Urethra In Men Research Articles

Acquired Diseases of the Urethra in Men and Women

Acquired Diseases of the Urethra in Men and Women

The use of neobladders in women undergoing cystectomy for transitional-cell cancer.

Recent studies have provided us with new insights into the natural history of female bladder cancer as well as the behavior of the isolated urethra after cystectomy. Based on more than 16 years of experience with orthotopic lower urinary tract reconstruction to the urethra in men, a similar approach was attempted in women with transitional-cell cancer of the bladder. Refinements in the technique of cystectomy and subsequent intestinourethral anastomosis based on anatomical, histological, and clinical studies are described that should improve postoperative results in women undergoing anterior exenteration and creation of an orthotopic neobladder to the urethra. Our findings in a series of 11 patients are presented and compared with data from other institutions. Improved postoperative continence and micturition without compromise of the oncological outcome may be a result of preservation of the entire lateral vaginal walls, nerve-sparing dissection of the bladder neck and proximal urethra, removal of 1 cm of proximal urethra en bloc with the cystectomy specimen, and a J-omentum flap or an additional attachment of the anastomosed intestinal pouch to surrounding pelvic structures. Taken together, our average of 90% daytime and 73% nighttime continence, 90% spontaneous residual-free micturition, and 100% patient satisfaction without compromise of the surgical oncological outcome seems to justify the creation of an orthotopic neobladder in selected women with bladder cancer.

Pressure-to-Cross-Sectional Area Relationships in the Proximal Urethra of Men with Bladder Outlet Obstruction

Pressure-to-Cross-Sectional Area Relationships in the Proximal Urethra of Men with Bladder Outlet Obstruction

Ultrasound in the evaluation of urethral stricture disease: a prospective study in 175 patients

To investigate the characteristic ultrasonic appearance of urethral stricture disease in men. Between 1990 and 1992 a prospective study in 175 men with the suspicion of urethral stricture was performed using urethral ultrasound as the first diagnostic procedure, followed by retrograde urethrography, voiding cystourethrography or urethroscopy. The sensitivity and specificity in detecting urethral strictures were 98% and 96% respectively. Ultrasound offers a three-dimensional study in the evaluation of the urethra without exposing the gonads to ionizing radiation. The exact length and depth of the stricture, the severity of the strictured segment as well as the anatomy of the periurethral scars were diagnosed accurately. Ultrasound is a simple, inexpensive and rapid investigation of the urethra which requires no exposure of the patient to ionizing radiation and should be the preferred diagnostic procedure in the evaluation of strictures in the anterior urethra in men.

Meatoscopy: an important technique for assessing meatal warts in men.

A total of 506 meatoscopic examinations showed this is a simple, safe, rapid, well-tolerated, useful procedure to assess the extent of warts at the meatus and in the distal urethra of men. The procedure was performed in 307 patients. Sixty-five (52.5%) of 124 men with meatal warts had additional urethral lesions not readily treatable. All proximal warts were confined to the fossa navicularis. Meatoscopy assisted in immediate rational planning of therapy. In assessing patients without meatal warts, lesions in the fossa navicularis were observed in 4 (6.7%) of 60 men with external penile warts, 4 (7.8%) of 51 men with a history of 3 previous episodes of urethritis, and in 8 (23.5%) of 34 men who had been in contact with warts. No relation was found between the distribution of warts, demographic details of patients, or duration of warts; the effect of previous urethritis on development of warts was unclear. It was concluded, following 199 repeated examinations, that the procedure was not associated with recurrence or proximal extension. Only 2 minor adverse events were recorded. Meatoscopy is recommended as part of the assessment of men with meatal warts and men who have been in contact with warts. The procedure should be considered in patients with external warts but no meatal warts, and in patients with a history of 3 previous episodes of urethritis over 3 years.

Imaging the urethra in men and women.

This review describes and illustrates the radiologic techniques, normal anatomy, and common congenital and acquired lesions of the urethra in men and women. Voiding cystourethrography and retrograde urethrography are the most common imaging modalities employed in the diagnosis of anatomic lesions of the urethra. The appearance of the urethra may then dictate the need for further functional evaluation with urodynamic studies. Congenital lesions in men include posterior and anterior urethral valves and duplicated urethra. In women, ectopic insertion of the ureter into the urethra is the usual congenital lesion. Acquired urethral lesions include benign prostatic hypertrophy in men and strictures and diverticula in both men and women.

Meatoscopy: a simple technique to examine the distal anterior urethra in men.

A common problem is to determine the site of the base of meatal warts in men and if the lesions will be suitable for the treatments available in genitourinary medicine (GUM) or sexually transmitted diseases (STD) clinics. Formal endoscopy requires sterile conditions and is therefore an expensive procedure. A simple safe cheap alternative is meatoscopy using an auroscope with inflation. This allows inspection of the anterior urethra to a depth of 5 or 6 cm. With this technique 175 examinations were performed on 153 patients. Warts were confined to the lips in 27 (56%) of 48 patients with meatal warts; in an additional 5 patients with meatal warts the warts arose from deep in the fossa navicularis and in 16 patients with meatal warts there were additional warts in the fossa navicularis invisible on clinical examination. No urethral warts were seen in 103 patients without meatal warts, comprising 47 patients with external genital warts and 56 without any warts. It is concluded that meatoscopy should be undertaken in all patients with meatal warts to determine the site of their base and to assess if there are any more proximal warts. This should be done as soon as the meatal warts are seen, and urethritis has been excluded, so that appropriate treatment can be planned.

Transitional Cell Carcinoma of the Urethra in Men Following Cystectomy for Bladder Cancer: Multivariate Analysis for Risk Factors

Multicentric development of transitional cell carcinoma in the urinary tract is well recognized. Of 169 male patients who underwent cystectomy for bladder cancer 18 (10.6%) demonstrated urethral cancer (all within 5 years after cystectomy). The risk factors involved in transitional cell carcinoma in regard to the occurrence of urethral cancer after cystectomy were examined by multivariate analysis. Characteristic patterns of bladder cancer in the cystectomy specimens were expressed by the grade, stage, number, size, location and gross pattern of the tumors. Significant risk factors in bladder cancer relating to the development of cancer in the retained urethra were papillary cancer, multiple cancers, and tumors in the bladder neck, prostatic urethra and prostatic gland. Among 19 patients with concomitant carcinoma in situ and/or multiple papillary tumors in the bladder who underwent simultaneous prophylactic urethrectomy with cystectomy in the same observed period 17 (89%) had no lesion in the resected urethra. The results of the multivariate analysis will be useful to avoid unnecessary prophylactic urethrectomy at cystectomy. However, further analysis and consideration of possible mechanisms of the secondary urethral cancer will be necessary to explain the discrepancy posed in the latter study involving 19 patients.

Type Incidence of Herpes Simplex Virus in Clinical Isolates from Patients with Herpes Genitalis

Isolates from a total of 228 patients with clinical herpes simplex were included in this study: 92 were from patients in their first episode and 136 were from patients with recurrent genital herpes...

Self-retaining intraurethral stent: an alternative to long-term indwelling catheters or surgery in the treatment of prostatism.

The self-retaining intraurethral coil is a device to stent the urethra in men who have severe urethral obstruction. It allows them to empty their bladders and still remain continent and sexually active. The device can be used in place of long-term indwelling catheters or as an alternative to surgery. During 1 year, we inserted the stent in 26 men who were poor operative risks. The treatment was successful in 20 (77%). All 20 were able to void satisfactorily. Four of the 20 resumed sexual activity, which previously had been prevented by indwelling catheters. Two patients who had delayed prostatic surgery because of fear of impotence were able to empty their bladders properly and to remain sexually active. Three patients subsequently had surgery, two after anticoagulant therapy could be stopped and one after renal function improved. No difficulties caused by the stent were encountered during surgery. Follow-up was for 2-12 months. Four patients who had had the stent in place for 12 months had no difficulties. In 16 of the 18 patients who had indwelling catheters and infected urine before insertion of the stent, sterilization of the urine was obtained after relatively short courses of antibiotic treatment. Short-term complications associated with the stent were incontinence or urinary retention. These were treated by repositioning the stent. Frequency of urination after insertion of the stent either disappeared spontaneously or was treated with anticholinergic drugs. In six patients, frequency was so severe that removal of the stent and insertion of an indwelling catheter were necessary. Slight to mild dysuria occurred immediately after surgery in all patients but eventually disappeared. Our experience suggests that the self-retaining intraurethral stent has considerable promise for the treatment of prostatic obstruction of the urethra.

Treatment of chronic nongonococcal urethritis with autologous blood instillations

Inflammation of the urethra in men often continues (and progresses) for a long time after the etiological factor (gonococcus, trichomonads, viral infection, etc.) is eliminated. A prolonged inflammatory reaction is caused by a number of reasons and primarily by the decrease of local protective properties of the mucous membrane as a result of inflammation and destructive processes.

Transitional Cell Carcinoma of the Urethra in Men After Radical Cystectomy for Bladder Cancer. Is Prophylactic Urethrectomy Indicated?

A retrospective study of the incidence and clinical course of transitional cell carcinoma of the urethra is reported. Of 110 consecutive male patients who underwent cystectomy during a 9-year period, 9 had or developed a urethral tumour. Five patients undergoing radical cystectomy had known or suspected urethral involvement which was confirmed at urethrectomy. All 5 had deeply invasive (T3 or T4) transitional cell carcinomas of the bladder and subsequently died of metastatic disease. Four patients underwent urethrectomy because of signs or symptoms of urethral recurrence at an average interval of 2.5 years after cystectomy. There were two deaths in this group, neither of which appeared to be due to urethral recurrence. Six additional patients had undergone prophylactic urethrectomy because of prostatic urethral involvement or diffuse carcinoma in situ in the cystectomy specimen, and none had identifiable tumour in the anterior urethra. The residual urethra is a potential focus for recurrent tumour and this necessitates careful follow-up with serial cytology, but the low incidence of urethral recurrence (3.5% in this series) does not appear to warrant routine urethrectomy at the time of cystectomy.

Transitional cell carcinoma of the urethra in men after radical cystectomy for bladder cancer. Is prophylactic urethrectomy indicated?

A retrospective study of the incidence and clinical course of transitional cell carcinoma of the urethra is reported. Of 110 consecutive male patients who underwent cystectomy during a 9-year period, 9 had or developed a urethral tumour. Five patients undergoing radical cystectomy had known or suspected urethral involvement which was confirmed at urethrectomy. All 5 had deeply invasive (T3 or T4) transitional cell carcinomas of the bladder and subsequently died of metastatic disease. Four patients underwent urethrectomy because of signs or symptoms of urethral recurrence at an average interval of 2.5 years after cystectomy. There were two deaths in this group, neither of which appeared to be due to urethral recurrence. Six additional patients had undergone prophylactic urethrectomy because of prostatic urethral involvement or diffuse carcinoma in situ in the cystectomy specimen, and none had identifiable tumour in the anterior urethra. The residual urethra is a potential focus for recurrent tumour and this necessitates careful follow-up with serial cytology, but the low incidence of urethral recurrence (3.5% in this series) does not appear to warrant routine urethrectomy at the time of cystectomy.

Urethral infection with Haemophilus ducreyi in Men

Carriage of Haemophilus ducreyi has not been adequately investigated in men, and its role in urethritis is unknown. In this study 456 men with H. ducreyi-culture positive genital ulcers were investigated. Among these men, 16 (3.5%) had urethritis. H. ducreyi was isolated from the urethra of nine men (1.9%). Of 57 men who had chancroid but not urethritis, none had H. ducreyi isolated from the urethra. Of 106 patients presenting with only acute urethritis, H. ducreyi was found in one. We conclude that H. ducreyi is responsible for acute urethritis in men, but that it rarely, if ever, can be cultured from the urethra of men with chancroid who do not have symptomatic urethritis.

Primary Carcinoma of the Urethra in Men

Primary Carcinoma of the Urethra in Men

Electrophysiological correlates of sensory innervation of the vesico‐urethral junction and urethra in man

AbstractTo investigate urethral sensory innervation in man, cerebral evoked potentials (CEPs) and bulbocavernous reflex (BCR) were recorded by stimulation of vesico‐urethral junction (VUJ), prostatic and distal urethra, and penile skin. A specially produced catheter with a pair of electrodes was used for bipolar stimulation along the lower urinary tract. In comparison to the potentials evoked by distal urethral stimulation, the shape differences and protracted latency of CEPs to VUJ stimulation suggest that the distal and proximal urethra are innervated by different peripheral afferents. Similarities of CEPs and BCR latencies produced by prostatic urethral and VUJ stimulation indicate that the sensory innervation of the prostatic urethra is provided by pelvic nerve afferents. The remaining distal parts of the urethra are innervated by pudendal nerves. This is indicated by shape similarities and latency characteristics of both CEPs and BCR when the distal urethra and glans skin are stimulated.

Is There Immunity to Chlamydial Infections of the Human Genital Tract?

Chlamydia trachomatis is commonly found in the urethra of men with gonococcal urethritis. Studies report a 20%-40% rate of double infection. A two-year study of men attending a venereal disease clinic in California showed that only 4% (4/99) or 7% (10/147) of men with gonorrhea had concomitant chlamydial infection, whereas 25-31% of the men with nongonococcal urethritis (NGU) had chlamydial infection. Men with gonorrhea seemed to have substantial recent exposure to chlamydial infection, since C. trachomatis was isolated from the cervix of 20% (36/180) of female contacts. Microimmunofluorescence (micro IF) tests showed that 93.6% (131/141) of the men with gonorrhea had IgG antibodies to Chlamydia and 36% (51/141) had IgM antibodies. IgG antibody rates were higher than those found among men who had NGU or no urethritis (83% and 65%, respectively), a fact which suggests that in this clinic setting the men with gonorrhea had very high antecedent exposure to C. trachomatis and may have been resistant to reinfection.

The Effect of Abdominal Pressure on Urinary Flow Rate

We examined the effect of abdominal pressure on urinary flow rate and urethral closure pressure in 46 subjects, ranging in age from 26 to 82 years. An increase in urinary flow rate caused by abdominal straining was not found when organic obstruction was present in the prostatic urethra in men or the proximal urethra in women, or when dysuria is caused by the lowered detrusor pressure. An increase in urinary flow rate caused by straining was noted when anterior urethral stricture or stress incontinence was present. The increase in urinary flow rate owing to straining was undetermined in the control group. The urethral closure pressure on the anti-stress incontinence zone increased as a result of straining at the same time and to the same degree as did the intravesical pressure. When the anti-stress incontinence zone was subjected to transurethral resection for canal formation urination became possible as a result of straining. The patients who were able to urinate with straining sometimes suffered temporary stress incontinence. The degree of straining did not determine whether the patient could urinate with straining. Therefore, it was concluded that abdominal pressure should be excluded from intravesical pressure in performing several urodynamic studies on the lower urinary tract, such as pressure flow studies, and that it is important to have a sufficient canal formation in the anti-stress incontinence zone when urination with straining is expected when performing an operation on patients with urethral obstruction in the anti-stress incontinence zone.

Gardnerella vaginalis-Associated Leukorrhea: The Disease and Its Treatment

Historically, infectious has been classified as trichomonal, yeast-associated, or nonspecific. In 1953, Leopold [1] identified an agent recovered from the urethra of men with prostatitis and women with clinical cervicitis that he felt belonged to the Haemophilus genus. Soon afterward, Lutz and Wurch [2] identified a similar organism in women with vaginal discharges. In a landmark paper in 1955, Gardner and Dukes [3] provided a detailed description of a clinical leukorrhea syndrome associated with this organism, and they unequivocally proclaimed Haemophilus vaginalis as the major cause of vaginitis. They proposed that the term nonspecific vaginitis be reserved for patients who did not show evidence of Trichomonas vaginalis, pathogenic yeasts, or H. vaginalis organisms. Since then, controversy has persisted regarding the role of this organism in and its appropriate treatment. In addition to these questions, the taxonomy of this organism has been repeatedly questioned. In 1963, Zinnemann and Turner [4] recommended that the organism be reclassified as Corynebacterium vaginale. In 1980, the organism was once again reclassified into a new genus and named Gardnerella vaginalis [5], in recognition of Gardner's work.

Quantitative study of Chlamydia trachomatis in genital infection.

Chlamydia trachomatis inclusion counts on inoculated McCoy cell coverslips were used as an index of the degree of infection of the cervix in women and of the urethra in men with urethritis. High inclusion counts were obtained significantly more often from men than from women, from women with cervical ectopy, and from women who had had recent sexual intercourse. Low inclusion counts were significantly more common in men with a past history of gonococcal urethritis. Higher chlamydial isolation rates in women with gonorrhoea and in women taking the contraceptive pill could not be attributed to a greater degree of infection, since inclusion counts were not raised in these patients. There was evidence that strains of C trachomatis might vary in their ability to establish themselves in the genital tract because high counts in men with NGU were associated with high counts in their female consorts and the levels of counts in men were associated with the frequency of chlamydial isolation from their female consorts. The relatively simple technique of inclusion counts in cultures for chlamydia from the genital tract may yield valuable information about the behaviour of different strains of C trachomatis in causing pathological changes, in the transmission of infection between individuals, and in the response to specific chemotherapy.