Comparative Study Of Optical Internal Urethrotomy Versus Anastomotic Urethroplasty For Short Segment Bulbar Urethral Stricture

2020 ◽  
Vol 16 (1) ◽  
pp. 21-25
Author(s):  
Asm Shafiul Azam ◽  
Akm Kawsar Habib ◽  
Sm Mahbub Alam ◽  
Md Habibur Rahman ◽  
Md Abdus Salam ◽  
...  
Keyword(s):  
Urethral Stricture ◽  
Internal Urethrotomy ◽  
Short Segment ◽  
College Hospital ◽  
Exact Probability ◽  
Urethral Strictures ◽  
Significant Difference ◽  
Urinary Stream ◽  
Optical Internal Urethrotomy ◽  
Anastomotic Urethroplasty

Objective: This study was conducted to compare the outcome of anastomotic urethroplasty with that of traditional optical internal urethrotomy in the treatment of short-segment bulbar urethral stricture. Methods: This comparative clinical study was conducted in the Department of Urology, Dhaka Medical College Hospital over a period 1 year from January 2007 to December 2008. A total of 50 patients with short-segment (< 2 cm) bulbar urethral strictures were consecutively included in the study. The test statistics used to analyses the data were Fisher’s Exact Probability Test, Student’s t-Test. For all analytical tests, the level of significance was set at 0.05 and p < 0.05 was considered significant. Results: About one-quarter (24%) of patients in OI Urethrotomy group experienced bleeding, 4% epididymitis and another 4% incontinence. In contrast, 8% of patients in Anastomotic Urethroplasty group complained of periurethral leakage, 8% fever and another 8% wound infection. Apart from bleeding, all the complications were almost homogeneously distributed between groups.Six (24%) of patients in OI Urethrotomy Group exhibited narrow urinary stream at month 3, as opposed to none in Anastomotic Urethroplasty Group (p = 0.001). Nearly 30% of patients in OI Urethrotomy Group had narrow urinary stream at month 6 compared 4% in Anastomotic Urethroplasty Group (p = 0.024). Of the 25 patients in OI Urethrotomy Group, 1(4%) developed UTI at month 3 and 5(20%) at month 6. None of the patients in Anastomotic Urethropasty Group developed UTI. There was significant difference between groups in terms of UTI at month 6 (p = 0.025).The recurrence rate of stricture in OI Urethrotomy was 24% (6 out of 25 patients) at month 3. However, none in Anastomotic Urethroplasty Group had history of recurrence of stricture (p = 0.011). At baseline the mean uroflowmetry was 5.5 ml/sec in both groups which immediately increased to 25.3 ± 2.6 ml/sec and 23.9 ± 2.2 ml/sec in OI urethrotomy and Anastomotic Urethroplasty groups respectively and then dropped to 18.4 ± 6.3 ml/sec and 20.2 ± 2.6 ml/sec in OI Urethrotomy and Anastomotic Urethroplasty groups respectively at month 3 and to 17.8 ± 6.4 ml/sec and 19.6 ± 2.6 ml/sec respectively at month 6. Conclusion: This study concludes that Anastomotic Urethroplasty is an effective and satisfactory technique for the treatment of short-segment bulbar urethral stricture. Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2013 p.21-25

scholarly journals Results of Buccal Mucosal Graft Urethroplasty in Management of Anterior Urethral Stricture – Experience in a Single Center

2020 ◽  
Vol 22 (2) ◽  
pp. 128-131
Author(s):  
Mohammad Abdul Aziz ◽  
Shafiqur Rahman ◽  
Mirza Mahbubul Hasan
Keyword(s):  
Success Rate ◽  
General Hospital ◽  
Urethral Stricture ◽  
Buccal Mucosa ◽  
Single Center ◽  
Internal Urethrotomy ◽  
Exclusion Criteria ◽  
Urethral Strictures ◽  
Buccal Mucosal Graft ◽  
Optical Internal Urethrotomy

Objective: To share our experience with buccal mucosal graft (BMG) urethroplasty for the management of anterior urethral strictures in BIRDEM General Hospital, Dhaka. Materials and methods: This study was conducted from January 2013 to January 2018. Patients selected according to inclusion and exclusion criteria. The oral mucosal characteristics were assessed in all patients during the initial workup. Single stage dorsolateral onlay graft urethroplasty done in all patients. They were followed according schedule for outcome and complications. Result:Total 59 patients were studied. Overall success rate of BMG urethroplasty was 88.1% at 12th month. Complications include development of periurethral abscess (3.4%), restructure (8.5%) development of fistula (1.7%). Total 8 patients underwent retreatment procedures like drainage of periurethral abscess, dilatation, optical internal urethrotomy (OIU) and revision urethroplasty. Conclusion:The buccal mucosa is easy to obtain and handle, therefore BMG urethroplasty is a safe and effective in managing anterior urethral stricture. Bangladesh Journal of Urology, Vol. 22, No. 2, July 2019 p.128-131

scholarly journals Use of intra-urethral steroid clobetasol cream to prevent the recurrence of urethral stricture after optical urethrotomy: Randomized clinical trial

Mediscope ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. 59-63
Author(s):  
M Ahmed ◽  
SM Hossain ◽  
MT Islam ◽  
G Kobir ◽  
BK Basu
Keyword(s):  
Urethral Stricture ◽  
Topical Steroid ◽  
Scar Tissue ◽  
Tissue Formation ◽  
Internal Urethrotomy ◽  
Proliferative Effect ◽  
Urethral Strictures ◽  
Stricture Recurrence ◽  
Optical Internal Urethrotomy ◽  
Scar Tissue Formation

Background: One of the most frequently used treatments of urethral strictures is the optical internal urethrotomy (OIU). About 20%-60% of urethral stricture patients develop recurrent stricture after Urethrotomy. Glucocorticoids have proved anti-proliferative effect and thereby used to reduce the formation of scar tissue. In urethral stricture, the main pathology is scar tissue formation. Objective: The aim of this study is to see the influence the local application of steroid clobetasol cream after Urethrotomy. Method: Between January to December 2016, all Bulbar urethral stricture patients attended to the hospital and private clinics, were included in this study. They were placed in two groups alternatively. They underwent standard OIU. First group (35 patients) offered clean intermittent self-catheterization (CISC) postoperatively without any steroid cream in urethra. The second group (35 patients) practiced CISC in the same way but used clobetasol cream with catheter. Both groups used topical anaesthesic Lidocain HCL for lubrication of urethra. Result: No patient developed recurrence with clobetasol cream after 3 months, but two patients developed recurrence without steroid. At 6 months, this result is 6 (17.14%) and 10 (28.57%) accordingly. Conclusion: Topical steroid clobetasol cream reduces urethral stricture recurrence. Mediscope Vol. 6, No. 2: Jul 2019, Page 59-63

scholarly journals Holmium laser vs. conventional (cold knife) direct visual internal urethrotomy for short-segment bulbar urethral stricture: Outcome analysis

2016 ◽  
Vol 10 (5-6) ◽  
pp. 161 ◽  
Author(s):  
Ankur Jhanwar ◽  
Manoj Kumar ◽  
Satya Narayan Sankhwar ◽  
Gaurav Prakash
Keyword(s):  
Urethral Stricture ◽  
Operating Time ◽  
Holmium Laser ◽  
Outcome Analysis ◽  
Internal Urethrotomy ◽  
Short Segment ◽  
Urethral Strictures ◽  
Group A ◽  
Cold Knife ◽  
Group B

Introduction: Our goal was to analyze the outcome between holmium laser and cold knife direct visual internal urethrotomy (DVIU) for short-segment bulbar urethral stricture.Methods: We conducted a prospective study comprised of 112 male patients seen from June 2013 to December 2014. Inclusion criterion was short-segment bulbar urethral stricture (≤1.5cm). Exclusion criteria were prior intervention/urethroplasty, pan-anterior urethral strictures, posterior stenosis, urinary tract infection, and those who lost to followup. Patients were divided into two groups; Group A (n=58) included cold knife DVIU and group B (n=54) included holmium laser endourethrotomy patients. Patient followup included uroflowmetry at postoperative Day 3, as well as at three months and six months.Results: Baseline demographics were comparable in both groups. A total of 107 patients met the inclusion criteria and five patients were excluded due to inadequate followup. Mean stricture length was 1.31 ± 0.252 cm (p=0.53) and 1.34 ± 0.251 cm in Groups A and B, respectively. Mean operating time in Group A was 16.3 ± 1.78 min and in Group B was 20.96 ± 2.23 min (p=0.0001). Five patients in Group A had bleeding after the procedure that was managed conservatively by applying perineal compression. Three patients in Group B had fluid extravasation postoperatively. Qmax (ml/s) was found to be statistically insignificant between the two groups at all followups.Conclusions: Both holmium laser and cold knife urethrotomy are safe and equally effective in treating short-segment bulbar urethral strictures in terms of outcome and complication rate. However, holmium laser requires more expertise and is a costly alternative.

scholarly journals Holmium: YAG Versus Cold Knife Internal Urethrotomy in the Management of Short Urethral Strictures: A Randomized Controlled Trial

2021 ◽  
Vol 12 (1) ◽  
pp. e35-e35
Author(s):  
Mohamed A. Gamal ◽  
Ahmed Higazy ◽  
Samuel F. Ebskharoun ◽  
Ahmed Radwan
Keyword(s):  
Urethral Stricture ◽  
Controlled Trial ◽  
Demographic Data ◽  
Holmium Laser ◽  
Success Rates ◽  
Internal Urethrotomy ◽  
Urethral Strictures ◽  
Significant Difference ◽  
Cold Knife ◽  
Male Patients

Introduction: our study aimed to assess the safety and efficacy of Holmium: YAG laser internal urethrotomy compared to the cold knife internal urethrotomy. Methods: Eighty adult male patients presented with a urethral stricture less than 1.5 cm were included in our study; they were randomly allocated into 2 groups representing Holmium and cold knife internal urethrotomy. A careful evaluation with ascending cystourethrogram and uroflowmetry were done on all patients, and they were followed up for 1 year with uroflowmetry. Results: Each group included 40 patients sharing the same demographic data. The most common cause of a urethral stricture in both groups was iatrogenic injury. The mean operative time of the cold knife urethrotomy procedure was 10.98 ± 2.40 minutes compared to 15.43 ± 2.48 minutes in the holmium laser urethrotomy group with a highly significant difference. The results showed success rates of 90% and 80% for the holmium laser and cold knife internal urethrotomy groups respectively. The perioperative complication according to the Clavien-Dindo classification, showed no statistically significant difference in grade 1 and 2 complications. A recurrence rate with the need for redo surgery representing grade 3B complication was seen in 4 cases in the Holmium group compared to 8 cases in the cold knife group with a statistically significant difference. Conclusion: Both Holmium Laser and cold knife internal urethrotomy are an effective surgical option for the treatment of a urethral stricture less than 1.5 cm with a promising outcome after 1-year follow-up with a better success rate using the Holmium laser.

scholarly journals Outcome Between Intralesional Injection of Triamcinolone following Optical Internal Urethrotomy (OIU) and OIU Alone for the Management of Short Segment Stricture of male Urethra

2021 ◽  
Vol 29 (2) ◽  
pp. 126-130
Author(s):  
Md Sazzad Hossain ◽  
Mir Ehteshamul Haque ◽  
Mohammad Zahid Hasan ◽  
Prodyut Kumar Saha ◽  
Mostafiger Rahman ◽  
...  
Keyword(s):  
Urethral Stricture ◽  
Statistical Tests ◽  
Time Interval ◽  
Intralesional Injection ◽  
Internal Urethrotomy ◽  
Short Segment ◽  
Quasi Experimental ◽  
Group A ◽  
Group B ◽  
Optical Internal Urethrotomy

Objective: To compare the outcome of optical internal urethrotomy (OIU) with or without intralesional triamcinolone acetonide injection for the treatment of short segment anterior urethral stricture. Methods: This prospective quasi experimental study was carried out in the department of Urology, DMCH, Dhaka from November 2015 to April 2017 on 50 patients with short segment of anterior urethral stricture. Cases were randomly allocated to group A (OIU without Triamcinolone) and group B (OIU with Triamcinolone). Each group consisted of 25 patients. Data were analyzed and compared by statistical tests. Results: There were no significant differences in the baseline characteristics of the patients. Recurrences of stricture urethra were higher among those without Triamcinolone than cases with Triamcinolone which was statistically significant (p=0.033) at 6 month and (p=0.016) at 9 months. Regarding mean time interval in month of development of recurrence of stricture was 6.1±1.66 months in Group A and 7.66±1.52 months in Group B which was statistically significant (p=0.001) Conclusion: OIU with intralesional triamcinolone is better than OIU alone. It significantly reduced and delayed the recurrence of anterior urethral stricture. J Dhaka Medical College, Vol. 29, No.2, October, 2020, Page 126-130

scholarly journals Role of visual internal urethrotomy in the management of short segment urethral stricture in male

2020 ◽  
Vol 4 (1) ◽  
pp. 74-77
Author(s):  
Sureshkumar K ◽  
Shukla PK ◽  
Gaharwar APS ◽  
Jeswani M ◽  
Sahu S
Keyword(s):  
Urethral Stricture ◽  
Internal Urethrotomy ◽  
Short Segment

scholarly journals Types of urethral stricture and their recurrence rates post urological treatments

2021 ◽  
Author(s):  
Wedyan Salem Basaif ◽  
Husam Hamad Alamri ◽  
Hind Waleed Mousa ◽  
Raghad Abdulelah Alsayed ◽  
Abdullah Mohammed Almohammadi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Current Evidence ◽  
Internal Urethrotomy ◽  
Recurrence Rates ◽  
Current Management ◽  
Urethral Strictures ◽  
Common Causes ◽  
Almost All ◽  
Anastomotic Urethroplasty

Urethral strictures can significantly impact the quality of life for patients because it can be associated with significant complications such as fistulas, bladder calculi, infections and sepsis. Additionally, it might even lead to renal failure. The worldwide prevalence of urethral strictures is high, with an estimated rate of 229-627 patients per 100,000 population. In this literature review, the aim was to discuss the types and etiology of urethral strictures and the recurrence rates following the different management modalities. Studies that were included in this review were published between January 2005 until May 2021. The results support the current evidence that the idiopathic and iatrogenic bulbar strictures are the most common types while penile strictures, the iatrogenic and inflammatory are the most common causes. Recurrence rates are reported after management with almost all of the current management modalities, indicating the need for better interventions to enhance the outcomes and alleviate the quality of care. The recurrence rate of strictures after treatment with internal urethrotomy and direct vision internal urethrotomy by three years is 65%. Other studies reported that the rate of recurrence was estimated to be around 14 after 6 months from internal urethrotomy and up to 27% after 12 months. The rate of complications and recurrence following treatment with anastomotic urethroplasty was estimated to be less than 5%. Detailed information and discussion were provided in the study manuscript.

scholarly journals Urethral Strictures and its Management at Tertiary Hospital of Nepal

2020 ◽  
Vol 18 (2) ◽  
pp. 310-312
Author(s):  
Kabir Tiwari ◽  
Amit Mani Upadhaya ◽  
Ashok Kunwar ◽  
Sanjesh Bhakta Shrestha
Keyword(s):  
Urethral Stricture ◽  
Bladder Neck ◽  
Surgical Techniques ◽  
Tertiary Hospital ◽  
Urethral Meatus ◽  
Common Site ◽  
Urethral Strictures ◽  
Different Types ◽  
Endoscopic Incision ◽  
Anastomotic Urethroplasty

Background: Urethral stricture can occur from urethral meatus to bladder neck. Treatment of urethral stricture include dilatation, endoscopic incision and anastomotic urethroplasty. The aim of this study is to report our experience in the management of different types of urethral strictures.Methods: We retrospectively reviewed the chart of all the patients of urethral stricture who received treatment at Kathmandu model hospital between January 2015 and October 2019. Different types of urethral stricture along with various modalities of treatment given were recorded.Results: Fifty patients were included in this study, all were males. Mean age was 49 (16-82) years. Bulbar urethra was the most common site in 54% of cases and bulbomembranous least common, only 10% of cases. Depending on sites and size of stricture, different types of surgery performed were meatoplasty, dviu and anastomotic urethroplasty.Conclusions: Urethral stricture is a troublesome disease and can occur anywhere from meatus to the bladder neck. Different surgical techniques are present and the treatment should be individualized, depending on location and length of the stricture.Keywords: Urethra; urethral stricture; urethroplasty

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 &lt; 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 &lt; 0.05). Conclusion: We believe that plasmakinetic surgery is better method than the cold knife technique for the treatment of urethral stricture.

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