No abstract

Idiopathic megalourethra in infants is an enlargement of the pendulous urethra with no evidence of distal obstruction. Two aborted fetuses at 14 and 19 weeks of gestational age exhibited megalourethra with definite complete distal obstruction. The urethras of these 2 fetuses were studied histologically confirming the presence of an uncanalized epithelial core in the glans obstructing the lumen of the patent urethra. Embryologically, this epithelial core is normal but early canalization achieves continuity with the lumen of the penile urethra. In these 2 fetuses canalization was arrested or delayed with complete obstruction of the urethra in the glans and dilatation of the pendulous urethra. In living children with this form of megalourethra the urethra of the glans is patent. Canalization of the epithelial core in the glans of the survivors may have been delayed rather than arrested and may be a cause of megalourethra.

The purpose of this paper is to describe the nerve pathways, reflex arcs and sphincter muscles responsible for the sensory and motor mechanisms of rectal continence. The data from which the reflex arcs were deduced were obtained from anal and rectal pressure profiles in children with normal and malformed rectums, and in children with injuries and deformities of the spinal cord which affect the neuromuscular control. These profiles were correlated with the clinical state of continence and with the known anatomy of both normal and abnormal states.

Caccourcterocele, a bizarre form of vesico‐urethral ureterocele, has two characteristics, (1) a wide incompetent orifice in the bladder and (2) a long submucosal tongue which extends along the female urethra deep to the mucosal lining of the urethra. The peculiar configuration of this ureterocele is not readily explained on the basis of obstruction, but rather on embryological grounds. The situation of the incompetent orifice in the bladder and the reflux of urine into the tongue in the urethra add a urethral obstructive component which induces urological damage. The Müllerian duct migration is responsible not only for the transposition of the orifices of some ectopic ureters from the trigone to the distal half of the female urethra, the urethrovaginal bridge and the hymen of the vagina, but also for the urethral extension of the caecoureterocele, which is “tongue‐tied” to the Müllerian ducts in their descent to the exterior. All other ureteroceles with “giant” orifices are likewise developmental in origin, though in many an obstructive component is superadded by virtue of the location of the orifice within the grasp of the internal sphincter of the urethra.