseases is continually evolving. Although various surgical techniques are available for the treatment of anterior urethral stricture, no one technique has been identified as the method of choice. This article provides a brief updated review of the surgical options for the management of different sites and different types of anterior urethral stricture. This review also covers present controversies in urethral reconstruction. Among the various procedures available for treating urethral stricture, one-stage buccal mucosal graft urethroplasty is currently widely used. The choice of technique for urethroplasty for an individual case largely depends on the expertise of the surgeon. Therefore, urologists working in this field should keep themselves updated on the numerous surgical techniques to deal with any condition of the urethra that might surface at the time of surgery. PMID:24044088

  14. Management of urethral strictures

    PubMed Central

    Mundy, A R

    2006-01-01

    Controlled clinical trials are unusual in surgery, rare in urology, and almost non‐existent as far as the management of urethral stricture is concerned. What data there are come largely from so called “expert opinion” and the quality of this is variable. None the less, the number of so called experts, past and present, is comparatively small and in broad principle their views more or less coincide. Although this review is therefore inevitably biased, it is unlikely that expert opinion will take issue with most of the general points raised here. PMID:16891437

  15. Congenital anterior urethral diverticulum.

    PubMed

    Singh, Sanjeet Kumar; Ansari, Ms

    2014-09-01

    Congenital anterior urethral diverticulum (CAUD) may be found all along the anterior urethra and may present itself at any age, from infant to adult. Most children with this condition present with difficulty in initiating micturition, dribbling of urine, poor urinary stream, or urinary tract infection. A careful history will reveal that these children never had a good urinary stream since birth, and the telltale sign is a cystic swelling of the penile urethra. In this paper, we present two cases of CAUD that were managed by excision of the diverticulum with primary repair. PMID:26328174

  16. KTP-532 laser ablation of urethral strictures

    NASA Astrophysics Data System (ADS)

    Malloy, Terrence R.

    1991-07-01

    In 1988, the KTP-532 laser was used to ablate a series of benign urethral strictures. Rather than using a single incision, as in urethrotomy, strictures were treated with a 360$DEG contact photoradiation. Thirty-one males, average age 53.2 years, received 37 treatments. Six patients underwent a second laser treatment. Stricture etiology was commonly iatrogenic (32%), traumatic (16%), and post-gonococcal (10%). Stricture location included mainly bulbar (49%), membranous (20%), and penile (12%) areas. The surgical technique consisted of a circumferential ablation followed by foley catheter placement (mean 10 days). Follow-up on 29 of 31 patients ranged from 1 to 16 months (mean 9.7) Complete success occurred in 17 patients (59%) who had no further symptoms or instrumentation. Partial success was seen in 6 patients (20.5%) with symptoms but no stricture recurrence. Six patients (20.5%) failed therapy requiring additional surgery or regular dilatations. No complications were encountered. Although longer assessment is required, KTP-532 laser ablation of urethral strictures appears efficacious.

  17. KTP-532 laser ablation of urethral strictures.

    PubMed

    Turek, P J; Malloy, T R; Cendron, M; Carpiniello, V L; Wein, A J

    1992-10-01

    In 1988 the KTP-532 laser was used to ablate a series of benign urethral strictures. Rather than using a single incision as in urethrotomy, strictures were treated with 360-degree contact photoradiation. Thirty-one male patients, average age 53.2 years, received thirty-seven treatments; 6 patients underwent a second laser treatment. Stricture etiology was commonly iatrogenic (32%), traumatic (16%), and postgonococcal (10%). Stricture location included mainly bulbar (49%), membranous (20%), and penile (12%) areas. The surgical technique consisted of circumferential ablation, followed by Foley catheter placement (mean, 10 days). Follow-up on 29 of 31 patients ranged from one to sixteen months (mean 9.7). Complete success occurred in 17 patients (59%) who had no further symptoms or instrumentation. Partial success was seen in 6 patients (20.5%) with symptom, but not stricture, recurrence. Six patients (20.5%) failed therapy, requiring additional surgery or regular dilations. No complications were seen. Although longer assessment is required, KTP-532 laser ablation of urethral strictures appears efficacious. PMID:1413350

  18. [Vaporization of urethral stenosis using the KTP 532 laser].

    PubMed

    Schmidlin, F; Oswald, M; Iselin, C; Rohner, S; Jichlinski, P; Delacrétaz, G; Leisinger, H J; Graber, P

    1997-01-01

    The authors treated 16 patients presenting with a total of 20 anterior urethral strictures using the KTP 16 Laser. The aetiology was iatrogenic in 50% of cases, infectious in 20% of cases, traumatic in 20% of cases and unknown in 10% of cases. The stricture was situated in the bulbous urethra (80%), membranous urethra (10%) or penil urethra (10%). Laser vaporization of the urethral stricture was performed over the entire circumference of the urethra when necessary, followed by bladder drainage by urethral catheter for 24 hours. All patients were prospectively reviewed at 3 weeks, 3 months and 6 months (clinical symptoms, uroflowmetry, cystourethrography). A complete symptom and urodynamic success was obtained in 13 patients (81%) at 3 and 6 months. The stricture recurred in 4 patients, but only three of them (19%) required treatment (reoperation of repeat dilatations). The mean maximum flow rate increased from 6 mL/s to 20 mL/s at 3 months and was maintained at 19 mL/s at 6 months. No intraoperative or postoperative complications were observed. In conclusion, our results confirm that KTP 532 laser urethral strictures is a reliable and effective method in the medium term. These good results also suggest an advantage in terms of the recurrence rate in comparison with internal urethrotomy. However, our series needs to be evaluated with a longer follow-up and prospective, randomized trials comparing the two methods need to be conducted. PMID:9157820

  19. Modified sonourethrography assists urethral catheterization.

    PubMed

    Minagawa, Tomonori; Suzuki, Toshiro; Domen, Takahisa; Yokoyama, Hitoshi; Ishikawa, Masakuni; Hirakata, Shiro; Nagai, Takashi; Nakazawa, Masaki; Ogawa, Teruyuki; Ishizuka, Osamu

    2016-07-01

    Sonourethrography (SUG) is an infrequently used modality to observe the male urethra. We modified SUG to examine the reasons for difficulty in urethral catheterization and to determine a safe approach to resolve these problems. Following retrograde urethral jelly injection, modified SUG (mSUG) was performed in male patients with difficulty in urethral catheterization. mSUG was performed using transcutaneous ultrasonography in patients for whom the catheter became lodged in the penile urethra. In other patients, mSUG was performed using transrectal ultrasonography. We divided the causes of difficult indwelling urethral catheterization into physiological and pathological conditions. With regard to physiological conditions, the urethral catheter became stuck in the bulbous portion, membranous urethra, and prostatic urethra. mSUG distinguished the problematic part of the urethra in real time, and it assisted in overcoming the problem. With regard to pathological conditions, urethral stricture after trauma or surgery was clearly demonstrated in the penile and prostatic portions of the urethra. As with physiological conditions, mSUG images assisted in navigating the catheter through the problematic pathological areas or demonstrated the need to abandon the catheterization. mSUG can visualize the male urethra clearly during urethral catheterization and provide real-time assistance with the procedure. PMID:26847624

  20. [Endoscopic treatment of urethral strictures].

    PubMed

    Oosterlinck, W; Lumen, N

    2006-08-01

    The present article reviews the literature regarding the endoscopic treatment of urethral strictures. Only few prospective randomised clinical trials with sufficient power have been performed and most of the literature provides evidence of only level 3 and 4. Since length, location, extent and calibre of the urethral stricture have an important impact on prognosis, diagnosis and the role of ultrasonography are discussed. Pathophysiology of wound healing is discussed in relation to urethrotomy, as it explains the outcomes of the procedure. Operative techniques using cold knife and laser, use of endoprostheses, indications, complications, results and postoperative management are described. The possible role of urethral catheters, hydraulic dilatations and corticosteroid applications are discussed. PMID:16970069

  1. Gram stain of urethral discharge

    MedlinePlus

    Urethral discharge Gram stain ... microscope slide. A series of stains called a Gram stain is applied to the specimen. The stained ... culture ) should be performed in addition to the gram stain. More sophisticated diagnostic tests (such as PCR ...

  2. The effect of urethral stricture on male fertility in Ife.

    PubMed

    Badejo, O A

    1990-01-01

    Twenty patients with Urethral stricture disease presenting with difficulty in micturition, azoospermia, and oligospermia were studied. Only 5% of our patients could firmly claim to be fertile at the time of presentation with a rise to 80% fertility rate at the end of management. Fifteen percent did not notice any change in their status. Surgical approach claimed better result over conservative management because of other complications following gonococcal infections. The need for a close forensic analysis in the determination of paternity in all cases of Urethral strictures was stressed while a treatment protocol of graft urethroplasty in all cases of traumatic rupture and dilatation in cases following inflammatory lesions of the urethra was established. PMID:2090990

  3. Challenges in the Diagnosis and Management of Acquired Nontraumatic Urethral Strictures in Boys in Yaoundé, Cameroon

    PubMed Central

    Mouafo Tambo, F. F.; Fossi kamga, G.; Kamadjou, C.; Mbouche, L.; Nwaha Makon, A. S.; Birraux, J.; Andze, O. G.; Angwafo, F. F.; Mure, P. Y.

    2016-01-01

    Introduction. Urethral strictures in boys denote narrowing of the urethra which can be congenital or acquired. In case of acquired strictures, the etiology is iatrogenic or traumatic and rarely infectious or inflammatory. The aim of this study was to highlight the diagnostic and therapeutic difficulties of acquired nontraumatic urethral strictures in boys in Yaoundé, Cameroon. Methodology. The authors report five cases of nontraumatic urethral strictures managed at the Pediatric Surgery Department of the YGOPH over a two-year period (November 2012–November 2014). In order to confirm the diagnosis of urethral stricture, all patients were assessed with both cystourethrography and urethrocystoscopy. Results. In all the cases the urethra was inflammatory with either a single or multiple strictures. The surgical management included internal urethrotomy (n = 1), urethral dilatation (n = 1), vesicostomy (n = 2), and urethral catheterization (n = 3). With a median follow-up of 8.2 months (4–16 months) all patients remained symptoms-free. Conclusion. The authors report the difficulties encountered in the diagnosis and management of nontraumatic urethral strictures in boys at a tertiary hospital in Yaoundé, Cameroon. The existence of an inflammatory etiology of urethral strictures in boys deserves to be considered. PMID:27239364

  4. Anterior Urethral Valves: Not Such a Benign Condition…

    PubMed Central

    Cruz-Diaz, Omar; Salomon, Anahi; Rosenberg, Eran; Moldes, Juan Manuel; de Badiola, Francisco; Labbie, Andrew Scott; Gosalbez, Rafael; Castellan, Miguel Alfredo

    2013-01-01

    Purpose: Anterior urethral valves (AUVs) is an unusual cause of congenital obstruction of the male urethra, being 15–30 times less common than posterior urethral valves (PUVs). It has been suggested that patients with congenital anterior urethral obstruction have a better prognosis than those with PUV, with less hydronephrosis, and a lower incidence of chronic renal insufficiency (5 vs. 30%). The long-term prognosis of AUVs is not clear in the literature. In this report we describe our experience and long-term follow up of patients with anterior urethral valve. Materials and Methods: We retrospectively identified 13 patients who presented with the diagnosis of AUVs in our institutions between January 1994 and June 2012. Two patients were excluded: one patient had no follow up after intervention; the other had a follow up <1 year. From the 11 patients included, we evaluated the gestational age, prenatal and postnatal ultrasound findings, voiding cystourethrogram findings, age upon valve ablation, micturition pattern, creatinine, and clinical follow up. Results: Between 1994 and 2012 we evaluated 150 patients with the diagnosis of urethral valves. Of this group, 11 patients (7.3%) had AUVs and an adequate follow up. Mean follow up is 6.3 years (2.5–12 years). Five (45.4%) patients had prenatal diagnosis of AUV. The most common prenatal ultrasonographic finding was bilateral hydronephrosis and distended bladder. One patient showed a large perineal cystic mass, which was confirmed to be a dilated anterior urethra. The mean gestational age was 37.6 weeks (27–40 WGA). Postnatally, 90% had trabeculated bladder, 80% hydronephrosis, and 40% renal dysplasia. The most common clinical presentation was urinary tract infection in five patients (45.4%), followed by weak urinary stream found in four patients (36.3%). The age at initial surgical intervention ranged between 7 days and 13 years. Seven (63.6%) patients had primary transurethral valve resection or

  5. Anterior Urethral Valve: A Rare But an Important Cause of Infravesical Urinary Tract Obstruction

    PubMed Central

    Parmar, Jitendra P.; Mohan, Chander; Vora, Maulik P.

    2016-01-01

    Summary Background Urethral valves are infravesical congenital anomalies, with the posterior urethral valve (PUV) being the most prevalent one. Anterior urethral valve (AUV) is a rare but a well-known congenital anomaly. AUV and diverticula can cause severe obstruction, whose repercussions on the proximal urinary system can be important. Few cases have been described; both separately and in association with urethral diverticulum. The presentation of such a rare but important case led us to a report with highlighting its classic imaging features. Case Report We present a case report of AUV with lower urinary tract symptoms in a 6-year-old boy with complaints of a poor stream of urine and strain to void. Unique findings were seen on Retrograde Urethrography (RGU) and Voiding Cysto-Urethrography (VCUG), i.e. linear incomplete filling defect in the penile urethra and associated mild dilatation of the anterior urethra ending in a smooth bulge. On cysto-urethroscopy the anterior urethral valve was confirmed and fulguration was done. Conclusions Congenital anterior urethral valve is an uncommon but important cause of infravesical lower urinary tract obstruction that is more common in male urethra. It can occur as an isolated AUV or in association with diverticulum and VATER anomalies. Early diagnosis and management of this rare condition is very important to prevent further damage, infection and vesicoureteral reflux. AUV may be associated with other congenital anomalies of the urinary system; therefore a full evaluation of the urinary system is essential. PMID:27231492

  6. [Laser treatment of urethral strictures].

    PubMed

    Klammert, R; Schneede, P; Kriegmair, M

    1994-07-01

    Since the late 1970s different laser systems have been applied for the treatment of urethral strictures. Thermal effects adjacent on tissue have made the long term results of Nd:-YAG and Ar+ laser application discouraging. New laser systems (KTP, Excimer, Ho: YAG) still have to prove their efficacy in randomized clinical trials against cold knife urethrotomy. PMID:7941175

  7. [Endoscopic management of urethral stricture].

    PubMed

    Rossi Neto, R; Tschirdewahn, S; Tschirderwahn, S; Rose, A; vom Dorp, F; Rübben, H

    2010-06-01

    Great progress has been seen in the treatment of urethral strictures since the first endoscopic urethrotomy was performed in 1893 by Felix Martin Oberländer in Dresden, Germany. With the introduction of endoscopic laser therapy and the variety of urethral reconstruction methods other ways to treat this important urologic entity became available. Despite this progress, urethrotomy still represents the preferred treatment concept for primary, short and bulbar urethral strictures. In this study we performed a 2-year retrospective analysis of 20 patients undergoing primary endoscopic urethrotomy by single bulbar or penile narrowing. A high incidence of recurrence was seen in 70% of the patients. Nevertheless, direct vision urethrotomy represented a safe and effective transitory method to treat these patients. Moreover, 80% of the patients preferred, in cases of recurrence, a repeated urethrotomy as the treatment of choice. Although the long-term results evidence high relapse rates after the first and second procedures, there have been no sufficient data in the literature which support the use of other methods. Furthermore, primary endoscopic management of urethral strictures remains a simple, safe, and cost-effective procedure that should be indicated before more invasive approaches are taken to provide relief to these patients from this limiting problem. PMID:20544332

  8. On Demand Urethral Dilatation Versus Intermittent Urethral Dilatation: Results and Complications in Women With Urethral Stricture

    PubMed Central

    Heidari, Fatemeh; Abbaszadeh, Shahin; Ghadian, Alireza; Tehrani Kia, Farahnaz

    2014-01-01

    Background: The treatment of urethral stricture in female patients is through dilatation of the urethra by tubes of increasing diameter. There are two main methods: intermittent dilatation and on demand dilatation. Objectives: The main aim of this study was to compare the results of these two methods, and to determine the best one. Patients and Methods: In this clinical trial study, we reviewed the documents of women diagnosed with urethral stricture, who came to the Baqiyatallah Clinic from 2007 and 2012. According to the method of dilatation, the patients were divided into two groups: intermittent dilatation and on demand dilatation. Patients’ data were then collected and analyzed. Results: Eighty-six patients were enrolled in the study. The mean age of the participants was 48.13 years (between 44 and 79 years). The mean urinary residual and maximum urinary flow speed changes, before and after on demand dilatation, were higher than in the intermittent method. Conclusions: For treating urethral stricture, on demand urethral dilatation is more effective than intermittent dilatation. PMID:24783171

  9. Buccal mucosa urethroplasty for adult urethral strictures

    PubMed Central

    Zimmerman, W. Britt; Santucci, Richard A.

    2011-01-01

    Urethral strictures are difficult to manage. Some treatment modalities for urethral strictures are fraught with high patient morbidity and stricture recurrence rates; however, an extremely useful tool in the armamentarium of the Reconstructive Urologist is buccal mucosal urethroplasty. We like buccal mucosa grafts because of its excellent short and long-term results, low post-operative complication rate, and relative ease of use. We utilize it for most our bulbar urethral stricture repairs and some pendulous urethral stricture repairs, usually in conjunction with a first-stage Johanson repair. In this report, we discuss multiple surgical techniques for repair of urethral stricture disease. Diagnosis, evaluation of candidacy, surgical techniques, post-operative care, and complications are included. The goal is to raise awareness of buccal mucosa grafting for the management urethral stricture disease. PMID:22022061

  10. Erectile function after anastomotic urethroplasty for pelvic fracture urethral injuries.

    PubMed

    El-Assmy, A; Harraz, A M; Benhassan, M; Nabeeh, A; Ibrahiem, El Hi

    2016-07-01

    There is an established association between ED and pelvic fracture urethral injuries (PFUIs). However, ED can occur after the injury and/or the urethral repair. To our knowledge, only one study of erectile function (EF) after urethroplasty for PFUIs used a validated questionnaire. This study was carried out to determine the impact of anastomotic posterior urethroplasty for PFUIs on EF. We retrospectively reviewed the computerized surgical records to identify patients who underwent anastomotic urethroplasty for PFUIs from 1998 to 2014. Those patients were contacted by phone or mail and were re-evaluated in the outpatient clinic by International Index of Erectile Function questionnaire; in unmarried men, the single-question self-report of ED was used for evaluation of EF, clinical examination and penile color Doppler ultrasonography (CDU) for men with ED. Overall, 58 patients were included in the study among whom 36 (62%) men were sexually active and the remaining 22 (38%) were single. The incidence of ED among our group is 72%. All patients developed ED after initial pelvic trauma and none of our patients had impaired EF after urethroplasty. The incidence of ED increased proportionally with severity of pelvic trauma. All patients with type-C pelvic fracture, associated symphysis pubis diastasis, sacroiliac joints diastasis and bilateral pubic ramus fractures had ED. Men with PFUIs had worse EF than men in other series with pelvic fractures without urethral injury. The majority (88%) of men with ED showed veno-occlusive dysfunction on penile CDU. So we concluded that men with PFUIs had a high incidence of ED up to 72%. Anastomotic posterior urethroplasty had no negative impact on EF and the development of ED after PFUIs was related to the severity of the original pelvic trauma. Veno-occlusive dysfunction is the commonest etiology of ED on penile CDU. PMID:27146349

  11. The mechanism of continence after posterior urethroplasty

    PubMed Central

    Bagga, Herman S.; Angermeier, Kenneth W.

    2015-01-01

    The standard of care after a pelvic fracture urethral injury is a repair via a one-stage anastomotic posterior urethroplasty using a step-wise perineal approach. The initial injury, immediate postoperative management, and surgical repair can all affect urinary continence in these patients. Proximal continence mechanisms, particularly the bladder neck, are particularly important in maintaining urinary continence in these patients. Patients with bladder neck dysfunction should be counselled about the greater risk of urinary incontinence. PMID:26019981

  12. Urethral and penile war injuries: The experience from civil violence in Iraq

    PubMed Central

    Al-Azzawi, Issam S.; Koraitim, Mamdouh M.

    2014-01-01

    Objective To determine the incidence, mechanism of injury, wounding pattern and surgical management of urethral and penile injuries sustained in civil violence during the Iraq war. Patients and methods In all, 2800 casualties with penetrating trauma to the abdomen and pelvis were received at the Al-Yarmouk Hospital, Baghdad, from January 2004 to June 2008. Of these casualties 504 (18%) had genitourinary trauma, including 45 (8.9%) with urethral and/or penile injuries. Results Of 45 patients, 29 (64%) were civilians and 16 (36%) were Iraqi military personnel. The injury was caused by an improvised explosive device (IED) in 25 (56%) patients and by individual firearms in 20 (44%). Of the patients, 24 had penile injuries, 15 had an injury to the bulbar urethra and six had an injury to the posterior urethra. Anterior urethral injuries were managed by primary repair, while posterior urethral injuries were managed by primary realignment in five patients and by a suprapubic cystostomy alone in one. An associated injury to major blood vessels was the cause of death in eight of nine patients who died soon after surgery (P < 0.001). Conclusion Urethral and penile injuries were caused by IEDs and individual firearms with a similar frequency. Most of the casualties were civilians and a minority were military personnel. Injuries to the anterior urethra can be managed by primary repair, while injuries to the posterior urethra can be managed by primary realignment. An associated trauma to major blood vessels was the leading cause of death in these casualties. PMID:26019940

  13. Bilateral posterior sternoclavicular dislocation.

    PubMed

    Baumann, Matthias; Vogel, Tobias; Weise, Kuno; Muratore, Tim; Trobisch, Per

    2010-07-01

    Posterior sternoclavicular dislocations are a rare injury, representing <5% of all sternoclavicular dislocations and 1 in 1600 shoulder girdle injuries. Proper imaging with computed tomography and prompt diagnosis are essential steps in preventing potentially lethal complications observed in approximately 3% of all posterior sternoclavicular dislocations. Surgical treatment is necessary if closed reduction fails. With the medial clavicular epiphysis being the last to close (between ages 22 and 25), children and adolescents typically present with epiphyseal fractures rather than joint dislocations. If closed reduction fails, open reduction and internal fixation (ORIF) should be considered in fractures, whereas complex reconstructions with tendon graft procedures have been recommended for joint dislocations. This article presents a case of a traumatic bilateral posterior sternoclavicular dislocation due to an epiphyseal fracture in a 15-year-old boy. To our knowledge, this is the first reported case of a bilateral posterior sternoclavicular dislocation. Attempted closed reduction failed with redislocation after 2 days. The patient subsequently required ORIF. This article describes our technique with anterior retraction of the medial clavicle, closure of the posterior periosteum, and ORIF using nonabsorbable sutures. Postoperative shoulder mobilization was started on day 1. At final follow-up, the patient was completely asymptomatic. PMID:20608625

  14. 21 CFR 876.5520 - Urethral dilator.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Urethral dilator. 876.5520 Section 876.5520 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5520 Urethral dilator....

  15. Balloon dilatation for male urethral strictures “revisited”

    PubMed Central

    Vyas, Jigish B.; Ganpule, Arvind P.; Muthu, Veermani; Sabnis, Ravindra B.; Desai, Mahesh R.

    2013-01-01

    Aims: To analyze the results of balloon dilatation for short segment male urethral strictures. Materials and Methods: Retrospective analysis was done of 120 patients undergoing urethral balloon dilatation since January 2004 to January 2012. The inclusion criteria for analysis was a short segment (less than 1.5 cm) stricture, exclusion criteria were pediatric, long (more than 1.5 cm), traumatic, malignant strictures. The parameters analyzed included presentation of patients, ascending urethrogram (AUG) and descending urethrogram findings, pre- and postoperative International prostate symptoms score (IPSS), uroflowmetry (Qmax), and post-void residue (PVR). Need for self calibration/ancillary procedures were assessed. Failure was defined as requirement for a subsequent endoscopic or open surgery. A urethral balloon catheter (Cook Urological, Spencer, Indiana) is passed over a guide wire after on table AUG and inflated till 180 psi for 5 minutes under fluoroscopy till waist disappears. Dilatation is followed by insertion of a Foley catheter. Patients were followed up at 1, 3, and 6 months. Results: Mean age was 49.86 years. Mean follow-up was 6 (2–60) months. IPSS improved from 21.6 preoperative to 5.6 postoperatively. Qmax increased from 5.7 to 19.1 and PVR decreased from 90.2 to 28.8 (P < 0.0001*) postoperatively. At 1, 3, and at 6 monthly follow-up, 69.2% (n = 82) patients were asymptomatic. Conclusions: Balloon dilation is a safe, well-tolerated procedure with minimal complications. Further randomized studies comparing balloon dilatation with direct internal visual urethrotomy are warranted. PMID:24311903

  16. Delayed urethral erosion after tension-free vaginal tape.

    PubMed

    Powers, Kenneth; Lazarou, George; Greston, Wilma Markus

    2006-06-01

    Urethral erosions have been reported with various sling materials placed by means of various techniques. The patient often presents in the immediate postoperative period, although late presentations have been described. The diagnosis is made on cystoscopy, and mesh excision with urethral reconstruction is advocated. We present the cases of two patients with urethral erosion after mid-urethral polypropylene sling who presented 3 months after surgery with urethral pain, mid-urethral blockage and symptoms of bladder dysfunction. Urethroscopy revealed the mesh bridging the lumen of the urethra. Trans-vaginal mesh excision and layered urethral reconstruction was curative in both patients. PMID:16741603

  17. [Perineal urethrostomy in complex anterior urethral stricture].

    PubMed

    Barbagli, G

    2010-06-01

    Staged urethroplasty is a well-known procedure for urethral reconstruction that had already been described by Russell in 1914 and was later popularized by Johanson, Turner-Warwick, Blandy, and Schreiter. It lends itself to the treatment of complex anterior urethral stricture in combination with lichen sclerosus, failed correction of hypospadias, fistula, via falsa, abscess, carcinoma, or previously unsuccessful urethroplasty. Perineal urethrostomy can be performed as a temporary or definitive measure. Some patients even decline further urethral reconstruction because they perceive subjective satisfaction after perineal urethrostomy that was originally intended to be temporary. PMID:20544335

  18. Urethritis

    MedlinePlus

    ... semen Burning pain while urinating ( dysuria ) Discharge from penis Fever (rare) Frequent or urgent urination Itching, tenderness, or swelling in penis Enlarged lymph nodes in the groin area Pain ...

  19. Urethritis

    MedlinePlus

    ... Drug Information, Search Drug Names, Generic and Brand Natural Products, Search Drug Interactions Pill Identifier News & Commentary ALL NEWS > Resources First Aid Videos Figures Images Audio Pronunciations The ...

  20. [Urethral leiomyoma during pregnancy: a case report].

    PubMed

    Silveira, Arlon Breno Figueiredo Nunes da; Riccetto, Cássio Luis Zanettini; Herrmann, Viviane; Palma, Paulo César Rodrigues; Tiecher, Juliane de Fátima Agostini

    2012-12-01

    The authors report a case of urethral leiomyoma diagnosed during pregnancy, which was conservatively treated up to the 38th week, when the pregnancy was interrupted. Thirty days after delivery, exeresis of the lesion was performed from the upper border of the urethral meatus and sutured with interrupted delayed-absorbable suture. The patient evolved favorably and presented no lesion recurrence during three months of follow up. PMID:23348657

  1. Urethral Diverticulum Masquerading as Anterior Vaginal Wall Cyst: A Diagnostic Dilemma

    PubMed Central

    Kaur, Gurpreet; Sharma, Abha; Suneja, Amita; Guleria, Kiran

    2015-01-01

    Urethral diverticulum (UD) is a condition in which a variably sized outpouching forms, next to the urethra. Because it connects to the urethra, this outpouching repeatedly gets filled with urine during micturition, thus causing symptoms. In females, it presents as a bulge in anterior vagina, mimicking a vaginal wall cyst. Various aetiologies proposed attributing to urethral diverticulum formation is repeated infection of the periurethral gland, childbirth trauma, iatrogenic and urethral instrumentation. Patients of UD present with non specific irritative lower urinary tract symptoms such as increased frequency, urgency and dysuria; symptoms may not correlate with the size of the diverticulum. Recurrent cystitis or urinary tract infection is seen in one-third of patients. Pain, hematuria, post-void dribbling, dyspareunia, urinary retention or incontinence is other symptoms. In some cases, there may be associated urethral calculi or carcinoma. Magnetic resonance imaging (MRI) is highly sensitive and specific for the diagnosis of UD, although non invasive sonography may be the first line investigation. Treatment is by transvaginal diverticulectomy or marsupialization. A 60-year-old P9L6 postmenopausal lady, presented with a tender, hard suburethral anterior vaginal wall mass. Cystourethroscopy revealed a small opening in posterior urethra, with stone visible through it. With the final diagnosis of suburethral diverticulum with retained multiple calculi, excision of the diverticulum and repair of urethra was done vaginally. Correct evaluation and treatment of this condition can lead to avoidance of urinary tract injury. PMID:26557574

  2. Bladder neck incompetence at posterior urethroplasty

    PubMed Central

    Koraitim, Mamdouh M.

    2015-01-01

    The finding of an incompetent bladder neck (BN) at the time of posterior urethroplasty will necessarily exacerbate the already difficult situation. In such cases the aim of the treatment is not only to restore urethral continuity by end-to-end urethral anastomosis, but also to restore the function of the BN to maintain urinary continence. Fortunately, the incidence of incompetence of the BN at posterior urethroplasty is uncommon, usually ≈4.5%. It seems that pelvic fracture-related BN injuries, in contrast to urethral injuries which result from a shearing force, are due to direct injury by the sharp edge of the fractured and displaced pubic bone. The risk of injuries to the BN is greater in children, in patients with a fracture involving both superior and inferior pubic rami on the same side, and in those managed initially by primary realignment. An incompetent BN is suspected by finding an open rectangular BN on cystography, and a fixedly open BN on suprapubic cystoscopy. An incompetent BN can be treated either subsequent to or concomitant with the urethral repair, according to whether a perineal or a perineo-abdominal urethroplasty is used, respectively. Several options have been reported to treat pelvic fracture-related BN incompetence, including reconstructing the BN, forming a new sphincter by tubularisation of a rectangular flap of the anterior bladder wall, and mechanical occlusion by an artificial sphincter or collagen injection. Reconstruction of the BN by the Young-Dees-Leadbetter∗∗ procedure probably provides the most successful results. PMID:26019982

  3. Three-Dimensional Imaging of Urethral Stricture Disease and Urethral Pathology for Operative Planning.

    PubMed

    Theisen, Katherine M; Kadow, Brian T; Rusilko, Paul J

    2016-08-01

    Diagnosing urethral pathology can prove difficult, as clinically, the presentation is often nonspecific and may be suggestive of multiple etiologies. Therefore, detailed and accurate urethral imaging in both males and females is critical. Since the early 1900s, conventional imaging studies including RUG and VCUG, with adjunct cystourethroscopy, have remained the gold standard diagnostic techniques to evaluate urethral pathology. However, limitations of conventional imaging have generated interest in finding alternative imaging modalities with comparable, if not superior, diagnostic accuracy, the goal being a more complete assessment of urethral pathology and anatomy that would allow for appropriate surgical planning. Imaging modalities with three-dimensional (3D) capabilities may provide more comprehensive information regarding urethral diseases through a more detailed illustration of periurethral soft tissue structures. Whether or not these imaging modalities will replace conventional studies is unclear, though there is an increasing body of literature that support their use. PMID:27278565

  4. One-step treatment of proximal hypospadias by the autologous graft of cultured urethral epithelium.

    PubMed

    Romagnoli, G; De Luca, M; Faranda, F; Franzi, A T; Cancedda, R

    1993-10-01

    Surgical management of severe proximal hypospadias or long strictures of the posterior urethra is a difficult clinical task. Often, the therapeutic approach involves the autologous graft of free flaps of bladder or oral mucosa. We recently reported the use of autologous graft of cultured squamous urethral epithelium during urethroplasty in patients with severe proximal hypospadias. The main limitation to the widespread use of cultured epithelium was the long hospitalization due to the requirement of 2 surgical steps. We now report a substantial modification of the surgical procedure which allows for rapid 1-step urethroplasty. Cultured squamous urethral epithelium is tubularized in vitro with the aid of a tubular polytetrafluoroethylene (Gore-Tex) support and 1-step urethroplasty is performed within 30 minutes. Results obtained in 8 patients are presented. PMID:8371392

  5. Urethral Stone Disease Leading to Retention After Hair-bearing Neophalloplasty

    PubMed Central

    Viviano, Robert; Morganstern, Bradley A.; O'Toole, Adam

    2014-01-01

    A 35-year-old male patient with a past history of traumatic penile amputation and subsequent penile reconstruction with a radial artery free flap phalloplasty presented to the urology clinic for urinary retention and complaint of a firm penile mass. The patient had been lost to follow-up for 2 years before this presentation. Patient had a suprapubic tube in place from initial surgery, with imaging showing 2 large uroliths encrusted around the end. Urethral stricture was suspected in the patient. On cystoscopy, an additional obstructing urolith was found in penile urethra, appearing to have formed in situ. PMID:26955545

  6. Male urethral strictures and their management

    PubMed Central

    Hampson, Lindsay A.; McAninch, Jack W.; Breyer, Benjamin N.

    2014-01-01

    Male urethral stricture disease is prevalent and has a substantial impact on quality of life and health-care costs. Management of urethral strictures is complex and depends on the characteristics of the stricture. Data show that there is no difference between urethral dilation and internal urethrotomy in terms of long-term outcomes; success rates range widely from 8–80%, with long-term success rates of 20–30%. For both of these procedures, the risk of recurrence is greater for men with longer strictures, penile urethral strictures, multiple strictures, presence of infection, or history of prior procedures. Analysis has shown that repeated use of urethrotomy is not clinically effective or cost-effective in these patients. Long-term success rates are higher for surgical reconstruction with urethroplasty, with most studies showing success rates of 85–90%. Many techniques have been utilized for urethroplasty, depending on the location, length, and character of the stricture. Successful management of urethral strictures requires detailed knowledge of anatomy, pathophysiology, proper patient selection, and reconstructive techniques. PMID:24346008

  7. Urethral caruncle: clinicopathologic features of 41 cases.

    PubMed

    Conces, Miriam R; Williamson, Sean R; Montironi, Rodolfo; Lopez-Beltran, Antonio; Scarpelli, Marina; Cheng, Liang

    2012-09-01

    Urethral caruncle is a benign polypoid mass of the urethral meatus in primarily postmenopausal women. Although a conclusive association with malignancy, urologic disorder, or systemic disease has not been established, often the lesion carries a challenging clinical differential diagnosis that includes malignancy. Conversely, unexpected malignancy is identified in some cases resembling caruncle clinically. We examined clinical and histopathologic characteristics in 41 patients. Medical records were assessed for presentation, clinical diagnosis, associated urothelial carcinoma, radiation treatment, tobacco use, immunologic/urologic disorder, and treatment strategy/outcome. Average patient age was 68 years (range, 28-87 years). Presenting symptoms were pain (37%), hematuria (27%), and dysuria (20%), in contrast to asymptomatic (32%). Clinical diagnosis favored malignancy in 10% of cases. Concurrent or subsequent urothelial carcinoma was present for 5 patients (12%), although none developed urethral carcinoma. Histologic features included mixed hyperplastic urothelial and squamous lining, overlying a variably fibrotic, edematous, inflamed, and vascular stroma. Invaginations of urothelium extending into the stroma were common (68%), showing rounded nests with cystic or glandular luminal spaces, similar to urethritis cystica/glandularis, without intestinal metaplasia. Two lesions included an organizing thrombus, 1 with intravascular papillary endothelial hyperplasia. Twenty patients were treated with topical medications without resolution. Three lesions recurred (7%) after excision. A subset of patients had history of smoking or previous pelvic irradiation. Urethral caruncle is an uncommon lesion that may clinically mimic benign and malignant conditions. Awareness of the spectrum of clinical and histologic differential diagnoses is important in dealing with this unusual disease. PMID:22397870

  8. Y-Type Urethral Duplication: A True Variant of the Anomaly or a Misnomer?

    PubMed

    AbouZeid, Amr A; Mohammad, Shaimaa A; Radwan, Nehal A; Safoury, Hesham S; El-Naggar, Osama; Hay, Sameh A

    2016-06-01

    Objectives The objective of this study was to define anatomical and radiological features of the so-called Y-type urethral duplication. Methods The study included four male patients and one female patient with congenital connection between the urogenital tract and the external anal orifice. Investigations included renal sonography, urethrograms, and magnetic resonance imaging pelvis in the last patient. The urethrograms of male patients were carefully reviewed, in addition to available urethrograms of similar cases that could be obtained through searching the literature. Results Unlike cases of urethral duplication, the male patients had always a complete prepuce and a functioning anterior urethra in 25%. The accessory uroanal channel had almost always a constant origin from the posterior urethra. Some tension seems to be exerted by the urethroanal tract pulling on and causing a kink in the posterior urethra. Management was simple in patients without anterior urethral hypoplasia (one male and the female patient). Both were treated by simple excision of the communicating ano-urogenital tract through a perineal approach with an excellent outcome. Histopathological examination of excised tracts revealed stratified squamous cell in the former and transitional cell lining in the latter. In patients with hypoplastic anterior urethra, staged urethral reconstruction was performed in two, and progressive dilatation of hypoplastic anterior urethra was tried in the last patient. Conclusion Several observations would support diagnosing the congenital connection between the urinary tract and the external anal orifice in the male as a congenital fistula rather than an accessory urethra. Confirming and accepting this information may have its impact on changing the current surgical approach. PMID:26024207

  9. 21 CFR 876.4590 - Interlocking urethral sound.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Interlocking urethral sound. 876.4590 Section 876...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4590 Interlocking urethral sound. (a) Identification. An interlocking urethral sound is a device that consists of two metal...

  10. 21 CFR 876.4590 - Interlocking urethral sound.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Interlocking urethral sound. 876.4590 Section 876...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4590 Interlocking urethral sound. (a) Identification. An interlocking urethral sound is a device that consists of two metal...

  11. 21 CFR 876.4590 - Interlocking urethral sound.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Interlocking urethral sound. 876.4590 Section 876...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4590 Interlocking urethral sound. (a) Identification. An interlocking urethral sound is a device that consists of two metal...

  12. 21 CFR 876.4590 - Interlocking urethral sound.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Interlocking urethral sound. 876.4590 Section 876...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4590 Interlocking urethral sound. (a) Identification. An interlocking urethral sound is a device that consists of two metal...

  13. 21 CFR 876.4590 - Interlocking urethral sound.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Interlocking urethral sound. 876.4590 Section 876...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4590 Interlocking urethral sound. (a) Identification. An interlocking urethral sound is a device that consists of two metal...

  14. 21 CFR 876.5520 - Urethral dilator.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Urethral dilator. 876.5520 Section 876.5520 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... flexibilities. The device may include a mechanism to expand the portion of the device in the urethra...

  15. Utilization of urethral plate in hypospadias surgery

    PubMed Central

    Snodgrass, Warren T.

    2008-01-01

    Purpose Recognition the urethral plate comprises tissues that normally should have created the urethra was an important milestone in hypospadias surgery, giving rise to new operative repairs - most notably the tubularized incised plate technique. This article reviews the current state of the art for hypospadias repair using tubularized, incised plate (TIP). Materials and Methods Personal experience and literature reports were reviewed to summarize use of TIP urethroplasty for distal, proximal, and re-operative hypospadias repairs. Results The TIP can be used to correct all distal and most proximal hypospadias. The major contraindication is ventral curvature that leads to urethral plate transection for straightening, which is only necessary in some proximal cases. Reoperations can also be performed using TIP provided the urethral plate has been maintained and is not grossly scarred. Complication rates are comparable to previously used techniques, while cosmetic appearance after TIP is considered superior to other available procedures. Conclusions Recognition of the urethral plate and its incorporation into the neourethra has revolutionized hypospadias repair. The most commonly used operative procedure today is TIP. PMID:19468397

  16. Pathologic Outcomes following Urethral Diverticulectomy in Women

    PubMed Central

    Laudano, Melissa A.; Jamzadeh, Asha E.; Lee, Richard K.; Robinson, Brian D.; Tyagi, Renuka; Kaplan, Steven A.; Te, Alexis E.

    2014-01-01

    Purpose. Although most urethral diverticula in women are benign, there is a subset of patients who develop malignant changes. Limited studies report the pathologic findings associated with this relatively rare entity. We describe the clinicopathologic findings of women who underwent urethral diverticulectomy. Methods. A consecutive series of 29 women who underwent surgical resection of a urethral diverticulum were identified between 1992 and 2013. Clinical and radiographic data was collected by retrospective review of patient medical records. All pathological slides were rereviewed by a single urologic pathologist. Results. Of the 14 women with clinical data, 9 (64%) presented with urgency, 7 (50%) with urinary frequency, 3 (21%) with urinary incontinence, and 3 (21%) with dysuria. Mean diverticular size was 2.3 (±1.4) cm. Although one patient (3%) had invasive adenocarcinoma on final pathology, the remaining 28 cases (97%) demonstrated benign features. The most common findings were inflammation (55%) and nephrogenic adenoma (21%). Conclusions. Although most urethral diverticula in women are benign, there is a subset of patients who develop malignancy in association with the diverticulum. In this series, 97% of cases had a benign histology. These findings are important when counseling patients regarding treatment options. PMID:24860605

  17. Holmium laser urethrotomy for urethral stricture.

    PubMed

    Hossain, A Z M Z; Khan, S A; Hossain, S; Salam, M A

    2004-08-01

    A prospective cross-sectional study was carried-out in the department of urology, Dhaka Medical College Hospital (DMCH) to evaluate the outcome of Laser urethrotomy for the treatment of urethral stricture. For this purpose, 30 male patients aged 15 to 60 years with short segment anterior urethral stricture (>2cm) were treated by HO:YAG Laser. The energy used for this purpose was 0.8 to 1.5 joules by LISA 80 Watt Holmium Laser machine. All patients were catheterized for less than 24 hours and were followed up for 6 to 12 months postoperatively by uroflowmetry and by retrograde with voiding cystourethrogram 3 monthly. The study revealed that out of 30 patients, 27(90%) showed good flow of urine (Qave>16.0 ml/sec) and adequate caliber urethra in retrograde urethrogram (RGU). Only 3(10%) patients showed narrow stream of urine (Qave<8.0 ml/sec) and recurrent stricture in RGU which were managed by optical internal urethrotomy (OIU) and clean intermittent self catheterization (CISC). The study showed satisfactory results in 90% cases with short term follow up. The study concludes that HO:YAG Laser urethrotomy for the treatment of short segment urethral stricture is highly effective. The study further reveals that the method is simple, safe and thus, it can be considered favorably as a new therapeutic option for the treatment of urethral stricture. However, long term follow up is necessary for making a final comment on this issue. PMID:15813486

  18. Spontaneous Intravesical Knotting of Urethral Catheter

    PubMed Central

    2011-01-01

    Infant feeding tubes (IFT) have been universally used as urethral catheters in neonates and children for several decades. Though generally a safe procedure, it may cause significant morbidity if the catheter spontaneously knots inside the bladder. We report this complication in three children including a neonate. PMID:22953288

  19. Management of radiation-induced urethral strictures

    PubMed Central

    Hofer, Matthias D.

    2015-01-01

    Radiation as a treatment option for prostate cancer has been chosen by many patients. One of the side effects encountered are radiation-induced urethral strictures which occur in up to 11% of patients. Radiation damage has often left the irradiated field fibrotic and with poor vascularization which make these strictures a challenging entity to treat. The mainstay of urologic management remains an urethroplasty procedure for which several approaches exist with variable optimal indication. Excision and primary anastomoses are ideal for shorter bulbar strictures that comprise the majority of radiation-induced urethral strictures. One advantage of this technique is that it does not require tissue transfers and success rates of 70-95% have consistently been reported. Substitution urethroplasty using remote graft tissue such as buccal mucosa are indicated if the length of the stricture precludes a tension-free primary anastomosis. Despite the challenge of graft survival in radiation-damaged and poorly vascularized recipient tissue, up to 83% of patients have been treated successfully although the numbers described in the literature are small. The most extensive repairs involve the use of tissue flaps, for example gracilis muscle, which may be required if the involved periurethral tissue is unable to provide sufficient vascular support for a post-operative urethral healing process. In summary, radiation-induced urethral strictures are a challenging entity. Most strictures are amenable to excision and primary anastomosis (EPA) with encouraging success rates but substitution urethroplasty may be indicated when extensive repair is needed. PMID:26816812

  20. Urethral erosion of transobturator male sling.

    PubMed

    Harris, Stephanie E; Guralnick, Michael L; O'Connor, R Corey

    2009-02-01

    The transobturator male sling has been introduced as an alternative to other surgical methods for the treatment of mild to moderate postprostatectomy stress urinary incontinence. We report the first published case of mesh erosion into the urethra observed 5 months after placement. The patient was treated with suprapubic tube urinary diversion, suburethral sling explantation, and buccal mucosal grafting of the urethral defect. PMID:18400275

  1. An Unexpected Course after Simultaneous Urethral Repair and Reimplantation of Penile Prosthesis in a Patient with a Urethral Stricture

    PubMed Central

    Shin, Yu Seob; Ko, Oh Seok; Zhang, Li Tao; Zhao, Chen

    2014-01-01

    We experienced the growth of urethral hair along the urethral stricture six years after simultaneous urethral repair and reimplantation of penile prosthesis (RPP) in a patient with a urethral stricture. We detected hair in the urethra with a stricture on the bulbous urethra. Further, we performed hair removal by using a pair of cystoscopic forceps and internal urethrotomy. Then, we performed RPP, and the patient voided well; the prosthesis worked very well and without any complications. One-stage urethroplasty with a pedicle island of the penile skin and RPP in a simultaneous stage may be an option for treating the long-segment urethral stricture in the penile prosthesis patient. However, we should pay attention to the urethral hair growth that can occur after urethral repair performed using a skin graft. PMID:25606569

  2. Perineal Pseudoaneurysm from Traumatic Foley Removal Leads to Recurrent Life-Threatening Hematuria

    PubMed Central

    Xue, Jingbing; Erturk, Erdal

    2015-01-01

    Abstract Hematuria resulting from urethral traumatic catheter insertion and removal is often encountered. Usually, hematuria resolves with conservative measures. We report a case of traumatic Foley removal leading to intermittent life-threatening hematuria resulting in blood loss anemia requiring multiple transfusions and multiple episodes of hypotension requiring pressors. A pelvic angiogram revealed a pseudoaneurysm of the left pudendal artery, which was treated with microcoil embolization leading to resolution of bleeding.

  3. Management of non-gonococcal urethritis.

    PubMed

    Moi, Harald; Blee, Karla; Horner, Patrick J

    2015-01-01

    Non-gonococcal urethritis (NGU), or inflammation of the urethra, is the most common treatable sexually transmitted syndrome in men, with approximately 20-50 % of cases being due to infection with Chlamydia trachomatis and 10-30 % Mycoplasma genitalium. Other causes are Ureaplasma urealyticum, Trichomonas vaginalis, anaerobes, Herpes simplex virus (HSV) and adenovirus. Up to half of the cases are non-specific. Urethritis is characterized by discharge, dysuria and/or urethral discomfort but may be asymptomatic. The diagnosis of urethritis is confirmed by demonstrating an excess of polymorpho-nuclear leucocytes (PMNLs) in a stained smear. An excess of mononuclear leucocytes in the smear indicates a viral etiology. In patients presenting with symptoms of urethritis, the diagnosis should be confirmed by microscopy of a stained smear, ruling out gonorrhea. Nucleid acid amplifications tests (NAAT) for Neisseria gonorrhoeae, C. trachomatis and for M. genitalium. If viral or protozoan aetiology is suspected, NAAT for HSV, adenovirus and T. vaginalis, if available. If marked symptoms and urethritis is confirmed, syndromic treatment should be given at the first appointment without waiting for the laboratory results. Treatment options are doxycycline 100 mg x 2 for one week or azithromycin 1 gram single dose or 1,5 gram distributed in five days. However, azithromycin as first line treatment without test of cure for M. genitalium and subsequent Moxifloxacin treatment of macrolide resistant strains will select and increase the macrolide resistant strains in the population. If positive for M. genitalium, test of cure samples should be collected no earlier than three weeks after start of treatment. If positive in test of cure, moxifloxacin 400 mg 7-14 days is indicated. Current partner(s) should be tested and treated with the same regimen. They should abstain from intercourse until both have completed treatment. Persistent or recurrent NGU must be confirmed with microscopy

  4. New frontiers in urethral reconstruction: injectables and alternative grafts

    PubMed Central

    2015-01-01

    Contemporary management of anterior urethral strictures requires both endoscopic as well as complex substitution urethroplasty, depending on the nature of the urethral stricture. Recent clinical and experimental studies have explored the possibility of augmenting traditional endoscopic urethral stricture management with anti-fibrotic injectable medications. Additionally, although buccal mucosa remains the gold standard graft for substitution urethroplasty, alternative grafts are necessary for reconstructing particularly complex urethral strictures in which there is insufficient buccal mucosa or in cases where it may be contraindicated. This review summarizes the data of the most promising injectable adjuncts to endoscopic stricture management and explores the alternative grafts available for reconstructing the most challenging urethral strictures. Further research is needed to define which injectable medications and alternative grafts may be best suited for urethral reconstruction in the future. PMID:26813260

  5. Spontaneous Postmenopausal Urethral Prolapse Treated Surgically and Successfully

    PubMed Central

    Klein, I.; Dekel, Y.; Stein, A.

    2014-01-01

    Urethral prolapse (UP) is a circular complete eversion of the distal urethral mucosa through the external meatus. It is a rare condition seen mostly in African-American premenarcheal girls. Both a medical and a surgical approach to this condition have been described. We present a case of a spontaneous urethral prolapse in a 60-year-old postmenopausal Caucasian woman, who failed medical management and underwent successful surgical management. The patient is asymptomatic 18 months following the procedure. PMID:25140273

  6. How to measure inner urethral wall softness.

    PubMed

    Plevnik, S; Vrtacnik, P

    1981-01-01

    The objective of this study was to develop and preliminarily test the measuring principle suitable for quantification of the capability of deformation of the inner urethral wall, i.e. quantification of inner urethral wall softness. The special measuring catheter was made of plexiglass with two conically shaped stainless steel electrodes mounted 5 cm from its distal tip. The principle of indirect compression measurement on the basis of impedance changes between the electrodes due to the introduction of the tissue between them was tested. The changes in impedance were measured in the distal male urethra during external manual compression, and in the anal sphincter during voluntary contractions and during coughing. The results obtained confirm the applicability as well as the significance of a further perfection of the new method. Calibration technique of the transducer was developed and tested in NaCl solution. PMID:7199730

  7. [Non-chlamydial non-gonococcal urethritis].

    PubMed

    Deguchi, Takashi; Yasuda, Mitsuru; Maeda, Shin-ichi

    2009-01-01

    Besides Chlamydia trachomatis, various microorganisms could cause non-gonococcal urethritis (NGU). Recently, Mycoplasma genitalium and Ureaplasma urealyticum (biovar 2) have been suggested to be other pathogens of NGU independent of C. trachomatis. Clinical findings of non-chlamydial NGU, including M. genitalium--or U. urealyticum-postive NGU, are not different from those of chlamydial NGU. M. genitalium and U. urealyticum (biovar 2) are susceptible to tetracyclines, macrolides, and fluoroquinolones. However, the post-treatment presence of M. genitalium in the urethra is significantly associated with persistent or recurrent urethritis. Eradication of this mycoplasma from the urethra is essential for managing M. genitalium-positive NGU. In treatment of non-chlamydial NGU, therefore, the antimicrobial agents that are active against M. genitalium should be chosen. PMID:19177768

  8. Distributed pressure sensors for a urethral catheter.

    PubMed

    Ahmadi, Mahdi; Rajamani, Rajesh; Timm, Gerald; Sezen, A S

    2015-08-01

    A flexible strip that incorporates multiple pressure sensors and is capable of being fixed to a urethral catheter is developed. The urethral catheter thus instrumented will be useful for measurement of pressure in a human urethra during urodynamic testing in a clinic. This would help diagnose the causes of urinary incontinence in patients. Capacitive pressure sensors are fabricated on a flexible polyimide-copper substrate using surface micromachining processes and alignment/assembly of the top and bottom portions of the sensor strip. The developed sensor strip is experimentally evaluated in an in vitro test rig using a pressure chamber. The sensor strip is shown to have adequate sensitivity and repeatability. While the calibration factors for the sensors on the strip vary from one sensor to another, even the least sensitive sensor has a resolution better than 0.1 psi. PMID:26738054

  9. [Treatment of the urethral sphincter insufficiency].

    PubMed

    Boissier, R; Karsenty, G

    2013-11-01

    The intrinsic sphincter insufficiency is a cause of stress urinary incontinence. Its definition is clinical and based on urodynamics. It is mostly met with women, in context of the post-obstetrical period or older women in a multifactorial context. For men, it occurs mainly as complication of the surgery of the cancer of prostate or bladder. An initial, clinical and paraclinical assessment allows to confirm the diagnosis of intrinsic sphincter insufficiency, to estimate its severity, and to identify associated mechanisms of incontinence (urethral hypermobility, bladder overactivity) to choose the most adapted treatment. The perineal reeducation is the treatment of first intention in both sexes. At the menopausal woman, the local hormonotherapy is a useful additive. In case of failure or of incomplete efficiency, the treatment of the intrinsic sphincter insufficiency is surgical. Bulking agents, urethral slings, peri-urethral balloons and artificial sphincter are 4 therapeutic options to discuss according to history, the severity of the incontinence, the expectations of the patient. PMID:24176408

  10. Dorsolateral onlay urethroplasty for pan anterior urethral stricture by a unilateral urethral mobilisation approach

    PubMed Central

    Chaudhary, Ranjit; Jain, Nidhi; Singh, Kulwant; Bisoniya, Hari Singh; Chaudhary, Rahul; Biswas, Rakesh

    2011-01-01

    The preferred management of urethral strictures involving long segments of anterior urethra is dorsal onlay buccal mucosa augmentation urethroplasty. This requires circumferential mobilisation of the urethra, which might cause ischaemia of the urethra in addition to chordee. The authors managed a pan anterior urethral stricture, applying a dorsolateral free graft by unilateral urethral mobilisation through a perineal approach. This is a recently described surgical technique which preserves the lateral vascular supply on one side thereby minimising ischaemia. Since circumferential mobilisation of urethra is not carried out in this technique, there are no chances of developing a chordee. Entire procedure is carried out by a perineal incision and no incision is made on the penis except for meatotomy. The pendulous urethra is accessed by penile eversion through the perineal wound. Obviating penile incisions minimises chances of wound infection and fistula formation. PMID:22689855

  11. Multiple urethral anomalies: Parameatal urethral cyst, penile curvature, incomplete hypospadiac anterior duplication of the urethra and distal hipospadias

    PubMed Central

    Tuglu, Devrim; Yuvanç, Ercan; Yılmaz, Erdal; Gur, Serhan; Batislam, Ertan

    2015-01-01

    The male genitourinary system is quite complex. There are numerous known anomalies of the male urethra either as isolated cases or in combination with other disorders. An improved understanding of the embryology and anatomy of the normal male urethral development might help explain the causes of the various urethral abnormalities. We contribute to the etiology of congenital anomalies with this multiple urethral anomalies case. PMID:26029298

  12. Isolated posterior capsular rupture following blunt head trauma

    PubMed Central

    Mansour, Ahmad M; Jaroudi, Mahmoud O; Hamam, Rola N; Maalouf, Fadi C

    2014-01-01

    Closed-globe traumatic cataract is not uncommon in males in the pediatric age group. However, there is a relative paucity of literature on isolated posterior lens capsule rupture associated with closed-globe traumatic cataract. We report a case of a 6-year-old boy who presented with white cataract 1 day after blunt trauma to the forehead associated with posterior capsular rupture that was detected by B-scan ultrasonography preoperatively. No stigmata of trauma outside the posterior capsule could be detected by slit-lamp exam, funduscopy, and optical coherence tomography. Phacoemulsification with posterior chamber intraocular lens implant was performed 24 hours after trauma, with the patient achieving 6/6 visual acuity 1 week and 6 months after surgery. Our case is unique, being the youngest (amblyogenic age) to be reported, with prompt surgical intervention, and with no signs of trauma outside the posterior capsule. PMID:25506201

  13. Amputation - traumatic

    MedlinePlus

    ... accidents, or from motor vehicle accidents. Natural disasters, war, and terrorist attacks can also cause traumatic amputations. ... bag and place the bag in an ice water bath. Do NOT directly put the body part ...

  14. Gonococcal Conjunctivitis Despite Successful Treatment of Male Urethritis Syndrome.

    PubMed

    Peters, Remco P H; Verweij, Stephan P; McIntyre, James A; Schaftenaar, Erik

    2016-02-01

    We report a case of progressive, cephalosporin-susceptible, Neisseria gonorrhoeae conjunctivitis despite successful treatment of male urethritis syndrome. We hypothesize that conjunctival infection progressed due to insufficient penetration of cefixime and azithromycin and point out that extragenital infection and male urethritis may not be cured simultaneously in settings where the syndromic approach is used. PMID:26760182

  15. A new technique for the obliterative urethral strictures

    PubMed Central

    Chen, Xianguo; Wang, Kexiao; Ye, Yuanping; Hao, Zongyao; Zhou, Jun; Fan, Song; Shi, Haoqiang; Liang, Chaozhao

    2013-01-01

    There have been a troublesome problem to treat with obliterative urethral strictures, the challenge is how to reduce wound of surgery and improve therapeutic success rates. In this study, we reported single-hospital institution case-series including 97 patients with obliterative urethral strictures were enrolled with “three lines lie within one imaginary plane (TLLWOIP)” to treat with patients with the obliterative urethral strictures. Perioperative variables and success rates were evaluated. Urinary flow rate, residual urine (RU) volume and quality-of-life score (QoLs) of patients were analyzed. In the obliterative urethral strictures, postoperative maximum urinary flow rate was 24.36±10.69 ml, and postoperative RU volume and QoLs outcomes were significantly lower than preoperative outcomes with TLLWOIP. A total of success rate was 62.9% with TLLWOIP. Our results suggested that it was ideal candidates for initial treatment with TLLWOIP for the obliterative urethral strictures. PMID:24294387

  16. Collagenase Clostridium histolyticum (Xiaflex) for the Treatment of Urethral Stricture Disease in a Rat Model of Urethral Fibrosis

    PubMed Central

    Sangkum, Premsant; Yafi, Faysal A.; Kim, Hogyoung; Bouljihad, Mostafa; Ranjan, Manish; Datta, Amrita; Mandava, Sree Harsha; Sikka, Suresh C.; Abdel-Mageed, Asim B.; Moparty, Krishnarao; Hellstrom, Wayne J. G.

    2016-01-01

    Objective To evaluate the treatment effect of collagenase Clostridium histolyticum (CCH) in a rat model of urethral fibrosis. Materials and Methods Thirty male Sprague-Dawley rats (300-350 g) were divided into 5 groups. The rat urethra was injected with normal saline in the sham group and, in the other 4 groups, the rat urethra was injected with 10 μg of transforming growth factor beta 1 to create fibrosis of the urethra. Two weeks following transforming growth factor beta 1 injection, the rats were injected with varying doses of CCH or vehicles, depending on their group. The rats were then euthanized at 4 weeks after CCH or vehicle injection. Urethral tissue was harvested for histologic and molecular analyses. Type I and III collagen levels were evaluated by Western blot analysis. Results There was urethral fibrosis and to significant increase in collagen type I and III expressions in the urethral fibrosis group compared with the sham group (P <.05). Urethral injection of CCH appeared to be safe and significantly reduce urethral fibrosis as well as collagen type I and III expressions in the high-dose CCH treatment groups when compared with the treatment control group (P <.01). Conclusion This study demonstrated a beneficial effect of CCH injections in a rat model of urethral fibrosis. These findings suggest a potential role for CCH as a therapeutic option in urethral stricture patients and warrant further investigation. PMID:26126692

  17. Female Urethral Diverticulum Containing a Giant Calculus

    PubMed Central

    Dong, ZhiLong; Wang, Hanzhang; Zuo, LinJun; Hou, MingLi

    2015-01-01

    Abstract Urethral diverticula with calculi have a low incidence as reported in the literature. Diverticulum of female urethra is rare, often discovered due to associated complications. We report a case of diverticulum of the female urethra containing giant calculi in a 62-year-old multiparous woman. She consulted with our office due to dysuria and a hard, painful periurethral mass in the anterior vagina wall. The diverticulum was approached surgically by a vaginal route, and local extraction of the calculi and subsequent diverticulectomy successfully treated the condition. Diagnosis of a complicated diverticulum can be easily achieved if one possesses a high degree of clinical symptoms. PMID:25997056

  18. Urethral catheters: can we reduce use?

    PubMed Central

    2011-01-01

    Background Indwelling urinary catheters are the main cause of healthcare-associated urinary tract infections. It can be expected that reduction of the use of urinary catheters will lead to decreased numbers of urinary tract infection. Methods The efficacy of an intervention programme to improve adherence to recommendations to reduce the use of urethral catheters was studied in a before-after comparison in ten Dutch hospitals. The programme detected barriers and facilitators and each individual facility was supported with developing their own intervention strategy. Outcome was evaluated by the prevalence of catheters, alternatives such as diapers, numbers of urinary tract infections, the percentage of correct indications and the duration of catheterization. The costs of the implementation as well as the catheterization were evaluated. Results Of a population of 16,495 hospitalized patients 3335 patients of whom 2943 were evaluable for the study, had a urethral catheter. The prevalence of urethral catheters decreased insignificantly in neurology (OR 0.93; 95% CI 0.77 - 1.13) and internal medicine wards (OR 0.97; 95% CI 0.83 - 1.13), decreased significantly in surgical wards (OR 0.84; 95% CI 0.75 - 0.96), but increased significantly in intensive care (IC) and coronary care (CC) units (OR 1.48; 95% CI 1.01 - 2.17). The use of alternatives was limited and remained so after the intervention. Duration of catheterization decreased insignificantly in IC/CC units (ratio after/before 0.95; 95% CI 0.78 - 1.16) and neurology (ratio 0.97; 95% CI 0.80 - 1.18) and significantly in internal medicine (ratio 0.81; 95% CI 0.69 - 0.96) and surgery wards (ratio 0.80; 95% CI 0.71 - 0.90). The percentage of correct indications on the day of inclusion increased from 50 to 67% (p < 0.0001). The prevalence of urinary tract infections in catheterized patients did not change. The mean cost saved per 100 patients was € 537. Conclusion Targeted implementation of recommendations from an

  19. Haemophilus parainfluenzae urethritis among homosexual men.

    PubMed

    Hsu, Meng-Shiuan; Wu, Mei-Yu; Lin, Tsui-Hsien; Liao, Chun-Hsing

    2015-08-01

    Haemophilus parainfluenzae is a common inhabitant of the human upper respiratory tract of the normal oral microflora. We report three men who had been having unprotected sex with men (MSM) and subsequently acquired H. parainfluenzae urethritis, which was confirmed by 16S rRNA gene sequencing analysis. Two men were treated with ceftriaxone and doxycycline, and the third man was treated with clarithromycin. All three patients responded to treatment. This case series highlights the potential role of H. parainfluenzae as a sexually transmitted genitourinary pathogen. PMID:23357607

  20. Female covered urethral duplication with urogenital sinus.

    PubMed

    Philippe-Chomette, Pascale; Zeidan, Smart; Belarbi, Nadia; Van Der Meer, Gretha; Oury, Jean-Francois; El-Ghoneimi, Alaa

    2012-02-01

    We report a covered urethral duplication in a girl presenting prenatally with an enlarged fluid-filled vulvar cyst, genital duplication, and urogenital sinus revealed by fetal magnetic resonance imaging (MRI) and serial ultrasounds. Physical examination revealed an enlarged vulvar mass covering the clitoris, a single orifice, and normally sited anus. Congenital adrenal hyperplasia was ruled out at birth. MRI in addition showed an accessory duct between the sinus and the urine-filled vulvar pouch with a bifid clitoris. A total urogenital sinus mobilization with resection of the accessory urethra and vulvoplasty was performed with uneventful follow-up. PMID:21601245

  1. Clinical efficacy of azithromycin for male nongonococcal urethritis.

    PubMed

    Takahashi, Satoshi; Matsukawa, Masanori; Kurimura, Yuichiro; Takeyama, Koh; Kunishima, Yasuharu; Iwasawa, Akihiko; Koroku, Mikio; Tanda, Hitoshi; Suzuki, Nobukazu; Takagi, Yoshio; Hirose, Takaoki; Nishimura, Masahiro; Tsukamoto, Taiji

    2008-12-01

    The aim of this study was to confirm the clinical efficacy of a single-dose azithromycin (AZM) regimen (1000 mg) for patients with nongonococcal urethritis in real-life practice. The study finally evaluated 55 patients, 42 who were symptomatic and 13 who were asymptomatic, after excluding 40 who visited clinics only once. Sixteen of the symptomatic patients were diagnosed as having nongonococcal chlamydial urethritis, 7 as having nongonococcal nonchlamydial urethritis, and 19 as having urethritis without any microbial detection. Chlamydia trachomatis was detected in 11 asymptomatic patients, Mycoplasma genitalium in 1, and Ureaplasma urealyticum in 1. Of the patients who were microbiologically evaluated before and after single-dose AZM, microbiological cure was achieved in 87% (20/23) of those with symptomatic nongonococcal urethritis and in 100% (13/13) of those with asymptomatic nongonococcal urethritis. The clinical cure rate was 86% for the 42 symptomatic patients with detectable and undetectable pathogens. There were adverse events in 5 (9%) patients but they were commonly mild and self-limited. In conclusion, the single-dose AZM regimen was well tolerated and eradicated the estimated and potential pathogens of nongonococcal urethritis. PMID:19089553

  2. Transperineal ultrasonography in stress urinary incontinence: The significance of urethral rotation angles

    PubMed Central

    Al-Saadi, Wasan Ismail

    2015-01-01

    Objective To assess, using transperineal ultrasonography (TPUS), the numerical value of the rotation of the bladder neck [represented by the difference in the anterior (α angle) and posterior urethral angles (β angle)] at rest and straining, in continent women and women with stress urinary incontinence (SUI), to ascertain if there are significant differences in the angles of rotation (Rα and Rβ) between the groups. Patients, subjects and methods In all, 30 women with SUI (SUI group) and 30 continent women (control group) were included. TPUS was performed at rest and straining (Valsalva manoeuver), and the threshold value for the urethral angles (α and β angles) for each group were estimated. The degree of rotation for each angle was calculated and was considered as the angle of rotation. Results Both the α and β angles were significantly different between the groups at rest and straining, and there was a significant difference in the mean increment in the value of each angle. Higher values of increment (higher rotation angles) were reported in the SUI group for both the α and β angles compared with those of the control group [mean (SD) Rα SUI group 19.43 (12.76) vs controls 10.53 (2.98) °; Rβ SUI group 28.30 (12.96) vs controls 16.33 (10.8) °; P < 0.001]. Conclusion Urethral rotation angles may assist in the assessment and diagnosis of patients with SUI, which may in turn reduce the need for more sophisticated urodynamic studies. PMID:26966596

  3. Posterior ankle impingement in athletes: Pathogenesis, imaging features and differential diagnoses.

    PubMed

    Hayashi, Daichi; Roemer, Frank W; D'Hooghe, Pieter; Guermazi, Ali

    2015-11-01

    Posterior ankle impingement is a clinical diagnosis which can be seen following a traumatic hyper-plantar flexion event and may lead to painful symptoms in athletes such as female dancers ('en pointe'), football players, javelin throwers and gymnasts. Symptoms of posterior ankle impingement are due to failure to accommodate the reduced interval between the posterosuperior aspect of the talus and tibial plafond during plantar flexion, and can be due to osseous or soft tissue lesions. There are multiple causes of posterior ankle impingement. Most commonly, the structural correlates of impingement relate to post-traumatic synovitis and intra-articular fibrous bands-scar tissue, capsular scarring, or bony prominences. The aims of this pictorial review article is to describe different types of posterior ankle impingement due to traumatic and non-traumatic osseous and soft tissue pathology in athletes, to describe diagnostic imaging strategies of these pathologies, and illustrate their imaging features, including relevant differential diagnoses. PMID:26239710

  4. The long-term results of temporary urethral stent placement for the treatment of recurrent bulbar urethral stricture disease

    PubMed Central

    Temeltas, Gokhan; Ucer, Oktay; Yuksel, Mehmet Bilgehan; Gumus, Bilal; Tatli, Volkan; Muezzinoglu, Talha

    2016-01-01

    ABSTRACT Aim: To evaluate the long term outcomes of temporary urethral stent placement for the treatment of recurrent bulbar urethral stricture. Materials and Methods: Twenty-eight patients who underwent temporary polymer coated urethral stent placement due to recurrent bulbar urethral stricture between 2010 and 2014 were enrolled in the study. The long term outcomes of the patients were analyzed. Results: The mean age of the patients was 62.3±6.4 (44–81). The overall clinical success was achieved in 18 (64.2%) of the 28 patients at a median (range) follow-up of 29 (7–46) months. No patient reported discomfort at the stent site. Stone formation was observed at the urethral stent implantation area only in one patient. Stenosis occurred in the distal end of the stents in two patients and took place in bulbar urethra in seven patients after removed the stents. The mean maximum urine flow rates were 6.24±2.81mL/sec and 19.12±4.31mL/sec before and at 3 months after the procedure, respectively. Conclusion: In this study, the success rate of temporary urethral stent placement has remained at 64.2% at a median follow-up of 29 months. Therefore, our outcomes have not achieved desired success rate for the standard treatment of recurrent bulbar urethral stricture. PMID:27256191

  5. The incidence of erectile dysfunction after pelvic fracture urethral injury: A systematic review and meta-analysis

    PubMed Central

    Blaschko, Sarah D.; Sanford, Melissa T.; Schlomer, Bruce J.; Alwaal, Amjad; Yang, Glen; Villalta, Jacqueline D.; Wessells, Hunter; McAninch, Jack W.; Breyer, Benjamin N.

    2014-01-01

    Background Pelvic fracture urethral injury (PFUI) is associated with a high risk of erectile dysfunction (ED). The effect of the type of posterior urethral disruption repair on erectile function has not been clearly established. We systematically reviewed and conducted a meta-analysis of the proportion of patients with ED at (i) baseline after pelvic fracture with PFUI, (ii) after immediate primary realignment, and (iii) after delayed urethroplasty. Methods Using search terms for primary realignment or urethroplasty and urethral disruption, we systematically reviewed PubMed and EMBASE. A meta-analysis of the proportion of patients with ED was conducted assuming a random-effects model. Results Of 734 articles found, 24 met the inclusion criteria. The estimate of the proportion (95% confidence interval) of patients with ED after (i) PFUI was 34 (25–45)%, after (ii) immediate primary realignment was 16 (8–26)%, and after (iii) delayed urethroplasty was an additional 3 (2–5)% more than the 34% after pelvic fracture in this cohort. Conclusions After pelvic fracture, 34% of patients had ED. After primary endoscopic alignment, patients had a lower reported rate of ED (16%). Delayed urethroplasty conferred an additional 3% risk above the 34% associated with PFUI alone, with 37% of patients having de novo ED. The difference in de novo ED after primary endoscopic alignment vs. delayed urethroplasty is probably due to reporting differences in ED and/or patients with less severe injury undergoing primary realignment. PMID:26019983

  6. Urethral cavernous hemangioma in a female patient: a rare entity

    PubMed Central

    Bolat, Mustafa Suat; Yüzüncü, Kubilay; Akdeniz, Ekrem; Demirdoven, Ayse Nurten

    2015-01-01

    Genitourinary hemangiomas are rare entities of the urinary system. We reported a female patient who suffered dyspareunia and intermitant hematuria that was proved as urethral cavernous hemangioma. Despite its benign nature, hemangiomas may recur due to incomplet excision. PMID:26985270

  7. Management of advanced primary urethral carcinomas.

    PubMed

    Dayyani, Farshid; Hoffman, Karen; Eifel, Patricia; Guo, Charles; Vikram, Raghu; Pagliaro, Lance C; Pettaway, Curtis

    2014-07-01

    Primary urethral carcinoma (PUC) is a rare malignancy accounting for <1% of genitourinary cancers, with a predilection for men and African-Americans. The sites and histology of urethral carcinoma vary by gender and anatomical location. Squamous cell carcinoma is most common among both genders but adenocarcinomas are noted in 15-35% of cases among women. Obstructive or irritative symptoms and haematuria are common modes of presentation. Clinical evaluation includes cystourethroscopy with biopsy and examination under anaesthesia. Magnetic resonance imaging provides a highly effective method to image the primary tumour while defıning the potential involvement of surrounding structures. Most tumours are localised, with regional metastases to nodal sites seen in up to 30% of cases in both genders, while distant metastases at presentation are rare (0-6%), but occur in up to 40% of cases with recurrent disease. Among men, the two most important prognostic factors are disease location and stage. Low-stage tumours (T1-2) and tumours involving the fossa navicularis or the penile urethra have a better prognosis than higher stage tumours (>T2 or N+) and lesions involving the bulbomembranous urethra. In women, in addition to stage and location, the size of the tumour has also prognostic implications. While surgery and radiation therapy (RT) are of benefit in early stage disease, advanced stage PUC requires multimodal treatment strategies to optimise local control and survival. These include induction chemotherapy followed by surgery or RT and concurrent chemoradiation with or without surgery. The latter strategy has been used successfully to treat other human papillomavirus-related cancers of the vagina, cervix and anus and may be of value in achieving organ preservation. Given the rarity of PUC, prospective multi-institutional studies are needed to better define the optimal treatment approach for this disease entity. PMID:24447439

  8. In-vivo laser induced urethral stricture animal model for investigating the potential of LDR-brachytherapy

    NASA Astrophysics Data System (ADS)

    Sroka, Ronald; Lellig, Katja; Bader, Markus; Stief, Christian; Weidlich, Patrick; Wechsel, G.; Assmann, Walter; Becker, R.; Fedorova, O.; Khoder, Wael

    2015-02-01

    Purpose: Treatment of urethral strictures is a major challenge in urology. For investigation of different treatment methods an animal model was developed by reproducible induction of urethral strictures in rabbits to mimic the human clinical situation. By means of this model the potential of endoluminal LDR brachytherapy using β-irradiation as prophylaxis of recurrent urethral strictures investigated. Material and Methods: A circumferential urethral stricture was induced by energy deposition using laser light application (wavelength λ=1470 nm, 10 W, 10 s, applied energy 100 J) in the posterior urethra of anaesthetized New Zealand White male rabbits. The radial light emitting fiber was introduced by means of a children resectoscope (14F). The grade of urethral stricture was evaluated in 18 rabbits using videourethroscopy and urethrography at day 28 after stricture induction. An innovative catheter was developed based on a β-irradiation emitting foil containing 32P, which was wrapped around the application system. Two main groups (each n=18) were separated. The "internal urethrotomy group" received after 28days of stricture induction immediately after surgical urethrotomy of the stricture the radioactive catheter for one week in a randomized, controlled and blinded manner. There were 3 subgroups with 6 animals each receiving 0 Gy, 15 Gy and 30 Gy. In contrast animals from the "De Nuovo group" received directly after the stricture induction (day 0) the radioactive catheter also for the duration of one week divided into the same dose subgroups. In order to determine the radiation tolerance of the urethral mucosa, additional animals without any stricture induction received a radioactive catheter applying a total dose of 30 Gy (n=2) and 15 Gy (n=1). Cystourethrography and endoscopic examination of urethra were performed on all operation days for monitoring treatment progress. Based on these investigation a classification of the stricture size was performed and

  9. Urethral strictures after radiation therapy for prostate cancer

    PubMed Central

    Dal Pra, Alan; Furrer, Marc; Thalmann, George; Spahn, Martin

    2016-01-01

    Urethral stricture after radiation therapy for localized prostate cancer is a delicate problem as the decreased availability of tissue healing and the close relation to the sphincter complicates any surgical approach. We here review the pathophysiology, dosimetry, and the disease specific aspects of urethral strictures after radiotherapy. Moreover we discuss different treatment option such as direct vision internal urethrotomy as well as techniques for open reconstruction with and without tissue transfer.

  10. Male urethral sarcoma: a case report and literature review

    PubMed Central

    Nogueira, Magno Almeida; dos Santos, Guilherme Campelo Lopes; Lopes, Roberto Iglesias; Campos, Octavio Henrique Arcos; Dall’Oglio, Marcos Francisco; Sant’Anna, Alexandre Crippa

    2016-01-01

    ABSTRACT Urethral tumors are rare and aggressive. They usually affect men (2:1) and occur more commonly in white (85% of cases). Soft tissue sarcomas are a heterogeneous group of tumors that arise from embryonic mesoderm. It represents 1% of all cases of urinary tract malignancies and rarely primary affect the ureter. We report a case of male urethral sarcoma. To date, only two similar cases have been published in literature. PMID:26398363

  11. Male urethral sarcoma: a case report and literature review.

    PubMed

    Nogueira, Magno Almeida; Santos, Guilherme Campelo Lopes Dos; Lopes, Roberto Iglesias; Campos, Octavio Henrique Arcos; Dall'Oglio, Marcos Francisco; Sant'Anna, Alexandre Crippa

    2016-03-01

    Urethral tumors are rare and aggressive. They usually affect men (2:1) and occur more commonly in white (85% of cases). Soft tissue sarcomas are a heterogeneous group of tumors that arise from embryonic mesoderm. It represents 1% of all cases of urinary tract malignancies and rarely primary affect the ureter. We report a case of male urethral sarcoma. To date, only two similar cases have been published in literature. PMID:26398363

  12. [Alternative endourologic methods for treatment of urethral stricture].

    PubMed

    Niesel, T; Moore, R G; Hofmann, R; Kavoussi, L R

    1998-01-01

    Advances in endoscopic instrumentation and techniques offer new alternatives for safe and effective treatment of urethral strictures. Visual internal urethrotomy, the standard treatment modality, is associated with new scar formation with stricture recurrence. This experience has led to the investigation of alternative techniques which would avoid or ameliorate this result. This article reviews the current literature and discusses these newer approaches, including balloon dilatation, laser urethrotomy, endoscopic urethroplasty, "cut to the light" and "core through" procedures, and urethral wallstent implantation. PMID:9540185

  13. Urethral strictures after radiation therapy for prostate cancer.

    PubMed

    Moltzahn, Felix; Dal Pra, Alan; Furrer, Marc; Thalmann, George; Spahn, Martin

    2016-09-01

    Urethral stricture after radiation therapy for localized prostate cancer is a delicate problem as the decreased availability of tissue healing and the close relation to the sphincter complicates any surgical approach. We here review the pathophysiology, dosimetry, and the disease specific aspects of urethral strictures after radiotherapy. Moreover we discuss different treatment option such as direct vision internal urethrotomy as well as techniques for open reconstruction with and without tissue transfer. PMID:27617311

  14. The morbidity of urethral stricture disease among male Medicare beneficiaries

    PubMed Central

    2010-01-01

    Background To date, the morbidity of urethral stricture disease among American men has not been analyzed using national datasets. We sought to analyze the morbidity of urethral stricture disease by measuring the rates of urinary tract infections and urinary incontinence among men with a diagnosis of urethral stricture. Methods We analyzed Medicare claims data for 1992, 1995, 1998, and 2001 to estimate the rate of dual diagnoses of urethral stricture with urinary tract infection and with urinary incontinence occurring in the same year among a 5% sample of beneficiaries. Male Medicare beneficiaries receiving co-incident ICD-9 codes indicating diagnoses of urethral stricture and either urinary tract infection or urinary incontinence within the same year were counted. Results The percentage of male patients with a diagnosis of urethral stricture who also were diagnosed with a urinary tract infection was 42% in 2001, an increase from 35% in 1992. Eleven percent of male Medicare beneficiaries with urethral stricture disease in 2001 were diagnosed with urinary incontinence in the same year. This represents an increase from 8% in 1992. Conclusions Among male Medicare beneficiaries diagnosed with urethral stricture disease in 2001, 42% were also diagnosed with a urinary tract infection, and 11% with incontinence. Although the overall incidence of stricture disease decreased over this time period, these rates of dual diagnoses increased from 1992 to 2001. Our findings shed light into the health burden of stricture disease on American men. In order to decrease the morbidity of stricture disease, early definitive management of strictures is warranted. PMID:20167087

  15. Urethral Sparing Histotripsy of the Prostate in a Canine Model

    PubMed Central

    Schade, George R.; Hall, Timothy L.; Roberts, William W.

    2012-01-01

    Objective To evaluate the feasibility and healing response to urethral sparing prostate histotripsy a canine model of benign prostatic hypertrophy. Methods Histotripsy was performed on 10 canines using a 750 kHz piezoelectric ultrasound transducer targeting the prostatic parenchyma while avoiding the urethra. Periprocedure prostatic urethral integrity was evaluated with serial cystourethroscopy. Evolution of histotripsy treatment effect and subjects’ response to urethral sparing was evaluated with serial ultrasound and laboratory evaluation, respectively. Subjects were euthanized acutely or chronically and findings were confirmed histologically. Results Bilateral treatment was possible in 8/10 subjects while unilateral treatment was performed in 2/10. Failure to spare the urethra was observed in 2/18 treatments; one acutely and one chronically despite normal cystourethroscopy for the first week. Modest prostatic volume reduction was seen in subjects survived to 8 weeks post-histotripsy. Laboratory studies revealed transient perioperative increases in mean white-blood cell count, C-reactive protein, and lactate dehydrogenase. On histology, 80% of successful urethral sparing treatment cavities were completely epithelialized, containing simple fluid with minimal cellular debris at 8 weeks despite no communication with the urethra. Conclusions Urethral sparing histotripsy of the prostate is feasible and well tolerated in a canine model, resulting in modest volume reduction and prompt resorption of homogenized tissue debris. Human studies to evaluate the clinical utility and symptomatic response of urethral sparing are needed. PMID:22840869

  16. Endoscopic removal of a proximal urethral stent using a holmium laser: Case report and literature review

    PubMed Central

    Botelho, Francisco; Thomas, Anil A.; Miocinovic, Ranko; Angermeier, Kenneth W.

    2012-01-01

    Urethral stents were initially developed for the management of urethral strictures and obstructive voiding disorders in select patients. Urethral stent complications are common and may require stent explantation, which is often quite challenging. We present our experience with endoscopic removal of an encrusted UroLume proximal urethral stent in a 72-year-old male using a holmium laser. The literature on various management options and outcomes for urethral stent removal is reviewed. Endoscopic removal of proximal urethral stents is feasible and safe and should be considered as the primary treatment option in patients requiring stent extraction. PMID:23248530

  17. Traumatic bone cyst of mandible.

    PubMed

    Surej Kumar, L K; Kurien, Nikhil; Thaha, Khaleel Ahamed

    2015-06-01

    The traumatic bone cyst, an uncommon lesion of the jaws, belongs to the category of 'pseudocyst' owing to its lack of a lining epithelial membrane. It is an asymptomatic lesion, which is often diagnosed accidentally during routine radiological examination commonly present in the posterior mandible as a unilocular radiolucency with scalloping borders. The exact etiopathogenesis of the lesion is still debated, though the role of trauma is often associated. Here we report a rare case of traumatic bone cyst in the anterior mandible, in a 16-year-old female patient with a previous history of trauma to chin; diagnosed and treated successfully in our surgical unit. The case is discussed in relation to its clinical presentation, etiopathogenesis, diagnosis, management and prognosis. PMID:26028875

  18. Traumatic Brain Injury

    MedlinePlus

    ... Center PTACs Workspaces Log-in Search for: Traumatic Brain Injury A legacy resource from NICHCY Disability Fact ... in her. Back to top What is Traumatic Brain Injury? A traumatic brain injury (TBI) is an ...

  19. SIU/ICUD Consultation on Urethral Strictures: Dilation, internal urethrotomy, and stenting of male anterior urethral strictures.

    PubMed

    Buckley, Jill C; Heyns, Chris; Gilling, Peter; Carney, Jeff

    2014-03-01

    Male urethral stricture is one of the oldest known urologic diseases, and continues to be a common and challenging urologic condition. Our objective was to review all contemporary and historial articles on the topic of dilation, internal urethrotomy, and stenting of male anterior urethral strictures. An extensive review of the scientific literature concerning anterior urethral urethrotomy/dilation/stenting was performed. Articles were included that met the criteria set by the International Consultation on Urological Diseases (ICUD) urethral strictures committee and were classified by level of evidence using the Oxford Centre for Evidence-Based Medicine criteria adapted from the work of the Agency for Health Care Policy and Research as modified for use in previous ICUD projects. Using criteria set forth by the ICUD, a committee of international experts in urethral stricture disease reviewed the literature and created a consensus statement incorporating levels of evidence and expert opinion in regard to dilation, internal urethrotomy, and stenting of male anterior urethral strictures. PMID:24286602

  20. Application of endoscopic Ho:YAG laser incision technique treating urethral strictures and urethral atresias in pediatric patients.

    PubMed

    Futao, Sun; Wentong, Zhang; Yan, Zhuang; Qingyu, Dong; Aiwu, Li

    2006-06-01

    Endoscopic holmium:yttrium-aluminum-garnet (Ho:YAG) laser incision is a new method applied in pediatric urology recent years. To evaluate its therapeutic efficacy on treating the pediatric patients with urethral strictures and urethral atresias, a retrospective study was performed from June 2001 to July 2005 in a total of 28 pediatric patients who underwent endoscopic internal urethrotomy using Ho:YAG laser in our center. In these patients, 25 had urethral strictures and 3 urethral atresias. Follow-up was done ranging from 2 months to 4 years to assess the treatment. Of the 28 patients, 25 (89.3%) have achieved satisfied result without complications following initial incisions. Two patients with urethral atresias and another with long lesion of stricture (> 2 cm) have postoperative stenosis (10.7%). Among the three reoccurred patients, two were successfully reoperated by Ho:YAG laser and open end-to-end anastomosis, respectively. One patient failed to follow-up. With the advantages of safety, efficacy and minimal invasion, endoscopic Ho:YAG laser incision technique could be used as a primary treatment in urethral stricture patients and is worthy to be popularized further in pediatric surgery. PMID:16736220

  1. Isolated posterior dislocation of the radial head without fracture of the ulna in a child.

    PubMed

    Wouters, E; Fortems, Y; Mulier, E; Stuyck, J; Fabry, G

    1993-01-01

    An isolated posterior dislocation of the radial head is a rare injury. We present a case report on an 11-year-old boy with a traumatic posterior radial head dislocation without fracture or bending of the ulna. The diagnosis can be difficult and should be supported with good radiographic images, since clinically the injury can be missed or misdiagnosed. PMID:8484316

  2. A protocol for managing urethral obstruction in male cats without urethral catheterization

    PubMed Central

    Cooper, Edward S.; Owens, Tammy J.; Chew, Dennis J.; Tony Buffington, C. A.

    2015-01-01

    Objective To determine efficacy of a protocol for managing urethral obstruction (UO) in male cats without urethral catheterization. Design Clinical trial. Animals 15 male cats with UO in which conventional treatment had been declined. Procedures Laboratory testing and abdominal radiography were performed, and cats with severe metabolic derangements or urinary calculi were excluded. Treatment included administration of acepromazine (0.25 mg, IM, or 2.5 mg, PO, q 8 h), buprenorphine (0.075 mg, PO, q 8 h), and medetomidine (0.1 mg, IM, q 24 h) and decompressive cystocentesis and SC administration of fluids as needed. Cats were placed in a quiet, dark environment to minimize stress. Treatment success was defined as spontaneous urination within 72 hours and subsequent discharge from the hospital. Results Treatment was successful in 11 of the 15 cats. In the remaining 4 cats, treatment was considered to have failed because of development of uroabdomen (n = 3) or hemoabdomen (1). Cats in which treatment failed had significantly higher serum creatinine concentrations than did cats in which treatment was successful. Necropsy was performed on 3 cats in which treatment had failed. All 3 had severe inflammatory disease of the urinary bladder, but none had evidence of bladder rupture. Conclusions and Clinical Relevance Results suggested that in male cats, a combination of pharmacological treatment, decompressive cystocentesis, and a low-stress environment may allow for resolution of UO without the need for urethral catheterization. This low-cost protocol could serve as an alternative to euthanasia when financial constraints prevent more extensive treatment. PMID:21118011

  3. Urethral duplication in males: our experience in ten cases.

    PubMed

    Arena, Salvatore; Arena, Carmela; Scuderi, Maria Grazia; Sanges, Giuseppe; Arena, Francesco; Di Benedetto, Vincenzo

    2007-08-01

    Urethral duplication is a rare congenital anomaly, affecting mainly boys. Clinical presentation varies because of the different anatomical patterns of this abnormality. We report our experience in ten males affected by urethral duplication. We retrospectively reviewed the records of ten males affected by urethral duplication. Mild cases of distal type I duplications as well as "Y-type" duplication associated to anorectal malformation were excluded. Evaluation included voiding cystourethrography, retrograde urethrography, intravenous urography and urethrocystoscopy. Mean age at diagnosis was 46.7 +/- 32.3 months A blind ending duplicated urethra (type I) was present in three patients, two urethras originating from a common bladder neck (type II A2) in three, an "Y-type" duplication in three and a complete bladder with incomplete urethral duplication in one. Surgical management included excision of the duplicated urethra in four patients while a displacement of the ventral urethra (in "Y-type" duplication) in perineal-scrotal or scrotal position was performed in two patients as first stage of urethral reconstruction. Good cosmetical and functional results were achieved in all six treated boys while surgical management was not required in four. Urethral duplication is often associated with genito-urinary and gastro-intestinal abnormalities. Embryology is unclear and a lot of hypotheses have been proposed. We believe that the same embryological explanation cannot be applied to all subtypes of urethral duplication. Management must be evaluated for each case. The overall prognosis is good, in spite of the presence of other severe associate congenital anomalies. PMID:17576574

  4. Traumatic amputations

    PubMed Central

    Ramasamy, Arul

    2013-01-01

    Traumatic amputations remain one of the most emotionally disturbing wounds of conflict, as demonstrated by their frequent use in films to illustrate the horrors of war. Unfortunately, they remain common injuries, particularly following explosions, and, in addition, many survivors require primary amputation for unsalvageable injuries or to save their life. A third group, late amputations, is being increasingly recognised, often as a result of the sequelae of complex foot injuries. This article will look at the epidemiology of these injuries and their acute management, complications and outcome. PMID:26516502

  5. Lymphocyte reactivity in patients with gonococcal urethritis.

    PubMed Central

    Rosenthal, L; Sandström, E

    1978-01-01

    Lymphocyte reactivity to virulent gonococcal antigen T2 and the non-pathogenic Neisseria pharyngis (NPN) has been studied by using the 14C-thymidine uptake in cell cultures from 42 patients with gonococcal urethritis and from 18 controls. The DNA synthesis in cell cultures with T2 antigen was higher in 21 female patients than in the 18 controls. No differences in DNA synthesis were observed in antigen-stimulated cell cultures from patients with single or multiple infections, from patients with urogenital complication, or from controls. Gonococcal antibodies in the serum were detected by the gonococcal complement-fixation test (GCFT). A study of the possible correlation between the outcome of the serological test and the cellular response to gonococcal antigen showed that 14C-thymidine uptake in lymphocyte cultures from male patients with negative GCFT, stimulated with T2 antigen, was much lower than the thymidine uptake in stimulated cell cultures from all the other male and female patients (P less than 0.001). The DNA synthesis was higher in cell cultures from seronegative women than from seronegative men (P less than 0.01). A significant difference (P less than 0.01) was also noted in the lymphocyte reactivity to gonococcal antigen between controls and all patients, except in those men who gave negative results to the serological tests. There were no differences between these two groups with respect to the thymidine uptake in NPN-stimulated cell cultures. PMID:678955

  6. Female Urethral Diverticulum: Current Diagnosis and Management.

    PubMed

    Crescenze, Iryna M; Goldman, Howard B

    2015-10-01

    While urethral diverticulum (UD) affects less than 20 per 1,000,000 women overall, it is thought to represent 1.4% of women with incontinence presenting to urology practices. It is hypothesized to evolve from periurethral glands that become obstructed, infected, and dilated over time, and patients typically present with dyspareunia, bothersome lower urinary tract symptoms (LUTS), and/or recurrent UTIs. In many patients, a periurethral mass can be appreciated on exam. In recent years, magnetic resonance imaging (MRI) has become the imaging test of choice for diagnosis of UD, but ultrasound (US) is a readily available alternative and provides good specificity at a lower cost. Surgical excision of the diverticulum with tension-free, water-tight, three-layer closure continues to be the mainstay of treatment of UD with most studies reporting cure rates of >90%. Concomitant treatment of preexisting stress incontinence with autologous fascial pubovaginal sling can be used at the time of diverticulectomy to avoid a secondary procedure. However, since secondary anti-incontinence procedures are needed in only a small number of patients, up-front stress incontinence treatment may result in significant overtreatment, and staged anti-incontinence procedures continue to be a reasonable option for patients with persistent bothersome stress urinary incontinence (SUI) after diverticulectomy. PMID:26267225

  7. Bougie urethral dilators: revival or survival?

    PubMed Central

    Al–Adawi, Mohammad Ahmad

    2013-01-01

    Objectives To present our center's experience in managing bladder outlet obstruction (BOO) conditions using bougie dilators. We described the dilation technique methodically for teaching purpose. Patients and method Retrospectively, a total of 196 medical records over the last four years denoting BOO conditions in men, women, and children were retrieved for analysis. Data reviewed for common complications was namely: perforation, recurrence, urinary tract obstruction (UTI) and inability to overcome the obstruction. Results Among the 196 analyzed cases, 24 (12.2%) cases were cured, whereas 172 (87.8%) cases reported complications. Within the complicated cases analyzed, 134 (68.4%) cases had recurrent obstructions, 13 (6.6%) cases had perforations, 6 (3.0%) cases developed UTI, while in 19 (9.7%) cases, we failed to pass the obstruction. Conclusions In our center where urethral dilation technique has revived four years ago, it turned back to be the standard choice in managing BOO cases. We propose the technique to Urology training program directors, all over the world, to teach it as a compulsory skill for junior urologists to master. PMID:24757552

  8. Necrotizing Urethritis due to Aerococcus urinae

    PubMed Central

    Babaeer, Abdulrahman A.; Nader, Claudia; Iacoviello, Vito; Tomera, Kevin

    2015-01-01

    A 49-year-old male presented to the emergency with hematuria and pain in the shaft of the penis for one day. The patient was found to be in a state of shock. The shaft of the penis and the scrotum were swollen and tender. No skin necrosis was observed and no crepitus was palpable. Serum white count (WBC) was 29.5 × 103/μL. A CT scan showed gas in the corpus spongiosum. Antibiotics were started with IV metronidazole, vancomycin, and piperacillin/tazobactam. Metronidazole was then replaced by clindamycin. Exploration was performed but no necrotic tissue was identified. Cystourethroscopy revealed dusky looking urethra. A suprapubic tube and a urethral catheter were placed in the bladder. WBC trended down to 13.9 × 103/μL on the fourth postoperative day. Urine culture grew Aerococcus urinae and blood cultures grew Alpha Hemolytic Streptococcus. On the sixth day, the patient was feeling worse and WBC increased. MRI revealed absent blood flow to the corpus spongiosum. Urethroscopy revealed necrosis of the urethra. Urethrectomy was performed via perineal approach. The patient immediately improved. The patient was discharged on the sixth postoperative day to continue ampicillin/sulbactam IV every 6 hours for a total of 4 weeks from the day of urethrectomy. PMID:26171271

  9. Necrotizing Urethritis due to Aerococcus urinae.

    PubMed

    Babaeer, Abdulrahman A; Nader, Claudia; Iacoviello, Vito; Tomera, Kevin

    2015-01-01

    A 49-year-old male presented to the emergency with hematuria and pain in the shaft of the penis for one day. The patient was found to be in a state of shock. The shaft of the penis and the scrotum were swollen and tender. No skin necrosis was observed and no crepitus was palpable. Serum white count (WBC) was 29.5 × 10(3)/μL. A CT scan showed gas in the corpus spongiosum. Antibiotics were started with IV metronidazole, vancomycin, and piperacillin/tazobactam. Metronidazole was then replaced by clindamycin. Exploration was performed but no necrotic tissue was identified. Cystourethroscopy revealed dusky looking urethra. A suprapubic tube and a urethral catheter were placed in the bladder. WBC trended down to 13.9 × 10(3)/μL on the fourth postoperative day. Urine culture grew Aerococcus urinae and blood cultures grew Alpha Hemolytic Streptococcus. On the sixth day, the patient was feeling worse and WBC increased. MRI revealed absent blood flow to the corpus spongiosum. Urethroscopy revealed necrosis of the urethra. Urethrectomy was performed via perineal approach. The patient immediately improved. The patient was discharged on the sixth postoperative day to continue ampicillin/sulbactam IV every 6 hours for a total of 4 weeks from the day of urethrectomy. PMID:26171271

  10. Surgical Outcome of Excision and End-to-End Anastomosis for Bulbar Urethral Stricture

    PubMed Central

    Suh, Jun-Gyo; Choi, Woo Suk; Paick, Jae-Seung

    2013-01-01

    Purpose Although direct-vision internal urethrotomy can be performed for the management of short, bulbar urethral strictures, excision and end-to-end anastomosis remains the best procedure to guarantee a high success rate. We performed a retrospective evaluation of patients who underwent bulbar end-to-end anastomosis to assess the factors affecting surgical outcome. Materials and Methods We reviewed 33 patients with an average age of 55 years who underwent bulbar end-to-end anastomosis. Stricture etiology was blunt perineal trauma (54.6%), iatrogenic (24.2%), idiopathic (12.1%), and infection (9.1%). A total of 21 patients (63.6%) underwent urethrotomy, dilation, or multiple treatments before referral to our center. Clinical outcome was considered a treatment failure when any postoperative instrumentation was needed. Results Mean operation time was 151 minutes (range, 100 to 215 minutes) and mean excised stricture length was 1.5 cm (range, 0.8 to 2.3 cm). At a mean follow-up of 42.6 months (range, 8 to 96 months), 29 patients (87.9%) were symptom-free and required no further procedure. Strictures recurred in 4 patients (12.1%) within 5 months after surgery. Of four recurrences, one patient was managed successfully by urethrotomy, whereas the remaining three did not respond to urethrotomy or dilation and required additional urethroplasty. The recurrence rate was significantly higher in the patients with nontraumatic causes (iatrogenic in three, infection in one patient) than in the patients with traumatic etiology. Conclusions Excision and end-to-end anastomosis for short, bulbar urethral stricture has an acceptable success rate of 87.9%. However, careful consideration is needed to decide on the surgical procedure if the stricture etiology is nontraumatic. PMID:23878686

  11. Endoscopic fetal urethrotomy for anterior urethral valves: a preliminary report.

    PubMed

    Sago, Haruhiko; Hayashi, Satoshi; Chiba, Toshio; Ueoka, Katsuhiko; Matsuoka, Kentaro; Nakagawa, Atsuko; Kitagawa, Michihiro

    2008-01-01

    Anterior urethral valves are a rare congenital anomaly associated with distal urethral obstruction, which can result in a poor prognosis. We report on the endoscopic creation of a fetal urethrotomy for obstructive uropathy resulting from anterior urethral valves. A 33-year-old woman was evaluated at 17 weeks gestation due to fetal megacystis. The diagnosis of anterior urethral valves was confirmed by the characteristic sonographic feature of a dilated membranous penile urethra. Oligohydramnios with normal-appearing kidneys and favorable urinary electrolytes led to fetal intervention. Ablation on the ventral site of the fetal penis for a cutaneous urethrotomy was performed using a YAG laser under a 1-mm fetoscope at 19 weeks gestation. Urine was drained from the incision and the dilated penis and the distended bladder shrunk with an increase in amniotic fluid. However, the fetus died unexpectedly on postoperative day 3, and chorioamnionitis was suspected as the etiology. While the outcome was unfavorable, our preliminary experience shows that fetal urethrotomy for obstructive uropathy can be achieved in utero using an endoscopic laser approach. Further experience will be required to evaluate the therapeutic value of this new procedure in the management of fetal anterior urethral valves. PMID:18648205

  12. Urethral hemangioma: case report and review of the literature

    PubMed Central

    Regragui, Souhail; Slaoui, Amine; Karmouni, Tarik; El Khader, Khalid; Koutani, Abdelatif; Attya, Ahmed Ibn

    2016-01-01

    Hemangiomas are benign vascular tumors. They are the prerogative of the liver and skin. And genitourinary localizations are rare and have only been rarely reported in the prostat, bladder, ureter or the perineum. In the light of published cases, urethral hemangiomas are mostly found in males. Few cases of hemangioma in the female urethra were reported. We report a cavernous hemangioma of the urethra in a 61 years old patient who presented bleeding from the urethra and micturition disorders. Physical examination revealed a tumor 3 cm x 2 polyploid arising from the terminal urethra (urethral hemangioma). We performed surgical resection of the tumor, along with bladder drainage. The postoperative course was simple. We update through a review of the literature aspects of the diagnostic and therapeutic care of the urethral hemangioma. PMID:27231506

  13. [Non-gonococcal infectious urethritis : pathogen spectrum and management].

    PubMed

    Lautenschlager, S

    2015-01-01

    For many years an increase in cases of urethritis has been observed in western Europe. In order to be able to combat this continuous rise, the perception of sexually transmitted diseases must be promoted, the clarification and screening must be intensified and therapy must be rapidly and correctly carried out. In addition to the commonest pathogens causing urethritis, namely chlamydia and gonococci, many other pathogenic microbes must be taken into consideration in the diagnostics. With respect to therapy, apart from the increasing resistance formation of Mycoplasma genitalium, the decreasing effectiveness of standard forms of treatment of other microbes must be emphasized. For chronic and recurrent urethritis in particular a broad clarification of the pathogen should be carried out to enable targeted treatment and also partner treatment. Priority must again be given to primary prevention. PMID:25410827

  14. Reconstruction of Rabbit Urethral Epithelium with Skin Keratinocytes

    PubMed Central

    Rogovaya, O. S.; Fayzulin, A. K.; Vasiliev, A. V.; Kononov, A. V.; Terskikh, V. V.

    2015-01-01

    We have investigated the living skin equivalent (LSE) as an alternative source of plastic material for closing full-thickness epithelial-stromal urethral injuries. The possibility of transdifferentiation of epidermal keratinocytes, a component of 3D tissue constructs, was investigated in vivo in a model of the recovery of urethral injuries in laboratory rabbits. Autologous grafting of LSE in de-epithelialized urethra showed that skin keratinocytes placed in a specific in vivo microenvironment can be incorporated into the damaged area and function as urothelium. The use of EGFP transfected keratinocytes allowed us to identify transplanted cells. The reconstructed urethral tubes did not develop strictures or fistulas at the site of the grafted LSE. Immunohistochemical studies of neo-urothelium revealed EGFP-positive cells expressing the urothelial markers K7 and UP3. PMID:25927003

  15. Balanitis xerotica obliterans with urethral stricture after hypospadias repair.

    PubMed

    Uemura, S; Hutson, J M; Woodward, A A; Kelly, J H; Chow, C W

    2000-01-01

    Three cases of urethral stricture due to balanitis xerotica obliterans (BXO) after hypospadias repair are reported. The first patient showed white, dense scarring on the prepuce before the hypospadias repair and developed a stricture of the urethra after the operation. The second and the third were uneventful for 6 and 2 years, respectively, after the hypospadias repair, and then developed urethral strictures. Pathologic diagnosis of the stenotic lesion is essential. Complete excision of the affected urethra with topical steroid ointment or sublesional triamcinolone injection is recommended for this condition. Although the complication of BXO after hypospadias repair is rare (3 out of 796 cases with hypospadias in our series), surgeons need to be aware of this condition as a cause for late onset of urethral problems. PMID:10663869

  16. Con: bulbomembranous anastomotic urethroplasty for pelvic fracture urethral injuries

    PubMed Central

    Tausch, Timothy J.

    2015-01-01

    Current literature remains controversial regarding whether to treat patients sustaining pelvic fracture urethral injuries (PFUIs) with primary endoscopic realignment (PER) versus suprapubic tube (SPT) placement alone with elective bulbomembranous anastomotic urethroplasty (BMAU). Success rates for PER following PFUI are wide-ranging, depending on various authors’ definitions of what defines a successful outcome. At our institution, for SPT/BMAU patients, the mean time to definitive resolution of stenosis was dramatically shorter compared to PER cases. The vast majority of PER patients required multiple endoscopic urethral interventions and/or experienced various other adverse events which were rarely noted among the SPT/BMAU group. While PER does occasionally result in urethral patency without the need for further intervention, the risk of delay in definitive treatment and potential for adverse events has led to a preference for SPT and elective BMAU at our institution. PMID:26816814

  17. Con: bulbomembranous anastomotic urethroplasty for pelvic fracture urethral injuries.

    PubMed

    Tausch, Timothy J; Morey, Allen F

    2015-02-01

    Current literature remains controversial regarding whether to treat patients sustaining pelvic fracture urethral injuries (PFUIs) with primary endoscopic realignment (PER) versus suprapubic tube (SPT) placement alone with elective bulbomembranous anastomotic urethroplasty (BMAU). Success rates for PER following PFUI are wide-ranging, depending on various authors' definitions of what defines a successful outcome. At our institution, for SPT/BMAU patients, the mean time to definitive resolution of stenosis was dramatically shorter compared to PER cases. The vast majority of PER patients required multiple endoscopic urethral interventions and/or experienced various other adverse events which were rarely noted among the SPT/BMAU group. While PER does occasionally result in urethral patency without the need for further intervention, the risk of delay in definitive treatment and potential for adverse events has led to a preference for SPT and elective BMAU at our institution. PMID:26816814

  18. [CLINICO-MORPHOLOGICAL FEATURES OF FEMALE URETHRAL MEATUS POLYPS].

    PubMed

    Nejmark, A I; Jakovlev, A V; Nepomnjashhih, L M

    2015-01-01

    The aim of the study was to establish the clinical and morphological characteristics of female urethral polyps including cases with concomitant sexually transmitted infections. A total of 150 women were enrolled in the study. The evaluation of microcirculatory changes, morphological parameters and immunogram indices of urethral polyps were carried out. The most common infectious agent in patients with urethral polyps was Ureaplasma urealyticum. In those cases predominance of inflammatory symptoms and elevated levels of serum proinflammatory cytokines were identified. It is found that the pronounced inflammatory reaction leads to an increase in the relative area of the subepithelial microvascular bed and the cellular elements population of lamina mucosa propria, as well as to the relative predominance of congestive forms of microcirculation disturbances according to the laser Doppler flowmetry. PMID:26390557

  19. Circumcision as a risk factor for urethritis in racial groups.

    PubMed

    Smith, G L; Greenup, R; Takafuji, E T

    1987-04-01

    A retrospective population-based case-control study of sexually transmitted urethritis was conducted at a large military base over a 21-month period. During the study, 9,514 patients were seen for sexually transmitted disease. The analysis was restricted to active duty males and showed that Blacks had 14.8 times the incidence rate of gonococcal urethritis (GCU) and 4.7 times the rate of nongonococcal urethritis (NGU) compared to Whites. There were slightly fewer cases of NGU than GCU. A case-control study of active duty soldiers showed that both Black and White circumcised subjects were 1.65 times as likely to have NGU as uncircumcised subjects (95% CI: 1.37-2.00). However, circumcision was not associated with an increased incidence of GCU. PMID:3826463

  20. Circumcision as a risk factor for urethritis in racial groups.

    PubMed Central

    Smith, G L; Greenup, R; Takafuji, E T

    1987-01-01

    A retrospective population-based case-control study of sexually transmitted urethritis was conducted at a large military base over a 21-month period. During the study, 9,514 patients were seen for sexually transmitted disease. The analysis was restricted to active duty males and showed that Blacks had 14.8 times the incidence rate of gonococcal urethritis (GCU) and 4.7 times the rate of nongonococcal urethritis (NGU) compared to Whites. There were slightly fewer cases of NGU than GCU. A case-control study of active duty soldiers showed that both Black and White circumcised subjects were 1.65 times as likely to have NGU as uncircumcised subjects (95% CI: 1.37-2.00). However, circumcision was not associated with an increased incidence of GCU. PMID:3826463

  1. Reconstruction of rabbit urethral epithelium with skin keratinocytes.

    PubMed

    Rogovaya, O S; Fayzulin, A K; Vasiliev, A V; Kononov, A V; Terskikh, V V

    2015-01-01

    We have investigated the living skin equivalent (LSE) as an alternative source of plastic material for closing full-thickness epithelial-stromal urethral injuries. The possibility of transdifferentiation of epidermal keratinocytes, a component of 3D tissue constructs, was investigated in vivo in a model of the recovery of urethral injuries in laboratory rabbits. Autologous grafting of LSE in de-epithelialized urethra showed that skin keratinocytes placed in a specific in vivo microenvironment can be incorporated into the damaged area and function as urothelium. The use of EGFP transfected keratinocytes allowed us to identify transplanted cells. The reconstructed urethral tubes did not develop strictures or fistulas at the site of the grafted LSE. Immunohistochemical studies of neo-urothelium revealed EGFP-positive cells expressing the urothelial markers K7 and UP3. PMID:25927003

  2. Virus culture studies in non-gonococcal urethritis

    PubMed Central

    Morton, R. S.; Gillespie, E. H.; Wilson, M. A.

    1964-01-01

    Specimens of urethal discharge and scrapings of the urethra from 45 men with non-gonococcal urethritis have been studied for virus content. Human amnion and monkey kidney cell cultures were inoculated. Various temperatures of incubation were used. Specimens were also inoculated into the yolk sac of seven-day fertile eggs. No cytopathic changes were detected in any specimen examined after direct incubation or after passage. No elementary bodies were seen in stained sections of yolk sacs. Haemagglutination and haemadsorption tests were negative. Paired sera from 21 cases were available for antibody titre study. Estimations of urethral temperature and pH were made. The cause of non-gonococcal urethritis remains to be discovered. PMID:14149932

  3. Treatment of urethral diseases with neodymium:YAG laser.

    PubMed

    Bloiso, G; Warner, R; Cohen, M

    1988-08-01

    Over a thirty-month period, a wide variety of common urethral problems were treated on an ambulatory basis, with the neodymium:yttrium-aluminum garnet (Nd:YAG) laser. When used discriminately, laser treatment appears to be an effective modality for the management of selected urethral strictures. Thus far, excellent results have been obtained in 30 of 31 cases of short strictures where laser urethrotomy was performed as the first stricture procedure (average follow-up 10 months). Furthermore, in a series of 36 cases of secondary bladder neck contractures, all of the evaluated patients responded well (average follow-up 7 months). Good results were obtained in only 11 of 48 complicated strictures (average follow-up 14 months). However, while most of these extensive strictures were not eradicated, laser therapy generally produced a documented clinical improvement, comparable to urethrotomy or dilatation, in 15 of these cases. A series of 24 condylomata involving the urethra were treated satisfactorily, with no recurrences (average follow-up 13 months). Laser treatment also has been used successfully for the management of several urethral caruncles, urethral polyps, two meatal hemangiomas, one urethral carcinoma, and a distal duplicated urethra. Recently, the Nd:YAG laser has been applied to the prostatic urethra with vaporization of obstructing median bar hyperplasia. Favorable results have been achieved in 5 of 6 cases treated with a newly developed technique that utilizes direct laser contact. Retrograde ejaculation has not been encountered in these patients (average follow-up 6 months). All of these procedures have been accomplished in the office, largely without urethral catheterization. Lidocaine jelly occasionally supplemented with intravenous sedation provided satisfactory anesthesia. PMID:3400132

  4. Medication Effects on Periurethral Sensation and Urethral Sphincter Activity

    PubMed Central

    Greer, W. Jerod; Gleason, Jonathan L.; Kenton, Kimberly; Szychowski, Jeff M.; Goode, Patricia S; Richter, Holly E

    2014-01-01

    Aim To characterize urethral neuromuscular function before and 2 weeks after medication therapy. Methods Premenopausal women without lower urinary tract symptoms were randomly allocated to one of six medications for 2 weeks (pseudoephedrine ER 120mg, imipramine 25mg, cyclobenzaprine 10mg, tamsulosin 0.4mg, solifenacin 5mg or placebo). At baseline and after medication, participants underwent testing: quantitative concentric needle EMG (CNE) of the urethral sphincter using automated Multi-Motor Unit Action Potential (MUP) software; current perception threshold (CPT) testing to measure periurethral sensation; and standard urodynamic pressure flow studies (PFS). Nonparametric tests were used to compare pre-post differences. Results 56 women had baseline testing; 48 (85.7%) completed follow-up CNE, and 49 (87.5%) completed follow-up CPT and PFS testing. Demographics showed no significant differences among medication groups with respect to age (mean 34.3 ± 10.1), BMI (mean 31.8 ± 7.5), parity (median 1, range 0–7), or race (14% Caucasian, 80% African American). PFS parameters were not significantly different within medication groups. No significant pre-post changes in CNE values were noted; however, trends in amplitudes were in a direction consistent with the expected physiologic effect of the medications. With CPT testing, a trend toward increased urethral sensation at the 5 Hz stimulation level, was observed following treatment with pseudoephedrine (0.15 to 0.09 mA at 5Hz; P=0.03). Conclusion In women without LUTS, pseudoephedrine improved urethral sensation, but not urethral neuromuscular function on CNE or pressure flow studies. Imipramine, cyclobenzaprine, tamsulosin, solifenacin, and placebo did not change urethral sensation or neuromuscular function. PMID:25185603

  5. Tissue engineering in urethral reconstruction—an update

    PubMed Central

    Mangera, Altaf; Chapple, Christopher R

    2013-01-01

    The field of tissue engineering is rapidly progressing. Much work has gone into developing a tissue engineered urethral graft. Current grafts, when long, can create initial donor site morbidity. In this article, we evaluate the progress made in finding a tissue engineered substitute for the human urethra. Researchers have investigated cell-free and cell-seeded grafts. We discuss different approaches to developing these grafts and review their reported successes in human studies. With further work, tissue engineered grafts may facilitate the management of lengthy urethral strictures requiring oral mucosa substitution urethroplasty. PMID:23042444

  6. Pro: endoscopic realignment for pelvic fracture urethral injuries

    PubMed Central

    Stein, Daniel M.

    2015-01-01

    Patients with pelvic fracture urethral distraction injuries may benefit from early endoscopic realignment. Realignment is associated with a low risk of immediate complications and has a high success rate for achieving catheter placement. Review of over thirty studies assessing for subsequent urethral stenosis, including at least a dozen that directly compare realignment to suprapubic diversion along, conclude that there is a benefit averaging at least 35% in favor of realignment. Furthermore, realignment may result in easier subsequent urethroplasty and possibly shorter stenoses. PMID:26816813

  7. Plastic end-to-end treatment of bulbar urethral stricture

    PubMed Central

    Hamza, Amir; Behrendt, Wolf; Tietze, Stefan

    2013-01-01

    For bulbar urethral strictures up to 2.5 cm in length, the one-stage urethral plastic surgery with stricture excision and direct end-to-end anastomosis remains the best procedure to guarantee a high success rate. This retrospective review shows the results of 21 patients who underwent bulbar end-to-end anastomosis from 2010–2013. In 20 cases (95.3%) good results were archived. The criteria of success were identified by pre- and postoperative radiological diagnostics and uroflowmetry. PMID:26504704

  8. Pro: endoscopic realignment for pelvic fracture urethral injuries.

    PubMed

    Stein, Daniel M; Santucci, Richard A

    2015-02-01

    Patients with pelvic fracture urethral distraction injuries may benefit from early endoscopic realignment. Realignment is associated with a low risk of immediate complications and has a high success rate for achieving catheter placement. Review of over thirty studies assessing for subsequent urethral stenosis, including at least a dozen that directly compare realignment to suprapubic diversion along, conclude that there is a benefit averaging at least 35% in favor of realignment. Furthermore, realignment may result in easier subsequent urethroplasty and possibly shorter stenoses. PMID:26816813

  9. Development of an artificial urethral valve using SMA actuators

    NASA Astrophysics Data System (ADS)

    Chonan, S.; Jiang, Z. W.; Tani, J.; Orikasa, S.; Tanahashi, Y.; Takagi, T.; Tanaka, M.; Tanikawa, J.

    1997-08-01

    The development of an artificial urethral valve for the treatment of urinary incontinence which occurs frequently in the aged is described. The prototype urethral valve is assembled in hand-drum form with four thin shape memory alloy (SMA) (nickel - titanium alloy) plates of 0.3 mm thickness. The shape memory effect in two directions is used to replace the urinary canal sphincter muscles and to control the canal opening and closing functions. The characteristic of the SMA is to assume the shape of a circular arc at normal temperatures and a flat shape at higher temperatures. Experiments have been conducted using a canine bladder and urinary canal.

  10. Urethral stone presenting as a stop valve--a rare complication of balanitis xerotica obliterans.

    PubMed

    Dogra, P N; Singh, I; Khaitan, A

    2001-01-01

    Balanitis xerotic obliterans (BXO) is the genital subcategory of lichen sclerosis et atrophicus. The association of BXO with urethral stone causing interruption of the urinary stream and voiding by manual displacement of the urethral stone has not been described before. We describe one such case of a young boy with BXO and urethral stone who voided by manually displacing the stone for over a year. The case is reported to emphasize the ingenuity of the patient in continuing to void for over a year despite the association of the impacted urethral stone with urethral stricture and BXO. PMID:12092665

  11. Traumatic unilateral internuclear ophthalmoplegia.

    PubMed

    Doe, Joseph W; Jay, Walter M

    2006-01-01

    A 23-year-old man was admitted for a closed head injury following a fall from a height of 5 meters from a ladder. Because of a C-7 burst fracture, a halo and halo vest were applied approximately 9 hours following the fall. Approximately 21 hours after the accident, the patient complained of diplopia. On neuro-ophthalmology evaluation, a unilateral internuclear ophthalmoplegia was noted. MRI of the brain, performed 3 days after application of the halo and vest, showed a small infarct at the posterior aspect of the inferior midbrain, slightly left of midline. At 9.5 weeks there was 90% improvement of the internuclear ophthalmoplegia noted. Of the reported cases in the medical literature of traumatic internuclear ophthalmoplegia, 30 (83.33%) cases were male and 6 (16.67%) were female. The mean age was 31.7. 54% of the cases were bilateral; 46% unilateral. Mechanisms include: motor vehicle accident: 28 (41.79%), fall: 7 (10.45%), blunt trauma: 11 (16.42%), penetrating trauma 1: (1.49%), bike accident 3: (4.48%), other: 1 (1.49%), Unknown: 16 (23.88%). PMID:17182412

  12. [Posterior capsule opacification].

    PubMed

    Milazzo, S; Grenot, M; Benzerroug, M

    2014-12-01

    Posterior capsule opacification (PCO) is the most common complication after cataract surgery, with an incidence of 30%. It tends to be considered a normal event in the natural history of cataract surgery. Better understanding of its pathophysiology and advancement of intraocular lens material and design along with the improvement of phacoemulsification technique have contributed to decrease the incidence of PCO. Although treatment by Nd: YAG laser posterior capsulotomy is quick and non-invasive, the opening of the posterior capsule may be associated with numerous complications. Prevention remains the best measure for controlling this pathology. PMID:25455552

  13. Congenital urethral stenosis in a male miniature piglet

    PubMed Central

    Pouleur-Larrat, Bénédicte; Maccolini, Edouard; Carmel, Eric Norman; Hélie, Pierre

    2014-01-01

    A 2-month-old male miniature pig showed progressive abdominal pain, pollakiuria, and stranguria that progressed to complete urinary obstruction. Postmortem examination revealed idiopathic urethral stenosis at the level of the recess, of probable congenital origin. Urinary tract malformations should be included in the differential diagnosis of miniature piglets with urinary disorders. PMID:24891635

  14. Outcome of urethral strictures treated by endoscopic urethrotomy and urethroplasty

    PubMed Central

    Tinaut-Ranera, Javier; Arrabal-Polo, Miguel Ángel; Merino-Salas, Sergio; Nogueras-Ocaña, Mercedes; López-León, Víctor Manuel; Palao-Yago, Francisco; Arrabal-Martín, Miguel; Lahoz-García, Clara; Alaminos, Miguel; Zuluaga-Gomez, Armando

    2014-01-01

    Introduction: We analyze the outcomes of patients with urethral stricture who underwent surgical treatment within the past 5 years. Methods: This is a retrospective study of male patients who underwent surgery for urethral stricture at our service from January 2008 to June 2012. We analyzed the comorbidities, type, length and location of the stricture and the surgical treatment outcome after endoscopic urethrotomy, urethroplasty or both. Results: In total, 45 patients with a mean age of 53.7 ± 16.7 years underwent surgical treatment for urethral stricture. Six months after surgery, 46.7% of the patients had a maximum urinary flow greater than 15 mL/s, whereas 87.3% of the patients exhibited no stricture by urethrography after the treatment. The success rate in the patients undergoing urethrotomy was 47.8% versus 86.4% in those undergoing urethroplasty (p = 0.01). Twenty percent of the patients in whom the initial urethrotomy had failed subsequently underwent urethroplasty, thereby increasing the treatment success. Conclusion: In most cases, the treatment of choice for urethral stricture should be urethroplasty. Previous treatment with urethrotomy does not appear to produce adverse effects that affect the outcome of a urethroplasty if urethrotomy failed, so urethrotomy may be indicated in patients with short strictures or in patients at high surgical risk. PMID:24454595

  15. A Method for Recording Urethral Pressure Profiles in Female Rats

    PubMed Central

    Xu, Shengfei; Li, Xiaohui; Xu, Lei; Chen, Biao; Tan, Huibing; Du, Guanghui

    2015-01-01

    Aims Urethral pressure profile (UPP) and leak-point pressure (LPP) measurements as well as external urethral sphincter (EUS) electromyography (EMG) and videourodynamic analyses are the primary methods for evaluating urethral function in humans. However, UPP recording in female rats, a widely used animal model, is challenging due to their small body sizes. This study reports a novel method for recording UPP in female rats. Materials and Methods Seventeen anesthetized female rats were studied. LPP data for 14 rats were included. The other 3 rats were excluded because of death or abnormal urogenital organs. UPP curves were recorded using a modified water-perfusion catheter system, with the lateral hole facing the 3-, 6-, 9-, and 12-o’clock positions in a randomized sequence. LPP, functional urethral length (FUL) and maximum urethral closure pressure (MUCP) were analyzed. Results The mean LPP was 64.39 ± 20.29 cm H2O. The mean FUL and MUCP values at the 3-, 6-, 9-, and 12-o’clock positions were 12.90 ± 1.20, 16.70 ± 1.95, 13.90 ± 2.42, and 11.60 ± 0.97 mm, respectively, and 38.70 ± 11.85, 33.90 ± 11.82, 37.40 ± 11.95, and 71.90 ± 23.01 cm H2O, respectively. The FUL at the 6-o’clock position and MUCP at the 12-o’clock position were significantly greater than those at the other 3 positions. The FUL and MUCP of repeated UPP recordings were not significantly different than those of the first recordings. Conclusions UPP recording using a modified method based on a water-perfusion catheter system is feasible and replicable in female rats. It produces UPP curves that sensitively and appreciably reflect detailed pressure changes at different points within the urethra and thus provides opportunity to evaluate urethral structures, especially the urethral sphincter, in detail. These results may enhance the utility of female rat models in research of urinary sphincter mechanisms. PMID:26502072

  16. Posterior fossa tumor

    MedlinePlus

    ... of the posterior fossa, it can block the flow of spinal fluid and cause increased pressure on the brain and ... the cancer early. A total blockage in the flow of spinal fluid can be life threatening. If tumors are found ...

  17. Posterior Tibial Tendon Dysfunction

    MedlinePlus

    ... when the posterior tibial tendon becomes inflamed or torn. As a result, the tendon may not be ... repetitive use. Once the tendon becomes inflamed or torn, the arch will slowly fall (collapse) over time. ...

  18. Posterior ankle impingement syndrome.

    PubMed

    Maquirriain, Javier

    2005-10-01

    Posterior ankle impingement syndrome is a clinical disorder characterized by posterior ankle pain that occurs in forced plantar flexion. The pain may be acute as a result of trauma or chronic from repetitive stress. Pathology of the os trigonum-talar process is the most common cause of this syndrome, but it also may result from flexor hallucis longus tenosynovitis, ankle osteochondritis, subtalar joint disease, and fracture. Patients usually report chronic or recurrent posterior ankle pain caused or exacerbated by forced plantar flexion or push-off maneuvers, such as may occur during dancing, kicking, or downhill running. Diagnosis of posterior ankle impingement syndrome is based primarily on clinical history and physical examination. Radiography, scintigraphy, computed tomography, and magnetic resonance imaging depict associated bone and soft-tissue abnormalities. Symptoms typically improve with nonsurgical management, but surgery may be required in refractory cases. PMID:16224109

  19. Post-Traumatic Cavernous Fistula Fed by Persistent Trigeminal Artery: Treatment by GDC Embolisation

    PubMed Central

    Deol, P.S.; Mishra, N.K.; Gupta, V.; Gaikwad, S.B.; Garg, A.; Singh, N.

    2001-01-01

    Summary A case of traumatic persistent primitive trigeminal artery (PPTA) cavernous sinus fistula treated with GDC embolisation is reported. Because of the small lumen of PPTA, posteriorly directed course and flow contribution from the posterior circulation, balloon embolisation via the carotid system was not considered appropriate. The fistula was successfully closed by GDC embolisation. PMID:20663331

  20. Painful Traumatic Trigeminal Neuropathy.

    PubMed

    Rafael, Benoliel; Sorin, Teich; Eli, Eliav

    2016-08-01

    This article discusses neuropathic pain of traumatic origin affecting the trigeminal nerve. This syndrome has been termed painful traumatic trigeminal neuropathy by the International Headache Society and replaces atypical odontalgia, deafferentation pain, traumatic neuropathy, and phantom toothache. The discussion emphasizes the diagnosis and the early and late management of injuries to the trigeminal nerve and subsequent painful conditions. PMID:27475512

  1. Traumatic injury of the bladder and urethra

    MedlinePlus

    Injury - bladder and urethra; Bruised bladder; Urethral injury; Bladder injury; Pelvic fracture; Urethral disruption ... Types of bladder injuries include: Blunt trauma (such as a blow to the body) Penetrating wounds (such as bullet or stab wounds) The ...

  2. Nonclosure of rectourethral fistula during posterior sagittal anorectoplasty: Our experience

    PubMed Central

    Jadhav, Sudhakar; Raut, Amit; Mandke, Jui; Patil, Santosh; Vora, Ravindra; Kittur, Dinesh

    2013-01-01

    Aim: To study the effect of nonclosure of rectourethral (RU) fistula and to do a comparative analysis of the complications with and without nonclosure of RU fistula during posterior sagittal anorectoplasty (PSARP) in anorectal malformation cases (ARM). Materials and Methods: A total of 68 cases of ARM were included in the study group, of which 34 cases were those in whom RU fistula was not closed (group A) during PSARP. Another 34 successive cases were included in study group B in whom the RU fistula was closed as is conventionally done by using interrupted sutures. Results: Comparatively, group A had none or minimum urological complications as compared to Group B. Conclusion: RU fistula closure is not mandatory during PSARP and nonclosure avoids urological complications. It especially avoids urethral complications, which are 100% preventable. PMID:23599574

  3. Missed diagnosis of complete urethral transection after sling: the case for translabial ultrasound.

    PubMed

    Rogo-Gupta, Lisa; Le, Ngoc-Bich; Raz, Shlomo

    2012-01-01

    Patients with complications of urethral sling placement for stress urinary incontinence are often treated for recurrent symptoms for years after initial reassuring evaluation. Translabial ultrasound is a noninvasive modality with minimal risks that can clearly diagnose urethral mesh complications. We present a 47-year-old premenopausal woman referred for treatment of urethral stricture and diverticulum 8 years after mesh sling placement. The diagnosis was made at an outside institution by voiding cystourethrogram and cystoscopy. However, translabial ultrasound confirmed the diagnosis of complete urethral transection, and the patient underwent a complex urethral reconstruction. Ultrasound should be used to evaluate patients with a history of urethral sling and persistent lower urinary tract symptoms. Referral to a center with advanced pelvic reconstruction services may be required. PMID:22453271

  4. Tibialis Posterior Tendon Entrapment Within Posterior Malleolar Fracture Fragment.

    PubMed

    Fantry, Amanda; Lareau, Craig; Vopat, Bryan; Blankenhorn, Brad

    2016-01-01

    Management of posterior malleolus fractures continues to be controversial, with respect to both need for fixation and fixation methods. Fixation methods include an open posterior approach to the ankle as well as percutaneous reduction and fixation with or without arthroscopy for visualization of the articular surface. Plain radiographs are unreliable in identifying fracture pattern and intraoperative reduction, making arthroscopy a valuable adjunct to posterior malleolus fracture management. In this article, we report a case of tibialis posterior tendon entrapment within a posterior malleolus fracture, as identified by arthroscopy and managed with open reduction. Tibialis posterior tendon entrapment within a posterior malleolus has not been previously reported. Ankle arthroscopy for posterior malleolus fractures provides an opportunity to identify soft-tissue or tendinous entrapment, articular surface reduction, and articular cartilage injuries unlikely to be identified with fluoroscopy alone and should be considered in reduction and fixation of posterior malleolus fractures. PMID:26991573

  5. Bulbar urethral stricture: How to optimise the use of buccal mucosal grafts.

    PubMed

    Warner, Jonathan N; Wisenbaugh, Eric S; Martins, Francisco E

    2016-06-01

    The use of buccal mucosa graft urethroplasty (BMGU) for bulbar urethral strictures has gained widespread popularity since the first report in 1996. Over the last two decades, there have been many modifications in the surgical technique. This, along with better understanding of urethral anatomy, has allowed the BMG to become the 'gold standard' in urethral substitution. The present article reviews the evolution and techniques of BMGU in order to answer the question - how do we optimise the use of BMGs? PMID:27489734

  6. [Current approaches to the treatment of non-gonococcal urethritis in men].

    PubMed

    Kondrat'eva, Iu S; Neĭmark, A I

    2011-01-01

    The study was made of 50 men suffering from non-gonococcal urethritis caused by mixed pathogenic and opportunistic urogenital infection. Clinical characteristics of urethritis in relation to infection pathogen are shown. The results of clinical and laboratory examinations were considered in choice of antibacterial therapy. Safocid, a combined antibacterial medicine, demonstrated its clinical and microbiological efficacy in the treatment of patients with non-gonococcal urethritis of mixed etiology. PMID:22066239

  7. A Case of Strangulated Urethral Prolapse in a Premenopausal Adult Female

    PubMed Central

    Jessop, Morris L.; Al-Omar, Osama

    2016-01-01

    Urethral prolapse in a premenopausal adult female is exceedingly rare. This paper describes a case of strangulated urethral prolapse presenting as a urethral mass in an unusual demographic and reviews the literature on etiology and management. Only a few cases have occurred in women of reproductive age. The etiology is likely multifactorial. Treatment with surgical excision provides good results in the majority of cases. PMID:27413572

  8. Use of overlapping buccal mucosa graft urethroplasty for complex anterior urethral strictures

    PubMed Central

    2015-01-01

    Complex anterior urethral stricture disease typically manifests as a symptomatic, severely narrowed, long stricture (or multiple strictures) in which conventional excision and/or augmentation is not feasible. Overlapping buccal mucosal graft urethroplasty (OBMGU) is an innovative hybrid technique, combining the well-established principles of dorsal and ventral graft augmentation to allow single stage reconstruction of complex anterior urethral strictures. In this review, we discuss the rationale, techniques, and outcomes of OBMGU for complex anterior urethral strictures. PMID:26813234

  9. Anterior urethral valve in an adolescent with nocturnal enuresis.

    PubMed

    Wu, Chia Chang; Yang, Stephen Shei Dei; Tsai, Yao Chou

    2007-11-01

    The anterior urethral valve (AUV) is a rare congenital urethral anomaly that can lead to variable urinary tract symptoms. We report on a 13-year-old boy with AUV who was referred from a primary care physician for nocturnal enuresis. AUV was disclosed by videourodynamic study and confirmed by simultaneous retrograde cystourethroscopy and antegrade urethroscopy. The AUV was ablated by neodymium:yttrium-aluminum-garnet contact laser at the 5-o'clock and 7-o'clock directions. A postoperative videourodynamic study depicted a patent urethra, a good maximal flow rate, and improved bladder capacity. His nocturnal enuresis had completely subsided at a follow-up period of longer than 24 months. PMID:18068473

  10. Muscular, myocutaneous, and fasciocutaneous flaps in complex urethral reconstruction.

    PubMed

    Zinman, Leonard

    2002-05-01

    The ability to achieve a long-term, stable, stricture-free, hairless urethral lumen in patients with complex anterior stricture and compromised genital skin is one of the ongoing challenges of reconstructive urologic surgery. The conservative approach by endoscopic urethrotomy or dilatation with a self-catheterization schedule rarely affects a definitive cure except in the short filmy superficial strictures of the bulbous portion of the urethra. Genital fasciocutaneous island flaps are currently the golden standard for definitive, reliable resolution of anterior urethral strictures in patients who have not undergone a prior surgical procedure that may alter the penile or scrotal circulation, or those with skin loss from trauma, decubiti, radiation, or balanitis xerotica obliterans. PMID:12371235

  11. Argon laser treatment of urethral stricture and vesical neck contracture.

    PubMed

    Adkins, W C

    1988-01-01

    The physical characteristics of the argon laser wavelength allow a precise incision with excellent hemostasis and negligible heating of adjacent tissues resulting in less scarring. These qualities are used to advantage in the treatment of strictures. The argon laser was used to perform 13 internal urethrotomies and ten vesical neck incisions. The operative method used is similar to optical internal urethrotomy. The argon probe incises hemostatically, reducing the need for extensive fulguration of tissues at the operative site and thereby reducing the tendency for more scar tissue to form and compromise the operation. The same hemostasis reduces the need for postoperative indwelling urethral catheterization. Utility of the argon device in most instances allows treatment to be conducted on an outpatient basis without general anesthesia and without use of postoperative urethral catheters, yielding an effective, cost-saving therapy. PMID:3210887

  12. Diabetes Insipidus after Traumatic Brain Injury

    PubMed Central

    Capatina, Cristina; Paluzzi, Alessandro; Mitchell, Rosalid; Karavitaki, Niki

    2015-01-01

    Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in many age groups. Neuroendocrine dysfunction has been recognized as a consequence of TBI and consists of both anterior and posterior pituitary insufficiency; water and electrolyte abnormalities (diabetes insipidus (DI) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH)) are amongst the most challenging sequelae. The acute head trauma can lead (directly or indirectly) to dysfunction of the hypothalamic neurons secreting antidiuretic hormone (ADH) or of the posterior pituitary gland causing post-traumatic DI (PTDI). PTDI is usually diagnosed in the first days after the trauma presenting with hypotonic polyuria. Frequently, the poor general status of most patients prevents adequate fluid intake to compensate the losses and severe dehydration and hypernatremia occur. Management consists of careful monitoring of fluid balance and hormonal replacement. PTDI is associated with high mortality, particularly when presenting very early following the injury. In many surviving patients, the PTDI is transient, lasting a few days to a few weeks and in a minority of cases, it is permanent requiring management similar to that offered to patients with non-traumatic central DI. PMID:26239685

  13. Complete Urethral Duplication in Children: A Case Report

    PubMed Central

    Roshanzamir, Fatollah; Mirshemirani, Alireza; Ghoroubi, Javad; Mahdavi, Alireza; Mohajerzadeh, Leily; Sarafi, Mehdi

    2016-01-01

    Introduction Urethral duplication (UD) is a rare congenital anomaly with multiple anatomical variants. Case Presentation In this article we present a four year-old child with complete UD. The patient was admitted for hypospadias repair, in evaluation we found type IIA1 UD according to Effmann classification. Patient underwent hypospadias repair saving complete UD. Conclusions After one year follow-up he has normal and continent urination. PMID:27307964

  14. Idiopathic urethritis in children: Classification and treatment with steroids

    PubMed Central

    Jayakumar, Sivasankar; Pringle, Kirsty; Ninan, George K.

    2014-01-01

    Background: Idiopathic urethritis [IU] in children is of unknown etiology and treatment options are limited. We propose a classification for IU based on cystourethroscopy findings and symptoms (Grade 1 – 4) and report our experience with use of topical and oral steroids in IU. Materials and Methods: Retrospective data collection of all male children (0-16 years) diagnosed with IU over a period of 8 years between 2005 and 2012 at our institution. Data was collected on patient demographics, laboratory and radiological investigations, cystourethroscopy findings, management and outcomes. Results: A total of 19 male children were diagnosed with IU. The median age of the patients was 13(7-16) years. Presenting symptoms included dysuria in 12; hematuria in 9; loin pain in 6; and scrotal pain in 2 patients. Both patients with scrotal pain had previous left scrotal exploration that revealed epididymitis. Serum C-reactive protein and Full blood count was tested in 15 patients and was within normal limits in all of them. Cystourethroscopy revealed urethritis of grade-I in 2; grade-II in 11; and grade-III in 3 patients. There were 3 patients with systemic symptoms from extra-urethral extension of inflammation (grade-IV). Mean follow up was 18.9(1-74) months. All patients had steroid instillation at the time of cystourethroscopy. Three patients with IU grade IV required oral steroids (prednisolone) in view of exacerbation of symptoms and signs despite steroid instillation. Complete resolution of symptoms and signs occurred in 18(94.7%) patients. Significant improvement in symptoms and signs was noted in 1(5.3%) patient who is still undergoing treatment. Conclusions: IU in male children can be successfully managed with steroid instillation, especially in grade I and II. Grade III, will need steroid instillation but treatment of scarring and stricture will necessitate longer duration of treatment. In children with IU and extra-urethral symptoms (grade IV), oral steroids may be

  15. Cholinergic urethral brush cells are widespread throughout placental mammals.

    PubMed

    Deckmann, Klaus; Krasteva-Christ, Gabriela; Rafiq, Amir; Herden, Christine; Wichmann, Judy; Knauf, Sascha; Nassenstein, Christina; Grevelding, Christoph G; Dorresteijn, Adriaan; Chubanov, Vladimir; Gudermann, Thomas; Bschleipfer, Thomas; Kummer, Wolfgang

    2015-11-01

    We previously identified a population of cholinergic epithelial cells in murine, human and rat urethrae that exhibits a structural marker of brush cells (villin) and expresses components of the canonical taste transduction signaling cascade (α-gustducin, phospholipase Cβ2 (PLCβ2), transient receptor potential cation channel melanostatin 5 (TRPM5)). These cells serve as sentinels, monitoring the chemical composition of the luminal content for potentially hazardous compounds such as bacteria, and initiate protective reflexes counteracting further ingression. In order to elucidate cross-species conservation of the urethral chemosensory pathway we investigated the occurrence and molecular make-up of urethral brush cells in placental mammals. We screened 11 additional species, at least one in each of the five mammalian taxonomic units primates, carnivora, perissodactyla, artiodactyla and rodentia, for immunohistochemical labeling of the acetylcholine synthesizing enzyme, choline acetyltransferase (ChAT), villin, and taste cascade components (α-gustducin, PLCβ2, TRPM5). Corresponding to findings in previously investigated species, urethral epithelial cells with brush cell shape were immunolabeled in all 11 mammals. In 8 species, immunoreactivities against all marker proteins and ChAT were observed, and double-labeling immunofluorescence confirmed the cholinergic nature of villin-positive and chemosensory (TRPM5-positive) cells. In cat and horse, these cells were not labeled by the ChAT antiserum used in this study, and unspecific reactions of the secondary antiserum precluded conclusions about ChAT-expression in the bovine epithelium. These data indicate that urethral brush cells are widespread throughout the mammalian kingdom and evolved not later than about 64.5millionyears ago. PMID:26044348

  16. Surgical correction of urethral dilatation in an intersex goat.

    PubMed

    Karras, S; Modransky, P; Welker, B

    1992-11-15

    Multiple congenital urethral abnormalities were successfully corrected in a polled goat kid. Anatomic genito-urinary abnormalities identified were paired testes with associated epididymis, ductus deferens, and active endometrial tissue. Blood karyotyping revealed the female state--XX sex chromosomes. This case exemplifies the complex interactions in addition to Y dominant Mendelian genetics that determine reproductive tract development in goats. The resultant intersex state is clinically recognized with greater frequency in polled progeny. PMID:1289340

  17. Case report: "Management of urethral stricture with Uttara Basti".

    PubMed

    Dudhamal, T S; Gupta, S K; Bhuyan, C

    2010-10-01

    A case of stricture of membranous urethra was treated with medicated oil used as Uttara Basti (administration of medicated oil through urethra) once daily for seven consecutive days. The treatment was repeated at a monthly interval for two months. The patient obtained remarkable improvement in his condition. This case highlights the fact that it is possible to treat the cases of urethral stricture with Uttara Basti. PMID:22557426

  18. Ultrastructural analysis of primary human urethral epithelial cell cultures infected with Neisseria gonorrhoeae.

    PubMed

    Harvey, H A; Ketterer, M R; Preston, A; Lubaroff, D; Williams, R; Apicella, M A

    1997-06-01

    In men with gonococcal urethritis, the urethral epithelial cell is a site of infection. To study the pathogenesis of gonorrhea in this cell type, we have developed a method to culture primary human urethral epithelial cells obtained at the time of urologic surgery. Fluorescent analysis demonstrated that 100% of the cells stained for keratin. Microscopic analyses indicated that these epithelial cells arrayed in a pattern similar to that seen in urethral epithelium. Using immunoelectron and confocal microscopy, we compared the infection process seen in primary cells with events occurring during natural infection of the same cell type in men with gonococcal urethritis. Immunoelectron microscopy studies of cells infected with Neisseria gonorrhoeae 1291 Opa+ P+ showed adherence of organisms to the epithelial cell membrane, pedestal formation with evidence of intimate association between the gonococcal and the epithelial cell membranes, and intracellular gonococci present in vacuoles. Confocal studies of primary urethral epithelial cells showed actin polymerization upon infection. Polyclonal antibodies to the asialoglycoprotein receptor (ASGP-R) demonstrated the presence of this receptor on infected cells in the primary urethral cell culture. In situ hybridization using a fluorescent-labeled probe specific to the ASGP-R mRNA demonstrated this message in uninfected and infected cells. These features were identical to those seen in urethral epithelial cells in exudates from males with gonorrhea. Infection of primary urethral cells in culture mimics events seen in natural infection and will allow detailed molecular analysis of gonococcal pathogenesis in a human epithelial cell which is commonly infected. PMID:9169783

  19. Urethral recurrence after cystectomy: current preventative measures, diagnosis and management.

    PubMed

    Chan, Yvonne; Fisher, Patrick; Tilki, Derya; Evans, Christopher P

    2016-04-01

    To summarise the current literature on the diagnosis and management of urethral recurrence (UR) after radical cystectomy (RC), as UR after RC is rare but associated with high mortality. With the recently increased use of orthotopic bladder substitution and the questionable benefit of prophylactic urethrectomy, identification of patients at high risk of UR, management of the remnant urethra, and treatment of UR become critical questions. A review of the PubMed database from 1980 to 2014 was performed to identify studies evaluating recurrent urothelial cancer of the urethra after RC. The search terms used included 'urethral recurrence', 'cystectomy' or 'cystoprostatectomy'. Selected studies provided information on the type of urinary diversion performed, the incidence of UR, and the time to UR. Incidence of UR after RC ranges from 1% to 8% with most recurrences occurring within the first 2 years after surgery. Increased risk of UR is associated with involvement of the prostate, tumour multifocality, bladder neck involvement, and cutaneous diversion. The median overall survival after UR ranges from 6 to 54 months and the 5-year disease-specific survival after UR is reported to be between zero and 83%. UR remains a relatively rare event. Current literature suggests that urethral wash cytology may be useful in patients with intermediate- to high-risk of recurrence to enable early detection of non-invasive disease, which may be amenable to conservative therapy before urethrectomy. PMID:26556525

  20. [Long-term results of endoscopic treatment of urethral strictures].

    PubMed

    Martov, A G; Ergakov, D V; Saliukov, R V; Fakhredinov, G A

    2007-01-01

    The aim of the study was assessment of efficacy of internal urethrotomies made in Research Institute of Urology and city urological hospital N 47. A total of 802 endoscopic operations were performed in 644 male patients aged from 16 to 89 years (mean age 58.6 years) with urethral stricture in 1994-2004. Internal optic urethrotomy was made in 733 cases with a cold knife, in 52--with electric knife and in 17 cases--with laser. Endoscopic urethral resection was conducted in 47 cases. The strictures (0.5-8 cm long, mean 1.4 cm) located most frequently in the bulbous urethra (n=426, 66.1%). Short-term results (12 months) of endoscopic treatment of urethral strictures showed that efficacy of the primary internal urethrotomy conducted according to the authors' technique reached 80.4%. Endoscopic reoperations (from 1 to 6) were performed in 98 (19.6%) patients. A complete rehabilitation (follow-up 9 years maximum) including stenting was achieved in 95.1% patients. In 32 (4.9%) patients endoscopic and rehabilitation measures failed to bring about satisfactory clinical outcomes. These patients were treated with open urethroplasty. Thus, internal optic urethrotomy is an effective therapeutic method. After primary urethrotomy recurrences of the strictures to be reoperated reach 19.6%. These can be successfully managed by endoscopic reoperations and rehabilitation measures. PMID:18254221

  1. Somatomotor and sensory urethral control of micturition in female rats

    PubMed Central

    Cruz, Yolanda; Pastelín, César; Balog, Brian M.; Zaszczurynski, Paul J.

    2014-01-01

    In rats, axons of external urethral sphincter (EUS) motoneurons travel through the anastomotic branch of the pudendal nerve (ABPD) and anastomotic branch of the lumbosacral trunk (ABLT) and converge in the motor branch of the sacral plexus (MBSP). The aim of the present study was to determine in female rats the contribution of these somatomotor pathways and urethral sensory innervation from the dorsal nerve of the clitoris on urinary continence and voiding. EUS electromyographic (EMG) activity during cystometry, leak point pressure (LPP), and voiding efficiency (VE) were assessed in anesthetized virgin Sprague-Dawley female rats before and after transection of the above nerve branches. Transection of the MBSP eliminated EUS EMG, decreased LPP by 50%, and significantly reduced bladder contraction duration, peak pressure, intercontraction interval, and VE. Transection of the ABPD or ABLT decreased EUS EMG discharge and LPP by 25% but did not affect VE. Transection of the dorsal nerve of the clitoris did not affect LPP but reduced contraction duration, peak pressure, intercontraction interval, and VE. We conclude that somatomotor control of micturition is provided by the MBSP with axons travelling through the ABPD and ABLT. Partial somatomotor urethral denervation induces mild urinary incontinence, whereas partial afferent denervation induces voiding dysfunction. ABPD and ABLT pathways could represent a safeguard ensuring innervation to the EUS in case of upper nerve damage. Detailed knowledge of neuroanatomy and functional innervation of the urethra will enable more accurate animal models of neural development, disease, and dysfunction in the future. PMID:25339694

  2. [The surgical results in traumatic cataract].

    PubMed

    Chiseliţă, D; Vancea, P P; Filimon, O; Brănişteanu, D; Bredetean, M; Poiata, I

    1995-01-01

    The retrospective analysis of the postoperative course in 204 traumatic cataracts (140 isolated, simple cataracts and 64 aggravated ones) showed an apparent functional improvement in the simple cases (preoperative and postoperative visual acuity 0.0139 and 0.8520, respectively); the incidence of postoperative detachment of retina was of 4.9%, that of postoperative endophthalmitis that of cystoid macular edema of 3.2%; complications more commonly occurred in aggravated traumatic cataracts and partially accounted for the poorer functional results. During the investigated interval (1988-1992) a rapid shift to extracapsular cataract extraction and posterior chamber lens implants was made. The crystalline grafts preserved binocular vision in 92% of the cases and contact lens in 50% of the cases. Lens implant remains a matchless solution for the visual rehabilitation of the patients with aphakia. PMID:7654673

  3. Transabdominal Robot-Assisted Laparoscopic Urethral Diverticulectomy of a Complex Anterior Horseshoe Diverticulum of the Proximal Urethra

    PubMed Central

    Sivarajan, Ganesh; Glickman, Leonard; Faber, Kenneth; Kim, Michelle; Fromer, Debra

    2015-01-01

    Abstract Complex, proximal, anteriorly located urethral diverticula present the reconstructive urologist with a uniquely challenging task for repair through a conventional transvaginal approach. Herein, we present the first report of urethral diverticulectomy to excise a large, anterior, horseshoe-shaped urethral diverticulum that resulted in bladder outlet obstruction, using a transabdominal robot-assisted laparoscopic approach.

  4. Electrospun Poly(l-lactide)/Poly(ethylene glycol) Scaffolds Seeded with Human Amniotic Mesenchymal Stem Cells for Urethral Epithelium Repair

    PubMed Central

    Lv, Xiaokui; Guo, Qianping; Han, Fengxuan; Chen, Chunyang; Ling, Christopher; Chen, Weiguo; Li, Bin

    2016-01-01

    Tissue engineering-based urethral replacement holds potential for repairing large segmental urethral defects, which remains a great challenge at present. This study aims to explore the potential of combining biodegradable poly(l-lactide) (PLLA)/poly(ethylene glycol) (PEG) scaffolds and human amniotic mesenchymal cells (hAMSCs) for repairing urethral defects. PLLA/PEG fibrous scaffolds with various PEG fractions were fabricated via electrospinning. The scaffolds were then seeded with hAMSCs prior to implantation in New Zealand male rabbits that had 2.0 cm-long defects in the urethras. The rabbits were randomly divided into three groups. In group A, hAMSCs were grown on PLLA/PEG scaffolds for two days and then implanted to the urethral defects. In group B, only the PLLA/PEG scaffolds were used to rebuild the rabbit urethral defect. In group C, the urethral defect was reconstructed using a regular urethral reparation technique. The repair efficacy was compared among the three groups by examining the urethral morphology, tissue reconstruction, luminal patency, and complication incidence (including calculus formation, urinary fistula, and urethral stricture) using histological evaluation and urethral radiography methods. Findings from this study indicate that hAMSCs-loaded PLLA/PEG scaffolds resulted in the best urethral defect repair in rabbits, which predicts the promising application of a tissue engineering approach for urethral repair. PMID:27517902

  5. Etiology of urethral discharge in West Africa: the role of Mycoplasma genitalium and Trichomonas vaginalis.

    PubMed Central

    Pépin, J.; Sobéla, F.; Deslandes, S.; Alary, M.; Wegner, K.; Khonde, N.; Kintin, F.; Kamuragiye, A.; Sylla, M.; Zerbo, P. J.; Baganizi, E.; Koné, A.; Kane, F.; Mâsse, B.; Viens, P.; Frost, E.

    2001-01-01

    OBJECTIVE: To determine the etiological role of pathogens other than Neisseria gonorrhoeae and Chlamydia trachomatis in urethral discharge in West African men. METHODS: Urethral swabs were obtained from 659 male patients presenting with urethral discharge in 72 primary health care facilities in seven West African countries, and in 339 controls presenting for complaints unrelated to the genitourinary tract. Polymerase chain reaction analysis was used to detect the presence of N. gonorrhoeae, C. trachomatis, Trichomonas vaginalis, Mycoplasma genitalium, and Ureaplasma urealyticum. FINDINGS: N. gonorrhoeae, T. vaginalis, C. trachomatis, and M. genitalium--but not U. urealyticum--were found more frequently in men with urethral discharge than in asymptomatic controls, being present in 61.9%, 13.8%, 13.4% and 10.0%, respectively, of cases of urethral discharge. Multiple infections were common. Among patients with gonococcal infection, T. vaginalis was as frequent a coinfection as C. trachomatis. M. genitalium, T. vaginalis, and C. trachomatis caused a similar clinical syndrome to that associated with gonococcal infection, but with a less severe urethral discharge. CONCLUSIONS: M. genitalium and T. vaginalis are important etiological agents of urethral discharge in West Africa. The frequent occurrence of multiple infections with any combination of four pathogens strongly supports the syndromic approach. The optimal use of metronidazole in flowcharts for the syndromic management of urethral discharge needs to be explored in therapeutic trials. PMID:11242818

  6. Para-meatal urethral cyst with bladder calculi: A case report and review of the literature.

    PubMed

    Patil, Siddangouda B; Patil, Nikhil Ashok; Kundargi, Vinay S; Biradar, Ashok N

    2015-01-01

    Para-meatal urethral cyst or median raphe cyst of the glans penis is a benign cystic lesion uncommonly encountered in prepubertal age group. Approximately, about 50 cases have been reported till date in the world literature. Herein we report a case of para-meatal urethral cyst concurrent with urinary bladder calculi. PMID:26539378

  7. Case of a congenital urethral duplication being unmasked following circumcision for balanitis xerotica obliterans.

    PubMed

    Boyd, Matthew; Woodward, Mark; Lambert, Anthony

    2010-07-01

    We present the case of an 11-year-old boy diagnosed with an Effmann Type II A1 urethral duplication after routine circumcision for balanitis xerotica obliterans (BXO). We discuss the pathophysiology, investigation and management both of BXO and urethral duplication. PMID:20529516

  8. Para-meatal urethral cyst with bladder calculi: A case report and review of the literature

    PubMed Central

    Patil, Siddangouda B.; Patil, Nikhil Ashok; Kundargi, Vinay S.; Biradar, Ashok N.

    2015-01-01

    Para-meatal urethral cyst or median raphe cyst of the glans penis is a benign cystic lesion uncommonly encountered in prepubertal age group. Approximately, about 50 cases have been reported till date in the world literature. Herein we report a case of para-meatal urethral cyst concurrent with urinary bladder calculi. PMID:26539378

  9. Sexually transmittable organisms in the urethra of males with and without urethritis.

    PubMed

    Elsner, P; Hartmann, A A; Wecker, I

    1987-06-01

    In 589 males, 169 with and 420 without urethritis, urethral swabs were taken and assessed semiquantitatively for the sexually transmittable infectious agents Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Trichomonas vaginalis and Candida species. The organisms were isolated in patients with and without urethritis as follows: N. gonorrhoeae with urethritis 19.5%, without 0.0%; C. trachomatis with urethritis 16.0%, without 2.9%; U. urealyticum (high cfu-counts) with urethritis 27.2%, without 11.7%; M. hominis (high cfu) with 4.7%, without 2.9%. Combined infections were more frequent in males with urethritis (20.8%) than in those without (5.4%). None of the investigated pathogenic microorganisms could be demonstrated in 37.9% of males with and in 71.2% of males without urethritis. Using loglinear analysis, a significant coincidence of infections with N. gonorrhoeae and U. urealyticum and of infections with U. urealyticum and M. hominis was found. It is concluded that an asymptomatic infection of the male urethra with sexually transmittable organisms is to be expected in partner's control examinations and in patients presenting for other STD like venereal warts or genital herpes. Therefore in these men, even if they are asymptomatic, a comprehensive microbiological examination is strongly recommended. PMID:3118595

  10. Effects of tamsulosin on resting urethral pressure and arterial blood pressure in anaesthetized female dogs.

    PubMed

    Ohtake, Akiyoshi; Sato, Shuichi; Sasamata, Masao; Miyata, Keiji

    2006-03-01

    The purposes of the present study were to investigate the effects of the alpha1-adrenoceptor antagonists tamsulosin, prazosin and urapidil on resting urethral pressure in anaesthetized female dogs, and to compare the results with their effects on arterial blood pressure. Tamsulosin decreased resting maximal urethral pressure in the urethral pressure profile in a dose-dependent fashion, whereas it had almost no effect on mean arterial blood pressure. Prazosin and urapidil also dose-dependently decreased resting maximal urethral pressure, but these effects were accompanied by decreases in mean arterial blood pressure. Thus, of these three compounds, tamsulosin dose-dependently decreased resting maximal urethral pressure with negligible effect on mean arterial blood pressure in female dogs. These results suggest that tamsulosin will be useful in the treatment of voiding dysfunction associated with bladder outlet obstruction in women, with little hypotensive effect. PMID:16536901

  11. Surgical options for posterior tibial plateau fracture

    PubMed Central

    Chen, Hongwei; Wu, Lijun

    2015-01-01

    Objective: To investigate surgical methods and clinical effectiveness of posteromedial and posterolateral approaches for the posterior tibial plateau fracture. Method: 21 cases who received surgery through posterior approaches for the treatment of posterior tibial plateau fractures (PTPFs) were included. Results: 21 cases were subject to follow-up for 12-24 months (an average of 16.2 months). No cases developed incision inflammation, neurovascular injury, internal fixation loosening and breakage. All fractures were healed. No cases developed knee varus and valgus deformity and fracture dislocation. After surgery, Rasmussen score for knee joint functions was 13-30 points (a mean of 24.2). The results were excellent in 12 cases, good in 7 cases and fair in 2 cases. The percentage of excellent and good results was 90.5%. Rasmussen radiology score was 10-18 points (a mean of 15.6 points). The results were excellent in 13 cases, good in 7 cases and fair in 1 cases. The percentage of excellent and good results was 95.2%. 1 case had significant limited range of knee flexion and extension, which was improved after phase II release under arthroscopy combined with function exercise. 2 cases developed traumatic arthritis, which was relieved after intra-articular injection with sodium hyaluronate and oral nonsteroidal anti-inflammatory drug. Conclusion: The posteromedial and posterolateral approaches for PTPF is good for reduction and fixation of PTPF. The approaches have benefits such as clear exposure, convenient placement of internal fixation, less trauma and good clinical outcome. PMID:26885086

  12. Early Experience With a Thermo-Expandable Stent (Memokath) for the Management of Recurrent Urethral Stricture

    PubMed Central

    Jung, Hyun Su; Kim, Joon Woo; Lee, Jun Nyung; Kim, Hyun Tae; Yoo, Eun Sang

    2013-01-01

    Purpose To report our early experience with thermo-expandable urethral stents (Memokath) for the management of recurrent urethral stricture and to assess the efficacy of urethral stents. Materials and Methods Between March 2012 and February 2013, 13 patients with recurrent urethral stricture after several attempts with direct visual internal urethrotomy (DVIU) or failed urethroplasty underwent DVIU with thermally expandable, nickel-titanium alloy urethral stent (Memokath) insertion. Follow-up study time points were at 1, 3, 6, 9, and 12 months after stent insertion. Follow-up evaluation included uroflowmetry, retrograde urethrogram, plain radiography, and urinalysis. Results The mean patient age was 47.7 years (range, 18 to 74 years). The mean urethral stricture length was 5.54 cm (range, 1 to 12 cm). There were six patients with bulbar, four patients with proximal penile, one patient with distal penile, and two patients with whole penile urethral strictures, respectively. The overall success rate was 69% (9/13) and the mean postoperative peak flow rate was 17.7 mL/s (range, 6 to 28 mL/s). Major complications occurred in four patients including one patient (7.7%) with urethrocutaneous fistula induced by the stent and three patients with urethral hyperplasia. The mean follow-up duration was 8.4 months. Conclusions Our initial clinical experience indicates that thermo-expandable stents can be another temporary management option for recurrent urethral stricture patients who are unfit for or refuse urethroplasty. Distal or whole penile urethral stricture can be factors predicting poor results. PMID:24363867

  13. Urethral Strictures and Stenoses Caused by Prostate Therapy.

    PubMed

    Chen, Mang L; Correa, Andres F; Santucci, Richard A

    2016-01-01

    The number of patients with prostate cancer and benign prostatic hyperplasia is on the rise. As a result, the volume of prostate treatment and treatment-related complications is also increasing. Urethral strictures and stenoses are relatively common complications that require individualized management based on the length and location of the obstruction, and the patient's overall health, and goals of care. In general, less invasive options such as dilation and urethrotomy are preferred as first-line therapy, followed by more invasive substitution, flap, and anastomotic urethroplasty. PMID:27601967

  14. Urethral Strictures and Stenoses Caused by Prostate Therapy

    PubMed Central

    Chen, Mang L.; Correa, Andres F.; Santucci, Richard A.

    2016-01-01

    The number of patients with prostate cancer and benign prostatic hyperplasia is on the rise. As a result, the volume of prostate treatment and treatment-related complications is also increasing. Urethral strictures and stenoses are relatively common complications that require individualized management based on the length and location of the obstruction, and the patient’s overall health, and goals of care. In general, less invasive options such as dilation and urethrotomy are preferred as first-line therapy, followed by more invasive substitution, flap, and anastomotic urethroplasty. PMID:27601967

  15. Three Distinct Urethral Fistulae 35 Years After Pelvic Radiation

    PubMed Central

    Sharma, Arindam; Kurtz, Michael P.; Eswara, Jairam R.

    2014-01-01

    Introduction: While the development of fistulae is a well-known complication of radiotherapy, such fistulae can often be challenging to manage. Case Presentation: We describe the case of a 37 year old male who developed in succession a urethrocutaneous fistula to the thigh, a rectourethral fistula and a peritoneo-urethral fistula 35 years after radiotherapy for pediatric pelvic rhabdomyosarcoma. These complications were managed successfully after multiple surgical procedures. Discussion: We subsequently discuss the different approaches currently employed for the management of radiation induced urinary fistulas and describe the rationale behind our approach towards their surgical management. PMID:24783170

  16. Retained Urethral Catheter Secondary to Placement in Proximal Ureter

    PubMed Central

    Sharda, Rajan

    2016-01-01

    We present an unusual complication secondary to indwelling urethral catheter placement. Routine catheter placement by the obstetrics team in a postpartum female leads to retention of the catheter and inability of its removal by both the obstetrics and urology teams. Although a retained urinary catheter is relatively common, inability to remove a catheter secondary to placement inadvertently into a ureter is extremely rare. In this paper we will discuss the options in removing a retained catheter and present our case of a retained catheter secondary to placement within the right proximal ureter. PMID:27144050

  17. Urethral duplication with unusual cause of bladder outlet obstruction

    PubMed Central

    Venkatramani, Vivek; George, Arun Jacob Philip; Chandrasingh, J.; Panda, Arabind; Devasia, Antony

    2016-01-01

    A 12-year-old boy presented with poor flow and recurrent urinary tract infections following hypospadias repair at the age of 3 years. The evaluation revealed urethral duplication with a hypoplastic dorsal urethra and patent ventral urethra. He also had duplication of the bladder neck, and on voiding cystourethrogram the ventral bladder neck appeared hypoplastic and compressed by the dorsal bladder neck during voiding. The possibility of functional obstruction of the ventral urethra by the occluded dorsal urethra was suspected, and he underwent a successful urethro-urethrostomy. PMID:27127361

  18. Experimental traumatic brain injury

    PubMed Central

    2010-01-01

    Traumatic brain injury, a leading cause of death and disability, is a result of an outside force causing mechanical disruption of brain tissue and delayed pathogenic events which collectively exacerbate the injury. These pathogenic injury processes are poorly understood and accordingly no effective neuroprotective treatment is available so far. Experimental models are essential for further clarification of the highly complex pathology of traumatic brain injury towards the development of novel treatments. Among the rodent models of traumatic brain injury the most commonly used are the weight-drop, the fluid percussion, and the cortical contusion injury models. As the entire spectrum of events that might occur in traumatic brain injury cannot be covered by one single rodent model, the design and choice of a specific model represents a major challenge for neuroscientists. This review summarizes and evaluates the strengths and weaknesses of the currently available rodent models for traumatic brain injury. PMID:20707892

  19. Traumatic Wound Dehiscence following Corneal Transplantation

    PubMed Central

    Jafarinasab, Mohammad-Reza; Feizi, Sepehr; Esfandiari, Hamed; Kheiri, Bahareh; Feizi, Mohadesse

    2012-01-01

    Purpose To investigate the incidence, mechanisms, characteristics, and visual outcomes of traumatic wound dehiscence following keratoplasty. Methods Medical records of 32 consecutive patients with traumatic globe rupture following keratoplasty who had been treated at our center from 2001 to 2009 were retrospectively reviewed. Results The study population consisted of 32 eyes of 32 patients including 25 men and 7 women with history of corneal transplantation who had sustained eye trauma leading to globe rupture. Mean patient age was 38.1 (range, 8 to 87) years and median interval between keratoplasty and the traumatic event was 9 months (range, 30 days to 20 years). Associated anterior segment findings included iris prolapse in 71.9%, lens extrusion in 34.4%, and hyphema in 40.6% of eyes. Posterior segment complications included vitreous prolapse (56%), vitreous hemorrhage (28%) and retinal detachment (18%). Eyes which had undergone deep anterior lamellar keratoplasty (DALK; 5 cases, 15.6%) tended to have less severe presentation and better final visual acuity. There was no correlation between the time interval from keratoplasty to the traumatic event, and final visual outcomes. Conclusion The host-graft interface demonstrates decreased stability long after surgery and the visual prognosis of traumatic wound dehiscence is poor in many cases. An intact Descemet’s membrane in DALK may mitigate the severity of ocular injuries, but even in these cases, the visual outcome of globe rupture is not good and prevention of ocular trauma should be emphasized to all patients undergoing any kind of keratoplasty. PMID:23264863

  20. Posterior Tibial Tendon Transfer.

    PubMed

    Shane, Amber M; Reeves, Christopher L; Cameron, Jordan D; Vazales, Ryan

    2016-01-01

    When performed correctly with the right patient population, a tibialis posterior muscle/tendon transfer is an effective procedure. Many different methods have been established for fixating the tendon, each of which has its' own indications. Passing through the interosseous membrane is the preferred and recommended method and should be used unless this is not possible. Good surgical planning based on patient needs and expectations, along with excellent postoperative care including early range of motion and physical therapy minimizes risk of complications and allows for the optimal outcome to be achieved. PMID:26590722

  1. Simple perineal and elaborated perineal posterior urethroplasty

    PubMed Central

    Webster, George D.; Peterson, Andrew C.

    2015-01-01

    A pelvic fracture urethral distraction defect (PFUDD) can present in varying lengths and degrees of complexity. In recent decades the repair of PFUDD has developed into a reliance on a perineal anastomotic approach for all but the most complex cases, which might still require an abdominal transpubic approach, or rarely a staged skin-inlay procedure. There is now controversy about the extent to which the perineal repair needs to be elaborated in individual patients. As originally described, the elaborated perineal approach comprises four steps that are used sequentially, as required, depending on the magnitude of the urethral defect. These steps are urethral mobilisation, corporal body separation, inferior wedge pubectomy and supra-crural urethral re-routing to the anastomosis. We present a review of the progressive repair, its reported use and outcomes and our recommendations for its continued use. PMID:26019973

  2. Primary squamous cell carcinoma of the urethral diverticulum mimicking prostate cancer: Case report and review of the literature

    PubMed Central

    Ekin, Rahmi Gokhan; Yildirim, Zubeyde; Bayol, Umit; Diniz, Gulden; Karaca, Cezmi; Zorlu, Ferruh

    2015-01-01

    Primary urethral carcinomas are uncommon, with urothelial carcinoma as the most common subtype. Urethral diverticulum is also rarely seen in men. A 44-year-old male presented with voiding symptoms. Abdominoperineal resection, prostatectomy, bladder neck excision, and proximal urethral excision were performed. A pathological examination revealed a well-differentiated squamous cell carcinoma (SCC) located inside an urethral diverticulum. We report this unusual case because primary SCC of the male urethral diverticulum is extremely rare. To our knowledge, our patient is only the second reported case. PMID:26029309

  3. The posterior bone block procedure in posterior shoulder instability: a long-term follow-up study.

    PubMed

    Meuffels, D E; Schuit, H; van Biezen, F C; Reijman, M; Verhaar, J A N

    2010-05-01

    We present the long-term outcome, at a median of 18 years (12.8 to 23.5) of open posterior bone block stabilisation for recurrent posterior instability of the shoulder in a heterogenous group of 11 patients previously reported on in 2001 at a median follow-up of six years. We found that five (45%) would not have chosen the operation again, and that four (36%) had further posterior dislocation. Clinical outcome was significantly worse after 18 years than after six years of follow-up (median Rowe score of 60 versus 90 (p = 0.027)). The median Western Ontario Shoulder Index was 60% (37% to 100%) at 18 years' follow-up, which is a moderate score. At the time of surgery four (36%) had glenohumeral radiological osteoarthritis, which was present in all after 18 years. This study showed poor long-term results of the posterior bone block procedure for posterior instability and a high rate of glenohumeral osteoarthritis although three patients with post-traumatic instability were pleased with the result of their operations. PMID:20436001

  4. Posterior Cortical Atrophy

    PubMed Central

    Crutch, Sebastian J; Lehmann, Manja; Schott, Jonathan M; Rabinovici, Gil D; Rossor, Martin N; Fox, Nick C

    2013-01-01

    Posterior cortical atrophy (PCA) is a neurodegenerative syndrome that is characterized by a progressive decline in visuospatial, visuoperceptual, literacy and praxic skills. The progressive neurodegeneration affecting parietal, occipital and occipito-temporal cortices which underlies PCA is attributable to Alzheimer's disease (AD) in the majority of patients. However, alternative underlying aetiologies including Dementia with Lewy Bodies (DLB), corticobasal degeneration (CBD) and prion disease have also been identified, and not all PCA patients have atrophy on clinical imaging. This heterogeneity has led to diagnostic and terminological inconsistencies, caused difficulty comparing studies from different centres, and limited the generalizability of clinical trials and investigations of factors driving phenotypic variability. Significant challenges remain in identifying the factors associated with both the selective vulnerability of posterior cortical regions and the young age of onset seen in PCA. Greater awareness of the syndrome and agreement over the correspondence between syndrome-and disease-level classifications are required in order to improve diagnostic accuracy, research study design and clinical management. PMID:22265212

  5. Optimising the outcome after anastomotic posterior urethroplasty

    PubMed Central

    Koraitim, Mamdouh M.

    2015-01-01

    Objectives To develop a plan that would optimise the outcome after an anastomotic repair of a pelvic fracture urethral injury (PFUI). Methods Data on the delayed repair of PFUI from reports in English were critically reviewed. The search criteria included reports by high-volume surgeons and those from tertiary centres of reconstructive urethral surgery. Results The delayed repair of a PFUI should not be attempted within 4–6 months of the initial trauma. A tension-free, scar-free and mucosa-to-mucosa urethral anastomosis is critically important for a successful outcome. Urethral defects shorter than a third of the bulbar urethral length can usually be repaired by a simple perineal operation, while longer defects usually need an elaborated perineal or perineo-abdominal transpubic procedure. The finest suture that provides adequate strength should always be used for a urethral anastomosis, generally 3/0 polyglactin 910 for adult patients and 4/0 for children. In transpubic urethroplasty, an omental wrapping of the intra-abdominal segment of the bulbar urethra and the site of anastomosis is mandatory. Conclusions Anastomotic repair of a PFUI entails various surgical components, and the importance of each of these should not be underestimated. Careful attention to these surgical components is mandatory for a successful outcome after repair. PMID:26019975

  6. Treatment of urethral strictures with the KTP 532 laser

    NASA Astrophysics Data System (ADS)

    Schmidlin, Franz R.; Oswald, Michael; Iselin, Christoph E.; Jichlinski, Patrice; Delacretaz, Guy P.; Leisinger, Hans-Juerg; Graber, Peter

    1997-05-01

    The objective of this study was to evaluate and compare the safety and efficacy of the KTP 532 laser to direct vision internal urethrotomy (DVIU) in the management of urethral strictures. A total of 32 patients were randomized prospectively in this study, 14 DVIU and 18 KTP 532 laser. Patients were evaluated postoperatively with flowmetry and in the case of recurrence with cystourethrography at 3, 12, 24 weeks. With the KTP 532 laser complete symptomatic and urodynamic success was achieved in 15 (83%) patients at 12 and 24 weeks. Success rate was lower in the DVIU group with 9 (64%) patients at 12 weeks and 8 (57%) patients at 24 weeks. With the KTP mean preoperative peak-flow was improved from 6 cc/s to 20 cc/s at 3, 12 and 24 weeks. With DVIU mean preoperative peak-flow was improved from 5.5 cc/s to 20 cc/s at 3 weeks followed by a steady decrease to 13 cc/s at 12 weeks and to 12 cc/s 24 weeks. No complications were observed in either group of patients. Our results confirm that stricture vaporization with the KTP 532 laser is a safe and efficient procedure. It thus represents a valuable alternative in the endoscopic treatment of urethral strictures.

  7. White matter integrity in highly traumatized adults with and without post-traumatic stress disorder.

    PubMed

    Fani, Negar; King, Tricia Z; Jovanovic, Tanja; Glover, Ebony M; Bradley, Bekh; Choi, Kisueng; Ely, Timothy; Gutman, David A; Ressler, Kerry J

    2012-11-01

    Prior structural imaging studies of post-traumatic stress disorder (PTSD) have observed smaller volumes of the hippocampus and cingulate cortex, yet little is known about the integrity of white matter connections between these structures in PTSD samples. The few published studies using diffusion tensor imaging (DTI) to measure white matter integrity in PTSD have described individuals with focal trauma rather than chronically stressed individuals, which limits generalization of findings to this population; in addition, these studies have lacked traumatized comparison groups without PTSD. The present DTI study examined microstructural integrity of white matter tracts in a sample of highly traumatized African-American women with (n=25) and without (n=26) PTSD using a tract-based spatial statistical approach, with threshold-free cluster enhancement. Our findings indicated that, relative to comparably traumatized controls, decreased integrity (measured by fractional anisotropy) of the posterior cingulum was observed in participants with PTSD (p<0.05). These findings indicate that reduced microarchitectural integrity of the cingulum, a white matter fiber that connects the entorhinal and cingulate cortices, appears to be associated with PTSD symptomatology. The role of this pathway in problems that characterize PTSD, such as inadequate extinction of learned fear, as well as attention and explicit memory functions, are discussed. PMID:22871912

  8. Internal Urethrotomy Under Local Urethral Anaesthesia Is Feasible With Sedation and Analgesia

    PubMed Central

    Uzun, Hakki; Zorba, Orhan Ünal; Tomak, Yakup; Bostan, Habip; Kalkan, Mehmet

    2012-01-01

    Background Urethral stricture is a common condition, and direct vision internal urethrotomy is prefered as the first treatment option by many urologists, for strictures shorter than 2 cm. This procedure is generally performed under general or spinal anaesthesia. Objectives To investigate the feasibility of adding local urethral anaesthesia to intravenous sedation and analgesia (sedoanalgesia) methods in patients undergoing internal urethrotomy. Patients and Methods A total of 21 and 15 patients with anterior urethral strictures underwent internal urethrotomy under local urethral anaesthesia, with or without sedoanalgesia, respectively. Patient discomfort and pain levels were evaluated using the visual analog scale (VAS). Statistical analyses were calculated with a Mann-Whitney U test to compare difference in VAS scores between the subjects in both groups. Results Two of the 15 (13%) patients operated under local urethral anaesthesia without sedoanalgesia were converted to general anaesthesia due to patient intolerability. Mean pain VAS scores for patients operated under 2% lidocain urethral gel anaesthesia with or without sedoanalgesia were 2.86 cm and 4.5 cm, respectively (P = 0.001). In addition, a VAS score over 3 cm was found in 3 of the 21 (14%) patients with, and 13 of the 15 (86%) patients without sedoanalgesia (P = 0.001). Conclusions The addition of intravenous sedoanalgesia improved the VAS scores of pain and discomfort, compared to patients operated under only local urethral anaesthesia. This may offer patients safer anaesthesia and shorter operative times with equilavent results in selected patients. PMID:23573506

  9. Traumatic Glaucoma in Children

    PubMed Central

    Kaur, Savleen; Singh Pandav, Surinder

    2014-01-01

    ABSTRACT Young patients are more prone to ocular trauma but most of the published studies describe complicated cataract as a result of trauma with its treatment modality. As a result, little is known about the different causes, common presenting signs and symptoms, visual outcomes, and most frequent management modalities of traumatic glaucoma in children. This review aims to study the demographical profile, presentation, management and outcome of traumatic glaucoma in children as well as the various factors associated with advanced glaucomatous changes. How to cite this article: Kaur S, Kaushik S, Pandav SS. Traumatic Glaucoma in Children. J Curr Glaucoma Pract 2014; 8(2):58-62. PMID:26997810

  10. Novel posterior fixation keratoprosthesis

    NASA Astrophysics Data System (ADS)

    Lacombe, Emmanuel

    1992-08-01

    The keratoprosthesis is the last solution for corneally blind patients that cannot benefit from corneal transplants. Keratoprostheses that have been designed to be affixed anteriorly usually necessitate multi-step surgical procedures and are continuously subjected to the extrusion forces generated by the positive intraocular pressure; therefore, clinical results in patients prove inconsistent. We proposed a novel keratoprosthesis concept that utilizes posterior corneal fixation which `a priori' minimizes the risk of aqueous leakage and expulsion. This prosthesis is implanted in a single procedure thereby reducing the number of surgical complications normally associated with anterior fixation devices. In addition, its novel design makes this keratoprosthesis implantable in phakic eyes. With an average follow-up of 13 months (range 3 to 25 months), our results on 21 cases are encouraging. Half of the keratoprostheses were implanted in severe burn cases, with the remainder in cases of pseudo- pemphigus. Good visual results and cosmetic appearance were obtained in 14 of 21 eyes.

  11. Use of an aortic stent graft extension for the treatment of urethral stricture in a dog.

    PubMed

    Bae, Jae Hyun; Kwon, Yong Hwan; Jung, Ye Chan; Jung, Ji Mo; Lee, Hae Beom; Lee, Ki Chang; Kim, Nam Soo; Kim, Min-Su

    2013-10-01

    A 2-year-old male mixed dog was referred to us for further evaluation and treatment of a 4-week-history of oliguria and abdominal distension after a surgical repair of urethral injury. To relieve the urethral stricture, we placed a self-expanding aortic stent graft extension with a partial coverage with an expanded polytetrafluoroethylene (ePTFE). After the placement of the stent, the dog presented with a normal urinary voiding, despite the presence of urinary incontinence. The current case indicates that the ePTFE-covered, self-expanding ASGE is an effective intervention for the treatment of severe urethral stricture in the dog. PMID:23676211

  12. Traumatic Brain Injury

    MedlinePlus

    ... disabilities include problems with cognition (thinking, memory, and reasoning), sensory processing (sight, hearing, touch, taste, and smell), ... barrier. NIH Patient Recruitment for Traumatic Brain Injury Clinical Trials At NIH Clinical Center Throughout the U.S. ...

  13. Traumatic Brain Injury

    MedlinePlus

    Traumatic brain injury (TBI) happens when a bump, blow, jolt, or other head injury causes damage to the brain. Every year, millions of people in the U.S. suffer brain injuries. More than half are bad enough that ...

  14. Traumatic Brain Injury

    MedlinePlus

    ... a wide range of changes affecting thinking, sensation, language, or emotions. TBI can be associated with post-traumatic stress disorder. People with severe injuries usually need rehabilitation. NIH: National Institute of Neurological Disorders and Stroke

  15. Traumatic Alterations in Consciousness: Traumatic Brain Injury

    PubMed Central

    Blyth, Brian J.; Bazarian, Jeffrey J.

    2010-01-01

    Mild traumatic brain injury (mTBI) refers to the clinical condition of transient alteration of consciousness as a result of traumatic injury to the brain. The priority of emergency care is to identify and facilitate the treatment of rare but potentially life threatening intra-cranial injuries associated with mTBI through the judicious application of appropriate imaging studies and neurosurgical consultation. Although post-mTBI symptoms quickly and completely resolve in the vast majority of cases, a significant number of patients will complain of lasting problems that may cause significant disability. Simple and early interventions such as patient education and appropriate referral can reduce the likelihood of chronic symptoms. Although definitive evidence is lacking, mTBI is likely to be related to significant long-term sequelae such as Alzheimer's disease and other neurodegenerative processes. PMID:20709244

  16. Evaluation and management of anterior urethral stricture disease

    PubMed Central

    Mangera, Altaf; Osman, Nadir; Chapple, Christopher

    2016-01-01

    Urethral stricture disease affects many men worldwide. Traditionally, the investigation of choice has been urethrography and the management of choice has been urethrotomy/dilatation. In this review, we discuss the evidence behind the use of ultrasonography in stricture assessment. We also discuss the factors a surgeon should consider when deciding the management options with each individual patient. Not all strictures are identical and surgeons should appreciate the poor long-term results of urethrotomy/dilatation for strictures longer than 2 cm, strictures in the penile urethra, recurrent strictures, and strictures secondary to lichen sclerosus. These patients may benefit from primary urethroplasty if they have many adverse features or secondary urethroplasty after the first recurrence. PMID:26918169

  17. A man with urethral polyembolokoilamania successfully treated with electroconvulsive therapy.

    PubMed

    Ingves, Matthew V; Lau, Timothy; Fedoroff, J Paul; Levine, Sharon

    2014-08-01

    Polyembolokoilamania is the act of inserting foreign objects into bodily orifices and can be classified as a paraphilia if done for sexual pleasure. Although problematic sexual behaviors are common in dementia, the majority of case reports of urethral polyembolokoilamania in the elderly have occurred in the absence of dementia or cognitive impairment. Little empirical evidence exists for managing problematic sexual behaviors in the elderly and in dementia. Most evidence in the form of case reports demonstrates that behavioral, environmental, and pharmacological interventions can be effective. In this case report, we describe the management of sexually disinhibited behavior in the form of polyembolokoilamania in a 67-year-old man suffering from treatment-resistant depression, obsessive compulsive disorder, and early signs of frontotemporal dementia. The successful treatment included a course of electroconvulsive therapy. PMID:24569921

  18. Eliminating pulse-induced artifacts in Urethral Pressure data.

    PubMed

    Klunder, Mario; Feuer, Ronny; Amend, Bastian; Kelp, Alexandra; Stenzl, Arnulf; Sievert, Karl-Dietrich; Sawodny, Oliver; Ederer, Michael

    2015-08-01

    Urethral Pressure Profilometry (UPP) is a tool in the diagnosis of urinary incontinence. The pressure profile along the urethra is measured by a special catheter in order to assess the contraction strength of the sphincter muscle. The use of microtip catheters with several pressure sensors and an integrated acceleration sensor enables signal reconstruction of the pressure distribution on the urethra's inside. Experimental data from minipigs exhibit artifact patterns in the pressure data. It is shown that these artifacts are caused by vascular pulsation in the sphincter structure. We therefore investigate different methods exploiting the time-correlation of the artifacts to eliminate pulse-induced artifacts in the pressure data without compromising the actual signal. Evaluation of these methods applied to experimental data conclude this work showing that both an Input-Model and Principal Component Analysis Decorrelation are effective at removing the artifacts. PMID:26736868

  19. Remote discovery of an asymptomatic bowel perforation by a mid-urethral sling.

    PubMed

    Elliott, Jason E; Maslow, Ken D

    2012-02-01

    Bowel perforation is a rare complication of mid-urethral sling procedures and is usually reported shortly after the surgery. We report a remotely discovered asymptomatic bowel injury found at the time of subsequent surgery. The patient with a history of several prior pelvic surgeries underwent an uneventful retropubic mid-urethral sling placement. Five years later, during an abdominal sacrocolpopexy procedure, mesh from the mid-urethral sling was found perforating the wall of the cecum and fixating it to the right pelvic sidewall. Cecal wedge resection was performed to excise the sling mesh. Asymptomatic bowel perforation by mid-urethral sling mesh has not been previously reported. Pelvic and abdominal surgeons should be aware of the possibility of finding this injury in patients with prior sling surgeries. PMID:22052439

  20. Juvenile allergic urethritis with urethro-ejaculatory reflux presenting as acute intermittent bilateral testicular torsion.

    PubMed

    Patel, Ramnik V; Brimioulle, Marina; Govani, Dhaval; Youssef, Talaat

    2015-01-01

    We report a case of juvenile allergic urethritis secondary to double concentrate orange squash of a famous brand in a 3-year-old boy who developed bilateral urethro-ejaculatory reflux (UER) and severe urethral, perineal and scrotal pain referred to both lower limbs intermittently predominantly during and after micturition-simulating features of bilateral intermittent testicular torsion. Accurate history, urinalysis, ultrasound, colour Doppler and food challenge were helpful in diagnosis. Topical steroids, antihistaminic, analgesic and anti-inflammatory medications together with withdrawal of the allergen produced complete recovery. Allergic urethritis in association with bilateral UER causing secondary seminal vesiculitis and epididymitis is rare. It presented as acute scrotum and responded to innovative treatment. Allergic disease can have a dramatic effect on a child's quality of life. This is the first documented case of allergic urethritis and associated UER presenting as juvenile acute scrotum. Steroids, antihistamines and anti-inflammatory agents together with avoidance of the allergen helped achieve recovery. PMID:26150614

  1. [Urethral duplication in pediatric age. A case report].

    PubMed

    Abbate, B; Centonze, N; Danti, D A

    2002-01-01

    Urethral duplication is a rare congenital anomaly, resulting from a wide range of malformations of the urogenital sinus. Generally, the duplication develops on the sagittal plane; the accessory urethra may run dorsally or ventrally to the orthotopic one. The duplication is defined as epispadic in the first case, and hypospadic in the second. In the medical literature approximately 150 cases have been reported. Relatively more frequent among males, it is often associated with other malformations of the urogenital tract or other organs. The authors present a case of a 4 year old child with a complete epispadic duplication, that is, two external meatus, one of which the dorsal aspect of the glans, and the other orthotopic. Clinically, duplication and weakening of the stream, urinary incontinence and UTI were present. US examination documented the normality of the upper urinary tract and of the bladder. Retrograde urethrocystography showed a completely permeable urethral duplication, with two external meatus. The excision of the accessory urethra was carried out together with the reconstruction of the hypospadic meatus with an "overlap anastomosis". The post-operatory period was uneventful, and one year after surgery the patient is asymptomatic, with normal uroflowmetric readings and echographically documented complete bladder emptying. In the opinion of the authors, the treatment is indicated in symptomatic forms and the surgical options varies, depending on the type and grade of malformation, its clinical manifestations and the presence of associated anomalies. Antibiotic treatment is not effective and other treatments, such as diathermocoagulation or the injection of caustic substances into the accessory duct have been abandoned. PMID:12494542

  2. Alternative endoscopic management in the treatment of urethral strictures.

    PubMed

    Niesel, T; Moore, R G; Alfert, H J; Kavoussi, L R

    1995-02-01

    Advances in endoscopic instrumentation and techniques have expanded our armamentarium for safe and effective treatment of urethral strictures. Endoscopic incision or dilation should remain the preferred treatment for uncomplicated primary strictures. Balloon dilation can be useful in the treatment of dense strictures. Incision using laser energy has yet to provide better results than procedures employing a cold knife. As such, it would be difficult to justify the added expense of laser urethrotomy. Endoscopic placement of free skin grafts into the bed of the urethra after transurethral resection or deep incision of the stricture is a novel approach that has shown a great deal of promise. Endourethroplasty is a reasonable alternative to open urethroplasty when treating long strictures, as more than 90% of the reported patients have had a successful outcome with no recurrence. However, larger experience with this procedure is necessary to verify its efficacy and for greater acceptance. The placement of indwelling stents is another new promising treatment option. Overall short-term success rates range from 75% to 100%, but the follow-up period is short, and little is known about the long-term risks of an indwelling foreign body in the urethra. Endoscopic incision via "cut-to-the-light" or "core-through" procedures is an excellent alternative in patients with obliterative strictures. Data from several centers reveal that the majority of patients gain relief of obstruction while maintaining continence and erectile potency. However, at least 25% of these patients will need further endoscopic management to maintain urethral patency. PMID:7780428

  3. Urethral Dysfunction in Female Mice with Estrogen Receptor β Deficiency

    PubMed Central

    Chen, Yung-Hsiang; Chen, Chao-Jung; Yeh, Shuyuan; Lin, Yu-Ning; Wu, Yang-Chang; Hsieh, Wen-Tsong; Wu, Bor-Tsang; Ma, Wen-Lung; Chen, Wen-Chi; Chang, Chawnshang; Chen, Huey-Yi

    2014-01-01

    Estrogen has various regulatory functions in the growth, development, and differentiation of the female urogenital system. This study investigated the roles of ERβ in stress urinary incontinence (SUI). Wild-type (ERβ+/+) and knockout (ERβ−/−) female mice were generated (aged 6–8 weeks, n = 6) and urethral function and protein expression were measured. Leak point pressures (LPP) and maximum urethral closure pressure (MUCP) were assessed in mice under urethane anesthesia. After the measurements, the urethras were removed for proteomic analysis using label-free quantitative proteomics by nano-liquid chromatography–mass spectrometry (LC-MS/MS) analysis. The interaction between these proteins was further analysed using MetaCore. Lastly, Western blot was used to confirm the candidate proteins. Compared with the ERβ+/+ group, the LPP and MUCP values of the ERβ−/− group were significantly decreased. Additionally, we identified 85 differentially expressed proteins in the urethra of ERβ−/− female mice; 57 proteins were up-regulated and 28 were down-regulated. The majority of the ERβ knockout-modified proteins were involved in cell-matrix adhesion, metabolism, immune response, signal transduction, nuclear receptor translational regelation, and muscle contraction and development. Western blot confirmed the up-regulation of myosin and collagen in urethra. By contrast, elastin was down-regulated in the ERβ−/− mice. This study is the first study to estimate protein expression changes in urethras from ERβ−/− female mice. These changes could be related to the molecular mechanism of ERβ in SUI. PMID:25275480

  4. [Posterior reversible encephalopathy syndrome].

    PubMed

    Fischer, M; Schmutzhard, E

    2016-06-01

    Posterior reversible encephalopathy syndrome refers to a neurological disorder characterized by headache, disorders of consciousness, visual disturbances, epileptic seizures, and subcortical vasogenic edema. About two thirds of patients develop neurological symptoms, which are associated with blood pressure fluctuations. One hypothesis is that hypertensive episodes cause autoregulatory failure, and values above the upper limit of cerebral autoregulation result in a breakthrough followed by hyperperfusion and blood-brain barrier dysfunction. In another hypothesis, endothelial dysfunction triggered by numerous factors including preeclampsia, immunosuppressive agents, chemotherapeutics, sepsis, or autoimmune disorders is thought to be the key pathomechanism. Endo- or exogenic toxic agents including pharmacological substances, cytokines, or bacterial toxins are supposed to trigger endothelial activation and dysfunction resulting in the release of vasoconstrictors, pro-inflammatory mediators, and vascular leakage. Diagnosis is usually based on clinical and neuroimaging findings that frequently show a bilateral, symmetric, and parietooccipital pattern. However, the diagnosis can often only be confirmed during the course of disease after excluding important differential diagnoses. Currently, there is no specific treatment available. Lowering of arterial blood pressure and eliminating the underlying cause usually leads to an improvement of clinical and neuroradiological findings. Admission to a critical care unit is required in about 40 % of patients due to complicating conditions including status epilepticus, cerebral vasoconstriction, ischemia, or intracerebral hemorrhage. Prognosis is favorable; in the majority of patients neurological deficits and imaging findings resolve completely. PMID:27272329

  5. Reappraisal of intergender differences in the urethral striated sphincter explains why a completely circular arrangement is difficult in females: a histological study using human fetuses

    PubMed Central

    Takenaka, Atsushi; Rodríguez-Vázquez, Jose Francisco; Murakami, Gen; Matsubara, Akio

    2012-01-01

    To investigate why the development of a completely circular striated sphincter is so rare, we examined histological sections of 11 female and 11 male mid-term human fetuses. In male fetuses, the striated muscle initially extended in the frontal, rather than in the horizontal plane. However, a knee-like portion was absent in the female fetal urethra because, on the inferior side of the vaginal end, a wide groove for the future vestibule opened inferiorly. Accordingly, it was difficult for the developing striated muscle to surround the groove, even though there was not a great difference in width or thickness between the female vestibule and the male urethra. The development of a completely circular striated sphincter seems to be impossible in females because of interruption of the frontal plane by the groove-like vestibule. However, we cannot rule out the possibility that before descent of the vagina, the urethral striated muscle extends posteriorly. PMID:22822461

  6. Recurrent urethral hairball and stone in a hypospadiac: management and prevention.

    PubMed

    Singh, I; Hemal, A K

    2001-08-01

    A 32-year-old perineal hypospadiac man presented with recurrent urethral hair growth, stone, and stricture with a history of multiple urethroplasties. He was treated by urethrolithotomy, internal urethrotomy, laser epilation of the hair-bearing urethral graft, closure of the fistula, and chemical depilation of the neourethral hair. A dilute solution of thioglycolate was prophylactically instilled into the neourethra at intervals of 3 months to ensure complete tricholysis and to prevent recurrent hair growth in the future. PMID:11552792

  7. Treatment of benign urethral strictures using a sapphire tipped neodymium:YAG laser.

    PubMed

    Smith, J A

    1989-11-01

    Sapphire tips increase the energy density and cutting effect of a neodymium:YAG laser. Sapphire tipped neodymium:YAG laser fibers were used to perform urethrotomy in 24 men with benign urethral strictures. The cutting effect was inadequate in 10 patients. Of the 24 patients 16 (67%) had a recurrent stricture within 1 year. Sapphire tipped neodymium:YAG laser fibers offer no apparent advantage over cold knife urethrotomy for treatment of benign urethral strictures. PMID:2810498

  8. Parameatal Urethral Cyst in a Newborn–A Case Report and Review of the Literature

    PubMed Central

    Spyridakis, Ioannis; Patoulias, Dimitrios; Tsioulas, Paschalis; Patoulias, Ioannis

    2016-01-01

    Parameatal urethral cysts are rare congenital lesions of the penis that are usually <1cm in diameter in the paediatric population and do not create any urinary difficulties. Their natural course is either to resolve or to be surgically excised without any postoperative complications. We report a case of a newborn with a parameatal urethral cyst that produced voiding difficulties and was treated by surgical excision. PMID:26894139

  9. Parameatal Urethral Cyst in a Newborn-A Case Report and Review of the Literature.

    PubMed

    Kaselas, Christos; Spyridakis, Ioannis; Patoulias, Dimitrios; Tsioulas, Paschalis; Patoulias, Ioannis

    2016-01-01

    Parameatal urethral cysts are rare congenital lesions of the penis that are usually <1cm in diameter in the paediatric population and do not create any urinary difficulties. Their natural course is either to resolve or to be surgically excised without any postoperative complications. We report a case of a newborn with a parameatal urethral cyst that produced voiding difficulties and was treated by surgical excision. PMID:26894139

  10. Palliative Surgery for Rare Cases of Anterior Urethral Metastasis in Prostate Cancer

    PubMed Central

    Gómez Gómez, Enrique; Carrasco Aznar, Jose Carlos; Moreno Rodríguez, Maria del Mar; Valero Rosa, José; Requena Tapia, Maria José

    2014-01-01

    Penis metastasis from prostate cancer is very rare, and its management varies from case to case as there are very few cases reported in the literature. We describe a patient with prostate cancer treated with radiotherapy and androgen deprivation therapy who presented with urethral bleeding as a symptom of anterior urethral metastasis during followup. We propose a way to manage this and review the literature. PMID:25161796

  11. Management of the stricture of fossa navicularis and pendulous urethral strictures

    PubMed Central

    Singh, Shrawan K.; Agrawal, Santosh K.; Mavuduru, Ravimohan S.

    2011-01-01

    Objective: Management of distal anterior urethral stricture is a common problem faced by practicing urologists. Literature on urethral stricture mainly pertains to bulbar urethral stricture and pelvic fracture urethral distraction defect. The present article aims to review the management of the strictures of fossa navicularis and pendulous urethra. Materials and Methods: The literature in English language was searched from the National Library of Medicine database, using the appropriate key words for the period 1985-2010. Out of 475 articles, 115 were selected for the review based on their relevance to the topic. Results: Etiology of stricture is shifting from infective to inflammatory and iatrogenic causes. Stricture of fossa navicularis is most often caused by lichen sclerosus et atrophicus and instrumentation. Direct visual internal urethrotomy is limited to selected cases in the management of pendulous urethral stricture. With experience and identification of various prognostic factors, conservative management by dilatation and internal urethrotomy is being replaced by various reconstructive procedures, using skin flaps and grafts with high success rates. Single-stage urethroplasty is preferred over the 2-stage procedure as the latter disfigures the penis and poses sexual problems temporarily. Conclusions: Flaps or grafts are useful for single-stage reconstruction of fossa navicularis and pendulous urethral strictures. The buccal and lingual mucosa serves as a preferred resource material for providing the inner lining of the urethra. Off-the-shelf materials, such as acellular collagen matrix, are promising. PMID:22022062

  12. Inability to pass a urethral catheter: the bedside role of the flexible cystoscope.

    PubMed

    Beaghler, M; Grasso, M; Loisides, P

    1994-08-01

    An all too common cause of urologic consultation is the inability to place a urethral catheter. Often other health care providers have unsuccessfully attempted catheter placement. Urethral false passages, perforations, and edema are common sequelae. Diseases such as urethral strictures, bladder neck contractures, and prostate cancer are often the underlying etiologies for failed catheterization. Traditionally, the use of filiforms and followers or the placement of a suprapubic tube is required to drain the lower urinary tract. Bedside flexible endoscopy was performed in this series not only to define the area and etiology of urethral obstruction, but also to facilitate catheter placement. Fifty-four patients were studied prospectively. Initial endoscopic assessment was based on bedside flexible cystoscopy. Most procedures were performed under topical lidocaine anesthetic. Under direct vision a 0.038 inch standard guide wire was directed through the area or areas of obstruction. Strictures, fibrosis, and false passages were dilated using a series of graduated Nottingham dilators over the guide wire. A Council-tipped urethral catheter was then placed over the guide wire to assure bladder drainage. In 52 of the 54 patients urethral obstructions were dilated and drainage catheters were placed into the bladder. No complications were encountered. This technique is simple, it avoids suprapubic puncture, and it minimizes unneeded trips to the operating room. PMID:8048205

  13. The significance of Chlamydia trachomatis in urethritis and prostatitis - differences in therapeutic approach - Croatian experience.

    PubMed

    Skerk, Visnja; Markovinovic, L; Zekan, S; Jaksic, J; Zidovec Lepej, S; Markotic, A; Skerk, Vedrana; Radosevic, V; Cvitkovic, L; Begovac, J

    2009-02-01

    We examined a total of 1014 patients over 18 years of age; 252 with urethritis and 762 with chronic prostatitis syndrome. the mean age of patients with urethritis was 32.7 and with prostatitis syndrome 37.6 years. Clinical symptoms of urethritis were present from a few days to several months. in patients with chronic prostatitis syndrome, symptoms were present for at least 3 months. Chlamydia trachomatis alone was confirmed in 26 (10%) and in combination with Ureaplasma urealyticum in 6 (2%) patients with urethritis. in 171 (68%) patients with urethritis neither C. trachomatis nor U. urealyticum or Mycoplasma hominis were found. C. trachomatis alone was confirmed in 70 (9%), and in combination with other microorganisms in 7 (1%) patients with chronic prostatitis syndrome. in Croatia, the frequency of chronic chlamydial prostatitis has not significantly changed in the last 10 years, while the frequency of infections among adolescents decreased. the recommended regimen for acute chlamydial urethritis in Croatia is azithromycin 1.0 g as a single dose, and a total dose of 4-4.5 g azithromycin for chronic chlamydial prostatitis. PMID:19297275

  14. Tissue Engineering for Human Urethral Reconstruction: Systematic Review of Recent Literature

    PubMed Central

    de Kemp, Vincent; de Graaf, Petra; Fledderus, Joost O.; Ruud Bosch, J. L. H.; de Kort, Laetitia M. O.

    2015-01-01

    Background Techniques to treat urethral stricture and hypospadias are restricted, as substitution of the unhealthy urethra with tissue from other origins (skin, bladder or buccal mucosa) has some limitations. Therefore, alternative sources of tissue for use in urethral reconstructions are considered, such as ex vivo engineered constructs. Purpose To review recent literature on tissue engineering for human urethral reconstruction. Methods A search was made in the PubMed and Embase databases restricted to the last 25 years and the English language. Results A total of 45 articles were selected describing the use of tissue engineering in urethral reconstruction. The results are discussed in four groups: autologous cell cultures, matrices/scaffolds, cell-seeded scaffolds, and clinical results of urethral reconstructions using these materials. Different progenitor cells were used, isolated from either urine or adipose tissue, but slightly better results were obtained with in vitro expansion of urothelial cells from bladder washings, tissue biopsies from the bladder (urothelium) or the oral cavity (buccal mucosa). Compared with a synthetic scaffold, a biological scaffold has the advantage of bioactive extracellular matrix proteins on its surface. When applied clinically, a non-seeded matrix only seems suited for use as an onlay graft. When a tubularized substitution is the aim, a cell-seeded construct seems more beneficial. Conclusions Considerable experience is available with tissue engineering of urethral tissue in vitro, produced with cells of different origin. Clinical and in vivo experiments show promising results. PMID:25689740

  15. Pediatric Traumatic Brain Injury.

    PubMed

    Schaller, Alexandra L; Lakhani, Saquib A; Hsu, Benson S

    2015-10-01

    The purpose of this article is to provide a better understanding of pediatric traumatic brain injury and its management. Within the pediatric age group, ages 1 to 19, injuries are the number one cause of death with traumatic brain injury being involved in almost 50 percent of these cases. This, along with the fact that the medical system spends over $1 billion annually on pediatric traumatic brain injury, makes this issue both timely and relevant to health care providers. Over the course of this article the epidemiology, physiology, pathophysiology, and treatment of pediatric traumatic brain injury will be explored. Emphasis will be placed on the role of the early responder and the immediate interventions that should be considered and/or performed. The management discussed in this article follows the most recent recommendations from the 2012 edition of the Guidelines for the Acute Medical Management of Severe Traumatic Brain Injury in Infants, Children, and Adolescents. Despite the focus of this article, it is important not to lose sight of the fact that an ounce of prevention is worth a pound--or, to be more precise and use the average human's brain measurements, just above three pounds--of cure. PMID:26630835

  16. Facilitating post traumatic growth

    PubMed Central

    Turner, de Sales; Cox, Helen

    2004-01-01

    Background Whilst negative responses to traumatic injury have been well documented in the literature, there is a small but growing body of work that identifies posttraumatic growth as a salient feature of this experience. We contribute to this discourse by reporting on the experiences of 13 individuals who were traumatically injured, had undergone extensive rehabilitation and were discharged from formal care. All participants were injured through involvement in a motor vehicle accident, with the exception of one, who was injured through falling off the roof of a house. Methods In this qualitative study, we used an audio-taped in-depth interview with each participant as the means of data collection. Interviews were transcribed verbatim and analysed thematically to determine the participants' unique perspectives on the experience of recovery from traumatic injury. In reporting the findings, all participants' were given a pseudonym to assure their anonymity. Results Most participants indicated that their involvement in a traumatic occurrence was a springboard for growth that enabled them to develop new perspectives on life and living. Conclusion There are a number of contributions that health providers may make to the recovery of individuals who have been traumatically injured to assist them to develop new views of vulnerability and strength, make changes in relationships, and facilitate philosophical, physical and spiritual growth. PMID:15248894

  17. Normal anatomic relationship between urethral sphincter complex and zones of prostrate in young Chinese males on MRI

    PubMed Central

    Wang, Xiangdong; Liu, Tieyan; Zhao, Jing; Sun, Jingyi; Chen, Yuefeng; Sun, Pengyu; Wang, Xuesong; Liu, Sheng

    2015-01-01

    Objective In this research, the normal anatomic relationship between urethral sphincter complex and zones of prostrate in young Chinese males has been studied. Methods: The sagittal, coronal, and axial T2-weighted non-fat suppressed fast spin-echo images of pelvic cavities of 86 Chinese young males were studied. Result: Urethral sphincter complex threaded through the prostate and divided it into 2 parts: transition zone (TZ), periurethral glands internal to the urethral sphincter and peripheral zone (PZ), central zone (CZ), anterior fibromuscular stroma (AFS) zone external to the urethral sphincter. The length of urethral striated sphincter is 12.26-20.94 mm (mean 16.59 mm) at membranous urethra. Conclusions: In this paper, we summarized the normal anatomic relationship between urethral sphincter complex and zones of prostrate in young Chinese males with no urinary control problems. PMID:26629244

  18. A case of a urethral diverticular adenocarcinoma after the fenestration of the anterior vaginal wall for pelvic floor abscess

    PubMed Central

    Watanabe, Ryuta; Sugahara, Takeshi; Hamada, Hitoshi

    2016-01-01

    A 61-year-old woman presented to the gynecology department with complaints of atypical genital bleeding. Magnetic resonance imaging revealed a localized urethral tumor extended to vagina. Histological test of the biopsy tissue of the mass suggested the adenocarcinoma. The patient was performed the fenestration of the anterior vaginal wall 15 years ago. Under the diagnosis of urethral diverticular adenocarcinoma, we performed standard open total cystectomy with lymph node excision and ileal conduit. We could not establish a diagnosis of urethral diverticulum from the histological test; however, we clinically diagnosed as urethral diverticular adenocarcinoma. Because carcinoma arising from urethral diverticula is reported, a close long-term follow-up for the recurrence or generation of malignant tumors by genitourinary examinations or images is necessary, for the patient with urethral diverticula. PMID:26941237

  19. TRAUMATIC BRAIN INJURY (TBI) DATABASE

    EPA Science Inventory

    The Traumatic Brain Injury National Data Center (TBINDC) at Kessler Medical Rehabilitation Research and Education Center is the coordinating center for the research and dissemination efforts of the Traumatic Brain Injury Model Systems (TBIMS) program funded by the National Instit...

  20. Vicarious traumatization: concept analysis.

    PubMed

    Tabor, Pamela Diane

    2011-12-01

    There is growing knowledge of the effects of stress on professionals, including various negative symptoms that may mirror the biopsychosocial effects exhibited by the victims of trauma. Multiple concepts including burn out, compassion fatigue, post-traumatic stress disorder (PTSD), and secondary traumatic stress, are terms that have been incorrectly interchanged with the term vicarious traumatization (VT). Clarity of vicarious victimization and understanding contributing factors is imperative in order to facilitate future research and implement timely and effective interventions, as well as sculpt evidence based practice. This concept anaylsis, complete with a concept map, discusses VT; related terminology; symptomology; prevention and relevant interventions; and discusses opportunities for personal/professional growth for nurses and especially forensic nurses working with victims of violence. PMID:22123041

  1. Detailed urethral dosimetry in the evaluation of prostate brachytherapy-related urinary morbidity

    SciTech Connect

    Allen, Zachariah A.; Merrick, Gregory S. . E-mail: gmerrick@wheelinghospital.com; Butler, Wayne M.; Wallner, Kent E.; Kurko, Brian; Anderson, Richard L.; Murray, Brian C.; Galbreath, Robert W.

    2005-07-15

    Purpose: To evaluate the relationship between urinary morbidity after prostate brachytherapy and urethral doses calculated at the base, midprostate, apex, and urogenital diaphragm. Methods and Materials: From February 1998 through July 2002, 186 consecutive patients without a prior history of a transurethral resection underwent monotherapeutic brachytherapy (no supplemental external beam radiation therapy or androgen deprivation therapy) with urethral-sparing techniques (average urethral dose 100%-140% minimum peripheral dose) for clinical T1c-T2b (2002 AJCC) prostate cancer. The median follow-up was 45.5 months. Urinary morbidity was defined by time to International Prostate Symptom Score (IPSS) resolution, maximum increase in IPSS, catheter dependency, and the need for postimplant surgical intervention. An alpha blocker was initiated approximately 2 weeks before implantation and continued at least until the IPSS returned to baseline. Evaluated parameters included overall urethral dose (average and maximum), doses to the base, midprostate, apex, and urogenital diaphragm, patient age, clinical T stage, preimplant IPSS, ultrasound volume, isotope, and D90 and V100/150/200. Results: Of the 186 patients, 176 (94.6%) had the urinary catheter permanently removed on the day of implantation with only 1 patient requiring a urinary catheter >5 days. No patient had a urethral stricture and only 2 patients (1.1%) required a postbrachytherapy transurethral resection of the prostate (TURP). For the entire cohort, IPSS on average peaked 2 weeks after implantation with a mean and median time to IPSS resolution of 14 and 3 weeks, respectively. For the entire cohort, only isotope predicted for IPSS resolution, while neither overall average prostatic urethra nor segmental urethral dose predicted for IPSS resolution. The maximum postimplant IPSS increase was best predicted by preimplant IPSS and the maximum apical urethral dose. Conclusions: With the routine use of prophylactic alpha

  2. Severe Traumatic Injury

    PubMed Central

    Minei, Joseph P.; Schmicker, Robert H.; Kerby, Jeffrey D.; Stiell, Ian G.; Schreiber, Martin A.; Bulger, Eileen; Tisherman, Samuel; Hoyt, David B.; Nichol, Graham

    2014-01-01

    Objectives The public health implications of regional variation in incidence and outcome of severe traumatic injury remain to be analyzed. The objective of this study was to determine whether the incidence and outcome associated with severe traumatic injury differs across geographic regions of North America. Methods A prospective, observational study was conducted of the Resuscitation Outcomes Consortium of all patients in 9 North American sites (6 US and 3 Canadian) sustaining severe traumatic injury from April 1, 2006 to March 31, 2007 followed to hospital discharge. Eligible patients were assessed by organized emergency medical services, and had field-based physiologic criteria including systolic blood pressure ≤90 mm Hg, Glasgow Coma Scale score ≤12, respiratory rate <10 or >29 per minute, advanced airway procedure, or traumatic death in the field. Census data were used to determine rates adjusted for age and sex. The main outcome measures were incidence rate, mortality rate, case fatality rate, and survival to discharge for patients sustaining severe traumatic injury assessed by EMS. Results The total catchment population of 20.5 million yielded 7080 cases of severe traumatic injury. Median age was 36 years and 67% were male. The median incidence of EMS-assessed severe traumatic injury per 100,000 population across sites was 37.4 (interquartile range [IQR] = 24.6 – 69.6); survival ranged from 39.8% to 80.8%, with a median of 64.5% (IQR = 55.5–78.4). About 942 cases were pronounced dead at the scene and 5857 patients were transported to hospital; 4477 (63.2%) were discharged alive. The median incidence of severe trauma due to a blunt mechanism, transported to hospital, was 25.8 (IQR = 13.1–44.3); survival ranged from 52.6% to 87.3%, with a median of 78.0% (IQR = 68.4–83.5). The median incidence of severe penetrating trauma, transported to hospital, was 2.6 (IQR = 1.5–10.4); survival ranged from 37.5% to 84.7%, with a median of 67.5% (IQR = 54.1

  3. Fulminant Panuveitis following Iris Suture Fixation of Posterior Chamber Intraocular Lens

    PubMed Central

    Mansour, Ahmad M.; Awwad, Shady T.

    2013-01-01

    We present a case of fulminant panuveitis following iris suture fixation of a posterior chamber intraocular lens. We hypothesize that the zonular dehiscence allowed the inflammatory cells in the anterior compartment to gain access to the posterior segment mimicking endophthalmitis or toxic anterior segment syndrome. Also certain bulky lens designs, like the current Rayner hydrophilic acrylic lens, are difficult to manipulate and hold in the optic capture position, and hence the iris fixation of these lenses can be traumatic and lengthy. It is advised to exchange such lenses with 3-piece intraocular lenses that are easy to fixate. PMID:23476849

  4. A Challenging Surgical Approach to Locally Advanced Primary Urethral Carcinoma

    PubMed Central

    Lucarelli, Giuseppe; Spilotros, Marco; Vavallo, Antonio; Palazzo, Silvano; Miacola, Carlos; Forte, Saverio; Matera, Matteo; Campagna, Marcello; Colamonico, Ottavio; Schiralli, Francesco; Sebastiani, Francesco; Di Cosmo, Federica; Bettocchi, Carlo; Di Lorenzo, Giuseppe; Buonerba, Carlo; Vincenti, Leonardo; Ludovico, Giuseppe; Ditonno, Pasquale; Battaglia, Michele

    2016-01-01

    Abstract Primary urethral carcinoma (PUC) is a rare and aggressive cancer, often underdetected and consequently unsatisfactorily treated. We report a case of advanced PUC, surgically treated with combined approaches. A 47-year-old man underwent transurethral resection of a urethral lesion with histological evidence of a poorly differentiated squamous cancer of the bulbomembranous urethra. Computed tomography (CT) and bone scans excluded metastatic spread of the disease but showed involvement of both corpora cavernosa (cT3N0M0). A radical surgical approach was advised, but the patient refused this and opted for chemotherapy. After 17 months the patient was referred to our department due to the evidence of a fistula in the scrotal area. CT scan showed bilateral metastatic disease in the inguinal, external iliac, and obturator lymph nodes as well as the involvement of both corpora cavernosa. Additionally, a fistula originating from the right corpus cavernosum extended to the scrotal skin. At this stage, the patient accepted the surgical treatment, consisting of different phases. Phase I: Radical extraperitoneal cystoprostatectomy with iliac-obturator lymph nodes dissection. Phase II: Creation of a urinary diversion through a Bricker ileal conduit. Phase III: Repositioning of the patient in lithotomic position for an overturned Y skin incision, total penectomy, fistula excision, and “en bloc” removal of surgical specimens including the bladder, through the perineal breach. Phase IV: Right inguinal lymphadenectomy. The procedure lasted 9-and-a-half hours, was complication-free, and intraoperative blood loss was 600 mL. The patient was discharged 8 days after surgery. Pathological examination documented a T4N2M0 tumor. The clinical situation was stable during the first 3 months postoperatively but then metastatic spread occurred, not responsive to adjuvant chemotherapy, which led to the patient's death 6 months after surgery. Patients with advanced stage tumors of

  5. Reinnervation of Urethral and Anal Sphincters With Femoral Motor Nerve to Pudendal Nerve Transfer

    PubMed Central

    Ruggieri, Michael R.; Braverman, Alan S.; Bernal, Raymond M.; Lamarre, Neil S.; Brown, Justin M.; Barbe, Mary F.

    2012-01-01

    Aims Lower motor neuron damage to sacral roots or nerves can result in incontinence and a flaccid urinary bladder. We showed bladder reinnervation after transfer of coccygeal to sacral ventral roots, and genitofemoral nerves (L1, 2 origin) to pelvic nerves. This study assesses the feasibility of urethral and anal sphincter reinnervation using transfer of motor branches of the femoral nerve (L2–4 origin) to pudendal nerves (S1, 2 origin) that innervate the urethral and anal sphincters in a canine model. Methods Sacral ventral roots were selected by their ability to stimulate bladder, urethral sphincter, and anal sphincter contraction and transected. Bilaterally, branches of the femoral nerve, specifically, nervus saphenous pars muscularis [Evans HE. Miller’s anatomy of the dog. Philadelphia: W.B. Saunders; 1993], were transferred and end-to-end anastomosed to transected pudendal nerve branches in the perineum, then enclosed in unipolar nerve cuff electrodes with leads to implanted RF micro-stimulators. Results Nerve stimulation induced increased anal and urethral sphincter pressures in five of six transferred nerves. Retrograde neurotracing from the bladder, urethral sphincter, and anal sphincter using fluorogold, fast blue, and fluororuby, demonstrated urethral and anal sphincter labeled neurons in L2–4 cord segments (but not S1–3) in nerve transfer canines, consistent with rein-nervation by the transferred femoral nerve motor branches. Controls had labeled neurons only in S1–3 segments. Postmortem DiI and DiO labeling confirmed axonal regrowth across the nerve repair site. Conclusions These results show spinal cord reinnervation of urethral and anal sphincter targets after sacral ventral root transection and femoral nerve transfer (NT) to the denervated pudendal nerve. These surgical procedures may allow patients to regain continence. PMID:21953679

  6. Dynamics of the sensory response to urethral flow over multiple time scales in rat

    PubMed Central

    Danziger, Zachary C; Grill, Warren M

    2015-01-01

    The pudendal nerve carries sensory information from the urethra that controls spinal reflexes necessary to maintain continence and achieve efficient micturition. Despite the key role urethral sensory feedback plays in regulation of the lower urinary tract, there is little information about the characteristics of urethral sensory responses to physiological stimuli, and the quantitative relationship between physiological stimuli and the evoked sensory activation is unknown. Such a relation is critical to understanding the neural control of the lower urinary tract and how dysfunction arises in disease states. We systematically quantified pudendal afferent responses to fluid flow in the urethra in vivo in the rat. We characterized the sensory response across a range of stimuli, and describe a previously unreported long-term neural accommodation phenomenon. We developed and validated a compact mechanistic mathematical model capable of reproducing the pudendal sensory activity in response to arbitrary profiles of urethral flows. These results describe the properties and function of urethral afferents that are necessary to understand how sensory disruption manifests in lower urinary tract pathophysiology. Key points Sensory information from the urethra is essential to maintain continence and to achieve efficient micturition and when compromised by disease or injury can lead to substantial loss of function. Despite the key role urethral sensory information plays in the lower urinary tract, the relationship between physiological urethral stimuli, such as fluid flow, and the neural sensory response is poorly understood. This work systematically quantifies pudendal afferent responses to a range of fluid flows in the urethra in vivo and describes a previously unknown long-term neural accommodation phenomenon in these afferents. We present a compact mechanistic mathematical model that reproduces the pudendal sensory activity in response to urethral flow. These results have

  7. Traumatic Brain Injury (TBI)

    MedlinePlus

    ... A. (2008). Mild traumatic brain injury in U.S. soldiers returning from Iraq. New England Journal of Medicine, 358, 453–463. ... and Spotlights U.S. hospitals miss followup for suspected child abuse Q&A with NICHD Acting Director Catherine ...

  8. Traumatic Brain Injury

    MedlinePlus

    ... a concussion may feel dazed and may lose vision or balance for a while after the injury A brain contusion is a bruise of the brain. This ... consciousness Headache Confusion Feeling dizzy or lightheaded Blurry vision ... or severe traumatic brain injury include all of the symptoms listed above ...

  9. Traumatic L5 Posterolateral Spondyloptosis: A Case Report and Review of the Literature

    PubMed Central

    Curtis, Erik; Gonda, David; Ciacci, Joseph

    2015-01-01

    Traumatic retrolisthesis of the lumbar spine is a rare clinical entity. Only a few case reports have shown retrolisthesis of the fractured fragment over the inferior vertebral body. Fracture dislocations of the spine are unstable injuries that require operative fixation to restore alignment and prevent progressive deformity. We present the case of a traumatic L5-S1 fracture dislocation with retrolisthesis of the L5 vertebral body over the superior aspect of S1 managed with anterior, middle, and posterior column reconstruction. The patient presented with paraplegia and bowel and bladder incontinence. Retrolisthesis fracture dislocations injuries are rare, and as such, there are no guidelines regarding their management. In our case, we performed an L5 vertebrectomy with anterior, middle, and posterior column reconstruction via a posterior approach using a lumbosacral-pelvic construct. The patient did not regain function in his distal lower extremities postoperatively. PMID:26180701

  10. Urethral Pain Among Prostate Cancer Survivors 1 to 14 Years After Radiation Therapy

    SciTech Connect

    Pettersson, Niclas; Olsson, Caroline; Tucker, Susan L.; Alsadius, David; Wilderaeng, Ulrica; Johansson, Karl-Axel; Steineck, Gunnar

    2013-01-01

    Purpose: To investigate how treatment-related and non-treatment-related factors impact urethral pain among long-term prostate cancer survivors. Methods and Materials: Men treated for prostate cancer with radiation therapy at the Sahlgrenska University Hospital in Goeteborg, Sweden from 1993 to 2006 were approached with a study-specific postal questionnaire addressing symptoms after treatment, including urethral burning pain during urination (n=985). The men had received primary or salvage external-beam radiation therapy (EBRT) or EBRT in combination with brachytherapy (BT). Prescribed doses were commonly 70 Gy in 2.0-Gy fractions for primary and salvage EBRT and 50 Gy plus 2 Multiplication-Sign 10.0 Gy for EBRT + BT. Prostatic urethral doses were assessed from treatment records. We also recruited 350 non-pelvic-irradiated, population-based controls matched for age and residency to provide symptom background rates. Results: Of the treated men, 16% (137 of 863) reported urethral pain, compared with 11% (27 of 242) of the controls. The median time to follow-up was 5.2 years (range, 1.1-14.3 years). Prostatic urethral doses were similar to prescription doses for EBRT and 100% to 115% for BT. Fractionation-corrected dose and time to follow-up affected the occurrence of the symptom. For a follow-up {>=}3 years, 19% of men (52 of 268) within the 70-Gy EBRT + BT group reported pain, compared with 10% of men (23 of 222) treated with 70 Gy primary EBRT (prevalence ratio 1.9; 95% confidence interval 1.2-3.0). Of the men treated with salvage EBRT, 10% (20 of 197) reported urethral pain. Conclusions: Survivors treated with EBRT + BT had a higher risk for urethral pain compared with those treated with EBRT. The symptom prevalence decreased with longer time to follow-up. We found a relationship between fractionation-corrected urethral dose and pain. Among long-term prostate cancer survivors, the occurrence of pain was not increased above the background rate for prostatic urethral

  11. Use and outcomes of amplatz renal dilator for treatment of urethral strictures

    PubMed Central

    Akkoc, Ali; Aydin, Cemil; Kartalmıs, Mahir; Topaktas, Ramazan; Altin, Selcuk; Yilmaz, Yakup

    2016-01-01

    ABSTRACT Introduction Urethral stricture disease is still a major problem in men. Many procedures are available for the treatment of urethral strictures; urethral dilatation is one of the oldest. The blind dilatation of urethral strictures may be a difficult and potentially dangerous procedure. The purpose of this study was to describe safe urethral dilatation using amplatz renal dilator and to report outcomes. Materials and Methods From 2010 to 2014, a total of 26 men with primary urethral strictures were managed by urethral dilatation using amplatz renal dilators. The parameters analyzed included presentation of patients, retrograde urethrography (RGU) findings, pre-and postoperative maximum flow rate (Qmax) on uroflowmetry (UF) and post-void residual urine (PVR). Patients were followed-up at 1.6 and 12 months. The technique described in this paper enables such strictures to be safely dilated after endoscopic placement of a suitable guidewire and stylet over which amplatz renal dilators are introduced. Results The mean age of the patients was 57.6 (35–72) years. The median stricture length was 0.82 (0.6–1.5)cm. Pre-operative uroflowmetry showed Qmax of 7.00 (4–12) mL/sec and ultrasonography showed PVR of 75.00 (45–195)mL. Postoperatively, Qmax improved to 18.00 (15–22)mL/sec (p<0.001) at 1 month, 17.00 (13–21)mL/sec (p<0.001) at 6 months and 15.00 (12–17)mL/sec (p<0.001) at 12 months. The post-operative PVR values were 22.50 (10–60)mL (p<0.001), 30.00 (10–70)mL (p<0.001) and 30.00 (10–70) mL (p<0.001) at 1.6 12 months, respectively. The median procedure time was 15.00 (12–22) minutes. None of the patients had a recurrence during a 12-month period of follow-up. Conclusion Urethral dilatation with amplatz renal dilators avoids the risks associated with blind dilatation techniques. This tecnique is a safe, easy, well-tolerated and cost-effective alternative for treatment of urethral strictures. PMID:27256192

  12. Types of Traumatic Lens Dislocations at Larkana.

    PubMed

    Shah, Syed Imtiaz Ali; Shah, Shujaat Ali; Rai, Partab; Siddiqui, Shahid Jamal; Abbasi, Safdar Ali; Katpar, Naeem Akhtar

    2016-08-01

    The objective of this study was to determine the pattern of traumatic lens dislocations presenting at our institute. This may help develop the preventive strategies. The number of cases of traumatic lens dislocations, presented at the Department of Ophthalmology, Chandka Medical College, Larkana, Pakistan, from January 2002 to June 2015, were 59 including 61.02% (n=36) males and 38.98% (n=23) females. Cause of trauma was wood or plant impalement in 35.6% (n=21) cases, cracker blast in 13.55% (n=8) cases, fall on ground in 11.86% (n=7) cases, penetrating injuries with needle, scissors or knife in 10.16% (n=6) cases, road traffic accidents in 10.16% (n=6) cases, sports injuries (cricket ball and gulle danda) in 8.47% (n=5) cases, firearm injuries in 5.1% (n=3) cases, and fist hitting in 5.1% (n=3) cases. Lens was dislocated posteriorly in 33.90% (n=20) cases, anteriorly in 25.42% (n=15) cases, inferiorly in 11.86% (n=7) cases, medially in 10.17% (n=6) cases, laterally in 10.17% (n=6) cases, superiorly in 6.78% (n=4) cases, and a single (1.69%) case of lenticele was seen. PMID:27539772

  13. Relationship between development of urethral stricture after transurethral resection of prostate and glycemic control

    PubMed Central

    Kumsar, Şükrü; Sağlam, Hasan Salih; Köse, Osman; Budak, Salih; Adsan, Oztuğ

    2014-01-01

    Objectives: The purpose of this study is to investigate the association of glycemic control prior to TUR-P and postoperative urethral stricture development. Materials and Methods: Of the 168 patients with a diagnosis of urethral stricture, who underwent internal urethrotomy in our hospital were retrospectively analyzed for this study. 98 patients who underwent monopolar TUR-P in our hospital previously and were developed urethral stricture were divided into two groups as diabetic and nondiabetic. Based on their HbA1c concentrations, diabetics were allocated to two groups with good (HbA1c ≤6.5%) or poor (HbA1c > 6,5%) glycemic control. Time to internal urethrotomy and the other operative parameters were compared among groups. Results: Time to internal urethrotomy after TUR-P was significantly shorter in diabetic patients with poor glycemic control than Group 1 and Group 2 (P = 0,02, P = 0,012) but no significant difference was found between Group 1 and Group 2 (P = 0,368). There was no significant difference in the mean diagnosed and resected prostate wight among groups There was no significant difference in the mean resection time and the mean time to urethral catheter removal among groups. Conclusions: Especially in poor glycemic control patients, urethral stricture development was seen in the early period after TUR-P. For this reason, in the elective TUR-P scheduled poor glycemic controlled patients the operation should be done after glycemic control. PMID:25371609

  14. Characterisation of Neisseria gonorrhoeae in semen during urethral infection in men.

    PubMed Central

    Isbey, S F; Alcorn, T M; Davis, R H; Haizlip, J; Leone, P A; Cohen, M S

    1997-01-01

    OBJECTIVE: To determine the number of Neisseria gonorrhoeae organisms in urine and semen in men with gonococcal urethritis, and to compare selected phenotypic characteristics of organisms harvested from the urethra and semen. DESIGN: Samples from two groups of subjects were examined. Patients with symptomatic urethritis receiving treatment at an STD clinic, as well as six subjects with experimental urethritis. Semen and urine specimens were obtained after the urethral exudate was sampled. RESULTS: Using quantitative cultures, we found an average of 6 x 10(6) gonococci in urine or semen of 17 men with symptomatic urethritis seeking treatment at an STD clinic, and 2 x 10(4) gonococci in secretions of six male subjects with early experimental infection. Gonococcal outer membrane opacity (Opa) proteins and lipo-oligosaccharide (LOS) recovered from urine and semen of these subjects were very similar. CONCLUSIONS: Men with symptomatic gonorrhoea excrete a large number of gonococci in semen which is not affected by the duration of symptoms. The similar phenotype of organisms in urine and semen suggests the bacteria come from the same compartment. These data help to explain the efficiency of gonococcal transmission from men to their partners, and identify an appropriate target for a preventative vaccine or immunotherapy designed to reduce the inoculum in infected patients. Images PMID:9534748

  15. Effect of Ovariectomy on External Urethral Sphincter Activity in Anesthetized Female Rats

    PubMed Central

    Cheng, Chen-Li; de Groat, William C.

    2011-01-01

    Purpose The postmenopausal hypoestrogen condition is associated with various lower urinary tract dysfunctions, including frequency, urgency, stress urinary incontinence and recurrent urinary infection. We determined whether hypoestrogen induced lower urinary tract dysfunction after ovariectomy is also associated with an alteration in external urethral sphincter activity. Materials and Methods Bilateral ovariectomy was performed in female Sprague-Dawley® rats and sham operated rats served as controls. Transvesical cystometry and external urethral sphincter electromyogram activity were monitored 4, 6 and 12 weeks after sham operation or bilateral ovariectomy and at 6 weeks in bilaterally ovariectomized rats treated with estrogen. Results The micturition reflex was elicited in sham operated and bilaterally ovariectomized, urethane anesthetized animals. Post-void residual urine increased and voiding efficiency decreased in rats with 4 to 12 weeks of bilateral ovariectomy. The silent period of external urethral sphincter electromyogram activity was shortened significantly and progressively at increased times after bilateral ovariectomy. These effects were prevented by estradiol treatment. Conclusions As evidenced by shortening of the external urethral sphincter electromyogram silent period in ovariectomized rats, the disruption of coordination between the external urethral sphincter and the detrusor muscle could decrease urine outflow and in turn voiding efficiency. Estrogen replacement reverses these changes, suggesting that the central pathways responsible for detrusor-sphincter coordination are modulated by gonadal hormones. PMID:21600603

  16. Posttraumatic persistent shoulder pain: Superior labrum anterior-posterior (SLAP) lesions

    PubMed Central

    Gulacti, Umut; Can, Cagdas; Erdogan, Mehmet Ozgur; Lok, Ugur; Buyukaslan, Hasan

    2013-01-01

    Patient: Male, 57 Final Diagnosis: Typ 2 Superior labrum anterior-posterior lesion Symptoms: Shoulder pain after trauma Medication: — Clinical Procedure: — Specialty: Orthopedics and Traumatology • Emergency Medicine Objective: Rare disease Background: Due to the anatomical and biomechanical characteristics of the shoulder, traumatic soft-tissue lesions are more common than osseous lesions. Superior labrum anterior-posterior (SLAP) lesions are an uncommon a cause of shoulder pain. SLAP is injury or separation of the glenoid labrum superior where the long head of biceps adheres. SLAP lesions are usually not seen on plain direct radiographs. Shoulder MRI and magnetic resonance arthrography are useful for diagnosis. Case Report: A 57-year-old man was admitted to the emergency department due to a low fall on his shoulder. In physical examination, active and passive shoulder motion was normal except for painful extension. Anterior-posterior shoulder x-ray imaging was normal. The patient required orthopedics consultation in the emergency observation unit due to persistent shoulder pain. In shoulder MRI, performed for diagnosis, type II lesion SLAP was detected. The patient was referred to a tertiary hospital due to lack of arthroscopy in our hospital. Conclusions: Shoulder traumas are usually soft-tissue injuries with no findings in x-rays. SLAP lesion is an uncommon cause of traumatic shoulder pain. For this reason, we recommend orthopedic consultation in post-traumatic persistent shoulder pain. PMID:23961305

  17. Isolated Posterior Fossa Involvement in Posterior Reversible Encephalopathy Syndrome

    PubMed Central

    Shimizu, Yukie; Tha, Khin Khin; Iguchi, Akihiro; Cho, Yuko; Yoshida, Atsushi; Fujima, Noriyuki; Tsukahara, Akiko; Shirato, Hiroki; Terae, Satoshi

    2013-01-01

    Summary Posterior reversible encephalopathy syndrome (PRES) is characterized by reversible vasogenic edema affecting the subcortical white matter of bilateral occipital and parietal lobes. We describe a case of isolated posterior fossa involvement of PRES which occurred during remission induction chemotherapy for T-cell acute lymphoblastic leukemia. Both the brainstem and cerebellum were extensively involved, but the supratentorial structures were completely spared. The follow-up magnetic resonance images revealed reversibility of most lesions. The knowledge of atypical radiological features of PRES is essential for prompt diagnosis. PMID:24199811

  18. Urethritis-associated Pathogens in Urine from Men with Non-gonococcal Urethritis: A Case-control Study.

    PubMed

    Frølund, Maria; Lidbrink, Peter; Wikström, Arne; Cowan, Susan; Ahrens, Peter; Jensen, Jørgen Skov

    2016-06-15

    The aetiology of non-gonococcal urethritis (NGU) remains unexplained in 30-40% of patients. Urine samples from men attending Swedish sexually transmitted disease clinics were examined by species-specific quantitative PCRs for Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis, Ureaplasma urealyticum, U. parvum, adenovirus, herpes simplex virus, Neisseria meningitidis, Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae. A total of 187 men with acute NGU (symptoms ≤ 30 days) and 24 with chronic NGU (symptoms < 30 days) were cases, and 73 men without NGU were controls. Number of lifetime sexual partners was negatively associated with U. urealyticum bacterial load. C. trachomatis and M. genitalium were associated with NGU, as was U. urealyticum, with bacterial loads ≥ 1.3 × 103 genome equivalents/ml urine. Virus and H. influenzae might explain a few NGU cases, but the aetiology in at least 24% of patients with acute NGU was unexplained. In multivariate analysis, detection of U. urealyticum was significantly more common in acute NGU (20%) compared with controls (11%). PMID:26658669

  19. Posterior polar cataract: A review

    PubMed Central

    Kalantan, Hatem

    2011-01-01

    Posterior polar cataract is a rare form of congenital cataract. It is usually inherited as an autosomal dominant disease, yet it can be sporadic. Five genes have been attributed to the formation of this disease. It is highly associated with complications during surgery, such as posterior capsule rupture and nucleus drop. The reason for this high complication rate is the strong adherence of the opacity to the weak posterior capsule. Different surgical strategies were described for the handling of this challenging entity, most of which emphasized the need for gentle maneuvering in dealing with these cases. It has a unique clinical appearance that should not be missed in order to anticipate, avoid, and minimize the impact of the complications associated with it. PMID:23960967

  20. Rethinking "posterior" tongue-tie.

    PubMed

    Douglas, Pamela Sylvia

    2013-12-01

    Currently, many clinicians who help with breastfeeding problems are diagnosing "posterior" tongue-tie in infants and performing or referring for frenotomy. In this "Speaking Out" article, I argue that the diagnosis of "posterior" tongue-tie has successfully raised awareness of the importance of impaired tongue function in breastfeeding difficulty. However, the diagnosis of "posterior" tongue-tie also applies a reductionist, medicalized theoretical frame to the complex problem of impaired tongue function, risking unintended outcomes. Impaired tongue function arises out of multiple interacting and co-evolving factors, including the interplay between social behaviors concerning breastfeeding and mother-infant biology. Consideration of theoretical frames is vital if we are to build an evidence base through efficient use of the scarce resources available for clinical breastfeeding research and minimize unintended outcomes. PMID:24143939

  1. Combined Use of the Mathieu and Incised Urethral Plate Techniques for Repair of Distal Penile Hypospadias.

    PubMed

    Nilamani, Mohanty; Bhusan, Nayak Bibhuti; Annadaprasad, Patnaik

    2015-12-01

    Though both the Mathieu and incised urethral plate techniques are individually described for single-stage repair of distal penile hypospadias, each has its own shortcomings. We describe the combination of the two techniques by taking their advantages and reducing their limitations. Thirteen patients belonging to the age group of 3-22 years with distal penile hypospadias and mild chordee were operated by this technique with a mean follow-up of 8 months. One patient had urethrocutaneous fistula, and another patient had partial skin necrosis which healed spontaneously without fistula. Both of these complications occurred in adult patients. None developed urethral stenosis, and the cosmesis of the glans was excellent in all cases. This technique is very helpful in patients having small flat glans and shallow urethral groove. PMID:26730091

  2. Feline urethral plugs and bladder uroliths: A review of 5484 submissions 1998–2003

    PubMed Central

    Houston, Doreen M.; Moore, Andrew E.P.; Favrin, Michael G.; Hoff, Brent

    2003-01-01

    The results of 5484 submissions from cats to the Canadian Veterinary Urolith Centre between February 1998 and February 2003 are presented. Of the submissions, 618 were urethral plugs and 4866 were bladder uroliths. The majority of the urethral plugs were from male domestic shorthair and longhair cats. Approximately 50% of the urolith submissions were oxalate, 44% were struvite. Oxalate uroliths were the most common mineral type in males and in Himalayan, Persian, and Siamese cats. Struvite uroliths were the most common mineral type in domestic shorthair and longhair cats. Females outnumbered males by 1.4:1 in struvite urolith submissions. A review of risk factors for urethral plugs and bladder uroliths is presented. PMID:14703082

  3. 2015 UK National Guideline on the management of non-gonococcal urethritis.

    PubMed

    Horner, P; Blee, K; O'Mahony, C; Muir, P; Evans, C; Radcliffe, K

    2016-02-01

    We present the updated British Association for Sexual Health and HIV guideline for the management of non-gonococcal urethritis in men. This document includes a review of the current literature on its aetiology, diagnosis and management. In particular it highlights the emerging evidence that azithromycin 1 g may result in the development of antimicrobial resistance in Mycoplasma genitalium and that neither azithromycin 1 g nor doxycycline 100 mg twice daily for seven days achieves a cure rate of >90% for this micro-organism. Evidence-based diagnostic and management strategies for men presenting with symptoms suggestive of urethritis, those confirmed to have non-gonococcal urethritis and those with persistent symptoms following first-line treatment are detailed. PMID:26002319

  4. Erbium:YAG laser incision of urethral strictures: early clinical results

    NASA Astrophysics Data System (ADS)

    Munoz, John A.; Riemer, Jennifer D.; Hayes, Gary B.; Negus, Dan; Fried, Nathaniel M.

    2007-02-01

    Two cases involving Erbium:YAG laser incision of proximal bulbar urethral strictures are described. Erbium:YAG laser radiation with a wavelength of 2.94 μm, pulse energy of 10 mJ, and a pulse repetition rate of 15 Hz, was delivered through a 2-m-long, 250-μm-core sapphire optical fiber in contact with tissue. Total laser irradiation time was 5 min. The first patient suffering from a virgin urethral stricture was treated and is stricture-free. The second patient suffering from a recurrent urethral stricture required further treatment. This case report describes the first clinical application of the Er:YAG laser in urology.

  5. Clinical evaluation of Apamarga-Ksharataila Uttarabasti in the management of urethral stricture

    PubMed Central

    Reddy, K. Rajeshwar

    2013-01-01

    Stricture urethra, though a rare condition, still is a rational and troublesome problem in the international society. Major complications caused by this disease are obstructed urine flow, urine stasis leading to urinary tract infection, calculi formation, etc. This condition can be correlated with Mutramarga Sankocha in Ayurveda. Modern medical science suggests urethral dilatation, which may cause bleeding, false passage and fistula formation in few cases. Surgical procedures have their own complications and limitations. Uttarabasti, a para-surgical procedure is the most effective available treatment in Ayurveda for the diseases of Mutravaha Strotas. In the present study, total 60 patients of urethral stricture were divided into two groups and treated with Uttarabasti (Group A) and urethral dilatation (Group B). The symptoms like obstructed urine flow, straining, dribbling and prolongation of micturation were assessed before and after treatment. The results of the study were significant on all the parameters. PMID:24250127

  6. Clinical evaluation of Apamarga-Ksharataila Uttarabasti in the management of urethral stricture.

    PubMed

    Reddy, K Rajeshwar

    2013-04-01

    Stricture urethra, though a rare condition, still is a rational and troublesome problem in the international society. Major complications caused by this disease are obstructed urine flow, urine stasis leading to urinary tract infection, calculi formation, etc. This condition can be correlated with Mutramarga Sankocha in Ayurveda. Modern medical science suggests urethral dilatation, which may cause bleeding, false passage and fistula formation in few cases. Surgical procedures have their own complications and limitations. Uttarabasti, a para-surgical procedure is the most effective available treatment in Ayurveda for the diseases of Mutravaha Strotas. In the present study, total 60 patients of urethral stricture were divided into two groups and treated with Uttarabasti (Group A) and urethral dilatation (Group B). The symptoms like obstructed urine flow, straining, dribbling and prolongation of micturation were assessed before and after treatment. The results of the study were significant on all the parameters. PMID:24250127

  7. Post traumatic stress disorder.

    PubMed

    Tiller, J; Kyrios, M; Bennett, P

    1996-10-01

    Post traumatic stress disorder (PTSD) occurs after a person has been exposed to a traumatic event involving actual or threatened death, and has responded with intense fear or helplessness. The event is then persistently re-experienced. The person avoids stimuli associated with the trauma and experiences a numbing of general responsiveness. Symptoms of increased arousal can occur as well as depression and anxiety. PTSD causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The general practitioner is uniquely placed to identify PTSD and can have a key role in treatment. Cognitive behavioural treatment is a central therapeutic approach and can be carried out in general practice. The issues are to counteract the physiological components, expose the patient to the feared situation and help the patient to relearn that the stimuli are not necessarily associated with danger or threat. Repeated brief consultations over time can facilitate this process. PMID:8936738

  8. Traumatic insemination in terrestrial arthropods.

    PubMed

    Tatarnic, Nikolai J; Cassis, Gerasimos; Siva-Jothy, Michael T

    2014-01-01

    Traumatic insemination is a bizarre form of mating practiced by some invertebrates in which males use hypodermic genitalia to penetrate their partner's body wall during copulation, frequently bypassing the female genital tract and ejaculating into their blood system. The requirements for traumatic insemination to evolve are stringent, yet surprisingly it has arisen multiple times within invertebrates. In terrestrial arthropods traumatic insemination is most prevalent in the true bug infraorder Cimicomorpha, where it has evolved independently at least three times. Traumatic insemination is thought to occur in the Strepsiptera and has recently been recorded in fruit fly and spider lineages. We review the putative selective pressures that may have led to the evolution of traumatic insemination across these lineages, as well as the pressures that continue to drive divergence in male and female reproductive morphology and behavior. Traumatic insemination mechanisms and attributes are compared across independent lineages. PMID:24160423

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

    PubMed Central

    Marshall, Stephen D.; Raup, Valary T.

    2015-01-01

    Asopa described the inlay of a graft into Snodgrass’s longitudinal urethral plate incision using a ventral sagittal urethrotomy approach in 2001. He claimed that this technique was easier to perform and led to less tissue ischemia due to no need for mobilization of the urethra. This approach has subsequently been popularized among reconstructive urologists as the dorsal inlay urethroplasty or Asopa technique. Depending on the location of the stricture, either a subcoronal circumferential incision is made for penile strictures, or a midline perineal incision is made for bulbar strictures. Other approaches for penile urethral strictures include the non-circumferential penile incisional approach and a penoscrotal approach. We generally prefer the circumferential degloving approach for penile urethral strictures. The penis is de-gloved and the urethra is split ventrally to exposure the stricture. It is then deepened to include the full thickness of the dorsal urethra. The dorsal surface is made raw and grafts are fixed on the urethral surface. Quilting sutures are placed to further anchor the graft. A Foley catheter is placed and the urethra is retubularized in two layers with special attention to the staggering of suture lines. The skin incision is then closed in layers. We have found that it is best to perform an Asopa urethroplasty when the urethral plate is ≥1 cm in width. The key to when to use the dorsal inlay technique all depends on the width of the urethral plate once the urethrotomy is performed, stricture etiology, and stricture location (penile vs. bulb). PMID:26816804

  10. Photodynamic therapy of urethral condylomata acuminata using topically 5-aminolevulinic acid

    NASA Astrophysics Data System (ADS)

    Wang, Xiuli; Wang, Hongwei; Wang, Haishan; Xu, Shizheng; Liao, Kanghuang; Hillemanns, Peter

    2005-07-01

    Background Electrocoagulation and laser evaporation for urethral condylomata acuminata have high recurrence rates and can be associated with urethral malformations. Objective To investigate the effect of photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) on urethral condylomata acuminata and to examine the histological changes in lesions of condylomata acuminata after ALA-PDT. Methods One hundred and sixty-four urethral condylomata patients were given topical ALA followed by intraurethral PDT through a cylindrical fiber. Among the cases, 16 penile and vulval condylomatous lesions in 11 patients were treated with topical ALA-PDT at same time. After the treatment, biopsy specimens were collected from the 16 penile and vulval lesions. The histological changes were then evaluated by light microscope and electron microscope. Results The complete response rate for urethral condylomata by topical ALA-PDT was 95.12% and the recurrence rate was 5.13% after 6 to 24 months follow-up. Keratinocytes in middle and upper layers of the epidermis with marked vacuolation and some necrocytosis were detected one and three hours after PDT. Necrosis in all layers of the epidermis was noted five hours after PDT by microscopy. In electron microscopy of kerationcytes, distinct ultrastructural abnormalities of mitochondrion, endoplasmic reticulum and membrane damage were observed. Apoptotic bodies were detected three hours after PDT and a large number of the keratinocytes exhibited necrosis five hours after PDT by electron microscope. Conclusions Results suggests that topical ALA-PDT is a simple, effective, relatively safe, less recurrent and comparatively well tolerated treatment for urethral condylomata acuminata. The mechanisms might be that ALA-PDT could trigger apoptotic process and necrosis in the HPV infected keratinocytes. Key words:

  11. Urethral complications after tension-free vaginal tape procedures: A surgical management case series

    PubMed Central

    Sergouniotis, Fotios; Jarlshammar, Björn; Larsson, Per-Göran

    2015-01-01

    AIM: To analyze the clinical features, diagnostic modalities, and the surgical management of urethral complications after tension-free vaginal tape procedures. METHODS: This study encompasses a retrospective review of nine patients presented with urethral complications after midurethral sling procedures. The patients underwent the procedures during a period from 1999 to 2012 in three different regional hospitals in the southwest part of Sweden. The time from sling placement to diagnosis, the risk factors, clinical features, diagnosis, surgical management, and functional outcome are presented. The presenting symptoms were described as either early onset (< 12 mo) or late onset (> 12 mo) according to when they were first reported. RESULTS: Eight cases of urethral erosion and one case of bladder-neck erosion were detected. The mean interval for diagnoses of the erosions ranged from 3 mo to 11 years. The most common presenting symptoms included de novo urgency with or without incontinence (7/9 patients), urinary retention/voiding dysfunction (4/9 patients), urethritis (4/9 patients), relapse of stress-incontinence (3/9 patients), recurrent urinary tract infections (5/9 patients), and hematuria (1/9 patient). In most cases, voiding dysfunction and urethritis occurred early after the operation. The surgical management applied in most cases was transurethral resection of the intraurethral part of the mesh. The removal of the intraurethral mesh resulted in improvement or complete cure of urgency symptoms in 5/7 patients with urgency. Four patients were reoperated with a new stress-incontinence surgery, one with laparoscopic Burch, and three with retropubic tension-free vaginal tape procedures. CONCLUSION: Urethral complications should be suspected in the case of de novo urgency and relapse of stress-incontinence. Transurethral excision of the intraurethral mesh is the recommended treatment. PMID:26167464

  12. Orandi flap for penile urethral stricture: Polishing the gold standard

    PubMed Central

    Goel, Apul; Kumar, Manoj; Singh, Manmeet

    2015-01-01

    Introduction: We describe the combined use of the Orandi flap and the scrotal skin advancement flap to reduce complications for pendulous urethral stricture in men >40 years old. Methods: Over the last 40 months, 10 men underwent urethroplasty for pendulous stricture by the modified Orandi urethroplasty. In this, additionally, a midline hairless scrotal skin flap of the size of the ventral skin defect on the pendulous portion was raised based on the dartos fascia. This flap was mobilized so that it reached the pendulous portion without tension and covered the penile defect. The catheter was removed after 4 weeks. Patients were followed every 3 months using uroflowmetry and the American Urological Association (AUA) symptom score. Results: The mean age was 55.5. Of the 10 patients, the etiology was post-catheterization in 5 and idiopathic in the remaining 5. Three men also had stricture extending into the bulbous urethra (repaired using buccal graft). The mean additional time needed for the flap coverage was 36.2 minutes (range: 30–45). The median follow-up was 12 months (range: 3–40). The mean postoperative symptom score was 5.2 and the mean flow rate was 20.1 mL/sec. In 2 men, the meatus got retracted to the distal penile part (probably due to downward traction by scrotal skin). No patient complained of disfigurement. Two men reported recurrence (1 each in bulbous and penile urethra). The limitations are small number of patients and the observational nature of this study. Conclusions: The intermediate-term results show that the modified Orandi urethroplasty is an acceptable treatment option with acceptable cosmetic results. PMID:26085873

  13. [Effects of traumatic stress].

    PubMed

    Herbst, Gesa; Jaeger, Ulrich; Leichsenring, Falk; Streeck-Fischer, Annette

    2009-01-01

    The diagnosis PTSD does not adequately describe the impact of exposure to childhood trauma of the developing child. The objective of the study was to examine the prevalence of different interpersonal trauma types and to describe the long-term effects of maltreatment and neglect in a clinical sample of 34 adolescents. The majority (62%) of the sample was exposed to two different types of trauma during childhood. Emotional abuse and emotional neglect have been the most common trauma types (59%; 53%). 71% of the traumatized adolescents did not meet the criteria for PTSD. The most common diagnosis in the sample was Borderline Personality Disorder. All average scores at SCL-90-Symptom-Scale were clinical significant. Half of the sample reported suicide attempts and self destructive behavior. One third reported substance abuse and aggressive behavior against others respectively. None of the traumatized adolescents had a positive Self-concept. Altogether the results show that abused children and adolescents have a range of psychological sequelae that are not captured in the PTSD diagnostic criteria. Therefore the results support the necessity for a new and more precise diagnosis for chronically traumatized children and adolescents. PMID:19961125

  14. Traumatic brain injury

    PubMed Central

    Risdall, Jane E.; Menon, David K.

    2011-01-01

    There is an increasing incidence of military traumatic brain injury (TBI), and similar injuries are seen in civilians in war zones or terrorist incidents. Indeed, blast-induced mild TBI has been referred to as the signature injury of the conflicts in Iraq and Afghanistan. Assessment involves schemes that are common in civilcian practice but, in common with civilian TBI, takes little account of information available from modern imaging (particularly diffusion tensor magnetic resonance imaging) and emerging biomarkers. The efficient logistics of clinical care delivery in the field may have a role in optimizing outcome. Clinical care has much in common with civilian TBI, but intracranial pressure monitoring is not always available, and protocols need to be modified to take account of this. In addition, severe early oedema has led to increasing use of decompressive craniectomy, and blast TBI may be associated with a higher incidence of vasospasm and pseudoaneurysm formation. Visual and/or auditory deficits are common, and there is a significant risk of post-traumatic epilepsy. TBI is rarely an isolated finding in this setting, and persistent post-concussive symptoms are commonly associated with post-traumatic stress disorder and chronic pain, a constellation of findings that has been called the polytrauma clinical triad. PMID:21149359

  15. Delayed traumatic diaphragmatic hernia

    PubMed Central

    Lu, Jing; Wang, Bo; Che, Xiangming; Li, Xuqi; Qiu, Guanglin; He, Shicai; Fan, Lin

    2016-01-01

    Abstract Background: Traumatic diaphragmatic hernias (TDHs) are sometimes difficult to identify at an early stage and can consequently result in diagnostic delays with life-threatening outcomes. It is the aim of this case study to highlight the difficulties encountered with the earlier detection of traumatic diaphragmatic hernias. Methods: Clinical data of patients who received treatment for delayed traumatic diaphragmatic hernias in registers of the First Affiliated Hospital of Xi’an Jiaotong University from 1998 to 2014 were analyzed retrospectively. Results: Six patients were included in this study. Left hemidiaphragm was affected in all of them. Most of the patients had a history of traffic accident and 1 a stab-penetrating injury. The interval from injury to developing symptoms ranged from 2 to 11 years (median 5 years). The hernial contents included the stomach, omentum, small intestine, and colon. Diaphragmatic injury was missed in all of them during the initial managements. All patients received operations once the diagnosis of delayed TDH was confirmed, and no postoperative mortality was detected. Conclusions: Delayed TDHs are not common, but can lead to serious consequences once occurred. Early detection of diaphragmatic injuries is crucial. Surgeons should maintain a high suspicion for injuries of the diaphragm in cases with abdominal or lower chest traumas, especially in the initial surgical explorations. We emphasize the need for radiographical follow-up to detect diaphragmatic injuries at an earlier stage. PMID:27512848

  16. The Use of Flaps and Grafts in the Treatment of Urethral Stricture Disease

    PubMed Central

    Wisenbaugh, Eric S.; Gelman, Joel

    2015-01-01

    The use of various grafts and flaps plays a critical role in the successful surgical management of urethral stricture disease. A thorough comprehension of relevant anatomy and principles of tissue transfer techniques are essential to understanding the appropriate use of grafts or flaps to optimize outcomes. We briefly review these principles and discuss which technique may be best suited for a given anterior urethral stricture, depending on the location and length of the stricture, the presence or absence of an intact corpus spongiosum, and the availability of adequate and healthy penile skin. PMID:26664357

  17. Anterior Urethrectomy for Primary Carcinoma of the Female Urethra Mimicking a Urethral Caruncle

    PubMed Central

    Shim, Ji Sung; Oh, Mi Mi; Lee, Jeong Gu

    2013-01-01

    Here we report a case of primary carcinoma of the female urethra. A 52-year-old woman presented with a palpable urethral mass associated with intermittent pain that she first experienced a few months prior. Clinical examination showed a urethral mass that appeared to be a caruncle; therefore, simple carunclectomy was performed. However, on histological examination, the mass was revealed to be a squamous cell carcinoma; therefore, anterior urethrectomy was performed. During a 4-year follow-up period, the patient has been well with no dysuria, dyspareunia, or incontinence. PMID:24466468

  18. Laser lithotripsy of a urethral calculus via ischial urethrotomy in a steer.

    PubMed

    Streeter, R N; Washburn, K E; Higbee, R G; Bartels, K E

    2001-09-01

    A steer examined because of obstructive urolithiasis and urethral rupture underwent laser lithotripsy, using a chromium-thulium-holmium:yttrium-aluminum-garnet (Ho:YAG) laser inserted through an ischial urethrotomy. Procedures were performed with caudal epidural anesthesia. Six months after surgery, the urethra was patent with no clinical evidence of urethral stricture or fistula. Ischial urethrotomy provided rapid access to the bladder for catheterization and to the obstructive urolith for lithotripsy. Laser lithotripsy was a rapid and effective means of urolith removal in this steer. PMID:11549094

  19. Urethral foreign body insertion for secondary gain in the incarcerated population.

    PubMed

    Mastromichalis, Michael; Sackman, Daniel; Tycast, James F; Chehval, Micheal J

    2011-10-01

    Not uncommonly, hostile prison environments can lead desperate prisoners to place foreign materials into natural orifices in an effort to gain transfer to an outside healthcare facility. In this article, we present a case series of urethral foreign body insertion of varying burdens and durations requiring transfer to our facility for surgical management. Endoscopic retrieval was the initial management in each case; one case required conversion to open cystotomy for complete removal due the orientation, amount of inserted foreign body, and erosion into the proximal urethral and bladder urothelium. PMID:22018157

  20. [Transurethral prostate resection prior to kidney transplantation leading to urethral cicatricial tissue].

    PubMed

    Schou-Jensen, Katrine; Mohammad, Wael

    2015-01-26

    In Denmark, kidney transplantations in patients above 50 years have increased during the last decade. Consequently, the number of patients with lower urinary tract symptoms due to prostate hypertrophy increases accordingly. We describe two patients, who both had a resection of the prostate while having anuria and waiting for a kidney transplantation from a deceased donor. In both cases it was impossible to place a urethral catheter during the following transplantation due to total urethral occlusion, so a suprapubic catheter was inserted until the scar tissue was dilated or resected by a later transurethral intervention. PMID:25612989

  1. Posterior Tibial Tendon Dysfunction (PTTD)

    MedlinePlus

    ... ACFAS | Información en Español Advanced Search Home » Foot & Ankle Conditions » Posterior Tibial Tendon Dysfunction (PTTD) Text Size ... the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change. ...

  2. Stereolithography for Posterior Fossa Cranioplasty

    PubMed Central

    Agner, Celso; Dujovny, Manuel; Evenhouse, Raymond; Charbel, Fady T.; Sadler, Lewis

    1998-01-01

    Posterior fossa cranioplasty has been suggested for improvement of neurological symptoms following craniectomy. However, there is no particular recommendation in the literature about techniques for prosthesis manufacture and implantation. We report our experience using rapid prototyping technology and stereolithography for pre-surgical implant design and production of cranioplasties. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5 PMID:17171056

  3. Endoscopic management of post-traumatic prostatic and supraprostatic strictures using Neodymium-YAG laser.

    PubMed

    Nabi, Ghulam; Dogra, Prem Nath

    2002-12-01

    We assessed the feasibility, efficacy and long-term results of endoscopic management using Neodymium-YAG (Nd-YAG) laser as a day care procedure in patients with post-traumatic supraprostatic and prostatic strictures. Three patients with post-traumatic prostatic and supraprostatic obliterative strictures underwent Nd-YAG laser core through urethrotomy as a day care procedure. Patient age ranged between 12 and 14 years. Mean duration of injury was 16 months. The length of stricture was assessed by bi-directional endoscopy prior to the procedure in all cases. Core through procedure was carried out using Nd-YAG laser under the guidance of a cystoscope placed antegradely. Patients were discharged on the same day with urethral catheter. Foley catheters were removed at 6 weeks. Nd-YAG laser core through procedure was carried out successfully in all cases with negligible blood loss in a mean time of 48 min. There were no intraoperative or postoperative complications. Patients were discharged on the same day. Follow-up cystogram was conducted at 6 weeks and urethroscopy at months. At a mean follow-up of 23 months, patients were asymptomatic and voiding well. Nd-YAG laser core through urethrotomy is a safe and effective procedure. It is a less invasive alternative to more complex urethroplasty procedures for patients with post-traumatic prostatic and supraprostatic strictures. It can be carried out as a day care procedure in carefully selected patients and has no complications. PMID:12492959

  4. Neglected Posterior Dislocation of Hip in Children - A Case Report

    PubMed Central

    Pal, Chandra Prakash; Kumar, Deepak; Sadana, Ashwani; Dinkar, Karuna Shankar

    2014-01-01

    Introduction: Traumatic dislocation of the hip in children is a rare injury. We report the outcome of 2 patients of neglected hip dislocation which were treated by open reduction and internal fixation by k-wires. Case Report: We treat 2 children both girls (one was of 4 years and other was 7 years of age). In both cases dislocation was unilateral and was not associated with any facture. Both cases were of posterior dislocation. in both cases open reduction and internal fixation was done by k wires. Hip spica was applied post operatively in both cases. The k wire was removed at 3 to 4 weeks. Patients were allowed to bear weight from gradual to full weight bearing after 6 weeks. Conclusion: We conclude that open reduction is a satisfactory treatment for neglected hip dislocation. It prevents not only deformity but also maintains limb length. PMID:27298953

  5. Chronic Traumatic Encephalopathy: The Neuropathological Legacy of Traumatic Brain Injury.

    PubMed

    Hay, Jennifer; Johnson, Victoria E; Smith, Douglas H; Stewart, William

    2016-05-23

    Almost a century ago, the first clinical account of the punch-drunk syndrome emerged, describing chronic neurological and neuropsychiatric sequelae occurring in former boxers. Thereafter, throughout the twentieth century, further reports added to our understanding of the neuropathological consequences of a career in boxing, leading to descriptions of a distinct neurodegenerative pathology, termed dementia pugilistica. During the past decade, growing recognition of this pathology in autopsy studies of nonboxers who were exposed to repetitive, mild traumatic brain injury, or to a single, moderate or severe traumatic brain injury, has led to an awareness that it is exposure to traumatic brain injury that carries with it a risk of this neurodegenerative disease, not the sport or the circumstance in which the injury is sustained. Furthermore, the neuropathology of the neurodegeneration that occurs after traumatic brain injury, now termed chronic traumatic encephalopathy, is acknowledged as being a complex, mixed, but distinctive pathology, the detail of which is reviewed in this article. PMID:26772317

  6. Prevalence of genital Mycoplasma, Ureaplasma, Gardnerella, and human papillomavirus in Japanese men with urethritis, and risk factors for detection of urethral human papillomavirus infection.

    PubMed

    Shigehara, Kazuyoshi; Kawaguchi, Shohei; Sasagawa, Toshiyuki; Furubayashi, Keiichi; Shimamura, Masayoshi; Maeda, Yuji; Konaka, Hiroyuki; Mizokami, Atsushi; Koh, Eitetsu; Namiki, Mikio

    2011-08-01

    To analyze the risk factors for HPV infection in the urethra, we examined the prevalence of various microorganisms, for example Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum, Gardnerella vaginalis, and human papillomavirus (HPV) in Japanese male patients with urethritis, and investigated their sexual backgrounds. Rubbed samples obtained from the distal urethra and questionnaires regarding sexual activity and demographic information were collected from 176 participants. N. gonorrhoeae, C. trachomatis, M. genitalium, M. hominis, U. urealyticum, U. parvum, G. vaginalis, and HPV were detected in 19, 26, 18, 12, 12, 8.5, 14, and 20%, respectively, of all cases in this study. Multivariate logistic regression analysis indicated that more than 4 sexual partners within the last year and presence of N. gonorrhoeae and/or C. trachomatis and/or M. genitalium infections were independent risk factors for urethral HPV infection, with odds ratios of 3.85 (95% CI 1.49-9.94) and 2.41 (95% CI 1.03-5.61), respectively. It is likely that urethral HPV detection is associated with current sexual activity and the presence of N. gonorrhoeae, C. trachomatis, and/or M. genitalium infections. PMID:21213011

  7. Urethral metastasis from a sigmoid colon carcinoma: a quite rare case report and review of the literature

    PubMed Central

    2014-01-01

    Background Urethral metastatic adenocarcinoma is extremely rare. Moreover, only 9 previous cases with metastases from colorectal cancer have been reported to date, and not much information on urethral metastases from colorectum is available so far. Case presentation We report our experience in the diagnosis and the management of the case with urethral metastasis from a sigmoid colon cancer. A 68-year-old man, who underwent laparoscopic sigmoidectomy for sigmoid colon carcinoma four years ago, presented gross hematuria with pain. Urethroscopy identified a papillo-nodular tumor 7 mm in diameter in the bulbar urethra. CT-scan imaging revealed the small mass of bulbous portion of urethra and solitary lung metastasis. Histological examination of the tumor obtained by transurethral resection showed moderately differentiated adenocarcinoma, which was diagnosed as a metastasis of a sigmoid colon carcinoma pathologically by morphological examination. Immunohistochemical analysis of the urethral tumor revealed the positive for cytokertin 20 and CDX2, whereas negative for cytokertin 7. These features were consistent with metastatic adenocarcinoma of the sigmoid colon cancer. As the management of this case with urethral and lung metastasis, 6-cycle of chemotherapy with fluorouracil with leucovorin plus oxaliplatin was administered to the patient, and these metastases were disappeared with no recurrence of disease for 34 months. Conclusion Urethral metastasis from colorectal cancer is a very rare occurrence. However, in the presence of urinary symptoms, the possibility of the urethral metastasis should be considered. PMID:24884559

  8. The appearances on ultrasound of the female urethral sphincter.

    PubMed

    Leonor de Gonzalez, E; Cosgrove, D O; Joseph, A E; Murch, C; Naik, K

    1988-08-01

    A rounded or ovoid midline structure with mean measurements of 1.30 cm x 1.33 cm x 0.96 cm in longitudinal, transverse and antero-posterior dimensions was routinely imaged at the bladder base in 97 female patients on pelvic ultrasound examination. Its position and appearance are reminiscent of a smaller version of the male prostate, and it has been dubbed the "female pseudoprostate". It appears to correspond with the external rhabdo-sphincter of the bladder. Its rounded shape may be confusing but it should not be misread as pathological. PMID:3046696

  9. FKBP5 Genotype and Structural Integrity of the Posterior Cingulum

    PubMed Central

    Fani, Negar; King, Tricia Z; Reiser, Emily; Binder, Elisabeth B; Jovanovic, Tanja; Bradley, Bekh; Ressler, Kerry J

    2014-01-01

    Alterations in the microarchitecture of the posterior cingulum (PC), a white matter tract proximal to the hippocampus that facilitates communication between the entorhinal and cingulate cortices, have been observed in individuals with psychiatric disorders, such as depression and post-traumatic stress disorder (PTSD). PC decrements may be a heritable source of vulnerability for the development of affective disorders; however, genetic substrates for these white matter abnormalities have not been identified. The FKBP5 gene product modulates glucocorticoid receptor function and has been previously associated with differential hippocampal structure, function, and affect disorder risk. Thus, FKBP5 is an attractive genetic target for investigations of PC integrity. We examined associations between PC integrity, measured through diffusion tensor imaging (DTI) and fractional anisotropy (FA; an index of white matter integrity), and polymorphisms in the FKBP5 SNP rs1360780 in a sample of 82 traumatized female civilians. Findings indicated that, compared with individuals without this allele, individuals who carried two ‘risk' alleles for this FKBP5 SNP (T allele; previously associated with mood and anxiety disorder risk) demonstrated significantly lower FA in the left PC, even after statistically controlling for variance associated with age, trauma exposure, and PTSD symptoms. These data suggest that specific allelic variants for an FKBP5 polymorphism are associated with decrements in the left PC microarchitecture. These white matter abnormalities may be a heritable biological marker that indicates increased vulnerability for the development of psychiatric disorders, such as PTSD. PMID:24253961

  10. Traumatic fat embolism syndrome.

    PubMed

    Al-Khuwaitir, Tarig S; Al-Moghairi, Abdurahman M; Sherbeeni, Suphia M; Subh, Hamed M

    2002-12-01

    Traumatic fat embolism syndrome occurs most often following fractures of long bones sustained in road traffic accidents and is a common cause of medical consultation from the orthopedic surgery department. The sub-clinical presentation is subtle and expresses itself by the presence of hypoxemia, while the full clinical syndrome compromises respiratory insufficiency, an altered consciousness and a characteristic petechial rash. Recognition is simple once the patient is viewed in the context of his or her clinical setting. Diagnosis is aided further by the presence of hematological and biochemical abnormalities including anemia, thrombocytopenia, an elevated erythrocyte sedimentation rate and fat macroglobulinemia. Imaging by chest radiograph, computed tomography or magnetic resonance of the brain is used to confirm the extent of the respective organ involvement and to exclude alternative pathologies. The release of free fatty acids into the circulation and their subsequent effects is the key pathological event. Treatment is based on supportive care and high-dose corticosteroid therapy. We report a patient with traumatic fat embolism syndrome who developed the syndromes classical symptoms and signs following fracture of the long bones of his left lower leg. Admission to an intensive care unit, mechanical ventilatory support with positive end-expiratory pressure and corticosteroid therapy lead to his improvement and allowed eventual open reduction and internal fixation and discharge of our patient. Modern therapy offers a relatively good prognosis for patients with traumatic fat embolism syndrome; the optimal dose and timing of corticosteroid therapy in prophylaxis and treatment however, remain the subject of intense debate. PMID:12518208

  11. Rotational and Axial Pattern Flaps in a Cat for Wound Reconstruction Secondary to Urethral Rupture.

    PubMed

    Watrous, Gwyneth K; Martin, Dawn M; Plesman, Rhea L; Ringwood, Brendon

    2016-01-01

    A 3 yr old intact male domestic shorthair cat was presented with urine extravasation from urethral rupture. Extensive skin necrosis developed in the perineal region and left hind limb that necessitated delayed primary wound closure with a caudal superficial epigastric axial pattern flap, scrotal and preputial rotational skin flaps, and perineal urethrostomy. PMID:26606210

  12. Vesicostomy as a Treatment Option for Epidermolisis Bullosa Case With Urethral and Meatal Involvement.

    PubMed

    Moradi, Mahmoudreza; Rezaee, Haress; Kaseb, Kaveh; Ebrahimi, Ali

    2016-07-01

    Epidermolisis Bullosa (EB) is a rare hereditary disorder that its junctional type is very rare one that involves epithelium, however, genitourinary epithelium involvement occurs so rarely. The present case is 5-year old boy; a known case of junctional EB whom had recurrent urinary retention due to meatal and urethral stenosis that was deteriorated by therapeutically interventions. PMID:27335789

  13. Anastomotic Urethroplasty in Female Urethral Stricture Guided by Cystoscopy – A Point of Technique

    PubMed Central

    Patil, Sachin; Dalela, Deepansh; Dalela, Divakar; Goel, Apul; Sankhwar, Pushpalata; Sankhwar, Satya N.

    2013-01-01

    Purpose: During anastomotic urethroplasty for stricture urethra with false passage using standard technique, there remains a chance of anastomosis of normal distal urethra to proximal false lumen. Herein, we present a point of technique in which by using antegrade cystoscope, one cannot just identify and dissect normal anatomical proximal urethral lumen, but also perform some of the steps for anastomosis under direct vision. This will avoid making anastomosis to false lumen and thus leading to further complications. Materials and Methods: We report a case of 35-years-female who was presented to us with total mid-urethral stricture with false passage following multiple urethral dilatation attempts. We used antegrade cystoscopy during anastomotic urethroplasty to identify and dissect the proximal end of urethra thereby avoiding anastomosis to false tract. Results: We successfully performed anastomotic urethroplasty avoiding false passage. Post-operative Uroflow showed Q max of 18 ml/sec. Voiding cystourethrogram post-operatively showed anastomosis between normal anatomical lumens. Conclusion: This modification of using antegrade cystoscopy helps to identify proximal urethral end which in turn helps in avoiding anastomosis to false tract and ensures anastomosis between normal lumens. PMID:24741435

  14. Anterior Urethral Stricture Disease Negatively Impacts the Quality of Life of Family Members

    PubMed Central

    Weese, Jonathan R.; Eswara, Jairam R.; Marshall, Stephen D.; Chang, Andrew J.; Vetter, Joel; Brandes, Steven B.

    2016-01-01

    Purpose. To quantify the quality of life (QoL) distress experienced by immediate family members of patients with urethral stricture via a questionnaire given prior to definitive urethroplasty. The emotional, social, and physical effects of urethral stricture disease on the QoL of family members have not been previously described. Materials and Methods. A questionnaire was administered prospectively to an immediate family member of 51 patients undergoing anterior urethroplasty by a single surgeon (SBB). The survey was comprised of twelve questions that addressed the emotional, social, and physical consequences experienced as a result of their loved one. Results. Of the 51 surveyed family members, most were female (92.2%), lived in the same household (86.3%), and slept in the same room as the patient (70.6%). Respondents experienced sleep disturbances (56.9%) and diminished social lives (43.1%). 82.4% felt stressed by the patient's surgical treatment, and 83.9% (26/31) felt that their intimacy was negatively impacted. Conclusions. Urethral stricture disease has a significant impact on the family members of those affected. These effects may last decades and include sleep disturbance, decreased social interactions, emotional stress, and impaired sexual intimacy. Treatment of urethral stricture disease should attempt to mitigate the impact of the disease on family members as well as the patient. PMID:27034658

  15. A systematic review of animal and clinical studies on the use of scaffolds for urethral repair.

    PubMed

    Qi, Na; Li, Wen-jiao; Tian, Hong

    2016-02-01

    Replacing urethral tissue with functional scaffolds has been one of the challenging problems in the field of urethra reconstruction or repair over the last several decades. Various scaffold materials have been used in animal studies, but clinical studies on use of scaffolds for urethral repair are scarce. The aim of this study was to review recent animal and clinical studies on the use of different scaffolds for urethral repair, and to evaluate these scaffolds based on the evidence from these studies. PubMed and OVID databases were searched to identify relevant studies, in conjunction with further manual search. Studies that met the inclusion criteria were systematically evaluated. Of 555 identified studies, 38 were included for analysis. It was found that in both animal and clinical studies, scaffolds seeded with cells were used for repair of large segmental defects of the urethra, such as in tubular urethroplasty. When the defect area was small, cell-free scaffolds were more likely to be applied. A lot of pre-clinical and limited clinical evidence showed that natural or artificial materials could be used as scaffolds for urethral repair. Urinary tissue engineering is still in the immature stage, and the safety, efficacy, cost-effectiveness of the scaffolds are needed for further study. PMID:26838750

  16. Urethral length measurement in women during sonographic urethrocystography – an analysis of repeatability and reproducibility

    PubMed Central

    Kociszewski, Jacek; Suzin, Jacek; Dresler, Maria; Surkont, Grzegorz

    2016-01-01

    There has been a rise in the use of sonographic urethrocystography in patients with a full bladder. So far, no publications have been made on the analysis of repeatability and reproducibility of the measurements performed during this procedure. Aim An assessment of repeatability and reproducibility of urethral length measurements during sonographic urethrocystography in females with a full bladder in the introital approach, using real-time two-dimensional transvaginal ultrasound. Material and methods The ultrasound was performed in accordance with a standardized technique in female patients with a full bladder containing 200–300 mL of liquid. A total of 92 patients were included in the analysis. Results The Intraclass Correlation Coefficient for repeatability and reproducibility of urethral length measurements in sonographic urethrocystography ranged between 0.9217 and 0.9873 (p = 0.0000). The analysis of ultrasound urethral length measurements taken by two different physicians at an interval of several months confirmed their very high compatibility (ICC = 0.81, p = 0.000). Conclusions Very good repeatability and reproducibility of urethral length findings during sonographic urethrocystography performed in accordance with the presented technique support the possible use of this type of examination in both clinical practice and research. PMID:27104000

  17. Does resectoscope size play a role in formation of urethral stricture following transurethral prostate resection?

    PubMed Central

    Günes, Mustafa; Keles, Muzaffer Oguz; Kaya, Cevdet; Koca, Orhan; Sertkaya, Zülfü; Akyüz, Mehmet; Altok, Muammer; Umul, Mehmet; Karaman, Muhammet Ihsan

    2015-01-01

    ABSTRACT Background and aims: To investigate the possible effect of resectoscope size on urethral stricture rate after monopolar TURP. Materials and Methods: A retrospective study of 71 men undergoing TURP was conducted at two centers’ from November 2009 to May 2013. The patients were divided into one of two groups according to the resectoscope diameter used for TURP. Resectoscope diameter was 24 F in group 1 (n=35) or 26 F in group 2 (n=36). Urethral catheter type, catheter removal time and energy type were kept constant for all patients. Urethral stricture formation in different localizations after TURP was compared between groups. Results: There was no significant difference between the two groups in terms of age, pre-operative prostate gland volume (PV), prostate-specific antigen (PSA), maximal urinary flow rates (Qmax), International Prostate Symptom Score (IPSS) and post-voiding residual urine volume (PVR). The resection time and weight of resected prostate tissue were similar for both groups (p>0.05). A statistically significant higher incidence of bulbar stricture was detected in group 2 compared to group1 (p=0.018). Conclusions: The use of small-diameter resectoscope shafts may cause a reduction in the incidence of uretral strictures in relation to urethral friction and mucosal damage. PMID:26401868

  18. Nd-YAG laser core-through urethrotomy in obliterative posttraumatic urethral strictures in children.

    PubMed

    Dogra, P N; Nabi, G

    2003-11-01

    This study analysed the feasibility and effectiveness of Nd-YAG laser core-through urethrotomy in the management of obliterative posttraumatic urethral strictures in children. Between May 1997 and April 2000, 61 patients underwent core-through urethrotomy in posttraumatic urethral strictures, ten of whom were children (ages 5-15 years). Three patients had had previous railroading procedures, two attempted core-through urethrotomy, and two underwent end-to-end urethroplasties. Patients were on suprapubic cystostomy for a mean period of 12 months with mean stricture length of 2 cm. Nd-YAG laser core-through urethrotomy was carried out using 600- micro m bare-contact fibre as a day care procedure. There were no intraoperative or postoperative complications. Micturating cystourethrography was performed 6 weeks following urethral catheter removal. Urethroscopy and uroflowmetry were carried out after 3 months. Mean follow-up was 24 months.Nd-YAG laser core-through urethrotomy was seen to be successful in all patients without any complications. All patients are voiding without obstructive symptoms. Four required optical urethrotomy/endoscopic dilatation at least twice. Nd-YAG laser core-through urethrotomy is a safe and effective procedure for the management of obliterative posttraumatic urethral strictures in children PMID:14579073

  19. Female sexual function following mid-urethral slings for the treatment of stress urinary incontinence.

    PubMed

    Alwaal, A; Tian, X; Huang, Y; Zhao, L; Ma, L; Lin, G; Deng, D

    2016-07-01

    The aim of our study was to describe the impact of mid-urethral sling procedure for the treatment of stress urinary incontinence (SUI) on female sexual function. We used PubMed (updated March 2015) to conduct a literature electronic search that included peer-reviewed English language articles. We analyzed the studies about the impact of mid-urethral slings on female sexual function. There are different and contradictory results of the effects of mid-urethral sling on female sexual function. However, more papers show that women undergoing mid-urethral sling procedures report that their sexual function is improved or remains unchanged. The main mechanism of this improved sexuality is the complete relief from coital incontinence, reduction in anxiety and avoidance of sex, whereas the most common symptom related to worsened sexual activity is dyspareunia. Women undergoing sling procedures for SUI should be informed that their sexual activity is likely to remain unchanged or even improve after the operation, but that dyspareunia may occur. PMID:27146350

  20. [Traumatic neurogenic shock].

    PubMed

    Maurin, O; de Régloix, S; Caballé, D; Arvis, A-M; Perrochon, J-C; Tourtier, J-P

    2013-05-01

    Traumatic neurogenic shock is a rare but serious complication of spinal cord injury. It associates bradycardia and hypotension caused by a medullary trauma. It is life-threatening for the patient and it aggravates the neurological deficit. Strict immobilization and a quick assessment of the gravity of cord injury are necessary as soon as prehospital care has begun. Initial treatment requires vasopressors associated with fluid resuscitation. Steroids are not recommended. Early decompression is recommended for incomplete deficit seen in the first 6 hours. We relate the case of secondary spinal shock to a luxation C6/C7 treated in prehospital care. PMID:23566590

  1. [Traumatic disease and metabolism].

    PubMed

    Deriabin, I I; Nasonkin, O S; Nemchenko, N S; Gol'm, N P; Zimina, Z P

    1984-06-01

    The authors have established that the traumatic disease is accompanied by phasic nonspecific changes of metabolism correlating with the trauma severity as well as with its specific features and outcomes. Within the first 3-7 days catabolic processes are found to prevail and metabolic acidosis develop. Later, anabolic processes become activated in the non-complicated course of the disease. Normalization of most biochemical processes is accomplished within 15-21 days. More pronounced and prolonged disturbances of metabolism are observed in complications and lethal outcomes. PMID:6474706

  2. Posterior cruciate ligament of the knee (image)

    MedlinePlus

    The posterior cruciate ligament (PCL) is a powerful ligament extending from the top-rear surface of the tibia to the bottom-front surface of the femur. The ligament prevents the knee joint from posterior instability.

  3. Bilateral posterior cerebral artery infarction.

    PubMed

    Ryan, Davinia; Murphy, Sinead M; Hennessey, Michael J

    2010-01-01

    We report the case of a 70-year-old man who presented with short-term memory impairment and a homonymous left inferior quadrantanopia secondary to simultaneous bilateral posterior cerebral artery (PCA) territory infarction. As in more than a quarter of cases of PCA infarction, no aetiological cause was identified. Unlike the transient nature of symptoms in some cases following unilateral infarction, his deficits persisted on 2-month follow-up. PMID:22798298

  4. [Local fibrinolytic technique in surgery of traumatic inctracranial hemorrhages].

    PubMed

    Krylov, V V; Burov, S A; Galankina, I E; Dash'ian, V G

    2006-01-01

    The emergence of neuroimaging techniques and new surgical technologies (neuroendocopy, navigation systems) in neurosurgery has substantially changed views of surgery for traumatic intracranial hematomas. The local fibrinolytic technique that has been applied to 40 victims aged 18 to 67 years (mean age 42.1 +/- 2 years) who had 18-to-97-cm3 hematomas is a promising direction of mini-invasive surgery for traumatic intracranial hematomas in patients in the compensated and subcompensated state. There were 32 males and 8 females. The procedure of the surgical intervention involves drainage of intracranial hematoma, followed by clot lysis and liquid blood aspiration along the drainage. A good outcome with a complete hematoma removal and clinical symptom regression was observed in 26 patients, a fair result with preservation of moderate neurological symptoms at hospital discharge was noted in 2 patients; 3 victims died. Recurrent bleedings were seen in 4 patients with epidural hematomas. A morphological study revealed the typical features of the morphogenesis of traumatic hematomas and perifocal brain tissue during local fibrinolytic therapy, which suggests that the area of damaging effect of bleeding on the adjacent brain tissue is decreased. Local fibrinolysis in surgery of traumatic intracranial hematomas may be considered to be one of the promising lines of treatment policy along with the existing traditional and current techniques and may be used as the method of choice in surgery of traumatic intracranial hematomas in patients in the compensated state. Removal of epidural hematomas through local fibrinolysis should be limited due to a high risk of recurrent hemorrhage and may be made only in a restricted contingent of patients with severe concomitant injury and concurrent somatic diseases when the risk of combined anesthesia and that of a longer operation are rather high. Moreover, of promise is that subtentorial epidural hematomas may be aspirated without

  5. Spinal hemianesthesia: Unilateral and posterior

    PubMed Central

    Imbelloni, Luiz Eduardo

    2014-01-01

    The injection of a non-isobaric local anesthetic should induce a unilateral spinal anesthesia in patients in a lateral decubitus position. The posterior spinal hemianesthesia only be obtained with hypobaric solutions injected in the jackknife position. The most important factors to be considered when performing a spinal hemianesthesia are: type and gauge of the needle, density of the local anesthetic relative to the CSF, position of the patient, speed of administration of the solution, time of stay in position, and dose/concentration/volume of the anesthetic solution. The distance between the spinal roots on the right-left sides and anterior-posterior is, approximately, 10-15 mm. This distance allows performing unilateral spinal anesthesia or posterior spinal anesthesia. The great advantage of obtaining spinal hemianesthesia is the reduction of cardiovascular changes. Likewise, both the dorsal and unilateral sensory block predominates in relation to the motor block. Because of the numerous advantages of producing spinal hemianesthesia, anesthesiologists should apply this technique more often. This review considers the factors which are relevant, plausible and proven to obtain spinal hemianesthesia. PMID:25886320

  6. An Indwelling Urethral Catheter Knotted Around a Double-J Ureteral Stent: An Unusual Complication after Kidney Transplantation

    PubMed Central

    Warmerdam, E. G.; Toorop, R. J.; Abrahams, A. C.; Berger, P.

    2011-01-01

    Urethral catheterization is a common procedure with a relatively low complication rate. Knotting of an indwelling urethral catheter is a very rare complication, and there are only a few case reports on knotted catheters, most of them concerning children. We report an especially rare case where a urethral catheter formed a knot around a double-J ureteral stent after a kidney transplantation. We will discuss the various risk factors for knotting of a catheter and the methods to untangle a knot. PMID:24533194

  7. Randomized controlled clinical trial on the efficacy of fosfomycin trometamol for uncomplicated gonococcal urethritis in men.

    PubMed

    Yuan, Z; He, C; Yan, S; Ke, Y; Tang, W

    2016-06-01

    We assessed the efficacy of fosfomycin trometamol in treating uncomplicated gonococcal urethritis in men. We conducted an open randomized controlled trial in 152 consecutive men with any main complaints suggestive of uncomplicated gonococcal urethritis in Dujiangyan Medical Center between 1 September 2013 and 31 August 2015. In total, 126 patients completed all aspects of this study. Sixty were provided therapy with fosfomycin trometamol 3 g orally on days 1, 3 and 5 in the intervention group; the other 61 were provided ceftriaxone 250 mg intramuscularly plus azithromycin 1 g orally simultaneously as a single dose in the control group. The primary outcomes involved clinical and microbiologic cure on days 7 and 14 after receipt of all the study medications. At the day 7 follow-up visit, all the 121 participants had complete resolution of clinical symptoms and signs. In addition, five patients (two in the intervention group and three in the control group) discontinued intervention because of unsuccessful treatment. After receipt of all the study medications, these five patients still had urethral purulent discharge and were switched to other unknown treatment regimens by other doctors. The bacterial smears and cultures of urethral or urine specimens in the 121 patients who completed all aspects of the study were negative on a test-of-cure visit. In the per-protocol analysis, both clinical and microbiologic cure were experienced by 96.8% (60/62 patients) in the intervention group and 95.3% (61/64 patients) in the control group. There were no recurrences at the day 14 test-of-cure visit. This trial indicates that fosfomycin trometamol exhibits excellent efficacy for treatment of uncomplicated gonococcal urethritis in men. Serious adverse effects are rare. PMID:27064136

  8. Management of recurrent anterior urethral strictures following buccal mucosal graft-urethroplasty: A single center experience

    PubMed Central

    Javali, Tarun Dilip; Katti, Amit; Nagaraj, Harohalli K.

    2016-01-01

    Objective: To describe the safety, feasibility and outcome of redo buccal mucosal graft urethroplasty in patients presenting with recurrent anterior urethral stricture following previous failed BMG urethroplasty. Materials and Methods: This was a retrospective chart review of 21 patients with recurrent anterior urethral stricture after buccal mucosal graft urethroplasty, who underwent redo urethroplasty at our institute between January 2008 to January 2014. All patients underwent preoperative evaluation in the form of uroflowmetry, RGU, sonourethrogram and urethroscopy. Among patients with isolated bulbar urethral stricture, who had previously undergone ventral onlay, redo dorsal onlay BMG urethroplasty was done and vice versa (9+8 patients). Three patients, who had previously undergone Kulkarni-Barbagli urethroplasty, underwent dorsal free graft urethroplasty by ventral sagittal urethrotomy approach. One patient who had previously undergone urethroplasty by ASOPA technique underwent 2-stage Bracka repair. Catheter removal was done on 21st postoperative day. Follow-up consisted of uroflow, PVR and AUA-SS. Failure was defined as requirement of any post operative procedure. Results: Idiopathic urethral strictures constituted the predominant etiology. Eleven patients presented with stricture recurrence involving the entire grafted area, while the remaining 10 patients had fibrotic ring like strictures at the proximal/distal graft-urethral anastomotic sites. The success rate of redo surgery was 85.7% at a mean follow-up of 41.8 months (range: 1 yr-6 yrs). Among the 18 patients who required no intervention during the follow-up period, the graft survival was longer compared to their initial time to failure. Conclusion: Redo buccal mucosal graft urethroplasty is safe and feasible with good intermediate term outcomes. PMID:26834398

  9. Early removal of urinary catheter after excision and primary anastomosis in anterior urethral stricture

    PubMed Central

    Bansal, Ankur; Sankhwar, Satyanarayan; Gupta, Ashok; Singh, Kawaljit; Patodia, Madhusudan; Aeron, Ruchir

    2016-01-01

    Objective To investigate the feasibility of removing the urinary catheter 7 days after excision and primary anastomosis (EPA) performed with the indication of anterior urethral stricture disease. Material and methods Retrospective review of medical records of the patients who had undergone EPA between January 2005 and December 2010 was performed. These patients were divided into 2 groups: Group 1 (urethral catheter removed on or before 7. postoperative day) and Group 2 (urethral catheter removed on 8. postoperative day or later). We compared 2 groups as for the frequency of extravasation as detected on retrograde pericatheter urethrogram (PUG) and recurrence rate till the last follow-up. Results PUG was performed on an average day 7 and 14 in Groups 1 (n=102) and 2 (n=134), respectively followed by removal of the catheter. Extravasation on the first PUG was detected in 6.8% of the patients in Group 1, and in 4.5% of the cases in Group 2 had extravasation on the first PUG. Urethral catheter was left in situ in these patients and a repeat PUG after one week was performed which was normal in all cases. The incidence of extravasation and recurrence rate did not differ significantly whether catheter was removed on day 7 or 14 (6.8% vs. 4.5% and 4.9% vs. 5.2% respectively) (p>0.5). Conclusion We conclude that removal of the catheter on postoperative day 7 after EPA does not increase the rate of extravasation and recurrence during long-term follow-up. Urethral catheter restricts physical activity in the postoperative period which is bothersome to the patient. Hence early removal of a catheter should be offered to men after EPA. PMID:27274892

  10. Traumatic pulmonary pseudocysts: CT findings.

    PubMed

    Tsitouridis, Ioannis; Tsinoglou, Konstantinos; Tsandiridis, Christos; Papastergiou, Christos; Bintoudi, Antonia

    2007-08-01

    Traumatic pulmonary pseudocyst constitutes an uncommon, though well recognized, manifestation of closed chest trauma. It is usually encountered in young patients, whose compliant chest wall permits the transmission of great compressive forces to the lung parenchyma and the laceration of the latter. Traumatic pulmonary pseudocyst is usually detected during the imaging evaluation of multi-injured patients with the use of computed tomography, as it is often not apparent in the initial supine anteroposterior chest radiographs. We present 5 cases of trauma patients, in whom we detected the presence of multiple traumatic pulmonary pseudocysts during the imaging evaluation of blunt chest trauma with the use of computed tomography. PMID:17721334

  11. Proximal hypospadias with skin-covered shaft of penis and absent urethral plate: An unknown variant and its management

    PubMed Central

    Rashid, Kumar A.; Bhat, Nisar A.

    2011-01-01

    We report a case of proximal hypospadias with an absent urethral plate having intact ventral shaft skin with hooded dorsal prepuce and a good glans groove. Such a variant of hypospadias has not been reported in the literature. PMID:22121320

  12. Isolated posterior cruciate ligament calcification.

    PubMed

    Koukoulias, Nikolaos E; Papastergiou, Stergios G

    2011-01-01

    The authors present a case of calcified posterior cruciate ligament (PCL). A 61-year-old female presented in our department reporting 12 months history of knee pain that was getting worse during the night. The patient was under medication for epileptic seizure, osteoporosis and hyperthyroidism. X-rays demonstrated calcification of the PCL. CT and MRI excluded any other intra-articular and extra-articular pathology. Arthroscopic debridement of the calcium deposits was performed and the symptoms resolved immediately, while the postoperative x-rays were normal. Histological examination confirmed the calcium nature of the lesion. Two years postoperatively the patient remains asymptomatic. PMID:22669889

  13. Isolated posterior cruciate ligament calcification

    PubMed Central

    Koukoulias, Nikolaos E; Papastergiou, Stergios G

    2011-01-01

    The authors present a case of calcified posterior cruciate ligament (PCL). A 61-year-old female presented in our department reporting 12 months history of knee pain that was getting worse during the night. The patient was under medication for epileptic seizure, osteoporosis and hyperthyroidism. X-rays demonstrated calcification of the PCL. CT and MRI excluded any other intra-articular and extra-articular pathology. Arthroscopic debridement of the calcium deposits was performed and the symptoms resolved immediately, while the postoperative x-rays were normal. Histological examination confirmed the calcium nature of the lesion. Two years postoperatively the patient remains asymptomatic. PMID:22669889

  14. Posterior ankyloglossia: a case report.

    PubMed

    Chu, Michael W; Bloom, David C

    2009-06-01

    Ankyloglossia, or tongue-tie, refers to an abnormally short lingual frenulum. Ankyloglossia is a recognized but poorly defined condition and has been reported to cause feeding difficulties, dysarthria, dyspnea, and social or mechanical problems. In infants, the most concerning symptoms are feeding difficulties and inability to breastfeed. While a recent trend toward breastfeeding has brought frenulectomy back into favor, the literature regarding treatment remains inconclusive. We report a case of posterior ankyloglossia with anterior mucosal hooding and a simple, safe, and effective way to treat it to improve breastfeeding. PMID:19303646

  15. Pelvic fracture-related urethral and bladder injury.

    PubMed

    Durrant, Jordan J; Ramasamy, A; Salmon, M S; Watkin, N; Sargeant, I

    2013-03-01

    Major pelvic ring fracture (PRF) due to blunt trauma results in lower urinary tract injury (LUTI) in up to 10% of cases. Significant comorbidity may result and this is particularly the case for unrecognised injury. The increase in military injuries due to improvised explosive devices in recent conflicts has revealed a complex injury cohort. The incidence of pelvic fracture related LUTI in these casualties is up to three times higher than that seen in civilian patients with pelvic fracture. A complete understanding of LUTI following pelvic fracture is still lacking. Complex fractures of the anterior pelvic arch are associated with LUTI and initial management is largely conservative. In battlefield injuries, the combination of the blast wave, penetrating fragment and bodily displacement results in open pelvic fracture combined with gross perineal and pelvic soft-tissue destruction and traumatic femoral amputations. These are some of the most challenging injuries that any surgical team will manage and life saving measures are the priority. There are established pathways for the management of LUTI following blunt trauma related pelvic fracture. Military injuries are more complex and require a significantly different approach. This paper outlines the developments in the understanding and management of pelvic fracture-related LUTI, focussing primarily on injury mechanisms and early management. Recent military surgical experience is discussed, highlighting the significant differences to civilian practice. PMID:23631324

  16. Comparison of Antimicrobial Susceptibilities of Pharyngeal, Rectal, and Urethral Neisseria gonorrhoeae Isolates among Men Who Have Sex with Men

    PubMed Central

    Zaidi, Akbar; Asbel, Lenore; Baldwin, Tamara; Gratzer, Beau; Guerry, Sarah; Kerani, Roxanne P.; Pathela, Preeti; Pettus, Kevin; Soge, Olusegun O.; Stirland, Ali; Weinstock, Hillard S.

    2015-01-01

    U.S. surveillance for Neisseria gonorrhoeae antimicrobial susceptibilities is based exclusively on male urethral isolates. These data inform gonorrhea treatment guidelines, including recommendations for the treatment of extragenital infections, but data on the susceptibilities of extragenital isolates are limited. We compared the antimicrobial susceptibilities of pharyngeal, rectal, and urethral gonococcal isolates collected from men who have sex with men (MSM), at five sentinel sites throughout the United States. MICs were determined by the agar dilution method. Generalized linear models were used to compare (i) the proportions of isolates with elevated MICs and (ii) geometric mean MICs according to anatomic site, adjusted for city. In December 2011 to September 2013, totals of 205 pharyngeal, 261 rectal, and 976 urethral isolates were obtained. The proportions of isolates with elevated ceftriaxone MICs (≥0.125 μg/ml) did not differ according to anatomic site (0.5% of pharyngeal isolates, 1.5% of rectal isolates, and 1.7% of urethral isolates, with a city-adjusted odds ratio [aOR] of 0.4 [95% confidence interval {CI}, 0.0 to 3.9] for pharyngeal versus urethral isolates and an aOR of 0.9 [95% CI, 0.2 to 4.2] for rectal versus urethral isolates). The city-adjusted geometric mean ceftriaxone MICs of pharyngeal (0.0153 μg/ml) and rectal (0.0157 μg/ml) isolates did not differ from that of urethral isolates (0.0150 μg/ml) (ratios of geometric mean MICs of 1.02 [95% CI, 0.90 to 1.17] and 1.05 [95% CI, 0.93 to 1.19], respectively). Similar results were observed for other antimicrobials, including cefixime and azithromycin. These findings suggest that, at the population level, gonococcal antimicrobial susceptibility surveillance based on urethral isolates from MSM adequately reflects the susceptibilities of N. gonorrhoeae strains circulating among MSM. PMID:25691638

  17. Comparison of antimicrobial susceptibilities of pharyngeal, rectal, and urethral Neisseria gonorrhoeae isolates among men who have sex with men.

    PubMed

    Kidd, Sarah; Zaidi, Akbar; Asbel, Lenore; Baldwin, Tamara; Gratzer, Beau; Guerry, Sarah; Kerani, Roxanne P; Pathela, Preeti; Pettus, Kevin; Soge, Olusegun O; Stirland, Ali; Weinstock, Hillard S

    2015-05-01

    U.S. surveillance for Neisseria gonorrhoeae antimicrobial susceptibilities is based exclusively on male urethral isolates. These data inform gonorrhea treatment guidelines, including recommendations for the treatment of extragenital infections, but data on the susceptibilities of extragenital isolates are limited. We compared the antimicrobial susceptibilities of pharyngeal, rectal, and urethral gonococcal isolates collected from men who have sex with men (MSM), at five sentinel sites throughout the United States. MICs were determined by the agar dilution method. Generalized linear models were used to compare (i) the proportions of isolates with elevated MICs and (ii) geometric mean MICs according to anatomic site, adjusted for city. In December 2011 to September 2013, totals of 205 pharyngeal, 261 rectal, and 976 urethral isolates were obtained. The proportions of isolates with elevated ceftriaxone MICs (≥ 0.125 μg/ml) did not differ according to anatomic site (0.5% of pharyngeal isolates, 1.5% of rectal isolates, and 1.7% of urethral isolates, with a city-adjusted odds ratio [aOR] of 0.4 [95% confidence interval {CI}, 0.0 to 3.9] for pharyngeal versus urethral isolates and an aOR of 0.9 [95% CI, 0.2 to 4.2] for rectal versus urethral isolates). The city-adjusted geometric mean ceftriaxone MICs of pharyngeal (0.0153 μg/ml) and rectal (0.0157 μg/ml) isolates did not differ from that of urethral isolates (0.0150 μg/ml) (ratios of geometric mean MICs of 1.02 [95% CI, 0.90 to 1.17] and 1.05 [95% CI, 0.93 to 1.19], respectively). Similar results were observed for other antimicrobials, including cefixime and azithromycin. These findings suggest that, at the population level, gonococcal antimicrobial susceptibility surveillance based on urethral isolates from MSM adequately reflects the susceptibilities of N. gonorrhoeae strains circulating among MSM. PMID:25691638

  18. Cell-Seeded Tubularized Scaffolds for Reconstruction of Long Urethral Defects: A Preclinical Study

    PubMed Central

    Orabi, Hazem; AbouShwareb, Tamer; Zhang, Yuanyuan; Yoo, James J.; Atala, Anthony

    2012-01-01

    Background The treatment options for patients requiring repair of a long segment of the urethra are limited by the availability of autologous tissues. We previously reported that acellular collagen-based tubularized constructs seeded with cells are able to repair small urethral defects in a rabbit model. Objective We explored the feasibility of engineering clinically relevant long urethras for surgical reconstruction in a canine preclinical model. Design, setting, and participants Autologous bladder epithelial and smooth muscle cells from 15 male dogs were grown and seeded onto preconfigured collagen-based tubular matrices (6 cm in length). The perineal urethral segment was removed in 21 male dogs. Urethroplasties were performed with tubularized collagen scaffolds seeded with cells in 15 animals. Tubularized constructs without cells were implanted in six animals. Serial urethrography and three-dimensional computed tomography (CT) scans were performed pre- and postoperatively at 1, 3, 6, and 12 mo. The animals were euthanized at their predetermined time points (three animals at 1 mo, and four at 3, 6, and 12 mo) for analyses. Outcome measurements and statistical analysis Statistical analysis of CT imaging and histology was not needed. Results and limitations CT urethrograms showed wide-caliber urethras without strictures in animals implanted with cell-seeded matrices. The urethral segments replaced with acellular scaffolds collapsed. Gross examination of the urethral implants seeded with cells showed normal-appearing tissue without evidence of fibrosis. Histologically, an epithelial cell layer surrounded by muscle fiber bundles was observed on the cell-seeded constructs, and cellular organization increased over time. The epithelial and smooth muscle phenotypes were confirmed using antibodies to pancytokeratins AE1/AE3 and smooth muscle–specific desmin. Formation of an epithelial cell layer occurred in the unseeded constructs, but few muscle fibers formed

  19. Changes in plasma gonadotropin concentrations and urethral closure pressure in the bitch during the 12 months following ovariectomy.

    PubMed

    Reichler, Iris Margaret; Pfeiffer, Esther; Piché, Claude A; Jöchle, Wolfgang; Roos, Malgorzata; Hubler, Madeleine; Arnold, Susi

    2004-11-01

    Urinary incontinence due to acquired urethral sphincter incompetence is a common side effect of spaying, for which the underlying cause remains unknown. Spaying not only results in a significant reduction in the urethral closure pressure within 1 year but also in an increase in the plasma gonadotropin concentrations. To investigate the possible link between the post-ovariectomy changes in plasma gonadotropins and in urethral closure pressure, gonadotropin and urodynamic measurements were performed in 10 Beagle bitches before and for a period of 1 year after spaying. Plasma gonadotropin concentrations rose quickly after ovariectomy and peak levels were seen within 3-5 weeks, followed by a sharp drop until week 10. A steady increase was observed subsequently until week 42, when a plateau was reached. One year after spaying, the mean FSH concentration was 75.3 +/- 32.1 ng/ml, a 17-fold increase, and the LH was 8.3 +/- 3.8 ng/ml, an eightfold increase over the pre-spaying values. Ten months after spaying, the mean urethral closure pressure (9.7 cm H2O) was significantly reduced when compared to the mean pre-operative value of 15.4 cm H2O. However, there was no clear relationship between the gonadotropin concentrations and the urethral closure pressure. From these results it seems unlikely that chronically elevated gonadotropins are the underlying cause for reduced urethral closure pressure after spaying resulting in urinary incontinence. PMID:15451248

  20. Post-Traumatic Stress Disorder

    MedlinePlus

    ... PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat. For Consumers General Information Post-Traumatic Stress Disorder ( NIMH ) Anxiety Information Stress Information Depression Information St. John's Wort Information See more Research ...

  1. Post-Traumatic Stress Disorder

    MedlinePlus

    ... Physician September 01, 2000, http://www.aafp.org/afp/20000901/1035.html) Post-traumatic Stress Reactions Following ... Physician August 01, 1999, http://www.aafp.org/afp/990800ap/524.html) Written by familydoctor.org editorial ...

  2. Post-traumatic stress disorder

    MedlinePlus

    Post-traumatic stress disorder (PTSD) is a type of anxiety disorder . It can occur after you have gone through an extreme ... Normally, after the event, the body recovers. The stress hormones and chemicals the body releases due to ...

  3. Post-traumatic stress disorder

    MedlinePlus

    ... some people, but not in others. Your genes, emotions, and family setting may all play roles. Past emotional trauma may increase your risk of PTSD after a recent traumatic event. With PTSD, the body's response to ...

  4. Post-Traumatic Stress Disorder

    MedlinePlus

    ... PTSD) is a real illness. You can get PTSD after living through or seeing a traumatic event, such ... at different times for different people. Signs of PTSD may start soon after a frightening event and then continue. Other people ...

  5. Longevity of Posterior Composite Restorations

    PubMed Central

    Opdam, N.J.M.; van de Sande, F.H.; Bronkhorst, E.; Cenci, M.S.; Bottenberg, P.; Pallesen, U.; Gaengler, P.; Lindberg, A.; Huysmans, M.C.D.N.J.M.; van Dijken, J.W.

    2014-01-01

    The aim of this meta-analysis, based on individual participant data from several studies, was to investigate the influence of patient-, materials-, and tooth-related variables on the survival of posterior resin composite restorations. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a search resulting in 12 longitudinal studies of direct posterior resin composite restorations with at least 5 years’ follow-up. Original datasets were still available, including placement/failure/censoring of restorations, restored surfaces, materials used, reasons for clinical failure, and caries-risk status. A database including all restorations was constructed, and a multivariate Cox regression method was used to analyze variables of interest [patient (age; gender; caries-risk status), jaw (upper; lower), number of restored surfaces, resin composite and adhesive materials, and use of glass-ionomer cement as base/liner (present or absent)]. The hazard ratios with respective 95% confidence intervals were determined, and annual failure rates were calculated for subgroups. Of all restorations, 2,816 (2,585 Class II and 231 Class I) were included in the analysis, of which 569 failed during the observation period. Main reasons for failure were caries and fracture. The regression analyses showed a significantly higher risk of failure for restorations in high-caries-risk individuals and those with a higher number of restored surfaces. PMID:25048250

  6. Huge interparietal posterior fontanel meningohydroencephalocele

    PubMed Central

    Dos Santos, Manuel Filipe Dias; de Santa Barbara, Rita de Cassia

    2015-01-01

    Congenital encephalocele is a neural tube defect characterized by a sac-like protrusion of the brain, meninges, and other intracranial structures through the skull, which is caused by an embryonic development abnormality. The most common location is at the occipital bone, and its incidence varies according to different world regions. We report a case of an 1-month and 7-day-old male child with a huge interparietal-posterior fontanel meningohydroencephalocele, a rare occurrence. Physical examination and volumetric computed tomography were diagnostic. The encephalocele was surgically resected. Intradural and extradural approaches were performed; the bone defect was not primarily closed. Two days after surgery, the patient developed hydrocephaly requiring ventriculoperitoneal shunting. The surgical treatment of the meningohydroencephalocele of the interparietal-posterior fontanel may be accompanied by technical challenges and followed by complications due to the presence of large blood vessels under the overlying skin. In these cases, huge sacs herniate through large bone defects including meninges, brain, and blood vessels. The latter present communication with the superior sagittal sinus and ventricular system. A favorable surgical outcome generally follows an accurate strategy taking into account individual features of the lesion. PMID:26484324

  7. Traumatic hand amputation while wakeboarding

    PubMed Central

    Woodacre, Timothy; Marshall, Morwena

    2011-01-01

    Wakeboarding is a sport increasing in popularity in the UK and the rest of the world. It is known to be associated with a high incidence of relatively minor injuries to the participating sportsperson. The authors present the case of a traumatic hand amputation to an associated third party and highlight the potential for serious injuries to all those directly involved with the sport. The authors demonstrate the successful application of military principles to a traumatic amputation in a civilian setting. PMID:22693318

  8. Anterior urethral valves without diverticulae: a report of two cases and a review of the literature.

    PubMed

    Singh, Dig Vijay; Taneja, Rajesh

    2014-05-01

    Two unusual cases of anterior urethral valves (AUV) without diverticulae are presented. The first case is a male child born with prenatal diagnosis of bilateral hydronephrosis. On cystoscopy, iris-like diaphragm valves were encountered about 3 mm distal to the skeletal sphincter. In the second case, an 18-month-old male child was investigated for recurrent febrile urinary tract infections and obstructed urinary symptoms. Cystoscopy confirmed the presence of slit-like valves 5 mm distal to the skeletal sphincter. Fulguration of the AUVs was performed in both cases. It may be worthwhile to review all cases of anterior urethral obstruction collectively and re-categorize them appropriately to include the unusual AUVs without diverticulum in that classification. PMID:24118555

  9. Does antibacterial ointment applied to urethral meatus in women prevent recurrent cystitis?

    PubMed

    Meyhoff, H H; Nordling, J; Gammelgaard, P A; Vejlsgaard, R

    1981-01-01

    In a double-blind placebo controlled clinical trial the preventive value of the antibacterial ointment povidone-iodine 10% (Isodine, Betadine) applied to urethral meatus was evaluated in 17 females suffering from recurrent urinary tract infections (UTI). The patients applied povidone-iodine respectively placebo ointment twice daily and before sexual intercourse in two 6-month periods in a cross-over design. No difference was observed in number of UTI during povidone-iodine and placebo prophylaxis. A decrease in the incidence of UTI was seen during application of any ointment. The antibacterial properties of povidone-iodine ointment is unimportant in the prophylaxis of reinfections as also indicated from urethral and periurethral cultures during the study revealing no change in pathogenic bacterial flora. An improved perineal hygiene in the context of application of ointment may be responsible for the reduction in UTI incidence in females with recurrent cystitis. PMID:7036332

  10. Antibody isotypes in urethral swabs of symptomatic and asymptomatic men infected with Trichomonas vaginalis.

    PubMed

    Imam, Naglaa F A; Eassa, Ahmed H A; Shoeib, Eman Y S; Abo-Raia, Gamal Y S

    2007-12-01

    Trichomoniasis may be asymptomatic or symptomatic in both sexes. The outcome of infection depends on the virulence factors of T. vaginalis, but these factors remain unclear. Genetic variability of the isolates and the host's immune response are likely to be key factors in that respect. Symptomatic and asymptomatic males infected with T. vaginalis were compared regarding the differences in antibody subclasses response in the urethral samples. In symptomatic cases there was a significant elevation in IgM, IgG1 & IgG2b levels in urethral samples, and a little, non-significant rise in IgG2a levels. However, there were no statistically significant differences between levels of IgA, IgG3 & IgG4. The results showed that specific IgG1 & IgM and to a lesser extent IgG2 may be involved in established symptomatic trichomoniasis in men, compared to asymptomatic ones. PMID:18383797

  11. Post-traumatic neurodegeneration and chronic traumatic encephalopathy.

    PubMed

    Daneshvar, Daniel H; Goldstein, Lee E; Kiernan, Patrick T; Stein, Thor D; McKee, Ann C

    2015-05-01

    Traumatic brain injury (TBI) is a leading cause of mortality and morbidity around the world. Concussive and subconcussive forms of closed-head injury due to impact or blast neurotrauma represent the most common types of TBI in civilian and military settings. It is becoming increasingly evident that TBI can lead to persistent, long-term debilitating effects, and in some cases, progressive neurodegeneration and chronic traumatic encephalopathy (CTE). The epidemiological literature suggests that a single moderate-to-severe TBI may be associated with accelerated neurodegeneration and increased risk of Alzheimer's disease, Parkinson's disease, or motor neuron disease. However, the pathologic phenotype of these post-traumatic neurodegenerations is largely unknown and there may be pathobiological differences between post-traumatic disease and the corresponding sporadic disorder. By contrast, the pathology of CTE is increasingly well known and is characterized by a distinctive pattern of progressive brain atrophy and accumulation of hyperphosphorylated tau neurofibrillary and glial tangles, dystrophic neurites, 43 kDa TAR DNA-binding protein (TDP-43) neuronal and glial aggregates, microvasculopathy, myelinated axonopathy, neuroinflammation, and white matter degeneration. Clinically, CTE is associated with behavioral changes, executive dysfunction, memory deficits, and cognitive impairments that begin insidiously and most often progress slowly over decades. Although research on the long-term effects of TBI is advancing quickly, the incidence and prevalence of post-traumatic neurodegeneration and CTE are unknown. Critical knowledge gaps include elucidation of pathogenic mechanisms, identification of genetic risk factors, and clarification of relevant variables-including age at exposure to trauma, history of prior and subsequent head trauma, substance use, gender, stress, and comorbidities-all of which may contribute to risk profiles and the development of post-traumatic

  12. [Inflammatory pseudo-tumor of the bladder expelled through the urethral meatus in a girl].

    PubMed

    Sarr, A; Thiam, I; Gueye, D; Sow, Y; Fall, B; Thiam, A; Sine, B; Ba, M; Diagne, B A

    2015-12-01

    Inflammatory pseudo-tumors of the bladder are rare benign tumors that mostly arise in the differential diagnosis of sarcomas in children. The authors report an unusual case of pedunculated inflammatory pseudo-tumor of the bladder that externalized by the urethral meatus in a 13-year-old girl. The treatment consisted of a ligation-resection of the pedicle, followed by resection of the tumor. After regular follow-up for 18 months there was no tumor recurrence. PMID:26552617

  13. Evaluation of Onlay Island Flap Technique in Shallow Urethral Plate Hypospadiasis

    PubMed Central

    Mohajerzadeh, Leily; Mirshemirani, Alireza; Rouzrokh, Mohsen; Sadeghian, Naser; Khaleghnejad-Tabari, Ahmad; Mahdavi, Alireza; Poorhasan, Sareh

    2016-01-01

    Background: Hypospadias is one of the most common congenital genital anomalies in males that necessitates to be operated early in infancy (when 6 to 9 months old). On the other hand, hypospadias is a challenging field of pediatric urology with multiple reconstruction techniques. A perfect hypospadias repair is supposed to return urethral continuity with sufficient caliber, eradicate phallus curvature, and supply an acceptable appearance with low complications. Objectives: This study aimed to evaluate the outcomes of using onlay island flap technique in the repair of hypospadias with shallow urethral plate. Patients and Methods: In this prospective study within June 2012 to December 2013, we performed onlay island flap procedure to repair hypospadias with shallow urethral plate measuring less than 6 millimeter. This technique was selected for all types of hypospadiasis except subcoronal type. Nesbit’s dorsal plication procedure was established for chordee. In cases with very small glans, urethroplasty was performed without glansplasty. Results: Twenty three patients with mean age of 30 (range 10 - 60) months underwent onlay island flap repair; all had a shallow urethral plate < 6 mm, 3 had a very small glans, and 18 had chordee. Meatus was located in distal shaft in 5 cases, mid shaft in 8, proximal in 6 and penoscrotal type in 4 patients. Chordee was corrected with Nesbit’s dorsal plication in 16 cases. Complications were: meatal stenosis in 2 cases and urethrocutaneous fistula in 2 patients, all of which were repaired surgically. Mean follow up time was 13 (3 - 20) months. All cases that had glansplasty have excellent esthetic appearance. Conclusions: This technique offers acceptable results regarding meatal stenosis, urethrocutaneous fistula and esthetic outcome. PMID:26848382

  14. Prefabricated partial distal urethral in 2-staged repair of proximal hypospadias with severe chordee

    PubMed Central

    Fan, Zhi-Qiang; Sun, Jian-Tao; Huangfu, Xue-Hun; Chen, Guo-Xiao; Hao, Jian-Wei; Liu, Zhong-Hua

    2015-01-01

    Purpose: To describe a new technique for staged hypospadias repair in which the urethral plate is divided and tubularized transverse island flap prefabricated partial distal urethral at the time of the first stage. Materials and methods: Sixteen patients with proximal hypospadias associated with severe chordee were operated on using a new staged technique. At the time of the first stage, the urethral plate was divided and chordee was corrected. Then tubularized transverse island flap was used to prefabricate partial distal urethra. The defective urethra was repaired using the Thiersch-Duplay principle at the second stage. Results: All participants have completed both stages of the operation. The mean follow-up duration was 18.4 months (range from 6 to 72 months). In the first-stage surgery, the modified tabularized transverse preputial island flap was performed on 6 patients, whereas the modified preputial double-faced island flap was performed on the other 10 patients. All of the prefabricated partial distal neourethras had no evidence of stenosis or scarring. The result of the second-stage procedure was a complete penis with integrated urethral. All patients were satisfied with cosmetic and functional results. Neither stricture nor diverticula was observed. A good urinary stream during the urination was attained in 12 (75.0%) patients. Four cases (25.0%) developed urethrocutaneous fistula after the second stage repair. Conclusions: In our preliminary series, this procedure improved functional and cosmetic results. It may be applicable to most cases of proximal hypospadias. Even when complications occur, they are less severe compared to those of the traditional staged approach. PMID:25932188

  15. Occult distal urethral carcinoma presenting as metastatic carcinoma in the inguinal lymph nodes.

    PubMed

    Hammer-Hansen, Niels; Høyer, Søren; Jensen, Jørgen Bjerggaard

    2015-02-01

    A 65-year-old man presented with metastatic squamous cell carcinoma in the inguinal lymph nodes from an unknown primary tumour. The initial work-up lacked clinical examination of the glans penis, in part due to the patient having phimosis. More than a year after presentation, a primary tumour, located distally on the penis, was diagnosed. A discussion of urethral carcinoma as well as inguinal lymph-node metastasis of unknown primary tumour is presented. PMID:25313619

  16. Efficacy of mitomycin C in reducing recurrence of anterior urethral stricture after internal optical urethrotomy

    PubMed Central

    Shahzad, Muhammad; Orakzai, Nasir; Khan, Ihsanullah; Ahmad, Mubashira

    2015-01-01

    Purpose To determine the efficacy of mitomycin C in reducing the recurrence of anterior urethral stricture after internal optical urethrotomy (IOU). Materials and Methods This was a randomized controlled trial conducted in the Department of Urology at the Institute of Kidney Diseases Peshawar from March 2011 to December 2013. A total of 151 patients who completed the study were divided into two groups by the lottery method. Group A (cases) comprised 78 patients in whom mitomycin C 0.1% was injected submucosally in the stricture after conventional IOU. Group B (controls) comprised 73 patients in whom IOU only was performed. Self-clean intermittent catheterization was not offered in either group. All patients were regularly followed up for 18 months. Recurrence was diagnosed by use of retrograde urethrogram in all patients and flexible urethroscopy in selected cases. Data were collected on a structured pro forma sheet and were analyzed by SPSS. Results The mean age of the patients in group A was 37.31±10.1 years and that in group B was 40.1±11.4 years. Recurrence of urethral stricture was recorded in 11 patients (14.1%) in group A and in 27 patients (36.9%) in group B (p=0.002). The mitomycin group also showed a delay in recurrence compared with the control group (p=0.002). Conclusions Recurrence of urethral stricture is high after optical urethrotomy. Mitomycin C was found to be highly effective in preventing the recurrence of urethral stricture after IOU. PMID:26366278

  17. Treatment of Traumatic Carotid-Cavernous Fistula

    PubMed Central

    Wu, Z.; Zhang, Y.; Wang, C.; YANG, X.; Li, Y.

    2000-01-01

    Summary From 1986 to the end of 1998, 482 cases of traumatic carotid-cavernous fistula (TCCF) were treated by means of intravascular embolisation technique. The experience is overviewed in this article. Many kinds of detachable balloon catheters (including Chinese made detachable balloon catheters), coils and cyano aery late were used as embolic materials. Transcervical, transfemoral, anterior communicating artery, posterior communicating artery approach, or transvenous approach were selected according to conditions. A combination of different approaches or materials was used for complex TCCF. We found that the special sign, named “bileakage sign”, indicated multileakage of TCCF and was not mentioned before. All 482 cases of TCCF were embolised successfully, of which 405 cases maintained the patency of internal carotid artery (ICA). No death related to the treatment occurred in our group and the symptoms or signs in 462 cases were relieved after embolisation. Emergency embolisation was needed in some conditions such as serious epistaxis, delayed or repeatedly subdural haematoma and rapid visual impairment. Endovascular treatment of TCCF is a safe and efficient method. The time of operation, approach, and materials for embolisation must be carefully selected in order to obtain the best result. PMID:20667206

  18. Intermittent catheterization in neurologic patients: Update on genitourinary tract infection and urethral trauma.

    PubMed

    Biardeau, X; Corcos, J

    2016-04-01

    Intermittent catheterization is considered the standard of care in most neurologic patients with lower urinary tract disorders. However, in this context, genitourinary tract infection and urethral trauma represent specific challenges. Such conditions have been found to significantly deteriorate quality of life and complicate subsequent treatments. Only optimal prevention associated with appropriate treatment allows for the long-term continuation of such bladder management. Here, we discuss the diagnosis and therapeutic and preventive approaches associated with genitourinary tract infection and urethral trauma in this specific population. This "state-of-the-art" article results from a literature review (MEDLINE articles and scientific society guidelines) and the authors' experience. It was structured in a didactic way to facilitate comprehension and promote the implementation of advice and recommendations in daily practice. Genitourinary tract infection and urethral trauma associated with intermittent catheterization in neurologic patients should be managed with a global approach, including patient and caregiver education, optimal catheterization with hydrophilic-coated or pre-lubricated catheters and adequate use of antibiotic therapy. PMID:27053002

  19. Hypothesis That Urethral Bulb (Corpus Spongiosum) Plays an Active Role in Male Urinary Continence

    PubMed Central

    Rehder, Peter; Staudacher, Nina M.; Schachtner, Joerg; Berger, Maria E.; Schillfahrt, Florian; Hauser, Verena; Mueller, Raphael; Skradski, Viktor; Horninger, Wolfgang; Glodny, Bernhard

    2016-01-01

    The proximal urethral bulb in men is enlarged, surrounds the bulbous urethra, and extends dorsally towards the perineum. During intercourse engorgement takes place due to increased blood flow through the corpus spongiosum. Antegrade ejaculation is facilitated by contraction of the bulbospongiosus muscles during climax. Micturition during sexual stimulation is functionally inhibited. Supporting the bulb may indirectly facilitate continence in a certain subset of patients with postprostatectomy incontinence. During physical activity with increased abdominal pressure, reflex contraction of the pelvic floor muscles as well as the bulbospongiosus muscles occurs to support sphincter function and limit urinary incontinence. Operations to the prostate may weaken urinary sphincter function. It is hypothesized that the distal urinary sphincter may be supported indirectly by placing a hammock underneath the urethral bulb. During moments of physical stress the “cushion” of blood within the supported corpus spongiosum helps to increase the zone of coaptation within the sphincteric (membranous) urethra. This may lead to urinary continence in patients treated by a transobturator repositioning sling in patients with postprostatectomy incontinence. This paper describes the possible role of the urethral bulb in male urinary continence, including its function after retroluminal sling placement (AdVance, AdVance XP® Male Sling System, Minnetonka, USA). PMID:27022393

  20. Bacteriology of the urethra in normal men and men with nongonococcal urethritis.

    PubMed Central

    Bowie, W R; Pollock, H M; Forsyth, P S; Floyd, J F; Alexander, E R; Wang, S P; Holmes, K K

    1977-01-01

    Sixty-nine Caucasian males without a previous history of urethritis and who developed nongonococcal urethritis (NGU) and 39 similar men without urethritis (NU) were cultured from the urethra for Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, aerobes, and anaerobes. C. trachomatis infection was proven by culture of serology in 26 (38%) of the NGU group and 1 (3%) of the NU group; the C. trachomatis-negative NGU group had significantly more U. urealyticum (81%) than the C. trachomatis-positive NGU group (42%) or the NU group (59%). Aerobes were isolated from significantly more NU men (91%) than from men with NGU (66%). The aerobic and anaerobic flora of the two NGU groups were similar. The NU group had significantly more aerobic lactobacilli. Haemophilus vaginalis, alpha-hemolytic streptococci (not Streptococcus faecalis), and anaerobes, predominantly Bacteroides species. This study has provided information about the prevalence and the variety of the aerobic and anaerobic microbiological flora of the anterior urethra of sexually active males. It does not implicate any bacteria other than C. trachomatis and U. urealyticum as potential causes of NGU. PMID:925148

  1. Treatment of Urethral Strictures from Irradiation and Other Nonsurgical Forms of Pelvic Cancer Treatment.

    PubMed

    Khourdaji, Iyad; Parke, Jacob; Chennamsetty, Avinash; Burks, Frank

    2015-01-01

    Radiation therapy (RT), external beam radiation therapy (EBRT), brachytherapy (BT), photon beam therapy (PBT), high intensity focused ultrasound (HIFU), and cryotherapy are noninvasive treatment options for pelvic malignancies and prostate cancer. Though effective in treating cancer, urethral stricture disease is an underrecognized and poorly reported sequela of these treatment modalities. Studies estimate the incidence of stricture from BT to be 1.8%, EBRT 1.7%, combined EBRT and BT 5.2%, and cryotherapy 2.5%. Radiation effects on the genitourinary system can manifest early or months to years after treatment with the onus being on the clinician to investigate and rule-out stricture disease as an underlying etiology for lower urinary tract symptoms. Obliterative endarteritis resulting in ischemia and fibrosis of the irradiated tissue complicates treatment strategies, which include urethral dilation, direct-vision internal urethrotomy (DVIU), urethral stents, and urethroplasty. Failure rates for dilation and DVIU are exceedingly high with several studies indicating that urethroplasty is the most definitive and durable treatment modality for patients with radiation-induced stricture disease. However, a detailed discussion should be offered regarding development or worsening of incontinence after treatment with urethroplasty. Further studies are required to assess the nature and treatment of cryotherapy and HIFU-induced strictures. PMID:26494994

  2. Treatment of Urethral Strictures from Irradiation and Other Nonsurgical Forms of Pelvic Cancer Treatment

    PubMed Central

    Khourdaji, Iyad; Parke, Jacob; Chennamsetty, Avinash; Burks, Frank

    2015-01-01

    Radiation therapy (RT), external beam radiation therapy (EBRT), brachytherapy (BT), photon beam therapy (PBT), high intensity focused ultrasound (HIFU), and cryotherapy are noninvasive treatment options for pelvic malignancies and prostate cancer. Though effective in treating cancer, urethral stricture disease is an underrecognized and poorly reported sequela of these treatment modalities. Studies estimate the incidence of stricture from BT to be 1.8%, EBRT 1.7%, combined EBRT and BT 5.2%, and cryotherapy 2.5%. Radiation effects on the genitourinary system can manifest early or months to years after treatment with the onus being on the clinician to investigate and rule-out stricture disease as an underlying etiology for lower urinary tract symptoms. Obliterative endarteritis resulting in ischemia and fibrosis of the irradiated tissue complicates treatment strategies, which include urethral dilation, direct-vision internal urethrotomy (DVIU), urethral stents, and urethroplasty. Failure rates for dilation and DVIU are exceedingly high with several studies indicating that urethroplasty is the most definitive and durable treatment modality for patients with radiation-induced stricture disease. However, a detailed discussion should be offered regarding development or worsening of incontinence after treatment with urethroplasty. Further studies are required to assess the nature and treatment of cryotherapy and HIFU-induced strictures. PMID:26494994

  3. Proximal urethral reconstruction using a distally based ventral bladder tube flap. An experimental study.

    PubMed

    Fowler, J D; Holmberg, D L

    1987-01-01

    Reconstruction of the proximal urethra using a distally based tube flap mobilized from the ventral bladder wall was performed on 12 clinically normal dogs after total prostatectomy and resection of 2 cm of membranous urethra. One dog was euthanized at 6 hours and one at 36 hours after surgery because of surgical complications. Five dogs were euthanized at 10 days, two dogs at 6 weeks and three dogs at 12 weeks. Advancement of the tube flap allowed for tension-free anastomosis to the membranous urethra. Vascular integrity was maintained in all flaps. Intermittent to continuous postoperative urinary incontinence occurred in 7 of 10 dogs. The incontinence was transient in all 6 and 12 week dogs except one in which a persistent stress incontinence developed. Mild to severe dysuria was noted in 8 of 10 dogs, but was also transient in all of the 6 and 12 week dogs, with the exception of one dog. Postoperative urethral closure pressure profilometry revealed decreased tone in the membranous urethra in all 6 and 12 week dogs. It was concluded that proximal urethral reconstruction, using a ventral bladder tube flap, is a viable technique that may permit functional urodynamic recovery in dogs with significant proximal urethral loss. PMID:3507133

  4. Penile inversion through a penoscrotal incision for the treatment of penile urethral strictures

    PubMed Central

    Tracey, James M; Zhumkhawala, Ali A; Chan, Kevin G.; Lau, Clayton S.

    2016-01-01

    Purpose This article describes a novel technique for the repair of penile urethral strictures and establishes the safety, feasibility, and efficacy of this innovative surgical approach. Materials and Methods Patients with urethral strictures underwent a one-sided anterior dorsal oral mucosal graft urethroplasty through a penoscrotal inversion technique. The clinical outcome was considered a failure when any instrumentation was needed postoperatively, including dilatation. Results Five patients underwent the novel procedure. The patients' mean age was 58 years. The cause of stricture was instrumentation in 2 cases (40%), lichen sclerosis in 1 case (20%), and failed hypospadias repair in 2 cases (40%). The mean stricture length was 3 cm. The overall mean (range) follow-up was 6 months (range, 3–9 months). Of the 5 patients, 4 (80%) had a successful outcome and 1 (20%) had a failed outcome. The failure was successfully treated by use of a meatotomy. Conclusions The penile inversion technique through a penoscrotal incision is a viable option for the management of penile urethral strictures with several advantages to other techniques: namely, no penile skin incision, a single-stage operation, and supine positioning. PMID:26981596

  5. Ruptured urinary bladder attributable to urethral compression by a haematoma after vertebral fracture in a bull

    PubMed Central

    2014-01-01

    Background In male cattle, rupture of the urinary bladder is usually associated with urethral obstruction by uroliths. Less common causes include urethral compression or stricture. This case report describes the findings in a young Limousion breeding bull with rupture of the urinary bladder because of urethral compression by a haematoma after coccygeal fracture. Case presentation The bull had been introduced into a 40-head Red-Holstein herd one week before being injured. One week after introduction to the herd, the bull had an acute onset of anorexia and he was referred to the clinic. There was marked abdominal distension, reduced skin turgor and enophthalmus. The serum concentration of urea and creatinine was increased. Ultrasonographic examination revealed severe ascites and abdominocentesis yielded clear yellow fluid with high urea and creatinine concentrations, which supported a diagnosis of uroperitoneum. The bull was euthanatized because of a poor prognosis. Postmortem examination revealed a comminuted fracture of the first two coccygeal vertebrae associated with a massive haematoma that obstructed entire pelvic cavity. The haematoma compressed the urethra thereby preventing outflow of urine, which resulted in a 5-cm tear ventrally at the neck of the bladder. It was assumed that the newly-introduced bull had sustained the vertebral fractures when he was mounted by a cow. Conclusions The present case study serves to expand the differential diagnosis of urinary bladder rupture. Therefore, in addition to obstructive urolithiasis, compression and stricture of the urethra might be considered in male cattle with uroperitoneum. PMID:24666697

  6. Hypothesis That Urethral Bulb (Corpus Spongiosum) Plays an Active Role in Male Urinary Continence.

    PubMed

    Rehder, Peter; Staudacher, Nina M; Schachtner, Joerg; Berger, Maria E; Schillfahrt, Florian; Hauser, Verena; Mueller, Raphael; Skradski, Viktor; Horninger, Wolfgang; Glodny, Bernhard

    2016-01-01

    The proximal urethral bulb in men is enlarged, surrounds the bulbous urethra, and extends dorsally towards the perineum. During intercourse engorgement takes place due to increased blood flow through the corpus spongiosum. Antegrade ejaculation is facilitated by contraction of the bulbospongiosus muscles during climax. Micturition during sexual stimulation is functionally inhibited. Supporting the bulb may indirectly facilitate continence in a certain subset of patients with postprostatectomy incontinence. During physical activity with increased abdominal pressure, reflex contraction of the pelvic floor muscles as well as the bulbospongiosus muscles occurs to support sphincter function and limit urinary incontinence. Operations to the prostate may weaken urinary sphincter function. It is hypothesized that the distal urinary sphincter may be supported indirectly by placing a hammock underneath the urethral bulb. During moments of physical stress the "cushion" of blood within the supported corpus spongiosum helps to increase the zone of coaptation within the sphincteric (membranous) urethra. This may lead to urinary continence in patients treated by a transobturator repositioning sling in patients with postprostatectomy incontinence. This paper describes the possible role of the urethral bulb in male urinary continence, including its function after retroluminal sling placement (AdVance, AdVance XP® Male Sling System, Minnetonka, USA). PMID:27022393

  7. Sexually dimorphic expression of Mafb regulates masculinization of the embryonic urethral formation

    PubMed Central

    Suzuki, Kentaro; Numata, Tomokazu; Suzuki, Hiroko; Raga, Dennis Diana; Ipulan, Lerrie Ann; Yokoyama, Chikako; Matsushita, Shoko; Hamada, Michito; Nakagata, Naomi; Nishinakamura, Ryuichi; Kume, Shoen; Takahashi, Satoru; Yamada, Gen

    2014-01-01

    Masculinization of external genitalia is an essential process in the formation of the male reproductive system. Prominent characteristics of this masculinization are the organ size and the sexual differentiation of the urethra. Although androgen is a pivotal inducer of the masculinization, the regulatory mechanism under the control of androgen is still unknown. Here, we address this longstanding question about how androgen induces masculinization of the embryonic external genitalia through the identification of the v-maf avian musculoaponeurotic fibrosarcoma oncogene homolog B (Mafb) gene. Mafb is expressed prominently in the mesenchyme of male genital tubercle (GT), the anlage of external genitalia. MAFB expression is rarely detected in the mesenchyme of female GTs. However, exposure to exogenous androgen induces its mesenchymal expression in female GTs. Furthermore, MAFB expression is prominently down-regulated in male GTs of androgen receptor (Ar) KO mice, indicating that AR signaling is necessary for its expression. It is revealed that Mafb KO male GTs exhibit defective embryonic urethral formation, giving insight into the common human congenital anomaly hypospadias. However, the size of Mafb KO male GTs is similar with that of wild-type males. Moreover, androgen treatment fails to induce urethral masculinization of the GTs in Mafb KO mice. The current results provide evidence that Mafb is an androgen-inducible, sexually dimorphic regulator of embryonic urethral masculinization. PMID:25362053

  8. Minimally invasive posterior hamstring harvest.

    PubMed

    Wilson, Trent J; Lubowitz, James H

    2013-01-01

    Autogenous hamstring harvesting for knee ligament reconstruction is a well-established standard. Minimally invasive posterior hamstring harvest is a simple, efficient, reproducible technique for harvest of the semitendinosus or gracilis tendon or both medial hamstring tendons. A 2- to 3-cm longitudinal incision from the popliteal crease proximally, in line with the semitendinosus tendon, is sufficient. The deep fascia is bluntly penetrated, and the tendon or tendons are identified. Adhesions are dissected. Then, an open tendon stripper is used to release the tendon or tendons proximally; a closed, sharp tendon stripper is used to release the tendon or tendons from the pes. Layered, absorbable skin closure is performed, and the skin is covered with a skin sealant, bolster dressing, and plastic adhesive bandage for 2 weeks. PMID:24266003

  9. Brachial artery injury due to closed posterior elbow dislocation: case report☆

    PubMed Central

    Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; do Val Sella, Guilherme; Checchia, Caio Santos; Checchia, Sergio Luiz

    2016-01-01

    An association between closed posterior elbow dislocation and traumatic brachial artery injury is rare. Absence of radial pulse on palpation is an important warning sign and arteriography is the gold-standard diagnostic test. Early diagnosis is essential for appropriate treatment to be provided. This consists of joint reduction and immobilization, along with urgent surgical restoration of arterial flow. Here, a case (novel to the Brazilian literature) of an association between these injuries (and the treatment implemented) in a 27-year-old male patient is reported. These injuries were sustained through physical assault. PMID:27069896

  10. Primary Burkitt lymphoma in the posterior mediastinum.

    PubMed

    Chaari, Zied; Charfi, Slim; Hentati, Abdessalem; Ayadi, Ines; Abid, Hanene; Frikha, Imed

    2015-11-01

    A 13-year-old boy was admitted to our hospital with complaints of posterior chest pain and dyspnea. Computed tomography and magnetic resonance imaging of the chest revealed a mass in the posterior mediastinum, extending from T8 to T11 with intraspinal involvement. A percutaneous core needle biopsy confirmed the diagnosis of Burkitt lymphoma. He was treated according to the Lymphoma Malignancy B protocol 2001 arm C3, but he presented with liver and brain relapses and died 7.5 months after admission. Although lymphoma is rarely localized in the posterior mediastinum, it should be considered in the differential diagnosis of posterior mediastinal masses in children. PMID:26038605

  11. Acute traumatic patellar dislocation.

    PubMed

    Duthon, V B

    2015-02-01

    Inaugural traumatic patellar dislocation is most often due to trauma sustained during physical or sports activity. Two-thirds of acute patellar dislocations occur in young active patients (less than 20 years old). Non-contact knee sprain in flexion and valgus is the leading mechanism in patellar dislocation, accounting for as many as 93% of all cases. The strong displacement of the patella tears the medial stabilizing structures, and notably the medial patellofemoral ligament (MPFL), which is almost always injured in acute patellar dislocation, most frequently at its femoral attachment. Lateral patellar glide can be assessed with the knee in extension or 20° flexion. Displacement by more than 50% of the patellar width is considered abnormal and may induce apprehension. Plain X-ray and CT are mandatory to diagnose bony risk factors for patellar dislocation, such as trochlear dysplasia or increased tibial tubercle-trochlear groove distance (TT-TG), and plan correction. MRI gives information on cartilage and capsulo-ligamentous status for treatment planning: free bodies or osteochondral fracture have to be treated surgically. If patellar dislocation occurs in an anatomically normal knee and osteochondral fracture is ruled out on MRI, non-operative treatment is usually recommended. PMID:25592052

  12. Chronic traumatic encephalopathy.

    PubMed

    Yi, Juneyoung; Padalino, David J; Chin, Lawrence S; Montenegro, Philip; Cantu, Robert C

    2013-01-01

    Sports-related concussion has gained increased prominence, in part due to media coverage of several well-known athletes who have died from consequences of chronic traumatic encephalopathy (CTE). CTE was first described by Martland in 1928 as a syndrome seen in boxers who had experienced significant head trauma from repeated blows. The classic symptoms of impaired cognition, mood, behavior, and motor skills also have been reported in professional football players, and in 2005, the histopathological findings of CTE were first reported in a former National Football League (NFL) player. These finding were similar to Alzheimer's disease in some ways but differed in critical areas such as a predominance of tau protein deposition over amyloid. The pathophysiology is still unknown but involves a history of repeated concussive and subconcussive blows and then a lag period before CTE symptoms become evident. The involvement of excitotoxic amino acids and abnormal microglial activation remain speculative. Early identification and prevention of this disease by reducing repeated blows to the head has become a critical focus of current research. PMID:23314081

  13. Hypertrophic olivary degeneration with gadolinium enhancement after posterior fossa surgery in a child with medulloblastoma.

    PubMed

    Nowak, Johannes; Alkonyi, Balint; Rutkowski, Stefan; Homola, György A; Warmuth-Metz, Monika

    2014-05-01

    Hypertrophic olivary degeneration (HOD) is a rare transsynaptic form of degeneration occurring secondary to the disruption of the dentato-rubro-olivary pathway ("Guillain-Mollaret triangle"). HOD can be caused by ischemic, hemorrhagic, traumatic, or neoplastic lesions, and it can also occur following posterior fossa surgery. MRI characteristics of HOD include T2 signal increase and hypertrophy. To date, blood–brain barrier disruption has not been reported in HOD. Here, we present the first case of HOD with temporary gadolinium enhancement in a 10-year-old child 7 months after resection of a posterior fossa medulloblastoma. The recognition of gadolinium enhancement as a radiological feature of HOD may help to distinguish between this benign secondary condition and tumor recurrence. PMID:24122017

  14. Dermal patch graft correction of severe chordee secondary to penile corporal body disproportion without urethral division in boys without hypospadias.

    PubMed

    Zaontz, M R; Dean, G E

    2016-08-01

    Historically, significant ventral penile curvature secondary to corporal body disproportion has been corrected either by dorsal plication or division of the urethral plate. In the rare situations where there is severe chordee in the face of an intact urethra with an orthotopic meatus, division of the urethral plate is commonly performed at the time of grafting the ventral defect created by incising the tunica albuginea. Subsequently, a staged procedure is necessary to reconnect the urethra at a later date. Herein the authors present a novel technique that shows it is possible to perform successful dermal patch orthoplasty without division of the urethra in patients with a normal orthotopic meatus and urethra via urethral mobilization. Three patients over the past 3 years with severe ventral chordee, orthotopic meati and normal urethral anatomy presented for correction. Two patients were 18 years old and one was 10 years old. All three boys were circumcised. The two older boys insisted on dorsal plication as a first approach which worked only temporarily for about 6 months while the younger boy had no prior surgery performed. Each boy underwent a circumcising incision, degloving of the shaft skin, extensive urethral mobilization and dermal patch graft orthoplasty to correct chordee. All surgeries were performed in an outpatient setting. No urinary drainage was used in any patient and a simple bio-occlusive dressing was employed in each case. Follow-up ranged from 11 months to 2 years (mean 1.5 years). All three boys have strong straight erections, full well directed urinary streams and no complications noted to date. Our conclusion based on this experience is that extensive urethral mobilization can allow for correction of severe ventral chordee without urethral division in a single operative setting in boys without hypospadias and a normal urethra. The accompanying movie herein describes the surgical technique. PMID:27561429

  15. Application of novel optical diffuser for urethral stricture treatment (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Nguyen, Trung Hau; Rhee, Yun-Hee; Ahn, Jin-Chul; Kang, Hyun Wook

    2016-02-01

    Optical fibers have frequently been used for photothermal laser therapy due to its efficiency to deliver laser energy directly to tissue. The aim of the current study was to develop a diffusing optical fiber to achieve radially uniform light irradiation for endoscopically treating urethral stricture. The optical diffuser was fabricated by micro-machining helical patterns on the fiber surface using CO2 laser light at 5 W. Visible light emission (632 nm) and spatial emissions (including polar, azimuthal, and longitudinal emissions) of the fiber tip were evaluated to validate the performance of the fabricated diffuser. Prior to tissue tests, numerical simulation on heat distribution was developed to estimate the degree of tissue coagulation depth during interstitial coagulation. Due to a high absorption coefficient by tissue water, 1470 nm laser was used for photothermal therapy treatment of urethral stricture to obtain a more precise depth profile. For in vitro tissue tests, porcine liver tissue was irradiated with three different power levels (3, 6, and 9 W) at various irradiation times. Porcine urethral tissue was also tested with the diffuser for 10 sec at 6 W to validate the feasibility of circumferential photothermal treatment. The treated tissue was stained with hematoxylin and eosin (H and E) and then imaged with an optical transmission microscope. The spatial emission characteristics of the diffusing optical fiber presented an almost uniform power distribution along the diffuser tip (less than 10% deviation) and around its circumference (less than 5% deviation). The peak temperature in simulation model at the tissue interface between the glass-cap and the tissue was 373 K that was higher than that at the distal end. The tissue tests showed that higher power levels resulted in lower coagulation thresholds (e.g., 1 sec at 9 W vs 8 sec at 3 W). Furthermore, the coagulation depth was approximately 20% thinner than the simulation results (p<0.001). The extent of

  16. Traumatic Brain Injury: FDA Research and Actions

    MedlinePlus

    ... For Consumers Home For Consumers Consumer Updates Traumatic Brain Injury: FDA Research and Actions Share Tweet Linkedin ... top What to Do if You Suspect Traumatic Brain Injury Anyone with signs of moderate or severe ...

  17. Post-Traumatic Stress Disorder (PDQ)

    MedlinePlus

    ... with post-traumatic stress need early treatment with methods that are used to treat other trauma victims. ... symptoms of post-traumatic stress. The crisis intervention method aims to relieve distress and help the patient ...

  18. Interventional Treatment for Post-traumatic Headache.

    PubMed

    Conidi, Francis X

    2016-06-01

    Post-traumatic headache (migraine) is the most common symptom of concussion and traumatic brain injury. An expert opinion-based review along with a literature review (PubMed) was conducted looking at known interventional procedures for post-traumatic headache using the keywords post-traumatic headache, post-traumatic migraine headache, concussion, mild traumatic brain injury, and traumatic brain injury and the following categories: mechanism, pathophysiology, treatment, physical therapy, neurostimulation, Botox@/Onabotulinum toxin, and surgical intervention. The results returned a total of 181 articles of which 52 were selected. None of the articles included randomized placebo-controlled studies, and most were either prospective or retrospective case analysis and/or review articles or consensus opinion papers, with most studies yielding positive results. Despite a lack of hard evidence, interventional procedures, alone or in combination, appear to be an effective treatment for post-traumatic headaches. PMID:27130542

  19. Traumatic corneal endothelial rings from homemade explosives.

    PubMed

    Ng, Soo Khai; Rudkin, Adam K; Galanopoulos, Anna

    2013-08-01

    Traumatic corneal endothelial rings are remarkably rare ocular findings that may result from blast injury. We present a unique case of bilateral traumatic corneal endothelial rings secondary to blast injury from homemade explosives. PMID:23474743

  20. Pseudoaneurysm of the Posterior Tibial Artery After Posterior Tibial Tendon Transfer.

    PubMed

    Elabdi, Monsef; Roukhsi, Redouane; Tijani, Youssef; Chtata, Hassan; Jaafar, Abdeloihab

    2016-01-01

    Pseudoaneurysm of the posterior tibial artery is an uncommon condition that, left untreated, can lead to hemorrhage, thrombosis, or emboli. We present the case of a 54-year-old male who developed pseudoaneurysm of the posterior tibial artery 4 months after undergoing tibialis posterior tendon transfer for management of peroneal nerve palsy, which had developed as a complication of hip arthroplasty. PMID:26972754

  1. Bony wall damage in the region of the middle and posterior cranial fossa observed during otosurgery

    PubMed Central

    Wiatr, Maciej; Składzień, Jacek; Tomik, Jerzy; Stręk, Paweł; Przeklasa-Muszyńska, Anna

    2012-01-01

    Summary Background Bony wall damages in the region of the middle and posterior cranial fossa are usually observed in cases of chronic otitis media. These defects can also be congenital, post-traumatic, iatrogenic or due to tumors. They can potentially lead to the development of intracranial complications. Material/Methods We analyzed patients who were diagnosed as having bony wall damage in the region of the middle and/or posterior cranial fossa. We also discuss methods of reconstruction during otosurgery. The analysis involves patients who underwent middle ear operations in the Department of Otolaryngology at the Jagiellonian University of Krakow between 2004 and 2008; 495 otosurgeries were performed during this period of time. Results In 70% of patients the reason for otosurgery was chronic otitis media. In 20%, bone defects occurred simultaneously with otosclerosis. Less than 10% underwent otosurgery for other reasons. Bony wall damage in the region of the middle and posterior cranial fossa were diagnosed in 46 patients who underwent surgery. In patients with bony wall damage, otogenic intracranial complications were described in 14 cases. Conclusions The performed reconstruction methods for bony wall damage, which used the fascia, strengthened with the pedicle muscle flap for larger defects and with either bone lamella or cartilage in specific cases, proved successful. Nearly 80% of bony wall damages in the region of the middle and posterior cranial fossa remain asymptomatic and are discovered incidentally during middle ear surgery. The above observations emphasize the significant role of pre-operative imaging diagnostics. PMID:22648242

  2. Posterior Cervical Foraminotomy: Indications, Technique, and Outcomes.

    PubMed

    Dodwad, Shah-Jahan M; Dodwad, Shah-Nawaz M; Prasarn, Mark L; Savage, Jason W; Patel, Alpesh A; Hsu, Wellington K

    2016-06-01

    Cervical radiculopathy presents with upper extremity pain, decreased sensation, and decreased strength caused by irritation of specific nerve root(s). After failure of conservative management, surgical options include anterior cervical decompression and fusion, disk arthroplasty, and posterior cervical foraminotomy. In this review, we discuss indications, techniques, and outcomes of posterior cervical laminoforaminotomy. PMID:27187617

  3. Consistently inconsistent, the posterior vaginal wall.

    PubMed

    Hale, Douglass S; Fenner, Dee

    2016-03-01

    Posterior vaginal wall prolapse is one of the most common prolapses encountered by gynecological surgeons. What appears to be a straightforward condition to diagnose and treat surgically for physicians has proven to be frustratingly unpredictable with regard to symptom relief for patients. Functional disorders such as dyssynergic defecation and constipation are often attributed to posterior vaginal wall prolapse. Little scientific evidence supports this assumption, emphasizing that structure and function are not synonymous when treating posterior vaginal wall prolapse. Rectoceles, enteroceles, sigmoidoceles, peritoneoceles, rectal and intraanal intussusception, rectal prolapse, and descending perineal syndrome are all conditions that have an impact on the posterior vaginal wall. All too often these different anatomic conditions are treated with the same surgical approach, addressing a posterior vaginal wall bulge with a traditional posterior colporrhaphy. Studies that examine the correlation between stage of posterior wall prolapse and patient symptoms have failed to reliably do so. Surgical outcomes measured by prolapse staging appear successful, yet patient expectations are often not met. As increasing attention is being placed on patient satisfaction outcomes concerning surgical treatments, this fact will need to be addressed. Surgeons will have to clearly communicate what can and what cannot be expected with surgical repair of posterior vaginal wall prolapse. PMID:26348375

  4. Memory for Traumatic Experiences in Early Childhood

    ERIC Educational Resources Information Center

    Cordon, Ingrid M.; Pipe, Margaret-Ellen; Sayfan, Liat; Melinder, Annika; Goodman, Gail S.

    2004-01-01

    Traumatic experiences in early childhood raise important questions about memory development in general and about the durability and accessibility of memories for traumatic events in particular. We discuss memory for early childhood traumatic events, from a developmental perspective, focusing on those factors that may equally influence memories for…

  5. Knowledge of Traumatic Brain Injury among Educators

    ERIC Educational Resources Information Center

    Ernst, William J.; Gallo, Adrienne B.; Sellers, Amanda L.; Mulrine, Jessica; MacNamara, Luciana; Abrahamson, Allison; Kneavel, Meredith

    2016-01-01

    The purpose of this study is to determine knowledge of traumatic brain injury among educators. Few studies have examined knowledge of traumatic brain injury in this population and fewer still have included a substantial proportion of general education teachers. Examining knowledge of traumatic brain injury in educators is important as the vast…

  6. Traumatic Childhood Events and Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Kerns, Connor Morrow; Newschaffer, Craig J.; Berkowitz, Steven J.

    2015-01-01

    Traumatic childhood events are associated with a wide range of negative physical, psychological and adaptive outcomes over the life course and are one of the few identifiable causes of psychiatric illness. Children with autism spectrum disorder (ASD) may be at increased risk for both encountering traumatic events and developing traumatic sequelae;…

  7. Surgical Reconstruction of the Urinary Sphincter after Traumatic Longitudinal Disruption

    PubMed Central

    Rehder, Peter; Schillfahrt, Florian; Skradski, Viktor

    2014-01-01

    The question is whether the urethral sphincter may be reconstructed after longitudinal injury similar to anal sphincter injuries. Analogue to obstetric, anal sphincter repair, an approximation repair of the sphincter may be feasible. An overlap repair is possible in anal sphincter repair, but because of the little tissue available in the urethral sphincter this is not an option. We describe three cases of urethral sphincter injury of different aetiologies. All resulted in a total longitudinal disruption of the muscular components of the urethral sphincter complex. After making the diagnosis of urethral sphincter injury, a primary approximation repair was done. Follow-up of at least two and up to three years is promising with one male patient being completely continent and the two female patients needing one safety pad per day. Longitudinal disruption of the muscular elements of the sphincteric urethra may be primarily reconstructed with good success using an approximation technique with simple interrupted sutures. PMID:25258694

  8. Traumatic asphyxia: An autopsy case.

    PubMed

    Türkmen, Nursel; Eren, Bülent; Erkol, Zerrin

    2015-01-01

    Traumatic asphyxia is a form of asphyxia where respiration is prevented by external pressure on the body. A 19-year-old man was found by relatives compressed by motorboat in the garage. The death was investigated by the prosecutor; body was taken to the Morgue Department for performing autopsy. On gross physical examination; the face, neck and upper part of the chest were congested and many petechiae were observed on the conjunctivae, but not in low extremities. Autopsy macroscopic examination of lungs revealed congestion, sub pleural superficial bleeding areas. In the presented case death was reported as traumatic asphyxia by thorax compression without other lethal factors. PMID:26585308

  9. Post-Traumatic Visual Loss

    PubMed Central

    Atkins, Edward J.; Newman, Nancy J.; Biousse, Valérie

    2010-01-01

    Visual loss following head trauma is common, and the diagnosis can be challenging for the neurologist called to perform an emergency room assessment. The approach to the patient with post-traumatic visual loss is complicated by a wide range of potential ocular and brain injuries with varying pathophysiology. In addition to direct injuries of the eye and orbit, traumatic optic neuropathies, carotid cavernous fistulas, and damage to the intracranial visual pathways are classic causes of visual loss after head trauma. This review provides an update on the diagnosis and management of these conditions. PMID:18660739

  10. Traumatic spondyloptosis: a series of 20 patients.

    PubMed

    Mishra, Akash; Agrawal, Deepak; Gupta, Deepak; Sinha, Sumit; Satyarthee, Guru D; Singh, Pankaj K

    2015-06-01

    OBJECT Spondyloptosis represents the most severe form of spondylolisthesis, which usually follows high-energy trauma. Few reports exist on this specific condition, and the largest series published to date consists of only 5 patients. In the present study the authors report the clinical observations and outcomes in a cohort of 20 patients admitted to a regional trauma center for severe injuries including spondyloptosis. METHODS The authors performed a retrospective chart review of patients admitted with spondyloptosis at their department over a 5-year period (March 2008-March 2013). Clinical, radiological, and operative details were reviewed for all patients. RESULTS In total, 20 patients with spondyloptosis were treated during the period reviewed. The mean age of the patients was 27 years (range 12-45 years), and 17 patients were male (2 boys and 15 men) and 3 were women. Fall from height (45%) and road traffic accidents (35%) were the most common causes of the spinal injuries. The grading of the American Spinal Injury Association (ASIA) was used to assess the severity of spinal cord injury, which for all patients was ASIA Grade A at the time of admission. In 11 patients (55%), the thoracolumbar junction (T10-L2) was involved in the injury, followed by the dorsal region (T1-9) in 7 patients (35%); 1 patient (5%) had lumbar and 1 patient (5%) sacral spondyloptosis. In 19 patients (95%), spondyloptosis was treated surgically, involving the posterior route in all cases. In 7 patients (37%), corpectomy was performed. None of the patients showed improvement in neurological deficits. The mean follow-up length was 37.5 months (range 3-60 months), and 5 patients died in the follow-up period from complications due to formation of bedsores (decubitus ulcers). CONCLUSIONS To the authors' best knowledge, this study was the largest of its kind on traumatic spondyloptosis. Its results illustrate the challenges of treating patients with this condition. Despite deformity

  11. Postoperative radiographic and clinical assessment of the treatment of posterior tibial plafond fractures using a posterior lateral incisional approach.

    PubMed

    Ruokun, Huang; Ming, Xie; Zhihong, Xiao; Zhenhua, Fang; Jingjing, Zhao; Kai, Xiao; Jing, Li

    2014-01-01

    The purpose of the present study was to evaluate the postoperative radiographic and functional outcomes of reduction and fixation of a posterior plafond fracture using a posterolateral approach. We included 38 patients with a tibial plafond fracture. Fixation was most commonly performed using screws, T plates, or meta plates. The average follow-up period was 38 (range 25 to 72) months. The clinical outcomes of these patients were evaluated using the American Orthopaedic Foot Ankle Society score. The radiographs of the included patients were evaluated twice within 2 months by 3 experienced orthopedic trauma surgeons, who performed the retrospective radiographic review. Articular step off measures included the radiographic appearance of the reduction using picture archiving and communication system measurement tools. All 32 patients showed radiologic evidence of bony union at the follow-up visit; 6 patients were lost to follow-up. The American Orthopaedic Foot Ankle Society average score was 92 points; 21 patients (93.7%) had excellent scores (90 to 100 points), 9 patients (28.1%) had good scores (80 to 89 points), and 2 patients (6.2%) had fair scores (<80 points). Excellent to good outcomes were noted in 93.7% of the patients. One patient developed a superficial infection. Another patient experienced a sural cutaneous nerve injury. The radiographic articular step off was measured as 1 mm or less in 29 patients (90.6%) and 1 to 2 mm in 3 patients (9.4%). One patient (3.1%) developed symptomatic post-traumatic arthritis. The posterolateral approach allowed for good exposure and buttress fixation of the posterior plafond fractures with few local complications. The anatomic repositioning and stable fixation resulted in good functional and subjective outcomes. PMID:25154653

  12. Traumatic Childhood Events and Autism Spectrum Disorder.

    PubMed

    Kerns, Connor Morrow; Newschaffer, Craig J; Berkowitz, Steven J

    2015-11-01

    Traumatic childhood events are associated with a wide range of negative physical, psychological and adaptive outcomes over the life course and are one of the few identifiable causes of psychiatric illness. Children with autism spectrum disorder (ASD) may be at increased risk for both encountering traumatic events and developing traumatic sequelae; however, this topic has been understudied. This review considers the rationale for examining traumatic events and related symptomology in individuals with ASD and summarizes the limited research on this topic. A conceptual framework for understanding the interplay of ASD, trauma and traumatic sequelae is proposed and recommendations for future research presented. PMID:25711547

  13. Congenital basis of posterior fossa anomalies

    PubMed Central

    Cotes, Claudia; Bonfante, Eliana; Lazor, Jillian; Jadhav, Siddharth; Caldas, Maria; Swischuk, Leonard

    2015-01-01

    The classification of posterior fossa congenital anomalies has been a controversial topic. Advances in genetics and imaging have allowed a better understanding of the embryologic development of these abnormalities. A new classification schema correlates the embryologic, morphologic, and genetic bases of these anomalies in order to better distinguish and describe them. Although they provide a better understanding of the clinical aspects and genetics of these disorders, it is crucial for the radiologist to be able to diagnose the congenital posterior fossa anomalies based on their morphology, since neuroimaging is usually the initial step when these disorders are suspected. We divide the most common posterior fossa congenital anomalies into two groups: 1) hindbrain malformations, including diseases with cerebellar or vermian agenesis, aplasia or hypoplasia and cystic posterior fossa anomalies; and 2) cranial vault malformations. In addition, we will review the embryologic development of the posterior fossa and, from the perspective of embryonic development, will describe the imaging appearance of congenital posterior fossa anomalies. Knowledge of the developmental bases of these malformations facilitates detection of the morphological changes identified on imaging, allowing accurate differentiation and diagnosis of congenital posterior fossa anomalies. PMID:26246090

  14. Decelerating burst and complex repetitive discharges in the striated muscle of the urethral sphincter, associated with urinary retention in women.

    PubMed Central

    Fowler, C J; Kirby, R S; Harrison, M J

    1985-01-01

    A type of electromyographic activity, formerly referred to as "pseudomyotonia", can be recorded from the striated muscle of the urethral sphincter using a concentric needle electrode. There are two components to this activity, complex repetitive discharges and decelerating bursts. The latter usually dominate recordings and sound very like myotonic discharges. Analysis of these discharges indicates that they are a form of "bizarre repetitive discharge", and as such, result from ephaptic spread of excitation between muscle fibres rather than from excitation arising in the terminal branches of the motor axon. Profuse activity of this type has been found in 15 women with symptoms of urethral dysfunction, including 11 with urinary retention. It is suggested that this activity is associated with a failure of urethral sphincter relaxation. Images PMID:4056803

  15. Sickle cell disease and posterior reversible leukoencephalopathy.

    PubMed

    Geevasinga, Nimeshan; Cole, Catherine; Herkes, Geoffrey K; Barnett, Yael; Lin, Jamie; Needham, Merrilee

    2014-08-01

    Sickle cell disease can present with neurological manifestations. One such presentation is with posterior reversible leukoencephalopathy also known as reversible posterior leukoencephalopathy. The condition is classically described as reversible over time; it commonly presents with oedematous changes involving the white matter of the occipital and parietal regions. Only a few patients with the association between sickle cell disease and posterior reversible leukoencephalopathy have been described in the adult literature. We present two patients from our institutions to emphasise the association between the two conditions and summarise the published cases in the literature. PMID:24656986

  16. Reconsidering Post-Traumatic Stress

    ERIC Educational Resources Information Center

    Berman, Dene S.; Davis-Berman, Jennifer

    2005-01-01

    This article serves to challenge the prevailing wisdom that suggests that most trauma is followed by post-traumatic stress disorder (PTSD), and is best treated with critical incident stress debriefing (CISD). Instead, recent evidence suggests that many individuals exposed to stress do not experience stress responses. Even those who do, however,…

  17. Understanding Traumatic Stress in Children

    ERIC Educational Resources Information Center

    Bassuk, Ellen L.; Konnath, Kristina; Volk, Katherine T.

    2006-01-01

    The unexpected loss of a loved one, a car accident, or exposure to a violent experience is familiar to many. Everyone reacts to such events, but the responses vary widely, ranging from numbness and withdrawal, to crying, nervousness, and agitation. Because traumatic events are prevalent, cause profound suffering, and may lead to life altering…

  18. Evaluation after Traumatic Brain Injury

    ERIC Educational Resources Information Center

    Trudel, Tina M.; Halper, James; Pines, Hayley; Cancro, Lorraine

    2010-01-01

    It is important to determine if a traumatic brain injury (TBI) has occurred when an individual is assessed in a hospital emergency room after a car accident, fall, or other injury that affects the head. This determination influences decisions about treatment. It is essential to screen for the injury, because the sooner they begin appropriate…

  19. Traumatic Brain Injury Inpatient Rehabilitation

    ERIC Educational Resources Information Center

    Im, Brian; Schrer, Marcia J.; Gaeta, Raphael; Elias, Eileen

    2010-01-01

    Traumatic brain injuries (TBI) can cause multiple medical and functional problems. As the brain is involved in regulating nearly every bodily function, a TBI can affect any part of the body and aspect of cognitive, behavioral, and physical functioning. However, TBI affects each individual differently. Optimal management requires understanding the…

  20. Early Experience with Hyaluronic Acid Instillation to Assist with Visual Internal Urethrotomy for Urethral Stricture

    PubMed Central

    Kim, Hak Min; Kang, Dong Il; Shim, Bong Suk

    2010-01-01

    Purpose The clinical usefulness of hyaluronic acid (HA) instillation during visual internal urethrotomy (VIU) for decreasing the incidence of recurrent urethral stricture was assessed. Materials and Methods Twenty-eight patients were treated by VIU with HA instillation between May 2007 and June 2009. After insertion of a Foley catheter following urethrotomy, HA was instilled via an 18-gauge tube catheter between the urethral lumen and Foley catheter. Seventeen cases were analyzed retrospectively 12 months postoperatively. We evaluated the success rate of this procedure by comparing retrograde urethrography (RGU) results, maximum flow rates, and postvoid residual urine volumes preoperatively and 3 and 12 months postoperatively. Success was defined as either a maximum flow rate of at least 15 ml/s or no visible urethral stricture on RGU at 12 months postoperatively. Results Total success rates were 76.5% (13/17) and 52.9% (9/17) at 3 and 12 months postoperatively, respectively. By etiology, success rates at 3 and 12 months postoperatively, respectively, were 66.7% and 33.3% for inflammation, 66.7% and 50.0% for trauma, and 83.3% and 66.7% for unknown causes. Success rates were 63.6% for strictures less than 10 mm in length and 33.3% for strictures of 10 mm or more in length at 12 months postoperatively. Success rates were 61.5% for single strictures and 25% for multiple strictures at 12 months postoperatively. Conclusions The success rate of VIU with HA instillation was not better than that observed in the literature for conventional VIU. PMID:21221206

  1. Standard Treatment Regimens for Nongonococcal Urethritis Have Similar but Declining Cure Rates: A Randomized Controlled Trial

    PubMed Central

    Manhart, Lisa E.; Gillespie, Catherine W.; Lowens, M. Sylvan; Khosropour, Christine M.; Colombara, Danny V.; Golden, Matthew R.; Hakhu, Navneet R.; Thomas, Katherine K.; Hughes, James P.; Jensen, Nicole L.; Totten, Patricia A.

    2013-01-01

    Background. Azithromycin or doxycycline is recommended for nongonococcal urethritis (NGU); recent evidence suggests their efficacy has declined. We compared azithromycin and doxycycline in men with NGU, hypothesizing that azithromycin was more effective than doxycycline. Methods. From January 2007 to July 2011, English-speaking males ≥16 years, attending a sexually transmitted diseases clinic in Seattle, Washington, with NGU (visible urethral discharge or ≥5 polymorphonuclear leukocytes per high-power field [PMNs/HPF]) were eligible for this double-blind, parallel-group superiority trial. Participants received active azithromycin (1 g) + placebo doxycycline or active doxycycline (100 mg twice daily for 7 days) + placebo azithromycin. Urine was tested for Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Ureaplasma urealyticum biovar 2 (UU-2), and Trichomonas vaginalis (TV) using nucleic acid amplification tests. Clinical cure (<5 PMNs/HPF with or without urethral symptoms and absence of discharge) and microbiologic cure (negative tests for CT, MG, and/or UU-2) were determined after 3 weeks. Results. Of 606 men, 304 were randomized to azithromycin and 302 to doxycycline; CT, MG, TV, and UU-2 were detected in 24%, 13%, 2%, and 23%, respectively. In modified intent-to-treat analyses, 172 of 216 (80%; 95% confidence interval [CI], 74%–85%) receiving azithromycin and 157 of 206 (76%; 95% CI, 70%–82%) receiving doxycycline experienced clinical cure (P = .40). In pathogen-specific analyses, clinical cure did not differ by arm, nor did microbiologic cure differ for CT (86% vs 90%, P = .56), MG (40% vs 30%, P = .41), or UU-2 (75% vs 70%, P = .50). No unexpected adverse events occurred. Conclusions. Clinical and microbiologic cure rates for NGU were somewhat low and there was no significant difference between azithromycin and doxycycline. Mycoplasma genitalium treatment failure was extremely common. Clinical Trials Registration. NCT00358462. PMID

  2. Treatment of bulbar urethral strictures a review, with personal critical remarks.

    PubMed

    Oosterlinck, Willem

    2003-05-27

    This is a review article on treatment of bulbar urethral strictures with personal critical remarks on newer developments. As a treatment of first intention there exists 4 options : dilatation, urethrotomy, end to end anastomosis and free graft, open urethroplasty. Success rate of dilatation and visual urethrotomy after 4 years is only 20 en 40% respectively. Laser urethrotomy could not fulfill expectations. End to end anastomosis obtains a very high success rate but is only applicable for short strictures. Free graft urethroplasty obtains success rates of +/- 80%. There is considerable debate on the best material for grafting. Buccal mucosa graft is the new wave, but this is not based on scientific data. Whether this graft should be used dorsally or ventrally is also a point of discussion. In view of the good results published with both techniques it is probably of no importance. Intraluminal stents are not indicated for complicated cases and give only good results in those cases which can easily be treated with other techniques. Metal self-retaining urethral stent, resorbable stents and endoscopic urethroplasty is briefly discussed. Redo's and complicated urethral strictures need often other solutions. Here skin flap from the penile skin and scrotal flap can be used. Advantages and drawbracks of both are discussed. There is still a place for two-stage procedures in complicated redo"s. The two-stage mesh-graft urethroplasty offers advantage over the use of scrotal skin. Some other rare techniques like substitution with bowel and pudendal thigh flap, to cover deep defects, are also discussed. PMID:12806105

  3. The current role of direct vision internal urethrotomy and self-catheterization for anterior urethral strictures

    PubMed Central

    Dubey, Deepak

    2011-01-01

    Introduction: Direct visual internal urethrotomy (DVIU) followed by intermittent self-dilatation (ISD) is the most commonly performed intervention for urethral stricture disease. The objective of this paper is to outline the current scientific evidence supporting this approach for its use in the management of anterior urethral strictures. Materials and Methods: A Pubmed database search was performed with the words “internal urethrotomy” and “internal urethrotomy” self-catheterization. All papers dealing with this subject were scrutinized. Cross-references from the retrieved articles were also viewed. Only English language articles were included in the analyses. Studies were analyzed to identify predictors for success for DVIU. Results: Initial studies showed excellent outcomes with DVIU with success rates ranging from 50% to 85%. However, these studies reported only short-term results. Recent studies with longer followup have shown a poor success rate ranging from 6% to 28%. Stricture length and degree of fibrosis (luminal narrowing) were found to be predictors of response. Repeated urethrotomies were associated with poor results. Studies involving intermittent self-catheterization following DVIU have shown no role in short-term ISD with one study reporting beneficial effects if continued for more than a year. A significant number of studies have shown long-term complications with SC and high dropout rates. Conclusions: DVIU is associated with poor long-term cure rates. It remains as a treatment of first choice for bulbar urethral strictures <1 cm with minimal spongiofibrosis. There is no role for repeated urethrotomy as outcomes are uniformly poor. ISD, when used for more than a year on a weekly or biweekly basis may delay the onset of stricture recurrence. PMID:22022065

  4. Unusual cause of urethral bleeding in an adolescent: a case in dilemma.

    PubMed

    Singh, Dig Vijay; Mandal, Arup Kumar

    2014-01-01

    Numerous cases of self-inflicted foreign bodies in the male urethra have been reported. A case of a self-inflicted urethral injury or hemangioma in an adolescent that presented a dilemma is described here. An adolescent male of 14 years presented with a complaint of intermittent urethral bleeding for a week. He attributed this to blunt trauma sustained while playing in school. On examination, there was no sign suggestive of any trauma or any abnormal lesion on the genitalia or surrounding area. On cystourethroscopy, there was a solitary hemorrhagic lesion of 0.5 cm with a bluish base on the ventral surface of the pendular urethra, 1 cm proximal to the fossa navicularis, which was ablated using Ho:YAG laser fiber (365 μm) through a working channel mounted in an OIU (optical internal urethrotomy) sheath. The absence of any sign of external trauma or presentation after 1 week of the incident suggests an element of falseness in the history. It may be due to embarrassment or fear, which contributes to self-insertion of foreign bodies into the urethra as the primary cause, especially in adolescent males. However, the trauma can be coincidental, with the bleeding of the urethra caused by a urethral lesion like a hemangioma and might present after a long gap of 1 week due to a lack of understanding or lack of severe symptoms. Most patients of self-inflicted injuries are too ashamed to admit that they inserted any object. A psychiatric evaluation is recommended for all these adolescents, with appropriate medical therapy when indicated. PMID:23633463

  5. Effect of dilution rate on feline urethral sperm motility, viability, and DNA integrity.

    PubMed

    Prochowska, Sylwia; Niżański, Wojciech; Ochota, Małgorzata; Partyka, Agnieszka

    2014-12-01

    This study was designed to investigate if the characteristics of feline urethral sperm can be affected by high dilution in an artificial medium. The semen collected by urethral catheterization from eight male cats was evaluated for sperm concentration and motility and subsequently diluted with a TRIS-based extender to the concentration of spermatozoa 10 × 10(6)/mL, 5 × 10(6)/mL, and 1 × 10(6)/mL. Immediately after the extension samples were assessed for motility, cell viability using SYBR-14 and propidium iodide, acrosome integrity using lectin from Arachis hypogaea Alexa Fluor 488 Conjugate, and propidium iodide and chromatin status by acridine orange. Compared with 10 × 10(6)/mL dilution rate, spermatozoa diluted to 1 × 10(6) sperm/mL had a significantly lower proportion of motile (31.1% ± 19.8 and 0.7% ± 1.6, respectively, P < 0.05) and viable spermatozoa (88.3% ± 3.1 and 69.1% ± 12.8, respectively, P < 0.01). There was no dilution-related difference in the acrosome integrity (76.7% ± 11.9 vs. 75.9% ± 10.6) and chromatin status (defragmentation index, 3.3% ± 0.97 vs. 3.4% ± 1.7). These results indicate that feline urethral semen is susceptible to high dilution rate, and some sperm characteristics can be artifactually changed by semen dilution. It also suggests the potential role of seminal plasma in maintaining sperm motility and viability in high dilution rates. PMID:25262548

  6. Nationwide surveillance of the antimicrobial susceptibility of Chlamydia trachomatis from male urethritis in Japan.

    PubMed

    Takahashi, Satoshi; Hamasuna, Ryoichi; Yasuda, Mitsuru; Ishikawa, Kiyohito; Hayami, Hiroshi; Uehara, Shinya; Yamamoto, Shingo; Minamitani, Shinichi; Kadota, Junichi; Iwata, Satoshi; Kaku, Mitsuo; Watanabe, Akira; Sato, Junko; Hanaki, Hideaki; Masumori, Naoya; Kiyota, Hiroshi; Egawa, Shin; Tanaka, Kazushi; Arakawa, Soichi; Fujisawa, Masato; Kumon, Hiromi; Wada, Koichiro; Kobayashi, Kanao; Matsubara, Akio; Matsumoto, Tetsuro; Eto, Masatoshi; Tatsugami, Katsunori; Kuroiwa, Kentaro; Ito, Kenji; Hosobe, Takahide; Hirayama, Hideo; Narita, Harunori; Yamaguchi, Takamasa; Ito, Shin; Sumii, Toru; Kawai, Shuichi; Kanokogi, Mototsugu; Kawano, Hiromi; Chokyu, Hirofumi; Uno, Satoshi; Monden, Koichi; Kaji, Shinichi; Kawahara, Motoshi; Takayama, Kazuo; Ito, Masayasu; Yoshioka, Masaru; Kano, Motonori; Konishi, Takatoshi; Kadena, Hitoshi; Nishi, Shohei; Nishimura, Hirofumi; Yamauchi, Takamine; Maeda, Shinichi; Horie, Masanobu; Ihara, Hideari; Matsumura, Masaru; Shirane, Takeshi; Takeyama, Koh; Akiyama, Kikuo; Takahashi, Koichi; Ikuyama, Toshihiro; Inatomi, Hisato; Yoh, Mutsumasa

    2016-09-01

    Genital chlamydial infection is a principal sexually transmitted infection worldwide. Chlamydia trachomatis can cause male urethritis, acute epididymitis, cervicitis, and pelvic inflammatory disease as sexually transmitted infections. Fortunately, homotypic resistant C. trachomatis strains have not been isolated to date; however, several studies have reported the isolation of heterotypic resistant strains from patients. In this surveillance study, clinical urethral discharge specimens were collected from patients with urethritis in 51 hospitals and clinics in 2009 and 38 in 2012. Based on serial cultures, the minimum inhibitory concentration (MIC) could be determined for 19 isolates in 2009 and 39 in 2012. In 2009 and 2012, the MICs (MIC90) of ciprofloxacin, levofloxacin, tosufloxacin, sitafloxacin, doxycycline, minocycline, erythromycin, clarithromycin, and azithromycin were 2 μg/ml and 1 μg/ml, 0.5 μg/ml and 0.5 μg/ml, 0.125 μg/ml and 0.125 μg/ml, 0.063 μg/ml and 0.063 μg/ml, 0.125 μg/ml and 0.125 μg/ml, 0.125 μg/ml and 0.125 μg/ml, 0.016 μg/ml and 0.016 μg/ml, and 0.063 μg/ml and 0.063 μg/ml, respectively. In summary, this surveillance project did not identify any resistant strain against fluoroquinolone, tetracycline, or macrolide agents in Japan. PMID:27452428

  7. Oral ciprofloxacin versus ceftriaxone for the treatment of urethritis from resistant Neisseria gonorrhoeae in Zambia.

    PubMed Central

    Bryan, J P; Hira, S K; Brady, W; Luo, N; Mwale, C; Mpoko, G; Krieg, R; Siwiwaliondo, E; Reichart, C; Waters, C

    1990-01-01

    Neisseria gonorrhoeae strains resistant to treatment with penicillin, tetracycline, and/or spectinomycin are increasing in prevalence in many parts of the world. In Zambia, 52% of N. gonorrhoeae isolates produced beta-lactamase in 1986. Few oral regimens have proven effective for treatment of resistant N. gonorrhoeae. We conducted a prospective, double-blind, randomized clinical trial of 250 mg of ciprofloxacin given orally versus 250 mg of ceftriaxone given intramuscularly for treatment of uncomplicated gonococcal urethritis in adult males. Two hundred men were enrolled and treated. The two groups were comparable in age (27.5 years), prevalence of latent syphilis (14 and 10%), and human immunodeficiency virus infection (32 and 38%). Of 165 patients with cultures positive for N. gonorrhoeae who returned for follow-up, ciprofloxacin cured 83 of 83 (100%), including 26 with penicillinase-producing N. gonorrhoeae (PPNG) and 21 with N. gonorrhoeae with chromosomally mediated resistance to multiple antibiotics (CMRNG), and ceftriaxone cured 81 of 82 (98.7%), including 30 with PPNG and 19 with CMRNG. Both treatment regimens were well tolerated. Chlamydia trachomatis in urethral exudate was found by direct fluorescent-antibody microscopic examination or by culture in 10 (5%) participants. All N. gonorrhoeae isolates were inhibited by ceftriaxone at 0.06 micrograms/ml, except one which was inhibited at 0.125 micrograms/ml, while ciprofloxacin inhibited all isolates at 0.03 micrograms/ml. Ciprofloxacin is a safe and effective therapy for uncomplicated gonococcal urethritis, including that caused by PPNG and CMRNG in human immunodeficiency virus-infected men. PMID:2113796

  8. Missed diagnosis of anterior urethral valve complicated with a foreign body: a cause for concern.

    PubMed

    Nayyar, Rishi; Chavda, Sundeep; Singh, Prabhjot; Gupta, Narmada P

    2011-01-01

    Anterior urethral valve (AUV) is a long known but rare anomaly, which is occasionally encountered in boys with obstructive uropathy. We present a case of AUV with a diverticulum which was misdiagnosed at other center as neurogenic bladder resulting in chronic renal failure. The case was further complicated by breakage of tip of the catheter used for clean intermittent catheterization (CIC) in the diverticulum presenting as a foreign body in the urethra. This article highlights the frequently missed diagnosis of AUV by most practitioners wrongly labeling it as neurogenic bladder, leading to improper management and renal failure in young boys. PMID:21478596

  9. Urethral Solitary Fibrous Tumor: A Rare Pathologic Diagnosis of a Periurethral Mass

    PubMed Central

    Semerjian, Alice

    2016-01-01

    Solitary fibrous tumors (SFTs) may occur at any site in the body. SFTs can only be conclusively diagnosed based on histopathologic and immunohistochemical characteristics of the tumor. The presence of SFTs in the abdomen and pelvis is extremely rare. To our knowledge no cases of urethral solitary fibrous tumor in the literature have been reported so far. We present a case of a solitary fibrous tumor arising from the urethra in a twenty-three-year-old female presenting with vaginal mass. PMID:27579199

  10. Female urethral diverticulum containing a giant calculus: a CARE-compliant case report.

    PubMed

    Dong, ZhiLong; Wang, Hanzhang; Zuo, LinJun; Hou, MingLi

    2015-05-01

    Urethral diverticula with calculi have a low incidence as reported in the literature. Diverticulum of female urethra is rare, often discovered due to associated complications. We report a case of diverticulum of the female urethra containing giant calculi in a 62-year-old multiparous woman. She consulted with our office due to dysuria and a hard, painful periurethral mass in the anterior vagina wall. The diverticulum was approached surgically by a vaginal route, and local extraction of the calculi and subsequent diverticulectomy successfully treated the condition.Diagnosis of a complicated diverticulum can be easily achieved if one possesses a high degree of clinical symptoms. PMID:25997056

  11. Prevention of stricture recurrence following urethral internal urethrotomy: routine repeated dilations or active surveillance?

    PubMed

    Tian, Ye; Wazir, Romel; Wang, Jianzhong; Wang, Kunjie; Li, Hong

    2016-01-01

    Strictures of the urethra are the most common cause of obstructed micturition in younger men and there is frequent recurrence after initial treatment. Currently, routine repeated dilations, including intermittent self-catheterisation (ISC) are prescribed by urologists to prevent urethral stricture recurrence. There is, however, no high level evidence available supporting the effectiveness of practicing these painful techniques. Balancing efficacy, adverse effects and costs, we hypothesize that active surveillance is a better option for preventing stricture recurrence as compared with routine repeated dilations. However, well designed, adequately powered multi-center trials with comprehensive evaluation are urgently needed to confirm our hypothesis. . PMID:27576888

  12. Urethral Solitary Fibrous Tumor: A Rare Pathologic Diagnosis of a Periurethral Mass.

    PubMed

    Moawad, Gaby N; Abi Khalil, Elias D; Silverbrook, Cheryl; Barak, Stephanie; Semerjian, Alice; Phillips, Michael

    2016-01-01

    Solitary fibrous tumors (SFTs) may occur at any site in the body. SFTs can only be conclusively diagnosed based on histopathologic and immunohistochemical characteristics of the tumor. The presence of SFTs in the abdomen and pelvis is extremely rare. To our knowledge no cases of urethral solitary fibrous tumor in the literature have been reported so far. We present a case of a solitary fibrous tumor arising from the urethra in a twenty-three-year-old female presenting with vaginal mass. PMID:27579199

  13. [One-stage surgical correction of complex urethral stenoses with a pedicled skin graft].

    PubMed

    Falandry, L

    1991-01-01

    The author reports his experience and the results of a series of 104 patients suffering from urethral strictures, operated by the same operator from September 1984 to March 1990 and treated by the same surgical method: one stage urethroplasty using a pedicled skin graft. The principles which guided his technique are: complete exposure of the pathological tissue, appropriate size and cut of the graft from a healthy skin zone, careful dissection of the pedicle, elliptical anastomosis at each end and sparing of the corpora cavernosa. Eighty percent of the urethral strictures encountered in the series were complex and situated in various locations: 19 were penile, 55 were bulbar perineal, 30 were bulbar membranous. The urethral strictures were fistulated for 31 cases, multi-operated in 32 case, half of the cases had upstream repercussions from the stenosed zone, and 17 cases had an accompanying pathology. Ninety-one percent of the patients benefited from a patch graft designed to widen the stenosed zone, while a tubular graft was performed for 13 patients to reconstitute a neo-urethra. For a large number of the cases studied, postoperative follow-up was done for two years and for some cases exceeded two years. The operative results were quickly obtained. Good results observed after 3 months generally did not deteriorate thereafter, whereas bad results observed immediately after operation are not definitive since they can be reoperated by the same technique. For 82.7% of the patients, definitive cure was obtained, while 96% of the total number of patients showed considerable improvement. The intermediate results, average (13.6%) and the bad results (3.6%) both show the same inducing factors: past history of localized dilatory manipulations, infected areas but mostly defective application of management techniques. The superiority of this type of surgical technique and its reliability are stressed in the discussion. Also analysed are the following: the difficulty

  14. Studies on the formation of crystalline bacterial biofilms on urethral catheters.

    PubMed

    Stickler, D; Morris, N; Moreno, M C; Sabbuba, N

    1998-09-01

    A model of the catheterised bladder was used to test the ability of urease-producing urinary tract pathogens to encrust urethral catheters. Encrustation was assessed by determining the amounts of calcium and magnesium deposited on the catheters and visualised by scanning electron microscopy. Urease-positive Morganella morganii, Klebsiella pneumoniae, and Pseudomonas aeruginosa failed to raise the urinary pH and form crystalline biofilms. In contrast, strains of Proteus mirabilis, Proteus vulgaris, and Providencia rettgeri generated alkaline urine (pH 8.3-8.6) and extensive catheter encrustation within 24 h. PMID:9832268

  15. [Magnetic urethral closure device. Negative outcome after implantation for the treatment of female urinary incontinence].

    PubMed

    Anding, R; van Ahlen, H; Müller, S C; Latz, S

    2015-07-01

    We report on a negative outcome after implantation of a magnetic urethral closure device, consisting of one part screwed into the pubic bone and one part as a vaginal cone, for the treatment of urinary stress incontinence grade III. Continence was never achieved for the patient. The urethra narrowed over time due to erosion and scarring and the patient started intermittent catheterization, because spontaneous micturition was not possible. The magnet was broken, the bladder neck was eroded, several fragments were found in the bladder, and numerous fragments were scattered throughout the small pelvis. Surgery consisted of removing most of the fragments, followed by bladder neck closure and suprapubic diversion. PMID:25989875

  16. Penile necrosis requiring penectomy complicating recto-urethral fistula post prostate cancer external beam radiation and brachytherapy.

    PubMed

    Kinahan, John; Pai, Howard; Martens, Mildred; Gray, Jason; Biberdorf, Darren; Mihailovic, Alex; McAuley, Iain

    2014-01-01

    Radiation therapy is a well-recognized treatment for unfavourable risk localized prostate cancer. Radiation induced recto-urethral fistulae are known rare complications particularly from brachytherapy. We report a case of a recto-urethral fistula 7 years post-external beam radiation and I-125 brachytherapy, which was complicated by a severe polymicrobial soft tissue infection. This infection required penectomy and pelvic exenteration with diverting colostomy, Indiana pouch urinary diversion and gracilis myo-cutaneuos flap closure of the perineum. PMID:24454604

  17. Epidemiology of traumatic hip dislocation in patients treated in Ceará, Brazil

    PubMed Central

    Lima, Luciana Cascão; do Nascimento, Robson Alves; de Almeida, Victor Monte Tenório; Façanha, Fernando Antônio Mendes

    2014-01-01

    OBJECTIVE: To describe the epidemiological profile of patients with traumatic hip dislocation treated in our Institute from November/2012 to July/2013. METHODS: A descriptive cross-sectional study based on interviews and involving 43 patients who suffered traumatic hip dislocation was conducted. RESULTS: The mean age of patients was 34.4 years old and 90.7% were male. Regarding the mechanism of injury, 95% involved traffic accidents. The posterior dislocation of the hip was the most common injury (93%). Associated lesions were observed in 74.4% of patients, hip fractures being the most frequent. The time span between accident and dislocation reduction was less than 6 hours in 37.2% of patients, between 6 and 12 hours in 32.5% and over 12 hours in 30.3%, ranging from 1 hour to 15 days. A fraction of 90.7% of patients was submitted to closed reduction. CONCLUSION: Traumatic hip dislocation affected mostly young adults, victims of traffic accidents. The posterior dislocation of the hip was the most frequent injury and closed reduction was performed in 90.7% of patients. The time span between accident and dislocation reduction was less than 12 hours in most patients. Level of Evidence III, Study of Nonconsecutive Patients. PMID:25061422

  18. Post Traumatic Pseudoaneurysm Arising from V4 Segment of Vertebral Artery: A Case Report.

    PubMed

    Huh, Chae Wook; Nam, Kyoung Hyup; Choi, Chang Hwa; Lee, Jae Il

    2015-10-01

    This case report describes a traumatic pseudoaneurysm arising from the right V4 segment of the vertebral artery, near the origin of the posterior inferior cerebellar artery. Post-traumatic vertebral artery pseudoaneurysm is rare, but associated with a high mortality rate. We report on an extremely rare case of post-traumatic pseudoaneurysm of the vertebral artery with delayed manifestation. A 9-year-old child was admitted to the emergency room after a pedestrian car accident. A computed tomography (CT) scan showed subarachnoid hemorrhage with intraventricular hemorrhage (IVH), multiple facial bones, and temporal bone fracture. External ventricular drainage and decompressive suboccipital craniectomy were performed for acute hydrocephalus and posterior fossa swelling. The patient's clinical condition became suddenly aggravated on the 15th hospital day, and brain CT confirmed appearance of a new 4th ventricle IVH. Digital subtraction angiography revealed a ruptured pseudoaneurysm arising from the right V4 segment of the vertebral artery. Parent artery occlusion using detachable coils was achieved. Despite intensive care, the patient's clinical condition showed continuous deterioration and the patient died of respiratory complications on the 52nd hospital day. PMID:27169084

  19. Posterior Reversible Encephalopathy Syndrome in ALL.

    PubMed

    Millichap, J Gordon

    2015-07-01

    Investigators from Soochow University, Suzhou, China, studied the possible pathogenetic mechanisms and treatment of posterior reversible encephalopathy syndrome (PRES) observed in 11 cases of pediatric acute lymphoblastic leukemia (ALL) after induction chemotherapy. PMID:26933594

  20. Posterior cruciate ligament (PCL) injury - aftercare

    MedlinePlus

    ... posterior cruciate ligament (PCL) is located inside your knee joint and connects the bones of your upper and ... such as a knee dislocation , you will need knee surgery to repair the joint. For milder injuries, you may not need surgery. ...

  1. Posterior Hip Pain in an Athletic Population

    PubMed Central

    Frank, Rachel M.; Slabaugh, Mark A.; Grumet, Robert C.; Virkus, Walter W.; Bush-Joseph, Charles A.; Nho, Shane J.

    2010-01-01

    Context: Posterior hip pain is a relatively uncommon but increasingly recognized complaint in the orthopaedic community. Patient complaints and presentations are often vague or nonspecific, making diagnosis and subsequent treatment decisions difficult. The purposes of this article are to review the anatomy and pathophysiology related to posterior hip pain in the athletic patient population. Evidence Acquisition: Data were collected through a thorough review of the literature via a MEDLINE search of all relevant articles between 1980 and 2010. Results: Many patients who complain of posterior hip pain actually have pain referred from another part of the body—notably, the lumbar spine or sacroiliac joint. Treatment options for posterior hip pain are typically nonoperative; however, surgery is warranted in some cases. Conclusions: Recent advancements in the understanding of hip anatomy, pathophysiology, and treatment options have enabled physicians to better diagnosis athletic hip injuries and select patients for appropriate treatment. PMID:23015944

  2. Inverted Internal Limiting Membrane Flap For Large Traumatic Macular Holes.

    PubMed

    Abou Shousha, Mohsen Ahmed

    2016-01-01

    The aim of the study was to assess the role of inverted internal limiting membrane flap as a treatment option for large traumatic macular holes.This is a prospective noncomparative study in which 12 eyes with large traumatic macular holes (basal diameter of 1300-2800 μm) since 3 to 6 months were subjected to standard 23-gauge vitrectomy with removal of the posterior hyaloid, brilliant blue G (BBG)-assisted internal limiting membrane peeling in a circular fashion keeping it attached to the edge of the hole to create a flap. At the end of the surgery, air fluid exchange was done with inversion of the internal limiting membrane flap inside the macular hole using the soft tipped cannula and sulfur hexafluoride 20% as tamponade. The main follow-up measures are the best corrected visual acuity and the optical coherence tomography for 6 to 9 months.All the included eyes had a closed hole from the first week postoperative and along the follow-up period (6-9 months). The best corrected visual acuity improved from 20/2000 to 20/200 with a median of 20/400 preoperatively to 20/400 to 20/50 with a median of 20/100 at the end of follow-up period.Inverted internal limiting membrane flap is a good adjuvant to standard vitrectomy in the management of large traumatic macular holes that led to the 100% closure rate and improvement of best corrected visual acuity. PMID:26817894

  3. Post-traumatic cervical spondyloptosis: A rare entity with multiple management options.

    PubMed

    Padwal, A; Shukla, D; Bhat, D I; Somanna, S; Devi, B I

    2016-06-01

    Post-traumatic cervical spondyloptosis is a rare condition associated with high energy injuries, and to our knowledge only case reports are available. There are no universally accepted treatment paradigms for these cases and management is individualised according to the case and surgeon preference. We retrospectively analysed our management and clinical outcomes of this condition. From January 2007 to August 2014 we treated eight patients with cervical spondyloptosis at our institute. Only two patients had no neurological deficits; all the remaining patients had partial cord injury. Seven were treated surgically with preoperative traction followed by anterior cervical discectomy and fusion with fixation in three patients, and combined anterior and posterior fusion and fixation in four. Depending on the presence of anterior compression by a disc an anterior first or posterior first approach was advocated. All four combined anterior and posterior fusion and fixation patients needed to be turned more than once (540°). There was no neurological deterioration in any of the patients, as they either improved or remained stable neurologically. Post-traumatic cervical spondyloptosis is a challenging entity to manage. Surgery can be done safely with good clinical and radiological outcome and needs to be tailored to the individual patient. PMID:26922508

  4. Oval capsulorhexis for phacoemulsification in posterior polar cataract with preexisting posterior capsule rupture.

    PubMed

    Singh, Kiranjit; Mittal, Vikas; Kaur, Harmit

    2011-07-01

    We describe use of an oval capsulorhexis rather than the conventional circular capsulorhexis for phacoemulsification in posterior polar cataract with preexisting posterior capsule rupture. An oval capsulorhexis minimizes the turbulence in the capsular bag by increasing the area available for efflux of fluid. It also enables end-to-end nuclear sculpting, removal of the nuclear fragment from the bag, intraocular lens (IOL) implantation, and vitrectomy without stretching the capsular bag. The smaller axis of the oval capsulorhexis facilitates optic capture of a sulcus-fixated IOL. The oval capsulorhexis can be used safely for phacoemulsification of all grades of nuclear sclerosis in posterior polar cataract with preexisting posterior capsule rupture. PMID:21700098

  5. Neural control of the female urethral and anal rhabdosphincters and pelvic floor muscles

    PubMed Central

    de Groat, William C.

    2010-01-01

    The urethral rhabdosphincter and pelvic floor muscles are important in maintenance of urinary continence and in preventing descent of pelvic organs [i.e., pelvic organ prolapse (POP)]. Despite its clinical importance and complexity, a comprehensive review of neural control of the rhabdosphincter and pelvic floor muscles is lacking. The present review places historical and recent basic science findings on neural control into the context of functional anatomy of the pelvic muscles and their coordination with visceral function and correlates basic science findings with clinical findings when possible. This review briefly describes the striated muscles of the pelvis and then provides details on the peripheral innervation and, in particular, the contributions of the pudendal and levator ani nerves to the function of the various pelvic muscles. The locations and unique phenotypic characteristics of rhabdosphincter motor neurons located in Onuf's nucleus, and levator ani motor neurons located diffusely in the sacral ventral horn, are provided along with the locations and phenotypes of primary afferent neurons that convey sensory information from these muscles. Spinal and supraspinal pathways mediating excitatory and inhibitory inputs to the motor neurons are described; the relative contributions of the nerves to urethral function and their involvement in POP and incontinence are discussed. Finally, a detailed summary of the neurochemical anatomy of Onuf's nucleus and the pharmacological control of the rhabdosphincter are provided. PMID:20484700

  6. Bitter triggers acetylcholine release from polymodal urethral chemosensory cells and bladder reflexes.

    PubMed

    Deckmann, Klaus; Filipski, Katharina; Krasteva-Christ, Gabriela; Fronius, Martin; Althaus, Mike; Rafiq, Amir; Papadakis, Tamara; Renno, Liane; Jurastow, Innokentij; Wessels, Lars; Wolff, Miriam; Schütz, Burkhard; Weihe, Eberhard; Chubanov, Vladimir; Gudermann, Thomas; Klein, Jochen; Bschleipfer, Thomas; Kummer, Wolfgang

    2014-06-01

    Chemosensory cells in the mucosal surface of the respiratory tract ("brush cells") use the canonical taste transduction cascade to detect potentially hazardous content and trigger local protective and aversive respiratory reflexes on stimulation. So far, the urogenital tract has been considered to lack this cell type. Here we report the presence of a previously unidentified cholinergic, polymodal chemosensory cell in the mammalian urethra, the potential portal of entry for bacteria and harmful substances into the urogenital system, but not in further centrally located parts of the urinary tract, such as the bladder, ureter, and renal pelvis. Urethral brush cells express bitter and umami taste receptors and downstream components of the taste transduction cascade; respond to stimulation with bitter (denatonium), umami (monosodium glutamate), and uropathogenic Escherichia coli; and release acetylcholine to communicate with other cells. They are approached by sensory nerve fibers expressing nicotinic acetylcholine receptors, and intraurethral application of denatonium reflexively increases activity of the bladder detrusor muscle in anesthetized rats. We propose a concept of urinary bladder control involving a previously unidentified cholinergic chemosensory cell monitoring the chemical composition of the urethral luminal microenvironment for potential hazardous content. PMID:24843119

  7. The Urethral Rhabdosphincter, Levator Ani Muscle, and Perineal Membrane: A Review

    PubMed Central

    Hinata, Nobuyuki; Murakami, Gen

    2014-01-01

    Detailed knowledge of the anatomy of the rhabdosphincter and adjacent tissues is mandatory during urologic surgery to ensure reliable oncologic and functional outcomes. To characterize the levator ani (LA) function for the urethral sphincter, we described connective tissue morphology between the LA and urethral rhabdosphincter. The interface tissue between the LA and rhabdosphincter area in males contained abundant irregularly arrayed elastic fibers and smooth muscles. The male rhabdosphincter was positioned alongside the LA to divide the elevation force and not in-series along the axis of LA contraction. The male perineal membrane was thin but solid and extends along the inferior margin or bottom of the rhabdosphincter area. In contrast, the female rhabdosphincter, including the compressor urethrae and urethrovaginal sphincter muscles, was embedded in the elastic fiber mesh that is continuous with the thick, multilaminar perineal membrane. The inferomedial edge of the female LA was attached to the upper surface of the perineal membrane and not directly attached to the rhabdosphincter. We presented new diagrams showing the gender differences in topographical anatomy of the LA and rhabdosphincter. PMID:24877147

  8. Recreational urethral sounding is associated with high risk sexual behaviour and sexually transmitted infections

    PubMed Central

    Breyer, Benjamin N.; Shindel, Alan W.

    2013-01-01

    OBJECTIVE To determine whether men who perform recreational sounding are at increased risk of engaging in unsafe sexual behaviours, developing sexually transmitted infections (STIs) and lower urinary tract symptoms (LUTS). SUBJECTS AND METHODS In a cross-sectional, international, internet-based survey of the sexual practices of >2000 men who have sex with men, subjects were asked if they had engaged in urethral sounding for sexual gratification. We compared ethnodemographic and health-related variables between the sounding and non-sounding populations. The International Prostate Symptom Score and a modified validated version of the International Index of Erectile Function were used to quantify LUTS and erectile dysfunction (ED) in both populations. RESULTS There were 2122 respondents with complete data, 228 (10.7%) of whom had engaged in recreational sounding. Men who had engaged in sounding were more likely to report certain high risk sexual behaviours (e.g. multiple sexual partners and sex with partners who were not well known) and had increased odds of reporting STIs. Men who had engaged in sounding had a slight but statistically significant increase in LUTS but no significant difference in prevalence of ED. CONCLUSIONS Urethral sounding is a sexual practice that is associated with higher risk sexual behaviour and carries the potential for morbidity. Research on means for risk reduction for men who choose to engage in recreational sounding requires further study. PMID:22221824

  9. Tubularized Penile-Flap Urethroplasty Using a Fasciocutaneous Random Pedicled Flap for Recurrent Anterior Urethral Stricture

    PubMed Central

    Lee, Byung Kwon

    2012-01-01

    This report describes the use of a tubularized random flap for the curative treatment of recurrent anterior urethral stricture. Under the condition of pendulous lithotomy and suprapubic cystostomy, the urethral stricture was removed via a midline ventral penile incision followed by elevation of the flap and insertion of an 18-Fr catheter. Subcutaneous buried interrupted sutures were used to reapproximate the waterproof tubularized neourethra and to coapt with the neourethra and each stump of the urethra, first proximally and then distally. The defect of the penile shaft was covered by advancement of the surrounding scrotal flap. The indwelling catheter was maintained for 21 days. A 9 month postoperative cystoscopy showed no flap necrosis, no mechanical stricture, and no hair growth on the lumen of the neourethra. The patient showed no voiding discomfort 6 months after the operation. The advantages of this procedure are the lack of need for microsurgery, shortening of admission, the use of only spinal anesthesia (no general anesthesia), and a relatively short operative time. The tubularized unilateral penile fasciocutaneous flap should be considered an option for initial flap urethroplasty as a curative technique. PMID:22783537

  10. Lipomatous nevus and urethral caruncle mistaken for ambiguous genitalia in a female infant.

    PubMed

    Brasileiro, Luciana Ferreira; Dias Pereira, Luis Antonio Violin; Miranda, Márcio Lopes; de Freitas, Leandro Luiz Lopes; Marques-de-Faria, Antonia Paula; Maciel-Guerra, Andrea Trevas; Guerra-Junior, Gil

    2016-02-01

    We report the case of a 46,XX infant referred at 3 months of age for evaluation of ambiguous genitalia with no palpable gonads. The phallus was replaced by a homogeneous peduncular structure covered by skin, and a second peduncular structure covered by mucosa was located between the labia minora above the urethral meatus and the vaginal opening. There were no associated anomalies, and she had normal growth and neuromotor development. During surgery to remove these structures, a bifid clitoris was detected and cystoscopy and vaginoscopy revealed normal female urethra and vagina. The structure located on the phallic region was a superficial lipomatous nevus, and the other mass was a congenital urethral caruncle with ectopic migration/differentiation of colonic epithelium into ventral and anterior part of the urogenital sinus. Both genital lipomas and congenital caruncles of the female urethra are very rare and their etiology is unknown. There is no previous report of coincidence of these two rare findings in an otherwise healthy girl. PMID:26353166

  11. Adjunctive maneuvers to treat urethral stricture: a review of the world literature

    PubMed Central

    Raheem, Omer A.

    2014-01-01

    The development of urethral stricture (US) or bladder neck contracture is a relatively uncommon but well described condition observed primarily in men. Despite familiarity with US disease, management remains challenging for urologists. Risk factors for the development of USs or bladder neck contracture include primary treatment modality, tobacco smoking, coronary artery disease and poorly controlled diabetes mellitus. Numerous treatment options exist for this condition that vary in procedural complexity, including intermittent self catheterization (CIC), serial urethral dilation, endoscopic techniques and open reconstructive repairs. Repetitive procedures for this condition may carry increased failure rates and morbidities. For the treatment of refractory or recalcitrant bladder neck contracture, newer intralesional anti-proliferative, anti-scar agents have been used in combination with transurethral bladder neck incisions to augment outcome and long-term effect. The primary focus of this systematic review of the published literature is to streamline and summarize various and newer therapeutic modalities available to manage patients with US or bladder neck contracture. PMID:26813349

  12. Initial experience with lingual mucosal graft urethroplasty for anterior urethral strictures

    PubMed Central

    Srivastava, Anand; Dutta, A.; Jain, D.K.

    2012-01-01

    Background To present the feasibility of lingual mucosal graft urethroplasty in anterior urethral strictures and appraisal of donor site morbidity. Methods From November 2007 to December 2010, 14 patients underwent dorsal onlay lingual mucosal graft urethroplasty for anterior urethral strictures. Lingual mucosal graft was harvested from the lateral and undersurface of the tongue. Check micturating cystourethrograms were done 2 weeks after catheter removal and uroflowmetry after 3 months. Success was defined as normal uroflowmetry rates at 3 months in the absence of any postoperative instrumentation. Tongue was assessed for any residual pain, taste disturbances or restricted movement at 3 months. Results Four patients had submucosal fibrosis of the oral cavity and their buccal mucosa was unfit for grafting. Mean (range) stricture length was 5 (3–16) cm and the operation time 170 (140–210) min. Graft width averaged 1.6 cm. Average length of harvested graft was 6.5 cm. Mean duration of follow-up was 12.8 months. Two patients developed stricture at the proximal anastomotic site. There were no donor site complications. Conclusions Lingual mucosal graft harvesting is simple, gives graft lengths comparable to buccal mucosa and is associated with negligible donor site morbidity. PMID:24532928

  13. A Giant Dumbbell Shaped Vesico-Prostatic Urethral Calculus: A Case Report and Review of Literature

    PubMed Central

    Prabhuswamy, Vinod Kumar; Tiwari, Rahul; Krishnamoorthy, Ramakrishnan

    2013-01-01

    Calculi in the urethra are an uncommon entity. Giant calculi in prostatic urethra are extremely rare. The decision about treatment strategy of calculi depends upon the size, shape, and position of the calculus and the status of the urethra. If the stone is large and immovable, it may be extracted via the perineal or the suprapubic approach. In most of the previous reported cases, giant calculi were extracted via the transvesical approach and external urethrotomy. A 38-year-old male patient presented with complaints of lower urinary tract symptoms. Further investigations showed a giant urethral calculus secondary to stricture of bulbo-membranous part of the urethra. Surgical removal of calculus was done via transvesical approach. Two calculi were found and extracted. One was a huge dumbbell calculus and the other was a smaller round calculus. This case was reported because of the rare size and the dumbbell nature of the stone. Giant urethral calculi are better managed by open surgery. PMID:23762742

  14. Single stage: dorsolateral onlay buccal mucosal urethroplasty for long anterior urethral strictures using perineal route

    PubMed Central

    Prabha, Vikram; Devaraju, Shishir; Vernekar, Ritesh; Hiremath, Murigendra

    2016-01-01

    ABSTRACT Objective To assess the outcome of single stage dorsolateral onlay buccal mucosal urethroplasty for long anterior urethral strictures (>4cm long) using a perineal incision. Materials and Methods From August 2010 to August 2013, 20 patients underwent BMG urethroplasty. The cause of stricture was Lichen sclerosis in 12 cases (60%), Instrumentation in 5 cases (25%), and unknown in 3 cases (15%). Strictures were approached through a perineal skin incision and penis was invaginated into it to access the entire urethra. All the grafts were placed dorsolaterally, preserving the bulbospongiosus muscle, central tendon of perineum and one-sided attachement of corpus spongiosum. Procedure was considered to be failure if the patient required instrumentation postoperatively. Results Mean stricture length was 8.5cm (range 4 to 12cm). Mean follow-up was 22.7 months (range 12 to 36 months). Overall success rate was 85%. There were 3 failures (meatal stenosis in 1, proximal stricture in 1 and whole length recurrent stricture in 1). Other complications included wound infection, urethrocutaneous fistula, brownish discharge per urethra and scrotal oedema. Conclusion Dorsolateral buccal mucosal urethroplasty for long anterior urethral strictures using a single perineal incision is simple, safe and easily reproducible by urologists with a good outcome. PMID:27286122

  15. A prospective randomized trial of ofloxacin vs. doxycycline in the treatment of uncomplicated male urethritis.

    PubMed

    Boslego, J W; Hicks, C B; Greenup, R; Thomas, R J; Wiener, H A; Ciak, J; Tramont, E C

    1988-01-01

    One hundred fourteen men with uncomplicated urethritis were randomized to receive 1 week of therapy with either doxycycline (100 mg twice daily) or ofloxacin (300 mg twice daily). Of the 109 men completing the post-treatment visit, 56 received ofloxacin and 52 (93%) were clinically cured. Forty four (83%) of the 53 men treated with doxycycline were cured. All 30 patients with gonorrhea (including three with penicillinase-producing Neisseria gonorrhoeae [PPNG] isolates) who were treated with ofloxacin became culture-negative, as compared with 32 of 34 patients receiving doxycycline. In contrast, three of 18 patients with Chlamydia trachomatis were microbiologic failures after ofloxacin therapy, while all ten treated with doxycycline were cured. Adverse effects of both treatment regimens were generally mild, and compliance was excellent except for one patient receiving doxycycline. These results show that ofloxacin, in a dosage of 300 mg taken orally twice daily for seven days, is an effective treatment for uncomplicated urethritis in men but may not reliably cure chlamydial infections. PMID:3147522

  16. Characterization of Posterior Glenoid Bone Loss

    PubMed Central

    Yanke, Adam Blair; Frank, Rachel M.; Shin, Jason J.; Van Thiel, Geoffrey S.; Verma, Nikhil N.; Cole, Brian J.; Romeo, Anthony A.; Provencher, Matthew T.

    2016-01-01

    Objectives: The purpose of this study was to characterize the morphology and location of posterior glenoid bone loss in pat ients with posterior instability instability utilizing computed tomography (CT). Methods: Clinical data was selected for patients with posterior shoulder instability that had undergone posterior stabilization (open or arthroscopic) or posterior osseous augmentation (distal tibia or iliac crest). Three fellowship-trained surgeons from two institutions contributed patients. Pre-operative CT data was collected for all patients. The axial cuts were segmented and reformatted in three-dimensions for glenoid analysis using Osirix. From this three-dimensional model, the following was calculated: percent bone loss (Nobuhara), total arc of the defect (degrees), and a clock-face description (start point, stop point, and average or direction). Pearson correlation coefficients were performed using significance of p<0.05. Results: Fifty shoulders from 50 patients were reviewed. Fourteen patients (average age 30 years; 93% male) had evidence of posterior glenoid bone loss and were included for evaluation. Defects on average involved 13.7±8.6% of the glenoid (range, 2-35%). The average start time (assuming all right shoulders) on the clock face was 10 o’clock ± 40 minutes and stopped at 6:30 ± 25 minutes. The average direction of the defect pointed toward 8:15 ± 25 minutes. The percent bone loss correlated with the total arc of the defect (Pearson: 0.93, p<0.05, R2: 0.86) and the direction of the bone loss (Pearson: 0.64, p<0.05, R2: 0.40). The direction of bone loss significantly moved more posterosuperior the larger the defect became (Pearson: 0.63, p<0.05, R2: 0.40). Conclusion: Posterior bone loss associated with posterior glenohumeral instability is typically directed posteriorly at 8:15 on the clock. As defect get bigger, this direction moves more posterosuperior. This information will help guide clinicians in understanding the typical location of

  17. Balser plate stabilization: an alternate therapy for traumatic sternoclavicular instability.

    PubMed

    Franck, Wolfgang M; Jannasch, Olof; Siassi, Michael; Hennig, Friedrich F

    2003-01-01

    Traumatic instability of the sternoclavicular joint is a rare condition. It can be treated by surgical cerclage fixation, which necessitates postoperative immobilization, an approach preventing early postoperative functional rehabilitation. Balser plate stabilization is a therapeutic alternative that does not require extended periods of immobilization. From January 1, 1996, to December 31, 2000, a total of 10 trauma patients with unstable sternoclavicular joints (Allman grade III) requiring surgical management were treated with Balser plate stabilization to allow early physiotherapy. The population included 7 patients with anterior dislocations, 2 with posterior dislocations, and 1 with medial epiphysiolysis in addition to posterior dislocation. Implants were removed from 9 patients after 3 months and 1 patient after 2 months. One year or longer after the procedure, 9 of 10 patients were available for follow-up; 1 patient had moved. The results achieved with this alternative treatment are excellent. There were no cases of redislocation. The only surgical complication was a seroma that required surgical drainage. One patient had arthrosis develop. Outcome was assessed with Constant (range, 84-100; mean, 90.2 +/- 6.6) and DASH (disabilities of the arm, shoulder, and hand) (range, 4.1-16.6; mean, 8.4 +/- 1.4) scores. For the rare case of sternoclavicular joint dislocation requiring open surgical reduction and stabilization, the Balser plate technique is reliable, permits early movement, has good postoperative results, and compares favorably with alternative methods. PMID:12851582

  18. Traumatic andropause after combat injury.

    PubMed

    Jones, Gareth Huw; Kirkman-Brown, Jackson; Sharma, Davendra Murray; Bowley, Douglas

    2015-01-01

    In association with lower extremity amputation, complex genitourinary injuries have emerged as a specific challenge in modern military trauma surgery. Testicular injury or loss has profound implications for the recovering serviceman, in terms of hormone production and future fertility. The initial focus of treatment for patients with traumatic testicular loss is haemostasis, resuscitation and management of concurrent life-threatening injuries. Multiple reoperations are commonly required to control infection in combat wounds; in a review of 300 major lower extremity amputations, 53% of limbs required revisional surgery, with infection the commonest indication. Atypical infections, such as invasive fungal organisms, can also complicate military wounding. We report the case of a severely wounded serviceman with complete traumatic andropause, whose symptomatic temperature swings were initially mistaken for signs of occult sepsis. PMID:26318170

  19. Fundamentals and clinical perspective of urethral sphincter instability as a contributing factor in patients with lower urinary tract dysfunction—ICI‐RS 2014

    PubMed Central

    Anding, Ralf; Rosier, Peter; Birder, Lori; Andersson, Karl Erik; Djurhuus, Jens Christian

    2016-01-01

    Aims Urethral pathophysiology is often neglected in discussions of bladder dysfunction. It has been debated whether “urethral sphincter instability,” referred to based on observed “urethral pressure variations,” is an important aspect of overactive bladder syndrome (OAB). The purpose of this report is to summarize current urethral pathophysiology evidence and outline directions for future research based on a literature review and discussions during the ICI‐RS meeting in Bristol in 2014. Methods Urethral pathophysiology with a focus on urethral pressure variation (UPV) was presented and discussed in a multidisciplinary think tank session at the ICI_R meeting in Bristol 2014. This think tank session was based on collaboration between physicians and basic science researchers. Results Experimental animal studies or studies performed in clinical series (predominantly symptomatic women) provided insights into UPV, but the findings were inconsistent and incomplete. However, UPV is certainly associated with lower urinary tract symptoms (likely OAB), and thus, future research on this topic is relevant. Conclusions Future research based on adequately defined clinical (and urodynamic) parameters with precisely defined patient groups might shed better light on the cause of OAB symptoms. Further fundamental investigation of urethral epithelial–neural interactions via the release of mediators should enhance our knowledge and improve the management of patients with OAB. Neurourol. Urodynam. 35:318–323, 2016. © 2016 The Authors. Neurourology and Urodynamics published by Wiley Periodicals, Inc. PMID:26872575

  20. Traumatic brain injury among Indiana state prisoners.

    PubMed

    Ray, Bradley; Sapp, Dona; Kincaid, Ashley

    2014-09-01

    Research on traumatic brain injury among inmates has focused on comparing the rate of traumatic brain injury among offenders to the general population, but also how best to screen for traumatic brain injury among this population. This study administered the short version of the Ohio State University Traumatic Brain Injury Identification Method to all male inmates admitted into Indiana state prisons were screened for a month (N = 831). Results indicate that 35.7% of the inmates reported experiencing a traumatic brain injury during their lifetime and that these inmates were more likely to have a psychiatric disorder and a prior period of incarceration than those without. Logistic regression analysis finds that a traumatic brain injury predicts the likelihood of prior incarceration net of age, race, education, and psychiatric disorder. This study suggests that brief instruments can be successfully implemented into prison screenings to help divert inmates into needed treatment. PMID:24588316

  1. Dorsally Placed Buccal Mucosal Graft Urethroplasty in Treatment of Long Urethral Strictures Using One-Stage Transperineal Approach

    PubMed Central

    Tavakkoli Tabassi, Kamyar

    2014-01-01

    Objectives. To evaluate the results of one-stage buccal mucosal urethroplasty in treatment of long urethral strictures. Methods. This retrospective study was carried out on 117 patients with long urethral strictures who underwent one-stage transperineal urethroplasty with dorsally placed buccal mucosal grafts (BMG). Success was defined as no need for any intervention during the follow-up period. Results. Among 117 patients with mean age of 39.55 ± 15.98 years, the strictures were located in penile urethra in 46 patients (39.32%), bulbar urethra in 33 (28.20%) and were panurethral in 38 (32.48%). The etiology of the urethral stricture was sexually transmitted disease (STD) in 17 (14.53%), lichen sclerosus in 15 (12.82%), trauma in 15 (12.82%), catheterization in 13 (11.11%), transurethral resection (TUR) in 6 (5.13%), and unknown in 51 (43.59%). The mean length of strictures was 9.31 ± 2.46 centimeters. During the mean followup of 18.9 ± 6.7 months success rate was 93.94% in bulbar strictures, 97.83% in penile strictures, and 84.21% in panurethral strictures (P value: 0.061). Conclusions. The success rate of transperineal urethroplasty with dorsally placed buccal mucosal grafts is equal in different sites of strictures with different etiologies. So reconstruction of long urethral strictures may be safely and effectively performed at a simple single operative procedure using this method of urethroplasty.

  2. Evaluation of holmium laser versus cold knife in optical internal urethrotomy for the management of short segment urethral stricture

    PubMed Central

    Jain, Sudhir Kumar; Kaza, Ram Chandra Murthy; Singh, Bipin Kumar

    2014-01-01

    Objectives: Sachse cold knife is conventionally used for optical internal urethrotomy intended to manage urethral strictures and Ho: YAG laser is an alternative to it. The aim of this study was to evaluate the role of urethral stricture treatment outcomes, efficacy, and complications using cold knife and Ho: YAG (Holmium laser) for optical internal urethrotomy Materials and Methods: In this prospective study included, 90 male patients age >18 years, with diagnosis of urethral stricture admitted for internal optical urethrotomy during April 2010 to March 2012. The patients were randomized into two groups containing 45 patients each using computer generated random number. In group A (Holmium group), internal urethrotomy was done with Holmium laser and in group B (Cold knife group) Sachse cold knife was used. Patients were followed up for 6 months after surgery in Out Patient Department on 15, 30 and 180 post-operative days. At each follow up visit physical examination, and uroflowmetry was performed along with noting complaints, if any. Results: The peak flow rates (PFR) were compared between the two groups on each follow up. At 180 days (6 month interval) the difference between mean of PFR for Holmium and Cold knife group was statistically highly significant (P < 0.001). Complications were seen in 12.22% of cases. Conclusion: Both modalities are effective in providing immediate relief to patients with single and short segment (<2 cm long) urethral strictures but more sustained response was attained with Cold knife urethrotomy. PMID:25371611

  3. Azithromycin treatment for nongonococcal urethritis negative for Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum, and Ureaplasma urealyticum.

    PubMed

    Maeda, Shin-ichi; Yasuda, Mitsuru; Ito, Shin; Seike, Kensaku; Ito, Shin-ichi; Deguchi, Takashi

    2009-02-01

    Some patients with nongonococcal urethritis (NGU) are negative for Chlamydia trachomatis, mycoplasmas, and ureaplasmas. The optimal antimicrobial chemotherapy for such NGU has not fully been clarified. We assessed the efficacy of azithromycin for treatment of nonmycoplasmal, nonureaplasmal, nonchlamydial NGU (NMNUNCNGU). Thirty-eight men whose first-pass urine was negative for Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum, and Ureaplasma urealyticum were treated with a single dose of 1 g azithromycin. Urethritis symptoms and polymorphonuclear leukocytes in urethral smears or in first-pass urine were assessed before and after treatment with azithromycin. Thirty-two (84.2%) of the 38 men with NMNUNCNGU showed no signs of urethral inflammation after treatment. The efficacy of this azithromycin regimen was comparable to that of the 7-day regimen of levofloxacin, gatifloxacin, minocycline, or clarithromycin reported previously. A single dose of 1 g azithromycin, which is effective not only for NGU due to specific pathogens but also for NMNUNCNGU, is an appropriate treatment for NGU. PMID:19228227

  4. Clinical efficacy of levofloxacin 500 mg once daily for 7 days for patients with non-gonococcal urethritis.

    PubMed

    Takahashi, Satoshi; Ichihara, Kohji; Hashimoto, Jiro; Kurimura, Yuichiro; Iwasawa, Akihiko; Hayashi, Kenji; Sunaoshi, Kenichi; Takeda, Koichi; Suzuki, Nobukazu; Satoh, Takashi; Tsukamoto, Taiji

    2011-06-01

    To confirm the efficacy of the treatment regimen with oral levofloxacin (LVFX) 500 mg once daily for 7 days for patients with non-gonococcal urethritis (NGU), we evaluated the microbiological and clinical outcomes of the regimen in those patients. We finally evaluated 53 patients with symptomatic NGU and 5 patients with asymptomatic NGU. As a result of microbiological examinations, 19 of the symptomatic patients were diagnosed as having non-gonococcal chlamydial urethritis (NGCU); 13 had non-gonococcal non-chlamydial urethritis (NGNCU), and 21 had urethritis without any microbial detection. Five of the asymptomatic patients were diagnosed as having NGCU. Microbiological cure was achieved in 91% of the 32 patients with symptomatic NGU and in 80% of the 5 patients with asymptomatic NGCU. Clinical cure was obtained in 92% of the 53 patients with symptomatic NGU. The microbiological eradication rate for Chlamydia trachomatis was 92% in 24 patients. As for other organisms, the microbiological eradication rate for Mycoplasma genitalium was 60% in 5 patients and that for Ureaplasma urealyticum was 100% in 10. The microbiological and clinical efficacy of oral LVFX 500 mg once daily for 7 days for the patients with NGU was the same for the azithromycin (AZM) 1,000 mg single dose that we previously reported. The eradication rates of C. trachomatis and U. urealyticum in the treatment regimen with LVFX 500 mg were high enough in the clinical setting; however, for M. genitalium, the rate was relatively inferior to that with AZM. PMID:21174140

  5. Investigation into the causes of indwelling urethral catheter implementation and its effects on clinical outcomes and health care resources among dementia patients with pneumonia: A retrospective cohort study.

    PubMed

    Maeda, Toshiki; Babazono, Akira; Nishi, Takumi; Yasui, Midori; Harano, Yumi

    2016-08-01

    There is a possibility that unnecessary treatments and low-quality medical care, such as inappropriate indwelling urethral catheter use, are being provided to older Japanese individuals.The aim of this study was to investigate contextual effects relating to indwelling urethral catheters in older people with dementia and to clarify the effects of indwelling urethral catheter use on patients' mortality, length of stay (LOS), and health care spending. This retrospective cohort study involved 4501 male and female Japanese participants. Those who were aged 75 or older with dementia and had a primary diagnosis of acute lower respiratory disease with antibiotics administered during hospitalization were eligible for inclusion. Patient mortality, LOS, and total charge during hospitalization were the main study outcomes. This study showed that indwelling urethral catheter use was significantly associated with higher mortality, longer LOS, and higher total charge for hospitalization. The pattern of indwelling urethral catheter use was clustered by care facility level. Physician density was significantly associated with indwelling urethral catheter use; the relationship was not linear but U-shaped, such that the approximate median had the lowest rate of urethral catheter use and this increased gradually toward both lower and higher physician densities. Our study found considerable variation in indwelling urethral catheter use between care facilities in older people with dementia. Additionally, indwelling urethral catheter use was related to poor outcomes. Based on these findings, we consider there to be an urgent need for constructing a framework to measure, report on, and promote the improvement of care quality for older individuals in Japan. PMID:27583898

  6. Investigation into the causes of indwelling urethral catheter implementation and its effects on clinical outcomes and health care resources among dementia patients with pneumonia

    PubMed Central

    Maeda, Toshiki; Babazono, Akira; Nishi, Takumi; Yasui, Midori; Harano, Yumi

    2016-01-01

    Abstract There is a possibility that unnecessary treatments and low-quality medical care, such as inappropriate indwelling urethral catheter use, are being provided to older Japanese individuals. The aim of this study was to investigate contextual effects relating to indwelling urethral catheters in older people with dementia and to clarify the effects of indwelling urethral catheter use on patients’ mortality, length of stay (LOS), and health care spending. This retrospective cohort study involved 4501 male and female Japanese participants. Those who were aged 75 or older with dementia and had a primary diagnosis of acute lower respiratory disease with antibiotics administered during hospitalization were eligible for inclusion. Patient mortality, LOS, and total charge during hospitalization were the main study outcomes. This study showed that indwelling urethral catheter use was significantly associated with higher mortality, longer LOS, and higher total charge for hospitalization. The pattern of indwelling urethral catheter use was clustered by care facility level. Physician density was significantly associated with indwelling urethral catheter use; the relationship was not linear but U-shaped, such that the approximate median had the lowest rate of urethral catheter use and this increased gradually toward both lower and higher physician densities. Our study found considerable variation in indwelling urethral catheter use between care facilities in older people with dementia. Additionally, indwelling urethral catheter use was related to poor outcomes. Based on these findings, we consider there to be an urgent need for constructing a framework to measure, report on, and promote the improvement of care quality for older individuals in Japan. PMID:27583898

  7. Traumatic occipitocervical disruption: a new technique for stabilisation. Case report and literature review.

    PubMed

    Anderson, A J; Towns, G M; Chiverton, N

    2006-11-01

    Traumatic atlanto-occipital dislocation in adults is usually fatal and survival without neurological deficit is rare. The surgical management of those who do survive is difficult and controversial. Most authorities recommend posterior occipitoaxial fusion, but this compromises cervical rotation. We describe a case in which a patient with a traumatic atlanto-occipital disruption but no neurological deficit was treated by atlanto-occipital fusion using a new technique consisting of cancellous bone autografting supported by an occipital plate linked by rods to lateral mass screws in the atlas. The technique is described in detail. At one year the neck was stable, radiological fusion had been achieved, and atlantoaxial rotation preserved. The rationale behind this approach is discussed and the relevant literature reviewed. We recommend the technique for injuries of this type. PMID:17075091

  8. Medico-legal implications of traumatic cataract.

    PubMed

    Moreschi, Carlo; Da Broi, Ugo; Lanzetta, Paolo

    2013-02-01

    Traumatic cataract is due to lens damage when mechanical, irradiative, electrical or chemical agents injury the globe. The appearance of a traumatic cataract is typically short and unilateral with rare spontaneous resolution and often involves other ocular anatomical areas. Medico-legal evaluation of the appearance and the consequences of a traumatic cataract requires a correct methodological approach with the support of qualified ophthalmological competences. PMID:23357390

  9. [Post-traumatic stress disorder after childbirth].

    PubMed

    Korábová, I; Masopustová, Z

    2016-01-01

    The aim of this paper is to introduce the issue of post-traumatic stress disorder after childbirth to health care professionals. The text focuses on the diagnostic definition of post-traumatic stress disorder after childbirth, symptoms, physiological background, prevalence, course, risk factors and consequences of post-traumatic stress disorder after childbirth for a woman, her child and her partner. Options for interventions and therapy are outlined as well. PMID:26982058

  10. Traumatic grief and traumatic stress in survivors 12 years after the genocide in Rwanda.

    PubMed

    Mutabaruka, Jean; Séjourné, Nathalène; Bui, Eric; Birmes, Philippe; Chabrol, Henri

    2012-10-01

    The relationship between exposure to traumatic events and traumatic grief and the role of mediating and moderating variables [peritraumatic distress, post traumatic stress disorder (PTSD) symptoms and symptoms of depression] were studied in survivors of the genocide of Batutsi in Rwanda in 1994. One hundred and two survivors (70 women, mean age 45 ± 7.53 years) participated in this retrospective study. All of them had lost a member of their family. The severity of traumatic exposure (Comprehensive Trauma Inventory), peritraumatic distress (Peritraumatic Distress Inventory), current PTSD symptoms (PTSD Checklist), depressive symptoms (Beck Depression Inventory) and traumatic grief symptoms (Inventory of Traumatic Grief) was evaluated. A hierarchical multiple regression analysis was then conducted to examine the relative contribution of each variable to the symptoms of traumatic grief. The severity of traumatic exposure was related to traumatic grief symptoms (B=0.06, R=0.6, R(2) =0.36 and ß=0.6, t=7.54, p=0.00). The Baron and Kenny procedure (1986) (including three separate regressions), along with the Sobel test, was used to test mediation effects. Peritraumatic distress and PTSD symptoms may be mediating variables between traumatic exposure and traumatic grief. Traumatic grief is a complex but assessable entity, where previous distress and suffering result from both psychological trauma and the loss of a loved one. PMID:22282057

  11. Posterior Predictive Bayesian Phylogenetic Model Selection

    PubMed Central

    Lewis, Paul O.; Xie, Wangang; Chen, Ming-Hui; Fan, Yu; Kuo, Lynn

    2014-01-01

    We present two distinctly different posterior predictive approaches to Bayesian phylogenetic model selection and illustrate these methods using examples from green algal protein-coding cpDNA sequences and flowering plant rDNA sequences. The Gelfand–Ghosh (GG) approach allows dissection of an overall measure of model fit into components due to posterior predictive variance (GGp) and goodness-of-fit (GGg), which distinguishes this method from the posterior predictive P-value approach. The conditional predictive ordinate (CPO) method provides a site-specific measure of model fit useful for exploratory analyses and can be combined over sites yielding the log pseudomarginal likelihood (LPML) which is useful as an overall measure of model fit. CPO provides a useful cross-validation approach that is computationally efficient, requiring only a sample from the posterior distribution (no additional simulation is required). Both GG and CPO add new perspectives to Bayesian phylogenetic model selection based on the predictive abilities of models and complement the perspective provided by the marginal likelihood (including Bayes Factor comparisons) based solely on the fit of competing models to observed data. [Bayesian; conditional predictive ordinate; CPO; L-measure; LPML; model selection; phylogenetics; posterior predictive.] PMID:24193892

  12. Notes from the Field: Increase in Neisseria meningitidis-Associated Urethritis Among Men at Two Sentinel Clinics - Columbus, Ohio, and Oakland County, Michigan, 2015.

    PubMed

    Bazan, Jose A; Peterson, Amy S; Kirkcaldy, Robert D; Briere, Elizabeth C; Maierhofer, Courtney; Turner, Abigail Norris; Licon, Denisse B; Parker, Nicole; Dennison, Amanda; Ervin, Melissa; Johnson, Laura; Weberman, Barbara; Hackert, Pamela; Wang, Xin; Kretz, Cecilia B; Abrams, A Jeanine; Trees, David L; Del Rio, Carlos; Stephens, David S; Tzeng, Yih-Ling; DiOrio, Mary; Roberts, Mysheika Williams

    2016-01-01

    Neisseria meningitidis (Nm) urogenital infections, although less common than infections caused by Neisseria gonorrhoeae (Ng), have been associated with urethritis, cervicitis, proctitis, and pelvic inflammatory disease. Nm can appear similar to Ng on Gram stain analysis (gram-negative intracellular diplococci) (1-5). Because Nm colonizes the nasopharynx, men who receive oral sex (fellatio) can acquire urethral Nm infections (1,3,5). This report describes an increase in Nm-associated urethritis in men attending sexual health clinics in Columbus, Ohio, and Oakland County, Michigan. PMID:27254649

  13. Mobile-bearing total knee arthroplasty: a full traumatic rotation of 180°.

    PubMed

    Sudanese, Alessandra; Castiello, Emanuela; Affatato, Saverio

    2013-06-25

    From February 2008 to September 2012 we implanted 204 mobile-bearing knee prostheses in 192 patients. All the prostheses were cemented (both femoral and tibial components), and the patella was not replaced. Only one early complication of the implants (1/204 = 0.004%) occurred after a traumatic event as a full 180° rotation of the mobile-bearing polyethylene insert. A 78-year-old woman presented with swelling and severe pain at her right knee. This traumatic event was the only case among our mobile-bearing insert patients. 
The failed polyethylene inserts were retrieved and studied using a scanning electron microscope (SEM, ZEISS EVO 50 EP, Cambridge, UK) operating at 20 kV. 
Scratching and pitting were found on the UHMWPE insert perpendicular to the machining tracks for the concave surface. SEM micrographs of the insert showed burnishing on the concave surfaces and longitudinal scratches were clearly detectable and well-marked on the analyzed surfaces. 
A traumatic, fully rotating, polyethylene insert is rare and our case is the first report describing a traumatic event with a complete 180 degree rotation mobile-bearing in a total knee prosthesis. 
In the literature few reports discuss clinical outcomes after total knee arthroplasty in patients with Parkinson's disease and they cite mixed results. However, some authors suggest that posterior-stabilized and cruciate-retaining TKA should work well while others prefer cruciate-retaining, condylar constrained kinetics, or hinged devices. Although we did not implant a posterior-stabilized mobile-bearing total knee prosthesis or a constrained prosthesis, we obtained good clinical and radiological results at the 2-year followup. PMID:23653296

  14. The management of moderate and severe congenital penile torsion associated with hypospadias: Urethral mobilisation is not a panacea against torsion

    PubMed Central

    Elbakry, Adel; Zakaria, Ahmed; Matar, Adel; El Nashar, Ahmed

    2013-01-01

    Objectives To evaluate the effectiveness of urethral mobilisation for correcting moderate and severe penile torsion associated with distal hypospadias. Patients and methods Nineteen patients with distal hypospadias and congenital moderate and severe penile torsion were treated surgically. The hypospadias was at the distal shaft, coronal and glanular in seven, eight and four patients, respectively, and six had mild chordee. The mean (SD, range) angle of torsion was 94.7 (19.9, 75–160)°. The urethra was mobilised down to the perineum. If the urethral mobilisation was insufficient the right border of the tunica albuginea was anchored to the pubic periosteum. The hypospadias was repaired using the urethral mobilisation and advancement technique, with a triangular plate flap for meatoplasty. The patients were followed up for 12–18 months. Results All patients had a successful functional and cosmetic outcome, with no residual torsion. Two patients had a small subcutaneous haematoma that resolved after conservative treatment. Massive oedema occurred in three patients and was treated conservatively. Urethral mobilisation did not correct the penile torsion completely. Although the mean (SD, range) angle of torsion was reduced to 86.1 (14.3, 65–130)°, statistically significantly different (P = 0.001), it was not clinically important. The presence of chordee had no significant correlation with the reduction of penile torsion. Conclusion Urethral mobilisation cannot completely correct moderate and severe penile torsion but it might only partly decrease the angle of torsion. Periosteal anchoring of the tunica albuginea might be the most reliable manoeuvre for the complete correction of penile torsion. PMID:26579237

  15. Vaginal-sparing ventral buccal mucosal graft urethroplasty for female urethral stricture: A novel modification of surgical technique

    PubMed Central

    Gani, Johan; Chee, Justin

    2016-01-01

    Purpose To present a novel modification of surgical technique to treat female urethral stricture (FUS) by a vaginal-sparing ventral buccal mucosal urethroplasty. Recurrent FUS represents an uncommon, though difficult clinical scenario to manage definitively. A variety of surgical techniques have been described to date, yet a lack of consensus on the optimal procedure persists. Materials and Methods We present a 51-year-old female with urethral stricture involving the entire urethra. Suspected etiology was iatrogenic from cystoscopy 17 years prior. Since then, the patient had undergone at least 25 formal urethral dilations and periods of self-dilation. In lithotomy position, the urethra was dilated to accommodate forceps, and ventral urethrotomy carried out sharply, exposing a bed of periurethral tissue. Buccal mucosa was harvested, and a ventral inlay technique facilitated by a nasal speculum, was used to place the graft from the proximal urethra/bladder neck to urethral meatus without a vaginal incision. Graft was sutured into place, and urethral Foley catheter inserted. Results The vaginal-sparing ventral buccal mucosal graft urethroplasty was deemed successful as of last follow-up. Flexible cystoscopy demonstrated patency of the repair at 6 months. At 10 months of follow-up, the patient was voiding well, with no urinary incontinence. No further interventions have been required. Conclusions This case describes a novel modification of surgical technique for performing buccal mucosal urethroplasty for FUS. By avoiding incision of the vaginal mucosa, benefits may include reduced: morbidity, urinary incontinence, and wound complications including urethro-vaginal fistula. PMID:27437540

  16. [Urethroplasty using a pedicled skin graft in one-stage treatment of urethral stenosis. Review of 87 cases].

    PubMed

    Falandry, L

    1990-11-01

    118 cases of urethral stenosis treated by the same surgeon from September, 1984, to December, 1989, have led the author to describing a one-stage technique for the surgical treatment of urethral stenosis using a widening implant or a pedicled penoscrotal tube. This technique is patterned on ORANDI's and BLANDY's procedures and utilizes a pedicled skin graft taken from a remote, therefore unaffected, site. 87 patients were treated with this procedure for urethral stenosis, often complicated by infection and fistulae, 34 after the failure of previous treatment. With a distance in time exceeding 2 years for most operated cases, the percentage of satisfied patients is of about 95%. The results were estimated according to the quality of urination, to the strength of the urine flow, to micturating and retrograde pyelography and to a fiberendoscopic checkup. In 71 cases (81.6%), the result was rated as good, immediately in 66 cases, after a second operation in 4 and after 3 operations in 1 case. The results were regarded as average in 12 cases (13.5%) and poor in 4 cases (4.6%). Cutaneous urethroplasty using a pedicled skin flap is relatively easy and represents an excellent procedure for the treatment of urethral stenosis owing to the low rate of failure and to the quality of the results obtained. The author stresses the advantages of grafting a well-vascularized skin flap, which is particularly indicated, whatever the site and extent, in cases of urethral stenosis with infection, fistulae or following several operations, the pedicled skin graft being a procedure of choice for all these aggravating factors. PMID:2269693

  17. Posterior osseous bridging of C1.

    PubMed

    Simsek, Serkan; Yigitkanli, Kazim; Comert, Ayhan; Acar, Halil I; Seckin, Hakan; Er, Uygur; Belen, Deniz; Tekdemir, Ibrahim; Elhan, Alaittin

    2008-06-01

    The sulcus of the vertebral artery is located behind the lateral mass of the atlas and in some cases is converted into a foramen by anomalous ossification known as the posterior ponticulus (osseous bridge). This study involved anatomical observations of 158 isolated anatomical specimens of dry C1 vertebrae. The incidence and types of posterior osseous bridging were identified for the 158 dry samples of atlas vertebrae. In nine (5.6%) dry C1 vertebrae, partial osseous bridging was detected (bilaterally in eight vertebrae and unilaterally on the left in one). Complete osseous bridging (arcuate foramen) was observed in six (3.8%) dry C1 vertebrae (bilaterally in one vertebra, unilaterally on the left in three, and on the right in two). Awareness of the types of posterior osseous bridging of C1 in craniocervical junction surgery is essential, and may be helpful in surgical interventions in this region. PMID:18378457

  18. Comparison of sonoelastography with sonourethrography and retrograde urethrography in the evaluation of male anterior urethral strictures

    PubMed Central

    Talreja, Shyam Manoharlal; Tomar, Vinay; Yadav, Sher Singh; Jaipal, Usha; Priyadarshi, Shivam; Agarwal, Neeraj; Vyas, Nachiket

    2016-01-01

    Objective Retrograde urethrography (RUG) is the most common and preferred imaging modality for imaging of the anterior urethral strictures despite its well-known limitations and disadvantages. Sonourethrography (SUG) was introduced in 1988 to overcome the limitations of RUG and to provide more accurate results. As proper selection of imaging modality is very important for planning the treatment, various advances in this area are required. One of the major factors for recurrence of stricture disease is spongiofibrosis. Sonoelastography (SE) is a newer technique, tried in various other pathologies. In this study, we have used this technique for the first time to assess its efficacy in the evaluation of anterior urethral stricture disease by comparison with RUG and SUG. Material and methods Between August 2014 and May 2015, 77 patients with clinical features of anterior urethral stricture disease were included in the study and evaluated by RUG followed by SUG and SE for stricture location, length, depth of spongiofibrosis and periurethral pathologies. The results were then correlated with operative and histopathological findings. Results Overall diagnostic accuracy of SE, SUG, and RGU for the estimation of stricture location, and length were estimated 92.68% vs. 91.54%, 79% vs. 78.87% and 80.48% vs. 43.66%, respectively, while for depth of spongiofibrosis SE, and SUG had accuracy rates of 87.3%, 48%, respectively. The mean length measured on SE was nearest to the mean intra-operative stricture length (21.34+11.8 mm). SE findings significantly correlated with the colour of bladder mucosa on cystoscopic examination (p=0.003) whereas the association was non-significant (p=0.127) for difficulty in incision. While a nonsignificant correlation existed between SUG findings related both to the colour of the bladder mucosa and difficulty in incision on cystoscopy, SE findings had a significant association (p<0.001) with histopathology findings for severe degree of fibrosis

  19. Human amniotic fluid stem cell injection therapy for urethral sphincter regeneration in an animal model

    PubMed Central

    2012-01-01

    Background Stem cell injection therapies have been proposed to overcome the limited efficacy and adverse reactions of bulking agents. However, most have significant limitations, including painful procurement, requirement for anesthesia, donor site infection and a frequently low cell yield. Recently, human amniotic fluid stem cells (hAFSCs) have been proposed as an ideal cell therapy source. In this study, we investigated whether periurethral injection of hAFSCs can restore urethral sphincter competency in a mouse model. Methods Amniotic fluids were collected and harvested cells were analyzed for stem cell characteristics and in vitro myogenic differentiation potency. Mice underwent bilateral pudendal nerve transection to generate a stress urinary incontinence (SUI) model and received either periurethral injection of hAFSCs, periurethral injection of Plasma-Lyte (control group), or underwent a sham (normal control group). For in vivo cell tracking, cells were labeled with silica-coated magnetic nanoparticles containing rhodamine B isothiocyanate (MNPs@SiO2 (RITC)) and were injected into the urethral sphincter region (n = 9). Signals were detected by optical imaging. Leak point pressure and closing pressure were recorded serially after injection. Tumorigenicity of hAFSCs was evaluated by implanting hAFSCs into the subcapsular space of the kidney, followed two weeks later by retrieval and histologic analysis. Results Flow activated cell sorting showed that hAFSCs expressed mesenchymal stem cell (MSC) markers, but no hematopoietic stem cell markers. Induction of myogenic differentiation in the hAFSCs resulted in expression of PAX7 and MYOD at Day 3, and DYSTROPHIN at Day 7. The nanoparticle-labeled hAFSCs could be tracked in vivo with optical imaging for up to 10 days after injection. Four weeks after injection, the mean LPP and CP were significantly increased in the hAFSC-injected group compared with the control group. Nerve regeneration and neuromuscular junction

  20. Posterior predictive checking of multiple imputation models.

    PubMed

    Nguyen, Cattram D; Lee, Katherine J; Carlin, John B

    2015-07-01

    Multiple imputation is gaining popularity as a strategy for handling missing data, but there is a scarcity of tools for checking imputation models, a critical step in model fitting. Posterior predictive checking (PPC) has been recommended as an imputation diagnostic. PPC involves simulating "replicated" data from the posterior predictive distribution of the model under scrutiny. Model fit is assessed by examining whether the analysis from the observed data appears typical of results obtained from the replicates produced by the model. A proposed diagnostic measure is the posterior predictive "p-value", an extreme value of which (i.e., a value close to 0 or 1) suggests a misfit between the model and the data. The aim of this study was to evaluate the performance of the posterior predictive p-value as an imputation diagnostic. Using simulation methods, we deliberately misspecified imputation models to determine whether posterior predictive p-values were effective in identifying these problems. When estimating the regression parameter of interest, we found that more extreme p-values were associated with poorer imputation model performance, although the results highlighted that traditional thresholds for classical p-values do not apply in this context. A shortcoming of the PPC method was its reduced ability to detect misspecified models with increasing amounts of missing data. Despite the limitations of posterior predictive p-values, they appear to have a valuable place in the imputer's toolkit. In addition to automated checking using p-values, we recommend imputers perform graphical checks and examine other summaries of the test quantity distribution. PMID:25939490

  1. Treatment of thoracic hemorrhage due to rupture of traumatic mediastinal hematoma.

    PubMed

    Yu, Hui-Jie; Zhang, Ling-Fang; Cao, Wei-Zhong

    2016-02-01

    Patients in traffic accidents are usually presented with pain and bleeding due to fractures or soft tissue injury. On some occasions, more severe complications may be triggered by the trauma. A review of the published English language literature reveals no survival case once the traumatic mediastinal hematoma is ruptured. In our case, a 54-year-old man suffering motorcycle accident was admitted to emergency department. Computed tomography scan revealed subdural hematoma combined with posterior mediastinal hematoma. The patient was saved and discharged with a satisfactory outcome. Here we hope to share our treatment experience in dealing with the patient with severe multiple trauma. PMID:27033275

  2. Damage to histaminergic tuberomammillary neurons and other hypothalamic neurons with traumatic brain injury.

    PubMed

    Valko, Philipp O; Gavrilov, Yury V; Yamamoto, Mihoko; Finn, Kristen; Reddy, Hasini; Haybaeck, Johannes; Weis, Serge; Scammell, Thomas E; Baumann, Christian R

    2015-01-01

    The need for increased sleep after traumatic brain injury is a common and disabling complaint, yet its etiology is unknown. Previous studies have demonstrated diffuse damage to various hypothalamic systems, but the integrity of the histaminergic tuberomammillary nucleus, a major arousal-promoting system located in the posterior hypothalamus, has never been examined in head trauma patients. Here, we demonstrate that severe head trauma is associated with a marked loss (41%) of histaminergic neurons. Reduced histamine signaling may contribute to increased sleep need, and therapies that enhance histaminergic tone may improve arousal after head trauma or other conditions. PMID:25363332

  3. Imaging the posterior mediastinum: a multimodality approach

    PubMed Central

    Occhipinti, Mariaelena; Heidinger, Benedikt H.; Franquet, Elisa; Eisenberg, Ronald L.; Bankier, Alexander A.

    2015-01-01

    The posterior mediastinum contains several structures that can produce a wide variety of pathologic conditions. Descending thoracic aorta, esophagus, azygos and hemiazygos veins, thoracic duct, lymph nodes, adipose tissue, and nerves are all located in this anatomical region and can produce diverse abnormalities. Although chest radiography may detect many of these pathologic conditions, computed tomography and magnetic resonance are the imaging modalities of choice for further defining the relationship of posterior mediastinal lesions to neighboring structures and showing specific imaging features that narrow the differential diagnosis. This review emphasizes modality-related answers to morphologic questions, which provide precise diagnostic information. PMID:25993732

  4. Imaging the posterior mediastinum: a multimodality approach.

    PubMed

    Occhipinti, Mariaelena; Heidinger, Benedikt H; Franquet, Elisa; Eisenberg, Ronald L; Bankier, Alexander A

    2015-01-01

    The posterior mediastinum contains several structures that can produce a wide variety of pathologic conditions. Descending thoracic aorta, esophagus, azygos and hemiazygos veins, thoracic duct, lymph nodes, adipose tissue, and nerves are all located in this anatomical region and can produce diverse abnormalities. Although chest radiography may detect many of these pathologic conditions, computed tomography and magnetic resonance are the imaging modalities of choice for further defining the relationship of posterior mediastinal lesions to neighboring structures and showing specific imaging features that narrow the differential diagnosis. This review emphasizes modality-related answers to morphologic questions, which provide precise diagnostic information. PMID:25993732

  5. Arthroscopic Approach to Posterior Ankle Impingement.

    PubMed

    Theodoulou, Michael H; Bohman, Laura

    2016-10-01

    Posterior ankle pain can occur for many reasons. If it is produced by forced plantarflexion of the foot, it is often a result of impingement from an enlarged posterior talar process or an os trigonum. This condition may present in an acute or chronic state. Management is initially nonoperative, but surgical treatments are available. This condition is often seen in athletes, so procedures that limit surgical trauma and allow early return to activity are ideal. An arthroscopic approach for this disorder produces good outcomes with limited complications. Understanding the indications, local anatomy, and surgical technique, allows good, reproducible outcomes. PMID:27599438

  6. Urethral Injuries

    MedlinePlus

    ... Information Drug Information, Search Drug Names, Generic and Brand Natural Products, Search Drug Interactions Pill Identifier News & Commentary ALL NEWS > Resources First Aid Videos Figures Images Audio Pronunciations The One-Page Manual of Health ...

  7. Urethral stricture

    MedlinePlus

    ... Enlarged or tender prostate Hardness on the under surface of the penis Redness or swelling of the penis Sometimes, the exam reveals no abnormalities. Tests include the following: Cystoscopy Post-void residual ( ...

  8. Prostatic urethral lift: A minimally invasive treatment for benign prostatic hyperplasia

    PubMed Central

    Garcia, Cindy; Chin, Peter; Rashid, Prem; Woo, Henry H.

    2015-01-01

    Prostatic urethral lift (PUL) is a minimally invasive procedure for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia. The procedure may be performed under local, spinal, or general anesthesia. The PUL procedure involves the delivery of implants that retract obstructing prostate lobes. Unlike other benign prostatic hyperplasia treatment options including pharmacological therapy, and the current invasive gold-standard transurethral resection of the prostate, the PUL procedure achieves quantifiable improvements in functional outcomes and quality of life, in the absence of major adverse events. Furthermore, improvement in LUTS may be attained while preserving erectile and ejaculatory function. Adverse effects associated with the PUL procedure are mild to moderate, and are transient in nature. The PUL procedure provides an alternative for men seeking treatment for bothersome LUTS, with fewer side-effects. PMID:26157759

  9. On-table urethral catheterisation during laparoscopic appendicectomy: Is it necessary?

    PubMed Central

    Nason, Gregory J.; Burke, Matthew J.; Aslam, Asadullah; Kelly, Michael E.; Walsh, Leon G.; Flood, Hugh D.; Giri, Subhasis K.

    2015-01-01

    Introduction: Laparoscopic appendicectomy (LA) is the most commonly performed surgical emergency procedure. The aim of this study was to highlight a series of iatrogenic bladder injuries during LA and suggest a simple method of prevention. Methods: A retrospective review was carried out of all LA performed in a university teaching hospital over a two year period 2012–2013. Iatrogenic visceral injuries were identified and operative notes examined. Results: During the study period 1124 appendicectomies were performed. Four iatrogenic bladder injuries occurred related to secondary trocar insertion. No patient was catheterised preoperatively. One of the injuries was identified intra-operatively, another in the early postoperative period where as two re-presented acutely unwell post-discharge from hospital. Three were repaired by laparotomy and one laparoscopically. Conclusion: Iatrogenic secondary trocar induced bladder injuries are a rare but preventable and potentially serious complication of LA. Urethral catheterisation during LA is a safe and simple method which can prevent this complication. PMID:25737758

  10. Chlamydial infection of the cervix in contacts of men with nongonococcal urethritis.

    PubMed Central

    Tait, I A; Rees, E; Hobson, D; Byng, R E; Tweedie, M C

    1980-01-01

    An investigation of chlamydial infection in sexual contacts of patients with nongonococcal urethritis (NGU) was carried out to determine the clinical signs of infection in the cervix, and their response to chemotherapy, and the incidence of cervical infection in the presence of ectopy and oral contraception. In 202 consecutive female contacts of NGU the isolation rate of Chlamydia trachomatis was 35%. Hypertrophic ectopy and endocervical mucopus were present in 19% and 37% of chlamydia-positive patients respectively and, in all but one, resolved after treatment. Only 14% of those followed up after treatment developed yeast infections. The chlamydial isolation rate was significantly higher in patients with hypertrophic ectopy and endocervical mucopus. Cervical ectopy and oral contraceptives acted additively, each producing a significant effect on the chlamydial isolation rate in the presence of the other but not when present alone. Images PMID:7370720

  11. [Urethral discharge in Morocco: prevalence of microorganisms and susceptibility of gonococcos].

    PubMed

    Alami, K; Aït Mbarek, N; Akrim, M; Bellaji, B; Hansali, A; Khattabi, H; Sekkat, A; El Aouad, R; Mahjour, J

    2002-11-01

    We studied 422 patients with urethral discharge recruited from 4 sentinel sites in Morocco to determine sociodemographic characteristics, history of STI infection, infecting organism and antibiotic susceptibility of Neisseria gonorrhoeae. The mean age of the sample was 28 years (range 16-67 years), and most were single, had multiple sex partners without taking protective measures and came from all social backgrounds; 59.9% had a history of a previous STI. The majority (87%) of the infections were the acute form. By polymerase chain reaction of urine samples of 399 patients, 41.6% had N. gonorrhoeae infection, 6.3% Chlamidia trachomatis and 10.8% both organisms; in 41.4% no organism was identified. N. gonorrhoeae was strongly susceptible to ciprofloxacin. PMID:15568457

  12. An unusual side effect of isotretinoin: retinoid dermatitis affecting external urethral meatus.

    PubMed

    Alli, Nuran; Yorulmaz, Ahu

    2015-01-01

    Isotretinoin (Iso) is the most effective drug against severe nodulocystic acne. As a synthetic oral retinoid, Iso exerts its actions by modulating cell growth and differentiation. Targeting all the pathophysiologic processes in acne development, Iso has been considered to be an unique drug, however it has several side effects. While chelitis, xerosis, ocular sicca, arthralgia, myalgia, headache, hyperlipidemia are the most common side effects, teratogenicity and depressive symptoms are the most concerning ones. In addition, Iso has unusual side effects which have been described for the first time in the literature. Here, we report a remarkable side effect of Iso in a 23-years-old male patient with retinoid dermatitis affecting the external uretral meatus. To our knowledge, only few cases of retinoid dermatitis in the urethral mucosa due to Iso have been reported in the literature so far. PMID:24964168

  13. Case of Urethral Foreign Body: IUD Perforation of the Bladder with Calculus Formation

    PubMed Central

    Gillis, E; Chhiv, N; Kang, S; Sayegh, R; Lotfipour, S

    2006-01-01

    A 28-year-old female presented to the Emergency Department (ED) with a chief complaint of strings protruding from her vagina. The patient also complained of recurrent symptoms of cystitis and occasional hematuria over the past five months without resolution after treatment. The patient underwent ED evaluation and was noted to have strings coated in calculus protruding from her urethral meatus. On AP abdominal film a T-shaped intrauterine device (IUD) with calculus was noted in the pelvis. By computed tomography (CT) scan the object was shown to be extruding from the vagina into the bladder. Of note the patient had a history of IUD use with supposed removal five years prior to presentation. The diagnosis of IUD perforation of the bladder with calculus formation was confirmed by cystoscopy, and the IUD and calculi were successfully removed without complication. PMID:20505808

  14. [Present status of transurethral laser technique in the treatment of urethral strictures (author's transl)].

    PubMed

    Bülow, H; Bülow, U; Levine, S; Wurster, H; Frohmüller, H

    1981-09-01

    The main difference between the conventional methods of urethrotomy and the laser method is that the scar tissue of the urethral stricture is not cut but removed by evaporisation. At present only neodymium: YAG and argon ion lasers are available for clinical endoscopic use. For the purpose of removing tissue neodymium: YAG lasers need irrigation with a gas in contrast to argon ion lasers that can be utilized with the well known water irrigation. Certain considerations and experiences suggest the carbon dioxide lasers to be the best ones for evaporating stricture tissue since they cause very limited zones of necrosis with immediate sealing of the wound edges. Transurethral carbon dioxide laser application, however, is still at an experimental stage, since convenient light transmission systems are not available for clinical use at the present time. PMID:6795783

  15. Staged urethroplasty in the management of complex anterior urethral stricture disease

    PubMed Central

    Mori, Ryan L.

    2015-01-01

    Staged buccal mucosa graft urethroplasty has emerged as a reliable procedure for difficult anterior urethral strictures not amenable to one-stage graft or flap reconstruction. It has primarily been used for strictures and/or fistulae occurring after previous surgery for hypospadias or those related to lichen sclerosus (LS). Success rates in these patient populations have improved when compared to earlier techniques. However, prior studies have demonstrated a number of patients requiring more than two procedures to complete the reconstruction, as well as some who have been content with their voiding pattern after the first operation and therefore elected to forego second stage tubularization. In this setting, we have reviewed the surgical technique and summarized previously published work. There may be an opportunity to complete more of these repairs in two operations using additional oral mucosa at the time of tubularization. PMID:26816806

  16. Bacterial colonization of the lower urinary tract in women with long-term indwelling urethral catheter.

    PubMed

    Eddeland, A; Hedelin, H

    1983-01-01

    The bacterial colonization of urethra and urine was studied over long periods in 16 hospitalized women with long-term indwelling bladder catheter. The cultured flora was polymicrobic and, except for Proteus mirabilis and Escherichia coli, rapidly changing. The colonization patterns showed marked inter-species variations. P. mirabilis was the species most commonly found, and in the urethra it was significantly more persistent than the other species. Unlike the other species, P. mirabilis was rarely found in urine without concomitant urethral growth. Prophylactic measures aimed to reduce the risk of permanent colonization by this pathogen, which is rendered particularly harmful by its urease production, should therefore be directed towards the urethra and the periurethral area. PMID:6361978

  17. Patients' compliance with follow-up after treatment of gonococcal urethritis.

    PubMed Central

    Mitchell, R. W.; Robson, H. G.

    1977-01-01

    By means of telephone tracing 96% follow-up was achieved in men treated for gonococcal urethritis. A large proportion (34.8%) of patients required one or more calls before follow-up could be obtained. Frequency of sexual re-exposure, proportion with persistent gonorrhea or reinfection, and interval between initial therapy and follow-up were greater in those who required telephone contact for follow-up than in the group who returned for follow-up. Failure to reappear for follow-up does not imply either bacteriologic cure or disappearance of symptoms. Control of gonococcal infection still depends largely upon aggressive methods of case finding, appropriate therapy and careful follow-up. PMID:401673

  18. [Urethral Fistula Caused by an Urethrovesical Foreign Body : A Case Report].

    PubMed

    Iwamoto, Takashi; Hosokawa, Yukinari; Otsuka, Kenji; Matsushita, Chie; Hayashi, Yoshiki; Onishi, Kenta; Fujimoto, Kiyohide

    2016-07-01

    A 68-year-old man presented with the chief complaint of swelling of the penis. A pencil had been inserted into his urethra by a commercial sex worker for sexual stimulation. On a computed tomography (CT) scan, a foreign object was visible throughout the urethra and in the urinary bladder. Cystoscopy performed under spinal anesthesia showed a pencil in the urethra. We attempted removing the object endoscopically by using a Holmium laser. However, the endoscopic procedure failed and finally, we removed the object by transvesical open surgery. At the same time, suprapubic cystostomy was performed for the disorder of the urethra. An anterior urethrocutaneous fistula was formed 5 days after the operation. After removal of the urethral catheter, he was managed with only suprapubic cystostomy. Conservative management of the urethrocutaneous fistula was effective. The fistula was completely closed 26 days after the operation. He was discharged 33 days after the operation. PMID:27569356

  19. Urethral adenocarcinoma associated with intestinal-type metaplasia, case report and literature review

    PubMed Central

    Hale, Christopher S; Huang, Hongying; Melamed, Jonathan; Xu, Ruliang; Roberts, Larry; Wieczorek, Rosemary; Pei, Zhiheng; Lee, Peng

    2013-01-01

    The presence of glandular epithelium in urinary tract biopsies poses a diagnostic challenge. Intestinal metaplasia of the urethra may be seen in many congenital, iatrogenic, and reactive conditions, as well as in association with malignant conditions such as urethral adenocarcinoma. We present a case of a 61 year-old woman presenting with microscopic hematuria. Successive biopsies showed glandular epithelium with focal atypia in close association with inflammation, but no overt malignancy. Only on surgical resection was the associated high grade adenocarcinoma revealed. When intestinal-type mucosa is present within a urinary tract biopsy, associated malignancy may be present only focally. Thorough sampling and consideration of the differential diagnosis is imperative. PMID:23923086

  20. [Complete urethral rupture with symphysis injury and anterior pelvic ring fracture during spontaneous delivery].

    PubMed

    Klotz, T; Derakhshani, P; Vorreuther, R; Engelmann, U

    1998-01-01

    We report on a complete longitudinal rupture of the urethra in combination with a rupture of the pubic symphysis and pelvic fracture during spontaneous vaginal delivery. Only after stabilisation of the pelvic fracture by external skeletal fixation adaptation of the urethra was possible. Three weeks later after removing of the transurethral catheter a mild stress incontinence could be observed. In the follow up one year later the patient was completely continent. The cosmetic result was satisfactory. There was no cystocele. An unclear haematuria after delivery needs a meticulous urological examination. Early repair of urethral disruption minimize the risk of severe incontinence. Coordinated care between the trauma surgeon and urologist is required for successful treatment of this rare combined injury after birth. PMID:9540189