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 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.

DOZ047.82: Outcome of thoracoscopic repair of type C esophageal atresia: single-center experience from North Africa

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
M Elbarbary ◽  
A Shalaby ◽  
M Elseoudi ◽  
M Ragab ◽  
A E Fares ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Esophageal Atresia ◽  
Operative Time ◽  
Primary Anastomosis ◽  
Single Center Experience ◽  
Resource Setting ◽  
Thoracoscopic Repair ◽  
Type C ◽  
The Mean ◽  
A Prospective Study

Abstract Background and Aim Thoracoscopic repair of esophageal atresia is gaining popularity worldwide owing to the availability of and advances in minimally invasive instruments. This report presents our early experience of thoracoscopic esophageal atresia repair (EA/TEF) in a single institute. Methods A prospective study on short-gap type C EA/TEF was conducted at Cairo University Specialized Pediatric Hospital from April 2016. The technique was standardized in all cases: patients placed in the fully prone position, and using a 5 mm 30° scope with 3 mm instruments and carried out by four experts in minimally invasive surgery. Data was collected to include patient demographics and operative time. The main outcome was survival. Secondary outcomes were leak rate and postoperative stricture. Results Over a period of 24 months (April 2016–April 2018) 136 cases of EA/TEF were admitted. Thoracoscopy was attempted in 76 cases. Thirty cases with pure atresia or long-gap anomaly were excluded from this study for gap length, leaving 46 (60%) nonconsecutive neonates who underwent thoracoscopic repair of their short-gap EA/TEF. Five cases (10.8%) were converted to open surgery via right thoracotomy. A primary anastomosis was possible in all cases, leaving the azygos intact. The mean age at operation was 8.7 days (range 2–32), the mean weight was 2.6 kg (range 1.8–3.6), and the mean operative time was 108.3 minutes (range 80–180). In the fully thoracoscopic patients the survival was 85.4% (n = 35). An anastomotic leak occurred in 17% (n = 7); it was managed conservatively in 2 and with esophagostomy and gastrostomy in 5 cases. Followup was at one week, one and three months postdischarge. A stricture developed in 5 (16.6%) of the 30 surviving patients who kept their native esophagus. Conclusions Thoracoscopic repair is a feasible alternative even in a low-resource setting. The better outcome compared to traditional open repair in our center may be due to patient selection bias.

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.

Surgery of the Lacrimal System

2011 ◽  
Author(s):  
Roger A. Dailey ◽  
Mauricio R. Chavez
Keyword(s):  
Prospective Study ◽  
Success Rate ◽  
Nasolacrimal Duct ◽  
The Other ◽  
Success Rates ◽  
Lacrimal Sac ◽  
Other Hand ◽  
A Prospective Study ◽  
External Dcr

Obstruction of the tear outflow system can occur anywhere along its course from the tear lake to the inferior meatus of the nose. Surgical techniques designed to relieve this functional or complete obstruction have been available for a long time. Toti of Italy described the dacryocystorhinostomy (DCR) procedure in 1908 as a treatment modality for obstruction of the nasolacrimal duct. His technique did not make use of mucosal flaps. Dupuy-Dutemps of France, on the other hand, encouraged the use of flaps. He recommended suturing together the nasal mucosal and lacrimal sac flaps. The success rate of the operation improved dramatically. Today the external DCR procedure makes use of modifications of both of these historically described procedures. In recent years, intranasal DCR has enjoyed renewed popularity. This procedure had been performed by Lester Jones and others for years but was dropped because the success rate was 80% at best. Although the use of endoscopic techniques and laser technology has been advocated by some authorities, the success rate (approximately 70%) with relatively short-term follow-up has limited its acceptance. More recently, Javate and associates reported a series of patients undergoing endoscopic DCR with the radiofrequency Ellman unit. Their reported success rate of 90% compared favorably with a 94% success rate in 50 age-matched patients undergoing external DCR with a follow-up of 9 months. This rate also compares favorably to the present authors’ success rate of approximately 95% in uncomplicated cases undergoing external DCR and a similar rate with the endoscopic approach without use of a laser. Therefore, the laser does not appear to offer any significant advantage over more traditional intranasal approaches, and the cost may actually be a financial disincentive to its use. The benefit of mitomycin continues to be debated. You and associates performed a prospective study showing favorable long-term success rates with the use of mitomycin. On the other hand, Liu and associates performed a prospective study that demonstrated no benefit. While the DCR works well for lacrimal sac or nasolacrimal duct obstruction, it does not address obstructions of the puncta and canaliculi.

scholarly journals Treatment of Bulbar Urethral Strictures. A Review, with Personal Critical Remarks

2003 ◽  
Vol 3 ◽  
pp. 443-454 ◽  
Author(s):  
Willem Oosterlinck
Keyword(s):  
Success Rate ◽  
Skin Flap ◽  
Scientific Data ◽  
New Wave ◽  
Success Rates ◽  
Free Graft ◽  
Two Stage ◽  
Urethral Strictures ◽  
Buccal Mucosa Graft ◽  
End To End

This is a review article on treatment of bulbar urethral strictures with personal critical remarks on newer developments. As a treatment of first intention there exists 4 options : dilatation, urethrotomy, end to end anastomosis and free graft, open urethroplasty. Success rate of dilatation and visual urethrotomy after 4 years is only 20 en 40 % respectively. Laser urethrotomy could not fulfill expectations. End to end anastomosis obtains a very high success rate but is only applicable for short strictures. Free graft urethroplasty obtains success rates of ± 80 %. There is considerable debate on the best material for grafting. Buccal mucosa graft is the new wave, but this is not based on scientific data. Whether this graft should be used dorsally or ventrally is also a point of discussion. In view of the good results published with both techniques it is probably of no importance. Intraluminal stents are not indicated for complicated cases and give only good results in those cases which can easily be treated with other techniques. Metal self-retaining urethral stent , resorbable stents and endoscopic urethroplasty is briefly discussed. Redo’s and complicated urethral strictures need often other solutions. Here skin flap from the penile skin and scrotal flap can be used. Advantages and drawbracks of both are discussed. There is still a place for two-stage procedures in complicated redo�s. The two-stage mesh-graft urethroplasty offers advantage over the use of scrotal skin. Some other rare techniques like substitution with bowel and pudendal thigh flap, to cover deep defects, are also discussed.

scholarly journals Outcomes of Dorsal and Ventral Buccal Graft Urethroplasty at a Tertiary Hospital in Uganda

ISRN Urology ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
S. Kaggwa ◽  
M. Galukande ◽  
H. Dabanja ◽  
H. Luweesi
Keyword(s):  
Success Rate ◽  
Buccal Mucosa ◽  
Tertiary Hospital ◽  
Sub Saharan Africa ◽  
Team Approach ◽  
Sexually Transmitted ◽  
Urethral Strictures ◽  
Sub Saharan ◽  
A Prospective Study

Purpose. Although the use of buccal mucosa in substitution urethroplasty has been practiced for some years, it has not been free of controversy over which surgical technique is the most appropriate to use. There is paucity of data in Sub-Saharan Africa about its success; this study presents the outcomes of dorsal and ventral buccal graft urethroplasty at a sub-Saharan tertiary hospital. Methods. This is a prospective study in which buccal mucosa was used for ventral and dorsal grafts; followup was up to two years. All patients provided informed written consent for the procedures. Results. Seventy-two patients with bulbar urethral strictures underwent buccal graft one-stage urethroplasty. Mean age was 55 years; etiology of the strictures was postinflammatory due to urethritis from sexually transmitted infections 97% (70/72) and trauma 3% (2/72). Buccal mucosa grafts were harvested from the cheek using a two-team approach. Grafts were placed on the ventral and dorsal urethral surfaces in 32 and 40 cases, respectively; the success rate was 84 and 80%, respectively. Repeated urethroplasty was successfully done among 10% (7/72) and patients reported resolution of symptoms in the follow-up period. Conclusion. There was no difference between dorsal and ventral onlay buccal graft outcomes for bulbar urethral strictures. The success rate was 80 to 84%.

scholarly journals Buccal mucosal graft urethroplasty in the treatment of urethral strictures: a prospective study

2021 ◽  
Vol 10 (1) ◽  
pp. 180
Author(s):  
Chetan Baragi ◽  
Raveendra Totad ◽  
Shankarsnehit Patil ◽  
Nandini Takkalaki
Keyword(s):  
Prospective Study ◽  
Surgical Repair ◽  
Primary Anastomosis ◽  
Standard Procedure ◽  
The Past ◽  
Urethral Strictures ◽  
Buccal Mucosal Graft ◽  
A Prospective Study ◽  
Graft Shrinkage

Background: Anterior urethral strictures develop due to a process of fibrosis and cicatrix formation of the urethral mucosa and the surrounding tissues. Its surgical management is a challenging problem, and has changed dramatically in the past several decades. Open surgical repair using grafts has become the gold standard procedure for anterior urethral strictures that are not amenable to excision and primary anastomosis. Oral mucosa harvested from the inner cheek (buccal mucosa) is an ideal material, and is most commonly used for substitution urethroplasty. Objective of current study was to establish the efficacy of the buccal mucosal graft urethroplasty by different onlay techniques in anterior urethral strictures.Methods: The study was a prospective study, done between August 2009 and December 2011. 25 cases of long anterior urethral strictures were managed by onlay urethroplasty by different techniques. Follow up ranged from 8-20 months.Results: 3 patients lost follow up after first visit. Post operative uroflowmetry was done in all patients after 1 month at the time of first follow up visit. Of 25 cases 21 (84%) were successful and 4 (16%) failed.Conclusions: In our study we have found that buccal mucosal graft can be safely used for substitution urethroplasty in all long anterior urethral strictures including cases with balanitis xerotic obliterance. It was very efficient in terms of less graft shrinkage or contracture as it is a full thickness graft.

Tympanoplasty in children – a prospective study

1998 ◽  
Vol 112 (12) ◽  
pp. 1147-1149 ◽  
Author(s):  
Yogesh Bajaj ◽  
A. S. Bais ◽  
Bakul Mukherjee
Keyword(s):  
Prospective Study ◽  
Success Rate ◽  
Type I ◽  
Success Rates ◽  
Two Factors ◽  
Considerable Controversy ◽  
Overlay Technique ◽  
Type I Tympanoplasty ◽  
One Year ◽  
A Prospective Study

AbstractConsiderable controversy surrounds the subject of tympanoplasty in children. This prospective study looked at the results of type-I tympanoplasty in children. Forty-five children in the age group of five to 14 years were selected for the study. All these cases had a central perforation without any evidence of cholesteatoma. The ear to be operated had to be dry for at least six weeks before surgery. Type I tympanoplasty was performed on these patients with autograft temporalis fascia by either the underlay or overlay technique.The overall success rates in 45 operations evaluated one year post-operatively was 91.1 per cent. The age of the patient had no influence on the success rate. The two factors which adversely influenced the success rate were the presence of near total perforation and bilateral perforations.It was concluded that type-I tympanoplasty has a good chance of success in children regardless of age.

scholarly journals First-line tracheal resection and primary anastomosis for postintubation tracheal stenosis

2016 ◽  
Vol 98 (6) ◽  
pp. 425-430 ◽  
Author(s):  
H Elsayed ◽  
AM Mostafa ◽  
S Soliman ◽  
T Shoukry ◽  
AA El-Nori ◽  
...  
Keyword(s):  
Tracheal Stenosis ◽  
De Novo ◽  
Primary Anastomosis ◽  
Length Of Hospital Stay ◽  
Tracheal Resection ◽  
Endoscopic Dilation ◽  
First Line ◽  
Median Length ◽  
A Prospective Study ◽  
Resection And Anastomosis

Introduction Tracheal stenosis following intubation is the most common indication for tracheal resection and reconstruction. Endoscopic dilation is almost always associated with recurrence. This study investigated first-line surgical resection and anastomosis performed in fit patients presenting with postintubation tracheal stenosis. Methods Between February 2011 and November 2014, a prospective study was performed involving patients who underwent first-line tracheal resection and primary anastomosis after presenting with postintubation tracheal stenosis. Results A total of 30 patients (20 male) were operated on. The median age was 23.5 years (range: 13–77 years). Seventeen patients (56.7%) had had previous endoscopic tracheal dilation, four (13.3%) had had tracheal stents inserted prior to surgery and one (3.3%) had undergone previous tracheal resection. Nineteen patients (63.3%) had had a tracheostomy. Eight patients (26.7%) had had no previous tracheal interventions. The median time of intubation in those developing tracheal stenosis was 20.5 days (range: 0–45 days). The median length of hospital stay was 10.5 days (range: 7–21 days). The success rate for anastomoses was 96.7% (29/30). One patient needed a permanent tracheostomy. The in-hospital mortality rate was 3.3%: 1 patient died from a chest infection 21 days after surgery. There was no mortality or morbidity in the group undergoing first-line surgery for de novo tracheal lesions. Conclusions First-line tracheal resection with primary anastomosis is a safe option for the treatment of tracheal stenosis following intubation and obviates the need for repeated dilations. Endoscopic dilation should be reserved for those patients with significant co-morbidities or as a temporary measure in non-equipped centres.

scholarly journals Urethroplasty in the management of urethral strictures: a literature review

2021 ◽  
Vol 8 (2) ◽  
pp. 915
Author(s):  
Wedyan Salem Basaif ◽  
Ali Ahmed Madkhali ◽  
Ahmed Ibrahim Almania ◽  
Raed Abdullah Mohammed ◽  
Manar Mohammed Alshahrani ◽  
...  
Keyword(s):  
Primary Anastomosis ◽  
Cost Effective ◽  
Primary Treatment ◽  
Corpus Spongiosum ◽  
Success Rates ◽  
Symptom Index ◽  
Urethral Strictures ◽  
Patient Reported ◽  
Endoscopic Urethrotomy ◽  
American Urological Association

Urethral stricture is defined as pathological urethral narrowing caused by corpus spongiosum fibrosis. The etiology of this condition is mostly idiopathic, which can also result from iatrogenic (like previous urethral surgeries, catheterization, or resection), inflammatory and traumatic causes. The evidence discussing the management of urethral strictures is scarce. The management starts with an appropriate evaluation of the condition through a comprehensive history taking (obstructive symptoms) and physical examination. Diagnostic investigations include cystoscopy (the most specific), urethrography, patient reported scales, like American urological association symptom index, uroflowmetry, and retrograde urethrography. Previous literature shows urethroplasty is cost effective, whether when it is used as the primary treatment or following a non-successful dilation and direct visualization internal urethrotomy. Moreover, open urethroplasty and endoscopic urethrotomy were comparable among both procedures in terms of voiding improvement; however, urethroplasty benefit was more durable. Akin to that, urethroplasty was found to be a successful procedure in up to 95% of the cases with the appropriate experience level. Although excision and primary anastomosis and augmentation/substitution urethroplasties have considerable long-term success rates, the EPA procedures have a controversial influence on sexual function, which may be unacceptable to some reconstructive urologists. In general, there are a few large scales, multi center studies that can produce high-quality evidence. There is an urge to develop more high-grade research in terms of ideal management of urethral strictures.

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