Infectious etiologies of genital elephantiasis outside of filariasis endemic regions: a case report

Background Isolated genital elephantiasis outside filariasis endemic tropical and subtropical regions is rare and presents a diagnostic and therapeutic challenge. Serologic and radiographic investigation must be undertaken to exclude reversible causes of genital elephantiasis. Case presentation Authors report herein the case of a 58-year-old patient with chronic penile and scrotal elephantiasis. He had a history of untreated urethritis and an endoscopic urethrotomy for urethra stricture three years ago. Serological test for chlamydiosis was positive. Retrograde urethrocystography demonstrated a bulbar urethra stricture. The patient spectacularly and completely improved after endoscopic urethrotomy and long-term doxycycline. Conclusions Early treatment of sexual transmitted infections such as chlamydiosis is important to prevent the evolution of penoscrotal elephantiasis and to avoid surgical procedures.

Metal self-expandable covered temporary urethral stent Allium in patients with irreversibile uroobstruction: Ten-year experience

Aim of this study is to judge effectiveness of new design, temporary, cover, metal selective urethral Allium stents in lower urinary tract symptoms treatment concerning all peri and post procedural complications. Material and methods: We observed group of 40 patients with longstanding history of lower urinary tract symptom, in which outflow obstruction was localized in bulbar urethra in 24 pts and in prostatic urethra in 13 pts. Residual voiding volume and prostate volume measurements by ultrasonography, urethrocystography, urine culture and uroflowmetry (bulbar urethra stricture PTS) were done before stent insertion. Procedure was done in all cases but one in ambulatory conditions, under local anesthesia with oral antibiotics administration day before and 5 days after. Objective and subjective parameters of stent effectiveness were estimated and statistically revealed. Results: Majority of pts (32/40) were satisfied with all the aspects of the procedure and with quality of life while urethra was stented. Urinary infection did not happen in any case, encrustation of the migrated stent occurred in 2 cases (6,4%). Emptying of the bladder was adequate while wearing either prostatic or bulbar urethra stent. Residual volume was significantly smaller, urinary flow significantly higher. In pts with bulbar urethra stricture urinary flow and morphology of patent urethra lumen, 6 months after stent extraction suggested prolonged-permanent recanalisation results. Conclusion: Site specific, metal Allium urethral stents enable adequate emptying of the urinary bladder with minimal and transient patient discomfort. Stent insertion and explantation are simple procedures to perform, when correctly indicated without significant early and late complications.

Outcome of Bulbar Urethra End to End Anastomosis in a Single Centre

Aims : A retrospective evaluation and statistical analysis of outcome in patients who underwent bulbar end to end anastomosis for stricture of bulbar urethra in Army Hospital. Methodology: 50 patients with average age of 35 years who underwent bulbar end to end anastomosis between 2005 and 2009 at Army Hospital were analyzed. Mean follow up was 24 months. Stricture etiology was catheter induced 40%, perineal trauma 30%, infection 13%, instrumentation 10% and unknown in 7%. Stricture length was 1cm (59%), 1 to 2 cm (37%) and above 2cm (4%). 30% of the patients were previously subjected to multiple dilatations and internal urethrotomy and clinical outcome was considered failure if postoperative instrumentation was required. Postoperative sexual dysfunction was judged using nonvalidated questionnaire. Results: Of the 50 cases, 80% were successful and treatment failure was 20 %. Failed cases are Managed with OIU and buccal mucosal graft and are being followed. Ten patients were unsatisfied with there sexual function out of which 5 had ejaculatory dissatisfaction, 3 with compromised erection and 2 had decreased glans sensitivity. Conclusion: Bulbar end to end anastomosis has success rate of 80%, with better outcome in fresh cases than in previously intervened cases. Sexual outcome is successful in 80%. Key words: bulbar urethra; stricture; anastomosis; outcome DOI: http://dx.doi.org/10.3126/mjsbh.v9i2.5024 Medical Journal of Shree Birendra Hospital Vol.9(2) 2010: 38-41