Скачать или смотреть 63) Congenital Anomalies of the Urethra

CONGENITAL ANOMALIES OF THE URETHRA -
Duplication of the urethra,
Congenital absence of the penis ( apenia),
Megalopenis or Micropenis

Congenital urethral stricture - Two common sites are the membranous urethra and in the region of the corona. The effects of such urethral structure are mainly obstruction to the flow of urine and back pressure from obstruction leading to hypertrophy of detrusor muscle uretero-vesiçal reflux Hydro-nephrosis and hydroureter. Secondary infection is also common.

MANAGEMENT- excretory urogram should be performed along with post-voiding film. Urethrogram may be necessary to delicate the site, degree and Target of the

Cystoscopic examination should be performed but the passage of the instrument may be arrested by the stricture Urethral dilatations with sounds or filiform bougies with followers are main treatment. Such strictures do respond well to dilatation but if fails internal urethrotomy or surgical repair of the stricture (urethroplasty) is performed.

Congenital valves of the posterior urethra :- Congenital posterior urethral valves are usually seen on the floor of the prostatic urethra jut below the veru-montanium. The peculiarity of these valves is that these allow the catheter to be passed easily, but obstruct the outflow of urine. Three types of clinical presentations are seen (a) when the valves are incomplete the patient may reach adolescent or adult life without symptoms but hypertrophy of be detrusor muscle venal diverticula, dilatation of the prostatic urethra and hypertrophy of the trigonal muscles are often noticed (b) Patients with moderate obstruction and abnormal urograms usually present earlier and (C) Sever obstruction with uraemia. voiding cystourethrography. . Cysto-urethroscopy fails to identify the valves as the irrigating fluid flows into the bladder with fully opening of the valves

TREATMENT - suprapubic cystostomy performed as an emergency life saving procedure the urea and NPN levels in the blood have come down to normal level transurethral resection of the valves should be performed.

Anterior urethral valves- A voiding cysto-urethrogram is again the best investigation for diagnosis are destroyed by trans-urethral route by fulguration through panendoscopy or by fragmentation by the passage of sounds .
Congenital obstruction of the neck of the bladder ( Marion's disease.) - symptoms are almost identical with those of the congenital valves of the posterior urethra Diagnosis can be made cystoscopy through which hypertrophied intra-ureteric ridge can be seen voiding cystourethrography treatment is Y-V Plasty.

CONTRACTURE OF THE BLADDER NECK -
AETIOLOGY - It is usually due to congenital muscular hypertrophy at the neck of the bladder or fibrosis at the same place as a sequel to chronic prostatitis in men or urethro trigonitis in females.

CLINICAL FEATURES - Patient may present at any age starting from young children to above 50 years Dysuria is the symptom with ultimate development of hydroureter and hydro-nephrosis urinary infections.

TREATMENT MEDICAL TREATMENT-Alpha blocking agents e.g. phenoxybenzamine have been used to relax the bladder neck .

SURGICAL TREATMENT - (i) Transurethral resection of the bladder neck has been performed with some success. the condition may recur in a few cases due to inadequate division of the fibers at the bladder neck.

(i) Bonni's operation - though transurethral resection is gaining popularity yet this open operation is suitable for failure case An Y- shaped incision is made on the anterior wall of the bladder near its neck the apex between two limbs of the Y is brought down to the end of the vertical limb of the Y to make the incision a V- shaped one this will increase the circumference of the neck of the bladder the V- shaped incision is now sutured .

NEOPLASMS OF THE URETHRA
-Polyp papilloma, angioma and carcinoma
Polyp these are usually seen around verumontanum.
Papilloma- These are usually seen in the fossa navicularis just inside the external urinary meatus .
Angioma- Haematuria is the main complaint, Treatment of all benign neoplasm is diathermy coagulation through a urethroscope.

Carcinoma- This is extremely rare.

Treatment-When the carcinoma is in the anterior urethra, either partial or total amputation of penis is required according to the site of carcinoma when carcinoma is situated in the posterior urethra more extensive operation in the from of radical prostatectomy should be considered .