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At least 37 records · Page 2Linked to original sources
PubMed2001

Urethritis associated with Chlamydia trachomatis: comparison of leukocyte esterase dipstick test of first-voided urine and methylene blue-stained urethral smear as predictors of chlamydial infection.

The use of nucleic acid amplification tests for the diagnosis of C. trachomatis has made it possible to send urine samples instead of urethral swab specimens to the laboratory. The sensitivity is very high, but not 100%, and we continue to perform a test for urethritis at our STD clinic. The aim of this study was to compare the performance of two alternative tests in the diagnosis of urethritis as predictors of C. trachomatis infection: the leukocyte esterase (LE) dipstick test of first-voided urine and polymorphonuclear leukocyte counts in a methylene blue-stained (MBS) urethral smear. Urine samples from 480 male patients attending an STD clinic were analysed using the LE test and LCR assay for C. trachomatis; urethral samples were analysed with MBS urethral smear and LCR. The majority (75.8%) of the 480 patients examined were asymptomatic. Chlamydial infection was detected in 50 patients. The sensitivity, specificity and positive predictive value of the LE test for predicting C. trachomatis infection were 46.0, 91.6 and 39.0%, respectively, among all patients examined and 25.9, 95.8 and 33.3%, respectively, among the asymptomatic patients. The corresponding values for the MBS urethral smear were 76.0, 82.1 and 33.0% among all patients and 63.0, 89.6 and 32.7% among the asymptomatic patients. At our STD clinic we chose to perform the examination of MBS urethral smears in the diagnosis of urethritis because of its higher sensitivity relative to the LE test for predicting C. trachomatis.

Adolescent↗
PubMed1998

Applications of the KTP laser in the treatment of posterior urethral valves, ureteroceles, and urethral strictures in the pediatric patient.

PURPOSE: We describes our experience using the potassium titanyl phosphate (KTP)-532 laser in treating posterior urethral valves, ureteroceles, and urethral strictures in the pediatric patient. METHODS: A retrospective chart review was performed from 1987 to 1997 on a total of 33 pediatric patients who underwent retrograde endoscopic treatment for posterior urethral valves (PUV), ureteroceles (UC), and urethral strictures using a KTP-532 laser. RESULTS: Overall, our success rate was excellent in the treatment of valves and ureteroceles. With a mean follow-up of three years in the PUV group, no urethral strictures of micturation abnormalities were seen. The majority of ureteroceles were decompressed and only half of our patients required and additional procedure. Our experience with urethral strictures, however, was not as promising. All of these patients ultimately required open urethral reconstruction. CONCLUSION: The desirable thermal characteristics of the KTP laser, along with minimal complications and the availability of delicate pediatric endoscopic instruments have made this operation optimally suited for treating posterior urethral valves and ureteroceles in infants. However, the advantages for treating urethral strictures in children with the laser still remains to be established.

Adolescent↗
PubMedDate not supplied

Comparison of the Gram-stained urethral smear and first-voided urine sediment in the diagnosis of nongonococcal urethritis.

The diagnostic sensitivity of the numbers of leukocytes in the sediment of first-voided urine and in gram-stained smears of urethral secretions was evaluated by a study of 62 men with symptoms of nongonococcal urethritis. Fifty-one patients (82.3%) had pyuria (defined as ten or more leukocytes per high-power field) in the sediment of first-voided urine, whereas 8 (45.2%) had more than four leukocytes per oil-immersion held in gram-stained urethral smears. Frequencies of positive first-voided urine sediments and urethral smears were similar in Chlamydia trachomatis--positive and -negative cases. Results of cultures, urinalyses, and urethral smears were not affected by recent micturition. Pyuria in the first-voided urine but not a positive urethral smear is a sensitive sign of urethritis whether or not urethral discharge is evident. Specimens of urethral secretions were subjected to different storage conditions to determine the effect on subsequent isolation of C. trachomatis. Equal rates of isolation were demonstrated for specimens that had been held at 4 degrees C for either four or 20-24 hr or frozen to -70 degrees C for one week prior to culture.

Chlamydia Infections↗
PubMed2006

Female urethral strictures: successful management with long-term clean intermittent catheterization after urethral dilatation.

OBJECTIVE: To report our experience in the diagnosis and treatment of urethral stricture in women. PATIENTS AND METHODS: A retrospective review of records and video-urodynamics identified women treated for urethral stricture between 1999 and 2004 at one institution by one surgeon. Urethral stricture was defined as a fixed anatomical narrowing between the bladder neck and distal urethra of <14 F preventing catheterization, and the diagnosis was confirmed by cysto-urethroscopy, and/or video-urodynamics. Women with a history of external beam radiotherapy to the pelvis, or of gynaecological, urethral or bladder malignancy, were excluded, and the women had a urethral biopsy to exclude a malignant cause of the stricture. Initial treatment consisted of urethral dilatation to > or = 30 F. After a period of indwelling catheterization, the women were placed on clean intermittent self-catheterization (CISC) at least once daily, and monitored every 3-6 months. At each follow-up, the urethra was catheterized to exclude recurrence. American Urological Association (AUA) symptom scores were obtained at presentation and at the initial 3 month follow-up. RESULTS: Seven women met the criteria for urethral stricture, and were followed for a mean (range) of 21 (6-34) months. All were initially maintained on daily CISC, and some were gradually reduced to weekly CISC for the duration of follow-up. No patient had a recurrent stricture while on CISC, and none has had a urethral reconstruction to manage their condition. AUA symptom scores improved in all of the women by a mean of 10.7 points. No complications related to catheterization were noted. CONCLUSION: Urethral stricture is rare in women. Long-term CISC in these women is safe and effective, and can avoid the need for major reconstructive surgery.

Adult↗
PubMedDate not supplied

Long-term outcome of posterior urethral valves ablation using the Mohan's urethral valvotome.

CONTEXT: Posterior urethral valves are the most common cause of mechanical infravesical obstruction in children. The disorder has a broad spectrum of severity and the patients could develop complications on the long term, even after valves ablation. OBJECTIVE: To report the result of the follow-up study of 26 children who had posterior urethral valves ablated with the Mohan's urethral valvotome at the University college hospital, Ibadan over a period of five years. STUDY DESIGN SETTING AND SUBJECTS: Children who had posterior urethral valves ablated with the Mohan's urethral valvotome at the UCH, Ibadan between January 1996 and December 2000 were followed up in the out patient clinic on a regular basis. RESULTS: A total of 26 patients with posterior urethral valves had the valves ablated with the Mohan's urethral valvotome during the period of the study. The period of follow-up varied between 18 months and five years. Problems noticed on follow-up include recurrent urinary tract infections in 35% of the cases, acute and chronic renal failure in 5% and 15% respectively, rickets, anaemia, malnutrition and urethral stricture. CONCLUSION: Children who had posterior urethral valves ablated should be followed up much beyond the immediate post valve ablation period as complications could arise on the long term.

Child↗
PubMed1995

[Changes in urethral pressure after intravenous injection of moxisylyte hydrochloride in urethral instability in women. Preliminary results].

OBJECTIVE: To study the action of an alpha blocker, Moxisylyte hydrochloride, during an intravenous test on the course of urethral pressure in women with urethral instability associated with urethral hypertonia. METHODS: The population consisted of 20 women with a mean age of 38 years, presenting with a clinical disorder of micturition (urinary incontinence: 15 cases, urgency: 17 cases, frequency, 17 cases) present for an average of 4 years and associated with resting urethral pressure variations ranging from 22 to 88 cm H2O (mean: 44.8 cm H2O) and static urethral pressures ranging 72 to 150 cm H2O (mean: 102.5 cm H2O). An urodynamic assessment was performed before and after intravenous injection of Moxisylyte hydrochloride at the dose of 0.5 mg/kg. RESULTS: Moxisylyte hydrochloride induced a significant reduction of urethral pressure variations, ranging from 8 to 42 cm H2O (mean: 21.9 cm H2O) and static urethral pressures, ranging from 47 to 102 cm H2O (mean: 68.8 cm H2O). Treatment was well tolerated in every case. CONCLUSION: These preliminary results need to be completed by a randomized placebo-controlled study to confirm a statistically significant effect of Moxisylyte hydrochloride on urethral pressure stability in women presenting with urethral instability.

Adult↗
PubMed2000

Anatomical studies of the urethral plate: why preservation of the urethral plate is important in hypospadias repair.

OBJECTIVE: To describe the detailed anatomy of the urethral plate in relation to its controversial role in hypospadias surgery. MATERIALS AND METHODS: A newborn penis with proximal penile hypospadias and two fetal penises with distal shaft hypospadias were included in the study; 30 normal fetal penises served as the control. Specimens were embedded in paraffin and serially sectioned (6 microm) after formalin fixation. Every 10th section was stained with haematoxylin and eosin. Immunohistochemical staining for nerves (S100), smooth muscles (alpha-actin), blood vessels (factor VIII) and epithelium (cytokeratins 7, 14 and 18) were used on selected sections, with particular attention to the urethral plate. Masson's trichrome and Sirius Red stains were used to localize collagen. RESULTS: There were extensive blood vessels, glands and smooth muscle under the urethral plate in the hypospadias specimens. These relatively well organized tissues corresponded to an abnormally formed corpus spongiosum. The glands underneath the urethral plate and adjacent to the normal urethra showed positive staining for cytokeratins 7 and 18, respectively (markers of endodermal origin) but were negative for cytokeratin 14 (a marker of ectodermal origin). Penile skin and urethral plate epithelium stained positively for cytokeratin 14 but not for cytokeratin 7 and 18. The urethral plate has a rich nerve supply, as determined by S100 staining. Collagen intensity under the urethral plate was no different from that in normal areas. Tunica albuginea stained intensely for type I and III collagen. CONCLUSION: These results show that the urethral plate is well vascularized, has a rich nerve supply and an extensive muscular and connective tissue backing. These features may explain the lower complication rate with onlay flaps than with tube flaps. Therefore, from these anatomical findings, we continue to advocate preservation of the urethral plate and the onlay island flap for hypospadias reconstruction.

Case-Control Studies↗
PubMed2005

[Correlation between urethral mobility and maximal urethral closure pressure and Valsalva leak-point pressure in women with urinary stress incontinence].

OBJECTIVE: The aim of our study was to examine the relationship between urethral mobility in females and maximum urethral closure pressure (MUCP) at rest, and between urethral mobility and Valsalva leakpoint pressure (VLPP), and to determine whether urethral mobility correlates with MUCP and VLPP. DESIGN: Cross-sectional clinical study. SETTINGS: Gynecological and Obstetric Clinic, First School of Medicine of Charles University and General Faculty Hospital, Prague. MATERIALS AND METHODS: Fifty-two women with previously untreated GSI were recruited to participate in a clinical study. Their mean age was 57.2, mean body mass index (BMI) 28, and mean parity 1.8. As part of the urethral pressure profile we determined MUCP and functional urethral length (FUL). VLPP was assessed during US examination using an ultrasound contrast medium and color Doppler velocimetry (CDV). A perineal ultrasound examination in patients in supine position (by Acuson 128 XP 10, curved array probe 5 MHz) to assess the position of UVJ and the middle of the urethra was performed. The bladder was filled with 300 ml sterile saline. RESULTS: We did not find statistically significant differences in the mobility of urethrovesical junction (UVJ) and middle of the urethra between patients with low or normal VLPP at 5% level. On the other hand, we found statistically significant correlation in the mobility of urethrovesical junction (UVJ) and middle of the urethra with MUCP, where these parameters were assessed as mutually dependent values. However, if we set the borderline of UVJ hypermobility at 50 degrees or more (the difference in the value of gamma angle at maximum Valsalva maneuvre and at rest), and a low MUCP at equal to or less than 30 cm H2O, then we do not observe any correlation between the values of urethral mobility and MUCP, since combinations of these two values are too extreme. CONCLUSIONS: This study mainly compares three parameters--the urethral mobility with MUCP and with VLPP. Based on our results we can conclude that there is no statistically significant correlation between hypermobility of the urethra and VLPP at 5% level. However, we did find a statistically significant correlation between MUCP and mobility of UVJ and middle of the urethra if the values for these parameters are not strictly assessed. If we set the borderline of UVJ hypermobility at 50 degrees or more and a low MUCP at equal to or less than 30 cm H2O, then we do not observe any correlation between the values of urethral mobility and MUCP.

Adult↗
PubMed1994

Urethral stricture and urethritis in men in Scotland.

OBJECTIVES: To examine the incidence of urethral stricture in men in Scotland during the years 1982-1991 in relation to the changing incidence of gonococcal and non-gonococcal urethritis (NGU) over the past 20 years. DESIGN: Retrospective study of incidence of urethral stricture in Scotland. METHOD: The number of new men in whom a diagnosis of urethral stricture was made for the years 1982-1991 was obtained using the new Scottish Record Linkage system, and the number of cases of gonorrhoea and NGU was obtained from Communicable Diseases (Scotland) Unit. Age-specific rates of urethral stricture were calculated and the Poisson regression model was used to test if there was a trend of rate with age or time change. RESULTS: There was a highly significant increase in the incidence of urethral stricture with age but only a slight increase in incidence over the study period within each age group. CONCLUSION: As the interaction between age and time was not significant, it is concluded that urethritis associated with sexually transmitted organisms is an uncommon cause of urethral stricture in Scotland.

Adolescent↗
PubMedDate not supplied

Value of the gram-stained urethral smear in the management of men with urethritis.

The value of the gram-stained urethral smear in clinical decision-making was assessed in a study of 250 men attending a clinic for sexually transmitted diseases. Of the 250 men, 132 (52.8%) had objective evidence of urethritis. Neisseria gonorrhoeae and/or Chlamydia trachomatis was isolated from 94 patients (37.6%). No pathogens were isolated from 38 patients (15.2%) who were diagnosed as having urethritis. Although the specificity (0.95) and positive predictive value (0.95) of the gram smear for culture-proved urethral infection was high, the relatively low sensitivity (0.66) and negative predictive value (0.63), led us to conclude that the test was of limited value in diagnosis and therapeutic decision-making when the patient was first seen. The decision to treat a patient should be based on a reliable history of dysuria and/or a urethral discharge in a patient at risk of infection, with or without an observable urethral discharge. Nevertheless, a gram smear should be done for all patients who are diagnosed presumptively as having urethritis, because it may be the only objective evidence of urethritis.

Chlamydia Infections↗
PubMed2006

Failure to detect urethral Trichomonas vaginalis in Japanese men with or without urethritis.

AIM: Trichomonas vaginalis may cause symptomatic or asymptomatic urethritis in men. There are few recent studies on the prevalence of T. vaginalis infection in Japanese men, and quantification of the number of cases of urethritis attributable to this pathogen has not been performed in Japan. The aim of this study was to determine the prevalence and morbidity of T. vaginalis infection in Japanese men. METHODS: One hundred subjects with or without urethritis were examined for the presence of urethral T. vaginalis using culture swabs. RESULTS: Urethral swabs from all subjects were negative for T. vaginalis. CONCLUSION: These results indicate Japanese men, including those with urethritis, have a low incidence of urethral T. vaginalis infection or colonization. T. vaginalis appears to be an uncommon pathogen for male urethritis in Japan.

Adolescent↗
PubMed2002

Urethral reconstruction with colonic mucosa in treatment of complex urethral stricture.

OBJECTIVE: To investigate the possibility of urethral reconstruction with colonic mucosa for the treatment of complex longer urethral stricture (>/= 10 cm). METHODS: From October 2000 to September 2001, 6 patients with complex longer urethral stricture were treated with colonic mucosal graft urethroplasty. They had under gone 3 previous unsuccessful urethral repairs on average. Urethral reconstruction with a free graft of colonic mucosa ranged from 10 to 15 cm (mean 12.17 cm). Follow-up included retrograde urethrography, urethroscopy, and uroflowmetry. RESULTS: The patients were followed up 3 - 14 months postoperatively (mean 7.8 months). Meatal stenosis developed in one patient 3 months after operation needed reoperation. The patient voided very well with urinary peak flow 28.7 ml per second duing follow-up for 12 months postoperatively. The other patients voided well with urinary peak flow greater than 15 ml per second. At urethroscopy, colonic mucosa was macroscopically difficult to distinguish from normal original urethral mucosa in 4 patients over 6 months after the operation. CONCLUSIONS: Colonic mucosa graft urethroplasty is feasible for the treatment of complex longer anterior urethral stricture. The technique is useful for urethral reconstruction when penial skin and bladder mucosa are not available.

Colon↗
PubMed1992

Urethral diverticula: evaluation by urethral pressure profilometry, cystourethroscopy, and the voiding cystourethrogram.

OBJECTIVE: To compare the value of urethral pressure profilometry with that of cystourethroscopy and the voiding cystourethrogram in the evaluation and management of urethral diverticula. METHODS: Twelve women with signs or symptoms of a urethral diverticulum were referred. The initial evaluation included cystourethroscopy and a voiding cystourethrogram. All then underwent urethral pressure profilometry. RESULTS: Nine of 12 patients had urethral diverticula, two had Skene duct cysts, and one had genuine stress incontinence. Both cystourethroscopy and voiding cystourethrography demonstrated diverticula in all patients who had them. Excision was the preliminary surgical plan in these women. Urethral pressure profilometry demonstrated a pressure depression or biphasic curve in all nine cases with diverticula. Stress incontinence was noted in one of these nine women. A biphasic curve was also noted in one woman with a Skene duct cyst and in the one who had genuine stress incontinence only. According to preset criteria for profilometry, excision was the planned operative procedure for all. CONCLUSIONS: Cystourethroscopy and voiding cystourethrography were satisfactory techniques for diagnosing urethral diverticula and planning appropriate surgical treatment. The urethral pressure profile confirmed the presence of a diverticulum, but noted pressure depressions in cases other than diverticula. Profilometry did not change the surgical plan for treating diverticula, but allowed the planning of additional incontinence surgery in one patient.

Adult↗
PubMed1989

Effect of adrenergic agents on urethral pressure and urethral compliance measurements in dog proximal urethra.

The effects of adrenergic drugs on urethral compliance and urethral closure pressure at the proximal urethra of dogs were investigated using a new probe. The probe, with a balloon at the tip, was equipped with two generating and two detecting electrodes. The probe was inserted into the proximal urethra, and saline was then infused at a constant rate into the balloon with an infusion pump. The pressure and cross-sectional area of the urethra were recorded and a correlation curve of these parameters was drawn. The regression (of the form y = ax + b) was determined from the curve. Urethral compliance and closure pressures were obtained from the values of "a" and "-b/a" respectively, and the maximum cross-sectional area was measured when no further distension of the urethra was obtained. Urethral compliance decreased after the administration of phenylephrine, but increased after the administration of prazosin and labetalol. The urethral closure pressure decreased after the administration of dopamine and haloperidol. There was no change in either urethral compliance or closure pressure after the administration of clonidine, yohimbine, isoproterenol, or propranolol. The results indicate that adrenergic drugs work on urethral compliance, and that the alpha-adrenergic receptor of the proximal urethra is of the alpha-1 type. The changes in the urethral pressure after dopamine administration seems to be a response mediated by dopamine receptors.

Animals↗
PubMed2005

The relationship between maximal urethral closure pressure and functional urethral length in anterior vaginal wall prolapse patients according to stage and age.

MUCP (Maximal urethral closure pressure) is known to be increased in patients with vaginal wall prolapse due to the mechanical obstruction of the urethra. However, urethral function following reduction has not yet been completely elucidated. Predicting postoperative urethral function may provide patients with important, additional information prior to surgery. Thus, this study was performed to evaluate the relationship between MUCP and functional urethral length (FUL) according to stage and age in anterior vaginal wall prolapse patients. 139 patients diagnosed with anterior vaginal wall prolapse at Yonsei University Medical College (YUMC) from March 1999 to May 2003 who had underwent urethral pressure profilometry following reduction were included in this study. The stage of pelvic organ prolapse (POP) was determined according to the dependent portion of the anterior vaginal wall (Aa, Ba). (By International Continence Society's POP Quantification system) Patients were divided into one of four age groups: patients in their 40s (n = 13), 50s (n = 53), 60s (n = 54), and 70 and over (n = 16). No difference in MUCP was found between the age groups. The FUL of patients in their 40s was shorter than that of patient's in their 50s and 60s. Patients were also divided into stages: stage II (n = 35), stage III (n = 76), and stage IV (n = 25). No significant difference in MUCP was found according to stage and FUL. However, a significant difference was noted between stage III and IV as stage IV was longer. Anterior vaginal wall prolapse is known to affect urethral function due to prolapse itself, but according to our study, prolapse itself did not alter urethral function. This suggests that, regardless of age and stage, prolapse corrective surgery does not affect the urethral function.

Adult↗