How To Remove Hair From Urethra
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Vishwajeet Singh,  Deepak Sharanappa Nagathan, Rahul Janak Sinha and Dheeraj Kumar Gupta | |
| Department of Urology, Male monarch George Medical University, Lucknow, India. | |
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| Received March 27, 2012; Accepted August 06, 2012. | |
| This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by- | |
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| Go to: Abstruse | |
| An 18-year-old human being born with aphallia had undergone phallic reconstruction in childhood followed past full urethral reconstruction with a buccal mucosal graft and groin-based pedicle (Singapore) flap urethroplasty at 13 years of age. The patient presented with obstructive voiding symptoms lasting 6 months followed by acute urinary retention. The results of a voiding cystourethrogram showed a filling defect in the distal urethra that had been reconstructed by use of the skin flap. On urethroscopy, a iii cm×2 cm sized tricholithobezoar was seen in the distal urethra. Pneumatic lithotripsy followed by bulbar urethrolithotomy was performed in the same operation to excerpt the bezoar. The remaining hairs were mechanically epilated. The patient has been doing well for 6 months of follow-upwards. | |
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Aphallia is a rare built anomaly with an estimated incidence of 1 in 10 to xxx million births, and around lx cases have been reported so far [ 1]. Definitive direction involves phalloplasty and urethral reconstruction, which is surgically challenging only is associated with adept outcomes [ 2]. The major drawbacks of phalloplasty are the urethral complications and problems with penile stiffeners. Regular follow-up is essential for early on detection of urethral complications such as urethral stricture, urethral stenosis, and urethral fistula [ three]. Urethral hairballs have occurred in patients who have undergone hypospadias repair post-obit urethroplasty with the use of a skin flap for repair and are particularly troublesome attributable to their recurrent nature. To the best of our knowledge, this is the beginning case report of a "tricholithobezoar," which is the formation of a stone over a hairball, equally a complication later phallic and urethral reconstruction in a patient with aphallia. Herein, we describe the clinical presentation, management, and prevention of such an unusual complication.
An xviii-year-former man born with aphallia had undergone phallic reconstruction in childhood at the historic period of thirteen years, which was followed by total urethral reconstruction with a buccal mucosal graft and groin-based pedicle (Singapore) flap. The patient had v years of regular follow-up after his urethral reconstruction. In the present case, he presented with a gradual onset of thinning of his urinary stream for 6 months followed by acute urinary retentiveness. Test revealed a business firm swelling in the perineum over the reconstructed urethra. Urethral catheterization to relieve the acute retention was unsuccessful and hence an emergency suprapubic cystostomy was performed. The results of a voiding cystourethrogram revealed a filling defect in the distal urethra (Fig. 1A). On urethroscopy, a solitary, smooth 3 cm×2 cm sized rock was seen in the dilated urethra (Fig. 1B). Pneumatic lithotripsy was used initially to fragment the stone, but owing to its resistant nature (because of the presence of hair in the stone interstices) (Fig. 2A), the stone could non be fragmented completely. A bulbar urethrotomy was therefore performed to remove the remaining bezoar (Fig. 2B). Following removal of the tricholithobezoar, hair from the inductive urethra was mechanically epilated. The urethrotomy was airtight primarily. The postoperative menses was uneventful and patient could successful void with a peak menstruum charge per unit of 16 mL/s.
A tricholithobezoar, or the formation of a stone over a hairball, is an unusual complexity and has been seen when a hair-begetting skin flap is used for urethral reconstruction, such as in hypospadias repair [ 4 , v], and during inadvertent introduction of hair into the float during catheterization or clean intermittent catheterization, especially in a paraplegic patient [ 6 , vii]. In our case, the phallic reconstruction was done with a neurovascular pudendal-thigh flap (Singapore flap). This pilus-bearing pare flap led to periodic shedding of hairs in the redundant urethra. The pilus acted as a nidus and along with other aggravating factors, such as stasis of urine in the dilated and sacculated urethra, recurrent urinary tract infections, and the lithogenic potential of urine, led to tricholithobezoar formation.
These stones present as gradually increasing painless lumps with obstructive urinary symptoms when present in the urethra and with recurrent episodes of urinary tract infections when present in the bladder. A evidently radiograph will bear witness characteristic serpiginous radio-opacity and an intravenous urogram will prove a filling defect in the float [ 7]. In our example, a patently X-ray was not done because just stricture and stenosis of the neourethra remained as part of the differential diagnosis. However, the voiding cystourethrogram showed a filling defect in the urethra that on urethroscopy was confirmed to be a rock.
The management of this instance was challenging because the stone was located in the surgically reconstructed neourethra and was difficult to fragment owing to the presence of hair in its interstices. Open urethrolithotomy or endoscopic urethrolithotripsy take been used to treat such stones with consummate clearance. In our case, pneumatic lithotripsy was performed to debulk the bezoar followed by urethrotomy, which helped in its consummate removal and minimized the size of the urethrotomy.
Elective epilation can exist a prophylactic measure to forestall tricholithobezoar germination. Gallium-aluminum-arsenate (GaAlAs) diode laser (wavelength 810 nm; at a power of 15 W for 2 seconds) through a side-firing laser fiber has been used in multiple sessions to destroy the hair follicles [ eight]. A dilute solution of thioglycolate has also been used to prevent recurrent hair growth but has met with limited success [ 8]. In the series past Lumen et al. [ iii] comparing a gratuitous radial forearm flap with a pedicled anterolateral thigh flap, 8 of eleven patients with phalloplasty underwent urethral reconstruction, and after a mean follow-up of 25 months, none of the patients developed such a complication. This could be due to the relative absence of hair in the free radial forearm flap, thus favoring its use to forbid such an unusual complexity. Mechanical epilation by plucking of hairs tin can also be washed whenever feasible, as in our instance.
In decision, patients with urethral reconstruction using a groin skin flap can nowadays with the long-term complexity of a tricholithobezoar. This case highlights the need for prophylactic removal of hairs along with long-term follow-up to discover such an unusual complexity.
The authors accept nothing to disclose.
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Source: https://www.icurology.org/DOIx.php?id=10.4111/kju.2013.54.5.345
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