scholarly journals Surgical treatment of urethral tuberculosis in men – history and present (literature review)

2021 ◽  
Vol 6 (4) ◽  
pp. 220-229
Author(s):  
A. A. Volkov ◽  
O. N. Zuban ◽  
M. N. Reshetnikov ◽  
D. V. Plotkin ◽  
E. M. Bogorodskaya
Keyword(s):  
Surgical Treatment ◽  
Literature Review ◽  
Urethral Stricture ◽  
Extrapulmonary Tuberculosis ◽  
Specific Therapy ◽  
Promising Direction ◽  
Clinical Recovery ◽  
Urine Diversion ◽  
Urethral Strictures ◽  
Urethral Dilation

The literature review provides data on tuberculosis of the urethra in men. This disease is rarely recorded, as a rule, at the stage of formation of the urethral stricture, which can develop many years after the onset of the disease. Urethral tuberculosis is usually secondary to other localizations of extrapulmonary tuberculosis, such as tuberculosis of the prostate, penis, kidney, and bladder, but there are also isolated forms of this disease. The most common symptoms of urethral tuberculosis are the presence of strictures, skin-urethral and recto-prostatic fistulas, and purulent urethritis. Almost always, with this disease, conservative specific therapy was carried out, which in some cases made it possible to completely eliminate the symptoms and ensure the patient’s clinical recovery. Tuberculous urethral strictures are operated on according to generally accepted rules, but there is no single algorithm for the surgical treatment of strictures of this etiology, often limiting itself only to urine diversion or urethral dilation. Of the urethroplasty, the most commonly used end-to-end urethral anastomosis. In our opinion, a promising direction is the use of various grafts for the surgical treatment of this disease.

scholarly journals Outcome of urethral strictures treated by endoscopic urethrotomy and urethroplasty

2014 ◽  
Vol 8 (1-2) ◽  
pp. 16 ◽  
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.

scholarly journals Rekanalizacija striktura uretre privremenim prekrivenim biokompatibilnim metalnim endoprotezama nove generacije

2007 ◽  
Vol 54 (3) ◽  
pp. 123-127 ◽  
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.

scholarly journals Internal urethrotomy versus plasmakinetic energy for surgical treatment of urethral stricture

2015 ◽  
Vol 87 (2) ◽  
pp. 161 ◽  
Author(s):  
Levent Ozcan ◽  
Emre Can Polat ◽  
Alper Otunctemur ◽  
Efe Onen ◽  
Oğuz Ozden Cebeci ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Urethral Stricture ◽  
Maximum Flow ◽  
Clinical History ◽  
Internal Urethrotomy ◽  
Urethral Strictures ◽  
Cold Knife ◽  
Group 2 ◽  
Stricture Recurrence ◽  
Group 1

Purpose: we aimed to compare the longterm outcome of surgical treatment of urethral stricture with the internal urethrotomy and plasmakinetic energy. Material and Methods: 60 patients, who have been operated due to urethral stricture were enrolled in our clinic. None of the patients had a medical history of urethral stricture. The urethral strictures were diagnosed by clinical history, uroflowmetry, ultrasonography and urethrography. The patients were divided two groups. Group 1 consisted of 30 patients treated with plasmakinetic urethrotomy and group 2 comprised 30 men treated with cold knife urethrotomy. Results: There were no statistically significant differences between two groups in terms of patient age, maximum flow rate (Qmax) and quality of life score (Qol) value. A statistical difference between the two groups was observed when we compared the 3rd-month uroflowmetry results. Group 1 patients had a mean postoperative Qmax value of 16,1 ± 2,3 ml/s, whereas group 2 had a mean postoperative Qmax value of 15,1 ± 2,2 ml/s (p < 0.05). In the cold knife group, 3 of 11 (27,7%) recurrences appeared within the first 3 months, whereas in the plasmakinetic group zero recurrences appeared within the first 3 months in our study. The urethral stricture recurrence rate up to the 12 month period was statistically significant for group 1 (n = 7, 23%) compared with group 2 (n = 11, 37%) (p < 0.05). Conclusion: We believe that plasmakinetic surgery is better method than the cold knife technique for the treatment of urethral stricture.

scholarly journals Urethral stricture in men – standards for the provision of high-tech medical care

2020 ◽  
Vol 13 (5) ◽  
pp. 72-78
Author(s):  
S.V. Kotov ◽  
◽  
M.M. Iritsyan ◽  
◽  
Keyword(s):  
Surgical Treatment ◽  
Medical Care ◽  
Urethral Stricture ◽  
World Literature ◽  
Surgical Techniques ◽  
Medical Insurance ◽  
High Tech ◽  
Skin Grafts ◽  
Urethral Strictures ◽  
The World

Introduction. Urethroplasty is currently the gold standard for treating urethral strictures. The use of various grafts and flaps for urethroplasty requires extensive experience of the surgeon. These methods have fairly high efficiency. According to the decree of the Government of the Russian Federation dated 12/07/2019, the implementation of urethroplasty using vascularized skin flaps and mucous grafts are included in the standards of high-tech medical care in obligatory medical insurance system. Purpose of the study. To evaluate the effectiveness of high-tech medical care for men with narrowing of the urethra. Materials and methods. The results of surgical treatment of patient with urethral strictures at the clinic of urology of N.I. Pirogov Russian national research medical university since January 2016 to February 2020 were analyzed. The study included patients who underwent surgical treatment according to the high-tech medical care within obligatory medical insurance program. Over the entire period high-tech care was provided to 90 patients. The stricture length was 2-19 cm (median – 4 cm). In 47 (52,3%) patients, the stricture was localized in the bulbous section, in 14 (15,6%) in the penile section, in 16 (17,7%) – penile-bulbous section of the urethra, 3 (3.3%) patients had a meatostenosis. In 10 (11,1%) cased a panurethral stricture was diagnosed. As for etiological factors, the iatrogenic strictures were dominated. They were diagnosed in 53 (58,9%) patients, traumatic strictures were in 14 (15,6%) patients and in 10 (11,1%) cases strictures arose after unsuccessful hypospadias treatment. The median of the Qmax before surgery was 4.64 ml / sec. Cystostomy before surgery was in 20 (22.2%) patients. Results. The follow-up period was 6 to 38 months (median 14 months). The IPSS value for the observation period was 8 points. The average drainage period was 14 days (from 7-28 days). The average Qmax at the time of observation was 21.4 ± 10.9 ml/sec. During the observation, recurrence of urethral stricture was diagnosed in 9 (10%) patients. The overall treatment efficiency was 90%. Discussion. The results of dorsal and ventral urethroplasty with a buccal flap were compared according to the data of various authors, which showed that their effectiveness is the same and ranges from 90-95%. According to the world literature, the results of multi-stage urethroplasty show an efficiency within 78-100%. Comparable results of simultaneous urethroplasty with buccal and skin grafts are presented; in some cases, with extended strictures, it is possible to combine buccal and skin grafts. In our work, the effectiveness of treatment was 90% and is comparable to world results. The preference was given to the buccal graft, because the rate of complications is less than with skin grafts. Conclusion. Urethroplasty using grafts and flaps requires a lot of experience as a surgeon. It’s implementation should undoubtedly take place in expert centers. The effectiveness of surgical techniques in most cases is comparable with long-term observation. Most experts in the world prefer a buccal graft, which causes fewer complications and cosmetic defects.

THE ETIOLOGY, SYMPTOMS, AND TREATMENT OF URETHRAL STRICTURES IN MALE CHILDREN

PEDIATRICS ◽  
1963 ◽  
Vol 31 (1) ◽  
pp. 80-86
Author(s):  
Guy W. Leadbetter
Keyword(s):  
Surgical Treatment ◽  
Urethral Stricture ◽  
Urethral Strictures

The cases of eight patients are presented in whom urethral stricture developed in childhood. Two of these were adults. Surgical treatment of urethral strictures in children is urged after an adequate trial of dilatation has failed. The results have been satisfactory.

scholarly journals Intermittent Self Dilation – An Option For The Prevention of Urethral Stricture Recurrence After Filliform Follower Urethral Dilation

2018 ◽  
Vol 14 (2) ◽  
pp. 38-40
Author(s):  
N M Shrestha
Keyword(s):  
Urethral Stricture ◽  
Clinical Symptoms ◽  
Urine Test ◽  
Group A ◽  
Prospective Comparative Study ◽  
Foley’S Catheter ◽  
Group B ◽  
Stricture Recurrence ◽  
Urethral Dilation ◽  
Lower Urinary

Background: Urethral stricture and its recurrence is still a major problem in male. Several procedures are present for the treatment of the disease. Lapides introduced the concept of intermittent self dilatation (ISD) which has decreased the incidence of recurrence of urethral stricture if doing properly. The aim of the this study was to report the outcomes of ISD for the treatment of urethral stricture after Filliform follower urethral dilatation (FFUD).Method: This was a prospective comparative study, conducted in the department of surgery, urology unit from March 2013 to February 2016. Total of 49 patients were enrolled and were randomly divided into Group A and Group B. In Group A, all the patients were taught ISD with Nelaton Catheter after FFUD. In group B, all patients underwent only FFUD for urethral stricture. In both groups, Foley's catheter was removed after 2 weeks of FFUD. These patients who had difficulty In passing urine or having lower urinary tract syndrome after removal of catheter, were evaluated for urethral stricture recurrency by clinical symptoms, ultrasonography, urine test for culture and sensitivity, cystoscopy/urethrogram as necessarily.Result: In Group A, 4 patients out of 20(20%)developed urethral stricture recurrency where as in Group B,18 patients out of 23 (78.26%) developed urethral stricture recurrency. Therefore, the rate of urethral stricture recurrence is significantly more in group B than the Group A (p< 0.001).Conclusion: ISD is an effective way for the prevention of urethtral stricture recurrence after FFUD. JNGMC,  Vol. 14 No. 2 December 2016, Page: 38-40

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.

“Proximalization is Advancement”—Zone 3 Frozen Elephant Trunk vs Zone 2 Frozen Elephant Trunk: A Literature Review

2021 ◽  
pp. 153857442110024
Author(s):  
Rozina Yasmin Choudhury ◽  
Kamran Basharat ◽  
Syeda Anum Zahra ◽  
Tien Tran ◽  
Lara Rimmer ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Treatment ◽  
Literature Review ◽  
Treatment Options ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Cord Injury ◽  
Aortic Pathologies

Over the decades, the Frozen Elephant Trunk (FET) technique has gained immense popularity allowing simplified treatment of complex aortic pathologies. FET is frequently used to treat aortic conditions involving the distal aortic arch and the proximal descending aorta in a single stage. Surgical preference has recently changed from FET procedures being performed at Zone 3 to Zone 2. There are several advantages of Zone 2 FET over Zone 3 FET including reduction in spinal cord injury, visceral ischemia, neurological and cardiovascular sequelae. In addition, Zone 2 FET is a technically less complicated procedure. Literature on the comparison between Zone 3 and Zone 2 FET is scarce and primarily observational and anecdotal. Therefore, further research is warranted in this paradigm to substantiate current surgical treatment options for complex aortic pathologies. In this review, we explore literature surrounding FET and the reasons for the shift in surgical preference from Zone 3 to Zone 2.

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