Case Of Urethral Diverticulum Research Articles

Laparoscopic-assisted anorectoplasty for anorectal malformation with rectobulbar fistula: A two-center comparative study with posterior sagittal anorectoplasty.

Due to the controversy on the feasibility of laparoscopic-assisted anorectoplasty (LAARP) for the treatment of the anorectal malformation (ARM) with rectobulbar fistula (RBF), this study aimed to compare the outcomes of LAARP and posterior sagittal anorectoplasty (PSARP) for ARM with RBF. Demographic data, postoperative complications, and bowel function of RBF patients who underwent LAARP and PSARP at 2 medical centers from 2016-2018 were retrospectively reviewed. Eighty-eight children with RBF were enrolled, including 43 in the LAARP group and 45 in the PSARP group. There were no significant differences in the sacral ratio (P = .222) or sacral agenesis (P = .374). Thirty-seven and 38 patients in the LAARP and PSARP groups were followed up for a median of 4.14 years. The postoperative complications were comparable between the groups (P = .624), with no cases of urethral diverticulum. The urination of all cases was normal and no evidence of cyst formation was found on MCU or MRI during the follow-up period. The incidence of rectal prolapse was similar between the 2 groups (9.3% vs 17.8%, P = .247). The groups had equivalent Bowel Function Score (15.29 ± 2.36 vs 15.58 ± 2.88, P = .645), but the LAARP group had better voluntary bowel movement (94.6% vs 84.2%, P = .148) by Krickenbeck classification. The intermediate-term outcomes of LAARP show that the urethral diverticulum was rare by the intraluminal incision of the fistular and the bowel function was comparable to that of PSARP in ARM with rectobulbar fistula. However, LAARP was associated with smaller perineal wounds.

Aspectos clínicos e cirúrgicos de hipospadia e divertículo uretal em caprinos

Hypospadia is the imperfect closure of the external urethra of the male which results from the incomplete fusion of the urogenital folds and abnormal openings of the penile urethra. The urethral diverticulum is the abnormal dilatation of the urethra, and can be of multifactorial origin and related to genetic, endocrinological and environmental factors. The objective of this article is to report on the clinical and surgical treatment of two cases of hypospadias and one case of urethral diverticulum in goats raised as pets, originated from cross breeding polled pairs. In Case 1 the hypospadias was characterized by two orifices on the ventral portion of the penis, separated by a 2 cm interruption of the urethra, and in Case 2 by an orifice on the ventral portion in the region of the urethra. In both cases there was an accumulation of urine in the middle ventral region of the foreskin, leading to distension of the skin. Both cases were successfully treated by urethrostomy and partial penectomy with fixation of the proximal urethral ostium to the skin. In Case 3, the animal was seen at ten days of age with presence of a diverticulum in the preputial region, however, the animal returned for new care only after four months due to urethral obstruction and died as a result of advanced azotemia. Surgical treatment of hypospadia, when performed before the development of azotemia associated with urinary retention, has been shown to be efficient, and post-operative care is important.

Wide-based oblique anastomosis reduces urethral stricture rate following the transverse preputial island flap procedure.

The transverse preputial island flap (TPIF) procedure remains one of the classic single-stage procedures for severe hypospadias repairs. The incidence of postoperative complications remained high. This study aims to describe a modified urethral anastomosis technique during the TPIF procedure for severe hypospadias repairs and report its outcomes. Data were collected retrospectively from consecutive patients who underwent the TPIF procedure by the same pediatric urologist between January 2018 and June 2023. Collected information included age at surgery, operative details, and outcomes at follow-up. Wide-based oblique anastomosis (WOA) technique was used as a modified urethral anastomosis in all cases. In brief, the dorsal edge of anastomosis was breadthwise anchored to the corpus cavernosum with 4-5 stitches, forming a spade-shaped anastomotic surface. A total of 72 patients were included in the study. The location of the corpus spongiosum division was penile in 27 patients (37.5%) and proximal in 45 patients (62.5%). The median glans width was 13 mm (range, 6-30 mm). The median ventral curvature after degloving was 45° (range, 30-150°). At a median follow-up of 4.1 years, complications occurred in 15 patients (20.8%), including nine cases of fistula, seven cases of urethral diverticulum and two cases of meatal stenosis. No cases of urethral stricture (US), urethral dehiscence, or ventral curvature occurred. Subsequent reoperations for diverticulum repairs showed that the dorsal side of the anastomosis was extensively fixed to the corpus cavernosum, forming a wide-based, spacious lumen. WOA technique is straightforward and effective, especially in the prevention of postoperative US.

Staged transverse preputial island flap urethroplasty for some proximal hypospadias with moderate-to-severe chordee

BackgroundWe aimed to assess the outcome of staged transverse preputial island flap (TPIF) urethroplasty for repairing certain cases of primary proximal hypospadias with moderate-to-severe chordee in children.MethodsNighty-two consecutive boys who underwent either one-stage or staged TPIF urethroplasty for the repair of proximal hypospadias with moderate-to-severe chordee between August 2015 and December 2019 were evaluated retrospectively. Patients were divided into two groups: one-stage TPIF urethroplasty group (n = 44) and staged TPIF urethroplasty group (n = 48). We noted and compared the postoperative complications, including urethrocutaneous fistula, urethral diverticula, residual penile curvature, and urethral stricture in both groups.ResultsBoth groups were followed up for 1–5 years, with an average of 3 years. No cases of residual or recurrence of penile chordee were reported in either group. In Group A, 9 patients (9/44, 20.4%) had postoperative urethrocutaneous fistula, and all patients underwent urinary fistula repair or urethroplasty. In Group B, postoperative urethrocutaneous fistula occurred in 2 cases (2/48, 4.1%), and one patient developed a urethrocutaneous fistula after the first operation, which was successfully repaired during the second operation. A urethrocutaneous fistula occurred in 1 case after completion of the second-stage operation; urethral fistula repair was performed successfully 6 months later. There were 2 cases of urethral stricture in Group A (2/44, 4.5%) and none in Group B. There were 6 cases of urethral diverticulum in Group A (6/44, 13.6%) and no cases of urethral diverticulum in Group B. The operative success rates were 61.3% and 95.8% in Group A and Group B, respectively (P < 0.001).ConclusionsCompared with one-stage TPIF urethroplasty, staged TPIF urethroplasty in the treatment of certain cases of primary proximal hypospadias with moderate-to-severe chordee resulted in fewer postoperative fistulas, urethral strictures and urethral diverticula. The staged TPIF urethroplasty procedure was effective in reducing the operation difficulty and complication rate of hypospadias, improving the curative effect of complex hypospadias and having good clinical application value.

Can magnetic resonance imaging differentiate among transurethral bulking agent, urethral diverticulum, and periurethral cyst?

To evaluate magnetic resonance imaging findings that differentiate among periurethral bulking agents (primarily collagen), urethral diverticulum, and periurethral cyst. We searched our radiologic database retrospectively from 2001 to 2017 for periurethral cystic lesions, identifying a total of 50 patients with 68 lesions. Final diagnoses in 68 lesions were bulking agents (27), urethral diverticula (29), and periurethral cysts (12). Two abdominal radiologists, blinded to clinical history, independently evaluated T1, T2, and post-contrast images. The readers assessed number, morphological features, location, connection to urethra and mass effect, signal intensity, and enhancement for each lesion. Fisher exact test and logistic regression analysis were performed for each univariate significant feature. The operative and pathologic reports were the reference standard. Magnetic resonance imaging features found more often in bulking agents versus urethral diverticulum were multiple lesions (P = 0.011), upper or upper-mid-urethral location (P ≤ 0.0001), lack of internal fluid/fluid level (P = 0.002), no urethral connection (P = 0.005), T1 isointensity, and T2 mild hyperintensity compared to muscles but lower T2 signal than urine (P < 0.0001). Most cases of urethral diverticula and periurethral cysts were detected at mid- and lower urethra. Urethral diverticula were larger than bulking agents and periurethral cysts (P = 0.005 and P = 0.023) (mean diameter = 24, 16, 15mm, respectively). Most bulking agents (93%) and urethral diverticula (90%) showed mass effect on urethra, while periurethral cysts (75%) did not (P < 0.0001). Signal intensity and lesion characterization on magnetic resonance imaging can significantly differentiate bulking agent from urethral diverticulum and periurethral cyst. Radiologists should consider differential diagnosis of a bulking agent, especially when distinguishing characteristics described here are present to prevent incorrect diagnosis and ultimately unnecessary surgical intervention.

Urethral diverticulum in pregnancy

Abstract Urethral diverticulum is rare in pregnancy. There is no clear guideline on the management of urethral diverticulum in pregnancy, but most cases were managed conservatively. We report a case of urethral diverticulum in a primigravida woman, who presented with anterior vaginal swelling at 14 weeks of gestation. She was managed conservatively and the cyst (approximately 8 cm × 13 cm) was aspirated during the early stage of labor. However her labor did not progress during the second stage, which resulted in an emergency cesarean section. She underwent diverticulectomy at 1 month postpartum because of the recurrence of the swelling and persistent discomfort. We believe that her dystocia may have been caused by factors other than the diverticulum. As previously described in literature, we concluded that, even in pregnant women with a large urethral diverticulum, vaginal delivery can still be considered with prior aspiration during the early stage of labor.

Indications de l’abord vaginal en chirurgie urologique: à propos de 30 cas

ObjectivesTo report the epidemiological features of patients operated by vaginal route, the patients’ pathologies and management. Patients and methodsFrom November 2005 to November 2010 in the department of Urology of the regional hospital center of Louga, all the patients who have been operated by vaginal route for genito-urinary disease were included in this study. All data were obtained by review of medical records and registers. ResultsThe study included 30 patients; one patient had two operations. The mean age was 42.17 years (range 20–70 years), SD 15.06. The mean parity was 4.06 (range 1–10). We noted 22 cases of external genito-urinary prolapse, 6 cases of vesico-vaginal fistula, one case of peri-urethral metastasis of gestational trophoblastic disease, one case of urethral diverticulum with calculi. The different constituents of genito-urinary prolapse were: cystoceles (21 cases, 11 of which were isolated), hysteroceles (11 cases) and rectoceles (3 cases). Three cases of genito-urinary prolapse were associated with stress urinary incontinence. All patients were treated without prosthesis placement. The procedures were: triple perineum operation with total hysterectomy (11 cases, 7 of which had annexectomy), repair of cystocele with posterior colpoperineorraphy (11 cases). Stress urinary incontinences (3 cases) was treated by Marion–Kelly technique. The vesico-vaginal fistulas were treated by splitting in two and closure the vesico-vaginal wall with interposition of Martius flap in five cases. The diverticulectomy was done for the urethral diverticulum. The peri-urethral metastasis of gestational trophoblastic disease was resected and the loss of substance repaired by using a Martius flap. Five patients who had triple perineum operation with total hysterectomy were transfused. A vesical injury observed was managed by vesical drainage. No mortality was noted. The satisfaction rate was 86.66%. We noted one failure and two patients were not seen during the follow period. ConclusionThe urological surgery by vaginal route is mainly practiced for genito-urinary prolapses in our institution. This surgery has many advantages concerning the cost, the morbidity and the convalescence. The question about using prosthesis reinforcement in certain cases, in certain countries makes that, the urological surgery without prosthesis will continue for many years.

Infected Multilocular Urethral Diverticulum Complicating Midurethral Transobturator Tape Procedure: A Case Report

The tension-free vaginal tape (TVT) and transobturator tape (TOT) procedures are now the most commonly performed operations for stress urinary incontinence (SUI) in the UK. The majority of reports in the literature relate to the success of TVT in treating SUI. However, there are little data regarding the associated complications. The occurrence of urethral diverticulum following a TVT is rare. The condition frequently presents with non-specific and non-classical symptoms and this leads to incorrect and delayed diagnosis. Reviewing the English literature, we could find three cases of urethral diverticula after a TVT procedure but we could not find any case of urethral diverticulum post TOT insertion. We report a case of a multilocular infected urethral diverticulum 5 years following TOT operation and we describe the management. J Clin Gynecol Obstet. 2014;3(4):138-140 doi: http://dx.doi.org/10.14740/jcgo260w

Infected Multilocular Urethral Diverticulum Complicating Midurethral Transobturator Tape Procedure: A Case Report

The tension-free vaginal tape (TVT) and transobturator tape (TOT) procedures are now the most commonly performed operations for stress urinary incontinence (SUI) in the UK. The majority of reports in the literature relate to the success of TVT in treating SUI. However, there are little data regarding the associated complications. The occurrence of urethral diverticulum following a TVT is rare. The condition frequently presents with non-specific and non-classical symptoms and this leads to incorrect and delayed diagnosis. Reviewing the English literature, we could find three cases of urethral diverticula after a TVT procedure but we could not find any case of urethral diverticulum post TOT insertion. We report a case of a multilocular infected urethral diverticulum 5 years following TOT operation and we describe the management.

Urethral diverticulum with proximal urethral stricture: An unusual presentation

Urethral diverticulum with distal stricture is a common entity. We are presenting a rare case of urethral diverticulum with proximal stricture. This is an uncommon case of a 55- year-old male paraplegic patient, who had urethrocutaneous fistula with distal urethral diverticulum and proximal urethral stricture. The patient was successfully managed by single-stage diverticulectomy and urethroplasty.

Réparation d’un épispadias compliquée d’un diverticule de l’urètre avec calcul

Diverticula of the male urethra are rare clinical entities. Congenital and acquired have similar modes of presentation. No case of urethral diverticulum, containing stone, complicating epispadias repair have been reported. We report the case of 8-year-old boy with an urethral diverticulum, containing stone, complicating epispadias repair. Diverticulectomy with removal of the stone by urethroplasty was performed. Through this observation and review of the literature, authors describe pathological and management finding of urethral diverticula.

Acquired male urethral diverticulum: case reports

Urethral diverticulum is a localised out pouching or fusiform dilatation of the urethra. It is an uncommon clinical entity affecting both males and females. Although, the diagnosis could be straightforward in the males, it may present as a diagnostic puzzle in the female because it often presents with non-specific symptomatology and diagnosis may not be easily made with common investigation techniques. Two cases of urethral diverticulum are presented to highlight the aetiopathogenesis of urethral diverticulum.

Divertículos adquiridos de uretra masculina: A propósito de siete casos. Revisión de la literatura

To report our personal experience in a rare urethral pathology in relation with iatrogenic sequelae from surgical treatment of lower urinary tract pathologies.We analyze the causes, type of presentation, and surgical treatment of seven cases of urethral diverticula, which account for 2.18% of the urethral procedures performed in our department, this latter representing 2.3% of a total of 11,845 surgical procedures in a period of 25 years.Male urethra diverticula go unnoticed because their initial symptoms are very similar to other lower urinary tract entities. But there is a definitive sign once the case is advanced: the appearance of a "lump" in the ventral side of the anterior urethra, the compression of which empties urinary content, sometimes fetid; or also the feeling of having a bag with stones if they host lithiasis. Surgical reconstructive treatment is very important to guarantee the absence of an obstacle distal to the cavity as well as to achieve a consistent ventral floor for the urethra to avoid recurrence, and that, as we will see, maybe obtained by various procedures. The attention to the original disease which indirectly had been the cause of the problem completes the therapeutic scheme for each case.

Urethral diverticulum in a female child

A urethral diverticulum in a female arises from the wall of the urethra and consists mainly of fibrous tissue lined with epithelium. It is uncommon, and usually presents between decades 3 and 5. Most patients present with non-specific, refractory, lower urinary tract symptoms, unrelated to the diverticulum size or number. The diverticulum may also present as a mass at the introitus. We report a case of urethral diverticulum in a female child that presented as an introital mass.

Transvaginal Ultrasound for the Diagnosis of Urethral Diverticulum

We reviewed our experience with urethral diverticula and transvaginal ultrasound to evaluate female patients with this condition. All female patients who underwent transvaginal ultrasound during evaluation for urethral diverticulum at our institution between May 1995 and April 2002 were identified by searching a data base. We reviewed the diagnostic evaluation and compared diagnostic techniques with transvaginal ultrasound for diagnosing urethral diverticulum. Of the 25 patients with suspected urethral diverticulum who underwent transvaginal ultrasound as a diagnostic procedure 10 (40%) were diagnosed with urethral diverticulum, including 10 in whom it was confirmed by surgery or other diagnostic procedures. Transvaginal ultrasound was less expensive than the other diagnostic modalities and in no case did it miss a urethral diverticulum that was identified by another diagnostic technique. Urethral diverticulum was detected on 1 of 3 voiding cystourethrograms (33%) and this study missed the diagnosis in 1 case that was diagnosed by transvaginal ultrasound. Three cases of urethral diverticulum were noted on transvaginal ultrasound after they were missed by cystoscopy. Videourodynamics were unable to diagnose urethral diverticulum. Transvaginal ultrasound is effective for evaluating patients with suspected urethral diverticulum. It is less expensive and may identify diverticula missed by other diagnostic modalities.

A Case of Urethral Diverticulum in Neonate

A Case of Urethral Diverticulum in Neonate

Female urethral diverticula

Most urethral diverticula should be diagnosed on clinical grounds alone, but investigations may be used to confirm the diagnosis in difficult cases, delineate the extent of the disease and investigate other entities such as stress incontinence. A high index of suspicion is required when assessing women with lower urinary tract symptoms to ensure that cases of urethral diverticulum are not missed. The cases presented demonstrate that greater awareness of the signs and symptoms of this not uncommon disease may facilitate early diagnosis. Our cases also show that surgical treatment is effective and worthwhile.

Unusual urethral diverticulum lined by colonic epithelium with Paneth cell metaplasia

Diverticulum of the female urethra has an incidence of 1.4% to 4.7%. It is generally agreed that the majority of these are acquired lesions. There is, however, evidence that some are of congenital origin. Documented cases of diverticula with colon-type tissue are rare. A case of urethral diverticulum with colonic epithelium and features of Paneth cell metaplasia is presented. Causes, symptoms, diagnostic methods, and treatment are discussed.

Urethral diverticula in young girls

Five cases of urethral diverticulum in young girls are herein presented. None of these children had associated local infections, unlike what is generally the case in adult women with a similar lesion. Three girls experienced spontaneous regression of the diverticulum. Therefore, unless the diverticulum causes clinical problems, postponement of surgical intervention is advised.

Urethral diverticulum with endometriosis

A case of urethral diverticulum in a female patient with endometriosis in the diverticular wall is presented. Review of the recent urologic literature reveals no such case reported previously. The diverticulum was excised and the urethral walls were approximated, with uneventful postoperative recovery.