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PubMedDate not supplied

[Treatment results in urethral strictures].

A total of 231 patients with urethral strictures were treated. The disease resulted from trauma, adenomectomy, chronic urethritis, prostatic sclerosis in 92, 72, 51 and 16 patients, respectively. Fifty-one patients underwent conservative treatment which involved bougienage, resolving and anti-inflammatory agents. 38 of them responded, 13 nonresponders were operated on. 72 patients were subjected to partial urethral tunneling according to an original technique which brought success in 90% of the cases. Out of 92 traumatic urethral strictures 88 were cured after end-to-end plastic reconstruction. It is believed that urethral strictures should be managed individually basing on the stricture cause, location, length, severity, complications.

Age Factors↗
PubMed1979

Urethral strictures in boys.

Our experience with urethral strictures in boys during a 15-year period confirms the findings of others that the most common etiology is iatrogenic. Traumatic and inflammatory strictures are rare. The congenital stricture differs fundamentally from acquired types of urethral strictures and would be termed more appropriately congenital urethral membrane. Urethral dilation and/or urethrotomy was unsuccessful in 47% of our patients, leading to secondary formation of a new stricture in 2 instances. However, urethroplasty was successful in 83% of our cases and seems to be indicated when 2 or more dilations are required.

Adolescent↗
PubMed1997

Reconstruction of traumatic posterior urethral strictures.

Reconstruction of posterior urethral disruption injuries is an extremely challenging surgical exercise even in the best of hands. A perineal anastomotic technique is successful in the vast majority of cases. Adequate excision of fibrotic tissue is of paramount importance in ensuring successful outcomes. A wide-caliber, spatulated tension-free bulboprostatic anastomosis is the goal of surgical reconstruction. Excellent long-term results can be expected from anastomotic urethroplasty in patients with traumatic posterior urethral strictures. Nearly all patients can void normally and retain continence postoperatively. Subsequent urethrotomy, when required, carries a high likelihood of success. A significant number of patients regain potency after urethral reconstruction. Persistent impotence probably reflects the severity of pelvic trauma.

Humans↗
PubMed1983

Complications and management of childhood urethral stricture disease.

In many ways, the management of urethral stricture disease in children parallels that in adults, but striking differences exist. The technical demands made because of the small size of the strictures and the delicacy of the tissues involved certainly provide more of a challenge. Newer instrumentation, improved techniques, and increased experience in children are helping us to meet these challenges. Visual urethrotomy should be considered the initial treatment of choice for anterior urethral strictures, and urethroplasty should be reserved for treatment failures. Attention to technical detail and proper patient preparation will ensure optimum results from urethroplasty. Posterior urethral strictures as a result of pelvic injury can be influenced by proper initial management but remain an open surgical disease of considerable challenge. The fact that in children a large proportion of urethral stricture disease is iatrogenic provides us with a real opportunity for prevention. As with any disease state, prevention or minimization of complications of treatment is the ultimate goal. It is only through a careful, thoughtful approach that we can begin to achieve that end.

Child↗
PubMed1991

Effect of catheter material on the incidence of urethral strictures.

The aetiology of urethral strictures in patients catheterised for short periods at the time of surgery is the subject of some debate. The occurrence of epidemics of strictures associated with certain batches of latex catheters, and the demonstrable in vitro cytotoxicity of latex in general, have supported the suggestion that catheter material (and in particular latex) has an important role. We have looked retrospectively at 299 patients undergoing transurethral resection of the prostate gland by 1 urologist, 135 of whom had a latex catheter and 164 a plastic one; 19 patients developed strictures over the next 12 months with no proven difference attributable to the catheter material. The study provides no evidence that the short-term use of latex catheters is associated with stricture formation.

Aged↗
PubMedDate not supplied

Urethral stricture and semen quality.

OBJECTIVE: To study the relationship between urethral stricture and infertility, which has not been well studied in the past. PATIENTS AND METHODS: In this study in West Africa, the mean semen values from 90 fertile controls and 32 infertile controls were compared to 40 men with incomplete urethral strictures (IUS) and 56 men with complete urethral strictures after treatment. Testicular biopsies were performed on 30 patients. Sexually transmitted urethritis accounted for 79% of the strictures within this group of patients. Repair of the strictures restored ejaculate in 39 men, and 22 men had normospermia (20 million/mL); however, the remainder had either azoospermia or oligospermia. The biopsies revealed normal spermatogenesis in 5 men, which suggested ductal obstruction, but 14 patients had destruction of seminiferous tubules suggesting end organ failure. Eleven other men had hypospermatogenesis, maturation arrest, or premature sloughing of cells, which may be amenable to treatment. CONCLUSIONS: These data suggest that early medical treatment and repair of urethral stricture may improve fertility for men with urethral strictures, especially strictures following infectious urethritis. Testicular biopsies may aid in the diagnosis of persistent infertility among these men, and should be considered as part of the work-up.

Adult↗
PubMed1984

Urethroplasty in the treatment of urethral strictures.

The treatment of urethral strictures has been revolutionised since urethroplasty was described three decades ago. Although majority of strictures respond to the age old procedure of bouginage, a small number, however, need surgical intervention because of associated complications. Over the past six years, thirty-four patients were treated by some form of urethroplasty. Eighteen had meatoplasty for meatal stenosis, two of which recurred and were converted to two stage anterior urethroplasty. Three patients, with long anterior stricture, were subjected to two staged operation as a primary procedure. The posterior urethra was affected in eight patients and two of them also had fistulae. All these patients were subjected to urethroplasty which was modified according to the extent of stricture. Two patients with prostato-membranous strictures were dealt with transpubically in one stage. In five patients the entire urethra distal to the membranous part was affected by a long standing stricture, three of whom were also complicated by fistulae. They were similarly dealt by a full length two stage urethroplasty. Satisfactory results were achieved in all except three patients whose stricture recurred and needed a surgical reconstruction. Only one patient in this series developed impotence and true incontinence.

Adolescent↗
PubMed1975

Turner-Warwick urethroplasty and urethral stricture. Results in 60 patients.

Sixty patients with urethral strictures at the bulbous and membranous levels were treated with Turner-Warwick urethroplasty. Initially, there were significant difficulties with restenosis of either the proximal or distal st-ma following the first-stage urethroplasty. Use of nitrofurazone-hydrocortisone (Furacin-Hc) urethral suppositories practically eliminated recurrent stomal stenosis after the first stage. Several additional modifications were made in the original technique; these included placement of urethral sutures prior to scrotal mobilization and abandonment of the suprapublic cystotomy for frainage at the second stage of the procedure. These modifications increased the chances of achieving a successful result while facilitating the actual surgery and improving the patients' comfort. The over-all success rate was approximately 90 per cent. Patients with urethral stricture surgery subsequent to prostatectomy had problems with urinary control, but not so if prostatectomy was done after the first stage of urethroplasty. It appears that the Turner-Warwick urethroplasty is good one, and predictably good results can be expected on selected patients with urethral strictures.

Abscess↗
PubMed1997

Single stage reconstruction of complex anterior urethral strictures: combined tissue transfer techniques.

PURPOSE: Reconstruction of most urethral strictures is possible with anastomotic, graft or skin flap procedures alone. We describe the combination of tissue transfer techniques to preserve the urethral plate and reconstruct long and complex urethral strictures in 1 stage. MATERIALS AND METHODS: We reviewed the results in 25 patients who underwent anterior urethroplasty requiring more than 1 tissue transfer technique to achieve urethral reconstruction in 1 stage. RESULTS: Outcome was excellent in 22 patients (88%). Seven patients with pan-urethral strictures (mean length 19 cm.) required a fasciocutaneous flap combined with a buccal mucosa, bladder epithelium or skin graft. A total of 13 patients with focally dense strictures underwent excision of the most severe portion of the stricture with dorsal reapproximation, thereby improving the quality of the urethral plate and allowing simultaneous flap or graft onlay reconstruction. Five patients with multiple separate strictures required a distal onlay fasciocutaneous flap with excision and end-to-end anastomosis of a separate, more proximal stricture. CONCLUSIONS: A thorough knowledge of the vascular supply of the urethra allowed creative application of different tissue transfer techniques, enabling 1-stage reconstruction of complex urethral strictures. An excellent outcome was achieved by preserving or revising the urethral plate and avoiding the problems associated with hair-bearing flaps and 2-stage procedures.

Adult↗
PubMed2004

Use of 7.5F flexible pediatric cystoscope in the staging and management of urethral stricture disease.

BACKGROUND AND PURPOSE: In the evaluation and treatment of patients with urethral strictures, assessment of the stricture is of paramount importance. To date, urologists have relied on retrograde or antegrade urethrography or both to define stricture length and associated characteristics. Antegrade urethrography typically requires suprapubic access to the bladder, adding to the morbidity of stricture treatment. Herein, we describe the feasibility of using a new method for diagnosing, staging, and managing urethral stricture disease. PATIENTS AND METHODS: Twenty-four men with urethral strictures underwent urethroscopy with a 7.5F, 26-cm "pediatric" flexible cystoscope to stage and manage their disease. Comparison of urethroscopy with retrograde urethrography was made with respect to characterizing the stricture. RESULTS: In all cases, the urethral strictures could be navigated with the 7.5F cystoscope. Documentation of the stricture length and the density of scar tissue and identification and characterization of additional pathology (urethral calculi proximal to the stricture in two patients) were possible in all cases, including four patients with recurrent stricture after complex urethroplasty. CONCLUSION: The 7.5F, 26-cm pediatric flexible cystoscope represents a useful tool in the diagnosis and management of urethral stricture disease. Further studies will be necessary to determine the cost-effectiveness, patient morbidity, and ability to tailor therapy appropriately in comparison with standard retrograde urethrography or voiding cystourethrography.

Cystoscopes↗
PubMed1992

Transurethral resection in children with urethral stricture and occlusion.

Technical considerations of urethral surgery in children are critical because of the small size and delicacy of their urethra. From 1984 to 1989, 10 children with serious traumatic urethral stricture (5 cases) and occlusion (5) were treated satisfactorily by an improved transurethral resection (TUR). The age of the children ranged from 4 to 14 years. The TUR technique, curative effects and prevention of urethral stricture are discussed.

Adolescent↗
PubMed2002

Prospective evaluation of the American Urological Association symptom index and peak urinary flow rate for the followup of men with known urethral stricture disease.

PURPOSE: We prospectively evaluated the American Urological Association (AUA) symptom index and maximum urine flow for predicting urethral stricture recurrence in men with a previous diagnosis of urethral stricture disease. MATERIALS AND METHODS: Patients were recruited at our urethral stricture clinic, where all newly diagnosed and previously treated men with urethral stricture present and are treated. The AUA symptom index was completed and uroflowmetry was done. The stricture was calibrated using Jacques catheters. If an 18Fr catheter could not be passed, a retrograde urethrogram was performed. Patients were treated with filiform dilation or direct vision internal urethrotomy. Uroflowmetry was repeated when the catheter was removed 3 days later and the AUA symptom index was repeated 1 month later. RESULTS: Data on 49 patients (170 consultations) between March 2000 and August 2001 were analyzed. Average patient age was 48 years. There was a significant negative correlation of urethral diameter with AUA symptom index and of AUA symptom index with maximum urine flow as well as a significant positive correlation of urethral diameter with maximum urine flow. We evaluated the usefulness of AUA symptom index and maximum urine flow at different cutoff levels for predicting urethral stricture in our study group. Using an AUA symptom index of greater than 10 or maximum urine flow of less than 15 ml. per second as cutoff values provided 93% sensitivity, 68% specificity, 78% positive predictive value, 89% negative predictive value and 82% overall accuracy. This method could have prevented further invasive studies in 34% of patients, while a clinically significant stricture would have been missed in only 4.3%. CONCLUSIONS: AUA symptom index combined with maximum urine flow is an accurate, time-saving and cost-effective tool for predicting recurrent stricture in patients with a known urethral stricture. It can be used to direct decision making on further invasive studies and treatment.

Adult↗
PubMed1979

A comparative study of electrosurgical vs. cold urethrotomy in the treatment of urethral strictures.

Thirty-one patients with urethral stricture were subjected to internal urethrotomy under visual control. The patients were divided into two groups according to the surgical procedure: electrosurgical or cold resection. A modification of the Sachse knife was introduced in order to permit its use with the American Cystoscope Makers Inc. instruments. The success rate with cold resection was 81.81% and with the electrosurgical procedure 40%. Internal urethrotomy with cold resection is a simple and harmless operation, being a first choice in the treatment of urethral stricture.

Adolescent↗
PubMed1989

Urethral stricture following aortic graft surgery.

The incidence of urethral stricture following aortic graft surgery was investigated retrospectively in a group of 127 men. They had been catheterised prior to their operation with latex catheters. One man had been treated for a stricture 9 months after his operation. Information about post-operative urinary symptoms was obtained from a further 94 surviving patients by postal questionnaires sent at least 12 months following surgery. Eight patients underwent urological review including, where indicated, urethrography under antibiotic cover; 3 patients were identified with urethral strictures, an incidence of 3.2%. This is similar to that occurring after cardiac surgery, and urethral strictures should be considered a hazard whenever catheters are used in surgical procedures.

Aorta↗
PubMed1994

Transurethral resection in children with urethral stricture and occlusion.

Technical considerations of urethral surgery in children are critical because of the small size and delicacy of the urethra. From 1984 to 1989, children ages 4 to 14 years with serious traumatic urethral strictures (n = 5) or occlusion (n = 5) were treated. For anterior lesions, transurethral resection (TUR) with a Storz urethroresectoscope (10F-15F) was used to excise all scar tissue after the stenotic tract had been incised or dilated. For lesions in the posterior urethra, the bladder was opened or the cystostomy tract dilated, allowing the operator's index finger to be passed to the posterior end of the lesion while an assistant's finger was inserted into the patient's rectum. A sharp-tip 4F sound was then guided up the urethra into the bladder, the lesion was dilated, and the scar tissue was excised. With an average of 24.4 months of follow-up, success was achieved in all patients, requiring one session in seven patients and two or three sessions in the others. Recurrences in three patients were cured by repeat TUR. There were three cases of epididymitis and two of scrotal edema. This procedure is recommended as the treatment of choice for children with urethral strictures or occlusions. Thorough clearance of scar tissue is valuable to enhance the cure rate.

Adolescent↗
PubMed1998

[General principles in treatment of urethral strictures].

This manuscript outlines the important points in the evaluation and treatment of urethral stricture disease. The algorithms described within are not presented as strict guidelines but rather are intended to give a logical thought progression which incorporates the basic principles of urethral reconstruction. It is important to determine the therapeutic goal before applying these principles. There are basically two arms of consideration, the first is to attempt to cure the patient of urethral stricture disease and the second is to simply manage the patient's urethral stricture disease without intent of cure. Applying the current knowledge of anatomy with modern tissue transfer techniques will achieve a highly successful, single stage reconstruction in most patients. Although approaching urethral stricture disease with the intent to cure is preferred, management may not be unreasonable in certain cases. Some patients have entensive co-morbidities or may prefer a trial of conservative measures before definitive treatment is undertaken. If the goal established is urethral reconstruction, the gold standard is to perform a single stage procedure that is highly successful and durable. Excision of the urethral stricture with primary anastomosis (EPA) represents this gold standard. However, ist application is limited by stricture location or length. An accurate evaluation of the stricture location, length, and associated spongiofibrosis is mandatory in forming viable options for repair. By exploiting the advantages of differing techniques, the proper course of action can be chosen which generally will solve even the most complex problem in one stage. The reconstructive surgeon come to the operative suite armed with the full knowledge and understanding of the principals and techniques which will result in a favorable outcome. It is not uncommon for intra-operative findings to guide the decision for the best alternative for urethral reconstruction. We also offer some helpful hints regarding positioning, sutures, exposure, and retractors.

Algorithms↗
PubMed1984

Role of urethral ischemia in the development of urethral strictures after cardiovascular surgery: a preliminary report.

A high incidence of urethral stricture was noted following cardiovascular surgery. In an attempt to elucidate factors predisposing to the occurrence of urethral stricture, we studied the penile blood flow in 7 patients presenting with strictures after cardiovascular surgery. Of these patients 5 had penile-brachial pressure indexes less than 0.5 and 6 had weak or absent erections. Of 14 patients studied prospectively by penile blood flow 2 had a low penile-brachial pressure index and suffered urethral strictures 6 weeks after cardiovascular surgery. This finding suggests that urethral ischemia could be a predisposing factor for the development of urethral strictures after cardiovascular surgery.

Adult↗