RESUMO
ABSTRACT Objective To examine the impact of obesity on perioperative outcomes and urethral stricture recurrence after anterior urethroplasty. Material and Methods We reviewed our prospectively maintained single-surgeon database to identify men with anterior urethral strictures who had undergone anastomotic or augmentation urethroplasty between October 2012 and March 2018. In all, 210 patients were included for primary analysis of perioperative outcomes, while 193 patients with at least 12 months follow-up were included for secondary analysis of stricture recurrence. Patients grouped by BMI were compared using univariate and multivariate analyses for perioperative outcomes and log rank testing for recurrence-free survival. Results Overall, 41% (n=86) of patients were obese and 58.6% (n=123) had bulbar urethral strictures. Obese patients had significantly longer urethral strictures (mean=6.7cm±4.7) than nonobese patients (p <0.001). Though urethroplasty in obese patients was associated with increased estimated blood loss (EBL) relative to normal BMI patients on both univariate (p=0.003) and multivariate (p <0.001) analyses, there was no difference in operative time, length of stay, or complication rate between BMI groups. At a mean follow-up interval of 36.7 months, 15% (n=29) of patients had stricture recurrence, yet recurrence-free survival was not significantly different between groups (log rank p=0.299). Dorsal augmentation urethroplasty resulted in significantly fewer recurrences in obese patients compared to nonobese patients (p=0.036). Conclusion Despite the association with increased urethral stricture length and EBL, obesity is not predictive of adverse perioperative outcomes or stricture recurrence. Obese patients should be offered urethral reconstruction, but patient selection and preoperative counseling remain imperative.
Assuntos
Humanos , Masculino , Adulto , Idoso , Procedimentos Cirúrgicos Urológicos Masculinos , Estreitamento Uretral/cirurgia , Recidiva , Uretra/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Obesidade/complicaçõesRESUMO
RESUMEN Objetivo: determinar el tiempo de sondaje postquirúrgico recomendado para evitar complicaciones en cirugías endourológicas del tracto urinario inferior. Materiales y métodos: se realizó una revisión bibliográfica actualizada sobre el tiempo de sondaje postquirúrgico recomendado para evitar complicaciones en cirugías endourológicas del tracto urinario inferior. Resultados: Se encontró asociación entre un mayor tiempo de sondaje y la ocurrencia de posteriores complicaciones relacionadas cirugías endourológicas del tracto urinario inferior, siendo el período menor a 72h el óptimo para la permanencia de la sonda ve-sical postquirúrgica en este tipo de intervenciones. No se identificaron factores de riesgo asociados a la prolongación del tiempo de sondaje postquirúrgico. Recomendaciones: El tipo de abordaje endoscópico se ha convertido en la actualidad en el tratamiento estándar de oro para la mayoría de las patologías del tracto urinario inferior; sin embargo, se requiere realizar más estudios sobre las complicaciones y factores de riesgo relacionados al tiempo de sondaje postquirúrgico para evitar complicaciones en cirugías endourológicas del tracto urinario inferior
ABSTRACT Objective: to determine the recommended post-surgical probing time to avoid complications in endourological surgeries of the lower urinary tract. Materials and methods: an updated bibliographic review was carried out on the recommended post-surgical catheterization time to avoid complications in endou-rological surgeries of the lower urinary tract. Results: An association was found between a longer catheterization time and the occurrence of subsequent complications related to endourological surgeries of the lower urinary tract, with the period of less than 72h being the optimal period for the permanence of the postsurgical urinary catheter in this type of intervention. No risk factors associated with prolonged postoperative probing time were identified. Recom-mendations: The type of endoscopic approach has now become the gold standard treatment for most lower urinary tract pathologies; However, more studies are required on the complications and risk factors related to the time of postoperative catheterization to avoid complications in endourological surgeries of the lower urinary tract
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Patologia , Terapêutica , Cateteres Urinários , Tempo , Fatores de Risco , Sonda de ProspecçãoRESUMO
SUMMARY INTRODUCTION Due to spongiofibrosis and inflammatory processes underlying the pathogenesis of urethral stricture, it is possible that the neutrophil-lymphocyte ratio (NLR) may give essential information about the course of the disease and recurrence possibilities. Our study aims to evaluate the correlation between NLR and recurrence rates. METHODS A total of 512 patients who underwent direct visual internal urethrotomy (DVIU) due to urethral stricture in our clinic between February 2010 and January 2018 were evaluated retrospectively. RESULTS The median follow up for non-recurrent and recurrent groups after DVIU was 30 and 36 months, respectively. During the follow-up, 280 (54.7%) of the patients had recurrences, and 232 (45,3%) had no recurrences. The mean time for recurrence after DVIU was 6,5±1,4 months, with a range of 1-36 months. The mean NLR in the non-recurrence group was 2,02±0,87, with a median of 1.9, and 3,66±2,30, with a median of 3 in the recurrence group. A highly significant statistical difference was observed between two groups in terms of neutrophil count and NLR (p: 0.000 - both). The area under curve value for NLR was 0.767, with a standard error of 0.021 (95% CI 0.727-0.808). The cut-off value of NLR was determined as 2.25, with a 70% sensitivity and 67,7% specificity. CONCLUSION By using NLR, the inflammatory features of the urethral tissue can be predicted, and possible recurrences after surgery can be estimated. Consequently, open urethroplasty techniques can be used in cases with a significant NLR value instead of the recurrent endoscopic procedure.
RESUMO INTRODUÇÃO Devido à espongiofibrose e processos inflamatórios subjacentes à patogênese da estenose uretral, pode-se pensar que a relação de linfócitos neutrofílicos (NLR) pode fornecer informações essenciais sobre o curso da doença e as possibilidades de recorrência. O objetivo do nosso estudo é avaliar a correlação entre NLR e taxas de recorrência. MÉTODOS Quinhentos e doze pacientes submetidos à uretrotomia interna visual direta (DVIU) devido à estenose uretral em nossa clínica entre as datas de fevereiro de 2010 e janeiro de 2018 foram avaliados retrospectivamente. RESULTADOS A mediana de acompanhamento para os grupos não recorrentes e recorrentes após a DVIU foi de 30 e 36 meses, respectivamente. Durante o seguimento, 280 (54,7%) dos pacientes tiveram recidivas e 232 (45,3%) não tiveram recidivas. O tempo médio de recorrência após a DVIU foi de 6,5±1,4 mês, com variação de 1-36 meses. A média da RNL no grupo sem recorrência foi de 2,02±0,87 com mediana de 1,9 e 3,66±2,30 com mediana de 3 no grupo com recidiva. Uma diferença estatística altamente significativa foi observada entre dois grupos em termos de contagem de neutrófilos e NLR (p: 0,000 - ambos). A área sob o valor da curva para NLR foi de 0,767 com um erro padrão de 0,021 (IC 95% 0,727-0,808). Valor de corte de NLR determinado como 2,25 com uma sensibilidade de 70%, especificidade de 67,7%. CONCLUSÃO Ao utilizar a RNL, as características inflamatórias do tecido uretral podem ser previstas e possíveis recidivas após a cirurgia podem ser estimadas. Dessa forma, técnicas de uretroplastia aberta podem ser usadas em casos com valor significativo de NLR em vez de procedimento endoscópico recorrente.
Assuntos
Humanos , Adulto , Idoso , Adulto Jovem , Estreitamento Uretral/sangue , Contagem de Linfócitos/métodos , Neutrófilos , Recidiva , Fatores de Tempo , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Estudos Retrospectivos , Curva ROC , Seguimentos , Resultado do Tratamento , Estatísticas não Paramétricas , Pessoa de Meia-IdadeRESUMO
ABSTRACT Purpose Penile skin flap uretroplasty is a useful technique for a long urethral stricture due to the ample length and surgical handling characteristics. We investigated the surgical technique and initial results of uretroplasty for anterior urethral strictures using a dorsal penile skin flap. Patients and methods From January 2003 to January 2018, a total of 77 patients underwent substitution urethroplasty using dorsal penile skin flap for bulbar urethral strictures in our institution. All patients were assessed preoperatively, and followed postoperatively by physical examination, urinalysis, retrograde and voiding urethrography, uroflowmetry and post-void residual urine measurement. Success was defined as no requirement of additional urethral instrumentation. Results The mean age was 45 years (10-87). The mean stricture length was 5cm (3-10cm). The mean flap length was 6cm. Urinary fistula was the most common postoperative complication. The mean follow-up was 60 months (6-120). The overall success rate was 88%. Recurrent strictures were found in 4 patients (5%) at 1 year. At 3 year follow-up, 5 (7%) more patients had recurrences. All recurrences were managed by internal urethrotomy. Conclusions Substitution urethroplasty using penile skin flap appear to be a safe and efficient technique for the treatment of a long and complex anterior urethral stricture. It provides encouraging cosmetic and functional results.
Assuntos
Humanos , Masculino , Criança , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Pênis/cirurgia , Retalhos Cirúrgicos/transplante , Estreitamento Uretral/cirurgia , Transplante de Pele/métodos , Complicações Pós-Operatórias , Recidiva , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento , Pessoa de Meia-IdadeRESUMO
Objetivos: La incidencia de lesión uretral bulboprostática secundaria a fractura pelviana es del 5-10%. Una uretroplastia exitosa garantiza el comienzo de la rehabilitación de los pacientes. Presentamos nuestra experiencia en el manejo quirúrgico de la estenosis uretral secundaria a fractura pelviana y resultados funcionales: tasa de éxito, reestenosis, disfunción eréctil e incontinencia urinaria. Evaluamos si existe asociación entre la falta de erecciones postrauma y la reestenosis. Materiales y métodos: Cincuenta y tres pacientes fueron operados durante el período comprendido entre 2001 y 2015. Todos fueron estudiados con cistoscopia flexible, cistouretrografía retrógrada y miccional. La técnica quirúrgica empleada fue la resección y anastomosis primaria. Se utilizó siempre la sistemática del abordaje perineal progresivo para lograr una anastomosis sin tensión. Interrogamos sobre la calidad de las erecciones posterior al trauma y después de la cirugía, y su estado de continencia urinaria. Se realizó un análisis estadístico donde se evaluó si la falta de erecciones era un factor de riesgo para recaída. Resultados: La edad promedio de los pacientes fue de 34,5 (r=17-67) años. La longitud promedio de la estenosis fue de 2,28 cm, siendo la uretra bulbomembranosa la más afectada (89%). La tasa de éxito fue del 86% (46/53), que asciende al 94% (50/53) al asociar un procedimiento endoscópico. Un solo paciente refirió disfunción eréctil postcirugía (1/19; 5,3%). Dos (3,7%) pacientes evolucionaron con incontinencia de orina de esfuerzo. No se hallaron diferencias estadísticamente significativas entre el grupo de pacientes con erecciones y aquellos sin erecciones en cuanto a la posibilidad de reestenosis. Conclusiones: La anastomosis bulbomembranosa por vía perineal es el tratamiento de elección de la estenosis uretral postfractura pelviana. Los índices de incontinencia de orina y disfunción eréctil no aumentan significativamente luego de la uretroplastia. En nuestra experiencia, la falta de erecciones preoperatoria no predice mayor índice de recaídas(AU)
Objectives: Bulboprostatic urethral stricture after pelvic fracture occurs in about 5-10%. A successful urethroplasty guarantees the beginning of patient recovery. We present our experience in the surgical management of posterior urethral stricture after pelvic fracture and functional outcomes (success and failure rates, erectile dysfunction and urinary incontinence). The association between the lack of erections post-trauma and the incidence of restenosis was also evaluated. Materials and methods: 53 patients were operated between 2001- 2015. Preop workout included a flexible cystoscopy and a combination of retrograde and voiding cystourethrogram to define the site and length of urethral stricture. Resection and primary anastomosis was the technique always employed. In all cases the progressive perineal approach was followed in order to achieve a tension free anastomosis. Erectile function and urinary continence were evaluated before and after surgery. Statistical analysis was performed to evaluate if lack of erections was a failure predictor. Results: Median age was 34.5 (r=17-67) years. Median urethral stricture length was 2.28 cm. Bulbomembranous junction was the most affected portion (89%). Success rate was 86% (46/53) ascending to 94% (50/53) when an endoscopic procedure was associated. One patient referred erectile dysfunction after surgery (1/19; 5.3%). Two patients (3.7%) developed stress urinary incontinence. The restenosis rate did not show statiscally differences between the erectile dysfunction and non-erectile dysfunction group. Conclusions: Perineal bulbomembranous anastomosis is the elected procedure for urethral stricture after pelvic fracture. Incidence of urinary incontinence and erectile dysfunction are not significantly elevated after urethroplasty. In our experience, lack of erections before surgery does not predict a higher rate of restenosis(AU)
Assuntos
Humanos , Masculino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Ossos Pélvicos/lesões , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Estreitamento Uretral/etiologia , Anastomose Cirúrgica/métodos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
ABSTRACT Objectives To assess patient satisfaction and quality of life after urethroplasty using two different self-reported outcome measures and to compare it with objective clinical data. Materials and Methods We prospectively collected data from 35 consecutive patients who underwent urethroplasty from January 2013 to September 2014. Patient demographics, International Prostate Symptom Score (IPSS), quality of life score, urethral stricture surgery patient-reported outcome measure (USS-PROM), maximum flow rate (Qmax) and post-void residual urine were collected before, two and eight months after surgery. Failure occurred when any postoperative instrumentation was performed. General estimation equation was used to compare the results and linear regression analysis to correlate both questionnaires with objective data. Results Mean age was 61 years. Urethroplasties were equally divided between anastomotic and buccal mucosa grafts and 19 patients (59.3%) had a previous urethral procedure. Overall success rate was 87.5%. IPSS improved from a mean 19 at baseline to 5.32 at 8 months (p <0.001). The mean USS-PROM score also improved from 13.21 preoperatively to 3.36 after surgery (p <0.001) and 84.3% of patients were satisfied or very satisfied with surgical results. Mean Qmax increased from 4.64mL/s to 11mL/s (p <0.001). Strong negative correlation was found respectively between flow rate and USS-PROM (r=-0.531, p <0.001) and with IPSS (r=-0.512, p <0.001). Conclusions Significant improvements in urinary symptoms and in quality of life are expected after urethroplasty and they are correlated with objective measures.
Assuntos
Humanos , Masculino , Adulto , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Qualidade de Vida , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Satisfação do Paciente/estatística & dados numéricos , Procedimentos de Cirurgia Plástica/estatística & dados numéricos , Autorrelato/normas , Período Pós-Operatório , Micção/fisiologia , Estudos Prospectivos , Seguimentos , Resultado do Tratamento , Análise Custo-Benefício , Medidas de Resultados Relatados pelo Paciente , Pessoa de Meia-IdadeRESUMO
ABSTRACT Aim: To evaluate the long term outcomes of temporary urethral stent placement for the treatment of recurrent bulbar urethral stricture. Materials and Methods: Twenty-eight patients who underwent temporary polymer coated urethral stent placement due to recurrent bulbar urethral stricture between 2010 and 2014 were enrolled in the study. The long term outcomes of the patients were analyzed. Results: The mean age of the patients was 62.3±6.4 (44–81). The overall clinical success was achieved in 18 (64.2%) of the 28 patients at a median (range) follow-up of 29 (7–46) months. No patient reported discomfort at the stent site. Stone formation was observed at the urethral stent implantation area only in one patient. Stenosis occurred in the distal end of the stents in two patients and took place in bulbar urethra in seven patients after removed the stents. The mean maximum urine flow rates were 6.24±2.81mL/sec and 19.12±4.31mL/sec before and at 3 months after the procedure, respectively. Conclusion: In this study, the success rate of temporary urethral stent placement has remained at 64.2% at a median follow-up of 29 months. Therefore, our outcomes have not achieved desired success rate for the standard treatment of recurrent bulbar urethral stricture.
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Stents , Implantação de Prótese/métodos , Recidiva , Fatores de Tempo , Uretra/diagnóstico por imagem , Estreitamento Uretral/diagnóstico por imagem , Seguimentos , Resultado do Tratamento , Remoção de Dispositivo , Dilatação/métodos , Pessoa de Meia-IdadeRESUMO
ABSTRACT Introduction Urethral stricture disease is still a major problem in men. Many procedures are available for the treatment of urethral strictures; urethral dilatation is one of the oldest. The blind dilatation of urethral strictures may be a difficult and potentially dangerous procedure. The purpose of this study was to describe safe urethral dilatation using amplatz renal dilator and to report outcomes. Materials and Methods From 2010 to 2014, a total of 26 men with primary urethral strictures were managed by urethral dilatation using amplatz renal dilators. The parameters analyzed included presentation of patients, retrograde urethrography (RGU) findings, pre-and postoperative maximum flow rate (Qmax) on uroflowmetry (UF) and post-void residual urine (PVR). Patients were followed-up at 1.6 and 12 months. The technique described in this paper enables such strictures to be safely dilated after endoscopic placement of a suitable guidewire and stylet over which amplatz renal dilators are introduced. Results The mean age of the patients was 57.6 (35–72) years. The median stricture length was 0.82 (0.6–1.5)cm. Pre-operative uroflowmetry showed Qmax of 7.00 (4–12) mL/sec and ultrasonography showed PVR of 75.00 (45–195)mL. Postoperatively, Qmax improved to 18.00 (15–22)mL/sec (p<0.001) at 1 month, 17.00 (13–21)mL/sec (p<0.001) at 6 months and 15.00 (12–17)mL/sec (p<0.001) at 12 months. The post-operative PVR values were 22.50 (10–60)mL (p<0.001), 30.00 (10–70)mL (p<0.001) and 30.00 (10–70) mL (p<0.001) at 1.6 12 months, respectively. The median procedure time was 15.00 (12–22) minutes. None of the patients had a recurrence during a 12-month period of follow-up. Conclusion Urethral dilatation with amplatz renal dilators avoids the risks associated with blind dilatation techniques. This tecnique is a safe, easy, well-tolerated and cost-effective alternative for treatment of urethral strictures.
Assuntos
Humanos , Masculino , Adulto , Idoso , Uretra , Estreitamento Uretral/terapia , Dilatação/instrumentação , Período Pós-Operatório , Recidiva , Fatores de Tempo , Cateterismo Urinário/instrumentação , Cateterismo Urinário/métodos , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores de Risco , Seguimentos , Resultado do Tratamento , Estatísticas não Paramétricas , Dilatação/métodos , Desenho de Equipamento , Duração da Cirurgia , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: Evaluate the efficiency and safety of bipolar plasma vaporization using plasma-cutting and plasma-loop electrodes for the treatment of posterior urethral stricture. Compare the outcomes following bipolar plasma vaporization with conventional cold-knife urethrotomy. METHODS: A randomized trial was performed to compare patient outcomes from the bipolar and cold-knife groups. All patients were assessed at 6 and 12 months postoperatively via urethrography and uroflowmetry. At the end of the first postoperative year, ureteroscopy was performed to evaluate the efficacy of the procedure. The mean follow-up time was 13.9 months (range: 12 to 21 months). If re-stenosis was not identified by both urethrography and ureteroscopy, the procedure was considered “successful”. RESULTS: Fifty-three male patients with posterior urethral strictures were selected and randomly divided into two groups: bipolar group (n=27) or cold-knife group (n=26). Patients in the bipolar group experienced a shorter operative time compared to the cold-knife group (23.45±7.64 hours vs 33.45±5.45 hours, respectively). The 12-month postoperative Qmax was faster in the bipolar group than in the cold-knife group (15.54±2.78 ml/sec vs 18.25±2.12 ml/sec, respectively). In the bipolar group, the recurrence-free rate was 81.5% at a mean follow-up time of 13.9 months. In the cold-knife group, the recurrence-free rate was 53.8%. CONCLUSIONS: The application of bipolar plasma-cutting and plasma-loop electrodes for the management of urethral stricture disease is a safe and reliable method that minimizes the morbidity of urethral stricture resection. The advantages include a lower recurrence rate and shorter operative time compared to the cold-knife technique.
Assuntos
Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Ablação por Cateter/métodos , Cistoscopia/métodos , Estreitamento Uretral/cirurgia , Eletrodos , Seguimentos , Tempo de Internação/estatística & dados numéricos , Duração da Cirurgia , Período Perioperatório , Estudos Prospectivos , Recidiva , Resultado do TratamentoRESUMO
ABSTRACTBackground and aims:To investigate the possible effect of resectoscope size on urethral stricture rate after monopolar TURP.Materials and Methods:A retrospective study of 71 men undergoing TURP was conducted at two centers’ from November 2009 to May 2013. The patients were divided into one of two groups according to the resectoscope diameter used for TURP. Resectoscope diameter was 24 F in group 1 (n=35) or 26 F in group 2 (n=36). Urethral catheter type, catheter removal time and energy type were kept constant for all patients. Urethral stricture formation in different localizations after TURP was compared between groups.Results:There was no significant difference between the two groups in terms of age, pre-operative prostate gland volume (PV), prostate-specific antigen (PSA), maximal urinary flow rates (Qmax), International Prostate Symptom Score (IPSS) and post-voiding residual urine volume (PVR). The resection time and weight of resected prostate tissue were similar for both groups (p>0.05). A statistically significant higher incidence of bulbar stricture was detected in group 2 compared to group1 (p=0.018).Conclusions:The use of small-diameter resectoscope shafts may cause a reduction in the incidence of uretral strictures in relation to urethral friction and mucosal damage.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Endoscópios/efeitos adversos , Próstata/patologia , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/instrumentação , Estreitamento Uretral/etiologia , Desenho de Equipamento , Seguimentos , Fricção , Mucosa/lesões , Duração da Cirurgia , Antígeno Prostático Específico/sangue , Qualidade de Vida , Estudos Retrospectivos , Estatísticas não Paramétricas , Ressecção Transuretral da Próstata/efeitos adversosRESUMO
Purpose: To evaluate the long term outcomes of permanent Memotherm urethral stent in the treatment of recurrent bulbar urethral stricture. Materials and Methods: Twenty patients who underwent permanent Memotherm urethral stent implantation due to recurrent bulbar urethral stricture following previous unsuccessful surgical procedure from 1996 to 2002 were included in the study. Long-term outcomes of the patients were evaluated. Results: The overall success rate was 87.5% at the end of the tenth year. There was discomfort in implantation area in eight patients about 1 month following the procedure. These patients were treated with alpha-blocker and anti-inflammatory drugs. Stone formation was observed at the urethral stent implantation area in two patients. Post-void dripping has been observed in 15 patients up to the postoperative 3rd month. Stress urinary incontinence was observed in a patient with a 1-year follow-up. Partial stent migration was observed in two patients. None of the patients experienced pain during erection. Conclusion: Memotherm urethral stent is a minimal invasive surgical procedure which can be safely and effectively used in patients with recurrent urethral stricture. .
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Stents , Estreitamento Uretral/cirurgia , Cateterismo Urinário/métodos , Seguimentos , Complicações Pós-Operatórias , Implantação de Prótese/métodos , Recidiva , Stents/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Estreitamento Uretral/complicações , Cateterismo Urinário/efeitos adversos , Incontinência Urinária por Estresse/etiologiaRESUMO
INTRODUCTION: Urethral strictures remain a reconstructive dilemma, due to high incidence of recurrence and less than satisfactory outcomes. Even experienced surgeons following strict surgical principles have not achieved optimal results, leading us to think whether the etiology of strictures dictate the outcome . We evaluated this "cause-effect" relationship highlighting the significance of the etiology on the overall prognosis of urethral strictures. MATERIALS AND METHODS: A total of 302 males with urethral strictures were assessed (both retrospectively and prospectively) over a period of ten years. The preoperative evaluation was performed by retrograde urethrogram, urethrosonogram, and uroflowmetry and categorized, based on etiology: a) as post traumatic, b) post infective, c) iatrogenic or d) unknown. Traumatic strictures were subjected to pelvic X-ray and sub-categorized into grades A, B and C, following the TILE classification. Patients were operated; with tunica albuginea urethroplasty for anterior strictures and U shape prostato-bulbar anastomosis for posterior strictures. RESULTS: Traumatic strictures accounted for 54 percent of cases. 127 of the 302 patients were treated using Tunica Albuginea Urethroplasty, while U shaped Prostatobulbar Anastomosis was performed on others. Post traumatic strictures had best outcome whereas post infective strictures had the worse outcome. Among strictures following pelvic fractures, TILE grades A and B had a better post operative course as compared to TILE C. Overall complication rate was 13.24 percent. CONCLUSION: Our study demonstrated that etiology of urethral strictures may play a vital role for the overall prognosis of urethral strictures.
Assuntos
Adolescente , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Estreitamento Uretral/etiologia , Estreitamento Uretral/terapia , Fraturas Ósseas/complicações , Prognóstico , Ossos Pélvicos/lesões , Resultado do Tratamento , Uretrite/complicações , Cateterismo Urinário/métodosRESUMO
PURPOSE: Pelvic fracture urethral distraction defect is usually managed by the end to end anastomotic urethroplasty. Surgical repair of those patients with post-traumatic complex posterior urethral defects, who have undergone failed previous surgical treatments, remains one of the most challenging problems in urology. Appendix urinary diversion could be used in such cases. However, the appendix tissue is not always usable. We report our experience on management of patients with long urethral defect with history of one or more failed urethroplasties by Monti channel urinary diversion. MATERIALS AND METHODS: From 2001 to 2007, we evaluated data from 8 male patients aged 28 to 76 years (mean age 42.5) in whom the Monti technique was performed. All cases had history of posterior urethral defect with one or more failed procedures for urethral reconstruction including urethroplasty. A 2 to 2.5 cm segment of ileum, which had a suitable blood supply, was cut. After the re-anastomosis of the ileum, we closed the opened ileum transversely surrounding a 14-16 Fr urethral catheter using running Vicryl sutures. The newly built tube was used as an appendix during diversion. RESULTS: All patients performed catheterization through the conduit without difficulty and stomal stenosis. Mild stomal incontinence occurred in one patient in the supine position who became continent after adjustment of the catheterization intervals. There was no dehiscence, necrosis or perforation of the tube. CONCLUSION: Based on our data, Monti's procedure seems to be a valuable technique in patients with very long complicated urethral defect who cannot be managed with routine urethroplastic techniques.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Íleo/transplante , Uretra/lesões , Estreitamento Uretral/cirurgia , Derivação Urinária/métodos , Seguimentos , Complicações Pós-Operatórias , Resultado do Tratamento , Uretra/cirurgia , Estreitamento Uretral/etiologiaRESUMO
Introduction: Posterior urethral strictures after prostatic radiotherapy or surgery for benign prostatic hyperplasia (BPH) refractory to minimal invasive procedures (dilation and/or endoscopic urethrotomy) are challenging to treat. Published reports of alternative curative management are extremely rare. This is a preliminary report on the treatment of these difficult strictures by urethroplasty. Materials and Methods: Seven cases were treated: 4 cases occurred after open prostatectomy or transurethral resection of the prostate for BPH, one case after external beam irradiation and 2 after brachytherapy. The 4 cases after BPH-related surgery were in fact complete obstructions at the bladder neck and the membranous urethra with the prostatic urethra still partially patent. Anastomotic repair by perineal route was done in all cases with bladder neck incision in the BPH-cases and prostatic apex resection in the radiotherapy cases. Results: Mean follow-up was 31 months (range: 12-72 months). The operation was successful, with preserved continence, in 3 of the 4 BPH-cases and in 2 of the 3 radiotherapy cases. An endoscopic incision was able to treat a short re-stricture in the BPH-patient and a longer stricture at the bulbar urethra could be managed with a perineostomy in the radiotherapy-patient. Conclusion: Posterior non-traumatic strictures refractory to minimal invasive procedures (dilation/endoscopic urethrotomy) can be treated by urethroplasty using an anastomotic repair with a bladder neck incision if necessary.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Seguimentos , Prostatectomia/efeitos adversos , Resultado do Tratamento , Uretra/cirurgia , Estreitamento Uretral/etiologiaRESUMO
OBJECTIVE: We evaluated the outcome of bipolar energy by using PlasmaKinetic cystoscope instruments in the treatment of urethral stricture and bladder neck contracture. MATERIALS AND METHODS: Twenty-two male patients with urethral stricture and five with bladder neck contracture were treated by endoscopic bipolar vaporization. The most common etiology for stricture formation was iatrogenic (85.2 percent) and the mean stricture length was 12.2 mm. All patients were evaluated with urethrography and uroflowmetry one month and 3 months after surgery. Urethroscopy was routinely performed at the end of the first year. Preoperative mean maximum flow rate (Q max) was 4.9 mL/s for urethral stricture and mean Q max was 3.4 mL/s for bladder neck contracture. The results were considered as "successful in patients where re-stenosis was not identified with both urethrography and urethroscopy. Minimum follow-up was 13.8 months (range 12 to 20). RESULTS: Tissue removal was rapid, bleeding was negligible and excellent visualization was maintained throughout the vaporization of the fibrotic tissue. Postoperative mean Q max was 14.9 mL/s and the success rate was 77.3 percent for urethral stricture at mean follow-up time of 14.2 months. The success rate was 60 percent with a mean follow-up time of 12.2 months for bladder neck contracture and the mean Q max was 16.2 mL/s, postoperatively. CONCLUSIONS: The study suggests that bipolar vaporization is a safe, inexpensive and reliable procedure with good results, minimal surgical morbidity, negligible blood loss, and thus, it could be considered as a new therapeutic option for the endoscopic treatment of urethral stricture and bladder neck contracture.