Background: To assess if trans-urethral snare of bladder tumor (TUSnBT) with subsequent stone basket retrieval can be used as an effective, time-saving adjunct resection technique for papillary bladder lesions. Methods: Via standard cystoscopy, TUSnBT was performed using a standard endoscopic polypectomy snare with subsequent tumor extraction utilizing a standard stone retrieval basket, when lesions were more than 10 mm in diameter. Smaller lesions were removed with the polypectomy snare. Standard trans-urethral resection of bladder tumors (TURBT) of the tumor bed was performed post TUSnBT. Histological assessment was performed and assessed separately per session. Results: In total, 18 papillary lesions, measuring between 9 and 26 mm, were resected via TUSnBT. Operative TUSnBT time, ranged between 10 and 60 seconds duration per lesion. No significant postoperative morbidity was experienced by patients within this cohort. Histo-pathological assessment revealed adequate muscle representation in 83.3 % of TUSnBT grouped sessions assessed. Conclusion: TUSnBT with stone retrieval basket retrieval is a feasible method in selected papillary bladder lesions, and may be coupled with standard TURBT resection techniques. This method is less time consuming and would prove beneficial in select lesions. It may also be beneficial to assist with reducing the resection time or inadvertent bladder perforation encountered during the conventional TURBT.

A 15-year-old male presented with a history of post micturition dribbling and 'enuresis'. He had no medical comorbidity nor any erectile dysfunction. His referral letter incorrectly assessed him as having a normal examination. However, on penile examination, a second urethral meatal opening 10 mm lateral to the meatus on the glans was observed (Figure 1A). No other abnormality was found on examination. A voiding cystourethrogram (VCUG) was performed, which demonstrated a double urethra exiting from the membranous urethra (Figure 1B).This anomaly was also defined using pelvic magnetic resonance imaging (MRI). For better definition of the duplicate urethra, prior to MRI the duplicate urethral opening was cannulated with a ureteric catheter (Axxcess TM Catheter, Boston Scientific, Marlborough, MA 01752-1234, USA).For stability and orientation of the penis during the study, the glans and penile shaft were secured in the midline to the lower abdominal wall, using an adhesive dressing.The MRI study confirmed a urethral duplication, within the right corporal body, in the coronal plane (Figure 2A). On cystoscopy the urethral ostium was seen, and a guide wire was advanced through the ostium of the duplicate urethra, exiting from the duplicate urethral meatus (Figure 2B). Despite adequate counselling, the patient Summary This report describes an isolated urethral duplication in the coronal plane in a child referred with primary 'enuresis'. This presentation is unique because duplications usually occur in the sagittal plane. In patients with suspected urethral duplication, magnetic resonance imaging in conjunction with catheterisation of the distal duplicate opening accurately delineates the abnormality, so that individualised treatment strategies can be considered.

Background: To describe a novel bladder fixation technique for use during endoscopic vesicostomy button insertion. Methods: After standard cystoscopic visualization of the bladder, a standard 18 G intravenous cannula was inserted into the bladder. A non-absorbable suture thread was placed through this intravenous cannula under cystoscopic vision. The proximal end of the suture was then removed using standard ureteroscopic grasping forceps (3 Fr) through another needle (15 G) inserted next to the initial puncture site (following a path at 30 degrees from the initial puncture tract) into the bladder. The suture ends were brought out of the bladder and tied at the skin level, 2 cm from the intended vesicostomy site. Sutures were removed on the second postoperative day. Results: This fixation technique allows for adequate fixation of the bladder dome to the anterior abdominal wall. These sutures also have less potential for cutaneous scarring and pain. No complications were reported. Conclusion: This simple fixation technique is easily performed using materials found in every urology suite. It also avoids the skills required with other previously reported fixation suture techniques, and can also be utilized for bladder fixation in cases of vesicoscopic laparoscopic or robotic assisted laparoscopic procedures.