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.

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.

Voice Therapy With Seniors: Attendance, Outcomes, and Associated Patient Characteristics

2019 ◽  
Vol 4 (5) ◽  
pp. 814-824 ◽  
Author(s):  
Bonnie E. Smith ◽  
Ruth Huntley Bahr ◽  
Hector N. Hernandez
Keyword(s):  
Outcome Data ◽  
Voice Therapy ◽  
Similar Data ◽  
Success Rates ◽  
Reflux Symptom Index ◽  
Voice Change ◽  
Related Factors ◽  
Symptom Index ◽  
Younger Patients ◽  
Unsuccessful Treatment

Purpose The purpose of this study was to determine the attendance and success rates for seniors in voice therapy, identify any contributing patient-related factors, and compare results to existing findings for younger patients. Method This retrospective study included information from the voice records of 50 seniors seen by the same speech-language pathologist in a private practice. Analysis of attendance and outcome data divided participants into 6 groups. Outcomes for Groups 1–3 (64% of patients) were considered successful (positive voice change), while outcomes for Groups 4–6 (36% of patients) were considered unsuccessful. These data were compared to similar data collected for younger adults in a previous study. Results The attendance and success rates for seniors in this study were higher than those previously reported for younger patients. Further consideration of patient factors revealed that reports of increased stress, Reflux Symptom Index scores > 13, and higher Voice Handicap Index functional subscale scores were significant in distinguishing between patients in the successful and unsuccessful treatment outcome groups. Conclusions The relatively high attendance and success rates among this sample of seniors suggest the desire to achieve voice improvement does not diminish with age, and chances for success in voice therapy among nonfrail seniors may be greater than for younger patients.

Two-stage chemical-biological treatment at Thessaloniki greater area WWTP - experiences and potentials

1995 ◽  
Vol 32 (9-10) ◽  
pp. 75-84 ◽  
Author(s):  
A. D. Andreadakis ◽  
G. H. Kristensen ◽  
A. Papadopoulos ◽  
C. Oikonomopoulos
Keyword(s):  
Biological Treatment ◽  
Treatment Plant ◽  
Cost Effective ◽  
Primary Treatment ◽  
Effective Control ◽  
Two Stage ◽  
Effluent Quality ◽  
Filamentous Microorganisms ◽  
Sludge Settling ◽  
The City

The wastewater from the city of Thessaloniki is discharged without treatment to the nearby inner part of the Thessaloniki Gulf. The existing, since 1989, treatment plant offers only primary treatment and did not operate since the expected effluent quality is not suitable for safe disposal to the available recipients. Upgrading of the plant for advanced biological treatment, including seasonal nitrogen removal, is due from 1995. In the mean time, after minor modifications completed in February 1992, the existing plant was put into operation as a two-stage chemical-biological treatment plant for 40 000 m3 d−1, which corresponds to about 35% of the total sewage flow. The operational results obtained during the two years operation period are presented and evaluated. All sewage and sludge treatment units of the plant perform better than expected, with the exception of the poor sludge settling characteristics, due to severe and persistent bulking caused by excessive growth of filamentous microorganisms, particularly M. Parvicella. Effective control of the bulking problem could lead to more cost-effective operation and increased influent flows.

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.

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