pediatrics
Penile and Urethral Anomalies
Urethral Anomalies
Most commonly acquired after circumcision in newborn boys, urethral meatal stenosis is occasionally congenital and associated with Hypospadias . Meatotomy is needed for a significantly deflected stream or for a pinpoint stream. Urethral Stricture causes obstruction along some part of the length of the urethra. It almost always occurs in boys, is usually acquired, and typically results from a crush injury after straddle trauma. Urethral strictures may also be iatrogenic and occur after surgery, most commonly after hypospadias repair, or after traumatic catheterization. Congenital urethral stricture may manifest similarly to urethral valves and may be diagnosed by prenatal ultrasonography, or postnatally by symptoms and signs of outlet obstruction or patent urachus and is confirmed by retrograde urethrography. Initial management is often with endoscopic urethrotomy, although open urethroplasty may be necessary. Urethral duplications and triplications are urethral anomalies. The patent urethra is the most ventral channel. Voiding cystourethrography (VCUG) should be done to determine patency and detect connection between the channels and the bladder. Surgical intervention is almost always necessary. In boys, folds in the posterior urethra may act as valves impairing urine flow. Urologic sequelae of urethral valves include urinary hesitancy, decreased urinary stream, Urinary Tract Infection (UTI) in Children , overflow incontinence, myogenic bladder malfunction, Diagnosis is often made by findings on routine prenatal ultrasonography, including severe bilateral hydroureteronephrosis or oligohydramnios. Cases suspected postnatally (often because of history of an abnormal urine stream) are confirmed by immediate voiding cystourethrography. Surgery (usually via endoscopy) is done at time of diagnosis to prevent progressive renal deterioration. If endoscopic valve ablation is not feasible, a temporary vesicostomy is indicated. A much less common anomaly, diverticulum of the anterior urethra, may act as a valve (anterior urethral valve). This anomaly is frequently treated endoscopically and occasionally by open reconstruction. Urethral prolapse is protrusion of a small portion of the distal urethra outside the meatus. Prolapse occurs mainly in girls, most commonly in Black girls. It may appear in infancy or later in childhood and usually manifests as an interlabial mass. When urethral prolapse occurs, the opening of the urethra resembles a donut with the meatus located in the center. It may become irritated and cause pain and/or bleeding. Treatment is usually conservative with a topical estrogen cream. Surgical intervention is rarely necessary. 