21/163. Ultrasound diagnosis of the anterior urethral valve. We present a neonate with an obstructing anterior urethral valve depicted by longitudinal transpenile ultrasound. Voiding images are recommended to identify the obstructing valve tissue. Ultrasound depiction of the anterior urethral valve tissue is identical to that seen in posterior urethral valves. ( info) |
22/163. Rectourinary fistula with a narrow urethra. A rectourinary fistula is a common accompaniment of anorectal malformations (arm) in boys. Most boys pass urine normally after reconstruction and closure of the fistula, but a few have serious problems because of a narrow urethra. In our series, a narrow urethra was encountered in three types of male arm: 3 rectourethral fistulae, 4 rectovesical fistulae, and 6 H-fistulae. We have studied the diagnostic and therapeutic problems that a narrow urethra produces in patients afflicted with each of these malformations. ( info) |
23/163. New modality for treatment of resistant anastomotic strictures after radical prostatectomy: UroLume urethral stent. A new approach for the treatment of vesicourethral anastomotic stricture after radical retropubic prostatectomy is presented. The patient had failed treatment with bougies, balloon dilation, and cold-knife incision of the anastomotic area. Transurethral resection of the bladder neck resulted in a rapid recurrence of the stricture. He was successfully treated with insertion of a UroLume urethral stent. After 18 months of follow-up, the patient is symptom free. ( info) |
24/163. Endourologic reconstruction of post-traumatic obliterated urethral stricture in a young female: a point of technique. INTRODUCTION: A simple endourologic technique for reconstruction of a post-traumatic obliterated urethra in a young unmarried woman is described as an alternative management to complex open urethral reconstruction. TECHNICAL CONSIDERATIONS: A 20-year-old woman presented with a post-traumatic obliterated urethra after a road traffic accident. The cystogram at 6 weeks did not reveal a bladder neck or urethra. The examination under anesthesia showed just a dimple at the presumed external urethral meatus. Antegrade cystoscopy revealed a complete block just distal to the bladder neck. A puncture was made from the external urethral meatus into the bladder through the bladder neck under antegrade cystoscopic guidance. The tract was dilated up to 18F using fascial dilators over a guidewire. A 16F Foley catheter was placed for 6 weeks. The operative time was 30 minutes, with no intraoperative complications. The catheter was removed at 6 weeks. Urethroscopy showed a normal urethra. She performed self-catheterization for the initial 3 months. A micturating cystourethrogram at 3 months revealed a normal urethra. She was continent and stricture free at follow-up of 16 months. CONCLUSION: This technique is simple and easy, with good results in selected cases of post-traumatic complete obliteration of the urethra with an intact bladder neck in young women. ( info) |
25/163. Posterior urethral valves causing urinomas: two case reports. The cases of two male babies with posterior urethral valves complicated by the formation of urinomas are reported. early diagnosis and treatment of this condition is important, as morbidity and mortality from resultant renal failure can be significant if it is unrecognized. ( info) |
26/163. Transosseous access for decompression of an obstructed pelvic kidney. We report a case of an obstructed pelvic kidney which was decompressed using a transosseous access route. The patient presented with obstructive uropathy and fever, necessitating decompression. Initial access was gained to the kidney by traversing the ilium, allowing subsequent retrograde placement of a double-J ureteric catheter. ( info) |
27/163. Urethral stone presenting as a stop valve--a rare complication of balanitis xerotica obliterans. Balanitis xerotic obliterans (BXO) is the genital subcategory of lichen sclerosis et atrophicus. The association of BXO with urethral stone causing interruption of the urinary stream and voiding by manual displacement of the urethral stone has not been described before. We describe one such case of a young boy with BXO and urethral stone who voided by manually displacing the stone for over a year. The case is reported to emphasize the ingenuity of the patient in continuing to void for over a year despite the association of the impacted urethral stone with urethral stricture and BXO. ( info) |
28/163. Treatment of a complete lower urinary tract obstruction secondary to an expandable foam sealant. We present a unique case of an iatrogenic complete lower urinary tract obstruction with an expandable foam sealant. A 41-year-old man presented in urinary retention 36 hours after self-injecting his urethra with the foam sealant, which could be palpated throughout his entire urethra. The sealant was removed from the distal urethra in numerous fragments with a hemostat and cystoscopically. A perfect mold of the bladder and prostatic urethra were removed by suprapubic cystotomy. cystoscopy 2 months later demonstrated a mild bulbar urethral stricture, but normal bladder mucosa. The cystoscopy at 6 months was normal. ( info) |
29/163. Botulinum toxin urethral sphincter injection resolves urinary retention after pubovaginal sling operation. The management of prolonged urinary retention following pubovaginal sling surgery typically involves transvaginal urethrolysis for anatomical urethral obstruction. Brubaker [1] recently reported on urethral sphincter abnormalities as a cause of postoperative urinary retention following either Burch suspension or pubovaginal sling procedure. We report a case of functional urethral obstruction and detrusor acontractility following pubovaginal sling surgery that was successfully treated by botulinum A toxin urethral sphincter injection. ( info) |
30/163. Possible maternal inheritance of a common obstructive urinary tract anomaly. Report of a case of a woman with multiple urinary tract infections and two sons with posterior urethral valves. BACKGROUND: Posterior urethral valves (PUVs) are the most common cause of lower urinary tract obstruction in boys. Several prior reports have described PUV in siblings and twins, often with a variable phenotype. CASE: PUVs were found in two brothers. The first child had developmental delay, while the second had a branchial cleft cyst and an anteriorly rotated right ear. The children's mother had a history of numerous urinary tract infections of unknown etiology. CONCLUSION: Though most cases of PUV appear to be sporadic, there are reports that suggest a partial genetic etiology, as our case suggests. ( info) |