Application progress of imaging examination in the diagnosis of urethral stricture / 现代泌尿外科杂志

Urethra stricture is one of the most common diseases of the urinary system. Accurate imaging diagnosis is key to the selection of surgical approach. At present, X-ray urethral imaging can show the form of urethra cavity, but not the tissues around the urethra. Sonourethrography (SUG) can dynamically identify the urethral cavity and the surrounding tissues without radiation exposure. Multi-layer spiral CT urethrography (CTU) has advantages of no need to adjust the position, quick scanning and reconstruction of the three-dimensional image, which can accurately show the location, length and degree of urethral stricture, and the spatial relationship with the surrounding tissues. Magnetic resonance urethrography (MRU) can provide useful information of the urethral stricture and soft tissues around the urethra, especially in urethral strictures caused by pelvic fractures and complex urethral stenosis. The choice of imaging method should be based on the etiology, anatomy, types of urethral injury and the general situation of patients. Appropriate imaging method can improve the diagnostic accuracy.

Complications of urethrography and its management / 中华泌尿外科杂志

This study retrospectively analyzed the clinical data of 28 male patients with urethral stricture who had complications during urethrography, including 14 cases of infection, 8 cases of urethral bleeding, 5 cases of contrast agent hypersensitivity, and 1 case of bladder rupture. The infection manifested as acute cystitis in 11 cases, acute pyelonephritis in 1 case, acute epididymitis in 1 case, and sepsis in 1 case. Hypersensitivity reaction was mild in 3 cases, moderate and severe in 2 cases. A child with bladder rupture was immediately transferred to open surgery for bladder repair. All patients were cured by corresponding treatment. The complications of urethrography have various manifestations and different degrees of severity, so we should pay attention to prevention and proper treatment.

Fournier’s gangrene following retrograde urethrography: a rare complication

Retrograde urethrography (RGU) is a useful investigation to look for urethral injuries. It can result in various complications like anaphylaxis due to contrast material, urinary tract infection and intravasation or extravasation of contrast. In this case report, a rare complication of RGU was seen in the form of Fournier’s gangrene. This complication was probably due to extravasation of contrast material during the procedure which lead to reactionary changes of the penile skin and scrotum. Patient was managed aggressively and had a good recovery and is on regular follow up.

Comparing retrograde urethrography readings with intraoperative findings in urethral stricture

Background: Urethral strictures are relatively common in men with most patients acquiring the disease due to injury or infection. The present study was conducted to assess the accuracy of retrograde urethrography (RGU) in diagnosing urethral strictures in patients presenting with lower urinary tract symptoms.Methods: All male patients presenting with lower urinary tract symptoms and referred for retrograde urethrogram to the Department of Radiodiagnosis, Bharati Vidyapeeth Medical College and Hospital (Deemed to be University), Sangli from November 2018 till January 2019 were included. The parameters of RGU were compared with intra-operative findings as gold standard to calculate the operating characteristics of RGU.Results: The present study included 42 patients, mean age 54.9±11.2 years. Grade I urethral stricture was observed in 42.8% and 26% had grade II stricture. Bulbar stricture was the most common location. The common presenting complaints were increased frequency (50%) and dribbling micturition (40.4%). Approximately one tenth of all patients had a history of trauma. RGU was 100% sensitive and 66.7% specific in detecting strictures of less than 2 cm. Overall accuracy of RGU in detecting urethral strictures of less than 2 cm was 83.3%.Conclusions: RGU is a reliable means for establishing the diagnosis of a suspected urethral stricture and also provides accurate staging information with regard to stricture number, length, location, and coexistent urethral pathology.

Viabilidade da técnica de transposição uretral pré-púbica mediante secção peniana em cadáveres de cães / Viability of the prepubic urethral transposition technique by penile section in dog cadavers

Descreve-se a viabilidade da técnica cirúrgica de transposição uretral pré-púbica em cadáveres de cães machos, adultos, advindos de um hospital veterinário, a fim de se avaliar a manutenção da luz uretral a partir de um desvio uretral pré-púbico, descrevendo-se detalhadamente a abordagem e as estruturas anatômicas envolvidas. A técnica consistiu inicialmente da orquiectomia, seguida de celiotomia retroumbilical, tração vesical cranial, secção transversa da uretra membranosa a 1cm caudal à próstata, espatulação e reparo da borda livre. A seguir, divulsão e secção do pênis 1,5cm caudal ao osso peniano, espatulação da borda uretral peniana e transposição desta em direção à cavidade abdominal, fazendo-se anastomose por meio de sutura interrompida simples à uretra membranosa. Foi mensurado o comprimento uretral desde o meato externo até o início da uretra prostática em dois momentos: pré e pós-transposição. Ao final, avaliou-se, por meio de uretrografia retrógrada de contraste positivo, o diâmetro e o selamento na anastomose uretral e o fluxo do contraste até a bexiga. A transposição uretral pré-púbica é uma técnica cirúrgica exequível, anatomicamente compatível com a espécie canina e capaz de manter o diâmetro uretral e o fluxo do contraste de forma satisfatória, com manutenção estética externa idêntica a um cão macho orquiectomizado.(AU)

We describe the viability of the surgical technique of pre-pubic urethral transposition in cadavers of adult male dogs, coming from a veterinary hospital to evaluate the maintenance of urethral light from a prepubic urethral deviation, describing in detail the approach and anatomical structures involved. The technique consisted initially of orchiectomy, followed by retroumbilical celiotomy, cranial vesical traction, transverse section of the membranous urethra at 1cm caudal to prostate, spatulation and free edge repair. Next, the penis divulsion and section 1.5cm caudal to the penile bone, spreading the penile urethral border and transposing it towards the abdominal cavity, making an anastomosis of simple interrupted suture to the membranous urethra. The dogs had the urethral length measured from the external meatus to the beginning of the prostatic urethra at two moments: pre-transposition and post-transposition. Postoperative retrograde urethrography was used to evaluate the diameter and sealing of the urethral anastomosis and contrast flow to the bladder. In conclusion, the prepubic urethral transposition is a feasible surgical technique, anatomically compatible with the canine species and able to maintain the urethral diameter and contrast flow satisfactorily, with an external esthetic maintenance identical to an orchiectomized male dog.(AU)

Transposição e anastomose uretral pré-púbica em um cão macho com estenose extensa da uretra intrapélvica / Prepubic urethral transposition in a male dog with extensive stenosis of the pelvic urethra

We report the use of a new surgical technique in a male dog affected by extensive stenosis of intrapelvic urethra through a antepubic urethral deviation, as an alternative to prepubic urethrostomy and ablation of the external genitalia. The technique consisted initially of orchiectomy, followed by retroumbilical celiotomy, transverse section of the penis in the pre-scrotal region and transposition of this towards the abdominal cavity by making anastomosis to the prostatic urethra. The dog was evaluated clinically and by urethrography retrograde positive contrast for up to four years after the procedure without any clinical signs, changes in urine stream or stenosis image. It is concluded that the pre-pubic urethral transposition is a viable alternative treatment for this dog affected by extensive stenosis of the membranous urethra.(AU)

Imaging diagnosis of enlarged prostatic utricle in children / 实用放射学杂志

Objective To discuss the image characteristics of enlarged prostatic utricle in children.Methods 13 children with enlarged prostatic utricle were retrospectively analyzed,6 of whom checked by voiding cystic urethrography (VCUG),5 of whom by MRI,2 of whom by both VCUG and MRI.Results 8 cases with VCUG showed round-like or long circle utricle filled with contrast media located in the rear posterior urethra.Among them,3 cases showed the tubiform between utricle and posterior urethra.The other 5 cases displayed overlap between utricle and urethra,and there was no tubiform between utricle and posterior urethra.7 cases with MRI showed oblong cyst at the right rear middle of the bladder that showed low signal with T1 weighted image and high signal with T2 weighted image,crossing the center of prostate gland.Among them,5 cases showed the communication between oblong cyst and posterior urethra.Also,among them,5 cases were associated with the orchitis,epididymis phlogistic,scrotal phlogistic,and 1 case showed the right renal agenesis.Conclusion The VCUG and MRI are helpful to check enlarged prostatic utricle in children.They have different advantages in different aspect.

Local Allergic Reaction to Contrast Material during Retrograde Urethrography.

Adverse reactions associated with parenteral use of contrast agents are widely recognized, but reactions to contrast agents following retrograde urethrography are much less common. A rare case of local allergic reaction to ionic contrast during retrograde urethrography in a 25-year-old male patient, who was treated conservatively, has been described.

Spontaneous partial rupture of the upper renal tract

Spontaneous partial rupture of upper renal tract is rare and is usually associated with urolithiasis. Other causes include instrumentations, trauma, pelvic cancer, retroperitoneal fibrosis, fluid overload, and pregnancy. We report two cases (46-year-old and 41-year-old men) of upper renal tract rupture. The first case had rupture of the ureter proximal to stone impaction and the second case had fornicial rupture secondary to stone impaction at the uretero-vesical junction. In contrast to ureteral rupture, fornicial extravasation is more common and the symptoms are always mild. The mechanism of ureteral rupture can be explained as either pressure around the ureteral wall due to stone impaction, or a tear caused by pressure during the passage of the stone. Fornicial rupture occurs when intra-pelvic pressure is greater than 35cm H2O. It is important to distinguish true rupture of the ureter from fornicial tear with extravasation, because both the outcome and treatment are different.

Significance of Retrograde Urethrography in Diagnosis and Treatment of Urethraltrauma / 中国基层医药

Objective To discuss the significance of the retrograde urethrography in diagnosis and treatment of urethraltrauma. Methods 78 cases with urethraltrauma treated by the retrograde urethrography were retrospectively analyzed. Results The location and extent of urethral injury was determined according to the place and speed of contrast medium overflow and the diffuse range. Among 78 cases ,29 cases were bulbar urethral trauma and other 49 cases were membranous urethral trauma.Conclusion Retrograde urethrography is simple, practical and easy to operate for determining the injured part of urethra and the extent of damage of urethraltrauma, and was instructional for the choice of operation method and incision.

The Role of Retrograde Urethrography as a Predictor of Early Recovery of Urinary Continence after Radical Retropubic Prostatectomy

PURPOSE: This study is designed to explore the role of retrograde urethrography as a predictor of recovery of urinary continence after radical retropubic prostatectomy. MATERIALS AND METHODS: A total of 40 patients who underwent radical retropubic prostatectomy from January 2005 to April 2007 were investigated. Among them one neurogenic bladder patient and one follow up loss patient were excluded. Voiding pattern and urinary incontinence were investigated with voiding diary monthly after Foley catheter removal. Recovery of urinary continence was defined as usage of less than 1 diaper per day. Pericatheter urethrography was conducted 2 weeks after operation. If definite bladder-urethral extravasation was not detected, an retrograde urethrography was performed immediately. 30 patients with sufficient length of urethra, regular margin of urethra and beaky appearance were defined as Group A, and 8 patients without above mentioned characteristics were marked as Group B. Differences between two groups were compared in terms of age, prostate volume, prostate specific antigen, urodynamic parameters, and duration of urinary incontinence. RESULTS: No significant differences were found in age, prostate volume, PSA between two groups. In group A, recovery rates of urinary continence were 70% (21 persons), 100% (30 persons) at 1,3 months after removal of catheter, respectively. In group B, rates of urinary continence recovery were 16.6% (1 person), 37.5% (3 persons), 75% (6 persons) at 1,3,4 months, respectively and 1 person regained continence at 7 months. CONCLUSION: A catheter free retrograde urethrography can be easily added after confirmation of bladder urethra anastomosis site healing. It gives us some valuable informations about external sphincter. The characteristics of retrograde urethrography can be used as a predictor of early recovery of postoperative incontinence.

Prostatic utricle associated with hypospadias and hermaphroditism / 대한비뇨기과학회지

From Jan. l985 to June 1990, 1O9 cases with hypospadias, five with male pseudohermaphroditism and four with true hermaphroditism have been studied radiologically in order to evaluate the incidence and configuration or prostatic utricle or vagina masculinus at Pusan National University Hospital. The results were as follows :. 1. The prostatic utricle or vagina masculinus, was found 27 cases (24.8%) out of 109 hypospadias. all of male pseudohermaphroditism and true hermaphroditism. 2. The prostatic utricle was found in 2 (l8.2%) out of 11 glandular hypospadias. 11 (l9.6%) out of 56 penile hypospadias, 12 (34.3%) out of 35 penoscrotal hypospadias and II (68.8%) out o 16 perineal hypospadias. 3. According to Ikoma's classification of prostatic utricle, grade 0, I, II, and III were 1 case (2.1%), 13 (36.1%). 7 (19.4%) and 15 (41.7%), respectively. The incidence and size of prostatic utricle increased according to the severity of hypospadias. 4. Most cases were asymptomatic. Irritative symptoms in bladder or urethra were noted in 4 cases ( 11.1%), and recurrent epididymitis in 3 (8.3%). 5. Of 3 cases with recurrent epididymitis, one had excision of the prostatic utricle. Of 5 male pseudohermaphroditism. 2 vagina masculinus were removed with simultaneous urethroplasty of 4 true hermaphroditism, vaginoplasty was done in 1 case and the removal of vagina masculinus and urethroplasty were done in 2 cases. Therefore. the voiding cystourethrography or retrograde urethrography is necessary for diagnosis of prostatic utricle. especially in cases of severe degree of hypospadias, hermaphroditism and recurrent epididymitis with uncertain causes.