The relationship between heart failure and smoking, and development of urethral stricture.

OBJECTIVE: To evaluate the relationship between heart failure (HF), chronic obstructive pulmonary disease (COPD), and smoking with the development of urethral stricture (US) by examining the patients who underwent transurethral prostate resection procedure, with and without the development of US in their follow-ups. METHODS: Among the patients who underwent transurethral resection of the prostate, 50 patients who developed US during their follow-ups formed group 1, while a total of 50 patients who did not develop US and were selected by lot formed group 2. The relationship between the patients' data on HF, COPD and smoking status and the development of US was investigated. RESULTS: The mean number of cigarettes smoked was statistically significantly high in the group with stricture (p = 0.007). Furthermore, pulmonary function test parameters of patients such as forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC were found to be statistically significantly higher in Group 2 (p < 0.001, p < 0.001, and p = 0.008, respectively). In the logistic regression analysis, being a smoker was found to be the strongest predictor (p = 0.032). CONCLUSION: Our study concluded that smoking, HF, and COPD significantly increase the risk of developing stricture after transurethral resection of the prostate.

OBJETIVO: Evaluar la relación de la insuficiencia cardiaca, la enfermedad pulmonar obstructiva crónica y el tabaquismo con el desarrollo de estenosis de uretra en pacientes sometidos a resección transuretral de próstata con y sin desarrollo de estenosis de uretra en su seguimiento. MÉTODO: Cincuenta pacientes que desarrollaron estenosis de uretra durante su seguimiento formaron el grupo 1, y 50 pacientes que no desarrollaron estenosis de uretra y fueron seleccionados por lote formaron el grupo 2. Se investigó la relación de los datos de los pacientes sobre insuficiencia cardiaca, enfermedad pulmonar obstructiva crónica y tabaquismo con el desarrollo de estenosis uretral. RESULTADOS: La media de cigarrillos fumados fue significativamente más alta en el grupo con estenosis (p = 0.007). Además, se encontró que los parámetros de las pruebas de función pulmonar de los pacientes, como FEV1, FVC y FEV1/FVC, eran significativamente más altos en el grupo 2 (p < 0.001, p < 0.001 y p = 0.008, respectivamente). CONCLUSIONES: El tabaquismo, la insuficiencia cardiaca y la enfermedad pulmonar obstructiva crónica aumentan significativamente el riesgo de desarrollar estenosis después de una resección transuretral de próstata.

Simplified urethral score system for predicting complex anterior urethroplasty.

OBJECTIVE: To assess U-score individual values as urethral complex surgery predictors. METHODS: Cross-sectional study including patients who received anterior urethroplasty from 2011 to 2019. U-score (etiology (1-2 points), number of strictures (1-2 points), anatomic location (1-2 points) and length (1-3 points)) was measured individually and globally. Surgical complexity was defined as low (anastomotic, buccal mucosal graft, and augmented anterior urethroplasty), and high complexity (double buccal mucosal graft, flap, and graft/flap combination). U-score components were included as complex surgery predictor and as main variable with individual probability values estimations and comparisons. Risk complex surgery probability groups were established. RESULTS: 654 patients were included. Mean age was 57.2 years. Low complexity surgery was performed in 464 patients (259 anastomotic, 144 graft, 61 augmented anterior urethroplasty) and high complexity was done in 190 (53 double buccal mucosa graft, 27 flap, 110 graft/flap comb.). In multivariate analysis length, number of strictures and location were predictors of complexity. Introducing U-Score as only variable in univariate model predicted an OR 8.52 (95%CI 6.1-11). Simplified U-score grouping set obtained by complex probability was: low risk (4-5 points), medium risk (6 points) and high risk of complexity (7-9 points) Predicted risk of complex surgery probability (95%CI) for low, median and high risk group were 1.6 (0-2.9), 19.1 (13.8-25.9) and 77.9 (61.6-88.7), respectively. CONCLUSIONS: U-score can be used as a tool to predict complex urethral surgery. We present a simplified U-score risk tool to assess individual complex anterior urethroplasty probability.

Safety and efficacy of urethroplasty based on age groups.

OBJECTIVE: To analyze the results and complications after urethroplasty based on patient age groups. As secondary objective, we analyzed the impact of operative complexity on each age group. MATERIAL AND METHODS: This is a retrospective cohort study that include male patients who underwent urethroplasty between January 2011 and December 2018. Data was obtained from the patients' electronic health records. Patients were grouped as follows: <60 years, 60-79 years and >80 years. Variables evaluated were history, comorbidities, previous surgeries and operative complexity. Restenosis-free survival and complications presented in each group were determined according to the Clavien-Dindo classification system. The SPSS® program was used for statistical analysis. RESULTS: A total of 783 patients were included, and the mean follow-up was 19 months. The estimated 2-year restenosis-free survival in the population under 60, 60-79 and over 80 years was 87, 87 and 93.9% (IC 95%), respectively. Univariate analysis showed that the age group was not a predictor of restenosis. Complex surgery is the only predictor of recurrence, increasing the risk by 60% (HR 1.64, 95% CI 1.05-2.56, p = 0.029). There was an overall complication rate of 30.8%, and 62% of these were Clavien ≤ II. We found no association between the frequency of complications and age. CONCLUSIONS: Urethroplasty is safe and effective regardless of age group. There are no statistically significant differences in outcomes and complications shown by the age group comparison. There were no significant differences when analyzing the impact of complex surgeries among the different age groups. The data indicate that age alone should not be taken as an absolute exclusion criterion for patients needing urethral reconstruction.

Safety and efficacy of urethroplasty based on age groups. / Seguridad y eficacia de la uretroplastia según grupos etarios.

OBJECTIVE: To analyze the results and complications after urethroplasty based on patient age groups. As secondary objective, we analyzed the impact of operative complexity on each age group. MATERIAL AND METHODS: This is a retrospective cohort study that include male patients who underwent urethroplasty between January 2011 and December 2018. Data was obtained from the patients' electronic health records. Patients were grouped as follows: < 60 years, 60-79 years and > 80 years. Variables evaluated were history, comorbidities, previous surgeries and operative complexity. Restenosis-free survival and complications presented in each group were determined according to the Clavien-Dindo classification system. The SPSS® program was used for statistical analysis. RESULTS: A total of 783 patients were included, and the mean follow-up was 19 months. The estimated 2-year restenosis-free survival in the population under 60, 60-79 and over 80 years was 87, 87 and 93.9% (IC 95%), respectively. Univariate analysis showed that the age group was not a predictor of restenosis. Complex surgery is the only predictor of recurrence, increasing the risk by 60% (HR 1.64, 95% CI 1.05-2.56, p = 0.029). There was an overall complication rate of 30.8%, and 62% of these were Clavien ≤ II. We found no association between the frequency of complications and age. CONCLUSIONS: Urethroplasty is safe and effective regardless of age group. There are no statistically significant differences in outcomes and complications shown by the age group comparison. There were no significant differences when analyzing the impact of complex surgeries among the different age groups. The data indicate that age alone should not be taken as an absolute exclusion criterion for patients needing urethral reconstruction.

A retirada dos urólitos de oxalato de cálcio e desobstrução da uretra através da realização da técnica cirúrgica uretrostomia em cães: relato de caso / Removal of calcium oxalate uroliths and urethral clearing through urethrostomy in dogs: case report / La retirada de urólitos de oxalato de calcio y desobstrucción de la uretra a través de realización de la técnica quirúrgica urestrostomía en perros: relato de caso

A uretra do macho é uma continuação do sistema de ductos, originada de um óstio interno no colo da bexiga urinária e estendida até o orifício peniano uretral externo na extremidade livre do pênis. Relata-se um caso de um canino, macho, SRD, de três anos, pesando 12 kg. Foi atendido no Hospital Veterinário Universitário "Jeremias Pereira da Silva" - HVU/UFPI, na área de Clínica Médica e Cirúrgica de cães e gatos. O mesmo apresentava manifestações clínicas como: dificuldade de locomoção, disúria, inapetência, hematúria, anúria, agressividade, dor abdominal, apatia e emagrecimento progressivo. A conduta clínica adotada diante do caso, após o resultado dos exames complementares que confirmaram o diagnostico inicial, indicativo de obstrução uretral total por urólitos de oxalato de cálcio, devido ao insucesso das tentativas clínicas de desobstrução foi optar pela técnica cirúrgica uretrostomia. Decorrido dez dias da cirurgia, o animal retornou para retirada dos pontos, apresentando-se em bom estado, alimentando-se bem, fluxo urinário constante (sem sangue), e andando normalmente. A urolitíase deve ser diagnosticada e tratada o mais previamente possível, uma vez que a doença se complica no avançar dos sinais clínicos, podendo ocasionar casos mais complexos, como obstruções urinárias severas e até morte do animal.(AU)

The male urethra is a continuation of the duct system originated from an internal ostium inside the bladder and extends to the external urethral penile hole at the free end of the penis. This is a case study of a 3-year old male mongrel dog weighing 12 kg. The dog was attended at the University Veterinary Hospital "Jeremias Pereira da Silva" ­ HVU/UFPI in the Clinical and Surgical Practice of dogs and cats. It presented clinical manifestations such as difficulty in walking, dysuria, loss of appetite, hematuria, anuria, aggressiveness, abdominal pain, lethargy and progressive weight loss. An urethrostomy was the clinical approach adopted for the case, after the laboratory tests confirmed the initial diagnosis of total urethral obstruction by calcium oxalate uroliths due to the failure of clinical unblocking attempts. Ten days after the surgery, the animal returned to the clinic to remove the stitches, and presented a good condition, feeding well, with a constant urine flow (no blood), and walking normally. Urolithiasis must be diagnosed and treated as early as possible, since the disease complicates itself with the worsening of the clinical signs, which may result in more complex cases, such as severe urinary obstruction and even the death of the animal.(AU)

La uretra del macho es una continuación del sistema de ductos, originada de un ostium interno en el cuello de la vejiga urinaria y se extiende hasta el orificio uretral externo en la extremidad libre del pene. Presentamos un caso de un canino, macho, SRD, de tres años, con un peso de 12 kg. Fue atendido en el Hospital Veterinario de la Universidad "Jeremías Pereira da Silva" - HVU/UFPI, en el campo de Clínica Médica y Quirúrgica de perros y gatos. Lo mismo presentaba manifestaciones clínicas como: dificultad para caminar, disuria, pérdida de apetito, hematuria, anuria, agresividad, dolor abdominal, letargo y pérdida progresiva de peso. La conducta clínica adoptada delante el caso, tras el resultado de los exámenes complementarios que confirmaron el diagnóstico inicial, indicativo de obstrucción uretral total de cálculos de oxalato de calcio, debido al fracaso de las tentativas clínicas de desbloqueo cupo optar por uretrostomía, técnica quirúrgica. Después de diez días de la cirugía el animal volvió para retirada de los puntos de sutura, presentándose en buen estado, alimentándose bien, flujo de orina constante (sin sangre), y caminando normalmente. La urolitiasis debe ser diagnosticada y tratada cuanto antes posible, ya que la enfermedad se complica con el avance de los signos clínicos, pudiendo causar casos más complejos, como obstrucciones urinarias severas e incluso la muerte del animal.(AU)

A retirada dos urólitos de oxalato de cálcio e desobstrução da uretra através da realização da técnica cirúrgica uretrostomia em cães: relato de caso / Removal of calcium oxalate uroliths and urethral clearing through urethrostomy in dogs: case report / La retirada de urólitos de oxalato de calcio y desobstrucción de la uretra a través de realización de la técnica quirúrgica urestrostomía en perros: relato de caso

A uretra do macho é uma continuação do sistema de ductos, originada de um óstio interno no colo da bexiga urinária e estendida até o orifício peniano uretral externo na extremidade livre do pênis. Relata-se um caso de um canino, macho, SRD, de três anos, pesando 12 kg. Foi atendido no Hospital Veterinário Universitário "Jeremias Pereira da Silva" - HVU/UFPI, na área de Clínica Médica e Cirúrgica de cães e gatos. O mesmo apresentava manifestações clínicas como: dificuldade de locomoção, disúria, inapetência, hematúria, anúria, agressividade, dor abdominal, apatia e emagrecimento progressivo. A conduta clínica adotada diante do caso, após o resultado dos exames complementares que confirmaram o diagnostico inicial, indicativo de obstrução uretral total por urólitos de oxalato de cálcio, devido ao insucesso das tentativas clínicas de desobstrução foi optar pela técnica cirúrgica uretrostomia. Decorrido dez dias da cirurgia, o animal retornou para retirada dos pontos, apresentando-se em bom estado, alimentando-se bem, fluxo urinário constante (sem sangue), e andando normalmente. A urolitíase deve ser diagnosticada e tratada o mais previamente possível, uma vez que a doença se complica no avançar dos sinais clínicos, podendo ocasionar casos mais complexos, como obstruções urinárias severas e até morte do animal.(AU)

The male urethra is a continuation of the duct system originated from an internal ostium inside the bladder and extends to the external urethral penile hole at the free end of the penis. This is a case study of a 3-year old male mongrel dog weighing 12 kg. The dog was attended at the University Veterinary Hospital "Jeremias Pereira da Silva" ­ HVU/UFPI in the Clinical and Surgical Practice of dogs and cats. It presented clinical manifestations such as difficulty in walking, dysuria, loss of appetite, hematuria, anuria, aggressiveness, abdominal pain, lethargy and progressive weight loss. An urethrostomy was the clinical approach adopted for the case, after the laboratory tests confirmed the initial diagnosis of total urethral obstruction by calcium oxalate uroliths due to the failure of clinical unblocking attempts. Ten days after the surgery, the animal returned to the clinic to remove the stitches, and presented a good condition, feeding well, with a constant urine flow (no blood), and walking normally. Urolithiasis must be diagnosed and treated as early as possible, since the disease complicates itself with the worsening of the clinical signs, which may result in more complex cases, such as severe urinary obstruction and even the death of the animal.(AU)

La uretra del macho es una continuación del sistema de ductos, originada de un ostium interno en el cuello de la vejiga urinaria y se extiende hasta el orificio uretral externo en la extremidad libre del pene. Presentamos un caso de un canino, macho, SRD, de tres años, con un peso de 12 kg. Fue atendido en el Hospital Veterinario de la Universidad "Jeremías Pereira da Silva" - HVU/UFPI, en el campo de Clínica Médica y Quirúrgica de perros y gatos. Lo mismo presentaba manifestaciones clínicas como: dificultad para caminar, disuria, pérdida de apetito, hematuria, anuria, agresividad, dolor abdominal, letargo y pérdida progresiva de peso. La conducta clínica adoptada delante el caso, tras el resultado de los exámenes complementarios que confirmaron el diagnóstico inicial, indicativo de obstrucción uretral total de cálculos de oxalato de calcio, debido al fracaso de las tentativas clínicas de desbloqueo cupo optar por uretrostomía, técnica quirúrgica. Después de diez días de la cirugía el animal volvió para retirada de los puntos de sutura, presentándose en buen estado, alimentándose bien, flujo de orina constante (sin sangre), y caminando normalmente. La urolitiasis debe ser diagnosticada y tratada cuanto antes posible, ya que la enfermedad se complica con el avance de los signos clínicos, pudiendo causar casos más complejos, como obstrucciones urinarias severas e incluso la muerte del animal.(AU)

Uretroplastía: experiencia del servicio de urología del Hospital Regional de Talca / Urethroplasty: experience of urology of the regional Hospital of Talca

Analizar en forma retrospectiva nuestros resultados con uretroplastías en 2 grupos según la técnica utilizada. MATERIAL Y MÉTODO: En el periodo 1997-2012 se efectuaron 58 Uretroplastías, 32 de sustitución (grupo 1) en los que se utilizó principalmente colgajo de piel de pene (77 por ciento) y 26 Uretroplastías anastomóticas (grupo 2). Motivo de análisis son 30 y 24 casos respectivamente. Un buen resultado se definió por un factor subjetivo (relato del paciente), Flujometría igual o mayor de 10 ml/seg. c/s IPSS igual o < 9.RESULTADOS: En el grupo 1 el 77 por ciento la lesión era >4 cm y con 83 por ciento de buenos resultados a una mediana de seguimiento de 41meses. El 23 por ciento, requirió procedimientos complementarios. El 61 por ciento tuvo algún compromiso de vascularización de piel de pene. En el grupo 2 el 46 por ciento fue por fractura de pelvis con una tasa de buenos resultados de 92 por ciento con una mediana de seguimiento de 25.5 meses, 21 por ciento de procedimientos complementarios de retoque y sin complicaciones. CONCLUSIONES: Nuestra serie tiene resultados comparables con lo publicados en la literatura.

Throughout this study the researcher(s) personal experience in urethroplasty during the period 1997-2012 was analyzed. To conduct it, the studied cases were divided into two different groups; the first group were 30 cases of substitution urethroplasty with a forty-one-months median follow-up, where the success rate was 83 percent. The most frequent complications were impairment of vascular supply of the penile skin secondary the use of distal penile circular fascio cutaneus flap(61 percent). The second group (group nº2) was composed by 24 cases of anastomotic urethroplasty with a median follow-up of 25,5 months, in this group the success rate was 92 percent and no complications were observed. After this study, it is possible to assert that the obtained results are in concordance with what is stated in the international literature.

Hacia un manejo racional de la estrechez de la uretra anterior: ¿Que dice la evidencia?: [revisión] / Evidence based rationale behind anterior urethra treatment: [review]

El manejo de las estenosis de la uretra anterior es controversial. Tradicionalmente se le ha tratado con métodos minimamente invasivos (dilataciones y uretrotomía interna). Sin embargo esos métodos no son capaces de curar a más del 30 por ciento a 35 por ciento de los pacientes. Por otro lado la cirugía de reconstrucción uretral (uretroplastia) es más compleja y requiere entrenamiento, pero puede curar a la vasta mayoría de los pacientes en un solo procedimiento quirúrgico. Debido a falta de experiencia y entrenamiento en uretroplastia, existe sobre-uso y abuso de los métodos no invasivos, en perjuicio de la calidad de vida de los pacientes. Existe amplia evidencia que la uretrotomía interna es un excelente método para estenosis de hasta 1cm de longitud, pero su efectividad disminuye dramáticamente por sobre 1,5 cm. Estenosis mas largas tienen indicación directa de uretroplastia, sobre todo si ya han fallado una uretrotomía previa. De este modo creemos que el manejo debe ser selectivo empleando el tratamiento apropiado orientado a curar y no solo paliar la enfermedad. Es necesario mejorar el entrenamiento de los urólogos en uretroplastia y/o establecer centros de referencia, de modo de ofrecer el tratamiento óptimo para cada caso.

Management of anterior urethral stricture disease is controversial. For centuries the primary management has been minimally invasive dilation or urethrotomy. However, there is ample evidence that these methods cannot cure more than one third of the patients. The rest are condemned to chronic repetitive non-curative instrumentation. Open reconstructive urethral surgery is the alternative. Although it requires training and experience, the majority of patients are cured in one surgical procedure. Unfortunately, due to lack of training in urethroplasty techniques, there is abuse of internal urethrotomy and dilation, severely compromising patient’s quality of life. Optical internal urethrotomy is an excellent choice in strictures up to 1 cm long, but dramatically loses effectiveness over 1.5 cm. Strictures >2.0 cm should be treated with urethroplasty, particularly if they have failed a previous urethrotomy. We believe that management should be selective, oriented to cure and not only to palliate of the disease. Urologists should improve their training in urethroplasty and we need to implement referral centers in order to offer the best treatment and the best results for each case.