Other conditions of the urethra

Other conditions of the urethra

Urethral fistula This is seen after failed hypospadias surgery ( Figure 85.2e Tight strictures with periurethral abscess can present as multi ple fistulae (watering-can perineum). Urethral calculi Urethral calculi can arise primarily behind a stricture or in an infected urethral diverticulum. More commonly , the stone is a renal calculus that has migrated to the urethra via the bladder. Clinical features Urethral calculi present as episodes of retention, pain or haematuria. Treatment A stone lodged within the prostatic urethra should be displaced back into the bladder and treated by laser or pneumatic fragmentation. Calculi in more distal parts of the urethra are fragmented in situ by a holmium/thulium laser. Open removal is indicated in large or multiple calculi inside a urethral diver ticulum. Neoplasms Bloody urethral discharge without infection should raise suspicion that the patient has a urethral tumour, although such tumours are rare. Multifocal transitional cell cancer of the bladder is sometimes associated with tumours in the prostatic urethra and occasionally more distally . They can be treated by local laser ablation but are associated with a tendency to distant spread. Squamous carcinoma may develop in an area of squamous metaplasia in patients with LS. It is treated by radical surgery and carries a poor prognosis.