[Effect of epidermal growth factor and testosterone on androgen receptor activation in urethral plate fibroblasts in hypospadias].

PubMed

Lin, Junshan; Xie, Cheng; Chen, Ruiqing; Li, Dumiao

2016-05-01

To investigate androgen receptor (AR) expression and the effect of epidermal growth factor (EGF) and testosterone on AR expression level.
 EGF or different concentrations of testosterone were incubated with the primary urethral plate fibroblasts from patients with hypospadias. The levels of AR expression in the fibroblasts were detected by immunocytochemical assays and graphical analysis.
 There was no significant difference in AR activation under physiological concentrations (3×10(-8) mol/L) of testosterone between the control and the distal hypospadias group (P>0.05). However, there was a significant decrease in AR activation in the proximal hypospadias group compared to that in the control group (P<0.001). Under the concentration of 3×10(-6) mol/L, the effects of testosterone on AR activation were dramatically different in the three groups (control group>distal hypospadias group>proximal hypospadias group, P<0.001). AR activation level in the group of proximal hypospadias was improved most obviously when EGF and physiological concentration of testosterone were employed in the urethral plate fibroblasts from hypospadias patients (P<0.001), and it was improved more in the distal hypospadias group than that in the control group (P=0.02).
 AR expression and activation in the urethral plate fibroblasts from hypospadias patients are abnormal. EGF can be used to improve AR activation in fibroblasts from different types of hypospadias, especially in the proximal type.

Microbubble-enhanced ultrasound to demonstrate urethral transection in a case of penile fracture.

PubMed

Czarnecki, Oliver; von Stempel, Conrad Brice; Sangster, Pippa; Walkden, Miles

2017-09-23

A 47-year-old man attended the emergency department following trauma during sexual intercourse after which he developed penile swelling and haematuria several hours later. A penile fracture was suspected but given the slightly atypical history, ultrasound was performed to look for a fracture. Given the history of haematuria, both a standard Doppler ultrasound and a microbubble-enhanced retrograde ultrasound urethrogram were performed. The Doppler confirmed the suspected diagnosis of penile fracture, and microbubble urethrogram demonstrated a urethral injury. This facilitated prompt surgical treatment and helped guide the surgical approach. Retrograde microbubble enhanced ultrasound urethrogram is a novel technique that can be used in conjunction with standard ultrasound to confirm the presence of a concurrent urethral rupture in penile fracture. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Delayed retropubic urethroplasty of completely transected urethra associated with pelvic fracture in girls.

PubMed

Hosseini, Jalil; Tavakkoli Tabassi, Kamyar; Razi, Abdollah

2009-01-01

The objective of the present study was to evaluate the results and the complications of delayed retropubic urethroplasty of completely transected urethra associated with pelvic fracture in girls. From 2002 to 2008, a total of 7 girls with complete urethral disruption after pelvic fracture were referred to our center and all of them underwent delayed retropubic urethroplasty with end-to-end anastomosis of the urethra. Seven female patients with a median age of 6 years old underwent delayed end-to-end anastomosis. The median time to surgery was 6 months from the trauma. Voiding was normal after catheter removal in all of the patients. The median follow-up was 36 months. Three patients had mild stress urinary incontinence after catheter removal. There are some different strategies for management of complete urethral avulsion in females who have sustained pelvic fracture, including early realignment, bladder flaps, and end-to-end anastomosis. The strategy of delayed end-to-end anastomosis urethroplasty with retropubic approach is sound and produces acceptable results. The use of flexible cystoscope and omental flap is effective in achieving continence after urethroplasty in such cases.

Single-Staged Improved Tubularized Preputial/Penile Skin Flap Urethroplasty for Obliterated Anterior Urethral Stricture: Long-Term Results.

PubMed

Xue, Jing-Dong; Xie, Hong; Fu, Qiang; Feng, Chao; Guo, Hui; Xu, Yue-Min

2016-01-01

To present an improved tubularized flap (ITF) technique and report the outcome of single-stage urethroplasty using preputial/penile skin flaps (PSFs) for the treatment of obliterative anterior urethral strictures (AUSs). From January 2000 to June 2012, 42 cases of obliterative AUS (3-14 cm, mean 6.38 cm) with urethral plate unsalvageable were treated using PSF-ITF urethroplasty including longitudinal skin flap, circular island flap, L-flap, Q-flap. Patients were divided into 3 groups: pendulous urethral stricture (Group A), bulbar urethral stricture (Group B) and panurethral strictures (Group C). Patients were followed up by uroflowmetry, urethrography and ureteroscope when necessary. The mean follow-up in these patients was 65 months (range 36 months-15 years). The primary success rates at 3-year follow-up were 75, 75 and 60% for Groups A, B and C, respectively. The overall success rates were 85, 83 and 70% with the remedial measure of a single visual internal urethrotomy at 3-year follow-up. A total 60% of the patients in the study completed more than 5 years of follow-up with no additional recurrence. Improved tubularized preputial/PSF urethroplasty with relatively high overall satisfaction is a novel technique for treatment of AUS when there is inadequate urethral plate or obliterative defects. © 2016 S. Karger AG, Basel.

Primary non-transecting bulbar urethroplasty long-term success rates are similar to transecting urethroplasty.

PubMed

Anderson, Kirk M; Blakely, Stephen A; O'Donnell, Colin I; Nikolavsky, Dmitriy; Flynn, Brian J

2017-01-01

To review the long-term outcomes of transecting versus non-transecting urethroplasty to repair bulbar urethral strictures. A retrospective review was conducted of 342 patients who underwent anterior urethroplasty performed by a single surgeon from 2003 to 2014. Patients were excluded from further analysis if there had been prior urethroplasty, stricture location outside the bulbous urethra, or age <18 years. In the transecting group, surgical techniques used included excision and primary anastomosis and augmented anastomotic urethroplasty. In the non-transecting group, surgical techniques used included non-transecting anastomotic urethroplasty and dorsal and/or ventral buccal grafting. The primary endpoint was stricture resolution in transecting vs. non-transecting bulbar urethroplasty. Success was defined as freedom from secondary procedures including dilation, urethrotomy, or repeat urethroplasty. One hundred and fifty-two patients met inclusion criteria. At a mean follow-up of 65 months (range: 10-138 months), stricture-free recurrence in the transecting and non-transecting groups was similar, 83% (n = 85/102) and 82% (n = 41/50), respectively (p = 0.84). Surgical technique (p = 0.91), stricture length (p = 0.8), and etiology (p = 0.6) did not affect stricture recurrence rate on multivariate analysis. There was no difference detected in time to stricture recurrence (p = 0.21). In this retrospective series, transecting and non-transecting primary bulbar urethroplasty resulted in similar long-term stricture resolution rate. Prospective studies are needed to determine what differences may present in outcomes related to sexual function and long-term success.

Detecting swift fox: Smoked-plate scent stations versus spotlighting

Treesearch

Daniel W. Uresk; Kieth E. Severson; Jody Javersak

2003-01-01

We compared two methods of detecting presence of swift fox: smoked-plate scent stations and spotlight counts. Tracks were counted on ten 1-mile (1.6-km) transects with bait/tracking plate stations every 0.1 mile (0.16 km). Vehicle spotlight counts were conducted on the same transects. Methods were compared with Spearman's rank order correlation. Repeated measures...

Systematic Review to Compare Urothelium Differentiation with Urethral Epithelium Differentiation in Fetal Development, as a Basis for Tissue Engineering of the Male Urethra.

PubMed

de Graaf, Petra; van der Linde, E Martine; Rosier, Peter F W M; Izeta, Ander; Sievert, Karl-Dietrich; Bosch, J L H Ruud; de Kort, Laetitia M O

2017-06-01

Tissue-engineered (TE) urethra is desirable in men with urethral disease (stricture or hypospadias) and shortage of local tissue. Although ideally a TE graft would contain urethral epithelium cells, currently, bladder epithelium (urothelium) is widely used, but morphologically different. Understanding the differences and similarities of urothelium and urethral epithelium could help design a protocol for in vitro generation of urethral epithelium to be used in TE grafts for the urethra. To understand the development toward urethral epithelium or urothelium to improve TE of the urethra. A literature search was done following PRISMA guidelines. Articles describing urethral epithelium and bladder urothelium development in laboratory animals and humans were selected. Twenty-nine studies on development of urethral epithelium and 29 studies on development of urothelium were included. Both tissue linings derive from endoderm and although adult urothelium and urethral epithelium are characterized by different gene expression profiles, the signaling pathways underlying their development are similar, including Shh, BMP, Wnt, and FGF. The progenitor of the urothelium and the urethral epithelium is the early fetal urogenital sinus (UGS). The urethral plate and the urothelium are both formed from the p63+ cells of the UGS. Keratin 20 and uroplakins are exclusively expressed in urothelium, not in the urethral epithelium. Further research has to be done on unique markers for the urethral epithelium. This review has summarized the current knowledge about embryonic development of urothelium versus urethral epithelium and especially focuses on the influencing factors that are potentially specific for the eventual morphological differences of both cell linings, to be a basis for developmental or tissue engineering of urethral tissue.

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.

Two-stage graft urethroplasty for proximal and complicated hypospadias in children: A retrospective study.

PubMed

Faure, Alice; Bouty, Aurore; Nyo, Yoke Lin; O'Brien, Mike; Heloury, Yves

2016-10-01

Although two-stage graft urethroplasty is widely used, the literature regarding the complication rates and functional characteristics of reconstructed neourethra is relatively modest. The aim was to analyze the complication rates and uroflow data of boys who have previously undergone a two-stage graft urethroplasty procedure for proximal and complicated hypospadias. We retrospectively reviewed the clinical outcomes of 52 boys with proximal (n = 44) and complicated (n = 8) hypospadias who underwent two-stage graft urethroplasty repair (median age of 15 months and 3 years respectively) between 2004 and 2015. Fifteen toilet-trained boys without fistulas underwent uroflowmetry. The uroflow data were plotted on age-volume-dependent normograms with normal controls. The median follow-up was 34 months (8 months-8 years). Complications were identified in three patients (6%) after the first stage (i.e. contracture of the graft) and in 20 patients (38.4%) after the second stage, including meatal stenosis (n = 8, 15.3%), urethral stricture (n = 4, 7.6%), urethrocutaneous fistula (n = 8, 15.3%), glandular dehiscence (n = 1, 1.9%), and diverticulum (n = 1, 1.9%). The patients with failed hypospadias experienced fewer complications than those who underwent the two-stage procedure for primary repair (25% and 45%, respectively). The reoperation rate was 36.8%. Eleven of the 15 toilet-trained boys were asymptomatic but exhibited flow rates below the normal range (median Q max  = 7 mL/s, range 3.5-16.7). Only one of the boys with a low flow rate was confirmed to have urethral stenosis under general anesthesia. In our study, primary hypospadias repair requiring urethral plate transection elicited worse outcomes than those observed in the prior failed hypospadias cases. However, because of our study's retrospective design, we were unable to accurately assess the initial position of the meatus in the redo hypospadias cases. Our data also demonstrated that the majority of cases without any voiding symptoms exhibited flow rates that were below the normal range despite no urethral stricture under general anesthesia. These findings indicate that urethras reconstructed via two-stage graft urethroplasty repair are not functionally equivalent to normal urethras, at least prior to puberty. Two-stage graft urethroplasty repair was successful in 62% of cases after the second-stage procedure, but one-third of the boys required a reoperation after the two-stage planned repair. We demonstrated that although we used a urethral tissue substitute, the urine flow patterns of the patients without strictures were abnormal. Copyright © 2016 Journal of Pediatric Urology Company. All rights reserved.

Results of a Two-stage Technique for Treatment of Proximal Hypospadias with Severe Curvature: Creation of a Urethral Plate Using a Vascularized Preputial Island Flap.

PubMed

Ozcan, Rahsan; Emre, Senol; Kendigelen, Pinar; Elicevik, Mehmet; Emir, Haluk; Soylet, Yunus; Buyukunal, S N Cenk

2016-04-16

To present the results of a two-stage technique used for the treatment of proximal hypospadias with severe curvature. The medical records of children with proximal hypospadias and severe curvature were retrospectively analyzed. A 2-stage procedure was performed in 30 children. In the first stage, the release of chordee was performed, and a well-vascularized preputial island flap was created. The vascularized island flap was brought anteriorly and sutured over the ventral surface of the glans and degloved penile shaft. The second stage was performed 6-8 months later. A neourethra was reconstructed by the tubularization of the preputial-urethral plate utilizing the principles of Duplay technique. All surgical procedures were performed between 2005 and 2011. The mean age of the patients was 4.4 years (1-17 years). The mean duration of urethral catheterization was 6 days after the first stage and 10 days following the second stage. The flaps were viable in all of the children. There was no residual chordee. Following the second stage (n = 30), complications developed in 11 children (36%), namely, a fistula in 7, a pinpoint fistula in 3, and a diverticulum formation in 1. The cosmetic outcome was satisfactory. Uroflowmetry measurements were evaluated, and only one patient had a diverticulum formation at the late follow-up. Vascularized preputial island flap is an alternative to free grafts for the reconstruction of the urethra. The main advantage of this flap technique is the creation of a thick, healthy and well-vascularized urethral plate. The advantages of this technique include better aesthetic appearance, an acceptable complication rate, and a very low rate of diverticula formation.

Evolution and hydration of the Juan de Fuca crust and uppermost mantle: a plate-scale seismic investigation from ridge to trench

NASA Astrophysics Data System (ADS)

Carbotte, S. M.; Canales, J.; Carton, H. D.; Nedimovic, M. R.; Han, S.; Marjanovic, M.; Gibson, J. C.; Janiszewski, H. A.; Horning, G.; Delescluse, M.; Watremez, L.; Farkas, A.; Biescas Gorriz, B.; Bornstein, G.; Childress, L. B.; Parker, B.

2012-12-01

The evolution of oceanic lithosphere involves incorporation of water into the physical and chemical structure of the crust and shallow mantle through fluid circulation, which initiates at the mid-ocean ridge and continues on the ridge flanks long after crustal formation. At subduction zones, water stored and transported with the descending plate is gradually released at depth, strongly influencing subduction zone processes. Cascadia is a young-lithosphere end member of the global subduction system where relatively little hydration of the downgoing Juan de Fuca (JdF) plate is expected due to its young age and presumed warm thermal state. However, numerous observations support the abundant presence of water within the subduction zone, suggesting that the JdF plate is significantly hydrated prior to subduction. Knowledge of the state of hydration of the JdF plate is limited, with few constraints on crustal and upper mantle structure. During the Cascadia Ridge-to-Trench experiment conducted in June-July 2012 over 4000 km of active source seismic data were acquired as part of a study of the evolution and state of hydration of the crust and shallow mantle of the JdF plate prior to subduction at the Cascadia margin. Coincident long-streamer (8 km) multi-channel seismic (MCS) and wide-angle ocean bottom seismometer (OBS) data were acquired in a two-ship program with the R/V Langseth (MGL1211), and R/V Oceanus (OC1206A). Our survey included two ridge-perpendicular transects across the full width of the JdF plate, a long trench-parallel line ~10 km seaward of the Cascadia deformation front, as well as three fan lines to study mantle anisotropy. The plate transects were chosen to provide reference sections of JdF plate evolution over the maximum range of JdF plate ages (8-9 Ma), offshore two contrasting regions of the Cascadia Subduction zone, and provide the first continuous ridge-to-trench images acquired at any oceanic plate. The trench-parallel line was designed to characterize variations in plate structure and hydration linked to JdF plate segmentation for over 450 km along the margin. Shipboard brute stacks of the MCS data reveal evidence for reactivation of abyssal hill faulting in the plate interior far from the trench. Ridgeward-dipping lower crustal reflectors are observed, similar to those observed in mature Pacific crust elsewhere, as well as conjugate reflectivity near the deformation front along the Oregon transect. Bright intracrustal reflectivity is also observed along the trench-parallel transect with marked changes in reflectivity along the Oregon and Washington margins. Initial inspection of the OBS record sections indicate good quality data with the expected oceanic crustal and upper mantle P-wave arrivals: Ps and Pg refractions through sedimentary and igneous layers, respectively, PmP wide-angle reflections from the crust-mantle transition zone, and Pn upper mantle refractions. The Pg-PmP-Pn triplication is typically observed at 40-50 km source-receiver offsets. Pn characteristics show evidence for upper mantle azimuthal anisotropic propagation: along the plate transects Pn is typically weaker and difficult to observe beyond ~80 km offsets, while along the trench-parallel transect Pn arrivals have higher amplitude and are easily observed up to source-receiver offsets of 160-180 km. An overview on the Cascadia Ridge to Trench data acquisition program and preliminary results will be presented.

Computational Modeling and Simulation of Genital Tubercle ...

EPA Pesticide Factsheets

Hypospadias is a developmental defect of urethral tube closure that has a complex etiology. Here, we describe a multicellular agent-based model of genital tubercle development that simulates urethrogenesis from the urethral plate stage to urethral tube closure in differentiating male embryos. The model, constructed in CompuCell3D, implemented spatially dynamic signals from SHH, FGF10, and androgen signaling pathways. These signals modulated stochastic cell behaviors, such as differential adhesion, cell motility, proliferation, and apoptosis. Urethral tube closure was an emergent property of the model that was quantitatively dependent on SHH and FGF10 induced effects on mesenchymal proliferation and endodermal apoptosis, ultimately linked to androgen signaling. In the absence of androgenization, simulated genital tubercle development defaulted to the female condition. Intermediate phenotypes associated with partial androgen deficiency resulted in incomplete closure. Using this computer model, complex relationships between urethral tube closure defects and disruption of underlying signaling pathways could be probed theoretically in multiplex disturbance scenarios and modeled into probabilistic predictions for individual risk for hypospadias and potentially other developmental defects of the male genital tubercle. We identify the minimal molecular network that determines the outcome of male genital tubercle development in mice.

Computational Modeling and Simulation of Genital Tubercle Development

EPA Pesticide Factsheets

Hypospadias is a developmental defect of urethral tube closure that has a complex etiology involving genetic and environmental factors, including anti-androgenic and estrogenic disrupting chemicals; however, little is known about the morphoregulatory consequences of androgen/estrogen balance during genital tubercle (GT) development. Computer models that predictively model sexual dimorphism of the GT may provide a useful resource to translate chemical-target bipartite networks and their developmental consequences across the human-relevant chemical universe. Here, we describe a multicellular agent-based model of genital tubercle (GT) development that simulates urethrogenesis from the sexually-indifferent urethral plate stage to urethral tube closure. The prototype model, constructed in CompuCell3D, recapitulates key aspects of GT morphogenesis controlled by SHH, FGF10, and androgen pathways through modulation of stochastic cell behaviors, including differential adhesion, motility, proliferation, and apoptosis. Proper urethral tube closure in the model was shown to depend quantitatively on SHH- and FGF10-induced effects on mesenchymal proliferation and epithelial apoptosis??both ultimately linked to androgen signaling. In the absence of androgen, GT development was feminized and with partial androgen deficiency, the model resolved with incomplete urethral tube closure, thereby providing an in silico platform for probabilistic prediction of hypospadias risk across c

Two-stage repair for severe proximal hypospadias using oral mucosal grafts: combination of a modified Bracka method and a modified Byars flap method.

PubMed

Mitsukawa, Nobuyuki; Saiga, Atsuomi; Akita, Shinsuke; Kubota, Yoshitaka; Kuriyama, Motone; Satoh, Kaneshige

2015-02-01

One-stage repair is a conventional treatment of hypospadias. If hypospadias is severe as in the scrotal type and perineal type, penile curvature sometimes cannot be corrected by dorsal midline plication alone. In addition to resection of the urethral plate, ventral grafting becomes necessary for insufficient skin and subcutaneous tissue. In recent years, there has been renewed interest in 2-stage repair for such severe cases and salvage of failed cases with scarring. In the present study, novel 2-stage urethroplasty was performed in 6 cases to repair severe proximal hypospadias which required resection of the urethral plate. This novel method consisted of a combination of a modified Bracka method using oral mucosal grafts and a modified Byars flap of the dorsal foreskin. Good results were obtained using this novel method.

Tubularized proximally-incised plate in distal/midshaft hypospadias repair.

PubMed

Marte, Antonio; Pintozzi, Lucia

2017-06-23

The aim of this study was to verify the validity, feasibility, and the functional results, by uroflowmetry, of Tubularized proximallyincised plate technique in selected case of distal/midshaft hypospadias. Out of 120 patients scheduled to undergo TIP (or Snodgrass) procedure, 23 were selected between January 2013 and January 2016 (19.1%). This case series comprised 16 patients with distal and 7 with midshaft hypospadias. Mean age at surgery was 2.9 years. The inclusion criteria were a deep and wide glandular groove and a proximal narrow urethral plate. The procedure was carried out as described by Snodgrass but the incision of the urethral plate, including the mucosal and submucosal tissue, was made only proximally, between the original meatus and the glandular groove in no case extending to the entire length of the plate. Postoperatively a foley catheter was left in place from 4 to 7 days. Uroflowmetry was performed when the patients age ranged from 2.5 to 5.7 years (mean age 3.11 years and mean follow-up 1.8 years, body surface 2). No patient presented fistulas nor perioperative complications. At uroflowmetry, eighteen patients presented values above the 25th percentile and 5 showed a borderline flow. All patients in this group remained stable without urinary symptoms. In selected cases, the tubularized proximally-incised plate yields satisfactory cosmetic and functional results for the treatment of midshaft proximal hypospadias. A long-term follow-up study is needed for further evaluation. Patient selection is crucial for the success of this technique.

The contemporary role of 1 vs. 2-stage repair for proximal hypospadias

PubMed Central

Dason, Shawn; Wong, Nathan

2014-01-01

This review discusses the most commonly employed techniques in the repair of proximal hypospadias, highlighting the advantages and disadvantages of single versus staged surgical techniques. Hypospadias can have a spectrum of severity with a urethral meatus ranging from the perineum to the glans. Associated abnormalities are commonly found with proximal hypospadias and encompass a large spectrum, including ventral curvature (VC) up to 50 degrees or more, ventral skin deficiency, a flattened glans, penile torsion and penoscrotal transposition. Our contemporary understanding of hypospadiology is comprised of a foundation built by experts who have described a number of techniques and their outcomes, combined with survey data detailing practice patterns. The two largest components of hypospadias repair include repair of VC and urethroplasty. VC greater than 20 degrees is considered clinically relevant to warrant surgical correction. To repair VC, the penis is first degloved—a procedure that may reduce or remove curvature by itself in some cases. Residual curvature is then repaired with dorsal plication techniques, transection of the urethral plate, and/or ventral lengthening techniques. Urethroplasty takes the form of 1- or 2-stage repairs. One-stage options include the tubularized incised urethroplasty (TIP) or various graft or flap-based techniques. Two-stage options also include grafts or flaps, including oral mucosal and preputial skin grafting. One stage repairs are an attractive option in that they may reduce cost, hospital stay, anesthetic risks, and time to the final result. The downside is that these repairs require mastery of multiple techniques may be more complex, and—depending on technique—have higher complication rates. Two-stage repairs are preferred by the majority of surveyed hypospadiologists. The 2-stage repair is versatile and has satisfactory outcomes, but necessitates a second procedure. Given the lack of clear high-quality evidence supporting the superiority of one approach over the others, hypospadiologists should develop their own algorithm, which gives them the best outcomes. PMID:26813851

The contemporary role of 1 vs. 2-stage repair for proximal hypospadias.

PubMed

Dason, Shawn; Wong, Nathan; Braga, Luis H

2014-12-01

This review discusses the most commonly employed techniques in the repair of proximal hypospadias, highlighting the advantages and disadvantages of single versus staged surgical techniques. Hypospadias can have a spectrum of severity with a urethral meatus ranging from the perineum to the glans. Associated abnormalities are commonly found with proximal hypospadias and encompass a large spectrum, including ventral curvature (VC) up to 50 degrees or more, ventral skin deficiency, a flattened glans, penile torsion and penoscrotal transposition. Our contemporary understanding of hypospadiology is comprised of a foundation built by experts who have described a number of techniques and their outcomes, combined with survey data detailing practice patterns. The two largest components of hypospadias repair include repair of VC and urethroplasty. VC greater than 20 degrees is considered clinically relevant to warrant surgical correction. To repair VC, the penis is first degloved-a procedure that may reduce or remove curvature by itself in some cases. Residual curvature is then repaired with dorsal plication techniques, transection of the urethral plate, and/or ventral lengthening techniques. Urethroplasty takes the form of 1- or 2-stage repairs. One-stage options include the tubularized incised urethroplasty (TIP) or various graft or flap-based techniques. Two-stage options also include grafts or flaps, including oral mucosal and preputial skin grafting. One stage repairs are an attractive option in that they may reduce cost, hospital stay, anesthetic risks, and time to the final result. The downside is that these repairs require mastery of multiple techniques may be more complex, and-depending on technique-have higher complication rates. Two-stage repairs are preferred by the majority of surveyed hypospadiologists. The 2-stage repair is versatile and has satisfactory outcomes, but necessitates a second procedure. Given the lack of clear high-quality evidence supporting the superiority of one approach over the others, hypospadiologists should develop their own algorithm, which gives them the best outcomes.

[Neo-urethroclitoroplasty according to Petrovic].

PubMed

Trombetta, Carlo; Liguori, Giovanni; Benvenuto, Sara; Petrovic, Milos; Napoli, Renata; Umari, Paolo; Rizzo, Michele; Zordani, Alessio

2011-01-01

We present a refinement to our original technique in MtF gender reassignment surgery. Our goal was to construct a neoclitoris, which is wet and covered with urethral neoprepuce. Since 1995 more than 300 transgender MtF patients have been operated at our institution. Our refinement has been applied to 12 cases and showed both excellent functional and cosmetic results during midterm follow-up. During 2010 several sex reassignment surgeries have been performed using our new technique that includes: bilateral orchiectomy, removal of corpora cavernosa of the penis, formation of the neourethra with neomeatus, neovaginoplasty by inversion of penoscrotal skin flaps, construction of the neoclitoris with preservation of the neurovascular bundle and exterior vulva formation. The refinement consists in creating a neoclitoris embedded in urethral mucosa using urethral flaps. These flaps are in continuity with the previously spatulated urethra. The urethral plate is further incised distally in a Y fashion. The urethral flaps are sutured around the neoclitoris to form a neo-urethroclitoris covered by urethral neoprepuce, which resembles a real female clitoris. The neoclitoris is positioned in the anatomical position of the male suspensory ligament of the penis that is also the natural anatomical position of the female clitoris. With this method we are able to construct a clitoris with a normal sensitivity embedded in urethral mucosa that remains wet and hairless. It can be easily stimulated during sexual intercourse, as most of the patients reported great satisfaction and ability to reach orgasm. We want to emphasize how both the cosmetic results and functionality of the neovagina and neoclitoris are important in this type of surgery for the quality of life of our patients. We are still far from a perfect surgical solution, but we are further improving our technique and follow our aims step by step.

Tubularized incised plate urethroplasty for hypospadias reoperation: a review and meta-analysis.

PubMed

Mousavi, Seyed A; Aarabi, Mohsen

2014-01-01

Tubularized Incised Plate (TIP) urethroplasty is a technique for urethral reconstruction of hypospadias although there are some controversies for its use in recurrent cases. The aim of this study was to review the results of TIP technique in various studies and the usage of different flaps for covering the repair site. Extensive Search was performed for articles published between 1994 and 2013 in common electronic databases. The overall TIP complication rates were estimated by a fixed effects model meta-analysis. 17 articles of hypospadia repair using the TIP method were reviewed. All studies performed surgery and repair on the basis of the Snodgrass's method; however, some introduced modifications to the method. The prevalence of complications in repeated TIP surgery was 11.1 to 33.3% and the most prevalent complication in different studies was fistula. Based on the meta-analysis, the overall estimation of complications was 21.8% (95% CI: 18.3 to 25.5). Most studies performed the incision of the urethral plate to create a supportive coverage upon neourethra, and confirmed its success. We recommend further investigation on using different flaps in well-designed randomized controlled trials to choose the best surgical method for repairing recurrent hypospadias.

Perineal hypospadias: the Bilateral Based (BILAB) skin flap technique.

PubMed

Hadidi, Ahmed T

2014-01-01

The purpose of this study was to present the "bilateral based skin flap (BILAB) technique" for patients with perineal hypospadias associated with severe deep chordee and report the follow up. The short urethral plate is incised, the hypoplastic corpus spongiosum excised, the glans split in the midline, and a healthy urethral plate is reconstructed from the lateral penile skin and foreskin to the tip of the glans. Between January 2005 and December 2011, the BILAB technique was performed in 68 patients with perineal hypospadias associated with severe chordee as a one or two stage repair. The records of 63 patients who maintained regular follow up were reviewed. The new urethra was reconstructed from the new urethral plate during the same setting in 26 patients. The remaining 37 patients had the urethroplasty performed 3-6 months later as a two stage repair. Patient age ranged from 8 months and 2 years (mean 10 months). Follow-up period ranged from 18 months to 8 years (mean 43 months). Satisfactory results were obtained in 54 patients (85%). Two children developed diverticula, two patients developed glans dehiscence, one child developed fistula, and one child had complete wound dehiscence, and urethroplasty was successfully reconstructed 6 months later. Three patients developed scar contraction 6-12 months after surgery. This was corrected by excision of the scarred intermediate layer. The BILAB technique is a reliable technique for patients with perineal hypospadias. It produces slit like meatus at the tip of the glans. The surgeon may decide intra-operatively whether to complete the urethroplasty in one or two stages. Long term follow up until puberty is being carried out. Copyright © 2014 Elsevier Inc. All rights reserved.

Urethral Lengthening in metoidioplasty (female-to-male sex reassignment surgery) by combined buccal mucosa graft and labia minora flap.

PubMed

Djordjevic, M L; Bizic, M; Stanojevic, D; Bumbasirevic, M; Kojovic, V; Majstorovic, M; Acimovic, M; Pandey, S; Perovic, S V

2009-08-01

To develop a technique for urethral reconstruction using a combined labia minora flap and buccal mucosa graft. Urethral lengthening is the most difficult part in female transsexuals and poses many challenges. From April 2005 to February 2008, 38 patients (aged 19-53 years) underwent single-stage metoidioplasty. The technique starts with clitoral lengthening and straightening by division of both clitoral ligaments dorsally and the short urethral plate ventrally. The buccal mucosa graft is quilted to the ventral side of the corpora cavernosa between the native orifice and the tip of the glans. The labia minora flap is dissected from its inner surface to form the ventral aspect of the neourethra. All suture lines are covered by the well-vascularized subcutaneous tissue originating from the labia minora. The labia majora are joined in the midline and 2 silicone testicular implants are inserted to create the scrotum. The neophallus is covered with the remaining clitoral and labial skin. The median follow-up was 22 months (range 11-42). The median neophallic length was 5.6 cm (range 4-9.2). The total length of the neourethra was 9.4-14.2 cm (median 10.8). Voiding while standing was reported by all 38 patients, and temporary dribbling and spraying were noted by 12. Two fistulas and one urethral erosion resulted from the testicular implant and required secondary revision. A combined buccal mucosa graft and labia minora flap present a good choice for urethral reconstruction in female-to-male transsexuals, with minimal postoperative complications.

Double inlay plus ventral onlay buccal mucosa graft for simultaneous penile and bulbar urethral stricture.

PubMed

Favorito, Luciano A; Conte, Paulo P; Sobrinho, Ulisses G; Martins, Rodrigo G; Accioly, Tomas

2017-11-17

Buccal mucosa grafts and fascio-cutaneous flaps are frequently used in long anterior urethral strictures (1). The inlay and onlay buccal mucosa grafts are easier to perform, do not need urethral mobilization and generally have good long-term results (2-4). In the present video, we present a case where we used a double buccal mucosa graft technique in a simultaneous penile and bulbar urethral stricture. A 54 year-old male patient was submitted to appendectomy where a urethral catheter was used for two days in May 2015. Three months after surgery, the patient complained of acute urinary retention and a supra-pubic tube was indicated. Urethrocystography was performed two weeks later and showed strictures in penile and bulbar urethra with 3.5 cm and 3 cm in length respectively. Urethroplasty was proposed for the surgical treatment in this case. We used a perineal approach with a ventral sagittal urethrotomy in both strictures. Penile urethra stricture measuring 3.5 cm in length was observed and a free graft from the buccal mucosa was harvested and placed into the longitudinal incision in the dorsal urethra and fixed with interrupted suture as dorsal inlay. Bulbar urethra stricture measuring 3 cm was observed and a free graft from the buccal mucosa was harvested and placed into the longitudinal incision in the ventral urethra and fixed with interrupted suture as ventral onlay. The ventral urethrotomy was closed over a 16Fr Foley catheter and the skin incision was then closed in layers. No intraoperative or postoperative complications occurred. The patient could achieve satisfactory voiding and no complication was seen during the six-month follow-up. Postoperative imaging demonstrated a widely patent urethra, and the mean peak flow was 12 mL/s. The BMG placement can be ventral, dorsal, lateral or combined dorsal and ventral BMG in the meeting of stricture but the first two are most common (5, 6). Ventral location provides the advantages of ease of exposure and good vascular supply by avoiding circumferential rotation of the urethra (7). Early success rates of dorsal and ventral onlay with BMG were 96 and 85%, respectively. However, long-term follow-up revealed essentially no difference in success rates (8-11). Anterior urethral stricture treatments are various, and comprehensive consideration should be given in selecting individualized treatment programs, which must be combined with the patient's stricture, length, complexity, and other factors. Traditionally, anastomotic procedures with transection and urethral excision are suggested for short bulbar strictures, while longer strictures are treated by patch graft urethroplasty preferably using the buccal mucosa as gold-standard material due to its histological characteristics. The current management for complex urethral strictures commonly uses open reconstruction with buccal mucosa urethroplasty. However, there are multiple situations whereby buccal mucosa is inadequate (pan-urethral stricture or prior buccal harvest) or inappropriate for utilization (heavy tobacco use or oral radiation). Multiple options exist for use as alternatives or adjuncts to buccal mucosa in complex urethral strictures (injectable antifibrotic agents, augmentation urethroplasty with skin flaps, lingual mucosa, colonic mucosa, and new developments in tissue engineering for urethral graft material). In the present case, our patient had two strictures and we chose to correct the first stricture with a dorsal graft and the bulbar stricture with a ventral graft because of our personal expertise. We can conclude that the double buccal mucosa graft is easier to perform and can be an option to repair multiple urethral strictures. Copyright® by the International Brazilian Journal of Urology.

Constraining the velocity structure of the Juan de Fuca plate from ridge to trench with a 2D tomographic study of wide angle OBS data

NASA Astrophysics Data System (ADS)

Boulahanis, B.; Canales, J. P.; Carbotte, S. M.; Carton, H. D.; Han, S.; Nedimovic, M. R.

2016-12-01

We conduct a two-dimensional travel time tomography study of a cross-plate, 300-km long, ocean bottom seismometer (OBS) transect collected as part of the Ridge to Trench (R2T) program to investigate the structure, evolution and state of hydration of the Juan de Fuca (JdF) plate from the ridge axis to subduction at the Cascadia margin offshore Washington. Our study employs the methodology of Korenaga et al. (2000) to derive a P-wave velocity model using wide-angle data from 15 OBSs spaced on average 15 km apart, spanning from the Endeavour segment of the JdF ridge to the Cascadia accretionary prism. A top down modeling approach is employed, first assessing velocities of the sediment layer, then the crust, and finally the upper mantle; at each stage of the inversion we fix the structure of the overlaying layers. Quality of data fit is evaluated using the root mean square value of the difference between predicted and observed travel times normalized by pick uncertainty. Previous studies provide a well-resolved multi-channel seismic (MCS) reflection image of this transect (Han et al., 2016), affording good constraints of the location of basement and Moho reflectors while allowing for comparison of the relationship between velocities and crustal structure. MCS results along this transect suggest evidence of little bending faulting confined to the sediment and upper-middle crust. An initial velocity model of the sediment layer above igneous crust is constructed utilizing the MCS derived sediment velocities. A one-dimensional velocity starting model of the oceanic crust is generated using the results of Horning et al. (in press) from a quasi-parallel cross-plate transect also acquired as part of the R2T study. Seismic velocities are compared to predicted velocities for crustal and mantle lithologies at temperatures estimated from a plate-cooling model and are used to provide constraints on water contents in these layers.

Algorithm for Optimal Urethral Coverage in Hypospadias and Fistula Repair: A Systematic Review.

PubMed

Fahmy, Omar; Khairul-Asri, Mohd Ghani; Schwentner, Christian; Schubert, Tina; Stenzl, Arnulf; Zahran, Mohamed Hassan; Gakis, Georgios

2016-08-01

Although urethral covering during hypospadias repair minimizes the incidence of fistula, wide variation in results among surgeons has been reported. To investigate what type of flap used during Snodgrass or fistula repair reduces the incidence of fistula occurrence. We systematically reviewed published results for urethral covering during Snodgrass and fistula repair procedures. An initial online search detected 1740 reports. After exclusion of ineligible studies at two stages, we included all patients with clear data on the covering technique used (dartos fascia [DF] vs tunica vaginalis flap [TVF]) and the incidence of postoperative fistula. A total of 51 reports were identified involving 4550 patients, including 33 series on DF use, 11 series on TVF use, and seven retrospective comparative studies. For distal hypospadias, double-layer DF had the lowest rate of fistula incidence when compared to single-layer DF (5/855 [0.6%] vs 156/3077 [5.1%]; p=0.004) and TVF (5/244, 2.0%), while the incidence was highest for single-layer DF among proximal hypospadias cases (9/102, 8.8%). Among repeat cases, fistula incidence was significantly lower for TVF (3/47, 6.4%) than for DF (26/140, 18.6%; p=0.020). Among patients with fistula after primary repair, the incidence of recurrence was 12.2% (11/90) after DF and 5.1% (5/97) after TVF (p=0.39). The absence of a minimum follow-up time and the lack of information regarding skin complications and rates of urethral stricture are limitations of this study. A double DF during tubularized incised plate urethroplasty should be considered for all patients with distal hypospadias. In proximal, repeat, and fistula repair cases, TVF should be the first choice. On the basis of these findings, we propose an evidence-based algorithm for surgeons who are still in their learning phase or want to improve their results. We systematically reviewed the impact of urethral covering in reducing fistula formation after hypospadias repair. We propose an algorithm that might help to maximize success rates for tubularized incised plate urethroplasty. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Comparison of two different methods for urethral lengthening in female to male (metoidioplasty) surgery.

PubMed

Djordjevic, Miroslav L; Bizic, Marta R

2013-05-01

Metoidioplasty presents one of the variants of phalloplasty in female transsexuals. Urethral lengthening is the most difficult part in this surgery and poses many challenges. We evaluated 207 patients who underwent metoidioplasty, aiming to compare two different surgical techniques of urethral lengthening, postoperative results, and complications. The study encompassed a total of 207 patients, aged from 18 to 62 years, who underwent single stage metoidioplasty between September 2002 and July 2011. The procedure included lengthening and straightening of the clitoris, urethral reconstruction, and scrotoplasty with implantation of testicular prostheses. Buccal mucosa graft was used in all cases for dorsal urethral plate formation and joined with one of the two different flaps: I-longitudinal dorsal clitoral skin flap (49 patients) and II-labia minora flap (158 patients). Results were analyzed using Z-test to evaluate the statistical difference between the two approaches. Also, postoperative questionnaire was used, which included questions on functioning and esthetical appearance of participating subjects as well as overall satisfaction. The median follow-up was 39 months (ranged 12-116 months). The total length of reconstructed urethra was measured during surgery in both groups. It ranged from 9.1 to 12.3 cm (median 9.5) in group I and from 9.4 to 14.2 cm (median 10.8) in group II. Voiding while standing was significantly better in group II (93%) than in group I (87.82%) (P < 0.05). Urethral fistula occurred in 16 patients in both groups (7.72%). There was statistically significant difference between the groups, with lower incidence in group II (5.69%) vs. group I (14.30%) (P < 0.05). Overall satisfaction was noted in 193 patients. Comparison of the two methods for urethral lengthening confirmed combined buccal mucosa graft and labia minora flap as a method of choice for urethroplasty in metoidioplasty, minimizing postoperative complications. © 2013 International Society for Sexual Medicine.

Salvaging the dehisced glans penis.

PubMed

White, C M; Hanna, M K

2018-05-30

The glans penis may show a deep groove (surgically favorable), or may appear flat with an absent sulcus (unfavorable). Glans dehiscence following hypospadias repair, especially after multiple surgeries, frequently results in a scarred, obliterated, or absent urethral plate. The glans penis appears to be flat and grooveless. This study reported on the outcome of a two-stage salvage repair for glans dehiscence in 49 consecutive patients. Retrospective chart review was performed for all patients who underwent repair for glans dehiscence following hypospadias repair. Between January 2009 and April 2015, 49 children aged 16 months to 18 years presented with glans dehiscence following hypospadias repair. The prior number of operations ranged from one to six. Eleven children had urethral fistulas, and seven had chordee. In the first stage, the flat glans was incised deeply to visualize, but spare, the corpora. Thereafter, a free graft of oral mucosa harvested either from the lower lip or cheek, or the residual preputial skin, was sutured to the glans cleft. The grafts were fenestrated, quilted in the midline, and a tie-over dressing was applied. Any fistula or chordee was repaired during the first stage. The neo-plate was tubularized 6-12 months later, and urine drainage with a catheter was maintained for 10-14 days. In 11 patients, skin flaps appeared dusky, and nitroglycerine ointment 2% was applied for 24 h to enhance the blood supply of the tissues. Subsequently, six of these children received nine or ten 90-min hyperbaric oxygen therapy sessions. Following the first stage, two patients developed hypertrophy of the mucosal grafts, and one skin graft contracted. These three patients underwent revision using a second buccal mucosal graft harvested from the cheek. One recurrent fistula was closed during the second stage. Following the second stage two patients developed a urethral fistula, and the distal sutures broke down in one patient, resulting in an over-sized meatus. None developed meatal stenosis or glans dehiscence. Graft initial take and subsequent behavior were unpredictable, but the two stage approach optimized the process of take and healing. Glans dehiscence was repaired safely and successfully by developing a deep groove, with creation of a new urethral plate followed by tubularization in two stages. Copyright © 2018. Published by Elsevier Ltd.

West margin of North America - A synthesis of recent seismic transects

USGS Publications Warehouse

Fuis, G.S.

1998-01-01

A comparison of the deep structure along nine recent transects of the west margin of North America shows many important similarities and differences. Common tectonic elements identified in the deep structure along these transects include actively subducting oceanic crust, accreted oceanic/arc (or oceanic-like) lithosphere of Mesozoic through Cenozoic ages. Cenozoic accretionary prisms, Mesozoic accretionary prisms, backstops to the Mesozoic prisms, and undivided lower crust. Not all of these elements are present along all transects. In this study, nine transects, including four crossing subduction zones and five crossing transform faults, are plotted at the same scale and vertical exaggeration (V.E. 1:1), using the above scheme for identifying tectonic elements. The four subduction-zone transects contain actively subducting oceanic crust. Cenozoic accretionary prisms, and bodies of basaltic rocks accreted in the Cenozoic, including remnants of a large, oceanic plateau in the Oregon and Vancouver Island transects. Rocks of age and composition (Eocene basalt) similar to the oceanic plateau are currently subducting in southern Alaska, where they are doubled up on top of Pacific oceanic crust and have apparently created a giant asperity, or impediment to subduction. Most of the subduction-zone transects also contain Mesozoic accretionary prisms, and two of them, Vancouver Island and Alaska, also contain thick, technically underplated bodies of late Mesozoic/early Cenozoic oceanic lithosphere, interpreted as fragments of the extinct Kula plate. In the upper crust, most of the five transform-fault transects (all in California) reflect: (1) tectonic wedging of a Mesozoic accretionary prism into a backstop, which includes Mesozoic/early Cenozoic forearc rocks and Mesozoic ophiolitic/arc basement rocks: and (2) shuffling of the subduction margin of California by strike-slip faulting. In the lower crust, they may reflect migration of the Mendocino triple junction northward (seen in rocks east of the San Andreas fault) and cessation of Farallon-plate subduction (seen in rocks west of the San Andreas fault). In northern California, lower-crustal rocks east of the San Andreas fault have oceanic-crustal velocity and thickness and contain patches of high reflectivity. They may represent basaltic rocks magmatically underplated in the wake of the migration of the Mendocino triple junction, or they may represent stalled, subducted fragments of the Farallon/Gorda plate. The latter alternative does not fit the accepted 'slabless window' model for the migration of the triple junction. This lower-crustal layer and the Moho are offset at the San Andreas and Maacama faults. In central California, a similar lower-crustal layer is observed west of the San Andreas fault. West of the continental slope, it is Pacitic oceanic crust, but beneath the continent it may represent either Pacific oceanic crust, stalled, subducted fragments (microplates) of the Farallon plate, or basaltic rocks magmatically underplated during subduction of the Pacific/Farallon ridge or during breakup of the subducted Farallon plate. The transect in southern California is only partly representative of regional structure, as the structure here is 3-dimensional. In the upper crust, a Mesozoic prism has been thrust beneath crystalline basement rocks of the San Gabriel Mountains and Mojave Desert. In the mid-crust, a bright reflective zone is interpreted as a possible 'master' decollement that can be traced from the fold-and-thrust belt of the Los Angeles basin northward to at least the San Andreas fault. A Moho depression beneath the San Gabriel Mountains is consistent with downwelling of lithospheric mantle beneath the Transverse Ranges that appears to be driving the compression across the Transverse Ranges and Los Angeles basin. ?? 1998 Elsevier Science B.V. All rights reserved.

Biometry of the hypospadic penis after hormone therapy (testosterone and estrogen): A randomized, double-blind controlled trial.

PubMed

Paiva, Kelly Christina de Castro; Bastos, André Netto; Miana, Laura Pimenta; Barros, Eveline de Souza; Ramos, Plínio Santos; Miranda, Lara Meneguelli; Faria, Natália Maia; Avarese de Figueiredo, André; de Bessa, José; Netto, José Murillo B

2016-08-01

The use of preoperative hormonal stimulation before hypospadias surgery aims to increase penile size and achieve better surgical results; however, the rules are not clear in the literature. We evaluated the effects of topical testosterone and estrogen in the hypospadic penis regarding biometric measures, side effects, and serum hormonal levels. To our knowledge, this is the first study using estradiol prior to hypospadias surgery. Sixty-nine children with hypospadias were randomly divided into three study groups: a control group (CG) of 17 children given placebo cream; a testosterone group (TG) of 28 children who used 1% testosterone propionate; and an estradiol group (EG) of 24 children using 0.01% estradiol. All subjects applied the topical ointment on the entire penis, twice daily for 30 days before surgical correction. Biometric evaluation of the penis included penile length and diameter, glans diameter, distance from the urethral meatus to the tip, and the width of the urethral plate. These measurements as well as serum hormone level, and side effects were evaluated prior to hormone use, and 30 and 90 days after. After 30 days an increase in penile diameter and length and diameter of the glans were observed in TG (p < 0.05). The width of the urethral plate and distance from meatus to the tip increased in TG, although not significantly. The most frequent side effects were appearance of pubic hair and darkening of the genital skin, mainly in TG, but these were transient and disappeared after 90 days of treatment. No significant variations were seen in serum hormonal levels (Table). As in previous studies, an increase in penile length and diameter, and glans diameter was observed with the use of testosterone. Proximal urethral plate width and distance from the meatus to the tip of the penis had a tendency to increase also in TG. Estradiol did not change biometric measure of the penis. Few side effects occurred after both hormones, and any that did improved after 90 days follow-up and did not change hormone serum levels. Preoperative use of topical testosterone increases penile size, diameter of the penis and glans. The use of estradiol does not change penile biometry. Side effects occur mainly with the use of testosterone and are transient. No significant and persistent hormonal changes were observed. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Further analysis of the Glans-Urethral Meatus-Shaft (GMS) hypospadias score: correlation with postoperative complications.

PubMed

Arlen, Angela M; Kirsch, Andrew J; Leong, Traci; Broecker, Bruce H; Smith, Edwin A; Elmore, James M

2015-04-01

The Glans-Urethral Meatus-Shaft (GMS) score is a concise and reproducible way to describe hypospadias severity. We classified boys undergoing primary hypospadias repair to determine the correlation between GMS score and postoperative complications. Between February 2011 and August 2013, patients undergoing primary hypospadias repair were prospectively scored using the GMS classification. GMS scoring included a 1-4 scale for each component: G - glans size/urethral plate quality, M - meatal location, and S - degree of shaft curvature, with more unfavorable characteristics assigned higher scores [Figure]. Demographics, repair type, and complications (urethrocutaneous fistula, meatal stenosis, glans dehiscence, phimosis, recurrent chordee and stricture) were assessed. Total and individual component scores were tested in uni- and multivariate analysis. Two-hundred and sixty-two boys (mean age 12.3 ± 13.7 months) undergoing primary hypospadias repair had a GMS score assigned. Mean GMS score was 7 ± 2.5 (G 2.1 ± 0.9, M 2.4 ± 1, S 2.4 ± 1). Mean clinical follow-up was 17.7 ± 9.3 months. Thirty-seven children (14.1%) had 45 complications. A significant relationship between the total GMS score and presence of any complication (p < 0.001) was observed; for every unit increase in GMS score the odds of any postoperative complication increased 1.44 times (95% CI, 1.24-1.68). Urethrocutaneuous fistula was the most common complication, occurring in 21 of 239 (8.8%) of single-stage repairs. Patients with mild hypospadias (GMS 3-6) had a 2.4% fistula rate vs. 11.1% for moderate (GMS 7-9) and 22.6% for severe (GMS 10-12) hypospadias (p < 0.001). Degree of chordee was an independent predictor of fistula on multivariate analysis; S4 (>60° ventral curvature) patients were 27 times more likely to develop a fistula than S1 (no curvature) boys (95% CI, 3.2-229). The GMS score is based on anatomic features (i.e. glans size/urethral plate quality, location of meatus, and degree of chordee) felt to most likely impact functional and cosmetic outcomes following hypospadias repair. We demonstrated a statistically significant increase in the likelihood of any postoperative complication with every unit increase in total GMS score. The concept that factors aside from meatal location affect hypospadias repair and outcomes is not novel, and degree of ventral curvature and urethral plate quality are often cited as important factors. In our series, boys with greater than 60° of ventral curvature undergoing a single-stage repair were 27 times more likely to develop a fistula than those without chordee on multivariate analysis, making severe curvature an independent predictor of urethrocutaneous fistula formation. That meatal location did not retain significance on multivariate analysis highlights the importance of considering the entire hypospadias complex when determining severity, rather than just evaluating the position of the meatus. Our study has several limitations that warrant consideration. While GMS scores were assigned prospectively, the data was collected retrospectively, subjecting it to flaws inherent with such study design. Furthermore, type of repair is influenced by surgeon preference and subjective assessment of hypospadias characteristics not incorporated in our scoring system (i.e. tissue quality, urethral hypoplasia, penoscrotal transposition). Despite these limitations, our study demonstrates a strong correlation between the GMS classification and surgical complications, furthering supporting its potential as a tool to standardize hypospadias severity and gauge postoperative complications. The Glans-Urethral Meatus-Shaft (GMS) classification provides a means by which hypospadias severity and reporting can be standardized, which may improve inter-study comparison of reconstructive outcomes. There is a strong correlation between complication risk and total GMS score. Degree of chordee (S score) is independently predictive of fistula rate. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

The 2009-11 SAHKE Experiment: Preliminary 3D Vp imaging across the interseismically locked southern Hikurangi margin, Wellington, New Zealand

NASA Astrophysics Data System (ADS)

Henrys, S. A.; Wech, A.; Sato, H.; Stern, T. A.; Okaya, D. A.; Iwasaki, T.; Savage, M. K.; Mochizuki, K.; Kurashimo, E.; Sutherland, R.

2013-12-01

We present a preliminary 3D Vp model from the Seismic Array HiKurangi Experiment (SAHKE). This joint project involving New Zealand, Japan, and US institutions aims to investigate the subduction zone fault characteristics beneath Wellington. Situated above where the Pacific Plate is subducting beneath the Australian plate at a rate of c. 42 mm/yr, the Wellington region provides a unique opportunity to investigate the frictional properties, geometry, and seismic potential of a shallow, locked megathrust fault. Here the coupled plate interface is 20-30 km deep beneath land and can be sampled with onshore/offshore data from 3 sides. We have published a 2D Vp model [Henrys et al., 2013] incorporating coast-to-coast onshore-offshore transect of 50 stations and utilising first arrivals from 2000 offshore MCS shots on either side. The transect velocity model also combined first arrivals from 800 stations with 100 m spacing recorded from 12 in-line, 500 kg onshore dynamite explosions. We have expanded the transect data to now include (i) first arrivals from the dense temporary array of 50 seismometers with c. 7 km spacing augmented with 25 regional network instruments to record 49 local and 45 teleseismic earthquakes over a four month period and (ii), 69,000 offshore airgun shots from 17 MCS lines crisscrossing two sides of the array. We combine all shot and earthquake recordings to simultaneously invert c. 750,000 first arrivals for velocity structure and hypocenters in the densely sampled volume. First results from 3D, Vp tomography and relocated hypocenters provide improved resolution over previous studies. Our improved velocity model provides a high-resolution geometry of the subducting plate to support interpretation of other phases identified in SAHKE shot gathers and local earthquakes. Henrys, S., A. Wech, R. Sutherland, T. Stern, M. Savage, H. Sato, K. Mochizuki, T. Iwasaki, D. Okaya, A. Seward, B. Tozer, J. Townend, E. Kurashimo, T. Iidaka, and T. Ishiyama (2013), SAHKE geophysical transect reveals crustal and subduction zone structure at the southern Hikurangi margin, New Zealand, Geochemistry, Geophysics, Geosystems.

A novel technique for repair of mid-penile hypospadias using a preputial skin flap: results of 110 patients.

PubMed

Elmoghazy, Hazem; Hussein, Mohamed M; Mohamed, Elnisr; Badawy, Abdelbasset; Alsagheer, Gamal; Abd Elhamed, Ahmed Mamdouh

2016-12-01

Several techniques have been used to repair mid-penile hypospadias; however, high failure rates and major complications have been reported. In this study, we describe a novel technique using a well-vascularized flap of the inner and outer preputial skin. A total of 110 male children with hypospadias underwent repair by our technique between 2008 and 2015. The inclusion criteria were children with mid-penile or slightly more proximal hypospadias, with or without ventral chordae, and an intact prepuce of the cobra eyes variety. Recurrent cases, patients with other preputial types, and circumcised children were excluded from this study. The prepared flap was sutured in its natural longitudinal orientation to the created urethral plate strip to form a neo-urethra over a urethral catheter. Outcome measures included surgical success without the formation of a urethra-cutaneous fistula, no ischaemia of the flaps, glans dehiscence or infection and functional outcome and cosmetic appearance. The median follow-up duration was 3.3 years. There were 63 cases of mid-penile hypospadias (57.3 %), and in 47 cases (42.7 %), the meatus was slightly more proximal. The age of the patients ranged from 1.1 to 8.0 years, with a mean age of 4.6 ± 1.2 years. Surgery was successful in 106 (96.4 %) cases. Minor complications occurred in 11 patients (10 %) and included oedema of glans in ten patients and bluish discoloration on the ventral aspect of the glans close to the suture line in three patients. All patients improved within 2 weeks after surgery. Long-term follow-up revealed a properly functioning urethra with a forward, projectile, single, compact, and rifled urinary stream of adequate calibre and cosmetically acceptable repair. No cases of meatal retraction, meatal stenosis, urethral stricture, or acquired urethral diverticulum occurred. Our technique is different from the split prepuce in situ technique. We create a narrow strip of the urethral plate that facilitates glanular closure, and we use the inner and adjacent outer skin in a vertical manner to preserve excess skin for penile coverage. Prepuce is split at midline to preserve more preputial skin with favourable dartos tissue for penile skin coverage. The glans is closed using a stitch-by-stitch method that has not been described previously. This study presents a novel technique for mid-penile hypospadias repair using a preputial skin flap with excellent results in terms of short- and long-term outcomes.

Delayed surgical repair of posttraumatic posterior urethral distraction defects in children and adolescents: long-term results.

PubMed

Podesta, Miguel; Podesta, Miguel

2015-04-01

Various surgical techniques have been proposed to treat pelvic fracture urethral distraction defects (PFUDDs) in children (Figure): primary alignment of the acute transected urethra, substitution procedures and delayed anastomosis urethroplasties (DAU) by perineal, elaborated perineal, transpubic or perineo-abdominal/partial transpubic access. However, long-term follow-up of surgical correction for PFUDDS with DAU is infrequently reported in the literature. Long-term efficacy of DAU in children and adolescents with PFUDDs was evaluated. Other surgical methods used to accomplish tension-free DAU were also described. We reviewed records of 49 male children aged 3.5-17.5 years (median 9.6) with PFUDDS who underwent DAU from 1980 to 2006. Median PFUDDs length was 3 cm (range 2-6). Six patients had prior failed treatments: anastomotic urethroplasties (5) and internal urethrotomy (1). Surgical access was transperineal in 28 cases and perineal/partial pubectomy in 21. Urethral rerouting was performed in 8 cases. Median follow-up was 6.5 years (range 5-22). On review median PFUDDS length in patients treated with primary cystostomy was 3 cm compared to those initially managed with urethral alignment (4 cm). Five patients treated with perineal DAU developed recurrent strictures at the anastomosis site, successfully managed with additional perineal/partial pubectomy anastomosis (4 cases) and internal urethrotomy (1). Primary and overall success rate was 89, 7% and 100%, respectively. Urinary incontinence occurred in 9 cases. Two had overflow incontinence and performed self-catheterization; 1 developed sphincter incontinence and required AUS placement, while 4 of 6 cases with mild stress incontinence achieved dryness at pubertal age. Retrospectively, associated bladder neck lesions at trauma time were noted in 5 patients. Three patients with erectile dysfunction before DAU remained impotent. In children, several factors make management of PFUDDs more difficult than in adults: 1) restricted surgical access to reach a high lying proximal urethral end, 2) long distraction defects, 3) simultaneous bladder neck and membranous urethral lesions and 4) small urethral caliber. In our experience and that of others (Turner Warwick, 1989 and Ranjan, 2012), radiographic and endoscopic findings provide information on stricture features; however, the final choice of surgical exposure to restore urethral continuity is made at operative time based on PFUDD complexity. Perineal exposure usually allows performing DAU in 2 cm long PFUDDs. Ten percent of our patients treated with perineal DAU developed recurrent strictures attributed to inappropriate access selection or unrecognized PFUDD complexity. Failures were treated endoscopically (1) and by perineal/partial pubectomy anastomotic urethroplasty (4) with 100% final success. We used perineal/partial pubectomy DAU in 43% of the cases to excise pelvic scarring and bridge long urethral gaps, with urethral rerouting in 8 cases. Success rate of initial perineal and perineal/partial pubectomy anastomotic procedures was 82% and 100%, respectively. Koraitim (1997), Orabi (2008) and Ranjan (2012) reported excellent outcomes in children with either transperineal or transpubic anastomotic repair, as opposed to poor results in those undergoing substitution urethroplaties. Most reports rarely evaluate urinary incontinence after successful DAU. At the end of follow-up only 2 of our 9 initial incontinent cases remain with acceptable stress incontinence. Retrospectively, in 5 cases the original trauma comprised the bladder neck and the membranous sphincter mechanism. In our series erectile dysfunction after trauma did not change after DAU except in 1 patient who regained potency 1 year after repair. All patients were referred after initial treatment was done elsewhere, thus they may represent the most severe PFUDDs cases. Additionally, erection dysfunction was not investigated in the kind of detail required due to patients' age. DAU has durable success rate for PFUDDs treatment in children with a healthy bulbar urethra. In childhood, additional surgical steps are frequently needed to achieve direct anastomotic repair. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Comparison of variables affecting the surgical outcomes of tubularized incised plate urethroplasty in adult and pediatric hypospadias.

PubMed

Bhat, A; Bhat, M; Kumar, V; Kumar, R; Mittal, R; Saksena, G

2016-04-01

The American Academy of Pediatrics recommends operating on hypospadias between the ages of 6-12 months. Since most births in developed countries are conducted in a hospital, parents are likely to be well informed and counseled about the hypospadias. However, significant numbers of births in developing countries are still conducted at home, with illiteracy, poverty and ignorance often leading to late presentation at the hospital. Reported hypospadias-repair complication rates are higher in adults compared with those having surgery in childhood. The present study's objective was to evaluate the factors affecting surgical outcome in hypospadias patients undergoing tubularized and tubularized incised plate urethroplasty (TIPU) in adulthood compared with childhood. A prospective study of 60 adult patients >16 years, and 60 pediatric patients <5 years who underwent TIPU for primary hypospadias between May 2008 and May 2012. Patients were operated on by a single surgeon, under similar circumstances, and were pre-operatively examined to assess meatal location, chordee, and torsion; they were also examined intra-operatively for quality of spongiosum and urethral plate width. The outcomes were assessed by patient/parents for satisfaction regarding cosmesis, urinary stream and complications. The age of the patients varied from 16 to 27 years, with a mean of 20.8 years in adults, and 6 months to 5 years, with a mean of 2.1 years, in children. The type of hypospadias, degree of curvature, quality of spongiosum and urethral plate width were comparable in both groups, but complication rates were higher in adults (16.7%) than in the pediatric (6.7%) group (Figure 1A-D). Meatal stenosis responded well to dilatation, but fistulae required revision surgery and had a cure rate of 100%. The median follow-up was 37 months in adults, and 39 months in children. The higher complication rates in adults may be due to more frequent erections; increased susceptibility to infection along with relatively reduced vascularity lead to poor wound healing and increased complication rates. The limitation of the study was the small number of patients with mid and proximal hypospadias having lesser incidences in comparison with distal hypospadias. Adequate number of patients in these subgroups could have further strengthened the statistical correlation. Secondly, there was no objective criterion like uroflowmetry to assess urinary stream. Complication rates were higher in adults undergoing TIPU compared with pediatric patients, which was also statistically significant in distal hypospadias. The important factors in surgical outcome were: severity of hypospadias, degree of curvature, quality of spongiosum, and urethral plate width. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

A novel method for determining sex in late term gestational mice based on the external genitalia

PubMed Central

Murdaugh, Laura B.; Mendoza-Romero, Haley N.; Fish, Eric W.

2018-01-01

In many experiments using fetal mice, it is necessary to determine the sex of the individual fetus. However, other than genotyping for sex-specific genes, there is no convenient, reliable method of sexing mice between gestational day (GD) 16.5 and GD 18.0. We designed a rapid, relatively simple visual method to determine the sex of mouse fetuses in the GD 16.5—GD 18.0 range that can be performed as part of a routine morphological assessment. By examining the genitalia for the presence or absence of key features, raters with minimal experience with the method were able to correctly identify the sex of embryos with 99% accuracy, while raters with no experience were 95% accurate. The critical genital features include: the presence or absence of urethral seam or proximal urethral meatus; the shape of the genitalia, and the presence or absence of an area related to the urethral plate. By comparing these morphological features of the external genitalia, we show a simple, accurate, and fast way to determine the sex of late stage mouse fetuses. Integrating this method into regular morphological assessments will facilitate the determination of sex differences in fetuses between GD 16.5 and GD 18.0. PMID:29617407

A new database on subduction seismicity at the global scale

NASA Astrophysics Data System (ADS)

Presti, D.; Heuret, A.; Funiciello, F.; Piromallo, C.

2012-04-01

In the framework of the EURYI Project 'Convergent margins and seismogenesis: defining the risk of great earthquakes by using statistical data and modelling', a global collection of recent intraslab seismicity has been performed. Based on EHB hypocenter and CMT Harvard catalogues, the hypocenters, nodal planes and seismic moments of worldwide subduction-related earthquakes were extracted for the period 1976 - 2007. Data were collected for centroid depths between sea level and 700 km and for magnitude Mw ≥ 5.5. For each subduction zone, a set of trench-normal transects were constructed choosing a 120km width of the cross-section on each side of a vertical plane and a spacing of 1 degree along the trench. For each of the 505 resulting transects, the whole subduction seismogenic zone was mapped as focal mechanisms projected on to a vertical plane after their faulting type classification according to the Aki-Richards convention. Transect by transect, fist the seismicity that can be considered not related to the subduction process under investigation was removed, then was selected the upper plate seismicity (i.e. earthquakes generated within the upper plate as a result of the subduction process). After deletion from the so obtained event subset of the interplate seismicity as identified in the framework of this project by Heuret et al. (2011), we can be reasonably confident that the remaining seismicity can be related to the subducting plate. Among these earthquakes we then selected the intermediate and deep depth seismicity. The upper limit of the intermediate depth seismicity is generally fixed at 70 km depth in order to avoid possible mixing with interplate seismicity. The ranking of intermediate depth and deep seismicity was in most of cases referred to earthquakes with focal depth between 70-300 km and with depth exceeding 300 km, respectively. Outer-rise seismicity was also selected. Following Heuret et al. (2011), the 505 transects were merged into 62 larger segments that were ideally homogeneous in terms of their seismogenic zone characteristics. Comparisons between main seismic parameters (e.g. cumulated seismic moment, P- and T-axes distributions, spatial and temporal distribution of largest magnitudes) with relation to both the different categories selected and the different segments have been performed in order to obtain a snapshot on the general behaviour of global subduction-related seismicity.

P-wave Velocity Structure Across the Mariana Trench and Implications for Hydration

NASA Astrophysics Data System (ADS)

Eimer, M. O.; Wiens, D.; Lizarralde, D.; Cai, C.

2017-12-01

Estimates of the water flux at subduction zones remain uncertain, particularly the amount of water brought into the trench by the subducting plate. Normal faulting related to the bending of the incoming plate has been proposed to provide pathways for water to hydrate the crust and upper mantle. A passive and active source seismic experiment spanning both the incoming plate and forearc was conducted in 2012 in central Mariana to examine the role of hydration at subduction zones. The active-source component of the survey used the R/V M.G. Langsethairgun array and 68 short period sensors, including suspended hydrophones, deployed on 4 transects. This study at the Mariana trench offers a comparison to related studies of incoming plate hydration in Middle America, where differing thermal structures related to plate age predict different stability fields for hydrous minerals. The forearc structure is also of interest, since Mariana is characterized by large serpentine seamounts and may have a serpentinized mantle wedge. The velocity structure will also be important for the relocation of earthquakes in the incoming plate, since the seismicity can offer a constraint for the depth extent of these bending faults. We examine the P-wave velocity structure along a 400-km long wide-angle refraction transect perpendicular to the trench and spanning both the forearc and incoming plate. Preliminary results indicate a velocity reduction in the crust and uppermost mantle at the bending region of the incoming plate, relative to the plate's structure away from the trench. This reduction suggests that outer-rise faults extend into the upper mantle and may have promoted serpentinization of that material. Mantle Pn refraction phases are not observed in the forearc, consistent with the ambient noise tomography results that show upper-mantle velocities similar to that of the lower crust. The lack of contrast between the upper mantle and crustal velocities from the ambient noise has been interpreted to indicate extensive serpentinization of the shallow mantle wedge.

The IODP NanTroSEIZE Transect: Accomplishments and Future Plans

NASA Astrophysics Data System (ADS)

Tobin, H. J.; Kinoshita, M.; Araki, E.; Byrne, T. B.; Kimura, G.; McNeill, L. C.; Moore, G. F.; Saffer, D. M.; Underwood, M.; Saito, S.

2009-12-01

The Nankai Trough Seismogenic Zone Experiment (NanTroSEIZE) is a decade-long project to investigate the processes and properties that determine the nature of frictional locking, creep and other fault behavior governing seismogenic rupture and tsunamigenesis on a major plate boundary where great subduction earthquakes occur. The main goal of the science plan is to sample and instrument the key faults in several locations across the transition from those dominated by frictionally stable, aseismic processes vs. those hypothesized to be frictionally locked (seismogenic) faults of the megathrust system. The transect includes primary drill sites from the incoming plate, across the outer accretionary complex of the lower slope, to the Kumano forearc basin and underlying up-dip end of the likely locked plate interface. The scale of this project required a division into multiple stages of operations, spanning a number of years and IODP expeditions. From September 2007 through October 2009, the NanTroSEIZE science team has achieved many of its primary goals during 5 expeditions. Completed drill sites to date include penetrations ranging from ~200 m to ~1600 m below the sea floor that have documented the faults and wall rocks of both the frontal thrust and out-of-sequence splay faults in the accretionary system, the sedimentary section of the subducting plate, and the thick forearc basin sedimentary record and underlying older subduction complex in the hanging wall of the main plate interface. Major results include characterization of: the fault zone geology, strain localization, and physical properties shallower than ~ 1 km, the distribution of ambient (and paleo-) stress orientations across the transect, the absence of evidence for focused fluid channeling along the principal shallow fault systems, and the tectonic history of the subduction system. Extensive downhole measurements and a 2-ship VSP have further documented stress, pressure, rock strength, and elastic properties around the boreholes. The first temporary long-term monitoring instruments are now in place in one sealed borehole, recording pore pressure and temperature. The most ambitious aspect of the NanTroSEIZE project remains for the now-scheduled next stage: drilling to ~ 7000 m below the sea bed across the faults of the main plate boundary, then placing long-term monitoring instruments into both deep and shallow sealed borehole observatories - all to test hypotheses of locking, strain accumulation, and interseismic fault processes.

Remarkably Consistent Thermal State of the south Central Chile Subduction Zone from 36°S to 45°S

NASA Astrophysics Data System (ADS)

Rotman, H.; Spinelli, G. A.

2013-12-01

Delineating the rupture areas of large subduction zone earthquakes is necessary for understanding the controls on seismic and aseismic slip on faults. For the largest recorded earthquake, an event in south central Chile in 1960 with moment magnitude 9.5, the rupture area is only loosely defined due to limitations in the global seismic network at the time. The rupture extends ~900 km along strike on the margin. Coastal deformation is consistent with either a constant rupture width of ~200 km along the entire length, or a much narrower width (~115 km) for the southern half of the rupture. A southward narrowing of the seismogenic zone has been hypothesized to result from warming of the subduction zone to the south, where the subducting plate is younger. Here, we present results of thermal models at 36°S, 38°S, 43°S, and 45°S to examine potential along-strike changes the thermal state of the margin. We find that temperatures in the subduction zone are strongly affected by both fluid circulation in the high permeability upper oceanic crust and frictional heating on the plate boundary fault. Hydrothermal circulation preferentially cools transects with young subducting lithosphere; frictional heating preferentially warms transects with older subducting lithosphere. The combined effects of frictional heating and hydrothermal circulation increase decollement temperatures in the 36°S and 38°S transects by up to ~155°C, and decrease temperatures in the 45°S transect by up to ~150°C. In our preferred models, decollement temperatures 200 km landward of the trench in all four transects are ~350-400°C. This is consistent with a constant ~200 km wide seismogenic zone for the 1960 Mw 9.5 rupture, with decreasing slip magnitude in the southern half of the rupture.

Evaluation of changes in vertical ground reaction forces as indicators of meniscal damage after transection of the cranial cruciate ligament in dogs.

PubMed

Trumble, Troy N; Billinghurst, R Clark; Bendele, Alison M; McIlwraith, C Wayne

2005-01-01

To determine whether decreases in peak vertical force of the hind limb after transection of the cranial cruciate ligament (CrCL) would be indicative of medial meniscal damage in dogs. 39 purpose-bred adult male Walker Hounds. The right CrCL was transected arthroscopically. Force plate measurements of the right hind limb were made prior to and 2, 4, 10, and 18 weeks after transection of the CrCL. Only dogs with > or =10% decreases in peak vertical force after week 2 were considered to have potential meniscal damage. Dogs that did not have > or =10% decreases in peak vertical force at any time point after week 2 were assigned to group 1. Group 2 dogs had > or =10% decreases in peak vertical force from weeks 2 to 4 only. Group 3 and 4 dogs had > or =10% decreases in peak vertical force from weeks 4 to 10 only or from weeks 10 to 18 only, respectively. Damage to menisci and articular cartilage was graded at week 18, and grades for groups 2 to 4 were compared with those of group 1. The percentage change in peak vertical force and impulse area was significantly different in groups 2 (n = 4), 3 (4), and 4 (4) at the end of each measurement period (weeks 4, 10, and 18, respectively) than in group 1 (27). The meniscal grade for groups 2 to 4 was significantly higher than for group 1. A > or =10% decrease in peak vertical force had sensitivity of 52% and accuracy of 72% for identifying dogs with moderate to severe medial meniscal damage. In dogs with transected or ruptured CrCLs, force plate analysis can detect acute exacerbation of lameness, which may be the result of secondary meniscal damage, and provide an objective noninvasive technique that delineates the temporal pattern of medial meniscal injury.

Multi-Channel Seismic Images of the Mariana Forearc: EW0202 Initial Results

NASA Astrophysics Data System (ADS)

Oakley, A. J.; Goodliffe, A. M.; Taylor, B.; Moore, G. F.; Fryer, P.

2002-12-01

During the Spring of 2002, the Mariana Subduction Factory was surveyed using multi-channel seismics (MCS) as the first major phase of a US-Japanese collaborative NSF-MARGINS funded project. The resulting geophysical transects extend from the Pacific Plate to the West Mariana remnant arc. For details of this survey, including the results from the back-arc, refer to Taylor et al. (this session). The incoming Pacific Plate and its accompanying seamounts are deformed by plate flexure, resulting in extension of the upper crust as it enters the subduction zone. The resultant trench parallel faults dominate the bathymetry and MCS data. Beneath the forearc, in the southern transects near Saipan, the subducting slab is imaged to a distance of 50-60 km arcward. In addition to ubiquitous trench parallel normal faulting, a N-S transect of the forearc clearly shows normal faults perpendicular to the trench resulting from N-S extension. On the east side of the Mariana Ridge, thick sediment packages extend into the forearc. Directly east of Saipan and Tinian, a large, deeply scouring slide mass is imaged. Several serpentine mud volcanoes (Big Blue, Turquoise and Celestial) were imaged on the Mariana Forearc. Deep horizontal reflectors (likely original forearc crust) are imaged under the flanks of some of these seamounts. A possible "throat" reflector is resolved on multiple profiles at the summit of Big Blue, the northern-most seamount in the study area. The flanks of Turquoise seamount terminate in toe thrusts that represent uplift and rotation of surrounding sediments as the volcano grows outward. These thrusts form a basal ridge around the seamount similar to that previously noted encircling Conical Seamount. Furthermore, MCS data has revealed that some forearc highs previously thought to be fault blocks are in actuality mud volcanoes.

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

Preservation of lower urinary tract function in posterior urethral stenosis: selection of appropriate patients for urethral stents.

PubMed

Eisenberg, Michael L; Elliott, Sean P; McAninch, Jack W

2007-12-01

We describe our experience with urethral stents to manage iatrogenic posterior urethral stenosis. We surveyed our retrospective database for patients in whom we placed a urethral stent for posterior urethral stricture disease. We reviewed patient age, comorbidities, indications for stent placement, stricture length, postoperative complications and the repeat stenosis rate. Overall we placed urethral stents in 13 patients, of whom 12 presented with posterior urethral stenosis and 1 presented with anterior and posterior stricture. The etiology of urethral stricture was prostate cancer therapy in 11 of 13 cases and simple prostatectomy in 2. Urethral stenting was chosen instead of urethral reconstruction largely due to prior radiation for prostate cancer and avoidance of the morbidity of surgery. Overall 6 of 13 patients required additional procedures for stricture recurrence, including 5 in previously irradiated patients. Two patients had stents removed due to migration or pain. Genitourinary infections developed in 5 of 13 patients. Eight of 13 patients with a posterior urethral stricture were incontinent, as expected after stent placement. Incontinence was managed by an artificial urinary sphincter in willing patients with 9 of 13 continent. Urethral stents provide reasonable treatment for patients with posterior urethral stenosis when attempting to preserve lower urinary tract function caused by stricture disease after prostate cancer therapy. Prior radiation seems to increase the failure rate. Continence can be maintained after posterior urethral stenting in select patients.

Afatinib in Advanced Refractory Urothelial Cancer

ClinicalTrials.gov

2017-09-28

Distal Urethral Cancer; Proximal Urethral Cancer; Recurrent Bladder Cancer; Recurrent Urethral Cancer; Stage III Bladder Cancer; Stage III Urethral Cancer; Stage IV Bladder Cancer; Stage IV Urethral Cancer; Ureter Cancer

Urethral calculi with a urethral fistula: a case report and review of the literature.

PubMed

Zeng, Mingqiang; Zeng, Fanchang; Wang, Zhao; Xue, Ruizhi; Huang, Liang; Xiang, Xuyu; Chen, Zhi; Tang, Zhengyan

2017-09-06

To explore and summarize the reasons why urethral calculi cause a urethral fistula. We retrospectively studied 1 patient in Xiangya hospital and all relevant literature published in English between 1989 and 2015. The patients (including those reported in the literature) were characterized by age, origin, location of calculus, size of calculus, fistulous track, and etiological factors. Most of urethral calculi associated with a urethral fistula were native generated. Urethral calculi can be formed in various locations of the urethra, and the size of the calculus ranged from small (multiple) calculi to giant stones. The fistula external orifice located at the root of the penis was relatively common, and there were various etiological factors, such as urethral strictures, urethral trauma induced by long-term catheterization, lumbar fractures, and congenital anomaly factors. They were managed by the excision of the fistulous tract, retrieval of the urethral stones, and/or debridement and pus drainage operations. Some elements, such as trauma, recurrent urinary tract infections, abscess formation induced by long-term catheterization, and urethral calculus, may be the risk factors for a urethral fistula.

Passive immunization of fetal rats with antiserum to luteinizing hormone-releasing hormone (LHRH) or transection of the central roots of the nervus terminalis does not affect rat pups' preference for home nest.

PubMed

Schwanzel-Fukuda, M; Pfaff, D W

1987-01-01

Luteinizing hormone-releasing hormone (LHRH) is found immunocytochemically in cell bodies and fibers of the nervus terminalis, a cranial nerve which courses from the nasal septum through the cribriform plate of the ethmoid bone (medial to the olfactory and vomeronasal nerves) and enters the forebrain, caudal to the olfactory bulbs. Immunoreactive LHRH is first detected in the nervus terminalis of the fetal rat at 15 days of gestation, preceding its detection by immunocytochemistry in any other area of the brain, including the median eminence, and preceding detection of immunoreactive luteinizing hormone (LH) in the anterior pituitary. During development of the rat fetus, the nervus terminalis is the principal source of LHRH in the nervous system from days 15 through 19 of a 21 day gestation period. We tested the notion that the LHRH system of the nervus terminalis is important for olfactory performance by examining the effects of administration of antisera to LHRH during fetal development (versus saline controls), or medial olfactory peduncle transections, in the neonatal rat, which would sever the central projections of the nervus terminalis (versus lateral peduncle transection, complete transection of the olfactory peduncles and the central nervus terminalis or controls) on preferences of rat pups for home nest. The hypothesis that LHRH is important for this chemosensory response was not confirmed. Neither antisera to LHRH nor medical olfactory peduncle transection disrupted preference for home shavings. Only complete olfactory peduncle transection had a significant effect compared to unoperated and sham-operated controls.

Is approximated de-epithelized glanuloplasty beneficial for hypospadiologist?

PubMed

ZakiEldahshoury, M; Gamal, W; Salem, E; Rashed, E; Mamdouh, A

2016-05-01

Further evaluation of the cosmetic and functional results of approximated de-epithelized glanuloplasty in different degree of hypospadias. This study included 96 male patients (DPH=68 & MPH=28). Patients selected for repair with glans approximation should have wide urethral plate & grooved glans. All cases were repaired with the classic TIP and glans approximation technique. Follow up was for one year by clinical examination of the meatal shape, size & site, glans shape, skin covering, suture line, urethral catheter, edema & fistula in addition to parent satisfaction. Mean operative time was 49±9minutes. As regards the functional and cosmetic outcomes, success was reported in 95.8%, while failure was in 4.16% in the form of glanular disruption in two patients and subcoronal urethrocutaneous fistula in another two patients. Glans approximation has many advantages, good cosmetic and functional results, short operative time, less blood loss, no need for tourniquet. Study of a large number of cases and comparing glans approximation with the classic TIP technique. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

National Patterns of Urethral Evaluation and Risk Factors for Urethral Injury in Patients With Penile Fracture.

PubMed

Pariser, Joseph J; Pearce, Shane M; Patel, Sanjay G; Bales, Gregory T

2015-07-01

To examine the epidemiology and timing of penile fracture, patterns of urethral evaluation, and risk factors for concomitant urethral injury. The National Inpatient Sample (2003-2011) was used to identify patients with penile fractures. Clinical data included age, race, comorbidity, insurance, hospital factors, timing, hematuria, and urinary symptoms. Rates of formal urethral evaluation (cystoscopy or urethrogram) and urethral injury were calculated. Multivariate logistic regression was used to identify predictors of urethral evaluation and risk factors for urethral injury. A weighted population of 3883 patients with penile fracture was identified. Presentations during weekends (37%) and summers (30%) were overrepresented (both P <.001). Urethral evaluation was performed in 882 patients (23%). Urethral injury was diagnosed in 813 patients (21%) with penile fracture. There was an increased odds of urethral evaluation with hematuria (odds ratio [OR] = 2.99; 95% confidence interval [CI], 1.03-8.73; P = .045) and a decrease for Hispanics (OR = 0.42; 95% CI, 0.22-0.82; P = .011). Older age (32-41 years: OR = 1.84; 95% CI, 1.07-3.16; P = .027; >41 years: OR = 2.25; 95% CI, 1.25-4.05; P = .007), black race (OR = 1.93; 95% CI, 1.12-3.34; P = .018), and hematuria (OR = 17.03; 95% CI, 3.20-90.54; P = .001) were independent risk factors for urethral injury. Penile fractures, which occur disproportionately during summer and weekends, were associated with a 21% risk of urethral injury. Urethral evaluations were performed in a minority of patients. Even in patients with hematuria, 55% of patients underwent formal urethral evaluation. On multivariate analysis of patients with penile fracture, hematuria as well as older age and black race were independently associated with concomitant urethral injury. Copyright © 2015 Elsevier Inc. All rights reserved.

An investigation of the effects from a urethral warming system on temperature distributions during cryoablation treatment of the prostate: a phantom study.

PubMed

Favazza, C P; Gorny, K R; King, D M; Rossman, P J; Felmlee, J P; Woodrum, D A; Mynderse, L A

2014-08-01

Introduction of urethral warmers to aid cryosurgery in the prostate has significantly reduced the incidence of urethral sloughing; however, the incidence rate still remains as high as 15%. Furthermore, urethral warmers have been associated with an increase of cancer recurrence rates. Here, we report results from our phantom-based investigation to determine the impact of a urethral warmer on temperature distributions around cryoneedles during cryosurgery. Cryoablation treatments were simulated in a tissue mimicking phantom containing a urethral warming catheter. Four different configurations of cryoneedles relative to urethral warming catheter were investigated. For each configuration, the freeze-thaw cycles were repeated with and without the urethral warming system activated. Temperature histories were recorded at various pre-arranged positions relative to the cryoneedles and urethral warming catheter. In all configurations, the urethral warming system was effective at maintaining sub-lethal temperatures at the simulated surface of the urethra. The warmer action, however, was additionally demonstrated to potentially negatively impact treatment lethality in the target zone by elevating minimal temperatures to sub-lethal levels. In all needle configurations, rates of freezing and thawing were not significantly affected by the use of the urethral warmer. The results indicate that the urethral warming system can protect urethral tissue during cryoablation therapy with cryoneedles placed as close as 5mm to the surface of the urethra. Using a urethral warming system and placing multiple cryoneedles within 1cm of each other delivers lethal cooling at least 5mm from the urethral surface while sparing urethral tissue. Copyright © 2014 Elsevier Inc. All rights reserved.

Mechanism of continence after repair of posterior urethral disruption: evidence of rhabdosphincter activity.

PubMed

Whitson, Jared M; McAninch, Jack W; Tanagho, Emil A; Metro, Michael J; Rahman, Nadeem U

2008-03-01

Controversy exists regarding continence mechanisms in patients who undergo posterior urethral reconstruction after pelvic fracture. Some evidence suggests that continence after posterior urethroplasty is maintained by the bladder neck or proximal urethral mechanism without a functioning distal mechanism. We studied distal urethral sphincter activity in patients who have undergone posterior urethroplasty for pelvic fracture. A total of 12 patients who had undergone surgical repair of urethral disruption involving the prostatomembranous region underwent videourodynamics with urethral pressure profiles at rest, and during stress and hold maneuvers. Bladder pressure and urethral pressure, including proximal and distal urethral sphincter activity and pressure, were assessed in each patient. All 12 patients had daytime continence of urine postoperatively with a followup after anastomotic urethroplasty of 12 to 242 months (mean 76). Average maximum urethral pressure was 71 cm H2O. Average maximum urethral closure pressure was 61 cm H2O. The average urethral pressure seen during a brief hold maneuver was 111 cm H2O. Average functional sphincteric length was 2.5 cm. Six of the 12 patients had clear evidence of distal urethral sphincter function, as demonstrated by the profile. Continence after anastomotic urethroplasty for posttraumatic urethral strictures is maintained primarily by the proximal bladder neck. However, there is a significant contribution of the rhabdosphincter in many patients.

Management of severe urethral complications of prostate cancer therapy.

PubMed

Elliott, Sean P; McAninch, Jack W; Chi, Thomas; Doyle, Sean M; Master, Viraj A

2006-12-01

We present our management of urethral stenosis and rectourinary fistula resulting from prostate cancer therapy. We concentrated on cases refractory to minimally invasive treatment, such as dilation, urethrotomy, and urinary and/or fecal diversion. In our prospectively collected urethral reconstruction database we identified patients who underwent reconstruction of urethral stenosis or rectourinary fistula who also received prior treatment for prostate cancer. We documented demographics, prostate cancer pretreatment characteristics, prostate cancer therapy type, urethral reconstruction type and success. A total of 48 patients met the inclusion criteria, including 16 with rectourinary fistula and 32 with urethral stenosis. Urethral complications followed prior radical prostatectomy, brachytherapy, external beam radiotherapy, cryotherapy, thermal ablation and any combination of these procedures. Stenosis repair was successful in 23 of 32 cases (73%) and it differed little between anterior and posterior urethral stenosis. Repair was accomplished by anastomotic urethroplasty in 19 cases, flap urethroplasty in 2, perineal urethrostomy in 2 and a urethral stent in 9. Prior external beam radiotherapy was a risk factor for urethral reconstruction failure. Fistula repair was successful in 14 of 15 patients (93%), excluding 1 who died postoperatively. The complexity of fistula management was dictated by fistula size and the presence or absence of coincident urethral stenosis. Urethral stenosis or rectourethral fistula following prostate cancer therapy can be managed by urethral reconstruction, such that normal voiding via the urethra is maintained, rather than abandoning the urethral outlet and performing heterotopic diversion. This can be accomplished with an acceptable rate of failure, given the complexity of the cases.

Urethral pull-through operation for the management of pelvic fracture urethral distraction defects.

PubMed

Yin, Lei; Li, Zhenhua; Kong, Chuize; Yu, Xiuyue; Zhu, Yuyan; Zhang, Yuxi; Jiang, Yuanjun

2011-10-01

To present our institutional experience in the management of pelvic fracture urethral distraction defects with urethral pull-through operation. Seventy-six patients (average age 34.5 years) with posterior urethral strictures caused by pelvic fracture urethral distraction defects underwent urethral pull-through operation at our department from July 1995 to September 2009. The estimated urethral stricture length was 2.0-3.5 cm (mean 2.5). Of these patients, 31 (41%) had undergone failed urethroplasty or urethrotomy after the initial management, and 5 (7%) had urethrorectal fistula. Urethral pull-through operation was performed 4-7 months (mean 4.9) after initial treatment or failed urethral reconstruction. The clinical outcome was considered a failure when any postoperative intervention was needed. Follow-up was 14-74 months (mean 42.5). The overall success rate was 89% (68/76). All treatment failures occurred within the first 6 months postoperatively. Failed repairs were successfully managed with internal urethrotomy in 1 patient, by urethral dilation in 6, and by another urethroplasty in 1. All patients were urinary-continent postoperatively. Of the potent patients, 2 (5%) became impotent after urethroplasty. There was no chordee, penile shortening, or urethral fistula recurrence. Urethral pull-through operation might be a less demanding and less time-consuming procedure. It does not increase the rate of impotence or incontinence and, with a high success rate, might serve as an alternative method for the management of pelvic fracture urethral distraction defects. Copyright © 2011 Elsevier Inc. All rights reserved.

Blind urethral catheterization in trauma patients suffering from lower urinary tract injuries.

PubMed

Shlamovitz, Gil Z; McCullough, Lynne

2007-02-01

The goals of our study were to review all cases of urethral and bladder trauma that presented to the University of California, Los Angeles (UCLA) Medical Center between January 1998 and August 2005 and determine (1) the clinical characteristics of patients with urethral and/or bladder injuries as well as the sensitivities of those clinical characteristics; (2) whether or not a blind attempt to insert a urethral catheter was performed; and (3) whether there is any evidence that a blind attempt to insert a urethral catheter worsened the initial urinary tract injury. This is a retrospective chart review. The study cohort comprised 46 patients with a mean age of 30 years, including 36 men (78.2%) and 10 women (21.8%). Bladder tears were found in 33 patients, 10 patients had urethral lacerations, and 3 patients had combined bladder and urethral lacerations. The most sensitive finding for urinary bladder or urethral injury was the presence of gross hematuria in the urethral catheter (100%, 95% confidence interval [CI] 0.63-0.89). Blinded insertion of a urethral catheter was attempted in 30 (90.9%, 95% CI 0.75-0.98) patients who suffered from urinary bladder injury, 6 (50%, 95% CI 0.26-0.87) patients who suffered from urethral injury and 1 (33%, 95% CI 0.0-0.9) patient who suffered from a combined urinary bladder and urethral injuries. We did not find evidence that a blind attempt to insert a urethral catheter worsened the initial urinary injury. Gross hematuria in the urethral catheter was the most sensitive sign for the presence of a urethral or urinary bladder injury in our study cohort, and often the only sign of such an injury. We found no evidence that a blind attempt to insert a urethral catheter in patients suffering from urethral and or urinary bladder injuries worsened the initial injury. Larger studies will be needed to determine the safety of blind urethral catheterization in patients that are suspected to suffer from a lower urological trauma. It is our opinion that the current guidelines should be revised to better reflect the current knowledge, technologies, and clinical practice.

Structure and Deformation of the Hikurangi-Kermadec Subduction Zone - Transitions Revealed by Seismic Wide-angle Data

NASA Astrophysics Data System (ADS)

Scherwath, M.; Kopp, H.; Flueh, E. R.; Henrys, S. A.; Sutherland, R.

2008-12-01

The Hikurangi-Kermadec subduction zone northeast of New Zealand represents an ideal target to study lateral variations of subduction zone processes. The incoming Pacific plate changes from being a large igneous province, called the Hikurangi Plateau, in the south to normal oceanic plate north of the Rapuhia Scarp. The overriding Australian plate of continental character in the south, forming the North Island of New Zealand, and changes to an island arc in the north. Further lateral variability exists in changes in volcanic and hydro-thermal activity, transitions from accretion to subduction erosion, backarc spreading and rifting, and is accompanied by northward increasing seismicity. As part of the MANGO project (Marine Geoscientific Investigations on the Input and Output of the Kermadec Subduction Zone), four marine geophysical transects of largely seismic reflection and refraction data provide constraints on the upper lithospheric structures across the Hikurangi-Kermadec Trench between 29-38 deg S. On MANGO profile 1 in the south, the initially shallow subduction of the incoming plateau coincides with crustal underplating beneath the East Cape ridge. To the west lies the 100 km wide and over 10 km deep Raukumara Basin. Seismic velocities of the upper mantle of both plates are around 8 km/s and are considered normal. In contrast, on MANGO profile 4, about 1000 km to the north around the volcanically active Raoul Island, the incoming oceanic crust appears to bend considerably steeper and thus causes a 50 km narrower forearc with a smaller forearc basin. Furthermore, the upper mantle velocities in both plates are relatively low (7.4-7.7 km/s), likely indicating strong bending related deformation of the incoming plate and thermal activity within the arc possibly due to spreading. The central two transects MANGO 2 and 3, though without data coverage of the structure of the incoming plate, are more similar to MANGO 4. The arc regions appear to be strongly affected by the activity of the arc. The arc crust of the northern MANGO 3 becomes significantly thinner in the backarc region due to extension, whereas the data from MANGO 2 likely show thermal activity from the adjacent arc volcanism.

Activation of somatosensory afferents elicit changes in vaginal blood flow and the urethrogenital reflex via autonomic efferents.

PubMed

Cai, R S; Alexander, M Sipski; Marson, L

2008-09-01

We examined the effects of pudendal sensory nerve stimulation and urethral distention on vaginal blood flow and the urethrogenital reflex, and the relationship between somatic and autonomic pathways regulating sexual responses. Distention of the urethra and stimulation of the pudendal sensory nerve were used to evoke changes in vaginal blood flow (laser Doppler perfusion monitoring) and pudendal motor nerve activity in anesthetized, spinally transected female rats. Bilateral cuts of either the pelvic or hypogastric nerve or both autonomic nerves were made, and blood flow and pudendal nerve responses were reexamined. Stimulation of the pudendal sensory nerve or urethral distention elicited consistent increases in vaginal blood flow and rhythmic firing of the pudendal motor nerve. Bilateral cuts of the pelvic plus hypogastric nerves significantly reduced vaginal blood flow responses without altering pudendal motor nerve responses. Pelvic nerve cuts also significantly reduced vaginal blood flow responses. In contrast, hypogastric nerve cuts did not significantly change vaginal blood flow. Bilateral cuts of the pudendal sensory nerve blocked pudendal motor nerve responses but stimulation of the central end evoked vaginal blood flow and pudendal motor nerve responses. Stimulation of the sensory branch of the pudendal nerve elicits vasodilatation of the vagina. The likely mechanism is via activation of spinal pathways that in turn activate pelvic nerve efferents to produced changes in vaginal blood flow. Climatic-like responses (firing of the pudendal motor nerve) occur in response to stimulation of the pudendal sensory nerve and do not require intact pelvic or hypogastric nerves.

Urethral sphincters response to cavernosus muscles stimulation with identification of cavernoso-urethral reflex.

PubMed

Shafik, A; Shafik, A A; Shafik, I; el-Sibai, O

2005-01-01

The functional activity of the urethral sphincters during cavernosus muscles' contraction at coitus has been poorly addressed in the literature. We investigated the hypothesis that cavernosus muscles' contraction affects reflex contraction of the urethral sphincters to guard against semen reflux into the urinary bladder or urine leakage from the bladder during orgasm and ejaculation. The electromyographic (EMG) response of the external (EUS) and internal (IUS) urethral sphincters to ischio- (ICM) and bulbo- (BCM) cavernosus muscle stimulation was studied in 15 healthy volunteers (9 men, 6 women, age 39.3 +/- 8.2 SD years). An electrode was applied to each of ICM and BCM (stimulating electrodes) and the 2 urethral sphincters (recording electrodes). The test was repeated after individual anesthetization of the urethral sphincters and the 2 cavernosus muscles, and after using saline instead of lidocaine. Upon stimulation of each of the 2 cavernosus muscles, the EUS and IUS recorded increased EMG activity. Repeated cavernosus muscles' stimulation evoked the urethral sphincteric response without fatigue. The urethral sphincters did not respond to stimulation of the anesthetized cavernosus muscles nor did the anesthetized urethral sphincters respond to cavernosus muscle stimulation. Saline infiltration instead of lidocaine did not affect the urethral sphincteric response to cavernosal muscle stimulation. Results were reproducible. Cavernosus muscles' contraction is suggested to effect EUS and IUS contraction. This action seems to be reflex and mediated through the 'cavernoso-urethral reflex.' Urethral sphincters contraction upon cavernosus muscles contraction during sexual intercourse presumably prevents urine leak from the urinary bladder to urethra, prevents retrograde ejaculation, and propels ejaculate from the posterior to the penile urethra. The cavernoso-urethral reflex can act a diagnostic tool in the investigations of patients with ejaculatory disorders.

Geodynamic evolution of the Taiwan-Luzon-Mindoro belt since the late eocene

NASA Astrophysics Data System (ADS)

Stephan, Jean François; Blanchet, René; Rangin, Claude; Pelletier, Bernard; Letouzey, Jean; Muller, Carla

1986-05-01

The structural framework of the Taiwan-Luzon-Mindoro belt (or festoon) is described, following three major transects: the Luzon transect with active subduction and active island arc; the Taiwan transect with active collision; the Mindoro transect with active subduction and inactive collision. Based on this geological study and on available geophysical data, a model for the geodynamic evolution of this portion of the Philippine Sea and Eurasia Plates boundary is proposed in a succession of reconstructions between the Late Eocene and the Present. The major geodynamic events are: (1) beginning of the opening of the South China Sea (S.C.S.) in Lower Oligocene times, contemporaneous with obduction of the Zambales and Angat ophiolites on Luzon. (2) subduction of a Mesozoic (?) oceanic basin along the proto-Manila trench from the Upper Oligocene to the Lower Miocene. (3) obduction of the South China Sea oceanic crust onto the Chinese and Reed Bank—Calamian passive margins in Middle Miocene time (14-15 Ma) related to a major kinematic reorganization (end of opening of the S.C.S.). (4) beginning of collision between the Luzon microblock and the two margins of the S.C.S. in the Upper Miocene (~ 7 Ma); collision is still active in Taiwan whereas it stopped in Mindoro during the Pliocene.

Habitat characterization of the Vema Fracture Zone and Puerto Rico Trench

NASA Astrophysics Data System (ADS)

Devey, C. W.; Augustin, N.; Brandt, A.; Brenke, N.; Köhler, J.; Lins, L.; Schmidt, C.; Yeo, I. A.

2018-02-01

Although many of the regions on and close to the mid-ocean ridges have been extensively mapped and sampled, the abyssal intraplate regions remain essentially unsampled and unmapped, leaving huge gaps in our understanding of their geologic history and present activity. Prominent bathymetric features in these intraplate regions are fracture zones. Here we present bathymetric and sampling information from a transatlantic transect along the Vema Fracture Zone (ca. 11°N), covering crustal ages from 109 - 0 Ma on the African plate and 0-62 Ma on the South American plate. The Vema Fracture Zone is the intraplate trace of the active Vema Transform plate boundary, which offsets the present-day Mid-Atlantic Ridge by ca. 300 km left-laterally, juxtaposing zero-age crust with crust of 20 million years age. Our results show clear evidence of tectonic activity along most of the Fracture Zone, in most places likely associated with active fluid flow. Within the active Vema Transform at crustal ages of ca. 10 Ma we found clear indications of fluid flow both in the sediments and the overlying water column. This region is > 120 km from the nearest spreading axis and increases by almost an order of magnitude the maximum off-axis distance that active hydrothermal discharge has been found on the oceanic crust. Sampling of the igneous seafloor was possible at all crustal ages and the accretionary fabric imprinted on the plate during its production was prominent everywhere. Seafloor sediments show signs of extensive bioturbation. In one area, high concentrations of spherical Mn-nodules were also found and sampled. At the end of the transect we also mapped and sampled the Puerto Rico Trough, a > 8000 m-deep basin north of the Caribbean arc. Here the seafloor morphology is more complicated and strongly influenced by transpressive tectonics.

Predictors for success of internal urethrotomy in patients with urethral contracture following perineal repair of pelvic fracture urethral injuries.

PubMed

Hong, Young-Kwon; Choi, Kyung-Hwa; Lee, Young-Tae; Lee, Seung-Ryeol

2017-05-01

Internal urethrotomy (IU) in patients with urethral contracture following perineal repair of pelvic fracture urethral injuries (PRPFUI) is troublesome. We evaluated the clinical factors affecting the surgical outcome of IU for urethral contracture after PRPFUI. We retrospectively reviewed the records of 35 patients who underwent IU for urethral contracture after PRPFUI between March 2004 and June 2013. Ages of patients ranged from 18 to 50, and their follow-up duration was more than 1year after IU. The urethral contracture was confirmed by retrograde urethrogram or cysto-urethroscopy. Success was defined as greater than 15mL/s of peak urinary flow rate at 1year after IU without any clinical evidence of urethral contracture. Success rates were investigated according to the number of IU. Age, body mass index, urethral defect length before PRPFUI, time interval between the original urethral injury and the PRPFUI or between a previous operation and the PRPFUI, time interval between the PRPFUI and the urethral contracture, number of PRPFUI performed, and the type of urethral lengthening procedure were compared between patients with and without success according to the number of IU. Among the 35 patients, the overall success rate of IU was 37% (13/35) during the mean follow-up period of 53 months (range: 17-148 months). There were 8 and 5 patients with success in first and second IU, respectively. However, there was no success after third IU. Urethral defect length before PRPFUI was significantly shorter in patients with success who underwent first and second IU (p<0.05). There were significant differences of success between patients with and without previous repeated failures of PRPFUI in first and second IU (p<0.05). Short urethral defect length and no previous surgical failures before PRPFUI are good prognostic factors for IU following PRPFUI. Only one or two IUs will be helpful in patients with urethral contracture following PRPFUI. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Experitoneal bladder perforation due to in-dwelling urethral catheter successfully treated by urethral drainage: a case report].

PubMed

Okuda, Hidenobu; Tei, Norihide; Shimizu, Kiyonori; Imazu, Tetsuo; Yoshimura, Kazuhiro; Kiyohara, Hisakazu

2008-07-01

Perforation of the bladder related to long-term indwelling urethral catheter is a rare and serious complication. A 85-year-old man with an indwelling urethral catheter presented severe hematuria, abdominal pain with rebound tenderness and muscular tension over the suprapubic area after the exchange of the urethral catheter. Computed tomography and cystogram revealed experitoneal bladder perforation due to indwelling catheter. Three weeks after the indwelling urethral catheter had been placed, the perforation was closed. In most cases, laparotomy and suprapubic cystostomy are performed. We describe the case of experitoneal bladder perforation successfully treated by urethral drainage.

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

[Transurethral thulium laser urethrotomy for urethral stricture].

PubMed

Liu, Chun-Lai; Zhang, Xi-Ling; Liu, Yi-Li; Wang, Ping

2011-09-01

To evaluate the effect of endourethrotomy with thulium laser as a minimally invasive treatment for urethral stricture. We treated 36 cases of urethral stricture or atresia by endourethrotomy with thulium laser, restored the urethral continuity by vaporization excision of the scar tissue, and observed the clinical effects and complications. The mean operation time was 35 min, ranging from 10 to 90 min. Smooth urination was achieved after 2-6 weeks of catheter indwelling, with no urinary incontinence. The patients were followed up for 4-24 (mean 12) months, during which 27 did not need any reintervention, 5 developed urinary thinning but cured by urethral dilation, 3 received another laser urethrotomy for previous negligence of timely urethral dilation, and the other 1 underwent open urethroplasty. Thulium laser urethrotomy is a safe and effective minimally invasive option for short urethral stricture, which is also suitable for severe urethral stricture and urethral atresia. Its short-term outcome is satisfactory, but its long-term effect remains to be further observed.

Urinary Retention

MedlinePlus

... urinary retention with • bladder drainage • urethral dilation • urethral stents • prostate medications • surgery The type and length of ... patient will receive sedation and regional anesthesia. Urethral Stents Another treatment for urethral stricture involves inserting an ...

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

Primary urethral reconstruction: the cost minimized approach to the bulbous urethral stricture.

PubMed

Rourke, Keith F; Jordan, Gerald H

2005-04-01

Treatment for urethral stricture disease often requires a choice between readily available direct vision internal urethrotomy (DVIU) and highly efficacious but more technically complex open urethral reconstruction. Using the short segment bulbous urethral stricture as a model, we determined which strategy is less costly. The costs of DVIU and open urethral reconstruction with stricture excision and primary anastomosis for a 2 cm bulbous urethral stricture were compared using a cost minimization decision analysis model. Clinical probability estimates for the DVIU treatment arm were the risk of bleeding, urinary tract infection and the risk of stricture recurrence. Estimates for the primary urethral reconstruction strategy were the risk of wound complications, complications of exaggerated lithotomy and the risk of treatment failure. Direct third party payer costs were determined in 2002 United States dollars. The model predicted that treatment with DVIU was more costly (17,747 dollars per patient) than immediate open urethral reconstruction (16,444 dollars per patient). This yielded an incremental cost savings of $1,304 per patient, favoring urethral reconstruction. Sensitivity analysis revealed that primary treatment with urethroplasty was economically advantageous within the range of clinically relevant events. Treatment with DVIU became more favorable when the long-term risk of stricture recurrence after DVIU was less than 60%. Treatment for short segment bulbous urethral strictures with primary reconstruction is less costly than treatment with DVIU. From a fiscal standpoint urethral reconstruction should be considered over DVIU in the majority of clinical circumstances.

Urethral calculi in young-adult Nigerian males: a case series.

PubMed

Gali, B M; Ali, N; Agbese, G O; Garba, I I; Musa, K

2011-01-01

Urethral calculi are rare and usually encountered in males with urethral pathology. To present our experience managing urethral calculi in a resource limited centre and review the literature. We did a chart review of management of patients with urethral calculi between January and April 2009, at Federal Medical Centre (FMC) Azare, Nigeria. We also reviewed the literature on this rare condition. Four young adult male Nigerians between the ages of 17 and 27 years presented with varying degrees of urethral pain and palpable calculi in the anterior urethra. Two presented with acute retention of urine, but none had haematuria. The calculi were radio-opaque, located in the anterior urethra with no associated urethral pathology. Three were solitary and one multiple. The composition of the urethral calculi was a mixture of calcium oxalate calcium carbonate, magnesium phosphate, one has additional cystine but none had struvite or uric acid. Their sizes ranged between 1cm ×1.5cm and 1.5cm × 5.5cm. External urethrotomy was the method of treatment. Urethral calculi are rare in our setting, with no clear identifiable aetiological factors which suggests urinary schistosomiasisbeing associsted. The occurrence of urethral calculi appears to have a relationship with childhood urinary schistosomasis.

Urethral lymphogranuloma venereum infections in men with anorectal lymphogranuloma venereum and their partners: the missing link in the current epidemic?

PubMed

de Vrieze, Nynke Hesselina Neeltje; van Rooijen, Martijn; Speksnijder, Arjen Gerard Cornelis Lambertus; de Vries, Henry John C

2013-08-01

Urethral lymphogranuloma venereum (LGV) is not screened routinely. We found that in 341 men having sex with men with anorectal LGV, 7 (2.1%) had concurrent urethral LGV. Among 59 partners, 4 (6.8%) had urethral LGV infections. Urethral LGV is common, probably key in transmission, and missed in current routine LGV screening algorithms.

Long-term outcome of primary endoscopic realignment for bulbous urethral injuries: risk factors of urethral stricture.

PubMed

Seo, Ill Young; Lee, Jea Whan; Park, Seung Chol; Rim, Joung Sik

2012-12-01

Although endoscopic realignment has been accepted as a standard treatment for urethral injuries, the long-term follow-up data on this procedure are not sufficient. We report the long-term outcome of primary endoscopic realignment in bulbous urethral injuries. Patients with bulbous urethral injuries were treated by primary endoscopic realignment between 1991 and 2005. The operative procedure included suprapubic cystostomy and transurethral catheterization using a guide wire, within 72 hours of injury. The study population included 51 patients with a minimum follow-up duration of 5 years. The most common causes of the injuries were straddle injury from falling down (74.5%), and pelvic bone fracture (7.8%). Gross hematuria was the most common complaint (92.2%). Twenty-three patients (45.1%) had complete urethral injuries. The mean time to operation after the injury was 38.8±43.2 hours. The mean operation time and mean indwelling time of a urethral Foley catheter were 55.5±37.6 minutes and 22.0±11.9 days, respectively. Twenty out of 51 patients (39.2%) were diagnosed with urethral stricture in 89.1±36.6 months after surgery. A multivariate analysis revealed that young age and operation time were independent risk factors for strictures as a complication of urethral realignment (hazard ratio [HR], 6.554, P=0.032; HR, 6.206, P=0.035). Urethral stricture commonly developed as a postoperative complication of primary endoscopic urethral realignment for bulbous urethral injury, especially in young age and long operation time.

Pazopanib in Treating Patients With Metastatic Urothelial Cancer

ClinicalTrials.gov

2014-05-22

Distal Urethral Cancer; Proximal Urethral Cancer; Recurrent Bladder Cancer; Recurrent Transitional Cell Cancer of the Renal Pelvis and Ureter; Recurrent Urethral Cancer; Stage IV Bladder Cancer; Transitional Cell Carcinoma of the Bladder; Urethral Cancer Associated With Invasive Bladder Cancer

Urethral injury in the multiple-injured patient.

PubMed

Cass, A S

1984-10-01

A total of 74 patients with urethral injury due to external trauma consisted of 48 posterior urethral injuries (25 complete rupture, 23 partial rupture) and 26 anterior urethral injuries (two complete rupture, 16 partial rupture, and eight contusion). The diagnosis was made by retrograde urethrography. All 48 patients with posterior urethral injury had associated injuries, including a fractured pelvis in 46, and a mortality rate of 33%. Only seven of the 26 patients with anterior urethral injury had associated injuries and a mortality rate of 14%. The management of posterior urethral injury is changing from primary realignment of the ruptured urethra to suprapubic cystostomy alone and followed later by urethral surgery for the resulting stricture. The impotence rate is significantly lower with management with suprapubic cystostomy alone. However, the type of pelvic fracture, the urethral injury itself disrupting neurovascular structures, and the surgical dissection (initial primary realignment or delayed urethroplasty) must be investigated before it can be determined whether the impotence associated with pelvic trauma is caused by the injury itself or by the surgical dissection undertaken to reconstruct the urethra.

Isotretinoin-induced urethritis versus non-gonococcal urethritis in a man who has sex with men: an open debate.

PubMed

Ballout, Rami A; Maatouk, Ismael

2018-01-01

This is the case of a young man presenting with urethritis despite a negative infectious work-up. Careful history taking elucidated a strong correlation between symptom onset and a recent dose escalation of isotretinoin for treatment of his refractory cystic acne. The urethral symptoms quickly resolved with dose reduction, suggesting urethritis as a rare adverse reaction of isotretinoin.

Urethral hydrodistension for management of urethral hypoplasia in prune belly syndrome: long-term results.

PubMed

Kajbafzadeh, Abdol-Mohammad; Rasouli, Mohammad Reza; Dianat, SeyedSaeid; Nezami, Behtash G; Mahboubi, Amir Hassan; Sina, Alireza

2010-11-01

The aim of the study was to evaluate the efficacy and safety of urethral hydrodistension for management of urethral hypoplasia in prune belly syndrome (PBS). During a 10-year period, 7 infants with PBS and urethral hypoplasia presented either with open urachus or surgically created urinary diversion referred to our hospital. Five milliliters of normal saline was pushed via a 22-gauge plastic angiocatheter into the urethra with simultaneous finger pressure on the perineum to occlude the proximal urethra that was repeated with higher volumes of the solution (up to 20 mL). The procedure was continued until a 6F or 8F feeding tube catheter confirmed the urethral patency. Hydrodistension was repeated in 3-month intervals till complete patency was confirmed by imaging. Median age of the infants was 6 (1-8) months. All urethral hydrodistension were successful after 1 to 3 sessions. Follow-up imaging studies showed significant improvement in all patients except one. Natural and surgically created urinary diversions were closed in 6 infants. The hydrodistension create an equal and constant pressure into the urethral wall without any urethral damage. This technique can be considered along with the other available methods for management of urethral hypoplasia in selected cases of PBS. Copyright © 2010 Elsevier Inc. All rights reserved.

Stimulated pressure profile at rest: a noninvasive method for assessing urethral sphincter function.

PubMed

Meyer, S; Kuntzer, T; De Grandi, P; Bachelard, O; Schreyer, A

1998-10-01

To validate a method for assessing urethral sphincter muscle function by recording rises in intraurethral pressure during repetitive pudendal nerve stimulations. A supine urethral pressure profile at rest was performed on 12 stress-continent and 28 stress-incontinent patients during repetitive pudendal nerve stimulations applied near the ischial spine, and the intraurethral pressure increases were calculated for each third of the urethral functional length. No significant difference in intraurethral pressure increases was seen between continent and stress-incontinent women. On the various regression curves, the intraurethral pressure increases showed a significant correlation with maximal urethral closure pressure values at rest and at stress (r = 0.36 to 0.54) and with the patient's age (r = 0.46), but not with pudendal nerve conduction times to the urethral sphincter on either side (r = 0.14 and 0.19). This method (1) measures intraurethral pressure increases that correlate well with the anatomic location of the urethral sphincter muscle, (2) shows there is no significant difference between them in continent and stress-incontinent patients, except in patients with a low-pressure urethra, and (3) demonstrates that they correlate well with the maximal urethral closure pressure and the patient's age, but not with pudendal motor latencies to the urethral sphincter. This method gives us a mapping of the urethral sphincter activity, explaining why some patients with a low-pressure urethra have less urinary loss than others with the same urethral closure pressure.

Urethral Cancer—Patient Version

Cancer.gov

Urethral cancer is rare and is more common in men than in women. Urethral cancer can metastasize (spread) quickly to tissues around the urethra and has often spread to nearby lymph nodes by the time it is diagnosed. Start here to find information on urethral cancer treatment.

Urethral Cancer—Health Professional Version

Cancer.gov

Urethral cancer is a rare cancer. There are three types of urethral cancer. Squamous cell carcinoma is the most common type. Transitional cell carcinoma of the urethra, and adenocarcinoma in the glands around the urethra are less common. Find evidence-based information on urethral cancer treatment.

Movement of fluids in the Nankai Trough area: Insights from 129I and halogen distributions along the IODP NanTroSEIZE transect

NASA Astrophysics Data System (ADS)

Tomaru, Hitoshi; Fehn, Udo

2015-01-01

Halogen concentrations and 129I/I ratios were determined in pore waters from the Nankai Trough subduction system, collected during IODP Expeditions 315, 316, 322, and 333 along the NanTroSEIZE transect. The transect allowed the first direct comparison of iodine results across an active subduction system, from subducting oceanic sediments to the accretionary prism, and the overlying forearc basin. In contrast to the other halogens (Cl and Br) iodine concentrations show large variations within and among the cores at all sites landward of the trough, I concentrations increase rapidly with depth and reach values several orders of magnitude higher than those in seawater, but are only slightly higher than seawater values at the seaward sites. Methane concentrations follow a similar pattern. Host sediments of the fluids are younger than 7 Ma in all the cores, but the ages of iodine in pore waters at the landward sites reach values beyond 30 Ma. In contrast, iodine seaward of the trough is in isotopic equilibrium with the host sediments, resulting in very similar iodine and sediment ages. The distribution of iodine concentrations and ages indicates that iodine at the landward sites has been transported there in aqueous fluids, probably together with methane, from old formations in the upper plate. The specific fluid pathways potentially were influenced by features such as the megasplay fault in the prism or the décollement. The results demonstrate large-scale transport of fluids carrying iodine and other compounds such as methane from old layers in the upper plate to surface locations landward of the Nankai Trough, while separate, but only local hydrologic processes occur in the marine sediments moving toward the trough.

LWD lithostratigraphy, physical properties and correlations across tectonic domains at the NanTroSEIZE drilling transect, Nankai Trough subduction zone, Japan

NASA Astrophysics Data System (ADS)

Tudge, J.; Webb, S. I.; Tobin, H. J.

2013-12-01

Since 2007 the Nankai Trough Seismogenic Zone Experiment (NanTroSEIZE) has drilled a total of 15 sites across the Nankai Trough subduction zone, including two sites on the incoming sediments of the Philippine Sea plate (PSP). Logging-while-drilling (LWD) data was acquired at 11 of these sites encompassing the forearc Kumano Basin, upper accretionary prism, toe region and input sites. Each of these tectonic domains is investigated for changes in physical properties and LWD characteristics, and this work fully integrates a large data set acquired over multiple years and IODP expeditions, most recently Expedition 338. Using the available logging-while-drilling data, primarily consisting of gamma ray, resistivity and sonic velocity, a log-based lithostratigraphy is developed at each site and integrated with the core, across the entire NanTroSEIZE transect. In addition to simple LWD characterization, the use of Iterative Non-hierarchical Cluster Analysis (INCA) on the sites with the full suite of LWD data clearly differentiates the unaltered forearc and slope basin sediments from the deformed sediments of the accretionary prism, suggesting the LWD is susceptible to the subtle changes in the physical properties between the tectonic domains. This differentiation is used to guide the development of tectonic-domain specific physical properties relationships. One of the most important physical property relationships between is the p-wave velocity and porosity. To fully characterize the character and properties of each tectonic domain we develop new velocity-porosity relationships for each domain found across the NanTroSEIZE transect. This allows the porosity of each domain to be characterized on the seismic scale and the resulting implications for porosity and pore pressure estimates across the plate interface fault zone.

Trans-Alaska Crustal Transect and continental evolution involving subduction underplating and synchronous foreland thrusting

USGS Publications Warehouse

Fuis, G.S.; Moore, Thomas E.; Plafker, G.; Brocher, T.M.; Fisher, M.A.; Mooney, W.D.; Nokleberg, W.J.; Page, R.A.; Beaudoin, B.C.; Christensen, N.I.; Levander, A.R.; Lutter, W.J.; Saltus, R.W.; Ruppert, N.A.

2008-01-01

We investigate the crustal structure and tectonic evolution of the North American continent in Alaska, where the continent has grown through magmatism, accretion, and tectonic underplating. In the 1980s and early 1990s, we conducted a geological and geophysical investigation, known as the Trans-Alaska Crustal Transect (TACT), along a 1350-km-long corridor from the Aleutian Trench to the Arctic coast. The most distinctive crustal structures and the deepest Moho along the transect are located near the Pacific and Arctic margins. Near the Pacific margin, we infer a stack of tectonically underplated oceanic layers interpreted as remnants of the extinct Kula (or Resurrection) plate. Continental Moho just north of this underplated stack is more than 55 km deep. Near the Arctic margin, the Brooks Range is underlain by large-scale duplex structures that overlie a tectonic wedge of North Slope crust and mantle. There, the Moho has been depressed to nearly 50 km depth. In contrast, the Moho of central Alaska is on average 32 km deep. In the Paleogene, tectonic underplating of Kula (or Resurrection) plate fragments overlapped in time with duplexing in the Brooks Range. Possible tectonic models linking these two regions include flat-slab subduction and an orogenic-float model. In the Neogene, the tectonics of the accreting Yakutat terrane have differed across a newly interpreted tear in the subducting Pacific oceanic lithosphere. East of the tear, Pacific oceanic lithosphere subducts steeply and alone beneath the Wrangell volcanoes, because the overlying Yakutat terrane has been left behind as underplated rocks beneath the rising St. Elias Range, in the coastal region. West of the tear, the Yakutat terrane and Pacific oceanic lithosphere subduct together at a gentle angle, and this thickened package inhibits volcanism. ?? 2008 The Geological Society of America.

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

Asymptomatic and symptomatic urethral gonorrhoea in men who have sex with men attending a sexual health service.

PubMed

Ong, J J; Fethers, K; Howden, B P; Fairley, C K; Chow, E P F; Williamson, D A; Petalotis, I; Aung, E; Kanhutu, K; De Petra, V; Chen, M Y

2017-08-01

Guidelines regarding whether men who have sex with men (MSM) without symptoms of urethritis should be screened for urethral gonorrhoea differ between countries. We examined the rate of asymptomatic urethral gonorrhoea in MSM using sensitive nucleic acid amplification testing. This study was conducted on consecutive MSM attending the Melbourne Sexual Health Centre between July 2015 and May 2016 for sexually transmitted infections screening. Gonorrhoea testing with the Aptima Combo 2 (AC2) assay was performed on all urine specimens obtained from MSM, whether symptoms of urethritis were present or not. Men were classified as having: typical discharge if they reported symptoms suggesting purulent discharge; other symptoms if they reported other symptoms of urethritis; and no symptoms if they reported no urethral symptoms. During the study period, there were 7941 clinic visits by 5947 individual MSM with 7090 urine specimens obtained from 5497 individual MSM tested with the AC2 assay. Urethral gonorrhoea was detected in 242 urine specimens from 228 individual MSM. The majority (189/242, 78%, 95% CI 73-83) reported typical discharge, 27/242 (11%, 95% CI 8-16) reported other urethral symptoms, and 26/242 (11%, 95% CI 7-15) reported no symptoms on the day of presentation and testing. Among men with urethral gonorrhoea, the proportions with concurrent pharyngeal or rectal gonorrhoea were 32% (134/210) and 64% (74/235), respectively. The mean interval between last reported sexual contact and onset of typical urethral discharge, where present, was 3.9 days. The findings from our study lend support to guidelines that recommend screening asymptomatic MSM for urethral gonorrhoea. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

VEGF Trap in Treating Patients With Recurrent, Locally Advanced, or Metastatic Cancer of the Urothelium

ClinicalTrials.gov

2014-10-10

Adenocarcinoma of the Bladder; Distal Urethral Cancer; Metastatic Transitional Cell Cancer of the Renal Pelvis and Ureter; Proximal Urethral Cancer; Recurrent Bladder Cancer; Recurrent Transitional Cell Cancer of the Renal Pelvis and Ureter; Recurrent Urethral Cancer; Squamous Cell Carcinoma of the Bladder; Stage III Bladder Cancer; Stage III Urethral Cancer; Stage IV Bladder Cancer; Transitional Cell Carcinoma of the Bladder; Urethral Cancer Associated With Invasive Bladder Cancer

Voiding and sexual dysfunctions after pelvic fracture urethral injuries treated with either initial cystostomy and delayed urethroplasty or immediate primary urethral realignment.

PubMed

Aşci, R; Sarikaya, S; Büyükalpelli, R; Saylik, A; Yilmaz, A F; Yildiz, S

1999-08-01

The aim of this study is to evaluate the effects of the different immediate treatment modalities on the sexual and voiding functions in pelvic fracture urethral injuries. The records of 38 male patients with traumatic posterior urethral injuries were reviewed, 18 of whom were treated by initial suprapubic cystostomy and delayed repair (Group 1), and 20 by primary urethral realignment (Group 2). Types of pelvic fractures and urethral injuries were classified according to surgical and radiological findings. Long-term voiding functions were determined by the patient questionnaire, residual urine and uroflow. Sexual functions were also determined by the patient questionnaire and a penile duplex ultrasound study. Mean follow-ups of Groups 1 and 2 were 37 and 39 months, respectively. Membranous urethral disruption extending to the urogenital diaphragm was the most frequent urethral injury (type 3), with incidences of 66.7% and 77.7%, respectively. There were no statistically significant differences in mean age, incidence of pelvic fracture types and urethral injury types between groups (p > 0.05). After the immediate treatments, 16.7% and 55% of the patients regained normal urination, and stricture developed in 83.3% and 45% of the patients, respectively. In 44.4% of the patients in Group 1 and 10% in Group 2, urethral strictures required open urethroplasty (p < 0.05). Erectile impotence before urethroplasty in 17.6% and 20%, anejaculation after urethroplasty in 17.6% and 15% and incontinence in 5.6% and 10% of the patients were found in Groups 1 and 2, respectively (p > 0.05). However, 88.8% and 90% of patients eventually achieved normal urination with complete continence. Sexual and voiding dysfunction after pelvic fracture posterior urethral injury seem to be the result of the injury itself, not of the immediate treatment modalities. In urethral disruption injuries, primary urethral realignment seems more favourable than suprapubic cystostomy and delayed repair.

Eccentric circummeatal based flap with limited urethral mobilization: An easy technique for distal hypospadias repair.

PubMed

Ekinci, Saniye; Çiftçi, Arbay Özden; Karnak, İbrahim; Şenocak, Mehmet Emin

2016-04-01

Hypospadias is a common congenital anomaly. Over 300 techniques have been described for repairing hypospadias. Eccentric circummeatal based flap with combined limited urethral mobilization technique (ECMB-LUM) is a simple procedure to repair distal hypospadias with minimal complication rate. This study presents results of this technique, highlighting surgical pitfalls to achieve the best result. Medical records of patients with distal hypospadias operated on using the same technique between 1998 and 2011 were reviewed retrospectively. Age at surgery, position of meatus preoperatively and postoperatively, duration of urethral catheterization and hospitalization, early and late complications, previous hypospadias repairs, and secondary surgical interventions were evaluated. In the surgical technique an eccentric circummeatal based flap is outlined. The proximal part of the flap is dissected from the underlying urethra and Buck's fascia. If the flap is not long enough, the distal urethra is mobilized a few millimeters (Figure). The eccentric flap is sutured to the tip of the glans. The glans wings are approximated in the midline. A urethral catheter of 6 Fr or 8 Fr is passed and left in the bulbous urethra or the urinary bladder. Diverged limbs of corpus spongiosum are approximated on the urethra, then, the glans and skin of the penile shaft are sutured. Of the 171 consecutive patients operated on using the ECMB-LUM technique; 115 had coronal, 47 had subcoronal, and nine had glanular meatus. The mean age at surgery was 4.5 (1-17) years. Patients were hospitalized for 2.2 ± 0.7 days. Mean duration of urethral catheterization was 2.3 ± 0.5 days. All but eight patients had ECBF-LUM as primary repair. There were no early complications such as bleeding, hematoma, and wound infection. All patients voided spontaneously after catheter removal. Late complications were meatal stenosis, urethrocutaneous fistula, meatal regression, and glandular dehiscence (Table). These patients were treated using dilatation, fistula repair, meatoplasty, and secondary repair with the same technique, respectively. Eventually all patients had a vertical slit-like meatus on the tip of a natural looking glans. The most commonly used distal hypospadias repair techniques are glanular approximation, meatal advancement and glanuloplasty, Koff, Mathieu, Thiersch-Duplay procedure, tubularized incised plate repairs, and modifications of these techniques. Cosmetic and functional results and complication rates of ECMB-LUM technique are comparable with those of the commonly used techniques. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Long-term effect of urethral dilatation and internal urethrotomy for urethral strictures.

PubMed

Veeratterapillay, Rajan; Pickard, Rob S

2012-11-01

Urethral dilatation and direct visual internal urethrotomy (DVIU) are widely used minimally invasive options to manage men with urethral strictures. Advances in open urethroplasty with better long-term cure rates have fuelled the continuing debate as to which treatment is best for primary and recurrent urethral strictures. We reviewed recent literature to identify contemporary practice of urethral dilatation and DVIU and the long-term outcome of these procedures. Systematic literature search for the period January 2010 to December 2011 showed that urethral dilatation and DVIU remain frequently used treatment options as confirmed by surveys of urologists in the USA and the Netherlands. Multiple reports of laser DVIU confirm the safety of this approach but long-term data were lacking. Stricture free rates from urethra dilatation and DVIU vary from 10 to 90% at 12 months, although adjunctive intermittent self-dilatation can reduce time to recurrence. Although quality-of-life benefit appears good in the short term, repeated procedures may harm sexual function in the long-term. Urethral dilatation and DVIU remain widely used in urethral stricture management but high-level comparative evidence of benefit and harms against urethroplasty in the short and long-term is still lacking.

Use of an Absorbable Urethral Stent for the Management of a Urethral Stricture in a Stallion.

PubMed

Trela, Jan M; Dechant, Julie E; Culp, William T; Whitcomb, Mary B; Palm, Carrie A; Nieto, Jorge E

2016-11-01

To describe the successful management of a urethral stricture with an absorbable stent in a stallion. Clinical report. Stallion with a urethral stricture. A 12-year-old Thoroughbred breeding stallion was evaluated for acute onset of colic. Uroperitoneum because of presumptive urinary bladder rupture, with urethral obstruction by a urethrolith, was diagnosed. The uroperitoneum was treated conservatively. The urethrolith was removed through a perineal urethrotomy. Approximately 15 weeks after urethrolith removal, the stallion presented with a urethral stricture. The stricture was unsuccessfully treated with an indwelling urinary catheter and 4 attempts at balloon dilation. Eight weeks after diagnosis of stricture, an absorbable polydioxanone (20 mm × 80 mm) urethral stent was implanted under percutaneous, ultrasound guidance. Urethroscopy was performed at 70, 155, and 230 days after stent placement and the endoscope passed through the affected site without complication. Urethroscopy at 155 days showed the stent had been reabsorbed. Follow-up 20 months after stent placement reports the stallion was able to void a normal urine stream. Absorbable urethral stent placement was a feasible treatment for urethral stricture in this stallion. © Copyright 2016 by The American College of Veterinary Surgeons.

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

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 sounds...

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 sounds...

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 sounds...

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 sounds...

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 sounds...

[Causes and management for male urethral stricture].

PubMed

Chen, Caifang; Zeng, Mingqiang; Xue, Ruizhi; Wang, Guilin; Gao, Zhiyong; Yuan, Wuxiong; Tang, Zhengyan

2018-05-28

To explore the etiology of male urethral stricture, analyze the therapeutic strategies of urethral stricture, and summarize the complicated cases.
 Methods: The data of 183 patients with urethral stricture were retrospectively analyzed, including etiology, obstruction site, stricture length, therapeutic strategy, and related complications.
 Results: The mean age was 49.7 years, the average course was 64.7 months, and the constituent ratio of 51 to 65 years old patients was 38.8% (71/183). The traumatic injury of patients accounted for 52.4% (96/183), in which the pelvic fracture accounted for 35.5% (65/183) and the straddle injury accounted for 16.9% (31/183). There were 54 cases of iatrogenic injury (29.5%). The posterior urethral stricture accounted for 45.9% (84/183), followed by the anterior urethral stricture (44.8%, 82/183) and the stenosis (6.6%, 12/183). A total of 99 patients (54.1%) received the end to end anastomosis, and 40 (21.9%) were treated with intracavitary surgery, such as endoscopic holmium laser, cold knife incision, endoscopic electroknife scar removal, balloon dilation, and urethral dilation. In the patients over 65-years old, the urethral stricture rate was 14.8% and the complication rate (70.4%) for transurethral resection of the prostate (TURP) was significantly higher than that of all samples (P<0.01).
 Conclusion: Both the etiology of male urethral stricture and the treatment strategy have changed and the incidence of traumatic and iatrogenic urethral stricture has increased in recent 3 years. The main treatment of urethral stricture has been transformed from endoscopic surgery into urethroplasty.

Management for the anterior combined with posterior urethral stricture: a 9-year single centre experience

PubMed Central

Deng, Tuo; Liao, Banghua; Luo, Deyi; Liu, Bing; Wang, Kunjie; Liu, Jiaming; Jin, Tao

2015-01-01

Objective: Therapy for anterior combined with posterior urethral stricture is difficult and controversial. This study aims to introduce a standard process for managing anterior combined with posterior urethral stricture. Patients and methods: 19 patients with anterior combined with posterior urethral stricture were treated following our standard process. Average (range) age was 52 (21-72) years old. In this standard process, anterior urethral stricture should be treated first. Endoscopic surgery is applied for anterior urethra stricture as a priority as long as obliteration does not occur, and operation for posterior urethral stricture can be conducted in the same stage. Otherwise, an open reconstructive urethroplasty for anterior urethral is needed; while in this condition, the unobliterated posterior urethra can also be treated with endoscopic surgery in the same stage; however, if posterior urethra obliteration exists, then open reconstructive urethroplasty for posterior urethral stricture should be applied 2-3 months later. Results: The median (range) follow-up time was 25.8 (3-56) months. All 19 patients were normal in urethrography after 1 month of the surgery. 4 patients (21.1%) recurred urethral stricture during follow-up, and the locations of recurred stricture were bulbomembranous urethra (2 cases), bulbar urethra (1 case) and bladder neck (1 case). 3 of them restored to health through urethral dilation, yet 1 underwent a second operation. 2 patients (10.5%) complaint of dripping urination. No one had painful erection, stress urinary incontinence or other complications. Conclusions: The management for anterior combined with posterior urethral stricture following our standard process is effective and safe. PMID:26064293

Mondia whitei (Periplocaceae) prevents and Guibourtia tessmannii (Caesalpiniaceae) facilitates fictive ejaculation in spinal male rats

PubMed Central

2013-01-01

Background Mondia whitei and Guibourtia tessmannii are used in Cameroon traditional medicine as aphrodisiacs. The present study was undertaken to evaluate the pro-ejaculatory effects of the aqueous and organic solvent extracts of these plants in spinal male rats. Methods In spinal cord transected and urethane-anesthetized rats, two electrodes where inserted into the bulbospongiosus muscles and the ejaculatory motor pattern was recorded on a polygraph after urethral and penile stimulations, intravenous injection of saline (0.1 ml/100 g), dopamine (0.1 μM/kg), aqueous and organic solvent plant extracts (20 mg/kg). Results In all spinal rats, urethral and penile stimulations always induced the ejaculatory motor pattern. Aqueous or hexane extract of Mondia whitei (20 mg/kg) prevented the expression of the ejaculatory motor pattern. The pro-ejaculatory effects of dopamine (0.1 μM/kg) were not abolished in spinal rats pre-treated with Mondia whitei extracts. Aqueous and methanolic stem bark extracts of Guibourtia tessmannii (20 mg/kg) induced fictive ejaculation characterized by rhythmic contractions of the bulbospongiosus muscles followed sometimes with expulsion of seminal plugs. In rats pre-treated with haloperidol (0.26 μM/kg), no ejaculatory motor pattern was recorded after intravenous injection of Guibourtia tessmannii extracts (20 mg/kg). Conclusion These results show that Mondia whitei possesses preventive effects on the expression of fictive ejaculation in spinal male rats, which is not mediated through dopaminergic pathway; on the contrary, the pro-ejaculatory activities of Guibourtia tessmannii require the integrity of dopaminergic system to exert its effects. The present findings further justify the ethno-medicinal claims of Mondia whitei and Guibourtia tessmannii. PMID:23295154

Gemcitabine Hydrochloride and Cisplatin With or Without Bevacizumab in Treating Patients With Advanced Urinary Tract Cancer

ClinicalTrials.gov

2018-06-11

Bladder Urothelial Carcinoma; Distal Urethral Carcinoma; Infiltrating Bladder Urothelial Carcinoma Associated With Urethral Carcinoma; Metastatic Urothelial Carcinoma of the Renal Pelvis and Ureter; Proximal Urethral Carcinoma; Recurrent Bladder Carcinoma; Recurrent Prostate Carcinoma; Recurrent Urethral Carcinoma; Recurrent Urothelial Carcinoma of the Renal Pelvis and Ureter; Regional Urothelial Carcinoma of the Renal Pelvis and Ureter; Stage IV Bladder Cancer AJCC v7; Stage IV Prostate Cancer AJCC v7; Stage IV Urethral Cancer AJCC v7; Ureter Carcinoma

[Urethroplasty and simultaneous perineal prostatectomy after traumatic urethral disruption and carcinoma of the prostate].

PubMed

Gillitzer, R; Hampel, C; Pahernik, S; Melchior, S W; Thüroff, J W

2006-09-01

We present a case of post-traumatic posterior urethral stricture and localized prostate cancer, which could be treated successfully with simultaneous radical perineal prostatectomy and membranous urethral stricture excision. After 6 months follow-up, the patient is continent with no evidence of stricture recurrence. Post-traumatic posterior urethral strictures can be managed surgically through a perineal approach with high success rates. Prostate surgery after pelvic fracture with posterior urethral distraction defects does not necessarily lead to stress urinary incontinence.

Erectile dysfunction in urethral stricture and pelvic fracture urethral injury patients: diagnosis, treatment, and outcomes.

PubMed

Sangkum, P; Levy, J; Yafi, F A; Hellstrom, W J G

2015-05-01

Urethral stricture disease, pelvic fracture urethral injury (PFUI), and their various treatment options are associated with erectile dysfunction (ED). The etiology of urethral stricture disease is multifactorial and includes trauma, inflammatory, and iatrogenic causes. Posterior urethral injuries are commonly associated with pelvic fractures. There is a spectrum in the severity of both conditions and this directly impacts the treatment options offered by the surgeon. Many published studies focus on the treatment outcomes and the relatively high recurrence rates after surgical repair. This communication reviews the current knowledge of the association between ED and urethral stricture disease, as well as PFUI. The incidence, pathophysiology, and clinical ramifications of both conditions on sexual function are discussed. The treatment options for ED in those patients are reviewed and summarized. © 2015 American Society of Andrology and European Academy of Andrology.

Outcomes of urethral calculi patients in an endemic region and an undiagnosed primary fossa navicularis calculus.

PubMed

Verit, Ayhan; Savas, Murat; Ciftci, Halil; Unal, Dogan; Yeni, Ercan; Kaya, Mete

2006-02-01

Urethral calculus is a rare form of urolithiasis with an incidence lower than 0.3%. We determined the outcomes of 15 patients with urethral stone, of which 8 were pediatric, including an undiagnosed primary fossa navicularis calculus. Fifteen consecutive male patients, of whom eight were children, with urethral calculi were assessed between 2000 and 2005 with a mean of 19 months' follow-up. All stones were fusiform in shape and solitary. Acute urinary retention, interrupted or weak stream, pain (penile, urethral, perineal) and gross hematuria were the main presenting symptoms in 7 (46.7%), 4 (26.7%), 3 (20%) and 1 (6.6%) patient, respectively. Six of them had accompanying urethral pathologies such as stenosis (primary or with hypospadias) and diverticulum. Two patients were associated with upper urinary tract calculi but none of them secondary to bladder calculi. A 50-year-old patient with a primary urethral stone disease had urethral meatal stenosis accompanied by lifelong lower urinary tract symptoms. Unlike the past reports, urethral stones secondary to bladder calculi were decreasing, especially in the pediatric population. However, the pediatric patients in their first decade are still under risk secondary to the upper urinary tract calculi or the primary ones.

Comparison of urethral diameters for calculating the urethral dose after permanent prostate brachytherapy.

PubMed

Tanaka, Osamu; Hayashi, Shinya; Matsuo, Masayuki; Nakano, Masahiro; Kubota, Yasuaki; Maeda, Sunaho; Ohtakara, Kazuhiro; Deguchi, Takashi; Hoshi, Hiroaki

2007-08-01

No studies have yet evaluated the effects of a dosimetric analysis for different urethral volumes. We therefore evaluated the effects of a dosimetric analysis to determine the different urethral volumes. This study was based on computed tomography/magnetic resonance imaging (CT/MRI) combined findings in 30 patients who had undergone prostate brachytherapy. Postimplant CT/MRI scans were performed 30 days after the implant. The urethra was contoured based on its diameter (8, 6, 4, 2, and 0 mm). The total urethral volume-in cubic centimeters [UrV150/200(cc)] and percent (UrV150%/200%), of the urethra receiving 150% or 200% of the prescribed dose-and the doses (UrD90/30/5) in Grays to 90%, 30%, and 5% of the urethral volume were measured based on the urethral diameters. The UrV150(cc) and UrD30 were statistically different between the of 8-, 6-, 4-, 2-, and 0-mm diameters, whereas the UrD5 was statistically different only between the 8-, 6-, and 4-mm diameters. Especially for UrD5, there was an approximately 40-Gy difference between the mean values for the 8- and 0-mm diameters. We recommend that the urethra should be contoured as a 4- to 6-mm diameter circle or one side of a triangle of 5-7 mm. By standardizing the urethral diameter, the urethral dose will be less affected by the total urethral volume.

The protective arm of the renin-angiotensin system may counteract the intense inflammatory process in fetuses with posterior urethral valves.

PubMed

Rocha, Natalia P; Bastos, Fernando M; Vieira, Érica L M; Prestes, Thiago R R; Silveira, Katia D da; Teixeira, Mauro M; Simões E Silva, Ana Cristina

2018-03-11

Posterior urethral valve is the most common lower urinary tract obstruction in male children. A high percentage of patients with posterior urethral valve evolve to end-stage renal disease. Previous studies showed that cytokines, chemokines, and components of the renin-angiotensin system contribute to the renal damage in obstructive uropathies. The authors recently found that urine samples from fetuses with posterior urethral valve have increased levels of inflammatory molecules. The aim of this study was to measure renin-angiotensin system molecules and to investigate their correlation with previously detected inflammatory markers in the same urine samples of fetuses with posterior urethral valve. Urine samples from 24 fetuses with posterior urethral valve were collected and compared to those from 22 healthy male newborns at the same gestational age (controls). Renin-angiotensin system components levels were measured by enzyme-linked immunosorbent assay. Fetuses with posterior urethral valve presented increased urinary levels of angiotensin (Ang) I, Ang-(1-7) and angiotensin-converting enzyme 2 in comparison with controls. ACE levels were significantly reduced and Ang II levels were similar in fetuses with posterior urethral valve in comparison with controls. Increased urinary levels of angiotensin-converting enzyme 2 and of Ang-(1-7) in fetuses with posterior urethral valve could represent a regulatory response to the intense inflammatory process triggered by posterior urethral valve. Copyright © 2018 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Pelvic fracture urethral distraction defects in children managed by anterior sagittal trans anorectal approach: a facilitating and safe access.

PubMed

Onofre, Luciano Silveira; Leão, Jovelino Quintino de Souza; Gomes, Adriano Luis; Heinisch, Antonio Carlos; Leão, Fernanda Ghilardi; Carnevale, José

2011-06-01

Trauma injuries of the posterior urethra resulting from pelvic fracture in children tend to be complete ruptures, with upper dislocation of the prostate. This paper aims to show our experience in using an anterior sagittal transanorectal approach (ASTRA) in the treatment of such injuries. The medical records of 11 patients with pelvic fracture urethral distraction defects who had undergone anastomotic urethroplasty through ASTRA between 1997 and 2009 were reviewed. Ages ranged from 1 year and 6 months to 23 years (mean age 11 years). Of the 11 patients, 8 had previously undergone failed urethroplasties. In 10 patients it was possible to perform tension free urethroplasty. One patient required inferior pubectomy and separation of the corpora cavernosa. Patients' follow-up time varied from 10 months to 10 years and 9 months (mean 41 months). One patient had a urethral fistula and evolved with a urethral diverticulum successfully managed by diverticulectomy. One patient presented a urethral stenosis managed by urethral dilatation. Of the 11 patients, 9 presented functional urethral flow and are continent. Two patients had no urethral flow. One is undergoing bladder catheterization through the Mitrofanoff principle and the other one through the urethra. No patient presented fecal incontinence or rectourethral fistula. This access, which is increasingly being used to approach posterior urethral diseases, has proved to be safe and effective in the treatment of pelvic fracture urethral distraction defects. Copyright © 2011 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

To sling or not to sling at time of abdominal sacrocolpopexy: a cost-effectiveness analysis.

PubMed

Richardson, Monica L; Elliott, Christopher S; Shaw, Jonathan G; Comiter, Craig V; Chen, Bertha; Sokol, Eric R

2013-10-01

We compare the cost-effectiveness of 3 strategies for the use of a mid urethral sling to prevent occult stress urinary incontinence in patients undergoing abdominal sacrocolpopexy. Using decision analysis modeling we compared cost-effectiveness during a 1-year postoperative period of 3 treatment approaches including 1) abdominal sacrocolpopexy alone with deferred option for mid urethral sling, 2) abdominal sacrocolpopexy with universal concomitant mid urethral sling and 3) preoperative urodynamic study for selective mid urethral sling. Using published data we modeled probabilities of stress urinary incontinence after abdominal sacrocolpopexy with or without mid urethral sling, the predictive value of urodynamic study to detect occult stress urinary incontinence and the likelihood of complications after mid urethral sling. Costs were derived from Medicare 2010 reimbursement rates. The main outcome modeled was incremental cost-effectiveness ratio per quality adjusted life-years gained. In addition to base case analysis, 1-way sensitivity analyses were performed. In our model, universally performing mid urethral sling at abdominal sacrocolpopexy was the most cost-effective approach with an incremental cost per quality adjusted life-year gained of $2,867 compared to abdominal sacrocolpopexy alone. Preoperative urodynamic study was more costly and less effective than universally performing intraoperative mid urethral sling. The cost-effectiveness of abdominal sacrocolpopexy plus mid urethral sling was robust to sensitivity analysis with a cost-effectiveness ratio consistently below $20,000 per quality adjusted life-year. Universal concomitant mid urethral sling is the most cost-effective prophylaxis strategy for occult stress urinary incontinence in women undergoing abdominal sacrocolpopexy. The use of preoperative urodynamic study to guide mid urethral sling placement at abdominal sacrocolpopexy is not cost-effective. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Effectiveness of syndromic management for male patients with urethral discharge symptoms in Amazonas, Brazil.

PubMed

Menezes Filho, Jonas Rodrigues de; Sardinha, José Carlos Gomes; Galbán, Enrique; Saraceni, Valéria; Talhari, Carolina

2017-01-01

Urethral discharge syndrome (UDS) is characterized by the presence of purulent or mucopurulent urethral discharge.The main etiological agents of this syndrome are Neisseria gonorrhoeae and Chlamydia trachomatis. To evaluate the effectiveness of the syndromic management to resolve symptoms in male urethral discharge syndrome cases in Manaus, Amazonas, Brazil. Retrospective cohort of male cases of urethral discharge syndrome observed at a clinic for sexually transmitted disease (STD) in 2013. Epidemiological and clinical data, as well as the results of urethral swabs, bacterioscopy, hybrid capture for C.trachomatis, wet-mount examination, and culture for N.gonorrhoeae, were obtained through medical chart reviews. Of the 800 urethral discharge syndrome cases observed at the STD clinic, 785 (98.1%) presented only urethral discharge syndrome, 633 (79.1%) returned for follow-up, 579 (91.5%) were considered clinically cured on the first visit, 41(6.5 %) were considered cured on the second visit, and 13(2.0%) did not reach clinical cure after two appointments. Regarding the etiological diagnosis, 42.7% of the patients presented a microbiological diagnosis of N.gonorrhoeae, 39.3% of non-gonococcal and non-chlamydia urethritis, 10.7% of C.trachomatis and 7.3% of co-infection with chlamydia and gonococcus. The odds of being considered cured in the first visit were greater in those who were unmarried, with greater schooling, and with an etiological diagnosis of gonorrhea. The diagnosis of non-gonococcal urethritis reduced the chance of cure in the first visit. A study conducted at a single center of STD treatment. Syndromic management of male urethral discharge syndrome performed in accordance with the Brazilian Ministry of Health STD guidelines was effective in resolving symptoms in the studied population. More studies with microbiological outcomes are needed to ensure the maintenance of the syndromic management.

Dual Pathology Causing Congenital Bladder Outlet Obstruction.

PubMed

Kwong, Ruth; Johal, Navroop S; Upasani, Anand; Paul, Anu; Cuckow, Peter

2017-12-07

Anterior urethral syringocele is an uncommon congenital deformity characterised by cystic dilatation of bulbo-urethral gland ducts and is usually asymptomatic. We present a case on 4-day-old male neonate who presented with bilateral antenatal hydroureteronephrosis and renal impairment and found to have urethral syringocele and posterior urethral valves (PUV). Copyright © 2017. Published by Elsevier Inc.

Trastuzumab in Treating Patients With Previously Treated, Locally Advanced, or Metastatic Cancer of the Urothelium

ClinicalTrials.gov

2013-05-01

Distal Urethral Cancer; Metastatic Transitional Cell Cancer of the Renal Pelvis and Ureter; Proximal Urethral Cancer; Recurrent Bladder Cancer; Recurrent Transitional Cell Cancer of the Renal Pelvis and Ureter; Recurrent Urethral Cancer; Stage IV Bladder Cancer; Transitional Cell Carcinoma of the Bladder; Urethral Cancer Associated With Invasive Bladder Cancer

A Giant Urethral Calculus.

PubMed

Sigdel, G; Agarwal, A; Keshaw, B W

2014-01-01

Urethral calculi are rare forms of urolithiasis. Majority of the calculi are migratory from urinary bladder or upper urinary tract. Primary urethral calculi usually occur in presence of urethral stricture or diverticulum. In this article we report a case of a giant posterior urethral calculus measuring 7x3x2 cm in a 47 years old male. Patient presented with acute retention of urine which was preceded by burning micturition and dribbling of urine for one week. The calculus was pushed in to the bladder through the cystoscope and was removed by suprapubic cystolithotomy.

The Efficacy of Bulbar Urethral Mobilization for Anastomotic Anterior Urethroplasty in a Case With Recurrent Anterior Urethral Stricture

PubMed Central

Fukui, Shinji; Aoki, Katsuya; Kaneko, Yoshiteru; Samma, Shoji; Fujimoto, Kiyohide

2014-01-01

A 2-month-old boy was diagnosed with febrile urinary tract infection. Voiding cystourethrography showed bulbar and anterior urethral strictures, and endoscopic internal urethrotomy was performed. He developed febrile urinary tract infection again and revealed the recurrence of the anterior urethral stricture. Consequently, endoscopic internal urethrotomy was performed 4 times. Because the anterior urethral stricture had not improved, he was referred to us. Anterior urethroplasty was performed when he was 5 years. After excision of the scarred portions of the urethra, the defect of the urethra was 20 mm. Transperineal bulbar urethral mobilization was performed, and a single-stage end-to-end anterior urethroplasty without tension could be performed simultaneously. PMID:26955558

The Efficacy of Bulbar Urethral Mobilization for Anastomotic Anterior Urethroplasty in a Case With Recurrent Anterior Urethral Stricture.

PubMed

Fukui, Shinji; Aoki, Katsuya; Kaneko, Yoshiteru; Samma, Shoji; Fujimoto, Kiyohide

2014-05-01

A 2-month-old boy was diagnosed with febrile urinary tract infection. Voiding cystourethrography showed bulbar and anterior urethral strictures, and endoscopic internal urethrotomy was performed. He developed febrile urinary tract infection again and revealed the recurrence of the anterior urethral stricture. Consequently, endoscopic internal urethrotomy was performed 4 times. Because the anterior urethral stricture had not improved, he was referred to us. Anterior urethroplasty was performed when he was 5 years. After excision of the scarred portions of the urethra, the defect of the urethra was 20 mm. Transperineal bulbar urethral mobilization was performed, and a single-stage end-to-end anterior urethroplasty without tension could be performed simultaneously.

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

Correlation of prostaglandin E2 concentrations in synovial fluid with ground reaction forces and clinical variables for pain or inflammation in dogs with osteoarthritis induced by transection of the cranial cruciate ligament.

PubMed

Trumble, Troy N; Billinghurst, R Clark; McIlwraith, C Wayne

2004-09-01

To evaluate the temporal pattern of prostaglandin (PG) E2 concentrations in synovial fluid after transection of the cranial cruciate ligament (CCL) in dogs and to correlate PGE2 concentrations with ground reaction forces and subjective clinical variables for lameness or pain. 19 purpose-bred adult male Walker Hounds. Force plate measurements, subjective clinical analysis of pain or lameness, and samples of synovial fluid were obtained before (baseline) and at various time points after arthroscopic transection of the right CCL. Concentrations of PGE2 were measured in synovial fluid samples, and the PGE2 concentrations were correlated with ground reaction forces and clinical variables. The PGE2 concentration increased significantly above the baseline value throughout the entire study, peaking 14 days after transection. Peak vertical force and vertical impulse significantly decreased by day 14 after transection, followed by an increase over time without returning to baseline values. All clinical variables (eg, lameness, degree of weight bearing, joint extension, cumulative pain score, effusion score, and total protein content of synovial fluid, except for WBC count in synovial fluid) increased significantly above baseline values. Significant negative correlations were detected between PGE2 concentrations and peak vertical force (r, -0.5720) and vertical impulse (r, -0.4618), and significant positive correlations were detected between PGE2 concentrations and the subjective lameness score (r, 0.5016) and effusion score (r, 0.6817). Assessment of the acute inflammatory process by measurement of PGE2 concentrations in synovial fluid may be correlated with the amount of pain or lameness in dogs.

Female urethral injuries associated with pelvic fracture: a systematic review of the literature.

PubMed

Patel, Devin N; Fok, Cynthia S; Webster, George D; Anger, Jennifer T

2017-12-01

To review systematically the literature on female urethral injuries associated with pelvic fracture and to determine the optimum management of this rare injury. Using Meta-analysis of Observational Studies in Epidemiology criteria, we searched the Cochrane, Pubmed and OVID databases for all articles available before 30 June 2016 using the terms 'female pelvic fracture urethroplasty', 'female urethral distraction', 'female pelvic fracture urethral injury' and 'female pelvic fracture urethra girls.' Two authors of this paper independently reviewed the titles, abstracts, and articles in duplicate. We identified 162 individual articles from the databases. Fifty-one articles met our criteria for full review, including 158 female patients with urethral trauma. Of these injuries, 83 (53%) were managed with immediate repair; 17/83 (20%) via primary alignment and 66/83 (80%) via anastomotic repair. The remaining 75/158 (47%) were managed with delayed repair. Rates of urethral stenosis and fistula were highest after primary alignment. Urethral integrity appears to be similar after both primary anastomosis and delayed repair; however, patients experienced significantly more incontinence and vaginal stenosis after delayed repair. Patients who underwent delayed urethral repair were more likely to undergo more extensive reconstructive surgery than those who underwent primary repair. The optimum management of female urethral distraction defects is based on very-low-quality literature. Based on our review of the available literature, primary anastomotic repair of a female urethral distraction defect via a vaginal approach as soon as the patient is haemodynamically stable appears to be optimal. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

A descriptive study of urethral discharge among men in Fiji.

PubMed

Gaunavinaka, Lavenia; Balak, Dashika; Varman, Sumanthla; Ram, Sharan; Graham, Stephen M

2014-10-17

Urethral discharge is a common presentation of sexually transmitted infection (STI) in men and known pathogens include Neisseria gonorrhoeae and Chlamydia trachomatis. There are no published data of the burden of urethral discharge among men in Fiji. To evaluate urethral discharge among men to determine the incidence, the frequency of recurrence and reported at-risk behaviour. We conducted a retrospective, descriptive study of clinical records of all men presenting with urethral discharge to two major reproductive health clinics. Data collected included self-reported at-risk behaviours, results of abnormal syphilis serology and antibiotics prescribed. The frequency of recurrence in the following 1-2 years of initial presentation was determined along with microbiological findings from urethral swab in this group. A total of 748 males presented with urethral discharge to the clinic in one year. This represents an incidence rate of at least 295 per 100,000 adult males per year in the study population. Within the next 1-2 years of the initial presentation, 102 (14%) of these re-presented out of which 42 had urethral swab taken for etiological diagnosis. The commonest isolate was Neisseria gonorrhoeae. Results of syphilis tests were available for 560 (75%) of patients and 29 (5%) were positive. Recurrence was not associated with self-reported at-risk behaviours. The incidence of urethral discharge among males in Fiji is very high and prevention strategies are urgently needed.

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

[Urethral stricture rate after prostate cancer radiotherapy : Five-year data of a certified prostate cancer center].

PubMed

Kranz, J; Maurer, G; Maurer, U; Deserno, O; Schulte, S; Steffens, J

2017-03-01

A urethral stricture is a scar of the urethral epithelium which can cause obstructive voiding dysfunction with consequential damage of the upper urinary tract. Almost 45% of all strictures are iatrogenic; they develop in 2-9% of patients after radical prostatectomy, but can also occur after prostate cancer radiotherapy. This study provides 5‑year data of a certified prostate cancer center (PKZ) in terms of urethral strictures. Between 01/2008 and 12/2012 a total of 519 men were irradiated for prostate cancer (LDR and HDR brachytherapy as well as external beam radiation). The entire cohort was followed-up prospectively according to a standardized protocol (by type of irradiation). Short segment urethral strictures were treated by urethrotomy, recurrent and long segment stenosis with buccal mucosa urethroplasty. A total of 18 of 519 (3.4%) patients developed a urethral stricture post-therapeutically, which recurred in 66% of cases after the first operative treatment. The largest risk for developing a urethral stricture is attributed to the HDR brachytherapy (8.9%). Urethral strictures after prostate cancer radiotherapy should be diagnosed and treated in time for long-term preservation of renal function. The rate of radiogenic urethral strictures (3.4%) is equivalent to those after radical prostatectomy. Due to a high rate of recurrences, urethrotomy has a limited importance after irradiation.

[Clinical studies on lower urinary tract injury].

PubMed

Tanaka, M; Ozono, S; Takashima, K; Yoshida, K; Hirao, Y; Okajima, E; Kaneko, Y; Tabata, S; Yoshida, K; Moriya, A

1997-01-01

A total of 61 patients with lower urinary tract injuries were treated at Nara Medical University and its affiliated hospitals, between January 1985 and June 1995. There were 9 patients with bladder injuries and 52 patients with urethral injuries. The main cause of bladder injury was a traffic accident sustained in 4 patients (44.5%) and that of urethral injury was an occupational accident sustained in 27 cases (51.9%). The major associated injuries were a bone fracture seen in 45 patients (73.8%) and an intrascrotal hematoma seen in 28 patients (45.9%). Posterior urethral injuries associated with pelvic bone fractures were classified into 3 types according to the classification reported by Colapinto et al.; 8 patients (32.0%) into Type I, 8 (32.0%) into Type II and 9 (36.0%) into Type III. Of the 25 patients with posterior urethral injuries, 8 (32.0%) underwent immediate surgical treatment, 12 (48.0%) underwent initial cystostomies and delayed surgical treatment and 5 (20.0%) received indwelling of urethral catheters. Postoperative complications of urethral injury included urethral stricture in 30 patients (57.7%), incontinence in 3 (5.8%) and impotence in 3 (5.8%). A significant relationship between the duration of cystostomy and the incidence of postoperative urethral stricture was observed in our patients. Therefore at least three weeks of cystostomy will be necessary in the management of patients with complicated urethral injuries.

Results of surgical excision of urethral prolapse in symptomatic patients.

PubMed

Hall, Mary E; Oyesanya, Tola; Cameron, Anne P

2017-11-01

Here, we present the clinical presentation and surgical outcomes of women with symptomatic urethral prolapse presenting to our institution over 20 years, and seek to provide treatment recommendations for management of symptomatic urethral prolapse and caruncle. A retrospective review of medical records from female patients who underwent surgery for symptomatic urethral prolapse from June 1995 to August 2015 was performed. Surgical technique consisted of a four-quadrant excisional approach for repair of urethral prolapse. A total of 26 patients were identified with a mean age of 38.8 years (range 3-81). The most common presentations were vaginal bleeding, hematuria, pain, and dysuria. All patients underwent surgical excision of urethral prolapse via a standard approach. Follow-up data was available in 24 patients. Six patients experienced temporary postoperative bleeding, and one patient required placement of a Foley catheter for tamponade. One patient experienced temporary postoperative urinary retention requiring Foley catheter placement. Three patients had visible recurrence of urethral prolapse, for which one later underwent re-excision. Surgical excision of urethral prolapse is a reasonable treatment option in patients who have tried conservative management without relief, as well as in those who present with severe symptoms. Possible complications following excision include postoperative bleeding and recurrence, and patients must be counseled accordingly. In this work, we propose a treatment algorithm for symptomatic urethral prolapse. © 2017 Wiley Periodicals, Inc.

Urethral Stenting for Obstructive Uropathy Utilizing Digital Radiography for Guidance: Feasibility and Clinical Outcome in 26 Dogs.

PubMed

Radhakrishnan, A

2017-03-01

Urethral stent placement is an interventional treatment option to alleviate urethral outflow obstruction. It has been described utilizing fluoroscopy, but fluoroscopy is not as readily available in private practice as digital radiography. To describe the use of digital radiography for urethral stent placement in dogs with obstructive uropathy. Twenty-six client-owned dogs presented for dysuria associated with benign and malignant causes of obstructive uropathy that underwent urethral stent placement. Retrospective study. Causes of obstructive uropathy included transitional cell carcinoma, prostatic carcinoma, hemangiosarcoma, obstructive proliferative urethritis, compressive vaginal leiomyosarcoma, and detrusor-sphincter dyssynergia. Survival time range was 1-48 months (median, 5 months). All dogs were discharged from the hospital with urine outflow restored. Intraprocedural complications included guide wire penetration of the urethral wall in 1 dog and improper stent placement in a second dog. Both complications were successfully managed at the time of the procedure with no follow-up problems noted in either patient. Urethral stent placement can be successfully performed utilizing digital radiography. The complications experienced can be avoided by more cautious progression with each step through the procedure and serial radiography. The application of digital radiography may allow treatment of urethral obstruction to become more readily available. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

Gemcitabine Hydrochloride and Cisplatin or High-Dose Methotrexate, Vinblastine, Doxorubicin Hydrochloride, and Cisplatin in Treating Patients With Urothelial Cancer

ClinicalTrials.gov

2014-01-27

Anterior Urethral Cancer; Localized Transitional Cell Cancer of the Renal Pelvis and Ureter; Posterior Urethral Cancer; Recurrent Bladder Cancer; Recurrent Urethral Cancer; Regional Transitional Cell Cancer of the Renal Pelvis and Ureter; Stage III Bladder Cancer; Transitional Cell Carcinoma of the Bladder; Ureter Cancer; Urethral Cancer Associated With Invasive Bladder Cancer

3D velocity imaging of Hikurangi subduction beneath the Wellington region, New Zealand

NASA Astrophysics Data System (ADS)

Wech, A.; Henrys, S. A.; Sutherland, R.; Seward, A. M.; Stern, T. A.; Sato, H.; Okaya, D. A.; Bassett, D.

2011-12-01

We present first results from the Seismic Array HiKurangi Experiment (SAHKE). This joint project involving institutions from New Zealand, Japan and the USA aims to investigate the subduction zone fault characteristics beneath the southernmost part of New Zealand's North Island. Situated above where the Pacific Plate is subducting beneath the Australian plate at a rate of ~42 mm/yr, the Wellington region provides a unique opportunity to investigate the frictional properties, geometry, and seismic potential of a shallow, locked megathrust fault. Here the coupled plate interface is 20-30 km deep beneath land and can be sampled with onshore-offshore data from 3 sides. An added interest to this project is that the elevated, oceanic, Hikurangi plateau has entered the subduction zone, east of Wellington, but it is still unclear how far the plateau has advanced westward into the subduction zone. SAHKE combines active and passive source data comprising 4 distinct data sets. 1) A dense temporary array of 50 seismometers with ~7 km spacing augmented 25 regional network instruments to record 49 local and 45 teleseismic earthquakes over a four month period. 2) These stations also recorded 69,000 offshore airgun shots from 17 lines crisscrossing two sides of the array. 3) An additional coast-to-coast transect of 50 stations cutting through the temporary array recorded ~2000 offshore shots on either side. 4) 1000 stations with 100m spacing along that same transect separately recorded 12 in-line, 500 kg onshore dynamite explosions. First inspection of the recent onshore shot gathers show excellent signal to noise and a band of three strong reflectors between 20 and 38 km at the western end of the profile. We combine shot and earthquake recordings to simultaneously invert ~750,000 first arrivals for velocity structure and hypocenters in the densely sampled volume. First results from 3D, Vp tomography and relocated hypocenters agree with previous studies and suggest the later weak signals are reflections from the top of the Pacific plate. Our improved velocity model provides a high-resolution geometry of the subducting plate to support interpretation of other phases identified in SAHKE shot gathers.

Shear-wave splitting observations of mantle anisotropy beneath Alaska

NASA Astrophysics Data System (ADS)

Bellesiles, A. K.; Christensen, D. H.; Entwistle, E.; Litherland, M.; Abers, G. A.; Song, X.

2009-12-01

Observations of seismic anisotropy were obtained from three different PASSCAL broadband experiments throughout Alaska, using shear-wave splitting from teleseismic SKS phases. The MOOS (Multidisciplinary Observations Of Subduction), BEAAR (Broadband Experiment Across the Alaska Range), and ARCTIC (Alaska Receiving Cross-Transects for the Inner Core) networks were used along with selected permanent broadband stations operated by AEIC (Alaska Earthquake Information Center) to produce seismic anisotropy results for the state of Alaska along a north south transect from the active subduction zone in the south, through continental Alaska, to the passive margin in the north. The BEAAR network is in-between the ARCTIC and MOOS networks above the subducting Pacific Plate and mantle wedge and shows a tight ~90 degree rotation of anisotropy above the 70km contour of the subducting plate. The southern stations in BEAAR yield anisotropy results that are subparallel to the Pacific Plate motion as it subducts under North America. These stations have an average fast direction of -45 degrees and 1.03 seconds of delay on average. The MOOS network in south central Alaska yielded similar results with an average fast direction of -30 degrees and delay times of .9 seconds. In the north portion of the BEAAR network the anisotropy is along strike of the subduction zone and has an average fast direction of 27 degrees with an average delay time of 1.4 seconds, although the delay times above the mantle wedge range from 1 to 2.5 seconds and are directly correlated to the length of ray path in the mantle wedge. This general trend NE/SW is seen in the ARCTIC stations to the north although the furthest north stations are oriented more NNE compared to those in BEAAR. The average fast direction for the ARCTIC network is 40 degrees with an average delay time of 1.05 seconds. These results show two distinct orientations of anisotropy in Alaska separated by the subducting Pacific Plate.

Management of infected urethral diverticulum with urethral dilation.

PubMed

Lazarou, George; Andrikopoulou, Maria; Cho, Sylvia

2015-01-01

Urethral diverticula are rare but underdiagnosed entities that may cause a variety of urinary and pelvic symptoms in women. Management can be very challenging, especially in cases of chronic infection. A 69-year-old gravida 4, para 2 woman with a history of type 2 diabetes and hypothyroidism presented with long history of a painful midline 3-cm suburethral cystic mass, recurrent urinary tract infections, dysuria, dyspareunia, and incomplete voiding. The diagnosis was consistent with an infected urethral diverticulum unresponsive to multiple courses of oral antibiotics. Given the patient's comorbidities and the persistence of infection of the diverticulum, conservative treatment with urethral dilation was performed before surgical treatment. Urethral dilation successfully alleviated the patient's symptoms; the surgical treatment was not ultimately required, and the patient continues to be completely asymptomatic well over 17 months later. We present a unique case of infected urethral diverticulum, which was conservatively treated with dilatation and resulted in resolution of all symptoms, and there is no need for further surgical management.

Pelvic fracture urethral injuries: evaluation of various methods of management.

PubMed

Koraitim, M M

1996-10-01

The results of various immediate treatments of urethral injuries complicating a fractured pelvis were evaluated. The records of 100 male patients with pelvic fracture urethral injury were reviewed, 73 of whom were treated by suprapubic cystostomy and delayed repair, 23 by primary realignment and 4 by primary suturing. Also, the findings of 771 patients reported in the literature were reviewed. Urethral stricture was an almost inevitable consequence (97% of the cases) after suprapubic cystostomy. Primary realignment decreased the incidence of stricture to 53% but produced a 36% impotence rate. Primary suturing also decreased the incidence of stricture to 49% but produced the greatest complication rates for impotence (56%) and incontinence (21%). Suprapubic cystostomy alone is indicated for incomplete urethral rupture, slight urethral distraction and critically unstable patients, and when there are inadequate facilities or inexperienced surgeons. Primary realignment is advised if there is wide separation of the urethral ends, or associated injury of the bladder neck or rectum. Primary suturing is not recommended for any condition.

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

Acute urinary retention in women due to urethral calculi: A rare case

PubMed Central

Turo, Rafal; Smolski, Michal; Kujawa, Magda; Brown, Stephen C.W.; Brough, Richard; Collins, Gerald N.

2014-01-01

We present a case of a 51-year-old woman with acute urinary retention caused by a urethral calculus. Urethral calculi in women are extremely rare and are usually formed in association with underlying genitourinary pathology. In this case, however, no pathology was detected via thorough urological evaluation. We discuss the pathogenesis, clinical presentation and treatment of urethral calculi. To our knowledge, this is the second reported case of a primary urethral calculus in a female with an anatomically normal urinary tract and the first in a middle-aged Caucasian female. PMID:24554984

Urethral dysfunction due to alloxan-induced diabetes. Urodynamic evaluation and action of sildenafil citrate.

PubMed

Gomes de Souza Pegorare, Ana Beatriz; Gonçalves, Marco Antonio; Martiniano de Oliveira, Alessandra; Rodrigues Junior, Antonio Antunes; Tucci, Silvio; Suaid, Haylton Jorge

2014-04-01

To evaluate the effect of diabetes mellitus and of sildenafil citrate on female urethral function. Twenty nine female rats were divided into four groups: G1 - (n=9), normal rats; G2 - (n=6), normal rats treated with sildenafil citrate; G3 - (n=9) rats with alloxan-induced diabetes; G4 - (n=5) rats with alloxan-induced diabetes treated with sildenafil citrate. Under anesthesia, urodynamic evaluation was performed by cystometry and urethral pressure simultaneously. A significant increase in urethral pressure was observed during micturition. Sildenafil citrate can partially reduced urethral pressure in diabetic female rats.

Pelvic fracture urethral injuries in girls.

PubMed

Podestá, M L; Jordan, G H

2001-05-01

Injuries to the female urethra associated with pelvic fracture are uncommon. They may vary from urethral contusion to partial or circumferential rupture. When disruption has occurred at the level of the proximal urethra, it is usually complete and often associated with vaginal laceration. We retrospectively reviewed the records of a series of girls with pelvic fracture urethral stricture and present surgical treatment to restore urethral continuity and the outcome. Between 1984 and 1997, 8 girls 4 to 16 years old (median age 9.6) with urethral injuries associated with pelvic fracture were treated at our institutions. Immediate therapy involved suprapubic cystostomy in 4 cases, urethral catheter alignment and simultaneous suprapubic cystostomy in 3, and primary suturing of the urethra, bladder neck and vagina in 1. Delayed 1-stage anastomotic repair was performed in 1 patient with urethral avulsion at the level of the bladder neck and in 5 with a proximal urethral distraction defect, while a neourethra was constructed from the anterior vaginal wall in a 2-stage procedure in 1 with mid urethral avulsion. Concomitant vaginal rupture in 7 cases was treated at delayed urethral reconstruction in 5 and by primary repair in 2. The surgical approach was retropubic in 3 cases, vaginal-retropubic in 1 and vaginal-transpubic in 4. Associated injuries included rectal injury in 3 girls and bladder neck laceration in 4. Overall postoperative followup was 6 months to 6.3 years (median 3 years). Urethral obliteration developed in all patients treated with suprapubic cystostomy and simultaneous urethral realignment. The stricture-free rate for 1-stage anastomotic repair and substitution urethroplasty was 100%. In 1 girl complete urinary incontinence developed, while another has mild stress incontinence. Retrospectively the 2 incontinent girls had had an associated bladder neck injury at the initial trauma. Two recurrent vaginal strictures were treated successfully with additional transpositions of lateral labial flaps. This study emphasizes that combined vaginal-partial transpubic access is a reliable approach for resolving complex obliterative urethral strictures and associated urethrovaginal fistulas or severe bladder neck damage after traumatic pelvic fracture injury in female pediatric patients. Although our experience with the initial management of these injuries is limited, we advocate early cystostomy drainage and deferred surgical reconstruction when life threatening clinical conditions are present or extensive traumatized tissue in the affected area precludes immediate ideal surgical repair.

Predictive Toxicology and Computer Simulation of Male ...

EPA Pesticide Factsheets

The reproductive tract is a complex, integrated organ system with diverse embryology and unique sensitivity to prenatal environmental exposures that disrupt morphoregulatory processes and endocrine signaling. U.S. EPA’s in vitro high-throughput screening (HTS) database (ToxCastDB) was used to profile the bioactivity of 54 chemicals with male developmental consequences across ~800 molecular and cellular features. The in vitro bioactivity on molecular targets could be condensed into 156 gene annotations in a bipartite network. These results highlighted the role of estrogen and androgen signaling pathways in male reproductive tract development, and importantly, broadened the list of molecular targets to include GPCRs, cytochrome-P450s, vascular remodeling proteins, and retinoic acid signaling. A multicellular agent-based model was used to simulate the complex interactions between morphoregulatory, endocrine, and environmental influences during genital tubercle (GT) development. Spatially dynamic signals (e.g., SHH, FGF10, and androgen) were implemented in the model to address differential adhesion, cell motility, proliferation, and apoptosis. Under control of androgen signaling, urethral tube closure was an emergent feature of the model that was linked to gender-specific rates of ventral mesenchymal proliferation and urethral plate endodermal apoptosis. A systemic parameter sweep was used to examine the sensitivity of crosstalk between genetic deficiency and envi

Multiscale Systems Modeling of Male Reproductive Tract ...

EPA Pesticide Factsheets

The reproductive tract is a complex, integrated organ system with diverse embryology and unique sensitivity to prenatal environmental exposures that disrupt morphoregulatory processes and endocrine signaling. U.S. EPA’s in vitro high-throughput screening (HTS) database (ToxCastDB) was used to profile the bioactivity of 54 chemicals with male developmental consequences across ~800 molecular and cellular features [Leung et al., accepted manuscript]. The in vitro bioactivity on molecular targets could be condensed into 156 gene annotations in a bipartite network. These results highlighted the role of estrogen and androgen signaling pathways in male reproductive tract development, and importantly, broadened the list of molecular targets to include GPCRs, cytochrome-P450s, vascular remodeling proteins, and retinoic acid signaling. A multicellular agent-based model was used to simulate the complex interactions between morphoregulatory, endocrine, and environmental influences during genital tubercle (GT) development. Spatially dynamic signals (e.g., SHH, FGF10, and androgen) were implemented in the model to address differential adhesion, cell motility, proliferation, and apoptosis. Urethral tube closure was an emergent feature of the model that was linked to gender-specific rates of ventral mesenchymal proliferation and urethral plate endodermal apoptosis, both under control of androgen signaling [Leung et al., manuscript in preparation]. A systemic parameter sweep w

Seismic imaging along a 600 km transect of the Alaska Subduction zone (Invited)

NASA Astrophysics Data System (ADS)

Calkins, J. A.; Abers, G. A.; Freymueller, J. T.; Rondenay, S.; Christensen, D. H.

2010-12-01

We present earthquake locations, scattered wavefield migration images, and phase velocity maps from preliminary analysis of combined seismic data from the Broadband Experiment Across the Alaska Range (BEAAR) and Multidisciplinary Observations of Onshore Subduction (MOOS) projects. Together, these PASSCAL broadband arrays sampled a 500+ km transect across a portion of the subduction zone characterized by the Yakutat terrane/Pacific plate boundary in the downgoing plate, and the Denali volcanic gap in the overriding plate. These are the first results from the MOOS experiment, a 34-station array that was deployed from 2006-2008 to fill in the gap between the TACT offshore refraction profile (south and east of the coastline of the Kenai Peninsula), and the BEAAR array (spanning the Alaska Range between Talkeetna and Fairbanks). 2-D images of the upper 150 km of the subduction zone were produced by migrating forward- and back-scattered arrivals in the coda of P waves from large teleseismic earthquakes, highlighting S-velocity perturbations from a smoothly-varying background model. The migration images reveal a shallowly north-dipping low velocity zone that is contiguous near 20 km depth on its updip end with previously obtained images of the subducting plate offshore. The low velocity zone steepens further to the north, and terminates near 120 km beneath the Alaska Range. We interpret this low velocity zone to be the crust of the downgoing plate, and the reduced seismic velocities to be indicative of hydrated gabbroic compositions. Earthquakes located using the temporary arrays and nearby stations of the Alaska Regional Seismic Network correlate spatially with the inferred subducting crust. Cross-sections taken along nearly orthogonal strike lines through the MOOS array reveal that both the dip angle and the thickness of the subducting low velocity zone change abruptly across a roughly NNW-SSE striking line drawn through the eastern Kenai Peninsula, coincident with a distinct change in locking at the subduction interface as revealed by previous geodetic studies. On the west end of the Kenai Peninsula, where seismically imaged downgoing crust appears oceanic, the geodetic signal mainly reflects postseismic deformation from the 1964 earthquake as evinced by southeast trending displacement vectors (with respect to fixed North America). While postseismic relaxation continues east of the boundary, NNW-directed elastic deformation due to locking at the plate boundary dominates the geodetic signal, and imaging reveals thickened Yakutat crust is subducting. The collocation of sharp changes in both deep structure and surface deformation suggest that the nature of the plate interface changes drastically across the western edge of the Yakutat block and that variations in downgoing plate structure control the strain field in the overriding plate.

Ixabepilone in Treating Patients With Advanced Urinary Tract Cancer

ClinicalTrials.gov

2013-01-23

Distal Urethral Cancer; Metastatic Transitional Cell Cancer of the Renal Pelvis and Ureter; Proximal Urethral Cancer; Recurrent Bladder Cancer; Recurrent Transitional Cell Cancer of the Renal Pelvis and Ureter; Recurrent Urethral Cancer; Regional Transitional Cell Cancer of the Renal Pelvis and Ureter; Stage III Bladder Cancer; Stage IV Bladder Cancer; Transitional Cell Carcinoma of the Bladder; Urethral Cancer Associated With Invasive Bladder Cancer

Fore- and Back-Arc Structures Along the Hikurangi-Kermadec Subduction Zone

NASA Astrophysics Data System (ADS)

Scherwath, M.; Kopp, H.; Flueh, E. R.; Henrys, S. A.; Sutherland, R.

2009-04-01

The Hikurangi-Kermadec subduction zone northeast of New Zealand represents an ideal target to study lateral variations of subduction zone processes. The incoming Pacific plate changes from being a large igneous province, called the Hikurangi Plateau, in the south to normal oceanic plate north of the Rapuhia Scarp. The overriding Australian plate is continental in the south, forming the North Island of New Zealand, and changes to an island arc in the north. Further lateral variability exists in changes in volcanic and hydro-thermal activity, transitions from accretion to subduction erosion, backarc spreading and rifting, and is accompanied by northward increasing seismicity. As part of the MANGO project (Marine Geoscientific Investigations on the Input and Output of the Kermadec Subduction Zone), four marine geophysical transects of largely seismic reflection and refraction data provide constraints on the upper lithospheric structures across the Hikurangi-Kermadec Trench between 29-38 degrees South. On MANGO profile 1 in the south, the initially shallow subduction of the incoming plateau coincides with crustal underplating beneath the East Cape ridge. To the west lies the 100 km wide and over 10 km deep Raukumara Basin. Seismic velocities of the upper arc mantle are around 8 km/s and are considered normal. In contrast, on MANGO profile 4, about 1000 km to the north around the volcanically active Raoul Island, the incoming oceanic crust appears to bend considerably steeper and thus causes a 50 km narrower forearc with a smaller forearc basin. Furthermore, the upper mantle velocities in both plates are relatively low (7.4-7.7 km/s), likely indicating strong bending related deformation of the incoming plate and thermal activity within the arc possibly due to spreading. Here, arc volcanism is relatively active, with many large volcanoes directly on the ridge. The central two transects MANGO 2 and 3, though without data coverage of the structure of the incoming plate, are more similar to MANGO 4. The arc regions appear to be strongly affected by the activity of the arc. The arc crust of the northern MANGO 3 becomes significantly thinner in the backarc region due to extension, and much reduced volcanism behind the ridge. The structures on MANGO 2, on the other hand, cover strong and densely spaced thermal activity from the adjacent arc volcanism, possibly linked to a recent, fluid-rich passage of the Hikurangi Plateau.

Gravity constraints on the geometry of the Big Bend of the San Andreas Fault in the southern Carrizo Plains and Pine Mountain egion

NASA Astrophysics Data System (ADS)

Altintas, Ali Can

The goal of this project is to combine gravity measurements with geologic observations to better understand the "Big Bend" of the San Andreas Fault (SAF) and its role in producing hydrocarbon-bearing structures in the southern Central Valley of California. The SAF is the main plate boundary structure between the Pacific and North American plates and accommodates ?35 mm/yr of dextral motion. The SAF can be divided into three main parts: the northern, central and southern segments. The boundary between the central and southern segments is the "Big Bend", which is characterized by an ≈30°, eastward bend. This fault curvature led to the creation of a series of roughly east-west thrust faults and the transverse mountain ranges. Four high-resolution gravity transects were conducted across locations on either side of the bend. A total of 166 new gravity measurements were collected. Previous studies suggest significantly inclined dip angle for the San Andreas Fault in the Big Bend area. Yet, our models indicate that the San Andreas Fault is near vertical in the Big Bend area. Also gravity cross-section models suggest that flower structures occur on either side of the bend. These structures are dominated by sedimentary rocks in the north and igneous rocks in the south. The two northern transects in the Carrizo plains have an ≈-70 mgal Bouguer anomaly. The SAF has a strike of ≈315° near these transects. The northern transects are characterized by multiple fault strands which cut marine and terrestrial Miocene sedimentary rocks as well as Quaternary alluvial valley deposits. These fault strands are characterized by ?6 mgal short wavelength variations in the Bouguer gravity anomaly, which correspond to low density fault gouge and fault splays that juxtapose rocks of varying densities. The southern transects cross part of the SAF with a strike of 285°, have a Bouguer anomaly of ≈-50 mgal and are characterized by a broad 15 mgal high. At this location the rocks on either side of the fault are Proterozoic - Cretaceous metamorphic or/and plutonic rocks. Previous work based on geologic mapping hypothesized the existence of a shallow, low angle Abel Mountain Thrust in which crystalline rocks were thrust over Miocene sedimentary rocks, near Apache Saddle. However, gravity models indicate the crystalline rocks are vertically extensive and form a positive flower structure bounded by high angle faults. Also, based on the thickness of fault adjacent sedimentary cover, the gravity models suggest a minimum exhumation of 5-6 km for crystalline rocks in the south. Assuming exhumation began with the switch from the transtensional San Gabriel Fault to transpressional San Andreas Fault at approximately 5 Ma, this indicates exhumation rates of 1 km/Ma. Overall, the broad gravity highs observed along the southern transects are due to uplift of basement rocks in this area.

Effectiveness of syndromic management for male patients with urethral discharge symptoms in Amazonas, Brazil*

PubMed Central

de Menezes Filho, Jonas Rodrigues; Sardinha, José Carlos Gomes; Galbán, Enrique; Saraceni, Valéria; Talhari, Carolina

2017-01-01

Background Urethral discharge syndrome (UDS) is characterized by the presence of purulent or mucopurulent urethral discharge.The main etiological agents of this syndrome are Neisseria gonorrhoeae and Chlamydia trachomatis. Objectives To evaluate the effectiveness of the syndromic management to resolve symptoms in male urethral discharge syndrome cases in Manaus, Amazonas, Brazil. Methods Retrospective cohort of male cases of urethral discharge syndrome observed at a clinic for sexually transmitted disease (STD) in 2013. Epidemiological and clinical data, as well as the results of urethral swabs, bacterioscopy, hybrid capture for C.trachomatis, wet-mount examination, and culture for N.gonorrhoeae, were obtained through medical chart reviews. Results Of the 800 urethral discharge syndrome cases observed at the STD clinic, 785 (98.1%) presented only urethral discharge syndrome, 633 (79.1%) returned for follow-up, 579 (91.5%) were considered clinically cured on the first visit, 41(6.5 %) were considered cured on the second visit, and 13(2.0%) did not reach clinical cure after two appointments. Regarding the etiological diagnosis, 42.7% of the patients presented a microbiological diagnosis of N.gonorrhoeae, 39.3% of non-gonococcal and non-chlamydia urethritis, 10.7% of C.trachomatis and 7.3% of co-infection with chlamydia and gonococcus. The odds of being considered cured in the first visit were greater in those who were unmarried, with greater schooling, and with an etiological diagnosis of gonorrhea. The diagnosis of non-gonococcal urethritis reduced the chance of cure in the first visit. Study limitation A study conducted at a single center of STD treatment. Conclusion Syndromic management of male urethral discharge syndrome performed in accordance with the Brazilian Ministry of Health STD guidelines was effective in resolving symptoms in the studied population. More studies with microbiological outcomes are needed to ensure the maintenance of the syndromic management. PMID:29364432

[Endoscopic realignment with drainage via a peel-away sheath for the treatment of urethral rupture: A report of 21 cases].

PubMed

Han, Cong-Xiang; Xu, Wei-Jie; Li, Wei; Yu, Zhong-Ying; Li, Jin-Yu; Lin, Xia-Cong; Zhao, Li

2016-07-01

To study the clinical effect endoscopic realignment with drainage via a peel-away sheath in the treatment of urethral rupture. We treated 21 urethral rupture patients by endoscopic realignment with drainage via a peel-away sheath using normal saline for irrigation under the normal nephroscope or Li Xun nephroscope, followed by analysis of the clinical results. The operation was successfully accomplished in 20 cases but failed in 1 and none experienced urinary extravasation. In the 14 cases of bulbar urethral rupture, the mean operation time was (5.1±1.6) min and the mean Foley catheter indwelling time was (26.0±5.1) d. Urethral stricture developed in 57.1% (8/14) of the cases after catheter removal, of which 1 was cured by internal urethrotomy and the other 7 by urethral sound dilation, with an average maximum urinary flow rate of (18.8±1.8) ml/s at 12 months after operation. In the 6 cases of posterior urethral rupture, the mean operation time was (15.8±7.5) min and the mean Foley catheter indwelling time was 8 weeks. Urethral stricture developed in all the 6 cases after catheter removal, of which 3 cases were cured by urethral dilation, 1 by internal urethrotomy, and 2 by open urethroplasty. The average maxium urinary flow rate of the 4 cases exempt from open surgery was (17.9±1.9) ml/s at 12 months after operation. Endoscopic realignment with drainage via a peel-away sheath can keep the operative field clear, avoid intraoperative rinse extravasation, shorten the operation time, improve the operation success rate, and achieve satisfactory early clinical outcomes in the treatment of either bulbar or posterior urethral rupture.

On the etiology of the electric activity of the external anal and urethral sphincters.

PubMed

Shafik, Ali A; Shafik, Ismail A; El Sibai, Olfat

2014-10-01

In a previous study, the external anal sphincter (EAS) in dogs, known to consist of skeletal muscle fibers, was proved to contain bundles of smooth muscle fibers in between as well. Cause of electric activity in the external anal and urethral sphincters is not known; the current study investigated this point. Slices from external anal and urethral sphincters of 21 cadavers (12 male, 9 female). Eighth were fully and mat wide neonates, 13 were adults, were stained with hematoxylin and eosin, Masson's trichrome and succinic dehydrogenase, and examined microscopically. Eighteen healthy volunteers, electromyography activity of their external anal and urethral sphincters was recorded at rest, on coughing, after pudendal nerve block and after drotaverine administration, (a smooth muscle relaxant). Anal and urethral pressures were also measured. Microscopic studies have shown that both external anal and urethral sphincters were formed of bundles of smooth muscle fibers present in between the skeletal muscle fibers. Bilateral pudendal nerve block did not abolish the external anal or the urethral sphincters electromyography activity at rest, or on coughing, and did not cause significant anal or urethral pressure changes (p > .05). Drotaverine administration lead to disappearance of the electromyography activity and significant decline of the anal and urethral pressures (p < .05). The results were reproducible when the tests were repeated in the same subject. Histologic examination revealed the presence of smooth muscle fibers, between the skeletal fibers of the external anal and urethral sphincters. Evidence suggests that the smooth muscle fibers are the source of the electric activity of the sphincters and might explain some physiologic phenomena such as the external anal contraction on rectal distension or on coughing.

Early removal of urethral catheter with suprapubic tube drainage versus urethral catheter drainage alone after robot-assisted laparoscopic radical prostatectomy.

PubMed

Prasad, Sandip M; Large, Michael C; Patel, Amit R; Famakinwa, Olufenwa; Galocy, R Matthew; Karrison, Theodore; Shalhav, Arieh L; Zagaja, Gregory P

2014-07-01

Retrospective single institution data suggest that postoperative pain after robot-assisted laparoscopic radical prostatectomy is decreased by early removal of the urethral catheter with suprapubic tube drainage. In a randomized patient population we determined whether suprapubic tube drainage with early urethral catheter removal would improve postoperative pain compared with urethral catheter drainage alone. Men with a body mass index of less than 40 kg/m(2) who had newly diagnosed prostate cancer and elected robot-assisted laparoscopic radical prostatectomy were included in analysis. Block randomization by surgeon was used and randomization assignment was done after completing the urethrovesical anastomosis. In patients assigned to suprapubic tube drainage the urethral catheter was removed on postoperative day 1 and all catheters were removed on postoperative day 7. Visual analog pain scale and satisfaction questionnaires were administered on postoperative days 0, 1 and 7. A total of 29 patients were randomized to the urethral catheter vs 29 to the suprapubic tube plus early urethral catheter removal at the time of interim futility analysis. Mean visual analog pain scale scores did not differ between the groups at any time point and a similar percent of patients cited the catheter as the greatest bother with nonsignificant differences in treatment related satisfaction. Complications during postoperative week 1 did not vary between the groups. Based on interim results the trial was terminated due to lack of effect. Patients randomized to suprapubic tube vs urethral catheter drainage for the week after prostatectomy had similar pain, catheter related bother and treatment related satisfaction in the perioperative period. We no longer routinely offer suprapubic tube drainage with early urethral catheter removal at our institution. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Outcomes of Endoscopic Realignment of Pelvic Fracture Associated Urethral Injuries at a Level 1 Trauma Center

PubMed Central

Leddy, Laura S.; Vanni, Alex J.; Wessells, Hunter; Voelzke, Bryan B.

2012-01-01

Purpose We examined the success of early endoscopic realignment of pelvic fracture associated urethral injury after blunt pelvic trauma. Materials and Methods A retrospective review was performed of patients with pelvic fracture associated urethral injury who underwent early endoscopic realignment using a retrograde or retrograde/antegrade approach from 2004 to 2010 at a Level 1 trauma center. Followup consisted of uroflowmetry, post-void residual and cystoscopic evaluation. Failure of early endoscopic realignment was defined as patients requiring urethral dilation, direct vision internal urethrotomy, posterior urethroplasty or self-catheterization after initial urethral catheter removal. Results A total of 19 consecutive patients (mean age 38 years) with blunt pelvic fracture associated urethral injury underwent early endoscopic realignment. Twelve cases of complete urethral disruption, 4 of incomplete disruption and 3 of indeterminate status were noted. Mean time to realignment was 2 days and mean duration of urethral catheterization after realignment was 53 days. One patient was lost to followup after early endoscopic realignment. Using an intent to treat analysis early endoscopic realignment failed in 15 of 19 patients (78.9%). Mean time to early endoscopic realignment failure after catheter removal was 79 days. The cases of early endoscopic realignment failure were managed with posterior urethroplasty (8), direct vision internal urethrotomy (3) and direct vision internal urethrotomy followed by posterior urethroplasty (3). Mean followup for the 4 patients considered to have undergone successful early endoscopic realignment was 2.1 years. Conclusions Early endoscopic realignment after blunt pelvic fracture associated urethral injury results in high rates of symptomatic urethral stricture requiring further operative treatment. Close followup after initial catheter removal is warranted, as the mean time to failure after early endoscopic realignment was 79 days in our cohort. PMID:22591965

General Information about Urethral Cancer

MedlinePlus

... Treatment Urethral Cancer Treatment (PDQ®)–Patient Version General Information About Urethral Cancer Go to Health Professional Version ... the PDQ Adult Treatment Editorial Board . Clinical Trial Information A clinical trial is a study to answer ...

Urethral Cancer Treatment (PDQ®)—Patient Version

Cancer.gov

Urethral cancer occurs in men and women and can spread quickly to lymph nodes near the urethra. Find out about risk factors, symptoms, tests to diagnose, prognosis, staging, and treatment for urethral cancer.

URETHROPLASTY FOR COMPLICATED ANTERIOR URETHRAL STRICTURES.

PubMed

Aoki, Katsuya; Hori, Shunta; Morizawa, Yosuke; Nakai, Yasushi; Miyake, Makito; Anai, Satoshi; Torimoto, Kazumasa; Yoneda, Tatsuo; Tanaka, Nobumichi; Yoshida, Katsunori; Fujimoto, Kiyohide

2016-01-01

(Objectives) To compare efficacy and outcome of urethroplasty for complicated anterior urethral strictures. (Methods) Twelve patients, included 3 boys, with anterior urethral stricture underwent urethroplasty after the failure of either urethral dilatation or internal urethrotomy. We evaluated pre- and post-operative Q max and surgical outcome. (Results) Four patients were treated with end-to-end anastomosis, included a case of bulbar urethral elongation simultaneously, one patient was treated with augmented anastomotic urethroplasty, three patients were treated with onlay urethroplasty with prepucial flap, one patient was treated with tubed urethroplasty with prepucial flap (Ducket procedure) and three patients were treated with onlay urethroplasty with buccal mucosal graft. Postoperative Qmax improved in all patients without major complications and recurrence during follow-up periods ranging from 17 to 102 months (mean 55 months). (Conclusions) Urethroplasty is an effective therapeutic procedure for complicated anterior urethral stricture.

Application of dermoscopy image analysis technique in diagnosing urethral condylomata acuminata.

PubMed

Zhang, Yunjie; Jiang, Shuang; Lin, Hui; Guo, Xiaojuan; Zou, Xianbiao

2018-01-01

In this study, cases with suspected urethral condylomata acuminata were examined by dermoscopy, in order to explore an effective method for clinical. To study the application of dermoscopy image analysis technique in clinical diagnosis of urethral condylomata acuminata. A total of 220 suspected urethral condylomata acuminata were clinically diagnosed first with the naked eyes, and then by using dermoscopy image analysis technique. Afterwards, a comparative analysis was made for the two diagnostic methods. Among the 220 suspected urethral condylomata acuminata, there was a higher positive rate by dermoscopy examination than visual observation. Dermoscopy examination technique is still restricted by its inapplicability in deep urethral orifice and skin wrinkles, and concordance between different clinicians may also vary. Dermoscopy image analysis technique features a high sensitivity, quick and accurate diagnosis and is non-invasive, and we recommend its use.

Seismic transect across the Lomonosov and Mendeleev Ridges: Constraints on the geological evolution of the Amerasia Basin, Arctic Ocean

NASA Astrophysics Data System (ADS)

Jokat, Wilfried; Ickrath, Michele; O'Connor, John

2013-10-01

We report on seismic and petrological data that provide new constraints on the geological evolution of the Amerasia Basin. A seismic reflection transect across the Makarov Basin, located between the Mendeleev and Lomonosov Ridges, shows a complete undisturbed sedimentary section of Mesozoic/Cenozoic age. In contrast to the Mendeleev Ridge, the margin of the Lomonosov Ridge is wide and shows horst and graben structures. We suggest that the Mendeleev Ridge is most likely volcanic in origin and support this finding with a 40Ar/39Ar isotopic age for a tholeiitic basalt sampled from the central Alpha/Mendeleev Ridge. Seismic reflection data for the Makarov Basin show no evidence of compressional features, consistent with the Lomonosov Ridge moving as a microplate in the Cenozoic. We propose that the Amerasia Basin moved as a single tectonic plate during the opening of the Eurasia Basin.

Gemcitabine Hydrochloride and Eribulin Mesylate in Treating Patients With Bladder Cancer That is Advanced or Cannot Be Removed by Surgery

ClinicalTrials.gov

2018-05-23

Metastatic Ureteral Neoplasm; Metastatic Urethral Neoplasm; Stage III Bladder Urothelial Carcinoma AJCC v6 and v7; Stage III Ureter Cancer AJCC v7; Stage III Urethral Cancer AJCC v7; Stage IV Bladder Urothelial Carcinoma AJCC v7; Stage IV Ureter Cancer AJCC v7; Stage IV Urethral Cancer AJCC v7; Ureter Urothelial Carcinoma; Urethral Urothelial Carcinoma

Observations on the function of the female urethra: II: Relation between maximum urethral closure pressure at rest and the degree of urethral incompetence.

PubMed

Schick, Erik; Bertrand, Pierre E; Jolivet-Tremblay, Martine; Dupont, Charles; Tessier, Jocelyne

2004-01-01

To study the relation between maximum urethral closure pressure (MUCP) at rest and the degree of urethral incompetence in the female. Two hundred fifty five patients aged 20 years or older, with stable bladders on multichannel urodynamics, without known neurological pathology, and with no previous history of pelvic or anti-incontinence surgery were included in the study. Resting urethral pressure profile (UPP) and the grade of urethral incompetence was registered. Mean age of the group was 45.6+/-12.7 years; mean MUCP was 62.7+/-28.5 cm of water. There was a statistically significant difference in the MUCP when the different grades of urethral incompetence were compared to each other, the higher grades being associated with a lower maximal closure pressure. This study demonstrates that there is a highly significant relationship between MUCP and between all grades of urethral incompetence. This supports previous observations that MUCP decreases when abdominal leak point pressure (ALPP) is low and that this might be secondary to some mechanical failure in the pressure transmission from the abdominal cavity to the urethra. Studies should never compare continent to incontinent cohorts without considering their ALPP because in doing so they are comparing groups that are functionally heterogeneous. Copyright 2003 Wiley-Liss, Inc.

Microstructural evidence for northeastward movement on the Chocolate Mountains fault zone, southeastern California

DOE Office of Scientific and Technical Information (OSTI.GOV)

Simpson, C.

1990-01-10

Microstructural analysis of rocks from the Chocolate Mountains fault zone, Gavilan Hills area, southeastern California, show unequivocal evidence for northeast directed transport of the upper plate gneisses over lower plate Orocopia schists. Samples were taken from transects through the fault zone. Prefaulting fabrics in upper plate gneisses show a strong component of northeast directed rotational deformation under lower amphibolite facies conditions. In contrast, prefaulting lower plate Orocopia schists show strongly coaxial fabrics (minimum stretch value of 2.2) formed at greenschist grade. Mylonitic fabrics associated with the Chocolate Mountains fault are predominantly northeast directed shear bands that are unidirectional (northeastward) inmore » the gneisses but bi-directional in the schists, suggesting a significant component of nonrotational deformation occurred in the Orocopia schists during and after emplacement of the upper plate. The kinematic findings are in agreement with Dillon et al. (1989), who found that the vergence of asymmetrical folds within the fault zone indicates overthrusting to the northeast, toward the craton, in this region. The available evidence favors a single protracted northeastward movement on the Chocolate Mountains fault zone with temperatures waning as deformation proceeded.« less

Single piece artificial urinary sphincter for secondary incontinence following successful repair of post traumatic urethral injury

PubMed Central

Kandpal, D. K.; Rawat, S. K.; Kanwar, S.; Baruha, A.; Chowdhary, S. K.

2013-01-01

Post traumatic urethral injury is uncommon in children. The management of this condition is dependent on the severity of injury. Initial suprapubic cystostomy with delayed repair is the conventional treatment. Successful reconstruction of urethral injury may be followed by urethral stricture, incontinence, impotence, and retrograde ejaculation. Successful repair of post traumatic urethral injury followed by secondary incontinence in children has not been well addressed in literature. We report the management of one such child, with satisfactory outcome with implantation of a new model of single piece artificial urinary sphincter in the bulbar urethra by perineal approach. PMID:24347870

Primary urethral reconstruction results in penile fracture.

PubMed

Barros, R; Silva, Mis; Antonucci, V; Schulze, L; Koifman, L; Favorito, L A

2018-01-01

Objective This study assessed primary urethral reconstruction results in patients with a penile fracture. Materials and methods Between January 2005 and April 2016, patients who underwent primary urethral reconstruction due to penile fracture were called for a follow-up. Epidemiological and clinical presentation data and operative findings were reviewed retrospectively. Partial urethral lesions were primarily treated with interrupted absorbable sutures over urethral catheter. In cases of complete urethral lesion, tension-free end-to-end anastomosis was performed. From the third month after surgery, all patients were interviewed using the International Prostate Symptom Score questionnaire and uroflowmetry. Retrograde urethrocystography was used in patients with urinary symptoms or altered uroflowmetry to rule out or confirm urethral stenosis. Results Of 175 patients with penile fractures, 27 (15.4%) had associated urethral injury. All patients were diagnosed with penile fracture by means of clinical history and physical examination. No subsequent examinations were conducted. Ages varied from 30 years to 58 years old (mean 39.2 years). All fractures resulted from sexual activity. Reported sexual positions were 'doggy style' position in eight cases (61.5%) and with the 'man on top' in five cases (38.4%). Ten patients (76.9%) experienced haematuria, ten (76.9%) had urethral bleeding and four (30.7%) suffered urinary retention. Unilateral and bilateral injury of the corpus cavernosum was observed in four (30.7%) and nine (69.2%) patients, respectively; partial injury was found in nine cases (69.3%) and complete urethral injury was noticed in four cases (30.7%). All cases of complete urethral injury were associated with bilateral lesion of the corpus cavernosum. Six patients who had uroflowmetry with maximum urinary flow rate below 15 ml/s and/or had IPSS above 7 underwent retrograde urethrocystogram, and this was normal in all cases, excluding the possibility of urethral stenosis. Two patients (15.3%) experienced surgical postoperative complications represented by an urethrocutaneous fistula and a subcutaneous abscess adjacent to the end-to-end anastomosis area. Conclusions Penile fracture is a rare urological emergency, especially when it is associated with a urethral lesion. This must be suspected when the clinical picture is suggestive or in cases of high-energy trauma, especially in bilateral lesions of the corpus cavernosum. Complementary imaging methods are not needed in these cases and immediate exploration should not be delayed. Primary urethroplasty produces satisfactory results with low complication levels. Nonetheless, prospective studies with larger samples should be conducted.

TRENDS IN STRICTURE MANAGEMENT AMONG MALE MEDICARE BENEFICIARIES: UNDERUSE OF URETHROPLASTY?

PubMed Central

Anger, Jennifer T.; Buckley, Jill C.; Santucci, Richard A.; Elliott, Sean P.; Saigal, Christopher S.

2012-01-01

Objectives We sought to analyze trends in male urethral stricture management through the use of 1992–2001 Medicare claims data, and to determine whether certain racial and ethnic groups bear a disproportionate burden of urethral stricture disease. Methods We analyzed Medicare claims for fiscal years 1992, 1995, 1998, and 2001. ICD-9 diagnosis codes were used to identify men with urethral stricture. Demographic characteristics assessed included patient age, race, and comorbidities as measured by the Charlson index. Treatments were identified by CPT-4 procedure codes and stratified into four treatment types: (1) urethral dilation, (2) direct vision internal urethrotomy (DVIU), (3) urethral stent/steroid injection, and (4) urethroplasty. Results Overall rates of stricture diagnosis decreased from 10,088 per 100,000 population in 1992 to 6,897 in 2001 (1.4% to 0.9%). Stricture prevalence was highest among African American and Hispanic men, although urethroplasty rates were highest among Caucasians. DVIU was the most common treatment, followed by urethral dilation, urethral stent/steroid injection, and urethroplasty. Urethroplasty rates remained stable, but quite low (0.6–0.8%), over the period of study. Conclusions Overall rates of stricture diagnosis decreased from 1992 to 2001. Despite the poor overall efficacy of urethrotomy and urethral dilation relative to urethroplasty, and despite the known complications of stent placement in this setting, urethroplasty rates were the lowest of all treatments. Although we cannot determine treatment success with these data, these findings suggest an underuse of the most efficacious treatment for urethral stricture disease, urethroplasty. PMID:21168194

Artificial urinary sphincter revision for urethral atrophy: Comparing single cuff downsizing and tandem cuff placement.

PubMed

Linder, Brian J; Viers, Boyd R; Ziegelmann, Matthew J; Rivera, Marcelino E; Elliott, Daniel S

2017-01-01

To compare outcomes for single urethral cuff downsizing versus tandem cuff placement during artificial urinary sphincter (AUS) revision for urethral atrophy. We identified 1778 AUS surgeries performed at our institution from 1990-2014. Of these, 406 were first AUS revisions, including 69 revisions for urethral atrophy. Multiple clinical and surgical variables were evaluated for potential association with device outcomes following revision, including surgical revision strategy (downsizing a single urethral cuff versus placing tandem urethral cuffs). Of the 69 revision surgeries for urethral atrophy at our institution, 56 (82%) were tandem cuff placements, 12 (18%) were single cuff downsizings and one was relocation of a single cuff. When comparing tandem cuff placements and single cuff downsizings, the cohorts were similar with regard to age (p=0.98), body-mass index (p=0.95), prior pelvic radiation exposure (p=0.73) and length of follow-up (p=0.12). Notably, there was no difference in 3-year overall device survival compared between single cuff and tandem cuff revisions (60% versus 76%, p=0.94). Likewise, no significant difference was identified for tandem cuff placement (ref. single cuff) when evaluating the risk of any tertiary surgery (HR 0.95, 95% CI 0.32-4.12, p=0.94) or urethral erosion/device infection following revision (HR 0.79, 95% CI 0.20-5.22, p=0.77). There was no significant difference in overall device survival in patients undergoing single cuff downsizing or tandem cuff placement during AUS revision for urethral atrophy. Copyright® by the International Brazilian Journal of Urology.

Effect of early realignment on length and delayed repair of postpelvic fracture urethral injury.

PubMed

Koraitim, Mamdouh M

2012-04-01

To determine the effect of early realignment of posterior urethral injury on the length and delayed repair of ensuing urethral defect. We reviewed the medical records of 120 patients with a pelvic fracture urethral defect who were referred for delayed repair from elsewhere from 1995 to 2009. The review was focused on 5 variables: initial management of urethral injury, length of urethral defect, type of delayed repair, continence, and erectile function. Of the patients, 26 were excluded from the study and 94 were categorized as having been initially treated by realignment (42 patients, group 1) or suprapubic cystostomy (52 patients, group 2). Urethral defects ≤ 2 cm in length were found in 28 patients (67%) in group 1 versus 22 (42%) in group 2. Defects >2 cm were found in 14 patients (33%) in group 1 versus 30 (58%) in group 2. The repair was accomplished by a simple perineal operation in 32 (76%) and 30 (58%) patients in groups 1 and 2, respectively. An elaborated perineal or perineo-abdominal procedure was required in 10 (24%) and 22 (42%) patients in groups 1 and 2, respectively (all P < .05). Incontinence occurred in 1 patient in group 1. Impotence developed in 10 (28%) of 36 realigned adults and in 2 (5%) of 38 adults with suprapubic cystostomy. Early realignment of posterior urethral injury decreases the length of the ensuing urethral defect and facilitates its delayed repair. Incontinence and impotence appear to result from the injury itself and not the treatment. Copyright © 2012 Elsevier Inc. All rights reserved.

Sorafenib in Treating Patients With Regional or Metastatic Cancer of the Urothelium

ClinicalTrials.gov

2014-05-20

Adenocarcinoma of the Bladder; Distal Urethral Cancer; Metastatic Transitional Cell Cancer of the Renal Pelvis and Ureter; Proximal Urethral Cancer; Recurrent Bladder Cancer; Recurrent Transitional Cell Cancer of the Renal Pelvis and Ureter; Recurrent Urethral Cancer; Regional Transitional Cell Cancer of the Renal Pelvis and Ureter; Squamous Cell Carcinoma of the Bladder; Stage III Bladder Cancer; Stage IV Bladder Cancer; Transitional Cell Carcinoma of the Bladder; Urethral Cancer Associated With Invasive Bladder Cancer

Endoscopic urethroplasty: an alternative to surgical reconstruction for complete urethral obliteration.

PubMed

Krishnamurthi, V; Spirnak, J P

1995-02-01

Urethral obliteration is an uncommon complication of urethral injury and is usually associated with pelvic fracture. Until recently, surgical reconstruction was the only means available to restore urethral continuity. Although formal urethroplasty may be associated with excellent success rates, impotence and incontinence are potential complications. Endoscopic urethroplasty has recently evolved into a suitable alternative to surgical reconstruction in selected cases. We review here the technique of endoscopic urethroplasty and include our initial results.

Fundamentals and clinical perspective of urethral sphincter instability as a contributing factor in patients with lower urinary tract dysfunction--ICI-RS 2014.

PubMed

Kirschner-Hermanns, Ruth; Anding, Ralf; Rosier, Peter; Birder, Lori; Andersson, Karl Erik; Djurhuus, Jens Christian

2016-02-01

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. 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. 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. 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. © 2016 The Authors. Neurourology and Urodynamics published by Wiley Periodicals, Inc.

[Reconstructive treatment of female urethral estenosis secondary to erosion by suburethral tape].

PubMed

Angulo, J C; Mateo, E; Lista, F; Andrés, G

2011-04-01

Female urethral stricture secondary to erosión by suburethral sling is an unfrequent problem of difficult solution. Ventral vaginal rotation flaps or buccal mucosa dorsal grafts are not useful because this type of stricture is very proximal (close to the bladder neck) and the vagina is thinned. We present our experience to manage this problem using excision of disease urethral tract, associated to bladder mucosa flap and vaginal sling using transverse vaginal flap to repair the weakened vaginal wall. Three females with urethral stricture secondary to urethral erosion of their sling were treated with a technique of combined urethroplasty with bladder flap and vaginal reinforcement with pediculated vaginal flap transferred in a mini-sling fashion. Two of the patients suffered chronic urinary retention and preoperative placement of urethral catheter was not possible. The patients were evaluated 12, 36 and 55 months after surgery, respectively. Surgery was performed without complications. Results were satisfactory in all the patients, reaching good micturition postoperative caliber and being without incontinence at follow-up. Patients with suburethral erosion by a synthetic sling and secondary severe urethral stricture need total extirpation of the mesh and complete reconstruction of the urethro-vaginal septum. Tension-free urethral suture and use of vaginal sling with the technique here described are two useful technical tips for this problem. Copyright © 2011 AEU. Published by Elsevier Espana. All rights reserved.

Vaginal birth and de novo stress incontinence: Relative contributions of urethral dysfunction and mobility

PubMed Central

DeLancey, John O. L.; Miller, Janis M.; Kearney, Rohna; Howard, Denise; Reddy, Pranathi; Umek, Wolfgang; Guire, Kenneth E.; Margulies, Rebecca U.; Ashton-Miller, James A.

2009-01-01

Background Vaginal birth increases the chance a woman will develop stress incontinence. This study evaluates the relative contributions of urethral mobility and urethral function to stress incontinence. Methods This is a case-control study with group matching. Eighty primiparous women with self-reported new stress incontinence 9–12 months postpartum were compared to 80 primiparous continent controls to identify impairments specific to stress incontinence. Eighty nulliparous continent controls were evaluated as a comparison group to allow us to determine birth-related changes not associated with stress incontinence. Urethral function was measured with urethral profilometry, and vesical neck mobility was assessed with ultrasound and Q-tip test. Urethral sphincter anatomy and mobility were evaluated using MRI. The association between urethral closure pressure, vesical neck movement, and incontinence were explored using logistic regression. Results Urethral closure pressure in primiparous incontinent women (62.9 +/− 25.2 s.d. cm H20) was lower than in primiparous continent women (83.0 +/− 21.0, p<0.001; effect size d= 0.91) who were similar to nulliparous women (90.3 +/− 25.0, p=0.09). Vesical neck movement measured during cough with ultrasound was the mobility parameter most associated with stress incontinence; 15.6 +/− 6.2 mm in incontinent women versus 10.9 +/− 6.2 in primiparous continent women (p < 0.0001, d = 0.75) or nulliparas (9.9 +/− 5.0, p=0.33). Logistic regression disclosed the two-variable model (max-rescaled R2 =0.37, p < 0.0001) was more strongly associated with stress incontinence than either single variable models, urethral closure pressure (R2 = 0.25, p <0.0001) or vesical neck movement (R2 = 0.16 p < 0.0001). Conclusions Lower maximal urethral closure pressure is the parameter most associated with de novo stress incontinence after first vaginal birth followed by vesical neck mobility. PMID:17666611

History of hypospadias: Lost in translation.

PubMed

Hadidi, Ahmed T

2017-02-01

The evolution of hypospadias surgery can be classified under 3 periods that were closely related to advances in surgical instruments, introduction of anesthesia, and newer suture materials. Stretching dominated the early period, tunneling during the Middle Ages, and flaps during the modern period. Suture materials have included at various time silver wires, horsehair, and stainless steel. Examination and translation of the original manuscripts showed that Galen recommended stretching and suturing of glanular hypospadias and not amputation or partial penectomy as has been currently reported. The term chordee was first introduced in the 18th century in relation to gonorrhea and was defined as "painful imperfect erection of the penis during gonorrhea, with downward incurvation." This was a common complication of gonorrhea before the introduction of antibiotics. Mettauer, Duplay, Mayo, and others used the terms incurvation, ventral deformity, ventral curvature, and others. Clinton Smith in 1938 was the first surgeon to use the term congenital chordee in direct relation to hypospadias. The use of prepuce for urethroplasty, popular now, was first reported by Liston in 1838, Rochet in 1899, Russell in 1900, and Mayo in 1901. The two stage repair performed in the early 20th century differed from that in the early 21st century in that urethroplasty was performed in the first stage and only anastomosis to the original meatus was performed in the second stage. The two-stage repair, currently known as Bracka's two-stage repair, was first described in 1962 by Cloutier. The use of the urethral plate in epispadias was first described by Liston in 1838, Thiersch in 1869 and by Anger & Duplay in hypospadias in 1874. Partially epithelialized urethroplasty using the urethral plate was described by Duplay in 1880, Russell 1915, Denis Browne 1940, Reddy 1975, Orkiszewski 1987, Rich 1989, and Snodgrass in 1994. V. Copyright © 2017 Elsevier Inc. All rights reserved.

Factors affecting urine EIA sensitivity in the detection of Chlamydia trachomatis in men.

PubMed Central

Talbot, H; Romanowski, B

1994-01-01

OBJECTIVE--This study examined the effects of four variables on the detection of Chlamydia trachomatis in urine from men by enzyme immunoassay (EIA). These variables were: symptoms and signs of urethritis, urine polymorphonuclear leucocytes (PMN), inclusion counts from urethral chlamydia cell cultures and the time between testing and last voiding. METHODS--Included were patients with and without symptoms and/or signs of urethritis attending the Edmonton Sexually Transmitted Disease Clinic. Men were asked to submit a 20 ml volume urine sample. Urethral swabs were collected for gram stain, chlamydia and gonorrhea culture. RESULTS--A total of 318 men were evaluated of whom 47 had chlamydia. Excluding six men who were coinfected with gonorrhoea, sensitivities and specificities of the Microtrak, Chlamydiazyme and IDEIA systems were 78.1% and 99.6%, 75.6% and 100%, and 80.5% and 97.8% respectively. Last void time did not affect the sensitivity. However, sensitivity was best when applied to men with severe evidence of urethritis. CONCLUSION--There is evidence that urine EIA could be used to detect chlamydia in men with acute urethritis but not in those without signs of urethritis. PMID:8206466

Evaluation of two techniques of partial urethral obstruction in the male rat model of bladder outlet obstruction.

PubMed

Melman, Arnold; Tar, Moses; Boczko, Judd; Christ, George; Leung, Albert C; Zhao, Weixin; Russell, Robert G

2005-11-01

To perform a comparison to determine which of two methods of partial urethral ligation produces the most consistent outcome and fewest side effects. Such a study has not been previously reported. Partial urethral ligation is a means of causing reproducible bladder outlet obstruction. In the male rat model, partial urethral obstruction can be performed either by perineal incision and bulbous urethral ligation or retropubic incision and midprostatic obstruction. Fifteen male Sprague-Dawley rats were studied. Five were selected for bulbous urethral obstruction through a perineal incision, five for midprostatic obstruction using a retropubic approach, and five for a sham operation through a perineal incision. The operative time was shorter and morbidity lower with the perineal approach compared with the retropubic approach. Inflammation or infection, or both, were seen in the prostate, bladder, proximal urethra, ureters, and kidneys in the rats in which a midprostatic obstruction was performed. The proximal urethra and prostate were mildly inflamed in those rats that underwent bulbous obstruction. Sham-operated rats exhibited mild prostatitis only. The perineal approach to the bulbous urethra is the method of choice for creating a partial urethral obstruction model of bladder outlet obstruction in the male rat.

Advances in urethral stricture management

PubMed Central

Gallegos, Maxx A.; Santucci, Richard A.

2016-01-01

Urethral stricture/stenosis is a narrowing of the urethral lumen. These conditions greatly impact the health and quality of life of patients. Management of urethral strictures/stenosis is complex and requires careful evaluation. The treatment options for urethral stricture vary in their success rates. Urethral dilation and internal urethrotomy are the most commonly performed procedures but carry the lowest chance for long-term success (0–9%). Urethroplasty has a much higher chance of success (85–90%) and is considered the gold-standard treatment. The most common urethroplasty techniques are excision and primary anastomosis and graft onlay urethroplasty. Anastomotic urethroplasty and graft urethroplasty have similar long-term success rates, although long-term data have yet to confirm equal efficacy. Anastomotic urethroplasty may have higher rates of sexual dysfunction. Posterior urethral stenosis is typically caused by previous urologic surgery. It is treated endoscopically with radial incisions. The use of mitomycin C may decrease recurrence. An exciting area of research is tissue engineering and scar modulation to augment stricture treatment. These include the use of acellular matrices or tissue-engineered buccal mucosa to produce grafting material for urethroplasty. Other experimental strategies aim to prevent scar formation altogether. PMID:28105329

The urethral pressure profiles in continent and stress-incontinent women.

PubMed

Henriksson, L; Andersson, K E; Ulmsten, U

1979-01-01

Simultaneous urethrocystometry, including recording of the urethral pressure profile, was performed in 127 women aged 30 to 69 years; 42 of the women were free from urologic disorders and 85 had stress incontinence of urine. Both groups were subgrouped according to age. The results in the continent and the incontinent women were analyzed separately, in order to disclose any age-related changes. The data within each decade of age were also comparatively analyzed. In the bladder pressure at rest no age-related changes were found, and the readings were similar in the continent and the incontinent women. The maximum urethral pressure fell significantly with rising age in both groups and was significantly reduced in stress incontinence. The urethral closure pressure showed variations similar to those in the maximum urethral pressure. No lower limit of urethral closure pressure that definitely predisposed to stress incontinence could be established. The functional length of the urethra diminished significantly with rising age in the continent, but not in the incontinent women. The absolute length of the urethra did not show such diminution. Both the functional and the absolute urethral length were significantly less in the incontinent than in the continent women in the age groups between 30 and 49 years.

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

Meatal Swabs Contain Less Cellular Material and Are Associated with a Decrease in Gram Stain Smear Quality Compared to Urethral Swabs in Men.

PubMed

Jordan, Stephen J; Schwebke, Jane R; Aaron, Kristal J; Van Der Pol, Barbara; Hook, Edward W

2017-07-01

Urethral swabs are the samples of choice for point-of-care Gram stain testing to diagnose Neisseria gonorrhoeae infection and nongonococcal urethritis (NGU) in men. As an alternative to urethral swabs, meatal swabs have been recommended for the collection of urethral discharge to diagnose N. gonorrhoeae and Chlamydia trachomatis infection in certain populations by nucleic acid amplification testing (NAAT), as they involve a less invasive collection method. However, as meatal swabs could be sampling a reduced surface area and result in fewer collected epithelial cells compared to urethral swabs, the adequacy of meatal swab specimens to collect sufficient cellular material for Gram stain testing remains unknown. We enrolled 66 men who underwent either urethral or meatal swabbing and compared the cellular content and Gram stain failure rate. We measured the difference in swab cellular content using the Cepheid Xpert CT/NG sample adequacy control crossing threshold (SAC CT ) and determined the failure rate of Gram stain smears (GSS) due to insufficient cellular material. In the absence of discharge, meatal smears were associated with a significant reduction in cellular content ( P = 0.0118), which corresponded with a GSS failure rate significantly higher than that for urethral swabs (45% versus 3%, respectively; P < 0.0001). When discharge was present, there was no difference among results from urethral and meatal swabs. Therefore, if GSS testing is being considered for point-of-care diagnosis of N. gonorrhoeae infection or NGU in men, meatal swabs should be avoided in the absence of a visible discharge. Copyright © 2017 American Society for Microbiology.

AT1 expression in human urethral stricture tissue.

PubMed

Siregar, Safendra; Parardya, Aga; Sibarani, Jupiter; Romdan, Tjahjodjati; Adi, Kuncoro; Hernowo, Bethy S; Yantisetiasti, Anglita

2017-01-01

Urethral stricture has a high recurrence rate. There is a common doctrine stating that "once a stricture, always a stricture". This fibrotic disease pathophysiology, pathologically characterized by excessive production, deposition and contraction of extracellular matrix is unknown. Angiotensin II type 1 (AT 1 ) receptor primarily induces angiogenesis, cellular proliferation and inflammatory responses. AT 1 receptors are also expressed in the fibroblasts of hypertrophic scars, whereas angiotensin II (AngII) regulates DNA synthesis in hypertrophic scar fibroblasts through a negative cross talk between AT 1 and angiotensin II type 2 (AT 2 ) receptors, which might contribute to the formation and maturation of human hypertrophic scars. This study was conducted to determine the expression of AT 1 receptors in urethral stricture tissues. Urethral stricture tissues were collected from patients during anastomotic urethroplasty surgery. There were 24 tissue samples collected in this study with 2 samples of normal urethra for the control group. Immunohistochemistry study was performed to detect the presence of AT 1 receptor expression. Data were analyzed using Mann-Whitney U test, and statistical analysis was performed with SPSS version 20. This study showed that positive staining of AT 1 receptor was found in all urethral stricture tissues (n=24). A total of 8.33% patients had low intensity, 41.67% had moderate intensity and 50% had high intensity of AT 1 receptors, while in the control group, 100% patients had no intensity of AT 1 receptors. Using the Mann-Whitney U test, it was found that urethral stricture tissue had a higher intensity of AT 1 receptors than normal urethral tissue with a p -value = 0.012. The results showed that AT 1 receptor had a higher intensity in the urethral stricture tissue and that AT 1 receptor may play an important role in the development of urethral stricture.

Characteristics Associated With Urethral and Rectal Gonorrhea and Chlamydia Diagnoses in a US National Sample of Gay and Bisexual Men: Results From the One Thousand Strong Panel.

PubMed

Grov, Christian; Cain, Demetria; Rendina, H Jonathan; Ventuneac, Ana; Parsons, Jeffrey T

2016-03-01

Gay and bisexual men are at elevated risk for Neisseria gonorrhoeae and Chlamydia trachomatis (GC/CT). Rectal GC/CT symptoms may be less obvious than urethral, increasing opportunities for undiagnosed rectal GC/CT. A US national sample of 1071 gay and bisexual men completed urethral and rectal GC/CT testing and an online survey. In total, 6.2% were GC/CT positive (5.3% rectal, 1.7% urethral). We calculated adjusted (for education, race, age, relationship status, having health insurance, and income) odds ratios for factors associated with rectal and urethral GC/CT diagnoses. Age was inversely associated with urethral and rectal GC/CT. Compared with white men, Latinos had significantly greater odds of rectal GC/CT. Among men who reported anal sex, those reporting only insertive sex had lower odds of rectal GC/CT than did men who reported both insertive and receptive. There was a positive association between rectal GC/CT and number of male partners (<12 months), the number of anal receptive acts, receptive condomless anal sex (CAS) acts, and insertive CAS acts. Compared with those who had engaged in both insertive and receptive anal sex, those who engaged in only receptive anal sex had lower odds of urethral GC/CT. The number of male partners (<12 months) was associated with increased odds of urethral GC/CT. Rectal GC/CT was more common than urethral and associated with some demographic and behavioral characteristics. Our finding that insertive CAS acts was associated with rectal GC/CT highlights that providers should screen patients for GC/CT via a full range of transmission routes, lest GC/CT go undiagnosed.

Impact of prior urethral manipulation on outcome of anastomotic urethroplasty for post-traumatic urethral stricture.

PubMed

Singh, Bhupendra P; Andankar, Mukund G; Swain, Sanjaya K; Das, Krishanu; Dassi, Vimal; Kaswan, Harish K; Agrawal, Vipul; Pathak, Hemant R

2010-01-01

To determine the impact of earlier urethral interventions on the outcomes of anastomotic urethroplasty in post-traumatic stricture urethra. From October 1995 to March 2008, a total of 58 patients with post-traumatic posterior urethral stricture underwent anastomotic urethroplasty. Eighteen patients had earlier undergone urethral intervention in the form of urethrotomy (3), endoscopic realignment (7), or open urethroplasty (8). Success was defined as no obstructive urinary symptoms, maximum urine flow rate > or = 15 mL/s, normal urethral imaging and/or urethroscopy, and no need of any intervention in the follow-up period. Patients who met the above objective criteria after needing 1 urethrotomy following urethroplasty were defined to have satisfactory outcome and were included in satisfactory result rate along with patients who had a successful outcome. Results were analyzed using unpaired t test, chi-square test, binary logistic regression, Kaplan-Meier curves, and log rank test. Previous interventions in the form of endoscopic realignment or urethroplasty have significant adverse effect on the success rate of subsequent anastomotic urethroplasty for post-traumatic posterior urethral strictures (P <.05). Previous intervention in the form of visual internal urethrotomies (up to 2 times) did not affect the outcome of subsequent anastomotic urethroplasty. Length of stricture and age of patient did not predict the outcome in traumatic posterior urethral strictures in logistic regression analysis. Previous failed railroading or urethroplasty significantly decrease the success of subsequent anastomotic urethroplasty. Hence, a primary realignment or urethroplasty should be avoided in suboptimal conditions and the cases of post-traumatic urethral stricture should be referred to centers with such expertise. 2010 Elsevier Inc. All rights reserved.

Trends in stricture management among male Medicare beneficiaries: underuse of urethroplasty?

PubMed

Anger, Jennifer T; Buckley, Jill C; Santucci, Richard A; Elliott, Sean P; Saigal, Christopher S

2011-02-01

To analyze the trends in male urethral stricture management using the 1992-2001 Medicare claims data and to determine whether certain racial and ethnic groups have a disproportionate burden of urethral stricture disease. We analyzed the Medicare claims for fiscal years 1992, 1995, 1998, and 2001. The "International Classification of Disease, 9th revision," diagnosis codes were used to identify men with urethral stricture. The demographic characteristics assessed included patient age, race, and comorbidities, as measured using the Charlson index. Treatments were identified using the Physician Current Procedural Terminology Coding System, 4th edition, procedure codes and stratified into 4 treatment types: urethral dilation, direct vision internal urethrotomy, urethral stent/steroid injection, and urethroplasty. The overall rates of stricture diagnosis decreased from 10,088/100,000 population in 1992 to 6897 in 2001 (from 1.4% to 0.9%). The stricture prevalence was greatest among black and Hispanic men, although the urethroplasty rates were greatest among white men. Direct vision internal urethrotomy was the most common treatment, followed by urethral dilation, urethral stent/steroid injection, and urethroplasty. The urethroplasty rates remained stable, but quite low (0.6%-0.8%), during the study period. The overall rates of stricture diagnosis decreased from 1992 to 2001. Despite the poor overall efficacy of urethrotomy and urethral dilation relative to urethroplasty and despite the known complications of stent placement in this setting, the urethroplasty rates were the lowest of all treatments. Although we could not determine the treatment success with these data, these findings suggest an underuse of the most efficacious treatment of urethral stricture disease, urethroplasty. Copyright © 2011. Published by Elsevier Inc.

Orthotopic bladder substitution in men revisited: identification of continence predictors.

PubMed

Koraitim, M M; Atta, M A; Foda, M K

2006-11-01

We determined the impact of the functional characteristics of the neobladder and urethral sphincter on continence results, and determined the most significant predictors of continence. A total of 88 male patients 29 to 70 years old underwent orthotopic bladder substitution with tubularized ileocecal segment (40) and detubularized sigmoid (25) or ileum (23). Uroflowmetry, cystometry and urethral pressure profilometry were performed at 13 to 36 months (mean 19) postoperatively. The correlation between urinary continence and 28 urodynamic variables was assessed. Parameters that correlated significantly with continence were entered into a multivariate analysis using a logistic regression model to determine the most significant predictors of continence. Maximum urethral closure pressure was the only parameter that showed a statistically significant correlation with diurnal continence. Nocturnal continence had not only a statistically significant positive correlation with maximum urethral closure pressure, but also statistically significant negative correlations with maximum contraction amplitude, and baseline pressure at mid and maximum capacity. Three of these 4 parameters, including maximum urethral closure pressure, maximum contraction amplitude and baseline pressure at mid capacity, proved to be significant predictors of continence on multivariate analysis. While daytime continence is determined by maximum urethral closure pressure, during the night it is the net result of 2 forces that have about equal influence but in opposite directions, that is maximum urethral closure pressure vs maximum contraction amplitude plus baseline pressure at mid capacity. Two equations were derived from the logistic regression model to predict the probability of continence after orthotopic bladder substitution, including Z1 (diurnal) = 0.605 + 0.0085 maximum urethral closure pressure and Z2 (nocturnal) = 0.841 + 0.01 [maximum urethral closure pressure - (maximum contraction amplitude + baseline pressure at mid capacity)].

Transpubic access using pedicle tubularized labial urethroplasty for the treatment of female urethral strictures associated with urethrovaginal fistulas secondary to pelvic fracture.

PubMed

Xu, Yue-Min; Sa, Ying-Long; Fu, Qiang; Zhang, Jiong; Xie, Hong; Jin, San-Bao

2009-07-01

Female urethral injury is rare, and there is no accepted standard approach for the repair of urethral strictures. To evaluate the efficacy of transpubic access using pedicle tubularized labial urethroplasty for urethral reconstruction in female patients with urethral obliterative strictures and urethrovaginal fistulas. Between January 1996 and December 2006, eight cases of female urethral strictures associated with urethrovaginal fistulas were treated using pedicle labial skin flaps. A flap of approximately 3x3.5x3cm of the labia minora or majora with its vascular pedicle was tubularized over an 18-22 Fr fenestrated silicone stent to create a neourethra. This technique was used in five women. Two flaps, approximately 1.5-3.5 cm, were taken from bilateral labia minora or majora and were pieced together to create a neourethra. This technique was used in three patients. We performed voiding cystourethrography and uroflowmetry to assess postoperative results. The patients were followed up for 10-118 mo (mean 48.25 mo) after the procedure. There were no postoperative complications. Two patients complained of dysuria, which resolved spontaneously after 2 wk. One patient experienced stress incontinence that resolved after 4 wk. At 3-mo follow-up, one patient complained of difficulty voiding; the urinary peak flow was 13 ml/s, and the patient was treated successfully with urethral dilation. All other patients had normal micturition following catheter removal. Pedicle labial urethroplasty is a reliable technique for the repair of extensive urethral damage, and a transpubic surgical approach provides wide and excellent exposure for the management of complex obliterative urethral strictures and urethrovaginal fistulas secondary to pelvic fracture.

Urethral pressure reflectometry during intra-abdominal pressure increase-an improved technique to characterize the urethral closure function in continent and stress urinary incontinent women.

PubMed

Saaby, Marie-Louise; Klarskov, Niels; Lose, Gunnar

2013-11-01

to assess the urethral closure function by urethral pressure reflectometry (UPR) during intra-abdominal pressure-increase in SUI and continent women. Twenty-five urodynamically proven SUI women and eight continent volunteer women were assessed by ICIQ-SF, pad-weighing test, incontinence diary, and UPR. UPR was conducted during resting and increased intra-abdominal pressure (P(Abd)) by straining. Related values of P(Abd) and urethral opening pressure (P(o)) were plotted into an abdomino-urethral pressuregram. Linear regression of the values was conducted, and the slope of the line ("APIR") and the intercept with the y-axis found. By the equation of the line, Po was calculated for various values of P(Abd), for example, 50 cm H2O (P(o-Abd 50)). The resting P(o) (P(o-rest)) and APIR, respectively, significantly differed in SUI and continent women but could not separate the two groups. The urethral closure equation (UCE) based on P(o-rest) and APIR provided a more detailed characterization of a woman's closure function based on the permanent closure forces (primarily generated by the urethral sphincteric unit) and the adjunctive closure forces (primarily generated by the support system). P(o-Abd 50) and UCE, respectively, which express the combined permanent and adjunctive closure forces and estimate the efficiency of the closure function, separated SUI and continent women and were highly significantly negatively correlated with ICIQ-SF, pad test, and the number of incontinence episodes. New parameters for characterization of the urethral closure function and possible dysfunctions and its efficiency were provided. P(o-Abd 50) and UCE may be used as diagnostic tests and severity measures. © 2013 Wiley Periodicals, Inc.

Expressed prostate secretions in the study of human papillomavirus epidemiology in the male.

PubMed

Smelov, Vitaly; Eklund, Carina; Bzhalava, Davit; Novikov, Andrey; Dillner, Joakim

2013-01-01

Exploring different sampling sites and methods is of interest for studies of the epidemiology of HPV infections in the male. Expressed prostate secretions (EPS) are obtained during digital rectal examination (DRE), a daily routine urological diagnostic procedure, following massage of the prostate. Urethral swabs and EPS samples were obtained from a consecutive sample of 752 men (mean age 32.4 years; median life-time sex partners 34) visiting urology outpatient clinics in St. Petersburg, Russia and tested for HPV DNA by general primer PCR, followed by genotyping using Luminex. Overall, 47.9% (360/752) of men were HPV-positive, with 42.0% (316/752) being positive for high-risk (HR-) HPV and 12.6% (95/752) for multiple HPV types. HPV-positivity in the EPS samples was 32.6% (27.7% HR-HPV) and in the urethral samples 25.9% (24.5% HR-HPV). 10.6% were HPV positive in both EPS and urethral samples. 6.4% had the same HPV-type in both EPS and urethral samples. 10.6% were HPV positive in both EPS and urethral samples. 6.4% had the same HPV-type in both EPS and urethral samples. The concordance between the urethral samples and EPS was 62.5% (470/752), with 80 cases double positive and 390 cases double negative in both sites. The sensitivity of urethral samples for overall HPV detection was 54.2% (195/360). Compared to analysis of urethral samples only, the analysis of EPS increased the HPV prevalence in this population with 26.2%. EPS represent informative sampling material for the study of HPV epidemiology in the male.

Transhepatic Hilar Approach for Perihilar Cholangiocarcinoma: Significance of Early Judgment of Resectability and Safe Vascular Reconstruction.

PubMed

Kuriyama, Naohisa; Isaji, Shuji; Tanemura, Akihiro; Iizawa, Yusuke; Kato, Hiroyuki; Murata, Yasuhiro; Azumi, Yoshinori; Kishiwada, Masashi; Mizuno, Shugo; Usui, Masanobu; Sakurai, Hiroyuki

2017-03-01

In the most common surgical procedure for perihilar cholangiocarcinoma, the margin status of the proximal bile duct is determined at the final step. Our procedure, the transhepatic hilar approach, confirms a cancer-negative margin status of the proximal bile duct first. We first performed a partial hepatic parenchymal transection to expose the hilar plate, and then transected the proximal bile duct to confirm margin status. Then, divisions of the hepatic artery and portal vein of the future resected liver are performed, followed by the residual hepatic parenchymal transection. The transhepatic hilar approach offers a wide surgical field for safe resection and reconstruction of the portal vein in the middle of the hepatectomy. We reviewed 23 patients with perihilar cholangiocarcinoma who underwent major hepatectomy using our procedure from 2011 to 2015. A combined vascular resection and reconstruction was carried out in 14 patients (60.9%). R0 resection was achieved in 17 patients (73.9%), and the overall 3-year survival rate was 52.9% (median survival time 52.4 months). The transhepatic hilar approach is useful and practicable regardless of local tumor extension, enabling us to determine tumor resectability and perform safe resection and reconstruction of the portal vein early in the operation.

Transhilar passage in right graft live donor liver transplantation: intrahilar anatomy and its impact on operative strategy.

PubMed

Radtke, A; Sotiropoulos, G C; Molmenti, E P; Sgourakis, G; Schroeder, T; Beckebaum, S; Peitgen, H-O; Cicinnati, V R; Broelsch, C E; Broering, D C; Malagó, M

2012-03-01

The passage through the hilar plate during right graft live donor liver transplantation (LDLT) can have dangerous consequences for both donors and recipients. The purpose of our study was to delineate hilar transection and biliary reconstruction strategies in right graft LDLT, with special consideration of central and peripheral hilar anatomical variants. A total of 71 consecutive donors underwent preoperative three-dimensional (3D) CT reconstructions and virtual 3D hepatectomies. A three-modal hilar passage strategy was applied, and its impact on operative strategy analyzed. In 68.4% of cases, type I and II anatomical configurations allowed for an en block hilar transection with simple anastomotic reconstructions. In 23.6% of cases, donors had "difficult" type II and types III/IV hilar bile duct anatomy that required stepwise hilar transections and complex graft biliary reconstructions. Morbidity rates for our early (A) and recent (B) experience periods were 67% and 39%, respectively. (1) Our two-level classification and 3D imaging technique allowed for donor-individualized transhilar passage. (2) A stepwise transhilar passage was favored in types III and IV inside the right-sided hilar corridor. (3) Reconstruction techniques showed no ameliorating effect on early/late biliary morbidity rates. © copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons.

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. (a...

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

Urethral pressure response patterns induced by squeeze in continent and incontinent women.

PubMed

Teleman, Pia M; Mattiasson, Anders

2007-09-01

Our aim was to compare the urethral pressure response pattern to pelvic floor muscle contractions in 20-27 years old, nulliparous continent women (n = 31) to that of continent (n = 28) and formerly untreated incontinent (n = 59) (53-63 years old) women. These women underwent urethral pressure measurements during rest and repeated pelvic muscle contractions. The response to the contractions was graded 0-4. The young continent women showed a mean urethral pressure response of 2.8, the middle-aged continent women 2.2 (NS vs young continent), and the incontinent women 1.5 (p < 0.05 vs middle-aged continent, p < 0.001 vs young continent). Urethral pressures during rest were significantly higher in the younger women than in both groups of middle-aged women. The decreased ability to increase urethral pressure on demand seen in middle-aged incontinent women compared to continent women of the same age as well as young women seems to be a consequence of a neuromuscular disorder rather than of age.

Painless Urethral Bleeding During Penile Erection in an Adult Man With Klippel-Trenaunay Syndrome: A Case Report.

PubMed

Lei, Hongen; Guan, Xing; Han, Hu; Qian, Xiaosong; Zhou, Xiaoguang; Zhang, Xiaodong; Tian, Long

2018-06-01

Klippel-Trenaunay syndrome (KTS) is a rare congenital vascular disorder characterized by a triad of cutaneous port wine capillary malformations, varicose veins, and hemihypertrophy of bone and soft tissues. To report on a rare case of KTS in an adult man manifested by painless urethral bleeding during penile erection briefly review the clinical presentation and management of the genitourinary forms of this syndrome. On presentation, the clinical features of this patient, including medical history, signs and symptoms, and imaging examinations, were recorded. After diagnosis and initial treatment, a literature review of the urethral features of KTS was performed and is discussed in this report. A 35-year-old man with KTS presented with painless urethral bleeding during penile erection that was associated with posterior urethral vascular malformations. The coagulation method was used to treat the malformation, and no urethral bleeding or gross hematuria occurred during a postoperative follow-up period of 6 months. This case demonstrates that coagulation therapy and careful follow-up can be adequate treatment approaches for urethral features of KTS. However, the long-term efficacy of coagulation for this disorder should be investigated further. Lei H, Guan X, Han H, et al. Painless Urethral Bleeding During Penile Erection in an Adult Man With Klippel-Trenaunay Syndrome: A Case Report. Sex Med 2018;6:180-183. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Is circumferential urethral mobilisation an overdo? A prospective outcome analysis of dorsal onlay and dorso - lateral onlay BMGU for anterior urethral strictures.

PubMed

Prakash, Gaurav; Singh, Bhupendra Pal; Sinha, Rahul Janak; Jhanwar, Ankur; Sankhwar, Satyanarayan

2018-01-01

For dorsal onlay graft placement, unilateral urethral mobilization is less invasive than standard circumferential urethral mobilization. Apart from success in terms of patency of urethra, other issues like sexual function, overall quality of life and patient satisfaction remain important issues while comparing outcomes of urethroplasty. To prospectively compare the objective as well as subjective outcomes of two approaches. Between July 2011 and January 2015, 136 adult males having anterior urethral stricture with urethral lumen ≥ 6 Fr. were prospectively assigned between two groups by alternate randomization. Operative time, complications, success rate (no obstructive symptoms, no need of any postoperative intervention, Q max > 15mL/sec), sexual functions (using Brief Male Sexual Function Inventory) were compared. Baseline parameters were similar in both groups (68 in each group). Overall success rate was similar in both groups (89 % and 91 % respectively). Improvement in total LUTS scores was similar in groups. Changes in overall health status (VAS and EQ 5D) was equal in both groups. Erectile function score was significantly decreased in DO than DL group while ejaculatory function and sexual desire remained stable after urethroplasty in both groups. In anterior urethral stricture buccal mucosa graft provides satisfactory results as onlay technique. No technique whether dorsolateral and dorsal techniques is superior to other. Dorsolateral technique needs minimal urethral mobilization and should be preferred whenever feasible. Copyright® by the International Brazilian Journal of Urology.

Office dilation of the female urethra: a quality of care problem in the field of urology.

PubMed

Santucci, Richard A; Payne, Christopher K; Anger, Jennifer T; Saigal, Christopher S

2008-11-01

Historically dilation of the female urethra was thought to be of value in the treatment of a variety of lower urinary tract symptoms. Subsequent work has more accurately classified these complaints as parts of various diseases or syndromes in which scant data exist to support the use of dilation. Yet Medicare reimbursement for urethral dilation remains generous and we describe practice patterns regarding female urethral dilation to characterize a potential quality of care issue. Health care use by females treated with urethral dilation was compiled using a complementary set of databases. Data sets were examined for relevant inpatient, outpatient and emergency room services for women of all ages. Female urethral dilation is common (929 per 100,000 patients) and is performed almost as much as treatment for male urethral stricture disease. Approximately 12% of these patients are subjected to costly studies such as retrograde urethrography. The overall national costs for treatment exceed $61 million per year and have increased 10% to 17% a year since 1994. A diagnosis of female urethral stricture increases health care expenditures by more than $1,800 per individual per year in insured populations. Urethral dilation is still common despite the fact that true female urethral stricture is an uncommon entity. This scenario is likely secondary to the persistence of the mostly discarded practice of dilating the unstrictured female urethra for a wide variety of complaints despite the lack of data suggesting that it improves lower urinary tract symptoms.

Human papillomavirus DNA in the urogenital tracts of men with gonorrhoea, penile warts or genital dermatoses.

PubMed Central

Hillman, R J; Ryait, B K; Botcherby, M; Taylor-Robinson, D

1993-01-01

OBJECTIVE--To assess the presence of human papillomavirus (HPV) DNA in urethral and urine specimens from men with and without sexually transmitted diseases. DESIGN--Prospective study. SETTING--Two London departments of genitourinary medicine PATIENTS--100 men with urethral gonorrhoea, 31 men with penile warts and 37 men with genital dermatoses. METHODS--Urethral and urine specimens were taken, HPV DNA extracted and then amplified using the polymerase chain reaction. HPV types 6, 11, 16, 18, 31 and 33 were identified using Southern blotting followed by hybridisation. RESULTS--HPV DNA was detected in 18-31% of urethral swab specimens and in 0-14% of urine specimens. Men with penile warts had HPV detected in urethral swabs more often than did men in the other two clinical groups. "High risk" HPV types were found in 71-83% of swab specimens and in 73-80% of urine specimens containing HPV DNA. CONCLUSIONS--HPV is present in the urogenital tracts of men with gonorrhoea, penile warts and with genital dermatoses. In men with urethral gonorrhoea, detection of HPV in urethral specimens is not related to the number of sexual partners, condom usage, racial origin or past history of genital warts. HPV DNA in the urethral swab and urine specimens may represent different aspects of the epidemiology of HPV in the male genital tract. The preponderance of HPV types 16 and 18 in all three groups of men may be relevant to the concept of the "high risk male". Images PMID:8392967

Substitution urethroplasty of complex and long-segment urethral strictures: a rationale for procedure selection.

PubMed

Xu, Yue-Min; Qiao, Yong; Sa, Ying-Long; Wu, Den-Long; Zhang, Xin-Ru; Zhang, Jion; Gu, Bao-Jun; Jin, San-Bao

2007-04-01

We evaluated the applications and outcomes of substitution urethroplasty, using a variety of techniques, in 65 patients with complex, long-segment urethral strictures. From January 1995 to December 2005, 65 patients with complex urethral strictures >8cm in length underwent substitution urethroplasty. Of the 65 patients, 43 underwent one-stage urethral reconstruction using mucosal grafts (28 colonic mucosal graft, 12 buccal mucosal graft, and 3 bladder mucosal graft), 17 patients underwent one-stage urethroplasty using pedicle flaps, and 5 patients underwent staged Johanson's urethroplasty. The mean follow-up time was 4.8 yr (range; 0.8-10 yr), with an overall success rate of 76.92% (50 of 65 cases). Complications developed in 15 patients (23.08%) and included recurrent stricture in 7 (10.77%), urethrocutaneous fistula in 3 (4.62%), coloabdominal fistula in 1 (1.54%), penile chordee in 2 (3.08%), and urethral pseudodiverticulum in 2 (3.08%). Recurrent strictures and urethral pseudodiverticulum were treated successfully with a subsequent procedure, including repeat urethroplasty in six cases and urethrotomy or dilation in three. Coloabdominal fistula was corrected only by dressing change; five patients await further reconstruction. Penile skin, colonic mucosal, and buccal mucosal grafts are excellent materials for substitution urethroplasty. Colonic mucosal graft urethroplasty is a feasible procedure for complicated urethral strictures involving the entire or multiple portions of the urethra and the technique may also be considered for urethral reconstruction in patients in whom other conventional procedures failed.

Immediate management of posterior urethral disruptions due to pelvic fracture: therapeutic alternatives.

PubMed

Podestá, M L; Medel, R; Castera, R; Ruarte, A

1997-04-01

We retrospectively reviewed the results of 3 types of initial management of pelvic fracture urethral disruption in children. From 1980 to 1994, 35 boys 2 to 15 years old (mean age 8.1) with prostatomembranous urethral disruption were treated, including 17 who also had associated injuries. Immediate treatment included suprapubic cystostomy and delayed urethroplasty in 19 patients (group 1), urethral catheter alignment without traction and concomitant suprapubic cystostomy in 10 (group 2), and primary retropubic anastomotic urethroplasty in 6 (group 3). In all patients in groups 1 and 2 severe urethral obliteration developed. Four group 3 patients (66%) had a stricture at the site of anastomotic repair. After delayed urethroplasty 16 group 1 (84%) and all 10 group 2 patients were continent. However, only 3 group 3 patients (50%) achieved continence. Retrospectively associated bladder neck injury occurred in 5 of the 6 incontinent boys. Erections were observed before and after treatment in all but 3 children. Unstable pelvic ring fractures (type IV) comprised 28% of all pelvic fractures with a high rate of associated injuries. As described, urethral alignment was not beneficial for avoiding urethral obliteration. Therefore we recommend suprapublic cystostomy as the only form of initial treatment in these cases. Urinary incontinence seems more likely related to associated bladder neck rupture and the severity of pelvic fracture rather than to initial treatment or delayed urethral repair. Consequently, when associated bladder neck injury is present, we advocate immediate surgical repair.

Investigating the mechanism underlying urinary continence recovery after radical prostatectomy: effectiveness of a longer urethral stump to prevent urinary incontinence.

PubMed

Kadono, Yoshifumi; Nohara, Takahiro; Kawaguchi, Shohei; Naito, Renato; Urata, Satoko; Nakashima, Kazufumi; Iijima, Masashi; Shigehara, Kazuyoshi; Izumi, Kouji; Gabata, Toshifumi; Mizokami, Atsushi

2018-02-28

To assess the chronological changes in urinary incontinence and urethral function before and after radical prostatectomy (RP), and to compare the findings of pelvic magnetic resonance imaging (MRI) before and after RP to evaluate the anatomical changes. In total, 185 patients were evaluated with regard to the position of the distal end of the membranous urethra (DMU) on a mid-sagittal MRI slice and urethral sphincter function using the urethral pressure profilometry. The patients also underwent an abdominal leak point pressure test before RP and at 10 days and 12 months after RP. The results were then compared with the chronological changes in urinary incontinence. The MRI results showed that the DMU shifted proximally to an average distance of 4 mm at 10 days after RP and returned to the preoperative position at 12 months after RP. Urethral sphincter function also worsened 10 days after RP, with recovery after 12 months. The residual length of the urethral stump and urinary incontinence were significantly associated with the migration length of the DMU at 10 days after RP. The residual length of the urethral stump was a significant predictor of urinary incontinence after RP. This is the first study to elucidate that the slight vertical repositioning of the membranous urethra after RP causes chronological changes in urinary incontinence. A long urethral residual stump reduces urinary incontinence after RP. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

Preliminary Analysis of AVIRIS Data for Tectonostratigraphic Assessment of Northern Guerrero

NASA Technical Reports Server (NTRS)

Lang, Harold R.; Cabral-Cano, Enrique

1996-01-01

The tectonostratigraphic evolution of the southern margin of North American Plate in Mexico is still in debate. Recent explanations assert Laramide age (Campanian-Eocene) accretion of far-traveled oceanic terranes (Campa and Coney, 1983; Sedlock et al. 1993). In 1989, we began an effort to bring new data to this debate through field mapping, incorporating Lansat Thematic Mapper and digital elevation data, along a 30km by 250km, east-west geologic transect on northern Guerrero State.

Effects of offshore oil drilling on Philippine reef corals.

USGS Publications Warehouse

Hudson, J.H.; Shinn, E.A.; Robbin, D.M.

1982-01-01

An offshore drilling site in an area of extensive live-coral bottom off NW Palawan Island, Philippines, was examined 15 months after well completion. Porites lutea growth rates showed that little suppression of head coral growth could be attributed to drilling. Diver observation, however, together with analysis of sampling transect photomosaics, revealed 70-90% reduction in foliose, branching, and plate-like corals in an iron-stained area that extended out from the wellheads in a 115 X 85-m ellipse.-from Authors

Evaluation of the outcomes after posterior urethroplasty.

PubMed

Liberman, Daniel; Pagliara, Travis J; Pisansky, Andrew; Elliott, Sean P

2015-03-01

Posterior urethral injury is a clinically significant complication of pelvic fractures. The management is complicated by the associated organ injuries, distortion of the pelvic anatomy and the ensuing fibrosis that occurs with urethral injury. We report a review of the outcomes after posterior urethroplasty in the context of pelvic fracture urethral injury.

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. Copyright © 2014 Elsevier Inc. All rights reserved.

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.

Do we assess urethral function adequately in LUTD and NLUTD? ICI-RS 2015.

PubMed

Gajewski, Jerzy B; Rosier, Peter F W M; Rahnama'i, Sajjad; Abrams, Paul

2017-04-01

Urethral function, as well as anatomy, play a significant role in voiding reflex and abnormalities in one or both contribute to the pathophysiology of Lower Urinary Tract Dysfunction (LUTD). We have several diagnostic tools to assess the urethral function or dysfunction but the question remains, are these adequate? This is a report of the proceedings of Think Tank P1: 'Do we assess urethral function adequately in LUTD and NLUTD?' from the annual International Consultation on Incontinence-Research Society, which took place September 22-24, 2014 in Bristol, UK. We have collected and discussed, as a committee, the evidence with regard to the urethra and the available relevant methods of testing urethral function, with the emphasis on female and male voiding dysfunction. We looked into previous research and clinical studies and compiled summaries of pertinent testing related to urethral function. The discussion has focused on clinical applications and the desirability of further development of functional tests and analyses in this field. There are limitations to most of the urethral function tests. Future perspectives and research should concentrate on further development of functional testing and imaging techniques with emphasis on standardization and clinical application of these tests. Neurourol. Urodynam. 36:935-942, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Perineal anastomotic urethroplasty for posttraumatic urethral stricture with or without previous urethral manipulations: a review of 61 cases with long-term followup.

PubMed

Lumen, Nicolaas; Hoebeke, Piet; Troyer, Bart De; Ysebaert, Barbara; Oosterlinck, Willem

2009-03-01

We retrospectively analyzed cases of anastomotic urethroplasty for posttraumatic urethral strictures that were done at our center. Surgical and functional outcomes were evaluated. The impact of previous urethral manipulations was assessed. Between 1993 and 2006, 61 males were treated with anastomotic urethroplasty because of urethral trauma after pelvic fracture. Mean followup was 67 months (range 19 to 173). In 21 of the 61 cases (34.4%) urethral manipulation had been performed previously (secondary cases) but had failed. All patients were treated via the perineal approach. In 9 patients (14.8%) recurrence was reported. The recurrence rate was higher in patients who underwent former treatment than in primary patients (19% vs 12.5%). Posttraumatic impotence was reported by 20 patients (32.8%) but in 2 erectile function was restored after treatment. One patient had minor stress incontinence. In 2 secondary cases the rectum was injured during the procedure but could be repaired. Anastomotic urethroplasty via the perineal approach is an excellent treatment for posttraumatic urethral stricture. Results are good at long-term followup. Although statistical significance has not been attained, failures and complications seem to be higher in patients who have already undergone failed urethroplasty.

Mycoplasmataceae Colonizations in Women With Urethral Pain Syndrome: A Case-Control Study.

PubMed

Kyndel, Anna; Elmér, Caroline; Källman, Owe; Altman, Daniel

2016-07-01

To determine if Mycoplasma genitalium, Ureaplasma urealyticum, and Ureaplasma parvum are more common in premenopausal women with urethral pain syndrome than in asymptomatic controls. We used a case-control study design to compare the prevalence of M. genitalium, U. urealyticum, and U. parvum using polymerase chain reaction (PCR) analysis in urine. Urethral pain syndrome was defined as localized urethral pain with or without accompanying lower urinary tract symptoms during the past month or longer and at least one negative urine culture. Among the 28 cases, 46% carried Ureaplasma species compared with 64% of the 92 controls overall (P = 0.09). There were no significant differences in the prevalence of U. parvum and U. urealyticum among controls than in patients with urethral pain syndrome (P = 0.35 and P = 0.33, respectively). Co-colonization with U. parvum and urealyticum was infrequent, and there was only one case of M. genitalium colonization, which occurred among the controls. The symptomatic profile of Ureaplasma carriers with urethral pain syndrome was heterogeneous with no clear pattern and did not differ significantly compared with patients negative for Ureaplasma. We found no evidence to support the notion that M. genitalium, U. parvum, and U. urealyticum are more prevalent in women with urethral pain syndrome than in women without lower urinary tract symptoms.

A Decade of Shear-Wave Splitting Observations in Alaska

NASA Astrophysics Data System (ADS)

Bellesiles, A. K.; Christensen, D. H.; Abers, G. A.; Hansen, R. A.; Pavlis, G. L.; Song, X.

2010-12-01

Over the last decade four PASSCAL experiments have been conducted in different regions of Alaska. ARCTIC, BEAAR and MOOS form a north-south transect across the state, from the Arctic Ocean to Price Williams Sound, while the STEEP experiment is currently deployed to the east of that line in the St Elias Mountains of Southeastern Alaska. Shear-wave splitting observations from these networks in addition to several permanent stations of the Alaska Earthquake Information Center were determined in an attempt to understand mantle flow under Alaska in a variety of different geologic settings. Results show two dominant splitting patterns in Alaska, separated by the subducted Pacific Plate. North of the subducted Pacific Plate fast directions are parallel to the trench (along strike of the subducted Pacific Plate) indicating large scale mantle flow in the northeast-southwest direction with higher anisotropy (splitting times) within the mantle wedge. Within or below the Pacific Plate fast directions are normal to the trench in the direction of Pacific Plate convergence. In addition to these two prominent splitting patterns there are several regions that do not match either of these trends. These more complex regions which include the results from STEEP could be due to several factors including effects from the edge of the Pacific Plate. The increase of station coverage that Earthscope will bring to Alaska will aid in developing a more complete model for anisotropy and mantle flow in Alaska.

Versatility of the ventral approach in bulbar urethroplasty using dorsal, ventral or dorsal plus ventral oral grafts.

PubMed

Palminteri, Enzo; Berdondini, Elisa; Fusco, Ferdinando; De Nunzio, Cosimo; Giannitsas, Kostas; Shokeir, Ahmed A

2012-06-01

To investigate the versatility of the ventral urethrotomy approach in bulbar reconstruction with buccal mucosa (BM) grafts placed on the dorsal, ventral or dorsal plus ventral urethral surface. Between 1999 and 2008, 216 patients with bulbar strictures underwent BM graft urethroplasty using the ventral-sagittal urethrotomy approach. Of these patients, 32 (14.8%; mean stricture 3.2 cm, range 1.5-5) had a dorsal graft urethroplasty (DGU), 121 (56%; mean stricture 3.7, range 1.5-8) a ventral graft urethroplasty (VGU), and 63 (29.2%; mean stricture 3.4, range 1.5-10) a dorsal plus ventral graft urethroplasty (DVGU). The strictured urethra was opened by a ventral-sagittal urethrotomy and BM graft was inserted dorsally or ventrally or dorsal plus ventral to augment the urethral plate. The median follow-up was 37 months. The overall 5-year actuarial success rate was 91.4%. The 5-year actuarial success rates were 87.8%, 95.5% and 86.3% for the DGU, VGU and DVGU, respectively. There were no statistically significant differences among the three groups. Success rates decreased significantly only with a stricture length of >4 cm. In BM graft bulbar urethroplasties the ventral urethrotomy access is simple and versatile, allowing an intraoperative choice of dorsal, ventral or combined dorsal and ventral grafting, with comparable success rates.

Controls on the rheological properties of peridotite at a palaeosubduction interface: A transect across the base of the Oman-UAE ophiolite

NASA Astrophysics Data System (ADS)

Ambrose, Tyler K.; Wallis, David; Hansen, Lars N.; Waters, Dave J.; Searle, Michael P.

2018-06-01

Studies of experimentally deformed rocks and small-scale natural shear zones have demonstrated that volumetrically minor phases can control strain localisation by limiting grain growth and promoting grain-size sensitive deformation mechanisms. These small-scale studies are often used to infer a critical role for minor phases in the development of plate boundaries. However, the role of minor phases in strain localisation at an actual plate boundary remains to be tested by direct observation. In order to test the hypothesis that minor phases control strain localisation at plate boundaries, we conducted microstructural analyses of peridotite samples collected along a ∼1 km transect across the base of the Oman-United Arab Emirates (UAE) ophiolite. The base of the ophiolite is marked by the Semail thrust, which represents the now exhumed contact between subducted oceanic crust and the overlying mantle wedge. As such, the base of the ophiolite provides the opportunity to directly examine a former plate boundary. Our results demonstrate that the mean olivine grain size is inversely proportional to the abundance of minor phases (primarily orthopyroxene, as well as clinopyroxene, hornblende, and spinel), consistent with suppression of grain growth by grain-boundary pinning. Our results also reveal that mean olivine grain size is proportional to CPO strength (both of which generally decrease towards the metamorphic sole), suggesting that the fraction of strain produced by different deformation mechanisms varied spatially. Experimentally-derived flow laws indicate that under the inferred deformation conditions, the viscosity of olivine was grain-size sensitive. As such, grain size, and thereby the abundance of minor phases, influenced viscosity during subduction-related deformation along the base of the mantle wedge. We calculate an order of magnitude decrease in the viscosity of olivine towards the base of the ophiolite, which suggests strain was localised near the subduction interface. Our data indicate that this rheological weakening was primarily the result of more abundant minor phases near the base of the ophiolite. Our interpretations are consistent with those of previous studies on experimentally deformed rocks and smaller-scale natural shear zones that indicate minor phases can exert the primary control on strain localisation. However, our study demonstrates for the first time that minor phases can control strain localisation at the scales relevant to a major plate boundary.

Buccal mucosal graft urethroplasty for proximal bulbar urethral stricture: A revisit of the surgical technique and analysis of eleven consecutive cases.

PubMed

Eshiobo, Irekpita; Ehizomen, Esezobor; Omosofe, F; Onuora, V

2016-01-01

Urethral stricture disease is prevalent, and many surgical techniques have been developed to treat it. Currently, urethroplasty for bulbar strictures implies ventral or dorsal stricturotomy and a buccal mucosa graft (BMG) patch. To describe the surgical approach of the ventral patch BMG urethroplasty for proximal bulbar urethral stricture and to analyze 11 consecutive cases for whom the technique was used. The diagnosis of urethral stricture was confirmed with a combined retrograde urethrography and micturating cystourethrography. A single team exposed the urethra, harvested, and planted the BMG in the lithotomy position under general anesthesia. The oral preoperative preparation was done with oraldene (hexetidine) mouth wash three times daily beginning from the 2 nd preoperative day. The buccal mucosa was harvested from the left inner cheek in all the patients. The donor site was left unclosed but packed with wet gauze. Data related to age, preoperative adverse conditions, stricture length, urine culture result, perineal/oral wound complications, postoperative residual urine volume, and duration of hospital stay were recorded. Eleven patients with proximal bulbar urethral stricture had BMG urethroplasty from August 2013 to October 2015. Stricture length ranged from 2 to 5 cm. In six (54%) of the men, the stricture resulted from urethritis thereby constituting the most common etiology of urethral stricture in this study. The preoperative adverse conditions were age above 70 in three, diabetes mellitus in two, severe dental caries in one, and recurrent stricture in two. All of them were able to resume reasonable oral intake 72 h postoperatively. One (9.2%) had perineal wound infection, while two (18.2%) still had mild pain at donor site 4 weeks postoperatively. Ten (90.9%) of the 11 patients had <30 ml residual urine volume at 2 months of follow-up. Urethritis is still a common cause of urethral stricture in this rural community. Ventral onlay buccal mucosal graft urethroplasty for proximal bulbar urethral stricture is safe, even in certain adverse preoperative conditions. Buccal mucosa from the cheek is however now preferred.

Urethral stricture Yemen experience.

PubMed

Al-Ba'adani, Tawfik H; Al-Asbahi, Walid; Al-Towaity, Mansour; Alwan, Mohammed; Al-Germozi, Shehab; Ghilan, Abdulelah; Telha, Khaled; Ben Godal, Mohammed; El-Nono, Ibraheim

2010-09-01

In order to evaluate the etiology of urethral stricture in our society and outcome of different types of surgical reconstruction used to treat them. This prospective study was carried out in the Urology and Nephrology Center, at Al-Thawra Modern General and Teaching Hospital, Sana'a, Yemen from July 2003 to July 2007 and included 62 male patients with complete urethral stricture whom underwent Urethral reconstructive surgery. The patients were evaluated by history, local and systemic physical examination, and radiological assessment according to each case. Patient's age ranged between 3 and 70 years (mean 25.31). Of 55 patients presented to the GER, 31 patients had car accident, 14 patients had gun shot injury, 9 patients fell from high, and one patient had bomb explosion. Five patients had history of traumatized catheterization and urethrocystoscopy, while two patients had history of urethritis. The site of the stricture was at the bulbomembranous area in 43 patients, in the penile urethra in 14 patients, and in bulbous urethra in 5 patients. The length of the urethral stricture was 10-30 mm in 39 patients (63%), <10 mm in 13 patients (21%) and of 30-70 mm in 10 patients (16%). A total of 15 patients (24%) with posterior urethral stricture of 10 mm or less (+2 patients with 1.2 and 1.5 cm), subjected to endoscopic treatment, 37 patients (60%) with stricture >10-30 mm, were underwent anastomotic urethral reconstruction and 10 patients (15%) with stricture >30 mm, were repaired utilizing tissue transfer technique. Follow-up period ranged from 3 months to 2 years (median 15 months), in which recurrent stricture was found in 11 patients (18%), wound dehiscence in 4 patients (6%) and fistula formation in 1 patient (1.5%), while no patient came with erectile dysfunction. Trauma is the commonest cause of urethral stricture in our country, therefore the control of it will decrease extremely the urethral stricture disease. No one technique is suitable for all types of the stricture, and the surgeon should be familiar with the different techniques and choose the most suitable one according to the case he deals with.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pettersson, Niclas, E-mail: niclas.pettersson@vgregion.se; Olsson, Caroline; Tucker, Susan L.

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 +more » 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 doses up to 70 Gy{sub 3}.« less

Long-term outcome of surgical treatment of penile fracture complicated by urethral rupture.

PubMed

El-Assmy, Ahmed; El-Tholoth, Hossam S; Mohsen, Tarek; Ibrahiem, El Housseiny I

2010-11-01

The combination of lesions of the penile urethra and the corpus cavernosum is rare and is likely to worsen the immediate and long-term prognosis. To assess the late effects of penile fractures complicated by urethral rupture treated by immediate surgical intervention. Fourteen patients with concomitant urethral rupture were treated surgically at our center. Those patients were seen in the outpatient follow-up clinic and were re-evaluated. Sexual Health Inventory for Men questionnaire, local examination, uroflowmetry and penile color Doppler ultrasound. The most common cause of penile fracture is sexual intercourse (50%). The site of tunical tear was in the proximal shaft of the penis in 3 patients (21%) and in the mid of the shaft in 11 patients (79%). Urethral injury was localized at the same level as the corpus cavernosum tear in all cases; and it was partial in 11 cases and complete in 3. Long-term follow-up (mean=90 months) was available for 12 patients; among whom there was no complications in 4 (33%), painful erection in 1 (8%), erectile dysfunction in 2 (17%), and palpable fibrous nodule in 5 (47%). All patients had a normal urinary flow except one who developed relative urethral narrowing that required regular dilatation for 1 month. The urethral injury complicating penile fracture is often partial and localized at the level of the corpora cavenosa tear. Standard treatment consists of immediate surgical repair of both urethral and corporal ruptures with no harmful long-term sequelae on urethral and erectile function in most of patients. © 2010 International Society for Sexual Medicine.

Urethral Foreign Bodies: Clinical Presentation and Management.

PubMed

Palmer, Cristina J; Houlihan, Matthew; Psutka, Sarah P; Ellis, K Alexandria; Vidal, Patricia; Hollowell, Courtney M P

2016-11-01

To review a single institution's 15-year experience with urethral foreign bodies, including evaluation, clinical findings, and treatment. In total, 27 patients comprising 35 episodes of inserted urethral foreign bodies were reviewed at Cook County Hospital between 2000 and 2015. Retrospective chart review was performed to describe the clinical presentation, rationale for insertion, management, recidivism, and sequelae. Median patient age was 26 (range 12-60). Twenty-six patients (97 %) were male, 1 was female (3%). Items inserted included pieces of plastic forks, spoons, metal screws and aluminum, pieces of cardboard or paper, staples, writing utensils such as pens and pencils, as well as coaxial cable and spray foam sealant. Reported reasons for insertion were self-stimulation, erectile enhancement, and attention seeking. Presenting symptoms included dysuria, gross hematuria, urinary retention, urinary tract infection, and penile discharge. The most common technique for removal was manual extraction with extrinsic pressure (n = 19, 54%). Other methods include endoscopic retrieval (n = 8, 23%), open cystotomy (n = 1, 3%), and voiding to expel the foreign body (n = 7, 20%). Postremoval complications included urinary tract infection (n = 7), sepsis (n = 4), urethral false passage (n = 5), laceration (n = 5), and stricture (n = 1). We present the largest single-institutional series of urethral foreign bodies to date. Urethral foreign body insertion is a relatively rare occurrence and, commonly, is a recurrent behavior. Urethral trauma related to foreign body insertion is associated with significant risk of infection and urethral injury with long-term sequelae. Copyright © 2016 Elsevier Inc. All rights reserved.

Posterior Urethroplasty Complexity and Prognosis Can be Described by a Novel Method: Posterior Urethral Stenosis Score.

PubMed

Wang, Lin; Lv, Xiangguo; Jin, Chongrui; Guo, Hailin; Shu, Huiquan; Fu, Qiang; Sa, Yinglong

2018-02-01

To develop a standardized PU-score (posterior urethral stenosis score), with the goal of using this scoring system as a preliminary predictor of surgical complexity and prognosis of posterior urethral stenosis. We retrospectively reviewed records of all patients who underwent posterior urethral surgery at our institution from 2013 to 2015. The PU-score is based on 5 components, namely etiology (1 or 2 points), location (1-3 points), length (1-3 points), urethral fistula (1 or 2 points), and posterior urethral false passage (1 point). We calculated the score of all patients and analyzed its association with surgical complexity, stenosis recurrence, intraoperative blood loss, erectile dysfunction, and urinary incontinence. There were 144 patients who underwent low complexity urethral surgery (direct vision internal urethrotomy, anastomosis with or without crural separation) with a mean score of 5.1 points, whereas 143 underwent high complexity urethroplasty (anastomosis with inferior pubectomy or urethrorectal fistula repair, perineal or scrotum skin flap urethroplasty, bladder flap urethroplasty) with a mean score of 6.9 points. The increase of PU-score was predictive of higher surgical complexity (P = .000), higher recurrence (P = .002), more intraoperative blood loss (P = .000), and decrease of preoperative (P = .037) or postoperative erectile function (P = .047). However, no association was observed between PU-score and urinary incontinence (P = .213). The PU-score is a novel and meaningful scoring system that describes the essential factors in determining the complexity and prognosis for posterior urethral stenosis. Copyright © 2017. Published by Elsevier Inc.

Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: Current topics and reviews.

PubMed

Horiguchi, Akio

2017-07-01

Male anterior urethral stricture is scarring of the subepithelial tissue of the corpus spongiosum that constricts the urethral lumen, decreasing the urinary stream. Its surgical management is a challenging problem, and has changed dramatically in the past several decades. Open surgical repair using grafts or flaps, called substitution urethroplasty, has become the gold standard procedure for anterior urethral strictures that are not amenable to excision and primary anastomosis. Oral mucosa harvested from the inner cheek (buccal mucosa) is an ideal material, and is most commonly used for substitution urethroplasty, and lingual mucosa harvested from the underside of the tongue has recently emerged as an alternative material with equivalent outcome. Onlay augmentation of oral mucosa graft on the ventral side (ventral onlay) or dorsal side (dorsal onlay, Barbagli procedure) has been widely used for bulbar urethral stricture with comparable success rates. In bulbar urethral strictures containing obliterative or nearly obliterative segments, either a two-sided dorsal plus ventral onlay (Palminteri technique) or a combination of excision and primary anastomosis and onlay augmentation (augmented anastomotic urethroplasty) are the procedures of choice. Most penile urethral strictures can be repaired in a one-stage procedure either by dorsal inlay with ventral sagittal urethrotomy (Asopa technique) or dorsolateral onlay with one-sided urethral dissection (Kulkarni technique); however, staged urethroplasty remains the procedure of choice for complex strictures, including strictures associated with genital lichen sclerosus or failed hypospadias. This article presents an overview of substitution urethroplasty using oral mucosa graft, and reviews current topics. © 2017 The Japanese Urological Association.

Total vaginectomy and urethral lengthening at time of neourethral prelamination in transgender men.

PubMed

Medina, Carlos A; Fein, Lydia A; Salgado, Christopher J

2017-11-29

For transgender men (TGM), gender-affirmation surgery (GAS) is often the final stage of their gender transition. GAS involves creating a neophallus, typically using tissue remote from the genital region, such as radial forearm free-flap phalloplasty. Essential to this process is vaginectomy. Complexity of vaginal fascial attachments, atrophy due to testosterone use, and need to preserve integrity of the vaginal epithelium for tissue rearrangement add to the intricacy of the procedure during GAS. We designed the technique presented here to minimize complications and contribute to overall success of the phalloplasty procedure. After obtaining approval from the Institutional Review Board, our transgender (TG) database at the University of Miami Hospital was reviewed to identify cases with vaginectomy and urethral elongation performed at the time of radial forearm free-flap phalloplasty prelamination. Surgical technique for posterior vaginectomy and anterior vaginal wall-flap harvest with subsequent urethral lengthening is detailed. Six patients underwent total vaginectomy and urethral elongation at the time of radial forearm free-flap phalloplasty prelamination. Mean estimated blood loss (EBL) was 290 ± 199.4 ml for the vaginectomy and urethral elongation, and no one required transfusion. There were no intraoperative complications (cystotomy, ureteral obstruction, enterotomy, proctotomy, or neurological injury). One patient had a urologic complication (urethral stricture) in the neobulbar urethra. Total vaginectomy and urethral lengthening procedures at the time of GAS are relatively safe procedures, and using the described technique provides excellent tissue for urethral prelamination and a low complication rate in both the short and long term.

Office Dilation of the Female Urethra: A Quality of Care Problem in the Field of Urology

PubMed Central

Santucci, Richard A.; Payne, Christopher K.; Saigal, Christopher S.

2008-01-01

Purpose: Historically dilation of the female urethra was thought to be of value in the treatment of a variety of lower urinary tract symptoms. Subsequent work has more accurately classified these complaints as parts of various diseases or syndromes in which scant data exist to support the use of dilation. Yet Medicare reimbursement for urethral dilation remains generous and we describe practice patterns regarding female urethral dilation to characterize a potential quality of care issue. Materials and Methods: Health care use by females treated with urethral dilation was compiled using a complementary set of databases. Data sets were examined for relevant inpatient, outpatient and emergency room services for women of all ages. Results: Female urethral dilation is common (929 per 100,000 patients) and is performed almost as much as treatment for male urethral stricture disease. Approximately 12% of these patients are subjected to costly studies such as retrograde urethrography. The overall national costs for treatment exceed $61 million per year and have increased 10% to 17% a year since 1994. A diagnosis of female urethral stricture increases health care expenditures by more than $1,800 per individual per year in insured populations. Conclusions: Urethral dilation is still common despite the fact that true female urethral stricture is an uncommon entity. This scenario is likely secondary to the persistence of the mostly discarded practice of dilating the unstrictured female urethra for a wide variety of complaints despite the lack of data suggesting that it improves lower urinary tract symptoms. PMID:18804232

Monti's procedure as an alternative technique in complex urethral distraction defect.

PubMed

Hosseini, Jalil; Kaviani, Ali; Mazloomfard, Mohammad M; Golshan, Ali R

2010-01-01

Pelvic fracture urethral distraction defect is usually managed by the end to end anastomotic urethroplasty. Surgical repair of those patients with post-traumatic complex posterior urethral defects, who have undergone failed previous surgical treatments, remains one of the most challenging problems in urology. Appendix urinary diversion could be used in such cases. However, the appendix tissue is not always usable. We report our experience on management of patients with long urethral defect with history of one or more failed urethroplasties by Monti channel urinary diversion. From 2001 to 2007, we evaluated data from 8 male patients aged 28 to 76 years (mean age 42.5) in whom the Monti technique was performed. All cases had history of posterior urethral defect with one or more failed procedures for urethral reconstruction including urethroplasty. A 2 to 2.5 cm segment of ileum, which had a suitable blood supply, was cut. After the re-anastomosis of the ileum, we closed the opened ileum transversely surrounding a 14-16 Fr urethral catheter using running Vicryl sutures. The newly built tube was used as an appendix during diversion. All patients performed catheterization through the conduit without difficulty and stomal stenosis. Mild stomal incontinence occurred in one patient in the supine position who became continent after adjustment of the catheterization intervals. There was no dehiscence, necrosis or perforation of the tube. Based on our data, Monti's procedure seems to be a valuable technique in patients with very long complicated urethral defect who cannot be managed with routine urethroplastic techniques.

Measurement of Dynamic Urethral Pressures with a High Resolution Manometry System in Continent and Incontinent Women

PubMed Central

Kirby, Anna C; Tan-Kim, Jasmine; Nager, Charles W.

2015-01-01

Objectives Female stress urinary incontinence (SUI) is caused by urethral dysfunction during dynamic conditions, but current technology has limitations in measuring urethral pressures under dynamic conditions. An 8-French high resolution manometry catheter (HRM) currently in clinical use in gastroenterology may accurately measure urethral pressures under dynamic conditions because it has a 25ms response rate and circumferential pressure sensors along the length of the catheter (ManoScan® ESO, Given Imaging). We evaluated the concordance, repeatability, and tolerability of this catheter. Methods We measured resting, cough, and strain maximum urethral closure pressures (MUCPs) using HRM and measured resting MUCPs with water perfusion side-hole catheter urethral pressure profilometry (UPP) in 37 continent and 28 stress incontinent subjects. Maneuvers were repeated after moving the HRM catheter along the urethral length to evaluate whether results depend on catheter positioning. Visual analog pain scores evaluated the comfort of HRM compared to UPP. Results The correlation coefficient for resting MUCPs measured by HRM vs. UPP was high (r = 0.79, p<0.001). Repeatability after catheter repositioning was high for rest, cough, and strain with HRM: r= 0.92, 0.89, and 0.89. Mean MUCPs (rest, cough, strain) were higher in continent than incontinent subjects (all p < 0.001) and decreased more in incontinent subjects than continent subjects during cough and strain maneuvers compared to rest. Conclusions This preliminary study shows that HRM is concordant with standard technology, repeatable, and well tolerated in the urethra. Incontinent women have more impairment of their urethral closure pressures during cough and strain than continent women. PMID:25185595

Measurement of dynamic urethral pressures with a high-resolution manometry system in continent and incontinent women.

PubMed

Kirby, Anna C; Tan-Kim, Jasmine; Nager, Charles W

2015-01-01

Female stress urinary incontinence is caused by urethral dysfunction during dynamic conditions, but current technology has limitations in measuring urethral pressures under these conditions. An 8-French high-resolution manometry (HRM) catheter currently in clinical use in gastroenterology may accurately measure urethral pressures under dynamic conditions because it has a 25-millisecond response rate and circumferential pressure sensors along the length of the catheter (ManoScan ESO; Given Imaging, Yoqneam, Israel). We evaluated the concordance, repeatability, and tolerability of this catheter. We measured resting, cough, and strain maximum urethral closure pressures (MUCPs) using HRM and measured resting MUCPs with water-perfusion side-hole catheter urethral pressure profilometry (UPP) in 37 continent and 28 stress-incontinent subjects. Maneuvers were repeated after moving the HRM catheter along the urethral length to evaluate whether results depend on catheter positioning. Visual analog pain scores evaluated the comfort of HRM compared to UPP. The correlation coefficient for resting MUCPs measured by HRM versus UPP was high (r = 0.79, P < 0.001). Repeatability after catheter repositioning was high for rest, cough, and strain with HRM: r = 0.92, 0.89, and 0.89. Mean MUCPs (rest, cough, and strain) were higher in continent than in incontinent subjects (all P < 0.001) and decreased more in incontinent subjects than in continent subjects during cough and strain maneuvers compared to rest. This preliminary study shows that HRM is concordant with standard technology, repeatable, and well tolerated in the urethra. Incontinent women have more impairment of their urethral closure pressures during cough and strain than continent women.

Rifting and subduction in the papuan peninsula, papua new guinea: The significance of the trobriand tough, the nubara strike-slip fault, and the woodlark rift to the present configuration of papua new guinea

NASA Astrophysics Data System (ADS)

Cameron, Milo Louis

The calculated extension (~111 km) across the Woodlark rift is incompatible with the > 130 km needed to exhume the Metamorphic Core Complexes on shallow angle faults (< 30°) using N-S extension in the Woodlark Basin. High resolution bathymetry, seismicity, and seismic reflection data indicate that the Nubara Fault continues west of the Trobriand Trough, intersects the Woodlark spreading center, and forms the northern boundary of the Woodlark plate and the southern boundary of the Trobriand plate. The newly defined Trobriand plate, to the north of this boundary, has moved SW-NE along the right lateral Nubara Fault, creating SW-NE extension in the region bounded by the MCC's of the D'Entrecasteaux Islands and Moresby Seamount. Gravity and bathymetry data extracted along four transect lines were used to model the gravity and flexure across the Nubara Fault boundary. Differences exist in the elastic thickness between the northern and southern parts of the lines at the Metamorphic Core Complexes of Goodenough Island (Te_south = 5.7 x 103 m; Te_north = 6.1 x 103 m) and Fergusson Island (Te_south = 1.2 x 103 m; Te_north = 5.5 x 103 m). Differences in the elastic strength of the lithosphere also exist at Moresby Seamount (Te_south = 4.2 x 103 m; Te_north = 4.7 x 103 m) and Egum Atoll (Te_south =7.5 x 103 m; Te_north = 1.3 x 104 m). The differences between the northern and southern parts of each transect line imply an east-west boundary that is interpreted to be the Nubara Fault. The opening of the Woodlark Basin resulted in the rotation of the Papuan Peninsula and the Woodlark Rise, strike slip motion between the Solomon Sea and the Woodlark Basin at the Nubara Fault, and the formation of the PAC-SOL-WLK; SOL-WLK-TRB triple junctions. The intersection of the Woodlark Spreading Center with the Nubara Fault added the AUS-WLK-TRB triple junction and established the Nubara Fault as the northern boundary of the Woodlark plate.

Reconstruction of posterior urethral disruption: tips for success from our experience and from a literature review.

PubMed

Kato, Haruaki; Kobayashi, Shinya; Kawakami, Masako; Inoue, Hiroo; Iijima, Kazuyoshi; Nishizawa, Osamu

2004-10-01

Repair of a posterior urethral disruption associated with a pelvic fracture is a challenge for urologic surgeons. Here, we provide surgical and strategic tips to facilitate the delayed surgical repair of urethral distraction defects. Nine patients each with a traumatic posterior urethral distraction defect underwent delayed transperineal or transperineoabdominal bulboprostatic anastomosis. Four patients had previously undergone multiple procedures. Seven patients regained satisfactory urination without incontinence, although one other patient is suffering from incontinence. In one patient, urethral disruption occurred again after removal of the urethral catheter, and he is being managed by suprapubic catheter. In our experience, the key to success is to perform a true bulboprostatic mucosa-to-mucosa anastomosis without tension. For this purpose, a transperineoabdominal approach is of particular importance when the healthy mucosa of the prostatic apex cannot be revealed through a perineal approach due to dense fibrous scar or fractured bone. A partial pubectomy may be necessary according to the situation. By the transperineoabdominal approach, the scar tissue can be bypassed through a broad sub-pubic-arch tunnel, and a reliable anastomosis achieved.

Fracture of the penis with urethral rupture.

PubMed

Roy, Mk; Matin, Ma; Alam, Mm; Suruzzaman, M; Rahman, Mm

2008-01-01

We report a rare case of penile fracture with incomplete urethral rupture in a 25 years old male who sustained the injury during sexual intercourse. He presented with a tense haematoma on the ventral aspect of the penile shaft, associated with urethral bleeding. Per urethral catheterization was possible though it was painful. Exploration and repair of the penile fracture and urethra were performed within 16 hrs. The patient made an uneventful recovery with good erectile and voiding function. This case illustrates the value of early surgical repair of the fracture in order to prevent complications. The true incidence of penile fracture is not known even in the Western countries because it is under reported or hidden for social embracement and even it is reported to physicians it remains undiagnosed or mismanaged. Very rarely it is associated with urethral rupture.

Pelvic fracture urethral injuries: the unresolved controversy.

PubMed

Koraitim, M M

1999-05-01

The unresolved controversies about pelvic fracture urethral injuries and whether any conclusions can be reached to develop a treatment plan for this lesion are determined. All data on pelvic fracture urethral injuries in the English literature for the last 50 years were critically analyzed. Studies were eligible only if data were complete and conclusive. The risk of urethral injury is influenced by the number of broken pubic rami as well as involvement of the sacroiliac joint. Depending on the magnitude of trauma, the membranous urethra is first stretched and then partially or completely ruptured at the bulbomembranous junction. Injuries to the prostatic urethra and bladder neck occur only in children. Injury to the female urethra usually is a partial tear of the anterior wall and rarely complete disruption of the proximal or distal urethra. Diagnosis depends on urethrography in men and on a high index of suspicion and urethroscopy in women. Of the 3 conventional treatment methods primary suturing of the disrupted urethral ends has the greatest complication rates of incontinence and impotence (21 and 56%, respectively). Primary realignment has double the incidence of impotence and half that of stricture compared to suprapubic cystostomy and delayed repair (36 versus 19 and 53 versus 97%, respectively, p <0.0001). In men surgical and endoscopic procedures do not compete but rather complement each other for treatment of different injuries under different circumstances, including indwelling catheter for urethral stretch injury, endoscopic stenting or suprapubic cystostomy for partial rupture, endoscopic realignment or suprapubic cystostomy for complete rupture with a minimal distraction defect and surgical realignment if the distraction defect is wide. Associated injury to the bladder, bladder neck or rectum dictates immediate exploration for repair but does not necessarily indicate exploration of the urethral injury site. In women treatment modalities are dictated by the level of urethral injury, including immediate retropubic realignment or suturing for proximal and transvaginal urethral advancement for distal injury.

Preliminary Analysis of AVIRIS Data for Tectonostratigraphic Assessment of Northern Guerrero State, Southern Mexico

NASA Technical Reports Server (NTRS)

Lang, Harold R.; Cabral-Cano, Enrique

1996-01-01

The tectonostratigraphic evolution of the southern margin of the North America Plate in Mexico is still in debate. Recent explanations assert Laramide age (Campanian-Eocene) accretion of far-travelled oceanic terranes. In 1989, we began an effort to bring new data to this debate through field mapping, incorporating Landsat Thematic Mapper and digital elevation data, along a 30 km by 250 km, east-west geologic transect of northern Guerrero State. Covering the region from Huetamo, Michoacan, to Papalutla, Guerrero (between latitude 18-19 deg N and longitude 101-99 deg W), our mapping results show that no stratigraphic incompatibilities suggesting terrane accretion exist in the region. In November 1994, AVIRIS data were acquired along the geologic transect in order to refine our stratigraphic assessment. One objective of this hyperspectral survey was to improve mapping of limestone, dolostone and gypsum-bearing facies of the Morelos Formation which record rudist carbonate platform environments during mid-Cretaceous time.

A Fluid Pulse on the Hikurangi Subduction Margin: Evidence From a Heat Flux Transect Across the Upper Limit of Gas Hydrate Stability

NASA Astrophysics Data System (ADS)

Pecher, I. A.; Villinger, H.; Kaul, N.; Crutchley, G. J.; Mountjoy, J. J.; Huhn, K.; Kukowski, N.; Henrys, S. A.; Rose, P. S.; Coffin, R. B.

2017-12-01

A transect of seafloor heat probe measurements on the Hikurangi Margin shows a significant increase of thermal gradients upslope of the updip limit of gas hydrate stability at the seafloor. We interpret these anomalously high thermal gradients as evidence for a fluid pulse leading to advective heat flux, while endothermic cooling from gas hydrate dissociation depresses temperatures in the hydrate stability field. Previous studies predict a seamount on the subducting Pacific Plate to cause significant overpressure beneath our study area, which may be the source of the fluid pulse. Double-bottom simulating reflections are present in our study area and likely caused by uplift based on gas hydrate phase boundary considerations, although we cannot exclude a thermogenic origin. We suggest that uplift may be associated with the leading edge of the subducting seamount. Our results provide further evidence for the transient nature of fluid expulsion in subduction zones.

Chlamydia trachomatis in non-specific urethritis.

PubMed Central

Terho, P

1978-01-01

Chlamydia trachomatis was isolated from 58.5% of 159 patients with non-specific urethritis (NSU) using irradiated McCoy cell cultures. Patients with persistent Chlamydia-positive NSU remained Chlamydia-positive each time they were examined before treatment and patients with Chlamydia-negative NSU remained Chlamydia-negative during the course of the illness. Neither the duration of symptoms of urethritis nor a history of previous urethritis affected the chlamydial isolation rate significantly. Of 40 patients with severe discharge 30 (75%) harboured C. trachomatis. One-third of the Chlamydia-positive patients had a severe urethral discharge, while this was present in only 15% of Chlamydia-negative patients. Complications--such as conjunctivitis, arthritis, and epididymitis--were more severe in men with Chlamdia-positive NSU than in those with Chlamydia-negative NSU. Of 64 men matched for sexual promiscuity but without urethritis, none harboured C. trachomatis in his urethra. This differs significantly (P less than 0.001) when compared with patients with NSU. C. trachomatis was isolated from the urogenital tract in 24 (42%) out of 57 female sexual contacts of patients with NSU. The presence of C. trachomatis in the women correlated significantly (P less than 0.001) with the isolation of the agent from their male contacts. These findings give further evidence for the aetiological role of C. trachomatis in non-specific urethritis and its sexual transmission. PMID:678958

Tissue engineering for human urethral reconstruction: systematic review of recent literature.

PubMed

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

2015-01-01

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. To review recent literature on tissue engineering for human urethral reconstruction. A search was made in the PubMed and Embase databases restricted to the last 25 years and the English language. 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. 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.

The Cost of Surveillance After Urethroplasty

PubMed Central

Zaid, Uwais B.; Hawkins, Mitchel; Wilson, Leslie; Ting, Jie; Harris, Catherine; Alwaal, Amjad; Zhao, Lee C.; Morey, Allen F.; Breyer, Benjamin N.

2015-01-01

Objectives To determine variability in urethral stricture surveillance. Urethral strictures impact quality of life and exact a large economic burden. Although urethroplasty is the gold standard for durable treatment, strictures recur in 8–18%. There are no universally accepted guidelines for post-urethroplasty surveillance. We performed a literature search to evaluate variability in surveillance protocols, analyzed costs, and reviewed performance of each commonly employed modality. Methods Medline search was performed using the keywords: “urethroplasty,” “urethral stricture,” “stricture recurrence” to ascertain commonly used surveillance strategies for stricture recurrence. We included English language manuscripts from the past 10 years with at least 10 patients, and age greater than 18. Cost data was calculated based on standard 2013 Centers for Medicare and Medicaid Services physician’s fees. Results Surveillance methods included retrograde urethrogram/voiding cystourethrogram (RUG/VCUG), cystourethroscopy, urethral ultrasound, AUA-Symptom Score, and post void residual (PVR) and urine flowmetry (UF) measurement. Most protocols call for a RUG/VCUG at time of catheter removal. Following this, UF/PVR, cystoscopy, urine culture, or a combination of UF and AUA-SS were performed at variable intervals. The first year follow-up cost of anterior urethral surgery ranged from $205 to $1,784. For posterior urethral surgery, follow-up cost for the first year ranged from $404 to $961. Conclusions Practice variability for surveillance of urethral stricture recurrence after urethroplasty leads to significant differences in cost. PMID:25819624

Circumferential urinary sphincter surface electromyography: A novel diagnostic method for intrinsic sphincter deficiency.

PubMed

Heesakkers, John; Gerretsen, Reza; Izeta, Ander; Sievert, Karl-Dietrich; Farag, Fawzy

2016-02-01

The diagnosis of intrinsic sphincter deficiency (ISD) in patients with stress urinary incontinence (SUI) is not well established. We explored the possibility of applying a new tool: minimally invasive circumferential sphincter surface electromyography (CSS-EMG) to assess the muscular integrity of the urethral sphincter in patients with SUI/ISD. CSS-EMG of the urethral sphincter and urodynamic studies were performed in 44 women with SUI. A urethral pressure profile (UPP) was measured in four directions. Maximal urethral closure pressure (MUCP) <40 cm/H2 O or the presence of SUI without urethral hypermobility was used to define ISD. Twenty-one patients had urodynamic SUI, 23 had no SUI and 12 patients had ISD. The mean average rectified value (ARV) of the motor unit action potential (MUAP), an indicator of the strength of urethral rhabdosphincter, was estimated. ARV measured in the 12 o'clock quadrant during maximal contraction was the only CSS-EMG parameter that had significant predictive value for ISD. With an increase in the 12 o'clock ARV value, the likelihood of ISD decreases (Odds Ratio 0.36 95% confidence interval 0.67-0.92). In the ROC curve with ARV measured in the 12 o'clock quadrant during maximal contraction, the explained area was 0.794 (P = 0.02); implying that ARV measured at the 12 o'clock quadrant during maximal contraction was able to predict ISD significantly. Myogenic changes of the urethral sphincter that contribute to ISD can be assessed with CSS-EMG. This new concept for assessing the functionality of the female urethral sphincter may assist with better understanding of the pathophysiology, the diagnosis and the treatment of SUI. © 2014 Wiley Periodicals, Inc.

Air charged and microtip catheters cannot be used interchangeably for urethral pressure measurement: a prospective, single-blind, randomized trial.

PubMed

Zehnder, Pascal; Roth, Beat; Burkhard, Fiona C; Kessler, Thomas M

2008-09-01

We determined and compared urethral pressure measurements using air charged and microtip catheters in a prospective, single-blind, randomized trial. A consecutive series of 64 women referred for urodynamic investigation underwent sequential urethral pressure measurements using an air charged and a microtip catheter in randomized order. Patients were blinded to the type and sequence of catheter used. Agreement between the 2 catheter systems was assessed using the Bland and Altman 95% limits of agreement method. Intraclass correlation coefficients of air charged and microtip catheters for maximum urethral closure pressure at rest were 0.97 and 0.93, and for functional profile length they were 0.9 and 0.78, respectively. Pearson's correlation coefficients and Lin's concordance coefficients of air charged and microtip catheters were r = 0.82 and rho = 0.79 for maximum urethral closure pressure at rest, and r = 0.73 and rho = 0.7 for functional profile length, respectively. When applying the Bland and Altman method, air charged catheters gave higher readings than microtip catheters for maximum urethral closure pressure at rest (mean difference 7.5 cm H(2)O) and functional profile length (mean difference 1.8 mm). There were wide 95% limits of agreement for differences in maximum urethral closure pressure at rest (-24.1 to 39 cm H(2)O) and functional profile length (-7.7 to 11.3 mm). For urethral pressure measurement the air charged catheter is at least as reliable as the microtip catheter and it generally gives higher readings. However, air charged and microtip catheters cannot be used interchangeably for clinical purposes because of insufficient agreement. Hence, clinicians should be aware that air charged and microtip catheters may yield completely different results, and these differences should be acknowledged during clinical decision making.

Thulium laser urethrotomy for urethral stricture: a preliminary report.

PubMed

Wang, Linhui; Wang, Zhixiang; Yang, Bo; Yang, Qing; Sun, Yinghao

2010-09-01

The outcome of thulium laser urethrotomy for patients with urethral stricture had not been reported. The purpose of this study was to evaluate outcome of endourethrotomy with the thulium laser as a minimally invasive treatment for urethral stricture. Twenty-one consecutive patients with urethral stricture were evaluated by retrograde uroflowmetry, International Prostate Symptom Score (IPSS), and quality of life preoperatively at a single academic center. All patients were treated with thulium laser urethrotomy. All patients were followed up for 12-24 months postoperatively by uroflowmetry and by retrograde with voiding cystourethrogram every 3 months. And all patients were followed up by mailed questionnaire, including IPSS and quality of life. Retrograde endoscopic thulium laser urethrotomy was performed in all 21 patients. Most patients (N = 16; 76.2%) did not need any reintervention. Five patients developed recurrent strictures, of them two patients were treated by another laser urethrotomy, one patient was treated by open urethroplasty with buccal mucosa and the other two patients' reintervention were treated by urethral dilation. No intraoperative complications were encountered, although in 9.5% (N = 2) of patients, a urinary tract infection was diagnosed postoperatively. No gross hematuria occurred. Including two patients treated with repeat laser urethrotomy, 17(81.0%) showed good flow of urine (Q(ave)>16.0 ml/second) and adequate caliber urethra in retrograde urethrogram (RGU) 12 months after operation. Three (14.3%) patients showed narrow stream of urine (Q(ave)<8.0 ml/second) and urethral dilation was done every month or 2 months. There was one patient whose Q(ave) was between 8.0 and 16.0 ml/second. And this patient was treated by neither urethral dilation nor another laser urethrotomy. The thulium laser urethrotomy was a safe and effective minimally invasive therapeutic modality for urethral stricture. 2010 Wiley-Liss, Inc.

Intermittent self-dilatation for urethral stricture disease in males: A systematic review and meta-analysis.

PubMed

Ivaz, Stella L; Veeratterapillay, Rajan; Jackson, Matthew J; Harding, Christopher K; Dorkin, Trevor J; Andrich, Daniela E; Mundy, Anthony R

2016-09-01

Intermittent self-dilatation (ISD) may be recommended to reduce the risk of recurrent urethral stricture. Level one evidence to support the use of this intervention is lacking. Determine the clinical and cost-effectiveness of ISD for the management of urethral stricture disease in males. The strategy developed for the Cochrane Incontinence Review Group as a whole (last searched May 7, 2014). Randomised trials where one arm was a programme of ISD for urethral stricture. At least two independent review authors carried out trial assessment, selection, and data abstraction. Data from six trials that were pooled and collectively rated very low quality per the GRADE approach, indicated that recurrent urethral stricture was less likely in men who performed ISD than those who did not (RR 0.70, 95% CI 0.48-1.00). Two trials compared programmes of ISD but the data were not combined and neither were sufficiently robust to draw firm conclusions. Three trials compared devices for performing ISD, results from one of which were too uncertain to determine the effects of a low friction hydrophilic catheter versus a polyvinyl chloride catheter on risk of recurrent urethral stricture (RR 0.32, 95% CI 0.07 to 1.40); another did not find evidence of a difference between 1% triamcinolone gel for lubricating the ISD catheter versus water-based gel on risk of recurrent urethral stricture (RR 0.68, 95% CI 0.35 to 1.32). No trials gave cost-effectiveness or validated PRO data. ISD may decrease the risk of recurrent urethral stricture. A well-designed RCT is required to determine whether that benefit alone is sufficient to make this intervention worthwhile and in whom. Neurourol. Urodynam. 35:759-763, 2016. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Misdiagnoses caused by use of indwelling urethral catheters in children with ureterovesical junction anomalies.

PubMed

Çelebi, Süleyman; Sander, Serdar; Kuzdan, Özgür; Özaydın, Seyithan; Güvenç, Ünal; Yavuz, Sevgi; Kıyak, Aysel; Demirali, Oyhan

2015-04-01

Children commonly undergo vesicograms for diagnosing vesicoureteral reflux (VUR). This requires urethral catheterization with transurethral replacement. We report misdiagnosed or related complications due to indwelling urethral catheters unintentionally placed in the ureter. From our computerized urology records over an 18-year period from January 1995 to May 2013, we retrospectively identified nine cases of 1850 vesicograms that had misdirection of a urethral catheter placed in a ureter. Foley catheters with inflating balloons were used to obtain the vesicograms. In all, 1850 vesicograms were performed (746 males, 1104 females; age 1 week to 14 years, mean age 3.8 years) using standard radiological techniques. Size 6-10 Fr indwelling urethral catheters were used, depending on the patient's age and gender. In nine cases (five females, four males), a misdirected urethral catheter was discovered in one of the ureters. The urethral catheter was in the left ureter in four patients and in the right ureter in five patients. Cystoscopic examination found ectopic ureteral openings in six patients: at the bladder neck in four and just below the bladder trigone in two. Three patients in this group with ectopic ureters were followed due a misdiagnosis of VUR. The remaining three patients had grade 3 or 4 VUR. In this group, the catheter passed into the ureter because of the enlarged ureterovesical junction. In one patient with VUR, intraparenchymal fluid leakage and transient hematuria occurred due to the rapid tension increase following the fast injection of contrast with liquid to one ureter. Although placing an indwelling urethral catheter is a relatively safe procedure, complications can occur, particularly in patients with ureterovesical anomalies, such as high-grade VUR or an ectopic ureter. Using catheters with inflating balloons can cause rapid increases in tension in the ureter, and related complications.

[Surgical approach of traumatic urethral injury in children. Experience at San Vicente of Paul Universitary Hospital. Medellín 1987-2007].

PubMed

Martínez Montoya, Jorge A; Tascón Acevedo, Natalia M

2009-04-01

In order to evaluate the efficacy of different surgical techniques for the correction of traumatic lesions of the urethra, we performed a retrospective study in those patients, and evaluated different complications such as postsurgical stenosis of the urethra, incontinence and impotence (erectile dysfunction). A retrospective study was conducted, reviewing the clinical charts of 43 patients admitted to the San Vicente of Paul Hospital, with diagnosis of traumatic rupture of the posterior urethra from 1987 to 2007. We analyzed different demographic data, type of surgical correction, early and late complications. The average age of the patients was 7.7 years, the average follow up was 30.6 months, and all the patients were male with a posterior urethral rupture. 27 Patients underwent a primary urethral repair (63%), 13 patients underwent a cistostomy with later urologic reconstruction (30%), in 3 patients (7%) other surgical procedures were made. Overall complication rate was 39.5%. These complications were: Urethral stenosis, 26 patients (60.5%), urinary retention secondary to obstruction, 10 patients (23.3%), incontinence 10 patients (23.3%) and impotence 7 patients (16.3%). Patients treated with a primary urethral repair presented a significantly less development of infection, obstruction and stenosis, (p<0.05). Patients with pelvis fracture associated to urethral trauma had a significant higher risk of developing stenosis and impotence. (p<0.05). Both different surgical techniques compared showed a similar complication and morbidity rates in middle follow up. Each procedure should be selected according to clinical condition of the patient, the extension of the urethral damage, the associated traumatic lesions and the surgeon's expertise. In our searched patients, treated with a primary urethral repair we found a significantly less development of infection, obstruction and stenosis.

Endoscopic Assessment and Prediction of Prostate Urethral Disintegration After Histotripsy Treatment in a Canine Model*

PubMed Central

Schade, George R.; Styn, Nicholas R.; Hall, Timothy L.

2012-01-01

Abstract Background and Purpose Histotripsy is a nonthermal focused ultrasound technology that uses acoustic cavitation to homogenize tissue. Previous research has demonstrated that the prostatic urethra is more resistant to histotripsy effects than prostate parenchyma, a finding that may complicate the creation of transurethral resection of the prostate-like treatment cavities. The purpose of this study was to characterize the endoscopic appearance of the prostatic urethra during and after histotripsy treatment and to identify features that are predictive of urethral disintegration. Materials and Methods Thirty-five histotripsy treatments were delivered in a transverse plane traversing the prostatic urethra in 17 canine subjects (1–3/prostate ≥1 cm apart). Real-time endoscopy was performed in the first four subjects to characterize development of acute urethral treatment effect (UTE). Serial postprocedure endoscopy was performed in all subjects to assess subsequent evolution of UTE. Results Endoscopy during histotripsy was feasible with observation of intraurethral cavitation, allowing characterization of the real-time progression of UTE from normal to frank urethral disintegration. While acute urethral fragmentation occurred in 3/35 (8.6%) treatments, frank urethral disintegration developed in 24/35 (68.5%) within 14 days of treatment. Treating until the appearance of hemostatic pale gray shaggy urothelium was the best predictor of achieving urethral fragmentation within 14 days of treatment with positive and negative predictive values of 0.91 and 0.89, respectively. Conclusion Endoscopic assessment of the urethra may be a useful adjunct to prostatic histotripsy to help guide therapy to ensure urethral disintegration, allowing drainage of the homogenized adenoma and effective tissue debulking. PMID:22050511

[A new generation of urethral stents--Allium in the therapy of symptomatic prostatic enlargement of various etiology].

PubMed

Marković, B B; Marković, Z; Yachia, D; Hadzi, Djokić J

2007-01-01

A number of urethral stents made of different materials, with different time of indwelling and different designs, primarily based on the vascular stent concept, have been applied in the clinical practice so far. According to the published studies, urethral stents have justified their clinical application, however with certain limitations. Within an attempt to overcome the limitations, a covered, temporary urethral stent was initially designed by Daniel Yachie and Ijko Markovi in Allium corporation from Israel. With its triangular shape, the stent is a replica of the obstructive prostatic urethral lumen. In has been applied in a series of 14 patients with lower urinary tract symptoms caused by the obstruction at the level of the prostatic urethra. The subjects were averagely aged 77.4 +/- 5.1 years. Allium prostatic stent remained in place in the patients for 4.93 +/- 3.17 months, at the average.

Trichomonas vaginalis infection: How significant is it in men presenting with recurrent or persistent symptoms of urethritis?

PubMed

Ng, Andrea; Ross, Jonathan D C

2016-01-01

Persistent or recurrent non-gonococcal urethritis has been reported to affect up to 10-20% of men attending sexual health clinics. An audit was undertaken to review the management of persistent or recurrent non-gonococcal urethritis in men presenting at Whittall Street Clinic, Birmingham, UK. Detection of Trichomonas vaginalis infection was with the newly-introduced nucleic acid amplification test. A total of 43 (8%) of 533 men treated for urethritis re-attended within three months with persistent or recurrent symptoms. Chlamydia trachomatis infection was identified in 13/40 (33%), T. vaginalis in 1/27 (4%) and Mycoplasma genitalium in 6/12 (50%). These findings suggest that the prevalence of T. vaginalis infection remains low in our clinic population and may not contribute significantly to persistent or recurrent non-gonococcal urethritis. © The Author(s) 2015.

Postpubertal genitourinary function following posterior urethral disruptions in children.

PubMed

Boone, T B; Wilson, W T; Husmann, D A

1992-10-01

A total of 24 boys sustaining a simultaneous pelvic fracture and posterior urethral disruption was observed from the time of injury through puberty. Average length of followup was 6 years. In contrast to the adult, in whom the urethra is invariably injured at the prostatomembranous junction, the posterior urethral disruptions in the prepubertal patient were at 3 distinct locations: 1) supraprostatic in 4 patients, 2) transprostatic in 4 and 3) prostatomembranous in 16. Prolonged followup through puberty in these children revealed that the frequency of complications was significantly higher for urethral injuries proximal to the prostatomembranous region compared to those at this latter site: impotence 75% versus 31%, intractable strictures following repairs 75% versus 12% and urinary incontinence 25% versus 0%. In summary, the prognosis of children who sustain a posterior urethral disruption should be based on the location of the injury and must remain guarded until the individual attains a postpubertal status.

Medical Surveillance Monthly Report (MSMR). Volume 15, Number 10, December 2008

DTIC Science & Technology

2008-12-01

gonococcal (NGU). Reporting locations Arthropod-borne Sexually transmitted Environmental Lyme disease Malaria Chlamydia Gonorrhea Syphilis‡ Urethritis§ Cold...gonococcal (NGU). Reporting location Arthropod-borne Sexually transmitted Environmental Lyme disease Malaria Chlamydia Gonorrhea Syphilis‡ Urethritis...Lyme disease Malaria Chlamydia Gonorrhea Syphilis‡ Urethritis§ Cold Heat 2007 2008 2007 2008 2007 2008 2007 2008 2007 2008 2007 2008 2007 2008 2007

Phase II Trial Of PS-341 (Bortezomib) In Patients With Previously Treated Advanced Urothelial Tract Transitional Cell Carcinoma

ClinicalTrials.gov

2013-06-04

Metastatic Transitional Cell Cancer of the Renal Pelvis and Ureter; Recurrent Bladder Cancer; Recurrent Transitional Cell Cancer of the Renal Pelvis and Ureter; Recurrent Urethral Cancer; Stage III Bladder Cancer; Stage III Urethral Cancer; Stage IV Bladder Cancer; Stage IV Urethral Cancer; Transitional Cell Carcinoma of the Bladder; Ureter Cancer

Y-type urethral duplication: an unusual variant of a rare anomaly.

PubMed

Kumaravel, S; Senthilnathan, R; Sankkarabarathi, C; Bagdi, R K; Soundararajan, S; Prasad, N

2004-12-01

Urethral duplications are rare anomalies. We present a 3-year-old continent boy passing urine since birth per anus while voiding from penis. Micturating cystourethrogram, retrograde urethrogram and cystoscopy revealed a Y connection between the posterior urethra and anal canal. The accessory channel was excised by a perineal approach. Histopathology revealed that the tract was lined by transitional epithelium, proving that it was indeed a case of urethral duplication; hence, we suggest that all urethroanal fistulas are not variants of anorectal malformations. Certain of these fistulas should be considered as variants of Y-type urethral duplication even if the orthotopic urethra is normal.

A simple technique to facilitate treatment of urethral strictures with optical internal urethrotomy.

PubMed

Stamatiou, Konstantinos; Papadatou, Aggeliki; Moschouris, Hippocrates; Kornezos, Ioannis; Pavlis, Anargiros; Christopoulos, Georgios

2014-01-01

Urethral stricture is a common condition that can lead to serious complications such as urinary infections and renal insufficiency secondary to urinary retention. Treatment options include catheterization, urethroplasty, endoscopic internal urethrotomy, and dilation. Optical internal urethrotomy offers faster recovery, minimal scarring, and less risk of infection, although recurrence is possible. However, technical difficulties associated with poor visualization of the stenosis or of the urethral lumen may increase procedural time and substantially increase the failure rates of internal urethrotomy. In this report we describe a technique for urethral catheterization via a suprapubic, percutaneous approach through the urinary bladder in order to facilitate endoscopic internal urethrotomy.

The Association of Congenital Urethral Duplication and Double Megalourethra

PubMed Central

Uçar, Murat; Karagözlü Akgül, Ahsen; Kılıç, Nizamettin; Balkan, Emin

2017-01-01

Background: Urethral duplication and megalourethra are rare urethral anomalies. However, the concomitance of urethral duplication and double megalourethra has not been reported previously. Case Report: A newborn was presented with penile swelling during voiding. Physical examination revealed a retractable foreskin and two external meatus of a double urethra. Retrograde urethrography demonstrated two complete megalourethras. Urethro-urethrostomy and urethroplasty were performed when the patient was 10 months old. The patient was followed up for one year without any urinary problems and has good cosmetics and urinary continence. Conclusion: The concomitance of these two rare anomalies and more importantly its surgical treatment makes this case report unique and valuable. PMID:29215339

Hypothyroidism impairs somatovisceral reflexes involved in micturition of female rabbits.

PubMed

Sánchez-García, Octavio; López-Juárez, Rhode; Rodríguez-Castelán, Julia; Corona-Quintanilla, Dora L; Martínez-Gómez, Margarita; Cuevas-Romero, Estela; Castelán, Francisco

2018-04-17

To determine the impact of hypothyroidism on the bladder and urethral functions as well as in the activation of the pubococcygeous (Pcm) and bulbospongiosus (Bsm) during micturition. Age-matched control and methimazole-induced hypothyroid female rabbits were used to simultaneously record cystometrograms, urethral pressure, and the reflex activation of Pcm and Bsm during the induced micturition. Urodynamic and urethral variables were measured. Activation or no activation of the Pcm and Bsm during the storage and voiding phases of micturition were categorized as 1 or 0. Significant differences (P ≤ 0.05) between control and hypothyroid groups were determined with unpaired Student-t or Mann-Whitney tests. One-month induced hypothyroidism increased the residual volume and threshold pressure while the opposite was true for the voided volume, maximal pressure, and voiding efficiency. Urethral pressure was also affected as supported by a notorious augmentation of the urethral resistance, among other changes in the rest of measured variables. Hypothyroidism also affected the reflex activation of the Pcm in the voiding phase of micturition. Our findings demonstrate hypothyroidism impairs the bladder and, urethral functions, and reflex activation of Pcm and Bsm affecting the micturition in female rabbits. © 2018 Wiley Periodicals, Inc.

Temporary vesicostomy-assisted urethroplasty for recurrent obliterated posterior urethral stricture.

PubMed

Liu, Jui-Ming; Wang, Ta-Min; Chiang, Yang-Jen; Chen, Hsiao-Wen; Chu, Sheng-Hsien; Liu, Kuan-Lin; Lin, Kuo-Jen

2012-01-01

We report the outcomes of temporary vesicostomy- assisted anastomotic urethroplasty in patients with recurrent obliterated posterior urethral stricture. A review of the medical records identified 12 men (mean age 35.8 years) who had undergone anastomotic urethroplasty for recurrent obliterated posterior stricture. Preoperative evaluation of the urethral defect included a simultaneous retrograde urethrogram and cystogram. The mean estimated preoperative radiographic length of the urethral disruption was 4.25 cm. All patients underwent 1-stage bulboprostatic anastomotic repair which was assisted by an intraoperative temporary vesicostomy. The initial objective success rate was 83%. The mean follow-up was 22 months. Voiding cystourethrography performed postoperatively demonstrated a wide, patent anastomosis in all but two cases. Urethroscopy performed 1 month after surgery revealed a patent anastomosis with normal urethral mucosa in all but two patients. The mean peak flow rate at the last follow-up visit was 16.3 ml/s. Two patients developed an anastomotic stricture 6 weeks after surgery that was successfully treated by direct visual internal urethrotomy. Finally, all patients had a patent urethra after salvage treatment postoperatively. An open 1-stage temporary vesicostomy- assisted urethroplasty for recurrent obliterated posterior urethral stricture provides satisfactory outcomes and minimal morbidities.

Pelvic fracture-associated urethral injuries in girls: experience with primary repair.

PubMed

Dorairajan, Lalgudi N; Gupta, Harendra; Kumar, Santosh

2004-07-01

To present our experience with four urethral injuries in females accompanying a pelvic fracture, managed with primary repair or realignment of the urethra. There were three teenage girls and one adult (22 years old). All the patients had complete urethral injuries associated with a pelvic fracture from accidents. They were managed by immediate suprapubic cystostomy followed by repair or realignment of the urethra over a catheter on the same day. The catheter was removed after 3 weeks and a voiding cysto-urethrogram taken. Thereafter they were followed with regular urethral calibration. All patients voided satisfactorily with a good stream; three were fully continent and the fourth had transient stress urinary incontinence. One patient needed dilatation at 2 months and another visual internal urethrotomy at 5 months. At a mean (range) follow-up of 33 (9-60) months all the patients had a normal voiding pattern and were continent; none developed vaginal stenosis. Primary repair of the urethra, and if that is impossible, simple urethral realignment over a catheter, is the procedure of choice for managing female urethral injury associated with a pelvic fracture. The procedure has the additional advantage of reducing the risk of vaginal stenosis.

[Urethral pain syndrome: fact or fiction--an update].

PubMed

Dreger, N M; Degener, S; Roth, S; Brandt, A S; Lazica, D A

2015-09-01

Urethral pain syndrome is a symptom complex including dysuria, urinary urgency and frequency, nocturia and persistent or intermittent urethral and/or pelvic pain in the absence of proven infection. These symptoms overlap with several other conditions, such as interstitial cystitis bladder pain syndrome and overactive bladder. Urethral pain syndrome may occur in men but is more frequent in women. The exact etiology is unknown but infectious and psychogenic factors, urethral spasms, early interstitial cystitis, hypoestrogenism, squamous metaplasia as well as gynecological risk factors are discussed. These aspects should be ruled out or confirmed in the diagnostic approach. Despite the assumption of a multifactorial etiology, pathophysiologically there is a common pathway: dysfunctional epithelium of the urethra becomes leaky which leads to bacterial and abacterial inflammation and ends in fibrosis due to the chronic impairment. The therapeutic approach should be multimodal using a trial and error concept: general treatment includes analgesia, antibiotics, alpha receptor blockers and muscle relaxants, antimuscarinic therapy, topical vaginal estrogen, psychological support and physical therapy. In cases of nonresponding patients intravesical and/or surgical therapy should be considered. The aim of this review is to summarize the preliminary findings on urethral pain syndrome and to elucidate the diagnostic and therapeutic options.

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

PubMed

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

2016-01-01

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. 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. 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.

Internal urethrotomy combined with antegrade flexible cystoscopy for management of obliterative urethral stricture.

PubMed

Hosseini, Seyed Jali; Kaviani, Ali; Vazirnia, Ali Reza

2008-01-01

We studied the safety and efficacy of flexible cystoscopy-guided internal urethrotomy in the management of obliterative urethral strictures. Forty-three flexible cystoscopy-guided internal urethrotomies were performed between 1999 and 2005. The indication for the procedure was nearly blinded bulbar or membranous urethral strictures not longer than 1 cm that would not allow passage of guide wire. Candidates were those who refused or were unable to undergo urtheroplasty. By monitoring any impression of the urethrotome on the monitor through the flexible cystoscope, we were able to do under-vision urethrotomy. All of the patients were started clean intermittent catheterization afterwards which was tapered over the following 6 months. Follow-up continued for 24 months after the last internal urethrotomy. Seventeen patients were younger than 65 years with a history of failed posterior urethroplasty, and 26 were older than 65 with poor cardiopulmonary conditions who had bulbar urethral stricture following straddle or iatrogenic injuries. Urethral stricture stabilized in 16 patients (37.2%) with a single session of urethrotomy and in 17 (39.5%) with 2 urethrotomies. Overall, urethral stricture stabilized in 76.7% of patients with 1 or 2 internal urethrotomies within 24 months of follow-up. No severe complication was reported. Flexible cystoscopy-guided internal urethrotomy is a simple, safe, and under-vision procedure in obliterative urethral strictures shorter than 1 cm. It can be an ideal option for patients who do not accept posterior urethroplasty or are in a poor cardiopulmonary condition that precludes general anesthesia.

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

Treatment of Overactive Bladder Syndrome with Urethral Calibration in Women

PubMed Central

Sato, Renee L; Matsuura, Grace HK; Wei, David C; Chen, John J

2013-01-01

Our objective was to determine whether urethral calibration with Walther's urethral sounds may be an effective treatment for overactive bladder syndrome. The diagnosis of overactive bladder syndrome is a clinical one based on the presence of urgency, with or without urge incontinence, and is usually accompanied by frequency and nocturia in the absence of obvious pathologic or metabolic disease. These symptoms exert a profound effect on the quality of life. Pharmacologic treatment is generally used to relieve symptoms, however anticholinergic medications may be associated with several undesirable side effects. There are case reports of symptom relief following a relatively quick and simple office procedure known as urethral dilation. It is hypothesized that this may be an effective treatment for the symptoms of overactive bladder. Women with clinical symptoms of overactive bladder were evaluated. Eighty-eight women were randomized to either urethral calibration (Treatment), or placebo (Control) treatment. Women's clinical outcomes at two and eight weeks were assessed and compared between the two treatment arms. Eight weeks after treatment, 31.1% (n=14) of women who underwent urethral calibration were responsive to the treatment versus 9.3% (n=4) of the Control group. Also, 51.1% (n=23) of women within the Treatment group showed at least a partial response versus 20.9% (n=9) of the Control group. Our conclusion is that Urethral calibration significantly improves the symptoms of overactive bladder when compared to placebo and may be an effective alternative treatment method. PMID:24167769

Acquired urethral obstruction in New World camelids: 34 cases (1995-2008).

PubMed

Duesterdieck-Zellmer, K F; Van Metre, D C; Cardenas, A; Cebra, C K

2014-08-01

Document the clinical features, short- and long-term outcomes and prognostic factors in New World camelids with acquired urethral obstruction. Retrospective case study. Case data from medical records of 34 New World camelids presenting with acquired urethral obstruction were collected and follow-up information on discharged patients was obtained. Associations with short- and long-term survival were evaluated using Wilcoxon rank-sum tests, exact-logistic regressions and Kaplan-Meier survival curves. Of the 34 New World camelids 23 were intact males and 11 were castrated; 4 animals were euthanased upon presentation, 7 were treated medically and 23 surgically, including urethrotomy, bladder marsupialisation, tube cystostomy alone or combined with urethrotomy, urethrostomy or penile reefing. Necrosis of the distal penis was found in 4 animals and all were short-term non-survivors. Short-term survival for surgical cases was 65%, and 57% for medical cases. Incomplete urethral obstruction at admission and surgical treatment were associated with increased odds of short-term survival. Of 14 records available for long-term follow-up, 6 animals were alive and 8 were dead (median follow-up 4.5 years, median survival time 2.5 years). Recurrence of urethral obstruction was associated with long-term non-survival. Surgically treated New World camelids with incomplete urethral obstruction have the best odds of short-term survival and those with recurrence of urethral obstruction have a poor prognosis for long-term survival. © 2014 Australian Veterinary Association.

What is the relationship between free flow and pressure flow studies in women?

PubMed

Duckett, Jonathan; Cheema, Katherine; Patil, Avanti; Basu, Maya; Beale, Sian; Wise, Brian

2013-03-01

The relationship between free flow (FFS) and pressure flow (PFS) voiding studies remains uncertain and the effect of a urethral catheter on flow rates has not been determined. The relationship between residuals obtained at FF and PFS has yet to be established. This was a prospective cohort study based on 474 consecutive women undergoing cystometry using different sized urethral catheters at different centres. FFS and PFS data were compared for different conditions and the relationship of residuals analysed for FFS and PFS. The null hypothesis was that urethral catheters do not produce an alteration in maximum flow rates for PFS and FF studies. Urethral catheterisation results in lower flow rates (p < 0.01) and this finding is confirmed when flows are corrected for voided volume (p < 0.01). FFS and PFS maximum flow rates are lower in women with DO than USI (p < 0.01). A 6-F urethral catheter does not have a significantly greater effect than a 4.5-F urethral catheter. A mathematical model can be applied to transform FFS to PFS flow rates and vice versa. There was no significant difference between the mean residuals of the two groups (FFS vs PFS-two-tailed t = 0.54, p = 0.59). Positive residuals in FFS showed a good association with positive residuals in the PFS (r = 0.53, p < 0.01) Urethral catheterisation results in lower maximum flow rates. The relationship can be compared mathematically. The null hypothesis can be rejected.

Medical Surveillance Monthly Report (MSMR). Volume 16, Number 2, February 2009

DTIC Science & Technology

2009-02-01

Urethritis, non-gonococcal (NGU). Reporting location Arthropod-borne Sexually transmitted Environmental Lyme disease Malaria Chlamydia Gonorrhea Syphilis...transmitted Environmental Lyme disease Malaria Chlamydia Gonorrhea Syphilis‡ Urethritis§ Cold Heat 2008 2009 2008 2009 2008 2009 2008 2009 2008 2009 2008...Environmental Lyme disease Malaria Chlamydia Gonorrhea Syphilis‡ Urethritis§ Cold Heat 2008 2009 2008 2009 2008 2009 2008 2009 2008 2009 2008 2009 2008

Common Pediatric Urological Disorders

PubMed Central

Robson, Wm. Lane M.; Leung, Alexander K.C.; Boag, Graham S.

1991-01-01

The clinical and radiological presentations of 12 pediatric urological disorders are described. The described disorders include pyelonephritis, vesicoureteral reflux, ureteropelvic obstruction, ureterovesical obstruction, ectopic ureterocele, posterior urethral valves, multicystic dysplastic kidney, polycystic kidney disease, ectopic kidney, staghorn calculi, urethral diverticulum, and urethral meatal stenosis. ImagesFigure 1-2Figure 3Figure 3Figure 4Figure 5Figure 6-7Figure 8-9Figure 10Figure 11-12 PMID:21229068

Posterior urethral stricture repair following trauma and pelvic fracture.

PubMed

Rios, Emilio; Martinez-Piñeiro, Luis; Álvarez-Maestro, Mario

2014-01-01

Posterior urethral injuries typically arise in the context of a pelvic fracture.The correct and appropriate initial treatment of associated urethral rupture is critical to the proper healing of the injury. In this paper, we provide a comprehensive review of the literature with special emphasis on the various treatments available: open or endoscopic primary realignment, immediate or delayed urethroplasty after suprapubic cystostomy, and delayed optical urethrotomy.

3D visualization of sheath folds in Ancient Roman marble wall coverings from Ephesos, Turkey

NASA Astrophysics Data System (ADS)

Wex, Sebastian; Passchier, Cees W.; de Kemp, Eric A.; İlhan, Sinan

2014-10-01

Archaeological excavations and restoration of a palatial Roman housing complex in Ephesos, Turkey yielded 40 wall-decorating plates of folded mylonitic marble (Cipollino verde), derived from the internal Hellenides near Karystos, Greece. Cipollino verde was commonly used for decoration purposes in Roman buildings. The plates were serial-sectioned from a single quarried block of 1,25 m3 and provided a research opportunity for detailed reconstruction of the 3D geometry of meterscale folds in mylonitized marble. A GOCAD model is used to visualize the internal fold structures of the marble, comprising curtain folds and multilayered sheath folds. The sheath folds are unusual in that they have their intermediate axis normal to the parent layering. This agrees with regional tectonic studies, which suggest that Cipollino verde structures formed by local constrictional non-coaxial flow. Sheath fold cross-section geometry, exposed on the surface of a plate or outcrop, is found to be independent of the intersection angle of the fold structure with the studied plane. Consequently, a single surface cannot be used as an indicator of the three-dimensional geometry of transected sheath folds.

Continental Evolution Involving Subduction Underplating and Synchronous Foreland Thrusting: Evidence from the Trans-Alaska Crustal Transect

NASA Astrophysics Data System (ADS)

Fuis, G. S.; Moore, T. E.; Plafker, G.; Brocher, T. M.; Fisher, M. A.; Mooney, W. D.; Nokleberg, W. J.; Page, R. A.; Beaudoin, B. C.; Christensen, N. I.; Levander, A.; Lutter, W. J.; Saltus, R. W.; Ruppert, N. A.

2010-12-01

We investigated the crustal structure and tectonic evolution of the North American continent in Alaska, where the continent has grown through magmatism, accretion, and tectonic underplating. In the 1980’s and early 1990’s, we conducted a geological and geophysical investigation, known as the Trans-Alaska Crustal Transect (TACT), along a 1350-km-long corridor from the Aleutian Trench to the Arctic coast. The most distinctive crustal structures and the deepest Moho along the transect are located near the Pacific and Arctic margins. Near the Pacific margin, we infer a stack of tectonically underplated oceanic layers interpreted to be remnants of the extinct Kula (or Resurrection) Plate. Continental Moho just north of this underplated stack is more than 55 km deep. Near the Arctic margin, the Brooks Range is underlain by north-vergent, crustal-scale duplexes that overlie a ramp on autochthonous North Slope crust. There, Moho has been depressed to nearly 50-km depth. In contrast, the Moho of central Alaska is on average 32 km deep. In the Paleogene, tectonic underplating of Kula- (or Resurrection-) Plate fragments overlapped in time with duplexing in the Brooks Range. Possible tectonic models linking these two widely separated regions include “flat-slab” subduction and an “orogenic-float” model. In the Neogene, the collision of the Yakutat terrane (YAK), in southern Alaska, correlates with renewed compression in northeast Alaska and northwest Canada, in a fashion somewhat similar to the tectonics in the Paleogene. The Yakutat terrane, riding atop the subducting Pacific oceanic lithosphere (POL), spans a newly interpreted tear in the POL. East of the tear, POL is interpreted to subduct steeply and alone beneath the Wrangell arc volcanoes because the overlying YAK has been left behind as tectonically underplated rocks beneath the rising St. Elias Range in the coastal region. West of the tear, the YAK and POL are interpreted to subduct together at a gentle angle (a few degrees from 0 to 400 km from the trench), and this thickened package inhibits arc volcanism.

Evaluation of Two Miniplate Systems and Figure-of-eight Bandages for Stabilization of Experimentally Induced Ulnar and Radial Fractures in Pigeons ( Columba livia ).

PubMed

Bennert, Beatrice M; Kircher, Patrick R; Gutbrod, Andreas; Riechert, Juliane; Hatt, Jean-Michel

2016-06-01

Although plate fixation has advantages over other fixation methods for certain indications, it is rarely used in avian surgery, especially in birds that weigh less than 1000 g. Exceptionally small plating systems for these birds are required, which are relatively expensive and difficult to insert. To study avian fracture healing after repair using miniplates, we evaluated 2 steel miniplate systems in 27 pigeons ( Columba livia ) divided into 4 groups. In each pigeon, the left ulna and radius were transected and the ulna was repaired with a bone plate. In groups A and B, a 1.3-mm adaption plate was applied without and with a figure-of-eight bandage; in groups C and D, a 1.0-mm compression plate was applied without and with a bandage, respectively. Healing was evaluated with radiographs after 3, 14, and 28 days; flight tests were conducted after 14, 21, and 28 days; and the wing was macroscopically examined after euthanasia of birds on day 28. Fractures healed without bending or distortion of the plate in all 27 birds, and no significant differences in healing were found between treatment groups. At the end of the study, 23 pigeons (85.2%) showed good or very good flight ability. Results show the 1.3-mm adaption plate and the 1.0-mm compression plate meet the requirements for avian osteosynthesis and can be recommended for fracture repair of the ulna or other long bones in birds weighing less than 500 g. The application of a figure-of-eight bandage might be beneficial in fracture healing.

Surgical correction of bladder neck contracture following prostate cancer treatment.

PubMed

Bugeja, Simon; Andrich, Daniela E; Mundy, Anthony R

2014-01-01

The surgical and non-surgical treatment of localised prostate cancer may be complicated by bladder neck contractures, prostatic urethral stenoses and bulbomembranous urethral strictures. In general, such complications following radical prostatectomy are less extensive, easier to treat and associated with a better outcome and more rapid recovery than the same complications following radiotherapy, high-intensity focussed ultrasound and cryotherapy. Treatment options range from minimally invasive endoscopic procedures to more complex and specialised open surgical reconstruction.In this chapter the surgical management of bladder neck contractures following the treatment of prostate cancer is described together with the management of prostatic urethral stenoses and bulbomembranous urethral strictures, given the difficulty in distinguishing them from one another clinically.

Micturating cystography and "double urethral catheter technique" to define the anatomy of anorectal malformations.

PubMed

Soccorso, G; Thyagarajan, M S; Murthi, G V; Sprigg, A

2008-02-01

Ano-rectal malformations (ARM) in the male patient may be associated with a fistulous communication between the rectum and urethra. Pre-operative radiological assessment is important to delineate (a) the presence and level of the fistula, (b) the anatomy of the posterior urethra and (c) any anomalies in adjacent structures. Bladder catheterisation can be technically difficult when performing an MCUG and distal loopogram in such patients. This can be due to urethral stricture, tortuous or kinked urethra or preferential passage of catheter into a large fistula and leads to an inadequate study. We describe a "double urethral catheter technique" to enable urethral catheterisation when the fistula is large.

Atezolizumab and CYT107 in Treating Participants With Locally Advanced, Inoperable, or Metastatic Urothelial Carcinoma

ClinicalTrials.gov

2018-05-18

Metastatic Bladder Urothelial Carcinoma; Metastatic Renal Pelvis Urothelial Carcinoma; Metastatic Ureter Urothelial Carcinoma; Metastatic Urethral Urothelial Carcinoma; Metastatic Urothelial Carcinoma; Recurrent Bladder Urothelial Carcinoma; Recurrent Renal Pelvis Urothelial Carcinoma; Recurrent Ureter Urothelial Carcinoma; Recurrent Urethral Urothelial Carcinoma; Stage III Bladder Cancer AJCC v8; Stage III Renal Pelvis Cancer AJCC v8; Stage III Ureter Cancer AJCC v8; Stage III Urethral Cancer AJCC v8; Stage IV Bladder Cancer AJCC v8; Stage IV Renal Pelvis Cancer AJCC v8; Stage IV Ureter Cancer AJCC v8; Stage IV Urethral Cancer AJCC v8; Stage IVA Bladder Cancer AJCC v8; Stage IVB Bladder Cancer AJCC v8

The urethral closure function in continent and stress urinary incontinent women assessed by urethral pressure reflectometry.

PubMed

Saaby, Marie-Louise

2014-02-01

Stress urinary incontinence (SUI) occurs when the bladder pressure exceeds the urethral pressure in connection with physical effort or exertion or when sneezing or coughing and depends both on the strength of the urethral closure function and the abdominal pressure to which it is subjected. The urethral closure function in continent women and the dysfunction causing SUI are not known in details. The currently accepted view is based on the concept of a sphincteric unit and a support system. Our incomplete knowledge relates to the complexity of the closure apparatus and to inadequate assessment methods which so far have not provided robust urodynamic diagnostic tools, severity measures, or parameters to assess outcome after intervention. Urethral Pressure Reflectometry (UPR) is a novel method that measures the urethral pressure and cross-sectional area (by use of sound waves) simultaneously. The technique involves insertion of only a small, light and flexible polyurethane bag in the urethra and therefore avoids the common artifacts encountered with conventional methods. The UPR parameters can be obtained at a specific site of the urethra, e.g. the high pressure zone, and during various circumstances, i.e. resting and squeezing. During the study period, we advanced the UPR technique to enable faster measurement (within 7 seconds by the continuous technique) which allowed assessment during increased intra-abdominal pressure induced by physical straining. We investigated the urethral closure function in continent and SUI women during resting and straining by the "fast" UPR technique. Thereby new promising urethral parameters were provided that allowed characterization of the closure function based on the permanent closure forces (primarily generated by the sphincteric unit, measured by the Po-rest) and the adjunctive closure forces (primarily generated by the support system, measured by the abdominal to urethral pressure impact ratio (APIR)). The new parameters enabled a more detailed description of the efficiency of the closure function and the extent and nature of a possible dysfunction in the individual woman. The urethral closure equation (UCE) and urethral opening pressure at an abdominal pressure of 50 cm H2O (Po-Abd 50), respectively, which combine the permanent and the adjunctive closure forces, could separate continent and SUI women and thus appear to be excellent diagnostic tests. Moreover, the parameters showed highly significant negative correlation with ICIQ-SF, pad test and the number of incontinence episodes per week and are therefore valid as urodynamic severity measures. UPR in SUI women before and after TVT demonstrated a more efficient urethral closure function after the operation. The Po-rest was unchanged suggesting that the sphincteric unit was virtually unaltered and hence the permanent closure forces unchanged. However, the resting opening elastance increased by 18% indicating that at the resting state the TVT somewhat improves the closure function by providing increased resistance against the dilation of the urethra, which probably explains the decreased maximum urine flow rate found after TVT in this and previous studies. The APIR increased in all patients after TVT suggesting that the support system was re-established and thus the adjunctive closure forces improved, regardless of the type of pre-operative dysfunction. The new UPR parameters may be used as outcome measures after treatment.

Early versus delayed internal urethrotomy for recurrent urethral stricture after urethroplasty in children.

PubMed

Hosseini, Seyyed Yousef; Safarinejad, Mohammad Reza

2005-01-01

Our aim was to evaluate the results of early versus delayed internal urethrotomy for management of recurrent urethral strictures after posterior urethroplasty in children. Twenty boys with proven posterior urethral strictures were treated by perineal posterior urethroplasty. Of these, 12 required internal urethrotomy. Each radiograph demonstrated a patent but irregular urethra with a decrease in diameter at the point of repair (fair results). Patients were then divided into 2 groups: 6 underwent early (within 6 weeks from urethroplasty), and 6 underwent delayed (after 12 weeks from urethroplasty), internal urethrotomy with the cold knife as a complementary treatment. The groups were comparable in terms of patient age, etiology of the primary urethral stricture, number of recurrences, length and site of the actual stricture, and preoperative maximum flow rate. Mean follow-up was 5 years. Kaplan-Meier analyses showed that the stricture-free rate was 66.6% after early, and 33.3% after delayed, internal urethrotomy (P = .03). Early internal urethrotomy should be considered in boys with recurrent urethral stricture after urethroplasty.

Post-traumatic female urethral reconstruction.

PubMed

Blaivas, Jerry G; Purohit, Rajveer S

2008-09-01

Post-traumatic urethral damage resulting in urethrovaginal fistulas or strictures, though rare, should be suspected in patients who have unexpected urinary incontinence or lower urinary tract symptoms after pelvic surgery, pelvic fracture, a long-term indwelling urethral catheter, or pelvic radiation. Careful physical examination and cystourethroscopy are critical to diagnose and assess the extent of the fistula. A concomitant vesicovaginal or ureterovaginal fistula should also be ruled out. The two main indications for reconstruction are sphincteric incontinence and urethral obstruction. Surgical correction intends to create a continent urethra that permits volitional, painless, and unobstructed passage of urine. An autologous pubovaginal sling, with or without a Martius flap at time of reconstruction, should be considered. The three approaches to urethral reconstruction are anterior bladder flaps, posterior bladder flaps, and vaginal wall flaps. We believe vaginal flaps are usually the best option. Options for vaginal repair of fistula include primary closure, peninsula flaps, bilateral labial pedicle flaps, and labial island flaps. Outcomes are optimized by using exacting surgical principles during repair and careful postoperative management by an experienced reconstructive surgeon.

Asymptomatic bacteriuria, bacteremia, and other infections due to NSU corynebacteria.

PubMed

Furness, G; Kaminski, Z

1975-11-01

By means of the new medium, nonspecific urethritis (NSU) chocolate agar, NSU corymebacteria were isolated from patients with asymptomatic bacteriuria, bacteremia, cervicitis, conjuctivitis, and pericarditis, and also with bone marrow, wound, and cul-de-sac infections. The NSU corynebacteria were considered the etiologic agents. On the basis of biochemical reactions, antibiotic sensitivity, and complement fixation tests some isolates were the same microorganisms. Both patients with conjunctivitis were infected with the same NSU corynebacteria. A second isolate was cultured from patients with osteomyelitis and cervicitis, while a third was recovered from an infected leg wound and from a patient with pericarditis. Seven of the isolates, when injected into rabbits hypersensitive to four NSU corynebacteria isolated from the inflamed epididymis of patients with epididymitis, elicited delayed hypersensitivity reactions, which indicated that they also were related antigenically. It is suggested that nonspecific urethritis and eididymitis may represent an infection with NSU corynebacteria, or may be an extension of bacteriuria due to these microorganisms, with a delayed hypersensitivity reaction as a possible additional complication. Colony counts on NSU chocolate agar of the bacteria in urines from male and female patients were higher than those obtained on conventional agar media. NSU chocolate agar is superior to other agar media for the isolation of pathogenic and saprophytic bacteria not only from the urogenital tract but also from other foci of infection. It is easily prepared from commercial blood agar plates and its use should be considered when a selective medium is not required.

Versatility of the ventral approach in bulbar urethroplasty using dorsal, ventral or dorsal plus ventral oral grafts

PubMed Central

Palminteri, Enzo; Berdondini, Elisa; Fusco, Ferdinando; Nunzio, Cosimo De; Giannitsas, Kostas; Shokeir, Ahmed A.

2012-01-01

Objectives To investigate the versatility of the ventral urethrotomy approach in bulbar reconstruction with buccal mucosa (BM) grafts placed on the dorsal, ventral or dorsal plus ventral urethral surface. Patients and methods Between 1999 and 2008, 216 patients with bulbar strictures underwent BM graft urethroplasty using the ventral-sagittal urethrotomy approach. Of these patients, 32 (14.8%; mean stricture 3.2 cm, range 1.5–5) had a dorsal graft urethroplasty (DGU), 121 (56%; mean stricture 3.7, range 1.5–8) a ventral graft urethroplasty (VGU), and 63 (29.2%; mean stricture 3.4, range 1.5–10) a dorsal plus ventral graft urethroplasty (DVGU). The strictured urethra was opened by a ventral-sagittal urethrotomy and BM graft was inserted dorsally or ventrally or dorsal plus ventral to augment the urethral plate. Results The median follow-up was 37 months. The overall 5-year actuarial success rate was 91.4%. The 5-year actuarial success rates were 87.8%, 95.5% and 86.3% for the DGU, VGU and DVGU, respectively. There were no statistically significant differences among the three groups. Success rates decreased significantly only with a stricture length of >4 cm. Conclusions In BM graft bulbar urethroplasties the ventral urethrotomy access is simple and versatile, allowing an intraoperative choice of dorsal, ventral or combined dorsal and ventral grafting, with comparable success rates. PMID:26558013

PCR for diagnosis of male Trichomonas vaginalis infection with chronic prostatitis and urethritis.

PubMed

Lee, Jong Jin; Moon, Hong Sang; Lee, Tchun Yong; Hwang, Hwan Sik; Ahn, Myoung-Hee; Ryu, Jae-Sook

2012-06-01

The aim of this study was to assess the usefulness of PCR for diagnosis of Trichomonas vaginalis infection among male patients with chronic recurrent prostatitis and urethritis. Between June 2001 and December 2003, a total of 33 patients visited the Department of Urology, Hanyang University Guri Hospital and were examined for T. vaginalis infection by PCR and culture in TYM medium. For the PCR, we used primers based on a repetitive sequence cloned from T. vaginalis (TV-E650). Voided bladder urine (VB1 and VB3) was sampled from 33 men with symptoms of lower urinary tract infection (urethral charge, residual urine sensation, and frequency). Culture failed to detect any T. vaginalis infection whereas PCR identified 7 cases of trichomoniasis (21.2%). Five of the 7 cases had been diagnosed with prostatitis and 2 with urethritis. PCR for the 5 prostatitis cases yielded a positive 330 bp band from bothVB1 and VB3, whereas positive results were only obtained from VB1 for the 2 urethritis patients. We showed that the PCR method could detect T. vaginalis when there was only 1 T. vaginalis cell per PCR mixture. Our results strongly support the usefulness of PCR on urine samples for detecting T. vaginalis in chronic prostatitis and urethritis patients.

Dorsolateral onlay urethroplasty for anterior urethral strictures by a unilateral urethral mobilization approach.

PubMed

Singh, Bhupendra P; Pathak, Hemant R; Andankar, Mukund G

2009-04-01

For management of long segment anterior urethral stricture, dorsal onlay urethroplasty is currently the most favored single-stage procedure. Conventional dorsal onlay urethroplasty requires circumferential mobilization of the urethra, which might cause ischemia of the urethra in addition to chordee. To determine the feasibility and short-term outcomes of applying a dorsolateral free graft to treat anterior urethral stricture by unilateral urethral mobilization through a perineal approach. A prospective study from September 2005 to March 2008 in a tertiary care teaching hospital. Seventeen patients with long or multiple strictures of the anterior urethra were treated by a dorsolateral free buccal mucosa graft. The pendulous urethra was accessed by penile eversion through the perineal wound. The urethra was not separated from the corporal bodies on one side and was only mobilized from the midline on the ventral aspect to beyond the midline on the dorsal aspect. The urethra was opened in the dorsal midline over the stricture. The buccal mucosa graft was secured on the ventral tunica of the corporal bodies. Mean and median. After a follow-up of 12-30 months, one recurrence developed and 1 patient needed an internal urethrotomy. A unilateral urethral mobilization approach for dorsolateral free graft urethroplasty is feasible for panurethral strictures of any length with good short-term success.

[Perineal urethrostomy plus secondary urethroplasty for ultralong urethral stricture: clinical outcomes and influence on the patient's quality of life].

PubMed

Wang, Yong-Quan; Zhang, Heng; Shen, Wen-Hao; Li, Long-Kun; Li, Wei-Bing; Xiong, En-Qing

2012-04-01

To investigate the outcomes of perineal urethrostomy plus secondary urethroplasty for ultralong urethral stricture and assess its influence on the patient's quality of life. We retrospectively analyzed 54 cases of ultralong urethral stricture treated by perineal urethrostomy from 2000 to 2010. The mean age of the patients was 40 years, and the average length of stricture was 6.5 cm. We evaluated the patients'quality of life by questionnaire investigation and the clinical outcomes based on IPSS, Qmax, the necessity of urethral dilation and satisfaction of the patients. The mean Qmax of the 54 patients was (14.0 +/- 4.7) ml/min. Of the 34 cases that underwent secondary urethroplasty, 22 (64.7%) achieved a mean Qmax of (12.0 +/- 3.5) ml/min, 8 (23.5%) needed regular urethral dilatation and 4 (11.8%) received internal urethrotomy because of restenosis. IPSS scores were 5.4 +/- 2.1 and 8.5 +/- 5.8 after perineal urethrostomy and secondary urethroplasty, respectively. Fifty of the total number of patients (92.6%) were satisfied with the results of perineal urethrostomy, and 22 of the 34 (64.7%) with the results of secondary urethroplasty. Perineal urethrostomy plus secondary urethroplasty is safe and effective for ultralong urethral stricture, and affects very little the patient's quality of life.

Traumatic lesions of the posterior urethra.

PubMed

Velarde-Ramos, L; Gómez-Illanes, R; Campos-Juanatey, F; Portillo-Martín, J A

2016-11-01

The posterior urethral lesions are associated with pelvis fractures in 5-10% of cases. The posterior urethra is attached to the pelvis bone by puboprostatic ligaments and the perineal membrane, which explains why disruption of the pelvic ring can injure the urethra at this level. To identify suspected cases of posterior urethral trauma and to perform the diagnosis and its immediate or deferred management. Search in PubMed of articles related to traumatic posterior urethral lesions, written in English or Spanish. We reviewed the relevant publications including literature reviews and chapters from books related to the topic. With patients with pelvis fractures, we must always rule out posterior urethral lesions. The diagnostic examination of choice is retrograde urethrography, which, along with the severity of the condition, will determine the management in the acute phase and whether the treatment will be performed immediately or deferred. Early diagnosis and proper acute management decrease the associated complications, such as strictures, urinary incontinence and erectile dysfunction. Despite the classical association between posterior urethral lesions and pelvic fractures, the management of those lesions (whether immediate or deferred) remains controversial. Thanks to the growing interest in urethral disease, there are an increasing number of studies that help us achieve better management of these lesions. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Factors affecting urethrocystographic parameters in urinary continent women.

PubMed

Yang, J M

1996-06-01

To evaluate the urethrocystographic changes in different conditions, 154 women were evaluated by using introital sonography. Patients were divided into three groups: group 1 (n = 103) normal, including 10 postmenopausal women; group 2 (n = 46) pregnant, including 16 women in the first trimester, 15 in the second trimester, and 15 in the third trimester; group 3 (n = 15) severe genitourinary prolapse. None of the 154 women had a history of urinary incontinence. The following parameters were measured at rest: urethral thickness, uretheral length, urethral inclination, and posterior urethrovesical angle. On maximum straining, urethral inclination, posterior urethrovesical angle, and rotational angle were measured. In general, age, parity, and menopause did not affect the urethrocystographic parameters in Group 1 patients. Postmenopausal women had a significant decrease in the urethral thickness compared with the premenopausal women (p = 0.026). Patients in Groups 2 and 3 had a significantly lower urethral position than those in group 1. However, hypermobility of the urethra was found only in Group 3. Different menstrual ages did not affect the urethral position but could affect the posterior urethrovesical angle at rest in the first trimester. Introital sonography, without the risk of radiation exposure, enables the observation of static and dynamic changes in the lower urinary tract, both repeatedly and reproducibly.

Use of Flexible Cystoscopy to Insert a Foley Catheter over a Guide Wire in Spinal Cord Injury Patients: Special Precautions to be Observed.

PubMed

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

2011-01-01

When urethral catheterisation is difficult or impossible in spinal cord injury patients, flexible cystoscopy and urethral catheterisation over a guide wire can be performed on the bedside, thus obviating the need for emergency suprapubic cystostomy. Spinal cord injury patients, who undergo flexible cystoscopy and urethral catheterisation over a guide wire, may develop potentially serious complications. (1) Persons with lesion above T-6 are susceptible to develop autonomic dysreflexia during cystoscopy and urethral catheterisation over a guide wire; nifedipine 5-10 milligrams may be administered sublingually just prior to the procedure to prevent autonomic dysreflexia. (2) Spinal cord injury patients are at increased risk for getting urine infections as compared to able-bodied individuals. Therefore, antibiotics should be given to patients who get haematuria or urethral bleeding following urethral catheterisation over a guide wire. (3) Some spinal cord injury patients may have a small capacity bladder; in these patients, the guide wire, which is introduced into the urinary bladder, may fold upon itself with the tip of guide wire entering the urethra. If this complication is not recognised and a catheter is inserted over the guide wire, the Foley catheter will then be misplaced in urethra despite using cystoscopy and guide wire.

Use of Flexible Cystoscopy to Insert a Foley Catheter over a Guide Wire in Spinal Cord Injury Patients: Special Precautions to be Observed

PubMed Central

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

2011-01-01

When urethral catheterisation is difficult or impossible in spinal cord injury patients, flexible cystoscopy and urethral catheterisation over a guide wire can be performed on the bedside, thus obviating the need for emergency suprapubic cystostomy. Spinal cord injury patients, who undergo flexible cystoscopy and urethral catheterisation over a guide wire, may develop potentially serious complications. (1) Persons with lesion above T-6 are susceptible to develop autonomic dysreflexia during cystoscopy and urethral catheterisation over a guide wire; nifedipine 5–10 milligrams may be administered sublingually just prior to the procedure to prevent autonomic dysreflexia. (2) Spinal cord injury patients are at increased risk for getting urine infections as compared to able-bodied individuals. Therefore, antibiotics should be given to patients who get haematuria or urethral bleeding following urethral catheterisation over a guide wire. (3) Some spinal cord injury patients may have a small capacity bladder; in these patients, the guide wire, which is introduced into the urinary bladder, may fold upon itself with the tip of guide wire entering the urethra. If this complication is not recognised and a catheter is inserted over the guide wire, the Foley catheter will then be misplaced in urethra despite using cystoscopy and guide wire. PMID:22110492

[Combination of the ureteral dilation catheter and balloon catheter under the ureteroscope in the treatment of male urethral stricture].

PubMed

Zhou, Yi; Li, Gong-hui; Yan, Jia-jun; Shen, Cong; Tang, Gui-hang; Xu, Gang

2016-01-01

To investigate the clinical application of the ureteral dilation catheter combined with the balloon catheter under the ureteroscope in the treatment of urethral stricture in men. Under the ureteroscope, 45 male patients with urethral stricture received placement of a zebra guide wire through the strictured urethra into the bladder and then a ureteral dilation catheter along the guide wire, followed by dilation of the urethra from F8 initially to F14 and F16. Again, the ureteroscope was used to determine the length of the strictured urethra, its distance to the external urethral orifice, and whether it was normally located. An F24 balloon catheter and then a metal urethral calibrator was used for the dilation of the strictured urethra. After removal of the F18-F22 urethral catheter at 8 weeks, the urinary flow rate was measured immediately and again at 3 months. All the operations were successfully performed without serious complications. The maximum urinary flow rate was (13.3-29.9) ml/s (mean [17.7 ± 3.2] ml/s) at the removal of the catheter and (15.2-30.8) ml/s (mean [19.8 ± 3.9] ml/s) at 3 months after it. Smooth urination was found in all the patients during the 6-24 months follow-up. The application of the ureteral dilation catheter combined with, the balloon catheter under the ureteroscope is a good option for the treatment of male urethral stricture for its advantages of uncomplicatedness, safety, effectiveness, few complications, less pain, high success rate, and repeatable operation.

Impacted anterior urethral calculus complicated by a stone-containing diverticulum in an elderly man: outcome of transurethral lithotripsy without resection of the diverticulum.

PubMed

Zhou, Tie; Chen, Guanghua; Zhang, Wei; Peng, Yonghan; Xiao, Liang; Xu, Chuangliang; Sun, Yinghao

2013-01-01

The prevalence of lower urinary tract symptoms (LUTS) is about 20% in men aged 40 or above. Other than benign prostatic hyperplasia (BPH), urethral diverticulum or calculus is not uncommon for LUTS in men. Surgical treatment is often recommended for urethral diverticulum or calculus, but treatment for an impacted urethral calculus complicated by a stone-containing diverticulum is challenging. An 82-year-old man had the persistence of LUTS despite having undergone transurethral resection of prostate for BPH. Regardless of treatment with broad spectrum antibiotics and an α-blocker, LUTS and post-void residual urine volume (100 mL) did not improve although repeated urinalysis showed reduction of WBCs from 100 to 10 per high power field. Further radiology revealed multiple urethral calculi and the stone configuration suggested the existence of a diverticulum. He was successfully treated without resecting the urethral diverticulum; and a new generation of ultrasound lithotripsy (EMS, Nyon, Switzerland) through a 22F offset rigid Storz nephroscope (Karl Storz, Tuttingen, Germany) was used to fragment the stones. The operative time was 30 minutes and the stones were cleanly removed. The patient was discharged after 48 hours with no immediate complications and free of LUTS during a 2 years follow-up. When the diverticulum is the result of a dilatation behind a calculus, removal of the calculus is all that is necessary. Compared with open surgery, ultrasound lithotripsy is less invasive with little harm to urethral mucosa; and more efficient as it absorbs stone fragments while crushing stones.

Dynamics of male pelvic floor muscle contraction observed with transperineal ultrasound imaging differ between voluntary and evoked coughs.

PubMed

Stafford, Ryan E; Mazzone, Stuart; Ashton-Miller, James A; Constantinou, Christos; Hodges, Paul W

2014-04-15

Coughing provokes stress urinary incontinence, and voluntary coughs are employed clinically to assess pelvic floor dysfunction. Understanding urethral dynamics during coughing in men is limited, and it is unclear whether voluntary coughs are an appropriate surrogate for spontaneous coughs. We aimed to investigate the dynamics of urethral motion in continent men during voluntary and evoked coughs. Thirteen men (28-42 years) with no history of urological disorders volunteered to participate. Transperineal ultrasound (US) images were recorded and synchronized with measures of intraabdominal pressure (IAP), airflow, and abdominal/chest wall electromyography during voluntary coughs and coughs evoked by inhalation of nebulized capsaicin. Temporal and spatial aspects of urethral movement induced by contraction of the striated urethral sphincter (SUS), levator ani (LA), and bulbocavernosus (BC) muscles and mechanical aspects of cough generation were investigated. Results showed coughing involved complex urethral dynamics. Urethral motion implied SUS and BC shortening and LA lengthening during preparatory and expulsion phases. Evoked coughs resulted in greater IAP, greater bladder base descent (LA lengthening), and greater midurethral displacement (SUS shortening). The preparatory inspiration cough phase was shorter during evoked coughs, as was the latency between onset of midurethral displacement and expulsion. Maximum midurethral displacement coincided with maximal bladder base descent during voluntary cough, but followed it during evoked cough. The data revealed complex interaction between muscles involved in continence in men. Spatial and temporal differences in urethral dynamics and cough mechanics between cough types suggest that voluntary coughing may not adequately assess capacity of the continence mechanism.

Comparative study between porcine small intestinal submucosa and buccal mucosa in a partial urethra substitution in rabbits.

PubMed

Kawano, Paulo Roberto; Fugita, Oscar Eduardo Hidetoshi; Yamamoto, Hamilto Akihissa; Quitzan, Juliany Gomes; Padovani, Carlos; Amaro, João Luiz

2012-05-01

Several urethral conditions may require tissue substitution. One collagen-base biomaterial that recently emerged as an option is small intestinal submucosa (SIS). The aim of this study was to compare the results of SIS and buccal mucosa for urethral substitution in rabbits. Thirty-six North Folk male rabbits were randomized into three groups. In all animals, a 10 × 5 mm urethral segment was excised, and the urethral defect was repaired using a one-layer SIS patch (group I [GI]); four-layer SIS (group II [GII]); or buccal mucosa (group III [GIII]). Urethrography was performed preoperatively and after 12 weeks. After sacrifice, graft retraction was objectively measured using Scion Image(®) computer analysis and by calculation of ellipse area. The grade of fibrosis, inflammatory reaction, vascular/epithelial regeneration, and collagen III/I ratio were analyzed by hematoxylin/eosin and Picrosirius red staining. Urethrography confirmed a wide urethral caliber without any signs of strictures after surgery. Urethral fistulae was diagnosed in 8.3% of cases (1 animal each group). Average graft shrinkage was 55.2% in GI; 44.2% in GII; and 57.2% in GIII (p<0.05). The intensity of chronic inflammation, fibrosis, epithelium regeneration, and neovascularization was similar in all groups (p>0.05). Collagen III/I ratio was higher in GII (GI: 119.6; GII: 257.2 and GIII: 115.0); p<0.01. The four-layer SIS is more advantageous than the one-layer SIS and buccal mucosa for urethral substitution in rabbits.

Redo-urethroplasty in pelvic fracture urethral distraction defect: an audit.

PubMed

Bhagat, Suresh K; Gopalakrishnan, Ganesh; Kumar, Santosh; Devasia, Antony; Kekre, Nitin S

2011-02-01

To predict the outcome of redo-urethroplasty after failed single or multiple open urethral procedures for pelvic fracture urethral distraction defects. From January 1997 to December 2006, 43 patients underwent redo-urethroplasty for pelvic fracture urethral distraction defect. Forty-one were referred from other centers. All had undergone open surgery along with an endoscopic procedure (one or more procedures in each patient) which included endoscopic internal urethrotomy, urethral stenting or urethral dilations. There were 43 men with mean age of 29 (range 11-52). Eleven had associated injuries: intraperitoneal bladder rupture (3), bladder neck (2), rectum (3), anal sphincter (2), combined bladder, rectum and anal sphincter (1). Trocar suprapubic cystostomy was performed in 22, rail-road procedures in 10 and open suprapubic cystostomy in 11 along with the management of associated injuries as immediate treatment. Of 43 patients, 28 had progressive perineal, and 12 had transpubic repair. Three patients had total bulbar necrosis, and they underwent prepuceal tube reconstruction (1) and staged substitution with BMG and standard scrotal inlay (2). Analysis of various factors like number of attempts at previous surgery and stricture length did not affect the outcome. A successful result was achieved in 36 (83.72%), improved and stable in five and failure in two. The overall result of redo-urethroplasty for pelvic fracture urethral distraction defect continues to be gratifying. Failures happen usually within the first 3 months. Substitution urethroplasty can be reserved for those who have long distraction defect. Long-term follow-up is essential using stringent criteria to measure success.

The transverse penile pedicled flap urethroplasty: description of a simplified technique for the dissection of the Fascio-cutaneous flap.

PubMed

Shittu, O B; Sotunmbi, P T

2015-06-01

Urethroplasty is often required for long urethral strictures or urethral strictures that have recurred after repeated urethral dilatations or urethrotomy. The transvers penile skin pedicled flap is very versatile for the reconstruction of long urethral stricture. However the meticulous sharp dissection required to develop it takes a long time to do and may be associated with button hole injuries to the vascular pedicle and the penile skin. We describe a simplified technique of raising the flap which does not require sharp dissection and is very quick to accomplish. Technique involves using a circumcising distal penile shaft skin incision to de-glove the penis by blunt dissection. The skin substitute, adequate to give appropriate urethra calibre is similarly dissected bluntly along with its vascular pedicle from the proximal penile skin. The techniques used to facilitate successful blunt dissection are described. In 9 adults with long, multiple urethral strictures, the average time to develop the flap was 15 minutes and complication have been limited to temporary urethro-cutaneous fistula at the ventral part of the circular skin closure. These fistulae closed on conservative treatment. No patient suffered button-hole injuries to either the vascular pedicle or the penile skin. This modification to the standard sharp dissection is very quick to accomplish. It also avoids the creation of button-hole injuries to either the vascular pedicle or the penile skin. It should make the use of this versatile flap more attractive in the reconstruction of long urethral strictures in those who may wish to use this option for reconstruction of long urethral strictures.

Experience with 32 Pelvic Fracture Urethral Defects Associated with Urethrorectal Fistulas: Transperineal Urethroplasty with Gracilis Muscle Interposition.

PubMed

Guo, Hailin; Sa, Yinglong; Fu, Qiang; Jin, Chongrui; Wang, Lin

2017-07-01

Pelvic fracture urethral defects associated with urethrorectal fistulas are rare and difficult to repair. The aim of this study was to evaluate the efficacy of transperineal urethroplasty with gracilis muscle interposition for the repair of pelvic fracture urethral defects associated with urethrorectal fistulas. We identified 32 patients who underwent transperineal urethroplasty with gracilis muscle interposition to repair pelvic fracture urethral defects associated with urethrorectal fistulas. Patient demographics as well as preoperative, operative and postoperative data were obtained. Mean followup was 33 months (range 6 to 64). The overall success rate was 91% (29 of 32 cases). One-stage repair was successful in 17 of 18 patients (94%) using perineal anastomosis with separation of the corporeal body and in 12 of 14 (86%) using perineal anastomosis with inferior pubectomy and separation of the corporeal body. All 22 patients (100%) without a previous history of repair were successfully treated. However, only 7 of 10 patients (70%) with a previous history of failed urethroplasty and urethrorectal fistula repair were cured. Recurrent urethral strictures developed in 2 cases. One patient was treated successfully with optical internal urethrotomy and the other was treated successfully with tubed perineoscrotal flap urethroplasty. Recurrent urethrorectal fistulas associated with urethral strictures developed in an additional patient. Transperineal urethroplasty with gracilis muscle interposition is a safe and effective surgical procedure for most pelvic fracture urethral defects associated with urethrorectal fistulas. Several other factors may affect its postoperative efficiency. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

A retrospective evaluation of challenges in urethral stricture management in a tertiary care centre of a poor resource community.

PubMed

Olajide, Abimbola Olaniyi; Olajide, Folakemi Olajumoke; Kolawole, Oladapo Adedayo; Oseni, Ismaila; Ajayi, Adewale Idowu

2013-11-01

Management of urethral stricture has evolved over the years with better understanding of the pathology, advancement in imaging, and introduction of several techniques of urethral reconstruction. In sub-Saharan Africa, advancement in management of urethral stricture may not be comparable with what obtained in most developed nations because of problems like late presentation and persistence of rare complications still reported in recent literature from the region. We set to evaluate the challenges faced by urologists involved in the management of urethral strictures in Osogbo, a poor resource community in south western Nigeria. A retrospective study was performed in the urology unit of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria between July 2007 and July 2012. Information was retrieved from patients' clinical notes and analyzed using statistical package for social sciences (SPSS) version 16.0. Eighty-four patients were treated during the period of study, their ages ranged between 19 and 89 years with the mean age of 52.3 years. The mean duration of symptoms before presentation was 3 years and 1 month. Inflammation resulting from sexually transmitted infection was the commonest etiology and more than 50% of the patients presented with complications. Sixteen patients (19.1%) received no treatment due to lack of fund. More than 90% were dependent, unemployed or underemployed. Single stage reconstruction by urethral substitution was the commonest form of repair with the restenosis rate of 4.4%. Prevalent socio-cultural and economic situation in south western Nigeria have added some peculiar challenges to the management of urethral stricture in the region.

Delayed repair of post-traumatic posterior urethral distraction injuries: long-term results.

PubMed

Tunc, H M; Tefekli, A H; Kaplancan, T; Esen, T

2000-06-01

There is still controversy regarding the treatment of post-traumatic posterior urethral distraction injuries. Initial suprapubic cystostomy and delayed perineal urethral reconstruction has been considered the reference standard. In this report, we review our experience with delayed perineal urethral reconstruction, with a focus on the long-term outcome and complications. A total of 77 men with posterior urethral distraction injury due to pelvic trauma underwent reconstruction with delayed perineal approach. In all cases, the area of fibrosis was aggressively excised, the corpus spongiosum was mobilized, and a tension-free, spatulated end-to-end anastomosis was achieved by splitting the corporeal bodies in 66.2% and by an additional perineally performed inferior pubectomy in 49.3% of the patients. The median time from injury to surgical repair was 12 months. The preoperative evaluation consisted of combined antegrade and retrograde cystourethrograms and cystourethrography. A detailed sexual history was obtained in 58 patients (75.3%). After a mean follow-up of 47 months (range 15 months to 14 years), the urethral continuity was adequate in 94. 8%; however, 2 patients required a perineal surgical revision (total of 79 operations). Postoperative incontinence was observed in 7 (9. 1%) of 77 patients. Postoperative erectile dysfunction was noted in 16.2% of patients who were known to be potent by history before surgery. Our results support the belief that delayed perineal reconstruction with extensive excision of fibrosis and a tension-free, spatulated end-to-end anastomosis is a successful treatment alternative for posterior urethral distraction defects, with acceptable morbidity.

Visibility of the urethral meatus and risk of urinary tract infections in uncircumcised boys

PubMed Central

Dubrovsky, Alexander Sasha; Foster, Bethany J.; Jednak, Roman; Mok, Elise; McGillivray, David

2012-01-01

Background: Uncircumcised boys are at higher risk for urinary tract infections than circumcised boys. Whether this risk varies with the visibility of the urethral meatus is not known. Our aim was to determine whether there is a hierarchy of risk among uncircumcised boys whose urethral meatuses are visible to differing degrees. Methods: We conducted a prospective cross-sectional study in one pediatric emergency department. We screened 440 circumcised and uncircumcised boys. Of these, 393 boys who were not toilet trained and for whom the treating physician had requested a catheter urine culture were included in our analysis. At the time of catheter insertion, a nurse characterized the visibility of the urethral meatus (phimosis) using a 3-point scale (completely visible, partially visible or nonvisible). Our primary outcome was urinary tract infection, and our primary exposure variable was the degree of phimosis: completely visible versus partially or nonvisible urethral meatus. Results: Cultures grew from urine samples from 30.0% of uncircumcised boys with a completely visible meatus, and from 23.8% of those with a partially or nonvisible meatus (p = 0.4). The unadjusted odds ratio (OR) for culture growth was 0.73 (95% confidence interval [CI] 0.35–1.52), and the adjusted OR was 0.41 (95% CI 0.17–0.95). Of the boys who were circumcised, 4.8% had urinary tract infections, which was significantly lower than the rate among uncircumcised boys with a completely visible urethral meatus (unadjusted OR 0.12 [95% CI 0.04–0.39], adjusted OR 0.07 [95% CI 0.02–0.26]). Interpretation: We did not see variation in the risk of urinary tract infection with the visibility of the urethral meatus among uncircumcised boys. Compared with circumcised boys, we saw a higher risk of urinary tract infection in uncircumcised boys, irrespective of urethral visibility. PMID:22777988

The effect of platelet rich fibrin on growth factor levels in urethral repair.

PubMed

Soyer, Tutku; Ayva, Şebnem; Boybeyi, Özlem; Aslan, Mustafa Kemal; Çakmak, Murat

2013-12-01

Platelet rich fibrin (PRF) is an autologous source of growth factors and promotes wound healing. An experimental study was performed to evaluate the effect of PRF on growth factor levels in urethral repair. Eighteen Wistar albino rats were included in the study. Rats were allocated in three groups (n:6): control (CG), sham (SG), and PRF (PRFG). In SG, a 5 mm vertical incision was performed in the penile urethra and repaired with 10/0 Vicryl® under a microscope. In PRFG, during the urethral repair as described in SG, 1 cc of blood was sampled from each rat and centrifuged for 10 minutes at 2400 rpm. PRF obtained from the centrifugation was placed on the repair site during closure. Penile urethras were sampled 24 hours after PRF application in PRFG and after urethral repair in SG. Transforming growth factor beta receptor (TGF-β-R-CD105), vascular endothelial growth factor (VEGF) and its receptor (VEGF-R), as well as endothelial growth factor receptor (EGFR), were evaluated in subepithelia of the penile skin and urethra. Groups were compared for growth factor levels and growth factor receptor expression with the Kruskal Wallis test. TGF-β-R levels were significantly decreased in SG when compared to CG (p<0.05). In PRFG, TGF-β-R was increased in both subepithelia of penile skin and urethra with respect to SG (p<0.05). When VEGF levels and its receptor expression were compared between SG and PRFG, VEGF levels were found to be increased in penile skin subepithelium, whereas VEGF-R expressions were decreased in urethral subepithelia in PRFG (p<0.05). There was no difference between groups for EGFR levels (p>0.05). Use of PRF after urethral repair increases TGF-β-R and VEGF expressions in urethral tissue. PRF can be considered as an alternative measure to improve the success of urethral repair. © 2013.

Sex-related penile fracture with complete urethral rupture: A case report and review of the literature.

PubMed

Garofalo, Marco; Bianchi, Lorenzo; Gentile, Giorgio; Borghesi, Marco; Vagnoni, Valerio; Dababneh, Hussam; Schiavina, Riccardo; Franceschelli, Alessandro; Romagnoli, Daniele; Colombo, Fulvio; Corcioni, Beniamino; Golfieri, Rita; Brunocilla, Eugenio

2015-09-30

To present the management of a patient with partial disruption of both cavernosal bodies and complete urethral rupture and to propose a non-systematic review of literature about complete urethral rupture. MATERIAL AND METHOD - CASE REPORT: A 46 years old man presented to our emergency department after a blunt injury of the penis during sexual intercourse. On physical examination there was subcutaneous hematoma extending over the proximal penile shaft with a dorsal-left sided deviation of the penis and urethral bleeding. Ultrasound investigation showed an hematoma in the ventral shaft of the penis with a discontinuity of the tunica albuginea of the right cavernosal corporum. The patient underwent immediate emergency surgery consisted on evacuation of the hematoma, reparation the partial defect of both two cavernosal bodies and end to end suture of the urethra that resulted completely disrupted. The urethral catheter was removed at the 12-th postoperative day without voiding symptoms after a retrograde urethrography. 6 months postoperatively the patients was evaluated with uroflowmetry demonstrating a max flow rate of 22 ml/s and optimal functional outcomes evaluated with validated questionnaires. 8 months after surgery the patients was evaluated by dynamic magnetic resonance (MRI) of the penis showing only a little curvature on the left side of the penile shaft. Penile fracture is an extremely uncommon urologic injury with approximately 1331 reported cases in the literature till the years 2001. To best of our knowledge from 2001 up today, 1839 more cases have been reported, only in 159 of them anterior urethral rupture was associated and in only 22 cases a complete urethral rupture was described. In our opinion, in order to prevent long term complications, in case of clinical suspicion of penile fracture, especially if it is associated to urethral disruption, emergency surgery should be the first choice of treatment.

Evaluation of syndromic patient management algorithm for urethral discharge.

PubMed

Djajakusumah, T; Sudigdoadi, S; Keersmaekers, K; Meheus, A

1998-06-01

To determine feasibility, validity, and cost effectiveness of the syndromic approach to male patients with urethral discharge in Bandung, Indonesia. The WHO algorithm on urethral discharge with no microscopy available was evaluated. Patients presented with a complaint of urethral discharge and if discharge was confirmed the algorithm was applied. Treatment covered gonococcal and chlamydial infection (ciprofloxacin 500 mg single oral dose plus doxycycline 100 mg, twice daily orally for 7 days). The gold standard for validation was gonococcal culture and chlamydia antigen detection. 140 male patients with a complaint of urethral discharge were enrolled; 119 had confirmed discharge and entered the decision tree: 107 were followed and 104 (97%) were clinically cured. Of the three patients with persistent discharge, one had a purulent urethral discharge, diagnosed as gonococcal urethritis and he was probably reinfected; two patients had a serous discharge and microbiological tests were negative. Overall, 106 out of 107 patients (99%) were microbiologically cured. Sensitivity of the algorithm is 100% and its positive predictive value (PPV) is 75% or 97% if validated against gold standard microbiological tests or Gram stain, respectively. Cost per patient is rupiah (Rp)5.894 ($US2.56) for the algorithm compared with Rp43.024 ($18.70) for full microbiological diagnosis. The cost estimate for an algorithm of urethral discharge with microscopy available is Rp6.432 ($2.80) The "symptom and sign" algorithm is fully adapted to the prevailing situation in primary healthcare settings, is acceptable to healthcare workers and patients (who are effectively treated at their first visit), is highly cost effective, is 100% sensitive (no false negatives, which is not the case with microbiological diagnosis), and has a high PPV, between 75% and 97%. It is an excellent patient management tool and a sound basis for partner notification so that it should have a major impact on STD/HIV control and prevention in both men and women.

Outcome of anastomotic posterior urethroplasty with various ancillary maneuvers for post-traumatic urethral injury. Does prior urethral manipulation affect the outcome of urethroplasty?

PubMed Central

Mehmood, Shahbaz; Alsulaiman, Omer Abdulaziz; Al Taweel, Waleed Mohammad

2018-01-01

Purpose: We present our success rate and complications of delayed anastomotic urethroplasty (DAU) in patients with post-traumatic posterior urethral injury. Materials and Methods: This was a retrospective study of patients aged ≥17 years that underwent DAU for post-traumatic posterior urethral injury during 2010–2014. Stricture length was measured by ascending and descending urethrogram. Success of procedure was considered when the patient was free of stricture-ralated obstruction and needed no further intervention. Primary group includes patients who underwent first time delayed urethroplasty while secondary group included patients who had some sort of urethral manipulation in local hospital. Results were analyzed using unpaired t-test, Chi-square test, binary logistic regression, Kaplan–Meier curves, and log-rank test. Results: Of the 80 male patients, 73 (91.25%) patients underwent primary DAU while 7 (8.75%) patients had secondary DAU. Median age, stricture length, and follow-up were 27.0 ± 12.7, 1.6 ± 0.9, and 3.2 ± 0.9, respectively. Overall, success rate was 83.75% while success rate in primary group was 89.04% and secondary group was only 28.57% (P = 0.0059). Regarding ancillary maneuvers, urethral mobilization alone was done in 29 (36.25%) patients with success rate (72.41%), corporeal body separation in 36 (45%) patients with success rate (91.66%), inferior wedge pubectomy in 13 (16.25%) with success rate (84.61%), supracrural rerouting in 1 (1.25%) with success rate (100%), and abdominoperineal approach in 1 (1.25%) with success rate of 100% (P = 0.193). Patients who had prior urethral manipulation affect the outcome of definitive anastomotic urethroplasty. Conclusion: DAU has durable success rate with less morbidity. Ancillary elaborated maneuvers are frequently needed in patients with complex and elongated post-traumatic posterior urethral defect with successful outcome. PMID:29719330

Acid-base and biochemical stabilization and quality of recovery in male cats with urethral obstruction and anesthetized with propofol or a combination of ketamine and diazepam

PubMed Central

Freitas, Gabrielle C.; Monteiro Carvalho Mori da Cunha, Marina G.; Gomes, Kleber; Monteiro Carvalho Mori da Cunha, João P.; Togni, Monique; Pippi, Ney L.; Carregaro, Adriano B.

2012-01-01

This study compared acid-base and biochemical changes and quality of recovery in male cats with experimentally induced urethral obstruction and anesthetized with either propofol or a combination of ketamine and diazepam for urethral catheterization. Ten male cats with urethral obstruction were enrolled for urethral catheterization and anesthetized with either ketamine-diazepam (KD) or propofol (P). Lactated Ringer’s solution was administered by intravenous (IV) beginning 15 min before and continuing for 48 h after relief of urethral obstruction. Quality of recovery and time to standing were evaluated. The urethral catheter was maintained to measure urinary output. Hematocrit (Hct), total plasma protein (TPP), albumin, total protein (TP), blood urea nitrogen (BUN), creatinine, pH, bicarbonate (HCO3−), chloride, base excess, anion gap, sodium, potassium, and partial pressure of carbon dioxide in mixed venous blood (pvCO2) were measured before urethral obstruction, at start of fluid therapy (0 h), and at subsequent intervals. The quality of recovery and time to standing were respectively 4 and 75 min in the KD group and 5 and 16 min in the P group. The blood urea nitrogen values were increased at 0, 2, and 8 h in both groups. Serum creatinine increased at 0 and 2 h in cats administered KD and at 0, 2, and 8 h in cats receiving P, although the values were above the reference range in both groups until 8 h. Acidosis occurred for up to 2 h in both groups. Acid-base and biochemical stabilization were similar in cats anesthetized with propofol or with ketamine-diazepam. Cats that received propofol recovered much faster, but the ketamine-diazepam combination was shown to be more advantageous when treating uncooperative cats as it can be administered by intramuscular (IM) injection. PMID:23277699

Repeat urethrotomy and dilation for the treatment of urethral stricture are neither clinically effective nor cost-effective.

PubMed

Greenwell, T J; Castle, C; Andrich, D E; MacDonald, J T; Nicol, D L; Mundy, A R

2004-07-01

We developed an algorithm for the management of urethral stricture based on cost-effectiveness. United Kingdom medical and hospital costs associated with the current management of urethral stricture were calculated using private medical insurance schedules of reimbursement and clean intermittent self-catheterization supply costs. These costs were applied to 126 new patients treated endoscopically for urethral stricture in a general urological setting between January 1, 1991 and December 31, 1999. Treatment failure was defined as recurrent symptomatic stricture requiring further operative intervention following initial intervention. Mean followup available was 25 months (range 1 to 132). The costs were urethrotomy/urethral dilation 2,250.00 pounds sterling (3,375.00 dollars, ratio 1.00), simple 1-stage urethroplasty 5,015.00 pounds sterling (7,522.50 dollars, ratio 2.23), complex 1-stage urethroplasty 5,335.00 pounds sterling (8,002.50 dollars, ratio 2.37) and 2-stage urethroplasty 10,370 pounds sterling (15,555.00 dollars, ratio 4.61). Of the 126 patients assessed 60 (47.6%) required more than 1 endoscopic retreatments (mean 3.13 each), 50 performed biweekly clean intermittent self-catheterization and 7 underwent urethroplasty during followup. The total cost per patient for all 126 patients for stricture treatment during followup was 6,113 pounds sterling (9,170 dollars). This cost was calculated by multiplying procedure cost by the number of procedures performed. A strategy of urethrotomy or urethral dilation as first line treatment, followed by urethroplasty for recurrence yielded a total cost per patient of 5,866 pounds sterling (8,799 dollars). A strategy of initial urethrotomy or urethral dilation followed by urethroplasty in patients with recurrent stricture proves to be the most cost-effective strategy. This financially based strategy concurs with evidence based best practice for urethral stricture management.

The significance of the open bladder neck associated with pelvic fracture urethral distraction defects.

PubMed

Iselin, C E; Webster, G D

1999-08-01

As a result of pelvic fracture urethral distraction defects, urinary continence relies predominantly on intact bladder neck function. Hence, when cystoscopy and/or cystography reveals an open bladder neck before urethroplasty, the probability of postoperative urinary incontinence may be significant. Unresolved issues are the necessity, the timing and the type of bladder neck repair. We report the outcome of various therapeutic options in patients with pelvic fracture urethral distraction defects and open bladder neck. We also attempt to identify prognostic factors of incontinence before urethroplasty. We retrospectively reviewed the records of 15 patients with a mean age of 30 years in whom an open bladder neck was identified before posterior urethroplasty between January 1981 and October 1997. Of the 15 patients 6 were continent and 8 were incontinent postoperatively. One patient underwent artificial urethral sphincter implantation simultaneously with pelvic fracture urethral distraction defect repair and was dry postoperatively without sphincter activation. Average bladder neck and prostatic urethral opening on the cystourethrogram before urethroplasty was significantly longer in incontinent (1.68 cm.) than in continent (0.9 cm.) patients. Of the 8 patients who were incontinent 6 underwent bladder neck reconstruction, 1 artificial urinary sphincter and 1 periurethral collagen implant. Five patients with bladder neck reconstruction are totally continent and 1 requires 1 pad daily. The patient who underwent collagen implant requires 2 pads daily and the patient who received an artificial urethral sphincter has minor urge leakage. Open bladder neck before urethroplasty may herald postoperative incontinence which may be predicted by radiographic and cystoscopic features. Evaluation of the risk of postoperative incontinence may be valuable, and eventually guide the necessity and timing of anti-incontinence surgery, although our preference remains to manage the pelvic fracture urethral distraction defects and bladder neck problem sequentially. Bladder neck reconstruction provides good postoperative continence rates and is our technique of choice.

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 implications for understanding urinary tract dysfunction caused by neuropathy or nerve damage, such as urinary retention or incontinence, as well as for the development of strategies to mitigate the symptoms of these conditions. PMID:26041695

[Effect of modified Badenoch operation on the treatment of posterior urethral stricture].

PubMed

Wang, Ping-xian; Zhang, Gen-pu; Huang, Chi-bing; Fan, Ming-qi; Feng, Jia-yu; Xiao, Ya

2012-02-01

To determine the effects of modified pull-through operation (Badenoch operation) on the treatment of posterior urethral stricture. From September 2001 to December 2010 traditional pull-through operation was Modified for two times in our center. A total of 129 patients with posttraumatic posterior urethral stricture resulting from pelvic fracture injury underwent the modified urethral pull-through operation. Stricture length was 1.5 to 5.3 cm (mean 2.9 cm). Of the patients 43 had undergone at least 1 previous failed management for stricture. In phase 1 (from September 2001 to January 2008), the improving items include: (1) The distal urethral end was stitched and tied to the catheter. (2) As catheter was inserted into bladder and 20 ml water was injected into catheter balloon, the distal urethral end was fixed in the proximal urethra and an overlaying of 1.5 cm was formed between the two ends. (3) Three weeks later, it was tried to insert the catheter to bladder. After the urethral stump necrosis and the catheter separating from the urethra, the catheter was removed. In phase 2 (from February 2008 to December 2010), based on the above, irrigating catheter was used. After the surgery, urethra was irrigated with 0.02% furacillin solution through the catheter 3 times a day. All patients were followed up for at least 6 months. If patients had no conscious dysuria and maximum urinary flow rate (Qmax) > 15 ml/s, the treatment was considered successful. All complications were recorded. In phase 1, the 96 patients (101 times) underwent the procedure. The treatment was successful in 88 patients (success rate 92%). Within 1 to 13 days after removal of the catheter, urethral stricture was recurred in 8 patients. They had to undergo cystostomy once more for 3 to 11 months before reoperation (the 3 patients' reoperation was in phase 2). The 8 cases were treated successfully. In phase 2, 33 patients (total 36 times) underwent the procedure. One patient was failed (success rate 97%). The actual follow-up time is 7 to 93 months (An average of 37.6 months). Qmax is (22 ± 5) ml/s. No complications such as urinary incontinence, erectile pain, urinary shortening happened. The modified urethral pull-through operation is effective for the surgical treatment of posttraumatic posterior urethral stricture. It has a high success rate with durable long-term results. Complications are few. The procedure is simple, less demanding and especially suitable in patients who had previously undergone failed surgical treatments.

Anterior Urethral Valve: Uncommon Association with Renal Duplicity.

PubMed

Salem, Amina Ben; Mazhoud, Ines; Laamiri, Rachida; Salem, Randa; Laajili, Hayet; Sahnoun, Lassaad; Hafsa, Chiraz

2017-01-01

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. We present a case of AUV diagnosed at 24th gestational week. Ultrasonography and fetal MRI revealed hydronephrotic kidneys with ureteral duplicity, a distended bladder and perineal cystic mass which confirmed dilated anterior urethra in a male fetus. Diagnosis was confirmed postnatally by voiding cystourethrogram and surgery.

Penile fracture with urethral trauma.

PubMed

de Carvalho, Arlindo Monteiro; de Melo, Fábio Martinez; Félix, Gabriella Alves de Lima; Sarmento, Juliana Fernandes; Capriglione, Maria Luisa Dutra

2013-01-01

We reported a case of a twenty-nine-year-old male who presented a penile fracture associated with urethral injury caused by a sexual intercourse. An ideal anamnesis and a special physical examination were determinant to correct diagnostics. Ultrasonography and uretrocistography must be performed for confirmation. The treatment is based on the presence of associated urethral injury. The surgical repair of cavernous body and urethra can produce good results, with a favorable prognosis and minimal rate of complications.

Pelvic fracture and associated urologic injuries.

PubMed

Brandes, S; Borrelli, J

2001-12-01

Successful management of patients with major pelvic injuries requires a team approach including orthopedic, urologic, and trauma surgeons. Each unstable pelvic disruption must be treated aggressively to minimize complications and maximize long-term functional outcome. Commonly associated urologic injuries include injuries of the urethra, corpora cavernosa (penis), bladder, and bladder neck. Bladder injuries are usually extraperitoneal and result from shearing forces or direct laceration by a bone spicule. Posterior urethral injuries occur more commonly with vertically applied forces, which typically create Malgaigne-type fractures. Common complications of urethral disruption are urethral stricture, incontinence, and impotence. Acute urethral injury management is controversial, although it appears that early primary realignment has promise for minimizing the complications. Impotence after pelvic fracture is predominantly vascular in origin, not neurologic as once thought.

Surgical Repair of Mid-shaft Hypospadias Using a Transverse Preputial Island Flap and Pedicled Dartos Flap Around Urethral Orifice.

PubMed

Liang, Weiqiang; Ji, Chenyang; Chen, Yuhong; Zhang, Ganling; Zhang, Jiaqi; Yao, Yuanyuan; Zhang, Jinming

2016-08-01

To evaluate the effects, particularly the incidence of anastomotic fistula, of a pedicled dartos flap around the urethral orifice in the treatment of urethroplasty of mid-shaft hypospadias. A total of 46 cases of congenital mid-shaft hypospadias were included in this study. The patients ranged in age from 0.7 to 25.4 years and the average was 5.8 years. The patients received penis chordee correction. A transverse preputial island flap was developed for urethral reconstruction. The proximal dartos of the urethral orifice was used to develop a pedicled dartos flap, which was transposed to cover and strengthen neourethral anastomosis. The ventral penile skin defect was repaired by another flap. The 46 patients were examined during follow-up visits for 6 months to 3 years. An anastomotic fistula was observed in one case (2.2 %). Scar healing without fistula was observed in another patient due to poor blood supply to part of the ventral penile skin. No other incidences of fistula, urethral rupture, flap necrosis, wound infections, urinary tract (meatal) stenosis, or urethral diverticulum were observed in the patients. A pedicled dartos flap around the urethral orifice can take advantage of well-vascularized local tissue to add a protective layer to the proximal aspect of the neourethral anastomosis for reducing the incidence of anastomotic fistula in mid-shaft hypospadias repair using a transverse preputial island flap. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Is prenatal urethral descent a risk factor for urinary incontinence during pregnancy and the postpartum period?

PubMed

Pizzoferrato, Anne-Cécile; Fauconnier, Arnaud; Bader, Georges; de Tayrac, Renaud; Fort, Julie; Fritel, Xavier

2016-07-01

Obstetric trauma during childbirth is considered a major risk factor for postpartum urinary incontinence (UI), particularly stress urinary incontinence. Our aim was to investigate the relation between postpartum UI, mode of delivery, and urethral descent, and to define a group of women who are particularly at risk of postnatal UI. A total of 186 women were included their first pregnancy. Validated questionnaires about urinary symptoms during pregnancy, 2 and 12 months after delivery, were administered. Urethral descent was assessed clinically and by ultrasound at inclusion. Multivariate logistic regression analysis was used to determine the risk factors for UI during pregnancy, at 2 months and 1 year after first delivery. The prevalence of UI was 38.6, 46.5, 35.6, and 34.4 % at inclusion, late pregnancy, 2 months postpartum, and 1 year postpartum respectively. No significant association was found between UI at late pregnancy and urethral descent assessed clinically or by ultrasound. The only risk factor for UI at 2 months postpartum was UI at inclusion (OR 6.27 [95 % CI 2.70-14.6]). The risk factors for UI at 1 year postpartum were UI at inclusion (6.14 [2.22-16.9]), body mass index (BMI), and urethral descent at inclusion, assessed clinically (7.21 [2.20-23.7]) or by ultrasound. The mode of delivery was not associated with urethral descent. Prenatal urethral descent and UI during pregnancy are risk factors for UI at 1 year postpartum. These results indicate that postnatal UI is more strongly influenced by susceptibility factors existing before first delivery than by the mode of delivery.

Sensitivity of Gram stain in the diagnosis of urethritis in men.

PubMed

Orellana, M Angeles; Gómez-Lus, M Luisa; Lora, David

2012-06-01

Acute urethritis is among the most common types of sexually transmitted diseases in men. The diagnosis usually requires microscopic evidence of urethritis, but sometimes urethral pathogens are detected in asymptomatic men without such evidence. The aims of this study were to assess the sensitivity of Gram stain in men with urethral symptoms and to relate it to the microorganisms isolated. Between January 2006 and December 2007, 491 urethral samples were analysed. The authors assessed the presence of leukocytes by Gram stain and tested specifically for Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis and Trichomonas vaginalis, as well as analysing the results of conventional culture. The percentages of positive samples as a function of Gram category were two or less polymorphonuclear leukocytes (PMNLs)/high-power field (HPF) 25% (92/364), three to four PMNLs/HPF 32% (18/57) and five or more PMNLs/HPF 54% (38/70). Classing samples with more than two PMNLs/HPF as positive, the sensitivity, specificity and positive likelihood ratio for Gram stain were 38% (95% CI 30 to 46), 79% (95% CI 75 to 84) and 1.8 (95% CI 1.4 to 2.4), respectively. On the other hand, taking as positive five or more PMNLs/HPF, the sensitivity, specificity and positive likelihood ratio for Gram stain were 26% (95% CI 18 to 33), 91% (95% CI 87 to 94) and 2.7 (95% CI 1.8 to 4.2), respectively. The sensitivity of Gram stain to Neisseria gonorrhoeae, Chlamydia trachomatis and Ureaplasma urealyticum were 80% (95% CI 64 to 96), 23% (95% CI 8 to 39) and 11% (95% CI 2 to 20), respectively. The low sensitivity of Gram stain means that negative results do not exclude the presence of urethritis in symptomatic patients.

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

Urethral caruncle: a lesion related to IgG4-associated sclerosing disease?

PubMed

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

2013-07-01

Urethral caruncle is a benign, polypoid urethral mass that occurs almost exclusively in postmenopausal women. Despite that these lesions are routinely managed with topical medications or excision, their pathogenesis is not well understood. We investigated the possibilities of autoimmune, viral and inflammatory myofibroblastic proliferations as possible aetiologies. In 38 patients with urethral caruncle, we utilised immunohistochemistry for immunoglobulin G (IgG) and IgG4 to assess for a potential autoimmune aetiology. Immunohistochemistry was performed in nine patients for Epstein-Barr virus, BK virus, human herpesvirus 8, human papillomavirus, adenovirus and anaplastic lymphoma kinase. Four patients (11%) showed infiltrates of ≥50 IgG4-positive plasma cells per high power field, of which all showed an IgG4 to IgG ratio greater than 40%. A statistically significant difference (p<0.01) was detected in the mean number of IgG4-positive cells (14.73 per high power field) compared with control benign urethral specimens (mean, 1.19). One patient with increased counts below this threshold had rheumatoid arthritis; none had documented autoimmune pancreatitis or other known manifestations of systemic IgG4-related sclerosing disease. All lesions showed negative reactions for the viral and inflammatory myofibroblastic markers. Urethral caruncle is a benign inflammatory and fibrous polypoid urethral mass of unclear aetiology. It appears unrelated to viral infection and lacks the abnormal expression of anaplastic lymphoma kinase protein, as seen in inflammatory myofibroblastic tumours. Increased numbers of IgG4-positive plasma cells in a subset of lesions raise the possibility that some cases may be related to the autoimmune phenomena of IgG4-associated disease.

A Retrospective Evaluation of Challenges in Urethral Stricture Management in a Tertiary Care Centre of a Poor Resource Community

PubMed Central

Olajide, Abimbola Olaniyi; Olajide, Folakemi Olajumoke; Kolawole, Oladapo Adedayo; Oseni, Ismaila; Ajayi, Adewale Idowu

2013-01-01

Background Management of urethral stricture has evolved over the years with better understanding of the pathology, advancement in imaging, and introduction of several techniques of urethral reconstruction. In sub-Saharan Africa, advancement in management of urethral stricture may not be comparable with what obtained in most developed nations because of problems like late presentation and persistence of rare complications still reported in recent literature from the region. Objectives We set to evaluate the challenges faced by urologists involved in the management of urethral strictures in Osogbo, a poor resource community in south western Nigeria. Patients and Methods A retrospective study was performed in the urology unit of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria between July 2007 and July 2012. Information was retrieved from patients’ clinical notes and analyzed using statistical package for social sciences (SPSS) version 16.0. Results Eighty-four patients were treated during the period of study, their ages ranged between 19 and 89 years with the mean age of 52.3 years. The mean duration of symptoms before presentation was 3 years and 1 month. Inflammation resulting from sexually transmitted infection was the commonest etiology and more than 50% of the patients presented with complications. Sixteen patients (19.1%) received no treatment due to lack of fund. More than 90% were dependent, unemployed or underemployed. Single stage reconstruction by urethral substitution was the commonest form of repair with the restenosis rate of 4.4%. Conclusions Prevalent socio-cultural and economic situation in south western Nigeria have added some peculiar challenges to the management of urethral stricture in the region. PMID:24693504

Internal fixation in pelvic fractures and primary repairs of associated genitourinary disruptions: a team approach.

PubMed

Routt, M L; Simonian, P T; Defalco, A J; Miller, J; Clarke, T

1996-05-01

Associated urological and orthopedic injuries of the pelvic ring are complex with numerous potential complications. These patients are treated optimally using a team approach. The combined expertise is not only helpful initially when managing these difficult patients, but also later as problems develop. This study describes a treatment protocol and reports the early results of 23 patients with unstable pelvic fractures and associated bladder or urethral disruptions, or both, treated surgically with open reduction and internal fixation of the anterior pelvic ring injuries at the same anesthetic and using the same surgical exposure as the urethral realignments or bladder repairs or both. Early complications occurred in four patients (17%): one patient sustained a fifth lumbar nerve injury caused by the pelvic reduction procedure, and three patients had anterior pelvic internal fixation failures. Late complications occurred in eight patients (35%). There was one deep wound infection (4.3%) that presented 6 weeks after injury. Late urological complications occurred in seven patients (30%). Four of the nine male patients with urethral disruptions had urethral stricture after their primary urethral realignments (44%). Three of the 18 male patients admitted to impotence (16.7%). One of the three had a residual thoracic paraplegia caused by a burst fracture. One of the five female patients had urinary incontinence and required a bladder suspension operation to restore normal function (20%). A low infection rate can be expected despite the use of internal fixation. Early urethral "indirect" realignments avoid more difficult delayed open repairs; however, late urological complication rates are still high. Early "direct" bladder repairs are easily performed at the time of anterior pelvic open reduction and internal fixation. Suprapubic tubes are not necessary to adequately divert the urine when large diameter urethral catheters are used in these patients.

Three-dimensional translabial ultrasound assessment of urethral supports and the urethral sphincter complex in stress urinary incontinence.

PubMed

Cassadó Garriga, Jordi; Pessarrodona Isern, Antoni; Rodríguez Carballeira, Monica; Pallarols Badia, Mar; Moya Del Corral, Manuela; Valls Esteve, Marta; Huguet Galofré, Eva

2017-09-01

The pathophysiological mechanism of incontinence is multifactorial. We evaluated the role of 3D-4D ultrasound in the assessment of the fascial supports of the urethra and the urethral sphincter complex (USC) for diagnosing stress urinary incontinence. Observational case-control study in women with and without stress urinary incontinence attending a urogynecology service and a general gynecology service. All women were interviewed, examined, and classified according to the Pelvic Organ Prolapse Quantification (POP-Q) and underwent a 3D-4D translabial ultrasound. Fascial supports of the urethra were assessed by tomographic ultrasound and were considered to be intact or absent if it was possible to identify them at eight levels on each side, urethral mobility was assessed on maximal Valsalva in sagittal section and the length and volume of the USC at rest and on maximal Valsalva were determined using the Virtual Organ Computer-aided Analysis (VOCAL) program. Variables were compared between continent and incontinent women. A total of 173 women were examined, 78 continent and 95 incontinent. There was a significant difference in urethral mobility between continent and incontinent women (12.82 mm vs. 21.85 mm, P < 0.001), but there was no significant difference in the percentage of supports affected (43.27% vs. 35.94%, P < 0.070). The length of the USC at rest was significantly shorter (P < 0.001) ​​in incontinent patients. Ultrasound evaluation of urethral supports does not discriminate between continent and incontinent women. However, the length of the USC at rest was shorter and urethral mobility was higher in incontinent women. Neurourol. Urodynam. 9999:XX-XX, 2016. © 2016 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Effects of birth trauma and estrogen on urethral elastic fibers and elastin expression.

PubMed

Lin, Guiting; Ning, Hongxiu; Wang, Guifang; Banie, Lia; Lue, Tom F; Lin, Ching-Shwun

2010-10-01

To investigate the effects of birth trauma and estrogen on urethral elastic fibers and elastin expression. Pregnant rats were subjected to sham operation (Delivery-only), DVDO (delivery, vaginal distension and ovariectomy), or DVDO + E₂ (estrogen). At 2, 4, 8, or 12 weeks, their urethras were harvested for elastic fiber staining and reverse transcription-polymerase chain reaction analysis. Urethral cells were treated with transforming growth factor- β1 (TGFβ1) and/or estrogen and analyzed for elastin mRNA expression. Urethral cells were also examined for the activities of Smad1- and Smad3/4-responsive elements in response to TGFβ1 and estrogen. At 8 weeks post-treatment, the urethras of DVDO rats had fewer and shorter elastic fibers when compared with Delivery-only rats, and those of DVDO + E₂ rats had fewer and shorter elastic fibers when compared with DVDO rats. Elastin mRNA was expressed at low levels in Delivery-only rats and at increasingly higher levels in DVDO rats at 2, 4, and 8 weeks but at sharply lower levels in DVDO + E₂ rats when compared with DVDO rats at 8 weeks. Urethral cells expressed increasingly higher levels of elastin mRNA in response to increasing concentrations of TGFβ1 up to 1 ng/mL. At this TGFβ1 concentration, urethral cells expressed significantly lower levels of elastin mRNA when treated with estrogen before or after TGFβ1 treatment. Both Smad1- and Smad3/4-responsive elements were activated by TGFβ1 and such activation was suppressed by estrogen. Birth trauma appears to activate urethral elastin expression via TGFβ1 signaling. Estrogen interferes with this signaling, resulting in improper assembly of elastic fibers. Copyright © 2010 Elsevier Inc. All rights reserved.

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:

Medical Surveillance Monthly Report (MSMR). Volume 16, Number 3, March 2009

DTIC Science & Technology

2009-03-01

Gonorrhea Syphilis‡ Urethritis§ Cold Heat 2008 2009 2008 2009 2008 2009 2008 2009 2008 2009 2008 2009 2008 2009 2008 2009 NORTH ATLANTIC Washington, DC... Gonorrhea Syphilis‡ Urethritis§ Cold Heat 2008 2009 2008 2009 2008 2009 2008 2009 2008 2009 2008 2009 2008 2009 2008 2009 NATIONAL CAPITOL AREA NNMC...Sexually transmitted Environmental Lyme disease Malaria Chlamydia Gonorrhea Syphilis‡ Urethritis§ Cold Heat 2008 2009 2008 2009 2008 2009 2008 2009 2008

Phosphoinositide-Driven Epithelial Proliferation in Prostatic Inflammation

DTIC Science & Technology

2009-04-01

IL-1β expression is localized to the urethral urothelium during development, and little or no expression is observed in the developing prostatic...ducts [Figure 3B]. By comparison, IL-1α expression is found both in the urethral urothelium and in the developing prostatic ducts [Figure 3A]. In...adult [C]. Hyperplasia was induced by E. coli for 5 days. In contrast, IL-1β [B,D] expression is localized to the urethral urothelium at P10 [B] and

Estradiol increases urethral tone through the local inhibition of neuronal nitric oxide synthase expression.

PubMed

Gamé, Xavier; Allard, Julien; Escourrou, Ghislaine; Gourdy, Pierre; Tack, Ivan; Rischmann, Pascal; Arnal, Jean-François; Malavaud, Bernard

2008-03-01

Estrogens are known to modulate lower urinary tract (LUT) trophicity and neuronal nitric oxide synthase (nNOS) expression in several organs. The aim of this study was to explore the effects of endogenous and supraestrus levels of 17beta-estradiol (E2) on LUT and urethral nNOS expression and function. LUT function and histology and urethral nNOS expression were studied in adult female mice subjected either to sham surgery, surgical castration, or castration plus chronic E2 supplementation (80 microg.kg(-1).day(-1), i.e., pregnancy level). The micturition pattern was profoundly altered by long-term supraestrus levels of E2 with decreased frequency paralleled by increased residual volumes higher than those of ovariectomized mice. Urethral resistance was increased twofold in E2-treated mice, with no structural changes in urethra, supporting a pure tonic mechanism. Acute nNOS inhibition by 7-nitroindazole decreased frequency and increased residual volumes in ovariectomized mice but had no additive effect on the micturition pattern of long-term supraestrus mice, showing that long-term supraestrus E2 levels and acute inhibition of nNOS activity had similar functional effects. Finally, E2 decreased urethral nNOS expression in ovariectomized mice. Long-term supraestrus levels of E2 increased urethral tone through inhibition of nNOS expression, whereas physiological levels of E2 had no effect.

Dorsal onlay lingual mucosal graft urethroplasty for urethral strictures in women.

PubMed

Sharma, Girish K; Pandey, Ashwani; Bansal, Harbans; Swain, Sameer; Das, Suren K; Trivedi, Sameer; Dwivedi, Udai S; Singh, Pratap B

2010-05-01

To describe the technique and results of dorsal onlay lingual mucosal graft (LMG) urethroplasty for the definitive management of urethral strictures in women. In all, 15 women (mean age 42 years) with a history suggestive of urethral stricture who had undergone multiple urethral dilatations and/or urethrotomy were selected for dorsal onlay LMG urethroplasty after thorough evaluation, from October 2006 to March 2008. After a suprameatal inverted-U incision, the dorsal aspect of the urethra was dissected and urethrotomy was done at the 12 o'clock position across the strictured segment. Tailored LMG harvested from the ventrolateral aspect of the tongue was then sutured to the urethrotomy wound over an 18 F silicone catheter. The preoperative mean maximum urinary flow rate of 7.2 mL/s increased to 29.87 mL/s, 26.95 mL/s and 26.86 mL/s with a 'normal' flow rate curve at 3, 6 and 12 months follow-up, respectively. One patient at the 3-month follow-up had submeatal stenosis and required urethral dilatation thrice at monthly intervals. At the 1-year follow-up, none of the present patients had any neurosensory complications, urinary incontinence, or long-term functional/aesthetic complication at the donor site. LMG urethroplasty using the dorsal onlay technique should be offered for correction of persistent female urethral stricture as it provides a simple, safe and effective approach with durable results.

Urethritis

MedlinePlus

... that cause this condition are E coli, chlamydia , gonorrhea . These bacteria also cause urinary tract infections and ... women only) Urinalysis and urine cultures Tests for gonorrhea , chlamydia , and other sexually transmitted illnesses (STI) Urethral ...

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.

Comparative urodynamic studies of continent and stress incontinent women in pregnancy and in the puerperium.

PubMed

Iosif, S; Ulmsten, U

1981-07-15

Twelve pregnant women were examined by urethral pressure profile measurement and simultaneous urethrocystometry early in pregnancy (weeks 12 to 16), in the thirty-eighth week, and 5 to 7 days after delivery. All patients reported symptoms of stress incontinence starting at an early 5 to 7 days after delivery. All patients reported symptoms of stress incontinence starting at an early gestational age, it was found that that the stress incontinent women, compared to 14 continent, healthy women from whom measurements were obtained earlier, had shorter urethral lengths. Furthermore, no increase in urethral length during pregnancy was registered among the stress incontinent women, whereas such an increase did occur in the continent women. In contrast to the continent women, the incontinent patients had a low urethral closure pressure at rest and this pressure did not appear to increase sufficiently to compensate for the progressive increase in bladder pressure during pregnancy. As a result the urethral closure pressure in the stress incontinent women, therefore, decreased more and more during stress situations as pregnancy progressed, resulting in an increased leakage of urine.

Continent women have better urethral neuromuscular function than those with stress incontinence

PubMed Central

Mueller, Elizabeth; Brubaker, Linda

2012-01-01

Introduction and hypothesis The objective of this study is to describe urethral neuromuscular function using concentric needle electromyography (EMG) in stress incontinent (SUI) and asymptomatic women. Methods Following Institutional Review Board approval, we recruited SUI and asymptomatic women without urinary incontinence. Participants underwent quantitative urethral EMG and urodynamic testing. Results Sixty-seven women (37 SUI, 30 continent) with mean±SD age of 44±12 years participated. Nearly all EMG parameters showed significant differences between continent and SUI women consistent with better motor unit recruitment in continent women. Continent women had larger-amplitude, longer-duration motor unit action potentials (MUP) with increased turns and better MUP recruitment during bladder filling (P<.05). Increasing age was inversely correlated with nearly all MUP parameters (P<.05), suggesting MUP to be consistent with neuropathy. Conclusions We found significant differences in multiple MUP parameters in urethral sphincter between continent and stress incontinent women, suggesting continent women have better urethral innervation. We also found significant neuropathic MUP changes with advancing age, regardless of continence status. PMID:21979386

Magnetic resonance imaging in assessment of stress urinary incontinence in women: Parameters differentiating urethral hypermobility and intrinsic sphincter deficiency.

PubMed

Macura, Katarzyna Jadwiga; Thompson, Richard Eugene; Bluemke, David Alan; Genadry, Rene

2015-11-28

To define the magnetic resonance imaging (MRI) parameters differentiating urethral hypermobility (UH) and intrinsic sphincter deficiency (ISD) in women with stress urinary incontinence (SUI). The static and dynamic MR images of 21 patients with SUI were correlated to urodynamic (UD) findings and compared to those of 10 continent controls. For the assessment of the urethra and integrity of the urethral support structures, we applied the high-resolution endocavitary MRI, such as intraurethral MRI, endovaginal or endorectal MRI. For the functional imaging of the urethral support, we performed dynamic MRI with the pelvic phased array coil. We assessed the following MRI parameters in both the patient and the volunteer groups: (1) urethral angle; (2) bladder neck descent; (3) status of the periurethral ligaments, (4) vaginal shape; (5) urethral sphincter integrity, length and muscle thickness at mid urethra; (6) bladder neck funneling; (7) status of the puborectalis muscle; (8) pubo-vaginal distance. UDs parameters were assessed in the patient study group as follows: (1) urethral mobility angle on Q-tip test; (2) Valsalva leak point pressure (VLPP) measured at 250 cc bladder volume; and (3) maximum urethral closure pressure (MUCP). The UH type of SUI was defined with the Q-tip test angle over 30 degrees, and VLPP pressure over 60 cm H2O. The ISD incontinence was defined with MUCP pressure below 20 cm H2O, and VLPP pressure less or equal to 60 cm H2O. We considered the associations between the MRI and clinical data and UDs using a variety of statistical tools to include linear regression, multivariate logistic regression and receiver operating characteristic (ROC) analysis. All statistical analyses were performed using STATA version 9.0 (StataCorp LP, College Station, TX). In the incontinent group, 52% have history of vaginal delivery trauma as compared to none in control group (P < 0.001). There was no difference between the continent volunteers and incontinent patients in body habitus as assessed by the body mass index. Pubovaginal distance and periurethral ligament disruption are significantly associated with incontinence; periurethral ligament symmetricity reduces the odds of incontinence by 87%. Bladder neck funneling and length of the suprapubic urethral sphincter are significantly associated with the type of incontinence on UDs; funneling reduced the odds of pure UH by almost 95%; increasing suprapubic urethral sphincter length at rest is highly associated with UH. Both MRI variables result in a predictive model for UDs diagnosis (area under the ROC = 0.944). MRI may play an important role in assessing the contribution of hypermobility and sphincteric dysfunction to the SUI in women when considering treatment options.

Magnetic resonance imaging in assessment of stress urinary incontinence in women: Parameters differentiating urethral hypermobility and intrinsic sphincter deficiency

PubMed Central

Macura, Katarzyna Jadwiga; Thompson, Richard Eugene; Bluemke, David Alan; Genadry, Rene

2015-01-01

AIM: To define the magnetic resonance imaging (MRI) parameters differentiating urethral hypermobility (UH) and intrinsic sphincter deficiency (ISD) in women with stress urinary incontinence (SUI). METHODS: The static and dynamic MR images of 21 patients with SUI were correlated to urodynamic (UD) findings and compared to those of 10 continent controls. For the assessment of the urethra and integrity of the urethral support structures, we applied the high-resolution endocavitary MRI, such as intraurethral MRI, endovaginal or endorectal MRI. For the functional imaging of the urethral support, we performed dynamic MRI with the pelvic phased array coil. We assessed the following MRI parameters in both the patient and the volunteer groups: (1) urethral angle; (2) bladder neck descent; (3) status of the periurethral ligaments, (4) vaginal shape; (5) urethral sphincter integrity, length and muscle thickness at mid urethra; (6) bladder neck funneling; (7) status of the puborectalis muscle; (8) pubo-vaginal distance. UDs parameters were assessed in the patient study group as follows: (1) urethral mobility angle on Q-tip test; (2) Valsalva leak point pressure (VLPP) measured at 250 cc bladder volume; and (3) maximum urethral closure pressure (MUCP). The UH type of SUI was defined with the Q-tip test angle over 30 degrees, and VLPP pressure over 60 cm H2O. The ISD incontinence was defined with MUCP pressure below 20 cm H2O, and VLPP pressure less or equal to 60 cm H2O. We considered the associations between the MRI and clinical data and UDs using a variety of statistical tools to include linear regression, multivariate logistic regression and receiver operating characteristic (ROC) analysis. All statistical analyses were performed using STATA version 9.0 (StataCorp LP, College Station, TX). RESULTS: In the incontinent group, 52% have history of vaginal delivery trauma as compared to none in control group (P < 0.001). There was no difference between the continent volunteers and incontinent patients in body habitus as assessed by the body mass index. Pubovaginal distance and periurethral ligament disruption are significantly associated with incontinence; periurethral ligament symmetricity reduces the odds of incontinence by 87%. Bladder neck funneling and length of the suprapubic urethral sphincter are significantly associated with the type of incontinence on UDs; funneling reduced the odds of pure UH by almost 95%; increasing suprapubic urethral sphincter length at rest is highly associated with UH. Both MRI variables result in a predictive model for UDs diagnosis (area under the ROC = 0.944). CONCLUSION: MRI may play an important role in assessing the contribution of hypermobility and sphincteric dysfunction to the SUI in women when considering treatment options. PMID:26644825

Phosphoinositide-Driven Epithelial Proliferation in Prostatic Inflammation

DTIC Science & Technology

2008-01-01

that IL-1β expression is localized to the urethral urothelium during development, and little or no expression is observed in the developing prostatic...ducts [Figure 3B]. By comparison, IL-1α expression is found both in the urethral urothelium and in the developing prostatic ducts [Figure 3A]. In...adult [C]. Hyperplasia was induced by E. coli for 5 days. In contrast, IL-1β [B,D] expression is localized to the urethral urothelium at P10 [B] and

Recurrent urethral obstruction secondary to idiopathic renal hematuria in a puppy.

PubMed

Hawthorne, J C; deHaan, J J; Goring, R L; Randall, S R; Kennedy, F S; Stone, E; Zimmerman, K M; McAbee, S W

1998-01-01

A seven-month-old, neutered male Catahoula leopard dog cross was presented for recurrent urethral obstruction and intermittent hematuria. After exploratory laparotomy and ventral cystotomy, unilateral idiopathic renal hematuria was diagnosed based on gross observation of hematuria from the left ureteral catheter. The hematuria resolved after nephrectomy of the left kidney. The histopathological diagnosis was multifocal, acute congestion and intratubular hemorrhage. Although idiopathic renal hematuria has been described previously, this puppy was unique because the hematuria caused recurrent, complete urethral obstruction.

Urodynamic investigation by telemetry in Beagle dogs: validation and effects of oral administration of current urological drugs: a pilot study

PubMed Central

2013-01-01

Background Vesico-urethral function may be evaluated in humans and dogs by conventional urodynamic testing (cystometry and urethral pressure profilometry) or by electromyography. These techniques are performed under general anaesthesia in dogs. However, anaesthesia can depress bladder and urethral pressures and inhibit the micturition reflex. The primary objective of this pilot study was to evaluate the use of telemetry for urodynamic investigation in dogs. We also aimed to determine the applicability of telemetry to toxicologic studies by assessing the repeatability of telemetric recordings. Results Conventional diuresis cystometry was performed in six continent adult female Beagle dogs prior to surgical implantation of telemetric and electromyographic devices. In the first phase of the telemetric study, continuous recordings were performed over 8 days and nights. Abdominal, intravesical and detrusor threshold pressures (Pdet th), voided volume (Vv), urethral smooth muscle electrical activity and involuntary detrusor contractions (IDC) were measured during the bladder filling phase and during micturition episodes. Vv recorded during telemetry was significantly lower than bladder volume obtained by diuresis cystometry. Repeatability of telemetric measurements was greater for observations recorded at night. IDC frequency and Pdet th were both lower and Vv was higher at night compared to values recorded during daytime. In the second phase of the telemetric study, phenylpropanolamine, oestriol, bethanechol, oxybutynin or duloxetine were administered orally for 15 days. For each drug, continuous recordings were performed overnight for 12 hours on days 0, 1, 8 and 15. Electromyographic urethral activity was significantly increased 8 days after oestriol or duloxetine administration. No significant changes in bladder function were observed at any time point. Conclusions In dogs, the high repeatability of nocturnal telemetric recordings indicates that this technique could provide more informative results for urologic research. Urethral smooth muscle electrical activity appears to be modified by administration of drugs with urethral tropism. In this pilot telemetric study, bladder function was not affected by oral administration of urological drugs at their recommended clinical dosages. Experimental studies, (pharmacokinetic and pharmacodynamic) and clinical studies are warranted to further define the effects of these drugs on vesico-urethral function in dogs. PMID:24099564

Applying aerial digital photography as a spectral remote sensing technique for macrophytic cover assessment in small rural streams

NASA Astrophysics Data System (ADS)

Anker, Y.; Hershkovitz, Y.; Gasith, A.; Ben-Dor, E.

2011-12-01

Although remote sensing of fluvial ecosystems is well developed, the tradeoff between spectral and spatial resolutions prevents its application in small streams (<3m width). In the current study, a remote sensing approach for monitoring and research of small ecosystem was developed. The method is based on differentiation between two indicative vegetation species out of the ecosystem flora. Since when studied, the channel was covered mostly by a filamentous green alga (Cladophora glomerata) and watercress (Nasturtium officinale), these species were chosen as indicative; nonetheless, common reed (Phragmites australis) was also classified in order to exclude it from the stream ROI. The procedure included: A. For both section and habitat scales classifications, acquisition of aerial digital RGB datasets. B. For section scale classification, hyperspectral (HSR) dataset acquisition. C. For calibration, HSR reflectance measurements of specific ground targets, in close proximity to each dataset acquisition swath. D. For habitat scale classification, manual, in-stream flora grid transects classification. The digital RGB datasets were converted to reflectance units by spectral calibration against colored reference plates. These red, green, blue, white, and black EVA foam reference plates were measured by an ASD field spectrometer and each was given a spectral value. Each spectral value was later applied to the spectral calibration and radiometric correction of spectral RGB (SRGB) cube. Spectral calibration of the HSR dataset was done using the empirical line method, based on reference values of progressive grey scale targets. Differentiation between the vegetation species was done by supervised classification both for the HSR and for the SRGB datasets. This procedure was done using the Spectral Angle Mapper function with the spectral pattern of each vegetation species as a spectral end member. Comparison between the two remote sensing techniques and between the SRGB classification and the in-situ transects indicates that: A. Stream vegetation classification resolution is about 4 cm by the SRGB method compared to about 1 m by HSR. Moreover, this resolution is also higher than of the manual grid transect classification. B. The SRGB method is by far the most cost-efficient. The combination of spectral information (rather than the cognitive color) and high spatial resolution of aerial photography provides noise filtration and better sub-water detection capabilities than the HSR technique. C. Only the SRGB method applies for habitat and section scales; hence, its application together with in-situ grid transects for validation, may be optimal for use in similar scenarios.
The HSR dataset was first degraded to 17 bands with the same spectral range as the RGB dataset and also to a dataset with 3 equivalent bands

Delayed vaginal and urethral mesh exposure: 10 years after TVT surgery.

PubMed

Khanuengkitkong, Siwatchaya; Lo, Tsia-Shu; Dass, Anil Krishna

2013-03-01

Delayed mesh exposure after tension-free vaginal tape (TVT) procedure is rare. We report a case of mesh exposure into the vagina and urethra that developed 10 years after TVT surgery. A 58-year-old postmenopausal woman presented with mixed urinary incontinence. She was investigated, and her stress urinary incontinence was cured with a TVT procedure 10 years ago. She was then scheduled follow-up annually. Two years postsurgery, a granulation tissue was observed and excised at the vaginal incision site. Vaginal examination 10 years postsurgery showed vaginal mesh erosion 0.5 cm from urethral meatus. Cystoscopy revealed concomitant urethral erosion at the posterior urethral wall. Mesh excision was performed, and urethra and vagina were repaired in layers. Postoperative recovery was uneventful. This finding shows that, although rare, complications can occur even after 10 years of TVT surgery.

Neodymium-YAG laser core through urethrotomy in obliterative posttraumatic urethral strictures after failed initial urethroplasty.

PubMed

Dogra, P N; Nabi, G

2002-01-01

To assess the feasibility, problems and results of Nd-YAG laser core through urethrotomy in the management of failed urethroplasty for posttraumatic bulbomembranous urethral strictures. 61 patients with obliterative posttraumatic urethral strictures were treated by Nd-YAG laser core through urethrotomy between May 1997 to April 2000. Of these, 5 patients had failed end-to-end urethroplasty done as an initial procedure at various periods of time. The procedure was performed as day care and patients were discharged within 6 h of procedure. At 24-30 months of follow-up, all patients are voiding well and are continent. Auxiliary procedures were required in 2 cases. Nd-YAG laser core through urethrotomy is a feasible day care option for patients of obliterative urethral strictures following failed initial urethroplasty with successful outcome. Copyright 2002 S. Karger AG, Basel

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

Injuries to the urethra and urinary bladder associated with fractures of the pelvis.

PubMed

Morehouse, D D

1988-03-01

The posterior urethra or urinary bladder may be injured in patients who sustain fractures of the bony pelvis. It is important to assess the urethra radiologically by retrograde urethrography before introducing a urethral catheter to avoid missing a urethral injury or causing further damage. The author's approach to the immediate management of urethral injury is suprapubic cystostomy. The urethra may be repaired later after other injuries have healed. With this approach the incidence of permanent impotence and incontinence will be low and the stricture cure rate high. If the urethra has not been injured, a catheter is introduced and cystography performed to rule out bladder injuries. If the bladder is ruptured, the area is explored, the perivesical space drained and urinary drainage is provided by either a suprapubic cystostomy or a urethral catheter.

Urethral Caruncle Presented as Premature Menarche in a 4-Year-Old Girl.

PubMed

Gamage, Manori; Beneragama, D

2018-01-01

Urethral caruncle (UC) is a benign fleshy outgrowth at the urethral meatus. It was first described by Samuel Sharp in 1750 and occurs mainly at the posterior lip of the urethra, and the exact aetiology is still uncertain. More often it was seen in the postmenopausal women, and only few cases are reported in young girls. Patients may be asymptomatic and could find this as an incidental finding or they may present with symptoms such as dysuria, bleeding per vagina, haematuria, a mass protruding through vagina, and acute retention of urine. Here, we report the case history of a 4-year-old girl presented with vaginal bleeding which was taken as she has attended menarche and found to have urethral caruncle which was the cause for bleeding. Histology confirmed the diagnosis, and girl was completely cured following surgical excision.

Urethral catheter insertion forces: a comparison of experience and training.

PubMed

Canales, Benjamin K; Weiland, Derek; Reardon, Scott; Monga, Manoj

2009-01-01

This study was undertaken to evaluate the insertion forces utilized during simulated placement of a urethral catheter by healthcare individuals with a variety of catheter experience. A 21F urethral catheter was mounted to a metal spring. Participants were asked to press the tubing spring against a force gauge and stop when they met a level of resistance that would typically make them terminate a catheter placement. Simulated catheter insertion was repeated fives times, and peak compression forces were recorded. Healthcare professionals were divided into six groups according to their title: urology staff, non-urology staff, urology resident/ fellow, non-urology resident/ fellow, medical student, and registered nurse. A total of fifty-seven healthcare professionals participated in the study. Urology staff (n = 6) had the lowest average insertion force for any group at 6.8 +/- 2.0 Newtons (N). Medical students (n = 10) had the least amount of experience (1 +/- 0 years) and the highest average insertion force range of 10.1 +/- 3.7 N. Health care workers with greater than 25 years experience used significantly less force during catheter insertions (4.9 +/- 1.8 N) compared to all groups (p < 0.01). We propose the maximum force that should be utilized during urethral catheter insertion is 5 Newtons. This force deserves validation in a larger population and should be considered when designing urethral catheters or creating catheter simulators. Understanding urethral catheter insertion forces may also aid in establishing competency parameters for health care professionals in training.

Vaginal-sparing ventral buccal mucosal graft urethroplasty for female urethral stricture: A novel modification of surgical technique.

PubMed

Hoag, Nathan; Gani, Johan; Chee, Justin

2016-07-01

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. 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. 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. 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.

The treatment of posterior urethral disruption associated with pelvic fractures: comparative experience of early realignment versus delayed urethroplasty.

PubMed

Mouraviev, Vladimir B; Coburn, Michael; Santucci, Richard A

2005-03-01

Urological treatment of the patient with severe mechanical trauma and urethral disruption remains controversial. Debate continues regarding the advisability of early realignment vs delayed open urethroplasty. We analyzed our experience with 96 patients to determine the long-term results of the 2 approaches. We retrospectively reviewed the records of 191 men with posterior urethral disruption after severe blunt pelvic injury between 1984 and 2001, of whom 96 survived. Data on 57 patients who underwent early realignment were compared to those on 39 treated with delayed urethroplasty with an average 8.8-year followup (range 1 to 22). All patients were evaluated postoperatively for incontinence, impotence and urethral strictures. The majority of patients had severe concomitant organ injuries (78%) and severe pelvic fractures (76%). The overall mortality rate was 51%. Diagnosis of urethral rupture was based on clinical findings and retrograde urethrography. Strictures developed in 49% of the early realignment group and in 100% of the suprapubic tube group. Impotence (33.6%) and incontinence (17.7%) were less frequent in the early realignment group than in the delayed reconstruction group (42.1% and 24.9%, respectively). Patients with delayed reconstruction underwent an average of 3.1 procedures compared with an average of 1.6 in the early realignment group. Early realignment may provide better outcomes than delayed open urethroplasty after posterior urethral disruption. Increased complications are not seen and, although it can be inconvenient in the massively injured patient, it appears to be a worthwhile maneuver.

Early endoscopic realignment of post-traumatic posterior urethral disruption.

PubMed

Moudouni, S M; Patard, J J; Manunta, A; Guiraud, P; Lobel, B; Guillé, F

2001-04-01

The management of complete or partial urethral disruption is controversial, and much debate continues regarding immediate versus delayed definitive therapy. We further analyze our experience and long-term results using early endoscopic realignment. Between April 1987 and January 1999, 29 men with posterior urethral disruption (23 complete and 6 partial) underwent primary urethral realignment 0 to 8 days after injury. Pelvic fractures were present in 23 patients. In all patients, the actual operating time for realignment was 75 minutes or less. All patients were evaluated postoperatively for incontinence, impotence, and strictures. After a mean follow-up of 68 months (range 18 to 155), all patients were continent. Four patients (13.7%) required conversion to an open perineal urethroplasty. At the last follow-up visit, 25 (86%) of the 29 patients were potent and 4 achieved adequate erections for intercourse using intracorporeal injections (prostaglandin E(1)). Twelve patients (41%) developed short secondary strictures and were successfully treated with internal urethrotomy. The mean follow-up of these 12 patients was 83 months (range 34 to 120). Urinary flow rate measurement at the last follow-up visit revealed satisfactory voiding parameters in all patients. Primary endoscopic realignment offers an effective method for treating traumatic urethral injuries. Our long-term follow-up provides additional support for the use of this technique by demonstrating that urethral continuity can be established without an increased incidence of impotence, stricture formation, or incontinence. In case of failure, endoscopic realignment does not compromise the result of secondary urethroplasty.

Catheter-less robotic radical prostatectomy using a custom-made synchronous anastomotic splint and vesical urinary diversion device: report of the initial series and perioperative outcomes.

PubMed

Tewari, Ashutosh; Rao, Sandhya; Mandhani, Anil

2008-09-01

To study the feasibility of avoiding a urethral catheter after robotic radical prostatectomy by using suprapubic diversion with a urethral splint, as urethral catheterization is often a source of major discomfort and pain to the patient, and can cause more concern to the patient than the procedure; we present the outcomes of a pilot study. This pilot study involved 30 patients; in group 1 (the study group of 10 patients) we used a custom-made suprapubic catheter which provided a small anastomotic splint, multiple holes for drainage and the ability to retract the splint to give a voiding trial before removing the drainage device. Group 2 was a control group of 20 patients who had standard urethral catheterization with an 18 F Silastic Foley catheter. Demographic, intraoperative and outcome data were measured and analysed. Urethral symptoms were recorded using a specially developed questionnaire. The two groups were comparable in terms of age, serum prostate specific antigen level, body mass index, Gleason scores, tumour stage, operative duration, amount of bleeding, console times, anastomotic leakage and postoperative retention rates. The study group had significantly less penile shaft or tip pain and discomfort during walking or sleeping. No patient in either group had haematuria or clot retention requiring irrigation. Urethral catheter-less robotic radical prostatectomy is feasible. The advantages are decreased penile shaft and tip pain, and decreased patient discomfort and an earlier return of continence.

Simple urethral dilatation, endoscopic urethrotomy, and urethroplasty for urethral stricture disease in adult men.

PubMed

Wong, Susan S W; Narahari, Radhakrishna; O'Riordan, Anna; Pickard, Robert

2010-04-14

Strictures of the urethra are the commonest cause of obstructed micturition in younger men and frequently recur after initial treatment. Standard treatment comprises internal widening of the strictured area by simple dilatation or by telescope-guided internal cutting (optical urethrotomy), but these interventions are associated with a high failure rate requiring repeated treatment. The alternative option of open urethroplasty whereby the urethral lumen is permanently widened by removal or grafting of the strictured segment is less likely to fail but requires greater expertise. Improved choice of graft material and shortened hospital stay suggest urethroplasty may be under used. The extent and quality of evidence guiding treatment choice for this condition is uncertain. To determine which is the best surgical treatment for male urethral stricture disease taking into account relative efficacy, adverse event rates and cost-effectiveness. We searched the Cochrane Incontinence Group Specialised Register (searched 26 March 2009), CENTRAL (2009, Issue 1), MEDLINE (January 1950 to March 2009), EMBASE (January 1980 to March 2009), OpenSIGLE (searched 26 March 2009), clinical trials registries and reference lists of relevant articles. We included publications reporting data from randomised or quasi-randomised controlled trials comparing the effectiveness of dilatation, urethrotomy and urethroplasty in the treatment of adult men with urethral stricture disease. Two authors evaluated trials for appropriateness for inclusion and methodological quality. Data extraction was performed using predetermined criteria. Analyses were carried out using the Cochrane Review Manager software; RevMan 5. Two randomised trials were identified. One trial compared the outcome of surgical urethral dilatation and optical urethrotomy in 210 adult men with urethral stricture disease. No significant difference was found in the proportion of men being stricture free at three years or in the median time to recurrence. The second trial compared the outcome of urethrotomy and urethroplasty in 50 men with traumatic stricture of the posterior urethra following pelvic fracture injury. After two years 16 of 25 (64%) men initially treated by urethrotomy required continued self-dilatation or further surgery for stricture recurrence compared to 6 of 25 (24%) men treated by primary urethroplasty. There was insufficient data to perform meta-analysis or to reliably determine effect size. There were insufficient data to determine which intervention is best for urethral stricture disease in terms of balancing efficacy, adverse effects and costs. Well designed, adequately powered multi-centre trials are needed to answer relevant clinical questions regarding treatment of men with urethral strictures.

Anterior Urethral Advancement as a Single-Stage Technique for Repair of Anterior Hypospadias: Our Experience.

PubMed

Gite, Venkat A; Nikose, Jayant V; Bote, Sachin M; Patil, Saurabh R

2017-07-02

Many techniques have been described to correct anterior hypospadias with variable results. Anterior urethral advancement as one stage technique was first described by Ti Chang Shing in 1984. It was also used for the repair of strictures and urethrocutaneous fistulae involving distal urethra. We report our experience of using this technique with some modification for the repair of anterior hypospadias. In the period between 2013-2015, 20 cases with anterior hypospadias including 2 cases of glanular, 3 cases of coronal, 12 cases of subcoronal and 3 cases of distal penile hypospadias were treated with anterior urethral advancement technique. Patients' age groups ranged from 18 months to 10 years. Postoperatively, patients were passing urine from tip of neomeatus with satisfactory stream during follow up period of 6 months to 2 years. There were no major complications in any of our patients except in one patient who developed meatal stenosis which was treated by periodic dilatation. Three fold urethral mobilization was sufficient in all cases. Anterior urethral advancement technique is a single-stage procedure with good cosmetic results and least complications for anterior hypospadias repair in properly selected cases.

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

Pathologic Outcomes following Urethral Diverticulectomy in Women.

PubMed

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

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.

Dorsal buccal mucosa graft urethroplasty for female urethral strictures.

PubMed

Migliari, Roberto; Leone, Pierluigi; Berdondini, Elisa; De Angelis, M; Barbagli, Guido; Palminteri, Enzo

2006-10-01

We describe the feasibility and complications of dorsal buccal mucosa graft urethroplasty in female patients with urethral stenosis. From April 2005 to July 2005, 3 women 45 to 65 years old (average age 53.7) with urethral stricture disease underwent urethral reconstruction using a dorsal buccal mucosa graft. Stricture etiology was unknown in 1 patient, ischemic in 1 and iatrogenic in 1. Buccal mucosa graft length was 5 to 6 cm and width was 2 to 3 cm. The urethra was freed dorsally until the bladder neck and then opened on the roof. The buccal mucosa patch was sutured to the margins of the opened urethra and the new roof of the augmented urethra was quilted to the clitoris corpora. In all cases voiding urethrogram after catheter removal showed a good urethral shape with absent urinary leakage. No urinary incontinence was evident postoperatively. On urodynamic investigation all patients showed an unobstructed Blaivas-Groutz nomogram. Two patients complained about irritative voiding symptoms at catheter removal, which subsided completely and spontaneously after a week. The dorsal approach with buccal mucosa graft allowed us to reconstruct an adequate urethra in females, decreasing the risks of incontinence and fistula.

[Physiology of the urethral sphincteric vesico-prostatic complex].

PubMed

Carmignani, L; Gadda, F; Dell'Orto, P; Ferruti, M; Grisotto, M; Rocco, F

2001-09-01

We propose a review of the literature about innervation and physiology of the urethral sphincteric complex. Parasympathetic innervation of the pelvic viscera comes from ventral branches of the sacral nerves (S2-S4). The orthosympathetic component derives from superior hypogastric plexus and runs down the hypogastric nerves to form the right and left pelvic plexus together with the parasympathetic component. The pelvic plexus is situated inferolaterally with respect to the rectum and runs on the surface of the levator ani muscle down to the prostatic apex. The pelvic plexus gives innervation to the rectum, the bladder, the prostate and the urethral sphincteric complex. The pelvic muscular floor is innervated by the somatic component (pudendal nerve) derived from the sacral branches (S2-S4). Bladder neck and smooth muscle urethral sphincter innervation is given mostly by the orthosympathetic component. The rhabdosphincter innervation comes from the pudendal nerve and from the pelvic plexus; its role in the continence mechanism is probably to give steady tonic urethral compression. Levator ani muscle takes part in the sphincteric complex with its anteromedial pubococcygeal portion. It plays its role strengthening the sphincteric tone during increase of the abdominal pressure or during active quick stop cessation of the urinary stream.

Dorsal buccal mucosal graft urethroplasty by a ventral sagittal urethrotomy and minimal-access perineal approach for anterior urethral stricture.

PubMed

Gupta, N P; Ansari, M S; Dogra, P N; Tandon, S

2004-06-01

To present the technique of dorsal buccal mucosal graft urethroplasty through a ventral sagittal urethrotomy and minimal access perineal approach for anterior urethral stricture. From July 2001 to December 2002, 12 patients with a long anterior urethral stricture had the anterior urethra reconstructed, using a one-stage urethroplasty with a dorsal onlay buccal mucosal graft through a ventral sagittal urethrotomy. The urethra was approached via a small perineal incision irrespective of the site and length of the stricture. The penis was everted through the perineal wound. No urethral dissection was used on laterally or dorsally, so as not to jeopardize the blood supply. The mean (range) length of the stricture was 5 (3-16) cm and the follow-up 12 (10-16) months. The results were good in 11 of the 12 patients. One patient developed a stricture at the proximal anastomotic site and required optical internal urethrotomy. Dorsal buccal mucosal graft urethroplasty via a minimal access perineal approach is a simple technique with a good surgical outcome; it does not require urethral dissection and mobilization and hence preserves the blood supply.

Posttraumatic posterior urethral strictures in children: a 20-year experience.

PubMed

Koraitim, M M

1997-02-01

We attempted to identify the particular features of strictures complicating pelvic fracture urethral injuries in children. A total of 68 boys 3 to 15 years old who had sustained pelvic fracture urethral disruption underwent 78 urethroplasties performed by bulboprostatic anastomosis through the perineum in 42, transpubically in 23 and by 2-stage urethroscrotal inlay in 13. Perineal and transurethral urethroplasty was successful in 93 and 91% of cases respectively. There was a 54% failure rate after urethroscrotal inlay. Urethral strictures were most commonly associated with Malgaigne's fracture (35% of cases) and straddle fracture with or without diastasis of the sacroiliac joint (26%). Strictures were almost invariably inferior to the verumontanum with prostatic displacement in 44% of cases. Length of the strictured segment may be overestimated or underestimated on urethrography as a result of incomplete filling of the prostatic urethra or a urinoma cavity connected with the proximal segment, respectively. Perineal or transpubic bulboprostatic anastomosis is the best treatment for posttraumatic strictures, while internal urethrotomy should be avoided since it may compromise the chance of subsequent anastomotic urethroplasty. Repair of associated bladder neck incompetence may be deferred until the resumption of urethral voiding after urethroplasty, when incontinence can be documented.

Incidence of urethral disruption in females with traumatic pelvic fractures.

PubMed

Carter, C T; Schafer, N

1993-05-01

According to the National Center for Health Statistics, in 1986 1.4 million female patients in the United States were admitted to inpatient and short-stay nonfederal hospitals as a result of injuries acquired secondary to trauma. Of these, 45,000 had traumatic pelvic fractures. Rupture of the urethra is the most important lower urinary tract injury associated with traumatic pelvic fracture because of the high incidence of serious complications, such as urethral stricture and incontinence. To our knowledge, there are no satisfactory studies in the English literature documenting the incidence of urethral disruption in females with traumatic pelvic fractures. The records of all women patients with pelvic fractures registered in the Latter Day Saints Hospital trauma registry between July 1, 1981 and August 31, 1987 were reviewed. Of 146 female patients with traumatic pelvic fractures who were hospitalized during this period, none was found to have an urethral injury. Two patients (1.4%) had bladder contusions, and one (.7%) had a bladder rupture. This was the first large series attempting to identify the true incidence of urethral disruption in females with traumatic pelvic fracture, and it was found to be a rare occurrence.

Anastomotic fibrous ring as cause of stricture recurrence after bulbar onlay graft urethroplasty.

PubMed

Barbagli, Guido; Guazzoni, Giorgio; Palminteri, Enzo; Lazzeri, Massimo

2006-08-01

We retrospectively reviewed patterns of failure after bulbar substitution urethroplasty. In particular we investigated the prevalence and location of anastomotic fibrous ring strictures occurring at the apical anastomoses between the graft and urethral plate after 3 types of onlay graft techniques. We reviewed the records of 107 patients who underwent bulbar urethroplasty between 1994 and 2004. Mean patient age was 44 years. Patients with lichen sclerosus, failed hypospadias repair or urethroplasty and panurethral strictures were excluded. A total of 45 patients underwent dorsal onlay skin graft urethroplasty, 50 underwent buccal mucosa onlay graft urethroplasty and 12 underwent augmented end-to-end urethroplasty. The clinical outcome was considered a success or failure at the time that any postoperative procedure was needed, including dilation. Mean followup was 74 months (range 12 to 130). Of 107 cases 85 (80%) were successful and 22 (20%) failed. Failure in 12 patients (11%) involved the whole grafted area and in 10 (9%) it involved the anastomotic site, which was distal and proximal in 5 each. Urethrography, urethral ultrasound and urethroscopy were fundamental for determining the difference between full-length and focal extension of re-stricture. Failures were treated with multistage urethroplasty in 12 cases, urethrotomy in 7 and 1-stage urethroplasty in 3. Of the patients 16 had a satisfactory final outcome and 6 underwent definitive perineal urinary diversion. The prevalence and location of anastomotic ring strictures after bulbar urethroplasty were uniformly distributed in after 3 surgical techniques using skin or buccal mucosa. Further studies are necessary to clarify the etiology of these fibrous ring strictures.

Soft tissue distraction using pentagonal frame for long-standing traumatic flexion deformity of interphalangeal joints.

PubMed

Nazerani, Shaharm; Keramati, Mohammad Reza; Vahedian, Jalal; Fereshtehnejad, Seyed-Mohammad

2012-01-01

Interphalangeal joint contracture is a challenging complication of hand trauma, which reduces the functional capacity of the entire hand. In this study we evaluated the results of soft tissue distraction with no collateral ligament transection or volar plate removal in comparison with traditional operation of contracture release and partial ligament transection and volar plate removal. In this prospective study, a total of 40 patients in two equal groups (A and B) were studied. Patients suffering from chronic flexion contracture of abrasive traumatic nature were included. Group A were treated by soft tissue distraction using pentagonal frame technique and in Group B the contracture release was followed by finger splinting. Analyzed data revealed a significant difference between the two groups for range of motion in the proximal interphalangeal joints (P less than 0.05), while it was not meaningful in the distal interphalangeal joints (P larger than 0.05). There was not a significant difference in the degrees of flexion contracture between groups (P larger than 0.05). Regression analysis showed that using pentagonal frame technique significantly increased the mean improvement in range of motion of proximal interphalangeal joints (P less than 0.001), while the higher the preoperative flexion contracture was observed in proximal interphalangeal joints, the lower improvement was achieved in range of motion of proximal interphalangeal joints after intervention (P less than 0.001). Soft tissue distraction using pentagonal frame technique with gradual and continuous collateral ligament and surrounding joint tissues distraction combined with skin Z-plasty significantly improves the range of motion in patients with chronic traumatic flexion deformity of proximal and/or distal interphalangeal joints.

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

Risk Factors for Urinary Tract Infection following Mid Urethral Sling Surgery.

PubMed

Vigil, Humberto R; Mallick, Ranjeeta; Nitti, Victor W; Lavallée, Luke T; Breau, Rodney H; Hickling, Duane R

2017-05-01

Mid urethral sling surgery is common. Postoperative urinary tract infection rates vary in the literature and independent risk factors for urinary tract infection are not well defined. We sought to determine the incidence of and risk factors for urinary tract infection following mid urethral sling surgery. A retrospective cohort of females who underwent sling surgery was captured from the 2006 to 2014 NSQIP® (National Surgical Quality Improvement Program®) database. Exclusion criteria included male gender, nonelective surgery, totally dependent functional status, preoperative infection, prior surgery within 30 days, ASA® (American Society of Anesthesiologists®) Physical Status Classification 4 or greater, concomitant procedure and operative time greater than 60 minutes. The primary outcome was the incidence of urinary tract infection within 30 days of mid urethral sling surgery. Risk factors for urinary tract infection were assessed by examining patient demographic, comorbidity and surgical variables. Logistic regression analyses were performed to estimate the ORs of individual risk factors. Multivariable logistic regression was then performed to adjust for confounding. A total of 9,022 mid urethral sling surgeries were identified. The urinary tract infection incidence was 2.6%. Factors independently associated with an increased infection risk included age greater than 65 years (OR 1.54, 95% CI 1.07-2.22), body mass index greater than 40 kg/m 2 (OR 1.89, 95% CI 1.23-2.92) and hospital admission (OR 2.06, 95% CI 1.37-3.11). Mid urethral sling surgery performed by urologists carried a reduced risk of infection compared to the surgery done by gynecologists (OR 0.52, 95% CI 0.40-0.69). The urinary tract infection risk following mid urethral sling surgery in NSQIP associated hospitals is low. Novel patient and surgical factors for postoperative urinary tract infection have been identified and merit further study. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Inhibitory effect of the urothelium/lamina propria on female porcine urethral contractility & effect of age.

PubMed

Folasire, Oladayo S; Chess-Williams, Russ; Sellers, Donna J

2017-09-01

The urethral uroepithelium has been implicated in urethral sensation and maintenance of continence. However, relatively little is known about the function of the urethral urothelium compared with that of the bladder. The aim of the study was to examine the role of the urothelium/lamina propria on contractility of the porcine urethra, along with the influence of nitric oxide, prostaglandins and ageing. Porcine urethral tissues, intact and denuded of urothelium/lamina propria, were mounted in tissue baths and contractions to noradrenaline, phenylephrine and carbachol obtained. Contractions in the presence of Nώ-nitro-l-arginine (100 μmol/L) and indomethacin (10 μmol/L) were examined, along with contractions of tissues from young (6 months) and older (3 years) animals. The urothelium/lamina propria of the urethra significantly inhibited contractions to carbachol, noradrenaline and phenylephrine. This inhibitory effect was not significantly different for the three agonists (58.7±10.3%, 60.4±12.6% and 39.4±12.2% inhibition; n=4-7), and was also observed when denuded tissues were co-incubated with a second tissue with intact urothelium/lamina propria (40.6±7.5% inhibition; n=6). Inhibition of nitric oxide and prostaglandin production did not attenuate the inhibitory effect of the urothelium/lamina propria on noradrenaline contractions. In addition, ageing did not alter the inhibitory effect for either phenylephrine contractions (33.9±2.2% vs 41.0±9.7%, young vs older urethral tissues) or noradrenaline contractions (32.9±11.1% vs 53.7±11.0%). In conclusion the urothelium/lamina propria of the urethra has an inhibitory effect on receptor-mediated urethral contraction. This inhibition is due to the release of a diffusible factor, and the effect is not mediated by nitric oxide or prostaglandins, or affected by age. © 2017 John Wiley & Sons Australia, Ltd.

Laparoscopic omentoplasty to support anastomotic urethroplasty in complex and redo pelvic fracture urethral defects.

PubMed

Kulkarni, Sanjay B; Barbagli, Guido; Joshi, Pankaj M; Hunter, Craig; Shahrour, Walid; Kulkarni, Jyotsna; Sansalone, Salvatore; Lazzeri, Massimo

2015-05-01

To test the hypothesis that a new surgical technique using elaborated perineal anastomotic urethroplasty combined with laparoscopic omentoplasty for patients with complex and prior failed pelvic fracture urethral defect repair was feasible, safe, and effective. We performed a prospective, observational, stage 2a study to observe treatment outcomes of combined perineal and laparoscopic approach for urethroplasty in patients with pelvic fracture urethral defect at a single center in Pune, India, between January 2012 and February 2013. Complex and redo patients with pelvic fracture urethral defect occurring after pelvic fracture urethral injury were included in the study. Anterior urethral strictures were excluded. The primary study outcome was the success rate of the surgical technique, and the secondary outcome was to evaluate feasibility and safety of the procedure. The clinical outcome was considered a failure when any postoperative instrumentation was needed. Fifteen male patients with a median age of 19 years were included in the study. Seven patients were adolescents (12-18 years) and 8 patients (53.3%) were adults (19-49 years). The mean number of prior urethroplasties was 1.8 (range, 1-3). All patients underwent elaborated bulbomembranous anastomosis using a perineal approach with inferior pubectomy combined with laparoscopic mobilization of the omentum into the perineum to envelope the anastomosis and to fill the perineal dead space. Of 15 patients, 14 (93.3%) were successful and 1 (6.6%) failed. One adolescent boy 14 years old developed a recurrent stricture 2 months after the procedure and was managed using internal urethrotomy. Median follow-up was 18 months (range, 13-24 months). Combining a laparoscopic omentoplasty to a membranobulbar anastomosis for complex and redo pelvic fracture urethral injury is successful, feasible, safe, and with minimal additional morbidity to the patient. The technique has the advantage of a perineal incision and the ability to use the omentum to support the anastomosis. Copyright © 2015 Elsevier Inc. All rights reserved.

Dorsal buccal mucosal graft urethroplasty for anterior urethral stricture by Asopa technique.

PubMed

Pisapati, V L N Murthy; Paturi, Srimannarayana; Bethu, Suresh; Jada, Srikanth; Chilumu, Ramreddy; Devraj, Rahul; Reddy, Bhargava; Sriramoju, Vidyasagar

2009-07-01

Buccal mucosal graft (BMG) substitution urethroplasty has become popular in the management of intractable anterior urethral strictures with good results. Excellent long-term results have been reported by both dorsal and ventral onlay techniques. Asopa reported a successful technique for dorsal placement of BMG in long anterior urethral strictures through a ventral sagittal approach. To evaluate prospectively the results and advantages of dorsal BMG urethroplasty for recurrent anterior urethral strictures by a ventral sagittal urethrotomy approach (Asopa technique). From December 2002 to December 2007, a total of 58 men underwent dorsal BMG urethroplasty by a ventral sagittal urethrotomy approach for recurrent urethral strictures. Forty-five of these patients with a follow-up period of 12-60 mo were prospectively evaluated, and the results were analysed. The urethra was split twice at the site of the stricture both ventrally and dorsally without mobilising it from its bed, and the buccal mucosal graft was secured in the dorsal urethral defect. The urethra was then retubularised in one stage. The overall results were good (87%), with a mean follow-up period of 42 mo. Seven patients developed minor wound infection, and five patients developed fistulae. There were six recurrences (6:45, 13%) during the follow-up period of 12-60 mo. Two patients with a panurethral stricture and four with bulbar or penobulbar strictures developed recurrences and were managed by optical urethrotomy and self-dilatation. The medium-term results were as good as those reported with the dorsal urethrotomy approach. Long-term results from this and other series are awaited. More randomised trials and meta-analyses are needed to establish this technique as a procedure of choice in future. The ventral sagittal urethrotomy approach is easier to perform than the dorsal urethrotomy approach, has good results, and is especially useful in long anterior urethral strictures.

Rapid exhumation of Cretaceous arc-rocks along the Blue Mountains restraining bend of the Enriquillo-Plantain Garden fault, Jamaica, using thermochronometry from multiple closure systems

NASA Astrophysics Data System (ADS)

Cochran, William J.; Spotila, James A.; Prince, Philip S.; McAleer, Ryan J.

2017-11-01

The effect of rapid erosion on kinematic partitioning along transpressional plate margins is not well understood, particularly in highly erosive climates. The Blue Mountains restraining bend (BMRB) of eastern Jamaica, bound to the south by the left-lateral Enriquillo-Plantain Garden fault (EPGF), offers an opportunity to test the effects of highly erosive climatic conditions on a 30-km-wide restraining bend system. No previous thermochronometric data exists in Jamaica to describe the spatial or temporal pattern of rock uplift and how oblique (> 20°) plate motion is partitioned into vertical strain. To define the exhumation history, we measured apatite (n = 10) and zircon (n = 6) (U-Th)/He ages, 40Ar/39Ar (n = 2; amphibole and K-spar) ages, and U/Pb zircon (n = 2) crystallization ages. Late Cretaceous U/Pb and 40Ar/39Ar ages (74-68 Ma) indicate rapid cooling following shallow emplacement of plutons during north-south subduction along the Great Caribbean Arc. Early to middle Miocene zircon helium ages (19-14 Ma) along a vertical transect suggest exhumation and island emergence at 0.2 mm/yr. Older zircon ages 10-15 km to the north (44-35 Ma) imply less rock uplift. Apatite helium ages are young (6-1 Ma) across the entire orogen, suggesting rapid exhumation of the BMRB since the late Miocene. These constraints are consistent with previous reports of restraining bend formation and early emergence of eastern Jamaica. An age-elevation relationship from a vertical transect implies an exhumation rate of 0.8 mm/yr, while calculated closure depths and thermal modeling suggests exhumation as rapid as 2 mm/yr. The rapid rock uplift rates in Jamaica are comparable to the most intense transpressive zones worldwide, despite the relatively slow (5-7 mm/yr) strike-slip rate. We hypothesize highly erosive conditions in Jamaica enable a higher fraction of plate motion to be accommodated by vertical deformation. Thus, strike-slip restraining bends may evolve differently depending on erosivity and local climate.

Rapid exhumation of Cretaceous arc-rocks along the Blue Mountains restraining bend of the Enriquillo-Plantain Garden fault, Jamaica, using thermochronometry from multiple closure systems

USGS Publications Warehouse

Cochran, William J.; Spotila, James A.; Prince, Philip S.; McAleer, Ryan J.

2017-01-01

The effect of rapid erosion on kinematic partitioning along transpressional plate margins is not well understood, particularly in highly erosive climates. The Blue Mountains restraining bend (BMRB) of eastern Jamaica, bound to the south by the left-lateral Enriquillo-Plantain Garden fault (EPGF), offers an opportunity to test the effects of highly erosive climatic conditions on a 30-km-wide restraining bend system. No previous thermochronometric data exists in Jamaica to describe the spatial or temporal pattern of rock uplift and how oblique (> 20°) plate motion is partitioned into vertical strain. To define the exhumation history, we measured apatite (n = 10) and zircon (n = 6) (U-Th)/He ages, 40Ar/39Ar (n = 2; amphibole and K-spar) ages, and U/Pb zircon (n = 2) crystallization ages. Late Cretaceous U/Pb and 40Ar/39Ar ages (74–68 Ma) indicate rapid cooling following shallow emplacement of plutons during north-south subduction along the Great Caribbean Arc. Early to middle Miocene zircon helium ages (19–14 Ma) along a vertical transect suggest exhumation and island emergence at ~ 0.2 mm/yr. Older zircon ages 10–15 km to the north (44–35 Ma) imply less rock uplift. Apatite helium ages are young (6–1 Ma) across the entire orogen, suggesting rapid exhumation of the BMRB since the late Miocene. These constraints are consistent with previous reports of restraining bend formation and early emergence of eastern Jamaica. An age-elevation relationship from a vertical transect implies an exhumation rate of 0.8 mm/yr, while calculated closure depths and thermal modeling suggests exhumation as rapid as 2 mm/yr. The rapid rock uplift rates in Jamaica are comparable to the most intense transpressive zones worldwide, despite the relatively slow (5–7 mm/yr) strike-slip rate. We hypothesize highly erosive conditions in Jamaica enable a higher fraction of plate motion to be accommodated by vertical deformation. Thus, strike-slip restraining bends may evolve differently depending on erosivity and local climate.

Urethral stricture

MedlinePlus

... It can also occur after a disease or injury. Rarely, it may be caused by pressure from a growing tumor near the urethra. Other factors that increase the risk for this condition include: Sexually ... Injury to the pelvic area Repeated urethritis Strictures that ...

Direct visual internal urethrotomy: Is it a durable treatment option?

PubMed Central

Pal, Dilip Kumar; Kumar, Sanjay; Ghosh, Bastab

2017-01-01

Objective: To evaluate the long-term success rate of direct vision internal urethrotomy as a treatment for anterior urethral strictures. Materials and Methods: We retrospectively analyzed the results for patients who underwent internal urethrotomy from January 2009 to January 2014 for anterior urethral strictures. Patients were followed till January 2016. Patients with complicated urethral strictures with a history of previous urethroplasty, hypospadias repair, or previous radiation were excluded from the study, as anticipated low success rate of direct visual internal urethrotomy (DVIU) in these patients. The Kaplan–Meier method was used to analyze stricture-free probability after the first, second, and third urethrotomy. Results: A total of 186 patients were included in this study. Stricture-free rates after first, second, and third urethrotomy were 29.66%, 22.64%, and 13.33%, respectively. Conclusions: Although DVIU may be a management option for anterior urethral stricture disease, it seems that long-term results are disappointing. PMID:28216923

Direct visual internal urethrotomy: Is it a durable treatment option?

PubMed

Pal, Dilip Kumar; Kumar, Sanjay; Ghosh, Bastab

2017-01-01

To evaluate the long-term success rate of direct vision internal urethrotomy as a treatment for anterior urethral strictures. We retrospectively analyzed the results for patients who underwent internal urethrotomy from January 2009 to January 2014 for anterior urethral strictures. Patients were followed till January 2016. Patients with complicated urethral strictures with a history of previous urethroplasty, hypospadias repair, or previous radiation were excluded from the study, as anticipated low success rate of direct visual internal urethrotomy (DVIU) in these patients. The Kaplan-Meier method was used to analyze stricture-free probability after the first, second, and third urethrotomy. A total of 186 patients were included in this study. Stricture-free rates after first, second, and third urethrotomy were 29.66%, 22.64%, and 13.33%, respectively. Although DVIU may be a management option for anterior urethral stricture disease, it seems that long-term results are disappointing.

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

Iliac Vein Compression Syndrome due to Bladder Distention Caused by Urethral Calculi

PubMed Central

Ikegami, Akiko; Kondo, Takeshi; Tsukamoto, Tomoko; Ohira, Yoshiyuki; Ikusaka, Masatomi

2015-01-01

We report a rare case of iliac vein compression syndrome caused by urethral calculus. A 71-year-old man had a history of urethral stenosis. He complained of bilateral leg edema and dysuria for 1 week. Physical examination revealed bilateral distention of the superficial epigastric veins, so obstruction of both common iliac veins or the inferior vena cava was suspected. Plain abdominal computed tomography showed a calculus in the pendulous urethra, distention of the bladder (as well as the right renal pelvis and ureter), and compression of the bilateral common iliac veins by the distended bladder. Iliac vein compression syndrome was diagnosed. Bilateral iliac vein compression due to bladder distention (secondary to neurogenic bladder, benign prostatic hyperplasia, or urethral calculus as in this case) is an infrequent cause of acute bilateral leg edema. Detecting distention of the superficial epigastric veins provides a clue for diagnosis of this syndrome. PMID:25802794

[Low-dose rate brachytherapy with locally integrated beta emitters after internal urethrotomy. A pilot project using an animal model].

PubMed

Weidlich, P; Adam, C; Sroka, R; Lanzl, I; Assmann, W; Stief, C

2007-09-01

The treatment of urethral strictures represents an unsolved urological problem. The effect of a (32)P-coated urethral catheter in the sense of low-dose rate brachytherapy to modulate wound healing will be analyzed in an animal experiment. Unfortunately it is not possible to present any results because this is being studied for the first time and there are no experiences with low-dose rate brachytherapy and this form of application in the lower urinary tract. Furthermore the animal experiment will only start in the near future. Both decade-long experiences with radiotherapy to treat benign diseases and our own results of previous studies in otolaryngology and ophthalmology let us expect a significantly lower formation of urethral strictures after internal urethrotomy. This study will contribute to improving the treatment of urethral strictures as demanded in previous papers.

Pelvic fracture injuries of the female urethra.

PubMed

Venn, S N; Greenwell, T J; Mundy, A R

1999-04-01

To review pelvic fracture urethral injuries in women, generally regarded as rare and thus discussed infrequently. Twelve patients (age range 7-51 years) with such injuries were reviewed; most had associated injuries, generally more severe than seen in males with urethral injuries. Patients with milder injuries, perhaps damaging just the innervation of the urethra, presented with incontinence; more severe injuries seemed to cause a longitudinal tear in the urethra but again patients presented mainly with incontinence problems. The most severe injuries were associated with complete rupture of the urethra and a distraction defect suggesting an avulsion injury. These problems were difficult to treat both reconstructively and in providing continence. Pelvic fracture urethral injuries occur in females, but less often than in males. The female urethra seems relatively resistant to injury; differing degrees of severity of pelvic trauma cause different types of urethral injury but in general, a more severe injury is needed to damage it than is necessary in males.

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.

Acoustic Reverse Time Migration of the Cascadia Subduction Zone Dataset

NASA Astrophysics Data System (ADS)

Jia, L.; Mallick, S.

2017-12-01

Reverse time migration (RTM) is a wave-equation based migration method, which provides more accurate images than ray-based migration methods, especially for the structures in deep areas, making it an effective tool for imaging the subduction plate boundary. In this work, we extend the work of Fortin (2015) and applied acoustic finite-element RTM on the Cascadia Subduction Zone (CSZ) dataset. The dataset was acquired by Cascadia Open-Access Seismic Transects (COAST) program, targeting the megathrust in the central Cascadia subduction zone (Figure 1). The data on a 2D seismic reflection line that crosses the Juan de Fuca/North American subduction boundary off Washington (Line 5) were pre-processed and worked through Kirchhoff prestack depth migration (PSDM). Figure 2 compares the depth image of Line 5 of the CSZ data using Kirchhoff PSDM (top) and RTM (bottom). In both images, the subducting plate is indicated with yellow arrows. Notice that the RTM image is much superior to the PSDM image by several aspects. First, the plate boundary appears to be much more continuous in the RTM image than the PSDM image. Second, the RTM image indicates the subducting plate is relatively smooth on the seaward (west) side between 0-50 km. Within the deformation front of the accretionary prism (50-80 km), the RTM image shows substantial roughness in the subducting plate. These features are not clear in the PSDM image. Third, the RTM image shows a lot of fine structures below the subducting plate which are almost absent in the PSDM image. Finally, the RTM image indicates that the plate is gently dipping within the undeformed sediment (0-50 km) and becomes steeply dipping beyond 50 km as it enters the deformation front of the accretionary prism. Although the same conclusion could be drawn from the discontinuous plate boundary imaged by PSDM, RTM results are far more convincing than the PSDM.

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

PubMed

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

2016-01-01

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. 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 21(st) postoperative day. Follow-up consisted of uroflow, PVR and AUA-SS. Failure was defined as requirement of any post operative procedure. 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. Redo buccal mucosal graft urethroplasty is safe and feasible with good intermediate term outcomes.

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

Urethral Cancer Treatment (PDQ®)—Health Professional Version

Cancer.gov

Urethral cancer treatment generally relies upon surgery. Radiation therapy and/or chemotherapy is sometimes used with extensive disease or in an attempt at organ preservation. Get detailed treatment information for newly diagnosed and recurrent disease in this clinician summary.

3D bioprinting of urethra with PCL/PLCL blend and dual autologous cells in fibrin hydrogel: An in vitro evaluation of biomimetic mechanical property and cell growth environment.

PubMed

Zhang, Kaile; Fu, Qiang; Yoo, James; Chen, Xiangxian; Chandra, Prafulla; Mo, Xiumei; Song, Lujie; Atala, Anthony; Zhao, Weixin

2017-03-01

Urethral stricture is a common condition seen after urethral injury. The currently available treatments are inadequate and there is a scarcity of substitute materials used for treatment of urethral stricture. The traditional tissue engineering of urethra involves scaffold design, fabrication and processing of multiple cell types. In this study, we have used 3D bioprinting technology to fabricate cell-laden urethra in vitro with different polymer types and structural characteristics. We hypothesized that use of PCL and PLCL polymers with a spiral scaffold design could mimic the structure and mechanical properties of natural urethra of rabbits, and cell-laden fibrin hydrogel could give a better microenvironment for cell growth. With using an integrated bioprinting system, tubular scaffold was formed with the biomaterials; meanwhile, urothelial cells (UCs) and smooth muscle cells (SMCs) were delivered evenly into inner and outer layers of the scaffold separately within the cell-laden hydrogel. The PCL/PLCL (50:50) spiral scaffold demonstrated mechanical properties equivalent to the native urethra in rabbit. Evaluation of the cell bioactivity in the bioprinted urethra revealed that UCs and SMCs maintained more than 80% viability even at 7days after printing. Both cell types also showed active proliferation and maintained the specific biomarkers in the cell-laden hydrogel. These results provided a foundation for further studies in 3D bioprinting of urethral constructs that mimic the natural urethral tissue in mechanical properties and cell bioactivity, as well a possibility of using the bioprinted construct for in vivo study of urethral implantation in animal model. The 3D bioprinting is a new technique to replace traditional tissue engineering. The present study is the first demonstration that it is feasible to create a urethral construct. Two kinds of biomaterials were used and achieved mechanical properties equivalent to that of native rabbit urethra. Bladder epithelial cells and smooth muscle cells were loaded in hydrogel and maintained sufficient viability and proliferation in the hydrogel. The highly porous scaffold could mimic a natural urethral base-membrane, and facilitate contacts between the printed epithelial cells and smooth muscle cells on both sides of the scaffold. These results provided a strong foundation for future studies on 3D bioprinted urethra. Copyright © 2016 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

The Cascadia Subduction Zone: two contrasting models of lithospheric structure

USGS Publications Warehouse

Romanyuk, T.V.; Blakely, R.; Mooney, W.D.

1998-01-01

The Pacific margin of North America is one of the most complicated regions in the world in terms of its structure and present day geodynamic regime. The aim of this work is to develop a better understanding of lithospheric structure of the Pacific Northwest, in particular the Cascadia subduction zone of Southwest Canada and Northwest USA. The goal is to compare and contrast the lithospheric density structure along two profiles across the subduction zone and to interpet the differences in terms of active processes. The subduction of the Juan de Fuca plate beneath North America changes markedly along the length of the subduction zone, notably in the angle of subduction, distribution of earthquakes and volcanism, goelogic and seismic structure of the upper plate, and regional horizontal stress. To investigate these characteristics, we conducted detailed density modeling of the crust and mantle along two transects across the Cascadia subduction zone. One crosses Vancouver Island and the Canadian margin, the other crosses the margin of central Oregon.

Paget's disease of the urethral meatus following transitional cell carcinoma of the bladder.

PubMed

Tomaszewski, J E; Korat, O C; LiVolsi, V A; Connor, A M; Wein, A

1986-02-01

Pagetoid extension of transitional cell carcinoma onto the urethral meatus following cystectomy is a rare complication of bladder carcinoma. We report 2 cases associated with severe dysplasia and carcinoma in situ of the periurethral glands.

Unsuccessful outcomes after posterior urethroplasty.

PubMed

Engel, Oliver; Fisch, Margit

2015-03-01

Posterior urethroplasty is the most common strategy for the treatment of post-traumatic urethral injuries. Especially in younger patients, post-traumatic injuries are a common reason for urethral strictures caused by road traffic accidents, with pelvic fracture or direct trauma to the perineum. In many cases early endoscopic realignment is the first attempt to restore the junction between proximal and distal urethra, but in some cases primary realignment is not possible or not enough to treat the urethral injury. In these cases suprapubic cystostomy alone and delayed repair by stricture excision and posterior urethroplasty is an alternative procedure to minimise the risk of stricture recurrence.

Atezolizumab With or Without Eribulin Mesylate in Treating Patients With Recurrent Locally Advanced or Metastatic Urothelial Cancer

ClinicalTrials.gov

2018-06-05

Metastatic Urothelial Carcinoma; Recurrent Bladder Urothelial Carcinoma; Recurrent Urethral Urothelial Carcinoma; Recurrent Urothelial Carcinoma of the Renal Pelvis and Ureter; Renal Pelvis Urothelial Carcinoma; Stage III Bladder Urothelial Carcinoma AJCC v6 and v7; Stage III Renal Pelvis Cancer AJCC v7; Stage III Ureter Cancer AJCC v7; Stage III Urethral Cancer AJCC v7; Stage IV Bladder Urothelial Carcinoma AJCC v7; Stage IV Renal Pelvis Cancer AJCC v7; Stage IV Ureter Cancer AJCC v7; Stage IV Urethral Cancer AJCC v7; Ureter Urothelial Carcinoma

Dynamic MRI confirms support of the mid-urethra by TVT and TVT-O surgery for stress incontinence.

PubMed

Rinne, Kirsi; Kainulainen, Sakari; Aukee, Sinikka; Heinonen, Seppo; Nilsson, Carl G

2011-06-01

To study changes in mid-urethral function with dynamic MRI in stress urinary incontinent women undergoing either tension-free vaginal tape (TVT) or TVT-obturator sling operations. Prospective clinical study. University hospital. Forty-two parous women with stress urinary incontinence recruited to dynamic magnetic resonance imaging before and after mid-urethral sling surgery. Control group of 16 healthy women. Dynamic magnetic resonance imaging at rest, during pelvic floor muscle contraction, coughing and voiding with a bladder volume of 200-300 ml. X- and Y- coordinates were used to determine the location of the mid-urethra during these activities. Changes in mid-urethral position after TVT and TVT-obturator operations during the different activities. Postoperatively the women could elevate their mid-urethra by pelvic floor muscle contraction significantly higher than before the operation (p<0.05). Despite a different support angle between the TVT and the TVT-O mid-urethral slings, we could not see any differences in the movement patterns. Mid-urethral slings support the mid-urethra and restrict downward movement during different activities. Movement patterns are similar after TVT and TVT-O operations. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

Limited experience, high body mass index and previous urethral surgery are risk factors for failure in open urethroplasty due to penile strictures.

PubMed

Ekerhult, Teresa O; Lindqvist, Klas; Peeker, Ralph; Grenabo, Lars

2015-01-01

The aim of this study was to evaluate outcomes and possible risk factors for failure of open urethroplasty due to penile urethral strictures. A retrospective chart review was undertaken of 90 patients with penile stricture undergoing 109 open urethroplasties between 2000 and 2011. In 80 urethroplasties, a one-stage procedure was performed: 68 of these had a pediculated penile skin flap, nine had a free buccal mucosal graft and three had a free skin graft. A two-stage procedure using buccal mucosa was performed in 29 urethroplasties. Failure was defined as when further urethral instrumentation was needed. The mean age in the one-stage and two-stage groups were 50 and 54 years, respectively. The success rates in the corresponding groups were 65% and 72%, with follow-up times of 63 and 40 months, respectively. Multivariable analyses disclosed body mass index (BMI) and previous urethral surgery to be significant risk factors for failure in the one-stage group. Failure over time significantly decreased during the study period. Both one- and two-stage penile urethroplasty demonstrated success rates in line with previous reports. Limited experience, high BMI and previous urethral surgery appear to be associated with less favourable outcome.

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

Outcome of urethral strictures treated by endoscopic urethrotomy and urethroplasty.

PubMed

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

We analyze the outcomes of patients with urethral stricture who underwent surgical treatment within the past 5 years. 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. 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. 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.

Outcomes of Direct Vision Internal Urethrotomy for Bulbar Urethral Strictures: Technique Modification with High Dose Triamcinolone Injection.

PubMed

Modh, Rishi; Cai, Peter Y; Sheffield, Alyssa; Yeung, Lawrence L

2015-01-01

Objective. To evaluate the recurrence rate of bulbar urethral strictures managed with cold knife direct vision internal urethrotomy and high dose corticosteroid injection. Methods. 28 patients with bulbar urethral strictures underwent direct vision internal urethrotomy with high dose triamcinolone injection into the periurethral tissue and were followed up for recurrence. Results. Our cohort had a mean age of 60 years and average stricture length of 1.85 cm, and 71% underwent multiple previous urethral stricture procedures with an average of 5.7 procedures each. Our technique modification of high dose corticosteroid injection had a recurrence rate of 29% at a mean follow-up of 20 months with a low rate of urinary tract infections. In patients who failed treatment, mean time to stricture recurrence was 7 months. Patients who were successfully treated had significantly better International Prostate Symptom Scores at 6, 9, and 12 months. There was no significant difference in maximum flow velocity on Uroflowmetry at last follow-up but there was significant difference in length of follow-up (p = 0.02). Conclusions. High dose corticosteroid injection at the time of direct vision internal urethrotomy is a safe and effective procedure to delay anatomical and symptomatic recurrence of bulbar urethral strictures, particularly in those who are poor candidates for urethroplasty.

Surgical repair of the iatrogenic falsepassage in the treatment of trauma-induced posterior urethral injuries.

PubMed

Dogan, Faruk; Sahin, Ali Feyzullah; Sarıkaya, Tevfik; Dırık, Alper

2014-03-28

Pelvic fracture associated urethral injury (PFAUI) is a rare and challenging sequel of blunt pelvic trauma. Treatment of iatrogenic false urethral passage (FUP) remains as a challenge for urologists. In this case report we reviewed the iatrogenic FUP caused by wrong procedures performed in the treatment of a patient with PFAUI and the treatment of posterior urethral stricture with transperineal bulbo-prostatic anatomic urethroplasty in the management of FUP. A 37-year-old male patient with PFAUI had undergone a laparotomy procedure for pelvic bone fracture, complete urethral rupture, and bladder perforation 8 years ago. After stricture formation, patient had undergone procedures that caused FUP. Following operations, he had a low urinary flow rate, and incontinence and urgency even with small amounts of urine. FUP was diagnosed by voiding cystourethrography and retrograde urethrography. FUP was fixed with open urethroplasty with the guidance of flexible antegrade urethtoscopy. False passage should always be taken into account in the differential diagnosis of patients with persistent symptoms that underwent PFAUI therapy. In addition, we believe that in the evaluation of patients with PFAUI suspected for having a false passage, bladder neck and urethra should be assessed by combining routine voiding cystourethrography and retrograde urethrography with preoperative flexible cystoscopy via suprapubic route.

Complex traumatic posterior urethral strictures.

PubMed

Turner-Warwick, R

1976-01-01

A distinction between simple and complex posterior urethral strictures is proposed. The development of a complex stricture, requiring an extensive transpubic repair, must be regarded as a less than admirable result of the initial treatment, even if it is occasionally inevitable. However, it is particularly important that our endeavors to improve the end result of the relatively rare severe urethral injuries should not result in over-management of the relatively minor injuries, since this could increase the stricture potential of many. Therefore, we must keep our over-all concepts of the initial management of urethral injuries under careful review. Posterior urethroplasty should be regarded as a specialist procedure. It can be made to appear beguilingly simple but it cannot be recommended for occasional or general use. Even the relatively simple free patch graft technique is inadvisable for use in the sphincter area for surgeons who do not have considerable experience of it in the relatively forgiving bulbourethral area. The results of repair of posterior urethral strictures, even the complex ones, by anastomotic procedures can be excellent but real competence depends upon a particular aptitude of the surgeon for the minutiae of reconstructive techniques, appropriate training in a specializing department, a real ongoing numerical experience and special instrumentation with facilities for detailed urodynamic evaluation of this sphincter active area of the urethra.

Open-label study evaluating outpatient urethral sphincter injections of onabotulinumtoxinA to treat women with urinary retention due to a primary disorder of sphincter relaxation (Fowler's syndrome).

PubMed

Panicker, Jalesh N; Seth, Jai H; Khan, Shahid; Gonzales, Gwen; Haslam, Collette; Kessler, Thomas M; Fowler, Clare J

2016-05-01

To assess the efficacy (defined as improvements in maximum urinary flow rate [Qmax ] of ≥50%, post-void residual urine volume [PVR] and scores on the International Prostate Symptom Score [IPSS] questionnaire) and safety of urethral sphincter injections of onabotulinumtoxinA in women with a primary disorder of urethral sphincter relaxation, characterised by an elevated urethral pressure profile (UPP) and specific findings at urethral sphincter electromyography (EMG), i.e. Fowler's syndrome. In this open-label pilot Institutional Review Board-approved study, 10 women with a primary disorder of urethral sphincter relaxation (elevated UPP, sphincter volume, and abnormal EMG) presenting with obstructed voiding (five) or in complete urinary retention (five) were recruited from a single tertiary referral centre. Baseline symptoms were assessed using the IPSS, and Qmax and PVR were measured. After 2% lidocaine injection, 100 U of onabotulinumtoxinA was injected into the striated urethral sphincter, divided on either side, under EMG guidance. Patients were reviewed at 1, 4 and 10 weeks after injection, and assessed using the IPSS, Qmax and PVR measurements. The UPP was repeated at week 4. The mean (range) patient age was 40 (25-65) years, and the mean symptom scores on the IPSS improved from 25.6 to 14.1, and the mean 'bother' score reduced from 6.1 to 3.5 at week 10. As compared with a baseline mean Qmax of 8.12 mL/s in the women who could void, the Qmax improved to 15.8 mL/s at week 10. Four of the five women in complete retention could void spontaneously, with a mean Qmax of 14.3 mL/s at week 10. The mean PVR decreased from 260 to 89 mL and the mean static UPP improved from 113 cmH2 O at baseline to 90 cmH2 O. No serious side-effects were reported. Three women with a history of recurrent urinary tract infections developed a urinary tract infection. There were no reports of stress urinary incontinence. Seven of the 10 women opted to return for repeat injections. This pilot study shows an improvement in patient-reported lower urinary tract symptoms, and the objective parameters of Qmax , PVR and UPP, at 10 weeks after urethral sphincter injections of onabotulinumtoxinA. No serious side-effects were reported. This treatment could represent a safe outpatient treatment for young women in retention due to a primary disorder of urethral sphincter relaxation. However, a larger study is required to confirm the findings of this pilot study. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

The effect of penile urethral fat graft application on urethral angiogenesis.

PubMed

Cakmak, M; Yazıcı, I; Boybeyi, O; Ayva, S; Aslan, M K; Senyucel, M F; Soyer, T

2015-10-01

Autologous fat grafts are rich in adipose-derived stem cells, providing optimal soft-tissue replacement and significant quantities of angiogenic growth factor. Although fat grafts (FG) are used in several clinical conditions, the use of FG in urethral repairs and the effects of FG to urethral repairs have not yet been reported. An experimental study was performed to evaluate the effect of FG on urethral angiogenesis and tissue growth factor (GF) levels. Sixteen Wistar albino, adult, male rats were allocated into two groups: the control group (CG) (n = 8) and the experiment group (EG) (n = 8). After anesthetization of all rats, 3-mm vertical incisions were made on the urethras, and then sutured with interrupted 5/0 vicryl sutures. The operations were performed under a stereo dissecting microscope under magnification (×20). In the CG, no additional procedure was performed. In the EG after the same surgical procedure, 1 mm(3) FG was removed from the inguinal region by sharp dissection with a knife. The grafts were trimmed to 1 × 1 mm dimensions on millimeter paper. The FGs were placed on the repaired urethras. The skin was then closed. Samples from urethral and penile skin were taken 21 days after surgery in both groups. Density and intensity of staining with vascular-endothelial GF (VEGF), VEGF-receptor, and endothelial-GF receptor (EGFR) in the endothelial and mesenchymal cells of the penile urethral vessels were immunohistochemically evaluated. Data obtained from immunohistochemical evaluations were analyzed with SPSS 15.0. The P-values lower than 0.05 were considered as significant. Density of VEGF staining was significantly decreased in the vascular endothelium of the EG compared to the CG (P < 0.05). Density of the EGFR staining was significantly decreased in the vascular endothelium of the EG compared to the CG (P < 0.05) (Table). Intensity of VEGF, VEGF-R and EGFR staining was not significantly different between the two groups. There were no significant differences between groups regarding to VEGFR staining and mesenchymal examination. Decreased density was found in the VEGF staining in the vascular endothelium. This could be explained by the day that the tissues were harvested or because autologous fat grafts might cause decreased growth factor levels, which is contrary to the literature data. Fat grafting has an immunohistochemical effect on the growth factor levels that are related to angiogenesis after urethral repair. It is difficult to make a firm conclusion about the role of fat grafting on urethral healing. Therefore, future studies are needed to see if FG can be used as an alternative to other procedures in order to avoid complications. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Simple urethral dilatation, endoscopic urethrotomy, and urethroplasty for urethral stricture disease in adult men.

PubMed

Wong, Susan S W; Aboumarzouk, Omar M; Narahari, Radhakrishna; O'Riordan, Anna; Pickard, Robert

2012-12-12

Strictures of the urethra are the most common cause of obstructed micturition in younger men and frequently recur after initial treatment. Standard treatment comprises internal widening of the strictured area by simple dilatation or by telescope-guided internal cutting (optical urethrotomy), but these interventions are associated with a high failure rate requiring repeated treatment. The alternative option of open urethroplasty whereby the urethral lumen is permanently widened by removal or grafting of the strictured segment is less likely to fail but requires greater expertise. Findings of Improved choice of graft material and shortened hospital stay suggest that urethroplasty may be under utilised. The extent and quality of evidence guiding treatment choice for this condition are uncertain.   To determine which is the best surgical treatment for male urethral stricture disease taking into account relative efficacy, adverse event rates and cost-effectiveness.   We searched the Cochrane Incontinence Group Specialised Register (searched 21 June 2012), CENTRAL (2012, Issue 6), MEDLINE (January 1946 to week 2 June 2012), EMBASE (January 1980 to week 25 2012), OpenSIGLE (searched 26 June 2012), clinical trials registries and reference lists of relevant articles. We included publications reporting data from randomised or quasi-randomised controlled trials comparing the effectiveness of dilatation, urethrotomy and urethroplasty in the treatment of adult men with urethral stricture disease. Two authors evaluated trials for appropriateness for inclusion and methodological quality. Data extraction was performed using predetermined criteria. Analyses were carried out using the Cochrane Review Manager software (RevMan 5). Two randomised trials were identified. One trial compared the outcomes of surgical urethral dilatation and optical urethrotomy in 210 adult men with urethral stricture disease. No significant difference was found in the proportion of men being stricture free at three years or in the median time to recurrence. The second trial compared the outcomes of urethrotomy and urethroplasty in 50 men with traumatic stricture of the posterior urethra following pelvic fracture injury. In the first six months, men were more likely to require further surgery in the urethrotomy group than in the primary urethroplasty group (RR 3.39, 95% CI 1.62 to 7.07). After two years, 16 of 25 (64%) men initially treated by urethrotomy required continued self-dilatation or further surgery for stricture recurrence compared to 6 of 25 (24%) men treated by primary urethroplasty. There were insufficient data to perform meta-analysis or to reliably determine effect size. There were insufficient data to determine which intervention is best for urethral stricture disease in terms of balancing efficacy, adverse effects and costs. Well designed, adequately powered multi-centre trials are needed to answer relevant clinical questions regarding treatment of men with urethral strictures.

Medical Surveillance Monthly Report. Volume 16, Number 7, July 2009

DTIC Science & Technology

2009-07-01

Reporting locations Arthropod-borne Sexually transmitted Environmental Lyme disease Malaria Chlamydia Gonorrhea Syphilis‡ Urethritis§ Cold Heat 2008 2009...borne Sexually transmitted Environmental Lyme disease Malaria Chlamydia Gonorrhea Syphilis‡ Urethritis§ Cold Heat 2008 2009 2008 2009 2008 2009 2008

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

Combined cystometrography and electromyography of the external urethral sphincter following complete primary repair of bladder exstrophy.

PubMed

Borer, Joseph G; Strakosha, Ruth; Bauer, Stuart B; Diamond, David A; Pennison, Melanie; Rosoklija, Ilina; Khoshbin, Shahram

2014-05-01

Concern in patients with bladder exstrophy after reconstruction regarding potential injury to pelvic neurourological anatomy and a resultant functional deficit prompted combined (simultaneous) cystometrography and electromyography after complete primary repair of bladder exstrophy. We determined whether complete primary repair of bladder exstrophy would adversely affect the innervation controlling bladder and external urethral sphincter function. Complete primary repair of bladder exstrophy was performed via a modified Mitchell technique in newborns without osteotomy. Postoperative evaluation included combined cystometrography and needle electrode electromyography via the perineum, approximating the external urethral sphincter muscle complex. Electromyography was done to evaluate the external urethral sphincter response to sacral reflex stimulation and during voiding. Nine boys and 4 girls underwent combined cystometrography/electromyography after complete primary repair of bladder exstrophy. Age at study and time after complete primary repair of bladder exstrophy was 3 months to 10 years (median 11.5 months). Cystometrography revealed absent detrusor overactivity and the presence of a sustained detrusor voiding contraction in all cases. Electromyography showed universally normal individual motor unit action potentials of biphasic pattern, amplitude and duration. The external urethral sphincter sacral reflex response was intact with a normal caliber with respect to Valsalva, Credé, bulbocavernosus and anocutaneous (bilateral) stimulation. Synergy was documented by abrupt silencing of external urethral sphincter electromyography activity during voiding. After complete primary repair of bladder exstrophy combined cystometrography/electromyography in patients with bladder exstrophy showed normal neurourological findings, including sacral reflex responses, sustained detrusor voiding contraction and synergic voiding, in all patients postoperatively. These findings confirm the safety of complete primary repair of bladder exstrophy. Based on our results we have discontinued routine electromyography in these patients. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

[Oral mucosa graft urethroplasty for complicated urethral strictures].

PubMed

Horiguchi, Akio; Sumitomo, Makoto; Kanbara, Taiki; Tsujita, Yujiro; Yoshii, Takahiko; Yoshii, Hidehiko; Satoh, Akinori; Asakuma, Junichi; Ito, Keiichi; Hayakawa, Masamichi; Asano, Tomohiko

2010-03-01

We evaluated the efficacy and outcome of one-stage oral mucosa graft urethroplasty, which is currently the procedure of choice for treating lengthy and complicated urethral strictures not amenable to excision and primary end-to-end anastomosis. Seven patients 33 to 74 years old (mean age = 53.7) underwent one-stage oral mucosa graft urethroplasty for a stricture in either the bulbar urethra (four patients), penile urethra (two patients), or pan-anterior urethra (one patient). Three of the strictures were due to trauma, one was due to inflammation, and one was due to a failed hypospadia repair. The other two were iatrogenic. All patients had previously undergone either internal urethrotomy or repeated urethral dilation. Three patients received a tube graft, three received a ventral onlay, and one received a dorsal onlay. A free graft of oral mucosa was harvested from the inside of each patient's left cheek, and if necessary to obtain a sufficient length, the harvest was extended to include mucosa from the lower lip and the right cheek. The graft lengths ranged from 2.5 to 12 cm (mean = 4.6 cm). A urethral catheter was left in place for 3 weeks postoperatively. While no severe complications at the donor site were observed during follow-up periods ranging from 3 to 55 months (mean = 14 months), two patients who had received a tube graft developed distal anastomotic ring strictures that were managed by internal urethrotomy. The other five required no postoperative urological procedure even though one who had received a ventral onlay developed a penoscrotal fistula. Oral mucosa is an ideal urethral graft, and oral mucosa graft urethroplasty is an effective procedure for repairing complicated urethral strictures involving long portions of the urethra.

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

Urethroplasty after Urethral Urolume Stent: an International Multicenter Experience.

PubMed

Angulo, Javier C; Kulkarni, Sanjay; Pankaj, Joshi; Nikolavsky, Dmitriy; Suarez, Pedro; Belinky, Javier; Virasoro, Ramón; DeLong, Jessica; Martins, Francisco E; Lumen, Nicolaas; Giudice, Carlos; Suárez, Oscar A; Menéndez, Nicolás; Capiel, Leandro; López-Alvarado, Damian; Ramirez, Erick A; Venkatesan, Krishnan; Husainat, Maha M; Esquinas, Cristina; Arance, Ignacio; Gómez, Reynaldo; Santucci, Richard

2018-05-08

To evaluate the outcomes and factors affecting success of urethroplasty in patients with stricture recurrence after Urolume® urethral stent. Retrospective international multicenter study on patients treated with urethral reconstruction after Urolume® stent. Stricture and stent length, time between urethral stent insertion and urethroplasty, age, mode of stent retrieval, type of urethroplasty, complications and baseline and post-urethroplasty voiding parameters were analyzed. Successful outcome was defined as standard voiding, without need of any postoperative adjunctive procedure. Sixty-three patients were included. Stent was removed at urethroplasty in 61 patients. Reconstruction technique was excision and primary anastomosis in 14(22.2%), dorsal onlay buccal mucosa graft (BMG) 9(14.3%), ventral onlay BMG 6(9.5%), dorso-lateral onlay BMG 9(14.3%), ventral onlay plus dorsal inlay BMG 3(4.8%), augmented anastomosis 5(7.9%), pedicled flap urethroplasty 6(9.5%), 2-stage procedure 4(6.4%) and perineal urethrostomy 7(11.1%). Success rate was 81% at a mean 59.7+63.4months. Dilatation and/or internal urethrotomy was performed in 10(15.9%), redo-urethroplasty in 5(7.9%). Total IPSS, QoL, Qmax and PVR significantly improved (p<.0001). Complications occurred in 8(12.7%), all Clavien-Dindo <2. Disease-free survival rate after reconstruction was 88.1%,79.5% and 76.7% at 1,3 and 5-years respectively. Explant of individual strands followed by onlay BMG is the most common approach and was significantly advantageous over the other techniques (p=.018). Urethroplasty in patients with Urolume® urethral stents is a viable option of reconstruction with a high success rate and very acceptable complication rate. Numerous techniques are viable, however, urethral preservation, tine-by-tine stent extraction and use of BMG augmentation produced significantly better outcomes. Copyright © 2018 Elsevier Inc. All rights reserved.

Neuromuscular Characterization of the Urethra in Continent Women

PubMed Central

Kenton, Kimberly; Mueller, Elizabeth; Brubaker, Linda

2011-01-01

Objectives To describe quantitative urethral function parameters in a racially diverse group of continent women. Materials and Methods Following Institutional Review Board approval, we recruited women without urinary incontinence from the community. To be considered continent, participants answered “never” to the first six questions on the stress subscale of the Medical, Epidemiologic, and Social Aspects of Aging urinary incontinence (MESA) questionnaire. Participants all underwent quantitative concentric urethral electromyography (EMG) and urodynamic testing (UDS). Results Thirty-one women with a mean±SD age of 39±14 years underwent EMG and UDS. The cohort was racially diverse with 13 Caucasians (43%), 13 African Americans (43%), and 4 Hispanics (14%). Body mass index (BMI) (P=.12, .06), age (P=.40, .64), and vaginal parity (P=.53, .76) did not differ by race or ethnicity. We did not detect differences in any EMG parameter by race, ethnicity or vaginally parity. A mean (range) of 30 motor unit action potential analysis (MUP) (10-55) were identified and analyzed in Multi-MUP analysis and 14 (8-21) were identified and analyzed in IP analysis. On average, 37±20% MUPs were polyphasic. Age significantly correlated with several measures of urethral sphincter function. Increasing age was inversely correlated with interference analysis (IP) turns (−.57, p=.001), IP amplitude (r=−.43, p=.02), IP turns/amplitude (r=−.54, p=.003), maximum urethral closure pressures (MUCP) (r=−.41, p=.04). Similarly, MUCP correlated with IP amplitude (r=.38, p=.04). Conclusions This urethral neuromuscular function data on the largest cohort of continent women fully characterized with quantitative urethral EMG demonstrates significant neuropathic MUP changes with advancing age. PMID:22453105

Severe anemia in cats with urethral obstruction: 17 cases (2002-2011).

PubMed

Beer, Kari Santoro; Drobatz, Kenneth J

2016-05-01

To characterize clinical parameters of cats with severe anemia due to suspected urinary bladder hemorrhage associated with urethral obstruction. Retrospective case-control study. University teaching hospital. Seventeen cats with urethral obstruction and severe anemia (group "UO-A") that required transfusion were identified via medical record database search. Thirty cats with urethral obstruction and mild or no anemia (group "UO") were included as controls. None. The median PCV of all cases at presentation was 28% (range, 9%-47%). Seven cats had PCV ≤20% at presentation, and all transfused cats had PCV ≤20% at the time of transfusion. Three cats did not receive a transfusion despite PCV ≤18%. Cats in the UO-A group had a significantly longer duration of clinical signs (P = 0.001), and were more likely to have a history of previous urethral obstruction (P = 0.011), have a heart murmur (P = 0.002), have a gallop rhythm (P = 0.005), and have lower blood pressure (P = 0.007) compared to those in the UO group. Additionally, UO-A cats had significantly lower pH, more negative base excess, higher BUN, and higher creatinine compared to UO cats. Duration of urinary catheterization was significantly (P = 0.016) longer in UO-A cats. All UO cats survived to discharge, whereas 4/17 (23.5%) UO-A cats were euthanized (P = 0.013). A history of previous urethral obstruction and longer duration of clinical signs may be important risk factors for severe anemia in UO cats. Additionally, UO-A cats appeared to be more severely affected, as evidenced by lower blood pressure, more severe metabolic acidosis, higher BUN and creatinine, and worse outcome. © Veterinary Emergency and Critical Care Society 2016.

Cost-effectiveness of microscopy of urethral smears for asymptomatic Mycoplasma genitalium urethritis in men in England.

PubMed

Sutton, Andrew J; Roberts, Tracy E; Jackson, Louise; Saunders, John; White, Peter J; Birger, Ruthie; Estcourt, Claudia

2018-01-01

The objective was to determine whether or not the limited use of urethral microscopy to diagnose asymptomatic and symptomatic non-chlamydial, non-gonococcal urethritis (NCNGU) in men is a cost-effective strategy to avert pelvic inflammatory disease (PID), ectopic pregnancy or infertility in female partners. Outputs from a transmission dynamic model of NCNGU in a population of 16-30 year olds in England simulating the number of consultations, PID cases and patients treated over time amongst others, were used along with secondary data to undertake a cost-effectiveness analysis carried out from a health care provider perspective. The main outcome measure was cost per case of PID averted. A secondary outcome measure was cost per major outcome averted, where a major outcome is a case of symptomatic PID, ectopic pregnancy, or infertility. Offering a limited number of asymptomatic men urethral microscopy was more effective than the current practice of no microscopy in terms of reducing the number of cases of PID with an incremental cost-effectiveness ratio of £15,700, meaning that an investment of £15,800 is required to avert one case of PID. For major outcomes averted, offering some asymptomatic men urethral microscopy was again found to be more effective than no microscopy, but here an investment of £49,900 is required to avert one major outcome. Testing asymptomatic men for NCNGU in a small number of genitourinary medicine settings in England is not cost-effective, and thus by maintaining the current practice of not offering this patient group microscopy, this continues to make savings for the health care provider.

Medical Surveillance Monthly Report (MSMR). Volume 16, Number 5, May 2009

DTIC Science & Technology

2009-05-01

location Arthropod-borne Sexually transmitted Environmental Lyme disease Malaria Chlamydia Gonorrhea Syphilis ‡ Urethritis§ Cold Heat 2008 2009 2008...borne Sexually transmitted Environmental Lyme disease Malaria Chlamydia Gonorrhea Syphilis ‡ Urethritis§ Cold Heat 2008 2009 2008 2009 2008 2009 2008

Optical urethrotomy under local anaesthesia is a feasible option in urethral stricture disease.

PubMed

Munks, D G; Alli, M O; Goad, E H Abdel

2010-01-01

The aim of our study was to assess the feasibility of performing optical urethrotomy for urethral stricture disease under local anaesthesia. A total of 33 patients with radiologically proven urethral stricture underwent optical urethrotomy by a single operator under local anaesthesia. Of these patients, 23 (70%) had stricture involving the corpora spongiosum and 18 (55%) of the patients were dependent on supra-pubic catheters. The procedure was successful in 30 cases (91%). The procedure was very well tolerated (average visual analogue pain score of 2/10) with an extremely low complication rate. The large number of patients with urethral stricture disease and the premium on operating time on formal theatre slates encouraged us to perform these procedures under local anaesthetic. Although most patients had severe stricture disease, the majority of cases were successful and very well tolerated. Optical urethrotomy under local anesthesia could be a viable option in the absence of formal theatre time and the facilities to perform general anaesthesia.

Above and below delayed endoscopic treatment of traumatic posterior urethral disruptions.

PubMed

Quint, H J; Stanisic, T H

1993-03-01

Between 1982 and 1990, 10 men with posterior urethral obliterations associated with pelvic fracture were managed with delayed above and below endoscopic reconstruction. After a mean of 43 months (range 7 to 108) of followup, all 10 men void with a peak flow rate of 12 ml. per second or greater and/or have a urethral caliber of 20F or greater. Concomitant prostatic hypertrophy somewhat compromises micturition in 4 older men. Nine patients are totally continent and 1 has mild stress incontinence. Five men who were potent after injury remain so after reconstruction. Of the 10 patients 6 required subsequent visual urethrotomy and/or scar resections, generally as outpatient or short stay procedures. In most instances voiding stabilized within 1 year, and interventions after this interval were unusual and generally trivial. We compare our experience with the results of others using a similar delayed endoscopic approach and conclude that this is a satisfactory method of managing traumatic posterior urethral obliterations, resulting in satisfactory voiding, continence and potency preservation.

Ion channels of the mammalian urethra

PubMed Central

Kyle, Barry D

2014-01-01

The mammalian urethra is a muscular tube responsible for ensuring that urine remains in the urinary bladder until urination. In order to prevent involuntary urine leakage, the urethral musculature must be capable of constricting the urethral lumen to an extent that exceeds bladder intravesicular pressure during the urine-filling phase. The main challenge in anti-incontinence treatments involves selectively-controlling the excitability of the smooth muscles in the lower urinary tract. Almost all strategies to battle urinary incontinence involve targeting the bladder and as a result, this tissue has been the focus for the majority of research and development efforts. There is now increasing recognition of the value of targeting the urethral musculature in the treatment and management of urinary incontinence. Newly-identified and characterized ion channels and pathways in the smooth muscle of the urethra provides a range of potential therapeutic targets for the treatment of urinary incontinence. This review provides a summary of the current state of knowledge of the ion channels discovered in urethral smooth muscle cells that regulate their excitability. PMID:25483582

Attitudes and knowledge of urethral catheters: a targeted educational intervention.

PubMed

Cohen, Andrew; Nottingham, Charles; Packiam, Vignesh; Jaskowiak, Nora; Gundeti, Mohan

2016-10-01

To assess the training of medical students and their confidence in urethral catheter placement, given growing evidence of unnecessary urology consults and iatrogenic injury. A third-year medical school class was queried about their attitudes and knowledge of catheter placement before and after the Clinical Biennium. The Clinical Biennium introduces hands-on skills prior to clinical clerkships. Urethral catheterisation is one of the skill stations that students rotate through, and urology residents provide a didactic session and supervised simulation. Confidence was self-rated regarding catheter technique, knowledge, troubleshooting, and comfort with placement in the same and opposite gender. Factual questions were posed about proper insertion and malfunctioning catheters. In all, 92 students participated in the initial survey, 41% female and 59% male, and 87% of the students had never placed a catheter. Students desired high confidence in catheter skills (4.4/5). There were no significant differences in responses for those with a desire to pursue urology vs other specialties, or procedural fields compared with non-procedural fields. Prior independent learning was reported by 38% of students and was a predictor for increased confidence across all domains (P < 0.05). In all, 16.7% of students initially identified proper male urethral insertion distance, which improved to 95.6% after the session. Student interest in urology modestly increased after the educational session (P = 0.028). At 3-6 months follow-up, students had performed a median (interquartile range) of 4 (2-7) urethral catheter placements, and 74.2% of students rated training useful or extremely useful. Indeed, 54.8% desired more instruction. Knowledge assessment indicated that 93% of students retained comprehension of proper male urethral insertion distance. Clinical Foley training rarely contradicted instruction from the Clinical Biennium (6.5%). At all time-points, medical student knowledge for troubleshooting catheters was low. Medical students strive for high confidence in urethral catheter placement. Prior targeted education improves confidence and knowledge. Together with clinical experience, these effects are durable up to 6 months. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

Pockmarks, fluid flow, and sediments outboard of the deformation front at the Cascadia Subduction Zone from analysis of multi-channel seismic and multi-beam sonar data

NASA Astrophysics Data System (ADS)

Gibson, J. C.; Carbotte, S. M.; Han, S.; Carton, H. D.; Canales, P.; Nedimovic, M. R.

2013-12-01

Evidence of active fluid flow and the nature of the sediment section near the Cascadia deformation front are explored using multi-channel (MCS) seismic and multi-beam sonar data collected in summer 2012 using the R/V Marcus G. Langseth during the Juan de Fuca Ridge to Trench Survey. The MCS data were collected along two full plate transects (the 'Oregon' and 'Washington' transects) and one trench parallel line using a 6600 cubic inch source, and an 8 km streamer with 636 channels (12.5 m spacing). The MCS data pre-stack processing sequence includes geometry definition, trace editing, F-K filter, and deconvolution. Velocity analysis is performed via semblance and constant velocity stacks in order to create a velocity model of the sediments and upper oceanic crust. The traces are then stacked, and post-stack time migrated. The sonar data were collected using the R/V Langseth's Kongsberg EM122 1°x1° multi-beam sonar with 288 beams and 432 total soundings across track. Using MB-system the sonar data are cleaned, and the bathymetry data are then gridded at 35 m, while the backscatter data are gridded at 15 m. From the high-resolution mapping data 48 pockmarks varying in diameter from 50 m - 1 km are identified within 60 km outboard of the deformation front. The surface expression of these large features in an area of heavy sedimentation is likely indicative of active fluid flow. In order to gain sub-seafloor perspective on these features the MCS data are draped below the bathymetry/backscatter grids using QPS Fledermaus. From this perspective, specific locations for detailed velocity and attribute analysis of the sediment section are chosen. Sediment velocity and attribute analysis also provide insight into apparent differences in the sediment section and décollement formation along the Oregon and Washington plate transects. While both lines intersect areas of dense pockmark concentration, the area around the Oregon transect has been shown to contain a continuous positive polarity sedimentary layer that is capping fluid expulsion above a reverse polarity protodécollement (e.g. Cochrane et al., 1994, JGR, 99, pp. 7033-7043). A décollement within the sediment section is not present along the Washington line (e.g. Gutscher et al., 2001, Geology, 29, pp. 379-382). However, this line does intersect the 'Bare' outcrops to the west, which have been shown to provide fluid recharge and discharge pathways for convective cooling of the crust (e.g. Fisher et al., 2003, Nature, 421, pp. 618-621). Detailed velocity models constructed from the MCS data will be used to investigate these regional differences. The location of the pockmarks and corresponding sediment properties will also be explored relative to regional variations in the structure of the deformation front and location of intraplate and interplate faulting.

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.

[Three theses on urethral disease].

PubMed

Chesa-Ponce, N

2012-01-01

To inform about three doctorate theses on urethral stenosis, presented in the University of Paris and Montpellier by Spanish authors. Of the Canary Island students who studied medicine in France during the xix century and beginning of the xx century, three stand out for having chosen the same subject for presentation of their doctorate thesis. We briefly analyze their biographies, placing special emphasis on the content of their doctorate thesis. Urethral stenosis was a very mentioned disease during the period studied due to its high incidence. We distinguish the therapeutic changes contributed in the three theses studied. Copyright © 2012 AEU. Published by Elsevier Espana. All rights reserved.

Advances in Surgical Reconstructive Techniques in the Management of Penile, Urethral, and Scrotal Cancer.

PubMed

Bickell, Michael; Beilan, Jonathan; Wallen, Jared; Wiegand, Lucas; Carrion, Rafael

2016-11-01

This article reviews the most up-to-date surgical treatment options for the reconstructive management of patients with penile, urethral, and scrotal cancer. Each organ system is examined individually. Techniques and discussion for penile cancer reconstruction include Mohs surgery, glans resurfacing, partial and total glansectomy, and phalloplasty. Included in the penile cancer reconstruction section is the use of penile prosthesis in phalloplasty patients after penectomy, tissue engineering in phallic regeneration, and penile transplantation. Reconstruction following treatment of primary urethral carcinoma and current techniques for scrotal cancer reconstruction using split-thickness skin grafts and flaps are described. Copyright © 2016 Elsevier Inc. All rights reserved.

Analysis of pressure-flow data in terms of computer-derived urethral resistance parameters.

PubMed

van Mastrigt, R; Kranse, M

1995-01-01

The simultaneous measurement of detrusor pressure and flow rate during voiding is at present the only way to measure or grade infravesical obstruction objectively. Numerous methods have been introduced to analyze the resulting data. These methods differ in aim (measurement of urethral resistance and/or diagnosis of obstruction), method (manual versus computerized data processing), theory or model used, and resolution (continuously variable parameters or a limited number of classes, the so-called monogram). In this paper, some aspects of these fundamental differences are discussed and illustrated. Subsequently, the properties and clinical performance of two computer-based methods for deriving continuous urethral resistance parameters are treated.

A bulbar artery pseudoaneurysm following traumatic urethral catheterization.

PubMed

Bettez, Mathieu; Aubé, Melanie; Sherbiny, Mohamed El; Cabrera, Tatiana; Jednak, Roman

2017-01-01

Traumatic urethral catheterization may result in a number of serious complications. A rare occurrence is the development of a urethral pseudoaneurysm. We report the case of a 13-year-old male who required placement of a Foley catheter for an orthopedic surgical procedure. The Foley was misplaced in the bulbourethra, resulting in the development of a bulbar artery pseudoaneurysm. Profuse bleeding via the urethra was noted after removal of the catheter, and the patient experienced severe intermittent hematuria during the postoperative period. Cystoscopy revealed a pulsatile mass within the bulbourethra. Angiography confirmed a bulbar artery pseudoaneurysm, which was successfully embolized with resolution of bleeding.

Contemporary Management of Primary Distal Urethral Cancer.

PubMed

Traboulsi, Samer L; Witjes, Johannes Alfred; Kassouf, Wassim

2016-11-01

Primary urethral cancer is one of the rare urologic tumors. Distal urethral tumors are usually less advanced at diagnosis compared with proximal tumors and have a good prognosis if treated appropriately. Low-stage distal tumors can be managed successfully with a surgical approach in men or radiation therapy in women. There are no clear-cut indications for the choice of the most appropriate treatment modality. Organ-preserving modalities have shown effective and should be used whenever they do not compromise the oncological safety to decrease the physical and psychological trauma of dismemberment or loss of sexual/urinary function. Copyright © 2016 Elsevier Inc. All rights reserved.

Surgical tips and tricks during urethroplasty for bulbar urethral strictures focusing on accurate localisation of the stricture: results from a tertiary centre.

PubMed

Kuo, Tricia L C; Venugopal, Suresh; Inman, Richard D; Chapple, Christopher R

2015-04-01

There are several techniques for characterising and localising an anterior urethral stricture, such as preoperative retrograde urethrography, ultrasonography, and endoscopy. However, these techniques have some limitations. The final determinant is intraoperative assessment, as this yields the most information and defines what surgical procedure is undertaken. We present our intraoperative approach for localising and operating on a urethral stricture, with assessment of outcomes. A retrospective review of urethral strictures operated was carried out. All patients had a bulbar or bulbomembranous urethroplasty. All patients were referred to a tertiary centre and operated on by two urethral reconstructive surgeons. Intraoperative identification of the stricture was performed by cystoscopy. The location of the stricture is demonstrated externally on the urethra by external transillumination of the urethra and comparison with the endoscopic picture. This is combined with accurate placement of a suture through the urethra, at the distal extremity of the stricture, verified precisely by endoscopy. Clinical data were collected in a dedicated database. Intraoperative details and postoperative follow-up data for each patient were recorded and analysed. A descriptive data analysis was performed. A representative group of 35 male patients who had surgery for bulbar stricture was randomly selected from January 2010 to December 2013. Mean follow-up was 13.8 mo (range 2-43 mo). Mean age was 46.5 yr (range 17-70 yr). Three patients had undergone previous urethroplasty and 26 patients had previous urethrotomy or dilatation. All patients had preoperative retrograde urethrography and most (85.7%) had endoscopic assessment. The majority of patients (48.6%) had a stricture length of >2-7 cm and 45.7% of patients required a buccal mucosa graft. There were no intraoperative complications. Postoperatively, two patients had a urinary tract infection. All patients were assessed postoperatively via flexible cystoscopy. Only one patient required subsequent optical urethrotomy for recurrence. Our intraoperative strategy for anterior urethral stricture assessment provides a clear stepwise approach, regardless of the type of urethroplasty eventually chosen (anastomotic disconnected or Heineke-Mikulicz) or augmentation (dorsal, ventral, or augmented roof strip). It is useful in all cases by allowing precise localisation of the incision in the urethra, whether the stricture is simple or complex. We studied the treatment of bulbar urethral strictures with different types of urethroplasty, using a specific technique to identify and characterise the length of the stricture. This technique is effective, precise, and applicable to all patients undergoing urethroplasty for bulbar urethral stricture. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Pediatric Bulbar and Posterior Urethral Injuries: Operative Outcomes and Long-Term Follow-Up.

PubMed

Trachta, Jan; Moravek, Jiri; Kriz, Jan; Padr, Radek; Skaba, Richard

2016-02-01

The aim of this study was to analyze complications and outcomes of end-to-end urethral anastomosis performed for posttraumatic bulbar strictures or posterior urethral injuries in pediatric patients. The records of 15 boys, age 18 years and below, admitted to our tertiary trauma center with urethral injuries from 1989 to 2014 were reviewed retrospectively. Out of these 15 boys, 7 were excluded (2 for iatrogenic trauma, 2 for minor straddle injuries who were not operated on, 2 for incomplete records, and 1 lost to follow-up) and 8 analyzed patients were operated for bulbar or posterior urethral injury. The mean follow-up after the operation was 4.5 years (range 0.5-10). To obtain up-to-date follow-up information, all the analyzed patients were contacted by a letter and telephone in January 2015 and asked about lower urinary tract or erectile dysfunction (ED) using the International Index of Erectile Function-5 questionnaire. Mean age at the time of injury was 12.3 years (range 5-17). Four patients with pelvic fracture had complete posterior urethra disruption, three patients after straddle injury developed obliterating stricture of the bulbar urethra and one patient had torn his bulbar urethra apart by a sharp hook. Except for the immediate exploration of the open perineal wound, all patients were operated via perineal approach 1 to 6 months after initial suprapubic catheter insertion. Five patients needed a cystotomy to identify the proximal urethral stump by a probe, and two patients had partial pubectomy to gain urethral length. Postoperative complications included stricture in anastomosis in six patients (all reoperated, four more than once including attempts of endoscopic internal urethrotomy). Six days after surgery, one patient developed massive external bleeding around a permanent urinary catheter due to a posttraumatic ruptured arterial aneurysm that was later stopped by urgent angiography and coil insertion. After discharge, three patients had transient stress incontinence. All patients had uroflowmetry maximum flow above 20 mL/s on their last follow-up except for two (12 and 15 mL/s). None have any lower urinary tract dysfunction symptoms in adulthood; one suffers from mild ED and two report moderate ED due to penile shortening. Delayed end-to-end anastomosis for pediatric urethral injury is a safe operational option. However, high rate of short-term complications and reoperations should be expected. Penile shortening is one of the most severe long-term complications. Georg Thieme Verlag KG Stuttgart · New York.

Hypospadias and concomitant undescended testis: Comparison of no skin incision with inguinal and scrotal skin incision orchiopexy.

PubMed

Sabetkish, Shabnam; Kajbafzadeh, Abdol-Mohammad; Sabetkish, Nastaran

2015-10-01

To present the feasibility of no skin incision orchiopexy in children with concomitant hypospadias and undescended testis (UDT) by a single subcoronal incision technique. To introduce the creation of subdartos muscle scrotal pouch with no scrotal skin incision. From one thousand and twenty-one children with hypospadias, 61 patients presented with concomitant palpable UDT and hypospadias. In group I (N = 34) single subcoronal incision with no scrotal skin incision was applied. In group II (N = 27), multi-incision technique was applied for classical orchiopexy and hypospadias surgery. For hypospadias reconstruction, all patients had classical subcoronal and para urethral plate incision with penile skin degloving according to the location of urethral meatus. Early and late complications, surgical time, hospital stay, and cosmetic results were recorded. Children with unilateral UDT and hypospadias had one incision in group I and three skin incisions in group II. Patients with bilateral UDT had one incision in group I and five skin incisions in group II. The operation time was significantly shorter in group I (93 ± 11 min) compared with group II (138 ± 17 min) (P = 0.03). Both groups were operated as day care basis; however, the hospital stay was slightly longer in group II (group I = 12 ± 2 h, vs group II = 16 ± 3 h) (P = 0.07). All testes were satisfactorily positioned into the bottom of the scrotum without development of any testicular atrophy. Single subcoronal penile skin incision is a feasible, safe, and cosmetically satisfactory technique in patients with hypospadias and concomitant UDT. Reduced postoperative pain, better objective cosmetic results, shorter operative time and comfortable post-operative period are the most significant advantages of this approach. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Urinary tract abnormalities in boys with recurrent urinary tract infections after hypospadias repair.

PubMed

Wehbi, Elias; Patel, Premal; Kanaroglou, Niki; Tam, Stephanie; Weber, Bryce; Lorenzo, Armando; Pippi Salle, Joao Luiz; Bagli, Darius; Koyle, Martin; Farhat, Walid A

2014-02-01

To examine the development of recurrent urinary tract infections (UTIs) in boys who have undergone hypospadias repair. We retrospectively reviewed the records of all boys who had recurrent UTIs after primary or redo tubularized incised plate (TIP) or transverse island flap (TVIF) repairs, between 1998 and 2009. Data on age, operating details, postoperative complications and imaging studies were collected. We attempted to identify risk factors for recurrent UTIs after hypospadias repair. During the study period, 43/2249 boys (1.91%) were diagnosed with recurrent UTIs after hypospadias repair. The boys' mean (range) age at repair was 14 (6-24) months and the median (range) follow-up was 6.5 (1.5-11) years. Primary TIP and TVIF were performed in 47% (20/43) and 35% (15/43) of the boys, respectively. Redo surgeries were performed in 18% of the boys (8/43). The initial meatal location was proximal in all TVIF and redo repairs, and in one of the TIP repairs. Postoperative voiding cysto-urethrography, ultrasonography and dimercapto-succinic acid (DMSA) scans were performed in 58% (25/43), 90% (39/43) and 19% (8/43) of the boys, respectively. Abnormalities were noted. Of those boys who underwent a TVIF repair, urethral diverticula were seen in 47% (7/15) and urethral fistulae were also seen in 47% (7/15). Conversely, in those who had a TIP repair, an elevated PVR and vesico-ureteric reflux were more common; they were found in 40% (8/20) and 50% (10/20) of patients, respectively. The pathophysiology of recurrent UTI is multifactorial, but postoperative complications seem to vary with type of procedure. Recurrent UTIs after hypospadias surgery should prompt a specific assessment for potentially functionally relevant and correctable anatomical abnormalities. © 2013 The Authors. BJU International © 2013 BJU International.

Memokath Stent Failure in Recurrent Bulbar Urethral Strictures: Results From an Investigative Pilot Stage 2A Study.

PubMed

Barbagli, Guido; Rimondi, Claudio; Balò, Sofia; Butnaru, Denis; Sansalone, Salvatore; Lazzeri, Massimo

2017-09-01

To evaluate the efficacy of the Memokath stent in managing recurrent bulbar urethral strictures. This is an investigative pilot stage 2A study in patients with a recurrent bulbar urethral stricture who underwent a Memokath stent implant from January 2014 to January 2016 in a single high-volume center for urethral reconstruction. The Memokath stent (Pnn Medical A/S, Kvistgaard, Denmark) was manufactured from nitinol, a biocompatible alloy of nickel and titanium, which was endoscopically placed. It had a 24-Fr outside diameter and was preloaded on a disposable delivery device. When correctly positioned, the stent was anchored by a warm water (55°C) instillation, which expanded the proximal end of the stent from 24 to 42 Fr .The stent was provided in lengths of 3-7 cm in 1-cm increments. Sixteen patients were included in the study. The median follow-up was 16 months. In 7 patients (43.7%), the stent was removed within 1 year. The main adverse events were pain, encrustations, stones, and recurrent strictures. Four patients (25%) were considered a success and 12 (75%) were failures. Study limitations include the small sample. The Memokath stent was deemed to be not clinically helpful and had significant side effects, and therefore should not be considered a treatment option for men with bulbar urethral strictures. Copyright © 2017 Elsevier Inc. All rights reserved.

Tissue engineering of urethra: Systematic review of recent literature.

PubMed

Žiaran, Stanislav; Galambošová, Martina; Danišovič, L'uboš

2017-12-01

The purpose of this article was to perform a systematic review of the recent literature on urethral tissue engineering. A total of 31 articles describing the use of tissue engineering for urethra reconstruction were included. The obtained results were discussed in three groups: cells, scaffolds, and clinical results of urethral reconstructions using these components. Stem cells of different origin were used in many experimental studies, but only autologous urothelial cells, fibroblasts, and keratinocytes were applied in clinical trials. Natural and synthetic scaffolds were studied in the context of urethral tissue engineering. The main advantage of synthetic ones is the fact that they can be obtained in unlimited amount and modified by different techniques, but scaffolds of natural origin normally contain chemical groups and bioactive proteins which increase the cell attachment and may promote the cell proliferation and differentiation. The most promising are smart scaffolds delivering different bioactive molecules or those that can be tubularized. In two clinical trials, only onlay-fashioned transplants were used for urethral reconstruction. However, the very promising results were obtained from animal studies where tubularized scaffolds, both non-seeded and cell-seeded, were applied. Impact statement The main goal of this article was to perform a systematic review of the recent literature on urethral tissue engineering. It summarizes the most recent information about cells, seeded or non-seeded scaffolds and clinical application with respect to regeneration of urethra.

[External sphincterotomy using bipolar vaporisation in saline. First results].

PubMed

Even, L; Guillotreau, J; Mingat, N; Castel-Lacanal, E; Braley, E; Malavaud, B; Marque, P; Rischmann, P; Gamé, X

2012-07-01

The aim of this study was to assess the feasibility, efficacy and tolerance of external urethral sphincter vaporization in saline for treating detrusor-sphincter dyssynergia. Between 2009 and 2011 a monocentric prospective study of ten men mean age 58±9 years with neurogenic detrusor-sphincter dyssynergia was carried out. Preoperative evaluation included kidney ultrasound scan, 24-hour creatinine clearance, urodynamics, retrograde and voiding urethrocystography and an at least 6 months temporary stent sphincterotomy. Postoperative assessment was composed of an ultrasound scan post-void residual volume measurement when the urethral catheter were removed and 1 year after the procedure, a retrograde and voiding urethrocystography at 3 months and a flexible cystoscopy at 1 year. At the catheter removal, eight patients emptied their bladder at completion, a supra-pubic catheter was temporary left in one case and a patient had a permanent urinary retention. For a mean follow-up of 22±11 months, eight patients emptied their bladder at completion and two had a complete urinary retention related to a detrusor underactivity. An orchitis occurred in one case 1 month after the procedure and an urethral stricture in four cases in 12.75±5.68 months on average. External urethral sphincter vaporisation saline was feasible and efficient for treating detrusor-sphincter dyssynergia but was associated with a high risk of urethral stricture. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Repeat Urethroplasty After Failed Urethral Reconstruction: Outcome Analysis of 130 Patients

PubMed Central

Blaschko, Sarah D.; McAninch, Jack W.; Myers, Jeremy B.; Schlomer, Bruce J.; Breyer, Benjamin N.

2013-01-01

Purpose Male urethral stricture disease accounts for a significant number of hospital admissions and health care expenditures. Although much research has been completed on treatment for urethral strictures, fewer studies have addressed the treatment of strictures in men with recurrent stricture disease after failed prior urethroplasty. We examined outcome results for repeat urethroplasty. Materials and Methods A prospectively collected, single surgeon urethroplasty database was queried from 1977 to 2011 for patients treated with repeat urethroplasty after failed prior urethral reconstruction. Stricture length and location, and repeat urethroplasty intervention and failure were evaluated with descriptive statistics, and univariate and multivariate logistic regression. Results Of 1,156 cases 168 patients underwent repeat urethroplasty after at least 1 failed prior urethroplasty. Of these patients 130 had a followup of 6 months or more and were included in analysis. Median patient age was 44 years (range 11 to 75). Median followup was 55 months (range 6 months to 20.75 years). Overall, 102 of 130 patients (78%) were successfully treated. For patients with failure median time to failure was 17 months (range 7 months to 16.8 years). Two or more failed prior urethroplasties and comorbidities associated with urethral stricture disease were associated with an increased risk of repeat urethroplasty failure. Conclusions Repeat urethroplasty is a successful treatment option. Patients in whom treatment failed had longer strictures and more complex repairs. PMID:23083654

Auditing the use and assessing the clinical utility of microscopy as a point-of-care test for Neisseria gonorrhoeae in a Sexual Health clinic.

PubMed

Mensforth, Sarah; Thorley, Nicola; Radcliffe, Keith

2018-02-01

We assessed whether urethral microscopy was performed as per clinic protocol for male clinic attendees reporting contact with Neisseria gonorrhoeae (GC), urethral symptoms or given a diagnosis of epididymo-orchitis (EO) over a 12-month period (9732 patients). Prevalence of gonorrhoea in the contacts, urethral symptoms and EO groups was 50, 12.7 and 1.6%, respectively. Microscopy was performed reliably for contacts (96%), those with discharge/dysuria with evidence of urethritis on examination (98%), but not those with EO (43%). We explored the clinical utility of microscopy as a point-of-care test for identifying urethral GC in each subgroup, using the APTIMA Combo 2 CT/GC nucleic acid amplification test as the comparator (1710 patients). Sensitivity of microscopy for each subgroup was good; there was no statistical difference between subgroup sensitivity using Fisher's exact test. Microscopy is valuable to ensure prompt diagnosis and contact tracing. All GC contacts were treated 'epidemiologically'; however, half of GC contacts did not have GC. Microscopy identified the majority of GC cases, including amongst contacts (71% of heterosexual contacts, 66% of contacts reporting sex with men). We propose that epidemiological treatment for GC contacts should be reconsidered on the grounds of antibiotic stewardship, favouring use of microscopy to guide treatment decisions.

Steroid instillation for idiopathic urethritis in children: an 8-year experience.

PubMed

Jayakumar, Sivasankar; Ninan, George Kaithayil; Pringle, Kirsty

2015-04-01

Idiopathic urethritis (IU) in children is of unknown etiology and treatment options are limited. We aim to report our experience with steroid instillation in IU in children. Retrospective data collection of all male children diagnosed with IU over a period of 8 years. Patients with balanitis xerotica obliterans (BXO) and positive urine culture at presentation were excluded from the study. Data were collected on patient demographics, laboratory and radiological investigations, cystoscopy findings, management, and outcomes. A total of 16 male children were diagnosed with IU. The mean age was 11.6 (7-16) years. Presenting symptoms included dysuria in 10; frank hematuria in 7; loin pain in 5; and scrotal pain in 2 patients. Serum C-reactive protein and full blood count was tested in 13 patients and was within normal limits in all of them. Endoscopy findings included posterior urethritis in 12, anterior urethritis in 2, and urethral stricture with inflammation in 2 patients. Ten patients required more than one episode of steroid instillation. Mean follow-up was 19.4 (1-74) months. Complete resolution of symptoms and signs occurred in 15 (93.6%) patients and improvement of symptoms and signs noted with ongoing treatment in 1 (6.4%) patient. IU in children can be successfully managed with steroid instillation. In our series, 93.6% of children had complete resolution of symptoms. Georg Thieme Verlag KG Stuttgart · New York.

Are older women more likely to receive surgical treatment for stress urinary incontinence since the introduction of the mid-urethral sling? An examination of Hospital Episode Statistics data.

PubMed

Gibson, W; Wagg, A

2016-07-01

To examine the trends in surgical treatment of stress urinary incontinence (SUI) in older women since the introduction of the mid-urethral sling. Analysis of data from Hospital Episode Statistics (HES) between 2000 and 2012. All surgical procedures for SUI in the National Health Service (NHS) in England. Retrospective cohort analysis of Hospital Episode Statistics for England from 2000 to 2012. Number of invasive, less invasive, and urethral bulking procedures performed in women in three age groups. There was a 90% fall in the number of invasive surgical treatments for SUI and a four-fold increase in the number of mid-urethral slings over this time. The total number of surgical procedures for SUI increased from 8458 to 13 219. However, the rise in the number of procedures in women aged over 75 was more modest-a three-fold increase from a low start of 187-and these women now make up a smaller proportion of all women receiving a mid-urethral sling (MUS). Despite the development and wide availability of a less invasive, safe and effective operation for stress urinary incontinence in older women, they do not appear to have benefitted. The reasons for this require prospective investigation. © 2015 Royal College of Obstetricians and Gynaecologists.

Garnet pyroxenite from Nilgiri Block, southern India: Vestiges of a Neoarchean volcanic arc

NASA Astrophysics Data System (ADS)

Samuel, Vinod O.; Kwon, Sanghoon; Santosh, M.; Sajeev, K.

2018-06-01

Southern peninsular India preserves records of Late Neoarchean-Early Paleoproterozoic continental building and cratonization. A transect from the Paleoarchean Dharwar Craton to the Neoarchean arc magmatic complex in the Nilgiri Block across the intervening Moyar Suture Zone reveals an arc-accretionary complex composed of banded iron formation (BIF), amphibolite, metatuff, garnet-kyanite schist, metagabbro, pyroxenite and charnockite. Here we investigate the petrology, geochronology and petrogenesis of the pyroxenite and garnet-clinopyroxenite. The pyroxenite is mainly composed of orthopyroxene and clinopyroxene with local domains/pockets enriched in a clinopyroxene-garnet assemblage. Thermobarometric calculations and phase equilibria modeling suggest that the orthopyroxene- and clinopyroxene-rich domains formed at 900-1000 °C, 1-1.2 GPa whereas the garnet- and clinopyroxene-rich domains record higher pressure of about 1.8-2 GPa at similar temperature conditions (900-1000 °C). Zircon U-Pb SHRIMP dating show weighted mean 207Pb-206Pb age of 2532 ± 22 Ma, with metamorphic overgrowth at 2520 ± 27 Ma and 2478 ± 27 Ma. We propose a tectonic model involving decoupling and break-off of the oceanic plate along the southern flanks of the Dharwar Craton, which initiated oceanic plate subduction. Slab melting eventually built the Nilgiri volcanic arc on top of the over-riding plate along the flanks of the Dharwar Craton. Our study supports an active plate tectonic regime at the end of the Archean Era, aiding in the growth of paleo-continents and their assembly into stable cratons.

Early changes in muscle atrophy and muscle fiber type conversion after spinal cord transection and peripheral nerve transection in rats.

PubMed

Higashino, Kosaku; Matsuura, Tetsuya; Suganuma, Katsuyoshi; Yukata, Kiminori; Nishisho, Toshihiko; Yasui, Natsuo

2013-05-20

Spinal cord transection and peripheral nerve transection cause muscle atrophy and muscle fiber type conversion. It is still unknown how spinal cord transection and peripheral nerve transection each affect the differentiation of muscle fiber type conversion mechanism and muscle atrophy. The aim of our study was to evaluate the difference of muscle weight change, muscle fiber type conversion, and Peroxisome proliferator-activated receptor-γ coactivatior-1α (PGC-1α) expression brought about by spinal cord transection and by peripheral nerve transection. Twenty-four Wistar rats underwent surgery, the control rats underwent a laminectomy; the spinal cord injury group underwent a spinal cord transection; the denervation group underwent a sciatic nerve transection. The rats were harvested of the soleus muscle and the TA muscle at 0 week, 1 week and 2 weeks after surgery. Histological examination was assessed using hematoxylin and eosin (H&E) staining and immunofluorescent staing. Western blot was performed with 3 groups. Both sciatic nerve transection and spinal cord transection caused muscle atrophy with the effect being more severe after sciatic nerve transection. Spinal cord transection caused a reduction in the expression of both sMHC protein and PGC-1α protein in the soleus muscle. On the other hand, sciatic nerve transection produced an increase in expression of sMHC protein and PGC-1α protein in the soleus muscle. The results of the expression of PGC-1α were expected in other words muscle atrophy after sciatic nerve transection is less than after spinal cord transection, however muscle atrophy after sciatic nerve transection was more severe than after spinal cord transection. In the conclusion, spinal cord transection diminished the expression of sMHC protein and PGC-1α protein in the soleus muscle. On the other hand, sciatic nerve transection enhanced the expression of sMHC protein and PGC-1α protein in the soleus muscle.

Medical Surveillance Monthly Report. Volume 16, Number 6, June 2009

DTIC Science & Technology

2009-06-01

Malaria Chlamydia Gonorrhea Syphilis‡ Urethritis§ Cold Heat 2008 2009 2008 2009 2008 2009 2008 2009 2008 2009 2008 2009 2008 2009 2008 2009 NORTH ATLANTIC...Arthropod-borne Sexually transmitted Environmental Lyme disease Malaria Chlamydia Gonorrhea Syphilis‡ Urethritis§ Cold Heat 2008 2009 2008 2009 2008 2009

Chemical Countermeasures for Antibiotic Resistance

DTIC Science & Technology

2015-01-01

MDR bacterial infections can cause sepsis, cellulitis and skin abscesses, pneumonia, toxic shock syndrome, osteomyelitis, and endocarditis among...colitis, urethritis, conjunctivitis, otitis, endocarditis , and periodontitis. Given the prominence of biofilms in infectious diseases, there has...include: lung infections of cystic fibrosis patients, colitis, urethritis, conjunctivitis, otitis, endocarditis and periodontitis. Additionally, biofilm

Preventing intra-urethral migration of a guidewire during antegrade placement of a JJ stent: a technical modification

PubMed Central

Bansal, Ankur; Gupta, Piyush; Dalela, Disha; Dalela, Diwakar

2016-01-01

A JJ stent is usually inserted in antegrade fashion after percutaneous renal surgery. We describe a new technical modification for antegrade stent insertion that prevents intraoperative intra-urethral migration of the guidewire and saves operative time and cost. PMID:26951444

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 documented for correlation. At further 28 days after catheter removal the animals were euthanasized and the urethra tissue was harvested. Histological examination of tissue with assessment of radiation damage, fibrotic and inflammatory changes were performed. After deblinding histological finding were correlated with the applied dose. Results: All animals developed a stricture, while 15/18 (83,3%) showed a significant, high grade stricture with more than 90% lumen narrowing. Histopathological examination including evaluation of urethral inflammation, fibrosis and collagen content were investigated in additional 6 rabbits confirming the former findings. No rabbits died prematurely during the study. The experiments showed that the procedure of the application of radioactive catheter was safe without any problems in contamination and protection handling. The combination of internal urethrotomy and LDR-brachytherapy results in a stricture free rate of 66.7% in the 15-Gy group, compared with only 33.3% among animals from the 0- and 30-Gy groups. Furthermore histological classification of inflammation and fibrosis of 0 Gy and 15 Gy showed similar extent. Conclusion: This new method of laser induced urethral stricture was very efficient and showed a high reproducibility, thus being useful for studying stenosis treatments. The experiments showed that application of local β-irradiation by means of radioactive catheters modulated the stenosis development. This kind of LDR-brachytherapy shows potential for prophylaxis of urethral stricture. As this was an animal pilot experiment a clinical dose response study is needed.

Nankai Stress History and Implications for an Overpressured Decollement

NASA Astrophysics Data System (ADS)

Moran, K.; O'Regan, M.

2005-12-01

The Nankai Trough, formed from the subduction of the Shikoku Basin beneath the island arc of southwestern Japan, is a relatively young accretionary complex converging at a rate of ~4 cm/yr [Shipboard Scientific Party, 2001a]. The region was studied during the Deep Sea Drilling Project and on three Ocean Drilling Program (ODP) Legs-131, 190 and 196. Three sites visited during these Legs form a single cross-margin transect (dubbed the Muroto Transect) that traverses the leading edge of the Nankai accretionary prism, from seaward of the deformation front at Site 1173, to close to the deformation front (Site 1174), and landward to the first frontal thrust (Site 808). The decollement, which forms the major boundary between the converging plates, occurs within the Lower Shikoku Basin stratigraphic unit. The ODP sites were drilled and cored to depths below the decollement (Sites 808 and 1174) and the proto-decollement (Site 1173). Here we present consolidation test results [Moran et al., 1993] that are consistent with porosity-depth functions from core and log measurements for the Lower Shikoku Basin sediments, assuming that the decollement is an overpressured seal. At 1173, where a true decollement has not yet formed, moderate fluid overpressures occur that can be fully attributed to high turbiditic sedimentation rates. Forward modeling of this site into the deformation front over a period of ~300 ky shows that the present 1173 porosity-depth function matches the porosity-depth function at 1174. These results suggest that the young decollement on the Muroto Transect at the deformation front and landward is highly overpressured and forms a seal to sediments below that can be classically modeled as a one-dimensional consolidation system.

Late Cretaceous-recent tectonic assembly of diverse crustal blocks in Central America, the Nicaraguan Rise, the Colombian Basin and northern South America as seen on a 1600-km-long, geologic and structural transect

NASA Astrophysics Data System (ADS)

Sanchez, J.; Mann, P.

2015-12-01

We have constructed a 1600-km-long transect from northern Honduras to northern Colombia that crosses northeastward-striking crustal blocks using a combination of offshore seismic data, gravity and magnetic data, well subsidence information, nearby outcrop information, and results from previous thermochronological, geochronological, geochemical and paleostress studies. The transect defines three major crustal and structural provinces: 1) Precambrian-Paleozoic, Chortis continental block whose northern edge is defined by the North America-Caribbean plate boundary. Events in this ~20-25-km-thick province include two major unconformities at the top of the Cretaceous and Eocene, associated southeast-dipping thrust faults related to collision of the Great Arc of the Caribbean (GAC) and Caribbean Large Igneous Province (CLIP) with the Chortis continental block. A third event is Eocene to recent subsidence and transtensional basins formed during the opening of the Cayman trough; 2) Late Cretaceous GAC and CLIP of oceanic arc and plateau origin, whose northern, deformed edge corresponds to the mapped Siuna belt of northern Nicaragua. This crustal province has a ~15-20-km-thick crust and is largely undeformed and extends across the Lower Nicaraguan Rise, Hess fault, to the southern limit of the Colombian basin where about 300 km of this province has been subducted beneath the accretionary wedge of the South Caribbean deformed belt of northwestern South America; and 3) Eocene to recent accretionary prism and intramontane basins on continental crust of northern South America, where Miocene accelerated exhumation and erosion of Paleogene and Cretaceous rocks reflect either shallow subduction of the CLIP or the Panama collisional event to the southwest.

The fate of neurotization techniques on reinnervation after denervation of the gastrocnemius muscle: an experimental study.

PubMed

Askar, I; Sabuncuoglu, B T; Yormuk, E; Saray, A

2001-07-01

In nerve injuries, if it is not possible to reinnervate muscle by using neurorrhaphy and nerve grafting technique, reinnervation should be provided by the use of neuroization-directly implanting motor nerve into muscle. A comparative study of three techniques of neurotization is presented in rabbits. In this experimental study, a total of 40 white New Zealand rabbits were used and divided into four groups, each including 10 rabbits. In the first group (control--Group 1), only surgical exposure of the gastrocnemius muscle, main muscle nerve (tibial nerve), and peroneal nerve was done, without any injury to the nerves. In the second group (direct neurotization group--Group 2), the tibial nerve was transected, and the peroneal nerve, which had already been divided into fascicles, was implanted into the lateral head of the gastrocnemius muscle aneural zone. In the third group (dual neurotization group--Group 3), the tibial nerve which had been transected and re-anastomosed, and the peroneal nerve were implanted into the lateral head of the gastrocnemius muscle. In the last experimental group (hyperneurotization group--Group 4), fascicles of the peroneal nerve were implanted into the lateral head of the gastrocnemius, preserving the tibial nerve. Six months later, changes in the histologic pattern and the functional recovery of the gastrocnemius muscle were investigated. It was found that functional recovery was achieved in all neurotization groups. Groups with the tibial nerve transected had less muscular weights than those of groups with the tibial nerve intact. EMG recordings showed that polyphasic and late potentials were frequently seen in groups with the tibial nerve transected. Degeneration and regeneration of myofibrils was observed in such groups as well. New motor end-plates, including vesicles, were formed in a scattered manner in all neurotization groups. As a result, the authors conclude that direct and dual neurotization techniques are useful in peripheral nerve injuries, if it is not possible to reinnervate muscle by using neurorraphy and nerve grafting, and that there is no suggested superiority among these techniques.

Uplift of the Eastern Cordillera, Colombia

NASA Astrophysics Data System (ADS)

Siravo, Gaia; Faccenna, Claudio; Giuditta Fellin, Maria; Molin, Paola; Bayona, German; Giachetta, Emanuele

2017-04-01

The Eastern Cordillera (EC) of Colombia is a double-vergent thrust and fold belt formed during the Cenozoic by the inversion of a Mesozoic rift. It is located 400 km far from the trench where the Nazca slab subducts below the South American plate. Tomography and seismicity highlight the presence of a flat slab subduction north of 5° N. Our goal is to explore the relation between surface and crustal processes in the topography growth of the EC north of 6° N. To reach this aim we integrate data derived from the fluvial network analysis with long-term erosion data derived from thermochronology. The northern EC is an asymmetric chain with a gentle flank on the western side and steep flank to the east. The two sides are separated by the maximum elevation of 5000 m reached at the Cocuy Sierra. Here the EC has the widest width ( 200 km) and changes northward to the Santander Massif Range. We obtained new low-T (U-Th)/He ages on zircons (ZHe) and apatites (AHe) from samples collected along two transects. Our ages combined with previous data indicate that along both transects exhumation occurred from shallow burial depths (≤ 6-8 km) during the Oligo-Miocene and locally continued until the Pliocene. Along the transect across the central part of the EC up to the Cocuy Sierra, the youngest Pliocene ages (AHe) are located at the highest elevations above 4000 m. Along the second transect the youngest ages are found close to and east of a main strike-slip structure (Bucaramanga fault). This fault has a significant dip-slip component evidenced by an offset of about 10 Ma among the AHe ages across the fault. The main rivers draining the northern EC flow parallel to the main tectonic structures and locally cut across them. The analysis of river longitudinal profiles reveal transient features such as knickpoint not related to lithological or structural contrast. Channel slope and chi analysis suggest a river capture event possibly influenced by the crustal structures. Wind gaps with matching Pleistocene fluvial deposits in addition to river elbows appear to confirm a drainage network reorganization phase given by fluvial piracy.

Triple Junctions, Boninites, and a New Microplate in the Western Pacific

NASA Astrophysics Data System (ADS)

Flores, J. A.; Casey, J.

2017-12-01

A new microplate has been discovered while trying to correlate melting processes in subduction zones that are forming boninites along the southern Mariana Plate. The westward boundary between the Mariana plate and the Philippine Sea plate is along a well-defined back-arc spreading center. The southern extension of this spreading center to the intersection with the Mariana Trench does not have a recognized morphological boundary. Previous work has hypothesized that subduction beneath a spreading center provides conditions required for boninite petrogenesis. Therefore, the exact location of the trench-trench-ridge triple junction needs to be found and correlated with known boninite locations. The triple junction was found using fault plane solutions to constrain the southern boundary of the two plates as it transects across the forearc. Normal faults suggest the triple junction to be at approximately 11.9N 144.1W; slip direction of reverse faults associated with the subducting plate are dominantly north-south west of this junction and northwest-southeast on the east side. While locating the southern boundary, the nucleation of a new spreading center that creates a ridge-ridge-ridge triple junction was found. The main spreading center trends mostly north-south until about 12.5N 143W, where two other spreading centers meet. The western spreading zone trends mostly east-west and seems to be in its infancy whereas there is another spreading center trending northwest-southeast. It is this last spreading center that forms the trench-ridge-trench triple junction. Discovery of these triple junctions isolates a piece of lithosphere that we interpret to be a new microplate that we name the Challenger Microplate.

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. Copyright © 2015 Elsevier Inc. All rights reserved.

Penile fracture: a rare case of simultaneous rupture of the one corpus cavernosum and complete urethral rupture.

PubMed

Nale, Djordje; Bojanić, Nebojša; Nikić, Predrag

2015-01-01

Penile fracture is a traumatic rupture of tunica albuginea and the tumescent corpora cavernosa due to the nonphysiological bending of the penile shaft, presenting with or without rupture of corpus pongiosum and urethra. The incidence of concomitant injury of the urethra is 0-38%. Complete urethral rupture is rare, but it is almost always associated with bilateral corporeal injury. We presented a patient with complete urethral rupture, and rupture of the right cavernous body. According to the available literature, this case is extremely rare. Fracture of the penis is relatively uncommon and is considered a urologic emergency. Prompt surgical explo- ration and repair can preserve erectile and voiding function.

Urethral anatomy and semen flow during ejaculation

NASA Astrophysics Data System (ADS)

Kelly, Diane

2016-11-01

Ejaculation is critical for reproductive success in many animals, but little is known about its hydrodynamics. In mammals, ejaculation pushes semen along the length of the penis through the urethra. Although the urethra also carries urine during micturition, the flow dynamics of micturition and ejaculation differ: semen is more viscous than urine, and the pressure that drives its flow is derived primarily from the rhythmic contractions of muscles at the base of the penis, which produce pulsatile rather than steady flow. In contrast, Johnston et al. (2014) describe a steady flow of semen through the crocodilian urethral groove during ejaculation. Anatomical differences of tissues associated with mammalian and crocodilian urethral structures may underlie these differences in flow behavior.

Transrectal ultrasound-guided extraction of impacted prostatic urethral calculi: a simple alternative to endoscopy

PubMed Central

Amend, Gregory; Gandhi, Jason; Smith, Noel L.; Weissbart, Steven J.; Schulsinger, David A.; Joshi, Gargi

2017-01-01

Urethral stones can become impacted in the posterior urethra, typically presenting with varying degrees of acute urinary retention and lower urinary tract symptoms. These are traditionally treated in the inpatient setting, with external urethrotomy or endoscopic push-back of the calculus into the urinary bladder followed by cystolitholapaxy or cystolithotripsy. However, these methods are invasive, involve general anesthesia, and require radiation. In this report, we describe a simple, minimally invasive, and safe alternative technique to visualize and remove impacted prostatic urethral stones under the real-time guidance of transrectal ultrasonography (TRUS). The urologist can accomplish this procedure in the office, avoiding radiation exposure to the patient and hospital admission. PMID:28725602

Management of posterior urethral strictures secondary to pelvic fractures in children.

PubMed

al-Rifaei, M A; Gaafar, S; Abdel-Rahman, M

1991-02-01

Bulboprostatic anastomotic urethroplasty was performed in 20 children with posterior urethral strictures secondary to bony pelvic fractures. The approach was perineal in 4 children and transpubic abdominoperineal in 16, with good postoperative results in 100 and 62.5%, respectively. In some children the urethral disruption occurred within the prostate itself and not at the prostatomembranous junction. In such cases the proximal sphincteric mechanism may be at risk and immediate repair of the injury is advisable. In the case of common prostatomembranous disruption displacement of the urethra may be significant. In such cases a transpubic approach is preferable. If the proximal sphincteric mechanism is deranged, it can be managed at the same time.

High-dose-rate brachytherapy – a novel treatment approach for primary clear cell adenocarcinoma of male urethra

PubMed Central

Lewis, Shirley; Pal, Mahendra; Bakshi, Ganesh; Ghadi, Yogesh G.; Menon, Santosh; Murthy, Vedang

2015-01-01

The incidence of male urethral cancer is rare with age preponderance of 50 to 60 years. The standard management approach is surgery. Here, we present a novel treatment approach for male urethral cancer. Thirty-six year old male, case of primary clear cell adenocarcinoma of urethra who refused surgery, underwent cystoscopic assisted intraluminal HDR brachytherapy. Patient received a dose of 36 Gy in 9 fractions (4 Gy per fraction) followed by a boost of 24 Gy in 6 fractions. At 11 months post treatment, disease is well controlled with no post treatment toxicity so far. Intraluminal brachytherapy seems to be an effective novel treatment for male urethral cancer. PMID:26207115

Leg 67: the Deep Sea Drilling Project Mid-America Trench transect off Guatemala.

USGS Publications Warehouse

von Huene, Roland E.

1980-01-01

Drilling on the Cocos plate recovered a basal chalk sequence deposited during early and mid-Miocene time, a short interval of abyssal red clay, and an upper sequence of late Miocene and younger sediment deposited within an area influenced by a terrigenous source. In the trench, a mud and sand fill less than 400,000 yr old overlies the oceanic sequence. The entire section shows no evidence of compressive deformation. In contrast, the section cored on the trench's landward slope 3 km from the trench axis is affected by tectonism. The section contains a Cretaceous to Pliocene claystone sequence capped by Pliocene to Quaternary hemipelagic slope deposits.- from Authors

Long-term urethral catheterisation.

PubMed

Turner, Bruce; Dickens, Nicola

This article discusses long-term urethral catheterisation, focusing on the relevant anatomy and physiology, indications for the procedure, catheter selection and catheter care. It is important that nurses have a good working knowledge of long-term catheterisation as the need for this intervention will increase with the rise in chronic health conditions and the ageing population.

Chemical Countermeasures for Antibiotic Resistance

DTIC Science & Technology

2014-04-01

osteomyelitis, and endocarditis among other symptoms. Serious cases result in organ failure (especially kidney), loss of limbs (via amputation) and...colitis, urethritis, conjunctivitis, otitis, endocarditis , and periodontitis. Given the prominence of biofilms in infectious diseases, there has been an...associated with bacterial biofilms include: lung infections of cystic fibrosis patients, colitis, urethritis, conjunctivitis, otitis, endocarditis

Preventing intra-urethral migration of a guidewire during antegrade placement of a JJ stent: a technical modification.

PubMed

Bansal, Ankur; Gupta, Piyush; Dalela, Disha; Dalela, Diwakar

2016-03-07

A JJ stent is usually inserted in antegrade fashion after percutaneous renal surgery. We describe a new technical modification for antegrade stent insertion that prevents intraoperative intra-urethral migration of the guidewire and saves operative time and cost. 2016 BMJ Publishing Group Ltd.

Failure of azithromycin 2.0 g in the treatment of gonococcal urethritis caused by high-level resistance in California.

PubMed

Gose, Severin O; Soge, Olusegun O; Beebe, James L; Nguyen, Duylinh; Stoltey, Juliet E; Bauer, Heidi M

2015-05-01

We report a treatment failure to azithromycin 2.0 g caused by a urethral Neisseria gonorrhoeae isolate with high-level azithromycin resistance in California. This report describes the epidemiological case investigation and phenotypic and genetic characterization of the treatment failure isolate.

Anterior urethral valves: an uncommon cause of obstructive uropathy in children.

PubMed

Kibar, Yusuf; Coban, Hidayet; Irkilata, H Cem; Erdemir, Fikret; Seckin, Bedrettin; Dayanc, Murat

2007-10-01

Anterior urethral valves (AUV) are rare entities generally described in case reports. They are an uncommon cause of lower urinary tract obstruction in children and can be difficult to diagnose. In the present study, we present our experience in four children with AUV along with a literature review. We retrospectively identified four children with AUV presented between 1998 and 2005 at age 4-9 years. Hematuria, urinary tract infection and weak voiding stream were the most common symptoms. Voiding cystourethrography (VCUG) confirmed the diagnosis of AUV. On cystourethroscopy, cusp-like valves in the anterior urethra were seen in all children. Transurethral endoscopic resection of the valves was carried out in three children using a pediatric resectoscope. In one child with a massive anterior urethral diverticulum, open resection of the valve, diverticulectomy and urethroplasty were performed. All patients were cured, none had complications as a result of surgery, and all reported a normal urinary stream at follow-up. Children with poor stream and recurrent infections should be evaluated carefully and anterior urethral valves should be considered in differential diagnosis of obstructive lesions.

Penile fracture and associated urethral injury: Experience at a tertiary care hospital

PubMed Central

Amit, Attam; Arun, Kerketta; Bharat, Behera; Navin, Ram; Sameer, Trivedi; Shankar, Dwivedi Udai

2013-01-01

Introduction: Penile fracture may be associated with urethral trauma in 1% to 38% of cases. We present our experience in treating 8 such cases. Methods: Data were collected retrospectively from hospital records and from out-patient department follow-up visits. Results: The mean age of the patients was 30.4 years; trauma during coitus was the most common cause of the penile fracture. One patient presented after 7 days. Two patients had normal examination of their penis despite typical history. All fractures were repaired on an emergency basis via subcoronal incision. In 2 patients with normal findings, the urethra had to be mobilized to locate the site of the injury. In 1 patient, the site of the urethral trauma was 1 cm away from the site of the corporal injury, which was localized by injecting sterile methylene blue per urethra. Postoperatively, all patients voided with good flow and had erections with adequate rigidity. Conclusion: A high level of suspicion for urethral injury during surgical exploration is warranted, especially in the presence of suggestive history and examination. PMID:23589751

Histomorphology of canine urethral sphincter systems, including three-dimensional reconstruction and magnetic resonance imaging.

PubMed

Stolzenburg, Jens-Uwe; Neuhaus, Jochen; Liatsikos, Evangelos N; Schwalenberg, Thilo; Ludewig, Eberhard; Ganzer, Roman

2006-03-01

To present a detailed anatomic description and comparison of the smooth and striated urethral sphincter in male and female dogs. We performed a thorough histologic evaluation, three-dimensional reconstruction, and magnetic resonance imaging of the lower urinary tract of male and female dogs. The lower urinary tract anatomy was investigated in 16 male and 18 female dogs by serial sectioning, including immunohistochemical staining and three-dimensional reconstruction. Magnetic resonance imaging performed in 5 male and 5 female dogs before histologic investigation helped to demonstrate the anatomy in vivo. A urethral sphincter muscle in both sexes existed without muscular connection to the pelvic floor. It ran circularly and consisted of an inner smooth and outer striated muscular part. In the female dog, the striated muscle encircled the urethra and vagina in the caudal third of the membranous urethra (musculus urethrovaginalis). A urinary diaphragm (diaphragma urogenitale) could not be found histologically or by magnetic resonance imaging. The dog is a suitable animal model for investigations of the urethral sphincter. In the female dog, attention should be given to the special topography of the musculus urethrovaginalis.

Symphysiotomy: a viable approach for delayed management of posterior urethral injuries in children.

PubMed

Basiri, Abbas; Shadpour, Pejman; Moradi, Mahmood Reza; Ahmadinia, Hossein; Madaen, Kazem

2002-11-01

The outcome of symphysiotomy for accessing pelvic fracture related, obliterative urethral strictures is described. In 7 boys and 3 girls 4 to 13 years old (mean age 6) surgical correction of a pelvic fracture related, obliterative urethral stricture was achieved through symphysiotomy. The stricture involved a prostatomembranous location in boys and complete vesicourethral distraction in girls. Patients were followed an average of 2.5 years (range 6 months to 4 years) by physical examination, urethrography and endoscopy. The stricture was successfully corrected in all patients and all void with a normal flow. All boys are continent but 2 of the 3 girls had early incontinence, which resolved with time in 1. In 2 of the 10 cases a previous attempt at perineal repair had already failed. No patient required urethrotomy or dilation and none had significant hemorrhage, fistulization, bladder hernia, chronic pain or secondary gait disturbance. Symphysiotomy is hereby revisited as a simple and effective approach for repairing traumatic posterior urethral injuries in the pediatric population. It can be performed instead of transpubic urethroplasty to manage long or otherwise complicated strictures.

Treatment of extensive urethral hemangioma with KTP/532 laser.

PubMed

Lauvetz, R W; Malek, R S; Husmann, D A

1996-01-01

Urethral hemangiomas are rare. They vary in size from pinpoint masses to extensive honeycomb-shape deformities leading to significant hematuria. For extensive lesions, therapeutic options have included extensive surgical resection and reconstruction or multistaged neodymium:yttrium-aluminum-garnet (Nd:YAG) laser photocoagulation. We report our experience with the use of potassium titanyl phosphate (KTP/532) laser for treatment of the extensive form. A 7-year-old boy presented with a 2-week history of urethral bleeding. He had extensive hemangiomas of the genital and perineal regions. Cystourethroscopy disclosed diffusely scattered honeycomb-shape hemangiomatous malformation of the anterior urethra. KTP/532 laser energy was delivered transurethrally to the hemangiomatous areas until they blanched. The Foley catheter was removed 24 hours postoperatively, and the patient voided clear urine without difficulty. He has remained trouble-free for more than 2 years. Judicious endoscopic single-stage therapy with KTP/532 laser may obviate open surgical intervention in most cases of extensive and symptomatic urethral hemangiomas. In view of our observation and the literature, KTP/532 laser therapy should be considered the first line of treatment.

Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. VI. Unusual Events in Urolithiasis: 1. Long-Standing Urethral Stones without Underlying Anatomical Abnormalities in Male Children.

PubMed

Gadelkareem, Rabea A; Shahat, Ahmed A; Abdelhafez, Mohamed F; Moeen, Ahmed M; Ibrahim, Abdelrady S; Safwat, Ahmed S

2018-06-06

The study aimed to present our center's experience with long-standing urethral stones in male children with normal urethra. Retrospective search of our center data was done for the cases of long-standing urethral stones with normal urethra in male children during the period July 2001 - June 2016. Demographic and clinical data were studied. Of more than 54,000 urolithiasis procedures, 17 male children (0.031%) were operated for long-standing urethral stones with normal urethra. In 14 cases (82.4%), residence was rural and parental education levels were low or none. All children were regularly prompted voiding with a history of difficulty or dysuria. All the stones lodged in the posterior urethra with an approximate mean duration of 2 months. The mean stone size of 11.29 ± 3.88 mm and rough surfaces in 88.2% of cases represented the main predisposing factors. Major complications included rectal prolapse in 1 case and vesicoureteral reflux in 3 cases. Endoscopic push-back was followed by disintegration in 76.5% or cystolithotomy in 17.7%, while it failed in 1 case that was treated by cystolithotomy. Long-standing urethral stones in male children with normal urethra are very rare misdiagnoses. Stone topography and sociocultural factors predisposed to their lodgments and negligence. Endoscopic treatment is the best approach. © 2018 S. Karger AG, Basel.

Transgenic animal model for studying the mechanism of obesity-associated stress urinary incontinence.

PubMed

Wang, Lin; Lin, Guiting; Lee, Yung-Chin; Reed-Maldonado, Amanda B; Sanford, Melissa T; Wang, Guifang; Li, Huixi; Banie, Lia; Xin, Zhengcheng; Lue, Tom F

2017-02-01

To study and compare the function and structure of the urethral sphincter in female Zucker lean (ZL) and Zucker fatty (ZF) rats and to assess the viability of ZF fats as a model for female obesity-associated stress urinary incontinence (SUI). Two study arms were created: a ZL arm including 16-week-old female ZL rats (ZUC-Lepr fa 186; n = 12) and a ZF arm including 16-week-old female ZF rats (ZUC-Lepr fa 185; n = 12). I.p. insulin tolerance testing was carried out before functional study. Metabolic cages, conscious cystometry and leak point pressure (LPP) assessments were conducted. Urethral tissues were harvested for immunofluorescence staining to check intramyocellular lipid (IMCL) and sphincter muscle (smooth muscle and striated muscle) composition. The ZF rats had insulin resistance, a greater voiding frequency and lower LPP compared with ZL rats (P < 0.05), with more IMCL deposition localized in the urethral striated muscle fibres of the ZF rats (P < 0.05). The thickness of the striated muscle layer and the ratio of striated muscle to smooth muscle were lower in ZF than in ZL rats. Obesity impairs urethral sphincter function via IMCL deposition and leads to atrophy and distortion of urethral striated muscle. The ZF rats could be a consistent and reliable animal model in which to study obesity-associated SUI. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

[Penis-preserving surgery in patients with primary penile urethral cancer].

PubMed

Maek, M; Musch, M; Arnold, G; Kröpfl, D

2014-12-01

Primary urethral cancer in males is a rare entity with only approximately 800 cases described, which is why it is difficult to formulate evidence-based guidelines for treatment. For tumors in the pT2 stage with a localization distal to the membranous urethra, a penis-preserving operation can be carried out. In the period from November 2006 to February 2014 a total of 4 patients with primary urethral cancer underwent a penis-preserving urethral resection. The tumor characteristics and treatment results were collated retrospectively. Of the four patients one had a transitional cell carcinoma of the mid-penile urethra in stage pT2 G2. In two out of the four patients a squamous cell carcinoma (PEC) was present in the mid-penile urethra in stages pT2 G2 and pT2 G3, respectively, with concomitant carcinoma in situ (CIS). The fourth patient had a PEC of the fossa terminalis in stage pT2 G2. Initially all patients underwent a penis-preserving resection. In one case, despite an initial R0 resection a local recurrence occurred and a complete penectomy was performed. Irradiation and lymphadenectomy were not carried out. At a mean follow-up of 37 months all patients are currently in complete remission. Primary penile urethral cancer can be treated by a penis-preserving operation. Close follow-up is essential because recurrence can arise despite an initial R0 resection.

Evaluation of holmium laser versus cold knife in optical internal urethrotomy for the management of short segment urethral stricture.

PubMed

Jain, Sudhir Kumar; Kaza, Ram Chandra Murthy; Singh, Bipin Kumar

2014-10-01

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. 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. 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. 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.

[Results of anastomotic urethroplasty for male urethral stricture disease].

PubMed

Fall, B; Zeondo, C; Sow, Y; Sarr, A; Sine, B; Thiam, A; Faye, S T; Sow, O; Traoré, A; Diao, B; Fall, P A; Ndoye, A K; Ba, M

2018-04-04

To report our experience with anastomotic uretroplasty (AU) due to male urethral stricture disease (USD) and to identify factors affecting the results. We conducted a retrospective study over a period of 4 years and 6 months (July 2012 to December 2016). Any subsequent use of endoscopic urethrotomy or new urethroplasty was considered a failure. Forty-eight cases were included. The mean age of patients was 53.5±17.3 years (23-87 years). Urinary retention was the reason for consultation in 42 cases (87.5%). The most common localization of USD was the bulbar urethra (n=45). The mean length of USD was 1.23±0.62cm (0.5-3cm) with a median length of 1cm. The etiology was post-infectious in 56.3% of cases. More than half (58.3%) of patients had already undergone at least one urethral manipulation. After an average follow-up of 21.1±12.6 months (1 to 52 months), the overall success rate was 77.1%. In univariate analysis, length, cause and location of the stricture, age of patient, the presenting symptoms of the stricture, previous urethral manipulation and surgeon experience did not significantly impact on the success rate of anastomotic urethroplasty at one and two years follow-up. The AU had provided good results in our practice. The infectious origin of the stricture and previous urethral manipulation did not significantly impact the result of this surgical technique. 4. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

[Surgical selection and efficacy assessment for membranous urethral trauma caused by pelvic fracture].

PubMed

Zhu, Li-Zhen; Liu, Liang-Le; Cai, Chun-Yuan; Yang, Guo-Jing; Zhang, Li-Cheng; Zhu, Qi

2012-08-01

To explore selection and efficacy assessment for membranous urethral trauma caused by pelvic fracture. From June 2000 to August 2010, 72 patients with membranous urethral trauma caused by pelvic fracture were selected. There were 46 males and 26 females,ranging age from 26 to 62 years (averaged 35.2 years). The time from injury to hospitalization time was 1 to 3 hours. According to Tile pelvic fracture classification, there were 8 patients with type A, 45 patients with type B, 19 patients with type C. Thirty of the 35 patients with partial rupture of posterior urethral were treated by catheterization,5 patients treated by rupture anastomosis on the stage I combined with cystostomy; 25 of the 37 patients with complete rupture of posterior urethra were treated by early realignment, and 12 patients were treated by cystostomy. Urinary incontinence, impotence and urethrostenosis were evaluated. All patients were followed up for 5 to 10 years (mean 7.7 years). Incidence of urethrostenosis, impotence and urinary incontinence in patients treated by cystostomy were significantly higher than rupture anastomosis on the stage I and early realignment (P < 0.05); while incidence in patients treated by catheterization was significantly lower than other groups (P < 0.05). For patients with partial rupture of posterior urethral, catheterization and rupture anastomosis on the stage I are preferred methods; while patients with complete rupture of posterior urethra, early realignment is a preferred method with advantages of simple operation and less complications.

Modified Primary Urethral Realignment Under Flexible Urethroscope.

PubMed

Huang, Guanglin; Man, Libo; Li, Guizhong; Wang, Hai; Liu, Ning

2017-02-01

To assess the clinical significance of flexible endoscopic realignment in the treatment of posterior urethral disruption in comparison to the traditional open realignment method. A total of 58 patients suffering posterior urethral disruption were enrolled into the current study from January 2003 to May 2009. Of them, 23 patients (Group A) were treated with modified technique of urethral realignment under flexible urethroscopy and 35 patients (Group B) received conventional open realignment. Either procedure was successfully performed in both groups. However, the operation time was significantly shorter in Group A (29.1 ± 9.5 min) than that in Group B (58.1 ± 11.2 min, p < 0.001). Also, patients in Group A had a significantly decreased incidence of stricture (4 of 23 cases in Group A versus 15 of 35 cases in Group B, p = 0.043) and formation of false urethra (0 of 23 cases in Group A versus 7 of 35 cases in Group B, p = 0.035). Prevalence of secondary urethroplasty was less in Group A (1/23) compared to Group B (8/35), but there was no statistical difference (p = 0.057). In addition, there was no significant difference in morbidity of urinary infection, incidence of incontinence, and impotence between the two groups (p > 0.05). Compared to the traditional open realignment, the new technique of urethral realignment under flexible endoscope has the advantage of short operation time, minimally invasive and less complications.

Early endoscopic realignment in posterior urethral injuries.

PubMed

Shrestha, B; Baidya, J L

2013-01-01

Posterior urethral injury requires meticulous tertiary care and optimum expertise to manage successfully. The aim of our study is to describe our experiences with pelvic injuries involving posterior urethra and their outcome after early endoscopic realignment. A prospective study was carried out in 20 patients with complete posterior urethral rupture, from November 2007 till October 2010. They presented with blunt traumatic pelvic fracture and underwent primary realignment of posterior urethra in our institute. The definitive diagnosis of urethral rupture was made after retrograde urethrography and antegrade urethrography where applicable. The initial management was suprapubic catheter insertion after primary trauma management in casualty. After a week of conservative management with intravenous antibiotics and pain management, patients were subjected to the endoscopic realignment. The follow up period was at least six months. The results were analyzed with SPSS software. After endoscopic realignment, all patients were advised CISC for the initial 3 months. All patients voided well after three months of CISC. However, 12 patients were lost to follow up by the end of 6 postoperative months. Out of eight remaining patients, two had features of restricture and were managed with DVU followed by CISC again. One patient with restricture had some degree of erectile dysfunction who improved significantly after phospodiesterase inhibitors. None of the patients had features of incontinence. Early endoscopic realignment of posterior urethra is a minimally invasive modality in the management of complete posterior urethral injury with low rates of incontinence and impotency.

Predictors of urethral stricture recurrence after endoscopic urethrotomy.

PubMed

Redón-Gálvez, L; Molina-Escudero, R; Álvarez-Ardura, M; Otaola-Arca, H; Alarcón Parra, R O; Páez-Borda, Á

2016-10-01

The aim of the study was to analyse the clinical-demographic variables of the series and the predictors of urethral stricture recurrence after endoscopic urethrotomy. We retrospectively analysed 67 patients who underwent Sachse endoscopic urethrotomy between June 2006 and September 2014. Those patients who had previously undergone endoscopic urethrotomy or urethroplasty were excluded. The other patients who presented urethral stricture were included. We analysed age, weight, smoking habit, and cardiovascular risk factors, as well as the number, location, length and aetiology of the strictures, previous urethrotomies, vesical catheter duration and postsurgical dilatations. A univariate and multivariate analysis was conducted using the chi-squared test or Fisher's test and logistic regression to identify the variables related to recurrence. Thirty-seven percent of the patients had a relapse. The majority of the patients were older than 60 years (56.7%), obese (74.6%), nonsmokers (88%) and had no cardiovascular factors (56.7%). The majority of the strictures were single (94%), <1cm (82%), bulbar urethral (64.2%), iatrogenic (67.2%) and with no prior urethrotomy (89.6%). The majority of the patients carried a vesical catheter for <15 days (85.1%) and did not undergo postsurgical dilatation (65.7%). Only the length of the stricture was an independent risk factor for recurrence (P=.025; relative risk, 5.7; 95% CI 1.21-26.41). In the treatment of urethral strictures through endoscopic urethrotomy, a stricture length >1cm is the only factor that predicts an increase in the risk of recurrence. We found no clinical or demographic factors that caused an increase in the incidence of recurrence. Similarly, technical factors such as increasing the bladder catheterisation time and urethral dilatations did not change the course of the disease. Their routine use is therefore unnecessary. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Signal processing in urodynamics: towards high definition urethral pressure profilometry.

PubMed

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

2016-03-22

Urethral pressure profilometry (UPP) is used in the diagnosis of stress urinary incontinence (SUI) which is a significant medical, social, and economic problem. Low spatial pressure resolution, common occurrence of artifacts, and uncertainties in data location limit the diagnostic value of UPP. To overcome these limitations, high definition urethral pressure profilometry (HD-UPP) combining enhanced UPP hardware and signal processing algorithms has been developed. In this work, we present the different signal processing steps in HD-UPP and show experimental results from female minipigs. We use a special microtip catheter with high angular pressure resolution and an integrated inclination sensor. Signals from the catheter are filtered and time-correlated artifacts removed. A signal reconstruction algorithm processes pressure data into a detailed pressure image on the urethra's inside. Finally, the pressure distribution on the urethra's outside is calculated through deconvolution. A mathematical model of the urethra is contained in a point-spread-function (PSF) which is identified depending on geometric and material properties of the urethra. We additionally investigate the PSF's frequency response to determine the relevant frequency band for pressure information on the urinary sphincter. Experimental pressure data are spatially located and processed into high resolution pressure images. Artifacts are successfully removed from data without blurring other details. The pressure distribution on the urethra's outside is reconstructed and compared to the one on the inside. Finally, the pressure images are mapped onto the urethral geometry calculated from inclination and position data to provide an integrated image of pressure distribution, anatomical shape, and location. With its advanced sensing capabilities, the novel microtip catheter collects an unprecedented amount of urethral pressure data. Through sequential signal processing steps, physicians are provided with detailed information on the pressure distribution in and around the urethra. Therefore, HD-UPP overcomes many current limitations of conventional UPP and offers the opportunity to evaluate urethral structures, especially the sphincter, in context of the correct anatomical location. This could enable the development of focal therapy approaches in the treatment of SUI.

Transverse preputial onlay island flap urethroplasty for single-stage correction of proximal hypospadias.

PubMed

Singal, Arbinder Kumar; Dubey, Manish; Jain, Viral

2016-07-01

Transverse preputial onlay island flap urethroplasty (TPOIF) was described initially for distal hypospadias, but has seen extended application for proximal hypospadias. We describe a set of modifications in the technique and results in a large series of proximal hypospadias. All children who underwent TPOIF repair for proximal hypospadias (proximal penile, penoscrotal and scrotal) from June 2006 to June 2013 by a single surgeon were prospectively followed till June, 2014. A standard technique and postoperative protocol were followed. Salient points to be emphasized in the technique: (1) dissection of the dartos pedicle till penopubic junction to prevent penile torsion, (2) incorporation of the spongiosum in the urethroplasty, (3) midline urethral plate incision in glans (hinging the plate), (4) Dartos blanket cover on whole urethroplasty. Out of 136 children with proximal hypospadias, 92 children who underwent TPOIF formed the study group. Out of 92 children, 48 (52 %) children required a tunica albuginea plication for chordee correction. In total, 16 (17 %) patients developed 24 complications and 11 children (12 %) required second surgeries: fistula closure in 7 (with meatoplasty in 5), glansplasty for glans dehiscence in 2 and excision of diverticulum in 2. Two children required a third surgery. Only 5 children had a noticeable penile torsion (less than 30 degree), and 7 had a patulous meatus. Transverse preputial onlay island flap urethroplasty can deliver reliable cosmetic and functional outcomes in proximal hypospadias.

Modified tubularized incised plate urethroplasty reduces the risk of fistula and meatal stenosis for proximal hypospadias: a report of 63 cases.

PubMed

Arshadi, Hamid; Sabetkish, Shabnam; Kajbafzadeh, Abdol-Mohammad

2017-12-01

To report the feasibility of modified tubularized incised plate (TIP) urethroplasty technique for proximal hypospadias in 63 cases. From January 2004 to March 2010, 63 patients underwent one-stage TIP urethroplasty (modified Snodgrass technique repair) using 2-3 of three covering layers (corpus spongiosum, dartos, and tunica vaginalis). The primary meatus was proximal penile, penoscrotal, scrotal, and perineal in 38, 13, 10, and 2 patients, respectively. All patients had chordee that was corrected with dorsal plication. Glanuloplasty was performed in all cases. Complications and cosmetic results were documented after 6-72 months of follow-up. A total of 63 boys with proximal hypospadias underwent Snodgrass hypospadias repair at a mean age of 8.5 months (range 6-54). Mean operative time was 210 ± 35 min. Patients were followed up with 6-month intervals for up to 6 years postoperatively. After 6 years of follow-up, nine urethrocutaneous fistulae, four bleeding, four meatal stenoses, and one urethral stricture were reported. Cosmetic result was satisfactory according to parent's opinion and another surgeon. No residual chordee was observed in any cases (without artificial correction). In conclusion, this preliminary report can be estimated as an alternative technique with acceptable complication and cosmetic results for proximal hypospadias correction.

Repair of urethral defects by an adipose mesenchymal stem cell‑porous silk fibroin material.

PubMed

Tian, Binqiang; Song, Lujie; Liang, Tao; Li, Zuowei; Ye, Xuxiao; Fu, Qiang; Li, Yonghui

2018-05-09

The aim of the present study was to determine whether it was possible to repair urethral defects with a material of adipose mesenchymal stem cells (ADMSCs)‑porous silk fibroin (SF). A total of 39 male New Zealand white rabbits were randomly divided into a control group, an SF group and a bromodeoxyuridine (BrdU)‑labeled ADMSCs‑SF group (SSF group; n=13/group). Defects were made by resecting the posterior urethral wall. The defects in the SF and SSF groups were repaired using SF and BrdU‑labeled ADMSCs‑SF materials respectively. Then the anterior wall was sutured, and the urethral catheter was retained for 3 weeks following surgery. The catheter was rinsed with nitrofurazone once a day. The cells with positive expressions of factor VIII related antigen (FVIII‑RAg), α‑smooth muscle actin (α‑SMA) and pan‑cytokeratin (AE1/AE3) were detected by immunohistochemical assay, and the distributions of BrdU positive cells and macrophages were observed. Urethrography was performed prior to and following surgery. All rabbits had normal urethral morphologies prior to surgery. The incidence rates of postoperative complications in the control, SF and SSF groups were 76.92 (7/13), 23.07 (3/13) and 15.38% (2/13), respectively (P<0.05). The number of positive macrophages in the SSF group was significantly lower than that of the SF group 4 weeks following surgery (P<0.05). In the SSF group, BrdU positive cells were scattered within the SF material following surgery, primarily at the intersection between the SF material and the urethra. The number of FVIII‑RAg positive cells in the SSF and SF groups were significantly different (P<0.05), which were also significantly higher than that of control group (P<0.01). The number of α‑SMA positive cells in the SSF and SF groups were significantly different (P<0.05), and these values also significantly exceeded those exhibited by the control group (P<0.01). In addition, the SSF and SF groups had positive staining of AE1/AE3. Similar to normal urethral mucosa, the cytoplasm was stained brownish yellow (P<0.05). It is thus feasible to repair urethral defects using ADMSCs‑SF material.

Interstitial rotating shield brachytherapy for prostate cancer.

PubMed

Adams, Quentin E; Xu, Jinghzu; Breitbach, Elizabeth K; Li, Xing; Enger, Shirin A; Rockey, William R; Kim, Yusung; Wu, Xiaodong; Flynn, Ryan T

2014-05-01

To present a novel needle, catheter, and radiation source system for interstitial rotating shield brachytherapy (I-RSBT) of the prostate. I-RSBT is a promising technique for reducing urethra, rectum, and bladder dose relative to conventional interstitial high-dose-rate brachytherapy (HDR-BT). A wire-mounted 62 GBq(153)Gd source is proposed with an encapsulated diameter of 0.59 mm, active diameter of 0.44 mm, and active length of 10 mm. A concept model I-RSBT needle/catheter pair was constructed using concentric 50 and 75 μm thick nickel-titanium alloy (nitinol) tubes. The needle is 16-gauge (1.651 mm) in outer diameter and the catheter contains a 535 μm thick platinum shield. I-RSBT and conventional HDR-BT treatment plans for a prostate cancer patient were generated based on Monte Carlo dose calculations. In order to minimize urethral dose, urethral dose gradient volumes within 0-5 mm of the urethra surface were allowed to receive doses less than the prescribed dose of 100%. The platinum shield reduced the dose rate on the shielded side of the source at 1 cm off-axis to 6.4% of the dose rate on the unshielded side. For the case considered, for the same minimum dose to the hottest 98% of the clinical target volume (D(98%)), I-RSBT reduced urethral D(0.1cc) below that of conventional HDR-BT by 29%, 33%, 38%, and 44% for urethral dose gradient volumes within 0, 1, 3, and 5 mm of the urethra surface, respectively. Percentages are expressed relative to the prescription dose of 100%. For the case considered, for the same urethral dose gradient volumes, rectum D(1cc) was reduced by 7%, 6%, 6%, and 6%, respectively, and bladder D(1cc) was reduced by 4%, 5%, 5%, and 6%, respectively. Treatment time to deliver 20 Gy with I-RSBT was 154 min with ten 62 GBq (153)Gd sources. For the case considered, the proposed(153)Gd-based I-RSBT system has the potential to lower the urethral dose relative to HDR-BT by 29%-44% if the clinician allows a urethral dose gradient volume of 0-5 mm around the urethra to receive a dose below the prescription. A multisource approach is necessary in order to deliver the proposed (153)Gd-based I-RSBT technique in reasonable treatment times.

Crustal-scale alpine tectonic evolution of the western Pyrenees - eastern Cantabrian Mountains (N Spain) from integration of structural data, low-T thermochronology and seismic constraint

NASA Astrophysics Data System (ADS)

DeFelipe, I.; Pedreira, D.; Pulgar, J. A.; Van der Beek, P.; Bernet, M.; Pik, R.

2017-12-01

The Pyrenean-Cantabrian Mountain belt extends in an E-W direction along the northern border of Spain and resulted from the convergence between the Iberian and European plates from the Late Cretaceous to the Miocene, in the context of the Alpine orogeny. The main aim of this work is to characterize the tectonic evolution at a crustal-scale of the transition zone from the Pyrenees to the Cantabrian Mountains, in the eastern Basque-Cantabrian Basin (BCB). We integrate structural work, thermochronology (apatite fission track and zircon (U-Th)/He) and geophysical information (shallow seismic reflection profiles, deep seismic refraction/wide-angle reflection profiles and seismicity distribution) to propose an evolutionary model since the Jurassic to the present. During the Albian, hyperextension related to the opening of the Bay of Biscay yielded to mantle unroofing to the base of the BCB. This process was favored by a detachment fault that connected the mantle in its footwall with the base of a deep basin in its hanging wall. During this process, the basin experienced HT metamorphism and fluid circulation caused the serpentinization of the upper part of the mantle. There is no evidence of seafloor mantle exhumation before the onset of the Alpine orogeny. The thermochronological study points to a N-vergent phase of contractional deformation in the late Eocene represented by the thin-skinned Leiza fault system followed in the early Oligocene by the S-vergent, thick-skinned, Ollín thrust. Exhumation rates for the late Eocene-early Oligocene are of 0.2-0.7 km/Myr. After that period, deformation continues southwards until the Miocene. The crustal-scale structure resultant of the Alpine orogeny consists of an Iberian plate that subducts below the European plate. The crust is segmented into four blocks separated by three S-vergent crustal faults inherited from the Cretaceous extensional period. The P-wave velocities in this transect show anomalous values (7.4 km/s) in the deepest part of the Iberian crust that may correspond to serpentinized mantle formed during the Cretaceous and later subducted. The Alpine shortening in this transect is estimated in ca. 90 km. Integration of structural, geophysical and thermochronological data, allows a more precise reconstruction of the crustal-scale Alpine cycle in the eastern BCB.

Location and description of transects for ecological studies in floodplain forests of the lower Suwannee River, Florida

USGS Publications Warehouse

Lewis, L.J.; Light, H.M.; Darst, M.R.

2001-01-01

Twelve transects were established in floodplain forests along the lower Suwannee River, Florida, as the principal data collection sites for a comprehensive study conducted by the U.S. Geological Survey and the Suwannee River Water Management District from 1996 to 2001. Data collected along the 12 transects included hydrologic conditions, land-surface elevations, soils, and vegetation of floodplain forests in relation to river flow. Transect locations are marked in the field with permanent markers at approximately 30 meter intervals. Detailed descriptions of the 12 transects and their locations are provided so that they can be used for future ecological studies. Descriptions of the transects include contact information necessary for access to the property on which the transects are located, maps showing transect locations and routes from the nearest city or major road, small scale maps of each transect showing marker locations, latitude and longitude of each marker, compass bearings of each transect line and graphs showing land-surface elevations of the transect with marker locations.

Granuloma Inguinale Simulating Squamous Cell Carcinoma.

PubMed

Mani, M Z; Singh, Trilochan; Mathew, Mary

1981-01-01

A case of extensive granuloma inguinale simulating squamous cell carcinoma is described. There was past history of urethritis leading to a urethral fistula. The ulcer healed almost completely within 19 days of receiving streptomycin injections. The patient had associated scabies and presumably also had latent syphillis (His VDRL was reactive in 1:8 dilution). The patient belonged to Madhya Pradesh.

Management of bladder neck stenosis and urethral stricture and stenosis following treatment for prostate cancer.

PubMed

Nicholson, Helen L; Al-Hakeem, Yasser; Maldonado, Javier J; Tse, Vincent

2017-07-01

The aim of this review is to examine all urethral strictures and stenoses subsequent to treatment for prostate cancer, including radical prostatectomy (RP), radiotherapy, high intensity focused ultrasound (HIFU) and cryotherapy. The overall majority respond to endoscopic treatment, including dilatation, direct visual internal urethrotomy (DVIU) or bladder neck incision (BNI). There are adjunct treatments to endoscopic management, including injections of corticosteroids and mitomycin C (MMC) and urethral stents, which remain controversial and are not currently mainstay of treatment. Recalcitrant strictures are most commonly managed with urethroplasty, while recalcitrant stenosis is relatively rare yet almost always associated with bothersome urinary incontinence, requiring bladder neck reconstruction and subsequent artificial urinary sphincter (AUS) implantation, or urinary diversion for the devastated outlet.

Management of bladder neck stenosis and urethral stricture and stenosis following treatment for prostate cancer

PubMed Central

Nicholson, Helen L.; Al-Hakeem, Yasser; Maldonado, Javier J.

2017-01-01

The aim of this review is to examine all urethral strictures and stenoses subsequent to treatment for prostate cancer, including radical prostatectomy (RP), radiotherapy, high intensity focused ultrasound (HIFU) and cryotherapy. The overall majority respond to endoscopic treatment, including dilatation, direct visual internal urethrotomy (DVIU) or bladder neck incision (BNI). There are adjunct treatments to endoscopic management, including injections of corticosteroids and mitomycin C (MMC) and urethral stents, which remain controversial and are not currently mainstay of treatment. Recalcitrant strictures are most commonly managed with urethroplasty, while recalcitrant stenosis is relatively rare yet almost always associated with bothersome urinary incontinence, requiring bladder neck reconstruction and subsequent artificial urinary sphincter (AUS) implantation, or urinary diversion for the devastated outlet. PMID:28791228

Asymptomatic urethral lymphogranuloma venereum: a case report.

PubMed

Charest, Louise; Fafard, Judith; Greenwald, Zoë R

2018-07-01

Since 2003, there has been a resurgence of lymphogranuloma venereum (LGV), a variant of Chlamydia trachomatis (CT), among men who have sex with men (MSM) in several urban areas of Europe and North America. LGV infection occurs most often at anal sites causing proctitis. Urethral and oropharyngeal infections are rare. In Quebec, LGV incidence has been increasing exponentially in recent years and the current guidelines support systematic LGV genotype testing among anorectal CT-positive samples only. This case report describes a patient with a urethral LGV infection, remarkable due to its prolonged asymptomatic development prior to the manifestation of an inguinal bubo. Physicians should be vigilant of potential cases of LGV and forward CT-positive samples occurring among individuals with LGV risk factors for genotype testing.

Unexpected complication after cystometry in the hypocompliant urinary bladder: formation of a knot in the double lumen urethral catheter--a case report.

PubMed

Ayyildiz, Ali; Huri, Emre; Nuhoğlu, Bariş; Germiyanoğlu, Cankon

2006-01-01

Urodynamic evaluation is frequently used in the follow-up of the treatment and diagnosis of incontinence, which develops in connection with a neurogenic or non-neurogenic reason. There is no identified serious complication during or after urodynamic evaluation, present in the literature up to date. Hematuria, due to the urethral catheter, the development of oedema in the urinary bladder wall and the development of urinary bladder spasm as a result of catheter irritation, are some of the complications, which may occur. In this paper, twist and knot formation in the double lumen urethral catheter after cystometry of a patient with a hypocompliant urinary bladder, has been presented.

Experience with management of posterior urethral injury associated with pelvic fracture.

PubMed

Coffield, K S; Weems, W L

1977-06-01

Review of records from 205 patients with pelvic fracture and hematuria revealed that 121 underwent urologic and radiographic evaluation. Of these patients 20 had severe posterior urethral injuries documented by urethrography of voiding cystourethrography: 9 underwent primary repair and 11 had delayed scrotal-inlay urethroplasty after initial cystostomy alone. Patients who underwent primary repair had a 77 per cent incidence of stricture, a 22 per cent incidence of incontinence and a 33 per cent incidence of impotency. Patients who underwent delayed closure had no incidence of stricture, incontinence or impotence. Patients in both groups had urinary tract infections. Simple cystostomy followed by delayed scrotal-inlay urethroplasty appears superior to primary realignment in the management of patients with posterior urethral injuries.

A role for subchondral bone changes in the process of osteoarthritis; a micro-CT study of two canine models.

PubMed

Sniekers, Yvonne H; Intema, Femke; Lafeber, Floris P J G; van Osch, Gerjo J V M; van Leeuwen, Johannes P T M; Weinans, Harrie; Mastbergen, Simon C

2008-02-12

This study evaluates changes in peri-articular bone in two canine models for osteoarthritis: the groove model and the anterior cruciate ligament transection (ACLT) model. Evaluation was performed at 10 and 20 weeks post-surgery and in addition a 3-weeks time point was studied for the groove model. Cartilage was analysed, and architecture of the subchondral plate and trabecular bone of epiphyses was quantified using micro-CT. At 10 and 20 weeks cartilage histology and biochemistry demonstrated characteristic features of osteoarthritis in both models (very mild changes at 3 weeks). The groove model presented osteophytes only at 20 weeks, whereas the ACLT model showed osteophytes already at 10 weeks. Trabecular bone changes in the groove model were small and not consistent. This contrasts the ACLT model in which bone volume fraction was clearly reduced at 10 and 20 weeks (15-20%). However, changes in metaphyseal bone indicate unloading in the ACLT model, not in the groove model. For both models the subchondral plate thickness was strongly reduced (25-40%) and plate porosity was strongly increased (25-85%) at all time points studied. These findings show differential regulation of subchondral trabecular bone in the groove and ACLT model, with mild changes in the groove model and more severe changes in the ACLT model. In the ACLT model, part of these changes may be explained by unloading of the treated leg. In contrast, subchondral plate thinning and increased porosity were very consistent in both models, independent of loading conditions, indicating that this thinning is an early response in the osteoarthritis process.

Comparison of nitinol urethral stent infections with indwelling catheter-associated urinary-tract infections.

PubMed

Egilmez, Tulga; Aridogan, I Atilla; Yachia, Daniel; Hassin, David

2006-04-01

To determine the efficacy of intraurethral metal stents in preventing or eradicating urinary-tract infections (UTI) during the management of bladder outlet obstruction (BOO) by comparing the frequency and nature of the infections with indwelling-catheter-associated UTI. The SAS relative-risk test was used to compare the risks of UTI in 76 patients with temporary urethral stents, 60 patients with BOO who had never been catheterized nor stented, and 34 patients with a permanent indwelling urethral catheter (PIUC). Infection was assessed 1 month after placement of the devices. Scanning electron microscopy (SEM) of the proximal and distal pieces of the stents removed from five patients with and five patients without UTI was carried out in a search for predisposing changes on the surfaces. After insertion of the catheter, UTI developed in 79.4% of the patients who originally had sterile urine. However, after insertion of the stent, UTI developed in only 40.9% of the patients with sterile urine. In 21 (44.6%) of the catheterized patients who had infected urine, UTI was eradicated after stent insertion. The SEM analysis of the stents showed that a thick organic layer had formed only on the infected devices but with no sign of erosion. Urinary infection is a significant problem in patients with PIUC but is significantly less frequent and less severe in patients with urethral stents. This advantage of stents over the conventional urethral catheter, in addition to their obvious convenience for the patient, make them good alternatives to reduce the risk of UTI.

On the art of anastomotic posterior urethroplasty: a 27-year experience.

PubMed

Koraitim, Mamdouh M

2005-01-01

We determined the various operative details of anastomotic posterior urethroplasty that are essential for a successful result. We reviewed the medical records of 155 patients who had undergone anastomotic repair of posterior urethral strictures or distraction defects between 1977 and 2003. Patient age ranged from 3 to 58 years (mean 21) and all except 1 had sustained a pelvic fracture urethral injury as the initial causative trauma. Repair was performed with a perineal procedure in 113 patients, elaborated perineal in 2 and perineo-abdominal in 40. Followup ranged from 1 to 22 years. The results were successful in 104 (90%) cases after perineal (including 2 elaborated perineal) and in 39 (98%) after perineo-abdominal repair. Successful results were sustained for up to 22 years after surgery. Urinary incontinence did not develop in any patients while 2 lost potency as a direct result of anastomotic surgery. Of the operative details 3 constitute the gold triad that assures a successful outcome, namely complete excision of scarred tissues, fixation of healthy mucosa of the 2 urethral ends and creation of a tension-free anastomosis. When the bulboprostatic urethral gap is 2.5 cm or less, restoration of urethral continuity may be accomplished with a perineal procedure after liberal mobilization of the bulbar urethra. For defects of 2.5 cm or greater the elaborated perineal or perineo-abdominal transpubic procedure should be used. In the presence of a competent bladder neck, anastomotic surgery does not result in urinary incontinence. Impotence is usually related to the original trauma and rarely (2%) to urethroplasty itself.

Urethral inflammatory response to ureaplasma is significantly lower than to Mycoplasma genitalium and Chlamydia trachomatis.

PubMed

Moi, Harald; Reinton, Nils; Randjelovic, Ivana; Reponen, Elina J; Syvertsen, Line; Moghaddam, Amir

2017-07-01

A non-syndromic approach to treatment of people with non-gonococcal urethritis (NGU) requires identification of pathogens and understanding of the role of those pathogens in causing disease. The most commonly detected and isolated micro-organisms in the male urethral tract are bacteria belonging to the family of Mycoplasmataceae, in particular Ureaplasma urealyticum and Ureaplasma parvum. To better understand the role of these Ureaplasma species in NGU, we have performed a prospective analysis of male patients voluntarily attending a drop in STI clinic in Oslo. Of 362 male patients who were tested for NGU using microscopy of urethral smears, we found the following sexually transmissible micro-organisms: 16% Chlamydia trachomatis, 5% Mycoplasma genitalium, 14% U. urealyticum, 14% U. parvum and 5% Mycoplasma hominis. We found a high concordance in detecting in turn U. urealyticum and U. parvum using 16s rRNA gene and ureD gene as targets for nucleic acid amplification testing (NAAT). Whilst there was a strong association between microscopic signs of NGU and C. trachomatis infection, association of M. genitalium and U. urealyticum infections in turn were found only in patients with severe NGU (>30 polymorphonuclear leucocytes, PMNL/high powered fields, HPF). U. parvum was found to colonise a high percentage of patients with no or mild signs of NGU (0-9 PMNL/HPF). We conclude that urethral inflammatory response to ureaplasmas is less severe than to C. trachomatis and M. genitalium in most patients and that testing and treatment of ureaplasma-positive patients should only be considered when other STIs have been ruled out.

Primary Realignment for Pelvic Fracture Urethral Injury Is Associated With Prolonged Time to Urethroplasty and Increased Stenosis Complexity.

PubMed

Horiguchi, Akio; Shinchi, Masayuki; Masunaga, Ayako; Okubo, Kazuki; Kawamura, Kazuki; Ojima, Kenichiro; Ito, Keiichi; Asano, Tomohiko; Azuma, Ryuichi

2017-10-01

To compare the clinical courses of patients with pelvic fracture urethral injury (PFUI) according to initial management strategy. We reviewed the clinical courses of 63 patients with PFUI who were initially treated elsewhere and underwent delayed anastomotic urethroplasty by a single surgeon between 2008 and 2015. Patients were grouped according to their initial treatment: by suprapubic tube placement alone (49 patients, SPT group) or primary realignment (14 patients, PR group). Time to urethroplasty was defined as the period between injury and delayed urethroplasty. Clinical data regarding the status of urethral stenosis, urethroplasty procedure, and treatment outcome were analyzed. The mean time to urethroplasty in the PR group was about 3 times than that in the SPT group (133 months vs 47 months, P = .035). Fifty percent of the PR group (7 of 14) had a history of repeated urethrotomy or dilation before referral, a percentage significantly higher than that of the SPT group (20.4%, 10 of 49, P = .027). The percentage of patients having a false passage and iatrogenic scar was significantly higher in the PR group (42.9% vs 16.3%, P = .035), but there was no significant between-group difference in urethral stenosis length, operative time, operative blood loss, or the percentage of patients requiring inferior pubectomy or urethral rerouting. PR does not facilitate delayed urethroplasty, and patients who undergo PR are at high risk of having a more complicated stenosis and longer time to urethroplasty, presumably because of repeated transurethral procedures. Copyright © 2017 Elsevier Inc. All rights reserved.

Mini-invasive techniques for the treatment of female stress urinary incontinence.

PubMed

Vianello, A; Costantini, E; Del Zingaro, M; Porena, M

2007-12-01

The aim of this study was to review recent literature on mini-invasive surgical technique for the treatment of female stress urinary incontinence (SUI). Surgical aspects, intraoperative and perioperative complications and objective and subjective outcomes were analyzed and compared. The PubMed databank from 2000 to February 2007 was searched for original prospective and randomized studies in English, on surgical treatment of female SUI, which avoided a laparotomic access to the female pelvis. Studies had to investigate at least 40 women with a minimum follow-up of 12 months. A total of 38 prospective studies were found: 27 of them were on mid-urethral slings; 8 assessed urethral injections; and 3 radiofrequency treatment. Fifteen studies were randomized. Follow-ups ranged from 12 to 60 months, except for sexual function which had a 6-month follow-up. Ten out of 38 studies assessed patients who did not refer pelvic organ prolapse or detrusor overactivity and had not undergone any previous anti-incontinence procedure. Mid-urethral slings showed good outcomes and are safe and brief to perform and have a relatively short learning curve. Urethral injections showed discouraging results, as they have poor outcomes and repetitive treatments are frequently necessary. Injections can be used in women with contraindications to major surgical procedures, with intrinsic sphincter deficiency as the main cause of incontinence. Radiofrequency showed worse results than mid-urethral slings and is a valuable choice in women who refuse more invasive procedures. The development of studies with longer follow-ups on mini-invasive surgical techniques are encouraged.

On the Stiffness of the Mesh and Urethral Mobility: A Finite Element Analysis.

PubMed

Brandão, Sofia; Parente, Marco; Da Roza, Thuane Huyer; Silva, Elisabete; Ramos, Isabel Maria; Mascarenhas, Teresa; Natal Jorge, Renato Manuel

2017-08-01

Midurethral slings are used to correct urethral hypermobility in female stress urinary incontinence (SUI), defined as the complaint of involuntary urine leakage when the intra-abdominal pressure (IAP) is increased. Structural and thermal features influence their mechanical properties, which may explain postoperative complications, e.g., erosion and urethral obstruction. We studied the effect of the mesh stiffness on urethral mobility at Valsalva maneuver, under impairment of the supporting structures (levator ani and/or ligaments), by using a numerical model. For that purpose, we modeled a sling with "lower" versus "higher" stiffness and evaluated the mobility of the bladder and urethra, that of the urethrovesical junction (the α-angle), and the force exerted at the fixation of the sling. The effect of impaired levator ani or pubourethral ligaments (PUL) alone on the organs displacement and α-angle opening was similar, showing their important role together on urethral stabilization. When the levator ani and all the ligaments were simulated as impaired, the descent of the bladder and urethra went up to 25.02 mm, that of the bladder neck was 14.57 mm, and the α-angle was 129.7 deg, in the range of what was found in women with SUI. Both meshes allowed returning to normal positioning, although at the cost of higher force exerted by the mesh with higher stiffness (3.4 N against 2.3 N), which can relate to tissue erosion. This finite element analysis allowed mimicking the biomechanical response of the pelvic structures in response to changing a material property of the midurethral synthetic mesh.

ASSOCIATIONS BETWEEN ULTRASOUND AND CLINICAL FINDINGS IN 87 CATS WITH URETHRAL OBSTRUCTION.

PubMed

Nevins, Jonathan R; Mai, Wilfried; Thomas, Emily

2015-01-01

Urethral obstruction is a life-threatening form of feline lower urinary tract disease. Ultrasonographic risk factors for reobstruction have not been previously reported. Purposes of this retrospective cross-sectional study were to describe urinary tract ultrasound findings in cats following acute urethral obstruction and determine whether ultrasound findings were associated with reobstruction. Inclusion criteria were a physical examination and history consistent with urethral obstruction, an abdominal ultrasound including a full evaluation of the urinary system within 24 h of hospitalization, and no cystocentesis prior to ultrasound examination. Medical records for included cats were reviewed and presence of azotemia, hyperkalemia, positive urine culture, and duration of hospitalization were recorded. For medically treated cats with available outcome data, presence of reobstruction was also recorded. Ultrasound images were reviewed and urinary tract characteristics were recorded. A total of 87 cats met inclusion criteria. Common ultrasound findings for the bladder included echogenic urine sediment, bladder wall thickening, pericystic effusion, hyperechoic pericystic fat, and increased urinary echoes; and for the kidneys/ureters included pyelectasia, renomegaly, perirenal effusion, hyperechoic perirenal fat, and ureteral dilation. Six-month postdischarge outcomes were available for 61 medically treated cats and 21 of these cats had reobstruction. No findings were associated with an increased risk of reobstruction. Ultrasonographic perirenal effusion was associated with severe hyperkalemia (P = 0.009, relative risk 5.75, 95% confidence interval [1.54-21.51]). Findings supported the use of ultrasound as an adjunct for treatment planning in cats presented with urethral obstruction but not as a method for predicting risk of reobstruction. © 2015 American College of Veterinary Radiology.

Genitourinary tract injuries in girls.

PubMed

Okur, H; Küçïkaydin, M; Kazez, A; Turan, C; Bozkurt, A

1996-09-01

To evaluate lower genitourinary tract injuries in girls and to propose guidelines for the investigation and initial management of this unusual injury. The hospital records of 38 girls (aged 2-13 years) treated in our institution because of lower genitourinary (LG) tract injury between 1988 and 1995 were reviewed retrospectively. Urethral ruptures were detected in six patients, but the most frequent injuries were to the vulva (63%) and vagina (53%). There were pelvic fractures in eight patients and femoral fractures in a further five. Eight patients had concomitant anorectal lacerations. Vaginal and perineal lacerations were repaired primarily and a temporary urethral catheter was placed for a mean of 3 days. Partial urethral disruptions were repaired primarily over a stenting catheter in three patients. In one case, vaginal laceration and proximal complete rupture of the urethra was managed through a transvaginal approach with end-to-end urethral anastomosis over a stenting catheter. There was a complete rupture of the distal urethra and avulsion of the external meatus in two cases and these patients were managed by urethral advancement and meatoplasty. Perineal physical signs did not reflect the severity of the lesions and cystovaginoscopy allowed localization of lacerations in some cases. Primary repair was possible in all cases. Three patients (8%) had wound infection after surgery. One patient had temporary urinary incontinence which was managed conservatively and one patient had faecal incontinence which needed secondary surgery. All female paediatric patients with suspected LG tract injury should undergo examination under anaesthesia to determine the degree of injury or possible concomitant injury to the urethra, bladder or rectum. Primary repair of these injuries is recommended.

Current concepts in the management of pelvic fracture urethral distraction defects

PubMed Central

Manikandan, Ramanitharan; Dorairajan, Lalgudi N.; Kumar, Santosh

2011-01-01

Objectives: Pelvic fracture urethral distraction defect (PFUDD) may be associated with disabling complications, such as recurrent stricture, urinary incontinence, and erectile dysfunction. In this article we review the current concepts in the evaluation and surgical management of PFUDD, including redo urethroplasty. Materials and Methods: A PubMed™ search was performed using the keywords “pelvic fracture urethral distraction defect, anastomotic urethroplasty, pelvic fracture urethral stricture, pelvic fracture urethral injuries, and redo-urethroplasty.” The search was limited to papers published from 1980 to March 2010 with special focus on those published in the last 15 years. The relevant articles were reviewed with regard to etiology, role of imaging, and the techniques of urethroplasty. Results: Pelvic fracture due to accidents was the most common etiology of PFUDD that usually involved the membranous urethra. Modern cross-sectional imaging, such as sonourethrography and magnetic resonance imaging help assess stricture pathology better, but their precise role in PFUDD management remains undefined. Surgical treatment with perineal anastomotic urethroplasty yields a success rate of more than 90% in most studies. The most important complication of surgical reconstruction is restenosis, occurring in less than 10% cases, most of which can be corrected by a redo anastomotic urethroplasty. The most common complication associated with this condition is erectile dysfunction. Urinary incontinence is a much rarer complication of this surgery in the present day. Conclusions: Anastomotic urethroplasty remains the cornerstone in the management of PFUDD, even in previously failed repairs. Newer innovations are needed to address the problem of erectile dysfunction associated with this condition. PMID:22022064

Primary realignment vs suprapubic cystostomy for the management of pelvic fracture-associated urethral injuries: a systematic review and meta-analysis.

PubMed

Barrett, Keith; Braga, Luis H; Farrokhyar, Forough; Davies, Timothy O

2014-04-01

To compare primary urethral realignment (PR) with suprapubic cystostomy (SPC) for the management of pelvic fracture-associated posterior urethral injuries with regards to rates of stricture, erectile dysfunction, and urinary incontinence. Two electronic databases (MEDLINE and EMBASE) were searched with the assistance of a librarian. Title, abstract, and full text screening was carried out by 2 independent reviewers, with discrepancies resolved by consensus. Narrative reviews, surveys, and historical articles were excluded. Only studies reporting a direct comparison of PR vs SPC for the management of posterior urethral injuries associated with blunt trauma in adults were included. Quality assessment of the included articles was performed in duplicate. Stricture incidence was evaluated for all included studies, as were erectile dysfunction and incontinence rates when reported. All outcomes were treated as dichotomous data with calculation of odds ratio and were pooled using a random effects model with Review Manager 5.1. Our comprehensive search yielded 161 unique articles. Nine articles were included in the final meta-analysis. Stricture rate was significantly lower in the PR group (odds ratio [OR] = 0.12, 95% confidence interval [CI] 0.04-0.41, P <.001). There was no significant difference between the 2 interventions with regards to erectile dysfunction (OR = 1.19, 95% CI 0.73-1.92, P = .49) or incontinence (OR = 0.75, 95% CI 0.38-1.48, P = .41). PR appears to reduce the incidence of stricture formation after pelvic fracture-associated posterior urethral injuries as compared with SPC. Copyright © 2014 Elsevier Inc. All rights reserved.

Operative techniques of anastomotic posterior urethroplasty for traumatic posterior urethral strictures.

PubMed

Zhou, Zhan-song; Song, Bo; Jin, Xi-yu; Xiong, En-qing; Zhang, Jia-hua

2007-04-01

To elucidate the details of operative technique of anastomotic posterior urethroplasty for traumatic posterior urethral strictures in attempt to offer a successful result. We reviewed the clinical data of 106 patients who had undergone anastomotic repair for posterior urethral strictures following traumatic pelvic fracture between 1979 and 2004. Patients'age ranged from 8 to 53 years (mean 27 years). Surgical repair was performed via perinea in 72 patients, modified transperineal repair in 5 and perineoabdominal repair in 29. Follow-up ranged from 1 to 23 years (mean 8 years). Among the 77 patients treated by perineal approaches, 69 (95.8%) were successfully repaired and 27 out of the 29 patients (93.1%) who were repaired by perineoabdominal protocols were successful. The successful results have sustained as long as 23 years in some cases. Urinary incontinence did not happen in any patients while impotence occurred as a result of the anastomotic surgery. Three important skills or principles will ensure a successful outcome, namely complete excision of scar tissues, a completely normal mucosa ready for anastomosis at both ends of the urethra, and a tension-free anastomosis. When the urethral stricture is below 2.5 cm long, restoration of urethral continuity can be accomplished by a perineal procedure. If the stricture is over 2.5 cm long, a modified perineal or transpubic perineoabdominal procedure should be used. In the presence of a competent bladder neck, anastomotic surgery does not result in urinary incontinence. Impotence is usually related to the original trauma and rarely (5.7%) to urethroplasty.

Is a sequence of tests during urethral pressure profilometry correlated with symptoms assessment in women?

PubMed

Valentini, Françoise A; Robain, Gilberte; Marti, Brigitte G

2012-01-01

Our purpose was, applying a strictly defined protocol for urethral profilometry, 1) to test the repeatability of same session rest maximum urethral closure pressure (MUCP) and 2) to search for correlation between women complaint and the changes in MUCP value (rest and dynamic tests). A population of 140 consecutive women referred for evaluation of lower urinary tract dysfunction was stratified in 4 groups according with the urinary symptoms: stress, urge, mixed incontinence and continent and in each group in 3 age groups (young, middle age and old). The sequence of tests recorded in supine position was: urethral pressure profile at rest bladder empty, after bladder filling at 250 mL (reference test), stress profile, fatigability (before (rest) and after 10 successive strong coughs), then in standing position. In all groups, there was no significant difference between the two MUCP values at rest bladder filled. In the three incontinent groups, MUCP was higher bladder empty than bladder filled (p < 0.05) except in the young sub-group. Stress incontinence led to significant decrease of MUCP during dynamic tests in the young group. MUCP was not modified after fatigability test in women with urge complaint whatever age. When recorded following a strictly defined protocol, MUCP at rest bladder filled has a good repeatability in individual. However a complex sequence of tests during urethral pressure profilometry remains discussed in middle-age and old age-groups, it allows specifying the stress component of incontinence in young women and the urgency component in all age-groups.

Sonographic evaluation of the bladder neck in continent and stress-incontinent women.

PubMed

Schaer, G N; Perucchini, D; Munz, E; Peschers, U; Koechli, O R; Delancey, J O

1999-03-01

To evaluate a new sonographic method to measure depth and width of proximal urethral dilation during coughing and Valsalva maneuver and to report its use in a group of stress-incontinent and continent women. Fifty-eight women were evaluated, 30 with and 28 without stress incontinence proven urodynamically, with a bladder volume of 300 mL and the subjects upright. Urethral pressure profiles at rest were performed with a 10 French microtip pressure catheter. Bladder neck dilation and descent were assessed by perineal ultrasound (5 MHz curved linear array transducer) with the help of ultrasound contrast medium (galactose suspension-Echovist-300), whereas abdominal pressure was assessed with an intrarectal balloon catheter. Statistical analysis used the nonparametric Mann-Whitney test. The depth and diameter of urethral dilation could be measured in all women. During Valsalva, all 30 incontinent women exhibited urethral dilation. One incontinent woman showed dilation only while performing a Valsalva maneuver, not during coughing. In the continent group, 12 women presented dilation during Valsalva and six during coughing. In continent women, dilation was visible only in those who were parous. Nulliparous women did not have dilation during Valsalva or coughing. Bladder neck descent was visible in continent and incontinent women. This method permits quantification of depth and diameter of bladder neck dilation, showing that both incontinent and continent women might have bladder neck dilation and that urinary continence can be established at different locations along the urethra in different women. Parity seems to be a main prerequisite for a proximal urethral defect with bladder neck dilation.

Autologous Pubovaginal Sling for the Treatment of Concomitant Female Urethral Diverticula and Stress Urinary Incontinence.

PubMed

Enemchukwu, Ekene; Lai, Caroline; Reynolds, William Stuart; Kaufman, Melissa; Dmochowski, Roger

2015-06-01

To describe our experience with concomitant repair of urethral diverticula and stress urinary incontinence (SUI) with autologous pubovaginal sling (PVS). A retrospective chart review between January 2006 and 2013 identified 38 women undergoing concomitant diverticulectomy and rectus sheath PVS. Patient demographics, presenting symptoms, prior urethral surgery, concomitant procedures, postoperative outcomes, and complications were evaluated. The mean duration of symptoms was 56.7 months. Eleven patients presented with recurrent diverticula and 5 patients had prior SUI surgery (3 midurethral slings, 1 PVS, and 1 bulking agent). One patient had a prior urethrolysis. All other slings were cut or excised at the time of surgery. All women had demonstrable SUI on cough stress test or urodynamics. The mean follow-up was 12.7 months. All postoperative voiding cystourethrograms were negative for contrast extravasation. One patient required prolonged (>4 weeks) suprapubic tube drainage for urinary retention. Four others required an additional 1 week of suprapubic tube drainage. Eighteen patients (47%) reported mixed urinary symptoms. Of these, 9 had complete resolution, whereas 9 experienced significant improvement. Overall, 97.3% reported resolution of their dysuria, dyspareunia, and pain symptoms and 90% reported complete resolution of their SUI symptoms. There were 2 urethral diverticula recurrences and 2 SUI recurrences. Perioperative complications, including hemorrhage, sling erosion, or urethrovaginal fistulas, were not observed. Concomitant PVS placement is a safe and effective treatment option for SUI in patients undergoing urethral diverticulectomy. The risks and benefits should be weighed and management individualized. Copyright © 2015 Elsevier Inc. All rights reserved.

Enigma of urethral pain syndrome: why are there so many ascribed etiologies and therapeutic approaches?

PubMed

Phillip, Harris; Okewole, Idris; Chilaka, Victor

2014-06-01

Urethral pain syndrome has had several sobriquets, which have led to much confusion over the existence of this pathological condition and the useful options in the care of the afflicted patient. Our aim was to explore the proposed etiologies of this syndrome, and to provide a critical analysis of each proposed etiology and present a balanced argument on the plausibility of the proposed etiology and therapeutic approaches. We carried out an English language electronic search in the following databases: Medline, Embase, Amed, Cinahl, Pubmed, Cochrane Library, Trip Database and SUMSearch using the following search terms: urethral syndrome, urethral diseases, urethra, urologic diseases etiology/etiology, presentation, treatment, outcome, therapeutics and treatment from 1951 to 2011. In excess of 200 articles were recovered. With the clearly defined objectives of analyzing the proposed etiologies and therapeutic regimes, two author(s) (HP and IO) perused the abstracts of all the recovered articles, selecting those that addressed the etiologies and therapeutic approaches to treating the urethral pain syndrome. The number of articles was reduced to 25. The full text of all 25 articles were retrieved and reviewed. Through the present article, we hope to elucidate the most probable etiology of this condition whilst simultaneously, advance a logical explanation for the apparent success in the treatment of this condition using a range of different therapeutic modalities. We have carried out a narrative review, which we hope will reduce some of the confusion around this clinical entity by combining the known facts about the disease. © 2014 The Japanese Urological Association.

Histologic Anatomy of the Anterior Vagina and Urethra.

PubMed

Mazloomdoost, Donna; Westermann, Lauren B; Mutema, George; Crisp, Catrina C; Kleeman, Steven D; Pauls, Rachel N

Vaginal and urethral histology is important to understanding the pathophysiology of the pelvic floor. En bloc removal of 4 female cadaveric pelvises was performed, with 18 to 25 serial sections obtained from each. The vaginal and urethral lengths were divided into distal and proximal sections; urethra was divided into anterior and posterior segments as well. Innervation and vasculature were qualified as small and large and quantified per high-power field. The mean vaginal length was 7.45 cm, and the mean urethral length was 3.38 cm. A distinct vaginal fibromuscular layer was noted, without evidence of a dense sheet of continuous collagen. An epithelial, lamina propria, and muscular layer surrounded the urethral lumen. Adipose and loose fibroconnective tissue separated the urethra from the anterior vagina in 41% of slides. Nerves and vasculature were concentrated in the lamina propria. More small nerves and vessels were grossly seen compared with larger counterparts in both the vagina and urethra. No significant differences in layer thickness, innervation, or vasculature were observed along the vaginal length. The posterior urethra had greater innervation than did the anterior (P = 0.012). The distal posterior urethra had more large vessels than did the proximal posterior urethra (P = 0.03). No other differences were noted in urethral sections. A vaginal fibromuscular layer was confirmed, refuting a true fascia. Innervation and vasculature were quantitatively the same along the anterior vagina. However, the posterior urethra had greater innervation than did anterior and is most innervated proximally. Nerve and vascular histology may relate to pelvic floor disorder etiology.

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. Copyright © 2015 Elsevier B.V. All rights reserved.

Tectonic Structure of the Middle America Pacific Margin and Incoming Cocos Plate From Costa Rica to Guatemala

NASA Astrophysics Data System (ADS)

Ranero, C. R.; Weinrebe, W.; Grevemeyer, I.; Phipps Morgan, J.; Vannucchi, P.; von Huene, R.

2003-12-01

A new multibeam bathymetry and magnetic survey with R/V SONNE in summer 2003 has mapped the continental margin and incoming plate of NW Nicaragua, El Salvador and Guatemala, extending existing coverage from offshore Costa Rica and part of Nicaragua to a full coverage map of about 1200 km long by 100 km wide area along the plate boundary. The incoming plate along Nicaragua, El Salvador and Guatemala is of similar age and was formed at superfast spreading rates; however, its morphology changes drastically along strike. The seafloor-spreading inherited morphology is very smooth along Nicaragua, but with ridges up to 800 m high in Guatemala, with a transition across El Salvador. The development and dimensions of the dominant inherited fabric seems to be related to discontinuities at the paleospreading center. A series of troughs oblique to the main fabric may indicate the location of pseudofaults and correspond to areas where the seafloor fabric is most prominent. Bending of the oceanic plate into the trench reactivates the inherited fabric forming a well pervasive faulting system along the oceanic trench slope. The continental slope displays three morphotectonic units that roughly correspond to the upper, middle and lower slope, although the across slope width of each unit is fairly variable. Small canyons and gullies that form at the sudden dip change across the shelf break carve the upper slope. The canyons coalesce and become shallower as the dip decreases downslope. Locally some large canyons continue into the slope toe. The middle slope is a rough terrain variable in width and dip sculptured by pervasive normal faulting and locally by mass wasting processes. The lower slope is formed by en echelon terraces striking similar to the rough terrain of the incoming plate and mimicking the half graben morphology of the underthusting plate. The three morphotectonic slope domains represent differences in tectonic activity, with more stable upper slope, a middle slope dominated by tectonic extension and the thin, highly fractured upper plate of the lower slope riffling over the incoming plate topography. The trench axis is largely empty, with local turbidite ponds at the mouth of a few large canyons transecting the entire slope.

Management of Long-Segment and Panurethral Stricture Disease.

PubMed

Martins, Francisco E; Kulkarni, Sanjay B; Joshi, Pankaj; Warner, Jonathan; Martins, Natalia

2015-01-01

Long-segment urethral stricture or panurethral stricture disease, involving the different anatomic segments of anterior urethra, is a relatively less common lesion of the anterior urethra compared to bulbar stricture. However, it is a particularly difficult surgical challenge for the reconstructive urologist. The etiology varies according to age and geographic location, lichen sclerosus being the most prevalent in some regions of the globe. Other common and significant causes are previous endoscopic urethral manipulations (urethral catheterization, cystourethroscopy, and transurethral resection), previous urethral surgery, trauma, inflammation, and idiopathic. The iatrogenic causes are the most predominant in the Western or industrialized countries, and lichen sclerosus is the most common in India. Several surgical procedures and their modifications, including those performed in one or more stages and with the use of adjunct tissue transfer maneuvers, have been developed and used worldwide, with varying long-term success. A one-stage, minimally invasive technique approached through a single perineal incision has gained widespread popularity for its effectiveness and reproducibility. Nonetheless, for a successful result, the reconstructive urologist should be experienced and familiar with the different treatment modalities currently available and select the best procedure for the individual patient.

An NTCP Analysis of Urethral Complications from Low Doserate Mono- and Bi-Radionuclide Brachytherapy.

PubMed

Nuttens, V E; Nahum, A E; Lucas, S

2011-01-01

Urethral NTCP has been determined for three prostates implanted with seeds based on (125)I (145 Gy), (103)Pd (125 Gy), (131)Cs (115 Gy), (103)Pd-(125)I (145 Gy), or (103)Pd-(131)Cs (115 Gy or 130 Gy). First, DU(20), meaning that 20% of the urhral volume receive a dose of at least DU(20), is converted into an I-125 LDR equivalent DU(20) in order to use the urethral NTCP model. Second, the propagation of uncertainties through the steps in the NTCP calculation was assessed in order to identify the parameters responsible for large data uncertainties. Two sets of radiobiological parameters were studied. The NTCP results all fall in the 19%-23% range and are associated with large uncertainties, making the comparison difficult. Depending on the dataset chosen, the ranking of NTCP values among the six seed implants studied changes. Moreover, the large uncertainties on the fitting parameters of the urethral NTCP model result in large uncertainty on the NTCP value. In conclusion, the use of NTCP model for permanent brachytherapy is feasible but it is essential that the uncertainties on the parameters in the model be reduced.

[Buccal mucosa graft augmented anastomotic urethroplasty for the treatment of bulbar urethral strictures].

PubMed

Virasoro, Ramón; Storme, Oscar Alfonso; Capiel, Leandro; Ghisini, Diego Andrés; Rovegno, AugustÍn

2015-12-01

To report our outcomes with the use of buccal mucosal graft anastomotic urethroplasty to reconstruct complex anterior urethral strictures. Between October 2007 and January 2011 we conducted a retrospective review of a series of 65 patients from 2 different centers. We analyzed demographic data, surgical outcomes and complications. Patient mean age was 50.09 years (range: 25 to 75), mean stricture length was 3.95 cm (range: 3 to 7 cm) and mean follow-up 33.13 months (range: 12.7 to 52.77). Eighty percent of patients had prior treatments, mainly direct visual internal urethrotomy (DVIU) and urethral dilatation. Most frequent etiologies were iatrogenic in 46.15% of patients and idiopathic in 35.38% of patients. Success rate was achieved in 96.92% of patients; only 2 patients presented recurrence and were treated successfully with one DVIU. Clavien Dindo I-II complications were found in 59% of patients. No patient had chronic sequels. Augmented anastomotic urethroplasty using dorsal onlay buccal mucosa graft enables correction, in one time, of long segment urethral strictures with severe spongiofibrosis and/or obliterated lumen. Our outcomes are comparable with those of previously reported in international series.

Prostatomembranous urethral disruptions: management by suprapubic cystostomy and delayed urethroplasty.

PubMed

Husmann, D A; Wilson, W T; Boone, T B; Allen, T D

1990-07-01

Management of prostatomembranous urethral disruptions associated with pelvic fractures remains a major controversy in urology. A group of 64 patients who suffered a prostatomembranous urethral disruption in association with a pelvic fracture and who were managed initially by suprapubic cystostomy with delayed urethroplasty was compared to 17 patients managed initially by primary realignment. No statistically significant difference in the incidence of impotence or urinary incontinence was found between the 2 groups (p greater than 0.5) Secondary reconstructions for impassable strictures developed in 95% of the patients treated by a suprapubic tube alone compared to 53% of those treated by primary realignment. Indeed, only 1 patient in the latter group achieved urethral continuity that did not require further intervention. We conclude that while primary realignment is associated with no increase in the instance of impotence and urinary incontinence, it subjects the patient to a major operation at a critical time and provides little in the way of long-term positive gains for the effort expended. In the final analysis the outcome is more dependent upon the nature of the injury and the quality of the repair than upon the order in which the repair is effected.

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. © 2013 Japanese Teratology Society.

Interstitial rotating shield brachytherapy for prostate cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Adams, Quentin E., E-mail: quentin-adams@uiowa.edu; Xu, Jinghzu; Breitbach, Elizabeth K.

Purpose: To present a novel needle, catheter, and radiation source system for interstitial rotating shield brachytherapy (I-RSBT) of the prostate. I-RSBT is a promising technique for reducing urethra, rectum, and bladder dose relative to conventional interstitial high-dose-rate brachytherapy (HDR-BT). Methods: A wire-mounted 62 GBq{sup 153}Gd source is proposed with an encapsulated diameter of 0.59 mm, active diameter of 0.44 mm, and active length of 10 mm. A concept model I-RSBT needle/catheter pair was constructed using concentric 50 and 75 μm thick nickel-titanium alloy (nitinol) tubes. The needle is 16-gauge (1.651 mm) in outer diameter and the catheter contains a 535more » μm thick platinum shield. I-RSBT and conventional HDR-BT treatment plans for a prostate cancer patient were generated based on Monte Carlo dose calculations. In order to minimize urethral dose, urethral dose gradient volumes within 0–5 mm of the urethra surface were allowed to receive doses less than the prescribed dose of 100%. Results: The platinum shield reduced the dose rate on the shielded side of the source at 1 cm off-axis to 6.4% of the dose rate on the unshielded side. For the case considered, for the same minimum dose to the hottest 98% of the clinical target volume (D{sub 98%}), I-RSBT reduced urethral D{sub 0.1cc} below that of conventional HDR-BT by 29%, 33%, 38%, and 44% for urethral dose gradient volumes within 0, 1, 3, and 5 mm of the urethra surface, respectively. Percentages are expressed relative to the prescription dose of 100%. For the case considered, for the same urethral dose gradient volumes, rectum D{sub 1cc} was reduced by 7%, 6%, 6%, and 6%, respectively, and bladder D{sub 1cc} was reduced by 4%, 5%, 5%, and 6%, respectively. Treatment time to deliver 20 Gy with I-RSBT was 154 min with ten 62 GBq {sup 153}Gd sources. Conclusions: For the case considered, the proposed{sup 153}Gd-based I-RSBT system has the potential to lower the urethral dose relative to HDR-BT by 29%–44% if the clinician allows a urethral dose gradient volume of 0–5 mm around the urethra to receive a dose below the prescription. A multisource approach is necessary in order to deliver the proposed {sup 153}Gd-based I-RSBT technique in reasonable treatment times.« less

Comparison of methylene blue/gentian violet stain to Gram's stain for the rapid diagnosis of gonococcal urethritis in men.

PubMed

Taylor, Stephanie N; DiCarlo, Richard P; Martin, David H

2011-11-01

We compared a simple, one-step staining procedure using a mixture of methylene blue and gentian violet to Gram stain for the detection of gonococcal urethritis. The sensitivity and specificity of both Gram stain and methylene blue/gentian violet stain were 97.3% and 99.6%, respectively. There was a 100% correlation between the 2 methods.

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

PubMed

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

2016-07-01

Evaluation of the safety and efficacy of intraurethral Mitomycin C (MMC) hydrogel for prevention of post-traumatic anterior urethral stricture recurrence after internal urethrotomy. 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. 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. 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 small number of patients, our results were not conclusive and further studies will be needed with a longer follow up time. © 2016 KUMS, All rights reserved.

The effect of intraurethral dexpanthenol on healing and fibrosis in rats with experimentally induced urethral trauma.

PubMed

Yardimci, Ibrahim; Karakan, Tolga; Resorlu, Berkan; Doluoglu, Omer Gokhan; Ozcan, Serkan; Aydın, Arif; Demirbas, Arif; Unverdi, Hatice; Eroglu, Muzaffer

2015-01-01

To determine the efficacy of dexpanthenol applied early after urethral trauma for preventing inflammation and spongiofibrosis. Twenty-seven rats were randomized and divided into 3 groups, with 9 rats in each group. The urethras of all rats were traumatized with a pediatric urethrotome knife at 6-o' clock. For 14 days, group I was given 0.9% saline twice a day (control group), group II was given dexpanthenol 500 mg/kg ampules once a day and 0.9% saline once a day, and group III was given dexpanthenol 500 mg/kg ampules twice a day intraurethrally using a 22 ga catheter sheath. On day 15, the penises of the rats were degloved to perform penectomy. The mean fibrosis scores were 2.4, 2.2, and 1.4, and mean inflammation scar scores were 2, 1.4, and 1.3 in groups I, II, and III, respectively. There was a significant difference between groups I and II for inflammation (P = .011); however, the difference for fibrosis was not significant (P = .331). The differences between groups I and III were statistically significantly different both for inflammation and fibrosis (P = .004 and P = .003, respectively). Groups II and III were not different significantly for inflammation (P = .638); however, there was less fibrosis in group III, in which high-dose dexpanthenol was administered. We showed that dexpanthenol applied early after urethral trauma significantly decreased inflammation and spongiofibrosis. We hope that our study will help to decrease strictures after urethral trauma and contribute to pharmaceutical investigations aiming to improve the success of the surgery for urethral strictures. Copyright © 2015 Elsevier Inc. All rights reserved.

Distinct Defensin Profiles in Neisseria gonorrhoeae and Chlamydia trachomatis Urethritis Reveal Novel Epithelial Cell-Neutrophil Interactions

PubMed Central

Porter, Edith; Yang, Huixia; Yavagal, Sujata; Preza, Gloria C.; Murillo, Omar; Lima, Heriberto; Greene, Sheila; Mahoozi, Laily; Klein-Patel, Marcia; Diamond, Gill; Gulati, Sunita; Ganz, Tomas; Rice, Peter A.; Quayle, Alison J.

2005-01-01

Defensins are key participants in mucosal innate defense. The varied antimicrobial activity and differential distribution of defensins at mucosal sites indicate that peptide repertoires are tailored to site-specific innate defense requirements. Nonetheless, few studies have investigated changes in peptide profiles and function after in vivo pathogen challenge. Here, we determined defensin profiles in urethral secretions of healthy men and men with Chlamydia trachomatis- and Neisseria gonorrhoeae-mediated urethritis by immunoblotting for the epithelial defensins HBD1, HBD2, and HD5 and the neutrophil defensins HNP1 to -3 (HNP1-3). HBD1 was not detectable in secretions, and HBD2 was only induced in a small proportion of the urethritis patients; however, HD5 and HNP1-3 were increased in C. trachomatis infection and significantly elevated in N. gonorrhoeae infection. When HNP1-3 levels were low, HD5 appeared mostly as the propeptide; however, when HNP1-3 levels were >10 μg/ml, HD5 was proteolytically processed, suggesting neutrophil proteases might contribute to HD5 processing. HD5 and HNP1-3 were bactericidal against C. trachomatis and N. gonorrhoeae, but HD5 activity was dependent upon N-terminal processing of the peptide. In vitro proteolysis of proHD5 by neutrophil proteases and analysis of urethral secretions by surface-enhanced laser desorption ionization substantiated that neutrophils contribute the key convertases for proHD5 in the urethra during these infections. This contrasts with the small intestine, where Paneth cells secrete both proHD5 and its processing enzyme, trypsin. In conclusion, we describe a unique defensin expression repertoire in response to inflammatory sexually transmitted infections and a novel host defense mechanism wherein epithelial cells collaborate with neutrophils to establish an antimicrobial barrier during infection. PMID:16040996

Comparison of TVT and TOT on urethral mobility and surgical outcomes in stress urinary incontinence with hypermobile urethra.

PubMed

Cavkaytar, Sabri; Kokanalı, Mahmut Kuntay; Guzel, Ali Irfan; Ozer, Irfan; Aksakal, Orhan Seyfi; Doganay, Melike

2015-07-01

To compare the change of urethral mobility after midurethral sling procedures in stress urinary incontinence with hypermobile urethra and assess these findings with surgical outcomes. 141 women who agreed to undergo midurethral sling operations due to stress urinary incontinence with hypermobile urethra were enrolled in this non-randomized prospective observational study. Preoperatively, urethral mobility was measured by Q tip test. All women were asked to complete Urogenital Distress Inventory Short Form (UDI-6) and Incontinence Impact Questionnaire Short Form (IIQ-7) to assess the quality of life. Six months postoperatively, Q tip test and quality of life assessment were repeated. The primary surgical outcomes were classified as cure, improvement and failure. Transient urinary obstruction, de novo urgency, voiding dysfunction were secondary surgical outcomes. Of 141 women, 50 (35. 5%) women underwent TOT, 91 (64.5%) underwent TVT. In both TOT and TVT groups, postoperative Q tip test values, IIQ-7 and UDI-6 scores were statistically reduced when compared with preoperative values. Postoperative Q tip test value in TVT group was significantly smaller than in TOT group [25°(15-45°) and 20° (15-45°), respectively]. When we compared the Q-tip test value, IIQ-7 and UDI-6 scores changes, there were no statistically significant changes between the groups. Postoperative urethral mobility was more frequent in TOT group than in TVT group (40% vs 23.1%, respectively). Postoperative primary and secondary outcomes were similar in both groups. Although midurethral slings decrease the urethtal hypermobility, postoperative mobility status of urethra does not effect surgical outcomes of midurethral slings in women with preoperative urethral hypermobility. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Prevalence and Risk Factors for Rectal and Urethral Sexually Transmitted Infections From Self-Collected Samples Among Young Men Who Have Sex With Men Participating in the Keep It Up! 2.0 Randomized Controlled Trial.

PubMed

Mustanski, Brian; Feinstein, Brian A; Madkins, Krystal; Sullivan, Patrick; Swann, Gregory

2017-08-01

Despite recommendations that sexually active men who have sex with men be regularly tested for sexually transmitted infections (STIs) and that testing reflect anatomical sites of potential exposure, regular testing is not widely performed, especially for rectal STIs. As such, little is known about the prevalence of rectal and urethral STIs among young men who have sex with men (YMSM). The current study examined the prevalence and risk factors for rectal and urethral chlamydia and gonorrhea in a sample of 1113 YMSM ages 18 to 29 years (mean, 24.07 years). Before participating in a randomized controlled trial for an online human immunodeficiency virus prevention program (Keep It Up! 2.0), participants completed self-report measures and self-collected urine and rectal samples. Participants mailed samples to a laboratory for nucleic acid amplification testing. Viability of self-collected samples was examined as a potential method to increase STI screening for MSM without access to STI testing clinics. Results indicated that 15.1% of participants tested positive for an STI, 13.0% for a rectal STI, 3.4% for a urethral STI, and 1.2% for both rectal and urethral STIs. Rectal chlamydia was significantly more common (8.8%) than rectal gonorrhea (5.0%). Rectal STIs were higher among black YMSM compared with white YMSM. Additionally, rectal STIs were positively associated with condomless receptive anal sex with casual partners. Findings call attention to the need for health care providers to test YMSM for rectal STIs. This study also demonstrates the viability of including self-collected samples for STI testing in an eHealth program.

Urethral advancement in hypospadias with a distal division of the corpus spongiosum: outcome in 158 cases.

PubMed

Thiry, S; Gorduza, D; Mouriquand, P

2014-06-01

Outcome of urethral mobilization and advancement (Koff procedure) in hypospadias with a distal division of the corpus spongiosum and redo cases with distal urethral failure. From January 1999 to November 2012, 158 children with a distal hypospadias (115 primary cases and 43 redo cases) underwent surgical repair using the Koff technique with a median age at surgery of 21 months (range, 12-217 months). Mean follow-up was 19 months (median, 14 months). Thirty patients (19%) presented with a complication (13.9% in primary cases and 32.5% in redo surgery) mostly at the beginning of our experience. Meatal stenosis was the most common one (3.5% in primary case, 6% overall). Ventral curvature (>10°), which is considered as a possible long-term iatrogenic complication of the Koff procedure, was not found in patients with fully grown penis except in one redo patient who had, retrospectively, an inadequate indication for this type of repair. Of 158 patients, 33 reached the age of puberty (>14 years old) with a mean follow-up of 34 months, only one presented with a significant ventral curvature. Urethral mobilization and advancement is a reasonable alternative for anterior hypospadias and distal fistula repair in selected cases. It has two major advantages compared to other techniques: it avoids any urethroplasty with non-urethral tissue and eliminates dysplastic tissues located beyond the division of the corpus spongiosum, which may not grow at the same pace as the rest of the penis. Significant iatrogenic curvature in fully grown penis is not supported by this series. Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Activity of the external urethral sphincter evoked by genital stimulation in male rats.

PubMed

Juárez, Raúl; Zempoalteca, René; Pacheco, Pablo; Lucio, Rosa Angélica; Medel, Alfonso; Cruz, Yolanda

2016-11-01

To determine whether the external urethral sphincter (EUS) fasciculi of male rats respond to the mechanical stimulation of genital structures and to characterize the pattern of the electromyographic (EMG) activity of the three regions of the EUS: the cranial (CrEUS), the medial (MeEUS) and the caudal (CaEUS). Electromyographic signals were recorded from the CrEUS, MeEUS and CaEUS regions of the male rat's EUS, before, during and after the mechanical stimulation of the urogenital structures. The CrEUS, MeEUS and CaEUS regions responded when brushing and squeezing the foreskin and glans as well as to penile and prostatic urethral distension. The CaEUS EMG amplitude (P < 0.01) and frequency (P < 0.05) were lower in comparison to the CrEUS and MeEUS responses to the mechanical stimulation. In addition, the CaEUS was characterized by a short or no afterdischarge. In contrast, the CrEUS and MeEUS responded by presenting a long discharge after the penile or prostatic urethral distension. The activity of the EUS is modulated by both, cutaneous and visceral genitourinary stimuli, with motor units being activated by mechanoreceptors located in the foreskin, glans, bladder, and urethra. The CrEUS, MeEUS and CaEUS have differential EMG patterns, indicating that the EUS consists of three anatomically and functionally different regions. Precise coordination in the muscular activity of these regions may be crucial for the control of male expulsive urethral functions, i.e., during voiding and ejaculation. Neurourol. Urodynam. 35:914-919, 2016. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

The prevalence of lymphogranuloma venereum infection in men who have sex with men: results of a multicentre case finding study

PubMed Central

Ward, H; Alexander, S; Carder, C; Dean, G; French, P; Ivens, D; Ling, C; Paul, J; Tong, W; White, J; Ison, C A

2009-01-01

Objective: To determine the prevalence of lymphogranuloma venereum (LGV) and non-LGV associated serovars of urethral and rectal Chlamydia trachomatis (CT) infection in men who have sex with men (MSM). Design: Multicentre cross-sectional survey. Setting: Four genitourinary medicine clinics in the United Kingdom from 2006–7. Subjects: 4825 urethral and 6778 rectal samples from consecutive MSM attending for sexual health screening. Methods: Urethral swabs or urine and rectal swabs were tested for CT using standard nucleic acid amplification tests. Chlamydia-positive specimens were sent to the reference laboratory for serovar determination. Main outcome: Positivity for both LGV and non-LGV associated CT serovars; proportion of cases that were symptomatic. Results: The positivity (with 95% confidence intervals) in rectal samples was 6.06% (5.51% to 6.66%) for non-LGV CT and 0.90% (0.69% to 1.16%) for LGV; for urethral samples 3.21% (2.74% to 3.76%) for non-LGV CT and 0.04% (0.01% to 0.16%) for LGV. The majority of LGV was symptomatic (95% of rectal, one of two urethral cases); non-LGV chlamydia was mostly symptomatic in the urethra (68%) but not in the rectum (16%). Conclusions: Chlamydial infections are common in MSM attending for sexual health screening, and the majority are non-LGV associated serovars. We did not identify a large reservoir of asymptomatic LGV in the rectum or urethra. Testing for chlamydia from the rectum and urethra should be included for MSM requesting a sexual health screen, but serovar-typing is not indicated in the absence of symptoms. We have yet to identify the source of most cases of LGV in the UK. PMID:19221105

[Urethritis syndrome and atypical germ flora of the exterior female genitalia (author's transl)].

PubMed

Hofstetter, A; Schmiedt, E; Weissenbacher, E R; Frank, S

1976-10-29

A positive microbiological evidence could be obtained 54 times from the smear of the exterior genitals of 80 women suffering from complaints that were caused by urethritis, criteria of the examinations being sterile catheter specimen, negative cystoscopical findings, and missing indications to anatomical changes in the urethral region. Cytological examinations of these cases with regard to the vaginal epithelium had the following results:Group I:6 times; group II: 37 times; group IIW:8 times; group IIId: once; group IVa:twice. The cytological tests were carried out according to the method of papanicolaou as modified by Soost. Furthermore, we could state the following degrees of purity: Degree I: 8 times; degree II:16 times; degree III: 30 times. The cytological examinations of the urethral epithelium demonstrated, in 52 cases, an increased appearance of "nude" completely exposed epithelial cell nuclei--a fact corresponding to a degenerative autolysis (according to Wied). In the 26 women with missing atypical germ flora within the region of the exterior genitals, exclusively groups I (according to Papanicolaou and Soost) and degrees of purity I were stated. These persons also demonstrated remarkably grave psychical disturbances, especially in the intimate regions. In the cases of positive microbiological evidence, the following measures have proved satisfactory: Vaginal hygienization combined with a directly aimed antibacterial therapy, and the prescription of preparations containing lactic acid. A transitory discontinuation of contraceptives is being discussed. Our examination results are emphasizing the necessity of an analysis of the germ flora in cases of complaints arising from urethritis. Also psychical disturbances must be taken into consideration in cases of missing urological and gynaecological criteria of evidence.

Quantitative Real-Time Polymerase Chain Reaction for the Diagnosis of Mycoplasma genitalium Infection in South African Men With and Without Symptoms of Urethritis.

PubMed

le Roux, Marie Cecilia; Hoosen, Anwar Ahmed

2017-01-01

This study was done to diagnose Mycoplasma genitalium infection based on bacterial load in urine specimens from symptomatic and asymptomatic men. Urine specimens from 94 men with visible urethral discharge, 206 with burning on micturition and 75 without symptoms presenting to a family practitioner were tested for M. genitalium as well as Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis by transcription-mediated amplification assays. A quantitative polymerase chain reaction assay was used to determine the bacterial load for all specimens in which M. genitalium was the only organism detected. Among the 375 specimens collected, M. genitalium was detected in 59 (15.7%) men (both symptomatic and asymptomatic) using the transcription-mediated amplification assay, and in 45 (12.0%) of the total population, it was the only pathogen detected. One or more pathogens were detected in 129 (43%) of the symptomatic men, with N. gonorrhoeae in 50 (16.7%); C. trachomatis in 37 (12.3%) and T. vaginalis present in 24 (8.0%) patients. Among the 17 patients where mixed infections were detected, M. genitalium with N. gonorrhoeae was the most common (11/17; 64.7%). Patients with visible urethral discharge had significantly higher M. genitalium concentrations than those with burning on micturition. The median M. genitalium load in symptomatic men was significantly higher than that in asymptomatic men. This study confirms the high prevalence of M. genitalium among men with urethritis in South Africa and demonstrates that there is a strong association with M. genitalium bacterial load and clinical urethritis. As the number of organisms increased, the severity of the symptoms increased, an indication of the role that the organism plays in disease progression.

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

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

2016-01-01

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. 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". 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%. 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.

Holmium laser vs. conventional (cold knife) direct visual internal urethrotomy for short-segment bulbar urethral stricture: Outcome analysis.

PubMed

Jhanwar, Ankur; Kumar, Manoj; Sankhwar, Satya Narayan; Prakash, Gaurav

2016-01-01

Our goal was to analyze the outcome between holmium laser and cold knife direct visual internal urethrotomy (DVIU) for short-segment bulbar urethral stricture. We conducted a prospective study comprised of 112 male patients seen from June 2013 to December 2014. Inclusion criterion was short-segment bulbar urethral stricture (≤1.5cm). Exclusion criteria were prior intervention/urethroplasty, pan-anterior urethral strictures, posterior stenosis, urinary tract infection, and those who lost to followup. Patients were divided into two groups; Group A (n=58) included cold knife DVIU and group B (n=54) included holmium laser endourethrotomy patients. Patient followup included uroflowmetry at postoperative Day 3, as well as at three months and six months. Baseline demographics were comparable in both groups. A total of 107 patients met the inclusion criteria and five patients were excluded due to inadequate followup. Mean stricture length was 1.31 ± 0.252 cm (p=0.53) and 1.34 ± 0.251 cm in Groups A and B, respectively. Mean operating time in Group A was 16.3 ± 1.78 min and in Group B was 20.96 ± 2.23 min (p=0.0001). Five patients in Group A had bleeding after the procedure that was managed conservatively by applying perineal compression. Three patients in Group B had fluid extravasation postoperatively. Qmax (ml/s) was found to be statistically insignificant between the two groups at all followups. Both holmium laser and cold knife urethrotomy are safe and equally effective in treating short-segment bulbar urethral strictures in terms of outcome and complication rate. However, holmium laser requires more expertise and is a costly alternative.

Visual Internal Urethrotomy With Intralesional Mitomycin C and Short-term Clean Intermittent Catheterization for the Management of Recurrent Urethral Strictures and Bladder Neck Contractures.

PubMed

Farrell, Michael R; Sherer, Benjamin A; Levine, Laurence A

2015-06-01

To evaluate our longitudinal experience using visual internal urethrotomy (VIU) with intralesional mitomycin C (MMC) and short-term clean intermittent catheterization (CIC) for urethral strictures and bladder neck contractures (BNC) after failure of endoscopic management. This case series involved review of our prospectively developed database of all men who underwent VIU with MMC and CIC in a standardized fashion for urethral stricture or BNC between 2010 and 2013 at our tertiary care medical center. Etiology was identified as radiation-induced stricture (RIS) or non-RIS and analyzed by stricture location. Cold knife incisions were made in a tri or quadrant fashion followed by intralesional injection of MMC and 1 month of once daily CIC. All 37 patients previously underwent at least 1 intervention for urethral stricture or BNC before VIU with MMC and CIC. Mean stricture length was 2.0 cm (range, 1-6 cm; standard deviation, 1.0 cm). Over the median follow-up period of 23 months (range, 12-39 months), 75.7% of patients required no additional surgical intervention (RIS, 54.5%; non-RIS, 84.6%; P = .051). In those that did recur, median time to stricture recurrence was 8 months (range, 2-28 months). One patient with recurrence required urethroplasty. VIU with MMC followed by short-term CIC provides a minimally invasive and widely available tool to manage complex recurrent urethral strictures (<3 cm) and BNC without significant morbidity. This approach may be most attractive for patients who are poor candidates for open surgery. Copyright © 2015 Elsevier Inc. All rights reserved.