Urethral injury in penile fracture: a narrative review

ABSTRACT Objective To present the evolution and the recent data on the etiology, diagnosis, management and outcomes of penile fracture (PF) with concomitant urethral injury. Materials and Methods We searched the Pubmed database between 1998 and 2019 using the following key words: "penile fracture", "fracture of penis", "trauma to penis", "rupture of corpora cavernosa", "urethral injury", "urethral rupture" and "urethral reconstruction". Results The incidence of urethral lesion in patients with PF varies by geographic region and etiology. Blood in the meatus, hematuria and voiding symptoms are highly indicative of urethral rupture. The diagnosis of PF is eminently clinical and complementary exams are not necessary. The treatment consists of urethral reconstruction and the most common complications found are urethral stenosis and urethrocutaneous fistula. Conclusion PF is an uncommon urological emergency, particularly in cases with urethral involvement. Urethral injury should be suspected in the presence of suggestive clinical signs, and diagnosis is usually clinical. Urgent urethral reconstruction is mandatory and produces satisfactory results with low levels of complications.

Urethral dysfunction due to alloxan-induced diabetes. Urodynamic and morphological evaluation

PURPOSE: To evaluate the effect of short and long term alloxan-induced diabetes on bladder and urethral function of female rats, and also describing its correlated morphological alterations. METHODS: Thirty five female rats were divided into three groups: G1 (n=9), control group; G2 (n=17), six weeks alloxan-induced diabetic rats; G3 (n=9), 20 weeks alloxan-induced diabetic rats. Functional evaluation was performed by cystometry and simultaneous measurements of the urethral pressure during bladder filling and voiding. Morphological evaluation was also performed with measurement of bladder and urethral fibrosis and collagen content and thickness of lamina propria and smooth muscle layers. RESULTS: The peak bladder pressures and contraction amplitudes were decreased in 100% and 47% of the G3 and G2 groups respectively, when compared to control. Bladder overactivity was observed in 53% of the G2 group. CONCLUSION: Alloxan-induced diabetes urethropathty in female rat was associated to bladder morphological alterations as higher thicknesses of it lamina propria, detrusor and adventicea. .

Duplicación rectal extrofiada asociada a malformación anorrectal y transposición pene-escrotal con hipospadias perineal: Reporte de un caso clínico / Exstrophy of rectal duplication associated with anorectal malformation and penoscrotal transposition with perineal hypospadias: A case report

Se presenta el caso de un paciente masculino quien requirió tratamiento por agenesia anorrectal con fístula rectouretral y transposición pene-escrotal con hipospadias perineal, acompañados de una masa perineal. La tumoración perineal se encontró íntimamente adherida y en continuidad al recto, lo que la hace compatible con una duplicación rectal extrofiada. La reconstrucción quirúrgica de la anomalía se realizó en etapas hasta lograr resultados funcionales y estéticos aceptables.

We present the case of a male patient who required treaatment due to anorectal agenesis with recto urethral fistula and penoscrotal transposition with perineal hypospadias, associated with a perineal tumor. The perineal tumor was found strongly adhered and contiguous to the rectum which makes it compatible with an exstrophy of rectal duplication. Surgical reconstruction of the birth defect was performed in stages until acceptable biological function and esthetic results were obtained.

Surgical repair of posterior urethral defects. Review of literature and presentation of experiences

The main objective of the present review article was to study the different aspects of reconstructive surgery for posterior urethral defects by reviewing the published articles and presentation of our experiences in the reconstructive urology division at Shohada-e-Tajrish hospital. The Medline was searched with the keywords of posterior urethroplasty, end-to-end anastomosis, excisional urethroplasty, anastomotic urethroplasty, pelvic fracture, bulboprostatic anastomosis, and urethral repair. The search was limited to papers published from 1980 to September 2008. We selected the relevant published articles in this database and also presented our experience at our reconstructive urology division. Of over 5000 search results, we selected 38 relevant articles with substantial contribution to the subject. Pelvic fracture due to accidents was the most common etiology of pelvic fracture urethral distraction defect that usually involved the membranous urethra. Surgical treatment of this disorder with perineal anastomotic urethroplasty was accompanied by a success rate of 82% to 95% in different studies. The most important complications of this surgery include urinary incontinence and impotence; however, the incidence of these complications has been reduced by using new surgical techniques. Complete preoperative assessment, the use of suitable reconstructive techniques, and in particular, the use of flexible cystoscopy can lead to acceptable outcomes of the surgical repair of pelvic fracture urethral distraction defects

The York-Mason technique for recto-urethral fistulas

OBJECTIVE: Recto-urethral fistula formation following radical prostatectomy is an uncommon but potentially devastating event. There is no consensus in the literature regarding the treatment of these fistulas. We present here our experiences treating recto-urethral fistulas. MATERIAL AND METHODS: We analyzed 8 cases of rectourethral fistula treated at our institution in the last seven years. Seven of the patients underwent repair of the fistula using the modified York-Mason procedure. RESULTS: The causes of the fistula were radical retropubic prostatectomy in five patients, perineal debridement of Fournier's gangrene in one, transvesical prostatectomy in one and transurethral resection of the prostate in the other patient. The most common clinical manifestation was fecaluria, present in 87.5 percent of the cases. The mean time elapsed between diagnosis and correction of the fistula was 29.6 (7-63) months. One spontaneous closure occurred after five months of delayed catheterization. Urinary and retrograde urethrocystography indicated the site of the fistula in 71.4 percent of the cases. No patient presented recurrence of the fistula after its correction with the modified York-Mason procedure. CONCLUSION: The performance of routine colostomy and cystostomy is unnecessary. The technique described by York-Mason permits easy access, reduces surgical and hospitalization times and presents low complication and morbidity rates when surgically correcting recto-urethral fistulas.

OBJETIVO: As fístulas reto-uretrais são de acesso difícil e por vezes complexo, sendo seu fechamento espontâneo raro. Com o diagnóstico precoce e aumento do número de intervenções, principalmente a cirurgia por adenocarcinoma da próstata localizado, sua incidência apesar de rara vem crescendo. Nós demonstramos a nossa experiência dos casos de fístulas reto-uretrais entre 2000 a 2006 com uma serie de oito pacientes, sendo que sete realizaram correção da fístula pela Técnica de York Mason modificada. MATERIAL E MÉTODO: Nos retrospectivamente analisamos os prontuários de todos os casos de fístulas reto-uretrais tratados no nosso serviço no período de 2000 a 2006. Sete de oito pacientes realizaram reparo da fístula através do procedimento de York Mason modificado. RESULTADOS: Cinco pacientes tiveram a fístula como conseqüência da Prostatectomia Radical Retropúbica, sendo os outros três após debridamento devido a Fasceíte de Fournier, Prostatectomia Transvesical e Ressecção Transuretral da Próstata. A fecalúria foi o quadro clínico prevalente em 87,5 por cento dos casos, o tempo médio entre o diagnóstico e a correção da fístula foi de 29,6 (7-63 meses) ocorreu um fechamento espontâneo após cinco meses de sondagem vesical de demora, a Uretrocistografia Retrograda e Miccional demonstrou a localização da fístula em 71,4 por cento. Nenhum paciente apresentou recidiva da fístula após correção pela técnica de York Mason modificada. A colostomia foi realizada em 50 por cento dos casos e não ocorreram casos de incontinência fecal ou estenose anal. CONCLUÇÃO: Após identificação de fístula reto-uretral, não é necessário à realização de colostomia e cistostomia de rotina. Sua correção pela técnica descrita por York Mason modificada nos propicia fácil acesso a sua localização, diminui o tempo cirúrgico e de internação, com baixos índices de complicações e morbidade.

A Importância do diagnóstico da deficiência esfincteriana uretral intrínseca em mulheres com incontinência urinária de esforço / The Importance of intrinsec sphincter urethral deficiency diagnosis in woman with effort urinary incontinence

Incontinência urinária de esforço (IUE) é conceituada como toda observação de perda involuntária de urina pelo óstio uretral externo, sincrônica ao esforço, espirro ou tosse. (Abrams et al., 2002). Tem causa multifatorial sendo elemento gerador de exclusão social, interferindo na saúde física e mental da paciente e comprometendo sua qualidade de vida. O diagnóstico da enfermidade é essencial, uma vez que a incontinência de esforço pode ser causada por deficiência esfincteriana ou por hipermobilidade da uretra. Sua diferenciação é prioridade antes de se propor tratamento cirúrgico, visto que os procedimentos de colpossuspenção retropúbicos tradicionais podem ter índices de falha de até 35 porcento em pacientes com defeito esfincteriano (Raz et al., 1992). Embora esta classificação permita distinguir duas bases fisiopatológicas distintas, é importante enfatizar que esta divisão não é absoluta. Existe espectro no qual os dois tipos podem co-existir independentemente. O termo "deficiência esfincteriana uretral intrínseca" refere-se ao subtipo de incontinência urinária de esforço causada pela inabilidade do mecanismo esfincteriano uretral em manter a coaptação da mucosa tanto no repouso quanto ao esforço físico. Difere da hipermobilidade do colo vesical por fatores de risco diferentes, maior gravidade dos sintomas e pior resposta ao tratamento (Bump et al., 1997). Esforços têm sido feitos na definição, reconhecimento, demonstração objetiva e manejo da deficiência esfincteriana intrínseca (Blaivas, 1991). Assim, a identificação pré-operatória destas pacientes é parte fundamental da propedêutica uroginecológica para o sucesso cirúrgico

Urethrorectal fistula by bull horn injury.

Bull horn injuries are common in rural India. Here one such case causing urethrorectal fistula has been reported. The patient was presented with history of bull horn injury 6 hours back. He was examined under general anaesthesia and found to have lacerations in the anus and anterior wall of rectum. Urgent retrograde urethrography and cystography showed partial rupture of bulbar urethra and urethrorectal fistula. Initially sigmoid colostomy and suprapubic cystostomy was done. Later optical internal urethrotomy was done. The patient was catheterised for 3 weeks and the fistula healed completely.

Treatment of Female Urethral Syndrome Refractory to Antibiotics

Various methods of treatment, other than antibiotic therapy, have been proposed for the treatment of female urethral syndrome; however, the results of these treatment methods are disappointing, due perhaps to the use of the wrong treatment approach. The aim of this study was to evaluate the effectiveness of external sphincter relaxant and biofeedback (BFB) with electrical stimulation therapy (EST) in patients who do not respond well to antibiotics. One hundred and five patients with a diagnosis of female urethral syndrome were entered into this study. Antibiotics were given as a first-line therapy for about 3 months. In cases of recurrent or incurable urethral syndrome, antibiotic therapy combined with external sphincter relaxant or BFB with EST were performed. External sphincter relaxant group was composed of 31 patients (29.5%) who showed functional urethral obstruction. Biofeedback group was composed of 41 patients (39.0%) who had severe pain or discomfort with irritative voiding symptoms. Subjective symptom was measured before and after therapy using the Bristol Female Lower Urinary Tract Symptoms questionnaire. Thirty-three patients (31.4%) were treated with antibiotic therapy alone and 7 (21.2%) of these patients recurred. The symptom score of this group changed from 10.51 to 2.85. In the antibiotics plus external sphincter relaxant group (N=31), the symptom score changed from 12.39 to 3.96. Five (16.1%) of these patients recurred and 3 of these 5 underwent urethral dilatation. In the antibiotics plus biofeedback group (N=41), the average urinary frequency changed from 12.2 to 7.7 times a day and nocturia changed from 2.4 to 0.6 times a night. The symptom score improved from 15.22 to 4.69 and the overall satisfaction rate was 87.8% (41.5%: very satisfied, 46.3%: satisfied, 12.2%: no response). Female urethral syndrome is not due to a single factor but is a complex disease due to various combined symptoms and mechanisms. This condition needs to be treated with an appropriate treatment protocol. We believe that satisfactory results could be obtained in female urethral syndrome, which has shown poor prognosis until now, by appropriately combining treatment methods, which include the use of external sphincter relaxants, biofeedback therapy and bladder training, according to indication, and depending on whether symptoms continue after initial antibiotic therapy.

Detection of mycoplasmas in urethral swabs from HIV-1 infected patients and control individuals using culture techniques and polymerase chain reaction

O objetivo do presente estudo foi determinar a prevalência de determinadas espécies de micoplasmas, tais como, Mycoplasma hominis, Ureaplasma urealyticum e Mycoplasma penetrans, em swabs uretrais de pacientes infectados com HIV-1 comparando com um grupo controle. Micoplasmas foram detectados por técnicas padräo de cultivo e pela reacäo de polimerase em cadeia para a qual foram utilizados "primers" genericos obtidos da regiäo conservada 16sRNA e "primers" nos dois metodos foi comparavel. Contudo, o PCR mostrou ser mais sensivel nas condicöes empregadas enquanto que o cultivo permitiu a quantificacäo dos isolados. Os resultados demonstraram näo haver diferenças significantes (p<0,05) nas taxas de positividade entre os metodos empregados para a detecçäo dos micoplasmas

Prolapso de mucosa uretral em meninas / Urethral Mucosa Prolapse

Entre janeiro de 1985 e dezembro de 1993 foram tratadas seis meninas com prolapso de mucosa uretral através da exérese cirúrgica de prolapso e ampliaçäo do meato uretral externo. A patologia predominou em criança de pele negra e classe social baixa. Os principais sintomas e sinais foram sangramento vaginal e tumores a nível do meato uretral externo. Os resultados, com seguimento de um mês, três meses, nove meses, 12 meses e 24 meses foram excelentes

Vesical fistulae--an experience from a developing country.

This study analyses patients with vesical fistulae presenting at a teaching, referral hospital over the last ten years. There were 62 cases of vesical fistulae of which 60 were obstetric in origin (44 home and 16 hospital deliveries) and 2 were following gynaecological surgery. Of the hospital deliveries which culminated in fistula formation, 8 were vaginal and 7 forceps deliveries. In one patient, lower segment caesarean section was carried out. After a thorough urological work-up, patients were subjected to standard technique of layered closure (61 by vaginal approach and one by abdominal). Repair was successful in 53 (87.09%) patients. Of the 9 failures, 4 were repeat repairs.

Fistules urethrales apres circumcision [a propos de 15 cas]

Circumcision is mostly performed in traditional way by barbers [90% of cases] accidents are unusual and may occur when inexperienced barbers do it. During last ten years, we just observed 15 cases of urethral fistula following circumcision. In 12 cases, the lesion was small, 2 to 3 mm. localized at balano-preputial segment; in two cases fistula was larger, .5 mm, and considered like traumatic hypospadius and in one case the striction around the glans was so deep that conservative surgery was impossible. In all cases but one conservative surgery was successful