Carbon ion radiotherapy with complete tumor regression for primary malignant melanoma of female urethra orifice: a case report

Primary malignant melanoma of the female urethra (PMMFU) is extremely rare, accounting for 0.2% of all melanomas, and fewer than 200 cases have been reported worldwide. Because of the small number of clinical cases and unclear biological characteristics, there is no uniform and standard treatment protocol. We herein describe the treatment of PMMFU using carbon ion radiotherapy. The radiotherapy was delivered at 60.8 Gy (RBE) in 16 fractions, once daily, five times per week. The patient achieved complete tumor disappearance within 1 year after carbon ion radiotherapy and remained disease-free thereafter. She developed acute grade 1 radiation dermatitis and urethritis, which resolved quickly; no other toxic effects were observed. At the time of this writing, her survival duration was 33 months. This case demonstrates that carbon ion radiotherapy may be a good option for primary genitourinary mucosal malignancies.

An impacted urethral stone: a rare cause of acute urinary retention in women—case report

Background Urethral calculi are rare, representing 1–2% of all calculi affecting the urinary tract. Impacted urethra calculi are commoner in males due to anatomical differences between the male and female urethra. The treatment approach is determined by the size and location of the stone, associated anomalies and available facilities. Case presentation We present the case of 35-year-old woman who presented with acute urinary retention secondary to an impacted urethral stone. The calculus could not be removed through the external urethral meatus due to the size of the stone. She had cystolithotomy after retrograde manipulation to the bladder. She did well postoperatively. This line of management was based on the size of the stone, and the available facilities which are typical of many hospitals in developing countries. Conclusions Urethral calculi are extremely rare in women. The treatment should be individualized.

The Right Instrument for the Right Purpose: Spreading the Use of Small Caliber Ureteroscope for the Inspection of the Male and Female Urethra

The inspection of the urethra in patients with documented or suspected urethral stricture should be carried out with small caliber ureteroscope of 6/7.5Ch. Different from flexible cystoscope (16Ch) or resectoscope (26Ch), small caliber ureteroscope allows a comprehensive evaluation of the stricture, including its length and the status of the mucosa in its proximity, without injuring or overstretching the urethra. With a small caliber ureteroscope it is also possible to cross the stricture, allowing the evaluation of the proximal urethra, the external urethral sphincter, and the bladder. A 6/7.5Ch ureteroscope also allows estimation of the real caliber of the stricture, providing a useful landmark for further treatment decisions.

AGE-RELATED CHANGES OF THE FEMALE URETHRA

Минимальные и максимальные показатели длины, ширины, площади или объема органов и структур нижних мочевых путей в норме могут различаться до 2-3 раз. С возрастом у здоровых женщин не меняются абсолютная и относительная длина мочеиспускательного канала, уретровезикальный угол и наклон уретры. И гладкая, и поперечнополосатая мышечные ткани, входящие в состав различных отделов женской уретры, подвергаются атрофии в процессе старения организма. Гладкая мышечная ткань менее изменчива с возрастом, но поперечнополосатые мышечные симпласты иногда полностью отсутствуют в биоптатах уретры пожилых пациентов. С возрастом уменьшаются васкуляризация и плотность иннервации структур мочеиспускательного канала, но возрастает содержание соединительной ткани в наружном сфинктере уретры. Мобильность мочеиспускательного канала у молодых женщин более выражена, чем у пожилых. Явная недостаточность современных работ, посвященных возрастным изменениям нижних мочевых путей, указывает на актуальность и необходимость продолжения изучения трансформации органов и тканей мочевыводящей системы при старении. Это может быть важным для определения этиологии и патогенеза некоторых патологических состояний, таких как стрессовое недержание мочи, а также для дифференциальной диагностики между возрастной нормой и патологией. The minimum and maximum indicators of the length, width, area or volume of organs and structures in the lower urinary tract can normally vary up to 2-3 times. With age, at healthy women the absolute and relative length of the urethra, the urethrovesical angle, and the inclination of the urethra do not change. Both smooth and striated muscle tissues, which are part of various departments of the female urethra, undergo atrophy during the aging process. Smooth muscle tissue is less variable with age, but striated muscle symplasts are sometimes completely absent in urethral biopsies from elderly patients. With age, the vascularization and density of the innervation decrease in the urethral structures, but the content of connective tissue in the external urethral sphincter increases. Urinary tract mobility at young women is more pronounced than at older women. The apparent insufficiency of modern investigations about age-related changes in the lower urinary tract indicates the relevance and need to continue studying of the organ and tissue transformation in the urinary system during aging, this may be important for determining the etiology and pathogenesis of some pathological conditions, such as stress urinary incontinence, as well as for differential diagnosis between age norm and pathology.