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Giant urethral diverticulum's caused by traumatic vesicle catheterization in children: a case report.
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MedLine Citation:
PMID:  22187597     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Urethral diverticula are saclike dilations of the urethra and are classified as either congenital or acquired. While urethral diverticula are commonly seen in female patients, they are rarely seen in men. The most common etiologies of male acquired diverticula include urethral trauma, stricture, abscess or post-hypospadias repair. We report a case of acquired urethral diverticula caused by a traumatic vesical catheterization in a 6-year old boy and review the literature on the topic.
Authors:
Khalid Kkhattala; Mohamed Rami; Aziz Elmadi; Lamia Chater; Abdelhalim Mahmoudi; Youssef Bouabadallah
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2011-10-10
Journal Detail:
Title:  The Pan African medical journal     Volume:  10     ISSN:  1937-8688     ISO Abbreviation:  Pan Afr Med J     Publication Date:  2011  
Date Detail:
Created Date:  2011-12-21     Completed Date:  2012-05-14     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  101517926     Medline TA:  Pan Afr Med J     Country:  Uganda    
Other Details:
Languages:  eng     Pagination:  15     Citation Subset:  IM    
Affiliation:
Department of Paediatric Surgery, University hospital of Fez, Fez, Morocco.
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MeSH Terms
Descriptor/Qualifier:
Child
Diverticulum / etiology*,  pathology
Humans
Male
Urethral Diseases / etiology*,  pathology
Urinary Bladder / injuries*
Urinary Catheterization / adverse effects*
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Full Text
Journal Information
Journal ID (nlm-ta): Pan Afr Med J
Journal ID (publisher-id): PAMJ
ISSN: 1937-8688
Publisher: The African Field Epidemiology Network
Article Information
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© Khalid Kkhattala et al.
open-access:
Received Day: 05 Month: 11 Year: 2010
Accepted Day: 26 Month: 8 Year: 2011
Electronic publication date: Day: 10 Month: 10 Year: 2011
collection publication date: Year: 2011
Volume: 10E-location ID: 15
ID: 3224068
PubMed Id: 22187597
Publisher Id: PAMJ-10-15

Giant urethral diverticulum's caused by traumatic vesicle catheterization in children: a case report
Khalid Kkhattala1&
Mohamed Rami1
Aziz Elmadi1
Lamia Chater1
Abdelhalim Mahmoudi1
Youssef Bouabadallah1
1Department of Paediatric Surgery, University hospital of Fez, Fez, Morocco
&Corresponding author: Khalid Khattala, Department of Pediatric Surgery, Faculty of Medicine and Pharmacy, University of Fez, BP. 1893; Km 2.200, Sidi Hrazem Road, Fez 30000, Morocco

Introduction

Male urethral diverticula are rare, they are classified as either congenital or acquired. The authors report a case of urethral diverticulum secondary to an exceptional aetiology in a 6 years old boy.


Patient and case report

A 6-years old boy was hospitalized in intensive care unit for severe cranial trauma. The patient developed a large diverticulum after vesical catheterization. It manifested as a mass on the ventral root of the penis (Figure 1) which caused urinary discharges when pressed gently. This mass increased gradually, leading to a penoscrotal fistula. A cystostomy was carried out, the diverticulum was opened to drawn the abscess (Figure 2). Five months later, we performed uretroplasty. The post surgery follow up was simple; the evolution was favourable at 5 years postop (Figure 3). The patient keeps a hemiparesy allowing walk.


Discussion

Male urethral diverticula are rare. Acquired diverticula are only slightly more frequent than congenital ones. In 50% of these cases peri-urethral suppuration was the promoting etiology (other etiologies are: anterior urethral valves in children [1,2] and ectopic ureter). All were found to have a posterior urethral diverticulum thought to represent the remains of the original recto-urethral fistula accompanying the high rectal atresia [4].

Symptoms included post-micturition dribble, recurrent urinary infections, poor urinary stream and palpable swelling. The anterior urethra and peno-scrotal junction were the most commonly affected sites. Complications included urethra-cutaneous fistula [5], urethral stricture [2] and wound infection [4].

The diagnosis is clinical, based on the development of a perineal mass or phlegmon. This diagnosis is confirmed by cysto-urethrography. Treatment is by open surgery and consists on diverticulectomy and repair of urethra in one stage.

We recommend urethral diverticulectomy as the treatment of choice whenever possible. We stress prophylaxis via gentle manipulation of the urethra and proper drainage of peri-urethral suppuration.


Conclusion

Urethral diverticula are uncommon, but should always be considered in young men with history of urethral surgery or trauma. The treatment is simple and the prognosis is usually good.


Competing interests

The authors declare no competing interests.

Authors’ contribution

KK contributed to the writing the manuscript and the treatment of the patient, Rami Mohamed and EA contributed to the writing the manuscript, CL and MA contributed to the treatment of the patient. BY contributed to the writing the manuscript and the treatment of the patient.


References
1. McLellan DL,Gaston MV,Diamond DA,Lebowitz RL,Mandell J,Atala A,Bauer SB. Anterior urethral valves and diverticula in children: a result of ruptured cowper's duct cyst?BJU IntYear: 2004Month: 8 943375815291870
2. Kajiwara M,Inoue K,Kato M,Usui A,Matsubara A,Usui T. Anterior urethral valves in children: A possible association between anterior urethral valves and Cowper's duct cystInt J UrolYear: 2007Month: 2 1421566017302575
3. Hanson GR,Thrasher JB. Urethral diverticulum as a sequela of unrepaired penile fractureCan J UrolYear: 2007Month: 2 1413461217324328
4. Vinnicombe SJ,Good CD,Hall CM. Posterior urethral diverticula: a complication of surgery for high anorectal malformationsPediatr Radiol.Year: 199626212068587810
5. Boyd SD,Raz S. Ectopic ureter presenting in midline urethral diverticulumUrologyYear: 1993Month: 6 41657148516996

Figures

[Figure ID: F0001]
Figure 1 

Mass on the ventral root of the penis of six years old boy who developed a large urethral diverticulum after vesical catheterization



[Figure ID: F0002]
Figure 2 

The urethral diverticulum opened



[Figure ID: F0003]
Figure 3 

Post urethral surgery aspect in a 6-years old boy who developed a large diverticulum after vesical catheterization



Article Categories:
  • Case Report

Keywords: Giant, urethral diverticulum, child, surgery, urology, traumatism.

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