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Results for “Urethral Stricture”

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At least 127 records · Page 7Linked to original sources

PubMed2004

1-stage urethral reconstruction using colonic mucosa graft for the treatment of a long complex urethral stricture.

PURPOSE: We investigated the possibility of urethroplasty with a free graft of colonic mucosa for long, complex urethral strictures. We report our initial experience with colonic mucosa graft urethroplasty for such urethral strictures in 16 patients. MATERIALS AND METHODS: Between September 2000 and December 2002, 16 patients with a long, complex urethral stricture were treated with colonic mucosal graft urethroplasty. Patients had undergone an average of 2.5 previous unsuccessful repairs. Urethral reconstruction was done with a 10 to 17 cm (median 13) graft of colonic mucosa RESULTS: Patients were followed 6 to 33 months postoperatively. Meatal stenosis that developed in 1 patient 3 months postoperatively needed reoperation. The patient was voiding well with a urinary peak flow of 28.7 ml per second during 9-month followup after reoperation. Hyperplasia of the verumontanum was observed during urethroscopy and transurethral colliculectomy was performed in 1 patient more than 14 months postoperatively. Uroflowmetry showed a urinary peak flow of 46.5 ml per second postoperatively. The other patients were voiding well with a urinary peak flow of greater than 15 ml per second. Urethrogram revealed a patent urethra with an adequate lumen and no significant graft sacculation. CONCLUSIONS: This initial experience in 16 patients indicates that colonic mucosa graft urethroplasty is a feasible procedure for long, complex anterior urethral strictures. The technique may be considered for urethral reconstruction when more conventional procedures have failed.

Adolescent↗

PubMed1984

Neodymium: YAG laser treatment of benign urethral strictures.

A total of 17 patients with benign urethral strictures underwent treatment with circumferential application of neodymium: YAG laser irradiation to the strictured area. Foley catheter drainage was used postoperatively in only 2 patients and no treatment complications were observed. Although early postoperative results were good 11 patients (64 per cent) suffered recurrent stricture within 6 months of treatment. With the method described, neodymium: YAG laser phototherapy of urethral strictures appears to offer no treatment advantages over conventional therapy and is associated with a high recurrence rate.

Adult↗

PubMed2001

980-nm diode laser treatment for recurrent urethral strictures.

OBJECTIVES: Our experience with laser treatment of urethral strictures with a 980-nm diode laser is reported. METHODS: 45 consecutive patients with relapsing urethral strictures (mean age 65, range 25-85 years) were treated between February 1995 and February 1998. The fibrous and scar tissue was cut and vaporized at the 6 o'clock position with the laser beam. RESULTS: 44/45 patients were available for follow-up at 1 year and 32/43 at 2 years. At 12 months the average peak flow rates of the patients was 18 ml/s, and at the second year assessment it was 15.5 ml/s. Of the patients 21/44 (47.7%) were extremely satisfied (0-1 of the quality-of-life, QoL, assessment index) with the procedure, 14/44 (31.8%) were satisfied (2 of the QoL assessment index), and 9/44 (20.4%) were not satisfied (> or = 3 of the QoL assessment index) due to the low flow rate or the recurrence of the stricture. (The sum of the first two categories is 79.5%.) At the second year assessment the percentage of satisfied patients reached 78%, with 71% of the patients stable without any dilatation. CONCLUSIONS: Usually in recurrent strictures of the urethra open surgery is suggested, but we believe that there is still a place for endoscopy. With the laser we can make an incision at the 6 o'clock position without significant bleeding, very easily opening the urethra. We had 79.5 and 71% good results at the 1- and 2-year assessments (mean peak flow rate of 18 and 15.5 ml/min), respectively. To date, no definitive conclusions can be drawn, but we believe that laser treatment is indicated for recurrent strictures in high risk or elderly patients and in those who demand a minimally invasive procedure.

Adult↗

PubMedDate not supplied

[Internal urethrotomy, a modern method in the treatment of urethral strictures].

The aim of this study was to evaluate the internal urethrotomy in the treatment of urethral strictures, by the retrospective analysis of 54 cases. The patients' age ranged between 18-92. 35 patients (64.8%) had iatrogenic strictures and 10 (18.5%) had traumatic ones. 35 patients presented with urinary infections before the procedure. Following internal urethrotomy, the medium hospital stay was 3.15 days. There were only 7 patients with postoperative fever and no death was recorded. The follow-up period was between 1-12 months with a medium of 9 months and only 2 patients required recurrent internal urethrotomy. Out of the 54 patients, 8 had recurrent urethral stricture disease and 6 of them had posttraumatic membranous urethral strictures. Optical internal urethrotomy appears to be the ideal therapeutic method of urethral strictures, because it has a low morbidity, it is safe to perform and the postoperative results are good. The hospitalization and the recovery periods are short, allowing a quick socio-professional reintegration. Most of the recurrencies occur with posttraumatic strictures.

Adolescent↗

PubMed2006

Magnetic resonance urethrography in comparison to retrograde urethrography in diagnosis of male urethral strictures: is it clinically relevant?

OBJECTIVE: To compare the clinical relevance of retrograde urethrography (RUG) and magnetic resonance (MR) urethrography in evaluating male urethral strictures. METHODS: Between January and April 2004, 20 men were referred to our institute for management of urethral strictures. The patients were investigated by conventional RUG and multiformat MR urethrography. The patients were examined by urethroscopy under anesthesia to be followed by definitive endoscopic or open operative intervention. The radiologic data were compared by endoscopic as well as operative findings in all the patients. RESULTS: Ten patients were managed by visual internal urethrotomy (VIU) and two by dilatation under anesthesia; two showed normal urethral caliber. Four patients required open urethral reconstructive procedures. Two patients underwent radical cystectomy and cutaneous diversion because of associated bladder or urethral malignancy. Although overall accuracy for diagnosis of urethral strictures was equal between both modalities (85%), MR urethrography provided extra clinical data in seven patients (35%). It was superior to RUG in judging the urethral stricture length in three patients, diagnosing a urethral tumor in one, detecting associated bladder mass in one, characterizing the site of urethra-rectal fistula in one, and accurately delineating the proximal urethra in the last patient. Unlike RUG, MR urethrography provided adequate information about the degree of spongiofibrosis in all patients. CONCLUSION: MR urethrography is a promising tool for defining male urethral strictures and can provide extra guidance for treatment planning that cannot be obtained with RUG.

Adolescent↗

PubMed1994

Prevention of urethral stricture recurrence using clean intermittent self-catheterization.

OBJECTIVE: To investigate the effect of clean intermittent catheterization (CIC) on prevention of urethral stricture recurrence after internal urethrotomy. PATIENTS AND METHODS: Of 55 men who were randomly selected, 43 completed the investigation. Of these, 21 patients performed CIC weekly for 1 year following Sachse's operation for urethral stricture and 22 patients formed the control group after the same operation. All had an objective examination for urethral stricture every 2 months after surgery. RESULTS: Significantly fewer (P < 0.01) patients developed recurrence of urethral stricture within the first postoperative year in the CIC group (n = 4) compared with the control group (n = 15). No CIC complications were seen, and patients who completed the CIC programme considered the method fully acceptable. CONCLUSION: Weekly CIC is a simple method of reducing the frequency of urethral stricture recurrence after internal urethrotomy.

Adolescent↗

PubMed1996

Internal urethrotomy in the management of anterior urethral strictures: long-term followup.

PURPOSE: We evaluated the long-term results of internal urethrotomy for anterior urethral strictures. MATERIALS AND METHODS: Between 1975 and 1990, 224 patients underwent internal urethrotomy for anterior urethral strictures. Median followup was 98 months (range 60 to 216). RESULTS: The recurrence rate after 1 urethrotomy was 68% overall, and 58% for bulbar, 84% for penile and 89% for penile bulbar urethral strictures. Repeated urethrotomies did not improve the success rate. Prognostic characteristics of bulbar urethral strictures associated with good results included single or primary strictures, length shorter than 10 mm. and caliber wider than 15F. Preoperative infection and etiology of the strictures did not correlate with results. Multiple urethrotomies achieve only temporary improvement and can be compared to repeated dilations. CONCLUSIONS: Alternative treatments should be considered for penile strictures and after failure of initial urethrotomy.

Adolescent↗

PubMed1991

Temporarily implanted urethral coil stent for the treatment of recurrent urethral strictures: a preliminary report.

A new urethral stent developed for use in recurrent urethral strictures is presented. This metallic coil is self-expanding when released from its introducing catheter. The stent was used in 18 patients with recurrent strictures necessitating frequent dilation or urethrotomy. The stent is introduced under fluoroscopic guidance after internal urethrotomy or simple dilation. Strictures of 5 to 60 mm. were treated successfully with this device. All strictures were distal to the external sphincter. No serious complications attributed to the device were recorded. When necessary, the stent could be repositioned either under fluoroscopic control or endoscopically. This device can hold the stenotic area of the urethra open for long intervals allowing for complete healing. Even after 6 months the stent is not covered with urethral epithelium and does not become incorporated into the urethral wall. It can be removed easily without an operation by simple manipulation. The large internal caliber permits passage of endoscopes up to 17F in patients who require cystoscopy. The device can be removed before transurethral resections and then a new stent can be inserted at the end of the procedure. Mean followup of our patients with the stent indwelling was 8 months (range 4 to 11 months). Followup after removal of the stent (6 patients) was 3 to 8 months (mean 5 months). The patients voided well during followup and were fully continent. No incrustations were noted in the removed stents even after 6 months and no stent became obstructed due to tissue proliferation or incrustation. In 1 patient the stricture recurred after 3 months and a new stent was inserted. Urine sterilization was obtained in 7 patients with infected urine after relatively short courses of antibiotics. This stent seems to be a promising tool for the nonoperative treatment of recurrent urethral strictures.

Humans↗

PubMed2006

[The treatment of complex urethral stricture greater than 8 cm long].

OBJECTIVE: To evaluate the selection of different procedures and the feasibility for the treatment of long segment urethral stricture. METHODS: Seventy-six patients with complex urethral stricture greater than 8 cm long underwent different procedures of urethroplasty. Of them various mucosa grafts urethral reconstruction were adopted in 42 cases (colonic mucosal graft, n = 26; buccal mucosal graft, n = 10; bladder mucosal graft, n = 6); One-stage pedicle flaps urethroplasty in 20; two-stage urethroplasty of Johanson procedure in 12; and penile urethra-prostatic urethra anastomosis, three-stage urethroplasty in 2. RESULTS: In early followed up (within 6 months postoperatively), 67 patients (88%) voided well and complications developed in 10. Among the 70 patients who lasted more than 1 year after operation, 51 cases were followed up. Forty-four patients voided well, and complications developed in 8. Of the 8 cases urethral restructure developed in 2 (18%) for pedicle flaps urethroplasty, 2 for colonic mucosal urethroplasty (9%), 1 for buccal mucosal graft (1/7), 1 for bladder mucosal graft (1/3); penile chordee in 2 (2/5), and one of them was accompanied by hair bearing neourethra for two-stage urethroplasty of Johanson procedure. CONCLUSIONS: Colonic mucosal and buccal mucosal grafts urethroplasty are feasible procedures for the treatment of long segment urethral stricture, and Colonic mucosal graft urethroplasty may be considered when more conventional procedures fail or complicated urethral strictures greater than 10 cm long.

Adolescent↗

PubMedDate not supplied

[Use of biodegradable stents in treating complex urethral strictures].

Seven men with complex urethral strictures after examination using three-dimentional and echocontrast sonourethrography were subjected to transurethral laser vaporation of the scar tissue in the region of the narrowing, implantation of the biodegradable urethral SR PLGA stents at contra cystourethroscopy. Internal drainage of the urinary bladder with the use of SR-PLGA stents provides protection against exogenous infection and complications of epicystostomic or urethral cathetarization. High informative value, low invasiveness and relative safety of sonourethrography allows one to revise the role of ultrasound investigation in the algorithm of diagnosis and choice of treatment for patients with strictures and obliterations of the urethra.

Adolescent↗

PubMed2002

Urethroplasty for refractory anterior urethral stricture.

PURPOSE: We present our results managing anterior urethral strictures previously treated with urethroplasty and/or urethrotomy. MATERIALS AND METHODS: During a 32-month period 69 males 10 to 76 years old (mean age 36) underwent treatment for anterior urethral stricture, including 32 (46%) and 26 (38%) previously treated with urethroplasty and urethrotomy, respectively. In 11 patients (16%) no previous procedures had been done. Anastomotic and dorsal patch urethroplasty was performed for bulbar stricture in 13 and 14 cases, respectively, while in 4 a penile skin flap was placed for penile stricture and in 38 a 2-stage procedure was done with urethral substitution using buccal mucosa or post-auricular skin grafts. Patients were followed with ascending urethrography at 3 weeks, and 12 and 18 months as well as with uroflowmetry. Symptoms were assessed for 6 months to 4 years. RESULTS: Only 1 stricture recurred in patients treated with anastomotic or patch urethroplasty, or a skin flap. Of the patients scheduled for a 2-stage procedure stage 1 revision was required due to graft scarring or stenosis at the urethrostomy site in 21% and stage 2 revision was required in 23%. Other complications in this series included fistula in 3% of cases, wound infection in 3% and post-void dribbling in 12%. CONCLUSIONS: Overall early results are good in our urethroplasty series in patients with a previously instrumented urethra. Patients should be advised of the possible need for multiple revisions of planned staged procedures. The increased rate of revision in these staged procedures compared with the excellent outcome of 1-stage procedures appears to be inherent in this operation in patients with multiple previous procedures rather than due to surgeon experience.

Adolescent↗

PubMed1981

Endoscopic internal urethrotomy for treatment of urethral strictures: midterm survey.

Success in the management of urethral strictures can be claimed only after many years, patients sometimes faring well for ten years or more before suffering a recurrence. We used endoscopic urethrotomy as primary treatment for a variety of urethral strictures in 123 patients. Follow-up is over two years for 63 patients and more than five years for 18. Over-all success rate at five years was 76 per cent. Failures are twice as frequent in strictures, regardless of their origin, involving the anterior urethra than in the bulbar or posterior urethra. Two-thirds occurred in the first year of follow-up, but, as in other techniques, recurrence can occur after four years.

Adolescent↗

PubMed2004

Ventral onlay buccal mucosal grafts for anterior urethral strictures: long-term followup.

PURPOSE: We present our long-term experience with buccal mucosal grafts, placed ventrally, for the treatment of anterior urethral strictures. MATERIALS AND METHODS: A total of 23 patients with anterior urethral strictures underwent urethral reconstruction using buccal mucosa as a ventral onlay graft, with 18 grafts placed in the bulbar and 5 in the penile urethra. All operations were performed in 1 stage by a single surgeon (NAA). Mean graft length was 4.9 cm (range 3 to 12). International Prostate Symptom Score and uroflowmetry were obtained preoperatively, at 3, 6 and 12 months postoperatively, and annually thereafter. Urethral imaging was obtained preoperatively, at catheter removal and selectively thereafter. RESULTS: Patients were followed for a mean of 50 months (range 17 to 94). Etiology of the strictures was instrumentation (in 9), idiopathic (in 9), prior hypospadias repair (in 2), urethritis (in 2) and trauma (in 1). Of the 23 patients 21 (91%) were previously treated for urethral stricture with a total of 59 procedures (mean 2.8 procedures per patient). Success, defined as normal voiding without any need for subsequent urethral manipulation, was achieved in 20 of 23 patients (87%). A distal anastomotic stricture developed in the remaining 3 patients, each managed with 1 internal urethrotomy. One of these patients continues to require monthly self-dilations. There were no fistulas or clinically perceptible graft sacculations. CONCLUSIONS: With long-term followup our series confirms the durability of ventrally placed buccal mucosal grafts for the treatment of anterior urethral strictures. This proven procedure results in a high success rate with few complications.

Adult↗

PubMed1998

Applications of the KTP laser in the treatment of posterior urethral valves, ureteroceles, and urethral strictures in the pediatric patient.

PURPOSE: We describes our experience using the potassium titanyl phosphate (KTP)-532 laser in treating posterior urethral valves, ureteroceles, and urethral strictures in the pediatric patient. METHODS: A retrospective chart review was performed from 1987 to 1997 on a total of 33 pediatric patients who underwent retrograde endoscopic treatment for posterior urethral valves (PUV), ureteroceles (UC), and urethral strictures using a KTP-532 laser. RESULTS: Overall, our success rate was excellent in the treatment of valves and ureteroceles. With a mean follow-up of three years in the PUV group, no urethral strictures of micturation abnormalities were seen. The majority of ureteroceles were decompressed and only half of our patients required and additional procedure. Our experience with urethral strictures, however, was not as promising. All of these patients ultimately required open urethral reconstruction. CONCLUSION: The desirable thermal characteristics of the KTP laser, along with minimal complications and the availability of delicate pediatric endoscopic instruments have made this operation optimally suited for treating posterior urethral valves and ureteroceles in infants. However, the advantages for treating urethral strictures in children with the laser still remains to be established.

Adolescent↗

PubMed2005

Perineal anastomotic urethroplasty for managing post-traumatic urethral strictures in children: the long-term outcome.

OBJECTIVE: To evaluate the long-term results of one-stage perineal anastomotic urethroplasty for post-traumatic paediatric urethral strictures. PATIENTS AND METHODS: Thirty-five boys who had a perineal anastomotic urethroplasty for post-traumatic bulbous or posterior urethral strictures between 1991 and 2003 were analysed retrospectively. Patients were followed up for a mean (range) of 46 (6-132) months by a history, urinary flow rate estimate, retrograde urethrography and voiding cysto-urethrography. RESULTS: The mean (range) age of the patients was 11.9 (6-18) years. The estimated radiographic stricture length before surgery was 2.6 (1-5) cm. The perineal anastomotic repair was successful in 31 of 35 (89%) patients. All treatment failures were at the anastomosis and were within the first year. Failed repairs were successfully managed endoscopically in two patients and by repeat perineal anastomotic repair in the remaining two, giving a final success rate of 100%. All boys are continent except two who had early stress incontinence, and that resolved with time. There was no chordee, penile shortening or urethral diverticula during the follow-up. CONCLUSIONS: The overall success of a one-stage perineal anastomotic repair of post-traumatic urethral strictures in boys is excellent, with minimal morbidity. Substitution urethroplasty or abdomino-perineal repair should be reserved for the occasional patients with concomitant anterior urethral stricture disease or a complex posterior urethral stricture, respectively.

Accidents, Traffic↗

PubMed1994

Ultrasound in the evaluation of urethral stricture disease: a prospective study in 175 patients.

OBJECTIVE: To investigate the characteristic ultrasonic appearance of urethral stricture disease in men. PATIENTS AND METHODS: Between 1990 and 1992 a prospective study in 175 men with the suspicion of urethral stricture was performed using urethral ultrasound as the first diagnostic procedure, followed by retrograde urethrography, voiding cystourethrography or urethroscopy. RESULTS: The sensitivity and specificity in detecting urethral strictures were 98% and 96% respectively. Ultrasound offers a three-dimensional study in the evaluation of the urethra without exposing the gonads to ionizing radiation. The exact length and depth of the stricture, the severity of the strictured segment as well as the anatomy of the periurethral scars were diagnosed accurately. CONCLUSION: Ultrasound is a simple, inexpensive and rapid investigation of the urethra which requires no exposure of the patient to ionizing radiation and should be the preferred diagnostic procedure in the evaluation of strictures in the anterior urethra in men.

Humans↗

PubMed2006

Long-term followup of visual internal urethrotomy for management of short (less than 1 cm) penile urethral strictures following hypospadias repair.

PURPOSE: We reviewed the results of direct vision urethrotomy for short (less than 1 cm) penile urethral strictures following hypospadias surgery. MATERIALS AND METHODS: Patients with less than 1 cm anterior penile urethral strictures located proximal to the meatus underwent direct vision urethrotomy. Based on the type of initial urethroplasty patients were randomly divided into treatment with direct vision urethrotomy vs direct vision urethrotomy plus clean intermittent catheterization for 3 months. Success was defined as absent obstructive voiding symptoms and a normal urine flow 2 years following the last patient instrumentation. RESULTS: Of patients with urethral strictures following hypospadias repair 44% (32) had previously undergone tubularized graft urethroplasty and 56% (40) had previously undergone flap urethroplasty, including a tubularized island flap in 18, an onlay flap in 11 and urethral plate urethroplasty in 11. Direct vision urethrotomy alone was performed in 51% of patients (37), and direct vision urethrotomy and clean intermittent catheterization were performed in 49% (35). Success with the 2 methods was similar, that is 24% (9 of 37 patients) vs 22% (8 of 35). Following direct vision urethrotomy all patients with tubularized graft urethroplasty showed failure (0 of 32). Success was noted in 11% of patients (2 of 18) with tubularized island flap urethroplasty compared to 72% (8 of 11) with onlay urethroplasty and 63% (7 of 11) with urethral plate urethroplasty (each p <0.05). CONCLUSIONS: The addition of clean intermittent catheterization to direct vision urethrotomy does not improve the likelihood of success. Direct vision urethrotomy for short (less than 1 cm) urethral stricture usually fails following any type of tubularized graft or flap urethroplasty but it had moderate success following onlay flap and urethral plate urethroplasties.

Follow-Up Studies↗

PubMed2003

The use of halofuginone in limiting urethral stricture formation and recurrence: an experimental study in rabbits.

PURPOSE: We developed a reproducible animal model for the induction of urethral stricture in the rabbit and evaluated the role of halofuginone in limiting stricture formation. MATERIALS AND METHODS: A total of 20 New Zealand male rabbits were used in the first phase of the experiment. Bulbar urethral stricture was induced by electrocoagulation. The animals were then randomly assigned to 2 groups of 10 each, which received a diet containing halofuginone or a normal diet. In the second phase electrocoagulation induced stricture was treated with visual internal urethrotomy in 45 rabbits. These rabbits were randomly assigned to 2 groups, namely a halofuginone and a control group. RESULTS: In the first phase stricture developed in 2 study rabbits (20%) vs 10 controls (100%). In the second phase 37 rabbits were evaluable (8 died). Recurrent stricture was observed in 5 of the 18 study rabbits (27%) vs 14 of the 19 controls (73%). CONCLUSIONS: Halofuginone is effective in limiting the occurrence of de novo urethral stricture and recurrent stricture after visual internal urethrotomy. This antifibrotic molecule may become an important therapy to treat urethral stricture and/or recurrence following endoscopic manipulation of stricture in humans.

Administration, Oral↗