Primary carcinoma of the male urethra developing after urethroplasty for stricture

Most investigators agree that a urethral stricture is a predisposing cause of primary carcinoma of the urethra. The etiology of the carcinoma is probably chronic irritation. The role of squamous metaplasia in the etiology is discussed briefly. A case of primary squamous cell carcinoma of the urethra occurring 4 years after a first stage urethroplasty is reported and 2 cases from the literature are described. The suggested origins of urethral malignancy after urethroplasty are 1) unrecognized malignancy at operation, 2) premalignant mucosal changes that progress postoperatively, 3) recurrence of stricture with continued irritation leading to malignant metaplasia and 4) malignant change in the urethroplasty skin flaps. Although rare, primary male urethral carcinoma is a deadly disease. The hope for early diagnosis is a high index of suspicion during urethroplasty and in subsequent followup studies. The patient presented herein also exhibited pseudohyperparathyroidism as a result of the malignancy.     

Varices of the male urethra

Protein changes occurred in callus cells of hypersensitive tobacco (Nicotiana tabacum var. Xanthi-nc) 72 hr after inoculation with tobacco mosaic virus and incubation on a minimal growth medium. Two protein bands, serologically related to viral coat protein, were obtained from extracts of infected cells following electrophoresis on 7% and 10% polyacrylamide gels. An additional, slower migrating protein, perhaps due to virus-induced stimulation of a host protein, also was detected. Although local lesions appeared on callus after 40 hr of incubation, four proteins previously reported in lesion-bearing hypersensitive tobacco leaves were not found. The possible significance of this and the usefulness of a callus-TMV system as a tool to study virus-induced protein changes are discussed.     

NonHodgkin's lymphoma of the male urethra

Ten cases of malignant lymphoma of the female urethra have been reported. To our knowledge we report the first such case in a man who presented in acute urinary retention with a mass protruding from the urethral meatus. Multiple subcutaneous nodules developed over the anterior abdominal wall and a 3 x 3 cm. mass developed above the umbilicus. Wedge resection of this mass was consistent with large cell lymphoma. Treatment consisted of 2 courses of arabinoside C, doxorubicin and prednisone. Followup 6 months later showed no urethral or other recurrence. Local excision, radical excision, radiotherapy (external beam and intracavitary) and chemotherapy have been used with success in other cases.     

Use of proximal-based vaginal flap in stricture of the female urethra

A proximal-based vaginal flap was used to repair a stenosis of the mid and distal urethra in a woman after a failure of urethral dilation and internal urethrotomy. A successful result was obtained with relief of the obstruction and preservation of the continence.     

Temporary spiral stent after endoscopic repair of posttraumatic stricture of prostatomembranous urethra

Acute bilateral infarcts in the territory of the posterior inferior cerebellum artery are rare and poorly documented in the literature. Thus, this report describes the clinical course and outcome in 3 patients. Although one was associated with coronary artery bypass surgery, the etiology was not known. Despite large territorial infarcts, the patients recovered to ambulation with minimal assistance.     

Membrano-bulbo-urethral junction stenosis. Posterior urethra obstruction due to extreme caliber disproportion in the male urethra

OBJECTIVE: Based on 4 cases of infravesical obstruction due to extreme caliber disproportion between the posterior urethra and the penile urethra, a pathophysiological mechanism for this dynamic obstruction is given and endoscopic treatment is described. SUBJECTS: Four cases of membrano-bulbo-urethral junction (MBUJ) stenosis, seen between September 1995 and April 1996, are described. Two boys had previous successful valve resection but still showed extreme ballooning of the posterior urethra. The other 2 boys showed bladder instability on urodynamics and the male variant of the spinning top urethra on voiding cystourethrography (VCUG). RESULTS: All cases were successfully treated by endoscopic incision at the 12 o'clock position of the kink between the posterior and the penile urethra which is seen when the full bladder is expressed. Disproportion in the posterior urethra, seen on VCUG, together with bad urinary flow measured on uroflowmetry raise the suspicion of MBUJ stenosis. CONCLUSION: Although rarely seen, extreme caliber disproportion in the male urethra can cause obstruction. Ballooning of the posterior urethra, caused by urethral valves, bladder instability resisted by voluntary sphincter contraction or congenital posterior urethral dilatation, creates an obstructive kink in the urethra comparable to some obstructions in ureteropelvic junction stenosis. If suspicion of such a form of obstruction arises, cystoscopy during pressure on the full bladder is mandatory in order to see the obstruction, descending as a membrane from the vault of the urethra.     

Innervation of the striated muscle of the membranous urethra of the male dog

PURPOSE: To identify the functional innervation of the striated muscle layer of the post-prostatic urethra of male dogs. MATERIALS AND METHODS: Detailed anatomic dissection of the pelvic and pudendal nerves was carried out. The pressure and contractile responses to stimulation of these nerves were recorded in vivo and in vitro. RESULTS: Small branches of the pelvic nerve entered the membranous urethra but passed through the striated muscle to the inner smooth muscle layer. Stimulation of the nerve with 1 msec pulses at 10 Hz produced a slow contraction of the urethra which was unaffected by d-tubocurarine. Pudendal nerve branches entered the striated layer from the caudal end. Stimulation produced a rapid, visible contraction that was abolished by d-tubocurarine. Field stimulation of isolated strips of striated muscle resulted only in rapid, d-tubocurarine sensitive contractions. CONCLUSIONS: The striated muscle of the membranous urethra is innervated exclusively by the pudendal nerve.     

Unusual cloacal exstrophy in a male neonate with a normal penis and urethra

El mouse is a mutant which has epileptic convulsions after tossing-up stimulations and has a hippocampal dysfunction. Platelet-derived growth factor B-chain homodimer has been reported to be a trophic factor of hippocampal neurons. We found that a recombinant PDGF-BB suppressed the convulsions of El mice in a dose-dependent manner. Furthermore, thrombin-treated mice manifested no convulsions, but thrombin receptor activating peptide-treated ones had convulsions. These findings suggest that an abnormality in PDGF-BB release may make El mice susceptible to tonic-clonic convulsions.     

The autonomic innervation of the human male and female bladder neck and proximal urethra

This study was undertaken to determine whether the increase in plasma glucagon concentration that occurs in response to prolonged exercise is modified by endurance exercise training. Eight subjects participated in an exercise program, consisting of running and bicycling, 4 days/wk for 10 wk. The training program resulted in an average increase in VO2 max of 18%. The average increase in plasma glucagon during a 60-min long bicycle exercise test that required 60% of the subjects' VO2 max was 107+/-28 pg/ml, from 116+/-14 pg/ml at rest to 223+/-37 pg/ml after 60 min of exercise, prior to training. After training the same absolute work rate resulted in an increase in plasma glucagon of only 20+/-6 pg/ml, from 125+/-20 to 145+/-16 pg/ml (P less than 0.02). A similar blunting of the glucagon response to exercise was seen during work of the same relative intensity after training. Plasma insulin concentration decreased from 18.1+/-2.5 to 7.6+/-1.6 muunits/ml during the 60 min of exercise before training. A similar decrease in insulin concentration was seen at the same relative work rate after training. However, the decrease in plasma insulin at the same absolute work rate, from 18.5+/-3.0 to 12.5+/-1.8 muunits/ml, was significantly smaller after training (P less than 0.05).     

Primary carcinoma of the male urethra. Report of a case and review of the literature

Contribution of one case of epidermoid carcinoma of the urethra in a 47-year old male with a several years old urethral stenosis. The significance of urethroscopy and the obtention of biopsies for diagnosis is emphasised. Also a review is made of the existing literature on the different therapeutical alternatives.     

On the size of the male urethra. Consequences of transurethral prostatic resection (author's transl)

More recently it has been claimed by some authors that a disproportion between the size of the resectoscope and the lumen of the urethra is supposedly the cause of urethral strictures following transurethral prostatic resection. For this reason the use of resectoscopes no larger than 24 F in size has been urged. Reports in the literature as well as our own investigations in connection with the transurethral resection by cold punch technique cast some doubt on the wisdom of this statement as long as other causes, such as thermal damage during electroresection, are not definitely excluded.     

Duplication of the urethra

Ten patients with patent urethral duplication are presented. Nine patients had two independent patient channels originating from the bladder or the posterior urethra. Both voiding cystourethro and retrograde urethrography are necessary to completely evaluate this anomaly. In each instance the ventral channel, regardless of the position of its meatus, proved to be the more functional urethra. In those patients whose dorsal channel was in an epispadiac position, the symphysis pubis was abnormally wide. A functionally and anatomically accurate classification is proposed, and the embryology of these anomalies is discussed.     

Carcinoma of the female urethra

Recurrent pseudomonal conjunctivitis, caused by poor soft contact lens care and the use of contaminated saline, is described. This problem can easily be avoided by proper sterilization, with boiling being the method of choice.     

Differences between proximal and distal portions of the male rabbit posterior urethra in the physiological role of muscarinic cholinergic receptors

The effect of feeding groups of mice with a diet containing 2000, 4000 and 6000 micrograms aluminum (Al3-/g) for two weeks (subacute) or 2000 and 4000 micrograms Al3+/g for eight weeks (subchronic) as well as the coadministration of vitamin E (alpha-tocopherol) 500 micrograms/g with Al3+, on the status of glutathione (GSH) and lipid peroxides as thiobarbituric acid reactive substances (TBARS) in whole brain tissues were evaluated. Changes in TBARS were further evaluated in vitro following the incubation of brain homogenates of the Al(3+)-fed mice in the presence of 50 microM FeSO4. The results of subacute experiments revealed that the brain levels of GSH were significantly decreased only in the group of mice that received 6000 micrograms Al3+/g diet (P < 0.05) and this effect was partially ameliorated when vitamin E was coadministered with Al3+. TBARS were significantly increased in vitro only in the presence of free iron ions and depended on the concentration of Al3+ in the diet. The effect was opposed by the vitamin E intake. Following subchronic Al3+ intake, the GSH content of the brain was significantly decreased only in the group of mice that received 4000 micrograms Al3+/g diet (P < 0.01), while TBARS were significantly increased in the brain tissues in vivo as well as in the presence of free iron ions in vitro. However, coadministration of vitamin E with Al3+ for eight weeks preserved GSH levels and decreased TBARS in the brain of mice in vivo and in the presence of free iron ions in vitro. It is concluded that the long term administration of vitamin E may prevent Al3(+)-stimulated oxidative injury in the brain.     

Diverticula of the female urethra

OBJECTIVES: The contribution of ultrasonography to pretreatment morphological assessment of strictures of the anterior urethra and assessment of the risk of recurrence after internal urethrotomy. MATERIAL AND METHODS: 33 patients (16-89 years) operated by internal urethrotomy for stricture of the anterior urethra and followed for at least 6 months. Preoperative urethral ultrasonography, recording the number, length and degree of strictures and echostructure of the peristenotic fibrosis of the corpus spongiosium. RESULTS: Ultrasound visualization of all urethral strictures, with no false-positives and no false-negatives. 11 patients relapsed after a mean interval of 5.7 months (1-16 months), 22 patients did not present recurrence: mean interval: 15.5 months (6-36 months). Corpus spongiosum fibrosis associated with urethral stricture is isoechoic to the corpus spongiosum (19 cases) or hyperechoic to the corpus spongiosum (14 cases). No statistical correlation was observed between the echostructure of the fibrous tissue and the risk of recurrence after internal urethrotomy. CONCLUSION: Ultrasonography allows excellent analysis of the morphological characteristics of a stricture of the male anterior urethra. In our experience, and in contrast with the limited data of the literature, no correlation was observed between the echostructure of the peristenotic fibrosis and the risk of recurrence after internal urethrotomy.     

Mucous prolapse of the urethra

Urethral prolapse represent a rare cause of urological consultation. Frequent in older women, it also happens in under 10-year-old little girls with a racial predominance. For most cases, medical treatment and follow-up are sufficient, but failure of these or possible complications may necessitate a surgical correction. Circumferential excision and muco-mucous suture are effective treatments with very few complications. About four case-reports, we are reviewing here the literature and discussing etiopathogenic mechanisms and therapeutic options for this disease.