scholarly journals Challenges in the Diagnosis and Management of Acquired Nontraumatic Urethral Strictures in Boys in Yaoundé, Cameroon

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
F. F. Mouafo Tambo ◽  
G. Fossi kamga ◽  
C. Kamadjou ◽  
L. Mbouche ◽  
A. S. Nwaha Makon ◽  
...  
Keyword(s):  
Surgical Management ◽  
Urethral Stricture ◽  
Pediatric Surgery ◽  
Tertiary Hospital ◽  
Internal Urethrotomy ◽  
Urethral Catheterization ◽  
Diagnosis And Management ◽  
Urethral Strictures ◽  
Surgery Department

Introduction. Urethral strictures in boys denote narrowing of the urethra which can be congenital or acquired. In case of acquired strictures, the etiology is iatrogenic or traumatic and rarely infectious or inflammatory. The aim of this study was to highlight the diagnostic and therapeutic difficulties of acquired nontraumatic urethral strictures in boys in Yaoundé, Cameroon.Methodology. The authors report five cases of nontraumatic urethral strictures managed at the Pediatric Surgery Department of the YGOPH over a two-year period (November 2012–November 2014). In order to confirm the diagnosis of urethral stricture, all patients were assessed with both cystourethrography and urethrocystoscopy.Results. In all the cases the urethra was inflammatory with either a single or multiple strictures. The surgical management included internal urethrotomy (n=1), urethral dilatation (n=1), vesicostomy (n=2), and urethral catheterization (n=3). With a median follow-up of 8.2 months (4–16 months) all patients remained symptoms-free.Conclusion. The authors report the difficulties encountered in the diagnosis and management of nontraumatic urethral strictures in boys at a tertiary hospital in Yaoundé, Cameroon. The existence of an inflammatory etiology of urethral strictures in boys deserves to be considered.

scholarly journals Severe Penile Curvature following Otis Urethrotomy

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Ersagun Karaguzel ◽  
Metin Gur ◽  
Dogan S. Tok ◽  
İlke O. Kazaz ◽  
Huseyin Eren ◽  
...  
Keyword(s):  
Urethral Stricture ◽  
Tunica Albuginea ◽  
High Recurrence Rate ◽  
Penile Curvature ◽  
Corpus Spongiosum ◽  
Tunica Vaginalis ◽  
Internal Urethrotomy ◽  
Urethral Catheterization ◽  
Cold Knife

Urethral stricture is a common urological pathology with a high recurrence rate after treatment. Urethral manipulations are among its main causes. In this paper, urethral stricture developed secondary to urethral catheterization and was treated with cold-knife internal urethrotomy and the Otis urethrotomy procedure. During the follow-up period, severe ventral penile curvature preventing sexual intercourse developed due to fibrosis of the corpus spongiosum and tunica albuginea of the penis. This ventral penile curvature was corrected with a separate operation using a tunica vaginalis flap harvested from the left scrotum.

scholarly journals DIRECT VISUAL INTERNAL URETHROTOMY (DVIU) FOR UNTREATED BULBAR URETHRAL STRICTURES. A SOLUTION?

2021 ◽  
pp. 15-16
Author(s):  
Abhiyutthan Singh Jadaon ◽  
Chitra Champawat ◽  
Chandra Pal Singh
Keyword(s):  
Treatment Failure ◽  
Urethral Stricture ◽  
Cox Regression ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Care Hospital ◽  
Internal Urethrotomy ◽  
Urethral Strictures ◽  
Alternative Approach

Introduction :Urethral stricture diseases have been treated with numerous approaches. Though open urethroplasty is considered a one-time solution [1], The direct visual internal urethrotomy (DVIU) is still considered an alternative approach in the stepladder of treatment [2,3]. Here we report our experience at a tertiary care hospital with DVIU in a homogeneous series of patients with bulbar urethral stricture who underwent strict follow-up and present a multivariable analysis of the results to identify signicant predictors of treatment failure. We wish to offer new insights into DVIU. Materials and method: We performed a retrospective analysis of patients who underwent internal urethrotomy. Patients who underwent DVIU for untreated bulbar urethral strictures with minimum follow-up of 12 months were included. Patients with traumatic stricture and stricture length >4 cm were excluded.The primary outcome was treatment failure. Multivariable Cox regression analyses by Stata v.12.0 were used to test the association between predictors:- Stricture etiology, stenosis length, preoperative maximum ow [pQmax]) and treatment failure. Results: 215 patients were included. Median follow-up was 35 months. At 5-yr follow-up the failure-free survival rate was 54.4%. On multivariable analysis pQmax was the only signicant predictor of treatment failure. Conclusions: DVIU success rate for untreated bulbar urethral strictures was signicantly associated with preoperative maximum ow rate. The patients with a pre- operative maximum ow lesser than 6 ml/s have a low probability of success and may be considered for alternative treatments such as open urethroplasty, especially when affected by long urethral strictures.

scholarly journals Sachse Laser in post-trauma urethral stricture. A valid alternative before urethroplasty.

2018 ◽  
Vol 2 (2) ◽  
Author(s):  
Astrit Mustafa ◽  
Evisa Zhapa ◽  
Francesco Saverio Grossi
Keyword(s):  
Urethral Stricture ◽  
Holmium Laser ◽  
Internal Urethrotomy ◽  
Urethral Strictures ◽  
Before And After ◽  
Cold Knife ◽  
Multiple Treatments ◽  
Voided Volume

Background: The most commonly used treatment modality for urethral strictures is the direct visual internal urethrotomy method according Sachse cold knife, but with low long-term success rate. Alternative method after failure is isurethroplasty with preputial flap or Buccal mucosa. The aim of this presentation is to report the efficacy of the Internal Urethrotomy with Holmium Laser (Sachse laser).Material and methods: We report three cases of urethral stenosis after trauma which treated with Internal Urethrotomy with Holmium Laser (Sachse laser) after failure of multiple treatments with Sachse cold knife. We evaluated and compared the uroflowmetry parameters before and after Sachse laser.Results: The average of uroflowmetry parameters before incision were: Q max 4.5 ml/sec, Q med 3 ml/sec. Voided Volume 323 cc, while after incision with Sachse laser were: Q max 30 ml/sec, Q med 12 ml/sec. Voided Volume 363 cc.No patients relapsed during follow-up time from 3 to 24 months.Conclusion: Even though these are only a few cases, we think that Sachse laser is a valid alternative after unsuccessful Sachse cold knife and before Urethroplasty, even in patients with urethral stricture after trauma.

scholarly journals Buccal One-Stage Mucosal Graft Urethroplasty for Urethral Stricture. Results of 10 Years of Experience.

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Gezim Galiqi ◽  
Artan Koni ◽  
Flamur Tartari ◽  
Albert Pesha ◽  
Shpetim Ymeri ◽  
...  
Keyword(s):  
Success Rate ◽  
Urethral Stricture ◽  
Buccal Mucosa ◽  
Dorsal Surface ◽  
Success Rates ◽  
Lower Lip ◽  
Bulbar Urethra ◽  
Urethral Strictures ◽  
Buccal Mucosa Graft

Aim: Representing our data regarding use of buccal mucosa for treatment of recurrent urethral stricture. Evaluating effectiveness of buccal graft for reconstruction of urethral segment both penile and bulbar urethra. Materials and methods: We repaired 95 urethral strictures with buccal mucosa grafts from 2004 to 2015. Mean patient age was 39 years. The etiology of stricture was unknown in 54% of cases in other cases ischemia, trauma, instrumentation was the reason. 96% had undergone previous urethrotomy or dilation. The buccal mucosa graft was harvested from lower lip mostly. Mean graft length was 3.8 cm. The graft was placed on the ventral and dorsal bulbar urethral surface in 61 and 34 cases, respectively. In pendulous urethra we routinely use the dorsal graft the Asopa inlay graft or Barbagli onlay graft. Clinical outcome was considered a success or failure at the time that any postoperative procedure was needed, including dilation. Mean follow-up was 36 months (range 16 to 62). Results: We had a success rate of 77% with dorsal inlay or onlay flap for pendulous urethra inferior than ventral graft used for bulbar urethra which was 81% success rate. Conclusions: In our experience the placement of buccal mucosa grafts into the ventral or dorsal surface of the bulbar urethra showed an acceptable success rates 81% and 77% respectively. Longer times of follow up is need to see if the results deteriorated more.

scholarly journals One-stage buccal two-flap urethroplasty using the Kulkarni technique for extended anterior urethral strictures

2020 ◽  
Vol 8 (4) ◽  
pp. 44-52
Author(s):  
M. I. Katibov ◽  
M. M. Alibekov ◽  
Z. M. Magomedov ◽  
A. M. Abdulkhalimov ◽  
V. G. Aydamirov
Keyword(s):  
Urethral Stricture ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Disease Recurrence ◽  
Urinary Flow ◽  
One Stage ◽  
Urethral Strictures ◽  
Prospective Control ◽  
Onlay Technique

Introduction. The problem of extended urethral strictures treatment remains relevant due to the complexity of the supervision of such patients and the high frequency of disease recurrence after surgical treatment.Purpose of the study. Evaluation of the effectiveness of one-stage buccal urethroplasty according to the Kulkarni technique using two flaps for extended anterior urethral strictures.Materials and methods. The study included 18 men with an extended anterior urethral stricture, who underwent buccal urethroplasty by perineal access using the Kulkarni dorsolateral onlay technique using two flaps from January 2018 to March 2020, and a postoperative follow-up period of at least 6 months. The study was prospective. Control examination was carried out 3, 6, 12, 18 and 24 months after surgery. The criteria for the recurrence of urethral stricture were the presence of complaints of deterioration in the quality of urination in combination with a decrease in the maximum urinary flow rate of less than 12 ml/sec and the presence of residual urine in an amount of more than 100 ml, as well as the need to perform any surgical intervention to restore the normal passage of urine.Results. The age of the patients ranged from 32 to 72 years (median 58 years). The length of the stricture ranged from 6 to 11 cm (median, 8 cm). The stricture was localized in the penile segment in 11 (61.1%) cases and the penile and bulbar urethra in 7 (38.9%) cases simultaneously. An iatrogenic cause of urethral stricture occurred in 11 (61.1) patients, idiopathic in 5 (27.8%) patients and inflammatory in 2 (11.1%) patients. The stricture was primary in 12 (66.7%) cases and recurrent in 6 (33.3%). Spontaneous urination was preserved in 6 (33.3%) patients, cystostomy existed in 12 (66.7%) patients. The follow-up period after surgery ranged from 3 to 24 months (median - 12 months). Recurrence of urethral stricture was noted in 3 (16.7%) cases. The use of this technique for recurrent forms of the urethral stricture (recurrence after the previous urethroplasty) is the most significant risk factor for treatment failure. 1 (5.6%) case of erectile dysfunction and stress urinary incontinence has taken place of the late postoperative complications.Conclusions. The Kulkarni operation using two buccal flaps for extended strictures of the anterior urethra allows to achieve high rates of efficacy and safety of a treatment, however, the risk of failure increases significantly when used for the treatment of recurrent types of strictures. 

scholarly journals Urethral Strictures and its Management at Tertiary Hospital of Nepal

2020 ◽  
Vol 18 (2) ◽  
pp. 310-312
Author(s):  
Kabir Tiwari ◽  
Amit Mani Upadhaya ◽  
Ashok Kunwar ◽  
Sanjesh Bhakta Shrestha
Keyword(s):  
Urethral Stricture ◽  
Bladder Neck ◽  
Surgical Techniques ◽  
Tertiary Hospital ◽  
Urethral Meatus ◽  
Common Site ◽  
Urethral Strictures ◽  
Different Types ◽  
Endoscopic Incision ◽  
Anastomotic Urethroplasty

Background: Urethral stricture can occur from urethral meatus to bladder neck. Treatment of urethral stricture include dilatation, endoscopic incision and anastomotic urethroplasty. The aim of this study is to report our experience in the management of different types of urethral strictures.Methods: We retrospectively reviewed the chart of all the patients of urethral stricture who received treatment at Kathmandu model hospital between January 2015 and October 2019. Different types of urethral stricture along with various modalities of treatment given were recorded.Results: Fifty patients were included in this study, all were males. Mean age was 49 (16-82) years. Bulbar urethra was the most common site in 54% of cases and bulbomembranous least common, only 10% of cases. Depending on sites and size of stricture, different types of surgery performed were meatoplasty, dviu and anastomotic urethroplasty.Conclusions: Urethral stricture is a troublesome disease and can occur anywhere from meatus to the bladder neck. Different surgical techniques are present and the treatment should be individualized, depending on location and length of the stricture.Keywords: Urethra; urethral stricture; urethroplasty

scholarly journals Internal urethrotomy versus plasmakinetic energy for surgical treatment of urethral stricture

2015 ◽  
Vol 87 (2) ◽  
pp. 161 ◽  
Author(s):  
Levent Ozcan ◽  
Emre Can Polat ◽  
Alper Otunctemur ◽  
Efe Onen ◽  
Oğuz Ozden Cebeci ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Urethral Stricture ◽  
Maximum Flow ◽  
Clinical History ◽  
Internal Urethrotomy ◽  
Urethral Strictures ◽  
Cold Knife ◽  
Group 2 ◽  
Stricture Recurrence ◽  
Group 1

Purpose: we aimed to compare the longterm outcome of surgical treatment of urethral stricture with the internal urethrotomy and plasmakinetic energy. Material and Methods: 60 patients, who have been operated due to urethral stricture were enrolled in our clinic. None of the patients had a medical history of urethral stricture. The urethral strictures were diagnosed by clinical history, uroflowmetry, ultrasonography and urethrography. The patients were divided two groups. Group 1 consisted of 30 patients treated with plasmakinetic urethrotomy and group 2 comprised 30 men treated with cold knife urethrotomy. Results: There were no statistically significant differences between two groups in terms of patient age, maximum flow rate (Qmax) and quality of life score (Qol) value. A statistical difference between the two groups was observed when we compared the 3rd-month uroflowmetry results. Group 1 patients had a mean postoperative Qmax value of 16,1 ± 2,3 ml/s, whereas group 2 had a mean postoperative Qmax value of 15,1 ± 2,2 ml/s (p < 0.05). In the cold knife group, 3 of 11 (27,7%) recurrences appeared within the first 3 months, whereas in the plasmakinetic group zero recurrences appeared within the first 3 months in our study. The urethral stricture recurrence rate up to the 12 month period was statistically significant for group 1 (n = 7, 23%) compared with group 2 (n = 11, 37%) (p < 0.05). Conclusion: We believe that plasmakinetic surgery is better method than the cold knife technique for the treatment of urethral stricture.

Evaluation of Holmium Laser versus Cold Knife in Optical Internal Urethrotomy for the Management of Urethral Stricture

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Wael Ali Maged ◽  
Mohamed Ahmed Gamal ◽  
Samuel Fayek Tawfeles
Keyword(s):  
Urethral Stricture ◽  
Treatment Effectiveness ◽  
Holmium Laser ◽  
Military Hospital ◽  
University Hospitals ◽  
Internal Urethrotomy ◽  
Cold Knife ◽  
Group 10 ◽  
Optical Internal Urethrotomy

Abstract Background : urethral stricture is one of the most difficult urological problems to cure adequately and is know to mankind since ages as it has been documented in ancient literature of Egyptians and Greeks. Aim of the work: the aim of our study is to evaluate and compare the outcomes of Ho:YAG laser urethrotomy with the conventional cold knife technique as regards treatment outcome, efficacy and complications Patients and methods: A total of 20 male patients presented to the urology department at El Maadi military hospital and Ain shams university hospitals diagnosed as urethral stricture requiring optical internal urethrotomy were included in this study. Patients were randomized into two groups : In group A (holmium group): 10 patients underwent internal urethrotomy with Holmium laser. In group B (cold knife group) 10 patients underwent internal urethrotomy with cold knife. Results: based upon uroflowmetry, assessment of treatment effectiveness and complications were made at 3 months follow-up. Post operative fall in the peak flow rate was noted during the follow up in both groups, but was highter fall in the holmium group than the cold knife group at the end of the third month.

scholarly journals Outcomes of Direct Vision Internal Urethrotomy for Bulbar Urethral Strictures: Technique Modification with High Dose Triamcinolone Injection

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Rishi Modh ◽  
Peter Y. Cai ◽  
Alyssa Sheffield ◽  
Lawrence L. Yeung
Keyword(s):  
Corticosteroid Injection ◽  
Direct Vision ◽  
High Dose ◽  
Internal Urethrotomy ◽  
High Dose Corticosteroid ◽  
Urethral Strictures ◽  
Significant Difference ◽  
Triamcinolone Injection ◽  
Dose Corticosteroid

Objective. To evaluate the recurrence rate of bulbar urethral strictures managed with cold knife direct vision internal urethrotomy and high dose corticosteroid injection.Methods. 28 patients with bulbar urethral strictures underwent direct vision internal urethrotomy with high dose triamcinolone injection into the periurethral tissue and were followed up for recurrence.Results. Our cohort had a mean age of 60 years and average stricture length of 1.85 cm, and 71% underwent multiple previous urethral stricture procedures with an average of 5.7 procedures each. Our technique modification of high dose corticosteroid injection had a recurrence rate of 29% at a mean follow-up of 20 months with a low rate of urinary tract infections. In patients who failed treatment, mean time to stricture recurrence was 7 months. Patients who were successfully treated had significantly better International Prostate Symptom Scores at 6, 9, and 12 months. There was no significant difference in maximum flow velocity on Uroflowmetry at last follow-up but there was significant difference in length of follow-up (p=0.02).Conclusions. High dose corticosteroid injection at the time of direct vision internal urethrotomy is a safe and effective procedure to delay anatomical and symptomatic recurrence of bulbar urethral strictures, particularly in those who are poor candidates for urethroplasty.

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