11/176. A ureterocutaneous fistula forty years after nephrectomy. The case of a woman presenting with a ureterocutaneous fistula 40 years after nephrectomy is described. Because of advanced respiratory disease and absence of infective activity, a conservative line of treatment with saline rinse was given. At 3 months follow-up the fistula had become chronic, with a small opening without signs of infection and ultrasound revealed no abscess. ( info) |
| A 68-year-old man presented with obstructive and irritative lower urinary tract symptoms and microscopic hematuria. Cystourethroscopy showed a circumferential stricture in the bulbar urethra that bled easily on contact. biopsy revealed malacoplakia. There was also focal nonspecific cystitis. The patient improved symptomatically, but the microscopic hematuria persisted. Follow-up biopsies showed persistent urethral malacoplakia and stricture. malacoplakia of the male urethra is exceptionally rare, this being the second reported case. ( info) |
13/176. Urethral plate salvage with dorsal graft promotes successful penile flap onlay reconstruction of severe pendulous strictures. PURPOSE: A modified 1-stage penile flap onlay reconstruction is presented for patients with a long stricture in whom the urethral plate is deficient or absent. MATERIALS AND methods: Of 37 patients who underwent transverse penile island flap onlay urethroplasty 3 men and 1 boy required simultaneous augmentation (2) or replacement (2) of an inadequate urethral plate. The 15-year-old boy had persistent severe chordee after multiple hypospadias procedures. A dorsal buccal mucosal graft was used in 3 cases and cadaveric dermal graft was used in 1. The goal of dorsal graft application in each case was to create a uniform urethral plate 1 cm. wide to promote successful 1-stage penile flap onlay reconstruction. RESULTS: No patient has required further instrumentation and all void without difficulty. In the 15-year-old boy chordee has completely resolved. CONCLUSIONS: Using dorsal grafts to salvage an inadequate urethral plate during 1-stage penile island flap onlay reconstruction obviates flap tubularization. ( info) |
14/176. Obliterated urethra: holmium:yttrium-aluminum-garnet cut-to-light with urolume stenting. Antegrade-retrograde urethrotomy, or the cut-to-light procedure, performed for obliterated urethra is associated with a high rate of recurrence of urethra] stricture. With the goal of reducing the stricture recurrence rate, we performed a modified cut-to-light procedure using a holmium:yttrium-aluminum-garnet laser and UroLume stenting in a 76-year-old man with urethral obliteration. ( info) |
| An unusual case of a 5-year-old boy with duplication of the glans, a rare variety of diphallia, is reported. The two glandes were arranged one above the other, the dorsal glans had only a blind pit while the ventral glans had a patent urethra with glanular hypospadias. The child also had right renal agenesis and a posterior urethral stricture. ( info) |
16/176. The use of pedicled appendix graft for substitution of urethra in recurrent urethral stricture. BACKGROUND: Recurrent posterior urethral strictures after failed urethroplasty may need urethral substitution. skin or mucosal grafts, currently used for this purpose, have a high complication rate. The authors describe the use of pedicled appendix for posterior urethral substitution. methods: Two boys with pelvic fracture urethral distraction injuries were treated for recurrent posterior urethral strictures after a failed perineal anastomotic urethroplasty. Through a perineal-transpubic approach the stricture tissue was excised, which resulted in a gap of 5 to 7 cm between the healthy ends. The vermiform appendix was mobilised on its own pedicle and transposed to the perineum; the proximal end of appendix was anastomosed to the prostatic urethra and the distal end (tip discarded) to the bulbar/penile urethra. omentum was transposed to wrap the anastomosis and fill the dead space. RESULTS: Normal micturition was restored in both patients. No further treatment was required after 1 dilatation in the first case. Both patients are continent. Potency status remains unchanged from the preoperative period with normal erections in 1 case. Follow-up (1 to 3 years) has been satisfactory with no complications. CONCLUSIONS: The appendix is a promising organ for posterior urethral replacement. It can be brought to the perineum on its own vascular pedicle. ( info) |
17/176. An unusual complication of penile prosthesis following urethroplasty. We report a case of an adult who had undergone transpubic urethroplasty for a 5-cm long posterior urethral stricture. A malleable penile prosthesis (AMS 600R) was implanted 19 months later for the trauma-related impotence. The patient was discovered to develop a complete obliteration of the urethra after removal of infected penile prosthesis 18 months later. Perineal urethroplasty cured his restricture. Suggestions are made to prevent urethral restricture if penile prosthesis is required after urethroplasty. ( info) |
18/176. Urethral substitution using an intestinal free flap: a novel approach. PURPOSE: patients who have extensive stricture disease, those in whom hypospadias repair fails and those who sustain significant urethral trauma pose a reconstructive challenge for genitourinary surgeons. We developed an additional reconstructive option for men with a severely diseased urethra when grafting procedures and local tissue flaps have failed or are otherwise contraindicated. MATERIALS AND methods: A genitourinary reconstructive team performed novel intestinal free flap substitution urethroplasty in 2 patients. A segment of jejunum is harvested on a vascular pedicle and plicated into an appropriate size urethral substitute. Microvascular anastomoses allow this segment to remain viable and functional. The technical aspects of repair and surgical considerations are detailed. RESULTS: The 2 patients have a satisfactory functional and cosmetic outcome. At short followup the urethral lumen remained patent and the intestinal urethra remained viable and intact. Both patients have good urinary streams and are able to void in the standing position. CONCLUSIONS: This initial experience in 2 patients indicates that intestinal segment urethral substitution may be considered within the reconstructive armamentarium of genitourinary surgeons when more conventional options have failed or are contraindicated. Continued vigilant followup is necessary to detail any secondary complications. In addition, further experience with this technique by other surgeons would help determine its overall usefulness. ( info) |
19/176. Giant calculus of the posterior urethra following recurrent penile urethral stricture. A case of an unusually large, proximal urethral calculus located very close to the external sphincter and caused by recurrent urethral stricture is presented. ( info) |
20/176. Sexual function after a urethroplasty for membranous-prostatic urethral stricture. A review is presented on the anatomy of nerves involved in penile erections, with respect to their exit from the pelvis. More detailed information is required. A road map of these nerves as they approach, traverse and exit from the urogenital diaphragm is needed, which would allow the surgeon to properly design the stricture repair operation. case reports are presented that suggest that the membranous urethra and urogenital diaphragm can be incised posteriorly in the midline without destroying the penile erection. Since subjective evaluation of penile erection may be misleading a method for objective evaluation is required. Further information regarding the effect on potency of the various types of operations involving the urogenital diaphragm for membranous-prostatic urethral strictures needs to be carefully accumulated. ( info) |