MODERN METHODS OF TREATING DISEASES OF THE BULBO-MEMBRANOUS PART OF URETHRA

Strictures of the bulbous-membranous urethra are a common cause of obstructive urination disorder. Modern trends in the development of medicine lead to a wider application of endoscopic method, a more frequent cause of iatrogenic injury of the urethra. At present, conservative, endourologic and reconstructive methods of care are used to treat urethral strictures. There are several conservative, endourological and reconstructive methods for treating patients with urethral stricture. Conservative methods include interventions that do not involve the destruction of urethral stricture or its reconstruction, such as stenting, blind dilatation, and recanalization of the urethra. Performing blind dilatation strictures of the bulbo-membranous urethra is not recommended because of the high risk of false path formation and low efficiency. Endourological operations refer to surgical methods of care and suggest the natural restoration of urethral tissues after the destruction of stricture. Because of the low effectiveness of correction of strictures of the posterior urethra (more than 90 % of relapses in five years), this method is a variant of temporary or palliative care. Currently, two approaches to the reconstruction of the bulbo-membranous urethra are used: anastomotic and replacement operations. Anastomotic surgery involves excision of the affected area and juxtaposition of healthy urethral tissues without tension. Replacement plastic allows to restore patency of the urethra by increasing the diameter of the lumen due to the implantation of various grafts. The article shows that, based on international clinical studies, the most effective method of reconstructing the bulbomembranous urethra is reconstructive surgical methods.

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Efficacy of Mitomycin C Combined with Direct Vision Internal Urethrotomy for Urethral Strictures: A Systematic Review and Meta-Analysis

Urologia Internationalis ◽

10.1159/000518977 ◽

2021 ◽

pp. 1-14

Author(s):

Chunru Xu ◽

Zhenpeng Zhu ◽

Lanruo Lin ◽

Tongde Lv ◽

Tianyu Cai ◽

...

Keyword(s):

Success Rate ◽

Mitomycin C ◽

Recurrence Rate ◽

Urethral Stricture ◽

Risk Of Bias ◽

Internal Urethrotomy ◽

Randomized Controlled ◽

Urethral Strictures ◽

Posterior Urethra

Background: The high recurrence of a urethral stricture after direct vision internal urethrotomy (DVIU) has been a problem for years. Mitomycin C (MMC) is an excellent antifibrosis antigen that has been used in many fields, but its effect on a urethral stricture remains controversial. The purpose of this review was to investigate the effectiveness of MMC in reducing the recurrence rate of a urethral stricture after the first urethrotomy. Methods: Common databases were searched for publications prior to November 30, 2020. Randomized controlled and cohort trials were all included. Recurrence and success rates after the first urethrotomy of the posterior urethra were the main outcomes. Revman 5.3 was used for statistical analysis. Two evaluation systems, the Cochrane risk of bias tool and the Newcastle Ottawa Scale, were used to examine the risk of bias for RCTs and all studies. The quality of evidence was assessed by the Grading of Recommendations, Assessment, Development, and Evaluation standard. Results: Sixteen trials were included, the reporting quality of which was generally poor, and the evidence level was very low to moderate. The addition of MMC could significantly reduce the recurrence rate of urethral strictures (risk ratio [RR] = 0.42; 95% confidence interval [CI]: 0.26, 0.67; p = 0.0002; 9 trials; 550 participants). The results of the subgroup analysis suggested that the effect of MMC combined with DVIU was significant in short (≤2 cm) anterior urethral strictures (RR = 0.39; 95% CI: 0.20, 0.78; p = 0.008), >12-month follow-up (RR = 0.45; 95% CI: 0.26, 0.76; p = 0.003). It also increased the success rate of the first urethrotomy procedure for posterior urethral contracture (RR = 0.74; 95% CI: 0.65, 0.84; p < 0.00001; 7 trials; 342 participants). Low-dose local injection of MMC was the most commonly used method. Conclusion: MMC combined with DVIU is a promising way to reduce the long-term recurrence rate of a short-segment anterior urethral stricture. It also increases the success rate of the first urethrotomy of the posterior urethra. However, more high-quality randomized controlled trials are needed.

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Buccal mucosal graft urethroplasty for radiation-induced urethral strictures: an evaluation using the extended Urethral Stricture Surgery Patient-Reported Outcome Measure (USS PROM)

World Journal of Urology ◽

10.1007/s00345-020-03102-5 ◽

2020 ◽

Vol 38 (11) ◽

pp. 2863-2872 ◽

Cited By ~ 2

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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Comparison of sonourethrography and retrograde urethrography in the evaluation of anterior urethral strictures

South African Journal of Radiology ◽

10.4102/sajr.v8i4.101 ◽

2004 ◽

Vol 8 (4) ◽

pp. 6

Author(s):

N. Khan ◽

H.M Modishi ◽

L.D.R. Tsatsi ◽

A. Kahloon ◽

A. Segone

Keyword(s):

Imaging Technique ◽

Ultrasonic Imaging ◽

Anterior Urethra ◽

Urethral Strictures ◽

Retrograde Urethrography ◽

Posterior Urethra

Radiographic retrograde urethrography (RUG) has traditionally been the preferred technique used by urologists to image the anterior urethra. Since originally described by McAninch et aL in 1988, ultrasonic imaging of the urethra has evolved into a powerful and clinically useful tool for the accurate delineation of urethral pathology. However the posterior urethra cannot be assessed reliably using this technique. Sonourethrography has proved to be more accurate than conventional radiographic urethrography in measuring stricture length throughout the anterior urethra. The objective and purpose of this study was to assess the efficacy of sonourethrography in the evaluation of anterior urethral strictures and also to explain its many advantages over traditional imaging technique.

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Outcome of urethral strictures treated by endoscopic urethrotomy and urethroplasty

Canadian Urological Association Journal ◽

10.5489/cuaj.1407 ◽

2014 ◽

Vol 8 (1-2) ◽

pp. 16 ◽

Cited By ~ 6

Author(s):

Javier Tinaut-Ranera ◽

Miguel Angel Arrabal-Polo ◽

Sergio Merino-Salas ◽

Mercedes Nogueras-Ocaña ◽

Victor Lopez-Leon ◽

...

Keyword(s):

Surgical Treatment ◽

Urethral Stricture ◽

Previous Treatment ◽

Urinary Flow ◽

The Past ◽

Urethral Strictures ◽

High Surgical Risk ◽

Endoscopic Urethrotomy ◽

Male Patients ◽

Maximum Urinary Flow

Introduction: We analyze the outcomes of patients with urethral stricture who underwent surgical treatment within the past 5 years.Methods: This is a retrospective study of male patients who underwent surgery for urethral stricture at our service from January 2008 to June 2012. We analyzed the comorbidities, type, length and location of the stricture and the surgical treatment outcome after endoscopic urethrotomy, urethroplasty or both.Results: In total, 45 patients with a mean age of 53.7 ± 16.7 years underwent surgical treatment for urethral stricture. Six months after surgery, 46.7% of the patients had a maximum urinary flow greater than 15 mL/s, whereas 87.3% of the patients exhibited no stricture by urethrography after the treatment. The success rate in the patients undergoing urethrotomy was 47.8% versus 86.4% in those undergoing urethroplasty (p = 0.01). Twenty percent of the patients in whom the initial urethrotomy had failed subsequently underwent urethroplasty, thereby increasing the treatment success.Conclusion: In most cases, the treatment of choice for urethral stricture should be urethroplasty. Previous treatment with urethrotomy does not appear to produce adverse effects that affect the outcome of a urethroplasty if urethrotomy failed, so urethrotomy may be indicated in patients with short strictures or in patients at high surgical risk.

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Rekanalizacija striktura uretre privremenim prekrivenim biokompatibilnim metalnim endoprotezama nove generacije

Acta chirurgica iugoslavica ◽

10.2298/aci0703123m ◽

2007 ◽

Vol 54 (3) ◽

pp. 123-127 ◽

Cited By ~ 1

Author(s):

Z. Markovic ◽

B.B. Markovic ◽

C. Tulic ◽

J. Hadzi-Djokic ◽

V. Stojanovic ◽

...

Keyword(s):

Surgical Treatment ◽

Urethral Stricture ◽

Stent Placement ◽

Clinical Issue ◽

Urethral Strictures ◽

Therapeutic Algorithm ◽

Common Etiology ◽

Previously Treated ◽

First Time

The male urethral stricture treatment is actual clinical issue with its resolution being increasingly frequently based on application of minimum invasive therapeutic interventional uroradiology methods. Since the methodology is applied over the last two decades, the most reasonable therapeutic algorithm has not been defined yet with respect to the correlation with the contemporary surgical treatment. The results of application of the temporary covered self-expandable nitinol Allium stents, which have been applied for the first time ever at our Institution in October 2003. Over the last 3 years, the method was applied in 40 males, averagely aged 54 years with urethral strictures previously treated by urological methods. In four cases, stent placement was performed after endourethral incision. The most common etiology of the stricture was the posttraumatic (55 %), post-inflammatory (32%) and iatrogenic (10%). In all the cases, stents were removed 12-14 months after their insertions. The results are evaluated using uroflowmetry and urethrocystography, revealing in 85% of the cases permanent recanalization free of dysuric complaints. Development of a stricture on the anterior stent end was evidenced in 15% of the cases.

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

Veterinary Record Case Reports ◽

10.1136/vetreccr-2020-001084 ◽

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.

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Biomechanical Analysis of Various Reconstructive Methods for the Mandibular Body and Ramus Defect Using a Free Vascularized Fibula Flap

BioMed Research International ◽

10.1155/2020/8797493 ◽

2020 ◽

Vol 2020 ◽

pp. 1-14

Author(s):

Xian Li ◽

Chao Jiang ◽

Hui Gao ◽

Chunjuan Wang ◽

Chao Wang ◽

...

Keyword(s):

Bone Mineral Density ◽

Finite Element ◽

Bone Mineral ◽

Mineral Density ◽

Fibula Flap ◽

Surgical Methods ◽

Vascularized Fibula ◽

Mandibular Body ◽

Reconstructive Methods

Several different methods exist for reconstructing the mandibular body and ramus defect with the use of a free vascularized fibula flap, but none have adequately addressed the long-term mechanical stability and osseointegration. The aim of this study is to compare the biomechanics of different surgical methods and to investigate the best approach for reconstructing the mandibular body and ramus defect. Five finite element models based on different reconstructive methods were simulated. Stress, strain, and displacement of connective bone sections were calculated for five models and compared. The models were printed using a 3D printer, and stiffness was measured using an electromechanical universal testing machine. The postoperative follow-up cone beam computed tomography (CBCT) was taken at different time points to analyze bone mineral density of connective bone sections. The results showed that the “double up” (DU) model was the most efficient for reconstructing a mandibular body and ramus defect by comparing the mechanical distribution of three sections under vertical and inclined loading conditions of 100 N. The stiffness detection showed that stiffness in the DU and “double down” (DD) models was higher compared with the “single up” (SU), “single down” (SD), and “distraction osteogenesis” (DO) models. We used the DU model for the surgery, and postoperative follow-up CBCT showed that bone mineral density of each fibular connective section increased gradually with time, plateauing at 12 weeks. We conclude that a free vascularized fibula flap of the DU type was the best approach for the reconstruction of the mandibular body and ramus defect. Preoperative finite element analysis and stiffness testing were shown to be very useful for maxillofacial reconstruction.

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Urethral strictures

10.1093/med/9780199659579.003.0050 ◽

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.

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The Use oF Flexible Cystoscope in Posterior Urethroplasty

Urologia Journal ◽

10.1177/039156030907600223 ◽

2009 ◽

Vol 76 (2) ◽

pp. 144-149

Author(s):

E. Palminteri ◽

E. Berdondini ◽

S. Maruccia ◽

M. Poluzzi ◽

D. Vecchio ◽

...

Keyword(s):

Urinary Incontinence ◽

Pelvic Trauma ◽

Patient Age ◽

Membranous Urethra ◽

Urethral Strictures ◽

Patient Âgé ◽

Flexible Cystoscope ◽

Age At Surgery

We present our experience with a simplified anastomotic posterior urethroplasty to highlight the necessity and usefulness of ancillary reconstructive maneuvers. We reviewed the records of 46 patients who had undergone anastomotic repair of posterior urethral strictures due to pelvic trauma between 2000 and 2007. Mean patient age at surgery was 43 years. Average stricture length was 2.3 cm. Repair was performed with a progressive perineal anastomotic procedure using flexible cystoscope by means of transcystostomic approach: after mobilization of the bulbo-membranous urethra and the corporal splitting, the prostatic apex is well visualized and the membranous urethra is sectioned proximally; the flexible cystoscope by means of transcystostomic approach facilitates to find the proximal urethral lumen and to perform the bulbo-prostatic anastomosis. Mean follow-up was 32 months. Of 46 cases, 40 (87 %) were successful and 6 (13 %) failed with recurrence of the stricture. Urinary incontinence did not develop in any patients. The operative details and maneuvers facilitate the preparation of the bulbo-membranous urethral tract and prostatic apex, and simplify the performance of the anastomotic repair.

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Complete Urethral Stricture of the Membranous Urethra: a Different Perspective

British Journal of Urology ◽

10.1111/j.1464-410x.1990.tb14661.x ◽

1990 ◽

Vol 65 (1) ◽

pp. 51-54 ◽

Cited By ~ 9

Author(s):

R. M. KERNOHAN ◽

K. K. ANWAR ◽

S. R. JOHNSTON

Keyword(s):

Urethral Stricture ◽

Membranous Urethra

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