Reasons of LUTS. M.F. SUKKARIEH, M.D BEIRUT_LIBANON.

Known Causes of LUTS Hypothesis: Neurogenic bladder Overactive bladder Prostatic Urethral valves Meatus stenosis BPH Carcinoma in situ in to the bladder A- or Nonbacterial prostatitis ???? And bacterial prostatitis Considerable causes of LUTS , prostatitis, enuresis, weak ejaculation and acquired urethral stricture post transurethral manipulations are the different forms of congenital penile urethral abnormalities in different grades and locations. Hypothesis:

Now I will present for you slides with congenital urethral abnormalities.

Normal urethra

28 YEARS OLD ( Ring ) Dysuria ,Drippling treated for 6 years for chronic abacterial prostatitis

48 years old(Ring) Dysuria with drippling for many years Prostate 12 grams

Dysuria with drippling post urination 28 years old ( Ring ) Dysuria with drippling post urination

26years old ( Ring ) LUTS , enuresis till 14 years

38 years old ( Ring ) Dysuria,Drippling

25 years old (Ring ) Dysuria, Drippling

73 years old

27 years Dysuria with Drippling

53 years old Severe Dysuria by spontaneous very small stone delivery Enuresis till 17 years of age

65 years old for checkup Drippling post Urination since childhood

44 years old

19 years old

28 years old ( Ring ) drippling

Urethral stone

34 years dysuria And drippling

36years old

43 years severe LUTS U/S :BPH 16.15 ml Blad. Capa.151.97ml and RH.:116.64ml

Persistent urethritis post intercourse Go. 30 years old ( Ring ) Persistent urethritis post intercourse Go.

26years old ( Diverticulum or butterfly ) Dysuria, Drippling post urination and ejacculation

36 years old ( 2 Rings ) Dysuria, drippling Weak ejacculation

26years old

Retrograde urethgrafy

Voiding urethrografy

Voiding urethrografy

2 accutes prostatitis at 47 and 50 years of age 50 years old (2 Rings ) 2 accutes prostatitis at 47 and 50 years of age

262626 26 years old

17 years old

R.B.C. in urine ,visual urethrocystoscopy , than retrograde urethrography 42 y old

Dysuria, drippling from youth (LUTS) 49 years old (Ring ) Dysuria, drippling from youth (LUTS)

20 years dribbling urination

50 years 0ld

43 YEARS OLD CATHETERISATION WAS NOT POSSIBLE

DIAGNOSIS _ URODYNAMIC _ ENDOSCOPICALLY - RADIOLOGICALLY

THE BEST METHODE FOR THE DIAGNOSTIC OF THE REASON OF LUTS BY PATIENT IS : THE RETRO-and ANTEGRADE URETHROGRAPHY

I THINK and BELIEVE too : THAT INSTEAD OF A- or NONBACTERIAL PROSTATITIS THERE IS CONGENITAL PENILE URETHRAL ABNORMALITIES AND DO NOT FORGET IT AS A REASON FOR BACTERIAL PROSTATITIS and ENURESIS TOO.

15-25% acquired urethral stricture post TUR-P. Manipulation. LOCATION Most common Unique : Bulbar region Less common : Multifocal and anterior urethral stricture. -Unnoticed blind instrumentation for this congenital malformation with the temperature of the resectoscope are the reason of the acquired urethral stricture.

Standards of Practice To reduce the percentage of acquired urethral strictures post TUR-P. manipulation, the following has been used till now : 1-Urethral dilatation before TUR-P. 2- 24 charr. Resectoscope (W. Mauermayer) 3-Otis- Mauermayer urethrotom before TUR-P.

Recommendation According to this new data, to avoid the acquired urethral stricture, I recommended: Before TUR-Manipulation, under vision urethroscopy : No abnormality: only urethral dilatation till 30 charr. With abnormality: Otis-Mauermayer-urethrotom.

OTIS-MAUERMAYER Urethrotom And the most effective is the use of OTIS-MAUERMAYER Urethrotom Von KARL STORTZ before any trans-urethral resection

68 years old post TUR-P for 24 grs prostate 2 years ago with same symptoms like before OP : Dysuria and Drippling post urination.

75 years , BPH :37grs R/U : 35 ml Week ejaul. as young TUR-P 2months ago . Urination and drippling More bad than before

50 years old Few days Post TUR

CONCLUSION These congenital urethral malformations are the reason of: 1-Enuresis, LUTS by patients and infected prostatitis 2- Acquired urethral stricture post TUR manipulations

Thank You