Urethral calculi: presentation and management.

OBJECTIVE: To determine the occurrence, symptoms, treatment and outcome in patients with urethral stones. PATIENTS AND METHODS: Fifty-one consecutive patients with urethral calculi were assessed prospectively; all were male and one was an infant. RESULTS: Acute retention of urine occurred in 78% of patients, urethral anatomical pathology in 6% and posterior urethral calculi in 88%. The urethral stones, solitary in each patient, consisted of calcium oxalate in 86%, struvite in 6%, mixed stones in 4%, calcium phosphate in 2% and uric acid in 2%. A methodical approach to therapy was used which aimed to clearly define the circumstances in which a given procedure was used, and the resulting success rate. CONCLUSION: The common belief that most urethral calculi in patients in developing countries originate from the bladder does not seem to be generally applicable. Urethral anatomical pathology does not seem to be a necessary condition for most of these calculi.

Anterior hypospadias. Is repair necessary with urination in a sitting or squatting position?

OBJECTIVE: To determine the chronic complication rate of anterior hypospadias repair and to explore whether the practice of placing the neomeatus at the tip of the penis should be applicable to all cases in our community where urination is in a sitting/squatting position. METHODS: Over a 10-year period commencing 1st September 1987, 312 patients had hypospadias repair of whom 72% had anterior hypospadias. The meatus was advanced to the tip of the penis in all repairs. The location of the meatus was also determined in 281 non-complaining men with a straight penis and normal sexual and reproductive functions. Following prior information that anterior hypospadias was not associated with sexual and reproductive dysfunction, 51 patients were given a choice between repair or no repair. RESULTS: Urethrocutaneous fistula occurred in 5% of patients, urethral stricture in 3% and meatal retraction in 3%, with 92% of patients having no complications. Forty six percent of non-complaining men had the meatus in locations other than the tip of the penis. Of 51 patients with the benefit of informed consent, 73% opted for no repair. CONCLUSION: Our results of anterior hypospadias repair compare favourably with those of other centers. Placement of the meatus at the tip of the penis for anterior hypospadias should not be applicable to all patients in this community where urination is in a sitting/squatting position. Before such repairs, an informed consent is warranted by making the patients and their parents aware of the non-association of sexual and reproductive disorders with these anomalies.