Calculi in a Female Urethral Diverticulum

Urinary stones are rarely seen in the urethra and are usually encountered in men with urethral stricture or diverticulum. The case of a 52-year-old woman presented, who consulted for weak stream associated with repeated urinary infections. The diverticulum was approached via vaginal route and the extraction was successful. The patient has been well, with no dysuria, dyspareunia, incontinence for 3-month follow-ups

A prospective cohort trial evaluating sexual function after urethral diverticulectomy.

OBJECTIVE Dyspareunia is a main symptom of urethral diverticulum in the female population, reported up to 60% of patients. Pain may cease after diverticulectomy as published in previous retrospective studies. To date scarce or no data exists on the postoperative outcome in terms of sexual function. The present study wants to quantify sexual function and evaluate lower urinary tract symptoms in sexually active patients after resection of urethral diverticulum. STUDY DESIGN In this prospective cohort trial at a tertiary referral center, we evaluated 40 female patients who presented with symptomatic urethral diverticulum and were sexually active. All of them underwent a standardized surgical procedure with inverted U-shape colpotomy between 2008 and 2018. The patients completed the Female Sexual Function Index (FSFI), which is determined by the mean score of the different domains, and underwent urodynamic assessment both at baseline examination before surgery and 12 months postoperatively. For statistical analysis, we conducted a paired Wilcoxon rank sum test analyzing the non-normally distributed non-parametric variables of the female sexual function index. RESULTS In two patients a malignancy was found in postoperative histology and received a different therapeutical approach. They have been excluded from statistical analysis. Sexual function improved in all domains (n = 38): total score (Z = -5.4, P < 0.000), satisfaction (Z = -5.3, P < 0.000), pain (Z = -5.4, P < 0.000), arousal (Z = -2.6, P = 0.010), lubrication (Z = -2.4, P = 0.020), desire (Z = -2.6, P = 0.009) and orgasm (Z = -2.2, P = 0.029). Maximum urethral closure pressure deteriorated from 39 to 36 cmH2O (P = 0.0008) and residual urine increased from 10 ml to 20 ml after surgery (P = 0.0019). No statistical significance is found for bladder capacity and free urinary flow. CONCLUSIONS All domains of the female sexual function index improved. Patients' bothersome symptoms, mainly pain may cease and sexual satisfaction increases, which is reassuring concerning patients' preoperative consent. We should be aware that occasionally an unexpected malignancy may be detected and it is mandatory to examine all excised tissue histologically. Lower urinary tract function remains clinically unchanged, although maximum urethral closure pressure deteriorated and postvoid residual increased though not being clinically significant

Diagnosis of Female Diverticula Using Magnetic Resonance Imaging

We investigate the ability of physical exam to diagnose urethral diverticula with or without magnetic resonance imaging (MRI) and exclusive of invasive modalities. A retrospective chart review of all women undergoing urethral diverticulectomy at our institution since 1999 was performed. We identified 28 female patients with a mean age at diagnosis of 42.6 years (range 18–66). Common presenting symptoms included dyspareunia, urgency, and frequency. Physical exam revealed a suspected urethral diverticulum in 26 (92.9%) patients, which was confirmed postoperatively in 17 of the 20 (85%) women who underwent surgical resection. Noninvasive imaging modalities (MRI or CT) were available for review in 20 (71%) cases and made the correct diagnosis of urethral diverticulum (presence or absence) in 19 (95%) patients. In those patients with symptoms of stress or urge incontinence (11, 39%), voiding cystourethrogram (VCUG) was performed. Urethral diverticula are often easily diagnosed on physical exam. MRI can be a useful adjunct for defining diverticular extent in surgical planning, especially for proximal and complex diverticula, and should be the modality of choice if clinical suspicion is high based on patient symptoms and physical exam

Urinary incontinence secondary to a suspected congenital urethral deformity in a kitten.

CASE SUMMARY: A 5-month-old entire male domestic shorthair kitten was referred for investigation of a month-long history of urinary incontinence. Clinical examination, baseline blood work and imaging (plain radiography and ultrasonography) were unremarkable. Urinalysis documented a urinary tract infection and a retrograde urethrocystogram revealed an outpouching of the pelvic urethra. Surgical exploration revealed the absence of the dorsal portion of the urethral wall in this section of pelvic urethra, replaced by an epithelial lined expanded 'pouch'. The ventral aspect of the urethra appeared grossly normal. A modified perineal urethrostomy was performed to create an anastomosis of the urethral pouch to the skin of the perineum alongside conventional castration. The kitten made a full recovery and the incontinence resolved within 48 h. A congenital urethral diverticulum and secondary urinary tract infection were deemed the most likely aetiology in this case. RELEVANCE AND NOVEL INFORMATION: Urethral diverticuli are a rare condition in veterinary medicine. To our knowledge, it has only been reported in two dogs and presumptively in one cat, all of which made a complete recovery after surgical intervention. The present case reports an unusual urethral deformity as a potential differential diagnosis for lower urinary tract signs in a young cat

Multiple Urethral Stones Causing Penile Gangrene

Penile urethral stones are a rare occurrence resulting from a number of causes including migration of stones within the urinary tract, urethral strictures, meatal stenosis, and obstructing tumours such as adenomatous metaplasia of the uroepithelium, hypospadias, urethral diverticulum, and very rarely primary fossa navicularis calculi. We report the case of a 54-year-old male presenting with penile gangrene and sepsis resulting from impaction of multiple stones within the penile urethra. This paper summarises the topic and discusses the pathophysiology of this unusual condition

Complications of Vaginal Synthetic Sling Surgeries in Women: Population Based Cohort Study

Synthetic sling surgery is the procedure of choice for surgical correction of stress urinary incontinence (SUI) in females. However, complications are recognized, with surgical intervention to treat them in some instances. In a retrospective study we identified and analyzed those complication to determine their incidence and associated predictive factors. A total of 59,887 women who had synthetic sling procedure were included. Incidence of surgically treated complications was 2.2 % ((95% CI 2.07- 2.30) and on 10 years follow up cumulative incident rate was 3.3% (95% CI 3.0- 3.5). There was no significant difference in complication rate between urologists versus gynecologists. A significant reduction in complications was noted with high surgical volume providers (HR 0.73, 95% CI 0.65-0.83). Patients’ factors like age and simultaneous surgeries had significant effect. Results address and supports Food and Drug recommendation about use of synthetic meshes and slings in vaginal surgery

Management of difficult cases in female urology and neurourology at the Reed M. Nesbit society meeting festschrift in honor of Edward J. McGuire, MD

This is a panel discussion of seven complex urologic cases in female urology and neurourology. Differences in diagnosis and management are discussed by this international panel of experts. Neurourol. Urodynam. 29:S2–S12, 2010. © 2010 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71363/1/20795_ftp.pd

Bladder Tumor in Women with Microscopic Hematuria: An Iranian Experience and a Review of the Literature

Aim. In this study we report our experience with microhematuria and its relation with bladder tumors in Iranian women. Materials and Methods. Overall 249 women were evaluated. Microscopic hematuria was defined as three or more red blood cells per high-power field on at least two different occasions. Patients with a history of gross hematuria or coagulation disorders, having organic diseases, urinary stones, urinary tract infections, nephrological diseases, and local lesions such as urethral caruncle were excluded from the study population. Final diagnosis of malignant tumors was done with cystoscopy and biopsy specimen pathological assessment in all cases. Results. Age for the study population was 49.7 ± 11.8 years. 95 (38%) of patients were identified during routine check up and presenting symptoms in other patients were frequency, dysuria, stress urge incontinence, urge incontinence, feeling of incomplete urine emptying, and flunk pain, respectively. Finally, 7 (2.8%) of study subjects were confirmed as having bladder tumors. One of tumor cases was diagnosed 24 months after initial assessments. Patients with bladder tumor were significantly older; more frequently had diverticulum in their bladder wall (P < .05). Conclusion. Female microscopic hematuria is relevant and deserves evaluations, especially in elderly patients. Patients whose reason for microhematuria would not be diagnosed at the initial evaluations should be followed