The Role Of Optical Internal Urethrotomy At Present Scenario

BACKGROUND Urethral stricture Is a relatively common urological disorder which every urologist encounters in his regular urological practice. They pose a significant Problem from both clinical and economic point of view. The etiology of stricture urethra has changed over times. Trauma has taken Over Infection as the commonest cause. The trauma can be either External (Trauma) Or Internal ( Instrumentation ). Another Important Cause Is Balanitis Xerotica Obliterans also Known as Lichen Sclerosus. In a Small Group Of Patients, No Particular Cause Can Be Made Out And They are Grouped Under 'Idiopathic. 'The Management Of Stricture has also evolved over the times. Despite the availability of various options for the treatment of stricture urethra, Internal Urethrotomy has remained as a popular option among the urologists in view of its Simplicity, Safety and Shorter Learning Curve. Optical Internal Urethrotomy (Oiu) Is Best Suited For Single, Bulbar Strictures shorter than 2 Cm, with minimal spongiofibrosis and with no past Internal Urethrotomy. Optical Internal Urethrotomy (Oiu) may be contra-indicated In suspected Urethral Malignancy, Coagulation Disorders Or Active Infection. Optical Internal Urethrotomy (Oiu) is not Suited for Long Strictures (>2 Cm), Multiple Strictures, Previous Optical Internal Urethrotomy (Oiu), Strictures Other than bulbar . AIM OFTHE STUDY — The impact of co morbid factor in the outcome of internal urethrotomy — Association of the site ,length of the stricture, with the outcome of internal urethrotomy. — The effect of Pharmacological adjuncts (mitomycin-c) to OIU. — Duration of catheterization after urethrotomy — Role of repeat urethrotomy METHODS This is a prospective observational and analytical study, conducted at the urology department, kilpauk medical college hospital and govt royapettah hospital chennai in the period between february 2016 to march 2017 . Atotal of 60 male patients, with an age ranged from 15 to 60 years presenting with anterior urethral stricture, were included in the study. RESULTS Most common etiological factor is secondary to iatrogenic .Most common site is bulbar urethra.Most common complication is recurrent stricture .Most common age group is 30 to 40 years of age and the most common presenting complaint is strain to void and thin stream of micturation .With OIU alone76.7 % of patients voiding well ,23.3% came with recurrent stricture . With OIU and mitomycin c 90 % of patients voiding well and the recurrence rate is about 10 % .Diabetes with uncontrolled blood sugar ,length and density of the stricture influencing significantly with results and recurrent stricture formation. CONCLUSION Optical internal urethrotomy is a safe,minimally invasive repeatable procedure for anterior urethral stricture with <1.5 cm with less spongiofibrosis. Mitomycin C significantly reduces the recurrence rate of urethral stricture following OIU,as seen in our study , it is Safe and easily available

Value of direct vision internal urethrotomy in treatment of urethral stricture-twenty-year clinical experience / 中华泌尿外科杂志

Objective To summarize the experience and evaluate the efficacy of treatment of urethral stricture using direct visual internal urethrotomy (DVIU).Methods The clinical data of 361 patients (age range 16 -72 years, mean age 38 years) with urethral stricture who underwent urethrotomy from 1990 to 2010 was retrospectively analyzed.The disease course ranged from three months to 78 months with a mean of 16 months.The stricture length ranged from 0.2 to 2.0 cm (mean 1.1 cm).Stricture length was split into four main groups:stricture length≤0.5 cm in 63 (group 1 ), stricture length ranging between 0.6 and 1.0 cm in 175 ( group 2), stricture length ranging between 1.0 and 1.5 cm in 85 ( group 3 ) , and stricture length ranging between 1.6 and 2.0 cm in 38 ( Group 4).Of the 238 patients with length less than 1.0 cm there were 148 who's scar thickness were less than 1.0 cm, and 90 who's scar thickness were greater than 1.0 cm.Of the 123 patients with length less than 2.0 cm there were 69 who's scar thickness was less than 1.0 cm, and 54 who's scar thickness was greater than 1.0 cm.Results Three patients with DVIU failed because of long occlusion and false passage.Three hundred and twenty patients were followed-up from 12 to 120 months (mean:42).Re-openiag procedures were performed on 174 patients (54.4%) due to recurrence.The re-openiag procedure rate was 3.3%, 49.7%, 83.3% and 97.1% in Group1, Group2,Group3 and Group4, respectively.On the basis of scar thickness, of the 207 patients with stricture length less than 1.0 cm, 38 of 136 patients (27.9%) with scar thickness less than 1.0 cm underwent opening operation, and 43 of 71 patients (60.6%) with scar thickness more than 1.0 cm underwent opening operation.One hundred and thirteen patients with stricture length more than 1.0 cm, 33 of 42 patients (78.6%) with scar thickness less than 1.0 cm underwent opening operation, and 60 of 71 patients (84.5%) with scar thickness more than 1.0 cm underwent opening operation.Conclusions Good efficacy can be achieved in patients whose urethral stricture length is less than 0.5cm or whose stricture length and scar thickness is less than 1.0 cm using DVIU.

Initial Experience with Endoscopic Holmium: YAG Laser Urethrotomy for Incomplete Urethral Stricture

PURPOSE: Endoscopic holmium:yttrium-aluminum-garnet (Ho:YAG) laser urethrotomy is an alternative method in the management of urethral strictures. We report our initial experience in 15 cases of evaluating the therapeutic efficacy of the holmium laser for treating incomplete urethral strictures. MATERIALS AND METHODS: Endoscopic holmium laser urethrotomy was primarily performed on 15 patients with incomplete urethral stricture. Exclusion criteria were complete urethral stricture and previous treatment of urethral stricture. Retrograde urethrography and uroflowmetry were performed preoperatively and were carried out as follow-up studies postoperatively. RESULTS: Successful results without recurrence were achieved in 8 of 15 patients. When we classified the results by stricture length, the success rate was 80% in strictures less than 2 cm, whereas there was no therapeutic effect in strictures over 2 cm. When we classified the results by etiology, the number of successful results in strictures with an inflammatory, trauma, iatrogenic, or unknown cause was 2 (2/8), 3 (3/4), 2 (2/2), and 1 (1/1), respectively. In 7 patients who failed treatment, we repeated holmium laser urethrotomy in 5 patients and urethroplasty in 2 patients. No operative complications occurred in any patients. CONCLUSIONS: Endoscopic holmium laser urethrotomy is a safe and effective minimally invasive therapeutic modality in cases of stricture less than 2 cm. Further data from long-term follow-up are necessary to compare the success rate with that of conventional urethrotomy and urethroplasty.

To evaluate the results of urethral striture treatment by internal urethrotomy

20 cases of uretral stenosis underwent an endoscopic investigation. Cutting endoscopically the stenosis was a simple technique with low cost and good efficacy in initial treatment, which could be applied in most of uretral stenosis cases excuding uretral fistula, infection and stenosis at a long segment. After operation, regular dilatation and examination were recommended.

Optical urethrotomy for anterior urethral stricture under a new local anesthesia: intracorpus spongiosum anesthesia / 重庆医科大学学报

Objectives:To determine the feasibility of routinely performing internal urethrotomy for anterior urethral stricture under intracorpus spongiosum anesthesia in an outpatient setting.Methods:In a consecutive series of 18 patients with anterior urethral stricture,a dosage of 2~3 ml of 1%~2% lidocaine was slowly injected into the glans penis.Next,optical urethrotomy was performed immediately with a cold-cutting knife.According to pain scale,the effect of this anesthetic technique was assessed by questionnaire.Results:Internal urethrotomy was successfully completed in all the patients.All patients had no pain or discomfort.All the minor procedures varying from 15 to 45 minutes in duration were successfully completed under the new local anesthesia without any additional IV sedation.The anesthesia was very satisfactory without any complications.Conclusions:Under intracorpus spongiosum anesthesia,optical urethrotomy can be routinely performed in an outpatient setting.With this new local anesthesia,internal urethrotomy is a safe,effective,simple,and inexpensive procedure for treatment of anterior urethral stricture.

Therapeutic Effect of Internal Urethrotomy in Post-traumatic Complete Urethral Stricture / 대한비뇨기과학회지

PURPOSE: Visual internal urethrotomy is a standard therapy for incomplete urethral stricture, and may also be a reasonable initial treatment for a complete urethral stricture of less than 1cm. However, it has not yet been determined which length is most suitable for an internal urethrotomy of a complete urethral stricture. To answer this question, we retrospectively assessed the success rate and complications of an internal urethrotomy as an initial treatment for a complete urethral stricture. MATERIALS AND METHODS: Between January 1991 and December 2000, an internal urethrotomy was performed on 28 patients for a complete urethral stricture. A primary successful result was defined as; a patient requiring only one operation, and a peak flow rate of more than 15ml/s. A secondary successful result was defined as; no recurrences within six months, and peak flow rate of more than 15ml/s.1,2 RESULTS: A primary successful result was seen in 73.3 and 15.4% of patients, with a urethral stricture of less than, and greater than 2cm, respectively. A secondary successful result was seen in 100 and 92.3% of the patients with a urethral stricture of less than (average number of operation: 1.4 times), and greater than 2cm (average number of operation: 2.8 times), respectively. CONCLUSIONS: In this study, we found that a visual internal urethrotomy might be considered, not only as an initial method of treatment when a complete urethral stricture is less than 2cm, but also as a possible method of treatment when a stricture is more than 2cm.

Optical internal urethrotomy

During a 20 month period, 38 patients with urethral strictures were treated by Optical Internal urethrotomy at East Avenue Medical Center. The surgical technique, parameters like etiology, location and length of stricture, and complications of the procedure were described. The overall success rate was 78.9%. Good results were achieved in 25 patients (65%) and satisfactory results were noted in 5 patients (13%). Failure rate was 21% while the complication rate was 18%. Patients with strictures more than 2 cm long had an unsatisfactory outcome. Optical Internal Urethrotomy was determined to be simple and determined to be safe technique that should be considered as an option before definitive urethroplasty.

Ten Years Experience of Post-Traumatic Complete Urethral Stricture Treated with Endoscopic Internal Urethrotomy / 대한비뇨기과학회지

We reviewed our experience retrospectively with 65 patients who had post-traumatic complete urethral stricture secondary to pelvic bone fracture or other causes during last 10 years. All patients underwent delayed endoscopic internal urethrotomy (EIU) 3 to 9 months later after immediate suprapubic diversion. Prior to EIU, the antegrade-retrograde urethrogram demonstrated a complete urethral disruption, and the length of urethral obstruction was measured from 0.5cm to 3.5cm (mean 1.4cm). Of 65 patients, 61 patients (94%) had successful operations, 4 patients (6%) whose strictures were measured more than 2.5cm were failed and treated with open urethroplasty. Sixty-one patients who eventually underwent successful endoscopic internal urethrotomy; 28 patients (46%) achieved satisfactory urethral voiding after first EIU; 33 patients (54%) took operations more than twice due to recurred partial urethral stricture. After 6 to 53 months (average-21months), fifty-six (86%) of 65 patients voided satisfactorily (incontinence in 3 patients). Five patients who did not void well even after successful EIU were diagnosed to have neurogenic bladder (detrusor areflexia). Of 65 patients, 16 patients (25%) had post-traumatic impotence. After the EIUs were performed, there were no newly developed impotences. There were no serious major complications. We concluded that direct visual internal urethrotomy was useful and safe as a primary minimally invasive therapeutic modality for post-traumatic complete urethral stricture in selected patients with relatively short urethral defect (less than 2.5cm).

Clinical Assessment of Visual Internal Urethrotomy as Primary Treatment of Urethral Stricture / 대한비뇨기과학회지

PURPOSE: We describe clinical assessment of visual internal urethrotomy (VIU) as primary treatment modality in 69 men who presented with complete or partial obstructed urethral stricture. MATERIALS AND METHODS: The 63 patients with partial obstructed urethral stricture were treated by typical VIU. The 6 men with complete obstructed urethral stricture were treated by VIU using sound passed through previously placed suprapubic tract as guide. RESULTS: The procedure was completed successfully in 57 of the 63 men with partial obstructed (90.5%) and 3 of 6 patients with complete obstructed urethral stricture (50%). CONCLUSIONS: VIU is a safe and effective as primary treatment plan when urethral stricture is partial obstructed and the impassable urethral segment is shorter than 1.0cm.

A Comparative Study of Visual Internal Urethrotomy and Perineal Urethroplasty in the Treatment of Posttraumatic Urethral Strictures / 대한비뇨기과학회지

The outcomes of treatment of 31 patients who were managed by single visual internal urethrotomy were compared with those of 25 patients managed by perineal urethroplasty to asses whether the replacement of almost urethroplasty by the simpler urethrotomy was justified. The overall successful results were achieved in 51.6% of visual internal urethrotomy and 76%, of urethroplasty. Patients with anterior urethral strictures more than 1 cm long or completely obliterated strictures had higher failure rates in the visual internal urethrotomy than urethroplasty (p<0.05). The morbidity rates were 9.6% in the visual internal urethrotomy and 24% in the urethroplasty. We recommend that visual internal urethrotomy be reserved for patients with urethral strictures 1 cm or less in length and posterior urethral stricture which is supposed to have a high recurrence rate since the procedure is simple and it does not compromise asecondary urethroplasty.

A Clinical Evaluation of Pediatric Urethral Stricture / 대한비뇨기과학회지

The results with management of urethral stricture are disappointing, with a high rate of early and late recurrence. Recently, the success of internal urethrotomy has made us question the role of open urethroplasty in the management of urethral strictures. Thus a clinical evaluation was made on 26 pediatric patients with urethral stricture in the Department of Urology, National Medical Center, during the period from Sep. 1978 to Aug. 1992. The stricture was incomplete in 15 cases and complete in 11 cases. The length of stricture was less than l cm in 17 cases, 1 to 2 cm in 3 cases, more than 2cm in 3 cases and multiple stricture in 3 cases. The treatment modality of incomplete urethral stricture was internal urethrotomy in 12 cases and urethroplasty in 3 cases regardless of length. Incomplete urethral stricture, internal urethrotomy was carried out in 8 cases with less than 1 cm long stricture and urethroplasty in 3 cases regardless of length. But all complete urethral stricture was carried out urethroplasty initially. The overall out come in incomplete urethral stricture, average urine flow rate ranged from 8.5ml/sec to 11.4ml/sec and incomplete urethral stricture, average urine flow rate ranged from 7.0 ml/sec to 20 ml/sec. We think that visual urethrotomy is a valuable initial method, when stricture is incomplete and urethroplasty is a valuable initial method, when stricture is complete.

Two Cases of Congenital Urethral Stenosis with Recurrent Urinary Tract Infection / 대한비뇨기과학회지

Congenital urethral stricture are uncommon in boys and occurs at the junction of the endodermal primary urethra and ectodermal secondary urethra. This structure is thought to be related embryonically to failure of complete dissolution of urogenital membrane at the junction of the urogenital sinus and genital fold. Endoscopically, this lesion is recognized as a ring-form stenosis just distal to the external urethral sphincter. Congenital urethral stricture is an important cause of recurrent urinary tract infections, enuresis, failure in thrive or hematuria in pediatric urological practice. The most effective treatment of this lesion is optic internal urethrotomy under direct vision. We report two cases of 6 and 12-year-old boys hospitalized with complaints of high fever, dysuria, urgency and frequency. Six-year-old boy has grade III VUR and 12-year-old boy has grade IV VUR with Hutch diverticulum. We managed with visual internal urethrotomy only in 6-year-old boy but visual internal urethrotomy and bilateral ureteroneocystostomy in 12-year-old boy.

Antegrade light guiding visual internal urethrotomy in complete urethral stricture / 대한비뇨기과학회지

Visual internal urethrotomy (VIU) is a valuable initial management methods of the patient with incomplete urethral stricture. VIU is not widely used in the management of the patient with complete urethral stricture, due to the risk of complication. We performed VIU in 10 male-patients had suffered from complete urethral stricture after trauma. We used a flexible Chole-nephroscoper connected with Xenon light source as a guide for the VIU. The length of the urethral stricture was 1.2 +/-0.8 cm. The operation time was 62 +/-26.4 min. The urethral catheter had indwelled for 20.3 +/-17.19 days. All the 10 complete urethral stricture patients became to void successfully. There was no specific serious complication. In conclusion, this method needs only short operative time, had little complication and did not require fluoroscopic guidance. We suggest that this alternative method may be useful and safe for the management of the complete urethral stricture.

A clinical evaluation of urethral stricture / 대한비뇨기과학회지

The results with management of urethral stricture are disappointing, with a high rate of early and late recurrence. Recently, the success of internal urethrotomy has made us question the role of open urethroplasty in the management of urethral strictures. Thus a clinical evaluation was made on 116 patients with urethral stricture in the Department of Urology, Masan Koryo General Hospital, during the period from May 1985 to July 1991. The or stricture was incomplete in 92 cases and complete in 24 cases. The length of stricture was less than 1cm in 86 cases, 1 to 2cm in 19 cases, more than 2cm in 3 cases and multiple strictures in 8 cases. The treatment modality of incomplete urethral stricture was internal urethrotomy in 68 cases and urethroplasty in 9 cases regardless of length, and dilatation in 15 cases with mild stricture. Incomplete urethral stricture, internal urethrotomy was carried out in 7 cases with less than 1cm long stricture and urethroplasty in 17 cases regardless of length. The overall success rate in incomplete urethral stricture was 88.2 % in internal urethrotomy and 88.9 % in urethroplasty, and in complete urethral stricture, 85.7 % in internal urethrotomy and 82. 4% in urethroplasty. We think that visual internal urethrotomy is a valuable initial method, when stricture is incomplete or less than 1cm in length in cases of complete urethral stricture.

Therapeutic effect of internal urethrotomy / 대한비뇨기과학회지

Forty nine endoscopic internal urethrotomy was performed on 37 patients with urethral stricture(including 12 patients of complete obstruction) during 8 years from 1984 to 1991. The results were as follows : 1.Internal urethrotomy can be performed under local anesthesia. 2. It can be repeated if necessary. 3. Complications were minimal. the overall morbidity rate was 16.2%. 4. Satisfactory results were obtained in 89.2% of the patients. Success rate was nearly 100% the case of short length of stricture. Success rate in the case of complete stricture was 75%. 5. As a prognostic factor, the length of stricture was more important than the severity of stricture. 6. When carefully performed, this procedure is highly valuable for the primary management of any type of urethral stricture.

The Experience of Indwelling Nylon(#1-0) for the Guidance of Managing Urethral Stricture under the Internal Urethrotomy / 대한비뇨기과학회지

Internal urethrotomy is widely accepted for the treatment of urethral stricture recently. However it is well known the fact that urethral stricture can be recurred after internal urethrotomy. In the presence of severe urethral stricture, internal urethrotomy can not be performed because the operator has difficulty finding his way through the urethra. During the internal urethrotomy or primary realignment of urethral rupture, we inserted the Nylon(#1-0) from the suprapubic into the bladder and then situated into the distal urethra for the guide of right way of re-internal urethrotomy when severe urethral stricture was developed after operation. With above methods, we experienced less difficulties to perform internal urethrotomy. We found the method as simple, easy way to manage of severe urethral stricture under the direct visual urethrotomy.

Clinical Assessment of Visual Internal Urethrotomy on Obliterated and Non-obliterated Urethral Stricture / 대한비뇨기과학회지

Visual internal urethrotomy may be a reasonable initial procedure of complete and incomplete urethral stricture before planning more extensive urethroplasty. However, it is essential to recognize its limitation because careless use can result in complications. So we have experienced 88 cases of complete and incomplete urethral stricture treated by visual internal urethrotomy. 1. In non-obliterated urethral stricture, satisfactory results were achieved in 57 of patients(78 %) after urethrotomy. Patients with more than 2cm long stricture and multiple strictures had the most unsatisfactory results ( required multiple urethrotomy). 2. In obliterated urethral stricture, 54 procedures of urethrotomy were carried out in 15 patients with complete urethral obstruction(average : 3.6times). When stricture was less than 1cm in length, good results were obtained in spite of several recurrences. However, when complete urethral stricture was more than 1cm in length, all patients failed due to recurred strictures. These results suggest that visual internal urethrotomy is a valuable initial method before urethroplasty, when stricture is less than 1cm in length in cases of complete urethral obstruction.

Internal Urethrotomy Using Optical Urethrotome for Urethral Stricture / 대한비뇨기과학회지

Urethral stricture has been most complicated problem in the field of urology. We have experienced 17 times of endoscopic internal urethrotomy in 13 cases with urethral stricture and reviewed results and complications with a brief literatures. Of 13 cases, 9 cases have been followed for 3 to 20 months. Satisfactory results were obtained in 7 cases(77.8%). The complication rate was 11.8%(2 cases). Average duration of retaining catheter was 12 days. In conclusion, endoscopic internal urethrotomy is thought to be safe and first choice of procedure for urethral stricture.

Endoscopic Internal Urethrotomy in the Management of Urethral Strictures / 대한비뇨기과학회지

95 cases of urethrotomy under direct vision were made on 60 patients with urethral strictures. The results were as followed. 1 When stricture length was less than 0.5cm, success rate by urethrotomy under direct vision (87 %) was very high and other factors contributing to success rate were diameter of stricture, site of stricture, UTI. 2. Urethrotomy under direct vision was highly useful for the primary management of any urethral strictures. 3. It can be easily repeated when the strictures are recurred. 4. Complications were minimal without serious problems.

Direct Visual Internal Urethrotomy as an Effective Treatment Modality for Traumatic Complete Urethral Stricture / 대한비뇨기과학회지

Internal urethrotomy under direct vision was utilized in the complete urethral stricture secondary to pelvic bone fracture or other trauma Prior to operation the antegrade-retrograde cystourethrogram demonstrated a complete disruption and the length of stricture at the level of bulbar and/or membranous urethra. To seek correct channel of proximal urethra was facilitated by an antegrade metal sound guidance performed through the suprapubic tract during urethrotomy. We found this technique a simple, easy and effective method in the management of traumatic complete urethral stricture.