Feasibility of Transvesical Prostate Resection and Its Effect on Postoperative Complications.

OBJECTIVE: To study the feasibility of transvesical prostate resection and its effect on urethral stricture. MATERIALS AND METHODS: We included 99 patients with symptomatic bladder outlet obstruction who underwent transvesical resection of prostate (TVRP; n = 48) and transurethral (TURP; n = 51) prostatectomy. We examined all the patients by means of digital rectal examination, transrectal ultrasound, and evaluated them by international prostate symptom score, quality of life score, uroflowmetric assessment and PSA level, and established definitive diagnosis. We followed up the patients in first month, third month, and the first year of the operation and monitored once a year in the following years. RESULTS: In this study, totally 99 symptomatic bladder outlet obstruction patients were included (TVRP = 48 and TURP = 51). Mean age of the patients were 66.5 ± 8.2vs 68 ± 9.8years for our patients with TVRP and TURP, respectively. Two groups displayed similar values in terms of improvements in the Qmax and PVR, and there were no statistically significant differences in between. We obtained similar values for resection time and weight of resected prostate tissue in both groups. Urethral stricture was not observed in TVRP group. In TURP group however, stricture was observed in 4 (7.8%) patients in bulbar urethra in sixth month at average. And there was also a concomitant urethral meatal stricture in one of these patients. When the 2 groups were compared, the rate of urethral stricture was statistically significantly higher in the TURP group (P = .001). CONCLUSION: Resection of prostate without using urethra significantly reduces the incidence of urethral stricture due to mucosal damage.

Buccal epithelium Expanded and Encapsulated in Scaffold-Hybrid Approach to Urethral Stricture (BEES-HAUS) procedure: A novel cell therapy-based pilot study.

OBJECTIVES: To describe the feasibility of a novel cell-based endoscopic technique using buccal epithelium, expanded and encapsulated in a thermoreversible gelation polymer scaffold for the treatment of urethral stricture. METHODS: Six male patients with bulbar urethral stricture ranging from 2.0 to 3.5 cm in length were included in this pilot study. Autologous buccal epithelial cells from a small buccal mucosal biopsy were isolated, cultured and encapsulated in thermoreversible gelation polymer scaffold, and were implanted at the stricture site after a wide endoscopic urethrotomy. RESULTS: All the patients voided well, with a mean peak flow rate of 24 mL/s. Urethroscopy carried out at 6 months showed healthy mucosa at the urethrotomy site. However, two of the six patients had recurrence at 18 and 24 months, respectively. CONCLUSIONS: This endoscopic-based Buccal epithelium Expanded and Encapsulated in Scaffold-Hybrid Approach to Urethral Stricture (BEES-HAUS) technique is a promising alternative for the open substitution buccal graft urethroplasty. It is possible to achieve the benefits of open substitution buccal urethroplasty with this endoscopic technique.

Management of complications after surgical outlet reduction for benign prostatic obstruction.

INTRODUCTION: Lower urinary tract symptoms are a common complaint. Surgery to debulk hyperplastic prostate tissue is indicated for men with symptoms refractory to medical therapy, or for those who cannot tolerate first-line medications. In recent decades, new endoscopic techniques have been developed to reduce the morbidity of transurethral resection of the prostate (TURP). Nonetheless, complications are still frequently encountered in the immediate, early, and remote postoperative setting. MATERIALS AND METHODS: In this review, we perform an in-depth examination of contemporary treatment strategies for long term complications of surgical outlet reduction procedures. Complications encountered in the remote postoperative setting such as erectile dysfunction (ED), urethral stricture, refractory incontinence, and bladder neck contracture were identified in the literature. RESULTS: Treatment strategies for ED after TURP do not differ from algorithms applied for ED due to other causes. Management of urethral stricture following TURP depends on the size and location of narrowing and can range from simple dilation to complex excision with grafting techniques or perineal urethrostomy. Refractory urinary incontinence requires a full diagnostic evaluation, and artificial urinary sphincter placement is efficacious for cases that do not respond to first-line medical therapy. Finally, numerous therapies for bladder neck contracture exist and vary in their invasiveness. CONCLUSION: Endoscopic reduction of the prostate for the male with benign prostatic obstruction via most contemporary modalities is a safe and effective means to decrease outlet resistance to urinary flow. However, late complications from these procedures still exist. Management of remote morbidity following TURP can be diagnostically and therapeutically complex, necessitating prompt referral to a genitourinary reconstruction specialist.

[Combined laser recanalization in the prostatic region of the urethra]. / Kombinirovannaia lazernaia rekanalizatsiia prostaticheskogo otdela uretry.

A case is reported of an effective use of laser endoscopic intervention in benign prostatic hyperplasia when urethral anatomic size was small. The combined laser recanalization helped recovery of adequate non-assisted urination. Long-term outcome was favorable.

[General considerations on and the role of internal urethrotomy in the treatment of urethral stricture]. / Considérations générales et place de l'urétrotomie interne dans le traitement du rétrécissement de l'urètre.

After stressing the importance of a precise diagnosis, the author defines the place of internal urethrotomy, which is certainly not always the first-line treatment that some would claim, due to its poor success rate and because an endoscopic reoperation is sometimes much less harmless than it appears. The importance of perfect anaesthesia for urethral surgery is then emphasised in view of the particular demands of this surgery. Finally, the author reviews the various approaches to the urethra and opening of the stricture.

Internal optical urethrotomy: a report of fifty-one cases treated under local anaesthesia.

Over the 15-month period beginning from October 1985, internal optical urethrotomy was successfully performed under local anaesthesia on 51 patients with urethral stricture. The procedure was well tolerated and 48 patients were discharged home on the day of operation. A urethral catheter (18 or 20F Foley) was left indwelling for one week post-operatively. Subsequently patency was assessed by check catheterisation using size 18F Nelaton Catheter, weekly for 6 weeks, and then at 3 monthly intervals. Thirty-nine patients have been followed up regularly for 3 to 15 months. Six patients restrictured (failed check catheterisation). The remaining 33 (84.6%) have retained urethral patency with no additional treatment.