Abstract: A posterior ledge at the bladder neck was seen in 158 patients (107 of whom were undergoing intermittent catheterization) on a sonographic voiding cystourethrogram. In 117 patients, the ledge was 0.5 cm or longer; 66 patients were on intermittent catheterization, and 51 experienced difficulty with catheterization, including vigorous bleeding in 4. Ledges less than 0.5 cm were discovered in 41 patients, all on intermittent catheterization, none of whom had difficulty with this procedure. The duration of intermittent catheterization and of detrusor-sphincter dyssynergia was shown statistically to be an important factor leading to the formation of the longer obstructing ledges (P less than 0.0005, Mann-Whitney test). Sphincterotomies were performed in 74 patients through the periurethral striated sphincter at 10 and 2 o'clock and extended to the bladder neck. The operation was a success in 73 (98%), all of whom were catheter-free, and in all of whom sonography revealed that the ledge had receded and the catheter was no longer obstructed.

Abstract: We report 6 patients with chronic renal failure who developed contrast intravasation/extravasation during voiding cystourethrography. Two patients underwent cystoscopy and were noted to have diffuse mucosal tears, but had normal appearing bladder mucosa on follow-up inspection. None of the patients experienced symptoms or clinical sequelae. Pathophysiological changes in the chronically unused bladder which predispose it to mucosal injury are considered.

Abstract: A dorsal incomplete duplicated urethra was found in a 13-year-old male, who had noticed occasional urinary incontinence and recurrent urinary tract infection. The accessory urethra lay dorsal from the glans to bladder neck in parallel with the normal ventral urethra. The external orifice of the accessory urethra was also dorsal to the normal urethral orifice in the glans. Voiding cystourethrogram demonstrated double stream but the patient did not notice it because of pseudophimosis. Retrograde urethrogram showed the accessory urethra which arised from the dorsal surface of the prostatic urethra with a parallel normal urethra. The pendular portion of the accessory urethra was surgically removed, the glans portion of the urethra and posterior urethra were cautilized with electrocoagulation for the purpose of preservation of urinary continence. The patient was postoperatively free from urinary tract infection and urinary incontinence.