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The article describes open surgical modalities for managing patients with severe obliterations of the anterior urethra. The mean age of patients was 70 years. The causes of urethral strictures and obliteration included prostatic adenomectomy, scrotal abscess with pelvic bone osteomyelitis, accidental removal of the bulbar and penile urethra during herniotomy and a prolonged use of an indwelling urethral catheter. Two patients underwent perineostomy (median and trapezoidal). In the third patient, scrotal skin was used to form "scrotal hypospadias" (a modified Johansons operation) and the fourth patient underwent Mikhalovskiis operation. All patients regained normal voiding.

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OBJECTIVE: To evaluate the effects of a single transrectal ultrasound (TRUS)-guided transperineal injection of botulinum toxin A (BTX-A) to the external urethral sphincter (EUS) for treating detrusor external sphincter dyssynergia (DESD). DESIGN: Descriptive study. SETTING: Rehabilitation hospital affiliated with a medical university. PARTICIPANTS: Patients (N=18) with suprasacral spinal cord injury who had DESD confirmed on video-urodynamic study. INTERVENTIONS: A single dose of 100U BTX-A was applied into the EUS via TRUS-guided transperineal route injection. MAIN OUTCOME MEASURES: Maximal detrusor pressure, detrusor leak-point pressure, integrated electromyography (iEMG), maximal pressure on static urethral pressure profilometry, and postvoiding residuals. RESULTS: There were significant reductions in iEMG (P=.008) and static (P=.012) and dynamic urethral pressure (P=.023), but not in detrusor pressure and detrusor leak-point pressure after treatment. Postvoiding residuals also significantly decreased in the first and second month after treatment (P<.012). CONCLUSIONS: TRUS-guided transperineal injection of BTX-A has beneficial effects in treating DESD.

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The repair of extensive posterior urethral stricture often poses a therapeutic dilemma, especially when the urethral defect is too extensive to be repaired with traditional methods and the stricture portion has a poor blood supply. This report details the successful substitution of an extensive posterior urethral stricture using a reconfigured sigmoid colon neourethra.

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Superoxide dismutase activity in blood red cells of patients with urethral strictures reflects the disease severity and the response to relevant treatment. Antioxidant therapy with dibunol on the first postoperative days, administration of vitamin E before and after the operation and laser biocontrolled chronotherapy for 2 weeks before and after the operation with repetition in 1-2 months are recommended in addition to conventional treatment to reduce probability of complications and recurrences after surgical treatment of urethral strictures.

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El ano imperforado es un defecto muy común y la evolución de diversos procedimientos quirúrgicos para su correción se iniciaron con Paul de Aegina (625-690). Después de este periodo se implementaron varias técnicas, pero todas con resultados decepcionantes. Los conceptos tradicioneales de esta clase de anomalía fueron secundarios a la investigación de dos pioneros australianos en las malformaciones anorrectales (Stephens y Smith). Sus conocimientos permanecieron probablemente validos hasta 1980, cuando Peña, un brillante cirujano pediatra mexicano, desarrolló la llamada anorrectoplastia sagital posterior. Esta operación fue un procedimiento revolucionario que cambió los conceptos tradicionales de la anatomofisiología anorrectal y ofreció la mejor opción terapéutica para los niños con ano imperforado. El acceso sagital posterior es una operación benigna que no tiene efectos adversos sobre la continencia fecal o urinaria. Por esto, ha sido recomendada para enfermedades como: estenosis rectal y uretral, seno urogenital, masa presacra, fístula vaginal y trauma pelvi-perineal

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Se emplearon injertos autólogos de mucosa bucal como sustitutos para la reconstrucción uretral en 13 pacientes pediátricos con defectos uretrales congénitos o adquiridos. Todos ellos tenían operaciones previas. Después de un seguimiento promedio de 22.6 meses se encontró adecuada integración del injerto en todos los casos. En nueve pacientes los resultados fueron excelentes. En un caso con hipospadias medio se presentó estenosis meatal y parcial del injerto, y en otro fístulas a nivel anastomótico. Dos pacientes con estenosis de uretra posterior postraumática multioperados desarrollaron fístula uretrorrectal y retracción parcial del injerto, respectivamente. El Uso de mucosa bucal constituye una alternativa útil para la reconstrucción de uretra a diferentes niveles en un sólo tiempo quirúrgico

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The treatment was conducted for 154 patients aged 3-69 with traumatic rupture of the urethra. Eighteen patients underwent primary suturing, five patients primary delayed repair of the urethra. Urethral patency was achieved in all the cases. In 127 cases urethral rupture was associated with visceral and skeletal injuries managed by epicystostomy with good results. 16 patients without extended diastasis of the urethral fragments got circular tubes. 24 patients out of 111 developed restenosis (7 due to urethrotomy and 17 after tunneling). Later on 14 of these and the rest 87 patients were subjected to plastic reconstruction. Out of 101 patients operated on 3 needed bougienage, 1 patients retained urethrorectal fistula. 8 patients had postoperative dynamic urethral obstruction removed upon augmentation of detrusor tonicity by means of intravenous administration of calcium chloride and strofantina. Copulative dysfunction occurred in 70% of the patients over 22 years of age. Extracavernous prosthetic implantations performed in 33 of them corrected erectile impotence [correction of importance].

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The management of strictures of the posterior urethra is reviewed in 75 adults and 19 children. Of the patients 66 were treated by a perineal pull-through technique and 28 underwent a transpubic approach. The transpubic approach provided excellent exposure to the damaged urethra with minimal morbidity, and good results were obtained in 89 per cent of the children and 69 per cent of the adults. Three patients had partial incontinence postoperatively but 2 recovered completely after 6 months. With the perineal pull-through technique, good results were achieved in 80 per cent of the children and 66 per cent of the adults. Worsening of sexual function was not seen in either treatment group as a consequence of the operation. As a result of this experience the transpubic approach is preferred in cases of complex urethral strictures, cases in which the length of the damaged urethra exceeds 3 cm. or in small children, reserving the pull-through technique for low-lying urethral strictures less than 3 cm. long.

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