BACKGROUND Primary signet ring cell carcinoma of the urethra in women is an exceedingly rare malignancy.It was first reported in postmenopausal women in 1987,and only five patients have been reported to date.CASE SUMM...BACKGROUND Primary signet ring cell carcinoma of the urethra in women is an exceedingly rare malignancy.It was first reported in postmenopausal women in 1987,and only five patients have been reported to date.CASE SUMMARY A 61-year-old woman presented with irregular vaginal bleeding,and subsequent evaluation identified a tumor located in the distal urethra.Upon diagnosis of primary urethral carcinoma,she underwent a distal urethrectomy.Histopathological analysis demonstrated that the tumor consisted of a combination of intestinal adenocarcinoma and signet ring cell carcinoma.At the 12-month postoperative follow-up,there was no evidence of disease recurrence.CONCLUSION This case report highlights the exceptional rarity of female urethral signet ring cell carcinoma,emphasizing the importance of early clinical detection and the necessity for precise and conservative surgical intervention.展开更多
Benign prostatic hyperplasia(BPH),prevalent in the aging male population,presented a unique surgical challenge in a 58-year-old patient with a history of multiple pelvic and hip surgeries,precluding conventional litho...Benign prostatic hyperplasia(BPH),prevalent in the aging male population,presented a unique surgical challenge in a 58-year-old patient with a history of multiple pelvic and hip surgeries,precluding conventional lithotomy and transurethral approaches.This report introduces an innovative,single-port transvesical robot-assisted simple prostatectomy with total urethral preservation.This pioneering technique,tailored for complex BPH management,demonstrated its efficacy and potential through favorable postoperative outcomes.This report underscores single-port transvesical robot-assisted simple prostatectomy with total urethral preservation as a promising surgical option for patients with BPH who are unable to assume the lithotomy position.展开更多
Objective:To conduct a systematic literature review on urethral calculi in a contemporary cohort describing etiology,investigation,and management patterns.Methods:A systematic search of MEDLINE and Cochrane Central Re...Objective:To conduct a systematic literature review on urethral calculi in a contemporary cohort describing etiology,investigation,and management patterns.Methods:A systematic search of MEDLINE and Cochrane Central Register of Controlled Trials(CENTRAL)databases was performed.Articles,including case reports and case series on urethral calculi published between January 2000 and December 2019,were included.Full-text manuscripts were reviewed for clinical parameters including symptomatology,etiology,medical history,investigations,treatment,and outcomes.Data were collated and analyzed with univariate methods.Results:Seventy-four publications met inclusion criteria,reporting on 95 cases.Voiding symptoms(41.1%),pain(40.0%),and acute urinary retention(32.6%)were common presenting features.Urethral calculi were most often initially investigated using plain X-ray(63.2%),with almost all radio-opaque(98.3%).Urethral calculi were frequently associated with coexistent bladder or upper urinary tract calculi(16.8%)and underlying urethral pathology(53.7%)including diverticulum(33.7%)or stricture(13.7%).Urethral calculi were most commonly managed with external urethrolithotomy(31.6%),retrograde manipulation(22.1%),and endoscopic in situ lithotripsy(17.9%).Conclusion:This unique systematic review of urethral calculi provided a summary of clinical features and treatment trends with a suggested treatment algorithm.Management in contemporary urological practice should be according to calculus size,shape,anatomical location,and presence of urethral pathology.展开更多
Urethral stricture is characterized by the chronic formation of fibrous tissue,leading to the narrowing of the urethral lumen.Despite the availability of various endoscopic treatments,the recurrence of urethral strict...Urethral stricture is characterized by the chronic formation of fibrous tissue,leading to the narrowing of the urethral lumen.Despite the availability of various endoscopic treatments,the recurrence of urethral strictures remains a common challenge.Postsurgery pharmacotherapy targeting tissue fibrosis is a promising option for reducing recurrence rates.Although drugs cannot replace surgery,they can be used as adjuvant therapies to improve outcomes.In this regard,many drugs have been proposed based on the mechanisms underlying the pathophysiology of urethral stricture.Ongoing studies have obtained substantial progress in treating urethral strictures,highlighting the potential for improved drug effectiveness through appropriate clinical delivery methods.Therefore,this review summarizes the latest researches on the mechanisms related to the pathophysiology of urethral stricture and the drugs to provide a theoretical basis and new insights for the effective use and future advancements in drug therapy for urethral stricture.展开更多
BACKGROUND Urethral stricture is a condition that often develops with trauma and results in narrowing of the urethral lumen.Although endoscopic methods are mostly used in its treatment,it has high recurrence rates.The...BACKGROUND Urethral stricture is a condition that often develops with trauma and results in narrowing of the urethral lumen.Although endoscopic methods are mostly used in its treatment,it has high recurrence rates.Therefore,open urethroplasty is recommended after unsuccessful endoscopic treatments.AIM To investigate the risk factors associated with urethral stricture recurrence.METHODS The data of male patients who underwent internal urethrotomy for urethral stricture between January 2017 and January 2023 were retrospectively analyzed.Demographic data,comorbidities,preoperative haemogram,and biochemical values obtained from peripheral blood and operative data were recorded.Patients were divided into two groups in terms of recurrence development;recurrence and non-recurrence.Initially recorded data were compared between the two groups.RESULTS A total of 303 patients were included in the study.The mean age of the patients was 66.6±13.6 years.The mean duration of recurrence development was 9.63±9.84(min-max:1-39)months in the recurrence group.Recurrence did not occur in non-recurrence group throughout the follow-up period with an average time of 44.15±24.07(min-max:12-84)months.In the comparison of both groups,the presence of diabetes mellitus(DM),hypertension(HT),and multiple comorbidi-ties were significantly higher in the recurrence(+)group(P=0.038,P=0.012,P=0.013).Blood group,postoperative use of non-steroidal anti-inflammatory drugs,preoperative cystostomy,cause of stricture,iatrogenic cause of stricture,location and length of stricture,indwelling urinary cathater size and day of catheter removal did not differ between the two groups.No statistically significant difference was observed between the two groups in terms of age,uroflowmetric maximum flow rate value,hemo-gram parameters,aspartate aminotransferase(AST),alanine aminotransferase(ALT),fasting blood sugar,creati-nine,glomerular filtration rate,neutrophil-lymphocyte ratio,platelet-lymphocyte ratio,lymphocyte-monocyte ratio,monocyte-lymphocyte ratio and AST/ALT ratios.CONCLUSION In patients with urethral stricture recurrence,only the frequency of DM and HT was high,while inflammation marker levels and stricture-related parameters were similar between the groups.展开更多
Pelvic fracture urethral distraction defects(PFUDDs)are relatively infrequent in boys,and treatment for PFUDDs presents one of the most difficult problems in urological practice.Anastomotic urethroplasty is considered...Pelvic fracture urethral distraction defects(PFUDDs)are relatively infrequent in boys,and treatment for PFUDDs presents one of the most difficult problems in urological practice.Anastomotic urethroplasty is considered an ideal surgical procedure for PFUDDs in boys.However,various surgical approaches for anastomotic urethroplasty have been proposed,including a simple transperineal approach,a tran sperineal in tercorporal septal separati on approach,a tran sperineal in ferior pubic approach,and a combined transpubic・perineal approach.This study aims to determine which surgical approach is best for PFUDDs in boys.We retrospectively identified 22 boys with PFUDDs aged 2-14 years who underwent anastomotic urethroplasty via different approaches between January 2008 and December 2017.Follow-up was performed in all the 22 patients for 6-123(mean:52.0)months.Finally,20 of the 22 boys(90.9%)were successfully treated,including 1 of 2 patients treated with a simple transperineal approach,3 of 3 with a transperineal approach with intercorporal septal separation,14 of 15 with a transperineal inferior pubic approach,and 2 of 2 with a combined transpubic-perineal approach.Two patients had failed outcomes after the operation,and stenosis recurred.Based on the outcome of the 22 patients,we can draw a preliminary conclusion that most boys(20/22)can be treated with a transperineal inferior pubic approach or simpler procedures without the need of completely removing or incising the pubis.The combined transpubic-perineal approach can be used in cases of extremely long urethral distract defects.展开更多
Background: Male urethral stricture is as yet considered one of the very popular and defying dilemmas to the urologist. Treatment modalities include dilation, endoscopic urethrotomy and urethroplasty, however internal...Background: Male urethral stricture is as yet considered one of the very popular and defying dilemmas to the urologist. Treatment modalities include dilation, endoscopic urethrotomy and urethroplasty, however internal optical urethrotomy displays rapid cure, lower scarring, and minimal hazard of infection. Purpose: To evaluate the efficacy of internal optical urethrotomy in the treatment of patients with urethral stricture. Patients & Methods: This study was carried out at Al-Yermouk Teaching Hospital/Baghdad/Iraq in the period between January 2015 and January 2018. A group of 75 male patients (16 - 25 years of age) presented with urethral strictures had been treated with internal optical urethrotomy. Follow-up period ranged from 1 - 3 months. Outcome was graded as good, fair and poor. Results: Out of 75 patients, 28 (37.3%) were (21 - 30) years of age. Trauma was the most popular source of stricture found in 40 (53.3%) and the most widespread presenting feature was poor urinary flow in 32 (42.6%) patients. Stricture in the bulbous urethra in 48 (64%) cases was found to be the most prevalent area followed by penile urethra in 16 (21.3%) cases. Overall response rate was good in 52 (69.3%) patients. Eleven (14.6%) patients exhibited only minor bleeding postoperatively with no other considerable complications. Conclusion: Internal optical urethrotomy is a dependable and effective procedure in treating urethral stricture.展开更多
Paraurethral cysts are a rare congenital abnormality seen in female neonates. We present the case of a female newborn with a paraurethral cyst resulting in urinary obstruction. Surgical intervention was chosen as a re...Paraurethral cysts are a rare congenital abnormality seen in female neonates. We present the case of a female newborn with a paraurethral cyst resulting in urinary obstruction. Surgical intervention was chosen as a result of the obstruction.展开更多
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 ev...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.展开更多
We report here the history and evolution of the use of oral mucosa in reconstructive urethral surgery since it was first used for urethroplasty in 1894.Since that time,many authors have contributed to develop,improve ...We report here the history and evolution of the use of oral mucosa in reconstructive urethral surgery since it was first used for urethroplasty in 1894.Since that time,many authors have contributed to develop,improve and popularize the use of oral mucosa as a substitute material.Paediatric urologists should be considered pioneers on the use of oral mucosa as they used it to repair primary and failed hypospadias.The use of oral mucosa to repair penile and bulbar urethral strictures was described,for the first time,in 1993.Important evolutions in the technique for harvesting oral mucosa from the cheek were reported in 1996.Today,oral mucosa is considered the gold standard material for any type of anterior urethroplasty in a one-or two-stage repair due to its biological and structural characteristics that make it a highly versatile that is adaptable to any environment required by the reconstructive urethral surgery.As the future approaches,tissue engineering techniques will provide patients with new materials originating from the oral epithelial mucosal cells,which are cultured and expanded into a scaffold.However,the path to reach this ambitious objective is still long and many difficulties must be overcome along the way.展开更多
Aim: A case-report on adenoma of the posterior urethra. Methods: In 131 cases of adenoma of the posteriorurethra, aged 17-79 (mean: 36.4) years, a detailed medical history was taken and urinalysis, urethroscopy, and p...Aim: A case-report on adenoma of the posterior urethra. Methods: In 131 cases of adenoma of the posteriorurethra, aged 17-79 (mean: 36.4) years, a detailed medical history was taken and urinalysis, urethroscopy, and pro-static specific antigen (PSA) immunohistochemical staining were performed. They were then treated with transurethralresection (TUR) or transurethral electric coagulation (TUEC). Results: Hemospennia occurred in 51% of the cas-es, hemamria in 38%, blood overflow from the urethral orifice in 6%, and dysuria in 5%. The position of the tumorwas at or around the vemmontanum. The appearance of the tumor was similar to those of a papilla, a villus, a dactylor polyp, or simply an engorgement. The tumor contained glandular alveoli and adeno-epithelial cells. PSA immuno-histochemistry was positive in the cytoplasm and nucleus of the adeno-epithelial cell. One hundred and tweenty-ninecases were cured after TUR or TUEC, while 2 patients recurred and were operated again. Conclusion: Adenoma ofthe posterior urethra is a common cause of hemospennia and hematuria in young men. Urethroscopic examination andbiopsy are the principal diagnostic measures. TUR or TUEC are believed to be the treatment of choice with a short-termrecurrence rate of around 1.5%. (Asian J Androl 2000; 3: 67-70)展开更多
Aim： To investigate the feasibility of the autologous fascia graft in urethra defect reconstruction. Methods： In 24 adult male rabbits, a standardized defect （17 mm） was created within the midportion of each ureth...Aim： To investigate the feasibility of the autologous fascia graft in urethra defect reconstruction. Methods： In 24 adult male rabbits, a standardized defect （17 mm） was created within the midportion of each urethra. Two-cm long fascial tube grafts were interposed between the cut ends of the urethra. Twenty-four rabbits were divided into 12 groups. At 0, 3, 10, 15, 21, 30, 45, 60, 90, 120, 150, and 180 days postoperatively, one group was killed. In the first four groups, rabbits were killed and specimens were obtained for histological examination. After 21 postoperative days, in the subsequent eight groups, retrograde urethrograms were carried out to evaluate urethral patency and caliber, then rabbits were killed and specimens were obtained. Results： In the histological study, advancement of the urethral transitional epithelium along scaffold provided by the fascial graft was determined. At the 30th day, the new urethra was completely covered with the transitional epithelium. Fistula formation was observed in two of 24 rabbits. In urethrograms, narrowing was determined in three of 16 rabbits. Conclusion： For segmental urethral reconstruction, fascial graft is a good urethral substitute because of its rapid epithelization capacity, low contraction degree and thinness. We therefore propose the use of fascial grafts for reconstruction of male-urethra defects in humans.展开更多
The objective of this study was to evaluate the biocompatibility of vessel extracellular matrix （VECM） from rabbit and to discuss the feasibility of vessel extracellular matrix as a matrix for urethral reconstructio...The objective of this study was to evaluate the biocompatibility of vessel extracellular matrix （VECM） from rabbit and to discuss the feasibility of vessel extracellular matrix as a matrix for urethral reconstruction. Primary cultured bladder smooth muscle cells isolated from New Zealand rabbits were implanted on VECM .The effects of VECM on rabbit bladder smooth muscle cells （RBSMCs） metabolic activity, attachment, proliferation were monitored in vitro with the aid of an inverted light microscope and a scanning electron microscope. The cell viability was monitored by MTT（methythiazolye tetrazolium bromide） after 1, 3, 5 days seeding. The in vivo tissue response to VECM was investigated by implanting them into the subcutaneous of rabbits. VECM exhibited a nontoxic and bioactive effect on RBSMCs. RBSMCs could be attached to and proliferated on VECM and maintained their morphologies. MTT assay showed RBSMCs cultured with the extracts of VECM were not significantly different from those of negative controls. In vivo, VECM demonstrated a favorable tissue compatibility without tissue necrosis, fibrosis and other abnormal response. VECM exhibited nontoxic and bioactive effects on RBSMC. It is a suitable material for urethral reconstruction.展开更多
BACKGROUND Clear cell adenocarcinoma of the urethra is a rare type of aggressive cancer with a poor prognosis.Clear cell carcinoma of the urethra represents less than 0.02%of all malignancies in women.Adenocarcinomas ...BACKGROUND Clear cell adenocarcinoma of the urethra is a rare type of aggressive cancer with a poor prognosis.Clear cell carcinoma of the urethra represents less than 0.02%of all malignancies in women.Adenocarcinomas account for 10%of female urethral carcinomas,of which 40%are the clear cell variant.Determining the presence or absence of certain mutations through genetic testing may predict whether a patient with cancer may benefit from a particular chemotherapy regimen.CASE SUMMARY A 40-year-old woman presented with a 3-year history of slow urinary flow and a 3-mo history of urinary urgency and frequency as well as gross hematuria.An abdominal and pelvic computed tomography scan demonstrated enlarged lymph nodes in the abdomen and pelvis.A biopsy of a left inguinal lymph node microscopically confirmed a metastatic adenocarcinoma of the urethra.Specialized genetic testing determined personalized chemotherapy.She was treated successfully with a non-platinum-based chemotherapy consisting of paclitaxel and bevacizumab.Following 3 cycles of paclitaxel and bevacizumab,she attained significant clinical improvement,and response by FDG-Positron emission tomography(PET)imaging showed a definite improvement in size and metabolic activity.She achieved complete response after 6 cycles of therapy by PET scan.The patient concluded 11 cycles of paclitaxel and bevacizumab,and a subsequent PET scan confirmed progression of metastatic disease.The patient was then treated with two cycles of doxorubicin after which a PET scan revealed a mixed response to the treatment.CONCLUSION We report the first case of a patient with metastatic clear cell adenocarcinoma of the urethra who underwent personalized chemotherapy after testing for cancer gene alterations.Our unique case represents the safe and effective use of nonplatinum-based chemotherapy in clear cell adenocarcinoma of the urethra.展开更多
Tubularized graft urethroplasty fails largely because of in adequate graft take. Prefabricati on of buccal mucosa lined flap has theoretical in dications for con structi ng neourethra with an in depe ndent blood suppl...Tubularized graft urethroplasty fails largely because of in adequate graft take. Prefabricati on of buccal mucosa lined flap has theoretical in dications for con structi ng neourethra with an in depe ndent blood supply. The efficacy of using a tissue expander capsule as an in duced vascular bed to prefabricate an axial vascularized buccal mucosa-lined flap for tubularized urethral rec on struction in a rabbit model was tested. The experiments were performed in three stages. First, silicone tissue expanders were inserted into the groin to induce vascularized capsule pouch formation. Next, buccal mucosa grafts were transplanted to the newly formed capsular tissue supplied by the axial vessel for buccal mucosa-lined flap prefabrication. Then, circumferential urethral defects were created and repaired by buccal mucosa graft (Group 1), capsule flap (Group 2) and prefabricated capsule buccal mucosa composite flap (Group 3). With retrograde urethrography, no rabbits in Group 1 maintained a wide urethral caliber. In Group 2, the discontinued epithelial layer rege nerated at 1 month, and the con structed n eourethra narrowed eve n though the lume n surface formed in tact urothelial cells at 3 months. In Group 3, buccal mucosa formed the lining in the neourethra and kept a wide urethral caliber for 3 mon ths. The capsule may serve as an in duced vascular bed for buccal mucosa-li ned flap prefabricati on. The prefabricated buccal mucosa-lined flap may serve as a neourethra flap for circumferential urethral replacement.展开更多
Aim: Describe the clinical, radiological and management of patients with posterior urethral valves. Materials and Methods: This was a retrospective descriptive study over a period going from January 2011 to December 2...Aim: Describe the clinical, radiological and management of patients with posterior urethral valves. Materials and Methods: This was a retrospective descriptive study over a period going from January 2011 to December 2016, reviewing 12 cases of patients treated for valves of the urethra posterior to the medical surgical center of urology in Cameroon at Douala. The variables studied were clinical, paraclinical, therapeutic and evolutionary. Results: In 5 years, we had diagnosed and treated 12 cases of posterior urethral valves, an average of 2.4 per year. The average age of patients was 41.6 months with extrems of 3 and 156 months. The reason for consultation was dominated by urinary tract infections. Urethrocystography and echography were performed in all patients and allowed to objectify a bilateral ureterohydronephrosis, a diverticular bladder in 9 cases and 4 cases of vesico-ureteral reflux, including a grade 4 according to the classification of Cendron, 8 patients suffered from acute urinary failure. Renal scintigraphyrealised on 3 patients had as objective in 1 patient the existence of a disfunctioning kidney. The treatment consisted of an endoscopic incision of the valves (n = 8), a vesicostomy (n = 3) and an iterative urethral dilatation with double J catheter placement (n = 1). The evolution was favorable (n = 7), and 5 cases of death were recorded. Conclusion: The endoscopic incision is the gold-standard of the treatment of the valves of the posterior urethra. The vesicostomy is an alternative in the absence of adequate technical platform. Despite adequate support, the prognosis remains burdened with significant mortality.展开更多
Surgical repair of complex posterior urethral disruptions remains one of the most challenging problems in urology.The efficacy of using a tissue expander capsule as an induced vascular bed to prefabricate axial vascul...Surgical repair of complex posterior urethral disruptions remains one of the most challenging problems in urology.The efficacy of using a tissue expander capsule as an induced vascular bed to prefabricate axial vascularized buccal mucosa-lined flaps for tubularized posterior urethral reconstruction in a rabbit model was tested.The experiments were performed in three stages.First,silicone tissue expanders were inserted into the groin to induce vascularized capsule pouch formation.Next,buccal mucosa grafts were transplanted into the newly formed capsular tissue supplied by axial vessels for buccal mucosa-lined flap prefabrication.Then,circumferential posterior urethral defects were created and repaired with the buccal mucosa graft(Group 1),the capsule flap(Group 2),and the prefabricated capsule buccal mucosa composite flap(Group 3).After surgery,notable contracture of the tubularized buccal mucosa graft was observed in the neourethra,and none of the rabbits in Group 1 maintained a wide urethral caliber.In Group 2,the retrieved neourethra showed little evidence of epithelial lining during the study period,and the lumen caliber was narrowed at the 3-month evaluation.In Group 3,the buccal mucosa formed the lining in the neourethra and maintained a wide urethral caliber for 3 months.The capsule may serve as an induced vascular bed for buccal mucosa-lined flap prefabrication.The prefabricated buccal mucosa-lined flap may serve as a neourethra flap for posterior urethral replacement.展开更多
Penile fracture is a rare urological emergency. It occurs mainly in young adults during sexual intercourse. In many instances, one of the corpora carvanosus is involved though bilateral injuries with or without corpus...Penile fracture is a rare urological emergency. It occurs mainly in young adults during sexual intercourse. In many instances, one of the corpora carvanosus is involved though bilateral injuries with or without corpus spongiosus involvement is not uncommon. However, isolated injury to corpus spongiosus is extremely rare. We report a case of isolated rupture of corpus spongiosum secondary to penile injury during coitus in a 43-year-old man that presented to University Hospital Souro Sanou of Bobo Dioulasso. He presented with history of persistence bleeding per urethra following penile injury during sexual intercourse. The Retrograde urethrography (RUG) showed a partial rupture of urethra, Moore type 3. Complementary penile ultrasound revealed extensive contusion of the urethra with circumferential hematoma and rupture of the distal 1/3 of the corpus spongiosus. He had gentle per urethral catheterization which was left for one month. Penile ultrasound sound done after removal of catheter showed residual injury and narrowing of the urethra.展开更多
Introduction: The urethral diverticulum or urethrocele corresponds to a saccular dilation of a portion of the urethral wall. Our objective was to report the clinical aspects, investigations and therapeutic aspects of ...Introduction: The urethral diverticulum or urethrocele corresponds to a saccular dilation of a portion of the urethral wall. Our objective was to report the clinical aspects, investigations and therapeutic aspects of three cases of congenital urethrocele. Observations: They were three male patients aged 11, 20 and 42 years, two of whom had consulted for terminal dribbling. The diagnosis of urethrocele was made for all patients with retrograde and voiding cystouretrography. Treatment consisted of resection of the urethrocele followed by urethroplasty for both cases. Conclusion: Diagnostic of congenital urethrocele must always be assessed when there is a persistent terminal dribbling, and systematically ask for a retrograde and voiding cystourethrography to confirm it.展开更多
<strong>Aim:</strong> To improve management of the posterior urethral valve (PUV) in children in a hospital environment. <strong>Patients and Methods:</strong> This was a retrospective descript...<strong>Aim:</strong> To improve management of the posterior urethral valve (PUV) in children in a hospital environment. <strong>Patients and Methods:</strong> This was a retrospective descriptive study that covered a sixteen (16) years period, from January 1, 2002 to December 31, 2017, In pediatric surgery and urology departments of our teaching hospital, 26 cases of posterior urethral valve (PUV) were involved. The diagnosis was made by retrograde urethrocystography and micturition, supplemented by ultrasound. <strong>Results:</strong> During this period, 26 patients (1.7%) had a PUV. The mean age of the patients was 73, 2 months with extremes ranging from 6 to 180 months. Fifteen patients consulted for dysuria, 8 for complete retention of urine. Only one patient had a history of rolling the valves to the benign ones. The main complications found were urinary tract infection in 15 children, urolithiasis in 3 children and renal failure in 2 children. Two children had serum creatinine values of 50 and 58 mg/L. The lamination of the posterior urethral valves was performed in all patients. In our series, we had one death from chronic renal failure in a 6-year-old child with a bilateral mute kidney at IVU. <strong>Conclusion:</strong> The valve diagnosis of the posterior urethra is made late because the diagnosis is still postnatal.展开更多
基金Supported by the Science and Technology Bureau Foundation of Jinhua,No.2021-4-300 and No.2020-3-062The Zhejiang Provincial Medical and Health Science and Technology Plan,No.2025KY1752。
文摘BACKGROUND Primary signet ring cell carcinoma of the urethra in women is an exceedingly rare malignancy.It was first reported in postmenopausal women in 1987,and only five patients have been reported to date.CASE SUMMARY A 61-year-old woman presented with irregular vaginal bleeding,and subsequent evaluation identified a tumor located in the distal urethra.Upon diagnosis of primary urethral carcinoma,she underwent a distal urethrectomy.Histopathological analysis demonstrated that the tumor consisted of a combination of intestinal adenocarcinoma and signet ring cell carcinoma.At the 12-month postoperative follow-up,there was no evidence of disease recurrence.CONCLUSION This case report highlights the exceptional rarity of female urethral signet ring cell carcinoma,emphasizing the importance of early clinical detection and the necessity for precise and conservative surgical intervention.
文摘Benign prostatic hyperplasia(BPH),prevalent in the aging male population,presented a unique surgical challenge in a 58-year-old patient with a history of multiple pelvic and hip surgeries,precluding conventional lithotomy and transurethral approaches.This report introduces an innovative,single-port transvesical robot-assisted simple prostatectomy with total urethral preservation.This pioneering technique,tailored for complex BPH management,demonstrated its efficacy and potential through favorable postoperative outcomes.This report underscores single-port transvesical robot-assisted simple prostatectomy with total urethral preservation as a promising surgical option for patients with BPH who are unable to assume the lithotomy position.
文摘Objective:To conduct a systematic literature review on urethral calculi in a contemporary cohort describing etiology,investigation,and management patterns.Methods:A systematic search of MEDLINE and Cochrane Central Register of Controlled Trials(CENTRAL)databases was performed.Articles,including case reports and case series on urethral calculi published between January 2000 and December 2019,were included.Full-text manuscripts were reviewed for clinical parameters including symptomatology,etiology,medical history,investigations,treatment,and outcomes.Data were collated and analyzed with univariate methods.Results:Seventy-four publications met inclusion criteria,reporting on 95 cases.Voiding symptoms(41.1%),pain(40.0%),and acute urinary retention(32.6%)were common presenting features.Urethral calculi were most often initially investigated using plain X-ray(63.2%),with almost all radio-opaque(98.3%).Urethral calculi were frequently associated with coexistent bladder or upper urinary tract calculi(16.8%)and underlying urethral pathology(53.7%)including diverticulum(33.7%)or stricture(13.7%).Urethral calculi were most commonly managed with external urethrolithotomy(31.6%),retrograde manipulation(22.1%),and endoscopic in situ lithotripsy(17.9%).Conclusion:This unique systematic review of urethral calculi provided a summary of clinical features and treatment trends with a suggested treatment algorithm.Management in contemporary urological practice should be according to calculus size,shape,anatomical location,and presence of urethral pathology.
基金This work was supported by the Natural Science Foundation of Jiangxi Province,China(No.20202BABL206031 and No.20224BAB216024).
文摘Urethral stricture is characterized by the chronic formation of fibrous tissue,leading to the narrowing of the urethral lumen.Despite the availability of various endoscopic treatments,the recurrence of urethral strictures remains a common challenge.Postsurgery pharmacotherapy targeting tissue fibrosis is a promising option for reducing recurrence rates.Although drugs cannot replace surgery,they can be used as adjuvant therapies to improve outcomes.In this regard,many drugs have been proposed based on the mechanisms underlying the pathophysiology of urethral stricture.Ongoing studies have obtained substantial progress in treating urethral strictures,highlighting the potential for improved drug effectiveness through appropriate clinical delivery methods.Therefore,this review summarizes the latest researches on the mechanisms related to the pathophysiology of urethral stricture and the drugs to provide a theoretical basis and new insights for the effective use and future advancements in drug therapy for urethral stricture.
文摘BACKGROUND Urethral stricture is a condition that often develops with trauma and results in narrowing of the urethral lumen.Although endoscopic methods are mostly used in its treatment,it has high recurrence rates.Therefore,open urethroplasty is recommended after unsuccessful endoscopic treatments.AIM To investigate the risk factors associated with urethral stricture recurrence.METHODS The data of male patients who underwent internal urethrotomy for urethral stricture between January 2017 and January 2023 were retrospectively analyzed.Demographic data,comorbidities,preoperative haemogram,and biochemical values obtained from peripheral blood and operative data were recorded.Patients were divided into two groups in terms of recurrence development;recurrence and non-recurrence.Initially recorded data were compared between the two groups.RESULTS A total of 303 patients were included in the study.The mean age of the patients was 66.6±13.6 years.The mean duration of recurrence development was 9.63±9.84(min-max:1-39)months in the recurrence group.Recurrence did not occur in non-recurrence group throughout the follow-up period with an average time of 44.15±24.07(min-max:12-84)months.In the comparison of both groups,the presence of diabetes mellitus(DM),hypertension(HT),and multiple comorbidi-ties were significantly higher in the recurrence(+)group(P=0.038,P=0.012,P=0.013).Blood group,postoperative use of non-steroidal anti-inflammatory drugs,preoperative cystostomy,cause of stricture,iatrogenic cause of stricture,location and length of stricture,indwelling urinary cathater size and day of catheter removal did not differ between the two groups.No statistically significant difference was observed between the two groups in terms of age,uroflowmetric maximum flow rate value,hemo-gram parameters,aspartate aminotransferase(AST),alanine aminotransferase(ALT),fasting blood sugar,creati-nine,glomerular filtration rate,neutrophil-lymphocyte ratio,platelet-lymphocyte ratio,lymphocyte-monocyte ratio,monocyte-lymphocyte ratio and AST/ALT ratios.CONCLUSION In patients with urethral stricture recurrence,only the frequency of DM and HT was high,while inflammation marker levels and stricture-related parameters were similar between the groups.
文摘Pelvic fracture urethral distraction defects(PFUDDs)are relatively infrequent in boys,and treatment for PFUDDs presents one of the most difficult problems in urological practice.Anastomotic urethroplasty is considered an ideal surgical procedure for PFUDDs in boys.However,various surgical approaches for anastomotic urethroplasty have been proposed,including a simple transperineal approach,a tran sperineal in tercorporal septal separati on approach,a tran sperineal in ferior pubic approach,and a combined transpubic・perineal approach.This study aims to determine which surgical approach is best for PFUDDs in boys.We retrospectively identified 22 boys with PFUDDs aged 2-14 years who underwent anastomotic urethroplasty via different approaches between January 2008 and December 2017.Follow-up was performed in all the 22 patients for 6-123(mean:52.0)months.Finally,20 of the 22 boys(90.9%)were successfully treated,including 1 of 2 patients treated with a simple transperineal approach,3 of 3 with a transperineal approach with intercorporal septal separation,14 of 15 with a transperineal inferior pubic approach,and 2 of 2 with a combined transpubic-perineal approach.Two patients had failed outcomes after the operation,and stenosis recurred.Based on the outcome of the 22 patients,we can draw a preliminary conclusion that most boys(20/22)can be treated with a transperineal inferior pubic approach or simpler procedures without the need of completely removing or incising the pubis.The combined transpubic-perineal approach can be used in cases of extremely long urethral distract defects.
文摘Background: Male urethral stricture is as yet considered one of the very popular and defying dilemmas to the urologist. Treatment modalities include dilation, endoscopic urethrotomy and urethroplasty, however internal optical urethrotomy displays rapid cure, lower scarring, and minimal hazard of infection. Purpose: To evaluate the efficacy of internal optical urethrotomy in the treatment of patients with urethral stricture. Patients & Methods: This study was carried out at Al-Yermouk Teaching Hospital/Baghdad/Iraq in the period between January 2015 and January 2018. A group of 75 male patients (16 - 25 years of age) presented with urethral strictures had been treated with internal optical urethrotomy. Follow-up period ranged from 1 - 3 months. Outcome was graded as good, fair and poor. Results: Out of 75 patients, 28 (37.3%) were (21 - 30) years of age. Trauma was the most popular source of stricture found in 40 (53.3%) and the most widespread presenting feature was poor urinary flow in 32 (42.6%) patients. Stricture in the bulbous urethra in 48 (64%) cases was found to be the most prevalent area followed by penile urethra in 16 (21.3%) cases. Overall response rate was good in 52 (69.3%) patients. Eleven (14.6%) patients exhibited only minor bleeding postoperatively with no other considerable complications. Conclusion: Internal optical urethrotomy is a dependable and effective procedure in treating urethral stricture.
文摘Paraurethral cysts are a rare congenital abnormality seen in female neonates. We present the case of a female newborn with a paraurethral cyst resulting in urinary obstruction. Surgical intervention was chosen as a result of the obstruction.
文摘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.
文摘We report here the history and evolution of the use of oral mucosa in reconstructive urethral surgery since it was first used for urethroplasty in 1894.Since that time,many authors have contributed to develop,improve and popularize the use of oral mucosa as a substitute material.Paediatric urologists should be considered pioneers on the use of oral mucosa as they used it to repair primary and failed hypospadias.The use of oral mucosa to repair penile and bulbar urethral strictures was described,for the first time,in 1993.Important evolutions in the technique for harvesting oral mucosa from the cheek were reported in 1996.Today,oral mucosa is considered the gold standard material for any type of anterior urethroplasty in a one-or two-stage repair due to its biological and structural characteristics that make it a highly versatile that is adaptable to any environment required by the reconstructive urethral surgery.As the future approaches,tissue engineering techniques will provide patients with new materials originating from the oral epithelial mucosal cells,which are cultured and expanded into a scaffold.However,the path to reach this ambitious objective is still long and many difficulties must be overcome along the way.
文摘Aim: A case-report on adenoma of the posterior urethra. Methods: In 131 cases of adenoma of the posteriorurethra, aged 17-79 (mean: 36.4) years, a detailed medical history was taken and urinalysis, urethroscopy, and pro-static specific antigen (PSA) immunohistochemical staining were performed. They were then treated with transurethralresection (TUR) or transurethral electric coagulation (TUEC). Results: Hemospennia occurred in 51% of the cas-es, hemamria in 38%, blood overflow from the urethral orifice in 6%, and dysuria in 5%. The position of the tumorwas at or around the vemmontanum. The appearance of the tumor was similar to those of a papilla, a villus, a dactylor polyp, or simply an engorgement. The tumor contained glandular alveoli and adeno-epithelial cells. PSA immuno-histochemistry was positive in the cytoplasm and nucleus of the adeno-epithelial cell. One hundred and tweenty-ninecases were cured after TUR or TUEC, while 2 patients recurred and were operated again. Conclusion: Adenoma ofthe posterior urethra is a common cause of hemospennia and hematuria in young men. Urethroscopic examination andbiopsy are the principal diagnostic measures. TUR or TUEC are believed to be the treatment of choice with a short-termrecurrence rate of around 1.5%. (Asian J Androl 2000; 3: 67-70)
文摘Aim： To investigate the feasibility of the autologous fascia graft in urethra defect reconstruction. Methods： In 24 adult male rabbits, a standardized defect （17 mm） was created within the midportion of each urethra. Two-cm long fascial tube grafts were interposed between the cut ends of the urethra. Twenty-four rabbits were divided into 12 groups. At 0, 3, 10, 15, 21, 30, 45, 60, 90, 120, 150, and 180 days postoperatively, one group was killed. In the first four groups, rabbits were killed and specimens were obtained for histological examination. After 21 postoperative days, in the subsequent eight groups, retrograde urethrograms were carried out to evaluate urethral patency and caliber, then rabbits were killed and specimens were obtained. Results： In the histological study, advancement of the urethral transitional epithelium along scaffold provided by the fascial graft was determined. At the 30th day, the new urethra was completely covered with the transitional epithelium. Fistula formation was observed in two of 24 rabbits. In urethrograms, narrowing was determined in three of 16 rabbits. Conclusion： For segmental urethral reconstruction, fascial graft is a good urethral substitute because of its rapid epithelization capacity, low contraction degree and thinness. We therefore propose the use of fascial grafts for reconstruction of male-urethra defects in humans.
基金the Key Program of Education Department of Hubei Province(No.301130697)
文摘The objective of this study was to evaluate the biocompatibility of vessel extracellular matrix （VECM） from rabbit and to discuss the feasibility of vessel extracellular matrix as a matrix for urethral reconstruction. Primary cultured bladder smooth muscle cells isolated from New Zealand rabbits were implanted on VECM .The effects of VECM on rabbit bladder smooth muscle cells （RBSMCs） metabolic activity, attachment, proliferation were monitored in vitro with the aid of an inverted light microscope and a scanning electron microscope. The cell viability was monitored by MTT（methythiazolye tetrazolium bromide） after 1, 3, 5 days seeding. The in vivo tissue response to VECM was investigated by implanting them into the subcutaneous of rabbits. VECM exhibited a nontoxic and bioactive effect on RBSMCs. RBSMCs could be attached to and proliferated on VECM and maintained their morphologies. MTT assay showed RBSMCs cultured with the extracts of VECM were not significantly different from those of negative controls. In vivo, VECM demonstrated a favorable tissue compatibility without tissue necrosis, fibrosis and other abnormal response. VECM exhibited nontoxic and bioactive effects on RBSMC. It is a suitable material for urethral reconstruction.
文摘BACKGROUND Clear cell adenocarcinoma of the urethra is a rare type of aggressive cancer with a poor prognosis.Clear cell carcinoma of the urethra represents less than 0.02%of all malignancies in women.Adenocarcinomas account for 10%of female urethral carcinomas,of which 40%are the clear cell variant.Determining the presence or absence of certain mutations through genetic testing may predict whether a patient with cancer may benefit from a particular chemotherapy regimen.CASE SUMMARY A 40-year-old woman presented with a 3-year history of slow urinary flow and a 3-mo history of urinary urgency and frequency as well as gross hematuria.An abdominal and pelvic computed tomography scan demonstrated enlarged lymph nodes in the abdomen and pelvis.A biopsy of a left inguinal lymph node microscopically confirmed a metastatic adenocarcinoma of the urethra.Specialized genetic testing determined personalized chemotherapy.She was treated successfully with a non-platinum-based chemotherapy consisting of paclitaxel and bevacizumab.Following 3 cycles of paclitaxel and bevacizumab,she attained significant clinical improvement,and response by FDG-Positron emission tomography(PET)imaging showed a definite improvement in size and metabolic activity.She achieved complete response after 6 cycles of therapy by PET scan.The patient concluded 11 cycles of paclitaxel and bevacizumab,and a subsequent PET scan confirmed progression of metastatic disease.The patient was then treated with two cycles of doxorubicin after which a PET scan revealed a mixed response to the treatment.CONCLUSION We report the first case of a patient with metastatic clear cell adenocarcinoma of the urethra who underwent personalized chemotherapy after testing for cancer gene alterations.Our unique case represents the safe and effective use of nonplatinum-based chemotherapy in clear cell adenocarcinoma of the urethra.
基金grants from the Ph.D. Candidate Innovation Fund of Shanghai Jiao Tong University School of Medicine (BXJ201741)the National Natural Science Foundation of China (81470911, 81870459)the Clinical Ability Improvement Project for Postgraduates of Shanghai Jiao Tong University School of Medicine (JQ201716).
文摘Tubularized graft urethroplasty fails largely because of in adequate graft take. Prefabricati on of buccal mucosa lined flap has theoretical in dications for con structi ng neourethra with an in depe ndent blood supply. The efficacy of using a tissue expander capsule as an in duced vascular bed to prefabricate an axial vascularized buccal mucosa-lined flap for tubularized urethral rec on struction in a rabbit model was tested. The experiments were performed in three stages. First, silicone tissue expanders were inserted into the groin to induce vascularized capsule pouch formation. Next, buccal mucosa grafts were transplanted to the newly formed capsular tissue supplied by the axial vessel for buccal mucosa-lined flap prefabrication. Then, circumferential urethral defects were created and repaired by buccal mucosa graft (Group 1), capsule flap (Group 2) and prefabricated capsule buccal mucosa composite flap (Group 3). With retrograde urethrography, no rabbits in Group 1 maintained a wide urethral caliber. In Group 2, the discontinued epithelial layer rege nerated at 1 month, and the con structed n eourethra narrowed eve n though the lume n surface formed in tact urothelial cells at 3 months. In Group 3, buccal mucosa formed the lining in the neourethra and kept a wide urethral caliber for 3 mon ths. The capsule may serve as an in duced vascular bed for buccal mucosa-li ned flap prefabricati on. The prefabricated buccal mucosa-lined flap may serve as a neourethra flap for circumferential urethral replacement.
文摘Aim: Describe the clinical, radiological and management of patients with posterior urethral valves. Materials and Methods: This was a retrospective descriptive study over a period going from January 2011 to December 2016, reviewing 12 cases of patients treated for valves of the urethra posterior to the medical surgical center of urology in Cameroon at Douala. The variables studied were clinical, paraclinical, therapeutic and evolutionary. Results: In 5 years, we had diagnosed and treated 12 cases of posterior urethral valves, an average of 2.4 per year. The average age of patients was 41.6 months with extrems of 3 and 156 months. The reason for consultation was dominated by urinary tract infections. Urethrocystography and echography were performed in all patients and allowed to objectify a bilateral ureterohydronephrosis, a diverticular bladder in 9 cases and 4 cases of vesico-ureteral reflux, including a grade 4 according to the classification of Cendron, 8 patients suffered from acute urinary failure. Renal scintigraphyrealised on 3 patients had as objective in 1 patient the existence of a disfunctioning kidney. The treatment consisted of an endoscopic incision of the valves (n = 8), a vesicostomy (n = 3) and an iterative urethral dilatation with double J catheter placement (n = 1). The evolution was favorable (n = 7), and 5 cases of death were recorded. Conclusion: The endoscopic incision is the gold-standard of the treatment of the valves of the posterior urethra. The vesicostomy is an alternative in the absence of adequate technical platform. Despite adequate support, the prognosis remains burdened with significant mortality.
基金by grants from the Ph.D.Candidate Innovation Fund of Shanghai Jiao Tong University School of Medicine(No.BXJ201741)the National Natural Science Foundation of China(No.81470911,No.81870459).
文摘Surgical repair of complex posterior urethral disruptions remains one of the most challenging problems in urology.The efficacy of using a tissue expander capsule as an induced vascular bed to prefabricate axial vascularized buccal mucosa-lined flaps for tubularized posterior urethral reconstruction in a rabbit model was tested.The experiments were performed in three stages.First,silicone tissue expanders were inserted into the groin to induce vascularized capsule pouch formation.Next,buccal mucosa grafts were transplanted into the newly formed capsular tissue supplied by axial vessels for buccal mucosa-lined flap prefabrication.Then,circumferential posterior urethral defects were created and repaired with the buccal mucosa graft(Group 1),the capsule flap(Group 2),and the prefabricated capsule buccal mucosa composite flap(Group 3).After surgery,notable contracture of the tubularized buccal mucosa graft was observed in the neourethra,and none of the rabbits in Group 1 maintained a wide urethral caliber.In Group 2,the retrieved neourethra showed little evidence of epithelial lining during the study period,and the lumen caliber was narrowed at the 3-month evaluation.In Group 3,the buccal mucosa formed the lining in the neourethra and maintained a wide urethral caliber for 3 months.The capsule may serve as an induced vascular bed for buccal mucosa-lined flap prefabrication.The prefabricated buccal mucosa-lined flap may serve as a neourethra flap for posterior urethral replacement.
文摘Penile fracture is a rare urological emergency. It occurs mainly in young adults during sexual intercourse. In many instances, one of the corpora carvanosus is involved though bilateral injuries with or without corpus spongiosus involvement is not uncommon. However, isolated injury to corpus spongiosus is extremely rare. We report a case of isolated rupture of corpus spongiosum secondary to penile injury during coitus in a 43-year-old man that presented to University Hospital Souro Sanou of Bobo Dioulasso. He presented with history of persistence bleeding per urethra following penile injury during sexual intercourse. The Retrograde urethrography (RUG) showed a partial rupture of urethra, Moore type 3. Complementary penile ultrasound revealed extensive contusion of the urethra with circumferential hematoma and rupture of the distal 1/3 of the corpus spongiosus. He had gentle per urethral catheterization which was left for one month. Penile ultrasound sound done after removal of catheter showed residual injury and narrowing of the urethra.
文摘Introduction: The urethral diverticulum or urethrocele corresponds to a saccular dilation of a portion of the urethral wall. Our objective was to report the clinical aspects, investigations and therapeutic aspects of three cases of congenital urethrocele. Observations: They were three male patients aged 11, 20 and 42 years, two of whom had consulted for terminal dribbling. The diagnosis of urethrocele was made for all patients with retrograde and voiding cystouretrography. Treatment consisted of resection of the urethrocele followed by urethroplasty for both cases. Conclusion: Diagnostic of congenital urethrocele must always be assessed when there is a persistent terminal dribbling, and systematically ask for a retrograde and voiding cystourethrography to confirm it.
文摘<strong>Aim:</strong> To improve management of the posterior urethral valve (PUV) in children in a hospital environment. <strong>Patients and Methods:</strong> This was a retrospective descriptive study that covered a sixteen (16) years period, from January 1, 2002 to December 31, 2017, In pediatric surgery and urology departments of our teaching hospital, 26 cases of posterior urethral valve (PUV) were involved. The diagnosis was made by retrograde urethrocystography and micturition, supplemented by ultrasound. <strong>Results:</strong> During this period, 26 patients (1.7%) had a PUV. The mean age of the patients was 73, 2 months with extremes ranging from 6 to 180 months. Fifteen patients consulted for dysuria, 8 for complete retention of urine. Only one patient had a history of rolling the valves to the benign ones. The main complications found were urinary tract infection in 15 children, urolithiasis in 3 children and renal failure in 2 children. Two children had serum creatinine values of 50 and 58 mg/L. The lamination of the posterior urethral valves was performed in all patients. In our series, we had one death from chronic renal failure in a 6-year-old child with a bilateral mute kidney at IVU. <strong>Conclusion:</strong> The valve diagnosis of the posterior urethra is made late because the diagnosis is still postnatal.
