Anterior urethral valves and diverticula in children: A result of ruptured Cowper's duct cyst?
Harvard University, Cambridge, Massachusetts, United States BJU International
(Impact Factor: 3.53).
09/2004; 94(3):375-8. DOI: 10.1111/j.1464-410X.2004.04854.x
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.
Available from: scielo.br
- "Está relacionada com a produção de um líquido claro e viscoso , de pH alcalino que lubrifica a uretra e a glande, neutraliza a acidez da uretra e a secreção vaginal ácida da mulher (Orts 1967, Ninomiya et al. 1995). No sêmen participa também como um fator necessário na coagulação e de defesa urogenital pela secreção de glicoproteínas, tais como o antígeno prostático específico (Pedron et al. 1997, McLellan et al. 2004, Chughtai et al. 2005). Em outros mamíferos sua função é pouco conhecida. "
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ABSTRACT: As glândulas bulbouretrais (GBU) no coelho (Oryctolagus cuniculus) e na cobaia (Cavia porcellus) desempenham um papel importante na fisiologia reprodutiva. No entanto, seus aspectos histológico e estereológico são escassos. Assim, o objetivo desta pesquisa foi comparar características estereológicas entre as GBU do coelho e da cobaia como um primeiro passo para a compreensão das variáveis morfométricas que participam nos processos reprodutivos. Foram utilizados 5 coelhos e 5 cobaias adultos machos, saudáveis, obtidos do Biotério da Universidade de La Frontera, Temuco, Chile. A região pélvica foi dissecada isolando-se a GBU de cada animal. Determinou-se o peso e o volume de cada glândula. Estas foram fixadas em formalina tamponada durante 24 horas e incluídas em paraplast. Cortes seriados de 4 μm de espessura foram corados com HE para análise estereológica. A média de células glandulares na GBU do coelho foi 19,50 x 105mm3 (DP 2,35) e da cobaia 10,57 x 105mm3 (DP 2,07) e a porcentagem média de tecido glandular foi de 25,52% (DP 2,20) e 17,20% (DP 3,33), respectivamente. Todos os parâmetros estereológicos comparados tiveram uma diferença estatisticamente significativa (p<0,0001). Estas diferenças poderiam ser explicadas porque há maior proximidade celular do epitélio secretor, menor diâmetro do lúmen dos ácinos e da relação núcleo citoplasma na GBU do coelho. Assim, os ácinos da GBU apresentam maior quantidade de células por mm3 do que na GBU do coelho. Estes parâmetros podem ser influenciados por fatores hormonais, etários, sazonais e ambientais, entre outros. Considerar as características morfológicas da GBU nesses animais poderia condicionar o êxito da reprodução por parte do macho.
Available from: Miguel A Castellan
- "On the other hand, patients with AUV have normal corpus spongiosum development (12). McLellan et al. suggested that anterior urethral diverticula may result from rupture of dilated bulbourethral glands (13). In our series, one patient was diagnosed with anterior urethral diverticulum and required resection of diverticulum and staged urethroplasty. "
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Anterior urethral valves (AUVs) is an unusual cause of congenital obstruction of the male urethra, being 15-30 times less common than posterior urethral valves (PUVs). It has been suggested that patients with congenital anterior urethral obstruction have a better prognosis than those with PUV, with less hydronephrosis, and a lower incidence of chronic renal insufficiency (5 vs. 30%). The long-term prognosis of AUVs is not clear in the literature. In this report we describe our experience and long-term follow up of patients with anterior urethral valve.
Materials and methods:
We retrospectively identified 13 patients who presented with the diagnosis of AUVs in our institutions between January 1994 and June 2012. Two patients were excluded: one patient had no follow up after intervention; the other had a follow up <1 year. From the 11 patients included, we evaluated the gestational age, prenatal and postnatal ultrasound findings, voiding cystourethrogram findings, age upon valve ablation, micturition pattern, creatinine, and clinical follow up.
Between 1994 and 2012 we evaluated 150 patients with the diagnosis of urethral valves. Of this group, 11 patients (7.3%) had AUVs and an adequate follow up. Mean follow up is 6.3 years (2.5-12 years). Five (45.4%) patients had prenatal diagnosis of AUV. The most common prenatal ultrasonographic finding was bilateral hydronephrosis and distended bladder. One patient showed a large perineal cystic mass, which was confirmed to be a dilated anterior urethra. The mean gestational age was 37.6 weeks (27-40 WGA). Postnatally, 90% had trabeculated bladder, 80% hydronephrosis, and 40% renal dysplasia. The most common clinical presentation was urinary tract infection in five patients (45.4%), followed by weak urinary stream found in four patients (36.3%). The age at initial surgical intervention ranged between 7 days and 13 years. Seven (63.6%) patients had primary transurethral valve resection or laser ablation and three patients (27.2%) had primary vesicostomies. One boy (9.1%) had penile urethrostomy with excision of urethral diverticulum. Two (18.2%) patients developed end-stage renal disease.
Anterior urethral valve is a rare congenital entity affecting the genitourinary system in males. Early urinary tract obstruction resulted in end-stage renal disease in 18% of our patient population. In our series, the complication rate and the evolution to renal failure are high and similar to patients with PUV. In patients with AUVs we recommend long-term follow up and close evaluation of patient's bladder and renal function.
Available from: Faisal Rauf Khan
- "Congenital urethral diverticula in males are rare, and patients can present with poor urinary flow, postmicturition dribbling, urinary tract infections, or penile ballooning in the neonatal and infancy period  , although later presentations into the teenage years have been known. The aetiology is unknown but theories include a ruptured syringocoele, cystic dilatation of the periurethral glands, and incomplete hypospadias . "
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ABSTRACT: We present the case of a 13-year-old boy with a congenital anterior urethral diverticulum. This is a rare condition in males which can lead to obstructive lower urinary tract symptoms and urosepsis. Diagnosis is by urethroscopy and radiological imaging. Surgical treatment can be open or endoscopic. Long-term followup is required to check for reoccurrence of the obstruction.
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