scholarly journals Treatment of urethral strictures in balanitis xerotica obliterans (BXO) using circular buccal mucosal meatoplasy: Experience of 15 cases

2014 ◽  
Vol 86 (1) ◽  
pp. 23 ◽  
Author(s):  
Abdulmuttalip Simsek ◽  
Sinasi Yavuz Onol ◽  
Omer Kurt
Keyword(s):  
Erectile Dysfunction ◽  
Urethral Catheter ◽  
Cosmetic Outcome ◽  
Urinary Flow ◽  
Urethral Meatus ◽  
Balanitis Xerotica Obliterans ◽  
Recurrent Stricture ◽  
Urethral Strictures ◽  
Included Patient

Objectives: Balanitis xerotica obliterans (BXO) related strictures involving the external urethral meatus. We reviewed our result with the use of circular mucosal graft in the reconstruction of strictures. Methods: Between March 1997 and January 2012, 15 patients underwent circular buccal mucosal urethroplasy for BXO related anterior urethral strictures. Urethral catheter was removed within 2 weeks. Follow-up included patient symptoms assessment, cosmetic outcome and uroflowmetry. Results: Median follow-up was 20.5 months (range 4 to 96). Mean postoperative peak urinary flow rate obtained 1 month after catheter removal was 22.4 ml per second. All patients had a normal meatus and none had recurrent stricture, chordee or erectile dysfunction. A functional and cosmetic outcome was achieved in 100% of the patients. Conclusions: Circular mucosal graft technique for treatment of meatal strictures is an efficient method for the restoration of a functional and cosmetic penis.

scholarly journals One-stage buccal two-flap urethroplasty using the Kulkarni technique for extended anterior urethral strictures

2020 ◽  
Vol 8 (4) ◽  
pp. 44-52
Author(s):  
M. I. Katibov ◽  
M. M. Alibekov ◽  
Z. M. Magomedov ◽  
A. M. Abdulkhalimov ◽  
V. G. Aydamirov
Keyword(s):  
Urethral Stricture ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Disease Recurrence ◽  
Urinary Flow ◽  
One Stage ◽  
Urethral Strictures ◽  
Prospective Control ◽  
Onlay Technique

Introduction. The problem of extended urethral strictures treatment remains relevant due to the complexity of the supervision of such patients and the high frequency of disease recurrence after surgical treatment.Purpose of the study. Evaluation of the effectiveness of one-stage buccal urethroplasty according to the Kulkarni technique using two flaps for extended anterior urethral strictures.Materials and methods. The study included 18 men with an extended anterior urethral stricture, who underwent buccal urethroplasty by perineal access using the Kulkarni dorsolateral onlay technique using two flaps from January 2018 to March 2020, and a postoperative follow-up period of at least 6 months. The study was prospective. Control examination was carried out 3, 6, 12, 18 and 24 months after surgery. The criteria for the recurrence of urethral stricture were the presence of complaints of deterioration in the quality of urination in combination with a decrease in the maximum urinary flow rate of less than 12 ml/sec and the presence of residual urine in an amount of more than 100 ml, as well as the need to perform any surgical intervention to restore the normal passage of urine.Results. The age of the patients ranged from 32 to 72 years (median 58 years). The length of the stricture ranged from 6 to 11 cm (median, 8 cm). The stricture was localized in the penile segment in 11 (61.1%) cases and the penile and bulbar urethra in 7 (38.9%) cases simultaneously. An iatrogenic cause of urethral stricture occurred in 11 (61.1) patients, idiopathic in 5 (27.8%) patients and inflammatory in 2 (11.1%) patients. The stricture was primary in 12 (66.7%) cases and recurrent in 6 (33.3%). Spontaneous urination was preserved in 6 (33.3%) patients, cystostomy existed in 12 (66.7%) patients. The follow-up period after surgery ranged from 3 to 24 months (median - 12 months). Recurrence of urethral stricture was noted in 3 (16.7%) cases. The use of this technique for recurrent forms of the urethral stricture (recurrence after the previous urethroplasty) is the most significant risk factor for treatment failure. 1 (5.6%) case of erectile dysfunction and stress urinary incontinence has taken place of the late postoperative complications.Conclusions. The Kulkarni operation using two buccal flaps for extended strictures of the anterior urethra allows to achieve high rates of efficacy and safety of a treatment, however, the risk of failure increases significantly when used for the treatment of recurrent types of strictures. 

scholarly journals Management of Pelvic Fracture Urethral Injury- 147 Cases

KYAMC Journal ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 179-183
Author(s):  
Hafiz Al Asad ◽  
Nahid Rahman Zico ◽  
AKM Shahadat Hossain ◽  
Zulfia Zinat Chowhury ◽  
Md Mostafizur Rahman ◽  
...  
Keyword(s):  
Erectile Dysfunction ◽  
Pelvic Fracture ◽  
Urethral Catheter ◽  
Urethral Injury ◽  
College Hospital ◽  
Medical College ◽  
History Of ◽  
Anastomotic Urethroplasty

Background: Dhaka Medical College Hospital is the highest referral center for PFUI. As anstomotic urethroplasty is a challenging surgery and most of the surgeons refer these type of injuries to our center, we performed this study to evaluate the outcome of our cases. Objective: This study aims to find the outcome and complications of perineal end to end anastomotic urethroplasty in the management of posterior urethral injury resulting from pelvic fracture. Materials and Methods: We performed 147 perineal bulbo-prostatic anastomotic urethroplasty for PFUIs from January, 2013 to May, 2019. Mean age was 37 years with majority between 21 to 50 years (>85%). Nine patients had history of failed anastomotic urethroplasty. After surgical intervention patients were discharged with a supra-pubic catheter (SPC) and per urethral catheter in situ. On 22nd POD urethral catheter was removed and SPC on the next day if patient can void normally. 1st and 2nd follow up done on of 3rd and 6th month respectively following surgery. If patient voided well and Qmax>15ml/ sec; repair was defined as successful. Results: Success rate of anastomotic urethroplasty for PFUI was 93.87%. Total 9 procedures were failed including 2 urethro-cutaneous fistula and needed re-do anastomosis. Erectile dysfunction (ED) was present in 18 patients before operation and after surgery 12 more patients developed ED and total number was 30 during first follow up, which reduced to 24 during second follow-up. Two patient developed incontinence which improved in subsequent follow-up. Conclusion: Anastomotic urethroplasty remains the gold standard in the management of PFUI. Erectile dysfunction is the main issue to be concerned and need special attention. KYAMC Journal Vol. 10, No.-4, January 2020, Page 179-183

scholarly journals Perineal Urethrostomy: Surgical and Functional Evaluation of Two Techniques

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Nicolaas Lumen ◽  
Matthias Beysens ◽  
Charles Van Praet ◽  
Karel Decaestecker ◽  
Anne-Francoise Spinoit ◽  
...  
Keyword(s):  
Quality Of Life ◽  
International Prostate Symptom Score ◽  
Urinary Flow ◽  
Functional Evaluation ◽  
Entire Cohort ◽  
Urethral Strictures ◽  
Surgical Failure ◽  
Maximum Urinary Flow

Introduction. PU is an option to manage complex and/or recurrent urethral strictures and is necessary after urethrectomy and/or penectomy. PU is generally assumed to be the last option before abandoning the urethral outlet.Methods. Between 2001 and 2013, 51 patients underwent PU. Mean age (± standard deviation) was60±15years. Only 13 patients (25.5%) did not undergo previous urethral interventions. PU was performed according to the Johanson(n=35)or Blandy(n=16)technique and these 2 groups were compared for surgical failure, maximum urinary flow (Qmax), urinary symptoms, and quality of life (according to the International Prostate Symptom Score).Results. Both groups were similar for patient’s and stricture characteristics. Only follow-up duration was significantly longer after Johanson PU (47.9 months versus 11.1 months;P=0.003). For the entire cohort, 11 patients (21.6%) were considered a failure (9 or 25.7% for Johanson group and 2 or 12.5% for Blandy group;P=0.248). There was a significant improvement ofQmaxin both groups. Quality of life after PU was comparable in both groups.Conclusions. PU is associated with a 21.6% recurrence rate and the patient should be informed about this risk.

scholarly journals Long-Term Followup after Electrocautery Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
F. Kallenberg ◽  
T. A. Hossack ◽  
H. H. Woo
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Transurethral Resection ◽  
Prostatic Hyperplasia ◽  
Urinary Flow ◽  
Complication Rates ◽  
Urethral Strictures ◽  
Voiding Symptoms ◽  
Stricture Rate ◽  
Historic Data

Introduction. For decades, transurethral resection of the prostate (TURP) has been the “gold standard” operation for benign prostatic hyperplasia (BPH) but is based mainly on historic data. The historic data lacks use of validated measures and current TURP differs significantly from that performed 30 years ago.Methods. Men who had undergone TURP between 2001 and 2005 were reviewed. International prostate symptom score (IPSS), quality of life (QOL) and peak urinary flow rate (Qmax⁡), and postvoid residual (PVR) were recorded. Operative details and postoperative complications were documented. Patients were then invited to attend for repeat assessment.Results. 91 patients participated. Mean follow-up time was 70 months. Mean follow-up results were IPSS—7; QoL—1.5;Qmax⁡—23 mL/s; PVR—45 mL. These were an improvement from baseline of 67%, 63%, 187%, and 80%, respectively. Early complication rates were low, with no blood transfusions, TUR syndrome, or deaths occurring. Urethral stricture rate was higher than anticipated at 14%.Conclusion. This study shows modern TURP still produces durable improvement in voiding symptoms which remains comparable with historic studies. This study, however, found a marked drop in early complications but, conversely, a higher than expected incidence of urethral strictures.

Safety and Efficacy of Trans-Perineal Urethroplasty for Management of Post-Traumatic Urethral Strictures in Pediatric Age-Group

2021 ◽  
pp. 1-5
Author(s):  
Radheshyam Chaudhari ◽  
Amit Sharma ◽  
Irfan Shaikh ◽  
Mukund Andankar ◽  
Hemant Pathak
Keyword(s):  
Pediatric Patients ◽  
Pelvic Trauma ◽  
Urinary Flow ◽  
Safety And Efficacy ◽  
Urethral Strictures ◽  
Pediatric Age Group ◽  
The Mean ◽  
Urethral Injuries ◽  
Anastomotic Urethroplasty

<b><i>Introduction:</i></b> Trans-perineal urethroplasty is the preferred treatment for distraction urethral injuries in adults. However, management of such injuries in children is challenging because of functional implications in a growing child. In the present study, we aim to evaluate the safety and efficacy of perineal urethroplasty for distraction urethral injuries in children. <b><i>Methods:</i></b> The medical records of prepubertal pediatric patients (age &#x3c;14 years) with traumatic urethral distraction injuries managed by perineal urethroplasty were retrospectively reviewed and analyzed with respect to demographics, stricture characteristics, management, complications, follow-up, and outcome. <b><i>Results:</i></b> A total of 14 patients were included in the study. Ten had membranous, and 4 had bulbar urethral strictures. All membranous strictures were secondary to pelvic trauma; bulbar strictures were secondary to blunt perineal trauma; 7 patients had associated pelvic fractures. Anastomotic urethroplasty was used in 10 patients (71.4%) and buccal mucosal graft urethroplasty was done in 4 patients (38.6%). The mean follow-up duration was 56 months (range 24–76). Surgery was primarily successful in 85.7%. Failed repair in 2 patients was successfully managed with augmented anastomotic urethroplasty. Post-operatively, the mean maximal urinary flow rate was 26.4 mL/s. No significant complications occurred. All boys are continent. There was no chordee or urethral diverticula, during follow-up. <b><i>Conclusion:</i></b> In pediatric patients, bulbar and membranous strictures can be treated successfully with urethroplasty using the perineal approach. Longer follow-up is needed to confirm that these good results are maintained as these patients cross into adulthood, especially as these repairs were done before puberty.

Urethral prostheses. An overview

1995 ◽  
Vol 62 (3) ◽  
pp. 340-346
Author(s):  
A. Tizzani ◽  
G. Bodo ◽  
A. De Zan ◽  
P. Piana ◽  
G. Casetta
Keyword(s):  
Steel Alloy ◽  
First Report ◽  
Urethral Strictures ◽  
New Frontier

The first report in Literature dealing with an endourethral prosthesis in the treatment of recurrent bulbar strictures dates back to 1988. Since then other prostheses with different design and materials have been proposed. The Urolume by A.M.S., the first ever, is used worldwide and its indications are better known due to a longer follow-up time. In 6 months epithelium covers the prosthesis and it is generally well tolerated, but some Authors do not agree with its use in the treatment of traumatic strictures. Titanium prostheses have been used in few cases. A temporary steel alloy prosthesis, the Urocoil, has been proposed recently. Not enough follow-up data are available about this and the new “thermic memory” prosthesis. The bigdegradable prosthesis, used till now only on rabbits, actually represents the new frontier in the treatment of urethral strictures.

scholarly journals Value of Three-Dimensional Digital Subtraction Angiography for Detection and Classification of Intracranial Aneurysm Remnants After Clipping

2021 ◽  
Author(s):  
Serge Marbacher ◽  
Matthias Halter ◽  
Deborah R Vogt ◽  
Jenny C Kienzler ◽  
Christian T J Magyar ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Digital Subtraction Angiography ◽  
Diagnostic Yield ◽  
Three Dimensional ◽  
P Value ◽  
Digital Subtraction ◽  
Patient Demographics ◽  
Included Patient ◽  
2D And 3D

Abstract BACKGROUND The current gold standard for evaluation of the surgical result after intracranial aneurysm (IA) clipping is two-dimensional (2D) digital subtraction angiography (DSA). While there is growing evidence that postoperative 3D-DSA is superior to 2D-DSA, there is a lack of data on intraoperative comparison. OBJECTIVE To compare the diagnostic yield of detection of IA remnants in intra- and postoperative 3D-DSA, categorize the remnants based on 3D-DSA findings, and examine associations between missed 2D-DSA remnants and IA characteristics. METHODS We evaluated 232 clipped IAs that were examined with intraoperative or postoperative 3D-DSA. Variables analyzed included patient demographics, IA and remnant distinguishing characteristics, and 2D- and 3D-DSA findings. Maximal IA remnant size detected by 3D-DSA was measured using a 3-point scale of 2-mm increments. RESULTS Although 3D-DSA detected all clipped IA remnants, 2D-DSA missed 30.4% (7 of 23) and 38.9% (14 of 36) clipped IA remnants in intraoperative and postoperative imaging, respectively (95% CI: 30 [ 12, 49] %; P-value .023 and 39 [23, 55] %; P-value = &lt;.001), and more often missed grade 1 (&lt; 2 mm) clipped remnants (odds ratio [95% CI]: 4.3 [1.6, 12.7], P-value .005). CONCLUSION Compared with 2D-DSA, 3D-DSA achieves a better diagnostic yield in the evaluation of clipped IA. Our proposed method to grade 3D-DSA remnants proved to be simple and practical. Especially small IA remnants have a high risk to be missed in 2D-DSA. We advocate routine use of either intraoperative or postoperative 3D-DSA as a baseline for lifelong follow-up of clipped IA.

scholarly journals Associations between depression and cardiometabolic health: A 27-year longitudinal study

2021 ◽  
pp. 1-11
Author(s):  
Hillary L. Ditmars ◽  
Mark W. Logue ◽  
Rosemary Toomey ◽  
Ruth E. McKenzie ◽  
Carol E. Franz ◽  
...  
Keyword(s):  
Erectile Dysfunction ◽  
Sleep Apnea ◽  
Twin Study ◽  
Health Conditions ◽  
Sensitivity Analyses ◽  
Cardiometabolic Health ◽  
Depression Symptoms ◽  
Polygenic Risk Score ◽  
Polygenic Risk

Abstract Background Clarifying the relationship between depression symptoms and cardiometabolic and related health could clarify risk factors and treatment targets. The objective of this study was to assess whether depression symptoms in midlife are associated with the subsequent onset of cardiometabolic health problems. Methods The study sample comprised 787 male twin veterans with polygenic risk score data who participated in the Harvard Twin Study of Substance Abuse (‘baseline’) and the longitudinal Vietnam Era Twin Study of Aging (‘follow-up’). Depression symptoms were assessed at baseline [mean age 41.42 years (s.d. = 2.34)] using the Diagnostic Interview Schedule, Version III, Revised. The onset of eight cardiometabolic conditions (atrial fibrillation, diabetes, erectile dysfunction, hypercholesterolemia, hypertension, myocardial infarction, sleep apnea, and stroke) was assessed via self-reported doctor diagnosis at follow-up [mean age 67.59 years (s.d. = 2.41)]. Results Total depression symptoms were longitudinally associated with incident diabetes (OR 1.29, 95% CI 1.07–1.57), erectile dysfunction (OR 1.32, 95% CI 1.10–1.59), hypercholesterolemia (OR 1.26, 95% CI 1.04–1.53), and sleep apnea (OR 1.40, 95% CI 1.13–1.74) over 27 years after controlling for age, alcohol consumption, smoking, body mass index, C-reactive protein, and polygenic risk for specific health conditions. In sensitivity analyses that excluded somatic depression symptoms, only the association with sleep apnea remained significant (OR 1.32, 95% CI 1.09–1.60). Conclusions A history of depression symptoms by early midlife is associated with an elevated risk for subsequent development of several self-reported health conditions. When isolated, non-somatic depression symptoms are associated with incident self-reported sleep apnea. Depression symptom history may be a predictor or marker of cardiometabolic risk over decades.

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