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OBJECTIVE: To assess whether omitting routine post-operative imaging adversely impacts clinical outcomes after bulbar urethroplasty. Contrast imaging is commonly performed prior to catheter removal after urethroplasty but the clinical need for this is unclear. METHODS: This was a matched, case-control analysis comparing patients undergoing routine voiding cystourethrogram (VCUG) prior to catheter removal after bulbar urethroplasty to patients without imaging. Patients were matched with respect to age, stricture etiology, length, and urethroplasty technique. Follow-up consisted of clinical assessment 3 weeks post-operatively for VCUG/catheter removal, cystoscopy at 3-4 months with clinical assessment annually. Outcome measures were 90-day complications (Clavien ≥2) and stricture recurrence (failure to pass a 16-Fr flexible cystoscope on follow-up). Chi-square and Kaplan-Meier analysis were conducted where appropriate. RESULTS: Hundred patients undergoing bulbar urethroplasty with VCUG prior to catheter removal were compared to 100 matched case controls without imaging. Groups did not differ with respect to failed endoscopic treatment (P = .82), prior urethroplasty (P = .09), comorbidities (P = .54), smoking (P = .42), or pre-operative bacteriuria (P = 1.00). The incidence of extravasation in the VCUG group was 2%. Overall 90-day complications were 9.5% and 15 patients developed recurrence with a median follow-up of 174 months. On chi-square analysis, 90-day complications did not differ between patients undergoing VCUG and those without (12% vs 7.0%; P = .34). On log-rank analysis, stricture recurrence did not differ between groups (P = .44). CONCLUSION: Routine imaging with VCUG after bulbar urethroplasty does not influence the risk of post-operative complications or stricture recurrence. Surgeons should consider avoiding this potentially unnecessary examination in routine clinical practice.
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Estreitamento Uretral , Masculino , Humanos , Estreitamento Uretral/diagnóstico por imagem , Estreitamento Uretral/cirurgia , Estreitamento Uretral/etiologia , Constrição Patológica/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Estudos Retrospectivos , Uretra/diagnóstico por imagem , Uretra/cirurgia , Cistoscopia , Resultado do TratamentoRESUMO
IMPORTANCE: In the past, urethral shape, mobility, and urodynamics have been used to retrospectively demonstrate correlations with stress urinary incontinence. Our previous work has shown a relationship between urethral function and shape in symptomatic women. OBJECTIVE: This study aimed to characterize the effect of pelvic floor squeeze and strain maneuvers on urethral shapes and pressure in a cohort of patients without pelvic floor disorders. STUDY DESIGN: In this cross-sectional study, volunteers underwent dynamic pelvic floor ultrasound examination, and a modified urodynamic study. Urethral length, thickness, and proximal and distal swing angles were measured at rest, squeeze, and strain. The midsagittal urethral walls were traced so that a statistical shape model could be performed. Means and standard deviations of imaging and urodynamic measures were calculated. RESULTS: Data from 19 participants were analyzed. On average during squeeze compared with rest, urethral length increased by 6%, thickness decreased by 42% (distal, P < 0.001), 10% (middle), and urethral pressure increased by 14%. Opposite shape changes-length decreased by 10% ( P = 0.001), thickness increased by 57% (distal, P < 0.001), 20% (middle, P < 0.001)-and increased urethral mobility were observed during strain, with larger pressure increases occurring (29%, P < 0.001). Fifty-one percent of the total shape variance described the differences between maneuvers. These differences were statistically different between groups ( P < 0.001 for comparisons, all others P > 0.05). CONCLUSIONS: Dynamic ultrasound and urodynamics allow for the establishment of baseline ranges in urethral metrics (2-dimensional measures, shape, and pressure) and how they are altered during maneuvers. These data can allow for a more objective identification of incontinence via ultrasound and urodynamic testing.
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Tosse , Incontinência Urinária por Estresse , Humanos , Feminino , Estudos Transversais , Estudos Retrospectivos , Incontinência Urinária por Estresse/diagnóstico por imagem , Uretra/diagnóstico por imagemRESUMO
INTRODUCTION: Diphallia is a rare anomaly. It has a range of appearances from a small accessory penile to complete duplication. METHODS: We present a 2 year-old boy with complete penile duplication. The left penile was the largest. NMR (Nuclear Magnetic Resonance) suggested one corporal body for each penile and VCUG (Voiding Cystourethrogram) showed a normal urethra in the right penile and stricture at glandular and mid penile urethra of the left penis. A Y confluence to bulbar urethra was observed confirming only one prostate and bladder. RESULTS: The cystoscopy through the right penile identified the urethral confluence in the bulbar area. We performed a meatotomy in the left penile to insert the cystoscope and confirmed the blind ending urethra. We decided to remove this penile. The penile was degloved entirely and clamped and took out the corpora at the base. DISCUSSION: Diphallia can have three presentations: only glans duplication, bifid diphallia and complete diphallia (two corpora cavernosa and a corpus spongiosum for each penile). In our case, each penile presented only one corpora cavernosa and the decision taken was based on urethral patency. CONCLUSION: The treatment should always be planned individually whereas associated anomalies with the goal of attaining satisfactory functional and cosmetic results.
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Doenças do Pênis , Pré-Escolar , Humanos , Imageamento por Ressonância Magnética , Masculino , Pênis/anormalidades , Pênis/diagnóstico por imagem , Pênis/cirurgia , Uretra/anormalidades , Uretra/diagnóstico por imagem , Uretra/cirurgia , Bexiga UrináriaRESUMO
ABSTRACT Purpose: To evaluate the use of transperineal ultrasonography while diagnosing stress urinary incontinence (SUI) by comparing the urethral angle (α), posterior urethrovesical angle (β), and bladder neck descent (BND) during rest and Valsalva maneuver in continent women and women with SUI. Materials and methods: This prospective observational study was conducted with 50 women with SUI and 50 continent women. Transperineal ultrasonography was performed at rest and during Valsalva maneuver. Q-tip test was performed. Results: During the Valsalva maneuver, both α and β angles were significantly higher in women with SUI (p <0.001). The difference between Valsalva and rest measurements of α and β angles (R α, R β) were also significantly higher in women with SUI (p <0.001). The cut-off point determined for the R α in the diagnosis of stress incontinence was 16° (80% sensitivity, 98% specificity). A statistically significant strong correlation was found between Q-tip test angle and R α value (p=0.000; r=0.890). Q-tip VAS pain scores were significantly higher than ultrasonography VAS pain scores (p <0.001). In relation to the bladder neck descent comparison between the two groups showed that BND was significantly higher in SUI group (p <0.001). The cut-off point determined for BND in the diagnosis of SUI was >11mm (90% sensitivity, 98% specificity). Conclusion: Transperineal ultrasonography is a practical, reliable, non-invasive and comfortable method for evaluation of SUI. It has the advantage of dynamic evaluation during the Valsalva maneuver. Rotation angles and BND have high sensitivity and specificity for detection of SUI. The change in α angle with Valsalva (Rα) can be used as an alternative to Q-tip test.
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Humanos , Masculino , Feminino , Incontinência Urinária por Estresse/diagnóstico por imagem , Bandagens , Uretra/diagnóstico por imagem , Estudos Prospectivos , UltrassonografiaRESUMO
ABSTRACT Introduction: The transverse vaginal septum (TVS) with congenital urethra-vaginal fistula (CUVF) is a rare anomaly of the mullerian duct (1, 2). Incomplete channelling of the vaginal plate, or an abnormality in the fusion of the vaginal component of mullerian duct with the urogenital sinus results in TVS (1, 3, 4). High CUVF occurs due to the persistent communication between the urogenital sinus and utero-vaginal primordium at the tubercle sinus, whereas low CUVF is due to excessive apoptosis of the vaginal plate during channelling (5). The principles of management of CUVF with TVS include: 1) TVS resection, 2) Create a neovagina. We present a case of CUVF with TVS managed by robotic assistance. Material and methods: A 24-year-old female, married for 3 years, presented with cyclical hematuria since menarche, dyspareunia and primary infertility. Examination revealed blind ending vagina 4cm from the introitus. Magnetic resonance imaging revealed a fistulous communication between urethra and vagina, and TVS. Cystourethroscopy confirmed a proximal urethra-vaginal fistula. Urethroscopy guided puncture of the TVS was performed, tract dilated and a catheter was placed across it. Robotic assisted transvaginal approach was planned. Air docking of robot was performed. Traction on the catheter was given to identify the incised edges of the septum. Vaginal flaps were raised laterally, fistulous tract was excised. Proximal vagina mucosa was identified and vaginoplasty was performed. Result: Patient's postoperative recovery was uneventful. Urethral catheter was removed after 5 days. She had normal voiding and menstruation. Vaginoscopy performed at 1st month follow-up, revealed an adequate vaginal lumen. Vaginal moulds were advised for 6 weeks during the night, following which she resumed her sexual activity. She conceived 6 months post-surgery, and delivered a child by caesarean section. Conclusion: We successfully managed this case by resection of septum, neovagina creation and thereby achieving normal menstruation and conception. The advantages of robotic approach were magnification, precision and manoeuvrability in a limited space, avoiding a vaginal release incision.