Treatment of Short Segment Anterior Urethral Stricture: Optical Internal Urethrotomy (OIU) Alone and OIU with Triamcinolone

Optical urethrotomy has been considered standard therapy for anterior urethral stricture since its introduction in 1976. Now optical internal urethrotomy (OIU) with intralesional triamcinolone injection is a safe and effective, minimally invasive therapeutic modality. The aim of the study is to compare the outcome of OIU alone and OIU with intralesional triamcinolone injection in the treatment of anterior urethral stricture. This Quasi Experimental study was carried out among 50 male patients with bulbar urethral stricture in the Department of Urology, Dhaka Medical College Hospital, Dhaka, over a period of six months. The age range of the patients were 32-46 years and patients were divided equally into two groups, OIU with and without intralesional triamcinolone acetonide injection as Group- A (experimental group, 25 patients) and Group- B (control group, 25 patients). Post-operative evaluation was done on the basis of history and uroflowmetry. Retrograde urethrography and micturating cystourethrography were done only in patient who developed obstructive voiding problems or flow rate below 10 ml/second. Follow up was done at regular interval on 7th day, 3rd month and 6th month. Post-operative outcomes were compared between two groups. Post-operative infection was significantly higher among those OIU with intralesional Triamcinolone acetonide injection (8%) than patients without intralesional Triamcinolone acetonide injection (4%). Per operative extravasations of urine were significantly higher among those without intralesional Triamcinolone acetonide injection (4%) than subjects with intralesional Triamcinolone acetonide injection. Extravasation not influenced by steroid but this patient subsequently suffered recurrence of stricture. In Group-A, pre and post-operative Q-max were 10.25±2.21 and 22.11±2.96 ml/sec respectively. In Group-B, pre and post-operative follow up Q-max were 10.37±2.55 and 19.54±2.65 mi/sec respectively. In Group-A, pre and post-operative voiding time was 85.20±4.20 and 27.10±3.36 sec respectively. In Group-B, pre and post-operative follow up voiding time were 86.37±4.55 and 31.45±2.55 sec respectively. Post-operative recurrences of stricture were significantly higher among those without intralesional Triamcinolone acetonide injection (24%) than subjects with intralesional Triamcinolone acetonide injection (12%). Post-operative it seems that triamcinolone injection after OIU is safe method to prevent the recurrence of urethral stricture Bangladesh Med J. 2019 Jan; 48 (1): 31-38

Download Full-text

Role of intermittent self catheterization in prevention of recurrence of stricture urethra following visual internal urethrotomy: a prospective single centre study

International Surgery Journal ◽

10.18203/2349-2902.isj20191130 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1093

Author(s):

Vijaya Kumar R. ◽

Sachin Dharwadkar ◽

Chirag Doshi ◽

Akshey Batta

Keyword(s):

Treatment Group ◽

Urethral Stricture ◽

Intermittent Catheterization ◽

Control Group ◽

Internal Urethrotomy ◽

Stricture Urethra ◽

Group A ◽

Group B ◽

Stricture Recurrence

Background: Stricture urethra is a highly recurrent disease. Various treatment modalities were used to prevent its recurrence post urethrotomy with variable success. The objective of this randomized study was to compare the stricture recurrence after optical internal urethrotomy with and without clean intermittent self catheterization in patients with anterior urethral stricture.Methods: A total of fourty patients aging 20-60 years with urethral stricture of up to 1cm and up to six months duration were selected randomly in to treatment group A (20 patients) control group B (20patients) and all patients were treated with VIU followed with indwelling catheter for 7 days. Patients with traumatic urethral stricture, congenital or malignant strictures were excluded. The treatment group A was taught to perform self clean intermittent catheterization by inserting Nelaton catheter. All patients were followed regularly at 3,6,12 months.Results: 4 (20%) patients in treatment group A had stricture recurrence while 15 (75%) out of 20 patients in control group B developed urethral stricture recurrence. In Group A 2 Patient developed stricture in first 6 months and 2 in next 6 months of follow up while in control group B 10 patients (50%)out of 20 had their recurrence in the first six months of follow-up while 5 (25%) in group B had their recurrence in the next six months of follow-up.Conclusions: Clean self intermittent catheterization is a simple, safe, cost effective and easy to perform procedure for prevention of urethral stricture with good acceptability and compliance.

Download Full-text

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

Journal of Dhaka Medical College ◽

10.3329/jdmc.v29i2.51186 ◽

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

Download Full-text

Efficacy and Safety of Fenofibrate in Uncomplicated Hyperbilirubinemia in Newborn: A Randomized Trial, with a 6-month Follow-up

Asian Journal of Pediatric Research ◽

10.9734/ajpr/2020/v4i230147 ◽

2020 ◽

pp. 37-42

Author(s):

Jayendra R. Gohil ◽

Vishal S. Rathod ◽

Bhoomika D. Rathod

Keyword(s):

Single Dose ◽

Serum Bilirubin ◽

Total Serum Bilirubin ◽

Total Serum ◽

Control Group ◽

Term Neonates ◽

Significant Difference ◽

Group A ◽

Group B

Objective: To study the effect and safety of Fenofibrate in uncomplicated hyperbilirubinemia in newborn with 6-month follow-up. Materials and Methods: This is a randomized controlled clinical trial conducted in 60 normal term neonates admitted for uncomplicated hyperbilirubinemia in NICU at Sir T G Hospital, Bhavnagar from January 2012 to December 2012. The data included: age, sex, total serum bilirubin (TSB), weight and duration of phototherapy. All neonates enrolled in the study received phototherapy. They were divided in two groups of 30 each: control group A and group B receiving Fenofibrate (100 mg/kg single dose). There was statistically insignificant difference between the parameters of age, sex, weight and TSB between the two groups at hospitalization. Data was analyzed by using appropriate statistical methods. Results: Mean values for total serum bilirubin in Fenofibrate group B at 24 and 48 hours after admission were significantly lower than those for control group A (p<0.0001, p=0.0001). There was no significant difference in fall of TSB between 24 and 48 hours. The mean duration of phototherapy in Fenofibrate group (44.8h: 24-72h) was significantly shorter than that in control group (55.2 h: 24‐96 h) (P=0.02). There were no side effects of the drug observed during the study and during 6 months follow up period. Conclusion: Fenofibrate as a single 100 mg/kg dose in healthy full term neonates, is effective and a safe drug (till six-month follow-up) for neonatal hyperbilirubinemia, that can decrease the time needed for phototherapy and hence hospitalization. Effect of a single dose seems to wane after 24 hours.

Download Full-text

Protocol on Comparative Clinical Efficacy of Tryushanadi Guggul and Navaka Guggul in Sthoulya (Overweight)

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i30a31628 ◽

2021 ◽

pp. 169-175

Author(s):

Ashvini Dineshrao Pardhekar ◽

Sadhana Misar(Wajpeyi) ◽

Vinod Ade

Keyword(s):

Clinical Efficacy ◽

The Body ◽

Control Group ◽

Arm Circumference ◽

Before And After ◽

Group A ◽

Excessive Intake ◽

Group B ◽

Excessive Accumulation

Background: Sthoulya is Medovaha Strotodushtijanya vyadhi, which includes abnormal and excessive accumulation of Medodhatu in the body. This is caused by lack of physical and mental activity, daytime sleep, excessive intake of madhur (sweet), snigdha ahar (oily diet) results in increase Kaphadosha and meda which results in Sthoulya (overweight) having symptoms of mild dysponea, thirst, drowsiness, excess sleep, appetite, offensive smell from the body, incapability to work and incapability to participate in sexual intercourse. Aim: Comparative clinical efficacy of Tryushanadi Guggul and Navaka Guggul in Sthoulya (overweight). Materials and methods: Total 60 patients of Sthoulya will enrolled and will divided into two groups (each group contains 30). Patients in group A (experimental group) will be given 1 gram Tryushanadi Guggul two times a day after meal with honey and in group B (control group)1 gram Navaka Guggul will administered two times a day after meal with honey for 30 days. Dietary changes and walking (30 minutes) will be advised to patients of both groups. Follow up will be taken on 15th day and 30th day. Assessment of subjective parameters like kshudrashwasa (exertional dyspnoea), swedadhikya (perspiration), atikshudha (increased appetite), nidradhikya (increased sleep) and objective parameters like body weight, B.M.I., mid arm circumference, waist-hip ratio and lipid profile will be done before and after treatment. Results: Subjective and objectives outcomes will be assessed by statistical analysis. Conclusion: It will be drawn from the result obtained.

Download Full-text

To Compare the Effect on IOP Following Primary Trabeculectomy with MMC 0.2% versus Trabeculectomy without MMC in Primary Open Angle Glaucoma

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i43b32577 ◽

2021 ◽

pp. 475-480

Author(s):

Zakaullah Gopang ◽

Shabeer Ahmed Bhutto ◽

Naeem Akhtar Katpar ◽

Arslan hassan Rajper ◽

Vijay Nagdev

Keyword(s):

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Test Group ◽

Control Group ◽

Open Angle ◽

Primary Procedure ◽

Group A ◽

Group B ◽

Medical University

Objective: To determine the effect on intraocular pressure following primary Trabeculectomy with MMC 0.2% versus Trabeculectomy without MMC in Primary Open Angle Glaucoma. Study Design: This is a prospective and experimental Study. Setting: Study carried out at Ophthalmology Department, Shaheed Mohtarma Benazir Bhutto Medical University Larkana, from 01-03-2020 to 31-08-2020 (06 Months). Materials and Methods: The patients with primary open angle glaucoma were selected from glaucoma clinic after taking careful history and clinical examination. Patients selected for trabeculectomy into two groups. Group A includes 43 patients while Group B also includes 43 patients. Among Group A patients adjunctive MMC 0.2mg/ml for a period of 3 minutes was used during trabeculectomy as a primary procedure (Test Group) while Group B patients were operated without MMC 0.2% (Control Group). Follow-up period of 06 months was observed in both groups. The span of study was from 01-03-2020 to 31-08-2020. Results: The total of 86 Eyes of 86 patients of POAG were included in this study. Group A patients were operated for trabeculectomy with MMC while group B patients were operated for trabeculectomy without MMC. The mean IOP before surgery of Group-A was 25.39±2.42 mmHg while in Group-B it was 26.23±4.23mmHg. At day 1 of surgery in Group-A patients IOP was 13.20±3.05 mmHg while in Group-B patients IOP, was 14.09±4.04 mmHg. After 3 months in Group-A, IOP was 13.04±3.81 mmHg in Group-B IOP was 14.01±4.18 mmHg. Out of 43 patients in Group-A, 41(95.3%) were succeeded while in Group-B, 39(90.7%)were succeeded. Significant result was found for IOP reduction after 6 months of surgeryin group-A IOP was 13.48 + 2.86 mmHg while in group-B, IOP was 15.09 ±2.64 (P=0.754). Conclusion: Trabeculectomy with MMC as a primary procedure seems to be more effective than trabeculectomy without MMC.

Download Full-text

Modified mini-open SRS-Schwab grade 4 osteotomy combined with percutaneous pedicle screws fixation in post-traumatic thoracolumbar kyphosis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03666-8 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Wubo Liu ◽

Yiwei Zhao ◽

Suomao Yuan ◽

Yonghao Tian ◽

Xinyu Liu

Keyword(s):

Back Pain ◽

Pedicle Screws ◽

Neurological Dysfunction ◽

Control Group ◽

Thoracolumbar Kyphosis ◽

Estimated Blood Loss ◽

Group A ◽

Post Traumatic ◽

Group B

Abstract Background We aimed to analyze the clinical results of Schwab grade 4 osteotomy combined with percutaneous pedicle screws (PPS) fixation for treatment of post-traumatic thoracolumbar kyphosis (PTK). Methods Thirty four patients with PTK (group A) were included in our study. The average age was 54.9 ± 3.3 years. All patients had severe back pain with 8.6 ± 1.3 VAS scores. The affected level was T12 in 16 patients and L1 in 18 patients. The average preoperative regional kyphosis angle (RKA) was 30.7 ± 6.00. Three patients had neurological dysfunction with ASIA grade D. All patients underwent Schwab grade 4 osteotomy combined with PPS fixation. The control group (Group B) were 26 PTK patients treated with Schwab grade 4 osteotomy and open pedicle screws fixation in our institution. Results Operation time in groups A and B was 280 ± 50 min and 210 ± 30 min, respectively (P < 0.05). Estimated blood loss in groups A and B was 310 ± 70 ml and 630 ± 40 ml, respectively (P < 0.05). No cerebral spinal fluid leakage, segmental nerve function damage, and other complications observed during and after the operations in both groups. RKA, SVA, and LL improved significantly after surgery in both groups (P < 0.05). The average correction rate in groups A and B was 64.5 and 66.3% (P > 0.05). CT showed that the misplacement rate in groups A and B was 5.5 and 6.6% (P > 0.05). The average follow-up in groups A and B was 25.2 ± 7.6 months and 30.6 ± 2.7 months. No fracture and other complications were observed in both groups. Solid bone fusion was showed in all cases at 6 months follow-up. In groups A and B, all patients with preoperative neurological dysfunction recovered to ASIA grade E at the last follow-up. The VAS score of back pain improved significantly from 8.6 ± 1.3 to 1.6 ± 1.0 at the last follow-up in group A (P < 0.05), while it improved significantly from 8.3 ± 1.2 to 3.0 ± 1.1 at the last follow-up in group B (P < 0.05). VAS of back pain was better in group A than that in group B. Conclusion Schwab grade 4 osteotomy combined with percutaneous pedicle screws fixation is a minimally invasive, safe and effective method for PTK treatment.

Download Full-text

Evaluation of Holmium Laser versus Cold Knife in Optical Internal Urethrotomy for the Management of Urethral Stricture

QJM ◽

10.1093/qjmed/hcab110.014 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Wael Ali Maged ◽

Mohamed Ahmed Gamal ◽

Samuel Fayek Tawfeles

Keyword(s):

Urethral Stricture ◽

Treatment Effectiveness ◽

Holmium Laser ◽

Military Hospital ◽

University Hospitals ◽

Internal Urethrotomy ◽

Cold Knife ◽

Group 10 ◽

Optical Internal Urethrotomy

Abstract Background : urethral stricture is one of the most difficult urological problems to cure adequately and is know to mankind since ages as it has been documented in ancient literature of Egyptians and Greeks. Aim of the work: the aim of our study is to evaluate and compare the outcomes of Ho:YAG laser urethrotomy with the conventional cold knife technique as regards treatment outcome, efficacy and complications Patients and methods: A total of 20 male patients presented to the urology department at El Maadi military hospital and Ain shams university hospitals diagnosed as urethral stricture requiring optical internal urethrotomy were included in this study. Patients were randomized into two groups : In group A (holmium group): 10 patients underwent internal urethrotomy with Holmium laser. In group B (cold knife group) 10 patients underwent internal urethrotomy with cold knife. Results: based upon uroflowmetry, assessment of treatment effectiveness and complications were made at 3 months follow-up. Post operative fall in the peak flow rate was noted during the follow up in both groups, but was highter fall in the holmium group than the cold knife group at the end of the third month.

Download Full-text

A Comparison of Acupuncture with Advice and Exercises on the Symptomatic Treatment of Osteoarthritis of the Hip – a Randomised Controlled Trial

Acupuncture in Medicine ◽

10.1136/aim.19.1.19 ◽

2001 ◽

Vol 19 (1) ◽

pp. 19-26 ◽

Cited By ~ 35

Author(s):

Roisin Haslam

Keyword(s):

Controlled Trial ◽

Randomised Trial ◽

Symptomatic Treatment ◽

Post Treatment ◽

Control Group ◽

Group A ◽

Pre Treatment ◽

Group B ◽

Randomised Controlled

Acupuncture is becoming a common technique within the physiotherapy profession as a treatment modality for pain relief; however, few randomised controlled trials have been undertaken to assess the effectiveness of acupuncture, particularly in the treatment of osteoarthritis (OA) of the hip. Therefore, a randomised trial to compare the effectiveness of acupuncture with advice and exercises on the symptomatic treatment of OA of the hip was carried out. Thirty-two patients awaiting a total hip arthroplasty were randomly allocated to either the experimental group, (A), to have six sessions of acupuncture each lasting up to 25 minutes, or the control group, (B), to be given advice and exercises for their hip over a six week period. Group A consisted of three men and 13 women, and group B consisted of four men and eight women. The average age in group A was 66 years and in group B it was 68 years. Patients were assessed for pain and functional ability, using a modified version of the WOMAC questionnaire, pre-treatment, immediately post-treatment and at eight weeks post-treatment. The pre-treatment WOMAC scores in the two groups were similar (p=0.85). There was a significant improvement in group A (decrease in WOMAC score) immediately post-treatment (p=0.002) and this was maintained at the eight-week follow-up (p=0.03). There were no significant changes in group B. When the changes in WOMAC scores were compared between groups, a significantly greater improvement was found between pre-treatment and immediately post-treatment in group A, compared with group B (p=0.02). The changes between pre-treatment and the eight-week follow-up also showed a significant improvement in group A compared with group B (p=0.03). In conclusion, this trial supports the hypothesis that acupuncture is more effective than advice and exercises in the symptomatic treatment of OA of the hip.

Download Full-text

Efficacy of Optical Internal Urethrotomy and Intralesional Injection of Vatsala-Santosh PGI Tri-Inject (Triamcinolone, Mitomycin C, and Hyaluronidase) in the Treatment of Anterior Urethral Stricture

Advances in Urology ◽

10.1155/2014/192710 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 9

Author(s):

Santosh Kumar ◽

Nitin Garg ◽

Shrawan Kumar Singh ◽

Arup Kumar Mandal

Keyword(s):

Success Rate ◽

Mitomycin C ◽

Recurrence Rate ◽

Urethral Stricture ◽

Clinical History ◽

Therapeutic Modality ◽

Intralesional Injection ◽

Internal Urethrotomy ◽

Retrograde Urethrogram ◽

Optical Internal Urethrotomy

Purpose. To study the efficacy of optical internal urethrotomy with intralesional injection of Vatsala-Santosh PGI tri-inject (triamcinolone, mitomycin C, and hyaluronidase) in the treatment of anterior urethral stricture.Material and Methods. A total of 103 patients with symptomatic anterior urethral stricture were evaluated on the basis of clinical history, physical examination, uroflowmetry, and retrograde urethrogram preoperatively. All patients were treated with optical internal urethrotomy followed by injection of tri-inject at the urethrotomy site. Tri-inject was prepared by diluting the combination of triamcinolone 40 mg, mitomycin C 2 mg, and hyaluronidase 3000 in 5–10 mL of saline according to length of stricture. An indwelling 18 Fr silicone catheter was left in place for a period of 7–21 days. All patients were followed up for 6–18 months postoperatively on the basis of history, uroflowmetry, and, if required, retrograde urethrogram and micturating urethrogram every 3 months.Results. The overall recurrence rate after first OIU is 19.4% (20 out of 103 patients), that is, a success rate of 80.6%. Overall recurrence rate after second procedure was 5.8% (6 out of 103 patients), that is, a success rate of 94.2%.Conclusion. Optical internal urethrotomy with intralesional injection of Vatsala-Santosh PGI tri-inject (triamcinolone, mitomycin C, and hyaluronidase) is a safe and effective minimally invasive therapeutic modality for short segment anterior urethral strictures.

Download Full-text

Gastroesophageal reflux disease after Helicobacter pylori eradication in gastric ulcer patients: A one-year follow-up study

Medicina ◽

10.3390/medicina44030027 ◽

2008 ◽

Vol 44 (3) ◽

pp. 211 ◽

Cited By ~ 6

Author(s):

Laimas Jonaitis ◽

Gediminas Kiudelis ◽

Limas Kupčinskas

Keyword(s):

Helicobacter Pylori ◽

Gastric Ulcer ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Control Group ◽

Helicobacter Pylori Eradication ◽

Group A ◽

Group B

The aim of this study was to evaluate the course of gastroesophageal reflux disease in gastric ulcer patients after successful Helicobacter pylori eradication (group A), in patients with persistent infection after attempt to eradicate Helicobacter pylori (group B), and in control group without Helicobacter pylori eradication treatment (group C). Materials and methods. Gastric ulcer patients (n=88) were assigned either to the group receiving Helicobacter pylori eradication treatment (54 patients) or to the control group (34 patients; omeprazole treatment for 4 weeks) and were followed up for 1-year or until gastric ulcer relapsed. Gastroesophageal reflux disease was diagnosed in patients who had erosive esophagitis and/or without esophagitis if they experienced heartburn and/or regurgitation at least 2 times a week and it was associated with impairment of daily activities (Genval consensus). Results. The study was completed by 69 patients: 25 in group A, 19 in group B, and 25 in group C. At the beginning and at the end of the follow-up, gastroesophageal reflux disease was diagnosed in 10 (40%) and 9 (36%) group A patients, respectively (P>0.05); in 12 (63%) and 8 (42%) group B patients, respectively (P>0.05); and in 9 (36%) and 5 (20%) group C patients, respectively (P>0.05). At the beginning and at the end of the follow-up, reflux esophagitis was found in 3 (12%) and 5 (20%) group A patients, respectively (P>0.05); in 5 (26%) and 5 (26%) group B patients (P>0.05); in 4 (16%) and 3 (12%) group C patients (P>0.05). Conclusion. There was no statistically significant difference regarding the development of gastroesophageal reflux disease in gastric ulcer patients after Helicobacter pylori eradication, in the patients with persistent infection after attempt to eradicate, and in the control group without Helicobacter pylori eradication treatment.

Download Full-text