Small spherical foreign bodies in the genitourinary tract and their management

Background Urogenital small foreign bodies (FBs) have rarely been reported in children, and their management is still challenging. This study aimed to describe the characteristics and treatment of spherical FBs no larger than 0.6 cm in the children’s genitourinary tracts. Methods The clinical data of spherical FBs removed in our hospital from June 2013 to June 2020 were recorded and retrospectively analyzed, including demographics, location, symptoms, imaging examinations and treatment methods. Results A total of 10 patients were enrolled: 6 girls and 4 boys. Their ages ranged from 5.1 to 16.8 years old, with a mean age of 9.2 years. The course of the disease ranged from 3 h to 1 year, and symptoms recurred in some cases. Their imaging characteristics were reviewed and analyzed, 6 patients underwent color Doppler ultrasonography, 1 patient was suspected to have an FB in the vagina, 7 patients underwent an X-ray examination, and FBs were revealed in 6 patients. All FBs were removed under endoscopic minimally invasive surgery. Six vaginal FBs were successfully retrieved via vaginoscopy, and in the other four cases, removal by transurethral cystoscopy failed because of mutual attraction, which was eliminated by laparoscopy under pneumovesicum. Postoperative recovery was uneventful; in a follow-up of 3 months to 2 years, there was no perforation or fistula formation, and there were no urethral strictures in boys. Conclusion Small spherical FBs are clinically rare; they are sometimes difficult to detect by imaging examinations and can be easily overlooked. Minimally invasive endoscopy remains the first-line approach for the diagnosis and removal of genitourinary spherical FBs.

One-Year Outcomes of the ROBUST II Study Evaluating the Use of a Drug-Coated Balloon for Treatment of Urethral Stricture

Objective To report 1-year results of the ROBUST II study investigating the safety and efficacy of a paclitaxel-coated balloon for the treatment of recurrent urethral strictures. Methods Subjects were adult men with a single anterior urethral stricture ≤ 3 cm in length and at least 2 prior stricture treatments. After treatment with the Optilume urethral drug-coated balloon (DCB), subjects were followed through 1 year. The primary safety endpoint was the rate of treatment-related serious complications at 90 days post-procedure. Efficacy outcomes included symptomatic assessments, erectile function measured using the International Index of Erectile Function (IIEF), Qmax, and anatomic success. Results Sixteen men with an average of 4.1 prior dilations were treated with the DCB. Anatomic success was achieved at 6 months in 73%. Average IPSS improved from 18.4 to 6.0 at 1 year (P < 0.001). Qmax improved from 6.9 mL/sec to 20.8 mL/sec (P < 0.001). There was no change in IIEF. Four subjects received additional treatment within 1 year. There were no treatment-related serious complications. Conclusions Short-term follow-up of men with urethral stricture treated with the Optilume DCB showed durable anatomic results at 6 months and sustained symptomatic improvement through 1 year. Treatment with the device was safe.

The Efficacy and Safety of a Conservative Management Approach to Radiation-Induced Male Urethral Strictures in Elderly Patients With Comorbidities

Objectives To assess the outcomes of a conservative management approach to radiation-induced urethral stricture disease (R-USD) in an elderly population with comorbidities. Methods Patients with R-USD managed with endoscopic procedures and/or clean intermittent catheterization (CIC) between 2007 and 2019 were included. Patients were excluded if they had an obliterative stricture, prior urethral reconstruction/urinary diversion surgery, or < 3 months follow-up. Primary outcome measures were urinary tract infection (UTI), acute urinary retention (AUR), serum creatinine, uroflowmetry/post-void residual, and urinary incontinence (UI). Failure was defined as progression to reconstructive surgery or permanent indwelling catheterization. Results Ninety-one men were analyzed with a median follow-up of 15.0 months (IQR 8.9 to 37.9). Median age was 75.4 years (IQR 70.0 to 80.0), body mass index was 26.5 kg/m2 (IQR 24.8 to 30.3), and Charlson comorbidity index was 6 (IQR 5 to 8). Median stricture length was 2.0 cm (IQR 2.0 to 3.0). Stricture location was bulbar (12%), bulbomembranous (75%), and prostatic (13%). A total of 90% underwent dilation, and 44% underwent direct visual internal urethrotomy (DVIU). For those that underwent these procedures, median number of dilations and DVIUs per patient was 2 (IQR 1 to 5) and 1 (IQR 1 to 3), respectively. Forty percent used CIC. Thirty-four percent developed a UTI, and 15% had an AUR episode requiring urgent treatment. Creatinine values, uroflowmetry measurements, and UI rates remained stable. Eighty percent avoided reconstructive surgery or indwelling catheterization. Conclusion Most elderly patients with comorbidities with R-USD appear to be effectively managed in the short-term with conservative strategies. Close observation is warranted because of the risk of UTIs and AUR. The potential long-term consequences of repetitive conservative interventions must be considered.

A Multimodality Review of Male Urethral Imaging: Pearls and Pitfalls with an Update on Urethral Stricture Treatment

Optimum radiological assessment of the male urethra requires knowledge of the normal urethral anatomy and ideal imaging techniques based on the specific clinical scenario. Retrograde urethrography is the workhorse examination for male urethral imaging, usually utilized as the initial, and often solitary, modality of choice not only in the setting of trauma, but also in the pre- and post-operative evaluation of urethral strictures. There is, however, growing interest in utilization of ultrasound and magnetic resonance for evaluation of the male urethra owing to lack of ionizing radiation and improved delineation of the adjacent tissue. We review the various modalities utilized for imaging of the male urethra for a variety of known or suspected disorders, and provide an update on current treatments of urethral strictures. Additionally, we detail the key information needed by urologists to guide management of urethral strictures. We conclude with a brief discussion of neophallus urethral diseases following female-to-male sexual confirmation surgery.

Buccal mucosal graft urethroplasty in the treatment of urethral strictures: a prospective study

Background: Anterior urethral strictures develop due to a process of fibrosis and cicatrix formation of the urethral mucosa and the surrounding tissues. Its surgical management is a challenging problem, and has changed dramatically in the past several decades. Open surgical repair using grafts has become the gold standard procedure for anterior urethral strictures that are not amenable to excision and primary anastomosis. Oral mucosa harvested from the inner cheek (buccal mucosa) is an ideal material, and is most commonly used for substitution urethroplasty. Objective of current study was to establish the efficacy of the buccal mucosal graft urethroplasty by different onlay techniques in anterior urethral strictures.Methods: The study was a prospective study, done between August 2009 and December 2011. 25 cases of long anterior urethral strictures were managed by onlay urethroplasty by different techniques. Follow up ranged from 8-20 months.Results: 3 patients lost follow up after first visit. Post operative uroflowmetry was done in all patients after 1 month at the time of first follow up visit. Of 25 cases 21 (84%) were successful and 4 (16%) failed.Conclusions: In our study we have found that buccal mucosal graft can be safely used for substitution urethroplasty in all long anterior urethral strictures including cases with balanitis xerotic obliterance. It was very efficient in terms of less graft shrinkage or contracture as it is a full thickness graft.