ROLE OF SONOURETHROGRAM IN EVALUATION OF SHORT SEGMENT ANTERIOR URETHRAL STRICTURE

INTRODUCTION: Retrograde urethrography (RGU) is the standard imaging study for the evaluation of anterior male urethra. Sonourethrography(SUG) offers comparable information with added advantages. MATERIAL AND METHODS: 196 males with anterior urethral stricture studied. RGU/MCU, sonourethrogram and urethroscopy done in all and information regarding urethral stricture was compared keeping urethroscopy as gold standard. Strictures > 4 cm were excluded. Chiou et al classication used to classify urethral stricture on SUG. Bulbar urethra was the most common si RESULTS & DISCUSSION: te for urethral stricture. Sensitivity of sonourethrography for location of stricture was >98%. Strength of agreement between SUG and urethroscopy for location of stricture was very good. Number of the strictures were diagnosed with higher accuracy on urethroscopy than SUG and RGU respectively. Kappa value for number of strictures was suggestive of very good agreement between SUG & urethroscopy. Length of stricture in urethroscopy was better correlating with SUG. Both RGU and SUG were equally sensitive in location and number of stricture while RGU correlated poorly in the bulbar urethra, older studies also showing RGU underestimating the length of stricture in bulbar urethra. Sonourethrography also providing additional information regarding periurethral pathologies. The complications encountered during RGU were contrast intravasation, pain during the procedure, urethral bleeding and UTI after the procedure. During sonourethrography no signicant complication noted. CONCLUSIONS: Sonourethrography is a multiplanar, easily available and cost-effective technique for evaluating anterior urethra without radiation exposure. When compared with RGU, sonourethrography is equally efcacious with added important technical advantages which help surgeons to plan surgical procedure.

Use of pedicled dartos flap wrap around technique in elaborarted perineal repair of complex pelvic fracture urethral distraction defect

Objectives: To describe the use of a pedicled dartos flap between the pubic bone and bulbar urethra after elaborate perineal urethroplasty in complex pelvic fracture urethral distraction defect. This is to prevent the risk of entrapment of the anastomotic area within a fibrous scar and hence prevent the risk of urethral stricture recurrence. Our objective is also to theorise the entity of bulbar urethral entrapment to describe the trapping of the bulbar urethra by fibrosis after extensive bone resection in complex cases of pelvic fracture urethral distraction defect. Methods: Ten patients with complex pelvic fracture urethral distraction defect underwent perineal urethroplasty at our institution from 2017 to 2019. Urethroplasty was done using the elaborated perineal approach in the standard fashion. Pedicled fibrofatty tissue along with dartos from the scrotum was used to separate the site of urethral anastomosis from the bare pubic bone and fill the dead space. Results: All patients are asymptomatic with no stricture recurrence in follow-up. Conclusions: Vascularised pedicle flap should become an important tenant in the elaborated perineal repair of complex pelvic fracture urethral distraction defect. It provides an ideal option in this scenario by decreasing the risk of urethral stricture recurrence without adding morbidity and minimum extra operative time. Level of evidence: Not applicable.

Bulbar urethrocavernous fistula in setting of inflatable penile prosthesis: a case report

Background Urethral injury or erosion of an inflatable penile prosthetic (IPP) cylinder is a rare complication of IPP placement. It can present with varying symptoms and management can be difficult with risk for future complications. We present a patient with an eroded IPP who developed a secondary contralateral urethrocavernous fistula requiring repeat urethroplasty. We also describe the literature surrounding these complications and strategies to prevent them. Case presentation A 69-year-old man with poorly controlled diabetes presented to our clinic with 6 months of intermittent white urethral discharge first noted after IPP removal and replacement by an outside urologist for device malfunction. Office cystoscopy revealed an eroded right-sided prosthetic cylinder in the bulbar urethra. The patient was taken to the operating room for IPP explantation with closure of right corporal defect, left sided malleable prosthesis placement, and primary excision with anastomosis of his bulbar urethra. A catheter was left in place for two weeks postoperatively, at which time a peri-catheter retrograde urethrogram was performed which showed no evidence of contrast extravasation and his catheter was subsequently removed. Several months later, he presented with recurrent urethral discharge without evidence of recurrent erosion on cystoscopy with development of scrotal abscesses following office cystoscopy, concerning for an unidentified urethral defect. He returned to the operating room for scrotal exploration and was noted on cystoscopy to have a pinpoint fistula between his left corporal body and his bulbar urethra. He underwent left sided malleable prosthetic explant, and non-transecting bulbar urethroplasty. Peri-catheter retrograde urethrogram two weeks later showed no contrast extravasation and he has had no recurrence of urethral discharge or scrotal abscesses since. Conclusions Urethral erosion and urethrocavernous fistula formation are rare complications of penile prosthesis placement. Risks are elevated in patients with corporal fibrosis, diabetes, those undergoing penile implant revision surgery, and those requiring prolonged urethral catheterization.

Urethral injury in children: Experience in a teaching hospital in Enugu, Nigeria

Background: Urethral injury in children is uncommon, and its treatment is challenging. This study evaluated our experience in the management of urethral injuries in children who presented at the paediatric surgical unit of a teaching hospital in Enugu, Nigeria. Methods: The medical records of patients younger than 15 years old admitted to our centre with urethral injury from January 2008 and December 2017 were reviewed retrospectively. Results: During the period of the study, 11 cases (all male) were managed. The mean age of the patients at presentation was 11 years. Road traffic accident was the most common mechanism of injury, and the bulbar urethra was the most injured part of the urethra. All the patients had urethroplasty through the perineal approach. There was 90% success at first instance. One patient required redo urethroplasty. Conclusion: Urethral trauma is associated with considerable morbidity. Road traffic accident was the most common mechanism of injury, and the bulbar urethra was the part of the urethra most affected. Transperineal urethroplasty was an effective modality of treatment.