Laser epilation of luminal hair following skin graft urethroplasty for hypospadias: the hair snare

A 66-year-old man, who underwent urethral reconstruction using skin grafts for hypospadias five decades earlier as a 13-year-old child, presented with burning micturition and recurrent UTI. A retrograde urethrogram along with micturating cystourethrogram revealed a bulbar urethral stricture and broad neck distal penile urethral diverticulum. On a cystourethroscopic examination, a urethral diverticulum was seen just proximal to the hypospadiac external urethral meatus with 12–15 hair follicles inside the diverticulum and a 1 cm long mid-bulbar stricture. Visual internal urethrotomy for the bulbar stricture, a diverticular neck incision, laser epilation and hair follicle photocoagulation was performed using a 30 W Ho:YAG laser. The depilated hair tufts were extracted. The process was repeated again in 6 months due to recurrent symptoms. A patent urethra with a wide open diverticulum without any residual hair follicles was confirmed. No perioperative complications noted and the patient is doing well on 1 month of follow-up.

Outcomes of transecting urethroplasty in management of different types of bulbar urethral strictures: single center experience

Background: The study aimed to evaluate the outcomes of transecting bulbar urethroplasty techniques used for management of bulbar urethral stricture as regards the success rate and sexual dysfunction.Methods: Our study was a prospective study and it was carried out at urology department Tanta university, Egypt. The study was approved our ethical committee and an informed consent was obtained from all participants. Thirty patients underwent transecting urethroplasty either excision and primary anastomosis (EPA) or augmented anastomotic urethroplasty. Assessment of the sexual function by sexual health inventory for men (SHIM) questionnaire and postoperatively. Retrograde urethrogram (RGU) and micturating cystourethrogram (MCUG) were performed by an experienced urological surgeon.Results: The age of studied patients ranged from 15-72 years with a mean of 41±13.87. The length of stricture ranged from 2-3 cm with a mean of 2.57±0.38. The stricture was non obliterative in 13 patients (43.3%), obliterative in 4 patients (13.3%) and near obliterative in 13 patients (43.3%). Anastomotic urethroplasty was carried out in 20 out of 30 patients (66.7%) and augmented anastomotic urethroplasty was carried out in 10 out of 30 patients (33.3%). The success rate was 90%. As regard erectile dysfunction, 5 patients reported erectile dysfunction (16.7%).Conclusions: Anastomotic urethroplasty of short segment bulbar strictures continues to have excellent success rates and durability, but some patients who undergo anastomotic urethroplasty experience de novo sexual dysfunction.

Urinary ascites in a neonate with posterior urethral valve

Urinary ascites in a newborn is an extremely rare condition, most commonly due to posterior urethral valves, due to transmission of high intravesical pressure to calyceal fornices, and subsequent urinary ascites either by calyceal perforation or filtration through walls of urinary tract and their rupture. We describe a newborn male baby, who presented with huge abdominal distension at birth, and diagnosed as urinary ascites on paracentesis. Baby was asphyxiated and required resuscitation at birth, and ventilatory support for 4 days in v/o significant abdominal distension. Micturating cystourethrogram (MCUG) and magnetic resonance imaging (MRI) showed posterior urethral valves. Baby also had a left sided urinoma and grade 4 vesicoureteral reflux (VUR) on MCUG. Post paracentesis and drainage of 400ml of ascetic fluid, and urinary catheterization, baby had significant improvement of deranged renal parameters, and diuresis, and could be weaned from ventilation. In v/o inability to negotiate a urethroscope, a vesicostomy was done for urinary drainage and fulguration of valves planned on follow-up.

SPECTRUM OF BLADDER DIVERTICULI PRESENTING WITH UNUSUAL SYMPTOMS: A CASE SERIES STUDY

Diverticula of the urinary bladder can occasionally appear as complex pelvic masses not obviously connected to the bladder. Such presentations can lead to diagnostic confusion and interpretative error. Sonographic ndings and clinical histories were reviewed in 10 patients in whom bladder diverticula were initially mistaken for other types of pathologic pelvic processes. Sonographic techniques that were helpful in elucidating the true nature of the lesions included scanning from different perspectives with increasing increments of bladder distension, post void images, colour Doppler interrogation and Valsalva manoeuvre. The sonographic ndings were correlated with micturating cystourethrogram and CT nding. The diagnosis of bladder diverticula should be considered and actively pursued when sonologists are confronted with pelvic masses of ambiguous origin.

Patent urachus and bladder outflow obstruction—chance or consequence? A study of a cohort of patients with complete patent urachus presenting to a tertiary urological center and a review of literature

Background To explore the association between patent urachus and bladder outflow obstruction (BOO). A retrospective review of patient records over a 35-year period (1983–2018) with complete patent urachus was performed. Antenatal ultrasound findings were noted, and postnatal investigations included ultrasound (US), micturating cystourethrogram (MCUG), functional nuclear medicine scans (MAG3, DTPA, and DMSA), and serum creatinine. Associated anomalies and management in all patients were analyzed. Results Sixty-six patients with all types of urachal remnants were identified of whom only 16 had a patent urachus. All presented clinically with a discharging umbilicus, 10/16 confirmed on MCUG and 4 had umbilical cord cysts on antenatal US. Twenty-five percent had associated bladder outlet obstruction (BOO): etiologies included atresia of posterior urethra, congenital urethral hypoplasia, urethral atresia with prune belly syndrome, and sacrococcygeal teratoma. Vesicoureteral reflux (VUR) was confirmed in 37%, and four of them had bladder outlet obstruction (BOO). Conclusion With patent urachus, bladder outflow obstruction occurs in the minority. Based on our findings, we commend US and cystogram to document VUR. The isolated PU should be treated nonoperatively up to a year of age. Renal function should be checked with the finding of VUR. The etiopathogenesis of the condition remains uncertain.

Symptomatic prostatic utricle: various approaches for treatment

Background Pediatric presentations of a prostatic utricle have received only little attention. The incidence of symptomatic prostatic utricle has been reported but most cases are asymptomatic. The purpose of this study is to highlight the various clinical presentations and surgical approaches to treat a symptomatic prostatic utricle. Results This study includes a series of 7 cases over a period of 5 years. The diagnosis of prostatic was made on the basis of clinical presentations, ultrasonography, micturating cystourethrogram, and cystoscopy. Of the 7 patients, the newborn patient had antenatally detected abdominal cystic mass which presented with postnatal urinary retention, 5 patients had various urinary complaints, and 1 older child with disorder of sexual differentiation (DSD) had urinary incontinence. Depending upon the grade of prostatic utricle, treatment was done in the form of laparoscopic-assisted excision in 1, laparotomy and excision in 1, perineal excision in 2, and cystoscopic fulguration in 3 patients. Postoperative period was uneventful. All the patients were followed for a period of 1–2 years. Most of them were asymptomatic except one child who had recurrent episodes of epidydimo orchitis which was treated conservatively, and he was also asymptomatic at the end of 1 year. Five patients who had associated hypospadias were observed for one year for any urinary complaints before they underwent definitive repair for hypospadias. Conclusion Prostatic utricle is a vestigial remnant of müllerian duct most commonly associated with posterior hypospadias. High index of suspicion for prostatic utricle in cases with recurrent urinary complaints helps in timely detection and appropriate treatment can prevent further complications. Cystoscopy and micturating cytourethrogram remains the gold standard for diagnosis.

Neurovesical dysfunction in anorectal malformation

Background: Anorectal malformations are congenital anomalies characterized by the absence of a normally formed anus. Obstructive uropathy, vesicoureteral reflux neurovesical dysfunction are the leading causes of mortality and morbidity in ARM. Early diagnosis and treatment of NVD prevents renal parenchymal damage.Surgical interventions for the correction of anorectal malformation may also lead to the development of NVD. The incidence of urologic and spinal anomalies associated with ARM and the relationship between the anorectal malformations, spinal abnormalities and voiding dysfunction was studied by means of MRI spine and urodynamic studies. Methods: A prospective, observational study was done over a period of 2 years. All patients with ARM underwent MRI of the spine, ultrasound of abdomen, micturating cystourethrogram and urodynamic study.Results: Forty two patients were included in this study. Out of the 42 patients 17 (40.5%) were female and 25 (59.5%) were male. The ages of the patients ranged from 4 months to 14 years with an average of 32.9 months. 5 patients (12%) had complaints pertaining to neurovesical dysfunction. MRI of the spine revealed abnormalities in 10 patients (23.8%). Urodynamic study was abnormal in 8 patients (19%). Therefore a total of 8 patients (19%) had neurovesical dysfunction in the present study. This included 3 female patients with cloaca and 5 male patients with high anorectal malformations.Conclusions: Neurovesical dysfunction is frequently seen in patients with anorectal malformations. NVD may be due to the spinal abnormalities or due to iatrogenic injuries to the bladder innervations during surgical reconstruction.

Neurological Complications and Associated Risk Factors in Children Affected with Chronic Kidney Disease

To investigate the correlation between chronic kidney disease (CKD) and the development of neurological disease among pediatric patients in Saudi Arabia. The present retrospective study recruited patients admitted to King Abdulaziz University Hospital during 2018. We reviewed electronic records to collect data on essential demographics including age, gender, and nationality; history of prior CNS disease or related symptoms; results of neurological physical examination; and findings of radiological investigations such as abdominal ultrasound, dimercaptosuccinic acid scan, micturating cystourethrogram, diethylene triamine pentaacetic acid scan, brain computed tomography, and magnetic resonance imaging. The most commonly diagnosed renal pathologies were neurogenic bladder and cystic kidney disease. The most common neurological manifestation was seizure disorder. Males were more frequently affected with neurological sequelae than females. The prevalence of neurological disorders was higher in patients over two years old. The most frequently observed stage of chronic kidney disease was stage 5. Most children who were affected with a neurological disorder required hemodialysis as part of their management plan. Patients with chronic kidney disease are at a high risk of neurocognitive defects. The type of management and renal diagnosis are significant factors that should be considered when anticipating central nervous system involvement in the case of chronic kidney disease.