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Results for “Urethral Stricture”

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At least 109 records · Page 6Linked to original sources

PubMed1998

High posttraumatic vaginal stricture combined with urethrovaginal fistula and urethral stricture in girls: reconstruction using a posterior sagittal pararectal approach.

PURPOSE: High vaginal stricture is a rare abnormality of traumatic origin, which in most cases is associated with urethral injury. Because to our knowledge there are no previous reports of surgical management of this condition, we describe our experience with plastic surgery performed via a posterior sagittal approach using local tissue in girls with posttraumatic vaginal stricture. MATERIALS AND METHODS: We performed vaginoplasty using a posterior sagittal pararectal approach in 6 girls 5 to 14 years old with posttraumatic high vaginal stricture. Five patients had urethral stricture and urethrovaginal fistula. In 5 cases bladder neck closure and the Mitrofanoff procedure were done. RESULTS: There were no complications in any patients during the immediate postoperative period. Followup studies 1 to 3 years later in all girls revealed a fully patent vaginal anastomosis. CONCLUSIONS: Principles of reconstruction that must be followed if a positive result is to be obtained include concurrent vaginoplasty and suture of the urethrovaginal fistula with separation of the suture line, complete excision of scars in the segments being joined, use of meeting flaps to lengthen the anastomotic line as much as possible, and prevention of ischemia and inflammation in the anastomotic region.

Adolescent↗

PubMed1984

Urethral stricture after transurethral resection.

After 101 transurethral resections, iatrogenic postoperative urethral strictures have occurred in 10 cases due to pathologic changes in the bladder and bladder neck. Urethral stricture after transurethral resection (TUR) thus has represented the most common postoperative complication. No morbidity increase of urethral strictures after TUR could be demonstrated in one of the analysed groups. Fifty per cent of the incidence rate of strictures was localized in the pars pendulans urethrae. Factors causing the stricture have been demonstrated, and the incidence rate of strictures was reduced when these factors were taken into consideration. Preference is given either to conservative or surgical therapy depending on the localization of the stricture, even though endoscopic methods are used more frequently now in the treatment of stenoses of the urethra.

Adult↗

PubMed1992

[Urethral stricture after TURP and transvesical prostatectomy].

In an attempt to elucidate factors predisposing to the occurrence of urethral stricture after transurethral resection of the prostate, we performed a prospective follow-up of 178 patients over 12-20 months. We took account of 11 factors that we considered important. Urethral strictures developed in 14.04% of the patients. The resection operations were carried out by five different surgeons, who had different rates of stricture. The only one of the 11 factors studied that was found to involve a statistically significant risk was the presence of an indwelling catheter for more than 3 days. No other factor influenced the result. This patient group was compared with a group of 73 patients followed up for 12-60 months following transvesical prostatectomy. In this group only one stricture (1.36% incidence rate) was observed retrospectively. It seems that urethral ischaemia might increase the risk of urethral stricture. Urethral injuries are considerably less frequent with open prostatectomy. Therefore, we recommend transvesical prostatectomy for pronounced prostatic hyperplasias.

Catheters, Indwelling↗

PubMed1992

[Urodynamic studies before and after gradual urethral dilatation with metal sounds for female urethral stricture].

We evaluated the urodynamics in women with urethral stricture after urethral dilatation. A total of 16 patients underwent treatment with gradual urethral dilatation at increasing intervals (2 weeks, 1 month, 3 months and 6 months). Their urethra was dilated up to 30 F. with metal sounds. Urethral calibration with bougie à boule, uroflowmetry and urethral pressure profile were performed before urethral dilatation and 1 week after the last dilatation. The urethral caliber was increased from 18.1 +/- 0.6 F. to 23.5 +/- 1.0 F. (P less than 0.005), average flow rate from 9.4 +/- 0.8 ml/sec to 11.2 +/- 1.1 ml/sec (P less than 0.025) and maximum urethral pressure with a full bladder decreased from 105.4 +/- 9.4 cmH2O to 87.5 +/- 10.5 cmH2O (P less than 0.05). With gradual urethral dilatation with metal sounds, (1) the urethra was significantly dilated, (2) maximum urethral pressure was significantly decreased and (3) average flow rate was significantly increased.

Adult↗

PubMed1991

European experience with the urethral Wallstent for urethral strictures.

We describe the use of the urethral Wallstent in 71 patients with urethral strictures. The stainless steel stent is self expanding when released from its endoscopic introducer. The results over a 3-year period have been good with only mild discomfort and slight urethral leakage for up to 3 months. Migration, infection and encrustation have not been a problem and serial endoscopic review shows healing to be variable but complete in up to 12 months. It is considered that this simple endoscopic technique offers a simple, safe and effective alternative to multiple dilatations, urethrotomies and urethroplasty procedures in patients with bulbar urethral strictures.

Equipment Design↗

PubMed2000

Balanitis xerotica obliterans with urethral stricture after hypospadias repair.

Three cases of urethral stricture due to balanitis xerotica obliterans (BXO) after hypospadias repair are reported. The first patient showed white, dense scarring on the prepuce before the hypospadias repair and developed a stricture of the urethra after the operation. The second and the third were uneventful for 6 and 2 years, respectively, after the hypospadias repair, and then developed urethral strictures. Pathologic diagnosis of the stenotic lesion is essential. Complete excision of the affected urethra with topical steroid ointment or sublesional triamcinolone injection is recommended for this condition. Although the complication of BXO after hypospadias repair is rare (3 out of 796 cases with hypospadias in our series), surgeons need to be aware of this condition as a cause for late onset of urethral problems.

Balanitis↗

PubMed2003

Urethral stricture repair with an off-the-shelf collagen matrix.

PURPOSE: In select patients with urethral strictures in whom genital skin is insufficient alternative tissues are needed for urethral reconstruction. We explored the feasibility of using a bladder submucosa collagen based inert matrix as a free graft substitute for urethral stricture repair. MATERIALS AND METHODS: A total of 28 patients 22 to 61 years old with a diagnosis of urethral stricture underwent reconstructive surgery using a collagen based inert matrix for urethral repair. The inert collagen matrix was trimmed to size as needed for each patient and the neourethra was created by anastomosing the matrix in an onlay fashion to the urethral plate with continuous 6-zero absorbable sutures. The size of the created neourethra ranged from 1.5 to 16 cm. A voiding history, physical examination, retrograde urethrography, uroflowmetry and cystoscopic examinations were performed preoperatively and postoperatively. Random urethral biopsies were also performed. RESULTS: After a 36 to 48-month followup (mean 37) 24 of the 28 patients had a successful outcome. The remaining 4 patients had a slight caliber decrease at the anastomotic sites on urethrography. A subcoronal fistula developed in 1 patient which closed spontaneously 1 year after repair. Mean maximum urine flow rate increased from the preoperative value of 9 +/- 1.29 to 19.7 +/- 3.07 ml. per second postoperatively. Cystoscopic studies revealed adequate caliber conduits and normal appearing urethral tissues. Histological examination of the biopsy specimens showed the typical urethral stratified epithelium. CONCLUSIONS: Use of an off-the-shelf collagen inert matrix appears to be beneficial for patients with urethral strictures and obviates the need for obtaining an autologous graft, thus eliminating donor site morbidity.

Adult↗

PubMed2000

The effect of halofuginone, an inhibitor of collagen type i synthesis, on urethral stricture formation: in vivo and in vitro study in a rat model.

PURPOSE: Urethral strictures are narrowing of the urethra caused by fibrosis due to excessive collagen production in response to an insult. We evaluated the effects of halofuginone, a potent inhibitor of collagen alpha1(I) gene expression, on experimentally induced urethral strictures in vivo and on rat urethral fibroblasts in vitro. MATERIALS AND METHODS: Applying coagulation current to the male rat urethra produced urethral strictures. Halofuginone was given to the animals for 7 days, starting on the day of stricture formation, either orally at 1 and 5 ppm in the diet or by injection of 0.03% halofuginone solution into the urethra. All rats were sacrificed on day 21. Collagen alpha1(I) gene expression was evaluated by in situ hybridization, collagen content by sirius red staining and urethral morphology by urethrogram. RESULTS: Coagulation current produced reproducible strictures with a typical urethrogram appearance, which were associated with increases in collagen alpha1(I) gene expression and collagen content at the stricture site. Halofuginone injected into the urethra or orally at 5 ppm normalized the urethrogram and prevented increases in collagen alpha1(I) gene expression and collagen content. Halofuginone at a concentration of 10-8 M. inhibited the collagen secreted by fibroblasts derived from the rat male urethra, which was due to inhibition of the collagen alpha1(I) gene expression. CONCLUSIONS: Halofuginone prevented stricture formation and may become an important mode of therapy in the prevention of restenosis during urethral stricture formation.

Animals↗

PubMed2005

Vasography in urethral stricture: novel application of an old technique.

Urethral stricture disease in men has traditionally been investigated with ascending and voiding cystourethrography as well as urethroscopy. The main emphasis during the preoperative assessment is on establishing the exact extent of the disease process in order to plan appropriate management. We describe a technique that represents a novel approach to the assessment of proximal urethral stricture and in selected cases would be of immense help in defining its precise nature and planning definitive treatment.

Catheterization↗

PubMed2002

[Treatment of 101 patients with traumatic urethral strictures by the method of V. Rusakov].

Urethral strictures after the pelvic bone and perineum injury are a common cause of disability in such patients. Outcomes of several methods of surgical treatment are unsatisfactory in unacceptably high percentage of the cases. This disease seems thus to be one of the most threatening problems in urological practice. Since 1978 to 2000, 101 patients with urethral traumatic strictures were treated by the method of anastomotic urethroplasty proposed by V. Rusakov, at the Urology Department of Vilnius University Hospital. Overviewed are the classification of urethral strictures by their etiology, clinical course, degree of narrowing of the urethra, localization, length and multiplicity as well as the complications. Pre-operation work-up, instruments, operation technique and post-operative care are discussed, too.

Adolescent↗

PubMed1979

Artifactual urethral stricture in male child.

Artifactual urethral obstruction at the suspensory ligament of the penis may be produced if the penis is left in its normally dependent position during a urethrogram. We present 2 such cases to re-emphasize this phenomenon so that caution is taken in interpreting distal bulbous urethral strictures.

Child↗

PubMed1989

A new stent for the treatment of urethral strictures. Preliminary report.

We describe a new urethral stent which was implanted into 12 patients with urethral strictures. The stent is woven in the form of a tubular mesh from fine stainless steel wire and is self-expanding when released from its small diameter delivery catheter. All patients have been treated successfully, with a good calibre urethra visible on urethrography and direct endoscopy and with improved urine flow rates. The mean follow-up of these patients was 7 months (range 2-13). Urethroscopy demonstrated complete epithelial covering of the implant in 4 to 6 months. Although the follow-up period was short, it seems that this simple technique may offer a lasting treatment for many urethral strictures. A longer follow-up will be necessary to exclude late complications.

Adult↗

PubMed1981

Percutaneous transvesical antegrade passage of urethral strictures.

Failure to pass a urethral stricture by retrograde instrumentation is generally accepted as excluding the possibility of closed internal urethrotomy. In 2 patients with impassable strictures percutaneous transvesical antegrade passage of a guide wire through the stricture was successful, paving the way for balloon dilatation of the stricture and visual internal urethrotomy. In view of the success rate of internal urethrotomy in treating strictures, it is recommended that this radiological method of dealing with an impassable stricture from above be used to avoid open operation and to allow internal urethrotomy to proceed. A protocol for the procedure is suggested.

Adult↗

PubMed1992

Guided dilatation of urethral strictures.

Ten patients with pinhole urethral strictures were treated by introducing a flexible guide wire endoscopically through the stricture then passing flexible hollow dilators over the wire across the stricture. The procedure was successful in 9 out of 10 patients. It inflicts minimal trauma to the urethra and is recommended as a practical substitute for optical urethrotomy where the latter is not available.

Academic Medical Centers↗

PubMed1987

Urethral strictures in boys.

While common in adult males, urethral strictures are comparatively rare in boys. We report our experience with this condition in 19 boys. Ten of the strictures were iatrogenic, seven traumatic, and three inflammatory in origin. Dilation is reportedly unsatisfactory for the management of most urethral strictures in children. In our series, however, 9 patients (47.3%) underwent urethral dilation as the only definitive form of treatment, while urethroplasty was successfully performed in the other 10 cases.

Child↗

PubMed1991

Spongiosography: a valuable adjunct to the diagnosis of urethral strictures.

To obtain better information on fibrotic tissue damage in urethral strictures we performed spongiosography, that is opacification of the spongy body by injection of contrast medium, in 32 patients in whom the diagnosis had already been established by uroflowmetry, urethrography and urethroscopy. Another 18 patients with erectile dysfunction served as the control group. The investigation was well tolerated by all patients and no side effects or complications were encountered. Attenuation or even interruption of the contrast medium within the corpus spongiosum on spongiosography clearly revealed the fibrosis in urethral strictures. The extent of scarring was completely independent of the clinical symptoms and urethrographic findings. Accordingly, our decision on the appropriate surgical treatment was based mainly on the results of spongiosography. If used as an additional routine investigation in cases of urethral stricture spongiosography may help to decrease the recurrence rate in the future.

Adult↗

PubMed2007

Adult anterior urethral strictures: a national practice patterns survey of board certified urologists in the United States.

PURPOSE: We determined the methods and patterns of the evaluation of and treatment for adult anterior urethral stricture disease by practicing urologists in the United States. MATERIALS AND METHODS: A nationwide survey of practicing members of the American Urological Association was performed by a mailed questionnaire. A total of 1,262 urologists were randomly selected from all 50 states, of whom 431 (34%) completed the questionnaire. RESULTS: Most urologists (63%) treat 6 to 20 urethral strictures yearly. The most common procedures used by those surveyed for urethral strictures were dilation (92.8%), optical internal urethrotomy (85.6%) and endourethral stent (23.4%). Minimally invasive procedures are used more frequently that any open urethroplasty technique. Furthermore, most urologists (57.8%) do not perform urethroplasty surgery. When used, the most common urethroplasty surgeries performed were end-to-end anastomotic urethroplasty, perineal urethrostomy and ventral skin graft urethroplasty. Few urologists (4.2%) performed buccal mucosa grafts. For a long bulbar urethral stricture or short bulbar urethral stricture refractory to internal urethrotomy 20% to 29% of respondents would refer to another urologist, while 31% to 33% would continue to manage the stricture by minimally invasive means despite predictable failure. Of the urologists 74% believed that the literature supports a reconstructive surgical ladder, in which urethroplasty is only performed after repeat failure of endoscopic methods. CONCLUSIONS: Most urologists in the United States have little experience with urethroplasty surgery. Most urologists erroneously believe that the literature supports a reconstructive surgical ladder for urethral stricture management. Unfamiliarity with the literature and inexperience with urethroplasty surgery have made the use of endoscopic methods inappropriately common.

Adult↗

PubMedDate not supplied

[Buried suture of the bladder in the surgical treatment of urethral stricture].

Surgical treatment for posttraumatic urethral stricture was carried out in 316 patients: tunneling in 42, Marion-Khol'tsov [correction of Kholtrov] operation with circular drainage in 185, tight suture of the bladder with transurethral drain using double-opening tube in 86 cases. Complications emerged in 28 patients. The best short- and long-term outcomes were obtained in the group subjected to tight suturing.

Drainage↗