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1.
Urology ; 135: 146-153, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31626854

RESUMO

OBJECTIVE: To evaluate the magnetic resonance imaging (MRI) findings of traumatic bulbar stricture and to evaluate their ability to estimate repair complexity. METHODS: Eighty-nine men with traumatic bulbar stricture who underwent urethrography and MRI at least 3 months postinjury and subsequent excision and primary anastomosis were retrospectively analyzed. The associations of MRI findings, including continuity of the tunica albuginea of the corpus spongiosum, periurethral fistula, spongiofibrosis length (SFL), and distal and proximal bulbar urethral length from the stricture, with urethrography and operative parameters were evaluated. RESULTS: Mean SFL was significantly longer than mean stricture length on urethrography (14.9 vs 7.9 mm, P <.0001). Periurethral fistula was found in 18 (20.2%) patients on MRI but not in 10 (55.6%) of them on urethrography. The corpus spongiosum was disrupted in 40 patients (55.1%) on MRI. On multivariate linear regression, SFL (standard coefficient, 0.25; t value, 2.31; P = .02) predicted operation time, while SFL (standard coefficient, 0.22; t value, 2.04; P = .04) and proximal bulbar urethral length (standard coefficient, -0.25; t value, -2.11; P = .04) independently predicted blood loss. Corporal splitting to reduce anastomotic tension and/or increase visualization during repair was needed in 33 patients (37.1%). Stricture length on urethrography (odds ratio [OR], 1.22; 95% confidence interval, 1.04-1.42; P = .006) and corpus spongiosum disruption (odds ratio, 5.51; 95% confidence interval, 1.57-19.34, P = .005) were independent predictors for the need of corporal splitting. CONCLUSION: In contrast to urethrography findings, MRI findings help predict traumatic bulbar stricture repair complexity.


Assuntos
Planejamento de Assistência ao Paciente , Doenças do Pênis/complicações , Pênis/lesões , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Estudos de Viabilidade , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/cirurgia , Pênis/diagnóstico por imagem , Período Pré-Operatório , Estudos Retrospectivos , Resultado do Tratamento , Uretra/diagnóstico por imagem , Estreitamento Uretral/diagnóstico por imagem , Estreitamento Uretral/etiologia
2.
Urologiia ; (5): 53-58, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808633

RESUMO

AIM: The aim of this study was to determine the possibilities of volumetric dynamic voiding multispiral computed cystourethrography (VDMMCT) for assessment of the lower urinary tract during voiding. MATERIALS AND METHODS: VDMMCT was performed in a series of 22 patients with various urethral pathologies using 320 detector rows (640 unique slices; row width 0,5 mm). This method allows to cover the scan area of 16 cm per one rotation of the X-ray tube. In all patients, the cross-sectional area of the various urethral parts was estimated and the urinary bladder volume and average urine flow rate during all voiding phases were calculated. RESULTS: VDMMCT was performed for dynamic evaluation of bladder volumes changes and analyzing a passage of contrasted urine throughout the urethra. The average volume of the urinary bladder was 356.3+/-179.9 ml, while the voiding volume was 299.5+/-154.8 ml. The average pre- and postoperative urine flow rate was 4.1+/-1.1 ml/s and 7.9+/-5.1 ml/s, respectively. The maximum urine flow rate was 19 ml/s. The average urethral diameter according to the VDMMCT after urethroplasty was 7.6+/-2.1 mm. The minimum length of urethral strictures was 17 mm, while the maximum length was 32 mm. CONCLUSION: Our results demonstrate the efficiency of the VDMMCT for assessing of the urethra throughout its length. VDMMCT can multidimensionally and dynamically represent the change of the bladder volume and the urine flow rate.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Estreitamento Uretral/diagnóstico , Urografia/métodos , Humanos , Masculino , Uretra , Estreitamento Uretral/diagnóstico por imagem , Bexiga Urinária , Micção
3.
Med Ultrason ; 21(3): 359-361, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31476219

RESUMO

Sonourethrography (SUG) is one of the basic imaging tools in the diagnosis of male anterior urethral strictures. So far, no one has described the use of this examination in transgender patients after "female-to-male" operation. Based on the presented case, we describe ultrasonographical features of the construction of a neophallus and offer information allowing a more accurate evaluation of urethral disorders in this group of patients.


Assuntos
Endossonografia/métodos , Pessoas Transgênero , Estreitamento Uretral/diagnóstico por imagem , Adulto , Humanos , Masculino , Uretra/diagnóstico por imagem
4.
Saudi Med J ; 40(7): 701-706, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31287131

RESUMO

OBJECTIVES: To investigate the correlation between the characteristics of urethral stricture and incision scars in patients with urethral stricture and median sternotomy incision. Methods: We identified 368 patients who had undergone internal urethrotomy between January 2014 and December 2017. A total of 49 male patients with a median sternotomy scar and diagnosed with  urethral stricture were retrospectively evaluated. The median sternotomy incision scars were assessed using the Vancouver Scar Scale (VSS) and the patients were divided into 2 groups. Group I consisted of patients with a VSS score of less than 4 points, and those with ≥4 points constituted group II. The groups were compared in terms of age, smoking habit, body mass index, diabetes mellitus, hypertension, urethral stricture etiology, length and localization, and stricture relapse after intervention. RESULTS: The mean total VSS score was 2.0 points in group I and 7.46 points in group II. There was a significant correlation between the VSS total score and the urethral stricture length among the whole study population (correlation coefficient value=0.481; p less than 0.001). The urethral stricture was longer as the VSS score increased. Conclusion: A poorly healed median sternotomy incision scar can predict a poor wound healing in the urethra tissue. Further large scale, multi-center and prospective studies are needed to clarify this relationship.


Assuntos
Cicatriz Hipertrófica/epidemiologia , Esternotomia , Estreitamento Uretral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Turquia/epidemiologia , Estreitamento Uretral/diagnóstico por imagem , Cicatrização
5.
Urology ; 127: 86-90, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30817961

RESUMO

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.


Assuntos
Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/cirurgia , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Estudos de Viabilidade , Seguimentos , Hematúria/diagnóstico , Hematúria/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Medição de Risco , Índice de Gravidade de Doença , Ressecção Transuretral da Próstata/efeitos adversos , Resultado do Tratamento , Ultrassom Focalizado Transretal de Alta Intensidade/métodos , Estreitamento Uretral/diagnóstico por imagem , Estreitamento Uretral/cirurgia , Retenção Urinária/diagnóstico , Retenção Urinária/epidemiologia , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia
6.
Eur J Pediatr Surg ; 29(1): 85-89, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30267391

RESUMO

INTRODUCTION: Delayed presentation of posterior urethral valves (PUVs) is a rare condition. Presentation and diagnosis of the patients with late PUVs are challenging. Voiding cystourethrogram (VCUG) is mainly practiced. In this study, we aimed to evaluate the children with late-presented PUVs, and the reliability of VCUG in this group. MATERIALS AND METHODS: Between January 2003 and December 2017 records of patients who were diagnosed with late-presented PUVs were analyzed. Delayed presentation of PUV was defined as patients who were diagnosed and treated after infancy. Cases were examined in terms of age at diagnosis, presenting symptoms, urinalysis, urinary ultrasound, urodynamic studies, VCUG, and dimercaptosuccinic acid scintigraphy findings. Postoperative follow-up conditions were also assessed. RESULTS: Seventeen boys were diagnosed with late-presented PUVs (mean age was 7.35 years). The most common symptoms at presentation were frequency (58.8%), day and nighttime incontinence (47%), and febrile urinary infection (41%). PUV was noted by VCUG in 10 patients alone. The classical sign of dilated posterior urethra was detected in 9 patients. The 10th patient had posterior urethral irregularity. Urethra could not be evaluated due to unsuccessful voiding in one patient. Six patients had normally appearing urethra on VCUG. Reflux was detected in nine (52.9%) patients. CONCLUSION: Late-presented PUVs may be missed on VCUG. Whether a PUV might be present is crucial in boys with a history of recurrent urinary infection, persistent reflux, and repetitive daytime incontinence. Based on our results, we conclude that cystoscopic examination should be preferred for those cases to diagnose PUVs regardless of VCUG results.


Assuntos
Cistografia/métodos , Uretra/anormalidades , Uretra/diagnóstico por imagem , Adolescente , Humanos , Masculino , Recidiva , Reprodutibilidade dos Testes , Estudos Retrospectivos , Uretra/cirurgia , Estreitamento Uretral/diagnóstico por imagem , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Infecções Urinárias/etiologia , Micção , Transtornos Urinários/etiologia
7.
J Urol ; 201(3): 563-572, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30240692

RESUMO

PURPOSE: We sought to characterize a standardized postoperative radiographic and functional voiding trial, and determine its impact on outcomes after substitution urethroplasty. MATERIALS AND METHODS: This is an observational, monocenter study of men who underwent 1-stage ventral onlay buccal mucosal graft urethroplasty for bulbar urethral stricture between January 2009 and December 2016. Patients were stratified by voiding trial success vs failure, including radiographic (extravasation or residual narrowness) and functional (post-void residual volume greater than 100 ml) failure, 21 days postoperatively. End points were voiding trial failure and recurrence-free survival. Regression models were created to determine risk factors of voiding trial failure and evaluate the impact of voiding trial failure on recurrence. RESULTS: The voiding trial succeeded and failed in 437 (85.2%) and 76 (14.8%), respectively, of 513 men. Of the latter men 54 (71.1%) showed evidence of extravasation and 22 (28.9%) had residual narrowness or functional failure. On multivariable logistic regression analyses no preoperative predictor of voiding trial failure was found (all p >0.05). At a median followup of 32 months Kaplan-Meier analyses (log rank test p = 0.033) and multivariable Cox regression analyses (HR 1.86, p = 0.037) revealed an association of voiding trial failure and stricture recurrence. When further stratifying voiding trial failure, residual narrowness or functional failure (HR 4.60, p <0.001) but not extravasation (HR 1.08, p = 0.9) was a risk factor for recurrence. Limitations include the retrospective assessment of investigated end points. CONCLUSIONS: Residual narrowness or functional failure at an early voiding trial after buccal mucosal graft urethroplasty may predict stricture recurrence. Identifying intraoperative complexity factors predicting initial voiding trial failure might be a key to identifying those individuals with early recurrence.


Assuntos
Mucosa Bucal/transplante , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Transtornos Urinários/diagnóstico , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Humanos , Masculino , Período Pós-Operatório , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recidiva , Uretra/diagnóstico por imagem , Uretra/patologia , Estreitamento Uretral/complicações , Estreitamento Uretral/diagnóstico por imagem , Transtornos Urinários/etiologia
8.
Int J Urol ; 26(2): 253-257, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30468021

RESUMO

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.


Assuntos
Terapia Baseada em Transplante de Células e Tecidos/métodos , Endoscopia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/transplante , Projetos Piloto , Recidiva , Tecidos Suporte , Resultado do Tratamento , Uretra/diagnóstico por imagem , Uretra/patologia , Uretra/cirurgia , Estreitamento Uretral/diagnóstico por imagem , Estreitamento Uretral/patologia
9.
Urol J ; 16(1): 67-71, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30058064

RESUMO

PURPOSE: Infra-vesical obstruction is uncommon in infants and generally due to urethral valves. Congenital urethral strictures (CUS), instead, defined as a concentric narrowing of the urethral lumen, are exceedingly rare in infants. MATERIALS AND METHODS: We reviewed our experience with 7 patients treated at our institution for CUS

Assuntos
Estreitamento Uretral/complicações , Estreitamento Uretral/terapia , Anormalidades Múltiplas/terapia , Canal Anal/anormalidades , Dilatação , Humanos , Lactente , Síndrome do Abdome em Ameixa Seca/terapia , Procedimentos Cirúrgicos Reconstrutivos , Reto/anormalidades , Estudos Retrospectivos , Estreitamento Uretral/congênito , Estreitamento Uretral/diagnóstico por imagem , Derivação Urinária , Refluxo Vesicoureteral/complicações
10.
BMJ Case Rep ; 11(1)2018 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-30567170

RESUMO

Caroli's disease is a rare congenital disorder with incidence rate of approximately 1 in 1 000 000 population. Renal anomalies which may be associated with Caroli's disease include medullary sponge kidney (MSK), cortical cysts, adult recessive polycystic kidney disease and rarely autosomal dominant polycystic kidney disease. Exact incidence of MSK in patients of Caroli's disease is not known. There are only a handful of reported cases of this association in literature. We hereby report a case of Caroli's disease with MSK with nephrocalcinosis. He presented to primary health centre with symptoms of urethral stricture due to lichen sclerosus et atrophicus and was managed with repeated co-axial dilatation but was never evaluated for underlying chronic renal insufficiency due to MSK. The thorough clinical examination and proper evaluation is important in patient of urethral stricture with underlying chronic renal insufficiency to avoid delayed diagnosis, management and related complications.


Assuntos
Doença de Caroli/diagnóstico , Falência Renal Crônica/diagnóstico , Rim em Esponja Medular/diagnóstico , Estreitamento Uretral/diagnóstico , Doença de Caroli/complicações , Doença de Caroli/diagnóstico por imagem , Colangiopancreatografia por Ressonância Magnética , Diagnóstico Diferencial , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/diagnóstico por imagem , Masculino , Rim em Esponja Medular/complicações , Rim em Esponja Medular/diagnóstico por imagem , Pessoa de Meia-Idade , Estreitamento Uretral/complicações , Estreitamento Uretral/diagnóstico por imagem , Procedimentos Cirúrgicos Urológicos Masculinos
11.
Med Ultrason ; 20(4): 436-440, 2018 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-30534649

RESUMO

AIM: To evaluate the urethral lesions and the degree of spongiofibrosis using cystourethrography (CUG) and sonourethrography (SUG) in order to propose the best imaging method for further surgical treatment. MATERIAL AND METHODS: The study involved 66 patients with anterior urethral strictures with indication for urethroplasty. Results of CUG and SUG were compared with each other and data from surgical protocol. RESULTS: Totally 72 strictures were detected; 47 in the bulbar part of urethra and 25 in the penile urethra. The mean length of the stenosis was 16.43 mm for CUG and 27.41 mm for SUG and 31.05 mm during surgery. The correlation levels between imaging techniques and intraoperative measurements were 0.55 (p<0.001) for CUG and 0.73 (p<0.001) for SUG. After dividing the strictures according to their location, better correlation for stenoses was obtained in penile urethra: 0.66 (p<0.001) for CUG and 0.86 (p<0.001) for SUG. CONCLUSIONS: SUG seems to be a simple and fast examination to evaluate urethral strictures. It is more accurate in comparison to CUG and gives a possibility to assess the spongiofibrosis. This information suggests that SUG can be a good complement to CUG in diagnosis of anterior urethtral strictures.


Assuntos
Cuidados Pré-Operatórios/métodos , Estreitamento Uretral/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Ultrassonografia/métodos , Uretra/diagnóstico por imagem , Adulto Jovem
12.
Radiol Technol ; 90(2): 149-167, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30420572

RESUMO

Retrograde urethrograms and voiding cystourethrograms provide clinicians with important information to determine treatment options and surgical interventions for patients with urethral abnormalities. This article discusses the elements with which radiologic technologists should be familiar, including urethra anatomy, the pathology of urethral abnormalities, imaging techniques, and special considerations for preoperative and postoperative patients.


Assuntos
Fluoroscopia , Uretra/anormalidades , Uretra/diagnóstico por imagem , Doenças Uretrais/diagnóstico por imagem , Adulto , Meios de Contraste , Humanos , Masculino , Segurança do Paciente , Exposição à Radiação/prevenção & controle , Proteção Radiológica , Estreitamento Uretral/diagnóstico por imagem , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Sistema Urinário/anatomia & histologia
13.
J Endourol ; 32(12): 1087-1092, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30191741

RESUMO

INTRODUCTION AND OBJECTIVES: Retrograde urethrogram (RUG) and voiding cystourethrogram (VCUG) are currently the gold standard imaging technique for diagnosis of urethral stricture and determination of stricture location. However, RUG and VCUG have multiple limitations. These techniques require exposure to ionizing radiation, the quality is operator and patient dependent, there is a moderate degree of invasiveness with urethral catheterization, can have artifacts because of patient positioning that underestimates stricture length. The development of novel imaging modalities without ionizing radiation to accurately evaluate the presence, location, length, and lumen cross-sectional area (CSA) of the urethral stricture would be of great value. The objective of this study was to develop a novel endoluminal ultrasound (ELUS) imaging technique that permits the accurate quantitation of urethral stricture. METHODS: Urethral strictures were created in rabbits (n = 5) by electrocautery and an ELUS technique was developed for subsequent luminal imaging. A 3.2F 40 MHz ultrasound (US) probe was introduced transurethrally and infused with US contrast agent. Images were recorded as the catheter was pulled back at a constant speed to acquire tomographic images. Lumen CSA over the entire urethral length was calculated using a custom methodology and validated in our laboratory. RESULTS: Urethral luminal CSA over the entire length of urethra before and after experimental stricture development was quantified including the length of stenosis. Intra- and interobserver variability (r = 0.99 for both) was excellent. CONCLUSIONS: Feasibility of ELUS as a quantitative technique to determine healthy urethral lumen and stricture CSA was demonstrated. The translational potential for a nonionizing imaging modality to better describe CSA, length, location, and uninvolved urethral CSA of the stricture is a significant improvement over current methodology.


Assuntos
Ultrassonografia/métodos , Uretra/diagnóstico por imagem , Estreitamento Uretral/diagnóstico por imagem , Animais , Meios de Contraste , Estudos Transversais , Masculino , Variações Dependentes do Observador , Coelhos , Tomografia Computadorizada por Raios X
14.
J Urol ; 200(6): 1308-1314, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30126826

RESUMO

PURPOSE: We compared the results of initial buccal mucosal graft urethroplasty to the results of repeat and secondary cases of previous urethroplasty done by any technique other than buccal mucosal graft urethroplasty. MATERIALS AND METHODS: We performed a retrospective study of patients who underwent buccal mucosal graft urethroplasty between January 2009 and December 2016 at a high volume center. Patients were stratified according to surgical sequence and characteristics were compared. We plotted Kaplan-Meier curves to compare stricture recurrence-free survival according to the surgical sequence. Multivariable Cox regression analyses were performed to delineate the impact of the surgical sequence on recurrence-free survival after adjusting for known clinical and surgical confounders. RESULTS: Of 534 men with a median followup of 33 months (IQR 17-52) 436 (81.6%), 64 (12.0%) and 34 (6.4%) underwent an initial, a repeat and a secondary procedure, respectively. Patient characteristics were comparable (each p ≥0.2). Patients with reoperative procedures had received more previous endoscopic interventions and were more often operated on by high volume surgeons (each p ≤0.021). Operative time, graft length, stricture location and surgical techniques were comparable (each p ≥0.1). The success rate of initial, repeat and secondary procedures was 87.4%, 87.5% and 70.6%, respectively. On survival analyses patients who underwent secondary procedures fared worse than those who underwent repeat or initial procedures (p = 0.010). Similarly a secondary procedure was an independent risk factor for recurrence (HR 2.42, 95% CI 1.03-5.68, p = 0.043). CONCLUSIONS: We found excellent results for repeat anterior 1-stage buccal mucosal graft urethroplasty, comparable to those of initial procedures. Patients who underwent secondary procedures were at higher risk for recurrence. However, when performed at a specialized center, the success rate was still high.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação/métodos , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Idoso , Anastomose Cirúrgica/métodos , Intervalo Livre de Doença , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/transplante , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Recidiva , Reoperação/efeitos adversos , Estudos Retrospectivos , Uretra/diagnóstico por imagem , Uretra/patologia , Estreitamento Uretral/diagnóstico por imagem , Estreitamento Uretral/patologia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
15.
Urologe A ; 57(8): 969-986, 2018 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-30073372

RESUMO

Dilatations of the urinary tract are discovered in increasing numbers in intrauterine or postnatal sonographic screening examinations. Only few urinary tract anomalies (e. g. urethral valves) require immediate therapy; however, ureteropelvic stenosis and primary megaureter in particular require a prognostic classification between relevant obstructions needing correction and dilations which do not affect renal function. Ultrasound, diuresis scintigraphy and magnetic resonance imaging (MRI) remain the main pillars of advanced diagnostics despite an increasing number of biomarkers. The prevention of progressive renal parenchymal damage is the main focus of diagnostic and therapeutic strategies, while avoiding unnecessary or unnecessarily stressful interventions.


Assuntos
Ureter/anormalidades , Uretra/anormalidades , Sistema Urinário/anormalidades , Dilatação , Humanos , Rim , Imagem por Ressonância Magnética , Cintilografia , Ureter/diagnóstico por imagem , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/etiologia , Estreitamento Uretral/diagnóstico por imagem , Estreitamento Uretral/etiologia , Sistema Urinário/diagnóstico por imagem , Doenças Urológicas/diagnóstico
16.
J Urol ; 200(6): 1302-1307, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30012364

RESUMO

PURPOSE: We evaluated the management of recurrent bulbar urethral stricture disease after urethroplasty at our institution. MATERIALS AND METHODS: We performed an institution review board approved, retrospective case study of our urethroplasty database to collect stricture related and postoperative information with an emphasis on bulbar urethral stricture disease recurrence after urethroplasty between 1996 and 2012. Repair types included primary anastomotic, augmented anastomotic and onlay repair. Recurrence, which was defined as the need for intervention, was diagnosed with cystoscopy or retrograde urethrogram. RESULTS: We identified 437 men who underwent urethroplasty of bulbar urethral stricture disease as performed by 2 surgeons from January 1996 to December 2012. Of the men 395 had available followup data. Recurrence was identified in 25 men (6.3%), of whom all presented with symptoms, including a weak stream in 23, urinary tract infection in 1 and pyelonephritis in 1. Median time to recurrence was 10 months. Recurrence was initially treated endoscopically in 23 of 25 cases (92%), dilatation in 12 and visual urethrotomy in 11. In 5 patients (22%) further recurrence developed after endoscopic treatment, which was managed by repeat urethroplasty in 2, self-calibration only in 2 and visual urethrotomy with subsequent self-calibration in 1. We identified 2 distinct phenotypes of recurrent stricture, including type A-short focal recurrence, which may be salvaged with an endoscopic procedure, and type B-the long graft length type, which is less likely to be salvaged with endoscopy. CONCLUSIONS: Recurrence after urethroplasty is most likely to develop within the first 12 months. Type A short focal recurrence may be managed by a salvage endoscopic procedure, including dilation or visual urethrotomy. These data on the phenotype of recurrence may be useful for patient treatment.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Criança , Cistoscopia , Dilatação , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Uretra/diagnóstico por imagem , Uretra/patologia , Estreitamento Uretral/diagnóstico por imagem , Estreitamento Uretral/patologia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto Jovem
18.
Int Urol Nephrol ; 50(7): 1257-1261, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29931662

RESUMO

PURPOSE: The published literature shows controversies with regard to the treatment of choice for longer stricture. Augmented anastomotic urethroplasty (AAU) was described for long bulbar urethral strictures with an extended area of narrowing and fibrosis, the technique combines the advantages of both anastomosis and graft substitution. We aimed to compare the dorsal and ventral strip anastomosis in the AAU. METHODS: A retrospective Review was conducted at the Department of Urology, Sohag University Hospital; we included adult patients with long bulbar urethral strictures (> 2 cm) who underwent dorsal or ventral strip AAU. Patients were followed at 1, 3, 6, and 12 months postoperatively for subjective improvements. The statistical analysis was carried with SPSS software version 24 for windows. RESULTS: At the end of follow-up, stricture recurrence occurred in 5 (12.5%) in ventral strip group compared to 6 (23.1%) in dorsal group, the difference was not statistically significant (p = 0.5). With regard to safety outcomes, there was no statistically significant difference between both groups in any of the postoperative complications, except post-void dribbling which showed higher incidence in dorsal strip group (p < 0.001). CONCLUSIONS: In conclusion, both dorsal strip and ventral strip techniques are feasible for long bulbar urethral strictures with comparable postoperative efficacy outcomes and high success rate.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/transplante , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Idoso , Anastomose Cirúrgica/métodos , Estudos de Coortes , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Recidiva , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Estreitamento Uretral/diagnóstico por imagem
19.
J Urol ; 200(4): 837-842, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29730205

RESUMO

PURPOSE: Approximately 10% to 20% of patients will have a recurrence after urethroplasty. Initial management of these recurrences is often by urethral dilation or direct vision internal urethrotomy. In the current study we describe the outcomes of endoscopic management of stricture recurrence after bulbar urethroplasty. MATERIALS AND METHODS: We retrospectively reviewed bulbar urethroplasty data from 5 surgeons in the TURNS (Trauma and Urologic Reconstruction Network of Surgeons). Men who underwent urethral dilation or direct vision internal urethrotomy for urethroplasty recurrence were identified. Recurrence was defined as the inability to pass a 17Fr cystoscope through the area of reconstruction. The primary outcome was the success rate of recurrence management. Comparisons were made between urethral dilation and direct vision internal urethrotomy, and then between endoscopic management of recurrences after excision and primary anastomosis urethroplasty vs substitutional repairs using time to event statistics. RESULTS: In 53 men recurrence was initially managed endoscopically. Median time to urethral stricture recurrence after urethroplasty was 5 months. At a median followup of 5 months the overall success rate was 42%. Success after urethral dilation was significantly less than after direct vision internal urethrotomy (1 of 10 patients or 10% vs 21 of 43 or 49%, p <0.001) with a failure HR of 3.15 (p = 0.03). Direct vision internal urethrotomy was more effective after substitutional failure than after excision and primary anastomosis urethroplasty (53% vs 13%, p = 0.005). CONCLUSIONS: Direct vision internal urethrotomy was more successful than urethral dilation in the management of stricture recurrence after bulbar urethroplasty. Direct vision internal urethrotomy was more successful in patients with recurrence after substitution urethroplasty compared to after excision and primary anastomosis urethroplasty. Perhaps this indicates a different mechanism of recurrence for excision and primary anastomosis urethroplasty (ischemic) vs substitution urethroplasty (nonischemic).


Assuntos
Dilatação/métodos , Endoscopia/métodos , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Idoso , Estudos de Coortes , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Modelos de Riscos Proporcionais , Recuperação de Função Fisiológica/fisiologia , Recidiva , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Resultado do Tratamento , Uretra/cirurgia , Estreitamento Uretral/diagnóstico por imagem , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
20.
BMC Urol ; 18(1): 46, 2018 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-29783971

RESUMO

BACKGROUND: The incidence of posterior urethral valve (PUV) is estimated at 1:5000-1:8000 males. It is the most common paediatric urologic urgency and the most common cause of male obstructive uropathy and chronic renal failure in children. The study aimed to describe the experience of Yaoundé gynaeco-obstetrics and paediatric hospital in the management of PUV. METHODS: Retrospectively, medical records were retrieved over a ten year period and all data recorded and analyzed for study objectives. Patients were called and evaluated for outcomes regarding morbidity and mortality. RESULTS: A total of 18 patients all males were managed over the ten year period, given prevalence of 13 cases/100,000 admissions and an admission rate of 2 per annum. The median age at presentation was 22 months and 13 (72.2%) participants presented late. Voiding urethrocystogram was done in all the participants where it showed dilated and elongated posterior urethral valves in 16 (88.9%) of the cases. Endoscopic valve ablation resulted in the relief of obstruction in all but 3 (16.7%) participants that had residual valves and 2 (11.2%) participants that had urethral stenosis. Type I valves were most common in 14 (78.0%) participants. The mean duration of follow up was 34.56 ± 21.47 months. Complications at final follow up were: 10 (55.6%) chronic renal failure, 2 (11.2%) end-stage renal failure. The case fatality rate was 5.6%. CONCLUSION: Many patients present late in our setting with already established complications. There is the need to counsel parents/guardians on the importance of long-term follow up after relief of obstruction.


Assuntos
Hospitais Pediátricos/tendências , Auditoria Médica/tendências , Obstrução Uretral/diagnóstico por imagem , Obstrução Uretral/epidemiologia , Estreitamento Uretral/diagnóstico por imagem , Estreitamento Uretral/epidemiologia , Camarões/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Tempo , Obstrução Uretral/terapia , Estreitamento Uretral/terapia
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