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Purpose: The urethro-vesical anastomosis represents one of the most challenging steps of robotic prostatectomy (RARP). To maximize postoperative management, we specifically designed our anastomosis quality score (AQS), based on the intraoperative characteristics of the urethra and bladder neck., Methods: This is a prospective study, conducted from April 2019 to March 2020. All the patients were classified into three different AQS categories (low, intermediate, high) based on the quality of the anastomosis. The postoperative management was modulated accordingly., Results: We enrolled 333 patients. According to AQS, no differences were recorded in intraoperative complications (p = 0.9). Median hospital stay and catheterization time were longer in AQS 1 group (p < 0.001). Additionally, the occurrence of postoperative complication was higher in AQS 1 category (p = 0.002) but, when focusing on the complications related to the quality of the anastomosis, no differences were found neither for acute urinary retention (p = 0.12) nor urine leakage (p = 0.11). Finally, concerning the continence recovery, no significant differences were found among the three groups for each time point. The highest potency recovery rate at one month of follow-up was recorded in AQS 3 category (p = 0. 03)., Conclusion: The AQS proposed revealed to be a valid too to intraoperatively categorize patients who underwent RARP on the basis of the urethral and bladder neck features. The modulated postoperative management for each specific score category allowed to limit the occurrence of complications and to maximize the functional outcomes., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.)

Objectives: The aim of this retrospective study is to describe the importance of serum creatinine levels for the long-term renal outcome in cases of posterior urethral valve., Methods: Records of 94 patients who underwent cystoscopic valve ablation were evaluated retrospectively. Demographic variables, radiologic findings, and serum creatinine levels were recorded. Patients were grouped according to the serum creatinine levels in the first month of life. Twenty-four patients' serum creatinine levels were found to be above 1 mg/dL in group 1 and ≤1 mg/dL in 70 patients in group 2., Results: The initial findings of 74 patients were as follows: pyelonephritis in 24 (32.43%) patients, hydronephrosis in 20 (27.02%), and inability to urinate in 18 (24.32%). Prenatal hydronephrosis was present in 36 cases (38.29%). Of the 92 voiding cystograms, 53.26% had findings that included vesicoureteral reflux. The mean serum creatinine levels of the patients in group 1 increased above 1 mg/dL in the 2nd year, the significant difference between the two groups lasted up to 7 years of age, and no significant difference was observed at the age of 7. The mean serum creatinine levels of the patients in group 2 were observed to increase above 1 mg/dL by the 10th year., Conclusions: In patients with posterior urethral valves, nadir creatinine, especially higher than 1 mg/dL, should be considered as high risk for end-stage renal disease. Therefore, clinicians should improve awareness about early detection and treatment of posterior urethral valves, and these patients should be monitored as early as possible for the risk of chronic kidney disease., (© 2020 John Wiley & Sons Australia, Ltd.)

Objective: To better define patient-reported outcomes after urethroplasty. While urethroplasty is the most effective treatment for urethral stricture, the majority of outcomes are reported using surgeon-defined endpoints., Methods: Patients were enrolled in a prospective study evaluating patient-reported outcomes after urethroplasty from 2012 to 2018. A number of domains were assessed preoperatively and 6 months postoperatively using both validated and nonvalidated measures including satisfaction, voiding function, urinary quality of life, erectile/ejaculatory function, penile appearance/curvature, and genitourinary pain., Results: Of 357 patients completing the study, mean age was 49.7 years with mean stricture length of 4.4 cm. Total 95.9% of patients were stricture-free on 6-month cystoscopy. Eighty percent of patients reported being satisfied with surgery, while 7.3% of patients were unsatisfied. Voiding function was globally improved after urethroplasty including International Prostate Symptom Score (19.3 vs 6.0; P < .0001), urinary quality of life (4.7 vs 1.6; P < .0001), postvoid dribbling (2.7 vs 2.5; P = .04), and sitting to void (2.4 vs 1.9; P < .0001). Additionally, genitourinary pain improved postoperatively (2.2 vs 1.6; P < .0001). Mean erectile function remained unchanged (17.7 vs 17.2; P = .46) but 12.0% of patients reported new onset erectile dysfunction. Reported ejaculatory dysfunction did not change significantly postoperatively (P = .13) but 7.1% of patients reported new ejaculatory dysfunction. Total 6.7% and 3.1% of patients complained of bothersome loss of penile length or curvature, respectively., Conclusion: Urethroplasty improves voiding function and genitourinary pain associated with urethral stricture. While sexual function is preserved for the majority of patients, a small proportion of patients describe new onset erectile dysfunction, penile shortening or curvature and should be counselled accordingly., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: We sought to characterize a standardized postoperative radiographic and functional voiding trial, and determine its impact on outcomes after substitution urethroplasty., Materials and Methods: This is an observational, monocenter study of men who underwent 1-stage ventral onlay buccal mucosal graft urethroplasty for bulbar urethral stricture between January 2009 and December 2016. Patients were stratified by voiding trial success vs failure, including radiographic (extravasation or residual narrowness) and functional (post-void residual volume greater than 100 ml) failure, 21 days postoperatively. End points were voiding trial failure and recurrence-free survival. Regression models were created to determine risk factors of voiding trial failure and evaluate the impact of voiding trial failure on recurrence., Results: The voiding trial succeeded and failed in 437 (85.2%) and 76 (14.8%), respectively, of 513 men. Of the latter men 54 (71.1%) showed evidence of extravasation and 22 (28.9%) had residual narrowness or functional failure. On multivariable logistic regression analyses no preoperative predictor of voiding trial failure was found (all p >0.05). At a median followup of 32 months Kaplan-Meier analyses (log rank test p = 0.033) and multivariable Cox regression analyses (HR 1.86, p = 0.037) revealed an association of voiding trial failure and stricture recurrence. When further stratifying voiding trial failure, residual narrowness or functional failure (HR 4.60, p <0.001) but not extravasation (HR 1.08, p = 0.9) was a risk factor for recurrence. Limitations include the retrospective assessment of investigated end points., Conclusions: Residual narrowness or functional failure at an early voiding trial after buccal mucosal graft urethroplasty may predict stricture recurrence. Identifying intraoperative complexity factors predicting initial voiding trial failure might be a key to identifying those individuals with early recurrence.

Introduction:  Delayed presentation of posterior urethral valves (PUVs) is a rare condition. Presentation and diagnosis of the patients with late PUVs are challenging. Voiding cystourethrogram (VCUG) is mainly practiced. In this study, we aimed to evaluate the children with late-presented PUVs, and the reliability of VCUG in this group., Materials and Methods:  Between January 2003 and December 2017 records of patients who were diagnosed with late-presented PUVs were analyzed. Delayed presentation of PUV was defined as patients who were diagnosed and treated after infancy. Cases were examined in terms of age at diagnosis, presenting symptoms, urinalysis, urinary ultrasound, urodynamic studies, VCUG, and dimercaptosuccinic acid scintigraphy findings. Postoperative follow-up conditions were also assessed., Results:  Seventeen boys were diagnosed with late-presented PUVs (mean age was 7.35 years). The most common symptoms at presentation were frequency (58.8%), day and nighttime incontinence (47%), and febrile urinary infection (41%). PUV was noted by VCUG in 10 patients alone. The classical sign of dilated posterior urethra was detected in 9 patients. The 10th patient had posterior urethral irregularity. Urethra could not be evaluated due to unsuccessful voiding in one patient. Six patients had normally appearing urethra on VCUG. Reflux was detected in nine (52.9%) patients., Conclusion:  Late-presented PUVs may be missed on VCUG. Whether a PUV might be present is crucial in boys with a history of recurrent urinary infection, persistent reflux, and repetitive daytime incontinence. Based on our results, we conclude that cystoscopic examination should be preferred for those cases to diagnose PUVs regardless of VCUG results., Competing Interests: None., (Georg Thieme Verlag KG Stuttgart · New York.)

Aims: We determined whether or not replication-defective herpes simplex virus vector-mediated kynurenine aminotransferase II (HSVrd-KAT II) suppressed the tonic activity of the urethral sphincter in spinal cord-injured (SCI) rats., Methods: Thirty-six adult female Sprague-Dawley rats were used to produce a spinal cord injury model. One week after spinalization, HSVrd-KAT II was injected into the urethral wall of rats and another two groups of SCI rats were treated with saline and HSVrd as controls. Three weeks after viral injection, the urethral pressure profile (UPP), continuous cystometry, and gene expression in the L6-S1 spinal cords were evaluated in all three groups., Results: In the HSVrd-KAT II group, the maximum urethral closure pressure (Pclo.max) and maximum voiding pressure were significantly decreased (23.6-24.9% and 31.6-30.9%, respectively), in addition to an increase in voiding efficiency(48.8-76%), compared with the sham and HSVrd groups. The KAT II protein and mRNA levels were significantly increased in HSV-KAT II group compared with the HSVrd group., Conclusion: KAT II gene therapy effectively reduced the urethral pressure, improving detrusor-sphincter dyssynergia (DSD), and detrusor overactivity (DO), probably by blocking the N-methyl-D-aspartate receptor (NMDAr) in the L6-S1 spinal cord. Neurourol. Urodynam. 36:1046-1051, 2017. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

A 24-year-old man presented with symptoms of difficulty in passage of urine, mixed with gas and stool from penoscrotal junction since birth. He had a history of surgery (posterior sagittal anorectoplasty) for imperforate anus in first week of his life. On physical examination, external meatus was adequate with small 5×5 mm fistulous opening noted at penoscrotal junction with normal anal tone and opening. On evaluation with retrograde urethrography, voiding cystourethrogram, cystoscopy and barium enema, he was found to have penile urethrocutaneous fistula of 0.5×0.5 cm with Y-type incomplete urethral duplication. Urethroanal fistula (Y-type urethral duplication) was of small size (<5 mm), so closed primarily through perineal route with interposition of ischiorectal fat. Penile urethrocutaneous fistula (4 mm) too was closed primarily and covered with tunica vaginalis flap in single sitting. It has been 6 months since surgery and the patient is fully continent and voiding well with no urinary or faecal leak., (2017 BMJ Publishing Group Ltd.)

Ideal therapy for lower urinary tract dysfunction in patients with spinal cord injury (SCI) should decrease detrusor overactivity, thereby promoting urine storage at low intravesical pressure and promoting efficient voiding at low pressure by decreasing detrusor-sphincter dyssynergia. Here we investigated blockade of various α-adrenoceptors to determine the subtype that was principally responsible for improving the voiding dysfunction. The effects of the intravenous α-blocker naftopidil, the α-blocker BMY 7378, and the α-blocker silodosin were evaluated using cystometrography and external urethral sphincter-electromyography (EMG) in decerebrated, unanesthetized female Sprague-Dawley rats with chronic SCI following transection at Th8. Parameters measured included the voided volume, residual volume, voiding efficiency, and burst and silent periods on EMG. Compared with values in decerebrated non-SCI rats, EMG of decerebrated SCI rats revealed more prominent tonic activity, significantly shorter periods of bursting activity, and a reduced ratio of the silent to active period during bursting. Compared with the value before drug administration (control), the voiding efficiency was significantly increased by naftopidil (1 and 3 mg/kg) (<0.05 each), and the burst (<0.01 and <0.05, respectively) and silent periods (<0.01 each) on EMG were significantly lengthened. BMY 7378 (1 mg/kg) significantly increased voiding efficiency and lengthened the burst periods (<0.05 each). Silodosin did not affect any parameters. These results suggest that α-blockade reduces the urethral resistance associated with detrusor-sphincter dyssynergia, thus improving voiding efficiency in SCI rats., (Copyright © 2016 the American Physiological Society.)

Megalourethra is a diffuse dilatation of the anterior urethra due to lack of corpus spongiosum with or without corpora cavernosa; it usually presents as a dilatation of that part of the urethra. The absence of these structures causes a ballooning of the urethra despite there being no mechanical obstruction. A 7-year-old boy presented with the complaints of weak stream, ballooning of the penis before and during voiding urine and post voiding dribbling. After examination and micturating urethrogram, he was diagnosed as having megalourethra, which was then corrected using reduction urethroplasty. These days megalourethra is diagnosed with prenatal ultrasonogram. This was a case of isolated delayed presentation of megalourethra without any associated anomaly.

Objective: To analyze the video-urodynamic results of voiding dysfunction in men of all ages with bothersome lower urinary tract symptoms (LUTS) after α-1 adrenoceptor blocker therapy., Methods: A total of 930 consecutive men over 45 years of age with LUTS who were failure treated with α-1 blocker therapy for at least one month were retrospectively studied. Patients underwent video-urodynamic studies to evaluate the cause of lower urinary tract dysfunction (LUTD). Clinical symptoms, prostatic measurements, and video-urodynamic findings were compared among different LUTD groups., Results: After video-urodynamic studies, 653 (70.2%) men were diagnosed with voiding dysfunction and 277 (29.8%) were with bladder dysfunction. Among patients with voiding dysfunction, bladder neck dysfunction (BND) occurred in 242 (37.1%), benign prostatic obstruction (BPO) in 298 (45.6%), and poor relaxation of the external sphincter (PRES) in 113 (17.3%). The symptom score did not differ significantly among the three subgroups. The mean age, total prostate volume (TPV), transition zone index, and prostate-specific antigen were also significantly higher in BPO patients compared with the other two subgroups, but no difference was noted between BND and PRES patients. BPO patients had significantly higher voiding pressure, higher Abrams-Griffiths number, lower Qmax, and a higher rate of detrusor overactivity than did patients in the other two subgroups., Conclusion: Bladder neck dysfunction and PRES play important roles in male LUTS. In men younger than 70 years with small TPV and persistent LUTS after α-1 blocker therapy, video-urodynamic studies should be performed to make an accurate diagnosis before invasive surgery is planned., (© 2014 Wiley Publishing Asia Pty Ltd.)

Purpose: To evaluate the safety and efficacy of valgus mucosa anastomosis in posterior urethra reconstruction., Methods: We retrospectively reviewed the medical records of 116 patients who had undergone anastomotic repair of posterior urethral strictures between 2009 and 2013. Seventy-six patients underwent valgus urethral mucosa anastomosis (group A), and 40 underwent traditional end-to-end anastomosis (group B). The voiding status, complication rate, and adjuvant therapy were compared between the two groups. The clinical outcome was considered a failure when any postoperative intervention was needed., Results: Patient age ranged from 11 to 68 years (mean 38.2 ± 10.6). Follow-up was 5-59 months (mean 19.5 ± 13.2). The estimated urethral stricture length was 0.5-3.5 cm (mean 1.85 ± 0.40). Of all patients, the number of patients with simple stricture and complicated stricture were 47 and 69 respectively, and there was no significant difference in the complexity of stricture between group A and group B (60.5 vs. 57.5%, P > 0.05). Besides, there was no significant difference in the follow-up time and length of stricture between the two groups (31.6 ± 12.0 vs. 35.1 ± 14.8 months, P > 0.05). Compared to group B, the operation success rate in group A was greatly improved (92.1 vs. 80%, P < 0.05), while the incidence of complication was similar between the two groups (31.6 vs. 27.5%, P > 0.05)., Conclusions: The valgus urethral mucosa anastomosis could significantly improve the operation success rate of end-to-end anastomosis, reduce the stricture recurrence rate, improve the long-term urination function, and not increase the incidence of complications. So, valgus urethral mucosa anastomosis is an easy, effective and reliable urethral anastomosis technique.

Urinary toxicity is common after low-dose-rate (LDR) brachytherapy, and the resolution of urinary toxicity is a concern. In particular, urinary frequency is the most common adverse event among the urinary toxicities. We have previously reported that approximately 70% of patients experience urinary frequency during the first 6 months after seed implantation. Most urinary adverse events were classified as Grade 1, and Grade 2 or higher adverse events were rare. The incidence of urinary retention was approximately 2-4%. A high International Prostate Symptom Score before seed implantation was an independent predictor of acute urinary toxicity of Grade 2 or higher. Several previous reports from the United States also supported this trend. In Japan, LDR brachytherapy was legally approved in 2003. A nationwide prospective cohort study entitled Japanese Prostate Cancer Outcome Study of Permanent Iodine-125 Seed Implantation was initiated in July 2005. It is an important issue to limit urinary toxicities in patients who undergo LDR brachytherapy., (Copyright © 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)

Unlabelled: The difficulty to access to the urethral meatus is found in women in relation to morphological abnormalities of urogenital or ectopic locations meatus, whether acquired (urethral meatus buried [UMB]) or congenital reality (urethra hypospadias [UH]). The pathophysiology is not unequivocal with lack of clear and specific studies., Purpose: Verify the existence of specific functional problems, assess the prevalence and identify the anatomical features of UMB and UH., Materials: UMB and UH were sought in a computerized database listing the patients attending a neurourology department between 2000 and 2014 for a pelvic-perineal disease. Each case was analysed for specific reached leaks, urinary tract infections and difficulties catheterization., Results: Of the 12,739, 131 patients (1%) met the inclusion criteria, including 18 UH and 113 UMB. Ninety-one patients consulted for urinary disorders of neurological origin. The circumstances of UMB and UH discovery were: perineal systematic review in 63 cases (48%); difficulties of urethral catheterization in 65 cases (49%); urinary incontinence for 3 patients (3%). Urinary tract infections have not led to the discovery of UMB or UH. Difficulties locating the urethral meatus were congenital (UH) in 18 cases (13%). In 113 cases (87%), it was an acquired abnormality (UMB) overweight for 16 patients (12%), troublesome spasticity of the adductor muscles in 18 cases (14%), vulvovaginal atrophy in 5 cases (4%) and a patient (1%) with a pelvic organ prolapse. No details were given for the remaining 72 patients (54%)., Conclusion: The urethral meatus difficult access due to MUE or UH can be met in a specialized service but the exact concept of MUE be defined. It can be considered as urethral meatus difficult to access and the cause is acquired. Functional impairment may be particularly important in patients requiring catheterization for bladder emptying., Level of Evidence: 4., (Copyright © 2014. Published by Elsevier Masson SAS.)

Purpose: Transurethral resection of the prostate (TURP) is considered by some as a risk factor for genitourinary (GU) toxicity after radiotherapy (RT). However, there are conflicting results regarding the interaction between RT and TURP with respect to GU toxicity. The purpose of this report is to review the published data concerning TURP before or after RT and its effect on urinary complication., Methods and Materials: A systematic literature review based on database searches in MEDLINE, EMBASE, Pubmed, Ovid, and Chochrane Library. The eligibility criteria of final review were (1) definitive RT for prostate cancer is reported; (2) comparison of GU toxicities between patients with and without TURP is reported; (3) minimum 5 patients after TURP are included., Results: Twelve articles regarding overall GU toxicity, 15 articles regarding urinary incontinence, and 13 articles regarding urinary or bladder neck stricture met eligibility criteria, and they were included in the final review. A quantitative synthesis from the data of selected articles was impossible because of variable grading systems and variable definitions in their comparisons between patients with and without TURP. However, most published articles demonstrated the increased risk of GU toxicity with TURP in patients treated with RT., Conclusions: Our systematic review strongly suggests that TURP is one of the risk factors of GU toxicity after RT. This needs to be taken seriously when prostate cancer patients with TURP are considered for RT either external beam or brachytherapy.

Presence of posterior urethral valves (PUV) is the most common cause of urinary tract obstruction in the male neonate. Late presentation occurs in 10% of cases. We present a case of PUVs in an adult male who presented with history of obstructive lower urinary tract symptoms and hematuria. On evaluation, he was found to have raised serum creatinine level. A voiding cystourethrogram (VCUG) could not be completely performed because of narrowing in the posterior urethra. A rigid urethrocystoscopy was performed at which he was found to have type-I posterior urethral valve which were fulgurated. A repeat uroflowmetry revealed maximum flow rate of 12 ml/second. This case highlights that PUVs is not solely a disease of infancy but may also present late. VCUG is the radiological investigation of choice but the diagnosis may be missed. A urethrocystoscopy is advised if there is a high index of suspicion.

Objective: Congenital anomalies or malformations of the urethra that involve number are extremely rare and only 7 cases of trifurcation of the urethra and under 500 cases of urethral duplication have been described., Methods: In the case we present, urethral duplication was diagnosed in adulthood, even though glans malformation with 2 urethral orifices was clearly evident and only 1 was functional., Results: The condition is usually diagnosed in childhood due to the presence of 2 urethral meatus or from double stream if both are functional; at other times, the condition is diagnosed from complications that trigger infections or obstruction or if it is associated with more extensive malformations., Conclusions: Urethral duplication is an extremely rare birth defect, and diagnosis in adulthood is even more uncommon. No single embryologic argument explains all the anatomic variants of urethral duplication. The treatment of the urethral duplication should be individualized according to the type of duplication and the clinical symtoms.

Voiding dysfunctions are common neurological complications after a stroke, yet there are few urodynamic studies of patients with cerebellar stroke. We report the video urodynamic findings of 15 patients with cerebellar stroke, including eight patients with ischemic and seven with hemorrhagic stroke. Their mean age was 75 ± 13.4 years and the mean interval from stroke to video urodynamic study was 11.2 ± 17.9 months. At urodynamic study, four (50 %) patients with ischemic stroke had urinary incontinence as did two (28 %) patients with hemorrhagic stroke. Detrusor overactivity (DO) was found in eight (53 %) patients, dyssynergic urethral sphincter in six (40 %), and nonrelaxing urethral sphincter in seven (47 %). DO occurred in six (75 %) of patients with ischemic stroke and in two (28.6 %) of patients with hemorrhagic stroke (p = 0.072). While DO was not found in five of the 15 patients within 2 months after the stroke, it was more frequently detected in eight (80 %) of the 10 remaining patients 2 or more months after stroke (p = 0.007). Four (80 %) of the five stroke patients had nonrelaxing sphincter and urinary retention within 2 months after stroke. Two or more months after their strokes, coordinated sphincter function was noted in two (20 %) patients and dyssynergic sphincter was found in six (60 %); two (20 %) remained with nonrelaxing sphincter. Thus, lower urinary tract dysfunction caused by cerebellar stroke may change with time. Knowledge of video urodynamic findings should help us better manage voiding dysfunction in patients with cerebellar stroke.

Posterior urethral valves are most commonly detected in the early neonatal period, the diagnosis often antenatally suspected from ultrasound findings. Nevertheless, some cases might go undetected and become manifest later in life with lower urinary tract symptoms. We describe the unusual case of a 5-year-old boy with a 2-month history of bladder distension, urinary dribbling, and epididymitis. Cystourethrography revealed posterior urethral valves with reflux into the seminal vesicles, vas deferens, and epididymis, bilaterally. A review of the published data is provided in the context of this unusual presentation pattern., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: To evaluate the results of a dorsal onlay augmented anastomosis using buccal mucosa to reconstruct long segment bulbar urethral strictures. The ideal treatment of long segment bulbar urethral strictures remains controversial. Urethroplasty with tissue transfer is typically required, but the optimal technique is unknown., Materials and Methods: A prospective cohort of 163 patients with complete follow-up data underwent dorsal onlay augmented anastomosis using buccal mucosa for long segment bulbar urethral strictures from November 2003 to March 2011. All patients underwent preoperative urethrography and cystoscopy. The follow-up protocol consisted of cystoscopy and subjective symptom assessment at 6 months and symptom assessment at 12 months, with repeat cystoscopy, if indicated. Annual symptom assessments were performed thereafter as required. Stricture recurrence was defined as a segment <16F on cystoscopy or the presence of intractable voiding symptoms. The secondary outcome measure was the incidence of postoperative complications using a nonvalidated questionnaire. Fisher's exact test was used to evaluate the patency and complication rates between patient age and stricture length., Results: The median follow-up period was 31.0 months (range 6-91). Of the 163 patients, 157 (96.9%) had no evidence of stricture recurrence. Postoperative complications included postvoid dribbling (41.7%; 68 of 163), urinary tract infection (3.7%; 6 of 163), erectile dysfunction (3.1%; 5 of 163), orchalgia (10.4%; 17 of 163), and donor site morbidity (4.3%; 7 of 163). Age was not associated with recurrence, but stricture length ≥5 cm was associated with a lower patency rate (P = .010)., Conclusion: Dorsal onlay augmented anastomosis using buccal mucosa demonstrated a 96.9% patency rate in our single-center prospective study and should be considered for reconstruction of long segment bulbar urethral strictures, especially with a focal segment of obliteration. Strictures ≥5 cm are prone to recurrence but are still amenable to dorsal onlay augmented anastomosis using buccal mucosa., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: To address the issue of sexual function and fertility in PUV patients., Patients and Methods: Of 47 patients (age > 18 years) treated for PUV in infancy 28 were contactable. They were sent a standard questionnaire requesting details on voiding dysfunction symptoms, and experience of erection, orgasm and ejaculation., Results: Of the 28, 16 (mean age 24 years) returned the questionnaire. Voiding frequency ranged from 3 to 10 times per day (mean = 5). Two patients had occasional mild diurnal incontinence but none had symptoms of overactivity. Three patients had a weak urinary stream. Renal function was normal in 9, 4 had a glomerular filtration rate <80 ml/min/1.73 m(2), and 3 had undergone renal transplant. Erections and orgasm were experienced by the 15 patients who responded to these questions, with 4 reporting mild or medium erectile dysfunction and 1, on dialysis, reporting slow ejaculation. Post-masturbation samples of semen and urine were collected from 6 patients. One had an alkaline pH, high percentage of immotile sperm and low sperm count. Another had a high concentration of abnormal forms, and seminal fluid was present in the urine of 3 patients., Conclusions: In long-term follow-up, 44% of PUV patients develop chronic renal failure or end-stage renal disease, but bladder dysfunction symptoms are infrequent. Sexual function is mostly normal. Total semen counts and motility are compatible with paternity in most patients., (Copyright © 2011 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Purpose: Girls with an anterior deflected urinary stream (ADUS) cannot void in the ideal toileting position, resulting in lower success rates of behavioral training programs. Purpose was to study prospectively the clinical effects of surgical meatus correction for ADUS in girls with dysfunctional voiding (DV)., Methods: A cohort of 171 DV patients aged 6-12 years was investigated. All had recurrent urinary tract infections (UTIs), staccato or interrupted uroflow, and >10% residual urine on ultrasound. For study purposes, all underwent a urodynamic study (UDS) to confirm DV. ADUS was recognized at first examination in 55 patients (32%) and a dorsally directed meatal correction was performed to achieve a normal direction of the urinary stream. The non-ADUS group (116 girls) was given behavioral therapy (BT); however, a subgroup of 11 girls with ADUS was detected with persistent complaints after failed BT. These 11 girls also underwent a meatal correction., Results: All DV complaints were resolved in 25 of the 55 (45%) girls from the original ADUS group and 8 of the 11 (73%) girls from the second group. During UDS, in the ADUS group free of complaints after meatal correction, a significantly higher P(max) (102 cmH(2) O) was found compared to those who did not benefit from correction (P(max) 76 cmH(2)O)., Conclusion: In this study, 39% of female DV patients had ADUS complaints. After surgical correction, 50% were free of all complaints without requiring any further behavioral training. The fast recovery into a normal voiding pattern in these girls shows that a meatus deformity needs to be looked for in all girls presenting with DV., (Copyright © 2012 Wiley Periodicals, Inc.)

Urethral duplication is a rare congenital genitourinary abnormality. The purpose of this report is to add to the scanty literature on the subject. We emphasize the significance of high index of suspicion, thorough evaluation, and to discourage circumcision performed by unqualified individuals. A six year old with a finding of urethral duplication is presented along with the review of the literature.The patient presented with of passage of urine from 2 orifices on the penis following circumcision, six months prior presentation. He voids with double streams - clear urine and the other haematuria. Examination revealed a normal primary urethral meatus and an accessory opening on the corona of the dorsal surface of the phallus. No other abnormality detected. Patient had single stage urethroplasty with good outcome. Urethral duplication is rare. Diagnosis requires a high index of suspicion. Optimal knowledge of the duplication is significant for the managing surgeon in order to avoid complications. The overall outcome is good.

Colorectal resection for endometriosis is a major operation exposing patients to the risk of severe digestive and urological complications. The objective of this review is to evaluate surgery-related urological morbidity of which little is known to date. We searched MEDLINE for articles published on colorectal resection for endometriosis between 1998 and March 2011 using the following terms: "bowel", "rectal", "colorectal", "rectovaginal", "rectosigmoid", "resection" and "endometriosis". We were not able to perform a meta- analysis due to a lack of complete data on urological complications so have focused this review on voiding dysfunction and ureteral injury. Thirty-two articles reporting on 3047 colorectal resections for endometriosis including 1930 segmental resections, 271 discoid resections and 846 rectal shavings were analysed. For voiding dysfunction, 28 series including 2563 colorectal resections were available. Postoperative voiding dysfunction varied from 0% to 30.4% with a mean value of 3.4% (73/2118). Fourteen series reported an incidence of ureterolysis comprising between 8.5% and 100% with a mean value of 46% (815/1772 patients). The risk of urinary fistulae evaluated in 26 series was estimated at 0.9% (24/2581 patients). Only one case of hydronephrosis was reported in 9 series including 1256 patients (0.07%). The incidence of urological morbidity associated with colorectal endometriosis is poorly documented and probably underestimated due to the short follow-up reported in the series. Moreover, as complication rates varied widely according to the type of surgery and the experience of the teams, further studies are required to identify risk factors of urological morbidity so as to adequately inform patients.

Congenital abnormalities of the genitourinary system have a definable durable impact on the adult lives of those individuals affected, despite prompt and appropriate surgical and medical intervention during infancy and childhood. Three abnormalities are described, including relatively common problems of the newborn male, such as hypospadias and cryptorchidism, as well as a less common issue, posterior urethral valves. An understanding and awareness of the consequences of these 3 congenital abnormalities is paramount for the long-term care of the pediatric patient as he transitions to adolescence and adulthood., (Copyright © 2012 Elsevier Inc. All rights reserved.)

We present a very rare case of stone formation in the periurethral gland of a 49-year-old woman who was referred to our hospital with suspicion of a malignant or granulomatous soft-tissue lesion in the paraurethral area. The lesion was excised and the histopathological examination revealed cystic dilatation and squamous metaplasia in the lining of the glandular structure and surrounding lymphocyte infiltration. The scanning electron microscope examination of the stone revealed egg shell-like stratified concentric calcifications. The chemical composition revealed by the X-ray diffraction technique was a mixture of calcium oxalate and phosphate similar both at the outer and inner layers.

Purpose: To report the toxicity outcome in patients with localized prostate cancer undergoing (125)I permanent-seed brachytherapy (BT) according to a urethra-sparing, intraoperative (IO), real-time planned conformal technique., Methods and Materials: Data were analyzed on 250 patients treated consecutively for low- or intermediate-risk prostate cancer between 2005 and 2009. The planned goal was urethral V(150) = 0. Acute and late genitourinary (GU), gastrointestinal (GI), and erectile toxicities were scored with the International Prostate Symptom Score (IPSS) questionnaire and Common Terminology Criteria for Adverse Events (version 3.0). Median follow-up time for patients with at least 2 years of follow-up (n = 130) was 34.4 months (range, 24-56.9 months)., Results: Mean IO urethra V(150) was 0.018% ± 0.08%. Mean prostate D(90) and V(100) on day-30 computed tomography scan were 158.0 ± 27.0 Gy and 92.1% ± 7.2%, respectively. Mean IPSS peak was 9.5 ± 6.3 1 month after BT (mean difference from baseline IPSS, 5.3). No acute GI toxicity was observed in 86.8% of patients. The 3-year probability of Grade ≥2 late GU toxicity-free survival was 77.4% ± 4.0%, with Grade 3 late GU toxicity encountered in only 3 patients. Three-year Grade 1 late GI toxicity-free survival was 86.1% ± 3.2%. No patient presented Grade ≥2 late GI toxicity. Of patients with normal sexual status at baseline, 20.7% manifested Grade ≥2 erectile dysfunction after BT. On multivariate analysis, elevated baseline IPSS (p = 0.016) and high-activity sources (median 0.61 mCi) (p = 0.033) predicted increased Grade ≥2 late GU toxicity., Conclusions: Urethra-sparing IO BT results in low acute and late GU toxicity compared with the literature. High seed activity and elevated IPSS at baseline increased long-term GU toxicity., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: To compare perioperative and functional outcomes after urethrovesical anastomosis (UVA) with barbed polyglyconate and monofilament poliglecaprone in robot-assisted radical prostatectomy (RARP). Barbed polyglyconate suture was first used for the UVA during RARP beginning in January 2010; safety and feasibility were previously demonstrated in 51 patients., Methods: From May to September 2010, 64 patients meeting all the inclusion criteria participated in the present multisurgeon prospective, randomized, controlled trial and underwent posterior repair and UVA during RARP with either barbed polyglyconate (n=33) or monofilament poliglecaprone (n=31) suture. The primary outcomes were the anastomotic (UVA) and posterior reconstruction times. Secondary outcomes included cystogram leak, bladder neck reconstruction rate, and 6-week functional outcomes assessed by a self-administered validated patient questionnaire., Results: Posterior reconstruction was performed within 3.3 minutes with the barbed suture versus 4.3 minutes with the monofilament poliglecaprone suture (23.3% reduction) and UVA within 10.1 versus 13.8 minutes, respectively (26.8% reduction). The absolute time difference for the 2-layer anastomosis was 4.7 minutes (a 26.0% reduction in the total anastomosis time). All other perioperative outcomes were equivalent between the 2 groups. Urinary functional outcomes, including the pad use and leakage rates, were equivalent at 6 weeks., Conclusion: Anastomosis during RARP with the V-Loc barbed suture can be performed safely and more efficiently than with standard monofilament suture. We demonstrated a 26% decrease in the anastomotic time with no increase in the adverse events, no instances of urinary retention and equivalent functional outcomes were measured with the self-administered patient questionnaire., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: To determine the effect of urethroplasty for urethral stricture disease on both voiding symptoms and sexual function through the use of validated patient questionnaires., Methods: Pre- and post-operative scores for the American Urological Association Symptom Index (AUASI), Incontinence Symptom Index (ISI), and Sexual Health Inventory for Men (SHIM) were obtained and compared for adult male patients undergoing urethroplasty. Score differences were then stratified by age. Relevant clinical and demographic characteristics were also examined., Results: Over the 15-year study period, 183 patients underwent 222 urethroplasties. Median age at the time of surgery was 45 years. Urethroplasties were performed for 207 anterior and 15 posterior urethral strictures. The most common approaches were primary anastomotic (36.5%), staged (23.9%), and buccal graft augmented (21.6%). Overall, 63% of men had a clinically meaningful (≥4 point) improvement in AUASI total score and 69% had improvement in their quality of life (QOL) score after urethroplasty. In aggregate, AUASI total scores improved by 7 points (P<.001), and QOL scores improved by 2 points (P<.001). There was no significant difference in ISI or SHIM scores before and after urethroplasty. AUASI total scores improved more dramatically in younger patients. Half of patients with improved AUASI QOL scores did not have a corollary improvement in their total score., Conclusions: As measured by validated questionnaires, patients of all ages can expect a meaningful improvement in bothersome voiding symptoms after urethroplasty for urethral stricture disease, with minimal impact on continence or erectile function., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Late presenting posterior urethral valves are very rare and often present ambiguously. The consequence of late detection can be profoundly detrimental, resulting in persistent voiding dysfunction and/or renal failure. We present an unusual case of a patient with posterior urethral valves who presented at the age of 28 years. We review the literature and discuss the clinical features, diagnosis, and treatment of this condition.

Urethral duplication is a rare congenital anomaly and presents as a spectrum of varying severity. This report present three cases of duplication of urethra whose presentation ranged from prepubic sinus to a complete urethral duplication. They were investigated using ultrasonography, retrograde urethrography and cystoscopy. They were treated depending on the severity of the anomaly. The management of these cases is discussed and the current literature on this rare entity reviewed.

Uroflowmetry, urethrocystoscopy and urethrography are either not readily available or the cost is prohibitive for many patients in low-resource countries. This paper examines the use of clinical history in post-urethroplasty follow-up. We retrospectively reviewed the outcome of 54 post-urethroplasty patients. Preoperative diagnostic work-up included simple blood tests and a retrograde urethrography, and postoperatively we did not perform any immediate diagnostic work-up. Follow-up of these patients was done through mobile phone calls and personal contacts. Eighty-nine per cent of our patients reported acceptable voiding over a mean follow-up period of 48.4 months - 79.6% were followed using mobile phone contact. In the majority of the urethral strictures cases, diagnostic work up can be kept to a minimum, thereby reducing cost. Follow-up can be done via phone calls and personal contact in many African countries where compliance is frequently less than encouraging. The spread of mobile phone networks across the continent has been remarkable.

Objective: Several factors have been identified as predictive of future renal function in children with posterior urethral valves (PUV). Our aim was to analyse upper and lower urinary tract outcome in patients with PUV, and determine any factors from the period of early management that were predictive of future renal function., Methods: The charts of 67 boys (mean age 2.4 years) diagnosed with PUV were reviewed. The most common presenting symptom was dribbling in 43.2% and UTI in 28.3%. Twenty-three (34.8%) patients developed end-stage renal disease aged 1-15 years. The mean time of renal survival was calculated as 7.8 (SEM=0.73) years., Results: Incontinence in patients over 5 years old, lower urinary tract dysfunction, serum creatinine level in first year or at the time of diagnosis, and presence of vesicoureteral reflux and high-grade bilateral reflux were significant risk factors for occurrence of renal failure in the future. Lower tract dysfunction was seen in 58.6% of patients. Postnatal diagnosis and presence of high-grade reflux were significant risk factors for the future occurrence of lower urinary tract dysfunction., Conclusion: It is important to recognize that PUV have consequences not only during childhood or before treatment, but also during or after the treatment period. Long-term assessment and follow-up of upper and lower urinary tract functions after valve ablation is necessary., (Published by Elsevier Ltd.)

Objective: The role of spinning top urethra (STU) in children with dysfunctional voiding was evaluated retrospectively., Material and Methods: From 1995 to 2002, the records of 154 children with dysfunctional voiding were reviewed retrospectively. Of the children 110 (71%) were girls and 44 (29%) were boys (mean age 8 years, range 4-14). All children were neurologically normal and no exhibited physical signs of occult spinal dysraphism. Patients were divided into two groups according to their width of proximal urethra: group I had STU and the group II had normal urethral width. The groups were compared with each other for gender, voiding symptoms, urinary tract infection (UTI), vesicoureteral reflux (VUR) and urodynamic observations., Results: There were 84 children (mean age 8.3 +/- 2.2 years, range 4-14) in group I and 70 (mean age 8.0 +/- 2.1 years, range 4-14) in group II; no significant age difference was found between the two groups (p = 0.4674). Group I consisted of 66 (71%) girls and 18 (29%) boys and group II 44 (63%) girls and 26 (37%) boys. STU was observed more in girls than boys in group I (p = 0.0316). UTI was observed in 57 patients (68%) in group I and 34 (49%) in group II (p = 0.0154). Mean duration of symptoms was 42 +/- 24 months (range 6-118) and 39 +/- 23 (range 3-120) months in groups I and II, respectively (p = 0.6302). Postvoid residual urine (PVR) more than 10% of expected bladder capacity was detected in 15 patients (18%) in group I and seven (10%) in group II. No association was found between the meaningful PVR and STU (p = 0.1653). The presence of detrusor overactivity during filling was observed in 54 patients (64%) in group I and 42 (60%) in group II (p = 0.4676). Diminished bladder compliance (< 10 ml/cmH(2)O) was detected in 34 patients (40%) in group I and 17 (24%) in group II (p = 0.0335). The mean voiding pressure was measured as 56 +/- 29 cmH(2)O in group I, which was significantly higher than in group II (49 +/- 25 cmH(2)O) (p = 0.0373). The mean flow rate during the emptying phase of urodynamics was 16 +/- 8 and 15 +/- 6 ml/s in groups I and II, respectively (not significant, p = 0.2686). VUR was detected in 16 patients (19%) in group I and two (3%) in group II (p = 0.0018)., Conclusions: STU was related to recurrent UTIs, VUR, poor bladder compliance and more serious functional urinary obstruction. Furthermore, STU may be a consequence of a neurogenic maturation defect in detrusor-sphincter coordination resembling that of urofacial syndrome, because development of this situation was found to be independent of the duration of symptoms.

Urethral reflexes are important regulators of micturition, and impairment of urethral afferent neuronal function may disrupt coordinated bladder and urethral activity, thereby contributing to voiding dysfunction in lower urinary tract disorders. Chemical stimulation by intraurethral irritant solution perfusion was used to determine whether urethral afferent neuronal function is altered in diabetes mellitus (DM). Sprague-Dawley rats were studied 10 wk after streptozotocin injection to induce DM or vehicle alone. Escalating doses of capsaicin (0.1-30 microM) or acetic acid (0.01-1%; AA) were perfused intraurethrally while recording isovolumetric bladder activity, urethral perfusion pressure, and electromyography of the external urethral sphincter (EUS-EMG). Some rats were additionally treated with alpha-bungarotoxin, hexamethonium, or bilateral transection of the sensory branches of the pudendal nerves (PudSNx). Intraurethral capsaicin inhibited bladder contractions in six out of seven control rats but not in any of six DM rats. Low-frequency oscillations (LFOs) of intraurethral pressure were observed in five out of six control rats with capsaicin-induced bladder inhibition. In contrast, intraurethral AA inhibited bladder contractions and enhanced tonic EUS-EMG activity in six out of six control and five out of six DM rats. LFOs occurred in four out of six control and three of five DM rats with AA-induced bladder inhibition. Chemically induced bladder inhibition and LFOs were not prevented by alpha-bungarotoxin but were eliminated by PudSNx and hexamethonium. Finally, LFOs were followed by phasic EUS activity. These findings show that DM affects urethral afferent neurons differentially, compromising those expressing TRPV1 receptors. Urethral smooth muscle LFOs are neurogenically mediated and induce EUS activity, revealing the existence of a hitherto undescribed reflex pathway: a smooth-to-striated muscle urethra-to-urethra reflex.

Purpose: To evaluate the correlation between dosimetric parameters and late rectal and urinary toxicities in high-dose-rate brachytherapy (HDR-BT) used as monotherapy for prostate cancer., Methods and Materials: The data of 83 patients treated with HDR-BT alone for prostate cancer from 2001 through 2005 at Osaka University Hospital were analyzed. Median follow-up time was 36 months (range, 18-70). The total prescribed dose was 54 Gy in nine fractions over 5 days. Correlation between dosimetric parameters and late toxicities was examined., Results: The means of V30, V40, V50, V60, V70, D1cc, D2cc, D5cc, and D10cc of the rectum were significantly higher in 18 patients who presented with late rectal toxicity (Grades 1-3 rectal bleeding) than in the other 65 patients who did not. A significant difference was observed for D1cc-10cc but not for D5-90. The statistically most significant difference was observed for V40 and D5cc. Late rectal toxicity rate was significantly higher for patients with rectal V40 >or= 8 cc than those with the rectal V40 < 8 cc (42% vs. 8%; p < 0.001), as well as for patients with rectal D5cc >or= 27 Gy compared with those with rectal D5cc < 27 Gy (50% vs. 11%; p < 0.001). Dosimetric parameters of the urethra of 15 patients with late urinary toxicity were not significantly different from the 68 patients without toxicity., Conclusion: Rectal V40 < 8 cc and D5cc < 27 Gy may be dose-volume constraints in HDR-BT used as monotherapy for prostate cancer.

Urethral erosion is a rare complication after the tension-free vaginal tape (TVT) procedure. Surgical management of this complication is challenging due to the potential for significant patient morbidity. A 50-year-old patient presented with lower urinary tract symptoms (LUTS) and incomplete voiding, 6 years after a TVT procedure performed for stress incontinence. An attempt at cystoscopy revealed an almost complete occlusion of the urethral lumen by a urethral erosion of the polypropylene mesh. A transurethral resection was performed under tactile traction. This procedure is a minimally invasive approach that avoids the need for a transvaginal procedure. Careful cystourethroscopy should be performed in patients presenting with new lower LUTS after TVT in order to avoid a delay in diagnosing a mesh erosion.

Objectives: To study the results and complications of the potassium-titanyl-phosphate (KTP, green) laser during transurethral incision of the bladder neck in the treatment of female voiding dysfunction due to bladder neck obstruction., Methods: A total of 40 women (43-79 years of age) with obstruction were identified. Patients with neurogenic, traumatic, or iatrogenic causes of obstruction were excluded. Preoperative investigations included a full urodynamic examination and urethrocystoscopy. Transurethral bladder neck incision with KTP was performed in all patients. Urodynamic results, clinical improvements in voiding symptoms, and volume of bleeding were assessed., Results: Of the 40 patients, 12 had chronic urinary retention and 28 had difficult micturition. The most common findings on urodynamic study were a high voiding pressure plus low flow rate and high urethral pressure. After treatment, the lower urinary tract symptoms were resolved or improved in all patients. Urodynamic study revealed decreased voiding pressure, post-void residual urine volume, and increased maximal flow rate., Conclusions: Transurethral incision of the bladder neck is effective in relieving voiding difficulties owing to anatomic or functional bladder neck obstruction in women. KTP has great efficacy in the treatment of female voiding dysfunction due to bladder neck obstruction., ((c) 2009 S. Karger AG, Basel.)

Congenital megalourethra is a very rare malformation, which has 2 anatomical variants, scafoid and fusiform. The etiology of this malformation is still a matter of discussion. A surgical approach is proposed here, which has been successfully used in the case of a boy affected by scafoid megalourethra.

Objective: In a prospective study we analysed the 3-yr results of the effects of radical retropubic prostatectomy (RRP) on detrusor and sphincter function by comparing urodynamic status preoperatively with that during longitudinal follow-up., Methods: Fifty-four consecutive patients underwent urodynamics with pressure flow studies and Valsalva leak point pressure measurements 3-7 d before RRP (baseline), and then 8 mo after surgery. Thirty-two patients were studied again 3 yr later. We analysed bladder compliance, detrusor overactivity (DO), detrusor contractility, and intrinsic sphincter deficiency (ISD)., Results: There was a significant increase in the number of patients with reduced bladder compliance at the 8-mo follow-up. De novo reduced bladder compliance was detected in 32.3% of patients and persisted in 28.1% at the 36-mo follow-up. De novo detrusor hypocontractility was observed in 51% of patients at 8 mo (p<0.05) and persisted in 25% of cases 3 yr later. No patients showed any postvoid residual volume. The associations between detrusor hypocontractility with DO and between detrusor hypocontractility with ISD were detected in 76.2% and 44% of patients, respectively, at 8 mo, and in 25% and in 34% of cases, respectively, at 36 mo of follow-up (p<0.05 and p<0.001)., Conclusions: Following RRP detrusor hypocontractility, decreased bladder compliance, and ISD represent de novo dysfunction probably due to bladder denervation during surgery. They become established conditions over time in about 30% of patients. Nevertheless, they do not produce voiding symptoms because patients develop new voiding behaviours.

This case report is about a 4-year-old patient with a IIA2 ''Y-type'' duplication, with the accessory urethra arising from the anterior orthotopic urethra and exiting in perineal-scrotal position, in association with posterior urethral valves (PUV). Cystourethroscopy through the ventral urethra revealed a type III urethral valve (diaphragm) and this was fulgurated. Duplicated dorsal urethra was excised surgically. Postoperative period was uneventful. This case is unique, because it shows PUV in a child with a very rare type of ''Y-type'' duplication. The presence of PUV in patients with urethral duplication is probably not an incidental finding but, to date, embryology of this rare association is not known.

Purpose: We sought to determine the effectiveness of biofeedback therapy and home pelvic floor exercises in children presenting with lower urinary tract dysfunction after posterior urethral valve ablation., Materials and Methods: Children with urodynamically proved lower urinary tract dysfunction after successful valve ablation were enrolled for biofeedback therapy and home pelvic floor exercises. Detrusor pressure and electromyography findings were visually conveyed to patients on the computer screen. Patients were instructed to interrupt detrusor pressure increments by tensing the pelvic floor musculature in the presence of detrusor overactivity. In the presence of the nonrelaxing pelvic floor patients were first instructed to tighten the pelvic floor musculature and then to relax., Results: A total of 30 children were enrolled for biofeedback therapy and home pelvic floor exercises between October 2005 and December 2006. Median patient age at first session was 5.1 years (range 4.5 to 12). Three patients (10%) had an excellent response, and 18 (60%) had a good response, with an overall consistent response of 70%. Nine patients (30%) had an inconsistent response. Mean number of sessions to achieve consistent urodynamic response was 3.5 (range 2 to 7). Mean baseline cystometric bladder capacity was 65% of normal for age (range 45% to 80%), which improved to a mean of 87.25% (50% to 100%) after treatment (p = 0.001). Of the 21 children who had a consistent response 11 (52%) do not require any further anticholinergics and 15 (71%) are free of clean intermittent catheterization. At a mean followup of 11 months (range 5 to 18) none of the patients had relapse., Conclusions: Biofeedback therapy and home pelvic floor exercises provide significant and durable relief in post-valve ablation persistent lower urinary tract dysfunction.

Aim: To examine the temporal effects of diabetes on the bladder and the external urethral sphincter (EUS) activity in rats., Methods: Female Sprague-Dawley rats (n = 24) were divided into two groups: streptozotocin-induced diabetic rats and age-matched controls. Cystometrograms (CMGs) were taken under urethane anesthesia and electromyograms (EMG) of the EUS were evaluated in all rats at 6 and 20 weeks after diabetes induction. After EMG assessment, the tissues of the urethra were harvested for morphological examination., Results: Diabetes caused reduction of body weight, but an increase in bladder weight. CMG measurements showed diabetes increased threshold volume, contraction duration, high-frequency oscillations (HFO), and residual volume. Peak contraction amplitude increased in 6-week but not 20-week diabetic rats. EUS-EMG measurements showed increased frequency of EUS-EMG bursting discharge during voiding in 6-week diabetic rats (8.1 +/- 0.2 vs. 6.9 +/- 0.6/sec) but not in 20-week (5.8 +/- 0.3 vs. 6.0 +/- 0.2/sec) diabetic rats compared with controls. EUS-EMG bursting periods were also increased in both 6-week and 20-week diabetic rats compared with controls. EUS-EMG silent periods were reduced in 6-week diabetic rats, but were not changed in 20-week diabetic rats compared with controls. Active periods did not change in 20-week diabetic rats, but increased in 6-week diabetic rats compared with controls. Morphometric analysis showed atrophy of the EUS after 20 week but not 6 weeks of DM induction., Conclusions: Our data indicates diabetes causes functional and anatomical abnormalities of the EUS. These abnormalities may contribute to the time-dependent bladder dysfunction in diabetic rats.

Objectives: Spinning top urethra (STU) deformity arises secondary to detrusor instability, leading to an increase in the intravesical pressure against a closed sphincter. We retrospectively analyzed the effect of biofeedback treatment on STU in children with dysfunctional voiding., Methods: A total of 121 patients with STU and voiding dysfunction were enrolled in this study. The patients divided into two groups. Group 1 (n = 49) were treated with simple bladder retraining with timed voiding, and group 2 (n = 72) were treated with biofeedback therapy. Voiding cystourethrography was performed 6 and 12 month later to determine the status of the STU after both therapies., Results: The patient age range was 5 to 13 years (mean 8.1 +/- 1.9) in group 1 and 5 to 13 years (mean 8.2 +/- 1.7) in group 2. Group 1 consisted of 41 girls and 8 boys; group 2 consisted of 63 girls and 9 boys. Voiding cystourethrography revealed vesicoureteral reflux in 39 and 59 children in groups 1 and 2, respectively. The improvement rates of the biofeedback therapy in children with STU and vesicoureteral reflux were significantly greater than the children treated with timed voiding at 6 months and 1-year of follow-up., Conclusions: For children admitted to urology clinics with urinary infection or complaints thought to be an unstable urinary bladder, proximal urethral dilation called STU is detected at a high frequency. It should be remembered that this situation can be related to vesicoureteral reflux and urinary bladder instability. Biofeedback training is a simple, effective, and well-tolerated treatment modality for these children.

Purpose: This study investigates whether the location and dose of urethral radiation received during transperineal interstitial permanent prostate brachytherapy determine the degree and type of urinary symptoms experienced subsequently., Methods and Materials: Data from a prospectively acquired database of 219 men treated with transperineal interstitial permanent prostate brachytherapy using (125)I (prescribed dose 145Gy) between May 2001 and June 2003 were reviewed. To assess the effect of regional urethral dosimetry, the prostate was divided into equal thirds (proximal, mid, and apical) with doses beyond this considered distal. Mean and peak doses for each region were correlated with total International Prostate Symptom Score (IPSS) and the irritative and obstructive components of the score. IPSS values at 1 month postimplant, time to resolution of IPSS, and the need for catheterization were used as outcome variables and analyzed with respect to dose using logistic and linear regression., Results: Peak and average doses with standard deviations to the proximal urethra were 168 (24) and 147 (24)Gy, mid prostatic urethra 192 (24) and 181 (21)Gy, and apical urethra 201 (28) and 192 (26)Gy. Catheterization was required for 28 men and was predicted by larger pretreatment transrectal ultrasound (TRUS) volume (OR 1.06 per unit change; 95% CI 1.03-1.10; p<0.001) and lower UV(150) (OR 0.30; 95% CI 0.13-0.68; p=0.004) in multivariate analysis. Greater IPSS at baseline (p<0.001) and preoperative TRUS volume (p=0.012) but conversely smaller D(30) doses (p=0.003) were predictive of IPSS outcomes at 1 month. IPSS returned to within two points of baseline for 72.2% of men by 1 year and 83.3% by 24 months. This was predicted by higher IPSS at baseline (OR 6.0; 95% CI 2.72-13.22; p<0.001), higher D(30) (OR 1.17; 95% CI 1.01-1.36; p=0.031), and lower V(100) (OR 0.39; 95% CI 0.22-0.70; p=0.002). Prostatic urethral segmental dosimetry failed to predict the need for catheterization, the nature of the urinary symptoms, or their time to resolution., Conclusions: Previously identified factors of importance for urinary morbidity such as pretreatment prostate volume and baseline urinary function were reemphasized in this study. Regional urethral dosimetry within contemporary practice does not seem to influence the nature or extent of urinary symptoms after prostate brachytherapy. Consequently, region sparing dosimetric modifications are not warranted to alter symptomatic outcomes.

Pregnant women usually acknowledge and more or less accept symptoms of urinary frequency, nocturia, and leakage as annoying aspects of pregnancy that are expected to resolve when the pregnancy is over. Studies have shown that urinary symptoms may be more than just "annoying" - the symptoms can markedly reduce quality of life. This article provides an overview of the lower urinary tract during pregnancy, including considerations of symptoms of urinary frequency; nocturia and incontinence; changes in bladder support; and the occurrence of urinary retention, a urologic emergency.

We studied the clinical presentation and management of four patients with anterior urethral valves; a rare cause of urethral obstruction in male children. One patient presented antenatally with oligohydramnios, bilateral hydronephrosis and bladder thickening suggestive of an infravesical obstruction. Two other patients presented postnatally at 1 and 2 years of age, respectively, with poor stream of urine since birth. The fourth patient presented at 9 years with frequency and dysuria. Diagnosis was established on either micturating cystourethrogram (MCU) (in 2) or on cystoscopy (in 2). All patients had cystoscopic ablation of the valves. One patient developed a postablation stricture that was resected with an end-to-end urethroplasty. He had an associated bilateral vesicoureteric junction (VUJ) obstruction for which a bilateral ureteric reimplantation was done at the same time. On long-term follow-up, all patients demonstrated a good stream of urine. The renal function is normal. Patients are continent and free of urinary infections. Anterior urethral valves are rare obstructive lesions in male children. The degree of obstruction is variable, and so they may present with mild micturition difficulty or severe obstruction with hydroureteronephrosis and renal impairment. Hence, it is important to evaluate the anterior urethra in any male child with suspected infravesical obstruction. The diagnosis is established by MCU or cystoscopy and the treatment is always surgical, either a transurethral ablation or an open resection. The long-term prognosis is good.

Urethral duplication is a rare congenital anomaly, affecting mainly boys. Generally, the duplication develops on the sagittal plane; the accessory urethra may run dorsally or ventrally to the orthotopic one. The embryology of this pathology is still controversial. In the English medical literature, approximately 175 cases have been reported. We report here a new case of urethral duplication type II A2 "Y" in a 14-year-old boy and review the current literature of this rare entity.

We report a case of parameatal urethral cyst in a 15-year-old boy which is a very rare congenital anomaly. The cyst recognized at infancy but the boy presented to our clinic at the age of 15 when the mass was grown enough to cause spraying of urine and poor cosmesis. Complete excision of the cyst with total removal of the epithelium is the required for treatment and prevention of recurrence.

Purpose: Several investigations have revealed that the alpha/beta ratio for prostate cancer is atypically low, and that hypofractionation or high-dose-rate (HDR) brachytherapy regimens using appropriate radiation doses may be expected to yield tumor control and late sequelae rates that are better or at least as favorable as those achieved with conventional radiation therapy. In this setting, we attempted treating localized prostate cancer patients with HDR brachytherapy combined with hypofractionated external beam radiation therapy (EBRT). The purpose of this study was to evaluate the feasibility of using this approach, with special emphasis on the relationship between the severity of acute genitourinary (GU) toxicity and the urethral dose calculated from the dose-volume histogram (DVH) of HDR brachytherapy., Methods and Materials: Between September 2000 and December 2003, 70 patients with localized prostate cancer were treated by iridium-192 HDR brachytherapy combined with hypofractionated EBRT at the Gunma University Hospital. Hypofractionated EBRT was administered in fraction doses of 3 Gy, three times per week; a total dose of 51 Gy was delivered to the prostate gland and the seminal vesicles using the four-field technique. No elective pelvic irradiation was performed. After the completion of EBRT, all the patients additionally received transrectal ultrasonography (TRUS)-guided HDR brachytherapy. The fraction size and the number of fractions in HDR brachytherapy were prospectively changed, whereas the total radiation dose for EBRT was fixed at 51 Gy. The fractionation in HDR brachytherapy was as follows: 5 Gy x 5, 7 Gy x 3, 9 Gy x 2, administered twice per day, although the biologic effective dose (BED) for HDR brachytherapy combined with EBRT, assuming that the alpha/beta ratio is 3, was almost equal to 138 in each fractionation group. The planning target volume was defined as the prostate gland with 5-mm margin all around, and the planning was conducted based on computed tomography images. The number of patients in each fractionation group was as follows: 13 in the 5-Gy group; 19 in the 7-Gy group, and 38 in the 9-Gy group. The tumor stage was T1 in 10 patients, T2 in 36 patients, and T3 in 24 patients. The Gleason score was 2-6 in 11 patients, 7 in 34 patients, and 8-10 in 25 patients. Androgen ablation was performed in all the patients. The median follow-up duration was 14 months (range 3-42 months). The toxicities were graded based on the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer toxicity criteria., Results: The main symptoms of acute GU toxicity were dysuria and increase in urinary frequency or nocturia. The grade distribution of acute GU toxicity in the patients was as follows: Grade 0-1, 39 patients (56%), and Grade 2-4, 31 patients (44%). One patient who developed acute urinary obstruction was classified as having Grade 4 toxicity. Comparison of the distribution of the grade of acute GU toxicity among the different fractionation groups revealed no statistically significant differences among the groups. The urethral dose in HDR brachytherapy was evaluated using the following DVH parameters: V30 (percentage of the urethral volume receiving 30% of the prescribed radiation dose), V80, V90, V100, V110, V120, V130, and V150. The V30-110 values in the patients with Grade 2-4 acute GU toxicity were significantly higher than those in patients with Grade 0-1 toxicity. On the other hand, there were no significant differences in the V120-150 values between patients with Grade 0-1 and Grade 2-4 toxicity. Regarding the influence of the number of needles implanted for the radiation therapy, patients with 11 needles or less showed a significantly higher incidence of Grade 2-4 acute GU toxicity compared with those with 12 needles or more (p < 0.05)., Conclusions: It was concluded that HDR brachytherapy combined with hypofractionated EBRT is feasible for localized prostate cancer when considered from the viewpoint of acute toxicity. Increase in the fraction dose or reduction in the number of fractions in HDR brachytherapy did not affect the severity of acute GU toxicity, and the volume of urethra receiving an equal or lower radiation dose than the prescribed dose was more closely associated with the grade severity of acute GU toxicity than that receiving a higher than the prescribed dose.