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PubMedDate not supplied

The effect of urethral stricture on male fertility in Ife.

Twenty patients with Urethral stricture disease presenting with difficulty in micturition, azoospermia, and oligospermia were studied. Only 5% of our patients could firmly claim to be fertile at the time of presentation with a rise to 80% fertility rate at the end of management. Fifteen percent did not notice any change in their status. Surgical approach claimed better result over conservative management because of other complications following gonococcal infections. The need for a close forensic analysis in the determination of paternity in all cases of Urethral strictures was stressed while a treatment protocol of graft urethroplasty in all cases of traumatic rupture and dilatation in cases following inflammatory lesions of the urethra was established.

Adult↗
PubMed1977

Surgical treatment of urethral stricture.

We reviewed 59 cases of urethral stricture diseases treated at Charity Hospital of Louisiana in New Orleans from 1965 to 1975 to determine whether surgery was a feasible alternative to repeated urethral dilatations. Five different surgical procedures were done: internal urethrotomy, Johanson-Leadbetter, patch-graft, Turner-Warwich, and dismembered technics. Results of internal urethrotomy were poor, but the other procedures had an overall success of 72 percent.

Humans↗
PubMed1978

Endoscopic management of urethral stricture.

Experience with transurethral management of urethral stricture using conventional urethroscope and resectroscope of both infant and adult size is reported and the surgical procedure described. Because incision, dilation, and resection of the stricture are done under direct visual control, it is safe and applicable even in severe strictures hitherto untreatable with other refined closed methods.

Adult↗
PubMed2000

Optimal management of the 3- to 6-centimeter anterior urethral stricture.

The optimal management of anterior urethral stricture that does not respond to an endoscopic urethrotomy or is found to be unsuitable for excision and anastomotic repair remains controversial. Genital skin island onlay flaps or buccal mucosal grafts are presently the most dependable single stage procedures used for strictures more than 3 cm in length. Nonhirsute penile island fasciocutaneous flaps constitute the most durable substitution technique for pendulous stricture disease, with long-term studies reporting 90% to 96% success. The complex proximal bulb and bulbomenbraneous stricture with a compromised proximal fibrous avascular bed is ideally managed with either a penile or scrotal island flap or some combination of partial urethral excision with a dorsally placed genital skin island. The buccal mucosal onlay graft is a promising addition to this reconstructive paradigm, and early outcomes have been favorable. The graft is presently used for bulbar strictures, avoiding the transsphincteric on pendulous location, or a compromised recipient bed. The present standard of care for proximal bulb strictures is wide bulbospongiosal mobilization, partial urethral excision, a floor strip anastomosis, and placement of an augmenting flap on the graft in a dorsal location.

Humans↗
PubMed2003

Comparison of radiographic and sonographic urethrography for assessing urethral strictures.

The aim of this study was to compare radiourethrography (RUG) and sonourethrography (SUG) for assessment of urethral strictures and to evaluate whether RUG underestimates stricture length, as has been reported. Fifty-one men with suspected urethral strictures were evaluated by both methods performed consecutively. Stricture lengths and diameters measured by RUG were significantly greater (mean 22%, 30%) than those measured by SUG because of radiographic magnification. Both methods, however, detected a similar percentage lumen reduction and similarly graded stricture severity. Equally significant non-correlation between both methods for length measurements in the bulbar and penile urethra ( p<0.001, R(2)=0.33 and 0.34, respectively) supported radiographic magnification. Previous inaccuracies appear to relate to RUG measurements of the central tight stricture (mean 44% of the entire length in our series), not the full stricture length. Use of sonographic contrast medium intra-urethrally improved the definition of long narrow strictures. The SUG gave information about peri-urethral tissues not provided by RUG. Once radiographic magnification was taken into account, there were no major differences in the assessment of urethral strictures by both methods. With correct measurement methods, RUG does not underestimate stricture length. For full assessment, the combination of RUG and SUG, which gives information about peri-urethral disease, is optimal in many patients.

Adult↗
PubMed2004

Post-traumatic posterior urethral strictures: preoperative decision making.

OBJECTIVES: To assess the reliability of certain preoperative findings in helping select the correct operation for post-traumatic posterior urethral strictures and distraction defects. METHODS: We reviewed all urethrography and endoscopy studies of 167 posterior urethral strictures and distraction defects complicating pelvic fracture urethral injury that had been corrected between 1977 and 2002. Correction was by anastomotic urethroplasty in 149 cases (107 perineal, 2 elaborated perineal, 40 perineo-abdominal), scroto-urethral inlay in 2, and optical urethrotomy in 16. The findings were correlated with those encountered during surgery. RESULTS: Successful results after optical urethrotomy were encountered only in cases of genuine urethral stricture with no loss of urethral continuity. Anastomotic urethroplasty could be accomplished by an ordinary perineal procedure when the length of the distraction defect was 3 cm or less and only by an elaborated perineal or a perineo-abdominal procedure when it was 3 cm or more. The 2 cases that were corrected by scrotal inlay had an extensively scarred anterior urethra that precluded urethral anastomosis. CONCLUSIONS: A genuine stricture may indicate optical urethrotomy, but a distraction defect indicates anastomotic urethroplasty. Defects shorter than 3 cm may be corrected by an ordinary perineal anastomosis, while defects longer than 3 cm usually need an elaborated perineal or perineo-abdominal procedure. The finding of a scarred anterior urethra usually precludes urethral anastomosis and dictates substitution urethroplasty.

Adolescent↗
PubMed1992

Recurrence of urethral stricture and late results after optical urethrotomy: comparison of strictures caused by toxic latex catheters and other causes.

During the years 1977-1985, 183 new urethral strictures were diagnosed and treated by optical urethrotomy. A sharp increase in the incidence of iatrogenic strictures was found in 1980-1981 which normalized after simultaneous changing of the resectoscope, lubricant and catheter type. In fact, an "epidemic" of urethral strictures associated with the use of indwelling latex catheters in cardiac operations was observed in Finland in those years. It is suggested that toxic latex catheters exacerbated the local mechanical injury caused by endoscopic surgery. The recurrence rate for our "epidemic" strictures was 54%, whereas in other cases it was 37% (p = 0.02), but there were no differences in the later course. The patients age, stricture site, postoperative period of catheter-drainage, length, diameter or multiplicity had no effect on the recurrence rate after the initial urethrotomy. Stricture recurrences occurred up to 8 years after the initial operation. Because of the chronic nature of the urethral stricture, a follow-up time of at least 10 years is needed before the final results of urethrotomy can be evaluated.

Adolescent↗
PubMed1979

The role of internal urethrotomy in the prevention of urethral stricture following transurethral resection of prostate.

Urethral stricture is the commonest late complication of transurethral prostatectomy. Although internal urethrotomy is widely practised to prevent structures, there are no reports of any controlled trials of the procedure. A prospective trial of internal urethrotomy, using the Otis urethrotome, in 210 consecutive transurethral prostatectomies is presented. Patients were divided into 2 groups, those undergoing urethrotomy before TUR ("Trial group") and those undergoing TUR without urethrotomy ("Control group"), and they were followed for a minimum of 6 months. The incidence of stricture in the control group was significantly greater than in the trial group (P less than 0.01). Analysis of all other variables revealed no difference between the 2 groups and it is concluded that internal urethrotomy does prevent stricture formation and that it should be undertaken routinely before transurethral resection.

Humans↗
PubMed2005

Use of cyclooxygenase-2 inhibitor for prevention of urethral strictures secondary to transurethral resection of the prostate.

OBJECTIVES: To analyze whether the addition of a cyclooxygenase (COX)-2 inhibitor after transurethral resection of the prostate (TURP) offers an advantage compared with TURP alone in reducing postoperative urethral strictures. At urethroscopy, stenosis of the urethra with a circumference of less than 19 mm was defined as stricture. METHODS: This was a prospective, unblinded, randomized, single-center study. Between December 2001 and December 2003, 96 consecutive men with benign prostatic hyperplasia underwent TURP. After TURP, patients were randomly assigned to receive or not receive a COX-2 inhibitor (rofecoxib 25 mg/day). In the group given the COX-2 inhibitor, the therapy was started at catheter removal and continued for 20 days. Follow-up was performed on an outpatient basis after 1 month. A diagnosis of postoperative urethral stricture was assessed during a follow-up of 12 months. RESULTS: At the 1-month visit, the mean and median improvement in the peak urinary flow rate from preoperative values was +6.25 +/- 3.76 mL/s (median 7.30) in the no COX-2 inhibitor group and +9.42 +/- 3.06 mL/s (median 8.75) in the COX-2 inhibitor group. The improvement was significantly (P < 0.0001) greater for the group treated with the COX-2 inhibitor. At 1 year of follow-up, a urethral stricture had been diagnosed in 8.3% of all cases; in particular, in 17% and 0% of cases in the no COX inhibitor group and COX-2 inhibitor group, respectively. Post-TURP COX-2 inhibitor therapy was significantly (P = 0.0039) and inversely (r = -0.2876) associated with urethral stricture development. CONCLUSIONS: We suggest that limited postoperative treatment with a COX-2 inhibitor can effectively prevent post-TURP urethral stricture development by specifically interfering with the inflammatory processes that can precede scar formation.

Aged↗
PubMed2003

Mechanism of continence after repair of post-traumatic posterior urethral strictures.

OBJECTIVES: To determine the mechanism of urinary continence after repair of post-traumatic posterior urethral strictures by perineal anastomotic urethroplasty. METHODS: Two groups of male patients were enrolled in this study. Group 1 consisted of 8 patients (mean age 31 years) who had undergone bulboprostatic anastomotic urethroplasty for strictures complicating a pelvic fracture urethral disruption. Group 2 consisted of 8 patients (mean age 32.5 years) with a normal urethra who were used as controls. All 16 patients underwent urethral pressure profilometry both at rest and with cough and hold maneuvers. RESULTS: In group I, urethral pressure profilometry showed much lower mean maximal urethral pressures and maximal urethral closure pressures, as well as a much shorter mean functional profile length than in group 2 (48 and 39 cm H(2)O versus 75 and 65 cm H(2)O and 2.4 versus 4 cm, respectively, P <0.0003). On cough maneuver, intra-abdominal pressure changes were transmitted along the entire functional profile length in group 1 and only along its first part in group 2. The hold maneuver increased urethral pressure in 5 patients (65%) in group 1 and in all 8 patients (100%) in group 2. CONCLUSIONS: Continence after anastomotic urethroplasty for post-traumatic posterior urethral strictures is maintained solely by the proximal urethral mechanism. Transmission of intra-abdominal pressure changes and contraction of pelvic floor musculature may augment urethral closure in these cases during stress conditions.

Adult↗
PubMed1996

Circular penile fasciocutaneous flap reconstruction of urethral strictures: technical considerations and results in 40 patients.

The reconstruction of complex anterior urethral strictures has evolved from free graft urethroplasty to the use of vascularized skin flaps. The circular penile fasciocutaneous flap is based on Buck's fascia, is hairless, and reliably provides 15 cm of skin. We have used this technique in 40 patients with urethral strictures from the fossa navicularis to the veru montanum. Indications include severe spongiofibrosis, penile urethral location, inflammatory or ischemic etiology, and need for complete tube replacement. A successful result was obtained in 85% of patients. Complete tube replacement is less successful than onlay type procedures (77% vs. 96%) and we make every effort to preserve the urethral plate. This technique is the mainstay of our armamentarium for the repair of urethral strictures and also allows an excellent cosmetic result.

Follow-Up Studies↗
PubMed2004

Effect of intraurethral Mitomycin-C on healing and fibrosis in rats with experimentally induced urethral stricture.

BACKGROUND: In the pathogenesis of urethral stricture, fibrosis is associated with an excessive collagen increase. After the recognition that topical application of Mitomycin-C (MMC) inhibits fibroblast proliferation and is effective in preventing scar formation, many studies have been carried out on this subject outside the scope of urology. The aim of the present study is to observe the intraurethral impact of the employment of low doses of MMC on scar formation and fibrosis in experimental rat model. METHODS: Urethral injuries were made by internal urethrotomy knife. The study was carried out with 35 adult male Wistar albino rats. Five rats were allocated to the control group (group 1), 10 to a group that was administered 2 mg/L MMC (group 2) and 20 to a group that was administered 10 mg/L MMC (group 3). Mitomycin-C was administered to the injured urethra in the form of irrigation for 5 min. The rats were sacrificed 14 days later in order to evaluate chronic inflammation and fibrosis and their penises were histopathologically examined under light microscopy with hematoxilen eosin and trichrom stains. RESULTS: When group 2 was compared with control group, the differences in hemosiderin-laden macrophages (HLM), mononuclear cell infiltration (MCI) and fibrosis were found to be statistically significant (P < 0.01, P < 0.05, P < 0.005, respectively). When group 3 was compared with control group, the differences in HLM, MCI and fibrosis were also found to be statistically significant (P < 0.05, P < 0.05, P < 0.005, respectively). In the comparison of group 2 with group 3, no statistically significant differences were found in terms of the these parameters. CONCLUSIONS: Although MMC is toxic at high doses, the antifibrotic effect of the intraurethral low dose MMC may be useful in combination therapy for internal urethrotomy.

Animals↗
PubMed1998

Current controversies in anterior urethral stricture repair: free-graft versus pedicled skin-flap reconstruction.

Reconstruction of long anterior urethral strictures that cannot be excised and reanastomosed remains controversial. We critically reviewed the literature on free-graft and pedicled skin-flap urethroplasty to determine the optimal method of repair. Overall, free grafts were successful in 84.3% of cases and flaps, in 85.9%. Buccal mucosa grafts are the most successful method for reconstruction of bulbar urethral strictures. For strictures in the penile urethral or a compromised graft bed a distal penile skin flap is the most reliable and tested approach. Dorsal free-graft urethroplasty may be considered when penile skin deficiency prevents use of a flap. For the most complex strictures, in which a flap is not possible and the graft bed is of poor quality, a mesh graft in two stages may be the only option. Thus, for reconstruction of complex anterior urethral strictures, both free-graft and flap procedures remain indispensable.

Evaluation Studies as Topic↗
PubMed1989

Etiology, treatment and recurrence of urethral strictures.

This is a study of urethral strictures in 50 Jordanian patients. The etiology, treatment and recurrence were discussed. The commonest causative agent was iatrogenic trauma and the commonest way of treatment was direct vision internal urethrotomy with an 80% non-recurrence rate.

Adolescent↗
PubMed2004

Long-term outcome of ventral buccal mucosa onlay graft urethroplasty for urethral stricture repair.

OBJECTIVES: To evaluate our patients who were treated with ventral buccal mucosa onlay grafts for open urethral stricture repair with a follow-up exceeding 5 years. Buccal mucosa onlay is widely used for urethral reconstruction; however, the long-term outcome of these patients remains unclear. METHODS: During the past 10 years, 67 patients underwent ventral buccal mucosa onlay graft surgery for urethral stricture repair. Of these, 32 were followed up for longer than 5 years (mean 6.9 years) for the occurrence and timing of any postoperative complications. All patients had undergone prior internal urethrotomy (mean 2.9 procedures), and the average length of the stricture was 4.3 cm (range 3 to 17). RESULTS: The overall complication rate was 25% (8 of 32). We observed one fistula, one graft infection/necrosis, two lower lip scars with transient impairment of lip motility, and four recurrent strictures (at the proximal anastomosis), all of which were treated successfully with internal urethrotomy. All but one recurrent stricture occurred during the first 12 postoperative months. CONCLUSIONS: Ventral buccal mucosa onlay grafting for urethral stricture repair provides stable long-term results with complications occurring primarily during the first 12 postoperative months.

Cicatrix↗
PubMed1981

Endoscopic management of urethral strictures in children.

The management of urethral strictures in children prior to urethroplasty has involved dilation and internal urethrotomy. Low success rates with these modalities led to the evaluation of visual urethrotomy and intralesional steroid injection. Of 12 patients so managed 10 achieved an excellent result, with 2 classified as having good results initially. These 2 cases were ultimately converted into the excellent category following repeat procedures. Non-invasive urinary flow rates proved invaluable in the management and assessment of these patients, and the success of their treatment.

Adolescent↗
PubMed1986

Complications of treatment of urethral stricture in our practice.

Bleeding is the most common early postoperative complication of the treatment of urethral stricture, while recurrent stricture is the most common late postoperative complication irrespective of the method of treatment applied. The different sophisticated methods of urethroplasty make it possible today to treat successfully complicated urethral strictures. The results of such treatment, however, have been associated with a variety of complications (impotence, incontinence and urethrocutaneous fistula), especially when simple methods such as bouginage are used. Although bouginage is associated with a greater recurrence rate of urethral stricture than is urethroplasty, the former should be encouraged in centres where facilities and trained urologists are limited, as it often occurs in the developing countries, since the method is simple and can be used as emergency without prior urethrogram.

Adolescent↗