Disintegrating Perineal Disease in Patients with Urethral Stricture and HIV Infection: A Review of 12 Cases

The aim of this study was to define disintegrating perineal disease (DPD) and to determine whether the fulminating nature of the condition could be explained by urine and perineal swab microbiology or perineal histology. A retrospective study that included 12 male patients with urethral strictures and DPD was performed. DPD was defined as a chronic; destructive; purulent perineal inflammation with multiple fistulae or sinuses of the perineum; scrotum or penoscrotal area; which continued for more than six weeks despite a patent urethra after direct vision internal urethrotomy (DVIU) or urinary diversion by means of suprapubic cystostomy. The median patient age was 43.5 years (range of 22-68 years). The patients all tested positive for human immunodeficiency virus (HIV) infection. Their mean CD4 count was 340 cells/mm3 (range of 244-1 252 cells/mm3). Histology of the fistula tracts showed non-specific inflammation in 8 patients (66.7); tuberculosis in 2 (16.7); hydradenitis suppurativa in one (8.3); and squamous cell carcinoma in situ with condylomata acuminata in one patient (8.3). DVIU was performed in 10 patients. Patency of the urethra could be achieved in only three patients for more than six weeks. Perineal urethrostomy was completed in three patients after failed DVIU. Ileal conduit urinary diversion and simple cystectomy was carried out in three patients and curing the DPD was accomplished in two. DPD relates to urethral stricture disease in HIV-positive men with secondary infection as the initiating cause; but no predominant microorganism is responsible for the condition. Simple cystectomy with urinary diversion may be the only solution to treating this debilitating disease

Medical education impact assessment: knowledge of final year medical students of Obafemi Awolowo University about male urethral catheterization

Urethral catheterization is one of the commonest procedures performed by doctors either for prophylactic; diagnostic or therapeutic purposes. The medical education impact of this procedure on graduating medical students was assessed using a structured questionnaire. This is a questionnaire - based study and the respondents were final year medical students who have completed their final examinations. There were 86 respondents with M:F ratio of 1. About a third of the respondents have not done urethral catheterization during their training while only 7have done the procedure more than 5 times. All the students know that urethral catheterization is a sterile procedure and 96knew that sterile gloves should be donned during the procedure. 92.4of the respondents knew that skin preparation was necessary during the procedure with 75of them responding that cetriomide and chlorhexidine solution was appropriate. 54of the students used xylocaine as lubricant while 46used KY Jelly. On the quantity of the lubricant for catheterization; only 2.7of the respondents felt that 11-15mls should be injected into the urethra. On the maximum amount of fluid to retain the balloon; only 36of the students responded that it should be according to the specified capacity of the balloon. Majority of the students (88) know that the catheter should get to theY-junction before it is inflated. Most of the students in this study were taught appropriately the procedure of urethral catheterization; however; about a third had not performed the procedure as a medical student

Distribution of Male Urethral Discharge among the Patients in Primary Health Care Centres of Jos North L.G.A.; Jos; Nigeria

Objectives: The study was to determine the distribution of male urethral discharge among the patients seen in primary health care centres of Jos North Local Government Area. Methods: Male patients with urethral discharge were recruited during their clinic days; from September 2004 to May 2006. A structured questionnaire was administered to the patients who gave their consent. Pre-treatment and post-treatment urethral samples were collected and processed according to standard laboratory procedures. Results: One hundred and seventy-six out of 200 patients completed the study. The age range and mean age of the patients were 11-60 years and 30.7 years respectively. The age decade 21-30 years constituted 100 (56.8) of 176 patients; commercial motorcyclists contributed 80 (45); the single marital status recorded 106 (60.2) while primary and secondary education status had 141 (80). Conclusion: Commercial motorcyclists recorded the highest risk of male urethral discharge; and the peak was among young adults of age decade 21-30 years; especially among the single and less educated

Les ruptures traumatiques de l'uretre posterieur : analyse de 87 cas au CHU de Conakry

Objectif : Rapporter notre experience dans la prise en charge des ruptures traumatiques de l'uretre posterieur. Patients et methodes : Quatre-vingt-sept patients presentant une rupture traumatique de l'uretre posterieur ont ete traites dans le service d'Urologie-Andrologie du CHU de Conakry de janvier 1988 a decembre 2004. Le contexte traumatique a ete un accident de la voie publique dans 68 (78;2) cas et un accident de travail dans 19 (21;8) cas. Seuls 32 (36;8) des patients ont ete recus dans les 72 heures qui ont suivi le traumatisme; les autres ont ete recus au stade de stenose uretrale constituee. Une fracture du bassin a ete notee chez 56 (64;4) patients. La symptomatologie clinique etait dominee par la retention d'urine dans 62 (71;3); l'uretrorragie dans 59 (67;8) et l'hematome perineal dans 23 (26;4) cas. Resultats : Le traitement a consiste en un realignement sur sonde uretrale en urgence; une reparation uretrale en urgence differee entre le 8e et le 10e jour et une uretroplastie tardive selon qu'il s'agissait d'une rupture recente ou ancienne de l'uretre. Les resultats therapeutiques ont ete bons dans 32 (36;8) et moyens dans 39 (44;8) cas. Une dysfonction erectile a ete notee chez 19 (21;8) patientsConclusion : Le traitement des ruptures de l'uretre posterieur demeure controverse; cependant pour nous; l'uretrorraphie termino-terminale en urgence differee reste la methode therapeutique de choix dans notre contexte devant l'impossibilite de pouvoir realiser un realignement endoscopique et en l'absence de lesions associees severes. Devant des lesions associees graves la refection uretrale passe au second plan cedant la priorite aux lesions engageant le pronostic vital

Tubularized incised plate (TIP) urethroplasty : extended use in hypospadias re-operation

Objective: Recently; tubularized incised plate (TIP) urethroplasty (Snodgrass repair) has gained popularity for the primary repair of distal and proximal hypospadias. This study was carried out to evaluate TIP urethroplasty in the repair of failed and complicated hypospadias cases. Patients and Methods: This study was carried out in the pediatric surgery unit; Departments of General Surgery and Urology; Zagazig University Hospital. Twenty-four patients with failed and complicated hypospadias with an intact urethral plate were included in this work. Thirteen patients (54) were younger than 3 years; and 3 patients (13) older than 6 years. The original hypospadias was coronal in 4; midshaft in 11 and penoscrotal in 9 cases. Wide fistula was present in 8 cases (32) and dehiscence was found in 6 cases (26). Previous procedures included meatal advancement and glanuloplasty incorporated (MAGPI) in 5 (21) cases; Mathieu procedure in 4 (17); and preputial flaps in 13 (55) cases. Two patients (8) had been subjected to previous TIP urethroplasty. Twenty cases had had a single preceding procedure; while 4 cases had been subjected to two previous trials of correction. The time that had elapsed before re-operation was less than 6 months in 14 cases (58). Results: Fistula occurred in 3 cases; two of them had had preoperative fistula. Meatal and anastomotic strictures occurred in 2 cases each and were completely managed by dilatation for 3-6 months. Wound infection occurred in 5 cases. Good cosmetic and functional results were achieved in 15 cases (63). TIP urethroplasty was found to be suitable for re-operating previously failed hypospadias cases because it reconstructs the urethra entirely from the urethral plate which is the least affected part after all types of repair. Also; no relation was found between the morphology of the urethral plate and the success of TIP repair. Most of the cases had an intact urethral plate which had not been incised in the primary procedure. Further studies are needed to assess the possibility of using a urethral plate which was previously incised in a primary procedure. Conclusion: TIP urethroplasty could be a reasonable procedure in failed and complicated hypospadias cases. It provides good cosmetic and functional results and can be done using minimal residual tissues remaining after primary procedures

L'uretrorraphie termino-terminale tardive dans la rupture post-traumatique de l'uretre posterieur

"Objective: To analyse the long-term results of the treatment of post-traumatic posterior urethral rupture by delayed bulboprostatic anastomotic repair and to evaluate the efficacy and advantages of this technique. Patients and Methods: Between February 1989 and February 2004; 15 patients underwent delayed bulboprostatic anastomotic repair of post-traumatic posterior urethral ruptures. The results were evaluated taking into account the quality of micturition; continence and erectile function. Results: After an average follow-up period of 34 months (range: 12 - 72 months); all our 15 patients were continent and voided with a satisfactory flow. To achieve this result; 5 patients (33;3) had to undergo internal ureterotomy. Only 4 patients (26.7) reported erectile problems. Conclusion: Delayed bulboprostatic anastomotic repair remains the ""gold standard"" in the treatment of post-traumatic posterior urethral rupture. Compared to other methods of treatment of post-traumatic stenosis of the ureter; this technique allows for a long-term success with minimal complications."

Posterior urethral valves induced micturition syncope in a Ghanaian boy

A case report of a five year old boy who suffered a fainting attack whilst at school. Both clinical evaluation and laboratory investigations were unrevealing of any neurologic; cardiovascular or metabolic disorders as the underlying cause. A complaint by his mother of inordinate straining during micturition and a history of recurrent urinary retention which had necessitated several urinary bladder catheterization pointed further studies into his renal function. Persisting posterior urethral valves were discovered from his classic micturiting cystourethrogram as the likely principal cause of his syncopal attack. He was treated by surgery