An unusual presentation of urethral duplication presenting with chronic bladder retention, left scrotal transposition and left renal agenesis

ABSTRACT Introduction and objective Urethral duplication is a rare congenital anomaly, with roughly 200 cases reported in the literature (1). It is more frequent in males, with few cases reported in females. The clinical presentation differs according to the anatomical variant present. The duplication most commonly occurs in the sagittal plane with one urethra located ventrally and the other dorsally (2). Usually the ventral urethra is the more functional of both. Duplications occurring in the coronal plane are quite rare and they are usually associated with bladder duplication (3). The purpose of this paper was to present a video of a boy with an unusual urethral duplication form. Materials and Methods Patient was born premature due to oligohydramnios at 7 months-gestational age and he has initial diagnosis of hypospadia. Since then, he presented at least 7 febrile UTI and mother complained of difficult micturition and a presence of a mass at lower abdomen. Patient was referred to our institution and we identified urethral duplication with a glandar and scrotal meatus, palpable bladder and left penile-hemiscrotum transposition. US and CT-scan showed left kidney agenesis and overdistended bladder. VCUG and retrograde urethrography showed duplication, presence of contrast in the seminal vesicles and complete catheterizing of both urethras was not possible. Results The topic urethra was dysplastic and not patent to a 4Fr plastic tube so we were unable to access it endoscopically. We performed initially a Mitrofanoff procedure to allow CIC and treat chronic retention. Six months later, we assessed both urethras surgically and concluded that dorsal urethra was dysplastic after 3cm still in the penile area and scrotal urethra was not possible to be catheterized. We excised the ventral urethra because of dribbling complaints up to bulbar area and reconstructed the scrotal transposition, keeping the topic urethra for cosmetic issues. Patient had excellent outcome, performs CIC every 4 hours and has not presented further UTI episodes. Discussion and conclusion The urethral duplication is an anomaly that has multiple anatomical presentations. There are several theories about the etiology, but none can explain all types of presentations. There is also more than one rating available, and the Effmann classification is the most detailed. The case exemplifies this varied spectrum of anatomic urethral duplication. It resembles the urethral duplication type IIa-Y, however, ventral urethra meatus was located in penoscrotal area and both urethras were at least partially hypoplastic/dysplastic associated with obstruction and bladder retention. In determining how to best manage a patient with Y-type urethral duplication, the caliber and quality of the orthotopic urethra must first be assessed. Published reports suggest that best outcomes are those using the ventral duplicated urethra for the reconstruction (4). In this case, none of urethras were functional and a supravesical outlet channel had to be provided. The treatment of this condition requires an individualized planning and a vast technical knowledge of reconstructive surgery.

Embolização seletiva das artérias prostáticas no tratamento da hiperplasia protática benigna / Selective arterial prostatic embolization to treat benign prostatic hyperplasia

Hiperplasia prostática benigna (HPB) é considerada a neoplasia masculina mais comum, além de ser a principal causa de sintomas do trato urinário baixo (STUB) em homens idosos. Se não tratada ou mal tratada, poderá levar o paciente a quadro de retenção urinária aguda, incontinência e infecção do trato urinário, progredindo em gravidade com a idade. Apesar do desenvolvimento de técnicas alternativas, a ressecção transuretral da próstata (RTU) continua sendo considerada o tratamento cirúrgico padrão ouro para HPB. Não obstante, a RTU pode estar associada a muitas comorbidades como, sangramento, sintomas urinários irritativos, disfunção sexual e ejaculação retrógrada. Por essa razão, o desenvolvimento de modalidades de tratamentos minimamente invasivos para o tratamento de HPB constitui um campo interessante de pesquisa clínica. Os objetivos deste estudo foram: (1) avaliar a viabilidade, a segurança e a eficácia da embolização das artérias prostáticas (EAP) nos pacientes com retenção urinária devido à HPB, (2) avaliar a porcentagem de redução volumétrica da próstata e a qualidade de vida após a EAP nos pacientes com retenção urinária devido à HPB. No presente estudo, Fase I prospective centro único, 11 pacientes portadores de retenção urinária devido à HPB foram tratados por meio da EAP entre agosto de 2009 e novembro de 2011. Exame físico, questionários de sintomas e qualidade de vida (International Prostate Symptom Score (IPSS) e Quality of Life (QoL)), dosagem do antígeno prostático específico (PSA), exames de imagens de ultrassom (US) e ressonância magnética (RM), e estudos urodinâmicos foram realizados antes e 1, 3, 6, e 12 meses depois da EAP. O tamanho da próstata variou de 30 a 90 gramas, e as embolizações foram realizadas com microesferas (Embospheres) de 300-500?m. O sucesso técnico (EAP bilateral) foi atingido em 75%, e o sucesso clínico (retirada do cateter vesical de demora e melhora dos sintomas) foi obtido em 91% (10 de 11 pacientes) dos casos...

Benign prostatic hyperplasia (BPH) is considered the most common neoplasm in men and is the main cause of lower urinary tract symptoms (LUTS) in the aging male. If left untreated or not effectively treated, can lead to acute urinary retention, incontinence, and urinary tract infections, progressing in severity with age. Despite the development of alternative techniques, transurethral resection of the prostate (TURP) is still considered the gold standard surgical treatment for BPH. However, TURP procedures can be associated with substantial morbidities such as bleeding, irritative urinary symptoms, erectile dysfunction and ejaculatory disorders. For this reason, the development of minimally invasive modalities for treatment of BPH has constituted an interesting field of research. The study objectives were: (1) to evaluate the feasibility, safety and efficacy of the prostatic artery embolization (PAE) in patients with urinary retention due to BPH, (2) to evaluate the percentage of reduction in prostate volume and quality of life after PAE in patients with urinary retention due to BPH. In the present study, a single-center prospective phase I study, 11 patients with urinary retention due to BPH were treated by PAE between August 2009 and November 2011. Physical examination, International Prostate Symptom Score (IPSS) and Quality of Life (QoL), prostate specific antigen (PSA) measurement, ultrasound (US) and magnetic resonance imaging (MRI), and urodynamic tests were performed at baseline, 1, 3, 6 and 12 months after PAE. Prostate size ranged from 30 to 90g, and embolizations were performed with 300- 500-?m Embosphere microspheres. Technical success (ie, bilateral PAE) was obtained in 75%, and clinical success (ie, catheter removal and symptom improvement) was obtained in 91% (10 of 11patients) of the cases. Postembolization syndrome manifested as mild pain in the perineum, retropúbica area, and/ or urethra. No major complications were observed. At the first year...

Early removal of 3 way foleys catheter after transurethral resection of prostate in beneficial?

To compare the outcome of three way foleys catheter removed on 2[nd] and 5[th] day after Transurethral resection of Prostate for BPH regarding postoperative retention of urine, urine culture and hospital stay. Quasi Experimental study. This study was carried out in Department of Urology, University of Medical and health sciences Jamshoro from July 2010 to December 2011. This study consisted of 50 patients were divided in two groups. Group A for catheter was removed on 2nd post operative day of Trans Uretheral resection of prostate and group B for catheter was removed on 5th Post Operative Day of Trans Uretheral resection of prostate, each group consist of 25 patients. Detailed History was taken from all the patients with special regard to the urinary retention. Inclusion criteria were that all diagnosed as case of BPH on the basis of history and investigations. Exclusion criteria included unfit patients for general anesthesia, presented with chronic urinary retention, hematological disorders, pre operative infected urine and concurrent uretheral structure. Re-catheterization were in 2 patients [8%] group A and 1 patient [4%] in group B. Post operative urine culture growth of organism [bacteriuria] were 1 patient [4%] A and 3 patients [12%] in group B. Duration of hospital stay in group A was 5.68 as compared to the patients in group B was 8.44 days. In conclusion, early catheter removal had a dramatic impact on hospital stay. Catheters can be removed early after transurethral resection of prostate with no increase in morbidity and maintain the efficacy of the procedure, resulting in considerable savings to their patients. Our study confirms the safety of an irrigation-free and early catheter removal policy after TURP

Recurrent vesicourethal stenosis after radical prostatectomy: how to treat it?

Vesicourethral anastomotic stricture and urinary incontinence are severe complications of radical prostatectomy because they cause great impact in the quality of life. Three patients that presented these complications after prostate radical surgery were assessed retrospectively. To treat the stenosis of the vesicourethral anastomosis an urolume was placed and later on, an artificial sphincter AMS 800 was implanted to treat the resulting urinary incontinence.

Early catheter removal after transurethral resection of the prostate.

INTRODUCTION: Post-operative care of transurethral resection of the prostate (TURP) includes prolonged bladder irrigation that places a heavy burden on the nursing staff and a substantial strain on the budget. There is a trend towards early catheter removal after TURP even to the extent of performing it as a day case. We explored the feasibility and limitations of early catheter removal after TURP in our unit. DESIGN: Prospective study. SETTING: Department of Urology, The National Hospital of Sri Lanka (NHSL), Colombo. PATIENTS AND METHODS: The study was in a tertiary referral centre (NHSL), on 65 patients with a mean age of 67.5 years who underwent TURP for mild to moderate enlargement of the prostate, less than 25 g, with lower urinary tract symptoms. Post-operative irrigation was maintained by diuretics at operation or a short term saline irrigation in the operating theatre. RESULTS: 17 patients developed clot retention in the ward that was managed by irrigation for 12 to 24 h. 62 patients who had clear or minimally blood-stained urine were tried without catheter after 24 h. Only two failed to pass urine. Patients without other complications were discharged from hospital after 1 or 2 successful voidings on the same day. There were no readmissions with complications. CONCLUSIONS: This study supports the feasibility of early catheter removal after a short irrigation period in TURP in the majority of patients with mild to moderate enlargement of the prostate without significantly increasing post-operative complications.

Termoterapia transuretral por microondas en el tratamiento de la hiperplasia benigna de la próstata: 3 años de seguimiento / Transurethral thermotherapy by microwaves in the treatment of benign prostatic hyperplasia: 3 years follow up

Durante un periódo de 53 meses hemos tratado 890 pacientes portadores de una hiperplasia prostática benigna de la Próstata a través de la Termoterapia transuretral mediante microondas. 365 pacientes completaron 3 años de seguimiento, incluyendo 35 que presentaban retención urinaria al momento de ser tratados. El tratamiento consistió en 1 sesión ambulatoria de 1 hora de duración bajo anestesia local. El score de Madsen-Iversen disminuyó de 11.7 (pretratamiento) a 4.1 después de 3 años de seguimiento (p = 0.01). El flujo máximo aumento desde 11.7 (antes del tratamiento) hasta los 14.9 después de 3 años (p = 0.01). El tratamiento fue bien tolerado excepto por tansitorias retenciones de orina en 101 pacientes, 2 enfermos relataron además ausencia de eyaculación post-tratamiento y ningún paciente ha referido impotencia. De los 35 pacientes en retención urinaria, 22 permanecen sin sonda después de 3 años de seguimiento (residuo postmiccional: 105 cc). Nuestros resultados indican que la Termoterapia transuretral es un tratamiento efectivo y seguro, el cual mejora los parámetros subjetivos y objetivos. Experiencias adicionales y un mayor tiempo de seguimiento determinaron el rol definitivo de esta terapia en el manejo de la hiperplasia prostática benigna de la Próstata

Retención urinaria secundaria al tratamiento quirúrgico de incontinencia urinaria de esfuerzo / Urinary retention secondary to surgical treatment for stress urinary incontinence

Se realizó un estudio retrospectivo, descriptivo, en el Instituto de Perinatología (INPer) de 1990 a 1994. Se revisasron 401 expedientes de pacientes con diagnóstico de incontinencia urinaria de esfuerzo que se sometieron a tratamiento quirúrgico. El objetivo del estudio fue determinar la frecuencia de retención urinaria en este tipo de pacientes. La retención urinaria se presentó en 103 de 401 pacientes (25.68 por ciento), en la operación de Pereyra modificada se observó en 67 de 195 (34.35 por ciento), en la operación de Burch modificada 25 de 131 (19.08 por ciento), en la plicatura de Kelly 9 de 70 (12.85 por ciento) y en 2 de 5 pacientes sometidas a operación de cabestrillo con politetrafluoroetileno (Gorotex). El problema de la retención urinaria se observó con mayor frecuencia en la cirugía vaginal (operación de Pereyra modificada y/o cabestrillo)