[Pathomorphological aspects of urethral strictures of various etiologies].

INTRODUCTION: The study of the structure of strictures of various etiologies is an open and uncertain issue of modern urology. AIM: To evaluate the morphological and immunohistochemical structure of strictures of various etiologies. MATERIALS AND METHODS: The study involved postoperative tissue of a pathologically altered urethra of 110 patients aged 23 to 74 years who underwent treatment at the University Clinic of Urology, Russian National Research Medical University. N.I. Pirogova (2014-2018) with Ds: urethral stricture. Morphological study: Van-Gieson staining; hemotoxylin - eosin. Immunohistochemical study: mouse monoclonal antibodies to muscle and connective tissue markers (Smooth Muscle Actin, Vimentin, Calponin) and inflammation markers (CD45R, CD58, CD138, CD20, CD3) were used as primary antibodies in all reactions. RESULTS: According to the revealed morphological changes, the material was divided into three groups: group I (n=27) - active inflammation; group II (n=33) - the predominant development of connective tissue with low activity of inflammation; group III (n=50) - mixed (chronic mild inflammation, an even amount of connective tissue). In a morphological study of idiopathic urethral strictures, it was noted that the multicolumnar epithelium was replaced by a multi-layer flat epithelium with a weakly pronounced keratinization. Inflammatory changes were mild, including the submucosal connective tissue and the spongy body. Spongiofibrosis is accompanied by a significant reduction in the vascular bed of both venous sinuses and arteries. The same changes were observed in the inflammatory genesis of urethral strictures. In the study of strictures with traumatic etiology, a restructuring of the cylindrical epithelium was observed. In cases with severe inflammation in the mucosa, the changes were atrophic-hyperplastic in nature with reactive cell atypia. CONCLUSION: urethral Strictures in men have a specific etiological factor, but the pathogenesis of urethral lesions can be divided into: post-traumatic and post-inflammatory.

[Iatrogenic urethral structures in men].

INTRODUCTION: Iatrogenic urethral damage is the leading etiologic factor for urethral stricture in men in developed countries and second after traumatic injury in developing ones. This study aimed to evaluate the frequency of iatrogenic strictures of the urethra and the results of their treatment. MATERIALS AND METHODS: This retrospective analysis comprised 133 patients who were treated for iatrogenic urethral stricture from 2011to 2016. Group I included 72 (54%) patients after trans(intra)urethral interventions (transurethral resection of the prostate or urinary bladder), urethral dilation, traumatic catheterization, etc. Forty-five (34%) patients with post-catheter strictures (ischemic/post-inflammatory), 7 (5%) patients after failed treatment of hypospadias, and 9 (7%) patients after open adenomectomy made up groups II, III, and IV. The diagnosis of recurrent stricture and the need for repeat surgical intervention were determined based on uroflowmetry, urethrography, and urethrocystoscopy. RESULTS: In group I, the mean extent (rank) of the stricture was 2 (0.1-15) cm, the most frequent location (85%) was the bulbar urethra. In group II, the most frequent location (71%) was also the bulbar urethra with a mean stricture length of 2.4 (0.3-13) cm. There were 4 cases of panurethral strictures, lesions of the penile urethra and meatal stenosis. In group III, the strictures were on average 6 (2-12) cm long. Patients group IV had strictures of the bulbar and prostatic urethra. In general, the effectiveness of endoscopic treatment (direct vision internal urethrotomy, DVIU) was 52%, the effectiveness of urethroplasty varied from 83 to 100% depending on the method. In group I, the effectiveness of the DVIU was 52%, various types of urethroplasty - 88-100%, in group II - 50% and 82-100%, respectively. In group III, the effectiveness of the single-stage/multi-stage buccal mucosa urethroplasty was estimated at 0%/100%. In group IV, the effectiveness of DVIU/urethroplasty/perineal prostatectomy was 20%/75%/100%. CONCLUSION: The proportion of iatrogenic urethral strictures in large megacities can reach 45%. Iatrogenic urethral strictures most commonly result from catheterization and transurethral interventions. Each subgroup of iatrogenic strictures is characterized by its location, extent and degree of urethral spongiofibrosis. With the correct choice of surgical modality, urethroplasty is almost twice more effective than DVIU.

[Surgical technique and the first clinical experience of augmentation urethroplasty without dividing of corpus spongiosum (KODAMA technique)].

AIM: In case of complex and long urethral stricture a use of augmentation technique is often limited by "critically" narrowing of urethral plate. In such cases, the augmentation anastomotic urethroplasty without division of the corpus spongiosum can be the method of choice, because it allows to perform simultaneous augmentation urethroplasty with maximal sparing of antegrade blood flow in corpus spongiosum. MATERIALS AND METHODS: In urologic clinic of N.I. Pirogov City Clinical Hospital No1 the analysis of 17 patients who were undergone to augmentation anastomotic urethroplasty without division of the corpus spongiosum (Kodama technique), performed by single surgeon from 2013 to 2017 yy was done. The meant stricture length was 3.75 cm (2-6). Penile, bulbar and panurethral stricture was found in 6 (35.3%), 7 (41.2%) and 4 (23.5%) cases, respectively. RESULTS: Technique efficiency was 88.2% and in 2 patients (11.8%) a stricture recurrence developed. The mean maximum flow rate before and after surgery were 5.4 and 23.1 ml/s, respectively (p<0.05). The mean catheterization time was 14 (7-30) days. There were no patients with de novo urinary incontinence and erectile dysfunction. CONCLUSION: The initial results of augmentation anastomotic urethroplasty without division of the corpus spongiosum showed high efficiency. To our opinion, the antegrade blood flow sparing makes it the method of choice in patients with long non-traumatic urethral stricture (without severe spongiofibrosis), good preoperative erectile function but isolated length of "critically" narrowing of the urethral lumen.

[Buccal mucosa transplant the concept of ideal graft in surgical management of peyronies disease].

INTRODUCTION: Surgical techniques in managing Peyronies disease include plication corporoplasty, plaque incision, grafting and penile prosthesis implantation. The question of an ideal transplant for corporoplasty remains open. AIM: To evaluate the effectiveness of the substitution corporoplasty using buccal mucosa transplant (BMT) in treating Peyronies disease. MATERIALS AND METHODS: From January 2011 to February 2016, 28 patients with stable stage Peyronies disease underwent substitution coroproplasty using BMT (incision and grafting). The mean age of patients was 54.8+/-6.2 years. All patients completed an IIEF-5 questionnaire and underwent a standard preoperative examination: anamnesis, physical examination, penile duplex pharmaco-ultrasonography and penile fixation photography to assess the type and angle of curvature. The average angle of penile curvature was 82.8 (45-120). All patients underwent incision and grafting using BMT; in 5 patients additionally the plication of the penile tunica albuginea was performed. Follow-up examinations were concluded at 3, 6 and 12 months and more after surgery. RESULTS: Median follow-up was 30 months. Postoperative penile straightening was achieved in 93% of patients. The duplex peak systolic velocity of the right and left cavernosal arteries improved from 42.59 to 45.64 cm/s and from 34.55 to 43.48 cm/s, respectively (p less or equal 0.05). CONCLUSION: Penile corproroplasty using BMT is a safe and effective method of treating patients with Peyronies disease. Follow-up clinical and instrumental examination showed no impairment of the erectile function or penile hemodynamics.