Giant urethral stone with diverticulum; a case report

Urethral calculi are rare and represent 1-2% of all urinary stone diseases. Rarely, calculus grows to large size and are labeled as a "giant urethral calculus". A 75-year-old male came to the OPD of Madinah Teaching Hospital Faisalabad with a chief complaint of suprapubic pain, penile pain, and hard mass on the left side of the scrotum and anterior perineum. The patient had a significant history of undergoing debridement for Meleney's and Fournier's gangrene, along with suprapubic cystostomy done about 1.5 years back. Physical examination revealed a solid mass with dimensions 6x7 cm on the left side of the scrotum and anterior perineum (left periurethral area). Open surgery was performed. A huge stone, 6x6cm, was removed. Diverticulae were excised, and urethroplasty was performed. A catheter was removed on the 21st postoperative with a satisfactory urinary stream.

A Rare Case of Complex Hernia Causing Urethral Obstruction

Abdominal wall hernias rarely cause obstruction of the urinary tract. We present the case of a patient undergoing regular smooth dilatations for urethral stricture since 8 years who developed right inguinoscrotal swelling and narrowing of urinary stream since 2 years of age. There was a growing difficulty in dilatation due to path distortion of urethra by the hernia. He had a history of open suprapubic cystostomy (SPC) 8 years ago. The patient refused surgery till he landed with an inability to pass dilators and difficulty in passing urine. He was taken up for right inguinal exploration with internal optic urethrotomy (IOU). Intraoperatively, he was found to have right inguinal hernia with incisional hernia at the site of SPC which was repaired and a cystoscopy revealed urethral deviation with anterior urethral stricture for which IOU was done. Postoperatively, the patient's urethral tract straightened and his urinary complaints resolved. A complex hernia can cause urethral deviation and obstruction due to pressure effects of its contents and should be repaired at an early stage.

Adverse Features of Rectourethral Fistula Requiring Extirpative Surgery and Permanent Dual Diversion: Our Experience and Recommendations

Introduction: To report a series of men with a rectourethral fistula (RUF) resulting from pelvic cancer treatments and explore their therapeutic differences and impact on the functional outcomes and quality of life highlighting the adverse features that should determine permanent urinary or dual diversion. Methods: A retrospective database search was performed in four centers to identify patients with RUF resulting from pelvic cancer treatment. Medical records were analyzed for the demographics, comorbidities, diagnostic evaluation, fistula characteristics, surgical approaches and outcomes. The endpoints analyzed included a successful fistula closure following a repair and the impact of the potential adverse features on outcomes. Results: Twenty-three patients, aged 57–79 years (median 68), underwent an RUF reconstruction. The median follow-up (FU) was 54 months (range 18–115). The patients were divided into two groups according to the etiology: radiation/energy-ablation treatments with or without surgery (G1, n = 10) and surgery only (G2, n = 13). All of the patients underwent a temporary diverting colostomy and suprapubic cystostomy. Overall, a successful RUF closure was achieved in 18 (78%) patients. An interposition flap was used in six (60%) patients and one (7.7%) patient in groups G1 and G2, respectively (p = 0.019). The RUF was managed successfully in all 13 patients in group G2 as opposed to 5/10 (50%) in group G1 (p = 0.008). The patients in the radiation/energy-ablation group were more likely to require permanent dual diversion (50% vs. 0%, p < 0.0075). Conclusion: Radiation/energy-ablation therapies are associated with a more severe RUF and more complex reconstructions. Most of these patients require an abdominoperineal approach and flap interposition. The failure of an RUF repair with the need for permanent dual diversion, eventually combined with extirpative surgery, is higher after previous radiation/energy-ablation treatment. Therefore, permanent dual diversion as the primary treatment should always be included in the decision-making process as reconstruction may be futile in specific settings.

Evaluation of laparoscopic repair for intraperitoneal bladder rupture at Da Nang Hospital

Introduction: To evaluate results of treatment from our preliminary experience of laparoscopic repair for intraperitoneal bladder rupture. Materials and Methods: 31 patients with traumatic intraperitoneal bladder rupture admitted to Da Nang Hospital from 1/2017 to 5/2020. Results: 31 patients with average ages (mean ± standard deviation) were 35.3 ± 9.0 years old. Operation time (mean ± standard deviation) was 67.5 ± 25.5 minutes. Hospital stay (mean ± standard deviation) was 9.5 ± 0.7 days. No intra- or postoperative complications were noted. The successful rate was 100%. Suprapubic cystostomy was placed in (mean ± standard deviation) 8.5 ± 0.7 days Conclusion: Laparoscopic repair of traumatic bladder rupture should be performed in hemodynamically stable patients without associated concurrent injuries. Key word: Intraperitoneal bladder rupture, laparoscopy, trauma. Tóm tắt Đặt vấn đề: Đánh giá kết quả phẫu thuật và kinh nghiệm của chúng tôi qua khâu vỡ bàng quang đơn thuần bằng phẫu thuật nội soi. Phương pháp nghiên cứu: 31 người bệnh nhập viện cấp cứu vì vỡ bàng quang trong phúc mạc đơn thuần, được phẫu thuật cấp cứu và điều trị tại khoa Ngoại tiết niệu Bệnh viện Đà Nẵng từ 1/2017 đến 5/2020. Kết quả: 31 người bệnh với độ tuổi trung bình lúc nhập viện là 35,3 ± 9,0 tuổi; Thời gian phẫu thuật trung bình là 67,5 ± 25,5 phút; Thời gian nằm viện trung bình là 9,5 ± 0,7 ngày; Không có biến chứng trong và sau mổ. Tỷ lệ thành công phẫu thuật 100%. Tất cả người bệnh được rút dẫn lưu bàng quang trung bình 8,5 ± 0,7 ngày. Kết luận: Phẫu thuật nội soi khâu vỡ bàng quang trong phúc mạc là phẫu thuật ít xâm lấn, có thể chỉ định trong phẫu thuật cấp cứu vỡ bàng quang đơn thuần, huyết động ổn định. Từ khóa: Vỡ bàng quang trong phúc mạc, phẫu thuật nội soi, chấn thương.

Comparative Study Between Outcomes of Early Primary Endoscopic Realignment Versus Suprapubic Cystostomy With Delayed Reconstruction in the Management of Posterior Urethral Injury

Objectives: To compare the outcomes of early primary endoscopic realignment and suprapubic cystostomy with the outcomes of delayed reconstruction in the management of posterior urethral injury. Methods: This is a quasi-experimental prospective study Conducted in the Urology department Dhaka medical college and hospital from January 2009 to December 2010. Atotal of 60 consecutive patients were selected for this study and inclusion criteria, male patients and age 18years and above. Posterior urethral injury resulting in distraction defect and urethral injury with pelvic fracture. Group-A, 28 patients underwent early primary endoscopic realignment after initial suprapubic urinary diversion and Group-B, 32 patients underwent primary suprapubic urinary diversion and delayed urethral reconstruction after 3 months of injury. Results: After procedure 21(75%) out of 28 patients in Group-A developed stricture 12(42.9%) had simple and short segment stricture and 7(32.1%) had simple and long segment stricture, while in Group-B 12(37.5%) patients developed simple and short segment stricture. All of the patients in Group-A had minimum blood loss during operation. While, majority (81.3%) of patients in Group-B had a history of maximum blood loss. None of the patients in Group-A developed incontinence throughout the observations period (from removal of catheter to 9 months), while 15.6% of the patients in Group-B had incontinence at removal of catheter after anastomotic urethroplasty and at 3 month. The incontinence further increased to 18.8% at 6 and 9 months. Complaints of impotence were significantly less in Group-A than that in Group-B throughout the period of observation (14.3% vs. 37.5%, p = 0.042; 14.3% vs. 37.5%, p = 0.042 and 14.3% vs. 37.5%, p = 0.042). At removal of urethral catheter, stricture formation was observed and statistically there was no difference in Group-A and Group-B (14.3% vs. 21.9% in Group-B, p = 0.448). At month 3, stricture formation was significantly higher in Group-A than that in Group-B (42.9% vs. 15.6%, p = 0.020). At month 6, about 18% of patients in Group-A had stricture, but none of patients in Group-B was found so (p = 0.018). Conclusions: Early primary endoscopic realignment of traumatic posterior urethral disruption is a simple, less traumatic, safe, and rapid technique. It provides a low morbidity and less postoperative complications. Though recurrent stricture formation is higher but the strictures are simple and short and amenable to be corrected endoscopically. It may be considered as initial therapy in the management of posterior urethral distraction defect over suprapubic cystostomy with delayed reconstruction. Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2014 p.29-35