Anterior Urethra Research Articles

A CASE OF PELVIC FRACTURE URETHRAL INJURY REPAIRED BY FOURTH URETHROPLASTY

Pelvic fracture urethral injury (PFUI) is relatively rare injury, and delayed urethroplasty is the gold standard for its repair. Because a failed urethroplasty results in increased scarring and reduced length of the available urethral segment, the salvage urethroplasty is a urologic challenge. We herein report the case of male patient with PFUI who could be salvaged after three failed urethroplasties. A 22-year-old male who had received a PFUI when he was 4 years old was referred for salvage urethroplasty after two perineal anastomotic urethroplasties and one transpubic urethroplasty had failed, leaving him unable to void and forced to keep having a suprapubic tube placed. The meatus was iatrogenically obliterated due to repeated treatments. Through an incision from the scrotum and right side of the root of the penis to the lower abdomen, the anterior urethra was circumferentially mobilized and transected at the distal urethral stump. The proximal urethral end was identified by palpitation with a metallic sound inserted through the suprapubic tube tract. The covering fibrotic scar tissue was completely removed and 8 anastomotic 4-0 polydioxanone sutures were placed to reapproximate the urethral mucosa. A pedicled gracilis muscle flap was created and wrapped around the anastomosis site and intrapelvic segment of the mobilized anterior urethra. A urethrogram 8 months after urethroplasty showed a wide caliber at the anastomosis site and a ventral midline meatotomy was subsequently performed. He is currently free from any instruments and can void well without the need for further intervention.

Congenital anterior urethral diverticulum

Abstract Congenital anterior urethral diverticulum is a very rare cause of lower urinary tract obstruction. It usually occurs at the penoscrotal junction but also may occur at the penile urethra. Two months old male baby presented with soft cystic swelling at the anterior urethra ballooning during micturition. Diagnosis was confirmed by MCUG and ultrasonography. Open diverticulectomy was done.

Penile urethral stricture disease

Patients affected by a urethral stricture account for a considerable cost to all healthcare systems. The estimated prevalence of all urethral stricture in the UK is 10/100,000 men during youth, increasing to about 40/100,000 by age 65 years and to more than 100/100,000 thereafter. A penile urethral stricture is a narrowing of the lumen of the urethra due to ischaemic fibrosis of the urethral epithelium and/or spongiofibrosis of the corpus spongiosum occurring within the penile urethra. Its aetiology is largely idiopathic but other important causes are failed hypospadias repair and lichen sclerosus, which account for 60% of all cases. Strictures of the anterior urethra account for 92% of cases: bulbar strictures are more frequent (46.9%), followed by penile (30.5%) and combined bulbar/penile (9.9%), that is, 40.4% of all men presenting with stricture will have a penile urethral stricture alone or in combination with a bulbar urethral stricture. There are several options for the treatment of penile urethral strictures ranging from less invasive treatments, including urethral dilatation and direct vision internal urethrotomy, to more complex augmentation graft and flap urethroplasty. The aim of the present review is to describe the aetiology and epidemiology of anterior urethral strictures and the available options reported in literature for their treatment. Level of evidence: 1a

A study of clinical profile of hypospadias cases at a medical college hospital of South Gujarat, India

Background: Hypospadias is a common congenital anomaly in which the anterior urethra is incompletely developed and does not extend to the tip of the glans penis. The present study was aimed to study clinical profile of hypospadias cases at a medical college hospital of southern Gujarat.Methods: This prospective study was conducted at a tertiary care hospital of South Gujarat, India including 32 patients of hypospadias. Data collected for each patient included age, sex, demography, and major symptoms, duration of symptoms and relevant past and treatment history.Results: Out of 32, 9 (28%) patients are between 4 years to 6 years of age and mean age of presentation of patients of hypospadias is 7.55 years. Twenty seven (84%) patients of Hypospadias were associated with prepucial hood, 17 (53%) patients of Hypospadias were associated with meatal stenosis, 6 (19%) patients of hypospadiasis were associated with severe chordee and 2 (6%) patients associated with narrow urethral plates.Conclusions: T Most cases of hypospadias were presented at age 9 years and below. Most common type of hypospadias was coronal and distal penile followed by penoscrotal type. Hypospadias was associated with prepucial hood (84%), meatal stenosis (53%), Chordee (19%) and narrow urethral plates (6%) out of total cases. Hypospadias was associated with undescended testis, bilateral retractile testis, cervical rib, mental retardation and microcephaly with mental retardation, squint and bifid tongue.

MP37-11 CAN SQUAMOUS CELL CARCINOMA OF THE ANTERIOR MALE URETHRA BE MANAGED BY FOLLOWING A PENILE CANCER BEST PRACTICE PATHWAY?

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease I1 Apr 2018MP37-11 CAN SQUAMOUS CELL CARCINOMA OF THE ANTERIOR MALE URETHRA BE MANAGED BY FOLLOWING A PENILE CANCER BEST PRACTICE PATHWAY? Aditya Manjunath, Hussain AlNajjar, Catherine Corbishley, Benjamin Ayres, and Nick Watkin Aditya ManjunathAditya Manjunath More articles by this author , Hussain AlNajjarHussain AlNajjar More articles by this author , Catherine CorbishleyCatherine Corbishley More articles by this author , Benjamin AyresBenjamin Ayres More articles by this author , and Nick WatkinNick Watkin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1217AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Primary squamous cell carcinoma of the anterior male urethra (SCCmu) is rare and the largest published series to date is only 18 patients. In our experience, we believe that SCCmu behaves in a similar way to primary squamous cell carcinoma of the penis (SCCp). In our tertiary referral centre we have managed patients with SCCmu based on our penile cancer pathway in a multi-disciplinary setting in the absence of alternative clinical evidence. We report a comparative study to test the hypothesis that it is oncologically acceptable to manage SCCmu according to the more established SCCp pathway. METHODS Data was collected prospectively on all patients with SCCmu and SCCp from 2001 to 2016. Cases of urothelial tumour, melanoma of urethral origin and metastases to the penis from other sites were excluded. All patients were discussed at our supra-regional MDT and managed according to network guidelines. Management included penile and urethral preserving surgery where possible and inguinal dynamic sentinel node biopsy for cN0 patients (from 2003). Pathology was reported and reviewed by specialist genito-urethral pathologists according to national guidelines. Comparative outcome measures included T stage, grade, histological sub-type and incidence of node positivity in cN0 and cN+ at presentation. 3 year cancer specific survival was calculated with Kaplan-Meier analysis for the 2 groups. RESULTS 77 SCCmu patients and 882 SCCp were compared. T stage (>pT1) 48% SCCmu vs 35% SCCp. High grade disease 78% SCCmu vs 48% SCCp. Basaloid subtypes SCCmu 58% vs 18.3% SCCp. Node negative (pN0) 49% SCCmu vs 60% SCCp. Extra capsular spread (ECS) 26% SCCmu vs 13.3% SCCp. Sentinel node biopsy positivity rate in cN0 28.8% SCCmu vs 22.3% SCCp. 3 year disease specific survival (DSS) 80.5% SCCmu vs 83.6% SCCp. 3 year DSS in the ECS group 55.9% (95% confidence interval 65.8 - 89.3) SCCmu vs 33.7% (95% confidence interval 9.9 - 57.5) SCCp. CONCLUSIONS SCCmu presents with more advanced disease and worse biological characteristics. Nodal drainage is primarily to inguinal nodes. Although 3 year DSS is similar, in the highest risk nodal group 3 year DSS is better in SCCmu with the same treatment algorithm. Our data supports continuing to manage SCCmu patients with our established SCCp pathway. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e495-e496 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Aditya Manjunath More articles by this author Hussain AlNajjar More articles by this author Catherine Corbishley More articles by this author Benjamin Ayres More articles by this author Nick Watkin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The problem of early continence recovery after radical prostatectomy

Background. The highest rate of incontinence after radical prostatectomy (RP) is observed in the first 2–6 months after surgery. In order to decrease the period of incontinence, virous surgical methods aimed at preservation and reconstruction of structures participating in the mechanism of urine retention has been developed and improved. The study objective is to evaluate effectiveness of an original method of formation of an urethral anastomosis in the early continence recovery. Materials and methods. Data on 126 patients who underwent retropubic RP were analyzed. Depending on the method of urethral anastomosis formation, patients were divided into 2 groups: in the 1 st group (n = 52) the patients underwent PR with urethra suspension m. levator ani, in the 2 nd (n = 74) – standard RP. In the 1 st group, 6 ligatures were applied to the anterior and posterior urethra walls: at the 12 and 6 hour projections through the mucosa, submucosa, and smooth muscle; at the 10, 2, 4, and 8 hour projections – more laterally with capture of the m. levator ani medial margins. Continence recovery was evaluated on days 1, 7, and 14 after urinary catheter removal and then at days 30, 90, 180, and 365 after RP. The criteria of continence were absence of urine leakage at rest and during physical activity and a necessity of using a safety liner. Results. There weren’t any significant differences at day 1 after urinary catheter removal between the two groups (р > 0.05). In the 1 st group, continence values at days 30, 90, and 180 after RP were significantly higher (57.7, 69.2, and 71.1 %, respectively) compared to the 2 nd group (35.1, 41.9, and 51.3 %, respectively) (р <0.05). Conclusion. Results of this work show significant benefits of RP with urethra suspension m. levator ani compared to standard RP per continence recovery criteria at days 7, 14, 30, 90, and 180 after the surgery. The technique of urethra suspension m. levator ani is easy to perform and ensures early continence recovery after RP.

Congenital scaphoid megalourethra associated with posterior urethral valve: A case report

Congenital scaphoid megalourethra is a very rare congenital anomaly of the anterior urethra in males. Here, a case of scaphoid megalourethra and posterior urethral valves is presented. A one and half year old male child came to us with complaints of ballooning at the tip of penis since birth. Micturating cystourethrogram showed a dilated glanular urethra. The patient underwent a Nesbitt’s longitudinal reduction urethroplasty with a single-staged, single layered repair. Post-operatively, the child passed a healthy stream of urine without straining.

Urethral reconstruction in patients with failed hypospadia repair

The tasks involved in reconstructing the urethra after failed hypospadias repair range from correction of atrivial meatal stenosis to reconstruction of the entire anterior urethra. To describe pathological findings in the urethra after failed hypospadias repairand the respective surgical methods used for their correction. The various pathological findings after unsuccessful hypospadias surgery are classified according to their location and complexity. The general rules of reconstruction that should be applied in each particular situation are described. Successful reconstruction of the urethra in patients with failed hypospadias surgery requires experience and good knowledge of the anatomy of the normal and hypospadic urethra andpenis. Mastery of plastic surgical techniques and profound knowledge of the various surgical methods of hypospadias surgery are essential.

The “G-Spot” Is Not a Structure Evident on Macroscopic Anatomic Dissection of the Vaginal Wall

BackgroundControversy exists in the literature regarding the presence or absence of an anatomic “G-spot.” However, few studies have examined the detailed topographic or histologic anatomy of the putative G-spot location. AimTo determine the anatomy of the anterior vaginal wall and present detailed, systematic, accessible findings from female cadaveric dissections to provide anatomic clarity with respect to this location. MethodsSystematic anatomic dissections were performed on 13 female cadavers (32–97 years old, 8 fixed and 5 fresh) to characterize the gross anatomy of the anterior vaginal wall. Digital photography was used to document dissections. Dissection preserved the anterior vaginal wall, urethra, and clitoris. In 9 cadavers, the vaginal epithelial layer was reflected to expose the underlying urethral wall and associated tissues. In 4 cadavers, the vaginal wall was left intact before preservation. Once photographed, 8 specimens were transversely sectioned for macroscopic inspection and histologic examination. OutcomesThe presence or absence of a macroscopic anatomic structure at detailed cadaveric pelvis dissection that corresponds to the previously described G-spot and gross anatomic description of the anterior vaginal wall. ResultsDeep to the lining epithelium of the anterior vaginal wall is the urethra. There is no macroscopic structure other than the urethra and vaginal wall lining in the location of the putative G-spot. Specifically, there is no apparent erectile or “spongy” tissue in the anterior vaginal wall, except where the urethra abuts the clitoris distally. Clinical ImplicationsThe absence of an anatomic structure corresponding to the putative G-spot helps clarify the controversy on this subject. Strengths and LimitationsLimitations to this study include limited access to specimens immediately after death and potential for observational bias. In addition, age, medical history, and cause of death are not publishable for privacy reasons. However, it is one of the most thorough and complete anatomic evaluations documenting the anatomic detail of the anterior vaginal wall. ConclusionThe G-spot, in its current description, is not identified as a discrete anatomic entity at macroscopic dissection of the urethra or vaginal wall. Further insights could be provided by histologic study.Hoag N, Keast JR, O'Connell HE. The “G-Spot” Is Not a Structure Evident on Macroscopic Anatomic Dissection of the Vaginal Wall. J Sex Med 2017;14:1524–1532.

Congenital megalourethra with left ectopic megaureter and bulbar urethral stricture: A rare entity

Congenital megalourethra is a rare disorder of anterior urethra. This disorder is characterized by the congenital absence of corpora spongiosum or cavernosa or both which leads to dilatation of the urethra. We present a case of congenital megalourethra in a 9-month-old child, which was associated with left ectopic megaureter and bulbar urethral stricture. Most of reported cases were treated by Nesbit urethroplasty. This case was initially treated by emergency trocar cystostomy and the left ureteroneocystostomy, and finally, reduction urethroplasty was carried out as a definitive treatment.

Three-Dimensional Computerized Model Based on the Sonourethrogram: A Novel Technique to Evaluate Anterior Urethral Stricture

The sonourethrogram is a useful alternative to the traditional retrograde urethrogram to evaluate anterior urethral strictures. With the development of 3-dimensional reconstructive techniques 3-dimensional urethral imaging can provide more accurate and useful information to enable the surgeon to make the best surgical decisions. We evaluated the accuracy and efficacy of a 3-dimensional reconstructed digital model of the urethra based on the sonourethrogram to assess anterior urethral disease. A total of 50 patients with an anterior urethral stricture and 10 healthy volunteers were enrolled in this study from April 2014 to January 2017. All patients and volunteers underwent sonourethrogram and retrograde urethrogram. Three-dimensional urethral models were reconstructed based on the sonourethrogram. Stricture length and location on retrograde urethrogram or sonourethrogram based images were compared with those found at operation. The 3-dimensional digital model revealed the entire anterior urethra, including the navicular fossa, and the penile and bulbar parts. The semitransparent model clearly demonstrated the structure of the corpus spongiosum and inside the urethral lumen. Further information on spongiofibrosis could also be seen in the 3-dimensional digital model. There was no significant difference in stricture length or location in the 3-dimensional model compared with retrograde urethrogram imaging and actual surgical findings. However, the latest technique could only reconstruct the short segment of the anterior urethra due to the probe width limitation. The 3-dimensional computerized model based on the sonourethrogram is a novel and effective technique of evaluating anterior urethral strictures.

Preputial mucosal graft for urethral repair

Urethral stricture disease is the commonest cause of morbidity in urology practice in sub-Saharan Africa. In contrast, prostate disease is commonly cited as the leading cause of urological disease in most urology practices in developed countries. In Africa, the aetiology of urethral stricture disease is compounded by a high prevalence of sexually transmitted infections (STIs), increasing levels of urethral trauma and over-stretched urological services. Thus, patients with prostate disease are treated with long-stay urethral catheters for periods often up to two years. This increases the risk of urethral stricture. The predominant aetiological factor is sexually transmitted infection due to gonococcus or chlamydia. This frequently leads to long severe strictures with spongiofibrosis, especially in the anterior urethra where the periurethral glands are located. These strictures respond poorly to urethral dilatation, optical urethrotomy or primary anastomosis. The majority of strictures in Africa are best treated by open substitution urethroplasty. The gold standard has been the use of buccal mucosa graft for this substitution procedure. This procedure poses a great challenge in most centres with limited resources. In these settings, we have found that the use of a dorsal onlay free preputial graft is easy to perform and gives good results.

The anterior sagittal transrectal approach (ASTRA) for cases associated with rectal implantation of the urethra: A retrospective review of six cases

Severe genital abnormalities such as urogenital sinus and urethral duplication with ectopic urethra in the rectum represent a major challenge in reconstructive urology. We aimed to review our cases presenting with functional ectopic urethra implanted in the rectum that were treated through an ASTRA approach. We reviewed the medical records of all patients who had undergone an ASTRA approach from 2005-2016. We collected data with interest to primary diagnosis, clinical presentation, additional procedure, immediate clinical outcome, complications, bowel habits after surgery, voiding and bladder emptying pattern and long term follow-up. Since 2005, we treated 6 cases using this method, consisting of 3 patients with congenital aphallia and 3 with Y-type urethral duplication. Two aphallia patients underwent De Castro's neophalloplasty with simultaneous anastomosis of proximal urethra to a tubed buccal mucosa neourethra and one had a neophalloplasty with transverse skin flaps and primary perineal urethrostomy. Two patients with Y-type urethral duplication had a complete urethroplasty performed (one end-to-end anastomosis and a two-stage repair). Last patient had a definitive perineal urethrostomy. At mean follow-up of 83.5 meses, only one patient voids through the urethra, four have a Mitrofanoff channel and two have a perineal urethrostomy. Immediate follow-up was uneventful and none of our patients had any bowel complications nor fecal incontinence. Domini et al. were the first proponents of the anterior sagittal transanorectal approach (ASTRA) as an alternative to classic Peña approach. Later, De Castro popularized specifically this technique as a relevant part of his neophalloplasty procedure to treat congenital aphallia. We did not find in this series any complications related to ASTRA technique in regards to bowel habits, fecal incontinence or infection but most of cases we tried to create a new anterior urethra and connect to the proximal stump failed. Moreover, we are skeptic to support simultaneous urethral repair when there is a dysplastic bulbar segment between the proximal stump and the end of the penile urethra normally at penoscrotal junction area by urethral duplication. Treatment at two-stages is also prone to fail in the midterm. At end, most of them will have either a Mitrofanoff or perineal urethral stoma as shown in our data. The ASTRA approach proved to be useful for cases of rectal implantation of the urethra. No complications related to anterior sphincter incision were documented. We believe it should be regarded as the treatment of choice for cases alike ours.

Direct Vision Internal Urethrotomy for Short Anterior Urethral Strictures and Beyond: Success Rates, Predictors of Treatment Failure, and Recurrence Management

To determine success rates, predictors of recurrence, and recurrence management of patients treated for short anterior urethral strictures by direct vision internal urethrotomy (DVIU). We identified 128 patients who underwent DVIU of the anterior urethra between December 2009 and March 2016. Follow-up was conducted by telephone interviews. Success rates were assessed by Kaplan-Meier estimators. Predictors of stricture recurrence and different further therapy strategies were identified by uni- and multivariable Cox regression analyses. The mean age was 63.8 years (standard deviation: 16.3) and the overall success rate was 51.6% (N = 66) at a median follow-up of 16 months (interquartile range: 6-43). Median time to stricture recurrence was six months (interquartile range: 2-12). In uni- and multivariable analyses, only repeat DVIU (hazard ratio [HR] = 1.87, 95% confidence interval (CI) = 1.13-3.11, P= .015; and HR=1.78, 95% CI = 1.05-3.03, P = .032, respectively) was a risk factor for recurrence. Of 62 patients with recurrence, 35.5% underwent urethroplasty, 29% underwent further endoscopic treatment, and 33.9% did not undergo further interventional therapy. Age (HR = 1.05, 95% CI = 1.01-1.09, P = .019) and diabetes (HR = 2.90, 95% CI = 1.02-8.26, P = .047) were predictors of no further interventional therapy. DVIU seems justifiable in short urethral strictures as a primary treatment. Prior DVIU was a risk factor for recurrence. In case of recurrence, about one-third of the patients did not undergo any further therapy. Higher age and diabetes predicted the denial of any further treatment.

The efficacy of intraurethral lidocaine in optical internal urethrotomy for anterior urethral stricture: a multicenter study.

Male anterior urethral strictures can be treated successfully with the help of optical internal urethrotomy (OIU) and is usually performed under general or regional anesthesia. In this study, we determined the efficacy of intraurethral lidocaine in OIU for anterior urethral stricture in an outpatient setting. A total 157 patients with anterior urethral strictures underwent OIU under local urethral anesthesia with lidocaine. Optical urethrotomy was performed with a cold-cutting knife. Visual analogue scale (VAS) was used to evaluate patient discomfort and pain levels. Using local anesthesia with lidocaine 2%, internal urethrotomy under vision was successfully completed in 151 of 157 patients. The overall success rate 96.1%. A total of 125 patients experienced mild, 26 patients moderate and 6 patients severe pain. The procedure was not completed in six patients because of severe pain. These patients went on OIU under general anesthesia. 18 (11.4%) recurrent strictures were seen during at least 6 months of follow-up. Topical intraurethral lidocaine is a simple and efficacious anesthesia technique for surgical procedures on the anterior urethra. It is a safe, cost-effective and a well tolerated procedure. OIU under topical anesthesia can be easily performed and satisfactorily completed in an outpatient setting. It is anesthetic efficacy and reasonable success rate when compared with the other anesthetic techniques may provide an alternative approach in the management of urethral strictures.

Anterior Urethral Valve: Uncommon Association with Renal Duplicity.

Anterior urethral valves (AUVs) is an unusual cause of congenital obstruction of the male urethra, being 15–30 times less common than posterior urethral valves. We present a case of AUV diagnosed at 24th gestational week. Ultrasonography and fetal MRI revealed hydronephrotic kidneys with ureteral duplicity, a distended bladder and perineal cystic mass which confirmed dilated anterior urethra in a male fetus. Diagnosis was confirmed postnatally by voiding cystourethrogram and surgery.

Urethrocutaneous fistula mimicking vesicocutaneous fistula: a rare entity

Urethral fistulas arising from the anterior urethra usually open on the ventral aspect and are located in the penile, scrotal or perineal region. A diabetic 65-year-old man presented with suprapubic...

Robot‐assisted partial prostatectomy for anterior prostate cancer: a step‐by‐step guide

To describe a step-by-step guide to robot-assisted anterior partial prostatectomy (RA-APP) for isolated magnetic resonance imaging (MRI)-detected anterior prostate cancer (APC). After Institutional Review Board approval, over an 8-year period (2008-2015), 17 consenting patients were enrolled in a prospective, single-arm, single-centre, Idea, Development, Evaluation, Assessment and Long-term evaluation of innovative surgery (IDEAL) phase 2a study. The inclusion criteria comprised pre-urethral, low-intermediate risk APC diagnosed by MRI and targeted biopsies. Patient position and port placement were identical to the transperitoneal RA radical prostatectomy procedure. Three steps of dissection were identified in the following order: (i) retrograde apical, after dorsal venous plexus division, transition zone (TZ) enucleation, and distal peripheral zone (PZ) sectioning; (ii) antegrade, at the bladder neck (BN) after anterior BN sectioning, TZ enucleation up to the verumontanum; and (iii) lateral dissections, including anterolateral PZ sectioning without incision of the endopelvic fascia. We report the incidence of perioperative complications. The RA completion of prostatectomy in four cases with cancer recurrence was performed at 0.3, 2.5, 2 and 2years, respectively. The RA-APP comprised en bloc excision of the anterior part of the prostate comprising of the anterior fibromuscular stroma, BN, prostate adenoma (TZ and median lobe) along with the proximal prostate urethra, PZ apical anterior horns, anterior aspect of the distal (sub-montanal) urethra, and anterior BN. The posterolateral parts of the PZ and distal (sub-montanal) urethra and peri-prostatic tissues were preserved intact. The bladder opening was sutured to the anterior sphincteric urethra wall and PZ lateral edges. The technique was feasible in all cases with no conversion to an open procedure. Perioperative complications were only Clavien-Dindo grade II. RA completion of prostatectomy was feasible in the four cases with cancer recurrence. PZ prostate-sparing RA-APP for isolated APC is feasible and safe, and represents an option for highly selected men with APCs as an alternative to other focal ablative therapy.

Post-Surgical Outcomes of Dorsolateral Onlay Urethroplasty

Background: The standard management of urethral strictures involving the anterior urethra is dorsal onlay buccal mucosa augmentation urethroplasty. This requires circumferential mobilisation of the urethra, which might cause ischemia of the urethra in addition to chordee. In this research, we managed the anterior urethral stricture, applying a dorsolateral onlay urethroplasty.Methodology: This prospective study was conducted in the Department of Urology, BIRDEM General Hospital& some private hospitals from July 2009 to June 2015, the outcomes of a total cases of 103 of one sided anterior dorsolateral onlay OMG Urethroplastywere assess and compared. Patients with anterior and recurrent urethral stricture more than 1 cm were included as study population. Urethrogram and Uroflowmetry were the mainstay of assessment. Success was defined as a maximum flow rate of>20 ml/sec., normal RGU, and/or urethroscopy. Poor outcomes were defined as the presence of obstructive urinary tract symptoms, Qmax <15 ml/sec., stricture diagnosed on retrograde urethrogram/ urethroscopy, and the need for any postoperative urethral intervention.Result: Of the 103 patients, 97 had (94.2%) successful outcome and 6 (5.8%) were failure. Four failed cases underwent optical internal urethrotomy and two patients had persistent narrowing and they were managed by BMG Urethroplasty. Follow up period was 12 months on an average. In conclusion, it can be said thatthe preservation of one sided vascular supply to the urethra and its entire muscular and neurogenic support represent significantly towards perfecting the surgical technique of urethral reconstruction using a minimally invasive approach.Conclusion: In this study, we found it to be a technically feasible, easily adoptable and finally successful procedure.Anwer Khan Modern Medical College Journal Vol. 7, No. 2: Jul 2016, P 16-19

Urethral carcinoma in situ: recognition and management.

Urethral carcinoma in situ (CIS) is an uncommon malignancy that is poorly described in the published literature and is often under-recognized in the clinical setting. This short case series reports some challenges associated with the recognition and management of this disease. A retrospective chart review was done over a 12-year period of patients presenting with urethral cancer to the Johns Hopkins Hospital. Four patients were identified with CIS of the anterior urethra, and their demographic and clinical data were recorded. Three patients presented with meatal lesions that were initially treated as infectious/inflammatory diseases before diagnoses of malignancy were determined following lesion biopsy. The fourth patient presented with painless hematuria and had a cystoscopy and biopsy of urethral polyps. All patients were treated surgically by sequential distal urethrectomy and various reconstructive procedures. Concurrent lymph node dissections were undertaken in two patients who had clinical or radiologic evidence of lymphadenopathy. One patient had persistent disease even after aggressive urethral resection, and he succumbed to his illness 2years later. This is the largest series of urethral CIS, a disease with potentially serious consequences. A high index of suspicion should be maintained when evaluating and managing these patients.