scholarly journals Clinical features of spongy urethral strictures requiring multi-stage urethroplasty or permanent urethrostomy

2021 ◽  
Vol 14 (3) ◽  
pp. 156-163
Author(s):  
V.P. Glukhov ◽  
◽  
A.V. Ilyash ◽  
V.V. Mitusov ◽  
D.V. Sizyakin ◽  
...  
Keyword(s):  
Clinical Features ◽  
Urethral Stricture ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Urethral Stricture Disease ◽  
One Stage ◽  
Urethral Strictures ◽  
Multi Stage ◽  
History Of ◽  
Urethral Surgery

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.

Urethral strictures

2017 ◽  
Author(s):  
Anthony R. Mundy ◽  
Daniela E. Andrich
Keyword(s):  
Urethral Stricture ◽  
Daily Basis ◽  
Current Approach ◽  
Curative Treatment ◽  
Urethral Stricture Disease ◽  
Urethral Strictures ◽  
History Of ◽  
The Subject ◽  
Ambivalent Attitude ◽  
Almost All

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.

scholarly journals The association of triglyceride levels with the incidence of initial and recurrent acute pancreatitis

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Robert J. Sanchez ◽  
Wenzhen Ge ◽  
Wenhui Wei ◽  
Manish P. Ponda ◽  
Robert S. Rosenson
Keyword(s):  
Acute Pancreatitis ◽  
Medical Records ◽  
Adult Population ◽  
Baseline Period ◽  
Prior History ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Recurrent Acute Pancreatitis ◽  
History Of ◽  
Nationally Representative

Abstract Background This retrospective cohort study assessed the annualized incidence rate (IR) of acute pancreatitis (AP) in a nationally representative US adult population, as well as the variation in the risk of AP events across strata of triglyceride (TG) levels. Methods Data were obtained from IQVIA’s US Ambulatory Electronic Medical Records (EMR) database linked with its LRxDx Open Claims database. Inclusion criteria included ≥1 serum TG value during the overlapping study period of the EMR and claims databases, ≥1 claim in the 12-month baseline period, and ≥ 1 claim in the 12 months post index. All TG measurements were assigned to the highest category reached: < 2.26, ≥2.26 to ≤5.65, > 5.65 to ≤9.94, > 9.94, and > 11.29 mmol/L (< 200, ≥200 to ≤500, > 500 to ≤880, > 880, and > 1000 mg/dL, respectively). The outcome of interest was AP, defined as a hospitalization event with AP as the principal diagnosis. Results In total, 7,119,195 patients met the inclusion/exclusion criteria, of whom 4158 (0.058%) had ≥1 AP events in the prior 12 months. Most patients (83%) had TGs < 2.26 mmol/L (< 200 mg/dL), while < 1% had TGs > 9.94 mmol/L (> 880 mg/dL). Overall, the IR of AP was low (0.08%; 95% confidence internal [CI], 0.08–0.08%), but increased with increasing TGs (0.08% in TGs < 2.26 mmol/L [< 200 mg/dL] to 1.21% in TGs > 11.29 mmol/L [> 1000 mg/dL]). In patients with a prior history of AP, the IR of AP increased dramatically; patients with ≥2 AP events at baseline had an IR of 29.98% (95% CI, 25.1–34.9%). Conclusion The risk of AP increases with increasing TG strata; however, the risk increases dramatically among patients with a recent history of AP.

Balloon dilation of a urethral stricture caused by a congenital obstructive proximal urethral membrane (COPUM) in a dog

2020 ◽  
Vol 8 (2) ◽  
pp. e001084
Author(s):  
Darren Kelly ◽  
Ingrid Isaac ◽  
Judith Cruzado-Perez ◽  
Florence Juvet
Keyword(s):  
Urethral Stricture ◽  
Balloon Dilation ◽  
Clinical Signs ◽  
Human Beings ◽  
Membranous Structure ◽  
First Report ◽  
Urethral Strictures ◽  
The Future ◽  
History Of ◽  
Proximal Urethra

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.

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 Retrograde urethrography, sonouretrography and magnetic resonance urethrography in evaluation of male urethral strictures. Should the novel methods become the new standard in radiological diagnosis of urethral stricture disease?

2021 ◽  
Author(s):  
Frankiewicz Mikolaj ◽  
Markiet Karolina ◽  
Kozak Oliwia ◽  
Krukowski Jakub ◽  
Kałużny Adam ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Urethral Stricture ◽  
Imaging Techniques ◽  
Accurate Method ◽  
Perfect Agreement ◽  
Urethral Stricture Disease ◽  
Urethral Strictures ◽  
Additional Imaging ◽  
Male Patients ◽  
Diagnostic Modalities

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.

scholarly journals AN UPDATE ON THE ASSOCIATION BETWEEN TYPE 2 DIABETES AND ALZHEIMER- A SYSTEMATIC REVIEW

2021 ◽  
Author(s):  
Juliana Almeida ◽  
Fernanda Almeida
Keyword(s):  
Type 2 Diabetes ◽  
Mexican Americans ◽  
Amyloid Β ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Memory And Attention ◽  
Randomized Controlled ◽  
Attention Skills ◽  
History Of

Background: The association of Type 2 Diabetes (T2D) and Alzheimer’s Disease (AD), that is 6th cause of death in United States, have been long noted. The history of T2D increases the risk for AD by 50-200% and the 10 years risk in 10-30%, which is 25-35 times the general. Objective: To investigate findings of the last 5 years that directly correlate T2D with AD. Methods: Use of the PICO strategy, conducted on September 17, on PubMed using “Alzheimer disease” and “diabetes mellitus” as descriptors, identifying 14 articles, selecting 4 after screening. Inclusion criteria: clinical and randomized controlled trials with diabetic and Alzheimer patients, published on the last 5 years. Exclusion criteria: articles focused on medications. Results: Mexican Americans are more likely to evolve T2D, to have an earlier onset and severer forms of AD. Furthermore, cell-free mitochondrial DNA, common in diabetics, is related to cognitive impairment. Besides, metformin improves learning, memory and attention skills, and BG control is linked to longer survival time and an apparent delay of the dementia. Moreover, lower levels of plasma amyloid-β (Aβ) 40 and 42 were found when T2D and higher levels of Aβ42 have been found in people treated with insulin, but the Aβ levels meaning needs to be clarified. Conclusion: T2D is often related to lifestyle and AD to a genetic component. Anyhow, more studies are needed to clarify the meaning of these findings. Study limitations: few trials performed.

Penile urethral stricture disease

2018 ◽  
Vol 12 (2) ◽  
pp. 145-157
Author(s):  
Marco Spilotros ◽  
Suzie Venn ◽  
Paul Anderson ◽  
Tamsin Greenwell
Keyword(s):  
Urethral Stricture ◽  
Lichen Sclerosus ◽  
Corpus Spongiosum ◽  
Hypospadias Repair ◽  
Internal Urethrotomy ◽  
Level Of Evidence ◽  
Urethral Stricture Disease ◽  
Urethral Strictures ◽  
Considerable Cost ◽  
The Uk

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

scholarly journals A study of second to fourth digit ratio in relation to verbal and numerical intelligence among medical students

Biomedicine ◽  
2021 ◽  
Vol 41 (3) ◽  
pp. 678-681
Author(s):  
G .Yuvarani ◽  
Jibi Paul ◽  
M. Manoj Abraham ◽  
N. Harikrishnan
Keyword(s):  
Shoulder Pain ◽  
Prospective Observational Study ◽  
External Rotation ◽  
Dominant Hand ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Female Population ◽  
Female Age ◽  
History Of ◽  
Severity Of The Disease

Introduction and Aim:Periarthritis shoulder is generally defined as a self - limiting disorder that affects mostly the diabetic persons. Periarthritis shoulder affects the older population with females at its peak.This study was intended to find out whether all the shoulder pain subjects were victims of periarthritis shoulder and to analyse the prevalence of periarthritis among subjects who were suffering from shoulder.   Materials and Methods:This study was a prospective, observational study conducted on the patients who visited the outpatient Physiotherapy Departments. Nearly 300 patients who came with shoulder pain were taken as samples. A detailed explanation about the purpose of the study was given to the subjects. The subjects included were based on the inclusion criteria pain more than 1 month, both male and female, age group of 40-60 years, both dominant and non-dominant hand, history of shoulder pain at night, progressive limitation of shoulder movement, particularly a reduction of at least half the normal range of abduction and external rotation.   Results:Based on the inclusion and exclusion criteria nearly 300 participants were selected and they were asked to fill the SPADI questionnaire. Out of 300 participants nearly 127 subjects were concluded with positive signs of periarthritis shoulder.   Conclusion: The result obtained from our study states that the severity of the disease is more among the female population. The subjects who are suffering from shoulder pain must be taken into anticipation that in future they may develop shoulder periarthritis.

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