scholarly journals Advances in urethral stricture management

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2913 ◽  
Author(s):  
Maxx A. Gallegos ◽  
Richard A. Santucci
Keyword(s):  
Urethral Stricture ◽  
Primary Anastomosis ◽  
Treatment Options ◽  
Success Rates ◽  
Urethral Strictures ◽  
Exciting Area ◽  
Equal Efficacy ◽  
Anastomotic Urethroplasty

Urethral stricture/stenosis is a narrowing of the urethral lumen. These conditions greatly impact the health and quality of life of patients. Management of urethral strictures/stenosis is complex and requires careful evaluation. The treatment options for urethral stricture vary in their success rates. Urethral dilation and internal urethrotomy are the most commonly performed procedures but carry the lowest chance for long-term success (0–9%). Urethroplasty has a much higher chance of success (85–90%) and is considered the gold-standard treatment. The most common urethroplasty techniques are excision and primary anastomosis and graft onlay urethroplasty. Anastomotic urethroplasty and graft urethroplasty have similar long-term success rates, although long-term data have yet to confirm equal efficacy. Anastomotic urethroplasty may have higher rates of sexual dysfunction. Posterior urethral stenosis is typically caused by previous urologic surgery. It is treated endoscopically with radial incisions. The use of mitomycin C may decrease recurrence. An exciting area of research is tissue engineering and scar modulation to augment stricture treatment. These include the use of acellular matrices or tissue-engineered buccal mucosa to produce grafting material for urethroplasty. Other experimental strategies aim to prevent scar formation altogether.

scholarly journals Outcomes of transecting urethroplasty in management of different types of bulbar urethral strictures: single center experience

2021 ◽  
Author(s):  
Ayman Moussa Atwa ◽  
Ayman Ahmed Hassan ◽  
Samir Shabaan Orabi ◽  
Samir Abdelhakim Elgamal ◽  
Osama Mostafa Elgamal
Keyword(s):  
Erectile Dysfunction ◽  
Success Rate ◽  
De Novo ◽  
Primary Anastomosis ◽  
Success Rates ◽  
Single Center Experience ◽  
Urethral Strictures ◽  
Micturating Cystourethrogram ◽  
A Prospective Study ◽  
Anastomotic Urethroplasty

Background: The study aimed to evaluate the outcomes of transecting bulbar urethroplasty techniques used for management of bulbar urethral stricture as regards the success rate and sexual dysfunction.Methods: Our study was a prospective study and it was carried out at urology department Tanta university, Egypt. The study was approved our ethical committee and an informed consent was obtained from all participants. Thirty patients underwent transecting urethroplasty either excision and primary anastomosis (EPA) or augmented anastomotic urethroplasty. Assessment of the sexual function by sexual health inventory for men (SHIM) questionnaire and postoperatively. Retrograde urethrogram (RGU) and micturating cystourethrogram (MCUG) were performed by an experienced urological surgeon.Results: The age of studied patients ranged from 15-72 years with a mean of  41±13.87. The length of stricture ranged from 2-3 cm with a mean of 2.57±0.38. The stricture was non obliterative in 13 patients (43.3%), obliterative in 4 patients (13.3%) and near obliterative in 13 patients (43.3%). Anastomotic urethroplasty was carried out in 20 out of 30 patients (66.7%) and augmented anastomotic urethroplasty was carried out in 10 out of 30 patients (33.3%). The success rate was 90%. As regard erectile dysfunction, 5 patients reported erectile dysfunction (16.7%).Conclusions: Anastomotic urethroplasty of short segment bulbar strictures continues to have excellent success rates and durability, but some patients who undergo anastomotic urethroplasty experience de novo sexual dysfunction.

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.

Thrombopoietin Receptor Agonists in Children with Immune Thrombocytopenia: A New Therapeutic Era

2020 ◽  
Vol 20 ◽  
Author(s):  
Giuseppe Lassandro ◽  
Valentina Palladino ◽  
Giovanni Carlo Del Vecchioa ◽  
Viviana Valeria Palmieri ◽  
Paola Carmela Corallo ◽  
...  
Keyword(s):  
Immune Thrombocytopenia ◽  
Treatment Options ◽  
Thrombopoietin Receptor Agonists ◽  
Receptor Agonists ◽  
Thrombopoietin Receptor ◽  
Related Quality ◽  
Health Related

Background and Objective: Immune thrombocytopenia (ITP) is a common bleeding disorder in childhood. The management of ITP in children is controversial, requiring personalized assessment of patients and therapeutic choices. Thrombopoietin receptor agonists (TPO-RAs), eltrombopag and romiplostim, have been shown to be safety and effective for the treatment of pediatric ITP. The aim of our research is defining the role of thrombopoietin receptor agonists in the management of pediatric ITP. Method: This review focuses on the use of TPO-RAs in pediatric ITP, in randomized trials and in clinical routine, highlighting their key role in management of the disease. Results: Eltrombopag and romiplostim appear effective treatment options for children with ITP. Several clinical studies have assessed that the use of TPO-RAs increases platelet count, decreases bleeding symptoms and improves health-related quality of life. Moreover, TPO-RAs are well tolerated with minor side effects. Conclusion: Although TPO-RAs long term efficacy and safety still require further investigations, their use is gradually expanding in clinical practice of children with ITP.

scholarly journals Bilateral adrenalectomy in Cushing's disease: Altered long-term quality of life compared to other treatment options

2019 ◽  
Vol 80 (1) ◽  
pp. 32-37 ◽  
Author(s):  
Pauline Sarkis ◽  
Muriel Rabilloud ◽  
Jean-Christophe Lifante ◽  
Anna Siamand ◽  
Emmanuel Jouanneau ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cushing’S Disease ◽  
Treatment Options ◽  
Bilateral Adrenalectomy ◽  
Cushing's Disease

Treatment options for hypoplastic left heart syndrome: a mother's perspective

1995 ◽  
Vol 15 (3) ◽  
pp. 70-72 ◽  
Author(s):  
LT Swanson
Keyword(s):  
Treatment Options ◽  
Palliative Surgery ◽  
First Year ◽  
Success Rates ◽  
Choice Of Treatment ◽  
New Treatment ◽  
Attending Physician ◽  
Left Heart Syndrome ◽  
Made In

The congenital heart defect of HLHS is nearly uniformly fatal without intervention. As surgeons gain experience with the techniques the success rates are improving; more infants with HLHS are being offered hope for survival and quality of life. The critical nature of this diagnosis, the relatively new treatment options, and uncertainty of the surgical outcome impose tremendous stress on the parents. Choice of treatment is difficult and should be made in collaboration with the attending physician. Although the first year of my son's life was difficult, the past 5 years have been wonderful. He continues to thrive and enjoy most of the activities other 6-year-olds enjoy. In retrospect, palliative surgery was a good option for him. As both his mother and a cardiac nurse, I recognize that he may once again require surgical intervention, but I am encouraged that medical and surgical advances are being made for children with HLHS.

Total hip replacement: modes of failure

2011 ◽  
Author(s):  
Rob Pollock
Keyword(s):  
Aseptic Loosening ◽  
Success Rates ◽  
Total Hip ◽  
Reactive Protein ◽  
Modes Of Failure ◽  
Total Hip Replacements ◽  
Hip Replacements ◽  
Simple Fixation

♦ Total hip replacements (THRs) may fail in various ways. They may become infected, they may be subject to aseptic loosening, they may dislocate, or a periprosthetic fracture may occur. The patient with a failed THR must be thoroughly assessed before treatment is contemplated♦ Infection may be acute or chronic. Assessment involves clinical assessment, plain radiographs, blood tests (C-reactive protein and erythrocyte sedimentation rate), hip aspiration, and, sometimes, nuclear medicine. The acutely infected hip may be treated with one-stage revision. This involves thorough lavage, debridement, and exchange of all modular components as well as long-term antibiotic therapy. The gold standard of treatment for a chronically infected THR is a two-stage revision. Success rates of 80–90% can be expected♦ Aseptic loosening typically occurs at the cement bone interface in hips where a metal-on-polyethylene bearing couple has been used. Bone resorption takes place as a result of an inflammatory response to small wear particles. After infection has been excluded the treatment of choice is a single-stage revision♦ Dislocation may be the result of patient factors, implant factors, or poor surgical technique. It is imperative for the clinician to minimize the risk by selecting patients carefully, using the correct combination of implants and performing surgery accurately♦ The management of periprosthetic fractures depends on how well the implants are fixed and quality of bone stock. Treatment ranges from simple fixation of the fracture through to revision augmented with strut allograft.

Long-Term Followup for Excision and Primary Anastomosis for Anterior Urethral Strictures

2007 ◽  
Vol 177 (5) ◽  
pp. 1803-1806 ◽  
Author(s):  
Ehab A. Eltahawy ◽  
Ramón Virasoro ◽  
Steven M. Schlossberg ◽  
Kurt A. McCammon ◽  
Gerald H. Jordan
Keyword(s):  
Primary Anastomosis ◽  
Urethral Strictures

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 Types of urethral stricture and their recurrence rates post urological treatments

2021 ◽  
Author(s):  
Wedyan Salem Basaif ◽  
Husam Hamad Alamri ◽  
Hind Waleed Mousa ◽  
Raghad Abdulelah Alsayed ◽  
Abdullah Mohammed Almohammadi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Current Evidence ◽  
Internal Urethrotomy ◽  
Recurrence Rates ◽  
Current Management ◽  
Urethral Strictures ◽  
Common Causes ◽  
Almost All ◽  
Anastomotic Urethroplasty

Urethral strictures can significantly impact the quality of life for patients because it can be associated with significant complications such as fistulas, bladder calculi, infections and sepsis. Additionally, it might even lead to renal failure. The worldwide prevalence of urethral strictures is high, with an estimated rate of 229-627 patients per 100,000 population. In this literature review, the aim was to discuss the types and etiology of urethral strictures and the recurrence rates following the different management modalities. Studies that were included in this review were published between January 2005 until May 2021. The results support the current evidence that the idiopathic and iatrogenic bulbar strictures are the most common types while penile strictures, the iatrogenic and inflammatory are the most common causes. Recurrence rates are reported after management with almost all of the current management modalities, indicating the need for better interventions to enhance the outcomes and alleviate the quality of care. The recurrence rate of strictures after treatment with internal urethrotomy and direct vision internal urethrotomy by three years is 65%. Other studies reported that the rate of recurrence was estimated to be around 14 after 6 months from internal urethrotomy and up to 27% after 12 months. The rate of complications and recurrence following treatment with anastomotic urethroplasty was estimated to be less than 5%. Detailed information and discussion were provided in the study manuscript.

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

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