Post-micturition Dribble Research Articles

114 - Urodynamic characteristics of post-micturition dribble in men

114 - Urodynamic characteristics of post-micturition dribble in men

Current Potential Outcomes of Buccal Mucosal Graft Anterior Urethroplasty for Male Urethral Stricture: A Single-Centre Study in Nepal.

Objective This study evaluates the efficacy and potential complications of Buccal Mucosal Graft (BMG) urethroplasty for anterior urethral stricture over a 48-month follow-up. Method A retrospective review was conducted on 130 patients who underwent various types of BMG urethroplasty between 2012 and 2019. Data on patient demographics, stricture etiology, and anatomic sitewere collected. Adverse outcomes such as complications likeerectile dysfunction (ED)persisting for over 12 months, and post-micturition dribbling (PMD) were analyzed to determine success rates, recurrent stricture risk factors, complications, and the definition of failure as stricture recurrence during the 48-month follow-up period. Results Of the 130 patients, there was a recurrence in 15.4 % (20 males), yielding a success rate of 84.6% (n=110). ED was reported in 11% (n=14) and PMD in 14% (n=18). All instances of ED were non-organic, and patients were administered oral phosphodiesterase type 5 (PDE5) inhibitors. These complications were observed in 20 patients (15.4%); with urinary fistula (3.0%), graft contracture (2.3%), graft failure (3.8%), urinary tract infection (UTI) (3.0%), and wound infection (2.3%) being the most prevalent after penile urethroplasty. Univariate analysis indicated age (31-50 years, >50 = P<0.05) at surgery, etiology (Balanitis Xerotica Obliterans (BXO)= P<0.05), stricture length (4.1-8 cm, >8 cm = P<0.05), and location as significant predictors of stricture recurrence. However, multivariate analysis highlighted penile location (P<0.05) as the sole independent predictor for restricture during the follow-up period. Conclusion BMG urethroplasty demonstrates a substantial 84.6% success rate in treating anterior urethral stricture over a 48-month follow-up period. This outcome underscores the advancements in healthcare quality in resource-limited settings in countries like Nepal.

Underactive bladder, Fowler's syndrome are potentially curable by uterosacral ligament repair.

Underactive bladder (UAB) is essentially an inability of the bladder to properly empty. UAB symptoms, when they co-occur with posterior fornix syndrome (PFS) symptoms (urge, frequency, nocturia, chronic pelvic pain), can be cured/improved, surgically by uterosacral ligament (USL) repair, non-surgically, by devices which give mechanical support of the USLs or strengthening pelvic muscle and ligaments with squatting-based exercises. The pathogenic pathway from weak USLs to UAB (and PFS) is that, when the muscles which externally open the posterior wall of the urethra contract against lax USLs, their contractile force weakens, and they cannot open the urethra adequately. The detrusor then contracts against a relatively unopened urethra to cause obstructive symptoms (i.e., UAB) such as slow stream, intermittent stream (stopping and starting), hesitancy (difficulty starting), feeling of incomplete emptying, and post-micturition dribble. Co-occurrence of PFS symptoms indicates that UAB may be part of the PFS, with USL causation, which can be tested by a tampon or probe in the posterior fornix. If the emptying (and other) PFS symptoms improve, it is a sign that UAB, and Fowler's syndrome (FS) can potentially be cured or improved by USL repair. Following USL repair, many studies have recorded very significant improvement in emptying symptoms, and objective tests, for example, postvoid residual (PVR), decreased natural bladder volume, and decreased emptying time. FS and UAB are most likely a part of the PFS and, therefore, potentially curable by USL repair.

Functional vesico-sphincteric disorders in children: clinical, urodynamic and evolutionary profile

Childhood vesico-sphincteric disorders are the cause of functional and psychological disability. They are also responsible for serious uronephrologic complications akin to neuro-bladder complications. In this study, we looked for the clinical manifestations linked to these disorders as well as the paraclinical and urodynamic anomalies and their therapeutic management. We carried out a retrospective and descriptive study of patients with vesico-sphincteric disorders, followed in the pediatrics department of Charles Nicolle hospital in Tunis. In total 26 patients were included in our study. The median age at the first consultation in a pediatric nephrology department was 9 years (IQR 25 = 6 years; IQR 75 = 11 years). There was a predominance of girls: 19 boys and 43 girls. The filling phase and the voiding phase were dominated by the combination of three or more symptoms. Bladder tenderness was reduced in 12% of cases. Nineteen percent of patients reported post micturition dribble in the post-voiding phase. The flow rate curve was polyphasic in 36% of cases and flat in 11% of cases. The median of the post void residual was 62, 2 mL (IQR 25 = 25 mL; IQR 75 = 102 mL). Cystometry showed reduced bladder sensation in 14% of cases, detrusor overactivity in 65% of cases, bladder hypocontractility in 8% of cases, hypocompliant bladder in 42% of cases and small capacity in 88% of cases. Sphincter dysynergia was noted in 34% of patients. Anticholinergics were the most used in the treatment of disorders (53%). Renal failure was noted in 45% of the patients of which 11% had end-renal stage failure. During follow-up 16% of our patients required kidney replacement therapy. Given the seriousness of vesico-sphincteric disorders in children and the late discovery in the majority of cases at the complication stage, targeted primary prevention must be carried out based on continuous training of primary care physicians to minimize the appearance of complications involving the functional and vital prognosis of these children.

Pediatric urethrovaginal reflux: an underestimated cause of urinary incontinence and its successful management.

Urethrovaginal reflux (UVR) secondary to vaginal urine entrapment is an unnoticed cause of daytime urinary leakage in toilet-trained girls. Our aim is to emphasize the diagnosis of UVR as a cause of urinary incontinence, its predisposing factors, early detection, and treatment. A total of 25 girls aged between 9 and 14years presented with mixed daytime urinary incontinence from 2019 to 2021. They were evaluated by detailed history, vaginal examination, focused neurological examination, bladder diaries, urine analysis, uroflowmetry, and residual urine assessment. Micturating cystourethrography was also performed in those girls who did not show improvement with a conservative line of management. The parents of these girls were educated about the cause of leakage. They were treated with behavioral modifications, urotherapy, correcting toilet postures, and reverse sitting on the commode. Urethrovaginal reflux was found in 6 of the 25 girls (24%). Their ages were 9, 10, 10, 11, 12, and 14years respectively. Two girls (10 and 14years old) had a body mass index more than 25. They all had a typical history of a small quantity of urine leakage 5-10min (post-micturition dribble) after every void. At follow-up after 12 months, all of them were free from urinary incontinence. Urethrovaginal reflux should be considered in the differential diagnoses of girls with day-time incontinence. The key to diagnosis is an appropriate and detailed history as it is common for parents or girls to ignore symptoms or fail to report them. Proper voiding instructions and behavioral therapy often resolve the problem.

(277) Proposal for a Clearer Definition and Classification of Urethral Complications Following Transmasculine Gender Affirmation Surgery

Abstract Introduction The use of free flap microsurgical neophallus construction with integrated urethra have improved outcomes for transmasculine gender affirmation surgery (GAS) but there is no accepted gold standard. Many authors have described urethral complications but only in heterogenous and small cohorts. Anatomical nomenclature is also confusing. Objective We aim to describe urethral complications in the largest cohort of patients to date and propose a naming and classification system to improve reporting, research and management of this common problem. Methods All transmasculine individuals undergoing phalloplasty including a free flap urethroplasty, with staged urethral lengthening at our centre over five consecutive years (2014 – 2019) were retrospectively reviewed from a prospective database. Metoidioplasty was excluded. The incidence, timing and management of urethral complications were extracted from a prospective database. Statistical analysis was by Chi-squared test. Results Three hundred and seventeen individuals with median follow-up of 4.3 years (interquartile range 3.6– 5.0 years) were included. Types of phalloplasty include forearm flap, anterolateral thigh flap and abdominal flap with free flap urethroplasty. Almost half (43.5%) developed a urethral complication (fistula, stricture, severe post-micturition dribbling or urethral hair/stone); most commonly fistulae (48.5%) followed by strictures (37.4%). Complications were significantly higher in flaps with integrated urethra compared to staged combination free flap urethroplasty (39% compared to 10%, p&amp;lt;0.0003). Forty-four individuals (12.4%) developed more than one complication (31% of complications). Overall, complications were mostly in the phallus (flap-related) (72.2%) followed by scrotal and perineal urethra. Repairs before and during routine second stage urethral lengthening were for phallus complications comprising fistulas and strictures. Strictures were more common than fistulas in contrast to individuals before urethral lengthening (p&amp;lt;0.001). Staging the urethral lengthening allowed 81.6% of individuals to be asymptomatic while awaiting routine repair. Vaginectomy did not reduce the risk of urethral fistulae. Conclusions The largest series to date suggests that urethral complications continue to be common following phalloplasty and are mostly phallus or flap related. Complications may also be lower if a staged free flap urethroplasty is offered. We show that the nature of urethral complications in phalloplasty change depending on the stage of genital GAS and should be classified based on type, location and timing of occurrence. This classification standardises reporting and will help guide the approach for surgical correction. Complications in the phallus urethra relate to an issue with the free flap and requires a different approach compared to complications following urethral lengthening that are more likely in the scrotal or native urethra. Many complications occur prior to urethral lengthening (81.6%) and can be repaired routinely at that time. Furthermore, we propose that the urethral segments are called the phallus, scrotal and native urethra to allow for clear and concise nomenclature. Disclosure No

(037) Contemporary Surgical and Functional Outcomes of Anterolateral Thigh Flap for Penile Reconstruction

Abstract Introduction The radial forearm free flap phalloplasty is the most commonly used flap for penile reconstruction. The anterolateral thigh (ALT) free flap was proposed in 2006 as an alternative due to the twin advantages of a more easily hidden scar and improved flexibility in the length of the flap. A pedicled variant of the ALT flap was proposed the same year thus offering greater security of vascular supply for suitable patients. Previous reports have highlighted higher rates of flap loss and low rates of integrated urethra. Objective The aim of the study is to report the contemporary surgical outcomes of ALT phalloplasty. In addition, the functional outcomes of the ALT flap phalloplasty are reported for the first time. Methods All patients undergoing ALT flap phalloplasty were included in the study between 2009 and 2021. Data were extracted from a comprehensive prospective database and the medical records. Functional outcomes were assessed by non-validated questionnaire. Results Seventy-six patients underwent ALT flap phalloplasty with a mean follow-up of 34 months (SEM ± 3.05). Median age of the patients was 32 (IQR 26 – 46) and body mass index was 24 (SEM ± 0.61). A significant minority had a previous phalloplasty (22%). In addition, 7% of patients had other co-morbidities including diabetes and peripheral vascular disease. Over half of all flaps (n=41) were designed with an integrated urethra and 6.6% (n=5) required free flap transfer. The average length of stay was seven days (SEM ±0.47). Post-surgery, five (6.6%) patients experienced total flap loss, with a further three (3.9%) experiencing partial loss. Urethral complications were common with eleven (26.8%) patients developing fistulae and three (7.3%) developing strictures. Fifty-three (69%) patients completed the functional outcomes questionnaire. Forty-three (81%) were generally satisfied with their phalloplasty, while thirty-four (65%) felt they had a good cosmetic outcome. Twenty-eight (53%) had sensation in at least half of their phallus. Eight (17%) experienced troublesome post-micturition dribbling. Conclusions Presented is one of the largest cohort of patients following genital gender affirmation surgery using the ALT flap phalloplasty. Over half of all patients successfully had an integrated urethra (gold standard for urethral reconstruction). Functional outcomes (an important determinant for the choice of a flap) are reported for the first time showing 81% of patients are satisfied despite a challenging cohort with almost a quarter of patients undergoing salvage following previous failed phalloplasty. Disclosure No

V08-07 FREE GRAFT + PEDICLED TUBE IN BULBAR NECROSIS: HOW TO MAKE IT WORK

You have accessJournal of UrologyCME1 Apr 2023V08-07 FREE GRAFT + PEDICLED TUBE IN BULBAR NECROSIS: HOW TO MAKE IT WORK Pankaj Joshi, Cora Fogging, Daniel Gomez, Apurva Anand, Rateesh Rajendran, Shreyas Bhadranavar, and Sanjay Kulkarni Pankaj JoshiPankaj Joshi More articles by this author , Cora FoggingCora Fogging More articles by this author , Daniel GomezDaniel Gomez More articles by this author , Apurva AnandApurva Anand More articles by this author , Rateesh RajendranRateesh Rajendran More articles by this author , Shreyas BhadranavarShreyas Bhadranavar More articles by this author , and Sanjay KulkarniSanjay Kulkarni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Redo Urethroplasty after pelvic fracture urethra injury are challenging cases. Bulbar necrosis happens due to poor flow in the circumflex and dorsal penile arteries. These leads to long gaps. We have extensive experience of bulbar urethral necrosis .Our algorithm uses pedicled preputial tube as the best option for such condition. We present rare situations where there are desperate attempts to solve the remaining gaps .and it works, How? METHODS: Our tertiary referral centre caters to over 500 Urethroplasties a year. These include more than 120 PFUI. We collected prospective data from 2010.These is a worksheet with over 50 parameters .Patients with bulbar necrosis with pedicled tube and yet remaining gap were included. We excise the outer skin as onlay one side(inner or outer) can be used as a flap. If there is still a gap remaining between the 2 urethral ends, we have used the excised preputial skin as free tube. We wrapped the dartos of the pedicled tube around the free tube. And it works. Catheter was kept for 6 weeks.Pericatheter urethrogram was performed before catheter removal. Patients were followed long term with uroflow, PVR,USG for upper tracts and AUA symptom score RESULTS: We had 9 patients out of 1564 who had such situations as shown in the video. In all 9 patients the urethra remained patent .Patients had good voiding per urethra. All patients had ED and 3. underwent penile prosthesis. All patients had post micturition dribble and diverticulum formation in long term. CONCLUSIONS: It is not recommended to perform free graft tube. However there are desperate situations. In these cases the blood supply came from the wrapped dartos tissue around the free graft tube. Other options would have been to leave a penoscrotal urethrostomy at the distal end of tube and perform a second staged penile urethroplasty later.Desperation urethroplasty works. Complex situations need simple answers. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e750 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pankaj Joshi More articles by this author Cora Fogging More articles by this author Daniel Gomez More articles by this author Apurva Anand More articles by this author Rateesh Rajendran More articles by this author Shreyas Bhadranavar More articles by this author Sanjay Kulkarni More articles by this author Expand All Advertisement PDF downloadLoading ...

Prevalence and Risk Factors of Postmicturition Dribble in Men

Abstract Purpose: We investigated postmicturition dribble (PMD) prevalence rates and risk factors in men. Materials and Methods: This cross-sectional study included 1037 men aged 31–86 years who participated in a male health survey. PMD was defined by involuntary urine loss immediately after urine was passed and was scaled from 0 to 5, depending on symptom severity. A score of ≥3 was considered significant PMD. PMD prevalence was also determined by age group, and logistic regression analyses were performed to identify risk factors. Results: The mean age of participants was 55.3 ± 8.9 years. Overall, 232 (22.4%) reported significant PMD. PMD prevalence significantly increased with age (P = 0.013): it was 18.2%, 17.2%, 20.8%, 28.7%, and 30.1% in men aged 30–39, 40–49, 50–59, 60–69, and ≥70 years old, respectively. Univariate analyses revealed that age, peak flow rate (Qmax), and prostate specific antigen levels were associated with significant PMD, while in multivariate analyses, only decreased Qmax was an independent risk factor. Conclusion: PMD was identified as a common condition in men across all age groups, and its prevalence significantly increased with age. The condition correlated more with voiding symptoms when compared with storage symptoms, and was associated with decreased Qmax.

Animal Models for the Study of Post-Micturition Dribble in Aged Male

Animal Models for the Study of Post-Micturition Dribble in Aged Male

Quality of Life of Saudi Women With Chronic Lower Urinary Tract Symptoms.

Background Chronic lower urinary symptoms (LUTS) are reported to affect more than half of women of all ages and have a significant impact on their quality of life (QoL). We aimed in this study to assess the QoL of adult Saudi women with chronic LUTS. Methods A cross-sectional study was done on 390 female patients diagnosed with LUTS at three tertiary care hospitals in Riyadh, Saudi Arabia, from October to December 2021. LUTS are classified into three categories: symptoms related to bladder storage (increased daytime frequency, nocturia, and urinary incontinence [UI]), symptoms of bladder voiding (hesitancy, extended micturition time, and insufficient emptying), and symptoms involved in the post-urination phase such as post-micturition dribbling. The data was collected using a self-administered questionnaire which comprised demographic characteristics, International Prostate Symptom Score (IPSS) for assessment of LUTS severity, and King's Health Questionnaire (KHQ) for assessment of QoL. Results After analyzing the study results, we found that symptoms were mild, moderate, and severe in 11%, 51%, and 39% of participants, respectively. Increased age and parity were found to have a significant association with increased symptom severity (p-value <0.05). The current study reported a moderate effect of LUTS on QoL. There was a significant correlation between increased symptom severity and negative impact on QoL, excluding the personal relationships domain. The highest scores in KHQ, which indicate worse QoL, were found in the domains of incontinence impact and emotions, while the lowest scores, which indicate better QoL, were found in the domains of social limitations and severity measures. Employed females were found to have worse QoL in the severity measures domain, which refers to the degree of urinary symptoms affecting day-to-day functioning. In addition, younger age, below 45 years, was found associated significantly with better QoL, especially in the domains of general health, personal relationships, and severity measures. Conclusion In the current study, the majority of patients reported moderate symptoms severity. Chronic LUTS have a significant impact on the QoL of Saudi women in many aspects, including physical, social, and emotional health, especially for those who have moderate to severe symptoms. Healthcare providers should assess high-risk women for the presence of LUTS. Furthermore, we recommend evaluating the QoL of patients with LUTS as a part of routine management.

The pressure flow study investigation of pathophysiology of post-micturition dribble in male patients.

In this study, we aimed to elucidate the pathophysiology of post-micturition dribble (PMD) through analyzing several variables including pressure flow study (PFS) findings and symptoms questionnaire. We retrospectively analyzed male patients who visited our department between 2010 and 2020. We used modified international prostate symptom score (m-IPSS), which consists of eight sub-score related to lower urinary tract symptoms (Incomplete Emptying, Frequency, Intermittency, Urgency, Weak Stream, Straining, Nocturia, and PMD) and one question related to quality of life (QOL). Multivariate regression analysis was conducted to evaluate the relationship between PMD and the variables, including age, prostate volume (PV), body mass index, bladder outlet obstruction index (BOOI), bladder contractility index, and bladder voiding efficiency, which were obtained by PFS. A total of 143 male patients were analyzed. The patients with PMD showed significantly larger PV and higher BOOI, and worse IPSS total and QOL score than those without PMD. Multivariate regression analysis showed that large PV and BOOI were significantly associated with PMD. In Spearman's correlation analysis, PMD and each m-IPSS sub-score except nocturia had significant positive correlation. Furthermore, Spearman's correlation analysis showed that PMD and QOL had significant strong positive correlation. PMD was significantly associated with large PV and BOO evaluated by PFS. Furthermore, PMD significantly exacerbated QOL. The severity of PMD and the other m-IPSS sub-score except nocturia could have intercorrelation with each other.

Diagnosis of female urethral diverticulum using pelvic floor ultrasound and comparison with voiding cystourethrogram (imaging study).

The purpose of this study was to evaluate the sensitivity and specificity of pelvic floor ultrasound (PFUS) in the diagnostic work-up of female urethral diverticulum (UD) and to compare results of PFUS with voiding cystourethrogram (VCUG). We retrospectively reviewed our database of patients, who received VCUG and PFUS for the diagnosis of UD. A total of 196 consecutive female patients with a minimum of one symptom, such as a lower urinary tract symptom (LUTS), postmicturition dribble, dyspareunia and recurrent urinary tract infection (UTI) who underwent initial diagnostics with VCUG and PFUS were selected. Diagnostic performance of both procedures, which included size, complexity, echogenicity. and content were compared. Recurrent UTI and LUTS were the most common symptoms, which were present in 165 (84%) and 163 patients (83%) respectively. Final diagnosis of UD was based on PFUS and VCUG findings in 69 (35%) and 58 (30%) cases respectively. Based on our study cohort, the sensitivity of PFUS in detecting UD was significantly higher than that of VCUG: 94% (IQR: 89-97) versus 78% (IQR: 73-85, p<0.01), with a trend toward higher specificity: 100% (IQR: 94-100) versus 84% (IQR: 78-84, p=0.05). Enabling direct UD visualisation, PFUS was associated with a positive predictive value (PPV) of 100% (IQR: 97-100) and a negative predictive value (NPV) of 88% (IQR: 78-95), whereas VCUG had an inferior accuracy with a PPV of 84 (IQR: 80-84) and a NPV of 68 (IQR: 62-79). In clinical practice, VCUG has a lower sensitivity than PFUS. Based on these results, we recommend the usage of dynamic PFUS as part of a non-invasive work-up.

V04-12 A SINGLE STAGE URETHROPLASTY FOR PRIMARY PENOSCROTAL ADULT HYPOSPADIAS

You have accessJournal of UrologyCME1 May 2022V04-12 A SINGLE STAGE URETHROPLASTY FOR PRIMARY PENOSCROTAL ADULT HYPOSPADIAS Pankaj Joshi, Vipin Sharma, Sandeep Bafna, Shreyas Bhadranawar, Marco Bandini, and Sanjay Kulkarni Pankaj JoshiPankaj Joshi More articles by this author , Vipin SharmaVipin Sharma More articles by this author , Sandeep BafnaSandeep Bafna More articles by this author , Shreyas BhadranawarShreyas Bhadranawar More articles by this author , Marco BandiniMarco Bandini More articles by this author , and Sanjay KulkarniSanjay Kulkarni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002560.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Management of hypospadias is challenging. This is due to the variable presentations and guarded healing. Majority get treated in childhood. Some progress as hypospadias cripple. But there are few that we see, uncorrected hypospadias who present as adults. This could be due to Scio economic conditions or lack of awareness that such patients remain uncorrected till adolescence or adults. These patients need a single stage surgery. We present our experience of such group of patients. METHODS: Ours is a tertiary care referral center for urethroplasty with experience of more than 6000 Urethroplasties in last 2 decades. We have performed over 500 failed hypospadias surgeries over past 2 decades. This is a prospective study from Jan 2010-July 2020.11 patients were adults who presented with primary penoscrotal hypospadias with chordee. Single stage surgery was performed. Standard progressive steps are penile degloving, ventral corporotomies, urethral transection, chordee correction with corporal grafting (BMG or bovine pericardium), pedicled preputial tube for urethra. RESULTS: Mean age 24 years. Operative time was 110 minutes. Catheter was kept for 6 weeks.2 developed UTI requiring antibiotics.3 patients had Urethrocutaneous fistula and all at the proximal level.1 patient with bovine pericardial graft had complete dehiscence. All those with BMG performed well. No residual chordee was seen. Patients were evaluated with PROMS. They were most happy with the shape of Glans. Follow up was 16 months. Common complaint was post micturition dribble and need to massage penis for ejaculation. CONCLUSIONS: Few patients present with primary uncorrected hypospadias in adulthood. Such patient’s merit chordee correction and single stage surgery. Corporal grafting offers improved penile length as compared to plication. Pedicled preputial tube helps performing a single stage surgery. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e370 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pankaj Joshi More articles by this author Vipin Sharma More articles by this author Sandeep Bafna More articles by this author Shreyas Bhadranawar More articles by this author Marco Bandini More articles by this author Sanjay Kulkarni More articles by this author Expand All Advertisement PDF downloadLoading ...

Сирингоцеле Купера (бульбоуретральная киста)

This article presents a clinical case of a 30-year-old patient with a closed cystic lesion in the bulbourethral gland, whose clinical presentation was masked as acute prostatitis. Cowper’s syringocele is a cystic dilation (deformity) of the main duct of the bulbourethral (Cowper’s) gland. This disease is not uncommon, but is rarely identified; it is often asymptomatic, and its clinical manifestations are highly variable, depending mainly on its type (open, closed) and are similar to lower urinary tract symptoms (perineal pain, post-micturition dribble, recurrent urinary tract infection, dysuria, etc.). A syringocele should be included in the examination algorithms for boys, adolescents, and men with signs of inflammatory diseases of the urogenital system or symptoms of infravesical obstruction. Ultrasonography is informative for closed cysts (a fluid-filled cavity may be identified); a pelvic MRI scan, supplemented by ureteroscopy, allows to visualize the cyst cavity and to determine its association with the urethra. Ureteroscopy is a preferable option for surgical treatment in most cases. Key words: bulbourethral gland cyst, lower urinary tract symptoms, Cowper’s syringocele, ureteroscopy

Pathophysiology and Management of Long-term Complications After Transvaginal Urethral Diverticulectomy.

Female urethral diverticulum (UD) is a rare and benign condition that presents as an epithelium-lined outpouching of the urethra. It has various symptoms, of which incontinence in the form of postmicturition dribble is the most common. The gold standard for the diagnosis of UD is magnetic resonance imaging, and the treatment of choice is transvaginal diverticulectomy. Despite the high success rate of transvaginal diverticulectomy, postoperative complications such as de novo stress urinary incontinence (SUI), recurrence, urethrovaginal fistula, recurrent urinary tract infections, newly-onset urgency, and urethral stricture can occur. De novo SUI is thought to result from weakening of the anatomical support of the urethra and bladder neck or damage to the urethral sphincter mechanism during diverticulectomy. It can be managed conservatively or may require surgical treatment such as a pubovaginal sling, Burch colposuspension, or urethral bulking agent injection. Concomitant SUI can be managed by concurrent or staged anti-incontinence surgery. Recurrent UD may be a newly formed diverticulum or the result of a remnant diverticulum from the previous diverticulectomy. In cases of recurrent UD requiring surgical repair, placing a rectus fascia pubovaginal sling may be an effective method to improve the surgical outcome. Urethrovaginal fistula is a rare, but devastating complication after urethral diverticulectomy; applying a Martius flap during fistula repair may improve the likelihood of a successful result. Malignancies in UD are rarely reported, and anterior pelvic exenteration is the recommended management in such cases.

PD31-10 NOVEL CLASSIFICATION OF URETHRAL COMPLICATIONS IN FEMALE TO MALE GENDER AFFIRMATION SURGERY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II (PD31)1 Sep 2021PD31-10 NOVEL CLASSIFICATION OF URETHRAL COMPLICATIONS IN FEMALE TO MALE GENDER AFFIRMATION SURGERY Wai Gin Lee, Virginia Li, David Ralph, and Nim Christopher Wai Gin LeeWai Gin Lee More articles by this author , Virginia LiVirginia Li More articles by this author , David RalphDavid Ralph More articles by this author , and Nim ChristopherNim Christopher More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002032.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Genital gender affirmation surgery (GAS) is challenging, and urethral complications are common. The use of free flap phallus construction with integrated urethra have improved outcomes but there is no accepted gold standard. Debate also continues on immediate versus staged urethral lengthening (anastomosis of phallus to native urethra). We propose a classification system for urethral complications to improve reporting, classification and management of this common adverse outcome. METHODS: All transgender men undergoing any phalloplasty including free flap urethroplasty, with staged urethral lengthening, in the United Kingdom over five consecutive years (2014–2019) were retrospectively included. The incidence, timing and management of urethral complications were extracted from a prospective database. Types of phalloplasty include forearm flap, anterolateral thigh flap and abdominal flap. RESULTS: Three hundred and seventeen men with median follow-up of 4.3 years (interquartile range 3.6–5.0 years) were included. Almost half of patients (43.5%) developed a urethral complication (fistula, stricture, severe post-micturition dribbling or urethral hair/stone); most commonly fistulas (49%) followed by strictures (37.6%). Forty-four patients (12.4%) developed more than one complication. The location was in the phallus (flap-related) (72.2%) followed by scrotal and perineal urethra. Repairs before and during routine second stage urethral lengthening were mostly for phallus (88.4%) complications comprising fistulas and strictures (99.1%). Strictures were more common than fistulas after urethral lengthening compared to before (p<0.001). Urethral hair, stones and post-micturition dribble were also more common. Staging the urethral lengthening allowed 60% of men to be asymptomatic while awaiting routine repair. CONCLUSIONS: The largest series of patients to date suggests that urethral complications continue to be common following transgender phalloplasty and are mostly phallus or flap related. The nature of urethral complications change depending on the stage of genital GAS and should be classified based on type, location and timing of occurrence. This standardises reporting and will help guide the approach for surgical correction. For example, complications in the phallus urethra relate to an issue with the free flap and therefore require a different approach compared to complications following urethral lengthening. A majority of complications occur prior to urethral lengthening and can be repaired routinely at the time. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e542-e542 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wai Gin Lee More articles by this author Virginia Li More articles by this author David Ralph More articles by this author Nim Christopher More articles by this author Expand All Advertisement Loading ...

MP56-04 THE PRESENTATION, MANAGEMENT AND OUTCOME OF FEMALE URETHRAL DIVERTICULUM SURGERY – DIFFERENT BUT EQUALLY EFFECTIVE EITHER SIDE OF THE POND

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III (MP56)1 Sep 2021MP56-04 THE PRESENTATION, MANAGEMENT AND OUTCOME OF FEMALE URETHRAL DIVERTICULUM SURGERY – DIFFERENT BUT EQUALLY EFFECTIVE EITHER SIDE OF THE POND Rachel Barratt, Catherine Culp, Helena Gresty, Jeremy Ockrim, Eric Rovner, and Tamsin Greenwell Rachel BarrattRachel Barratt More articles by this author , Catherine CulpCatherine Culp More articles by this author , Helena GrestyHelena Gresty More articles by this author , Jeremy OckrimJeremy Ockrim More articles by this author , Eric RovnerEric Rovner More articles by this author , and Tamsin GreenwellTamsin Greenwell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002086.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess symptomatic and functional outcomes of urethral diverticulum excision in women and to compare management and outcomes at 2 high volume centres – 1 in the UK and 1 in the USA. METHODS: Retrospective review of the notes and imaging of all female patients having excision of a symptomatic urethral diverticulum between 2004 and 2018 for symptomatic urethral diverticulum. Data on patient demographics, urethral diverticulum characteristics and outcomes in particular symptomatic resolution, diverticulum recurrence and persistent/new onset urinary incontinece were noted.Statistical analysis was by Students T -Test and Chi-Squared. Significance was taken as P< 0.05. RESULTS: 191 women median age 45 years (range 19-78) had excision of their urethral diverticulum +/- Martius Fat Pad Interposition (N= 131) during the study period. 21(11%) patients had a simultaneous pubovaginal sling (PVS) or mid-urethral tape (MUT). 169 (88%) had preoperative pelvic MRI, 134 (79.2%) had pre-operative video-urodynamics and 124 (65%) had a complex urethral diverticulum.2 (1%) women had symptomatic and 3 (1.5%) had asymptomatic (on MRI only) urethral diverticulum recurrence at a mean follow-up of 24.2 months (range 0-156). Urinary incontinence was present in 164 (85.8%) pre-operatively and 64(33.5%) post-operatively; 32 (16.8%) of whom rated their incontinence as mild. Other symptomatic outcomes are detailed in Table 1: *P < 0.05 CONCLUSIONS: The commonest symptoms of urethral diverticulum are lump in the vagina, urethral or vaginal pain and dysuria. Following excision, the majority of symptoms resolve with urethral discharge most likely and frequency/urgency least likely to resolve. There are significant differences in outcomes for post-micturition dribble, urethral or vaginal pain, poor flow, recurrent UTIs and frequency/urgency between the 2 centres which most likely represent patient and diverticulum factors rather than treatment factors. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e970-e970 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rachel Barratt More articles by this author Catherine Culp More articles by this author Helena Gresty More articles by this author Jeremy Ockrim More articles by this author Eric Rovner More articles by this author Tamsin Greenwell More articles by this author Expand All Advertisement Loading ...

Urodynamics criteria of detrusor underactivity in women underwent middle urethral sling for stress urinary incontinence: What is the clinical role?

To assess the role of detrusor underactivity (DUA), diagnosed by different urodynamic criteria, on outcomes of women underwent middle urethral sling (MUS) for stress urinary incontinence (SUI). In this prospective study, DUA criteria of women with SUI, naïve for SUI surgery, candidates to MUS were: I Pdet@Qmax ≤10 cm H2O and Qmax ≤12 mL/s (Jeong et al.) ii Pdet@Qmax<30 cm H2O and Qmax<10 mL/s (Abarbanel and Marcus) iii Pdet@Qmax<20 cm H2O and Qmax<15 mL/s and BVE < 90% (BVE criteria) iv Pdet@Qmax<20 cm H2O + Qmax (PIP1 Griffiths) Control group (CG) comprised non-DUA patients. Preoperative and at 2-years follow-up evaluation included physical examination, uroflowmetry, post void residual urine (PVR), ICIQ-FLUTS. 102 patients fulfilled 2-years controls. DUA rate range was 16.7% (BVE) - 53.9% (PIP1-Griffith). The POUR rate varied: 20% (PIP1-Griffith) - 35.3% (BVE), 10% in CG. Tape incision rate for POUR was 3.4% in DUA, 4.5% in CG. No patients had urinary retention at 2-years follow-up. In DUA groups, Qmax did not change significantly after surgery and PVR was low. SUI recurrence rate was 2.8% in DUA, 4.5% in CG. Preoperatively, urgency and post-micturition dribble were the most (82.4%) and the less (26.7%) reported symptoms, respectively. At follow-up, frequency was the most prevalent (56.1%), reduced sensation/bladder pain the less usual (23.1%). ICIQ-FLUTS scores were higher in DUA groups. DUA did not have a negative impact on MUS outcomes in a mid-term follow-up. Early postoperative voiding complication rates changed according to the type of DUA urodynamic criteria.

P0394 - Incidence of post-micturition dribble after bulbar urethroplasty using transecting and non-transecting approaches

P0394 - Incidence of post-micturition dribble after bulbar urethroplasty using transecting and non-transecting approaches