scholarly journals Buccal Mucosal Graft Urethroplasty as Primary Repair Has Significantly Better Outcome Than After Failed Dviu Cases- a Clinical Trial

2020 ◽  
Vol 21 (1) ◽  
pp. 3-7
Author(s):  
Hasina Sadia Khan ◽  
AKM Anwarul Islam ◽  
AKM Khurshidul Alam ◽  
Mohammad Salahuddin Faruque ◽  
Ismat Jahan ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Urethral Stricture ◽  
Flow Rate ◽  
Primary Repair ◽  
Urine Flow ◽  
Control Group ◽  
Study Group ◽  
Short Segment ◽  
Buccal Mucosal Graft ◽  
Stricture Recurrence

Introduction: Direct Visual Internal Urethrotomy (DVIU) is the most commonly used technique for short segment bulbar urethral stricture till date. But it has a high failure and recurrence rate. On the other hand, urethroplasty is regarded as the gold standard treatment for urethral stricture. Moreover, for bulbar urethral stricture, usually more than 3cm stricture are treated with substitution urethroplasty. Current practice for short segment bulbar urethral stricture is multiple sessions of DVIU and then buccal mucosal graft (BMG) urethroplasty if they fail. But repeated DVIU make the stricture segment longer and more fibrotic. Considering the morbidities following repeated DVIU, this prospective clinical trial has been designed to compare the outcome of BMG urethroplasty after failed urethrotomy versus primary repair. Objective: To determine stricture recurrence, PVR and flow of urine in between primary BMG urethroplasty group and after failed DVIU group. Patients and Methods: The present study was conducted in the department of Urology, BSMMU between July’15 - February’17. Patients of short segment bulbar urethral stricture between 1.5- 3 cm without any previous DVIU were enrolled as study group(n=22) and patients with history of failed DVIU were included as control group(n=22). All the patients were followed upto 12 months after BMG urethroplasty and recurrence of stricture (by RGU and MCU), PVR and maximum urine flow rate (Qmax) in between two groups were compared. Results: The stricture recurrence rate was found significantly higher in control group than in the study group (p=0.042). The study group showed highly significant (0.000) decrease in post-operative PVR and significant (0.009) increase in post operative maximum urine flow rate than the control group as was assumed in the hypothesis. Conclusion: The present study propose that BMG urethroplasty as primary repair for bulbar urethral stricture within a length of 1.5-3 cm in younger age group (upto 45 years ) is very effective than BMG urethroplasty after failed DVIU cases. But long term multicentric trial is needed to further comment. Bangladesh Journal of Urology, Vol. 21, No. 1, January 2018 p.3-7

scholarly journals Outcome of Anastomotic Urethroplasty in Posterior Urethral Distraction Defect With or Without Mucosal Fixation- a Randomized Clinical Trial

2020 ◽  
Vol 21 (1) ◽  
pp. 31-34
Author(s):  
Sayem Hossain ◽  
AKM Khurshidul Alam ◽  
Hasina Sadia Khan ◽  
Mohammad Salahuddin Faruque ◽  
Ismat Jahan ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Failure Rate ◽  
Flow Rate ◽  
Influencing Factor ◽  
Urine Flow ◽  
Urine Flow Rate ◽  
Control Group ◽  
Study Group ◽  
Anastomotic Urethroplasty

Introduction: Anastomotic urethroplasty is the treatment of choice for posterior urethral distraction defect. To notice the high failure rate of anastomotic urethroplasty, several peri-operative factors are identified. Among the per-operative factors, mucosal fixation of the both urethral ends is one of the outcome influencing factor that is recently identified. So, this randomized clinical trial has been designed to compare the outcome of anastomotic urethroplasty in posterior urethral distraction defects with or without mucosal fixation. Objective: To compare the outcome of anastomotic urethroplasty of PUDD patient groups with or without mucosal fixation in terms of post-operative IPSS, maximum urine flow rate and post void residual urine. Patients and Methods: The present study was conducted in the department of Urology, BSMMU between January’16 - November’17. Posterior urethral distraction defects with length of gap between two urethral segments upto 3 cm. were included in the study. The patients in whom anastomotic urethroplasty were done with mucosal fixation were enrolled as study group(n=21) and patients in whom anastomotic urethroplasty were done without mucosal fixation were included as control group(n=21). All the patients were followed upto 6 months of anstomotic urethroplasty and failure of anastomotic urethroplasty (by RGU and MCU), PVR and maximum urine flow rate (Qmax) in between two groups were compared. Result: The failure rate was found significantly higher in control group than in the study group (p=0.043). The control group showed highly significant (0.001) increase in postoperative PVR than the study group and the study group showed significant (0.007) increase in post operative maximum urine flow rate than the control group as was assumed in the hypothesis. Conclusion: In conclusion, it can be said that anastomotic urethroplasty with mucosal fixation is a better option than anstomotic urethroplasty without mucosal fixation. But multicentric trial is needed to further comment. Bangladesh Journal of Urology, Vol. 21, No. 1, January 2018 p.31-34

scholarly journals Management of men with ultra-short penile urethral stricture using augmented anastomotic penile skin flap urethroplasty; a retrospective analysis

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Abdel W. El-Kassaby ◽  
Mohammed Saber Khalaf ◽  
Ahmed M. Reyad
Keyword(s):  
Success Rate ◽  
Urethral Stricture ◽  
Flow Rate ◽  
Skin Flap ◽  
Maximum Flow ◽  
Maximum Flow Rate ◽  
Control Group ◽  
Study Group ◽  
Significant Difference ◽  
Dorsal Onlay

Abstract Background The management of short anterior urethral stricture is challenging. Our study aims to evaluate the outcome of augmented anastomotic urethroplasty (AAU) for the management of men with ultra-short penile urethral stricture, and to compare it with the dorsal onlay buccal mucosa graft. Methods Databases of two tertiary referral centres were retrospectively reviewed to retrieve data of men with ultra-short penile urethral stricture who underwent urethroplasty from 2013 to 2020. Patients who underwent AAU with ventral onlay pedicled skin flap were considered the study group, while patients treated with the dorsal onlay graft augmentation were included as controls. Surgical outcomes included urethral patency, improvement in the maximum flow rate (Qmax), change in sexual satisfaction, and any reported complications. Results Thirty-four patients (and 30 controls) with a median age of 26–27 years were included in the study. The maximum flow rate improved significantly in both groups compared to the preoperative value (p < 0.001). The success rate was 88% in the study group compared to 76.7% in the control group. There was no statistically significant difference in the frequency of postoperative penile curvature nor the ventral sacculation between the two groups (p = 0.788 and 0.913). The operative time was statistically significantly longer in the control group (p = 0.044), while the frequency of postoperative void dripping was much higher in the study group (p = 0.007). Conclusion The success rate and complications of AAU for men with ultra-short penile urethral stricture were comparable to the dorsal buccal graft.

Outcome of Buccal Mucosal Graft Urethroplasty in Long Segment Anterior Urethral Stricture

2020 ◽  
Vol 19 (2) ◽  
pp. 64-68
Author(s):  
Mrinmoy Biswas ◽  
Sudip Das Gupta ◽  
Mohammed Mizanur Rahman ◽  
Sharif Mohammad Wasimuddin
Keyword(s):  
Urethral Stricture ◽  
Flow Rate ◽  
Surgical Outcome ◽  
Simple Technique ◽  
Anterior Segment ◽  
Maximum Flow ◽  
Anastomotic Site ◽  
Buccal Mucosal Graft ◽  
Male Patients

Objective: To assess the success of BMG urethroplasty in long segment anterior urethral stricture. Method: From January 2014 to December 2015, twenty male patients with long anterior segment urethral stricture were managed by BMG urethroplasty. After voiding trial they were followed up at 3 month with Uroflowmetry, RGU & MCU and PVR measurement by USG. Patients were further followed up with Uroflowmetry and PVR at 6 months interval.Successful outcome was defined as normal voiding with a maximum flow rate >15ml /sec and PVR<50 ml with consideration of maximum one attempt of OIU after catheter removal. Results: Mean stricture length was 5.2 cm (range 3-9 cm) and mean follow-up was 15.55 months (range 6-23 months). Only two patients developed stricture at proximal anastomotic site during follow-up. One of them voided normally after single attempt of OIU. Other one required second attempt of OIU and was considered as failure (5%). Conclusion: BMG urethroplasty is a simple technique with good surgical outcome. Bangladesh Journal of Urology, Vol. 19, No. 2, July 2016 p.64-68

Lichen sclerosis–induced long segment anterior urethral stricture: The early outcome of one-stage repair using dorsolateral onlay buccal mucosa graft

2021 ◽  
pp. 039156032110033
Author(s):  
Atef Fathi ◽  
Omar Mohamed ◽  
Osama Mahmoud ◽  
Gamal A Alsagheer ◽  
Ahmed M Reyad ◽  
...  
Keyword(s):  
Success Rate ◽  
Urethral Stricture ◽  
Flow Rate ◽  
Urine Volume ◽  
Maximum Flow ◽  
Maximum Flow Rate ◽  
P Value ◽  
Onlay Graft ◽  
Voiding Symptoms ◽  
Stricture Recurrence

Background: Substitution urethroplasty using buccal mucosal grafts can be performed by several approaches including ventral onlay graft, dorsal onlay graft, or ventral urethrotomy with dorsal inlay graft. Our study aims to evaluate the surgical outcome of dorsolateral buccal mucosal graft for long segment anterior urethral stricture >6 cm in patients with Lichen sclerosus (LS). Methods: A retrospective study included patients who underwent repair for long segment anterior urethral stricture >6 cm due to LS between January 2013 and April 2019. All patients were followed-up at 3, 6, 9, and 12 months postoperatively and then yearly by clinical symptoms, uroflowmetry, and calculation of post-void residual urine volume. Retrograde urethrogram was requested for patients with voiding symptoms or decreased maximum flow rate. Stricture recurrence that required subsequent urethrotomy or urethroplasty was considered failure. The success rate and surgical complications were collected and analyzed. Results: Thirty patients were identified. The median age (range) was 39 (25–61) years and a median (range) stricture length was 8 (6–14) cm. Most of postoperative complications were of minor degree. The success rate at median follow-up of 15 (12–24) months was 86.5%. The median maximum flow rate increased significantly from 6 (2–11) ml/s preoperatively to 18 (range: 6–23) ml/s at the 6th month ( p value < 0.001). Conclusion: Dorsolateral buccal mucosal grafts urethroplasty for long anterior urethral stricture caused by LS has a high success rate and low risk of complications including stricture recurrence.

scholarly journals Short-Segment Instrumentation with Fractured Vertebrae Augmentation by Screws and Bone Substitute for Thoracolumbar Unstable Burst Fractures

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Jen-Chung Liao ◽  
Wen-Jer Chen
Keyword(s):  
Bone Substitute ◽  
Bone Substitutes ◽  
Control Group ◽  
Study Group ◽  
Short Segment ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Local Kyphosis ◽  
Surgical Failure

Background. For thoracolumbar burst fractures, traditional four-screw (one above and one below) short-segment instrumentation is popular and has a high failure rate. Additional augmentation at the fractured vertebrae is believed to reduce surgical failure. The purpose of this study was to examine the clinical and radiographic results of patients who underwent short-segment posterior instrumentation with augmentation by screws and bone substitutes at the fractured vertebrae and to compare these data to those of patients who underwent long-segment instrumentation for thoracolumbar burst fractures. Methods. The study group had twenty patients who underwent short-segment instrumentation with additional augmentation by two screws and bone substitutes at the fractured vertebrae. The control group contained twenty-two patients who underwent eight-screw long instrumentation without vertebra augmentation. Local kyphosis and the anterior body height of the fractured vertebrae were measured. The severity of the fractured vertebrae was evaluated with the load sharing classification (LSC). Any implant failure or loss of correction >10° at the final follow-up was defined as surgical failure. Results. Both groups had similar distributions in terms of age, sex, the injured level, and the mechanism of injury before operation. During the operation, the study group had significantly less blood loss (136.0 vs. 363.6 ml, p=0.001) and required shorter operating times (146.8 vs. 157.5 minutes, p=0.112) than the control group. Immediately after surgery, the study group had better correction of the local kyphosis angle (13.4° vs. 11.9°, p=0.212) and restoration of the anterior height (34.7% vs. 31.0%, p=0.326) than the control group. At the final follow-up, no patients in the study group and only one patient in the control group experienced surgical failure. Conclusions. Patients with thoracolumbar burst fractures who received six-screw short-segment posterior fixators with augmentation at the level of the fractured vertebrae via injectable artificial bone substitute achieved satisfactory clinical and radiographic results, and this method could replace long-segment instrumentation methods used in unstable thoracolumbar burst fractures.

scholarly journals The Efficacy of Once-Daily Dose of Phenobarbital in Children with Generalized Tonic-Clonic Epilepsy

2018 ◽  
Vol 35 (7-8) ◽  
pp. 172-9
Author(s):  
Amril A. Burhany ◽  
Sofyan Ismael ◽  
Hardiono Pusponegoro
Keyword(s):  
Clinical Trial ◽  
Plasma Concentrations ◽  
Serum Levels ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Study Group ◽  
Once Daily ◽  
Daily Dose ◽  
Plasma Measurements ◽  
Better Than

In spite of its long half life, phenobarbital is still given twice-daily in the treatment of generalized tonic-clonic epilepsy. This study aims to determine if daily dose of phenobarbital given once differs to that given twice daily. Subjects of this unblinded controlled clinical trial were generalized tonic-clonic epilepsy patients ranging in age from 1-15 years. There were 40 study cases and 42 controls. We gave phenobarbital 4-6 mg/kg/day once-daily for study group and twice-daily dose for control group. History, physical and EEG examination and phenobarbital plasma measurements were obtained a t the beginning of the study and four weeks later. The ratio of the second to first phenobarbital plasma concentrations in the study group was 0.99 while in the control group it was 1.02. The proportion of seizure-free patients in the study group increased from 70% at the beginning to 85% at the end of study, and in the control group from 64.3% to 83.3%. Hyperactivity and irritability increased in both groups, and there were no significant differences in mean serum levels, seizures control, hyperactivity and irritability in both groups. Drowsiness was found in 50% of cases, but statistically significant decrease were found in study group. The compliance of the study group (92.5%) was significantly better than that of the control group (71.4%).

scholarly journals The Effect of Adding Low-Dose Naloxone to Intrathecal Morphine on Postoperative Pain and Morphine Related Side Effects after Cesarean Section: A Double-Blind, Randomized, Clinical Trial

2019 ◽  
Vol 7 (23) ◽  
pp. 3979-3983 ◽  
Author(s):  
Saloumeh Peivandi ◽  
Mohammad Reza Habibi ◽  
Afshin Gholipour Baradari ◽  
Abdolmajid Gholinataj ◽  
Ali Habibi ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Pain Intensity ◽  
Spinal Anaesthesia ◽  
Postoperative Nausea ◽  
Low Dose ◽  
Intrathecal Morphine ◽  
Control Group ◽  
Study Group ◽  
Double Blind

BACKGROUND: Nowadays, spinal anaesthesia is a suitable choice for most elective and emergency cesarean section (C-section) deliveries. AIM: This study aimed to determine the effect of adding low-dose naloxone to intrathecal morphine on postoperative pain and morphine related side effects after C-section. MATERIAL AND METHODS: In the present double-blind, randomised clinical trial, 70 women aged over 18 years, who were candidates for elective medical C-section under spinal anaesthesia were selected and randomly assigned to either the study group or the control group. For spinal anaesthesia, 10 mg of Bupivacaine plus 100 μg of morphine was administered for all patients. However, patients in the study group received 20 µg of naloxone intrathecally; but the patients in the control group only received normal saline as a placebo. After surgery, patient-controlled analgesia (PCA) pump with paracetamol (Apotel®) was connected to each patient. The intensity of postoperative pain in the patients was evaluated and recorded using Visual Acuity Screening (VAS) at 2, 4, 6 and 24 hours after the surgery. The patients were also examined for postoperative nausea and pruritus. RESULTS: Regardless of the groups to which the patients were assigned, a significant difference in pain intensity was observed during the study period (time effect; p < 0.001). Although the intensity of pain was lower in the study group, the difference was not statistically significant (group effect; p = 0.84). Also, there was no group time interaction between pain intensity and the times studied (p = 0.61). The incidence rates of postoperative nausea and pruritus were significantly lower in the study group compared to the control group (p < 0.001). CONCLUSION: According to the results of this study, adding low dose naloxone to intrathecal morphine did not significantly change postoperative pain intensity in the patients undergone elective C-section using spinal anaesthesia; however, significantly decreased the severity of postoperative nausea and pruritus.

A prospective, multicenter, randomized clinical trial of UGT1A1 promoter polymorphism for irinotecan dose escalation in metastatic colorectal cancer patients treated with bevacizumab plus FOLFIRI as the first-line setting (PURE FIST).

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 625-625
Author(s):  
Jaw-Yuan Wang
Keyword(s):  
Colorectal Cancer ◽  
Clinical Trial ◽  
Metastatic Colorectal Cancer ◽  
Dose Escalation ◽  
Control Group ◽  
Study Group ◽  
First Line ◽  
Line Setting ◽  
And Control ◽  
Irinotecan Dose

625 Background: The polymorphisms of genes encoding drug-metabolizing enzymes can play a crucial role in the increased susceptibility of patients to chemotherapy. This study is a prospective, multicenter, randomized clinical trial to compare the clinical outcomes and adverse events in metastatic colorectal cancer (mCRC) patients treated with bevacizumab plus 5-fluorouracil/leucovorin/irinotecan (FOLFIRI) with or without UGT1A1genotyping and irinotecan dose escalation as the first-line setting (NCT02256800). Methods: The enrolled patients were randomly assigned to one of two groups on the basis of receiving UGT1A1 genotyping or not. The study group receives a biweekly FOLFIRI plus bevacizumab, with irinotecan dose escalation based on UGT1A1 genotyping; whereas the control group receives the conventional biweekly FOLFIRI plus bevacizumab without UGT1A1 genotyping. The primary endpoint was the overall response rate (ORR), and the second endpoint was progression-free survival (PFS), overall survival (OS) and toxicities between the two groups. Results: BetweenAugust 2013 and May 2016, eighty-eight mCRC patients were enrolled, including 45 patients in the study group and 43 patients in the control group. With a median follow up time of 12.5 months (range, 5-30), the ORR was 71.4% vs. 44.2% ( P = 0.011). The PFS was 14.04 ± 1.44 vs. 9.08 ± 0.58 months in study group and control group ( P = 0.195), OS was 19.12 ± 1.24 vs. 14.16 ± 1.04 months ( P = 0.098), and ≥ Gr. III anemia was 2.2% vs. 23.3% ( P= 0.002) in study group and control group, respectively. However, there were no significant differences in ≥ Gr. III leukopenia or diarrhea even though the 1.36 fold relative dose intensity (RDI) in the study group. Conclusions: In the current study, patients with mCRC undergoing UGT1A1 genotyping may receive escalated doses of irinotecan for a potentially more favorable clinical response and outcome, in addition to acceptable toxicities. Such a personalized medicine based on genotyping may be feasible for potentially clinical practice. Clinical trial information: NCT02256800.

The Effect of Topical Application of Pure Honey on Radiation-induced Mucositis: A Randomized Clinical Trial

2008 ◽  
Vol 9 (3) ◽  
pp. 40-47 ◽  
Author(s):  
M. Motallebnejad ◽  
S. Akram ◽  
A. Moghadamnia ◽  
Z. Moulana ◽  
S. Omidi
Keyword(s):  
Clinical Trial ◽  
Radiation Therapy ◽  
Head And Neck ◽  
Randomized Clinical Trial ◽  
Topical Application ◽  
Control Group ◽  
Study Group ◽  
Early Effect ◽  
Radiation Induced ◽  
Natural Honey

Abstract Aim Radiation-induced mucositis is an early effect of head and neck radiotherapy. Mucositis can cause ulcers, and patients may experience pain and dysphasia which need treatment. The aim of this study is to evaluate the effect of pure natural honey on radiation induced mucositis. Methods and Materials In this randomized single blind (examiner blind) clinical trial 40 patients with head and neck cancer requiring radiation to the oropharyngeal mucosa were randomly assigned to two groups. Twenty patients assigned to the study group received honey, while both the study and control groups received standard head and neck radiation therapy based on a standard protocol. In the study group patients were instructed to take 20 ml of honey 15 minutes before radiation therapy, then again at intervals of 15 minutes and six hours after radiation. In the control group patients were instructed to rinse with 20 ml of saline before and after radiation. Patients were evaluated weekly for progression of mucositis using the Oral Mucositis Assessing Scale (OMAS). Data were analyzed using the independent t-test, Mann-Whitney, and Friedman tests. Results A significant reduction in mucositis among honey-received patients compared with controls (p=0.000) occurred. Conclusion Within the limits of this study the results showed the application of natural honey is effective in managing radiation induced mucositis. Clinical Significance Natural honey is a product with rich nutritional qualities that could be a pleasant, simple, and economic modality for the management of radiation mucositis. Citation Motallebnejad M, Akram S, Moghadamnia A, Moulana Z, Omidi S. The Effect of Topical Application of Pure Honey on Radiation-induced Mucositis: A Randomized Clinical Trial. J Contemp Dent Pract 2008 March; (9)3:040-047.

scholarly journals Supervised physical therapy in women treated with radiotherapy for breast cancer

2016 ◽  
Vol 24 (0) ◽  
Author(s):  
Nara Fernanda Braz da Silva Leal ◽  
Harley Francisco de Oliveira ◽  
Hélio Humberto Angotti Carrara
Keyword(s):  
Breast Cancer ◽  
Clinical Trial ◽  
Physical Therapy ◽  
Range Of Motion ◽  
External Rotation ◽  
Control Group ◽  
Study Group ◽  
Upper Limbs ◽  
Registration Number

ABSTRACT Objective: to evaluate the effect of physical therapy on the range of motion of the shoulders and perimetry of the upper limbs in women treated with radiotherapy for breast cancer. Methods: a total of 35 participants were randomized into two groups, with 18 in the control group (CG) and 17 in the study group (SG). Both of the groups underwent three evaluations to assess the range of motion of the shoulders and perimetry of the upper limbs, and the study group underwent supervised physical therapy for the upper limbs. Results: the CG had deficits in external rotation in evaluations 1, 2, and 3, whereas the SG had deficits in flexion, abduction, and external rotation in evaluation 1. The deficit in abduction was recovered in evaluation 2, whereas the deficits in all movements were recovered in evaluation 3. No significant differences in perimetry were observed between the groups. Conclusion: the applied supervised physical therapy was effective in recovering the deficit in abduction after radiotherapy, and the deficits in flexion and external rotation were recovered within two months after the end of radiotherapy. Registration number of the clinical trial: NCT02198118.

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