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A case of penile replantation is reported in which a 37-year-old man suffered a self-inflicted complete penile amputation. Replantation was successfully performed; at 3 months after surgery, a urethrocystogram demonstrated the absence of urethral stricture. Although complete erection has yet to be obtained, no other functional impairments have been encountered at 7 months after replantation. Reconstruction of the venous system is considered to be one of the most important factors in achieving a successful penile replantation.

In the case of 81 patients, we conducted a perineal ultrasound and a lateral chain urethrocystography under standard conditions. The data collected were compared. The object of this prospective study was, to estimate the comparability of both methods. We also compared, whether the ultrasonically measured values were different between the supine and upright position. The measured values of both methods corresponded at rest, while during strain the values are different. During Valsalva's manoeuvre, the ultrasound method reflects the mobility of the bladder neck better, while the funnelling of the bladder neck can be examined better by lateral chain urethrocystography. The differences between the supine and upright positions were minor in the ultrasound examination, although the funnelling of the bladder neck could be detected better in the upright position. Our study shows that all important measured values can be collected with perineal ultrasound. Except for the funnelling of the bladder neck, typical findings of incontinence can be better shown with perineal ultrasound.

Perineal sonography and urethrocystography were performed on 45 patients in the same sitting to evaluate the sonographical method with regard to its applicability as a routine examination method. Corresponding results were obtained 14 times (= 30%). In 31 patients (= 70%) urethrocystographic and ultrasonic measurements diverged. The urethrocystogram must therefore remain an integral part in the work-up of urinary incontinence.

Objetivo: Evaluamos los resultados a largo plazo de la uretroplastia término-terminal. Material y Métodos: Revisamos 40 pacientes afectos de estenosis de uretra bulbar de etiología diversa: yatrógena 40%, traumática 15%, infecciosa 2% y desconocida 40%. En 17 casos se realizó previamente uretrotomía interna. El estudio mediante CUMS reveló una localización bulbar en todos los casos y una longitud inferior a 1 cm en 13 casos, entre 1-2 cm en 26 casos y entre 2-3 cm en 1 caso. El flujo máximo varió de 3-13 ml/s. Se valoró mediante cultivo preoperatorio la ausencia de bacteriuria. El tiempo medio de seguimiento fue de 45 meses (12- 142 meses). Se consideró resuelta la estenosis cuando no aparecieron datos radiológicos ni flujométricos compatibles con reestenosis. Resultados: En 37 casos (92%) los resultados fueron satisfactorios, no precisando los pacientes ningún otro procedimiento quirúrgico secundario. Tras la cirugía el flujo máximo varió entre 18-45 ml/s. En dos de los tres pacientes con reestenosis la uretrotomía interna endoscópica fue resolutiva. Se trató de dos pacientes con estenosis de origen traumático y longitud mayor a 1,5 cm. En el tercer paciente con recidiva se optó finalmente por realizar una nueva uretroplastia termino-terminal, con buen resultado posterior. Conclusiones: La uretroplastia término-terminal es una técnica altamente resolutiva en la estenosis de uretra bulbar. El diagnóstico preoperatorio se basa en el estudio radiológico (CUMS). El control postoperatorio debe fundamentarse en la clínica y estudio flujométrico. El origen traumático de la estenosis empeora los resultados de la cirugía. En casos de reestenosis la uretrotomía interna endoscópica permite complementar de forma exitosa los resultados de la uretroplastia. Objective: We evaluated long term results of end-to-end urethroplasty. Material and methods: We reviewed 40 patients with bulbar urethral stricture of diverse origin: iatrogenic 40%, traumatic 15%, infectious 2% and unknown 40%. In 17 cases internal urethrotomy was made previously. The radiological study with retrograde and voiding cystogram revealed a bulbar location in all cases and a length inferior to 1 cm in 13 cases, between 1-2 cm in 26 cases and 2-3 cm in 1 case. The maximum flow rate varied between 3-13 ml/s. The absence of bacteriuria was valued by means of preoperating culture. The average time of pursuit was 45 months (12-142 months). The stricture was considered resolute when not appear compatible radiological or functional finds of failure. Results: In 37 cases (92%) the results were satisfactory, without secondary surgical procedure. After surgery maximum flow-rate varied between 18-45 ml/s. In two patients with failure, internal urethrotomy was decisive. In this case the stricture origin was traumatic. The third patient with failure was finally chosen to make new endto- end urethroplasty, with good later result. Conclusions: End-to-end urethroplasty is a highly decisive technique for bulbar urethral stricture. The preoperating diagnosis is based on the radiological study (retrograde and voiding cystogram). The postoperating control must be based on clinic and uroflow study. Traumatic stricture repair showed worse results. In cases of failure, internal urethrotomy allows to complement successful results of end-to-end urethroplasty.

In 398 patients suffering from urinary incontinence seven urodynamic parameters were investigated. 75% resp. 78% had a normal max. urethral closure pressure. Only a part of the women was characterized by a descensus of the genital tract. Some more patients showed anatomic abnormalities in the urethrovesical configuration by x-ray urethrocystogram. 1/5 res. 1/3 of descendent anterior vaginal walls proved to have a cystocele. If one requires for successful incontinence operation a normal max. urethral closure pressure and an objectively proven abnormality of the urethrovesical configuration, only 65% resp. 67% of our incontinence women have a chance of being cured by incontinence operation.

In recent years, accurate preoperative diagnosis has been increasingly emphasized as an important therapeutic aspect of urinary incontinence in women. One of the diagnostic modalities employed is the lateral urethrocystogram. 25 patients with recurrent stress induced urinary incontinence were subjected to a dura-sling operation. The median duration of incontinence-related problems until secondary surgery (loop surgery) was 2.6 years. Radiological investigations before and after loop surgery showed, that this operation produces good morphological results, if the preoperative diagnosis is accurate. In 84% of the patients the continence obtained was verified by clinical evidence and radiologic findings.

In Reply.— I believe that a number of urologists would agree with Dr Langlois, and I would gladly rebut his comments. The available data on urgency and frequency and the prevalence of meatal stenosis do not match Dr Langlois's impressions, but rather suggest that he sees a select population of enuretics. Hallgren,1in a study of several hundred enuretic children attending a clinic, found that 22% experienced frequent urination; 7%, urgent urination, and 14%, both. Only 2.5% of the enuretic children had malformed urinary tracts; 3% were found to have obstructive lesions by urethrocystogram; and less than 1% of intravenous pyelograms showed an anomaly. Very different figures have been reported from urologic clinics, for example, by Mahony.2The answer to these questions seems to depend on the pool of patients and on one's special interest, but Hallgren's data are probably closest to the experience of family practitioners and