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

2. 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:

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

4. Normal urethra

5. 28 YEARS OLD ( Ring )
Dysuria ,Drippling treated for 6 years for chronic abacterial prostatitis

7. 48 years old(Ring) Dysuria with drippling for many years
Prostate 12 grams

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

9. 26years old
( Ring )
LUTS , enuresis till 14 years

10. 38 years old ( Ring )
Dysuria,Drippling

11. 25 years old
(Ring )
Dysuria,
Drippling

13. 73 years old

14. 27 years Dysuria with Drippling

15. 53 years old
Severe Dysuria by spontaneous very small stone delivery
Enuresis till 17 years of age

16. 65 years old for
checkup
Drippling post
Urination since childhood

22. 44 years old

23. 19 years old

24. 28 years old ( Ring ) drippling

29. Urethral stone

30. 34 years dysuria
And drippling

31. 36years old

32. 43 years severe LUTS
U/S :BPH ml Blad. Capa ml and
RH.:116.64ml

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

35. 26years old ( Diverticulum or butterfly )
Dysuria, Drippling post urination and ejacculation

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

40. 26years old

41. Retrograde urethgrafy

42. Voiding urethrografy

43. Voiding urethrografy

45. 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

46. 262626
26 years old

47. 17 years old

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

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

51. 20 years dribbling urination

52. 50 years 0ld

53. 43 YEARS OLD
CATHETERISATION WAS
NOT POSSIBLE

55. DIAGNOSIS
_ URODYNAMIC
_ ENDOSCOPICALLY
- RADIOLOGICALLY

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

57. 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.

58. 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.

59. 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.

60. 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.

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

62. 68 years old post TUR-P for 24 grs prostate 2 years ago with same symptoms like before OP :
Dysuria and Drippling post urination.

63. 75 years , BPH :37grs
R/U : 35 ml
Week ejaul. as young
TUR-P 2months ago .
Urination and drippling
More bad than before

64. 50 years old
Few days Post TUR

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

67. Thank You