Cases2

1. Case discussion

2. Case (1)
• Male patient 36 years old.
• C/O Weak stream and Straining 1 year ago.
• Lower abdominal surgery 10 y ago (no clear
history)
• O/E: NAD apart from scar of previous surgery

3. Case (1) Retrograde urehtrogram

4. Case (1)
• DVIU?
– Is it an option here?
– Where to incise in this segment.

5. Case (1)
• Antifibrotic agents?
– Indications.
– Which agent?
– Technique.
– Clinical advantage

6. Case (1)
• Opssss (history of DVIU 2 yrs ago).
– Any more investigations to be added?
– Does this change your management? Why?

7. Case (1)
• Urethroplasty?
–EPA or AUGMENTATION (ventral/dorsal)?
–TRANSETING or NON-TRANSECTING?

9. Case 2

10. Case 2
• Forty Six (46) Years old male.
• History of previous distal hypospadias repair
at childhood.
• Progressive course of weak stream, straining
over the past 18 months.

12. Case 2
Plan of management
• One stage / two stages?
• Penile skin flap or graft?
• Which flap?
• Which graft?

13. Case 2
• What you will do for the stricture in the
posterior urethra?

14. Case 2

15. Case 3

16. Case 3

17. Case 3
• Thirty (30) Years old male.
• History of RTA 11 weeks ago.
• PFUD - Suprapubic catheter.
• Posterior pelvic fixation.

18. • IIEF5 score 7
• Paraesthesia at the distal penis.
• Glans was relatively cold
on examination.
Case 3

19. Any further investigations needed.
- MRI for proximal urethral
assessment.
- Any role for
Doppler/ pelvic angiography
Case 3

20. • Time of urethroplasty.
• Informed consent (future of, continence and
Erection).
• previous pelvic fixation any
special precautions.
Case 3

21. THANK YOU
arifmarof@yahoo.com