Purpose: To test the hypothesis if dilation or direct visual internal urethrotomy (DVIU) are predictive of urethroplasty failure. Retrospective study, from 1999 to 2010, including184 patients (median age 37 years) who...Purpose: To test the hypothesis if dilation or direct visual internal urethrotomy (DVIU) are predictive of urethroplasty failure. Retrospective study, from 1999 to 2010, including184 patients (median age 37 years) who underwent ventral onlay oral graft urethroplasty for bulbar strictures. Exclusion criteria were traumatic strictures, lichen sclerosus, failed hypospadias repair, failed urethroplasty, panurethral strictures, and incomplete medical charts. Pre-operative evaluation included clinical history, physical examination, urine culture, residual urine measurement, uroflowmetry, urethrography, ultrasound and urethroscopy. Surgery was considered a failure when any post-operative instrumentation was needed. Median follow-up was 48 months. Out of 184 patients, 38 (20.7%) had not undergone previous treatment, 7 (3.8%) had undergone dilation, 81 (44%) DVIU and 58 (31.5%) DVIU associated with dilation. Out of 184 patients, 157 (85.3%) were successful and 27 (14.7%) failures. Out of 38 patients who had not undergone previous treatment, 33 (86.8%) were successful;out of 7 patients who had undergone dilation, 6 (85.7%) were successful;out of 81 patients who had undergone DVIU, 72 (88.9%) were successful;out of 58 patients who had undergone DVIU and dilation, 46 (79.3%) were successful. According to the number of previous DVIU, ventral graft urethroplasty for bulbar strictures showed high failure rate in patients who had undergone more than four DVIU associated or not with dilation.展开更多
<strong>Background:</strong> Urethral stricture is a not uncommon pathology consisting of the narrowing of the urethra lumen with consequent reduction or cessation of urine flow. <strong>Objective:&l...<strong>Background:</strong> Urethral stricture is a not uncommon pathology consisting of the narrowing of the urethra lumen with consequent reduction or cessation of urine flow. <strong>Objective:</strong> The objective is to retrospectively evaluate the results of treatment of urethral strictures by endoscopic internal urethrotomy in a series of 233 cases. <strong>Patients and Methods:</strong> It is Retrospective and descriptive study of 233 cases of urethral strictures treated by endoscopic internal urethrotomy under visual control in a private facility in Abidjan (Ivory Coast) over the period from 1 December 2007 to 31 December 2017. The study parameters were epidemiological, etiological, characteristics of the narrowing and the outcome of the treatment according to the predictive elements. <strong>Results:</strong> 233 patients were treated with endoscopic internal urethrotomy (EIU). All patients were male. The mean age of the patients was 49 years with extremes from 17 to 84 years. Dysuria (55.79%) was the most frequent reason for consultation: the etiologies were infectious (51.50%), traumatic (32.18%), and iatrogenic (13.73%) and not found (2.57%). Retrograde urethrocystography with fictional films performed in all patients showed the following characteristics: the stricture was bulbar (81.04%), unique (55.79%) and short in 68.6%. There was a 39.91% good outcome after the first EUS. The average follow-up was 3 years. Mortality was nil and morbidity was assessed at 4.72%. The result was better when the procedure concerned a short (≤3 cm), single stenosis on the posterior urethra. The average duration of the postoperative urinary catheter was 14 days on average. The poor results (60.08%) were observed in cases of long stenosis, located on the anterior urethra or concerning elderly patients. 69.28% were cured after a second urethrotomy;the remaining cases were managed by urethroplasty or urethral dilatation. <strong>Conclusion:</strong> IEU is a simple, reproducible and attractive procedure with an overall success rate of 81.54% in 3 years. Its indication must be made in the case of short stenosis, single posterior and in the young subject.展开更多
BACKGROUND While several treatment options are available for pediatric urethral strictures,the appropriate treatment must be based on several factors.Although endoscopic visual internal urethrotomy(EVIU)could be a fir...BACKGROUND While several treatment options are available for pediatric urethral strictures,the appropriate treatment must be based on several factors.Although endoscopic visual internal urethrotomy(EVIU)could be a first-line treatment option for short pediatric urethral strictures,it is not feasible if the urethroscope cannot pass through the stricture point.Herein,we present a pediatric case of severe posttraumatic bulbous urethral stricture that was successfully treated by EVIU after securing the urethral route via interventional balloon dilatation.CASE SUMMARY A 12-year-old boy presented at our outpatient clinic with the inability to urinate.He had sustained a straddle injury three months prior.The post-void residual urine volume was 644 mL,and retrograde urethrography confirmed severe stricture of the bulbous urethra.EVIU was planned;however,the first attempt to treat the stricture failed because the urethroscope could not pass through the stricture point.The urethral route was subsequently secured via balloon dilatation of the stricture,which was performed in collaboration with specialists from the department of interventional radiology.The urethroscope was then able to pass,and the repeat EVIU was successful.CONCLUSION Interventional urethral balloon dilatation before EVIU may help secure the urethral route in the treatment of pediatric urethral strictures.展开更多
BACKGROUND Urethral stricture is a condition that often develops with trauma and results in narrowing of the urethral lumen.Although endoscopic methods are mostly used in its treatment,it has high recurrence rates.The...BACKGROUND Urethral stricture is a condition that often develops with trauma and results in narrowing of the urethral lumen.Although endoscopic methods are mostly used in its treatment,it has high recurrence rates.Therefore,open urethroplasty is recommended after unsuccessful endoscopic treatments.AIM To investigate the risk factors associated with urethral stricture recurrence.METHODS The data of male patients who underwent internal urethrotomy for urethral stricture between January 2017 and January 2023 were retrospectively analyzed.Demographic data,comorbidities,preoperative haemogram,and biochemical values obtained from peripheral blood and operative data were recorded.Patients were divided into two groups in terms of recurrence development;recurrence and non-recurrence.Initially recorded data were compared between the two groups.RESULTS A total of 303 patients were included in the study.The mean age of the patients was 66.6±13.6 years.The mean duration of recurrence development was 9.63±9.84(min-max:1-39)months in the recurrence group.Recurrence did not occur in non-recurrence group throughout the follow-up period with an average time of 44.15±24.07(min-max:12-84)months.In the comparison of both groups,the presence of diabetes mellitus(DM),hypertension(HT),and multiple comorbidi-ties were significantly higher in the recurrence(+)group(P=0.038,P=0.012,P=0.013).Blood group,postoperative use of non-steroidal anti-inflammatory drugs,preoperative cystostomy,cause of stricture,iatrogenic cause of stricture,location and length of stricture,indwelling urinary cathater size and day of catheter removal did not differ between the two groups.No statistically significant difference was observed between the two groups in terms of age,uroflowmetric maximum flow rate value,hemo-gram parameters,aspartate aminotransferase(AST),alanine aminotransferase(ALT),fasting blood sugar,creati-nine,glomerular filtration rate,neutrophil-lymphocyte ratio,platelet-lymphocyte ratio,lymphocyte-monocyte ratio,monocyte-lymphocyte ratio and AST/ALT ratios.CONCLUSION In patients with urethral stricture recurrence,only the frequency of DM and HT was high,while inflammation marker levels and stricture-related parameters were similar between the groups.展开更多
Background: Male urethral stricture is as yet considered one of the very popular and defying dilemmas to the urologist. Treatment modalities include dilation, endoscopic urethrotomy and urethroplasty, however internal...Background: Male urethral stricture is as yet considered one of the very popular and defying dilemmas to the urologist. Treatment modalities include dilation, endoscopic urethrotomy and urethroplasty, however internal optical urethrotomy displays rapid cure, lower scarring, and minimal hazard of infection. Purpose: To evaluate the efficacy of internal optical urethrotomy in the treatment of patients with urethral stricture. Patients & Methods: This study was carried out at Al-Yermouk Teaching Hospital/Baghdad/Iraq in the period between January 2015 and January 2018. A group of 75 male patients (16 - 25 years of age) presented with urethral strictures had been treated with internal optical urethrotomy. Follow-up period ranged from 1 - 3 months. Outcome was graded as good, fair and poor. Results: Out of 75 patients, 28 (37.3%) were (21 - 30) years of age. Trauma was the most popular source of stricture found in 40 (53.3%) and the most widespread presenting feature was poor urinary flow in 32 (42.6%) patients. Stricture in the bulbous urethra in 48 (64%) cases was found to be the most prevalent area followed by penile urethra in 16 (21.3%) cases. Overall response rate was good in 52 (69.3%) patients. Eleven (14.6%) patients exhibited only minor bleeding postoperatively with no other considerable complications. Conclusion: Internal optical urethrotomy is a dependable and effective procedure in treating urethral stricture.展开更多
<strong>Introduction:</strong> Endoscopic internal urethrotomy (EIU) is a technique that consists of an incision of the stenosed urethra under visual control. Its indication is widespread since the first d...<strong>Introduction:</strong> Endoscopic internal urethrotomy (EIU) is a technique that consists of an incision of the stenosed urethra under visual control. Its indication is widespread since the first description in 1971 by Sachse. The objective was to analyze the results of EIU in the treatment of urethral stenosis (US) at the Andro-Urology Department of the UHC of Conakry. <strong>Methodology:</strong> It is a prospective descriptive study, lasting 18 months (January 2016-30 June 2017). It involved 102 patients. The variables were: age, etiology of US, type of catheter, duration of catheter wear and recurrences. After a 12-month follow-up, our results were considered good in the absence of recurrences. <strong>Results:</strong> The average age was 54.25 years with the extremes comprising between 16 and 96 years. The main reasons for medical checkup were chronic urine retention at 58.82%. Etiology infection was the most frequent with a ratio of 81.37%, while <em>Escherichia coli</em> was found at 51.29%. US was bulbar (71.57%), unique (67.64%) and less than 1 cm (60.78%). Surgical complication occurred with 9 patients (8.82%) with urethrorrhagia and the external genital organs infiltration in 4 cases. Results were good for 77 patients (75.49%). Stenosis post infection, long and multiple stenoses, urethral catheterization with latex catheter and urethral catheterization of more than 4 days were strongly associated with the recurrence occurrence. <strong>Conclusion:</strong> The EIU is a minimally invasive surgical technique that offers good results.展开更多
Introduction: Male urethral stricture is one of the oldest urological disorders. Many techniques have been proposed to treat them, including endoscopic internal urethrotomy (DVIU). Material and Methods: To evaluate th...Introduction: Male urethral stricture is one of the oldest urological disorders. Many techniques have been proposed to treat them, including endoscopic internal urethrotomy (DVIU). Material and Methods: To evaluate the contribution of this technique in the treatment of urethra narrowing, a retrospective study on the records of patients with urethral stricture treated with endoscopic internal urethrotomy between January 2014 and December 2021 in the urology division of the Souro Sanou University Teaching Hospital. Results: A total of 44 male patients with urethral stricture were treated with this technique and 48 procedures were performed. The average age of the patients was 53.2 ± 18.2 years. The etiology of the stricture was dominated by iatrogenic, infectious, traumatic and idiopathic causes in 43.2% (n = 19), 27.3% (n = 12), 20.4 % (n = 9), and 9.1% (n = 4) respectively. The location of the stricture was bulbar in 72.7%, and the anterior penile urethra in 15.9%. The overall success rate was 72.7% with satisfactory urination without dysuria, evaluated after removal of the urinary catheter, at three months this rate fell to 69.1%, and at 6 months this rate was 67.5%. Five cases (5) of extravasation of blood or irrigation fluid into the scrotum were reported and managed conservatively as well as two (2) cases of false routes with postoperative oedema of the penis were observed. Conclusion: DVIU is a simple technique, free of major morbidity and requiring only short-term hospitalization. It can be proposed as a first-line treatment for urethral stricture.展开更多
<strong>Background:</strong> The aim of this study was to evaluate the outcomes of stricture treatment using endoscopic internal urethrotomy in the male urethra. <strong>Patients and Methods:</str...<strong>Background:</strong> The aim of this study was to evaluate the outcomes of stricture treatment using endoscopic internal urethrotomy in the male urethra. <strong>Patients and Methods:</strong> We conducted a retrospective study from 2012 to 2017 at the Urology and Andrology Department of the University Hospital in Brazzaville, Congo. Medical records of 30 patients who underwent endoscopic internal urethrotomy for urethral stricture were analyzed. We studied the following variables: frequency of urethral stricture, age of patient, onset, cause and location of urethral stricture, duration of bladder catheterization, duration of hospitalization, and postoperative complications. The treatment outcome was assessed after a follow-up of 2.6 years (extreme: 2 and 4 years). Outcomes were considered successful or good when the patients had a normal urine flow and an unobstructed urethra at the Retrograde Urethrogram (RUG). <strong>Results:</strong> The mean age was 47.5 ± 9.7 years (range: 17 to 83 years). Dysuria was the most common symptom reported. We found that urethral stricture was mostly caused by infectious diseases (20 patients). The urethral stricture was located at the membranous urethra in 4 patients, the bulbar urethra in 25 patients, and the penile urethra in 1 patient. The mean duration of the bladder catheterization was 2.3 days. Hospitalization duration was 36 hours. We observed the following complications: urethrorrhagia in 3 patients, acute orchiepididymitis. We achieved good results in 23 patients. <strong>Conclusion:</strong> In our context where the practice of endoscopic internal urethrotomy is recent, it provides satisfactory results for the treatment of short urethral male stricture.展开更多
Introduction: Endoscopic internal urethrotomy (EIU) is a method for stricture opening using transurethral incision by direct visualisation of the urethral channel, resulting in a widening of the urinary canal with the...Introduction: Endoscopic internal urethrotomy (EIU) is a method for stricture opening using transurethral incision by direct visualisation of the urethral channel, resulting in a widening of the urinary canal with the aim of improving the quality of bladder emptying. The aim of the study was to evaluate the indication and results of EIU in the treatment of stenosis of the male urethra in the Urology-Andrology Department of Kara Teaching Hospital. Methodology: This was a cross-sectional descriptive study with retrospective data collection in the Urology-Andrology department of Kara Teaching Hospital. It involved 21 records of patients with urethral stenosis treated by endoscopic internal urethrotomy (EIU) in the said department during the period from January 2021 to September 2023. The following variables were evaluated: age, circumstance of discovery, site, length, number, etiology of the urethral stenosis and evolution of the patients. Results: The mean age of the patients was 59.2 ± 11.7 years. Infectious etiology of stenosis was predominant with 10 patients (47.6%) followed by trauma with 5 cases (23.8%). The bulbar urethra was the most frequently observed site, with 11 cases (52.4%). The length was mostly less than 2 cm in 12 patients (57.1%). Stenosis was unique in 14 patients (66.7%). The mean postoperative follow-up time was 3.2 months. The result was immediately better in 11 patients (52.4%) and it was poor in 8 patients (38.1%) who required maintenance dilation sessions.展开更多
Objective To summarize the experience and evaluate the efficacy of treatment of urethral stricture using direct visual internal urethrotomy ( DVIU) . Methods The clinical data of 361 patients ( age range 16 - 72 years...Objective To summarize the experience and evaluate the efficacy of treatment of urethral stricture using direct visual internal urethrotomy ( DVIU) . Methods The clinical data of 361 patients ( age range 16 - 72 years, mean age 38 years) with urethral stricture who underwent urethrotomy from 1990 to 2010 was retrospectively ana-展开更多
Posterior urethral injuries typically arise in the context of a pelvic fracture.Retrograde urethrography is the preferred diagnostic test in trauma patients with pelvic fracture where a posterior urethral rupture is s...Posterior urethral injuries typically arise in the context of a pelvic fracture.Retrograde urethrography is the preferred diagnostic test in trauma patients with pelvic fracture where a posterior urethral rupture is suspected.Pelvic fractures however preclude the adequate positioning of the patient on the X-ray table on admission and computed tomography scan with intravenous contrast and delayed films generally performed first.Suprapubic bladder catheter placement under ultrasound guidance should be performed whenever a posterior urethral disruption is suspected.Early diagnosis and proper acute management decrease the associated complications,such as strictures,urinary incontinence and erectile dysfunction.The correct and appropriate initial treatment of associated urethral rupture is critical to the proper healing of the injury.Placing of a suprapubic cystostomy on admission and delayed anastomotic urethroplasty after 3e6 months continues to be the gold standard of treatment.In this paper,we provide a comprehensive review of the literature with a special emphasis on the various treatments available:Open or endoscopic primary realignment,immediate or delayed urethroplasty after suprapubic cystostomy,and delayed optical urethrotomy.展开更多
Objectives： We retrospectively reviewed the urethral stricture cases treated in our tertiary center, and assessed the safety and feasibility of the high-pressure balloon dilation （HPBD） technique for anterior ureth...Objectives： We retrospectively reviewed the urethral stricture cases treated in our tertiary center, and assessed the safety and feasibility of the high-pressure balloon dilation （HPBD） technique for anterior urethral stricture Methods： From January 2009 to December 2012, a total of 31 patients with anterior urethral strictures underwent HPBD at our center, while another 25 cases were treated by direct vision internal urethrotomy （DVIU）. Patient de- mographics, stricture characteristics, surgical techniques, and operative outcomes were assessed and compared between the two groups. The Kaplan-Meier survival analysis was applied to evaluate the stricture-free rate for the two surgical techniques. Results： The operation time was much shorter for the HPBD procedure than for the DVIU （（13.19±2.68） min vs. （18.44±3.29） min, P〈0.01）. For the HPBD group, the major postoperative complications as urethral bleeding and urinary tract infection （UTI） were less frequently encountered than those in DVIU （urethral bleeding： 2/31 vs. 8/25, P=0.017; UTI： 1/31 vs. 6/25 P=0.037）. The Kaplan-Meier survival analysis showed that there was no significant difference in stricture-free rate at 36 months between the two groups （P=-0.21, hazard ratio （HR）=0.65, 95% confidence interval （CI）： 0.34 to 1.26）. However, there was a significantly higher stricture-free survival in the HPBD group at 12 months （P=-0.02, HR=0.35, 95% CI： 0.14 to 0.87）, which indicated that the stricture recurrence could be delayed by using the HPBD technique. Conclusions： HPBD was effective and safe and it could be considered as an alternative treatment modality for anterior urethral stricture disease.展开更多
Objective:To prospectively follow up a cohort of anterior urethral stricture disease patients managed with balloon dilation(BD)for 3 years to evaluate the long-term outcomes and to study factors that contribute to rec...Objective:To prospectively follow up a cohort of anterior urethral stricture disease patients managed with balloon dilation(BD)for 3 years to evaluate the long-term outcomes and to study factors that contribute to recurrence.Methods:This study included men who had urethral BD for significant anterior urethral stricture disease between January 2017 and March 2019.Data about the patient age,stricture characteristics,and recurrence date were recorded,along with information on postoperative indwelling catheter use and operative complications.Furthermore,information about the self-calibration procedure was collected and where available,free flow(FF)measurements during the follow-up period were recorded and analyzed.Success was defined as a lack of symptoms and acceptable FF rates(maximum flow rate>12 mL/s).Results:The final analysis was conducted on 187 patients.The mean follow-up period was 37 months.The long-term overall success rate at the end of our study was 66.8%.Our recurrence rate was 7.4%at 12 months,24.7%at 24 months,and reached 33.2%at the end of our study.The time to recurrence ranged from 91 days to 1635 days,with a mean of 670 days.The stricture-free survival was significantly shorter with lengthy peno-bulbar(p=0.031)and multiple strictures(p=0.015),and in the group of patients who were not committed to self-calibration protocol(p<0.011).However,post-procedural self-calibration was the most important factor that may have decreased the incidence of recurrence(odds ratioZ5.85).Adjuvant self-calibration after BD not only reduced the recurrence rate from 85.4%in the non-self-calibration group to 15.1%in the self-calibration one(p<0.001),but also improved the overall stricture-free survival and FF parameters.展开更多
Objective:Female urethral stricture (FUS) accounts for about 4%–13% of cases of female bladder outlet obstruction. FUS was and is still managed by repeated dilatations and/or direct visual internal urethrotomy. There...Objective:Female urethral stricture (FUS) accounts for about 4%–13% of cases of female bladder outlet obstruction. FUS was and is still managed by repeated dilatations and/or direct visual internal urethrotomy. There are many alternative options for reconstruction like buccal or vaginal mucosal graft urethroplasty. Our aim was to describe the technique of dorsal onlay buccal mucosal graft (BMG) urethroplasty for FUS and present the outcomes.Methods:Between January 2014 and December 2021, 37 patients who underwent dorsal onlay BMG urethroplasty were included in the study. Their pre-operative diagnosis was confirmed with uroflowmetry, micturating cystourethrogram, urethral calibration, and on table cystoscopy. Bladder catheter was removed after 2 weeks. Patients were followed up at 3 months, 6 months, 1 year, and then annually with urine analysis, uroflowmetry, and post-void residual assessment. We defined success as a maximum flow rate (Q_(max)) above 15 mL/s without the need for an additional instrumentation.Results:The mean age of patients was 47.8 (standard deviation [SD] 11.3) years. Twenty patients had previously undergone urethral dilatations. The mean pre-operative Q_(max) was 7.79 (SD 3.73) mL/s. However, the mean Q_(max) improved to 23.20 (SD 8.25) mL/s after surgery. The mean post-void residual urine after surgery was 30.50 (SD 10.70) mL. This reduced from a mean value of 139.00 (SD 147.24) mL before surgery. The mean follow-up was 30.2 (SD 18.3, range 18–44) months. There was no post-operative incontinence. There were Clavien–Dindo Grade 1 complications in 6 out of 37 (16.2 %) patients during hospital stay. The only long-term complication was recurrence of stricture in 4 (10.8%) patients.Conclusion:Dorsal onlay BMG urethroplasty in females is a safe, effective technique which can avoid repeated painful dilatations and multiple urethrotomies. One should always consider reconstruction in FUS without any fear of incontinence.展开更多
Background: Urethral stricture is a pathology frequently encountered in urological practice. Management is often surgical, with possible recurrences. What about this pathology in Kara, a semi-urban city? Objective: As...Background: Urethral stricture is a pathology frequently encountered in urological practice. Management is often surgical, with possible recurrences. What about this pathology in Kara, a semi-urban city? Objective: Assess the management of male urethral stricture in Kara. Patients and Methods: This was a descriptive study with retrospective data collection. The study took place in the urology department of the teaching hospital of Kara, from December 2020 to December 2022. All cases of male urethral stricture, surgically treated at the teaching hospital of Kara, were listed. The inclusion criteria were as follows: any patient who had been treated surgically for male urethral stricture in the urology department of the teaching Hospital of Kara. The operating theater register and hospital records were used to collect the data. The diagnosis of urethral stricture had been made with retrograde urethrogram. A total of 24 patients were treated for male urethral stricture during the study period. The following variables were studied: age, reason for consultation, location, length, and etiology of the stricture;the type of treatment received: optical internal urethrotomy, or anastomotic urethroplasty, and the results. The result was considered good if, after removal of the urethral catheter, the patient regained his micturition without the need for dilatation;the result was considered average if, after removal of the urethral catheter, the patient needed one or more dilatation sessions to regain urination;the result was considered poor if, after removal of the catheter, the patient did not regain good micturition despite the urethral dilatation sessions. Microsoft excel and epi info 7 software were used for data processing. Results: The average age of our patients was 43.7 years ± 10.18 with extremes ranging from 27 to 70 years. The most represented age groups were that of 40 to 50 years, with 37.5% of cases;and that of 30 to 40 years with 33.3% of cases. The patients had consulted for urine retention in 66.6% of cases;the location of urethral stricture was bulbar in 45.8% of cases. The most found etiology was infectious in 58.3% of cases. Among our patients, 58.3% had received optical internal urethrotomy as treatment, while 41.6% of our patients had received anastomotic urethroplasty as treatment. Postoperatively, after removal of the urinary catheter, 87.5% of patients had benefited from one or repeated dilatation. In terms of results, we had a good result in 20.8% of patients;the result was average in 45.8% of patients, and poor in 33.3% of patients. The average duration of follow-up was 14.3 +/- 7.2 months (3-27). Conclusion: Male urethral stricture mainly affects young adults in Kara. Surgical management is done by optical internal urethrotomy and/or anastomotic urethroplasty.展开更多
文摘Purpose: To test the hypothesis if dilation or direct visual internal urethrotomy (DVIU) are predictive of urethroplasty failure. Retrospective study, from 1999 to 2010, including184 patients (median age 37 years) who underwent ventral onlay oral graft urethroplasty for bulbar strictures. Exclusion criteria were traumatic strictures, lichen sclerosus, failed hypospadias repair, failed urethroplasty, panurethral strictures, and incomplete medical charts. Pre-operative evaluation included clinical history, physical examination, urine culture, residual urine measurement, uroflowmetry, urethrography, ultrasound and urethroscopy. Surgery was considered a failure when any post-operative instrumentation was needed. Median follow-up was 48 months. Out of 184 patients, 38 (20.7%) had not undergone previous treatment, 7 (3.8%) had undergone dilation, 81 (44%) DVIU and 58 (31.5%) DVIU associated with dilation. Out of 184 patients, 157 (85.3%) were successful and 27 (14.7%) failures. Out of 38 patients who had not undergone previous treatment, 33 (86.8%) were successful;out of 7 patients who had undergone dilation, 6 (85.7%) were successful;out of 81 patients who had undergone DVIU, 72 (88.9%) were successful;out of 58 patients who had undergone DVIU and dilation, 46 (79.3%) were successful. According to the number of previous DVIU, ventral graft urethroplasty for bulbar strictures showed high failure rate in patients who had undergone more than four DVIU associated or not with dilation.
文摘<strong>Background:</strong> Urethral stricture is a not uncommon pathology consisting of the narrowing of the urethra lumen with consequent reduction or cessation of urine flow. <strong>Objective:</strong> The objective is to retrospectively evaluate the results of treatment of urethral strictures by endoscopic internal urethrotomy in a series of 233 cases. <strong>Patients and Methods:</strong> It is Retrospective and descriptive study of 233 cases of urethral strictures treated by endoscopic internal urethrotomy under visual control in a private facility in Abidjan (Ivory Coast) over the period from 1 December 2007 to 31 December 2017. The study parameters were epidemiological, etiological, characteristics of the narrowing and the outcome of the treatment according to the predictive elements. <strong>Results:</strong> 233 patients were treated with endoscopic internal urethrotomy (EIU). All patients were male. The mean age of the patients was 49 years with extremes from 17 to 84 years. Dysuria (55.79%) was the most frequent reason for consultation: the etiologies were infectious (51.50%), traumatic (32.18%), and iatrogenic (13.73%) and not found (2.57%). Retrograde urethrocystography with fictional films performed in all patients showed the following characteristics: the stricture was bulbar (81.04%), unique (55.79%) and short in 68.6%. There was a 39.91% good outcome after the first EUS. The average follow-up was 3 years. Mortality was nil and morbidity was assessed at 4.72%. The result was better when the procedure concerned a short (≤3 cm), single stenosis on the posterior urethra. The average duration of the postoperative urinary catheter was 14 days on average. The poor results (60.08%) were observed in cases of long stenosis, located on the anterior urethra or concerning elderly patients. 69.28% were cured after a second urethrotomy;the remaining cases were managed by urethroplasty or urethral dilatation. <strong>Conclusion:</strong> IEU is a simple, reproducible and attractive procedure with an overall success rate of 81.54% in 3 years. Its indication must be made in the case of short stenosis, single posterior and in the young subject.
基金Supported by the National Research Foundation of Korea Grant founded by the Korea Government,No.NRF-2022R1A2C1007169.
文摘BACKGROUND While several treatment options are available for pediatric urethral strictures,the appropriate treatment must be based on several factors.Although endoscopic visual internal urethrotomy(EVIU)could be a first-line treatment option for short pediatric urethral strictures,it is not feasible if the urethroscope cannot pass through the stricture point.Herein,we present a pediatric case of severe posttraumatic bulbous urethral stricture that was successfully treated by EVIU after securing the urethral route via interventional balloon dilatation.CASE SUMMARY A 12-year-old boy presented at our outpatient clinic with the inability to urinate.He had sustained a straddle injury three months prior.The post-void residual urine volume was 644 mL,and retrograde urethrography confirmed severe stricture of the bulbous urethra.EVIU was planned;however,the first attempt to treat the stricture failed because the urethroscope could not pass through the stricture point.The urethral route was subsequently secured via balloon dilatation of the stricture,which was performed in collaboration with specialists from the department of interventional radiology.The urethroscope was then able to pass,and the repeat EVIU was successful.CONCLUSION Interventional urethral balloon dilatation before EVIU may help secure the urethral route in the treatment of pediatric urethral strictures.
文摘BACKGROUND Urethral stricture is a condition that often develops with trauma and results in narrowing of the urethral lumen.Although endoscopic methods are mostly used in its treatment,it has high recurrence rates.Therefore,open urethroplasty is recommended after unsuccessful endoscopic treatments.AIM To investigate the risk factors associated with urethral stricture recurrence.METHODS The data of male patients who underwent internal urethrotomy for urethral stricture between January 2017 and January 2023 were retrospectively analyzed.Demographic data,comorbidities,preoperative haemogram,and biochemical values obtained from peripheral blood and operative data were recorded.Patients were divided into two groups in terms of recurrence development;recurrence and non-recurrence.Initially recorded data were compared between the two groups.RESULTS A total of 303 patients were included in the study.The mean age of the patients was 66.6±13.6 years.The mean duration of recurrence development was 9.63±9.84(min-max:1-39)months in the recurrence group.Recurrence did not occur in non-recurrence group throughout the follow-up period with an average time of 44.15±24.07(min-max:12-84)months.In the comparison of both groups,the presence of diabetes mellitus(DM),hypertension(HT),and multiple comorbidi-ties were significantly higher in the recurrence(+)group(P=0.038,P=0.012,P=0.013).Blood group,postoperative use of non-steroidal anti-inflammatory drugs,preoperative cystostomy,cause of stricture,iatrogenic cause of stricture,location and length of stricture,indwelling urinary cathater size and day of catheter removal did not differ between the two groups.No statistically significant difference was observed between the two groups in terms of age,uroflowmetric maximum flow rate value,hemo-gram parameters,aspartate aminotransferase(AST),alanine aminotransferase(ALT),fasting blood sugar,creati-nine,glomerular filtration rate,neutrophil-lymphocyte ratio,platelet-lymphocyte ratio,lymphocyte-monocyte ratio,monocyte-lymphocyte ratio and AST/ALT ratios.CONCLUSION In patients with urethral stricture recurrence,only the frequency of DM and HT was high,while inflammation marker levels and stricture-related parameters were similar between the groups.
文摘Background: Male urethral stricture is as yet considered one of the very popular and defying dilemmas to the urologist. Treatment modalities include dilation, endoscopic urethrotomy and urethroplasty, however internal optical urethrotomy displays rapid cure, lower scarring, and minimal hazard of infection. Purpose: To evaluate the efficacy of internal optical urethrotomy in the treatment of patients with urethral stricture. Patients & Methods: This study was carried out at Al-Yermouk Teaching Hospital/Baghdad/Iraq in the period between January 2015 and January 2018. A group of 75 male patients (16 - 25 years of age) presented with urethral strictures had been treated with internal optical urethrotomy. Follow-up period ranged from 1 - 3 months. Outcome was graded as good, fair and poor. Results: Out of 75 patients, 28 (37.3%) were (21 - 30) years of age. Trauma was the most popular source of stricture found in 40 (53.3%) and the most widespread presenting feature was poor urinary flow in 32 (42.6%) patients. Stricture in the bulbous urethra in 48 (64%) cases was found to be the most prevalent area followed by penile urethra in 16 (21.3%) cases. Overall response rate was good in 52 (69.3%) patients. Eleven (14.6%) patients exhibited only minor bleeding postoperatively with no other considerable complications. Conclusion: Internal optical urethrotomy is a dependable and effective procedure in treating urethral stricture.
文摘<strong>Introduction:</strong> Endoscopic internal urethrotomy (EIU) is a technique that consists of an incision of the stenosed urethra under visual control. Its indication is widespread since the first description in 1971 by Sachse. The objective was to analyze the results of EIU in the treatment of urethral stenosis (US) at the Andro-Urology Department of the UHC of Conakry. <strong>Methodology:</strong> It is a prospective descriptive study, lasting 18 months (January 2016-30 June 2017). It involved 102 patients. The variables were: age, etiology of US, type of catheter, duration of catheter wear and recurrences. After a 12-month follow-up, our results were considered good in the absence of recurrences. <strong>Results:</strong> The average age was 54.25 years with the extremes comprising between 16 and 96 years. The main reasons for medical checkup were chronic urine retention at 58.82%. Etiology infection was the most frequent with a ratio of 81.37%, while <em>Escherichia coli</em> was found at 51.29%. US was bulbar (71.57%), unique (67.64%) and less than 1 cm (60.78%). Surgical complication occurred with 9 patients (8.82%) with urethrorrhagia and the external genital organs infiltration in 4 cases. Results were good for 77 patients (75.49%). Stenosis post infection, long and multiple stenoses, urethral catheterization with latex catheter and urethral catheterization of more than 4 days were strongly associated with the recurrence occurrence. <strong>Conclusion:</strong> The EIU is a minimally invasive surgical technique that offers good results.
文摘Introduction: Male urethral stricture is one of the oldest urological disorders. Many techniques have been proposed to treat them, including endoscopic internal urethrotomy (DVIU). Material and Methods: To evaluate the contribution of this technique in the treatment of urethra narrowing, a retrospective study on the records of patients with urethral stricture treated with endoscopic internal urethrotomy between January 2014 and December 2021 in the urology division of the Souro Sanou University Teaching Hospital. Results: A total of 44 male patients with urethral stricture were treated with this technique and 48 procedures were performed. The average age of the patients was 53.2 ± 18.2 years. The etiology of the stricture was dominated by iatrogenic, infectious, traumatic and idiopathic causes in 43.2% (n = 19), 27.3% (n = 12), 20.4 % (n = 9), and 9.1% (n = 4) respectively. The location of the stricture was bulbar in 72.7%, and the anterior penile urethra in 15.9%. The overall success rate was 72.7% with satisfactory urination without dysuria, evaluated after removal of the urinary catheter, at three months this rate fell to 69.1%, and at 6 months this rate was 67.5%. Five cases (5) of extravasation of blood or irrigation fluid into the scrotum were reported and managed conservatively as well as two (2) cases of false routes with postoperative oedema of the penis were observed. Conclusion: DVIU is a simple technique, free of major morbidity and requiring only short-term hospitalization. It can be proposed as a first-line treatment for urethral stricture.
文摘<strong>Background:</strong> The aim of this study was to evaluate the outcomes of stricture treatment using endoscopic internal urethrotomy in the male urethra. <strong>Patients and Methods:</strong> We conducted a retrospective study from 2012 to 2017 at the Urology and Andrology Department of the University Hospital in Brazzaville, Congo. Medical records of 30 patients who underwent endoscopic internal urethrotomy for urethral stricture were analyzed. We studied the following variables: frequency of urethral stricture, age of patient, onset, cause and location of urethral stricture, duration of bladder catheterization, duration of hospitalization, and postoperative complications. The treatment outcome was assessed after a follow-up of 2.6 years (extreme: 2 and 4 years). Outcomes were considered successful or good when the patients had a normal urine flow and an unobstructed urethra at the Retrograde Urethrogram (RUG). <strong>Results:</strong> The mean age was 47.5 ± 9.7 years (range: 17 to 83 years). Dysuria was the most common symptom reported. We found that urethral stricture was mostly caused by infectious diseases (20 patients). The urethral stricture was located at the membranous urethra in 4 patients, the bulbar urethra in 25 patients, and the penile urethra in 1 patient. The mean duration of the bladder catheterization was 2.3 days. Hospitalization duration was 36 hours. We observed the following complications: urethrorrhagia in 3 patients, acute orchiepididymitis. We achieved good results in 23 patients. <strong>Conclusion:</strong> In our context where the practice of endoscopic internal urethrotomy is recent, it provides satisfactory results for the treatment of short urethral male stricture.
文摘Introduction: Endoscopic internal urethrotomy (EIU) is a method for stricture opening using transurethral incision by direct visualisation of the urethral channel, resulting in a widening of the urinary canal with the aim of improving the quality of bladder emptying. The aim of the study was to evaluate the indication and results of EIU in the treatment of stenosis of the male urethra in the Urology-Andrology Department of Kara Teaching Hospital. Methodology: This was a cross-sectional descriptive study with retrospective data collection in the Urology-Andrology department of Kara Teaching Hospital. It involved 21 records of patients with urethral stenosis treated by endoscopic internal urethrotomy (EIU) in the said department during the period from January 2021 to September 2023. The following variables were evaluated: age, circumstance of discovery, site, length, number, etiology of the urethral stenosis and evolution of the patients. Results: The mean age of the patients was 59.2 ± 11.7 years. Infectious etiology of stenosis was predominant with 10 patients (47.6%) followed by trauma with 5 cases (23.8%). The bulbar urethra was the most frequently observed site, with 11 cases (52.4%). The length was mostly less than 2 cm in 12 patients (57.1%). Stenosis was unique in 14 patients (66.7%). The mean postoperative follow-up time was 3.2 months. The result was immediately better in 11 patients (52.4%) and it was poor in 8 patients (38.1%) who required maintenance dilation sessions.
文摘Objective To summarize the experience and evaluate the efficacy of treatment of urethral stricture using direct visual internal urethrotomy ( DVIU) . Methods The clinical data of 361 patients ( age range 16 - 72 years, mean age 38 years) with urethral stricture who underwent urethrotomy from 1990 to 2010 was retrospectively ana-
文摘Posterior urethral injuries typically arise in the context of a pelvic fracture.Retrograde urethrography is the preferred diagnostic test in trauma patients with pelvic fracture where a posterior urethral rupture is suspected.Pelvic fractures however preclude the adequate positioning of the patient on the X-ray table on admission and computed tomography scan with intravenous contrast and delayed films generally performed first.Suprapubic bladder catheter placement under ultrasound guidance should be performed whenever a posterior urethral disruption is suspected.Early diagnosis and proper acute management decrease the associated complications,such as strictures,urinary incontinence and erectile dysfunction.The correct and appropriate initial treatment of associated urethral rupture is critical to the proper healing of the injury.Placing of a suprapubic cystostomy on admission and delayed anastomotic urethroplasty after 3e6 months continues to be the gold standard of treatment.In this paper,we provide a comprehensive review of the literature with a special emphasis on the various treatments available:Open or endoscopic primary realignment,immediate or delayed urethroplasty after suprapubic cystostomy,and delayed optical urethrotomy.
基金Project supported by the Medical Health Program of Zhejiang Province(No.2014ZDA011)the Zhejiang Provincial Natural Science Foundation of China(No.2015KYB222)
文摘Objectives： We retrospectively reviewed the urethral stricture cases treated in our tertiary center, and assessed the safety and feasibility of the high-pressure balloon dilation （HPBD） technique for anterior urethral stricture Methods： From January 2009 to December 2012, a total of 31 patients with anterior urethral strictures underwent HPBD at our center, while another 25 cases were treated by direct vision internal urethrotomy （DVIU）. Patient de- mographics, stricture characteristics, surgical techniques, and operative outcomes were assessed and compared between the two groups. The Kaplan-Meier survival analysis was applied to evaluate the stricture-free rate for the two surgical techniques. Results： The operation time was much shorter for the HPBD procedure than for the DVIU （（13.19±2.68） min vs. （18.44±3.29） min, P〈0.01）. For the HPBD group, the major postoperative complications as urethral bleeding and urinary tract infection （UTI） were less frequently encountered than those in DVIU （urethral bleeding： 2/31 vs. 8/25, P=0.017; UTI： 1/31 vs. 6/25 P=0.037）. The Kaplan-Meier survival analysis showed that there was no significant difference in stricture-free rate at 36 months between the two groups （P=-0.21, hazard ratio （HR）=0.65, 95% confidence interval （CI）： 0.34 to 1.26）. However, there was a significantly higher stricture-free survival in the HPBD group at 12 months （P=-0.02, HR=0.35, 95% CI： 0.14 to 0.87）, which indicated that the stricture recurrence could be delayed by using the HPBD technique. Conclusions： HPBD was effective and safe and it could be considered as an alternative treatment modality for anterior urethral stricture disease.
文摘Objective:To prospectively follow up a cohort of anterior urethral stricture disease patients managed with balloon dilation(BD)for 3 years to evaluate the long-term outcomes and to study factors that contribute to recurrence.Methods:This study included men who had urethral BD for significant anterior urethral stricture disease between January 2017 and March 2019.Data about the patient age,stricture characteristics,and recurrence date were recorded,along with information on postoperative indwelling catheter use and operative complications.Furthermore,information about the self-calibration procedure was collected and where available,free flow(FF)measurements during the follow-up period were recorded and analyzed.Success was defined as a lack of symptoms and acceptable FF rates(maximum flow rate>12 mL/s).Results:The final analysis was conducted on 187 patients.The mean follow-up period was 37 months.The long-term overall success rate at the end of our study was 66.8%.Our recurrence rate was 7.4%at 12 months,24.7%at 24 months,and reached 33.2%at the end of our study.The time to recurrence ranged from 91 days to 1635 days,with a mean of 670 days.The stricture-free survival was significantly shorter with lengthy peno-bulbar(p=0.031)and multiple strictures(p=0.015),and in the group of patients who were not committed to self-calibration protocol(p<0.011).However,post-procedural self-calibration was the most important factor that may have decreased the incidence of recurrence(odds ratioZ5.85).Adjuvant self-calibration after BD not only reduced the recurrence rate from 85.4%in the non-self-calibration group to 15.1%in the self-calibration one(p<0.001),but also improved the overall stricture-free survival and FF parameters.
文摘Objective:Female urethral stricture (FUS) accounts for about 4%–13% of cases of female bladder outlet obstruction. FUS was and is still managed by repeated dilatations and/or direct visual internal urethrotomy. There are many alternative options for reconstruction like buccal or vaginal mucosal graft urethroplasty. Our aim was to describe the technique of dorsal onlay buccal mucosal graft (BMG) urethroplasty for FUS and present the outcomes.Methods:Between January 2014 and December 2021, 37 patients who underwent dorsal onlay BMG urethroplasty were included in the study. Their pre-operative diagnosis was confirmed with uroflowmetry, micturating cystourethrogram, urethral calibration, and on table cystoscopy. Bladder catheter was removed after 2 weeks. Patients were followed up at 3 months, 6 months, 1 year, and then annually with urine analysis, uroflowmetry, and post-void residual assessment. We defined success as a maximum flow rate (Q_(max)) above 15 mL/s without the need for an additional instrumentation.Results:The mean age of patients was 47.8 (standard deviation [SD] 11.3) years. Twenty patients had previously undergone urethral dilatations. The mean pre-operative Q_(max) was 7.79 (SD 3.73) mL/s. However, the mean Q_(max) improved to 23.20 (SD 8.25) mL/s after surgery. The mean post-void residual urine after surgery was 30.50 (SD 10.70) mL. This reduced from a mean value of 139.00 (SD 147.24) mL before surgery. The mean follow-up was 30.2 (SD 18.3, range 18–44) months. There was no post-operative incontinence. There were Clavien–Dindo Grade 1 complications in 6 out of 37 (16.2 %) patients during hospital stay. The only long-term complication was recurrence of stricture in 4 (10.8%) patients.Conclusion:Dorsal onlay BMG urethroplasty in females is a safe, effective technique which can avoid repeated painful dilatations and multiple urethrotomies. One should always consider reconstruction in FUS without any fear of incontinence.
文摘Background: Urethral stricture is a pathology frequently encountered in urological practice. Management is often surgical, with possible recurrences. What about this pathology in Kara, a semi-urban city? Objective: Assess the management of male urethral stricture in Kara. Patients and Methods: This was a descriptive study with retrospective data collection. The study took place in the urology department of the teaching hospital of Kara, from December 2020 to December 2022. All cases of male urethral stricture, surgically treated at the teaching hospital of Kara, were listed. The inclusion criteria were as follows: any patient who had been treated surgically for male urethral stricture in the urology department of the teaching Hospital of Kara. The operating theater register and hospital records were used to collect the data. The diagnosis of urethral stricture had been made with retrograde urethrogram. A total of 24 patients were treated for male urethral stricture during the study period. The following variables were studied: age, reason for consultation, location, length, and etiology of the stricture;the type of treatment received: optical internal urethrotomy, or anastomotic urethroplasty, and the results. The result was considered good if, after removal of the urethral catheter, the patient regained his micturition without the need for dilatation;the result was considered average if, after removal of the urethral catheter, the patient needed one or more dilatation sessions to regain urination;the result was considered poor if, after removal of the catheter, the patient did not regain good micturition despite the urethral dilatation sessions. Microsoft excel and epi info 7 software were used for data processing. Results: The average age of our patients was 43.7 years ± 10.18 with extremes ranging from 27 to 70 years. The most represented age groups were that of 40 to 50 years, with 37.5% of cases;and that of 30 to 40 years with 33.3% of cases. The patients had consulted for urine retention in 66.6% of cases;the location of urethral stricture was bulbar in 45.8% of cases. The most found etiology was infectious in 58.3% of cases. Among our patients, 58.3% had received optical internal urethrotomy as treatment, while 41.6% of our patients had received anastomotic urethroplasty as treatment. Postoperatively, after removal of the urinary catheter, 87.5% of patients had benefited from one or repeated dilatation. In terms of results, we had a good result in 20.8% of patients;the result was average in 45.8% of patients, and poor in 33.3% of patients. The average duration of follow-up was 14.3 +/- 7.2 months (3-27). Conclusion: Male urethral stricture mainly affects young adults in Kara. Surgical management is done by optical internal urethrotomy and/or anastomotic urethroplasty.
