Urethral strictures

Author(s):  
Anthony R. Mundy ◽  
Daniela E. Andrich

Urethral strictures are common and almost all urologists will deal with them on a regular if not daily basis. They have always been common and the history of the subject stretches back to 3,000 BC. Urethral dilators have been found in the tombs of the pharaohs so that they might be able to catheterize themselves or dilate their own strictures in the afterlife. Urethrotomy and dilatation are two of the most frequently performed procedures in urology. But these are usually only palliative, and curative treatment by urethroplasty is performed by very few urologists. In part this is because most strictures are bulbar strictures and most non-bulbar strictures are seen only by reconstructive urologists; but in part this represents a somewhat ambivalent attitude of most urologists to urethral stricture disease. In this chapter, we will attempt to clarify the current approach to this problem.

2021 ◽  
Vol 14 (3) ◽  
pp. 156-163
Author(s):  
V.P. Glukhov ◽  
◽  
A.V. Ilyash ◽  
V.V. Mitusov ◽  
D.V. Sizyakin ◽  
...  

Introduction. Extended spongy urethral strictures require the use of plastic surgery techniques. In most cases, a one-stage urethral repair can be performed. However, staged urethroplasty and permanent urethrostomy are important in patients with extremely complex urethral strictures. Purpose of the study. To determine the clinical features of spongy urethral strictures, which cannot be cured by one-stage urethroplasty, but are subject to multistage plastic or permanent urethrostomy. Materials and methods. The study included 158 patients who underwent surgery for urethral strictures in 2010 − 2019. Inclusion criteria: spongy urethral strictures requiring staged urethroplasty or permanent urethrostomy. Exclusion criteria: age<18 years, proximal urethral strictures, urethra-vesical anastomosis and bladder neck stenosis, previously untreated congenital anomalies (hypospadias and epispadias), and history of any other urethral surgery not meeting the inclusion criteria. Results. The age of the patients ranged from 18 to 88 years. Iatrogenic (34.8%) and inflammatory (32.3%) urethral lesions predominate in the structure of etiological factors with the most common penile localization of narrowing (43.7%). The length of strictures in half of the patients exceeds 6 cm; a quarter of the sample has subtotal and total spongy urethral lesions. The proportion of recurrent urethral strictures is 56.3%. The average duration of the urethral stricture disease reaches 8 years. In 61.3% of cases, the disease is accompanied by complications from both local tissues and organs of the urinary and reproductive systems. Conclusion. Clinical evaluation of patients with spongy urethral strictures requiring multi-stage urethroplasty or permanent urethrostomy reveals a particular severity of urethral stricture disease. This category of patients has a high risk of unsuccessful outcomes with one-stage surgery. In these cases, patients require a multi-staged urethroplasty or a permanent urethrostomy.


1971 ◽  
Vol 29 (1) ◽  
pp. 51-67 ◽  
Author(s):  
J. H. Baker

Slade's Case is of such significance in the history of the common law that it has, quite properly, been the subject of more scrutiny and discussion in recent years than any other case of the same age. The foundation of all this discussion has been Coke's report, which is the only full report in print. The accuracy and completeness of Coke's version have hardly been challenged, and the discussions have assumed that it contains almost all there is to know about the case. This assumption must be discarded if we are to understand the contemporary significance of the case.


2020 ◽  
Vol 8 (2) ◽  
pp. e001084
Author(s):  
Darren Kelly ◽  
Ingrid Isaac ◽  
Judith Cruzado-Perez ◽  
Florence Juvet

Congenital urethral strictures are well recognised in human beings and have recently been described in two cats but have not been previously reported in dogs. A 10-month-old female English Bull Terrier presented with a life-long history of being unable to pass a normal stream of urine. Urethrocystoscopy confirmed the presence of a stricture lesion in the proximal urethra. This thin, membranous structure was effaced under endoscopic visualisation using a 10 mm diameter balloon-dilation catheter. Complete and sustained resolution of clinical signs occurred after a single dilation procedure. To the best of our knowledge, this is the first report of a congenital urethral stricture in a dog and the term congenital obstructive proximal urethral membrane may be useful for describing these lesions in the future.


1895 ◽  
Vol 57 (340-346) ◽  
pp. 192-197 ◽  

The effect of position of the body upon the circulation of the blood is a matter of daily observation with the physician and surgeon, but it has been curiously neglected by physiologists. So far as my researches into the history of the subject go, the mere fact that the feet-down position lowers arterial pressure, and that the feet-up position heightens it, is almost all that has been determined. In 1885, Hermann placed the subject in the hands of two pupils, Blumberg and Wagner, with the object of investigating the dynamic and hydrostatic effects of gravity on the circulation.


2016 ◽  
Vol 33 (S1) ◽  
pp. S43-S43
Author(s):  
L. Küey

Discrimination could be defined as the attitudes and behavior based on the group differences. Any group acknowledged and proclaimed as ‘the other’ by prevailing zeitgeist and dominant social powers, and further dehumanized may become the subject of discrimination. Moreover, internalized discrimination perpetuates this process. In a spectrum from dislike and micro-aggression to overt violence towards ‘the other’, it exists almost in all societies in varying degrees and forms; all forms involving some practices of exclusion and rejection. Hence, almost all the same human physical and psychosocial characteristics that constitute the bases for in-group identities and reference systems could also become the foundations of discrimination towards the humans identified as out-groups. Added to this, othering, arising from imagined and generalized differences and used to distinguish groups of people as separate from the norm reinforces and maintains discrimination.Accordingly, discrimination built on race, color, sex, gender, gender identity, nationality and ethnicity, religious beliefs, age, physical and mental disabilities, employment, caste and language have been the focus of a vast variety of anti-discriminatory and inclusive efforts. National acts and international legislative measures and conventions, political and public movements and campaigns, human rights movements, education programs, NGO activities are some examples of such anti-discriminatory and inclusive efforts. All these efforts have significant economic, political and psychosocial components.Albeit the widespread exercise of discrimination, peoples of the world also have a long history of searching, aiming and practicing more inclusive ways of solving conflicts of interests between in-groups and out-groups. This presentation will mainly focus on the psychosocial aspects of the anti-discriminative efforts and search a room for hope and its realistic bases for a more non-violent, egalitarian and peaceful human existence.Disclosure of interestThe author has not supplied his declaration of competing interest.


2021 ◽  
pp. 193-200
Author(s):  
Eric D. Perakslis ◽  
Martin Stanley

“Smart” devices have become ubiquitous in society and are used by almost all of us on a daily basis, but the security history of these devices is notorious due to their lack of protections. The vision of a smart clinic where real-time patient data arrives on-site before the patient, where check-in desks are no longer necessary, and where treatment and prevention advice are based upon an entirely new spectrum of biophysical and socioeconomic measures is truly compelling but also fraught with hazards. Data can be misused and misinterpreted. Unconscious bias can slip into any well-intentioned data analysis and any “fully wired” building is most likely an attack-surface nightmare. To realize the vision of smart clinics, a complete shift in mindset to “first do no harm” is essential.


1933 ◽  
Author(s):  
◽  
Margaret Ellen Bell

Counties: Webster, Wright, Christian, Douglas, Ozark, Taney, Stone, Barry, and McDonald||"If, by chance, all the written evidence of the history of a region, the character of its people, its economic structure, and its physical qualities were swept away, the story of that region could be reconstructed with an astounding degree of accuracy, from the place-names of the section alone. The place-names of these counties of the Ozarks remarkably mirror its early history, its people, and their interests and tastes. To enable the reader to grasp the subject more easily and trace its course more methodically, a table of classification has been presented and discussed in the first chapter. All the names have been grouped under five heads: 1) Borrowed Names, 2) Historical Names, 3) Personal Names, 4) Environmental Names, and 5) Subjective Names. These five heads will cover practically all the place-names found in any locality, except for the unsolved and doubtful ones. These unsolved names have been listed at the end of Chapter One for the benefit of future investigators and students. Besides these five groups of classification there remain five additional ways in which almost all the names will repay study. They are: 1) The Composition of Names, 2) The Linguistic Features, such as spelling, pronunciation, and dialect words, 3) Non-English Names, 4) and 6) Folkways and Folklore. Chapter Two comprises a brief survey and discussion of the names with regard to these five special features. Chapter Three, embracing by far the greater part of the thesis in bulk, consists of a dictionary of all the place-names studied. In an Appendix I have discussed separately the school names of the section. Last of all I have placed my Bibliography."--Pages 18-19.||"This thesis is the record of careful research into the origin of the place-names of the lower southwest counties of Missouri. Nine counties, Webster, Wright, Christian, Douglas, Ozark, Taney, Stone, Barry, and McDonald have been studied, and the origin of place-names of counties, towns, post offices, streams, "hollows", hills, springs, "knobs", rivers, prairies, townships, mountains, valleys, ridges, gaps, and "balds" have been recorded, in so far as it was possible. These nine counties constitute a large part of what is known as the Ozark Region. It is only in the last few decades that the possibilities and the resources of this region have been fully realized. However, it is in the early history of this section that the romance of pioneer settlement and the character and qualities of these people are most clearly seen."--Page 1.


Author(s):  
Frankiewicz Mikolaj ◽  
Markiet Karolina ◽  
Kozak Oliwia ◽  
Krukowski Jakub ◽  
Kałużny Adam ◽  
...  

Abstract Purpose To verify which of the diagnostic modalities: Voiding cystouretrography (VCUG), Sonouretrography (SUG) or Magnetic resonance uretrography (MRU) is the most accurate in the assessment of urethral strictures in males and in what cases the application of novel imaging techniques benefits most. Methods 55 male patients with a diagnosis of urethral stricture, were enrolled in this prospective study. Initial diagnosis of urethral stricture was based on anamnesis, uroflowmetry and VCUG. Additional imaging procedures—SUG and MRU were performed before the surgery. Virtual models and 3D printed models of the urethra with the stricture were created based on the MRU data. Exact stricture length and location were evaluated by each radiological method and accuracy was verified intraoperatively. Agreement between SUG and MRU assessments of spongiofibrosis was evaluated. MRU images were independently interpreted by two radiologists (MRU 1, MRU 2) and rater reliability was calculated. Results MRU was the most accurate [(95% CI 0.786–0.882), p < 0.0005] with an average overestimation of 1.145 mm (MRU 1) and 0.727 mm (MRU 2) as compared with the operative measure. VCUG was less accurate [(95% CI 0.536–0.769), p < 0.0005] with an average underestimation of 1.509 mm as compared with operative measure. SUG was the least accurate method [(95% CI 0.510–0.776), p < 0.0005] with an average overestimation of 2.127 mm as compared with the operative measure. There was almost perfect agreement of MRU interpretations between the radiologists. Conclusions VCUG is still considered as a ‘gold standard’ in diagnosing urethral stricture disease despite its limitations. SUG and MRU provide extra guidance in preoperative planning and should be considered as supplemental for diagnosing urethral stricture. Combination of VCUG and SUG may be an optimal set of radiological tools for diagnosing patients with urethral strictures located in the penile urethra. MRU is the most accurate method and should particularly be considered in cases of post-traumatic or multiple strictures and strictures located in the posterior urethra.


2018 ◽  
Vol 12 (2) ◽  
pp. 145-157
Author(s):  
Marco Spilotros ◽  
Suzie Venn ◽  
Paul Anderson ◽  
Tamsin Greenwell

Patients affected by a urethral stricture account for a considerable cost to all healthcare systems. The estimated prevalence of all urethral stricture in the UK is 10/100,000 men during youth, increasing to about 40/100,000 by age 65 years and to more than 100/100,000 thereafter. A penile urethral stricture is a narrowing of the lumen of the urethra due to ischaemic fibrosis of the urethral epithelium and/or spongiofibrosis of the corpus spongiosum occurring within the penile urethra. Its aetiology is largely idiopathic but other important causes are failed hypospadias repair and lichen sclerosus, which account for 60% of all cases. Strictures of the anterior urethra account for 92% of cases: bulbar strictures are more frequent (46.9%), followed by penile (30.5%) and combined bulbar/penile (9.9%), that is, 40.4% of all men presenting with stricture will have a penile urethral stricture alone or in combination with a bulbar urethral stricture. There are several options for the treatment of penile urethral strictures ranging from less invasive treatments, including urethral dilatation and direct vision internal urethrotomy, to more complex augmentation graft and flap urethroplasty. The aim of the present review is to describe the aetiology and epidemiology of anterior urethral strictures and the available options reported in literature for their treatment. Level of evidence: 1a


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