Bladder outlet obstruction in women: functional causes.

Bladder outlet obstruction (BOO) in women has received less focus in the past, as compared with BOO in men; however, more recently, studies have further examined BOO and voiding dysfunction in women to define the various etiologies, diagnostic criteria, and treatment strategies. The differential diagnosis in women is broad and includes anatomic, neurologic, and functional etiologies. This review focuses on the functional etiologies, including dysfunctional voiding, Fowler's syndrome, and primary bladder neck obstruction in adult women.

Surgical excision of strangulated urethral prolapse mimicking urethral carcinoma under local anesthesia in a postmenopausal woman.

Urethral prolapse is frequently reported in girls; however, the clinical condition is frequently encountered in postmenopausal women by urologists and gynecologists. The treatment of urethral prolapse is controversial. Information regarding the treatment and pathophysiology of this clinical entity in postmenopausal women is sparse in the published literature. We report a case of strangulated urethral prolapse that was successfully treated by surgical excision under local anaesthesia.

Posterior sagittal pararectal approach with rectal mobilization for repair of rectourethral fistula: an alternative approach.

OBJECTIVES: To present this clinical series to report our initial experience with our technique as an alternative approach for treatment of rectourethral fistulas (RUFs). RUFS are a devastating complication of the urinary tract. The most appropriate approach remains controversial. METHODS: From March 2002 to August 2007, 8 patients with RUF were referred to our institution. The etiology of the RUF was a fractured pelvis in 2, radical prostatectomy in 1, transurethral resection of the prostate in 1, anterior bowel resection in 1, and a pull-through operation in 3. Of the 8 patients, 5 had undergone urinary diversion and 3 had undergone a previous repair that had failed. They were evaluated and treated using the posterior sagittal approach with rectal mobilization. The fistulas were excised, and both the urethra and rectum were repaired. The inferior half of the gluteus maximus muscle was used as barrier in 5 of the 8 patients. The operative and immediate and late postoperative complications were recorded. The clinical outcome was defined as success when the patients experienced no fecaluria or pneumaturia. RESULTS: All 8 patients, with a mean age of 38.7 years, were completely cured of their RUF. The mean operative time was 290 minutes, and the mean blood loss was 637.5 mL. The median hospital stay was 18 days. Early postoperative complications included wound infection in 1 and deep vein thrombosis in 1 patient. One patient developed a late complication of urinary incontinence. CONCLUSIONS: Our approach is safe, provides excellent exposure, and allows for dissection under direct vision. The gluteus maximus flap is a good, nearby flap that can be used with minimal host morbidity.

Urethral pain syndrome and its management.

UNLABELLED: Urethral pain syndrome is occurrence of persistent or recurrent episodic urethral pain usually on voiding with daytime frequency and nocturia, in the absence of proven infection or other obvious pathology. This is a condition of uncertain etiology. The objective of this article is to review etiology, diagnosis, and management of urethral pain syndrome. Since there is paucity of information on randomized trials, search of published literature has been made using keywords such as "urethral pain syndrome", "painful bladder syndrome", "urethral stenosis", and "lower urinary tract symptoms". Urethral pain syndrome is a disease of ambiguous etiology. Diagnosis is mainly based upon symptoms, and investigations are aimed to exclude other conditions affecting lower urinary tract. Various modalities of treatment including antibiotics, alpha-blockers, acupuncture, and laser therapy have been proved successful. Psychological support is very important in this group of women. Management requires multidisciplinary approach, and treatment at its best is by trial and error. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to explain that the urethral pain syndrome (UPS) has specific signs and symptoms without specific responses to a variety of treatment options and recall that treatment may require a multidisciplinary approach and a lot of sensitivity by the physician.

Infecciones genitales debidas a Chlamydia trachomatis / Genital infections caused by Chlamydia trachomatis

C. trachomatis es la bacteria más frecuentemente involucrada en la etiología de las enfermedades de transmisión sexual. En la mujer la cervicitis, que se puede complicar con endometritis, salpingitis e infertilidad, es la presentación clínica más común. Sin embargo, la mayoría de las infecciones genitales en la mujer son asintomáticas. En el hombre la uretritis y la epididimitis son formas frecuentes de presentación. El diagnóstico de las infecciones por C. trachomatis se puede hacer por métodos de detección de antígenos incluyendo la amplificación de los ácidos nucleicos. Dependiendo de la presentación clínica diversos protocolos de tratamiento se pueden implementar (AU)

[Value of prostatic massage for detection of Chlamydia trachomatis in the male urethra]. / Intérêt du massage prostatique pour la mise en évidence de Chlamydia trachomatis dans l'urètre masculin.

The aim of this work was to evaluate prostatic massage (PM) as diagnostic method of chronic chlamydial infection (possible etiologic agent of male infertility or chronic prostatitis). 105 men were examined. One urethral swabbing and one urine sampling are done before PM. After PM, prostatic fluid is collected spontaneously and in a minimum volume of urine. Chlamydial isolation samples are treated by 3 methods: culture on HeLa 229 cells, immunoenzymology and direct immunofluorescence. Of 107 samplings, 22 were positive. In 13 patients (14 samplings) the result was positive by PM alone. In those cases, prostatic massage was the only way to establish the Chlamydial infection, when urethral swabbing, usual method, is negative. If confirmed, the interest of prostatic massage rests on detection of unknown genital Chlamydial infection, and this, by a non surgical method.

Unusual fistulae between the rectum and the lower urinary tract: simple techniques for diagnosis.

This paper presents two unusual fistulae between the rectum and the lower urinary tract in adults, one a posttraumatic fistula following dilatation of a sigmoid colon stricture and the other a congenital anomaly. In both cases a contrast enema was negative; in one case a voiding cystourethrogram was negative. The fistula was demonstrated in case 1 by repeating the enema and having the patient raise his intraabdominal pressure, and in case 2 by having the patient hold while attempting to pass flatus during a cystogram, which demonstrated gas bubbles entering the bladder.

The urethral syndrome.

The term urethral syndrome reflects irritation in the external urethral (striated) sphincter. The cause of this condition may be as much poor voiding habits as it is infection or trauma. Treatment principles therefore involve retraining the voiding mechanism, as well as the judicious use of antibiotics, skeletal muscle relaxants, and an alpha-blocker. Neurostimulation has been used successfully to relieve symptoms in occasional refractory cases.