Letter: Intestinal heterotopia in urethral caruncle.

We report a case of urethral caruncle with intestinal heterotopia in a 26-year-old woman. This entity is rarely reported.

Sequential therapy for gonococci inflammation of paraurethral glands in males.

OBJECTIVE: To approach the method of sequential therapy in gonococcal inflammation of the paraurethral glands around the external urethral orifice in males. METHODS: Step one: ceftriaxone sodium (1 g intramuscularly (IM) once daily for 5 days) was used for all patients. Step two: refractory patients from step one were treated with incision and drainage, followed by administration of IM ceftriaxone sodium. Step three: patients' sinus tracts were cauterized with a monopulse CO(2) laser. RESULTS: After step one, 34 patients recovered (recovery rate 70.83%). However, 14 patients were unaffected, and sinus tracts appeared in two patients. After step two, 11 of 14 patients recovered and three patients developed sinus tracts, two of whom had sinus tracts in step one that did not heal in step two. After step three, all patients with sinus tracts that had been treated with monopulse CO(2) laser therapy recovered in 2 weeks. CONCLUSION: This sequential therapy can be used to successfully treat gonococcal inflammation of the paraurethral glands around the external urethral orifice in males.

Management of "watering-can" perineum.

OBJECTIVES: To review the management of watering-can perineum (WCP) in a Nigerian centre and to outline challenges of its management. DESIGN: A retrospective review of cases of watering-can perineum over a seven-year period. SETTING: Usmanu Danfodiyo University Teaching Hospital, Sokoto, a Nigerian tertiary health centre. SUBJECTS: Forty one patients with the diagnosis of watering-can perineum managed from January 1997 to December, 2003. RESULTS: There were 41 cases of watering-can perineum. The mean age at presentation was 46.0 years (range: 7 to 80). Characteristically, all the patients had long standing neglected urethral stricture. Eighteen (43.9%) presented with single active fistulae while eight (19.5%) had more than four (9.8%) active external openings. Fistulae were located in the perineum (58.5%), scrotum (41.6%), penis (14.6%), penoscrotal junction (9.8%) and thigh (49%). The strictures were post inflammatory in 73% of patients. Bulbar strictures constituted 63.4% of cases. At presentation, patients were in general planned for initial suprapubic cystostomy (SPC) followed by assessment of stricture and finally urethroplasty in six months. Patients who could not afford urethroplasty were offered dilatation. The immediate outcome of urethroplasty was satisfactory in 70.6% of patients. CONCLUSION: Watering-can perineum was a common sequel of long standing neglected inflammatory urethral stricture. SPC followed by urethroplasty gave the best results. Prevention and adequate treatment of urethritis, prompt treatment of urethral stricture, and affordable and accessible reconstructive urologic service are recommended to reduce the incidence of WCP and suffering of the patients.

[Cystic ureteritis in a kidney transplantation candidate]. / Ureteritis quística en paciente candidata a trasplante renal.

Cystic ureteritis is a very uncommon pathology, whose pathogenesis is not well established. It is usually asociated with chronic infectious factors. It presents unspecific symptoms but characteristic radiologic findings. There is not an especific treatment for this disease. Kidney transplant is the final pathway for patients with chronic renal failure. We report a case of cystic ureteritis diagnosed during pre-transplant study.

Ureteritis quística en paciente candidata a trasplante renal / Cystic ureteritis in a kidney trasplantation candidate

La ureteritis quística es una patología muy infrecuente, sin que hasta el momento se haya establecido su patogénesis exacta. Se presenta con sintomatología inespecífica, pero sin embargo los hallazgos radiológicos son bastante orientativos. No hay un tratamiento específico para estos pacientes, siendo el trasplante renal el paso final para los que desarrollen insuficiencia renal crónica terminal (IRCT).Presentamos un caso de ureteritis crónica diagnosticado durante el estudio pretrasplante de una paciente con IRCT (AU)

Cystic ureteritis is a very uncommon pathology, whose pathogenesis is not well established. It is usually asociated with chronic infectious factors. It presents unspecific symptoms but characteristic radiologic findings. There is not an especific treatment for this disease. Kidney trasplant is the final pathway for patients with chronic renal failure. We report a case of cystic ureteritis diagnosed during pre-trasplant study (AU)

Buccal mucosal graft for urethral reconstruction.

Urethral reconstruction with graft substances, such as skin and bladder mucosa, has been previously used when primary anastomosis cannot be achieved. However, stricture and meatal prolapse are associated with these grafts. We report the use of buccal mucosa for the reconstruction of urethral defects in 3 patients. One patient with failed operation for hypospadias received tube buccal mucosal graft for urethral replacement. Two patients with urethral necrosis and stricture received onlay buccal mucosal graft. All patients were disease-free during follow-up (range, 12 to 49 months; mean, 36 months). One patient had a pinhole fistula that was successfully managed with simple repair. This technique appears to be useful for urethral reconstruction when a local graft is not available, even in patients with complicated conditions.

The use of a low-profile cystostomy tube to relieve urethral obstruction in a dog.

A 10-year-old, spayed female Dalmatian was diagnosed with granulomatous urethritis causing urethral obstruction. Due to the extensive involvement of the urethra, a urethrostomy was not possible. A commercially available, silicone, low-profile gastrostomy tube was placed as a prepubic cystostomy tube to achieve urinary diversion. This tube is easy to use, has a one-way valve, and lies flush with the skin margin, thereby decreasing the likelihood of inadvertent removal. This tube should be considered to achieve long-term urinary diversion when urethral involvement is extensive.

[Endoscopic treatment of complete obliteration of posterior urethra]. / Endoskopsko lechenie na pulnata obliteratsiia na zadnata uretra.

The authors shared their experience in regard of treatment of complete urethral obliteration. In a 14-year they diagnosed and treated 37 patients (aged 22-74 years) with obstruction of the lower urinary tract as a result of complete urethral obliteration. The etiology include 14 patients after perineal urethral trauma, in 10 patients the main cause was urethral inflammation of posterior urethra, in 8--as a consequence of transurethral surgery and in 5--after suprapubic prostatectomy. Main diagnostic methods they used were retrograde urethrography and urethroscopy with 0 degree fiberoptic. In all patients an endoscopic incision of fibrotic tissue was carried out thus the entering the bladder cavity was successful. In some patients operative technique with a Benique through cystostomy cannel and bladder neck just opposite to the urethrotome knife was used. In three patients (8.2%) the procedure failed due to the massive urethral hemorrhage. They report recurrent urethral strictures in 24 patients (64.8%), treated with visual urethrotomy. The continence was compromised in 6 patients (16.2%).

[Treatment of inflammatory urethral stenosis with endoscopic urethrotomy]. / Traitement des sténoses inflammatoires de l'urètre par urétrotomie endoscopique.

Urethral stricture, mainly consisting of cases of inflammatory stricture, is a frequent occurrence in Morocco. Numerous techniques have been proposed to treat these disorders, including internal endoscopic urethrotomy (IEU). Initially described by Otis and Maisonneuve using a blind approach, IEU was then further developed by Saches who carried out direct vision urethrotomy. It rapidly became established as the method of choice for primary treatment of urethral stricture, and classical surgery was limited to those cases in which this method had failed. However, although this technique is relatively simple and appears to be efficient, there is in fact a high relapse rate, necessitating repeated IEU; therefore at present there is a tendency to return to the classical methods of anastomotic resection and urethroplasty after the second or third IEU. Although the relapse rate is low for short, single or bulbar strictures, it is high for penile strictures and for those with accompanying severe periurethral fibrosis. In this study, we have reported the results of a homogeneous series of 149 cases of urethral stricture treated by internal urethrotomy. The aim of this retrospective study was to better define the indications for adopting this technique, and also to determine the reasons for failure. The various alternatives to IEU (resection, plasty) have been examined, as has their respective failure rate.

[Endoscopic treatment of complete obliteration of posterior urethra]. / Endoskopsko lechenie na p'lnata obliteratsiia na zadnata uretra.

The authors shared their experience in regard of treatment of complete urethral obliteration. In a 14-year they diagnosed and treated 37 patients (aged 22-74 years) with obstruction of the lower urinary tract as a result of complete urethral obliteration. The etiology include 14 patients after perineal urethral trauma, in 10 patients the main cause was urethral inflammation of posterior urethra, in 8--as a consequence of transurethal surgery and in 5--after suprapubic prostatectomy. Main diagnostic methods they used were retrograde urethrography and urethroscopy with 0. fiberoptic. In all patients an endoscopic incision of fibrotic tissue was carried out thus the entering the bladder cavity was successful. In some patients operative technique with a Benique through cystostomy cannel and bladder neck just opposite to the urethrotome knife was used. In three patients (8.2%) the procedure failed due to the massive urethral hemorrhage. They report recurrent urethral strictures in 24 patients (64.8%), treated with visual urethrotomy. The continence was compromised in 6 patients (16.2%).

Management and complications following trigonal-colonic anastomosis in a dog: five-year evaluation.

Urinary diversion procedures in the dog have been described for both benign and malignant processes involving the bladder, urethra, or both. These procedures are performed rather infrequently, primarily because of the potential complications associated with urinary diversion into an intact gastrointestinal system. A case managed for five years following trigonal-colonic anastomosis for lymphocytic-plasmacytic urethritis is presented, along with a review of urinary diversion techniques. Postoperative management recommendations following urinary diversion are discussed.

Bacteriologic, histologic and ultrasonographic findings in strictures recurring after urethrotomy. A preliminary study.

Twelve men with recurrent anterior urethral stricture after endoscopic urethrotomy (2-12 attempts) underwent open urethroplasty with en bloc removal of diseased urethral segments. Bacteriologic and histologic studies of the excised urethral tracts (mucosa and spongiosum tissue) were performed. The bacteriologic findings were compared with the results of preoperative urine cultures and urethral swabs for chlamydia. The histologic findings were related to preoperative ultrasonographic observations, in order to evaluate the accuracy of ultrasonography in depicting structural changes in spongiosum around the strictured urethral tract. Beta-haemolytic streptococci and Streptococcus faecalis were cultured from the excised spongiosum, without correlation to the preoperative culture results. The histologic studies confirmed the usefulness of urethral ultrasonography for accurate demonstration of the inflammatory changes involving spongiosum around the strictures.

[Urethrotomia interna: clinical importance of internal urethrotomy in recurrent cystourethritis and irritable bladder in women (author's transl)]. / Urethrotomia interna. Klinische Bedeutung der inneren Harnröhrenschlitzung bei der rezidivierenden Zysto-Urethritis bzw. Reizblase der Frau.

The present results show that operative dilatation of the female urethra in recurrent bladder complaints and demonstrable obstruction is a very promising form of treatment which can be carried out by every practising urologist with anesthetic availability. Failures must be accepted, because at all events one question remains unanswered: why one patient can be helped by the treatment whereas in another the complaints persist.

Cryosurgery for the urethral syndrome: preliminary communication.

A method has been devised for treating the urethral syndrome by cryosurgery using a special applicator. The results in the first 35 cases are presented and compared with a similar group of women treated by urethral dilatation. The cryosurgical method has proved to be successful and free of complications. The study is being continued.