Urinary Stream Research Articles

Incomplete penoscrotal transposition as a phenotype of 49XXXXY Klinefelter variant and its surgical management

The 49XXXXY Klinefelter variant is rare and chromosomal analysis is required for diagnosis. We discuss the surgical management of incomplete penoscrotal transposition and consider this characteristic as an associated genital anomaly. We report the case of a patient who initially presented with a poor urinary stream. Physical examination revealed an incomplete penoscrotal transposition and a subcoronal hypospadias. Investigations included blood tests, abdominal Ultrasound and a chromosomal analysis. A multidisciplinary team (MDT) approach facilitated diagnosis of the 49 XXXXY Klinefelter variant. At MDT, medical and surgical management were discussed with the parent. We opted for delayed surgical correction of the incomplete penoscrotal transposition in the pre-pubertal period due to unavailability of topical hormone therapy. Operative technique aimed to relocate the scrotum in a dependent position. This was achieved via an inverted omega incision to create scrotal flaps that were rotated inferomedially for midline closure. Post-operatively, the patient can now urinate standing up with a good stream and has improved cosmesis. Incomplete penoscrotal transposition can be surgically corrected in the pre pubertal period with a good functional outcome. Chromosomal analysis is necessary in evaluating this associated genital anomaly and for diagnosis of 49XXXXY Klinefelter variant. • The 49XXXXY Klinefelter variant is rare and diagnosed by chromosomal analysis. • Incomplete penoscrotal transposition (PST) may be an associated phenotype. • Incomplete PST can be surgically corrected in the pre pubertal period.

Ayurvedic management of hypocontractile detrusor- a case study

Hypocontractile detrusor or detrusor underactivity is increasing day by day. Symptoms of underactive bladder include slow urinary stream, hesitancy, and straining to void, with or without feeling of incomplete bladder emptying sometimes with storage symptoms. In this particular case the disease oc-curred after her delivery (FTND). Hypocontractile detrusor can be corelated with mutrakrcchra in Ayurveda where there is derangement in normal urina-tion process associated with difficulty in urination and dysuria. Avagaha sweda is specifically indicated for the treatment of mutrakrcchra. Role of Ayurveda especially avagaha sweda in hypocontractile detrusor resulted due to strenuous labor is the subject of this study. By proper administration of avagaha sweda; the usage of catheter can be avoided. Thus to improve the quality of life of patients who are effected with Hypocontractile detrusor Along with that we can explore the efficacy of Ayurvedic management and panchakarma procedures in this particular disease more precisely and accu-rately.

Evaluation of Double-Faced Tubularized Preputial Flap versus Duckett's Procedure for Repair of Penoscrotal Hypospadias with Significant Penile Curvature: A Comparative Study.

Background Proximal hypospadias, with significant curvature, is one of the most challenging anomalies. Great diversity and a large number of procedures described over the last 4 decades confirmed the fact that no single procedure has been universally accepted or successful. So, the aim of this study is to evaluate double-faced tubularized preputial flap (DFPF) versus transverse tubularized inner preputial flap (Duckett's procedure) as regards surgical outcomes, complications rate, and cosmetic results for repair of penoscrotal hypospadias with chordee. Patients and Methods. This was a prospective comparative study on 144 children with primary penoscrotal hypospadias with moderate or severe chordee, conducted at New Damietta and Assuit hospitals, Al-Azhar University, from March 2016 to March 2022. The patients were randomly divided into two equal groups; group A (n = 72) underwent DFPF, and group B (n = 72) underwent Duckett's procedure. Results No significant difference was identified as regards demographic data. The follow-up period ranged from 20 to 66 months (mean of 28 months after DFPF and 31 months after Duckett's repair), and the complication rate was 20.1% (29 of 144 children). There were statistically significant differences between the two groups as regards the urethral stricture, penile rotation, and total complication rate. HOSE score was adopted for assessment of surgical outcomes, urine stream, and cosmetic results. Conclusions The DFPF technique is feasible and reliable for one-stage repair of penoscrotal hypospadias with chordee and can be considered as a good option as it ensures better surgical and cosmetic outcomes with lower incidence of complications.

Congenital anterior urethral valves and diverticulum: A case series and association with posterior urethral valves

There is limited data regarding long-term results and associated complications in patients with anterior urethral valve (AUV) and diverticulum (AUD). We retrospectively reviewed AUV/AUD cases managed by us between the year 2002-2020. Presentation, investigations, management, concomitant posterior urethral valves (PUV) and pre-operative characteristics predisposing to long-term poor renal outcome were assessed. There were 27 patients [AUV (n=11); AUD (n=16)] with 5 having concomitant PUV. All presented with poor urinary stream and dribbling at a median age of 1-year (5 days-12 years). More patients with AUD (9 of 16, 56.3%) especially with concomitant PUV presented at ≤1-year-age as compared to those with AUV (4 of 11, 36.4%). Concomitant PUV and AUD cases (n=3) had characteristic micturating cystourethrography (MCUG) features. (Fig. 1A) Retrograde urethrography delineated the valve and distal urethra dimensions better (Fig.1B, C). Urethral hypoplasia distal to the valve (n=4) urethral duplication (n=1) were associated (Fig.1D). Syringocele was ruled out in proximal AUD by absence of filling defect on MCUG and appearance of urethral walls on urethrocystoscopy. Serum creatinine > 1mg/dL (n=5), trabeculated bladder (n=12), and vesicoureteral reflux (VUR) (n=12) was noted at presentation. Diverticulum/valve excision (n=13, 48.2%), fulguration alone (n=12, 44.4%) and primary urinary diversion (n=2, 7.4%) were performed. Follow up (range:3 mo-19 years), showed deranged renal function tests (n=6), VUR (n=4), impaired renal function on scans (n=8), and lower urinary tract dysfunction (n=7). Outcome with and without associated PUV was similar. Long term results were better in AUV compared to AUD. Pre-operative raised serum creatinine (>1mg/dL), trabeculated bladder, non-dilated posterior urethra on MCUG and bilateral impaired renal function on scans had significant association with follow up eGFR less than 60ml/kg/min. Co-existing PUV and AUD present earlier and have specific imaging findings. In proximal AUD, possibility of syringocele should be kept in mind, as they have similar presentation and imaging. Concomitant PUV did not alter prognosis. Secondary effects on bladder and renal function were more with AUD. Follow up eGFR less than 60ml/kg/min was associated with pre-operative elevated serum creatinine, trabeculated bladder, non-dilated posterior urethra, and bilateral impaired renal function on scans.

Paraurethral leiomyoma in a 22-year-old woman: A case report

Leiomyoma is a benign fibromuscular neoplasm originating from smooth muscle cells. Paraurethral leiomyoma is an extremely rare, benign, hormone-dependent​ growth from the mesenchymal cells in paraurethral space of female urethra. They usually appear in the reproductive age group women, mean age of presentation being approximately 41 years. A 22-year-old woman presented with palpable mass at vagina and weak urinary stream. She underwent clinical examination and MRI imaging followed by transvaginal excision of the mass. Histopathological examination confirmed paraurethral leiomyoma. Paraurethral leiomyoma make up approximately five percent of urethral tumors. This case depicts the presentation and treatment of a paraurethral leiomyoma in one of the youngest women reported in the literature.

Irreversible Electroporation Balloon Therapy for Palliative Treatment of Obstructive Urethral Transitional Cell Carcinoma in Dogs.

Progression of transitional cell carcinoma (TCC) in dogs often leads to urinary obstruction. This observational pilot study aimed to evaluate the safety and efficacy of irreversible electroporation (IRE) balloon therapy for the palliative treatment of TCC with partial urethral obstruction. Three client-owned dogs diagnosed with TCC causing partial urethral obstruction were enrolled. After ultrasonographic and cystoscopic examination, IRE pulse protocols were delivered through a balloon catheter device inflated within the urethral lumen. After the procedure, the patients were kept overnight for monitoring and a recheck was planned 28 days later. No complication was observed during the procedure and postprocedural monitoring. After 28 days, one dog had a complete normalization of the urine stream, one dog had stable stranguria, and one dog was presented with a urethral obstruction secondary to progression of the TCC. On recheck ultrasound, one dog had a 38% diminution of the urethral mass diameter whereas the other two dogs had a mass stable in size. IRE balloon therapy seems to be a feasible and apparently safe minimally invasive novel therapy for the palliative treatment of TCC causing urethral obstruction. Further studies are needed to better characterize the safety, efficacy, and outcome of this therapy.

Incidental diagnosis and treatment of posterior urethral valve in a child with osteogenesis imperfecta: a case report

Posterior urethral valve is the commonest cause of both urinary tract obstruction and chronic renal disease in male children. The patients may present with the complications of the disease such as impaired renal function, urinary tract infection, or anaemia. Reports abound about the association of other congenital defects with posterior urethral valve but few studies have reported the association of this disease with osteogenesis imperfecta. An 8-year-old male on management for osteogenesis imperfecta who presented to our facility following renal function test in keeping with impaired renal function and imaging result in keeping with right renal agenesis and left renal parenchymal disease, these investigations were done as part of work up for surgical treatment of osteogenesis imperfecta. Evaluation revealed posterior urethral valve and he had valvotomy with Mohan’s urethral valvotome with satisfactory improvement in urine stream and renal function after the procedure. Posterior urethral valve can also occur with osteogenesis imperfecta not commonly reported to occur with it. Diagnosis of posterior urethral valve should be ruled out in any male patient with congenital abnormality to avoid missing the diagnosis when present as this can lead to renal failure.

Distal hypospadias repair: Comparative study between snodgrass and transverse preputial onlay flap

Distal hypospadias repair has several operative strategies such as tubularized incised plate (TIP); Transverse preputial onlay flap (TPOF) and Modified Mathieu Procedure. The aim of our work is to compare between TIP and TPOF techniques in the outcome. We conducted this comparative study on 66 patients with different types of distal hypospadias divided in two groups A and B for TIP and TPOF respectively. We reported outcome and complications for both TIP and TPOF repair. Our results revealed mean operative time was significantly higher in group B (123.1±6.8min) than in group A (93.73±3.9min, P value<0.001). Postoperative urinary fistula was reported in group A (15.2%) while no fistula in group B (p value=0.05). The vertical slit appearance of meatus was better in group A (54.5%) than in group B (24.2%, P value 0.023). As regard to hypospadias objective scoring evaluation (HOSE) (Summary Figure) the meatal shape score was higher in group A (1.55±0.51) than in group B (1.24±0.44, p value=0.0l), the urinary stream score was significantly higher in group A (1.82±0.39) than in group B (1.97±0.17, p value=0.04) and the urinary fistula score was significantly higher in group A (3.79±0.60) than in group B (4±0, p value=0.04). Complications are more common after TIP than in TPOF. As regard the meatus shape, the naturally looking vertical slit like meatus was achieved more in the TIP than in TPOF. We advocate further studies with a large number of patients with a long follow up period. TPOF is a great option to consider in cases of distal hypospadias because it is an effective technique for primary distal hypospadias repair with a good cosmetic outcome and a low associated complication.

MULTI-DISCIPLINARY INTERVENTION FOR LABIAL FUSION IN A CASE OF VULVAL LICHEN PLANUS.

Vulvo-vaginal lichen planus is a very distressing and rare forms of non-venereal genital dermatoses. Erosive variants of Lichen planus often have a protracted course and has a higher risk of malignant transformation. This case was a 53-year- old woman, previously diagnosed with lichen planus on conservative treatment, who now presented with symptomatic labial adhesions and urinary complaints like urgency, frequency and poor urine stream. Clinical examination revealed normally developed labia majora, partially but extensively fused labia minora including the clitoral hood. Urethral opening was not visualised, while a small vaginal orifice was seen with no ulcerations. A multi-disciplinary team consisting of urologist and plastic and cosmetic surgeon dissected out the labial adhesions with the electrocautery and reconstructed the vaginal and urethral openings. Cystoscopy followed by urethral dilatation was done for urethral narrowing. Postoperatively, on following up the patient the adhesions were completely separated, and the area healed well. No recurrences were noted. Though aggressive management with topical steroids and other measures often improves symptoms on short term basis, few patients may require long term management by multi-disciplinary team to optimize the outcomes.

A novel triple dartous fixation in hypospadias repair

ObjectiveThis study investigates the impact of the use of dartos covering to augment the neourethra on functional and cosmetic results. To evaluate a novel technique demonstrating how to fix dartos flap to cover the neourethra as a barrier in hypospadias repair. Patients and methodsThis study comprised 204 male patients with different degree of hypospadias (DPH = 132, coronal hypospadias = 46, MPH = 26). Their ages ranged from 1 to 23 ys (mean age = 2 ys). Penile chordee was in (DPH = 45, coronal hypospadias = 33, MPH = 26). All patients had abnormal downward directed urinary stream. Hypospadias repair was performed by the classic TIP technique in addition to our novel modification of dartos covering. Patients were submitted to 5 years of follow-up including clinical examination of the functional and cosmetic parameters. ResultsSuccess rates were reported in 200 patients, 3 patients had complications with subcoronal urethrocutaneous fistula and one patient with complete repair disruption. ConclusionTriple dartos fixation is a simple technique for all hypospadiologists to minimize urethrocutaneous fistula as common complication of hypospadias repair with good functional and cosmetic results.

Urethral Cancer After Urethroplasty: A Case Report and Review of the Literature

ObjectiveTo review and report data on transformation to urethral carcinoma after urethroplasty for urethral stricture disease. Primary urethral carcinoma is a rare entity, and guidelines lack high quality data from which to cite. Urethroplasty is a highly effective treatment for urethral stricture disease, though in rare cases complications may include development of urethral carcinoma. MethodsA systematic PubMed search was performed to identify all articles describing patients with urethral carcinoma after urethroplasty. Data were collected on the following parameters: patient age and sex, indication for urethroplasty, presentation of cancer, imaging, pathology, presence of metastasis, intervention, and outcome. ResultsThe final cohort included fourteen patients, 13 from previously published cases and one from our institution. The median patient age at presentation was 60, most had endoscopic management prior to urethroplasty, and the majority presented with decreased urinary stream. All patients developed squamous cell carcinoma of the urethra. Patients underwent radical resection, lymph node dissection, chemotherapy, or radiotherapy, often in combination. A majority of patients had died at the time of case report. ConclusionDevelopment of urethral squamous cell carcinoma, particularly after urethroplasty, is a rarely encountered process. Patients and urologists must have a high index of suspicion and investigate symptoms such as fistula or lower urinary tract symptoms, even if these occur many months or even years after buccal mucosa graft . By compiling previously reported cases and adding an additional case to the literature, we hope that familiarity with this entity will lead to earlier recognition and diagnosis of disease.

Assessment of postoperative cosmetic outcomes of distal form hypospadias repair with the Hypospadias Objective Scoring Evaluation (HOSE).

Aim A standardized assessment for the optimal repair of hypospadias remains elusive. The aim of this study was to assess a postoperative cosmetic outcome of hypospadias repair using a validated questionnaire, Hypospadias Objective Scoring Evaluation (HOSE). Methods During the period between January 2016 and May 2019, 40 patients who underwent hypospadias repair were identified and they agreed to a follow-up using the HOSE. Distal hypospadias repairs underwent a cross-sectional assessment of the cosmetic outcome. Cosmetic assessment was performed by an independent physician using the HOSE scoring system. Results The native meatus was coronal in 10 (25%), subcoronal in eight (20%), and distal penile in 22 (55%) patients. Mean followup was 35.90 months (SD ±29.58) postoperatively (range 12-162 months). Complications occurred in one (2.5%) patient. Out of 40 uncomplicated repairs, 39 (97.5%) were satisfactory. A vertical slit-like meatus located at the distal glans was created in 33 (82.5%) boys, and at the proximal glans in seven (17.5%). The urinary stream was single and straight in 39 and spray in one patient. A straight erection was observed in 39 (97.5%) boys. The median HOSE score was 16 (range 12-16). One patient had a small, single coronal fistula. The technique used included tubularised incised plate urethroplasty. Conclusion The HOSE score is simple, easy, non-invasive and non-expensive tool for objective assessment of long-term outcomes of hypospadias repair.

Susceptibility Pattern of E. coli Isolates from Urinary Tract Infections, in Quetta

Globally Urinary tract infections (UTIs) are the serious health problem affecting about 150 million people per year. The most common cause of UTI is Gram negative bacteria that Belong to the family Enterobacteriaceae. Members of these families include Escherichia Coli, Klebsiella, Enterobacter and Proteus. Mid stream urine was collected in a sterile container from suspected case of UTI. The urine was inoculated by 1mm loop, on Mac Conkey agar and EMB agar, incubated at 37c, for 24 hours in aerobic atmosphere. After 24 the colony was examined for colony morphology, gram staining motility test. Biochemical test like Indole, Methyl red, Voges – Proskaur Citrate inoculated in related test media to identify the E. coli strains. Susceptibility pattern was done by disk diffusion method. Total 40 isolates of E. coli were included in this study. Out of them 22 were female and 18 were male patients. The age ranges from 4 less than 14 years 10 patients, 15-29 years, 12 patients from 30 -44 years,7 patients of 45-59 years. 7 more than 60 years age. The Antibiotic susceptibility was Imipenem 96.66%, Nitrofurantoin 96.15%, Amikacin 85%, Meropenem 71.42%, Fosfomycin 66.66%, Ceftazidime 27.27%, Pipemidic Acid 26%, Ceftriaxone 24.24%, Ciprofloxacin 14.81%, Nalidixic Acid 12.5%.E. coli is becoming resistant to routine urinary antibiotics like Nalidixic Acid Pipemidic Acid and Quinolones like ciprofloxacin. Cephalosporins are also loosing sensitivity against E. coli. Imipenem, Nitrofurantoin and Amikacin has good susceptibility against E. coli in urinary isolates

Post Penile Inversion Vaginoplasty Clinical Examination: Considerations and Techniques.

Post Penile Inversion Vaginoplasty Clinical Examination: Considerations and Techniques.

Assessment of Cases of Congenital Obstructive Uropathy in Children

Background: The aim is to assess cases of congenital obstructive uropathy in children.Material &amp; Methods:Sixty- five children in age ranged 5-12 years of either gender with congenital obstructive uropathy were recruited for the study. In all cases, ultrasonography was done in all cases. Growth of the child was monitored and height standard deviation score (Ht-SDS) was calculated annually. Glomerular filtration rate (ml/min/1.73 m2) was calculated.Results:Out of 65 patients, males were 40 and females were 25. Etiology found to be ureteropelvic junction obstruction (PUJO) in 12, posterior urethral valve (PUV) in 14, PUJO + PUV in 30 and obstructive megaureter in 9 cases. Symptoms were fever in 34, pain abdomen in 20, burning micturition in 45, poor urinary stream in 21 and flank pain in 15 cases. Treatment given was pyeloplasty in 14, nephrectomy in 20, PUV fulguration in 11, ureterocele decompression in 12 and ureteric reimplantation in 8 cases.Conclusions:Most common etiologies for congenital obstructive uropathy in children were congenital uretero-pelvic junction obstruction and posterior urethral valve. Male preponderance was seen with burning micturition.

The effect of nettle root extract on urinary problems in older men with benign prostatic hyperplasia: A randomized clinical trial

BackgroundBenign prostatic hyperplasia is one of the most common benign tumor in men. Due to frequent side effects associated with medications used to treat prostatic hyperplasia, the use of herbal plants such as nettle has increased for the management of this ailment. PurposeThe purpose of the present study was to determine the effect of nettle root extract on urinary problems, prostatic specific antigen level, and prostate volume in older men with benign prostatic hyperplasia. Study designThe present study was a randomized clinical trial. MethodsThis study was conducted on 80 participants with benign prostatic hyperplasia referred to a urology clinic in Kashan, Iran. The participants were randomly assigned into experimental (n = 40) and control (n = 40) groups. The participants in the experimental and control groups received a tablet containing 300 mg of nettle root extract or a placebo (starch), respectively, twice a day for eight weeks. Before and after the intervention, the participants were assessed regarding their prostatic specific antigen level, prostate volume, and the American Urological Association Symptoms Scores associated with urinary problems. Data was analyzed using the Fisher’s exact test, the Chi-square test, the Paired t-test, and the independent samples t-test. ResultsAfter the intervention, there were significant differences between the groups in terms of urinary frequency (control: −0.17 ± 0.74 versus experimental: −0.5 ± 0.67; p = 0.04), urinary urgency (control: 0.12 ± 0.91 versus experimental: −0.32 ± 0.69; p = 0.01), and nocturia (control: 0.0 ± 0.65 versus experimental: −0.28 ± 0.64; p = 0.05). The group comparisons showed that there was no significant difference between the groups in terms of changes in the prostate-specific antigen level (p = 0.44), prostate volume (p = 0.22), feeling of incomplete emptying (p = 0.72), intermittency (p = 0.26), weak urine stream (p = 0.44), straining (p = 0.85), and quality of life (p = 0.91) associated with urinary problems. ConclusionThe use of nettle root extract in combination with conventional medical treatment of BPH was effective in decreasing the severity of urinary problems, including urinary frequency, urgency, and nocturia in participants. However, the nettle extract was not effective in modifying prostate-specific antigen level, prostate volume, feeling of incomplete emptying, intermittency, urine stream, straining, and quality of life associated with urinary problems. Nettle extract is recommended for use as a complementary intervention along with traditional medical treatments of benign prostatic hyperplasia.

MP08-07 LONG TERM CONSEQUENCES OF FAILURE TO REPAIR CORPUS SPONGIOSUM IN DISTAL HYPOSPADIAS

You have accessJournal of UrologyCME1 May 2022MP08-07 LONG TERM CONSEQUENCES OF FAILURE TO REPAIR CORPUS SPONGIOSUM IN DISTAL HYPOSPADIAS David Ali, and Moneer Hanna David AliDavid Ali More articles by this author , and Moneer HannaMoneer Hanna More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002530.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Several surgical techniques have been described in the repair of hypospadias; however, none mention the role of repairing the corpus spongiosum. Herein we review our experience with adolescents who underwent hypospadias repair during childhood and their main complaints were partially or totally related to spongiosum defects. Their surgical outcomes are also discussed. METHODS: Between 2007 and 2017, 26 patients aged between 13 and 28 years of age (median 19 years) were operated upon to repair of the deficiency or absence of corpus spongiosum. The primary hypospadias repairs included meatal advancement and glanduloplasty (MAGPI) repair (N=10); tubularized incised plate (TIP) (N=9), and in 7 patients the primary repair was unknown. RESULTS: The main complaints were urinary infections (N=5), spraying of the urinary stream and dripping of urine (N=10) and distal urethral swelling during voiding (N=15). In 5 patients, the urethral wall was thin and covered with adherent epidermis only. In 14 patients, the laterally displaced spongiosum pillars were mobilized and approximated using interrupted log lasting absorbable sutures. Four patients had significant spongiosum deficiency and urethral swelling during urination resulting in mild diverticulum formation. In 2 patients the spongiosum pillars were fixed and could not be mobilized to provide a tension-free closure, a thick Dartos scrotal flap was used to cover the plicated urethral wall. 12 out of 25 patients underwent glandular contouring and/or meatoplasty simultaneously to improve the penile esthetics. The median follow-up period was 4 years. 6 patients were excluded from this series due to no follow-up. 18 out of 19 patients reported normal and steady urinary stream, absence of urethral swelling during voiding and no postvoid dripping. One patient developed glans dehiscence and is voiding through a coronal meatus; he declined further surgery. None developed urinary infection. The mild curvature was corrected successfully in all 4 patients. CONCLUSIONS: Failure to recognize and/or repair the corpus spongiosum defect during childhood distal hypospadias repair may become symptomatic during adolescence however, the abnormality can be corrected successfully. Source of Funding: No source of funding was provided for this study © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e127 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Ali More articles by this author Moneer Hanna More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD53-04 BIODEGRADABLE DEVICE FOR CONTROLLED RELEASE OF CISPLATIN AS LOCAL CHEMOTHERAPY FOR BLADDER CANCER

You have accessJournal of UrologyCME1 May 2022PD53-04 BIODEGRADABLE DEVICE FOR CONTROLLED RELEASE OF CISPLATIN AS LOCAL CHEMOTHERAPY FOR BLADDER CANCER Gilad Amiel, Alexandra Bukchin-Tihomirov, Ahmed Kabha, Azik Hoffman, and Eyal Zussman Gilad AmielGilad Amiel More articles by this author , Alexandra Bukchin-TihomirovAlexandra Bukchin-Tihomirov More articles by this author , Ahmed KabhaAhmed Kabha More articles by this author , Azik HoffmanAzik Hoffman More articles by this author , and Eyal ZussmanEyal Zussman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002630.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The usual treatment for bladder tumors after local resection is instillation of chemotherapy or immunological treatment. These treatments are challenging due to short exposure time or dilution by urine production. We have developed a biodegradable device that gradually releases cisplatin into the urinary tract, to eliminate cancer cells. The device is lodged in the renal pelvis, as an alternative strategy for injecting substances into the bladder. METHODS: Using PLGA-produced poly-lactic-glycolic-acid nanofibres, we were able to trap within the polymer matrix the cisplatin that would be released into the urine stream with the gradual breakdown of the device. We tested our ability to build a device that would sit in the renal pelvis, the amount of cisplatin that could be loaded on the device, the rate of release of cisplatin at different concentrations, and the response of different TCC cell lines to exposure to cisplatin released from the disintegrated device. RESULTS: The device was built in the shape of KORIGAMI for maximizing its’ surface area. Cisplatin was imprinted in various concentrations (1.17-2.34% w / w). In a bioreactor that simulates artificial urine interaction with the device, a cisplatin release rate of 26% of its contents within the first 6 hours and a release of 94% of the contents after a week at a flow rate of 30 ml / hour was demonstrated. The stent completely disintegrated within 4 weeks. Two TCC cell-lines were tested (T24 & NTB9) and apoptosis was demonstrated within a few hours at all concentrations tested. CONCLUSIONS: We attempted to build a nanofiber model as a reservoir for active substances trapped in a polymer, that decomposes under urinary flow conditions. We developed a stent that releases at a predetermined rate, a drug for a period of about several weeks. We started with cisplatin, the most effective chemotherapy in the treatment of bladder cancer. We anticipate that the location of the device in the renal pelvis it will reduce bladder irritation of existing stents. We are planned to implant the device in the renal pelvis of a swine model. We believe that a device that allows for long-term controlled release will provide a significant advantage over existing bladder cancer treatments that require multiple instillations. Source of Funding: KAMIN Grant, Israel Ministry of Science © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e911 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gilad Amiel More articles by this author Alexandra Bukchin-Tihomirov More articles by this author Ahmed Kabha More articles by this author Azik Hoffman More articles by this author Eyal Zussman More articles by this author Expand All Advertisement PDF DownloadLoading ...

Voiding cysto-urethrography of complete urethral duplication in a child, a case report

BackgroundUrethral duplication is a very uncommon congenital anomaly that predominantly affects males. This condition is distinguished by the presence of two urethras, which might be incomplete or complete. The diagnosis of urethral duplication is very important, and missing this diagnosis leads to the delayed surgical correction of patients. Voiding cysto-urethrography is an important diagnostic method to diagnose the urethral duplication that can provide a standard view for surgical operation and determine the type of duplication.Case presentationIn the present study, we report a 5-year-old boy with complete urethral duplication diagnosed via voiding cysto-urethrography in our medical center. We reviewed the classification of this anomaly, indications of surgery, the importance of voiding cysto-urethrography, and the role of other imaging modalities to diagnose the urethral duplication.ConclusionFor children with a double urinary stream, a complete genital examination and radiological assessment are required not only to diagnose urethral duplication but also to determine the kind of urethral duplication and rule out related anomalies. These findings guide surgeons in planning the best treatment for the patients to prevent future complications. Voiding cysto-urethrography is one of the most useful and beneficial procedures to diagnose the urethral duplication which can be used as a first imaging modality, especially when there are double functional urethras.

Penile strangulation, a study of two cases.

IntroductionPenile strangulation is one of the rarest clinical findings. So, we aimed to present the clinical case of two cases that we encountered at our institute.Presentation of casesCase 1. A 26-year-male with bipolar disorder presented to emergency room with complaints of metallic ring entrapment in the penis for 4 days. A gold-plated metallic ring measuring 1 × 0.25 cm was found encircling the coronal sulcus along with foul-smelling pus and slough underneath as a result of necrosis of the skin. Jumbo cutter was used to cut the ring. Loose sutures were applied to the injured part with debridement. Case 2. A 66-year-old man presented to emergency with complaints of penile swelling and poor urinary stream for the last 2 days. Local examination showed a plastic ring of water bottle seen stuck at the root of penis. Distal penis was edematous with multiple areas of skin discoloration and petechia. The ring was cut with simple surgical scissor.DiscussionThis clinically emergency condition may lead to wide range of vascular and mechanical injuries if the treatment is delayed. Plastic rings can be easily cut out whilst metallic objects which are thick and hard are difficult to remove. Pliers' application or use of jumbo cutter as in one of our cases is beneficial for prompt release of edematous pressure and salvage of the penis.ConclusionPenile strangulation due to foreign body is a rare clinically emergency condition. Urgent intervention is necessary to remove the object causing constriction along the penis.