Case report laparoscopy-assisted pre-pubic urethrostomy as a palliative procedure for resection of distal urethral tumor in a female dog.

BACKGROUND: This paper presents the first described case of laparoscopy-assisted prepubic urethrostomy and laparoscopic resection of a tumor of the distal part of the urethra in a female dog as a palliative treatment. CASE PRESENTATION: An intact, 11 -year-old, mixed breed female dog, weighing 15 kg, was admitted with signs of urinary obstruction and difficulty with catheterization. Vaginal, rectal, and endoscopic examinations revealed a firm mass in the pelvic cavity at the level of the pelvic urethra. Ultrasound and computed tomography examination showed enlargement of the urethral wall (5.5 cm width and 3 cm thick), which was significantly restricting the patency of the urethra. The lesion affected only the distal part of the urethra without the presence of local or distant metastatic changes. The affected portion of the urethra was laparoscopically removed while performing pre-pubic urethrostomy with laparoscopy. The patient regained full consciousness immediately after the end of anesthesia, without signs of urinary incontinence. Histopathological examination of the removed urethra revealed an oncological margin only from the side of the bladder. In the period of 2.5 months after the procedure, the owner did not notice any symptoms that could indicate a postoperative recurrence, which was diagnosed three months after the procedure. CONCLUSIONS: Pre-pubic urethrostomy can be successfully performed with the assistance of laparoscopy. The use of minimally invasive surgery will allow, in selected cases, removal of the urethral tumor, and in inoperable cases, to perform a minimally invasive palliative pre-pubic urethrostomy.

Clinical characteristics and endoscopic treatment of hematospermia with postcoital hematuria.

BACKGROUND: Recurrent hematospermia accompanied by postejaculatory hematuria is a very rare phenomenon, has not been well understood in the clinical setting, and usually leads to misdiagnosis and mistreatment. The aim of this study was to summarize the clinical characteristics, etiologic diagnosis, and endoscopic treatment of hematospermia with postcoital hematuria. METHODS: We collected the clinical data from 39 patients of hematospermia with postcoital hematuria, who were admitted to our hospital from May 2014 to October 2019. The etiologic diagnostic process and endoscopic surgery were analyzed retrospectively, and we observed and evaluated the efficacy and any complications during follow-up. RESULTS: The average age of the 39 patients was 44.1 years (range, 18-61 years), and the disease history ranged from 1 month to 20 years, with a median duration of 24 months. All of the patients were observed by urethrocystoscopy, which showed 38 cases of posterior urethral hemangioma (PUH) or abnormal varicose vessels, and 1 case of anterior urethral hemangioma. Of these, 18 patients underwent transurethral resection of urethral hemangioma, and 21 patients underwent transurethral electrocauterization. Postoperative follow-up ranged from 1 to 56 months, with a median of 16 months. The symptoms disappeared in 37 patients and recurred in 2 patients two to 3 months after the operation. The two recurrent patients were treated again by transurethral electrocauterization, and their symptoms then disappeared. CONCLUSIONS: PUH is the most common cause of hematospermia with postejaculatory hematuria. Herein, we demonstrated that transurethral resection or electrocauterization provides a safe, effective, and minimally invasive method for the treatment of PUH.

Ultrastructural Analysis of Urethral Polyps against the Background of Urogenital Infection.

We performed an electron microscopic study of samples of urethral polyps obtained from 90 women (mean age 52.5±4.9 years). According to PCR and culture studies, the most common infectious agent in patients with urethral polyps is U. urealyticum (100% cases). In 70% cases, this infectious agent was present as monoinfection, of these, clinically significant concentration (>106 CFU/ml) were found in 53.3% cases. In 30% cases, associations with C. trachomatis, T. vaginalis, and M. genitalium were found. We observed significant ultrastructural heterogeneity of the epithelial cells in urethral polyps, which manifested in a combination of hyperplastic and metaplastic changes and signs of cytodestruction. Detection of mycoplasma-like bodies in connective tissue mononuclear cells and viral particles in epithelial cells during ultrastructural study, including cases with negative PCR results, indicates the pathogenetic role of latent infection in the formation of urethral polyps.

[Urethral Hemangioma with Repeated Urinary Retention by Posterection Hematuria].

A 73-year-old man presented to our hospital due to postejaculation gross hematuria and dysuria. Three months after onset, urinary retention occurred repeatedly. Under general anesthesia, cystourethroscopy following drug-induced erection was performed. A solitary sessile lesion with varicosis was found between the verumontanum and external sphincter. The tumor was resected endoscopically and recurrence was not observed during the follow-up period. Histological examination revealed a cavernous hemangioma of the urethra. Urologists should keep in mind that urethral hemangioma can be a cause of hematuria after erection or ejaculation.

Female paraurethral leiomyoma: treatment and long-term follow-up.

INTRODUCTION: We describe our experience with evaluating the ideal management of female paraurethral leiomyomas from imaging to surgery and follow-up. METHODS: Between January 2009 and January 2012, we treated six women (age range 32-49 years) affected by paraurethral leiomyoma of different sizes. RESULTS: All the six patients underwent transvaginal excision of the mass. They are free of recurrence at follow-up (range 32-72 months). Two patients developed stress urinary incontinence after the excision: in both cases, incontinence was corrected by a tension-free vaginal tape-obturator (TVT-O) placement. In one patient, a fascial sling was necessary to repair a urethral lesion that developed during surgical excision of the mass. CONCLUSION: A well-defined protocol for diagnosing and managing a paraurethral mass had not been established as yet due the rarity of the mass. We suggest performing pelvic magnetic resonance imaging (MRI) as a primary examination, followed by lesion biopsy. Complete surgical resection performed transvaginally should be the treatment of choice. As paraurethral leiomyomas does not originate from intraurethral smooth-muscle component, urethral lesion is rare. Excision of female urethral leiomyoma transvaginally is safe, and postoperative urinary incontinence, if any, can be easily corrected with minimally invasive tecniques.

Pathomorphological Analysis and Evaluation of Microcirculation in Polyps of the External Urethral Meatus in Women.

Combinations of various factors of polypogenesis determine the formation of a mixed structural phenotype of urethral polyps consisting of heterogeneous changes of the epithelium (hyperplasia, metaplasia, and erosions), inflammatory cell infiltration of the stroma, and dilatation of the venous plexus vessels. Urogenital infections are associated with the predominance of symptoms of inflammation, high serum levels of IL-1ß and TNF-α, more extensive areas of inflammatory infiltration and subepithelial microvascular bed, predominance of hyperemic form of microcirculatory disorders. The combination of hyperplastic reactions of the epithelial layer with neoangiogenesis and myofibroblast proliferation in the subepithelial zone confirms the key role of dysregeneratory hyperplasia in the mechanisms of polypogenesis.

[A Female Paraurethral Leiomyoma Causing Urinary Retention: A Case Report].

Leiomyoma is a benign smooth muscle tumor which is rarely found in the paraurethral region. We report a case of paraurethral leiomyoma in a 44-year-old female who visited a clinic complaining of urinary retention. Magnetic resonance imaging revealed a 9 cm mass adjacent to the urethra. She was referred to our department. Transvaginal needle biopsy was performed and the histopathological diagnosis was leiomyoma. The mass was completely excised transperitoneally and transvaginally. The resected specimen was 8 × 7 × 4.5 cm in size and 194 g in weight. Histopathological diagnosis was leiomyoma and the tumor cells demonstrated immunoreactivity for estrogen receptors and progesterone receptors. Herpost operative course was uneventful and she gained normal voiding function. In a follow-up after 3 months, there was no evidence of recurrence. We discuss the clinical and pathological features of the paraurethral leiomyoma.

Uncommun etiology of pediatric Hematuria: urethral lymphangioma.

We report a case of urethral cystic lymphangioma. Hematuria is the revealing symptom. Im our knowledge, is the third case described in literature.

Urethral adenocarcinoma in a mental deficiency patient.

OBJECTIVE: To report the case of a urethral tumour in a patient with mental deficiency. METHODS/ RESULTS: Complete resection of the tumour was performed and the pathologic examination informed the presence of urethral adenocarcinoma. The patient is disease-free twelve months after surgery. CONCLUSIONS: Bibliographic review for diagnosis and treatment was performed.

[Cardiorespiratory arrest due to acute pulmonary thromboembolism during chemotherapy for female urothelial carcinoma of urethra: a case report].

We report a case of deep vein thrombosis and acute pulmonary thromboembolism that occurred during chemotherapy for urethral carcinoma. A 68-year-old woman suffered from dysuria for a period of 2 years. When the symptoms worsened, a urethral catheter was placed and she was referred to our hospital for further examinations. Imaging analysis revealed a urethral tumor with multiple metastases. Pathological diagnosis on a specimen obtained from transurethral resection of the urethral mucosa was urothelial carcinoma and combined chemotherapy with gemcitabine and cisplatin was administered. On day 6 of the second course, the patient collapsed and was found to be in cardiorespiratory arrest. Cardiopulmonary resuscitation was successful and she received percutaneous cardiopulmonary support. Computed tomography at that time revealed a pulmonary embolism and deep vein thrombosis in the right popliteal vein. After her condition improved, an inferior vena cava filter was inserted to avoid further thromboembolism. The patient decided to continue the chemotherapy despite this episode. After the fourth course of combined chemotherapy, the urethral tumor and metastatic tumors were downsized, and she could urinate as she did before.

Case report: transitional cell carcinoma in situ within a urethral diverticulum.

A 56-year-old female smoker presented after long diagnostic delay with high-grade transitional cell carcinoma in situ within a urethral diverticulum. This is the third report of this type in the literature. Preoperative investigations, including urine cytology and magnetic resonance imaging (MRI), were not helpful.

Periurethral angioleiomyoma in a female patient.

A 51-year-old white woman, gravida 4, para 3-0-1-3 referred to our urogynecology clinic for evaluation of questionable symptomatic pelvic organ prolapse was found to have a periurethral mass with associated urinary urgency. She underwent transvaginal excision of this mass, and pathology revealed angioleiomyoma. Her urinary urgency has resolved after surgery. No prior periurethral angioleiomyoma has been reported in female patients.

Urethral Cancer After Urethroplasty: A Case Report and Review of the Literature.

OBJECTIVE: To review and report data on transformation to urethral carcinoma after urethroplasty for urethral stricture disease. Primary urethral carcinoma is a rare entity, and guidelines lack high quality data from which to cite. Urethroplasty is a highly effective treatment for urethral stricture disease, though in rare cases complications may include development of urethral carcinoma. METHODS: A systematic PubMed search was performed to identify all articles describing patients with urethral carcinoma after urethroplasty. Data were collected on the following parameters: patient age and sex, indication for urethroplasty, presentation of cancer, imaging, pathology, presence of metastasis, intervention, and outcome. RESULTS: The final cohort included fourteen patients, 13 from previously published cases and one from our institution. The median patient age at presentation was 60, most had endoscopic management prior to urethroplasty, and the majority presented with decreased urinary stream. All patients developed squamous cell carcinoma of the urethra. Patients underwent radical resection, lymph node dissection, chemotherapy, or radiotherapy, often in combination. A majority of patients had died at the time of case report. CONCLUSION: Development of urethral squamous cell carcinoma, particularly after urethroplasty, is a rarely encountered process. Patients and urologists must have a high index of suspicion and investigate symptoms such as fistula or lower urinary tract symptoms, even if these occur many months or even years after buccal mucosa graft . By compiling previously reported cases and adding an additional case to the literature, we hope that familiarity with this entity will lead to earlier recognition and diagnosis of disease.

[Female urethral adenocarcinoma with urinary retention: a case report].

A 57-year-old woman presented with urinary retention. Computed tomography revealed a pelvic mass. Vaginal examination revealed an elastic-hard mass beneath the anterior vaginal wall. Intravenous pyelography demonstrated the filling defect of bladder. Magnetic resonance imaging revealed the mass that had invaded bladder neck at dorsal side of urethra. Pathological examination of transvaginal needle biopsy suggested well-differentiated adenocarcinoma. Total cystectomy and ileal conduct formation was performed. Pathological diagnosis was urethral adenocarcinoma. She had local recurrence at perineum at seven months after the operation, and tumor resection was performed. Five months after the operation, she had no evidence of recurrence.

Primary urethral carcinoma - unexpected cause of urethral stricture. Case report and review of the literature.

Primary cancer of urethra (PCU) is one of rarest malignancies of the urinary tract. In early stages this type of cancer presents non specific symptoms which can be mistaken with more common urethral strictures. That is why the PCU is frequently recognize in a locally advanced stage. The basic tool used in the diagnosis is MRI, but ultrasonography can be also used at the beginning of diagnosis. We present the case of 66-year old patient with PCU, initially diagnosed due to urethral stricture. We report probably the first case of well documented sonourethrography findings in PCU.

Urethral diverticular with broadly squamous metaplasia in a patient with urethral diverticular calculi: A case report.

RATIONALE: There are already several reports concerning the occurrence of urethral diverticulum (UD) in female patients, but only rarely has a article describing UD combined with UD calculi or squamous carcinoma been published. Moreover, a case with squamous carcinoma and UD calculi at the same time has never been reported, making this the first case report about this condition. PATIENT CONCERNS: A 43-year-old woman presented to the gynaecology department with a complaint of a hard mass beneath the anterior vaginal wall. DIAGNOSES: Transvaginal ultrasound (TVU) revealed a UD. INTERVENTIONS: We performed a standard urethral diverticular excision. Intraoperatively, we identified and removed a stone from the diverticulum. The intraoperative finding of a stone challenged the diagnosis of UD, with subsequent histological examination of biopsy tissue from the mass demonstrating broadly squamous metaplasia. OUTCOMES: The broadly squamous metaplasia predominantly originated from the stone, and the stone was entirely removed. No complications occurred during the whole follow-up period. Moreover, after the 12-month follow-up, there was no diverticular recurrence or carcinoma metastasis. LESSONS: UD calculi may be considered a risk factor for female urethra squamous metaplasia, which with the potential of squamous carcinoma, so patients will be advised to treat this condition immediately.

Transitional cell carcinoma of the urethra [correction of ureter] in a patient with buttock pain: a case report.

This case reports on a patient with an unusual presentation of a rare tumor: urethral transitional cell carcinoma (TCC). Urethral TCC occurs in approximately 0.7% to 4.0% of patients who have had primary bladder cancer. The initial symptoms usually involve hematuria, with approximately a third of patients reporting flank area pain. Buttock pain and the absence of hematuria are uncommon with this disorder. The patient was initially suspected to have piriformis syndrome, but when he did not respond as expected to treatment, and because of his history of primary bladder cancer, further evaluation was undertaken and the diagnosis was made. The patient responded well to radiation and chemotherapy. Musculoskeletal physicians should be particularly suspicious of the presence of urethral TCC in a patient with a history of primary bladder cancer who reports low back or buttock pain, particularly if the patient does not respond quickly to treatment.

[Leiomyoma of the urethra - cause of an obstruction misdiagnosed as hereditary urethral stricture in a young man]. / Leiomyom der Urethra - Ursache einer als angeborene Harnröhrenenge fehlgedeuteten Striktur beim jungen Mann.

Leiomyomas are benign neoplasms arising from smooth muscle cells. We describe the case of a 17-year-old boy admitted with progressive severe obstructive voiding symptoms. Retrograde urethrography showed a bulbous urethral stricture which was resected with primary urethral anastomosis. Histopathological examination confirmed the very rare case of a leiomyoma of the urethra. In patients with urethral stricture, leiomyoma should be included in the diagnostic considerations.