Anterior urethral valves and diverticula in children: a result of ruptured Cowper's duct cyst?
ABSTRACT To review a series of children with anterior urethral valves and diverticula, to elucidate the pathophysiology and optimal management of this entity.
Nine cases (all boys; 1963 to 2003) were reviewed retrospectively.
Seven of nine boys had bulbar diverticula. Continuity between Cowper's duct and the diverticulum was noted endoscopically in two and confirmed radiographically in one. Initially, open surgery was curative but more recently endoscopic management has been the procedure of choice.
This series indicates that the distal lip of a ruptured syringocele may function as a flap-valve, leading to anterior urethral obstruction. Advances in imaging and endoscopic instruments have altered the mode of presentation and management of this entity.
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ABSTRACT: The method of computed tomography (CT) brought forward the question about the anatomic adequacy of the images obtained. At the beginning the carnivores were used as experimental models for the needs of human medicine. Along with the increase in canine and feline populations and in connection with the ensuing and rising diagnostic requirements the interest in CT is increasing in veterinary medicine too. Consequently the clinical cardiology is faced with different anatomical reconstructions of topographic images which impose to examine and make precise the cardiovascular structures in order to remove the diagnostic dilemmas resulting from the individual particularities, the situation of the organs in the thoracic and pelvic cavities at different body positions. The method computed tomography (CT) was invented by Godfrey Hounsfield in 1970 and was based on conventional X-ray technique. Already at the time of its invention the question about the anatomical adequacy of the images obtained arose. With regard to this (1) scanned volunteers and compared CT images with transverse anatomical slices (2) have described normal CT mediastinal anatomy, and (3) has made a comparative evaluation of normal and pathological CT morphology of the heart and the great blood vessels (4) have given macroanatomical directions about the requirements of the imaging diagnosing, and (5) have traced the venous thoracic system in man through anatomical models obtained comparatively by imaging methods (routine radiography, conventional venography, CT, MRI). In order to make precise the anatomical _____________________________01/2009; 7(7):76-83.
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ABSTRACT: Anterior urethral valves (AUVs) are uncommon congenital anomalies causing urethral obstruction in boys. Medical records of 13 children were reviewed retrospectively. Each patient (pt) was evaluated with voiding cysto-urethrogram (VCUG) and renal ultrasonography. Pts older than 5 years performed an uroflowmetry. Serum creatine was determined in all children. All pts had difficulty in voiding and eight had recurrent urinary tract infection. Renal function was normal in all pts. VCUG showed filling of Cowper's duct in a pt. In a case, a vesicoureteral reflux was discovered. Uroflowmetry showed a flat trace in all cases. Transurethral endoscopic resection of the valves was carried out in 11 children while open resection was necessary in two children. At serial follow-up, all pts remain symptom-free and uroflowmetry documented regular pattern. Anterior urethral valves are rare lesions that may create problems at different stages. Some AUVs may result from the obstruction distal lip of a ruptured syringocele. Improvements in endoscopic equipment allow for minimally invasive transurethral resection. Large diverticula are best managed with open diverticulectomy and reconstruction. In newborns with severe altered urinary tract drainage, particularly in low birth-weight infant, a vesicostomy may be necessary.Pediatric Surgery International 07/2009; 25(7):613-6. · 1.22 Impact Factor