Historical and Current Practices in the Management of Fossa Navicularis Strictures.

PURPOSE OF REVIEW: Fossa navicularis strictures represent a surgically challenging disease process that requires detailed preoperative planning and an understanding of each patient's goals in order to achieve a satisfactory long-term outcome. This review summarizes the various approaches used in the management of fossa navicularis strictures over the past several decades. RECENT FINDINGS: In addition to existing evidence to support open flap- and graft-based reconstruction, recent studies suggest a potential role for limited open repair via a transurethral approach. Open repair of fossa navicularis strictures has become the standard of care with high success rates using local skin flaps or tissue grafts. There remains a very limited role for minimally invasive techniques in definitive management of this disease.

[The urethra of Napoleon, a conduit towards the end of the Empire?] / L'urètre de Napoléon, un conduit vers la fin de l'Empire.

INTRODUCTION: Napoleon died of a cancer of the stomach. Another assumption can be proposed, that of an uronéphrologique pathology. MATERIAL AND METHOD: It is about a historical study basing on the report of autopsy of Antommarchi and the assumptions formulated according to the urinary and nephrologic symptoms presented during his life. RESULTS: Napoleon presented signs of nephropathy in a probable context of metabolic syndrome and many signs of dysurie early on probable stricture of the urethra related to the intensive practice of horse. CONCLUSION: The urethra of Napoleon led France of the empire to the republic.

Carlos Richard de Beauregard y el tratamiento de la estenosis uretral blenorrágica en el Madrid del siglo XVIII: publicidad, secreto e impostura / Charles Richard de Beauregard and the treatment of blennorrhagic urethral stenosis in Madrid in the 18th century: Advertising, secrecy and deception

Objetivos: Describir la introducción del tratamiento de la estenosis uretral blenorrágica en la ciudad de Madrid en el siglo XVIII por el cirujano francés Charles de Beauregard, las formulaciones empleadas en la elaboración de sus personales ®candelillas», la publicidad en prensa, su comercialización y distribución. Material y métodos: Revisión no sistemática de la prensa madrileña Gaceta de Madrid y Diario curioso, erudito, económico y comercial, entre 1759 y 1790. Revisión de la bibliografía médica del siglo XVIII conservada en el Fondo Antiguo de la Biblioteca Histórica de la Universidad Complutense (Madrid). Búsqueda en portal Google ®Carlos Richard de Beauregard». Resultados: Charles de Beauregard dedicó preferentemente su actividad profesional al tratamiento de las secuelas uretrales de la blenorragia, fimosis y parafimosis, introduciendo en la sociedad española del siglo XVIII, con pretendida originalidad y manifiesto interés comercial, métodos terapéuticos basados en el acetato de plomo, que ya habían sido desarrollados en Francia por Thomas Goulard. Conclusiones: Las secuelas uretrales de enfermedades como la uretritis blenorrágica, la fimosis estenótica o la parafimosis eran muy prevalentes, y de compleja solución para la urología de la época en el Madrid del siglo XVIII. Charles de Beauregard introdujo novedosos tratamientos (pero no originales), invasivos pero no cruentos, alcanzando fama y prestigio social, recurriendo a publicitar su actividad profesional y comercializar los productos terapéuticos que elaboraba mediante anuncios remitidos a la prensa periódica(Gaceta de Madrid)

Objectives: Describe the introduction of the treatment for blennorrhagic urethral stenosis in the city of Madrid in the 18th century by the French surgeon Charles de Beauregard, the formulations employed in the preparation of his personal ®bougies», the advertising in the press, their marketing and distribution. Material and methods: Nonsystematic review of the Madrid newspaper Gaceta de Madrid y Diario curioso, erudito, económico y comercial (Madrid Gazette, curious, erudite, financial and commercial) between 1759 and 1790. Review of the medical literature of the 18th century preserved in the Fondo Antiguo of the Biblioteca Histórica ofUniversidad Complutense de Madrid (Historical Resource of the Historical Library of the Complutense University of Madrid). A Google search of ®Charles Richard de Beauregard». Results: Charles de Beauregard focused his professional work mainly on the treatment of the urethral sequela of blennorrhagia, phimosis and paraphimosis. He introduced to 18th century Spanish society (with purported originality and clear commercial interests) therapeutic methods based on lead acetate that had already been developed in France by Thomas Goulard. Conclusions: The urethral sequela of diseases such as blennorrhagic urethritis, stenotic phimosis and paraphimosis were highly prevalent in 18th century Madrid and required complex solutions for the practice of urology of that era. Charles de Beauregard introduced innovative but not original treatments that were invasive but not bloody and that provided him with fame and social prestige. He advertised his professional activity and marketed his therapeutic products through advertisements submitted to the daily press (Madrid Gazette, Gaceta de Madrid)

Charles Richard de Beauregard and the treatment of blennorrhagic urethral stenosis in Madrid in the 18th century: Advertising, secrecy and deception.

OBJECTIVES: Describe the introduction of the treatment for blennorrhagic urethral stenosis in the city of Madrid in the 18th century by the French surgeon Charles de Beauregard, the formulations employed in the preparation of his personal «bougies¼, the advertising in the press, their marketing and distribution. MATERIAL AND METHODS: Nonsystematic review of the Madrid newspaper Gaceta de Madrid y Diario curioso, erudito, económico y comercial (Madrid Gazette, curious, erudite, financial and commercial) between 1759 and 1790. Review of the medical literature of the 18th century preserved in the Fondo Antiguo of the Biblioteca Histórica of Universidad Complutense de Madrid (Historical Resource of the Historical Library of the Complutense University of Madrid). A Google search of «Charles Richard de Beauregard¼. RESULTS: Charles de Beauregard focused his professional work mainly on the treatment of the urethral sequela of blennorrhagia, phimosis and paraphimosis. He introduced to 18th century Spanish society (with purported originality and clear commercial interests) therapeutic methods based on lead acetate that had already been developed in France by Thomas Goulard. CONCLUSIONS: The urethral sequela of diseases such as blennorrhagic urethritis, stenotic phimosis and paraphimosis were highly prevalent in 18th century Madrid and required complex solutions for the practice of urology of that era. Charles de Beauregard introduced innovative but not original treatments that were invasive but not bloody and that provided him with fame and social prestige. He advertised his professional activity and marketed his therapeutic products through advertisements submitted to the daily press (Madrid Gazette, Gaceta de Madrid).

Tres tesis sobre estenosis de uretra / Three Theses on Urethral Disease

Objetivo: Dar a conocer la existencia de tres tesis doctorales sobre estenosis de uretra, presentadas en la Universidades de París y Montpellier por autores españoles. Material y métodos: De los estudiantes canarios que durante el siglo XIX y comienzos del XX estudiaron medicina en Francia destacamos tres que tienen en común el haber elegido el mismo tema para la presentación de su tesis doctoral. Resultados: Analizamos brevemente sus biografías, haciendo especial referencia al contenido de sus tesis doctorales. Conclusiones: La estenosis de uretra fue una patología muy citada durante el periodo estudiado por su alta incidencia. Distinguimos los cambios terapéuticos que se aportaron en las tres tesis estudiadas (AU)

Objective: To inform about three doctorate theses on urethral stenosis, presented in the University of Paris and Montpellier by Spanish authors. Material and methods: Of the Canary Island students who studied medicine in France during the XIX century and beginning of the XX century, three stand out for having chosen the same subject for presentation of their doctorate thesis. Results: We briefly analyze their biographies, placing special emphasis on the content of their doctorate thesis. Conclusions: Urethral stenosis was a very mentioned disease during the period studied due to its high incidence. We distinguish the therapeutic changes contributed in the three theses studied (AU)

Estenosis de la anastomosis vesicouretral tras prostatectomía radical y radioterapia postoperatoria / Vesicourethral anastomotic stricture following radical prostatectomy with or without postoperative radiotherapy

Objetivo: conocer la incidencia de la estenosis de la anastomosis vesicouretral en pacientes con cáncer de próstata tratados con prostatectomía radical. El objetivo secundario fue analizar si la radioterapia postoperatoria incrementa el riesgo de presentar una estenosis de la anastomosis. Material y métodos: se revisaron retrospectivamente las historias de los pacientes sometidos a prostatectomía radical como tratamiento primario entre enero 2000 y diciembre del 2008, con un seguimiento clínico mínimo de 12 meses. Del total de pacientes 258 cumplían los requisitos anteriores. De ellos 25 (9,6%) recibieron radioterapia postoperatoria, 12 (48%) de forma adyuvante y 13 (52%) de rescate. La edad media de los pacientes irradiados fue 64 (46-77) años. La mediana del PSA pre-radioterapia fue 2,3 (0,04-26,1)ng/ ml. El tiempo medio entre la cirugía y la radioterapia fue 17,4 (3-72) meses. La dosis media administrada fue 68 (58-70) Gy. El seguimiento medio fue 50,5 (15-117) meses. Resultados: de 25 pacientes prostatectomizados que recibieron radioterapia 4 (16%) desarrollaron estenosis de la anastomosis vesicouretral. El tiempo medio desde la finalización de la radioterapia hasta la aparición de la estenosis fue de 4 meses (1-22). Por otro lado, 36 (15,4%) pacientes prostatectomizados que no recibieron radioterapia postoperatoria presentaron esta misma complicación. Comparativamente no se apreciaron diferencias significativas entre ambos grupos (p = 0,599).Conclusiones: en nuestra revisión retrospectiva, la radioterapia postoperatoria no incrementó de forma significativa la incidencia de estenosis de la anastomosis vesicouretral (AU)

Objective: To know the incidence of vesicourethral anastomotic stricture in patients with prostate cancer treated with radical prostatectomy. Our secondary aim was to verify if postoperative radiotherapy increases the risk of presenting anastomotic stricture. Materials and methods: We retrospectively checked the clinical records of patients that had undergone radical prostatectomy as their primary treatment between January 2000 and December2008, with a minimum clinical follow-up of 12 months. Of the total patients, 258 met the foregoing requirements. Of them, 25 (9.6%) received postoperative radiotherapy, 12 (48%) received adjuvant radiotherapy and 13 (52%) received salvage radiotherapy. The mean age of the patients that received radiotherapy was 64 (46-77) years. The mean pre-radiotherapy PSA was 2.3 (0.04-26.1) ng/ ml. The mean time between surgery and radiotherapy was 17.4 (3-72) months. The mean dosage administered was 68 (58-70) Gy. The mean follow-up was 50.5(15-177) months. Results: Of 25 prostatectomized patients that received radiotherapy, four (16%) developed vesicourethral anastomotic stricture. The mean time from the completion of the radiotherapy until the appearance of the stricture was 4 months (1-22). On the other hand, 36 (15.4%) of the prostatectomized patients that did not receive postoperative radiotherapy presented the same complication. Comparatively, we did not note significant differences between both groups (p = 0.599). Conclusions: In our retrospective review, postoperative radiotherapy did not significantly increase the incidence of vesicourethral anastomotic stricture (AU)

Urethral strictures.

What's known on the subject? and What does the study add? Urethral strictures are common and increasingly common in an ageing population. The treatment is controversial and particularly the relative roles of urethrotomy or urethral dilatation on the one hand and urethroplasty on the other. This review aims to provide a comprehensive overview of the subject including less commonly discussed issues such as the history and pathology of stricture disease. We would hope that a comprehensive overview of the subject will give a sharper perspective to aid the investigation and management of patients with urethral strictures.

Estenosis uretral en la mujer: Etiología, diagnóstico y tratamiento / Female Urethral Stricture: Etiology, diagnostic and treatment

La estenosis uretral en la mujer es una causa poco frecuente de obstrucción infravesical, entidad ya de por sí poco habitual en el sexo femenino. La mayoría de los casos son secundarios a procedimientos quirúrgicos del área urogenital, la fibrosis periuretral es el mecanismo de acción implicado independientemente de la causa. Existe cierta controversia en cuanto a los criterios diagnósticos pero parece claro que se trata de obstrucciones estructurales que afectan al tercio medio y distal de la uretra. No existe un consenso en cuanto al tratamiento, pero maniobras menos agresivas como las dilataciones o la uretrotomia interna son las técnicas de elección para las estenosis primarias, teniendo en cuenta el alto porcentaje de recidivas que presentan. Las técnicas de reconstrucción uretral mediante el uso de diversos tipos de injertos oflaps estarían indicadas en aquellos casos recidivados o bien en los que existe un defecto parcial o total uretral (AU)

Female urethral stricture is an infrequent cause of bladder outlet obstruction, which is also a rare clinical entity in women. The most frequent etiology is the previous urogenital surgery. Periurethral fibrosis is the final cause regardless the etiology. Considerably controversie sorrounds in the diagnostic criteria but the estrictures are structural obstructions which involve media and distal third of the female urethra. There is no treatment consensus, but less agresive maneuvers such as dilatations and urethrotomies are chosen to treat primary estrictures, although the high recurrence rates. Reconstructive tecniques with the use of several flaps and grafts should be considered in recurrent cases and when there is a partial or total urethral defect (AU)

Inicio y desarrollo de la ureterorrenoscopia / Birth and development of ureterorenoscopy

Se describe en este trabajo la historia del desarrollo de la ureterrenoscopia rígida que comenzó en 1979 y hoy en día es una realidad en la mayoría de los servicios urológicos del mundo. Desde el primer Ureterorrenoscopio con un calibre extraordinariamente amplio y sin ningún sistema de dilatación, ni tampoco ningún sistema operativo, fue desarrollándose la actual técnica en donde desde la bomba de hidratación hidráulica hasta la fragmentación con láser ha permitido convertir a la ureterorrenoscopia en un procedimiento habitual para la resolución de litiasis, extracción de cuerpos extraños intraureterales ó renales, resolución de estenosis, diagnóstico de hematurias unilateralesy tratamiento endourológica de tumores uroteliales muy seleccionados

In this paper we describe the history of the development of rigid ureterorenoscopy. It started in 1979 and today is a reality in most urological departments of the world. From the first ureterorenoscope with a extraordinarily large caliber and no dilation or operative systems, the current technique have developed, so that from hydraulic water pump to laser fragmentation have enabled to make ureterorenoscopy a common procedure for the resolution of urinary stones, extraction of foreign bodies in the ureter or kidney, treatment of stenosis, diagnosis of unilateral hematuria and endourological treatment of selected urothelial tumors

[Historic review of the treatment of urethral stenosis]. / Reseñas históricas sobre el tratamiento de la estenosis uretral.

The present paper reviews the various therapeutical schemes with which urologists have approached the difficult problem of urethral stenosis. It pictures a brief history of one particular chapter of Urology that has troubled men since the dawn of mankind and of which many questions still remain unresolved.

Cirugía de la estenosis uretral: análisis y revisión de 50 casos / Surgery of the urethral stenosis: analysis and review of 50 cases

Uno de los problemas de la práctica urológico de resolución más difícil es la estenosis de la uretra, pués afecta a grupos de población de edad económicamente activa en México, y repercute de manera importante en los aspectos personales, laborales y sociales de la vida de los pacientes que la padecen. Son numerosos las técnicas y los procedimientos quirúrgicos que se han descrito para resolver este problema importante de salud pública, y varían entre dilataciones uretrales, técnicas endoscópicas, anastomosis e injertos cutáneos y técnicas de dos tiempos y plastías transpúbicas. En este informe se presenta una revisión de la experiencia obtenida durante los tres últimos años con las técnicas que se han empleado en las diferentes formas de presentación de las estrecheces uretrales de los pacientes atendidos en esta unidad del IMSS, con un análisis de los resultados obtenidos y comentarios y conclusiones al respecto.

[Urethrostenosis from Dupuytren to Guyon: "the tools and the men"]. / L'urétrosténie de Dupuytren à Guyon "des outils et des hommes".

Great progress has been made in the management of urethral narrowing during the second half of the 20th century owing to the appearance of urology as a specialty, to the spinoff of lithotripsy, to the motivation provided by the Argenteuil award and to the refinement of surgical tools. Progress was made in the exploration (impression dilatators, ball exploration) and treatment: permanent or progressive dilatation, cauterization, internal or external urethrotomy. Biographical notes are then given about the surgeons who made this progress possible: Amussat, Benique, Civiale, Desormeaux, Ducamp, Guillon, Heurteloup, Lallemand, Leroy D'Etioles, Maisonneuve, Reybard and Segalas.

[Urethral stricture. A history. From antiquity to the 18th century]. / Rétrécissement de l'urètre. Historique. De l'antiquité au XVIIIe siècle.

Long undistinguished from the other causes of lower urinary tract obstruction, stenosis of the urethra was truly individualized only in the XVIIIth century. Throughout this long history, treatment opposed repeated dilatations, capable of maintaining an acceptable urethral caliber, and methods aimed at directly destroying the stenosis, thereby ensuring permanent recovery.