Complication Of Urethral Stricture Research Articles

Application of Allogeneic Human Acellular Dermal Matrix Reduces the Incidence of Fistula in Hypospadias Repair.

BackgroundUrethrocutaneous fistula is one of the most common complications arising from hypospadias surgery. The purpose of our study was to investigate the effectiveness and safety of allogeneic human acellular dermal matrix (HADM) application as a means of preventing the occurrence of urethrocutaneous fistula following hypospadias surgery.MethodsThis is a non-randomized study of 219 cases (out of 270 patients with hypospadias) which satisfied inclusion and exclusion criteria. These patients were divided into two groups: 101 HADM patients, and 118 control patients (who did not receive HADM). In the control group, 77 boys were treated by single-stage urethroplasty (TIP) and 41 underwent staged urethroplasty (Thiersch-Duplay). In the HADM group, 59 boys underwent the TIP and 42 underwent the Thiersch-Duplay. In the postoperative period, we recorded the incidence of infection, urethrocutaneous fistula, and urethral stricture complications in these two groups of patients. The effectiveness and safety of HADM in preventing urethrocutaneous fistula following hypospadias surgery were evaluated according to these indicators.ResultsIn the control group, following the operation there were 16 cases of infection, 38 cases of urethrocutaneous fistula after extubating, and 5 cases of urethral stricture. In the HADM group, there were 19 cases of postoperative infection, 12 cases of urethrocutaneous fistula after extubating, and 5 children with urethral stricture. In comparing the two groups, it was found that the postoperative infection rate (13.6 vs. 18.8%) and the incidence of urethral stricture (4.2 vs. 5.0%) were not statistically significant (P > 0.05), while the postoperative urethrocutaneous fistula rate (32.2 vs. 11.9%) was statistically significant (P < 0.001).ConclusionIt is found that HADM application can significantly reduce the incidence of urethrocutaneous fistula complications, without increasing the risk of infection and urethral stricture.

Ballpoint pen tip as a long-duration intraurethral foreign body: a case report

Case description: A 21-year-old man sought medical attention due to self-insertion of a ballpoint pen into his urethra four months earlier, with incomplete removal. He stated he had difficulty urinating, reduced urinary stream caliber, and needed to strain to urinate. Physical examination revealed a palpable solid object inside the distal urethra. Urethral stricture was ruled out through urethrocystography, and mobility of the foreign body was observed. It was removed through meatoplasty and the “milking” technique. Urethrocystoscopy revealed no associated complications and there were none during the six-month follow-up. &#x0D; Relevance: Given that there are very few reports on foreign bodies inside the urethra for long periods of time, the present case provides information on the treatment of such patients.&#x0D; Clinical implications: The insertion of a foreign body into the urethra is uncommon and is generally associated with psychiatric disorders or sexually oriented activity. Intraurethral foreign bodies can be associated with the complications of urethral stricture, infections, urolithiasis, and fistulas, among others.&#x0D; Conclusions: Diagnosis and treatment were carried out empirically due to lack of evidence in the medical literature, with excellent results.

Bolígrafo como cuerpo extraño de larga evolución intrauretral: reporte de un caso

Descripción del caso: Se presenta el caso de un paciente masculino de 21 años que acude a consulta por introducirse una pluma para escribir dentro de la uretra desde hace 4 meses extrayéndola incompleta. El paciente refiere dificultad miccional, disminución del calibre de la orina y esfuerzo miccional. A la exploración se encuentra cuerpo extraño sólido dentro de uretra distal. La uretrocistografía descarta estenosis uretral y muestra movilidad del objeto. Se realiza extracción del objeto con ordeñamiento con meatoplastia y con la uretrocistoscopía se descartan complicaciones asociadas, tuvo un seguimiento de 6 meses sin complicaciones.&#x0D; Relevancia: La importancia de este caso es que existen muy pocos reportes de casos de cuerpos extraños intrauretrales de larga evolución, por lo que este caso aporta información para el tratamiento de estos pacientes.&#x0D; Implicaciones clínicas: La introducción de cuerpos extraños intrauretrales es una práctica poco frecuente y generalmente se asocia a patología psiquiátrica o motivaciones sexuales. Los cuerpos extraños intrauretrales pueden asociarse a complicaciones como estenosis uretral, infecciones, urolitiasis, fístulas, entre otros.&#x0D; Conclusiones: Debido a la falta de evidencias en la bibliografía médica, el diagnóstico y tratamiento se establecieron de manera empírica con excelentes resultados.

Study of etiology, clinical presentation, management procedures performed and complications of urethral stricture patients at a tertiary hospital

Background: Urethral stricture is narrowing of a segment of the urethra which is surrounded by corpus spongiosum. The overall incidence of stricture disease varies from 0.6% to 0.9% worldwide. Urethral stricture obstructs lower urinary tract, causes micturition disturbances, can also damage the entire urinary tract, resulting in loss of renal function. In present study we aimed to study etiology, clinical presentation, management procedures and complications of urethral stricture at a tertiary hospital. Material and Methods: Present study was single-center, prospective, observational study, conducted patients diagnosed to have urethral strictures, underwent initial management during the study period and willing to participate. Patients treated by dilatation, Direct vision internal urethrotomy (DVIU), open surgery (urethroplasty). Results: This study included 50 patients of male and female genders of different age groups. Male to female ratio was 3.55 : 1. Maximum patients (32%) were from the age-group 31-40 years with mean age of 45.7 +16.59 years. Causes of urethral stricture in most of the patients were infections (30%) and trauma (50%). Most patients are treated by the serial urethral dilatation (58%). Other procedures were visual internal urethrotomy (VIU) (26%) and surgery including buccal mucosal graft (BMG) urethroplasty (16%). Postoperatively out of 50 patients 7 patients experienced Pain [14%] and 43 patients doesn‘t have pain in postoperative period. [86%]. About 8 patients have fever in postoperative period [16%] and hematuria is seen in 18 patients [36%]. Conclusion: Trauma and infections were the leading cause of urethral stricture. Visual Internal Urethrotomy and urethroplasty were the mainstay of treatment with satisfactory outcome.

Efficacy of Needle Electrode Three-Point Method on Bladder Neck Contracture After Transurethral Resection of the Prostate

Introduction: Benign prostate hyperplasia (BPH) is a common disease among the elderly, which is the major cause of lower urinary tract symptoms. Transurethral resection of the prostate (TURP) is widely used for the treatment of BPH. However, complications of urethral stricture and bladder neck contracture (BNC) occur postoperation that causes poor quality of life in patients. Reported incidence of BNC ranges from 0.3% to 9.6%.1,2 Bladder neck incision, laser vaporization, and balloon dilatation are applied for the treatment of BNC with overall high recurrence rates. In recent years, new techniques such as T-plasty, a modified YV-plasty, and robot-assisted laparoscopic Y-V plasty were performed in the treatment of BNC and achieved satisfactory outcomes with success rate of 83.3%–90%.3,4 However, these techniques are complicated and difficult for the primary urologists to master. This video shows a transurethral approach by using a needle electrode to incise the pathway from the bladder outlet to the proximal verumontanum at 5, 7, and 12 o'clock positions, respectively, the depth of the incision should reach the adipose layer. Materials and Methods: From February 2015 to August 2019, the bladder necks from 48 patients with BNC after TURP were incised by the needle electrode at the 5, 7, and 12 o'clock positions, which extended the incision from the bladder outlet to the proximal verumontanum until exposure of the adipose layer. During the whole procedure in the treatment of BNC including cut of the residual prostate scar tissue, three-point incision by the needle electrode was the most important for the treatment of BNC, which could be against the formation of fibrous rings and prevent the recurrence of BNC. Patient's preoperation properties, peri- and postsurgical data, such as time of operative, postsurgical bladder irrigation, catheter duration, and hospital stay, as well as data of the international prostate symptom score (IPSS), maximum flow rate (Qmax), and postvoid residual (PVR), were recorded 1 and 6 months after surgery. Results: All 48 cases of BNC were effectively treated in (49.6 ± 14.4) minutes with (15.1 ± 4.6) hours for postoperative bladder irrigation. The urethral catheter was withdrawn at (5.6 ± 2.4) days post-treatment. Only one case had dysuria after postoperative catheter removal, the other 47 cases on re-examination after 1 and 6 months showed that IPSS and PVR were significantly decreased, but Qmax was increased when compared with preoperation (p < 0.001). Importantly, there were no significantly different outcomes between 1 and 6 months postoperation (p > 0.05). Strikingly, 20 cases followed up 6–24 months, mean of 12 months, had no urinary incontinence, retrograde ejaculation, and recurrence of BNC. Conclusions: Transurethral incision of bladder neck by the three-point method using the needle electrode for the treatment of BNC is mini-invasive, safe, effective, and reliable and may be implemented in the clinical setting. No competing financial interests exist. Runtime of video: 6 mins 53 secs

Comparing complications of urethral stricture across various ages: a retrospective analysis of findings from retrograde urethrogram and voiding cysto-urethrogram over 10\u2009years

ObjectiveTo determine the rate and the distribution of the structural defects in the urinary bladder complicating urethral stricture in men, and to compare the complications observed in the younger patients to those observed in the older patients.MethodsRetrospectively, case files of patients diagnosed of urethral stricture using retrograde urethrogram (RUG) and voiding cysto-urethrogram (VCUG) from February 2009 to August 2018 were analyzed. Stricture characteristics were outlined. In addition, complicating structural defects in the lower urinary tract proximal to the stricture site were documented. The complicating defects identified in the patients were segregated according to age for any observable associations. Logistic regression analysis was used to define the nature of the association of patient age, stricture site, number and length, with distribution of complicating structural defects. Analyses were done using SPSS® version 20.ResultsWithin the 10-year review period, 257 of 421 suspected cases of urethral stricture were confirmed. Patients are between 1 and 104 years of age (mean: 50.1 ± 19.1 years; median: 51.0 years IQR 35.0–65.0). Bulbar (34.2%); short segment (62.6%); partial (73.9%) strictures are prevalent. Forty-seven (18.3%) of 257 patients presented with 1 or more complications. Bladder diverticulum (8.6%) and urethra-cutaneous fistula (6.6%) are prevalent complications. The distribution of complications does not vary with age, or with stricture characteristics.ConclusionPresentation with complications is not uncommon. The distribution of these complications does not vary with age or with stricture characteristics.

Long term follow up of proximal hypospadias repair-urethral stricture should be excluded in adults who present with epididymo-orchitis.

Epididymo-orchitis (EO) is a well-known complication of urinary tract infections (UTI) in children. This is commonly seen in children who had hypospadias repair or in those who had surgery for anorectal malformation especially when it results in urethral stricture. However EO occurring as a complication of urethral stricture in adults operated for hypospadias in childhood is not well documented in the literature. This is a retrospective review of four adults who had proximal hypospadias repair in childhood. All four men presented to us with EO. They were thoroughly investigated to rule out presence of urethral stricture. Three patients had urethral stricture of which two responded well to dilatation and one required cystoscopy and visual internal urethrotomy. The fourth patient did not have urethral stricture. EO in this patient is thought to be due to excessive straining during micturition causing reflux into seminal vesicles. Urethral stricture should be excluded in any adult who had a hypospadias repair and presents with EO. Urethral strictures after hypospadias surgery respond well to dilatation and to endoscopic urethrotomy.

1046 poster URETHRAL STRICTURE AS A COMPLICATION OF HIGH DOSE RATE BRACHYTHERAPY FOR PROSTATE CANCER

Purpose: Urethral stricture is one of the well-known complications of treatment for prostate cancer, regardless of the particular type of therapeutic modality. The goal of our study was to determine the incidence, timing, and outcomes of urethral strictures in the cohort of patients undergoing high dose rate (HDR) brachytherapy for prostate cancer. Materials: A retrospective review of 360 consecutive patients undergoing HDR brachytherapy at our institution from 1997-2009 was performed. Among the 360 patients, 158 patients had high risk prostate cancer, 187 patients had intermediate risk prostate cancer, and 15 patients had low risk prostate cancer. Three hundred thirty-six patients (93%) received neo-adjuvant hormone therapy. The HDR protocol typically called for 3 treatment sessions over a period of 24 hours in 2 days. A single radioactive iridium-192 source was used with a nominal activity of 370 GBq. The peripheral minimum dose to the prostate gland per session was 6 Gy. All patients received supplementary external beam radiation therapy after completion of the brachytherapy procedure, and external beam dose ranged from 45 Gy to 50.4 Gy (median 50 Gy) using conventional fractionation schemes. Twenty patients were lost to follow up or had insufficient follow up and were excluded from analysis. All urethral strictures were diagnosed cystoscopically. Patient demographics, operative, and postoperative data were reviewed. Results: Three hundred thirty-nine patients were analyzed with an overall survival rate of 98.6%, at a mean follow-up of 55 months. Two patients died from metastasis and 2 other patients died from unrelated causes. Two hundred eighty-two patients (83.1%) are currently free of disease or biochemical progression. Twenty-two patients (6.5%) have developed urethral strictures to-date. The median time between radiation therapy and the diagnosis of urethral stricture was 4 years (range 1-8 years), with nearly all strictures located in the bulbomembranous urethra. At last follow-up, 2 patients had a stable, patent urethra. One of these patients was managed with single balloon dilation, while the other patient underwent urethroplasty after failing endoscopic management. The remaining 20 patients did not have a stable patent urethra. Nine (41%) of these patients required a urethral dilation schedule, and 3 patients (14%) needed either suprapubic tube or urethral catheter drainage. Five patients (23%) have required multiple endoscopic procedures or dilations (range 2-7), while 3 patients (14%) have required dilation at last follow-up. Conclusions: Urethral stricture incidence from HDR brachytherapy in combination with external beam radiotherapy for clinically localized prostate cancer is 6.5%. Although radiation induced urethral stricture has a relatively low incidence, it could result in significant morbidity for the patient. Short term data supports HDR brachytherapy as an equivalent therapy for localized prostate cancer, but should be limited to high volume centers to minimize refractory urethral stricture complications.