Complete Urethral Transection Research Articles

Penile Entrapment Syndrome in Young Children

Introduction Entrapment syndromes can occur in extremities like the genitalia, the penis, toes and fingres and mostly due to hair shed by the mother mostly in young children but may be other materials are involved specially in adults. Penile hair Entrapment syndrome is an uncommon health problem that leads to devastating injuries to the urethra and penis including urethral fistula up to urethral complete transaction and penile injury up to penile amputation. We are going to discuss our experience with the problem. Materials and Methods All 15 patients between 2018 and 2020 had been operated upon for various degrees of Penile hair Entrapment syndrome from simple single urethral fistula, and complete urethral transection, their ages ranged between 1.5 years to 4.6 years. Follow up ranged between 6 months to 1.4 years. Each patient was invstigated and examined at the emergency room for other entrapment syndromes and the causative agent was removed and the patients were admitted for managing their urethral and penile injuries. Results All 15 patient but 1 had complete healing with fistula healing and normal voiding with no meatal stenosis or urethral divritculum. One patient had incomplete urethral Closure wit redo operation and fistula closure. Discussion There are multiple reports and literature that address the problem yet nobody took into account how to prevent it. There should be public awarence about the problem, the mother should examine her child for any entrapment syndrome and if any suspicious finding she sholud seek medical advice. Conclusion Penile entrapment syndromes are uncommon urological health problems that can face the urologist but he should be aware of the problem that can affect young children and he should put in mind the problem to manage it as early as possible to prevent further damage of the valuable urethra and penis.

Isolated penile injury in boys: Accident, negligence, or abuse?

Aim:The aim of the study was to highlight the etiology, spectrum of presentation, and management of isolated penile trauma in boys.Methods:A retrospective review of boys treated for isolated penile trauma between January 2015 and June 2019 at a tertiary-level hospital.Results:Nine children were admitted over 4½ years. Etiology: The mechanism of penile injury (PI) was penile hair tourniquet (n = 5), postcircumcision (n = 2), dog bite (n = 1), and scald injury (n = 1). Extent of injury includes complete urethral transection at corona (n = 4); loss of urethral plate in a case of hypospadias (n = 1); complete loss of glans (n = 1); penile transection at corona (n = 1); total penile amputation (n = 1); and deep partial-thickness burns of penile shaft and adjacent suprapubic skin (n = 1). Management: One patient absconded. The remaining patients were managed as follows: calibration of urethral meatus (n = 1); penile burn was managed with dressing and antibiotics; coring of glans with urethral end–end anastomoses (n = 4); Bettocchi's quadrangular lower abdominal flap phalloplasty (n = 1); and Bracka's staged urethroplasty (n = 1). Complications include wound infection following trauma (n = 4), postsurgical infection (n = 3), urethrocutaneous fistula (n = 2), and reapplication of penile hair tourniquet (n = 1).Conclusion:Isolated PI in boys is not uncommon. Most are preventable if the parents are apprized and watchful. The clinician should also be vigilant regarding child maltreatment. A staged approach tailored to the type of injury provides a satisfactory outcome.

Delayed presentation of Penile tourniquet syndrome due to hair coil as complete urethral transection: A devastating complication

Penile tourniquet syndrome (PTS) is a condition in which a hair coil is wrapped around the penis causing damage to the urethra and penis. The spectrum of complications due to PTS may range from simple oedema of the penis to complete penile necrosis. We are reporting an 8-year-old boy who presented late to us with complete urethral transection having history of hair coil around penis 3 years back. Examination of the external genitalia revealed complete urethral transection at the coronal sulcus and deeply grooved cut mark at the dorsal part of the glans. The coronal sulcus was shallow and the glans overhanging. The urethral defect was about 0.5 cm. Following evaluation the patient underwent urethral repair by end to end anastamosis and was able to pass urine through the native urethral meatus postoperatively. Most of the cases reported in literature presented soon after the urethral injury unlike the index case which was discovered after 3 years.

PENILE FRACTURE WITH COMPLETE URETHRAL TRANSECTION

Penile fracture with associated urethral injury is rare, but if it is associated with a complete urethral transection, then it is very rareand needs utmost attention to deal with it. This type of cases should be dealt with very precaution, and proper investigation shouldbe done preoperatively to avoid post-operative complications. Here, we present a case of penile injury with complete urethralrupture and its successful management.

Missed Diagnosis of Complete Urethral Transection After Sling

Patients with complications of urethral sling placement for stress urinary incontinence are often treated for recurrent symptoms for years after initial reassuring evaluation. Translabial ultrasound is a noninvasive modality with minimal risks that can clearly diagnose urethral mesh complications. We present a 47-year-old premenopausal woman referred for treatment of urethral stricture and diverticulum 8 years after mesh sling placement. The diagnosis was made at an outside institution by voiding cystourethrogram and cystoscopy. However, translabial ultrasound confirmed the diagnosis of complete urethral transection, and the patient underwent a complex urethral reconstruction. Ultrasound should be used to evaluate patients with a history of urethral sling and persistent lower urinary tract symptoms. Referral to a center with advanced pelvic reconstruction services may be required.

Progressive hair coil penile tourniquet syndrome: multicenter experience with 25 cases

Objective Penile hair tourniquet syndrome is an uncommon syndrome characterized by progressive penile strangulation by a hair tie. Complications reported include urethrocutaneous fistula, complete urethral transection, penile gangrene, and penile amputation. Prevention of such major complications depends on awareness of the etiology and presence of a high index of suspicion for early diagnosis. Patients and Methods Twenty-five children presenting with different degrees of hair coil penile strangulation syndrome have been operated on in the period from 2000 to 2007 in 2 tertiary care centers in the city of Alexandria. Eighteen boys had complete transection of the urethra at the coronal sulcus. Seven boys had partial transection of the ventral wall of the urethra at the coronal sulcus. Repair of the penis was done in all children in a single stage. Results The mean age of boys is 3 years and 9 months (2-5 years). The mean follow-up is 20.7 (6-48) months. Urethral catheter was left for a mean of 5.5 (4-7) days. In the mean follow-up period, we had 4 complications in the form of 2 tiny urethrocutaneous fistulas and 2 anastomotic urethral strictures. The fistulae were closed surgically after the primary surgery by 1 year in the 2 cases, with no recurrence. Urethral strictures were managed by endoscopic visual urethrotomy, with no recurrence. Conclusion Penile tourniquet syndrome can cause serious penile complications. Awareness of this rare syndrome can help in preventing such complications. Being familiar with the surgical reconstruction guarantees high success rate.

Adolescent with penile fracture and complete urethral transection

We report the first pediatric case of penile fracture with complete urethral transection caused by accidental fall. The patient presented atypically with the majority of swelling and ecchymosis occurring in the scrotal area rather than the penile shaft. The urethral injury occurred at the junction of the penile and bulbar urethra with significant urinary extravasation into the scrotum. The injury was repaired with plastic reanastomosis of the corpora cavernosa and urethra using a scrotal approach, rather than the commonly described degloving incision. The diagnosis and management of this unusual injury and the implications with respect to the pathophysiology of penile fracture are discussed.

Rectus Urethromyoplasty of Radical Prostatectomy Anastomosis Decreases Postoperative Incontinence and Anastomotic Stricture; Technique and Preliminary Results

To investigate the effect of rectus urethromyoplasty on vesicourethral anastomosis healing during radical retropubic prostatectomy (RRP) and in an animal model. Three groups of 10 female rats were studied. After complete urethral transection, group A animals underwent a primary urethral anastomosis, while rectus urethromyoplasty was used to reinforce the anastomosis of the animals in group B. Group C animals served as controls. All animals underwent urodynamic evaluation one month postoperatively, then were sacrificed for histological analysis. In 3 clinical subjects at the time of RRP, a 2-3 cm x 6-8 cm. strip of rectus muscle was isolated with its blood supply intact, emanating from an inferior epigastric artery pedicle. This muscular band was used to encircle the vesico-urethral anastomosis, suspending it slightly but without tension, and securing it to the pubic symphysis. The micturition pattern, bladder capacity, and leak point pressure of the 3 groups of animals were not significantly different. Histological examination of the rectus sling revealed viable muscle with histofibroblast, collagen, and blood vessel ingrowth from the vascular rectus muscle into the urethra. Three successful clinical rectus urethromyoplasty cases were performed with over 12 months of follow-up. Reinforcement of the vesico-urethral anastomosis using rectus urethromyoplasty at the time of radical prostatectomy may improve continence by increasing urethral support and mucosal coaptation. This technique may decrease the incidence of stricture formation by augmenting blood supply available for healing of the anastomosis. Rectus urethromyoplasty may be especially beneficial to patients with an increased risk of requiring adjuvant radiation therapy post-prostatectomy.

Delayed transection of urethra by mersilene tape

This report is of a patient with complete urethral transection after undergoing a mersilene sling urethral suspension. This unusual complication eventually presented as an anterior urethral pseudodiverticulum containing the mersilene tape with a secondary calculus.