Cases reported "Urethral Diseases"

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1/13. Primary adenocarcinoma arising from a paraurethral cyst in a female patient.

    A very rare case of primary adenocarcinoma arising from a paraurethral cyst in a 63-year-old woman is reported. Initially she was diagnosed as having a simple paraurethral cyst because of absent communication with the urethra. The resected paraurethral cyst was histologically associated with adenocarcinoma. We also performed chemotherapy composed of methotrexate, vinblastine, Adriamycin and cisplatin because of lymph node metastasis. Our treatment, however, was not effective and the patient died of systemic metastases.
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2/13. A case of rectal atresia associated with recto-bulbar urethral fistula.

    Rectal atresia is a rare condition in which the anus and sphincter muscles are normally developed, with usually no fistulous communication with the urinary tract. An unusual case of rectal atresia associated with recto-bulbar urethral fistula treated by a combination of colo-anal anastomosis and mucosal proctectomy via a posterior sagittal approach is reported for the first time.
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3/13. Low anorectal malformation associated with 'ano-urethro-cutaneous' fistula.

    Anorectal malformations are one of the common congenital anomalies encountered in the newborn period. The plethora of anomalies described makes it a complex subject for embryological explanations. Fistulous communications between the blind rectum and the urinary tract are common in boys with high/intermediate anomalies, but it is uncommon in children with low anorectal malformations, more so a double fistula. We are reporting a case of 'ano-uerthro-cutaneous fistula' associated with a low ano rectal malformation.
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4/13. Covered exstrophy with visceral sequestration: case report and review of literature.

    We report a case of a male newborn with asymmetrical epispadic diphallia and congenital urethral fistula, and exomphalos minor. A segment of bowel was attached in the region of the pubis; with no communication to the underlying bowel. This was excised; histological examination revealed this to be a colonic remnant. The excision of the examphalos minor and approximation of the pubis and the rectus sheath over the bladder was also done; urethroplasty is planned at a later date. A comprehensive review of the available literature revealed only eight such cases before this; the possible embryology is discussed.
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5/13. Augmented-pressure colostogram in imperforate anus with fistula.

    Most newborns with imperforate anus, except for those with very low varieties, undergo a diverting colostomy performed in the postnatal period, with definitive surgical repair at a later age. Accurate demonstration of the anatomy of any associated fistula between the rectum and urogenital tract is essential for optimal surgical management. An augmented-pressure distal segment colostogram is recommended prior to definitive repair, both to confirm the level of rectal atresia and to define any associated fistulous communication. We report a case of high imperforate anus with rectourethral fistula in which the fistulous tract was not identified on the conventional contrast colostogram but was readily delineated when an augmented-pressure modification of the technique was utilized. The technical aspects of augmented-pressure colostography are presented.
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6/13. Urethral fistula and sinus formation in hidradenitis suppurativa.

    Two patients with severe hidradenitis suppurativa are reported. In Case 2, with widespread and superficial disease without communication with internal organs, there was a good response to intensive surgical intervention. In the patient with hidradenitis suppurativa and urethral fistula formation adequate surgical treatment was not technically feasible and treatment had to be continued for at least 2 years without permanent cure in sight. A search of the literature confirms that this differentiation is important as the cases with fistulous involvement of internal organs tend to have a bad prognosis.
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7/13. Hyperchloremic metabolic acidosis as a clue to recto-urethral fistula in an infant with anal atresia.

    An infant with high anal atresia and transverse colostomy, in whom initial radiologic evaluation of the urinary tract had been normal, developed hyperchloremic metabolic acidosis at 24 days of age. gastroenteritis and renal tubular acidosis as possible causes for this metabolic disturbance were excluded, which prompted a repeat investigation of the possibility of a communication between the urinary tract and the rectum. A recto-urethral fistula was demonstrated by urethrography. Analysis of the fluid obtained from the left colon as compared to urine in the bladder and voided urine demonstrated that electrolyte exchange was taking place in the colon, resulting in hyperchloremic hypokalemic acidosis. Treatment with oral sodium bicarbonate and daily lavage of the left colon resulted in normalization of the acid-base status and catch-up growth of the baby. Hyperchloremic acidosis associated with anal atresia and recto-urinary communication appears to be uncommon. However, early diagnosis and treatment of the metabolic derangement are of importance as it may determine the infant's overall prognosis.
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8/13. Urethroperineal-rectal fistula in Crohn's disease.

    A 19-year-old white male with Crohn's disease, who complained of passing urine per rectum and having retrograde ejaculations, was noted to have a urethroperineal-rectal fistula. The fistulous communication remained patent despite pharmacologic therapy, a diversion ileostomy, and a total proctocolectomy. A fistulectomy and definitive urethral repair finally resulted in resolution of the problem.
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9/13. "H-type" urethrorectal communication and complete urethral stenosis with unilateral renal agenesis.

    Congenital "H-type" urethrorectal communication with complete urethral stenosis is extremely rare in the pediatric population. The evaluation and surgical treatment of a "H-type" urethrorectal communication with complete urethral stenosis presenting in a 4-month-old infant is described. Additionally, he had a left renal agenesis and anal stenosis.
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10/13. "H-type" urethroanal fistula.

    Stephens and Smith have recently described a urethroanal connection through which urine was passed preferentially into the otherwise normal rectum at the pectinate line. Other authors have reported similar deformities. The term "congenital 'H-type' anourethral fistula" was proposed for this rare anomaly by deVries and Friedland in 1974. In this communication, we describe two examples of the "H-type" urethroanal fistula (Fig. 1). Each patient also had tracheoesophageal fistula. One patient (R.P.), now 11 yr of age, has had successful correction of the anomaly. The other patient (T.McC.), a small premature baby whose uroanal deformity was investigated radiographically, died of sepsis and uremia. The anatomical relationships in this baby were investigated histologically in the autopsy specimen by means of serial sections. From this study, it has been possible to determine the sphincteric anatomy and to suggest a possible pathoembryology of the defect.
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