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Pananterior urethral stricture involving the penile and bulbar urethra is a challenging urological condition in the Indian population. In India, Balanitis Xerotica Obliterans (BXO) or Lichen Sclerosus (LS) is the most common cause of pananterior urethral stricture. Various surgical techniques have been described in the literature for present condition, with varied outcomes. However, there is still a need for a simple and effective procedure to address this problem. Hereby, the authors present a case series that included five male patients with BXO and pananterior urethral stricture who underwent Detubularised Non Augmented (DNA) urethroplasty between January 2022 and December 2022. The median age of the patients was 45 years, with a mean stricture length of 13 cm. The median follow-up period was 11 months. During the procedure, a scroto-perineal incision was made, and the anterior urethra was ventrally cut open from the meatus to the junction of the stricturous and normal urethra. A right-sided Tunica Vaginalis (TV) flap was raised (left is left), and the cut-open anterior urethra was wrapped with the TV flap, creating a "controlled fistula" at the proximal end of the detubularised urethra. The average operative time was 1.5 hours. The success of the procedure was determined by a postoperative peak flow rate of 12 mL/sec or more, with no further need for urethral dilatation or direct vision internal urethrotomy. The procedure was successful in 4 out of 5 cases (80%). One patient developed a narrowed urethra during follow-up and required serial catheter upgradation for urethral dilatation. In conclusion, DNA urethroplasty was found to be a simple and effective treatment option for the notorious pananterior urethral stricture associated with BXO. [ABSTRACT FROM AUTHOR]

Most common population at risk for both symptomatic urinary tract infection (UTI) and asymptomatic bacteriuria, however, is sexually active women. Although asymptomatic infection in this group does not clearly produce serious medical problems, it may be a predictor of future symptomatic infection. Women are more susceptible to infection than men because of the shorter length of the female urethra. Perineal bacterial microbiota that originate in the gastrointestinal tract are the usual pathogens, especially if the bacteria possess factors that facilitate their binding to the uroepithelium. Sexual intercourse facilitates entry of the bacteria into the female urethra. Pregnant women are extra at risk of expand UTIs due to physiological adjustments withinside the urinary tract. UTI constitute severe threats to human health worldwide and hundreds of thousands of the humans affected every year. The aim of this study was to know the prevalence and antimicrobial susceptibility pattern of isolates in pregnant female patients. A total two hundred pregnant and non-pregnant females patients had been included on this study after obtaining the consent. Under strict aseptic precautions midstream urine samples had been taken from all sufferers. All the samples had been processed with the aid of using the usage of standard bacteriological methods i.e. wet mount, inoculation on blood agar and MacConkey's agar after which diagnosed with the aid of using standard biochemical tests, antibiotic sensitivity trying out changed into completed with the aid of using Kirby Bauer's disc diffusion method. In this study 80 out of 200 females patient i.e. 40% were showed UTI of which a most of 20 to 30 years age group had a considerably better occurrence of UTI i.e. 56.25%, while the age group of 60 years and above suggests the lowest contamination rate i.e 2.5% as compared to others. Females belonging to lower socioeconomic status had been extra liable to UTI then others. Pregnant females were more prone to UTI then non-pregnant females i.e. 52.73% and 35.17% respectively. Amongst pregnant females, primigravida and those in the first and second trimesters had been at higher risk. All isolates had been sensitivity to ampicillin+sulbactam, sparfloxacin, and gatifloxacin. Our study mentioned that the prevalence of UTIs was 40%; the pregnant female patients were more prone to UTI than non-pregnant females. The most isolated microorganism had been Escherichia coli which was maximum accountable for UTIs. The sexually active age group 26-30 years was highly at risk of UTI. Females belonging to lower socioeconomic status had been extra liable to contamination. Pregnancy was one in each of the predisposing elements for UTI. All isolates had been confirmed sensitivity to ampicillin+sulbactam, sparfloxacin, and gatifloxacin. [ABSTRACT FROM AUTHOR]

Duplication of urethra is a rare congenital anomaly; a Y-shaped urethral duplication is the rarest variant and lacks a standardised treatment plan. We report a nine-year-old male patient with a Y-duplication of urethra diagnosed during neonatal age who presented to a tertiary care teaching hospital in India in 2018. The patient had undergone a vesicostomy on the seventh day of life for passing urine per anus and was lost to follow-up thereafter. At eight years of age, there was a failed attempt at disconnection of the duplicated urethral tract from the anus after colostomy. The patient was managed successfully by progressive dilatation of the orthotopic urethra, which required multiple stages, followed by separation of the urethra from the rectum. At three-years follow-up the patient was continent and asymptomatic. [ABSTRACT FROM AUTHOR]

Pediatric patients need a higher dose of tacrolimus for posttransplant immunosuppression due to its high clearance. In addition, genetic polymorphism in cytochrome P450 (CYP) 3A5 enzyme (CYP3A5*1/*3) is an important determinant for its serum concentration. Substantial data exist about the requirement of higher doses of tacrolimus in patients with the CYP3A5*1 genotype (extensive metabolizer). Ketoconazole, an inhibitor of CYP, leads to the reduction of the tacrolimus dose while maintaining therapeutic levels in transplant recipients. However, very few studies have mentioned coadministration of ketoconazole and tacrolimus in pediatric renal transplant recipients. Herein, we present a case of a 10-year-old boy with end-stage renal disease due to posterior urethral valves who underwent a living-related kidney transplant. We also emphasize the importance of CYP3A5 genotype evaluation in deciding the course of the treatment and maintaining therapeutic levels of tacrolimus in pediatric transplant recipients. [ABSTRACT FROM AUTHOR]

Background: The data pertaining to the lower urinary tract disorders in dogs in India is very merge. This retrospective analysis presents a retrospective analysis of incidence of affections of lower urinary tract in dogs. Methods: The cases of different affections of lower urinary tract presented at the Veterinary Clinical Complex, Veterinary College, Anand Agricultural University, Anand during April-2012 to March-2017 were screened and detailed information regarding age, sex and breed were collected and analysed to calculate percentage of incidence of different affections of lower urinary tract viz., surgical affections and non-surgical affection. Conclusion: Total 24319 cases of lower urinary tract affections in dogs were registered. Among them 5854 (24.07%) surgical cases comprising urolithiasis (81, 76.42%), bladder neoplasia (25, 23.58%) and 18465 (75.93%) non-surgical affections with cystitis (176, 0.95%) cases. The highest incidence of urolithiasis was 25.93 per cent in the year 2014-15 and in 7 to 9 years aged dogs (35.80%). The sex wise per cent incidence was higher in male (72.84) than female (27.16). The urinary bladder calculi was the highest (72.84%) followed by the urethra (16.05%) and both the locations (11.11%). The year wise highest per cent incidence of cystitis was recorded for the year 2015-16 (52.27). The age wise per cent incidence of cystitis was equally higher 28.98 in the age groups of 7 to 9 and 10 to 12 years, each. The year wise the highest per cent incidence of neoplasia of urinary bladder (TCC) in dogs was 52.00 for the year 2015-2016. The age wise per cent incidence of neoplasia of urinary bladder was the highest in 7 to 9 years age groups (36.00). The sex wise per cent incidence for neoplasia in urinary bladder was higher in male (64.00) than female (36.00). The breed wise highest per cent incidence of urolithiasis was in Pomeranian (25.93), cystitis in Pug (28.41) and neoplasia of bladder (TCC) Labrador and Pug (20.00, each). [ABSTRACT FROM AUTHOR]

Urethral foreign bodies are mostly self-inserted because of exotic impulse, desire of sexual gratification, psychosexual problems, or under alcohol influence. Most of the foreign bodies are easily inserted, but the failure of removing it becomes the reason of presentation to the hospital. A 15-year-old male presented with a 35-cm-long thorny twig inserted into the urethra, which got impacted leading to painful hematuria. The twig was removed by an over-loading technique using a nasogastric tube (Ryle's tube) in a remote island of India. The procedure was successful without causing additional trauma during the removal of the foreign body. [ABSTRACT FROM AUTHOR]

Size of the external urethral meatus in adult Indian males is not yet documented. However, for choosing optimum size of an instrument, it is important to know the maximum stretchable external urethral meatal size in a particular patient. Hence, a prospective study was conducted at our institution to document the maximum stretchable adult male external urethral meatus size. After obtaining consent, 340 adult males who were undergoing urethral instrumentation for reasons other than the diseases of the urethra underwent urethral calibration using a 'urethral calibrator' during February 2009 to April 2010. Data were analyzed using the SPSS 17. The average maximum stretchable external urethral meatal size in an Indian adult male was 28.49 Fr. Ours is the only study to document the maximum stretchable adult external urethral meatal size in Indian males which helps us for better instrumentation. [ABSTRACT FROM AUTHOR]

Abstract: Although, urethral injuries are relatively uncommon, their incidence has been increasing due to increasing incidence of road traffic accidents. Initial management of urethral injury depends upon the degree and location of the injury, patients'' haemodynamic status, and any associated injuries. Besides these factors, availability of clinical infrastructure and clinical expertise also play a significant role in making appropriate management decisions at the time of injury. [Copyright &y& Elsevier]

Purpose: We compared posterior urethral strictures after pelvic fracture urethral distraction defects in India and Italy. Materials and Methods: We retrospectively analyzed the records of patients in India and Italy who underwent repair for posterior urethral stricture after pelvic fracture urethral distraction defect. We investigated etiology, emergency treatment type, the specialist involved in emergency treatment, the type of stricture resulting from trauma and primary repair, posterior urethroplasty techniques and results. Results: Of 255 patients with a median age of 33 years 117 (45.8%) and 138 (54.2%) were evaluated in India and Italy, respectively. In India the most common causes of pelvic fracture urethral distraction defects were pedestrian (35%), motorcycle (26.5%) and bicycle (12.8%) accidents. The most common emergency treatment was suprapubic cystostomy (79.5% of cases). Of the patients 70.1% were treated in emergency fashion by a surgeon and 85.4% had complex posterior urethral strictures. The most common technique was anastomosis with inferior and total pubectomy in 56.4% and 15.3% of cases, respectively. In Italy the etiology was mainly automobile accidents (39.2%). The most common emergency treatment was endoscopic realignment (49.2% of cases). Of the patients 92.7% were treated in emergency fashion by a urologist and 68.1% had simple urethral strictures. Perineal anastomosis and laser urethrotomy were the most used techniques (38.4% and 21.1% of cases, respectively). In India 92 cases (78.6%) were successful and 25 (21.4%) failed while in Italy 120 (86.9%) were successful and 18 (13.1%) failed. Median followup was 74 months (range 12 to 239). Conclusions: Differences in emergency treatment for pelvic fracture urethral distraction defects influence the choice of delayed posterior repair and results. [Copyright &y& Elsevier]

Genitourinary tuberculosis contributes to 10-14% of extrapulmonary tuberculosis and is a major health problem in India. Prostate tuberculosis is uncommon and is usually found incidentally following transurethral resection. The most common mode of involvement is hematogenous, though descending infection and direct intracanalicular extension is known. Predisposing factors include prior tubercular infection, immuno-compromised status, previous BCG therapy. The presentation is diffuse caseating epitheloid cell granulomas, which can be confirmed by prostate biopsy. Urine PCR has good sensitivity (95.5%) and specificity ( 98.12%) in diagnosis. Imaging techniques like TRUS and CT/MRI also allow good visualization of the lesion and its extension. Urethral tuberculosis is very rare and is usually secondary to upper tract or genital tuberculosis. The presentation may be acute urethritis or chronic stricture or fistulae. The treatment of choice is chemotherapy with 3-4 anti tubercular drugs for initial 6-12 weeks and later 2 drugs for additional 3-6 months. Surgery is usually reserved for cases where chemotherapy fails and is done after 4-6 weeks of ATT. With a high index of suspicion it may be possible to diagnose a larger number of cases of prostatic and urethral tuberculosis especially in this country where tuberculosis is almost endemic. [ABSTRACT FROM AUTHOR]

Objective: The urethral length has not been measured in the Indian population. Even the international literature in this arena is very sparse. This paper is an attempt to develop a simple anatomical database for urethral length. Materials and Methods: Between January 2010 and April 2011, the urethral lengths of 422 adult male patients who required catheterization as part of regular treatment at our hospital, were recorded after obtaining consent from the patients and from the scientific and ethics review boards of the institution. Patients with history of prostatic or urethral abnormalities were excluded. The balloon of a sterile Foley's catheter was inflated using 10 cc of saline. The length from the junction of the balloon to the 'Y' junction of the Foley was measured. The catheter was then passed into the bladder and re-inflated to same volume. The penis was gently straightened and the length of the catheter outside the penis was measured till the premarked point at the 'Y' junction. Subtracting this from the original length gave the length of the urethra. Results: The mean length of the urethra was 17.55 + 1.42 cm with a range between 14 and 22.5 cm. Conclusions: Literature in which the length of the normal adult male urethra is recorded for a significant sample size is very scarce. Our data adds to basic anatomic information of the male urethra specific to the Indian population. Statistical Methods: Descriptive statistical analysis was performed. The non-linear regression analysis was employed to find the normative values of urethral length according to age class. [ABSTRACT FROM AUTHOR]

Background: Urethral stricture disease in children is not uncommon as assumed; however, most of the information about the etiology, features, and natural history of pediatric strictures is extrapolations from adult series as the literature on this common entity is sparse, and most of the studies are small series., Objective: The current etiology and clinical features of urethral stricture disease in the pediatric population in the developing world were determined., Materials and Methods: The data of children with urethral stricture disease, who had undergone treatment in the tertiary center from 2001 to 2017, were retrospectively analyzed. After excluding girls, the database was analyzed for clinical presentation, possible causes of stricture, site and number of strictures, and length of stricture and for previous interventions. Subanalysis was performed for stricture etiology by patient age, stricture length, site, previous treatments, and presentation with paraurethral abscess., Results: A total of 195 boys with strictures were identified. The common causes of pediatric urethral stricture were traumatic (36.9%), iatrogenic (31.8%), and idiopathic (28.7%). The anterior urethra was the location of the stricture in 141 patients (72.3%). Iatrogenic causes (due to catheterization, hypospadias repair, and valve fulguration) accounted for the majority of anterior urethral strictures (61/141 or 43.2%). Younger children had a tendency to have an iatrogenic and idiopathic cause for strictures, whereas older children had a traumatic etiology; 18.6% of strictures in children younger than 10 years were secondary to trauma, whereas 44.9% of the strictures in patients older than 10 years were traumatic in origin. Trauma was the major cause of posterior urethral strictures (53/54 or 98.1%) and was always associated with pelvic fracture. Strictures due to lichen sclerosus or infectious cause were rare (5 patients or 2.6%). The length of strictures was longer in pan anterior urethral strictures (mean: 82.0 mm) than that of those due to lichen sclerosus (mean: 42.5 mm) and in patients who had undergone previous treatment (mean: 28.7 mm)., Conclusion: Iatrogenic causes such as catheterization and hypospadias repair account for the majority of anterior urethral stricture disease in the pediatric population, especially the younger age-group. However, as the child grows, there is a gradual preponderance of traumatic urethral strictures, including posterior urethral strictures., (Copyright © 2019. Published by Elsevier Ltd.)

Introduction: Pediatric pelvic fracture-associated urethral injuries (PFUIs) are relatively rare injuries that occur in secondary to high impact pelvic trauma. There is no consensus yet on the optimal management approach., Objectives: In this study, the authors reviewed their experience of pediatric PFUIs and discussed the current spectrum of potential management options., Study Design: The authors retrospectively evaluated a cohort of 33 children (≤14 years) treated for PFUI between January 2005 and December 2017., Results: The mean age of presentation was 11.2 ± 2.1 years (range 6-14). All the subjects were male. Average stricture length was 2.5 + 1.4 cm. Transperineal anastomotic repair (TPAR) was done in 27 patients; Mitrofanoff procedure was done in three patients; Badenoch's procedure, preputial flap, and transpubic urethroplasty (TPU) was done in 1 patient each. Overall success rate for TPAR was 85%. Minor complications (Clavien grade I and II) were seen in eight cases (24.2%). Average hospital stay was 11.3 days (range 6-15). The mean follow-up duration was 13.8 months (range 9-18)., Discussion: As not many large overview studies were known, this retrospective study is small step for developing a protocol for patients with a pediatric PFUI that needs treatment. The goal of surgery in pediatric PFUI-associated posterior urethral strictures is to achieve a tension-free bulboprostatic anastomosis after excision of the distraction segment. Transperineal anastomotic repair is the best and most commonly performed surgery for pediatric PFUI with 85-98% success rates. The success rates for TPAR may be lower in children because of smaller pelvic cavity, small caliber urethra, and poorly formed elastic spongiosa. Hence, a TPAR should be attempted in every case of posterior urethral stricture post-PFUI. If a tension-free anastomosis is not possible, then procedures depending on local stricture characteristics such as TPU may be required., Conclusion: Most pediatric posterior urethral strictures post-PFUI (≤2 cm) can be managed by delayed TPAR with reasonable success rates. Few selected patients may require procedures such as TPU based on local stricture characteristics., (Copyright © 2019 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

The article discusses a study that was conducted to analyze the impact of nonclosure of rectourethral (RU) fistula and to do a analysis by comparison of the complications with and without nonclosure of RU fistula at the time of posterior sagittal anorectoplasty (PSARP) in anorectal malformation cases (ARM). It also highlights the risks and complications involved in it. It concludes that RU fistula closure is not necessary during PSARP and nonclosure avoids urological complications.

Eunuchs seek medical attention only when extremely distressed by symptoms. No scientific publication has highlighted the medical problems of eunuchs in India till date, probably because of lack of access to this community and their reluctance in seeking medical help. We evaluated four eunuchs in the last three years with chronic retention of urine due to urethral stenosis, caused by an incorrect method of amputation of the penis and urethra. Though the management of the problem is simple, the article highlights the traditional method of castration and penectomy which is practiced in Indian eunuchs which leads to urethral stenosis. [ABSTRACT FROM AUTHOR]

Rhinosporidiosis is a chronic granulomatous disease caused by a fungus, Rhinisporidium seeberi. Though the favored site is the nasal mucosa, urethral involvement does occur in this disease, only a few cases are reported in the literature and they are mostly from India. Here we report a case of recurrent urethral rhinosporidiosis, presenting as a protruding mass from the urethral orifice during voiding. [ABSTRACT FROM AUTHOR]

Introduction: Management of PFUDD with bladder neck incompetence is technically demanding and requires a considerable expertise and experience. We managed such a case with anstomotic urethroplasty and rectus fascial sling. Methods: A 35 years male met a road traffic accident and had urethral injury along with pelvic fracture. SPC diversion was done. After 3 months of diversion a core through VIU was done. Voiding trial was given after one month, which failed. Patient was referred to us. Physical examination was within normal limits. Filling cystogram showed a normal outline of bladder with opened bladder neck and complete obliteration at prostatomembranous junction. RGU showed normal anterior urethra with complete obliteration at the level of bulbomembranous junction. Antegrade scopy revealed an open bladder neck. We used abdominoperineal route to manage this case. Anastomotic urethroplasty was done. A rectus fascial sling was placed at the level of the bladder neck. MCU done after 3 weeks showed acceptable result. Patient is voiding well without any incontinence. Results: Incontinence in PFUDD can be due to encasement of the bladder neck in a fibrotic scar, injury to the bladder neck or neurological injury. Management of such a case is quite challenging. Literature supports to manage such conditions in two stages. We performed both the procedures in the same sitting as the findings were quite unequivocal. Conclusions: Simultaneous management of the PFUDD with open bladder neck is feasible in single sitting with anastomotic urethroplasty and rectus fascial sling in experienced hands. [ABSTRACT FROM AUTHOR]