scholarly journals Urethral Reconstruction in a Reference Center in Eastern Colombia

2019 ◽  
Vol 29 (01) ◽  
pp. 026-031
Author(s):  
Verónica Tobar-Roa ◽  
Ana María Ortiz-Zableh ◽  
Daniel José Mantilla-Rey ◽  
Guillermo Sarmiento-Sarmiento
Keyword(s):  
Urethral Stricture ◽  
Reconstructive Surgery ◽  
Primary Anastomosis ◽  
Small Sample ◽  
Urethral Reconstruction ◽  
Reference Center ◽  
Surgery Patient ◽  
Patient Reported ◽  
The Mean ◽  
Urethral Reconstructive Surgery

Abstract Introduction and Objectives Urethral stricture is a complex pathology of multiple etiologies, and of unknown incidence in our country. There are multiple options for the management of urethral stricture, from minimally invasive procedures, like urethral dilation or direct vision internal urethrotomy, to open surgical reconstruction using excision and primary anastomosis (EPA), or augmented urethroplasty with tissue graft.The aim of the present study is to describe the characteristics of the patients managed with urethral reconstructive surgery in a reference center in eastern Colombia. Methods Observational retrospective cohort study. Data was obtained from patients undergoing urethral reconstructive surgery at the institution from August 2013 to December 2017. All of the surgeries were performed by the same surgical team. The clinical and demographic variables were collected, and the validated urethral stricture surgery patient-reported outcome measure (USS-PROM) questionnaire was applied. Results A total of 56 patients were included in the study, 26 patients (46.4%) underwent excision and primary anastomosis (EPA), and 30 (53.6%) underwent graft urethroplasty. The average age at the time of the intervention was 53.3 years old. The most frequent etiology was trauma, and the mean length of the stenosis was 1.7 cm for the EPA group, and 3 cm for the graft urethroplasty group (p = 0.009). A history of previous surgery was found in 66% of the patients, and radiotherapy in 2 patients.The mean follow-up was of 14 months (range: 0–52 months), observing similar success rates for both techniques. Despite of the small sample size, when analyzing the Kaplan-Meier curves, we observed a tendency of a better response in the group without previous treatments and with stenosis with a length < 2 cm.The rate of postoperative complications was of 23%, with no statistical difference between the 2 groups. The USS-PROM questionnaire was applied to 29 patients, finding that 27 out of 29 respondents were satisfied with the results of the procedure, and all of them would recommend it to another person. Conclusions The results of our study show that urethral reconstruction surgery performed in an experienced center is associated with a good success rate, and that patients are satisfied with the result of the procedure.

scholarly journals Buccal mucosal graft urethroplasty for radiation-induced urethral strictures: an evaluation using the extended Urethral Stricture Surgery Patient-Reported Outcome Measure (USS PROM)

2020 ◽  
Vol 38 (11) ◽  
pp. 2863-2872 ◽  
Author(s):  
Malte W. Vetterlein ◽  
◽  
Luis A. Kluth ◽  
Valentin Zumstein ◽  
Christian P. Meyer ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Urethral Stricture ◽  
Outcome Measure ◽  
Patient Reported Outcome ◽  
Patient Reported Outcome Measure ◽  
Urethral Strictures ◽  
Buccal Mucosal Graft ◽  
Surgery Patient ◽  
Patient Reported ◽  
Radiation Induced

Abstract Objectives To evaluate objective treatment success and subjective patient-reported outcomes in patients with radiation-induced urethral strictures undergoing single-stage urethroplasty. Patients and methods Monocentric study of patients who underwent single-stage ventral onlay buccal mucosal graft urethroplasty for a radiation-induced stricture between January 2009 and December 2016. Patients were characterized by descriptive analyses. Kaplan–Meier estimates were employed to plot recurrence-free survival. Recurrence was defined as any subsequent urethral instrumentation (dilation, urethrotomy, urethroplasty). Patient-reported functional outcomes were evaluated using the validated German extension of the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS PROM). Results Overall, 47 patients were available for final analyses. Median age was 70 (IQR 65–74). Except for two, all patients had undergone pelvic radiation therapy for prostate cancer. Predominant modality was external beam radiation therapy in 70% of patients. Stricture recurrence rate was 33% at a median follow-up of 44 months (IQR 28–68). In 37 patients with available USS PROM data, mean six-item LUTS score was 7.2 (SD 4.3). Mean ICIQ sum score was 9.8 (SD 5.4). Overall, 53% of patients reported daily leaking and of all, 26% patients underwent subsequent artificial urinary sphincter implantation. Mean IIEF-EF score was 4.4 (SD 7.1), indicating severe erectile dysfunction. In 38 patients with data regarding the generic health status and treatment satisfaction, mean EQ-5D index score and EQ VAS score was 0.91 (SD 0.15) and 65 (SD 21), respectively. Overall, 71% of patients were satisfied with the outcome. Conclusion The success rate and functional outcome after BMGU for radiation-induced strictures were reasonable. However, compared to existing long-term data on non-irradiated patients, the outcome is impaired and patients should be counseled accordingly.

scholarly journals Evaluation of the short-term outcome of unilateral urethral mobilization for the management of bulbar urethral stricture

2021 ◽  
Vol 9 (12) ◽  
pp. 3506
Author(s):  
Kartik Chandra Ghosh ◽  
Prodyut Kumar Saha ◽  
Masud Ahmed ◽  
Farhad Mahmud ◽  
Uttam Karmaker
Keyword(s):  
Urethral Stricture ◽  
Flow Rate ◽  
Urine Volume ◽  
Postoperative Outcome ◽  
Urinary Flow Rate ◽  
Urethral Reconstruction ◽  
Urinary Flow ◽  
College Hospital ◽  
Term Outcome ◽  
The Mean

Background: In modern urology, successful male urethral reconstruction poses a continuing challenge.Methods: It was a quasi-experimental study conducted in the department of urology, Dhaka medical college hospital, Dhaka, Bangladesh between January 2010 to December 2011. 35 patients having bulbar urethral strictures admitted in the department were study participants. All the participants underwent unilateral urethral mobilization, for buccal mucosa graft urethroplasty and followed up at least six months. RGU and MCU was done when peak flow was <15 ml /sec in uroflowmetry. Urethroscopy was done at 3rd and 6th month. The statistics used to analyze the data were descriptive statistics, and the tests done were student’s t-test, chi-square test, ANOVA, and Fisher exact test.Results: The length of strictures was observed ≤3 cm among 31% (n=11) and >3 cm among 69% (n=24) patients. As the immediate postoperative outcome among the participants, we found the mean peak urinary flow rate (Qmax), 15.3±1.2 and voided urine volume (ml), 328.8±50. Finally, as the postoperative outcome after 6 months among the participants, we found the mean peak urinary flow rate (Qmax), 24.2±2.9; voided urine volume (ml), 330.8±50.1 and PVR (ml), 11.6±3.3. In this study, some potential complications were bleeding and wound infection which were found among 11.43% and 17.14% patients respectively. Conclusions: Considering the satisfactory outcomes and lower complications unilateral urethral mobilization procedure can be considered as an effective treatment method for the management of bulbar urethral stricture.  

scholarly journals A False Route Case of Primary Excision Anastomosis (EPA) Procedure in The Treatment of Traumatic Bulbar Urethral Stricture

2019 ◽  
Vol 2 (3) ◽  
Author(s):  
I Gusti Ayu Putri Purwanthi ◽  
Gede Wirya Kusuma Duarsa ◽  
Tjok Gde Agung Senapathi
Keyword(s):  
Urethral Stricture ◽  
Primary Anastomosis ◽  
Psychological Problem ◽  
Pelvic Injury ◽  
Urethral Reconstruction ◽  
Unexpected Result ◽  
Urethral Strictures ◽  
Radiologic Evaluation ◽  
History Of

The bulbar urethra stricture is the most common form of anterior urethral stricture. The treatment of urethral strictures are varies and remains a challenging field in urology. Excision Primary Anastomosis (EPA) described as the most effective intervention for traumatic urethral stricture cases with a long-term success rate. This case report described male, 42 years old with history of pelvic injury. He had underwent cystostomy and conservative management for his pelvic injury. After EPA and pubectomy procedure in September 2019, he was still unable to void from his urethra. Radiologic evaluation with BVUC was done on October 2019, showing total obstruction of urethral as high as superior aspects of pars bulbosa, unfavourable anastomosed and displaced urethra. Acquired urethral stricture or fistula is an unexpected result of urethral reconstruction and leads to much inconvenience as well as psychological problem for the patient. This condition is avoidable by operation that was performed by experienced urologist and using a flexible cystoscopy as a guidance.

scholarly journals Is Standardization Transferable? Initial Experience of Urethral Surgery at the University Hospital Frankfurt

2020 ◽  
Vol 7 ◽  
Author(s):  
Mike Wenzel ◽  
Marieke J. Krimphove ◽  
Benedikt Lauer ◽  
Benedikt Hoeh ◽  
Matthias J. Müller ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Urethral Stricture ◽  
Final Analysis ◽  
University Hospital ◽  
Successful Implementation ◽  
Complication Rates ◽  
Surgery Patient ◽  
Patient Reported ◽  
The University ◽  
Urethral Surgery

Background: Since January 2018 performance of urethroplasties is done on regular basis at the University Hospital Frankfurt (UKF). We aimed to implement and transfer an institutional standardized perioperative algorithm for urethral surgery (established at the University Hospital Hamburg-Eppendorf—UKE) using a validated Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROM) in patients undergoing urethroplasty at UKF.Materials and Methods: We retrospectively analyzed all patients who underwent urethroplasty for urethral stricture disease between January 2018 and January 2020 at UKF. All patients were offered to revisit for clinical follow-up (FU) and completion of USS-PROM. Primary end point was stricture recurrence-free survival (RFS). Secondary endpoints were functional outcomes, quality of life (QoL), and patient satisfaction.Results: In total, 50 patients underwent urethroplasty and 74 and 24% had a history of previous urethrotomy or urethroplasty, respectively. A buccal mucosal graft urethroplasty was performed in 86% (n = 43). After patient's exclusion due to lost of FU, FU &lt;3 months, and/or a pending second stage procedure, 40 patients were eligible for final analysis. At median FU of 10 months (interquartile-range 5.0–18.0), RFS was 83%. After successful voiding trial, the postoperative median Qmax significantly improved (24.0 vs. 7.0 mL/s; p &lt; 0.01). Conversely, median residual urine decreased significantly (78 vs. 10 mL; p &lt; 0.01). Overall, 95% of patients stated that QoL improved and 90% were satisfied by the surgical outcome.Conclusions: We demonstrated a successful implementation and transfer of an institutional standardized perioperative algorithm for urethral surgery from one location (UKE) to another (UKF). In our short-term FU, urethroplasty showed excellent RFS, low complication rates, good functional results, improvement of QoL and high patient satisfaction. PROMs allow an objective comparison between different centers.

Anxiety, depression, fatigue, and headache burden in the pediatric hydrocephalus population

2020 ◽  
Vol 26 (5) ◽  
pp. 483-489 ◽  
Author(s):  
Kathrin Zimmerman ◽  
Bobby May ◽  
Katherine Barnes ◽  
Anastasia Arynchyna ◽  
Elizabeth N. Alford ◽  
...  
Keyword(s):  
General Population ◽  
Emotional Health ◽  
Chronic Medical Condition ◽  
Measurement Information ◽  
Burden Of Headache ◽  
Pediatric Hydrocephalus ◽  
Patient Reported ◽  
The Mean ◽  
Moderate Range ◽  
Anxiety Depression

OBJECTIVEChildhood hydrocephalus is a common chronic medical condition. However, little is known about the burden of headache and psychological comorbidities in children living with hydrocephalus. The purpose of this study was to determine the prevalence and severity of these conditions among the pediatric hydrocephalus population.METHODSDuring routine neurosurgery clinic visits from July 2017 to February 2018, the authors administered four surveys to children ages 7 years and older: Pediatric Migraine Disability Assessment (PedMIDAS), Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety, PROMIS Depression, and PROMIS Fatigue. The PedMIDAS is an assessment of headache disability in pediatric and adolescent patients. The PROMIS measures are pediatric self-reported instruments to assess social and emotional health. PROMIS measures utilize T-scores (mean 50, SD 10) to compare anxiety, depression, and fatigue in specific populations to those in the US general population. Clinical and demographic data were collected from the medical record (hydrocephalus etiology, shunt infection, race, etc.) and tested for associations with survey measure scores.RESULTSForty children completed the PedMIDAS. Ten percent of them were in the severe headache range, 5% were in the moderate range, and 5% were in the mild range. There was a statistically significant association between undergoing a cluster of shunt operations and headache burden (p = 0.003).Forty children completed all three PROMIS measures. The mean anxiety score was 45.8 (SD 11.7), and 2.5% of children scored in the severe anxiety range, 17.5% in the moderate range, and 20% in the mild range. The mean depression score was 42.7 (SD 10.0), with 2.5% of children scoring in the severe depression range, 5% in the moderate range, and 12.5% in the mild range. The mean fatigue score was 45.1 (SD 16.4), with 15% percent of children scoring in the severe fatigue range, 10% in the moderate range, and 7.5% in the mild range. There were no statistically significant associations between child anxiety, depression, or fatigue and clinical or demographic variables.CONCLUSIONSChildren with hydrocephalus have an average burden of headache, anxiety, depression, and fatigue as compared to the general population overall. Having a cluster of shunt operations correlates with a higher headache burden, but no clinical or demographic variable is associated with anxiety, depression, or fatigue.

scholarly journals Long-Term Efficacy, Visual Performance and Patient Reported Outcomes with a Trifocal Intraocular Lens: A Six-Year Follow-up

2021 ◽  
Vol 10 (9) ◽  
pp. 2009
Author(s):  
Joaquín Fernández ◽  
Manuel Rodríguez-Vallejo ◽  
Javier Martinez ◽  
Noemi Burguera ◽  
David P. Piñero
Keyword(s):  
Intraocular Lens ◽  
Patient Reported Outcomes ◽  
Phone Call ◽  
Distortion Analysis ◽  
Patient Reported ◽  
Visual Function Questionnaire ◽  
Secondary Objective ◽  
Defocus Curve ◽  
The Mean

(1) Background: To evaluate the efficacy at 6 years postoperative after the implantation of a trifocal intraocular lens (IOL) AT Lisa Tri 839MP. The secondary objective was to evaluate the contrast sensitivity defocus curve (CSDC), light distortion analysis (LDA), and patient reported outcomes (PROs). (2) Methods: Sixty-two subjects participated in phone call interviews to collect data regarding a visual function questionnaire (VF-14), a patient reported spectacle independence questionnaire (PRSIQ), and questions related to satisfaction and decision to be implanted with the same IOL. Thirty-seven of these subjects were consecutively invited to a study visit for measurement of their visual acuity (VA), CSDC, and LDA. (3) Results: The mean monocular distance corrected VA was −0.05, 0.08, and 0.05 logMAR at far and distances of 67 cm and 40 cm, respectively. These VAs were significantly superior to those reported in previous literature (p < 0.05). The total area under the CSDC was 2.29 logCS/m−1 and the light distortion index 18.82%. The mean VF-14 score was 94.73, with 19.4% of subjects requiring spectacles occasionally for near distances, and 88.9% considering the decision of being operated again; (4) Conclusions: Long-term AT LISA Tri 839MP IOL efficacy results were equal or better than those reported 12 months postoperatively in previous studies. The spectacle independence and satisfaction rates were comparable to those reported in short-term studies.

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