Is it possible to reduce the complications and mortality of patients undergoing radical cystectomy? Effectiveness of pre-operative parameters. A prospective study.

OBJECTIVE: To evaluate the relationship between serum albumin, hematocrit (HTC), age-dependent Charlson comorbidity index, body mass index (BMI), and deleted operation time in predicting mortality and complications associated with radical cystectomy. MATERIALS AND METHODS: All patients planned for radical cystectomy owing to bladder cancer were investigated prospectively between 2015 and 2016 in our clinic. A total of 55 cases were included in the study. Patients' characteristics, preoperative serum albumin values, hematocrit level, age-dependent Charlson comorbidity index (CCI), body mass index and deleted operation time, drainage catheter time, gas-stool expulsion time were recorded. The patients were followed up for 90 days. RESULTS: Age of cases, Charlson comorbidity index scores, and HCT were not different in patients with or without complications (overall) or severe complications nor in patients who died or survived after the procedure. The albumin value of the cases with observed mortality and complications was significantly lower than that of the cases with no mortality and complications. In multivariate and univariate analysis, low albumin level was established to be meaningful in predicting mortality and serious complications. The cut-off point for albumin, according to mortality, was found to be 4.1. Mortality within 90 days was 16.3% (n = 9). CONCLUSIONS: We have evaluated albumin as a marker that could indicate both mortality and the presence of severe complications after radical cystectomy and urinary diversion.

Extracorporeal Shock Wave Lithotripsy Management of Renal Stones in Children: Does Anesthesia Affect the Treatment Outcomes on an Age-based Manner?

OBJECTIVE: To evaluate beneficial effect of anesthesia on extracorporeal shock wave lithotripsy (SWL) in children older than 9 years. PATIENTS AND METHODS: A total of 61 children (aged between 9 and 17 years) treated with SWL for renal stones were included. Depending on the use of general anesthesia, the children were divided into 2 groups: cases treated with SWL under anesthesia (group 1, n = 27) and cases treated with SWL without anesthesia (group 2, n = 34). The patients in both groups were comparatively evaluated with respect to treatment-related parameters (stone size, stone laterality, stone location, mean number of sessions, mean number of shock waves applied, residual fragments size, stone-free rate [SFR], clinically significant residual fragment complications, and need for additional intervention). The efficacy quotient was also evaluated. RESULTS: The overall mean stone size was 10.48 ± 4.27 mm. Although there was no significant difference regarding the stone size (P = .924), stone laterality (P = .240), stone localization (P = .084), mean number of sessions (P = .392), SFR (P = .666), clinically significant residue (P = .526), size of residual fragments (P = .315), complication rates (P = 1.000), and need for additional intervention (P = 1.000), the mean number of shock waves applied was significantly higher in patients treated without anesthesia (group 2) (P = .001). The efficacy quotient was 41.7% and 35.4% for groups 1 and 2, respectively. CONCLUSION: Our findings indicate that anesthesia-free SWL for renal stones in children aged older than 9 years is feasible and successful with similar treatment outcome data observed in cases with the same age range being treated under anesthesia. We believe that SWL without anesthesia can be applied in a safe and successful manner in relatively older and cooperative children.

The effects of stress incontinence surgery on sexual function and life quality of women.

OBJECTIVE: To evaluate Transobturator tape (TOT) and Burch colposuspension procedure's effects on sexual functions and life quality. MATERIALS AND METHODS: A total of 81 patients who underwent TOT (n = 49) or Burch (n = 32) with stress incontinence were included in this prospective study. Preoperatively and at postoperative 6 month follow up pad and stress tests, physical examinations, Female Sexual Function Index (FSFI), International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), Urinary Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7) questionnaires were performed. Patient Global Impression of Improvement (PGI-I) questionnare was added postoperatively. RESULTS: According to stress test, success rate was found to be 69% and 45%, in the TOT and Burch groups respectively. Pad test decreased in both groups (p < 0.05). PGI-I scores was higher in the TOT group when compared to Burch group (p = 0.031). ICIQ-SF scores were improved in both TOT (p < 0.0001) and Burch groups (p < 0.012). IUDI-6 and IIQ-7 scores improved only in TOT group. Total FSFI scores did not change in both groups but only in TOT group sexual desire improved. Total FSFI scores did not change in patients that were successful and unsuccessful according to the stress test in both TOT and Burch groups (p < 0.05). CONCLUSIONS: TOT and Burch procedures have no effect on the sexual functions. However TOT improved life quality of patients.

Stone size and quality of life: A critical evaluation after extracorporeal shock wave lithotripsy.

OBJECTIVES: To evaluate the quality of life (QoL) of the patients after extracorporeal shockwave lithotripsy (ESWL) on a treated stone size related basis. METHODS: 90 patients undergoing ESWL for kidney stones were divided into three groups; Group 1 (n: 30, ≤ 10 mm), Group 2 (n: 28, 11 mm- ≤ 20 mm) and Group 3 (n: 32, 20- 25 mm). During 3- months follow-up, outcome of the procedure, number of cases with emergency department visits, analgesic required, re-tretatment rates, additional procedures and the changes in the QoL were evaluated. RESULTS: the number of emergency department visits and mean analgesic need; re-treatment rates and additional procedures were significantly higher in Group 3. Evaluation of the QoL scores in three groups showed that cases with larger stone still had lower scores during 3-month evaluation. CONCLUSIONS: Stone size could help us to predict the possible impact of ESWL on the QoL and depending on the size of the stone treated, a well planned indication and effective management possibly by an experienced urologist could limit the changes in the QoL of the patients.

Predictive parameters for medical expulsive therapy in ureteral stones: a critical evaluation.

To evaluate the predictive value of some certain radiological as well as stone-related parameters for medical expulsive therapy (MET) success with an alpha blocker in ureteral stones. A total 129 patients receiving MET for 5 to 10 mm ureteral stones were evaluated. Patients were divided into two subgroups where MET was successful in 64 cases (49.61%) and unsuccessful in 65 cases (50.39%). Prior to management, stone size, location, position in the ureter, degree of hydronephrosis, diameter of ureteral lumen proximal to the stone, ureteral wall thickness along with patient's demographics including body mass index (BMI) values were evaluated and recorded. The possible predictive values of these parameters for stone expulsion (and stone expulsion time) were evaluated in a comparative manner between two groups. The overall mean patient age and stone size values were 38.02 ± 0.94 years and 40.31 ± 1.13 mm(2), respectively. Regarding the predictive values of these parameters for MET-success, while stone size and localization, degree of hydronephrosis, proximal ureteral diameter and ureteral wall thickness were found to be highly predictive for MET-success, patients age, BMI values and stone density had no predictive value on this aspect. Our findings indicated that some stone and anatomical factors may be used to predict the success of MET in an effective manner. With this approach unnecessary use of these drugs that may cause a delay for stone removal will be avoided and the possible adverse effects of obstruction as well as stone-related clinical symptoms could be minimized.

Does metabolic syndrome increase the risk of infective complications after prostate biopsy? A critical evaluation.

PURPOSE: To evaluate the possible association between metabolic syndrome (MetS) and infectious complications after prostate biopsy. METHODS: A total of 480 men underwent prostatic biopsy due to elevated prostate-specific antigen levels and/or abnormal digital rectal examination. Patients were divided into two subgroups with respect to the presence or absence of MetS. Patients in both groups were closely followed with respect to infectious complications after biopsy and the possible effect of MetS as a certain risk factor on these complications was evaluated with a multivariate analysis. RESULTS: Infectious complications were observed in 33 cases (6.8%), while urinary tract infection (UTI) was detected in 30 (6.2%) cases, sepsis occurred in three (0.6%) cases. The percentage of the cases with infectious complications was 11.0 and 3.4% in men with and without MetS, respectively (p = 0.002). These rates were 3.7 versus 1.5%, respectively, for UTI (p < 0.003) and 0.9 versus 0.4%, respectively, for sepsis in both groups (p = 0.594). Multivariate analysis of the data confirmed that MetS was associated with an increased risk of infective complications (odds ratio 3.44 and 95% CI 1.56-7.58, p < 0.002) after this procedure. CONCLUSIONS: MetS could pose a certain increased risk for infectious complications after prostate biopsy. Patients with MetS should be considered as risk cases for this procedure, and they should be evaluated and followed in a very close manner with respect to these complications.

Does extracorporeal shock wave lithotripsy cause hearing impairment in children?

PURPOSE: We evaluated the possible effects of noise created by high energy shock waves on the hearing function of children treated with extracorporeal shock wave lithotripsy. MATERIALS AND METHODS: A total of 65 children with normal hearing function were included in the study. Patients were divided into 3 groups, ie those becoming stone-free after 1 session of shock wave lithotripsy (group 1, 22 children), those requiring 3 sessions to achieve stone-free status (group 2, 21) and healthy children/controls (group 3, 22). Extracorporeal shock wave lithotripsy was applied with patients in the supine position with a 90-minute frequency and a total of 2,000 shock waves in each session (Compact Sigma, Dornier MedTech, Wessling, Germany). Second energy level was used with a maximum energy value of 58 joules per session in all patients. Hearing function and possible cochlear impairment were evaluated by transient evoked otoacoustic emissions test at 1.0, 1.4, 2.0, 2.8 and 4.0 kHz frequencies before the procedure, 2 hours later, and 1 month after completion of the first shock wave lithotripsy session in groups 1 and 2. In controls the same evaluation procedures were performed at the beginning of the study and 7 weeks later. RESULTS: Regarding transient evoked otoacoustic emissions data, in groups 1 and 2 there was no significant alteration in values obtained after shock wave lithotripsy compared to values obtained at the beginning of the study, similar to controls. CONCLUSIONS: A well planned shock wave lithotripsy procedure is a safe and effective treatment in children with urinary stones and causes no detectable harmful effect on hearing function.

A rare complication of ESWL: focal metastatic multiple organ abscesses in a horseshoe kidney.

Extracorporeal shock wave lithotripsy (ESWL) is an effective treatment modality in the minimal invasive management of urinary system stone disease. Although the majority of the complications occuring after ESWL are minor (most common ones are gross haematuria, pain, perinephritic hematoma); bacteriuria may also occur in some cases which sometimes can lead to sepsis and even metastatic abscess formation in a very rare part of the cases treated. In this rare situation infection agent spreads quickly via hematogenous route and causes abscess formation in different parts of the body. Majority of such cases usually have an underlying systemic disease like diabetes mellitus (DM), malignancy, HIV or steroid use which lead to disruption of immune system functions. Abscess formation following ESWL is extremely rare and usually limited with some case reports published in the literature. Herein, we present a diabetic case with formation of multiple abscess foci in kidney, as well as in lungs and liver following ESWL. The patient was first admitted to our emergency department with high fever and respiratory distress and misdiagnosed as metastatic tumor foci based on radiologic findings. To the best of our knowledge, our case is the first one in the literature in whom simultanous abscess formation in multiple organ systems has been documented following an otherwise uneventful ESWL.

Does extracorporeal shock wave lithotripsy cause hearing impairment?

OBJECTIVE: To evaluate the possible effects of extracorporeal shock wave lithotripsy (ESWL) on the hearing status of the patients in this prospective controlled study. METHODS: A total of 40 patients with normal hearing function were included to the study. We had 20 patients each in the study group and control group. The treatment parameters were standardized in all 3 sessions in which a total of 3000 shock waves with a rate of 90/min along with a total energy value of 126 J at the fourth energy level have been applied (Dornier Compact Sigma, Medtech, Germany). In addition to the testing of hearing functions and possible cochlear impairment by Transient Evoked Otoacoustic Emissions test at 1.0, 1.4, 2.0, 2.8, and 4.0 kHz frequencies, complications such as ear pain, tinnitus, and hearing loss have been well evaluated in each patient before the procedure and 2 hours and 1 month after the completion of the third session of ESWL in the study group. The same evaluation procedures were performed before the study and after 7-weeks in the control group. RESULTS: Regarding Transient Evoked Otoacoustic Emissions data obtained in study group and control group patients, there was no significant alteration in values obtained after ESWL when compared with the values before the procedure. CONCLUSION: A well-planned ESWL procedure is a safe and effective treatment in urinary stones and causes no detectable harmful effect on the hearing function of treated patients.

Metastasis of non-muscle-invasive bladder cancer into the thyroid gland: a literature review accompanied by a rare case.

Bladder cancer is the most prevalent malignancy of the urinary tract. About 90% of bladder cancers are urothelial carcinomas. Seventy percent of cases newly diagnosed are superficial diseases; roughly 30% of newly diagnosed cases are muscle-invasive metastatic diseases. Bladder urothelial carcinoma primarily metastasizes into regional lymph nodes and then into liver, lung, mediastinum, bone, and adrenal gland. In our case, non-muscle-invasive bladder cancer metastasized into the bone, mediastinum, iliac lymph node, and adrenal and thyroid glands. This is the first reported case in the current literature in which urothelial carcinoma metastasized into the thyroid gland.

Comparison of the efficacy of isosorbide mononitrate and doxazosin in the treatment of lower urinary tract symptoms and benign prostatic hyperplasia: a randomized clinical trial.

OBJECTIVE: We aimed to compare the efficacy of isosorbide mononitrate and doxazosin in the treatment of lower urinary tract symptoms (LUTS). PATIENTS AND METHODS: 80 patients with LUTS were included in this randomized clinical study. All patients were evaluated with uroflowmetry, post-void residual (PVR) urine, prostate volume, International Prostate Symptom Score (IPSS), serum PSA, urinalysis and culture. 40 patients were prescribed doxazosin for 4 weeks, another 40 were prescribed isosorbide mononitrate for 4 weeks. Urologic re-evaluation was done at the end of the study. RESULTS: 74 patients completed the study. The mean age of patients was 59.6 ± 0.7 years, the mean PSA value was 1.7 ± 0.1 ng/ml and the mean prostate volume was 41.9 ± 1.7 ml. Doxazosin markedly improved IPSS (from 16.2 ± 0.7 to 9.5 ± 0.5), maximum urinary flow rate (from 10.9 ± 0.7 to 12.8 ± 0.6 ml/s) and PVR urine (from 68.1 ± 9.4 to 39.0 ± 4.4 ml) (p < 0.0001, p < 0.0001, p = 0.0004, respectively). Isosorbide only improved IPSS (from 16.5 ± 0.9 to 14.6 ± 0.8) (p = 0.032). CONCLUSIONS: Daily administration of isosorbide does not seem to be an alternative to α-blocker therapy. Controlled, randomized novel studies are required to establish that whether nitric oxide donors are an effective alternative in LUTS treatment.

A prospective randomized multicenter study of Turkish Society of Urooncology comparing two different mechanical bowel preparation methods for radical cystectomy.

OBJECTIVE: To investigate the outcomes and complication rates of urinary diversion using mechanical bowel preparation (BP) with 3 day conventional and limited BP method through a standard perioperative care plan. MATERIALS AND METHODS: This study was designed as a prospective randomized multicenter trial. All patients were randomized to 2 groups. Patients in standard 3-day BP protocol received diet restriction, oral antibiotics to bowel flora, oral laxatives, and saline enemas over a 3-day period, whereas limited the BP arm received liberal use of liquid diet, sodium phosphate laxative, and self administered enema the day before surgery. All patients received same perioperative treatment protocol. The endpoints for the assessment of outcome were anastomotic leakage, wound infection, wound dehiscence, intraperitoneal abscess, peritonitis, sepsis, ileus, reoperation, and mortality. Bowel function recovery, including time to first bowel movement, time to first oral intake, time to regular oral intake, and length of hospital stay were also assessed. RESULTS: Fifty-six patients in 3-day BP and 56 in limited BP arm were evaluable for the study end points. Postoperatively, 1 patient in limited BP and 2 patients in 3-day BP arm died. There was no statistical difference in any of the variables assessed throughout the study, however, a favorable return of bowel function and time to discharge as well as lower complication rate were observed in limited BP group. CONCLUSIONS: Regarding all endpoints, including septic and nonseptic complications, current clinical research offers no evidence to show any advantage of 3-day BP over limited BP.

Comparison of two experimental models for urethral stricture in the anterior urethra of the male rabbit.

OBJECTIVE: To compare 2 urethral stricture models and determine the appropriate model for the generation of urethral stricture in rabbits. METHODS: A total of 28 adult male New Zealand rabbits were included in the present study. They were separated randomly into 3 groups. Urethroscopy was performed using a pediatric resectoscope (13F). In 1 group (10 rabbits), circumferential electrocoagulation of the anterior urethra 2-3 mm long was performed until ulceration of the mucosa occurred. In the second group (10 rabbits), 2-3 mm wide resection from the anterior urethra was performed that was deep enough to expose the periurethral tissue to allow urine leakage from the lumen. The remaining 8 rabbits as the control group underwent only urethroscopy. On the 30th day, retrograde urethrography and urethroscopy were performed to evaluate urethral stricture formation. Histologic examination was done to evaluate the urethral pathologic changes. RESULTS: According to the urethrography and urethroscopy findings, no rabbits in the electrocoagulation or control group developed urethral stricture; however, significant stricture formation was observed in every case of the electroresection group. Regenerating urothelium at the luminal side of the urethra was seen in 6 rabbits in the electrocoagulation group and 4 showed normal urethra. In the electroresection group, extensive fibrosis that obstructed the urethral lumen and nodular collagen bundles in the urethral wall were seen. CONCLUSION: The electroresection method is more reliable than the electrocoagulation method in developing urethral stricture in the rabbit model. A 2-3-mm-wide resection from the anterior urethra can successfully generate urethral stricture with respect to electrocoagulation. Electroresection offers an ideal animal model for generating urethral stricture.

Factors affecting the number of debridements in Fournier's gangrene: our results in 36 cases.

BACKGROUND: We aimed to evaluate the factors potentially affecting the number of surgical debridements in patients with Fournier's gangrene (FG) who underwent single or multiple operative sessions. METHODS: We retrospectively reviewed the data of 36 patients with FG. The patients were assigned to one of two groups according to the number of debridements (Group I: single session; Group II: ?2 sessions). Data of the patients (clinical and surgical data, lesion characteristics, FG severity index, and prognosis) were compared between the groups. RESULTS: The mean age of the patients was 55.5 years, and all were male. Group I consisted of 21 patients and Group II of 15 patients. The mean number of debridements was 2.2 in Group II. Our overall mortality rate was 11% (Group I: 4.8% vs Group II: 20%; p=0.287). Diabetes was the most common coexistent pathology (44%). Time to admission to the clinic, size of the lesions at admission, and FG Severity Index (FGSI) scores of the groups were similar. In Group II, FGSI scores were found increased before each of the repeated debridement sessions (p<0.05). CONCLUSION: There was no difference in the clinical data of the patients who required single or multiple debridement sessions; however, FGSI may be useful in deciding repeated debridements, as it was found increased at each repeated session.

Effectiveness of medical treatment in overcoming the ureteral double-J stent related symptoms.

BACKGROUND: We investigated whether the frequency of lower urinary tract symptoms (LUTS) increased in patients in whom double-J stents were applied. We also evaluated several medical therapy protocols to treat symptoms related with ureteral stents. MATERIALS AND METHODS: A total of 108 patients, in whom unilateral double-j stent was applied during ureteral stone treatment, were included. Before the double-J stent was applied, all patients completed storage components of the "International Prostate Symptom Score" (IPSSs), quality of life components of the IPSS (IPSS-QOL) and "Overactive Bladder Questionnaire" (OABq) forms and scores were calculated. After the procedure, cases were randomized into 5 groups, an antiinflammatory was given to Group 1, spasmolytic to Group 2, anticholinergic to Group 3 and α-blocker to Group 4. No additional drug was given to Group 5 as this control group. During the fourth week of the procedure, IPSSs, IPSS-QOL and OABq forms were again completed and scores were compared with the previous ones. RESULTS: When all the cases were evaluated, the IPSSs, IPSS-QOL and OABq scores of patients in whom the double-J stent was applied were statistically significantly higher the procedure. Compared to the control group, the cases where the double-J stent was applied showed a higher IPSSs, IPSS-QOL and OABq scores and none of the medical therapies could prevent this increase. INTERPRETATION: The frequency of LUTS increased in cases where the ureteral stent was applied and discomfort continued as long as the stent stayed in the body.

Oxytocin immunoreactivity in the corpus cavernosum of patients with erectile dysfunction.

OBJECTIVES: Oxytocin is released by the posterior pituitary gland during male orgasm. Additionally, the presence of an oxytocin receptor gene and protein expression in human corpus cavernosum is demonstrated, and it has contractile activity on the smooth muscle of the animal and human corpus cavernosum in vitro. The aim of this study was to investigate the immunoreactivity of oxytocin in corpus cavernosum of patients with organic erectile dysfunction and to compare it with healthy controls. METHODS: Cavernous biopsies were obtained from 31 patients with erectile dysfunction and 11 patients without erectile dysfunction. Oxytocin immunohistochemistry was performed using the streptavidin-biotin immunoperoxidase staining on all cases. Intensity and proportion of stained cells were added for the immunoreactivity score. RESULTS: The mean ages of patients with erectile dysfunction and controls were 41.47 ± 2.08 and 36.50 ± 3.35 years, respectively (p > 0.05). Oxytocin expression was detected in smooth muscle as well as in endothelial cells in both groups. The mean oxytocin immunoreactivity score values of patients with erectile dysfunction and controls were also 2.16 ± 0.12 and 2.30 ± 0.21, respectively (p > 0.05). There was no significant difference in immunoreactivity scores both in arterial and cavernosal failure and also in smoker and nonsmoker groups (p > 0.05). Immunoreactivity scores were not statistically significantly different between patients with concomitant medical disorders and patients with no other medical disorder (p > 0.05). CONCLUSION: We detected oxytocin immunoreactivity in male corpus cavernosum, but staining was not different between patients with erectile dysfunction and controls. However, further studies are necessary to reach a final conclusion regarding the effects of oxytocin on corpus cavernosum.

Amputation of glans penis: a rare circumcision complication and successful management with primary anastomosis and hyperbaric oxygen therapy.

Penile amputation is an uncommon condition that requires immediate surgical replantation. Routine standardized procedures for dealing with this medical condition do not exist. We describe a case of complete guillotine-type glans penis amputation and review the relevant literature. We performed urethral end-to-end approximation and glanular anastomosis and then applied hyperbaric oxygen therapy postoperatively. We obtained very good cosmetic and functional results.

Effectiveness of doxazosin on erectile dysfunction in patients with lower urinary tract symptoms.

OBJECTIVE: We evaluated the effectiveness of doxazosin on ED in patients with LUTS/BPH and ED by using symptom score scales. We also evaluated whether or not the presence of asymptomatic inflammatory prostatitis had an effect on the alteration in the symptom scores. PATIENTS AND METHODS: A total of 36 male patients were included in the study. For all the cases, "International Prostate Symptom Score" (IPSS), "National Health Institute Chronic Prostatitis Symptom Index" (NIH-CPSI) and "International Index of Erectile Function" (IIEF-5) were investigated, and the scores were calculated in the first visit. Doxazosin was given for 30 days, and at the second visit IPSS, NIH-CPSI and IIEF-5 scores, Qmax and PMR were once more analysed. Afterwards, the alterations of the scores between visits were statistically compared. RESULTS: Mean age of the 36 cases included in the study was 59.03 ± 1.35. The alterations in parameters between 1st and 2nd visit were compared in the cases who used doxazosin and a statistically significant decrease in IPSS, NIH-CPSI scores and statistically significant increase in Qmax were observed. Besides, there was a statistically significant increase in IIEF-5 score. In addition, when the cases were divided into two groups patients with asymptomatic inflammatory prostatitis and without asymptomatic inflammatory prostatitis, there was not any difference in all scores. CONCLUSION: Doxazocin use in cases with LUTS/BPH and ED has an improving effect on ED as well as LUTS. Therefore, we believe that in the future, single agents or combined therapies might have a place in cases with LUTS/BPH and ED.

Antegrade endourethroplasty with free skin graft for recurrent vesicourethral anastomotic strictures after radical prostatectomy.

PURPOSE: To investigate the efficacy of the antegrade endourethroplasty technique for the management of frequently recurrent vesicourethral anastomotic strictures that develop after retropubic radical prostatectomy. PATIENTS AND METHODS: Between January 2006 and February 2008, endoscopic antegrade urethroplasty was performed in 11 patients with recurrent vesicourethral anastomotic strictures that developed after retropubic radical prostatectomy (RRP). The mean age of the patients was 64.6 years. In the first step of this two-step procedure, the graft bed was prepared by transurethral resection of the vesicourethral anastomotic stricture region. In the next step, after 3 days, an Amplatz sheath was placed in the urinary bladder suprapubically. Then, an endobronchial catheter was inserted from the external urethral meatus and extended out of the body from the suprapubic region through the Amplatz sheath. A graft taken from anteromedial section of the arm was tubularized on the catheter balloon. The graft was placed into the bladder neck antegradely under endoscopic vision. Subsequently, the graft carrier catheter was fixed by previously placed two polypropylene sutures inserted into the proximal and distal part of the stricture zone percutaneously from the perineum. The transurethral catheter was taken out delicately on postoperative day 21. RESULTS: Urethral patency succeeded in 6 of the 11 (54.5%) patients, and maximum flow rate was more than 13 mL/s in follow-up. Graft necrosis occurred in two patients, and the stricture recurred in three patients in two months postoperatively. CONCLUSION: Antegrade endourethroplasty may be a suitable alternative to open surgical reconstruction in selected patients with recurrent bladder neck stricture following RRP. Further studies, including more patients with modifications, are needed to improve the success rate.