Complications of proximal hypospadias repair with transverse preputial island flap urethroplasty: a 15-year experience with long-term follow-up / 亚洲男科学杂志(英文版)

There is still debate regarding the optimal surgical approach for proximal hypospadias. This retrospective study aims to evaluate the long-term outcomes using transverse preputial island flap urethroplasty. A total of 320 patients were included, with a mean follow-up of 40.2 months (range: 1-156 months). Complications were encountered in 125 patients (39.1%), including fistulas in 53 (16.6%), urethral strictures in 31 (9.7%), and diverticula in 41 (12.8%). The mean timing of presentation with a complication was 15.8 months (median: 1.7, range: 1-145), of which 79.2% were early complications and 20.8% were late complications. In all, 20.8% of the patients with complications presented after ≥1 year, and 12.8% presented after ≥5 years. Univariate analysis revealed that age at the time of surgery, flap length, and location of the urethral meatus were not correlated with complications. A stricture was present in 31.7% (13/41) of those with diverticula (P < 0.001), while late urethral diverticula were accompanied by urethral strictures in 11.1% (1/9) of cases (P = 0.213). These results indicate that transverse preputial island flap urethroplasty still has a high incidence of complications, even when performed by highly experienced physicians. Most complications of hypospadias are diagnosed within 1 year postoperatively, while fistulas and urinary strictures generally occur within 2 months and diverticula tend to be present by 1 year.

Aspects épidémiologiques, cliniques et prise en charge de sténose urétrale chez l'adulte dans un Hôpital de District de Ngaoundéré, Cameroun

Introduction: l'objectif était de déterminer les aspects épidémiologiques, cliniques et prise en charge de la sténose de l'urètre à l'Hôpital Protestant de Ngaoundéré (HPN).Méthodes: une étude rétrospective a été conduite, basée sur la revue des dossiers des patients hospitalisés pour sténose urétrale dans l'unité urologique de l'HPN, d'une période d'un an (janvier 2013 à janvier 2014). Seuls les dossiers complets étaient inclus.Résultats: 57 patients ont été retenus sur les 69 dossiers enregistrés dont tous était de sexe masculin. L'âge moyen était 52,6 ans (19 ans à 85 ans). La tranche d'âge la plus représentée était celle de 41 à 60 ans. La sténose urétrale représentait 0,6% des consultations externes, 11,36 % des hospitalisations en chirurgie, et 6,96% des interventions chirurgicales dans cette structure sanitaire. La dysurie (70, 17%) était le principal motif de consultation. Les étiologies étaient d'origines infectieuses (52,63%), traumatiques (26,32%) et iatrogènes (21,05%). L'ECBU réalisé sur tous les patients a permis d'isoler les gonocoques (14,03%) et Escherichia coli (21,05%), le reste de culture était stérile (64,91%). L'Uretro-Cystographie Rétrograde (UCR) a été réalisée sur 28 patients (49,12%), dont 26 cas était des rétrécissements antérieurs (92,85%). L'Urétrotomie Interne Endoscopique (UTI) était le geste chirurgical le plus réalisé (58%). La sténose était le plus souvent localisée au niveau des régions bulbaires et péno-bulbaires. Le taux de guérison était de 87,73% contre 12,27% de récidives.Conclusion: la sténose urétrale est fréquente en Urologie de l'HPN mais les patients consultent souvent en stade compliqué. L'urétrotomie interne endoscopique a montré des résultats plausibles

Use and outcomes of amplatz renal dilator for treatment of urethral strictures

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.

Comprehensive analysis of etiology on the prognosis of urethral strictures

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.

L'urethrorraphie terminoterminale dans le traitement des retrecissements de l' uretre bulbaire et membraneux

Objectifs: Evaluer les resultats de d'uretrorraphie termino-terminale dans le traitement des stenoses de l'uretre bulbaire et membraneux a travers l'etude de la serie de notre service et une revue recente de la litteraturePatients et methodes: Il s'agit d'une etude retrospective basee sur la revue des dossiers medicaux des patients ayant beneficies d'une Uretrorraphie Termino-Terminale (UTT) dans notre formation entre Fevrier 2006 et Fevrier 2010. La moyenne d'age des patients etait de38; 3 ans. L'etiologie du retrecissement uretral etait infectieuse et traumatique respectivement dans 40et 60des cas. Chez 68d'entre eux; le retrecissement uretral etait localise au niveau bulbaire et chez 32au niveau membraneux. Tous les patients avaient une stenoseunique inferieure a 2 cm a l'uretro-cystographie retrograde et mictionnelle.Resultats: La duree moyenne de suivi etait de 28 mois. Le taux de succes de l'uretrorraphie termino-terminale dans notre etude etait de 88. 12des patients avaient presente une recidive de la stenose. Tow patients (8) ayant une stenose bulbaire avaient rapporte des troubles ejaculatoires. Aucun de nos patients (0) n'avait presente ni dysfonction erectile ni incontinence suite a cette intervention.Conclusion: L'uretroplastie anastomotique termino-terminale permet des taux eleves de repermeabilisation uretrale apres une premiere procedure. Le taux de recidive de la stenose reste faible comparativement aux autres techniques chirurgicales. Les troubles ejaculatoires peuvent etre prevenus par une dissection minutieuse et une restitution anatomique des muscles bulbo-caverneux

Urethral Stricture and HIV: Unusual Presentations and Treatment Challenge

Objective: The clinico-pathologic features of urethral stricture in patients with HIV/AIDS are not yet clearly described in the literature. HIV/AIDS has changed the natural course and clinical features of most infectious diseases. We describe some of the features of post-inflammatory strictures associated with HIV Infection and assess the treatment challenges and outcomes of other causes of urethral stricture. Patients and Methods: Consecutive men with urethral stricture who presented to the University Hospital of Gondar; North-West Ethiopia were enrolled. The HIV status; cause of the stricture; type of treatment and outcome were recorded. Results: There were 25 post-traumatic and 15 post-gonococcal urethral strictures. All posttraumatic and 5 of the post-gonococcal urethral stricture patients were HIV negative. All 10 HIV positive patients had longer and denser urethral strictures than expected. The time between gonococcal infection and urethral stricture development was 3-5 years in HIV positive patients. The treatment of post-traumatic stricture included progressive perineal anastomotic urethroplasty and a good outcome was seen in more than 95. However; the surgical treatment of patients with HIV infection was a challenge. Conclusion: If post-inflammatory urethral stricture occurs in a young man where the time between known gonococcal infection and development of stricture is short (less than 5 years); HIV coinfection is most likely. The stricture in these patients will be longer and denser and not amenable to conventional endoscopic urethrotomy

Optical urethrotomy in strictures following fracture pelvis

Management of posterior urethral injuries with pelvic fracture remains a major controversy and has always been a challenge to urologists. Objective of this study was to see the outcome of optical internal urethrotomy in treatment of urethral strictures following fracture pelvis. This prospective study was conducted at the Urology Department, Lady Reading Hospital, Peshawar from January 2007 to July 2008. A total of 45 male patients [20-60 years of age] and having urethral strictures following fracture pelvis were treated with internal optical urethrotomy. Follow-up ranged from 3 months to 1 year. Fracture pelvis resulting from the road traffic accident, was the cause of urethral stricture. The good and fair results of internal optical urethrotomy were 68.56% patients who were treated with single internal optical urethrotomy. Internal optical urethrotomy was repeated in 22.86% of patients. Clean intermittent self urethral dilatation was applied as adjuvant treatment to prevent recurrence of stricture for variable period ranging from 1 to 3 months. Internal optical urethrotomy is safe and effective procedure for short yet inaccessible strictures from the perineum

Intermittent self dilatation--still a viable option for treatment of urethral stricture disease.

The study was conducted to find out if intermittent self dilatation (ISD) is still a viable option for treatment of urethral strictures in patients who had undergone either urethral dilatation or urethrotomy prior to ISD. The study included 310 male patients with the age range from 17 to 93 years old from January 1996 to March 2007. The data was gathered from the computer data base kept by the urology unit in the hospital. A questionnaire was used to evaluate their tolerance towards the procedure and quality of life. Of the total number of patients 262 replied to the questionnaire. The mean follow up was 57.68 months with 67.7% continuing with the procedure. The procedure was well tolerated by 84.1% of patients and 79.6% had no technical difficulty. The most number of patients carrying out this procedure were in the 6th and 7th decade of life. There was a recurrence rate of urethral strictures of 16.9%. It is seen that even today ISD following an endoscopic procedure is a viable treatment option. The patients seem to tolerate this procedure well and it is an option in the elderly patient group who may not be fit or willing to undergo reconstructive surgery or urethroplasty.

Posterior urethral valves in childhood : experience in a center with scarce facilities

Objective: Posterior urethral valves (PUV) are the most common congenital causes of lower urinary tract obstruction in male children; but few cases have been reported from Nigeria. In this study we describe our 7-year experience of management of PUV in children in order to increase the awareness of this condition in our environment. Patients and Methods : This is a report of 41 consecutive children with PUV who were managed at the Jos University Teaching Hospitals (JUTH); Jos; Nigeria; from June 2000 to April 2006. Their age at presentation ranged from 2 days to 15 years (mean: 2.5 years). The relevant clinical; laboratory and radiological data were entered into a database and analyzed.Results: Twenty-eight patients presented with a condition highly suspicious of PUV; while 7 patients presented with other urological conditions. Six patients presented with non-urological symptoms which caused a delay in diagnosis and institution of treatment. Voiding cystourethrography was diagnostic in all cases. In the majority of patients (n=31); management consisted of transurethral balloon avulsion of the valves yielding a satisfactory outcome in over 80. Conclusion : Although this study was restricted to one hospital; there appears to be a high incidence of PUV in children in North Central Nigeria. An increased awareness of varied clinical features; a high index of suspicion and simple conservative treatment by balloon avulsion of PUV would improve the outcome.of the patients. Urethral stricture was the main complication (which responded to serial dilatation) and occurred in 3 patients. The postoperative mortality rate was 2.6

Buccal mucosa urethroplasty for bulbar urethral strictures

Objectives: Urethroplasty with the buccal mucosa graft is an excellent option for the treatment of urethral stricture disease. The authors report their 10-year experience with buccal mucosa graft urethroplasty by the dorsal and ventral approach. Patients and Methods: From June 1994 to May 2003; 67 patients with bulbar urethral stricture underwent buccal mucosa urethroplasty. A free graft of buccal mucosa was used as an onlay; ten patients were operated by the ventral approach and the remaining 57 by the dorsal approach. After the bulbar urethra is exposed; we perform a dorsal endoscopic cold knife urethrotomy until the urethra is fully opened. After measurement of the defect; the graft is harvested from the lower lip and sutured to the urethra and to the corpora cavernosa. A transurethral grooved catheter and suprapubic drainage are left for 7 and 14 days; respectively. Results: The median follow-up was 58 months (range 12 - 110). Recurrence of the stricture occurred in 4(3/67) of the patients with a recurrence rate of 2/10 (20) and 1/57 (2) for the ventral and dorsal onlay patients; respectively. The overall complication rate was 9/67 (13). Conclusions: Buccal mucosa urethroplasty provides a high long-term success rate for the treatment of bulbar urethral strictures. The dorsal onlay may be superior to the ventral onlay approach

Reconstrucción nde la uretra posterior postrauma por via perineal / Postraumatic posterior urethra reconstruction through a perineal approach

Introducción y objetivos: La lesión de la uretra posterior postrauma es un complejo problema a resolver en un paciente que, probablemente por meses, ha transitado por el consultorio y quirófano de varios especialistas para resolver las distintas alteraciones generadas por el accidente. Una de las maneras de resolver la estrechez es por via perianal realizando una anastomosis bulboprostática. El objetivo de esta presentación es evaluar los resultados obtenidos con este abordaje. Métodos: Se presenta la evolución de 22 pacientes con lesión de la uretra posterior operados por vía perianal. El rango de seguimiento osciló entre los 12 y 101 meses, con una media de 48,2 meses. Cuarenta por ciento de los pacientes tenían intentos de realinación en agudo. Los pacientes se controlaron el primer año con endoscopia, uretrografía y flujometría. Luego del año, con flujometría y endoscopia en los que la aceptaron. Resultados: La cirigía fue exitosa en 21 pacientes (95,4 por ciento). Ningún paciente necesitó de otro precedimiento, salvo dos (9 por ciento), a quienes realizamos una uretrotomía interna a los 13 y 20 meses del posoperatorio. Se registró un solo fracaso que necesito de una segunda reconstrucción, con buena evolución posterior. Un paciente perdió la función sexual a causa de la cirugía y dos la recuperaron luego de la misma. Conclusión: De acuerdo a nuestra experiencia, el abordaje perineal y la anastomosis bulboprostática es una opción segura y que generalmente no necesita de otro procedimiento complementario. En un mínimo porcentaje, la función sexual puede ser afectada

Uretrotomia interna en el tratamiento de la estenosis de uretra bulbar (EUB) / Internal urethrotomy as a treatment of the bulbar urethral stricture

Objetivo: Determinar el porcentaje de reestenosis posterior al tratamiento de la EUB con uretrotomía interna. Material y Métodos: Fueron tratados un total de 31 pacientes portadores de EUB cuya longitud fuera igual o menor de 0,5 cm, en los cuales el seguimiento promedio fue de 25,3 meses. Se excluyeron aquellos con áreas de espongiofibrosis, tratamiento previo por su estenosis o en tratamiento por carcinoma transicional de vejiga. En al 90 por ciento de los casos el procedimiento se realizó en forma ambulatoria bajo anestesia local. Resultados: El 58 por ciento de los pacientes presentaromn estenosis postoperatorias en un tiempo promedio de 5,4 meses. La distribución del tiempo de estenosis mostró una curva bimodal en el primer y cuarto trimestre, detectándose el 83 por ciento de las recurrencias dentro del primer año. El 100 por ciento de los pacientes que fueron tratados nuevamnete con uretrotomía interna (n:10) sufrieron reestenosis en el primer trimestre del postoperatorio. Conclusión: Aun en popblaciones altamente seleccionadas como la presente, el porcentaje de reestenosis es cvonsiderable, debiendo extenderse el seguimiento de los pacientes a largo plazo. El empleo reiterado de la uretrotomía interna en el tratamiento de la EUB res uina opción desaconsejable como tratamiento definitivo en poblaciones similares a las estudiadas. El empleo de anestesia local y manejo ambulatorio de estos pacientes debe ser considerado

Manejo endourológico de una estenosis posterior a una transuretero-uretorostomía / Endouroological management of the posterior stenosis transureteroureteral anastomotic

El avance en las técnicas endourológicas en los últimos años ha convertido al tratamiento endoscópico de las obstrucciones del uréter en una alternativa razonable al compararla con la cirugía abierta. El presente es el reporte de un paciente que presentó estrechez de una anastomosis transureteroureteral y el cual fue tratado por vía percutánea anterógrada con la ayuda del fluoroscopio y el de instrumental endourológico consiguiéndose recanalizar el segmento esterosado y obteniéndose un resultado satisfactorio a otro plazo. El seguimiento a largo plazo de este tipo de pacientes nos permitirá emitir conclusiones definitivas en cuanto a la eficacia de esta modalidad de tratamiento

Uretoplastias en un tiempo en la estenosis de uretra: nuestra experiencia en 33 casos / One stage urethroplasties in urethral stenosis: our experiencie in 33 patients

Se presentan los resultados de una serie de 33 pacientes con estenosis de uretra extensas que fueron tratados en forma consecutiva con uretroplastias a cielo abierto con tecnicas en un tiempo. En 27 pacientes (81,9 por ciento) se empleo piel genital en forma de colgajo tubulado o en parche como elementop de ampliacion o sustitucion uretral, en 5 (15 por ciento) se utilizo la anastomosis termino-terminal como precedimiento quirurgico, en 2 (3 por ciento) se empleo un injerto de mucosa bucal, en uno como unico tratamiento y en otro como parte de otro procedimiento quirurgico. El seguimiento promedio de los pacientes operados fue de 12,4 meses. En los 27 pacientes tratados con uretroplastias de sustitucion o ampliacion la complicacion mas frecuente, observada en 5 de ellos (18,5 por ciento),fue la presencia de pequenas areas de necrosis epidermica, en 2 (7,4 por ciento) se observaron fistulas uretrocutaneas y en 2 (7,4 por ciento) estenosis postoperatoria en la boca proximal de la anastomoisis. Del grupo de 5 pacientes tratados con anastomisis termino-terminal, un paciente presento incontinencia de orina de esfuerzo, no habiendose observado estenosis hasta el momento. Considerando la poblacion total (n:33) 84,84 por ciento de los pacientes evolucionaron favorablemente, entediendose por tal la ausencia de fistula, estenosis, impotencia, incontinencia postoperatoria o la presencia de grandes areas de necrosis en piel de la zona quirurgica. Si bien el seguimiento es aun poco prolongado, creemos que las tecnicas empleada son recomendables para el tratamiento en un tiempo de la estenosis de uretra

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

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

Estenosis uretral adquirida / Acquired urethral stenosis

En el Hospital IPSS "Alberto Sabogal" del Callao, se estudió desde febrero de 1982 (fecha de su fundación), hasta diciembre de 1986 un total de 127 pacientes con estenosis uretral adquirida, observándose una mayor incidencia entre los 40 y 69 años de edad; de acuerdo al sexo, la totalidad de pacientes afectados fueron hombres, teniéndose como antecedente más importante el adenoma prostático (78%) y la gonorrea (25%). La sintomatología más frecuentemente hallada fueron la disminución del chorro urinario, las infecciones urinarias, la polaquiuria y la disuria por lo que el 76% de pacientes fueron sometidos a cistoscopía y 30% al cistouretrograma. El tratamiento prescrito fue la dilatación en más de una oportunidad (90%), y los casos rebeldes tuvieron necesidad de cirugía (23%) en tanto que solo en un 10% tuvieron necesidad de una sola dilatación. la evolución fue favorable en un 85%, y el 15% restante tuvieron necesidad de controles periódicos por la persistencia de síntomas

role of visual urethrotomy in the primary treatment of obliterated posterior urethral structures

Ten cases of obliterated posterior urethral stricture were managed with visual urethrotomy. A half circle C shaped sound was introduced through the supra public cystostomy into the posterior urethra and was used as a guide for urethrotomy. When the sound was impossible to pass into the posterior urethra, methylene blue dye was installed in the bladder and used instead of the sound. Nine patients out of 10 had acceptable urine flow rate after visual urethrotomy. Visual urethrotomy is a simple, repeatable, safe and useful procedure for the management of stricture urethra. The long-term results were not guaranteed and the follow up for long periods was recommended