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PubMed1988

Balloon catheter dilatation of urethral strictures.

Seven patients with urethral strictures due to different causes were treated by balloon catheter dilatation. The dilatation was performed on an outpatient basis in conjunction with suprapubic voiding cystourethrography and under fluoroscopic control. Only diazepam sedation and topical anesthesia were used. No indwelling catheters were placed in the urethra after the procedure. Six of the seven patients have been followed for 6-26 months, and only two have required redilatations. There have been no complications that required therapy. The initial success with our technique and that reported by others suggest that balloon catheter dilatation offers a good alternative treatment for urethral strictures to replace bouginage, urethrotomy, and urethroplasty.

Adolescent↗
PubMed2006

Female urethral strictures: successful management with long-term clean intermittent catheterization after urethral dilatation.

OBJECTIVE: To report our experience in the diagnosis and treatment of urethral stricture in women. PATIENTS AND METHODS: A retrospective review of records and video-urodynamics identified women treated for urethral stricture between 1999 and 2004 at one institution by one surgeon. Urethral stricture was defined as a fixed anatomical narrowing between the bladder neck and distal urethra of <14 F preventing catheterization, and the diagnosis was confirmed by cysto-urethroscopy, and/or video-urodynamics. Women with a history of external beam radiotherapy to the pelvis, or of gynaecological, urethral or bladder malignancy, were excluded, and the women had a urethral biopsy to exclude a malignant cause of the stricture. Initial treatment consisted of urethral dilatation to > or = 30 F. After a period of indwelling catheterization, the women were placed on clean intermittent self-catheterization (CISC) at least once daily, and monitored every 3-6 months. At each follow-up, the urethra was catheterized to exclude recurrence. American Urological Association (AUA) symptom scores were obtained at presentation and at the initial 3 month follow-up. RESULTS: Seven women met the criteria for urethral stricture, and were followed for a mean (range) of 21 (6-34) months. All were initially maintained on daily CISC, and some were gradually reduced to weekly CISC for the duration of follow-up. No patient had a recurrent stricture while on CISC, and none has had a urethral reconstruction to manage their condition. AUA symptom scores improved in all of the women by a mean of 10.7 points. No complications related to catheterization were noted. CONCLUSION: Urethral stricture is rare in women. Long-term CISC in these women is safe and effective, and can avoid the need for major reconstructive surgery.

Adult↗
PubMed1981

Incidence of urethral stricture after transurethral resection of prostate. Effects of urinary infection, urethral flora, and catheter material and size.

Urethral stricture is the most common complication of transurethral resection of prostate, occurring in up to 29 per cent of cases. A prospective trial was initiated to ascertain if the presence of positive urine and urethral bacterial cultures made any significant difference in urethral stricture incidence. One hundred patients were entered in the trial, 50 receiving latex catheters and 50 receiving Teflon catheters. There was no significant difference between the two groups in incidence of urethral stricture, and there was no correlation between positive urine and urethral bacterial cultures and stricture formation. It is suggested, therefore, tha urethral catheter material and size and the presence of organisms in the urine and in the urethra do not contribute significantly to the formation of urethral stricture following transurethral resection of the prostate.

Humans↗
PubMed1993

[Direct vision internal urethrotomy in the treatment of urethral stricture].

Forty-eight patients with urethral stricture were treated with direct vision internal urethrotomy from March 1987 to December 1991. The etiological factors, surgical techniques, complications and results were described. The operation was successful in 46 patients (95.8%) and failure in 2. Follow-up for 6 to 24 months showed that satisfactory results were obtained in 44 patients (91.7%). It is considered that direct vision internal urethrotomy, a safe, effective and less complication technique, can be as a procedure of first choice for the treatment of male urethral stricture. The length of urethral stricture and excessive per urethral disease are important factors affecting postoperation results.

Adolescent↗
PubMed1981

Prevention of urethral strictures in the management of posterior urethral valves.

Our 28 patients with posterior urethral valves managed with transurethral resection have sufficient followup to evaluate the development of urethral strictures. Of these 28 patients 14 were less than 1 year old when the valves were resected and strictures developed in 7 (50 per cent). Of the 14 patients who were more than 1 year old when the valves were resected none had a stricture. Within the latter group was a subgroup of patients who were treated with early vesicostomy and later valve resection. None of these patients suffered a stricture. Our data indicate that stricture formation is high when valve resection is attempted in the neonate or small infant and can be prevented by primary vesicostomy and delayed valve resection.

Adolescent↗
PubMed2006

Effect of mitomycin C on anterior urethral stricture recurrence after internal urethrotomy.

OBJECTIVES: Urethral stricture is one of the oldest known urologic diseases and remains a common problem with high morbidity. Internal urethrotomy refers to any procedure that opens the stricture by incising or ablating it transurethrally. The most common complication of internal urethrotomy is stricture recurrence. The curative success rate of internal urethrotomy is approximately 20%. Mitomycin C has antifibroblast and anticollagen properties and in sporadic reports of animal and clinical studies it has increased the success rate of trabeculectomy and myringotomy. This study evaluated the efficacy of mitomycin C in the prevention of anterior urethral stricture recurrence after internal urethrotomy. PATIENTS AND METHODS: Forty male patients with anterior urethral strictures were randomized to undergo internal urethrotomy with or without urethral submucosal mitomycin C injection. Using general anaesthesia, the urethrotomy was performed under direct vision. Mitomycin C (0.1mg) was injected submucosally at the urethrotomy site in 20 patients. The patients were re-evaluated after 6 mo and the stricture recurrence rate was compared between the two groups (chi(2) analysis). RESULTS: Urethral stricture recurred in 2 patients (10%) in the mitomycin C-treated group and in 10 patients (50%) in the other group. This difference in stricture recurrence between the two groups was statistically significant (p=0.006). CONCLUSIONS: To our knowledge, this is the first prospective, randomized, clinical trial to evaluate the efficacy of mitomycin C application in internal urethrotomy. Submucosal injection of mitomycin C significantly reduced stricture recurrence after internal urethrotomy. Further investigations are warranted to confirm its efficacy and safety.

Adolescent↗
PubMed2003

Open reconstruction of pediatric and adolescent urethral strictures: long-term followup.

PURPOSE: Pediatric urethral stricture disease represents a significant surgical challenge. Published operative series of pediatric urethral reconstruction include small numbers or lack long-term followup. We examined the long-term outcome of open reconstructive techniques for pediatric urethral strictures. MATERIALS AND METHODS: From March 1987 through August 2002, 17 boys 7 to 17 years old underwent open urethral reconstruction with followup. Trauma was the etiology in 88% of cases. Nine patients had anterior urethral stricture and 8 had traumatic posterior urethral disruption. Strictures secondary to failed hypospadias correction were not included in analysis. In 10 patients (59%) previous management with open or endoscopic procedures had failed. Followup in all patients consisted of symptomatic evaluation, voiding cystourethrography and flexible urethroscopy. RESULTS: One-stage perineal urethral reconstruction was performed in all patients without retropubic or transpubic dissection. All patients were stricture-free and continent at a mean followup of 67 months. A total of 18 open surgical procedures were needed. A patient with posterior urethral disruption required reoperation for recurrent stricture disease but had excellent long-term results after the second operation. Chordee, penile shortening and urethral diverticula were not noted during followup. CONCLUSIONS: Open urethral reconstruction of adolescent and pediatric strictures provides excellent long-term results with minimal morbidity. When considering the importance of repair durability in the pediatric urethral stricture population, urethral reconstruction should be strongly considered the primary treatment option. Endoscopic procedures should be reserved for patients with short bulbar strictures associated with minimal spongiofibrosis. As in the literature, we do not advocate repeat direct vision internal urethrotomy.

Adolescent↗
PubMed2006

[Prevention of urethral stricture after transurethral vaporesection of prostate by adjustable urethral tractor].

OBJECTIVE: To reduce the complication by transurethral vaporesection of prostate (TUVP) using adjustable urethral tractor. METHODS: One hundred and six cases with benign prostate hypertrophy underwent TUVP and catheter traction after operation by an adjustable tractor. The results by catheter traction were compared with those by rubberized cloth paste and carbasus compression. RESULT: The urethral stricture occurred in 2.7%, 6.7%, 30.4% of cases by the catheter traction, rubberized cloth paste and carbasus compression respectively, which had statistical significance (P <0.01). CONCLUSION: The incidence of urethral stricture can be reduced by catheter traction after TUVP.

Aged↗
PubMed2004

Urethral stricture after pancreas-kidney transplantation due to polypoid urethritis.

Urologic complications are common after pancreas-kidney transplantation using bladder drainage. We report a case of urethral stricture caused by polypoid urethritis occurring 4 years after simultaneous pancreas-kidney transplantation. Endoscopic exploration revealed irregular, ragged-appearing urethral mucosa. The diagnosis of polypoid urethritis was confirmed histopathologically.

Adult↗
PubMed1993

The "Wallstent": a new stent for the treatment of urethral strictures.

Ten patients have been reviewed in whom urethral stents were implanted for treatment of urethral stricture. Their urethral strictures had been treated with a median of 4.2 endoscopic urethrotomies under direct vision without success. The patients were first treated with optical urethrotomy, and dilatation to 30 F--after which the stents were inserted under direct endoscopic control. A total of 12 stents were inserted. All patients had a 30 mm stent inserted first, and two patients had an additional 20 mm stent inserted because of recurrent stricture at the distal or proximal end of the first stent. One patient had a urethrotomy 12 months after insertion of the stent because of a short recurrent stricture at its distal end. The median length of follow up was 24 months. The median preoperative maximum flow rate was 6.5 ml/s, and the median postoperative maximum flow rate was 20.3 ml/s. Half the patients had postmicturition dribbling postoperatively. The stents were covered with epithelium after 6-18 months, most between 12 and 18 months.

Adult↗
PubMed1990

[Retrograde balloon catheter dilatation of urethral stenosis--experience in benign prostatic hypertrophy and postoperative urethral stricture].

Retrograde transurethral balloon dilatation of urethral stenosis was performed in five patients: four patients with benign prostatic hypertrophy and one with urethral stricture following open prostatectomy. Significant resolution of symptoms of dysuria was seen in four patients throughout the follow-up period of 12 to 18 months. A balloon diameter of 25 mm was considered to be necessary for prostatic hypertrophy. The unsatisfactory result in one patient with prostatic hypertrophy was believed to be caused by incomplete dilation due to a small balloon diameter. Mild transient hematuria was seen in all cases. Only one patient with postoperative urethral stricture complained of pain during balloon inflation, while other patients with prostatic hypertrophy did not complain of any apparent pain. We conclude that this technique is a safe and effective method of treatment for prostatic hypertrophy and other urethral strictures.

Aged↗
PubMed1997

Inlay-onlay flap urethroplasty for hypospadias and urethral stricture repair.

PURPOSE: The absence of a segment of the urethral plate renders the onlay urethroplasty procedure impossible. The plate may be too short (in hypospadias), or scarred after previous repair or due to a dense urethral stricture. A modified approach with restoration of urethral plate continuity is proposed instead of the tubularized island flap associated with higher complication rates. MATERIAL AND METHODS: In 12 of 20 patients with a partially deficient urethral plate the inlay-onlay preputial island flap was used. The wider part of the flap is inlaid in place of the missing plate and anastomosed to the residual plate. Formation of the urethra is then completed with standard onlay overlapping of the flap. In another 8 patients the combined (partially tubularized in advance) tube-onlay flap was used. RESULTS: The inlay-onlay flap technique was used in 3 new hypospadias patients, in 4 with a scarred, hair-bearing plate after previous operations and in 5 with virtually no urethral plate because of a dense urethral stricture. No urethral complications were encountered. Of the 8 patients undergoing the combined tube-onlay repair 3 had complications, including meatal stenosis (2) and partial dehiscence (1). CONCLUSIONS: Inlay-onlay flap urethroplasty allows correction of complex cases of hypospadias or urethral stricture with a partially deficient urethral plate in 1 stage with a low complication rate.

Adolescent↗
PubMed2003

[One-stage urethroplasty using colonic mucosa in the treatment of complex lengthy urethral stricture].

OBJECTIVE: To investigate the feasibility of urethral reconstruction with colonic mucosa graft in the treatment of complex lengthy urethral stricture. METHODS: Between October 2000 and May 2003, 19 male patients with complex lengthy urethral stricture that had undergone unsuccessful urethral repair 3 times on average, aged 18 - 65, were treated with free graft of colonic mucosa 10 to 17 cm (mean 13.2 cm) long. The patients were followed-up for 6 - 36 months (17 months on average) by retrograde urethrography, urethroscopy, and uroflometry. RESULTS: Meatal stenosis that needed reoperation was developed in 1 patient 3 months postoperatively. This patient became voiding very well with a urinary peak flow of 28.7 ml per second during the follow-up of 12 months after the second operation. Hyperplasia of verumontanum was observed during urethroscopy in 1 patient 14 months postoperatively. Uroflometry examination showed a urinary peak flow of 46.5 ml/s after transurethral colliculectomy. The other 17 patients were voiding well with a urinary peak flow greater than 15 ml/s (16 to 28.5 ml/s). CONCLUSION: Colonic mucosa graft urethroplasty is a feasible procedure for the treatment of complex lengthy urethral stricture, particularly when the more conventional options fail or are contraindicated.

Adolescent↗
PubMed1991

Balloon dilatation for entire urethral stricture.

Two patients with entire urethral stricture were treated with balloon dilatation of the whole urethra using a torpedo-type dilatation balloon with satisfactory results. Postdilatation urethrograms revealed that the lumen of the urethra was of satisfactory width in both cases, and the patients are now voiding normally. There has been no complication requiring therapy. These successful results suggest that this technique is a good alternative treatment for entire urethral stricture, and can replace conventional dilatation.

Aged↗
PubMed2002

The dosimetry of prostate brachytherapy-induced urethral strictures.

PURPOSE: There is a paucity of data regarding the incidence of urethral strictures after prostate brachytherapy. In this study, we evaluate multiple clinical, treatment, and dosimetric parameters to identify factors associated with the development of brachytherapy-induced urethral strictures. METHODS AND MATERIALS: 425 patients underwent transperineal ultrasound-guided prostate brachytherapy using either (103)Pd or (125)I for clinical T1b/T3a NxM0 (1997, American Joint Committee on Cancer) adenocarcinoma of the prostate gland from April 1995 to October 1999. No patient was lost to follow-up. 221 patients were implanted with (103)Pd and 204 patients with (125)I. The median patient age was 68 years (range 48-81 years). The median follow-up was 35.2 months (range 15-72 months). Follow-up was calculated from the day of implantation. Thirteen patients developed brachytherapy-induced strictures, and all strictures involved the membranous urethra. A control group of 35 patients was rigorously matched to the stricture patients in terms of treatment approach; i.e., choice of isotope, plus or minus radiation therapy, and plus or minus hormonal manipulation. Nine of the 13 stricture patients had detailed Day 0 urethral dosimetry available for review. The apex of the prostate gland and the membranous urethra were defined by CT evaluation. Urethral dosimetry was reported for the prostatic urethra, the apical slice of the prostate gland, and the membranous urethra which was defined as extending 20 mm in length. RESULTS: The 5-year actuarial risk of a urethral stricture was 5.3%, with a median time to development of 26.6 months (range 7.8-44.1 months). Of multiple clinical and treatment parameters evaluated, only the duration of hormonal manipulation (>4 months, p = 0.011) was predictive for the development of a urethral stricture. The radiation dose to the membranous urethra was significantly greater in patients with strictures than those without: 97.6% +/- 20.8% vs. 81.0% +/- 19.8% of prescribed minimum prostate dose, mPD (p = 0.031). The urethral dose 20 mm distal to the prostate apex was 57.6% +/- 23.8% vs. 31.5% +/- 13.9% of mPD for the stricture and control patients, respectively (p = 0.011). In addition, the extent of the 75% mPD and 50% mPD levels beyond the prostatic apex was also significantly greater for stricture patients, 16.6 +/- 5.3 mm vs. 11.9 +/- 4.5 mm (p = 0.010) and 19.0 +/- 3.2 mm vs. 16.0 +/- 3.4 mm (p = 0.021), respectively. Dose to the prostatic urethra was not predictive of stricture, but the magnitude and extent of high-dose regions within the prostate were predictive of stricture. Twelve of the 13 patients who developed urethral strictures were successfully managed by dilatation/transurethral incision. To date, 1 of the 12 patients has required a second dilatation. The remaining patient developed an iatrogenic induced injury and was catheter-dependent for 6 months. CONCLUSIONS: After prostate brachytherapy, the actuarial 5-year incidence of urethral strictures is 5.3% with a median time to development of 26.6 months. All strictures involved the membranous urethra and occurred within the first 44 months after brachytherapy. In most cases, membranous urethral strictures are easily managed with dilatation/incision. Factors predicting for the development of a urethral stricture included the magnitude and extent of high-dose regions within the prostate, the mean membranous urethra dose and the dose 20 mm distal to the prostatic apex, the maximum extent along the membranous urethra of certain dose levels, and the duration of hormonal manipulation.

Aged↗
PubMed2002

Urethral reconstruction with colonic mucosa in treatment of complex urethral stricture.

OBJECTIVE: To investigate the possibility of urethral reconstruction with colonic mucosa for the treatment of complex longer urethral stricture (>/= 10 cm). METHODS: From October 2000 to September 2001, 6 patients with complex longer urethral stricture were treated with colonic mucosal graft urethroplasty. They had under gone 3 previous unsuccessful urethral repairs on average. Urethral reconstruction with a free graft of colonic mucosa ranged from 10 to 15 cm (mean 12.17 cm). Follow-up included retrograde urethrography, urethroscopy, and uroflowmetry. RESULTS: The patients were followed up 3 - 14 months postoperatively (mean 7.8 months). Meatal stenosis developed in one patient 3 months after operation needed reoperation. The patient voided very well with urinary peak flow 28.7 ml per second duing follow-up for 12 months postoperatively. The other patients voided well with urinary peak flow greater than 15 ml per second. At urethroscopy, colonic mucosa was macroscopically difficult to distinguish from normal original urethral mucosa in 4 patients over 6 months after the operation. CONCLUSIONS: Colonic mucosa graft urethroplasty is feasible for the treatment of complex longer anterior urethral stricture. The technique is useful for urethral reconstruction when penial skin and bladder mucosa are not available.

Colon↗