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Case 2.16
Published in Monica Fawzy, Plastic Surgery Vivas for the FRCS(Plast), 2023
How would you manage a urethral stricture?The first step is to diagnose it: the patient will present clinically with symptoms of frequency and repeated infections.Investigations include:ultrasound of the bladder and kidneys – with expected secondary hypertrophy of the bladder and renal cortical thinning in the case of a urethral stricture, andurine flowmetry – which is expected to show an abnormal flow rate curve and a residual volume due to the outflow obstruction.It is important to note that some patients will have mild obstruction visible on flowmetry but will be asymptomatic and these patients do not need an operation.Treatmentconsists initially of urethral dilation,but many will eventually require a urethroplasty.
Surgical treatment of disorders of sexual development
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Rafael V. Pieretti, Patricia K. Donahoe
In cases requiring a multistage repair, a preputial graft or an oral mucosa graft can be used. If the penis has a severe ventral penile curvature, transverse dorsal corporotomies are made at the point of maximal concavity and a ventral dermal graft is sutured to the edges of the defect. The second stage is 6-9 months later and urethroplasty is performed. Two suture layers are used; the first is done with interrupted stitches of 7/0 PDS or 7/0 Vicryl•with a TG-40 needle, the second layer is a running suture of 7/0 PDS. A penile dressing is fashioned with surgical wrapped around the penis; 2 × 2 gauze; coban tape; and Tegarderm, which minimizes the postoperative swelling and bleeding. The dressing is usually removed on the third postoperative day.
Developmental abnormalities of the genitalia: intersex, hypospadias, and cryptorchidism
Published in J Kellogg Parsons, E James Wright, The Brady Urology Manual, 2019
Urethroplasty: Options include meatoplasty/glanuloplasty, meatal advancement and glanuloplasty (MAGPI), urethral plate incision and tubularization (Snodgrass), tissue flaps (including Onlay), and grafts.
What are the challenges in the pharmacotherapeutic management of male genital tuberculosis?
Published in Expert Opinion on Pharmacotherapy, 2023
Aditya Prakash Sharma, Rajeev Kumar
Genital TB does not universally respond to pharmacotherapy and may require additional surgery [14]. There is limited data on the effectiveness of pharmacotherapy in managing infertility caused by genital TB [15]. The sequelae of TB in the genital organs often results from inflammation, scarring, and distortion of the anatomy and may no longer be amenable to medical therapy [16]. Surgical treatments such as vaso-vasostomy, vaso-epididymal anastomosis, and transurethral resection or incision of ejaculatory duct have been described for patients developing male infertility secondary to genital tuberculosis [6]. Structural abnormalities can also cause cosmetic deformities (Figure 1), functional obstructions, and anatomic obstructions which persist despite adequate pharmacotherapy. Scrotal and prostatic abscesses may require drainage if they do not respond to medical treatment. Cases of urethral strictures requiring urethroplasty have also been reported [17].
One-year follow-up after urethroplasty, with the focus on both lower urinary tract and erectile function
Published in Scandinavian Journal of Urology, 2020
David Míka, Jan Krhut, Kateřina Ryšánková, Radek Sýkora, Libor Luňáček, Peter Zvara
In the past, most USD cases were treated with urethral dilatations and/or internal urethrotomy. These methods are currently reserved for palliative care, while urethroplasty became the gold standard. This trend is evident, as the number of open urethroplasties performed in the United States increased more than 3-fold between 2004 and 2012 [3]. Urethroplasty is a safe surgical procedure with low incidence of perioperative morbidity and mortality [4]. Studies conducted at specialized centers with a sufficient volume of urethroplasty procedures report a success rate above 80% [5]. On the other hand, it must be recognized that a consensus on the definition of success in the US treatment is lacking. Previously, no need for re-treatment was accepted as a definition of success [6]. Today, most studies report success based on quantifiable functional outcome data obtained mostly from retrograde urethrography and uroflowmetry. The effect of urethral surgery on erectile function was first evaluated in a study by Mundy [7] published in 1993. Since then, only a limited number of studies focusing on this aspect of treatment have been published, yielding conflicting results [8].
Could the bulbar urethral end location on the cystourethrogram predict the outcome after posterior urethroplasty for pelvic fracture urethral injury?
Published in Arab Journal of Urology, 2023
Ahmed M. Harraz, Adel Nabeeh, Ramy Elbaz, Abdalla Abdelhamid, Mohamed Tharwat, Amr A. Elbakry, Ahmed S. El-Hefnawy, Ahmed El-Assmy, Ahmed Mosbah, Mohamed H. Zahran
Electronic records were available for 250 patients of whom 158 (196 urethroplasty procedures) had CUG images available and of adequate quality. The mean patients’ age and body mass index were 32.7 (14.2) years and 27.7 (8.1) Kg/m2, respectively. The procedure was done 2 times in 26 (16.5%) patients and 3 times in 6 (3.8%). Primary realignment was not done in any of our patients with all underwent suprapubic cystostomy at the time of urethral injury. The median (IQR) time to urethroplasty was 4 (3–6) months. Postoperatively, superficial wound infection occurred in 4 patients and required frequent dressing. Blood transfusion was required in 7 patients. The median (IQR) hospital stay was 6 days (5–9).