Cases reported "Urethral Diseases"

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11/44. Anorectal agenesis with a rectourethral fistula diagnosed in an adult: report of a case.

    We report an unusual case of anorectal agenesis with a rectourethral fistula diagnosed in a 48-year-old man. The patient presented after noticing hematuria, although he had been aware of urinary leakage from his colostomy with occasional fecal urine for about 4 years. He had had a double-barrel colostomy created soon after birth for an imperforate anus, with revision at the age of 4 years to correct a prolapse of the stoma, but his malformation had never been repaired. We performed a physical examination, which did not reveal a perineal fistula, but urethrocystography demonstrated high anorectal agenesis with a rectourethral fistula. Thus, we resected the rectourethral fistula and created an end-colostomy. The patient had an uneventful postoperative course, and was discharged in good health on postoperative day 19. To our knowledge, this is the oldest patient to be diagnosed with anorectal agenesis and undergo resection of a rectourethral fistula.
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12/44. Long-term penile incarceration by a metal ring resulting in urethral erosion and chronic lymphedema.

    A patient presented with a metal ring around the base of his penis. The ring had been placed 3 years prior to presentation. Intra-operative findings revealed a ventral erosion with complete transection of the urethra and massive fixed lymphedema of the penile skin distal to the ring. Treatment consisted of removal of the ring with metal shears and bolt cutters. Small reduction of the edema was seen 3 months following removal, and the patient refused further treatment. The most interesting part of the outcome was the preservation of penile urethral voiding although intromission was not possible.
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13/44. Ultrasound diagnosis of intra-urethral tension-free vaginal tape (TVT) position as a cause of postoperative voiding dysfunction and retropubic pain.

    Intra-urethral Prolene tape erosion is a rare postoperative complication of tension-free vaginal tape (TVT) plasty. In cases reported in the literature, intra-urethral tape positioning has been diagnosed by urethroscopy as late as 3-12 months after the procedure. Introital ultrasound using a vaginal sector scanner allows for the non-invasive assessment of the position of the Prolene tape in relation to the urethra. Postoperative introital ultrasound might shorten the interval between surgery and the time of diagnosis of an intra-urethrally placed tape and thus significantly shorten the duration of symptoms. We present a patient with urethral pain syndrome and dysuria following TVT plasty. In this case, introital ultrasound was not performed until 8 months after surgery, when it demonstrated intra-urethral Prolene tape positioning as the cause of the patient's complaints. All symptoms disappeared after surgical removal of the intra-urethrally placed parts of the tape. The patient is continent, suggesting that the remaining para-urethral portions of the Prolene tape depicted sonographically ensured adequate stabilization of the mid-urethra in this case. The case report emphasizes the role of introital ultrasound in assessing Prolene tape position relative to the urethra on sagittal and transverse angulated views in the postoperative diagnostic evaluation of functional disturbances occurring after TVT plasty.
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ranking = 3.5
keywords = operative
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14/44. Posterior urethral diverticulum after laparoscopic-assisted repair of high-type anorectal malformation in a male patient: surgical treatment and prevention.

    Currently, laparoscopic-assisted colon pull-through (LACPT) is the treatment of choice for male patients with high-type imperforate anus and rectourethral fistula. Since laparoscopy was introduced for treating this condition, reports concerning post-LACPT complications are rare. Here we discuss the case of a boy, now 3.5 years old, born at 37 weeks' gestation weighing 2,300 g, who was diagnosed with rectobulbar urethral fistula (RUF) at birth. LACPT was performed when the boy was 11 months old and weighed 7.2 kg. No intraoperative complications occurred, and the initial post-LACPT course was uneventful. When he was 2 years old, he developed dysuria requiring urethral catheterization. Diagnostic radiology confirmed a large cystic mass behind the bladder, suggestive of a posterior urethral diverticulum (PUD). Histopathology of the excised mucosa of the cyst showed colonic mucosa, confirming that the cyst was indeed an enlarged residual RUF. We discuss our treatment and our approach to prevention.
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15/44. Transsphincteric repair of rectourethral fistulas following laparoscopic radical prostatectomy.

    Rectourethral fistula is a serious complication following laparoscopic radical prostatectomy. We report our experience with a transsphincteric approach in the repair of this uncommon complication. The rectourethral fistula was repaired in a three-stage procedure comprising fecal diversion, transsphincteric repair of the fistula and, finally, closure of the stoma. Two patients with rectourethral fistulas underwent this procedure and the postoperative course was uneventful. In conclusion, a transsphincteric approach in the repair of rectourethral fistula by a three-stage procedure is safe and may be the treatment of choice.
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keywords = operative
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16/44. Transurethral resection of transvaginal tape.

    Urethral erosion is an uncommon complication after tension-free vaginal tape (TVT) procedure. However, management is a challenge and morbidity significant because of the necessity to incise the urethra to gain access to the material. This is a report of a case of transurethral resection of such mesh. A 77-year-old women presented at 7 months postoperatively with complaints of incomplete emptying and persistent incontinence. Urodynamic testing and cystoscopy revealed intrinsic sphincter deficiency, an elevated post void residual and erosion of the TVT tape into the urethral lumen. The tape was removed without any incisions via an operative cystoscope and hysteroscopic scissors. All urinary symptoms resolved. Partial urethral transection can be managed successfully with transurethral resection of the material. This diagnosis should be considered in patients with incomplete emptying and recurrent incontinence.
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ranking = 1
keywords = operative
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17/44. Urethral diverticulum: diagnosis with virtual CT urethroscopy.

    OBJECTIVE: A 26-year-old woman presented with urinary frequency. Findings were negative on voiding cystourethrography. Cystourethroscopy failed to reveal a urethral diverticulum. A new method of virtual CT urethroscopy was performed using a 16-MDCT scanner. The orifice of the diverticulum was identified clearly on 3D virtual urethroscopy. Intraoperatively, the diverticulum was identified, with the orifice location compatible with that seen on virtual urethroscopy. CONCLUSION: Virtual CT urethroscopy provides more information than conventional urethral examinations and is less invasive than conventional urethroscopy.
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ranking = 0.5
keywords = operative
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18/44. Transanal endoscopic microsurgical repair of iatrogenic recto-urethral fistula.

    BACKGROUND: Recto-urethral fistula formation following radical prostatectomy is an uncommon but potentially devastating event. Traditional surgery for such fistulae is technically demanding, jeopardizes continence and usually necessitates a diverting colostomy. We present the case of an iatrogenic fistula treated by a transanal endoscopic microsurgical approach, without recourse to a stoma. METHOD: A 71-year-old man had recently undergone a radical prostatectomy, complicated by significant intra-operative haemorrhage. He subsequently developed a recto-urethral fistula, confirmed clinically and endoscopically. Due to his bleeding diathesis, he was considered for, and underwent, a transanal endoscopic microsurgical (TEMS) repair. CONCLUSION: TEMS is a safe and reliable minimally-invasive surgical technique for the treatment of this difficult condition.
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keywords = operative
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19/44. Laparoscopic transvesical urethrorectal fistula repair: a new technique.

    INTRODUCTION: Urethrorectal fistulas are rare, and several open operative approaches and techniques have been used in treatment. We report our preliminary experience with laparoscopic transvesical urethrorectal fistula repair after iatrogenic urethrorectal fistula. A 65-year-old man with insulin-dependent diabetes mellitus and peripheral vascular disease was hospitalized 6 months after transurethral resection of the prostate for benign prostatic hyperplasia with a recurrent urinary tract infection, fecaluria, and urine leakage from the rectum during voiding. Urethrocystoscopy revealed a urethrorectal fistula in the prostatic fossa. Primary conservative treatment failed. TECHNICAL CONSIDERATIONS: The patient was placed in the lithotomy position, and the suprapubic tract was dilated to allow a 10-mm telescope. carbon dioxide gas was used to distend the bladder (15 mm Hg, flow rate 3 L/min). Next, two 3-mm pediatric trocars were inserted under direct vision. The fistula was identified and the edge of the fistula excised. A running suture (3-0 PDS, RB needle) was used to close the fistula. Finally, a 16F Foley urethral catheter was passed under direct vision, followed by a suprapubic catheter. On postoperative day 12, retrograde cystography revealed no contrast leakage from the rectum. Follow-up after 3 months showed no recurrence of the fistula. CONCLUSIONS: A transvesical laparoscopic technique might be useful for selective cases of urethrorectal fistula. Other methods of laparoscopic urethrorectal fistula repair have included bivalving of the bladder and omental interposition. The laparoscopic transvesical approach provides many advantages, including easy access and identification of the fistula tract, good surgical exposure, and minimal tissue manipulation.
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keywords = operative
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20/44. Anterior transanal, transsphincteric sagittal approach for fistula repair secondary to laparoscopic radical prostatectomy: a simple and effective technique.

    INTRODUCTION: To report our experience with the anterior, transanal, transsphincteric, sagittal approach in the correction of rectourinary fistula secondary to laparoscopic radical prostatectomy. TECHNICAL CONSIDERATIONS: Of the first 110 laparoscopic extraperitoneal radical prostatectomies performed from December 2001 to February 2004, 9 (8%) were complicated by rectal injury. Of the nine rectal lesions, seven were diagnosed intraoperatively and the rectal defects closed laparoscopically. Primary repair failed in 1 of the 7 patients. In 2 other patients, the rectal injuries were missed intraoperatively, and a rectourinary fistula later developed. Rectourinary fistula was confirmed in these 3 patients by cystoscopy and digital rectal examination. The procedure chosen for repair was the anterior sagittal transrectal anal approach. The time from diagnosis to fistula repair was 1 to 3 months. fistula repair was successful in all patients. The mean follow-up was 12 to 24 months. No patient presented with fecal incontinence or anal strictures. Postprostatectomy urinary continence was not affected by the procedure. CONCLUSIONS: The transsphincteric transanal surgical approach provides many advantages for the repair of acquired urethrorectal fistulas after laparoscopic radical prostatectomy. It allows for good surgical exposure and fistula tract identification and ensures good access to well-vascularized tissue. This surgical technique is simple, effective, reproducible, and associated with minimal morbidity.
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ranking = 1
keywords = operative
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