Surgical treatment of urethral tuberculosis in men – history and present (literature review)

The literature review provides data on tuberculosis of the urethra in men. This disease is rarely recorded, as a rule, at the stage of formation of the urethral stricture, which can develop many years after the onset of the disease. Urethral tuberculosis is usually secondary to other localizations of extrapulmonary tuberculosis, such as tuberculosis of the prostate, penis, kidney, and bladder, but there are also isolated forms of this disease. The most common symptoms of urethral tuberculosis are the presence of strictures, skin-urethral and recto-prostatic fistulas, and purulent urethritis. Almost always, with this disease, conservative specific therapy was carried out, which in some cases made it possible to completely eliminate the symptoms and ensure the patient’s clinical recovery. Tuberculous urethral strictures are operated on according to generally accepted rules, but there is no single algorithm for the surgical treatment of strictures of this etiology, often limiting itself only to urine diversion or urethral dilation. Of the urethroplasty, the most commonly used end-to-end urethral anastomosis. In our opinion, a promising direction is the use of various grafts for the surgical treatment of this disease.

The scope, presentation, and management of genitourinary complications in patients presenting with high-grade urethral complications after radiotherapy for prostate cancer

Introduction: The scope of complications arising after radiotherapy (RT) treatment for prostate cancer is underrecognized and not well-described. The objective of this study is to describe the presentation, scope, and management of genitourinary complications (GU) in patients referred for high-grade urethral complications or sphincter weakness incontinence after prostate RT. Methods: A retrospective review was performed of patients referred to a reconstructive urologist for management of grade 4 urethral complications and sphincter weakness incontinence after prostate RT from December 2004 to December 2015. Patients’ signs, symptoms, complications, and treatments are described. Results: A total of 120 patients were identified with a mean age of 67.8 years; 55.8% (n=67) received external beam radiotherapy (EBRT), 38.3% (n=46) brachytherapy (BT), and 5.8% (n=7) combination RT. The mean time to first complication after RT was 57.7 months (1–219) and number of complications per patient was 5.12.2. The most common associated complications were urethral stenosis (n=106, 88.3%), sphincter weakness urinary incontinence (n=55, 45.8%), radiation cystitis (n=61, 50.8%), refractory storage lower urinary tract symptoms (n=106, 88.3%), genitourinary pain (n=28, 23.3%), and prostate necrosis/abscess (n=17, 14.2%). Patients required a mean of 7.44.4 treatments over a 33-month period, including urethral dilation/urethrotomy (n= 93, 77.5%), urethroplasty (n=53, 44.2%), transurethral resection (n=52, 43.3%), cystolithopaxy (n=14, 11.7%), artificial urinary sphincter (n=8, 6.7%), and urinary diversion (n=8, 6.7%). Patients with RT combined with other modalities had more complications (6.2 vs. 4.2, p=0.001), higher rates of incontinence (93.8% vs. 29.5%, p=0.001), necrosis (31.3% vs. 8.0%, p=0.003), erectile dysfunction (84.4% vs. 51.1%, p=0.001), and hematuria (59.4% vs. 36.4%, p=0.04). Conclusions: Urethral complications related to prostate RT are seldom an isolated problem and require a substantial amount of urological resources and interventions.

Is the Tongue an “Alternative Donor Site for Anterior Urethroplasty”?

Objective: To evaluate the effectiveness of a lingual mucosal graft (LMG) urethroplasty for long segment (>2cm) anterior urethral strictures. Materials and Methods: A total of 30 patients underwent urethroplasty for anterior urethral strictures using dorsal onlay of a LMG from January 2009 to December 2010. We selected 21 to 56 years old (mean age 36.6). Stricture length was 22 to 59 mm (mean 36); 14 strictures were in the bulbar urethra, 09 were in the proximal penile and 07 were in both bulbar and penile urethra. Postoperatively all patients were followed with urethrography, uroflowmetry, cystourethrography and urethroscopy after 3weeks, 3 months and 06 months. Successful reconstruction criteria were peak flow rate greater than 15 ml per second and no need for postoperative urethral dilation. Results: The mean period of follow-up was 9 months (range 4-12). The overall success rate at 3rd week and 3rd month was 96.7% and at 6th month was 90%. Three patients developed repeat stricture at the anastomotic site. All the patients were able to resume oral fluid within 24 h, eat soft solid diet in 48–72 h and return to normal diet after 4– 5 days of surgery. No patient suffered from difficulty in opening the mouth, salivation disturbances, or difficulty in protrusion of tongue. Conclusions: LMG is easy to harvest. LMG seems to be associated with less postoperative pain and a minor risk of donor site complications or without any functional or esthetic deficiency. The tongue may be the best alternative donor site. Bangladesh Journal of Urology, Vol. 15, No. 1, Jan 2012 p.11-14

Female Urethroplasty: A Practical Guide Emphasizing Diagnosis and Surgical Treatment of Female Urethral Stricture Disease

Female urethral strictures are rare. Guidelines on how to diagnose and treat these strictures are lacking. At present, only expert opinion is available to guide clinical practice. Once the diagnosis is suspected based on obstructive voiding symptoms and uroflowmetry, most clinicians will use in addition video-urodynamics (including urethrography), urethral calibration and cystourethroscopy for confirmation of the diagnosis. Clinical inspection and gynaecological examination are also important. Urethral dilation is usually the first-line treatment despite the lack of long-term success. Female urethroplasty is associated with higher success rates. A multitude of techniques are described but not one technique has shown superiority above another. This narrative review aims to provide a clinical guide for diagnosis and treatment to the urologist motivated to perform female urethroplasty.