Congenital Parameatal Urethral Cyst in The Male: A Case Report and Review of Literature

Purpose:: To report one case of parameatal urethral cyst.Background : Parameatal urethral cyst is a scarce congenital condition that was first reported in two males in 1956, until now in reported literature only found less than 50 cases, in both adults and children. Our patient, case of parameatal urethral cyst in a 5 years old boy is reported. Complete excision with total removal of the epithelium of the cyst is required management for the treatment and prevention of cyst reocurrance.Case Report:a 5 years old male with a cystic lesion around urethral meatus since birth. At least 5 month the parents complain distorted urinary flow and poor appearance, and no other urinary symptom, no history of trauma. On physical examination, cystic mass with spherical shape which was about 0.5 cm in diameter was found around external meatus. There was no inflammatory sign. And there was normal blood laboratory (blood counts and blood chemistry) and urine laboratory (urine analysis and urine culture). The patient undergo completely excision of the cyst under general anaesthesia, and remove all of the lining epithelium. Good appearance results were obtained after 2 months follow up, without meatal strictures and urine stream problems, and no postoperative complications or recurrence. Pathological : Squamous epithelial, granulation tissue with chronic inflamationConclusions :Parameatal urethral cyst is a very rare benign condition that is asymptomatic in most of the cases. It may be present since birth or appear later and is prevalent in young males. Its etiology remains unclear and treatment is by complete surgical excision to avoid complications and recurrence. Good cosmetic results were obtained in this case without any recurrence at two months follow up.Parameatal cyst, Glans penis, external meatus urethra, Urethral cyst

Modified Snodgrass Repair for Hypospadias: Outcome at a General Surgical Unit

Background: Hypospadias occurs in around one in 200-300 male live births and is the most common congenital abnormality of the urethra. There are three characteristic features; Firstly the external meatus opens on the underside of the penis or the perineum, secondly the ventral aspect of the prepuce is poorly developed ('hooded prepuce') and thirdly there is usually a ventral deformity of the erect penis (chordee). Many methods have been used to repair hypospadias. We worked on Modified Snodgrass repair for mid-shaft and distal hypospadias in a General Surgical Unit. Objective: To study the outcome of Modified Snodgrass Repair with respect to outcome and post operative complications like fistulas, disruption, meatal stenosis, residual chordae ,penile torsion and infections.Material and Methods: All patients with hypospadias according to exclusion and inclusion criteria admitted to Surgical B unit of Saidu Teaching Hospital from 1st January 2015 to 21st December, 2019 were entered in the study. U shape incision was made around the urethral plate. Urethral incisions were extended to the mid-glans. Urethral plate was incised in center upto midglans. After tubularization of urethral plate and circumferential incision proximal to coronal sulcus from each edge of urethral plate, the penile skin was degloved upto or near to penoscrotal junction depending upon extent of chordee. Neourethra was formed and covered by Dorsal Dartos facial flap which was slit in the centre and brought out to ventral surface by passing the glans through the slit. The child was followed after a week to change dressing and after 10 days to remove catheter and then after one month and three months for checking complications and outcome.Results: Total of 100 subjects were included in study,(67%) having anterior and (43%) having middle hypospadias. Mean age was 3.7 years. Complications were recorded in 21% of patients. Urethro cutaneous fistula in 9%, Total disruption in 1%, Infections in 5%, Meatal stenosis in 2% ,Catheter blockage in 2% and penile torsion occurred in 2% of patients. 97% cases had good cosmetic shape. The fistulas were repaired after 6 months in two layers and had satisfactory results.Conclusion: A properly performed Modified Snodgross repair can be performed in General Surgical Unit with reasonable efficacy if expertise is available

Audiogram in Response to Stimulation Delivered to Fluid Applied to the External Meatus

Background and Objectives: Hearing can be elicited in response to vibratory stimuli delivered to fluid in the external auditory meatus. To obtain a complete audiogram in subjects with normal hearing in response to pure tone vibratory stimuli delivered to fluid applied to the external meatus.Subjects and Methods: Pure tone vibratory stimuli in the audiometric range from 0.25 to 6.0 kHz were delivered to fluid applied to the external meatus of eight participants with normal hearing (15 dB or better) using a rod attached to a standard clinical bone vibrator. The fluid thresholds obtained were compared to the air conduction (AC), bone conduction (BC; mastoid), and soft tissue conduction (STC; neck) thresholds in the same subjects.Results: Fluid stimulation thresholds were obtained at every frequency in each subject. The fluid and STC (neck) audiograms sloped down at higher frequencies, while the AC and BC audiograms were flat. It is likely that the fluid stimulation audiograms did not involve AC mechanisms or even, possibly, osseous BC mechanisms.Conclusions: The thresholds elicited in response to the fluid in the meatus likely reflect a form of STC and may result from excitation of the inner ear by the vibrations induced in the fluid. The sloping fluid audiograms may reflect transmission pathways that are less effective at higher frequencies.

Study of treatment options in stricture urethra management and success rate in different types and sites of stricture

Background: A urethral stricture is a scar of the subepithelial tissue of the corpus spongiosum that constricts the urethral lumen. As the constriction progresses, obstruction develops and leads to symptoms either directly related to the obstruction or as a secondary consequence.Methods: All the cases of stricture urethra presented to our institute between June 2017 to June 2019 (n=60) in whom treatment was required were studied in a prospective manner. All cases of obstructive voiding symptoms are evaluated by conducting uroflowmetry studies (ESPON, gravimetric type). Obstructive voiding symptoms are evaluated by using the American Urological Association questionnaire.Results: The data collected was divided into 3 groups: infective causes of stricture (n=22), traumatic causes of stricture (n=14) and idiopathic causes of stricture (n=24). The mean age of presentation was 34.4 years (range of 20 to 50 years). 18 (30.00%) patients had stricture in the bulbo-urethra, 12 (20.00%) at the external meatus, 4 patients had stricture at the bulbo-membranous region. Procedures undertaken during the study were visual internal urethrotomy in 20, anastomotic urethroplasty in 17 patients and Augmented urethroplasty in 23 patients. In our series of 60 patients, 48 patients had a Qmax of >15 ml/sec. Average success rate was 80.1%, 12 patients had a Qmax of <15 ml/sec.Conclusions: It is unwise to make sweeping recommendations for best practice for reconstructive urethral surgery based on the literature because each patient clearly requires an individualized approach based on individual circumstances. Buccal mucosa is the most widely used graft has excellent results in all types of urethroplasty.

Analisis Variasi Ketebalan Kepala pada pemeriksaan Mastoid Proyeksi Axiolateral Metode Schuller terhadap Gambaran Anatomis

Background: Axiolateral projection of mastoid examination with Schuller method using angle range of 25°-30° caudad according to Bontrager (2010). The difference thickness of the human’s head will cause range of angles of axiolateral projection of mastoid examination using Schuller projection. The inappropriate angle will affect the different anatomical information. Axiolateral projection of mastoid examination using Schuller projection in Radiology Installation of dr. Soetomo Hospital used an angle that is 25° for all patients with different thickness of the head. This study aims to determine the differences in anatomical image clarity on radiographic image of axiolateral projection of mastoid examination using Schuller method with an angle that is 25° with variations of head thickness between 12 to 14.5 cm.Methods: This research was a quantitative research with an experimental approach. Subjects of this reearch were 10 respondents. Data analyzed statistically by Kruskal Wallis test and Mann Whitney test.Results: The results showed that there was difference in anatomical image of axiolateral projection of mastoid examination with Schuller method with 25° angle. Result of statistical test to get optimal radiographic image of mastoid using Schuller method showed the significant value, which was 0,000. Differences in anatomical image was also shown on the assessment results from 10 respondents which most of respondents assess anatomical features on a 14.5 cm head thickness was very good.Conclusion: There were differences anotomical information of mastoid radiograph using schuller method with thickness variaton of head. Head thickness of 14.5 cm can show anatomical image of the mastoid air cells, bony labirinth, condyle mandible, temporomandibular joint (TMJ), Aacousticus the external meatus (MAE) and tegmen tympani. The CR angle should be considered based on head thickness.

Comparison of Snodgross and para-meatal based flap technique for hypospadiasis

Objective: To compare the two surgical procedures Snod gross & parameatal based flap technique for mid & distal penile hypospadias including cosmosis. Study design: Randomized Clinical interventional trail. Place of study: This study was conducted in the Urology Department of Assir Central University Hospital ABHA, KSA and Department of Urology & Renal transplantation, Jinnah Hospital, Lahore from June 2002 to Dec 2004. Material & Methods: Thirty-two patients were selected for this randomized clinical intervention study with mid shaft & distal hypospadias fulfilling the inclusion criteria. Snod Gross and parameatal based flap technique was assigned randomly to patients comprising of two groups of sixteen each. Watertight closure was made with 6/0 vicryl. Tourniquet or 1:10000 epinephrine were used. Follow up at 2 weeks, three months; 6 months post catheter or stent removal and the patient were assessed on criteria of cosmosis, time for surgery and complications associated with the procedure. Results: Th irty-two patients who underwent procedure of Snodgross & parameatal-based flap in the management of mid shaft & distal penile Hypospadias. Age ranged from 2-12 years. The mean age was 5.23+4 years. The presentation of patients was dystocia of external meatus with misdirected stream in sixteen (50%) patients, spraying of urine in six (25%) and narrow stream in 4(13%) patients. Eighteen patients were having distal penile and fourteen were having mid shaft hypospadias. Following Snod grass technique all patients had good cosmetic results without any complication. Following parameatal based flap, one patients (6.3%) develop wound dehiscence, three patients (18.8%) develop urethral fistula, two patients (12.5%) showed metal retrieval and twenty patients showed good cosmosis. In our study, comparison between Snodgross & parameatal-based flap, the success rate was 100% and 62.4% respectively. Conclusions: Success with Snod gross procedure is better with no complications and good cosmosis. Complications rate was 37.6 % in-patient with para-meatal technique.

SURVEI KESEHATAN TELINGA MASYARAKAT PESISIR PANTAI BAHU

Ear is the part of human’s organs that gives important contribution in hearing and balance process. Ear absorbs 20% of information in daily life. The result of National Health Survey in 7 provinces in 1993-1996 showed that there was a high prevalence (16.8%) of morbidity on ear disturbance. Indonesia is an archipelago country since 70% of its area is sea. This study aimed to obtain the ear health profile of people that live along the Bahu beach. This was a descriptive observasional study with a cross sectional design. Samples were 31 people. Data were obtained from external meatus acusticus examination by ear-nose-throat specialists. The results showed that the most frequent was cerumen in 7 people in right and left ears. Perforation of tympanic membrane of right and left ears were found in 2 people. Conclusion: The ear health status of most people living along Bahu beach was good. However, perforation of tympanic membranes were still found in a small number.Keywords: ear health, ear examinationAbstrak: Telinga adalah organ tubuh yang berperan penting pada proses pendengaran dan keseimbangan. Telinga merupakan salah satu indra yang menyerap sebesar 20% informasi dari kehidupan sehari-hari. Hasil Survei Nasional Kesehatan di 7 provinsi tahun 1993-1996, prevalensi morbiditas telinga yang paling tinggi yaitu gangguan pendengaran sebesar 16,8%. Indonesia sendiri merupakan negara kepulauan yang hampir 70% wilayahnya terdiri dari laut. Penelitian ini bertujuan untuk mendapatkan data survei mengenai gambaran kesehatan telinga pada masyarakat pesisir pantai Bahu. Jenis penelitian ialah deskriptif observasional dengan pendekatan potong lintang. Sampel penelitian berjumlah 31 orang. Pengambilan data dilakukan dengan pemeriksaan meatus austikus eksternus oleh dokter spesialis THT-KL. Hasil. penelitian memperlihatkan yang terbanyak ialah serumen pada 7 orang di telinga kanan dan telinga kiri. Pada pemeriksaan membran timpani ditemukan perforasi telinga kanan dan kiri sebanyak 2 orang. Simpulan: Status kesehatan telinga sebagian besar masyarakat pesisir pantai Bahu sudah baik. Walaupun demikian, perforasi membran timpani masih ditemukan pada sebagian kecil masyarakat.Kata kunci: kesehatan telinga, pemeriksaan telinga

Manual Replacement of Double J Stent Without Fluoroscopy

It is not always possible to replace a ureteric stent with a new one due to the fact that tumoral effect increases in ureter with time. We present our experience of manual replacement of double J stent without fluoroscopy. The data from 23 female patients who underwent double J stent replacement with a total of 110 times was retrospectively analyzed. The steps of technique are as follows: take out distal end of the double J stent through urethra to external urethral meatus cystoscopically, insert a 0.035-inch guide wire through double J stent to the renal pelvis or intra pelvicaliceal system, take out old double J stent over guide wire, slide new stent over guide wire and at external meatus level take out guide wire while gently sliding distal end of double J stent over guide wire into urethra. The mean age was 58.39 ± 9.21 years. Cervical, endometrial, and ovarian cancer were diagnosed in 16, 4, and 3 patients respectively. The mean follow-up and indwelling period were 13.8 ± 5.2, 3.8 ± 0.6 months, respectively. Increased pelvicaliceal dilatation, serum creatinine level, or renal parenchymal loss was not observed. Replacement of double J stents with this technique is easy and can be used successfully in distal ureteral obstructions.

Spontaneous Postmenopausal Urethral Prolapse Treated Surgically and Successfully

Urethral prolapse (UP) is a circular complete eversion of the distal urethral mucosa through the external meatus. It is a rare condition seen mostly in African-American premenarcheal girls. Both a medical and a surgical approach to this condition have been described. We present a case of a spontaneous urethral prolapse in a 60-year-old postmenopausal Caucasian woman, who failed medical management and underwent successful surgical management. The patient is asymptomatic 18 months following the procedure.