No abstract

Epispadias is a rare urogenital malformation characterized by more or less complete aplasia of the upper part of the urethra. It is commonly associated with bladder exstrophy. Isolated epispadias occurs in 10% of cases. Continent and incontinent epispadias may be distinguished. We report the case of a 29-year old patient presenting with dysuria associated with the impossibility of having sexual intercourses. Physical examination of the external genitalia showed slit-like abnormal urethral opening on the distal half of the dorsal side of the penis. Patient’s penis didn’t have dorsal curvature (chordee), the corpus cavernosum was palpated and slightly lateralized. The abdominal wall was without abnormalities. The remainder of the clinical examination was normal. Given this anomaly, the diagnosis of balano-pubic continent epispadias was retained. Ultrasound of the urinary tract was normal and pelvis X-ray without preparation showed interpubic diastasis. The patient underwent single-stage surgery using Cantwell-Young technique. Immediate postoperative outcome was without abnormalities; the urethral probe was removed 21 days later, after wound healing. Functional and aesthetics outcome evaluated at three and six months was satisfactory without penis shortness.

We here report the case of a 43-year old motorcyclist who was initially examined in the emergency department for injuries following a road accident with a car. The patient had pelvic trauma with extensive symphyseal disjunction (A). He underwent orthopedic treatment based on weight compensation. During the two weeks immediately following the trauma, patient's evolution was marked by the occurrence of fistulous orifice at the level of the inner right thigh (B) associated with urinary outflow and wounds due to local skin maceration around the fistula. Radiologically, abdominopelvic CT scan at extended injection-to-scan acquisition time showed contrast extravasation laterally, into the bladder and at the level of the right thigh root due to subperitoneal rupture of the bladder (C). Uretrocystography objectified symphyseal disjunction visible on the non-contrast abdominal X-ray film. Moreover, uretrocystography showed fistulous track after uterovesical opacification (D). Standard laboratory tests were normal. Given the subperitoneal rupture of the bladder and the absence of associated lesions, conservative treatment by prolonged bladder drainage with urethral catheter and local care of the fistulous orifice were performed. Patient's evolution was marked by complete drying up of the fistula.

The incidence of female urethral cancer is rare and accounts for 0.02% of all women’s cancers. It is dominated by epidermoid carcinoma, which most commonly develops in the distal portion of the urethra, extending to inguinal lymph nodes. The diagnosis is confirmed in the distal forms on the basis of uretrocystoscopy with biopsy. Abdominopelvic MRI allows to determine tumor extension as well as its infiltration into tissues and peri-urethral organs. As in superficial tumors of the distal urethra, simple circumferential resection of the urethra associated with resection of the adjacent portion of the anterior surface of the vagina is sufficient. We here report the case of a 59-year old diabetic and hypertensive female patient presenting for irritative lower urinary tract symptoms, associated with vulvar mass. Clinical examination showed mucosal ectropion extending from the urethral meatus associated with extensive local inflammation. The patient underwent wide excision of the ectropion which was diagnosed as squamous cell carcinoma. Abdominopelvic MRI was normal.