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Results for “Urethral Stricture”

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At least 145 records · Page 8Linked to original sources

PubMed2003

Guide wire-assisted urethral dilatation for urethral strictures in pediatric urology.

PURPOSE: The aim of this study was to report the results of 32 cases of dilatation of urethral stricture using a guide wire and sheath dilator technique supplemented by clean intermittent catheterization if further stabilization of the urethral stricture was felt warranted. METHODS: The procedure involves insertion of a straight flexi-tip lubricated guide wire through the urethral stricture under cystoscopic guidance followed by insertion of a series of sheath dilators. Dilatation was followed by insertion of a Foley catheter, which was left in situ for 1 to 3 days. Patients underwent repeat cystoscopy to evaluate the urethra for recurrent stricture and those with a recalcitrant stricture were commenced on clean intermittent catheterization (CIC) to stabilize the narrowing. RESULTS: Thirty-two patients were included. They have been followed up for up to 2(1/2) years after their last cystoscopy (mean, 16 months). Thirteen of 32 patients had more than 4 dilatations under anesthesia. Twelve patients had undergone CIC postoperatively. Complications included a urinary tract infection in 3 boys and bladder spasms in one. No false passage or sepsis occurred with this approach. CONCLUSIONS: Guide wire-assisted urethral dilatation helps avoid risks associated with blind dilatation techniques and appears to be a safe and simple alternative for management of urethral strictures in pediatric urology.

Adolescent↗

PubMed1992

[Pedicled penis skin flap for unilateral correction of extensive urethral strictures including meatus reconstruction].

Many techniques have been described for the repair of recurrent urethral strictures. We report our experience with the use of vascularized island skin flap repairs of urethral strictures as a one-stage procedure in 24 patients and describe the rationale for selection of the procedure, surgical technique used, results and complications. Using the pedicled penile island flap and the inner preputial skin one-stage correction is possible in urethral strictures up to the tip of the penis. The combined use of scrotal skin increases the risk of complications and thus should be avoided. Meatal reconstruction as described by De Sy gives excellent functional and cosmetic results.

Adolescent↗

PubMed2004

Repeat urethrotomy and dilation for the treatment of urethral stricture are neither clinically effective nor cost-effective.

PURPOSE: We developed an algorithm for the management of urethral stricture based on cost-effectiveness. MATERIALS AND METHODS: United Kingdom medical and hospital costs associated with the current management of urethral stricture were calculated using private medical insurance schedules of reimbursement and clean intermittent self-catheterization supply costs. These costs were applied to 126 new patients treated endoscopically for urethral stricture in a general urological setting between January 1, 1991 and December 31, 1999. Treatment failure was defined as recurrent symptomatic stricture requiring further operative intervention following initial intervention. Mean followup available was 25 months (range 1 to 132). RESULTS: The costs were urethrotomy/urethral dilation 2,250.00 pounds sterling (3,375.00 dollars, ratio 1.00), simple 1-stage urethroplasty 5,015.00 pounds sterling (7,522.50 dollars, ratio 2.23), complex 1-stage urethroplasty 5,335.00 pounds sterling (8,002.50 dollars, ratio 2.37) and 2-stage urethroplasty 10,370 pounds sterling (15,555.00 dollars, ratio 4.61). Of the 126 patients assessed 60 (47.6%) required more than 1 endoscopic retreatments (mean 3.13 each), 50 performed biweekly clean intermittent self-catheterization and 7 underwent urethroplasty during followup. The total cost per patient for all 126 patients for stricture treatment during followup was 6,113 pounds sterling (9,170 dollars). This cost was calculated by multiplying procedure cost by the number of procedures performed. A strategy of urethrotomy or urethral dilation as first line treatment, followed by urethroplasty for recurrence yielded a total cost per patient of 5,866 pounds sterling (8,799 dollars). CONCLUSIONS: A strategy of initial urethrotomy or urethral dilation followed by urethroplasty in patients with recurrent stricture proves to be the most cost-effective strategy. This financially based strategy concurs with evidence based best practice for urethral stricture management.

Adolescent↗

PubMed1995

A simple nonmetal stent for treatment of urethral strictures: a preliminary report.

PURPOSE: A polyurethane temporary stent has been designed for urethral strictures in patients who are unfit or unwilling to undergo surgery. MATERIALS AND METHODS: The stent resembles a Malecot catheter and is inserted easily through the urethrotome sheath immediately after urethrotomy. The stent was used in 22 patients with recurrent urethral strictures and was left in the urethra for 3 to 24 months. RESULTS: Mean followup was 11.2 months. All patients were treated successfully and had improved urine flow rates (maximum 15 to 21 ml. per second). In no patient was the stent obstructed by incrustation for up to 2 years. CONCLUSIONS: This simple stent may offer effective treatment for many urethral strictures.

Adult↗

PubMed1980

[Our experience in the treatment of urethral strictures].

114 patients were treated for urethral strictures. 54% of the strictures were of infectious origin and 46% of traumatic origin. Of the urethral plastic procedures the methods according to Turner-Warwick and Johanson have been the best. 10 of 14 operations according to the method of Turner-Warwick had good results. All 5 operations according to the method of Johanson showed good results. The best results however, were found following internal urethrotomy according to the method of Sachse. 80 patients were treated by this method and 35 were followed for more than one year. 71% had good results and an additional 26% had good results following a second procedure. We prefer the internal urethrotomy under direct vision and only when this fails we consider the open plastic procedures.

Follow-Up Studies↗

PubMed1999

Buccal mucosa urethroplasty for the treatment of bulbar urethral strictures.

PURPOSE: We report the results of urethroplasty with a free graft of buccal mucosa as a dorsal onlay for the treatment of bulbar urethral strictures. MATERIALS AND METHODS: Since June 1994, 30 patients with bulbar urethral strictures have been treated with buccal mucosa urethroplasty. Urethroplasty was performed with a free graft of buccal mucosa using a ventral onlay in the first 7 patients and a dorsal onlay in 23. Dorsal urethrotomy was performed with a Sachse urethrotome after the bulbar urethra was separated from the corpora. The buccal mucosa onlay was sutured to the urethra and corpora cavernosa to ensure a patent urethra. RESULTS: At 20-month followup (range 3 to 50) the success rate was 96% (29 of 30 patients). Urethral stricture recurred in only 1 of 7 patients in the ventral onlay and none of 23 in the dorsal onlay group. CONCLUSIONS: Preliminary results of urethroplasty for bulbar urethral strictures with a dorsal onlay graft of buccal mucosa are excellent. Longer followup is needed to evaluate definitive results.

Adolescent↗

PubMed1997

Posttraumatic posterior urethral strictures in children: a 20-year experience.

PURPOSE: We attempted to identify the particular features of strictures complicating pelvic fracture urethral injuries in children. MATERIALS AND METHODS: A total of 68 boys 3 to 15 years old who had sustained pelvic fracture urethral disruption underwent 78 urethroplasties performed by bulboprostatic anastomosis through the perineum in 42, transpubically in 23 and by 2-stage urethroscrotal inlay in 13. RESULTS: Perineal and transurethral urethroplasty was successful in 93 and 91% of cases respectively. There was a 54% failure rate after urethroscrotal inlay. CONCLUSIONS: Urethral strictures were most commonly associated with Malgaigne's fracture (35% of cases) and straddle fracture with or without diastasis of the sacroiliac joint (26%). Strictures were almost invariably inferior to the verumontanum with prostatic displacement in 44% of cases. Length of the strictured segment may be overestimated or underestimated on urethrography as a result of incomplete filling of the prostatic urethra or a urinoma cavity connected with the proximal segment, respectively. Perineal or transpubic bulboprostatic anastomosis is the best treatment for posttraumatic strictures, while internal urethrotomy should be avoided since it may compromise the chance of subsequent anastomotic urethroplasty. Repair of associated bladder neck incompetence may be deferred until the resumption of urethral voiding after urethroplasty, when incontinence can be documented.

Adolescent↗

PubMed2001

The use of the diode laser for treating urethral strictures.

OBJECTIVE: To evaluate the efficacy of the diode laser as a new tool for treating urethral strictures. Patients and methods The study comprised 22 patients with urethral strictures; a diode laser was used to circumferentially ablate the scar tissue of the strictures. Through a cystoscope, a 400-600 micrometer semirigid fibre was used to transmit the laser energy in the direct-contact mode. The procedure was carried out with the patient under general or spinal anaesthesia, but the last three patients successfully tolerated local anaesthesia. A catheter was then left in place for 1-5 days. RESULTS: The patients were followed for a mean (range) of 26.7 (9-39) months; in the 14 with previously untreated strictures the procedure was successful in 11, with no recurrence during the follow-up. However, seven of the eight patients with a recurrent stricture after previous internal cold-knife urethrotomy had a further recurrence, but occurring at longer intervals than after the internal urethrotomy. Conclusion This experience with the diode laser for treating urethral strictures suggests that it is safe and reliable, especially as the first line of treatment.

Adolescent↗

PubMed1997

[Treatment of posterior urethral break caused by pelvic fracture and inflammatory urethral stricture via laying three silicone tubers into urethra].

We investigated a new approach for the treatment of posterior urethral break caused by pelvic fracture and inflammatory urethral stricture. 7-10 days after the operation of urethral realignment on patients with urethral break caused by pelvic fracture or after forced dilatation of inflammatory urethral stricture, three silicone tubers were laid into urethra and kept there for three months. In 66 cases of urethral break, the cure rate (58/66) was 87.9%, the improving rate (2/66) 3.0% and the failure rate (6/66) 9.1%. In 15 cases of inflammatory urethral stricture, the recovery rate was 100%. In this group of 81 cases, the cure rate was 92.6% and failure rate was only 7.4%. This new therapeutic approach proved to be simple, safe and effective. It could also dramatically reduce the infection or the stricture of urethra.

Adolescent↗

PubMed2006

Staged pendulous-prostatic anastomotic urethroplasty followed by reconstruction of the anterior urethra: an effective treatment for long-segment bulbar and membranous urethral stricture.

OBJECTIVES: To describe a novel surgical technique for male long-segment urethral stricture after pelvic trauma using the intact and pedicled pendulous urethra to replace the bulbar and membranous urethra, followed by reconstruction of the anterior urethra. METHODS: Two patients with long-segment post-traumatic bulbar and membranous urethral strictures with short left pendulous urethras who had undergone several failed previous surgeries were treated with staged pendulous-prostatic anastomotic urethroplasty followed by reconstruction of the anterior urethra. This procedure was divided into three stages. First-stage surgery was mobilization of the anterior urethra down to the coronary sulcus and then rerouted to the prostatic urethra followed by pendulous-prostatic anastomotic urethroplasty with transposition of the penis to the perineum. Second-stage surgery was transecting the anterior urethra at the revascularised coronary sulcus 6 mo later, followed by straightening of the penis and urethroperineostomy. Third-stage surgery was reconstruction of the anterior urethra 6 mo later. RESULTS: Postoperatively, the two patients reported satisfactory voiding. For patient 1, retrograde urethrography showed that the urethra was patent, and that the mean maximal flow rate (MFR) was 18.4 ml/s with no postvoiding residual urine after the third-stage surgery and at 3-yr follow-up. For patient 2, a 22F urethral catheter could pass smoothly through the urethra, and the MFR was 19.5 ml/s with no postvoiding residual urine at 2-yr follow-up. CONCLUSIONS: This procedure was an effective surgical option for men with complex long-segment post-traumatic bulbar and membranous urethral strictures, especially for those who had undergone failed previous surgical treatments.

Adult↗

PubMed2002

Extracellular matrix changes in urethral stricture disease.

PURPOSE: Glycosaminoglycans (GAGs) and collagen are major components of the extracellular matrix and they have key roles in fibrotic diseases. Little is known about the molecular environment in urethral stricture and the majority of the studies available focused on collagen analysis. However, to our knowledge there are no data on GAG composition in urethral stricture disease. MATERIALS AND METHODS: Bulbar urethral strictured segments were obtained from 10 patients 18 to 61 years old (mean age 41.8) who underwent end-to-end anastomotic urethroplasty. GAGs in dry tissue samples were extracted by papain digestion and cetylpyridinium chloride/ethanol precipitation. The concentration of total GAGs was assessed by hexuronic acid assay and expressed in microg. hexuronic acid per mg. dry tissue, while the proportion of sulfated GAGs was determined by agarose gel electrophoresis. The concentration of hyaluronic acid was determined by ion exchange chromatography and total tissue collagen was estimated as its hydroxyproline content. The control group consisted of 10 bulbar urethras obtained from fresh normal cadavers 22 to 53 years old (mean age 32.8). RESULTS: Mean total GAG concentration plus or minus standard deviation in the stricture group was 1.09 +/- 0.13, which was significantly lower than in controls (p <0.05). While the predominant GAG in normal bulbar urethras was hyaluronic acid, dermatan sulfate predominated in strictured urethras (mean 44.1% +/- 8.4 and 45.6% +/- 7.7%, respectively). Hyaluronic acid decreased 49.9% and dermatan sulfate increased 68.3%. There were no significant changes in the concentration of heparan sulfate or chondroitin sulfate in normal and strictured bulbar urethras. Mean total collagen significantly increased 32.3% (p <0.05). CONCLUSIONS: Composition changes in GAGs in strictured urethras could contribute to the noncompliant nature of urethral scar tissue and cause functional changes. These results may be useful for defining new targets for therapy for urethral stricture disease.

Adolescent↗

PubMedDate not supplied

[The endoscopic treatment of extensive urethral strictures and obliteration of the urethra and bladder neck].

Extensive urethral strictures, obliteration of the urethra and bladder cervix are thought to be the most complicated urological diseases. They occur more frequently in young and middle-aged persons consequently to pelvic and perineal traumas or they are complications of surgical interventions. Open surgery often cause complications such as suppuration of the operative wound, emergence of urinary fistulas, enuresis, recurrence of the structure or obliteration. Negative results of these operations are also shortening of the penis, erectile dysfunction causing serious social dysadaptation. Current advances in endoscopic instruments and imaging provided design of endoscopic techniques able to represent an effective alternative to open surgical interventions in urethral strictures, obliteration of the urethra and bladder cervix. The experience gained in the Clinic of the Research Institute of Urology in the practice of updated and novel endoscopic interventions aimed at recovery of urethral patency (strictures longer than 1 cm--inner optic urethrotomy, obliteration of the urethra and bladder cervix--endoscopic recanalization) has proved the advantages of the endoscopic techniques over open operative interventions. They are most cost-effective, result in better outcomes, bring about no erectile dysfunction.

Adolescent↗

PubMed2004

Treatment of the posterior urethral stricture: experience with 13 cases.

OBJECTIVE: To review our experience with the treatment of posterior urethral stricture. METHOD: A elaborated retrospective analysis of the treatment of 13 cases of posterior urethral stricture was conducted with the typical cases. RESULT: Good therapeutic results were achieved in these cases after treatment with cryoablation, electrotome or open surgery. CONCLUSION: Proper initial treatment, adequate surgical approach, anti-infection measures and postoperative urethral dilatation are the key elements in successful treatment of posterior urethral stricture.

Adolescent↗

PubMed2006

Rectourethral fistula associated with two short segment urethral strictures in the anterior and posterior urethra: single-stage reconstruction using buccal mucosa and a radial forearm fasciocutaneous free flap.

INTRODUCTION: We report a novel surgical technique used to repair a rectourethral fistula associated with two short-segment urethral strictures located in the anterior and posterior segments of the urethra in a patient with prior unsuccessful repairs. TECHNICAL CONSIDERATIONS: The anterior urethral stricture was reconstructed with a ventral onlay of buccal mucosa in the exaggerated lithotomy position. In a modified prone position, the rectourethral fistula was repaired using the transrectal transsphincteric (York-Mason) technique and the posterior urethral stricture with a radial forearm fasciocutaneous free flap which was anastomosed to the inferior gluteal artery and vein. The coexistence of a rectourethral fistula and distal urethral stricture requires simultaneous repair, because the urethral pressure from the distal obstruction may compromise fistula closure. Reconstructive efforts should be tailored to minimize disruption of the urethral blood supply in patients with previous pelvic trauma. Rectal and urethral repairs should be separated by well-vascularized tissue to prevent fistula recurrence. CONCLUSIONS: The radial fasciocutaneous flap may offer the reconstructive surgeon another surgical option for complex urethral stricture and rectourethral fistula reconstruction when the local blood supply is in question. Longer follow-up and more cases are needed to further evaluate the continued use of this technique.

Adult↗

PubMed1990

Endoscopic management of urethral stricture: "cut to the light" procedure.

Traumatic and iatrogenic urethral strictures present serious management difficulties. Classically their repair has been done through transpubic or perineal approaches. We have investigated the endoscopic route. In this study, 6 patients with dense posterior urethral strictures were managed endoscopically. The results of this "cut to the light" technique compare favorably with the more elaborate open procedures. The operation can be performed easily and carries very low morbidity.

Adult↗

PubMed2002

A bioabsorbable self-expandable, self-reinforced poly-L-lactic acid urethral stent for recurrent urethral strictures: long-term results.

BACKGROUND AND PURPOSE: Biodegradable urethral stents have been used clinically for some years mainly in order to prevent postoperative urinary retention after minimally invasive thermotreatment of benign prostatic hyperplasia. We previously reported a 15-month-follow-up pilot study of a bioabsorbable self-expandable, self-reinforced poly-L-lactic acid (SR-PLLA) urethral stent in combination with optical urethrotomy in the treatment of recurrent urethral strictures. The present aim was to evaluate the long-term results of this new treatment modality. PATIENTS AND METHODS: A series of 22 patients with severe urethral strictures (mean number of earlier urethrotomies 2.5) were involved. An SR-PLLA spiral stent with a bioabsorption time of 10 to 12 months was inserted into the urethra at the stricture site immediately after optical urethrotomy. Uroflowmetry, measurement of postvoiding residual urine, urine culture, and urethroscopy were performed preoperatively and at 1 and 3 months and then every 3 months up to 12 months, with subsequent follow-up visits every 6 months. The mean follow-up was 46 months. RESULTS: The treatment was successful in 8 of the 22 patients (36%). Six recurrences were found within the stented area and 15 outside. Patients with failure have since been treated with several urethrotomies and repeat self-dilatations or free skin urethroplasties. CONCLUSIONS: The results of the use of a bioabsorbable SR-PLLA urethral stent for the treatment of recurrent strictures were encouraging. Without this additional therapy, the recurrence rate of strictures might have been much higher. The main problem was sudden collapse of the stent, possibly induced by outer compression. A new generation of bioabsorbable stents is already under development.

Absorbable Implants↗

PubMed2004

The distribution of neuronal and inducible nitric oxide synthase in urethral stricture formation.

PURPOSE: The distribution of neuronal (n) and inducible (i) nitric oxide synthase (NOS) may have a role in the maintenance of normal urethral spongiosum and during the development of spongiofibrosis in urethral stricture disease. MATERIALS AND METHODS: Eight normal and 33 strictured human bulbar urethras were studied by histological and immunohistochemical techniques for the neuronal markers S-100, nNOS and iNOS. The smooth muscle-to-collagen ratio was calculated by morphometric analysis of Masson's trichrome sections. Immunohistochemical staining patterns of the neuronal markers in normal urethral tissue was compared to that in urethral stricture tissue with spongiofibrosis. RESULTS: The smooth muscle-to-collagen ratio was significantly lower in the strictured urethra compared to that in the control group (p = 0.001). In the strictured bulbar urethra nNOS immunoreactivity was decreased compared to that in normal urethral tissue. The severity of spongiofibrosis corresponded to the loss of nNOS immunoreactivity. iNOS immunoreactivity was found in strictured urethral epithelium and spongiosal tissue, whereas the control group was nonimmunoreactive to iNOS. CONCLUSIONS: Urethral stricture formation is a fibrotic process associated with significant changes in NOS metabolism. Abnormal collagen synthesis following urethral trauma may be stimulated by inappropriate iNOS activity. A functional nerve supply to the urethral spongiosum seems to be crucial in the maintenance of the unique ultrastructure of the urethral spongiosum.

Adult↗

PubMed1994

[Congenital urethral strictures].

We present 12 patients with presumed congenital urethral stricture (mean age at diagnosis 20 years). They complained of various urological symptoms, including dysuria, transient urinary retention, urgency and reduced flow. The time from onset of symptoms to diagnosis averaged 18 months. The strictures were presumed congenital because no patient had a history of urethral infection or of instrumentation, and all the strictures were at the proximal bulbar urethra, as has been described for congenital, bulbar, urethral stricture. We treated 5 patients initially by internal urethrotomy, of whom 2 required transurethral dilatation at follow-up. 7 others were treated initially by transurethral dilatation, 4 of whom required more than 1 treatment. Follow-up has averaged 21 months. In 8 of 10 patients the maximal urinary flow at latest follow-up is greater than 20 ml/sec.

Adult↗