1/8. Benign periurethral masses in women.Benign periurethral masses were encountered in 4 women. The masses included 2 vaginal leiomyomas, 1 of which was found simultaneously with a urethral diverticulum, a fibrocystic urethral mass and hyperplastic glandular tissue obstructing the bladder outlet and resembling male prostate. The physical and endoscopic features were helpful in establishing the benign nature and extent of the lesions. Although the bladder base was deformed on an excretory urographic cystogram in each case the radiographic features were non-specific except as they applied to a urethral diverticulum. Transvaginal needle biopsy is recommended in contemplation of open surgical excision. Leiomyomas are best approached transvaginally and anterior urethral masses can be reached suprapubically.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/8. Contemporary evaluation and management of the female urethral diverticulum.We are in agreement with Davis and Telinde, who state, "The most important single diagnostic instrument for the discovery of suburethral diverticula is the high index of suspicion" [25]. The key to successful treatment of a female diverticulum is not only in the surgical management but also in the identification and evaluation of patients who present with a myriad of symptoms. It is our responsibility to include urethral diverticula in the differential diagnoses before the labels of interstitial cystitis, urethral syndrome, or urgency frequency syndrome are misplaced. The diagnosis may be elusive and the pathology difficult to identify on physical examination. However, if the index of suspicion is high and the proper radiologic imaging studies are gathered, then the correct diagnosis will often be made. The evaluation of the female urethral diverticulum has evolved greatly over the past several years. However, once appropriate diagnosis is made, the management scheme is fairly straightforward. Strict adherence to principles of surgical reconstruction allows one to eradicate the diverticulum while simultaneously preventing complications and recurrences.- - - - - - - - - - ranking = 17.458177089194keywords = physical examination, physical (Clic here for more details about this article) |
3/8. Congenital urethral fistula with normal anus: a report of two cases.Congenital rectourethral or anourethral fistulae without imperforate anus in males are rare, representing less than 1% of anorectal malformations. We report our experience with two males with "N type" urethral fistulae. One, a 5-year-old boy, presented with recurrent urinary tract infections (UTIs) and passage of urine per anus. Investigations included a voiding cystourethrogram (VCUG), which demonstrated a fistula from the urethra to the anus. On physical examination, a small perianal opening was noted just outside the anus, which drained a small amount of urine after voiding. The fistula was excised via a perineal approach. The second patient is a 5-year-old boy with a long history of recurrent UTI requiring multiple hospitalizations since the newborn period. Chronic renal failure developed as a complication of repeated urinary tract infections. Investigations showed a single hydronephrotic pelvic kidney and a small bladder. He underwent numerous diagnostic and reconstructive procedures including cystoscopy and augmentation cystoplasty. Recurrent infections continued and an N type anourethral fistula was eventually diagnosed. The fistula was located between the anal canal and the membranous urethra. An anterior perineal approach was also used. Both fistulae were easily located, and reconstructive surgery of the urethra was not required. Postoperative VCUGs in both patients were normal. They have been free of infection with normal urinary continence since resection of the fistula. Congenital N type anourethral fistulae are rare, but should be considered in cases of recurrent urinary tract infections. The diagnosis may be missed by endoscopic procedures, but VCUG should demonstrate the fistulous tract.- - - - - - - - - - ranking = 17.458177089194keywords = physical examination, physical (Clic here for more details about this article) |
4/8. Anorectal agenesis with a rectourethral fistula diagnosed in an adult: report of a case.We report an unusual case of anorectal agenesis with a rectourethral fistula diagnosed in a 48-year-old man. The patient presented after noticing hematuria, although he had been aware of urinary leakage from his colostomy with occasional fecal urine for about 4 years. He had had a double-barrel colostomy created soon after birth for an imperforate anus, with revision at the age of 4 years to correct a prolapse of the stoma, but his malformation had never been repaired. We performed a physical examination, which did not reveal a perineal fistula, but urethrocystography demonstrated high anorectal agenesis with a rectourethral fistula. Thus, we resected the rectourethral fistula and created an end-colostomy. The patient had an uneventful postoperative course, and was discharged in good health on postoperative day 19. To our knowledge, this is the oldest patient to be diagnosed with anorectal agenesis and undergo resection of a rectourethral fistula.- - - - - - - - - - ranking = 17.458177089194keywords = physical examination, physical (Clic here for more details about this article) |
5/8. Stenosis and fistulae with neglected vaginal foreign bodies. A case report.foreign bodies present in the vagina for long periods of time are infrequent but potentially serious findings in adult women. Significant injury can occur to bowel, bladder or other pelvic structures. Repair of fistulae is delayed following removal of the foreign bodies until the chronic inflammation produced by the objects has resolved. Coexisting psychiatric illness or physical abuse may complicate the evaluation and treatment of some women with long-standing vaginal foreign bodies.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/8. female urethral diverticula: double-balloon catheter study.A double-balloon catheter was used to evaluate the female urethra in 51 patients. Six different radiographic appearances were identified. Three of the categories are considered variants of normal. One of the categories consisted of eight patients with urethral diverticula. All showed large rounded or lobulated collections of contrast material which were adjacent to the urethra and which persisted on postvoid films. Other abnormalities should be closely correlated with the clinical findings to determine their significance. The diagnosis of urethral diverticulum may be missed, as physical examination and endoscopy can be negative. Therefore, the optimal method for identifying its presence and extent includes both a double-balloon catheter study and a voiding cystourethrogram.- - - - - - - - - - ranking = 17.458177089194keywords = physical examination, physical (Clic here for more details about this article) |
7/8. Skene's duct cyst in adult women: report of two cases.Skene's duct cysts in the adult are uncommon lesions. Complete urologic examinations are necessary because these lesions simulate other clinically important lesions. Herein we report two cases of Skene's duct cyst in adult women. In these cases we could make differential diagnosis by physical, radiological and endoscopic examinations.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/8. Urethral complications of urinary catheterization presenting as primary scrotal masses: sonographic diagnosis.We report on 2 debilitated male patients who had penile urethral complications of transurethral catheter drainage. One patient had a urethral diverticulum, and the other had a Foley catheter misplaced through a urethral perforation. Both lesions mimicked primary intrascrotal masses on physical examination and were therefore evaluated by scrotal sonography. The correct diagnosis of each lesion required careful examination of the mass and its anatomic relationship to the adjacent urethra. Penile urethral complications of catheterization in debilitated patients must be included in the differential diagnosis of scrotal cystic masses. These cases also emphasize the necessity of a thorough sonographic examination that extends beyond the specific area of presumed clinical interest.- - - - - - - - - - ranking = 17.458177089194keywords = physical examination, physical (Clic here for more details about this article) |