Endoscopic Internal Urethrotomy Research Articles

Redo-urethroplasty in pelvic fracture urethral distraction defect: an audit

To predict the outcome of redo-urethroplasty after failed single or multiple open urethral procedures for pelvic fracture urethral distraction defects. From January 1997 to December 2006, 43 patients underwent redo-urethroplasty for pelvic fracture urethral distraction defect. Forty-one were referred from other centers. All had undergone open surgery along with an endoscopic procedure (one or more procedures in each patient) which included endoscopic internal urethrotomy, urethral stenting or urethral dilations. There were 43 men with mean age of 29 (range 11-52). Eleven had associated injuries: intraperitoneal bladder rupture (3), bladder neck (2), rectum (3), anal sphincter (2), combined bladder, rectum and anal sphincter (1). Trocar suprapubic cystostomy was performed in 22, rail-road procedures in 10 and open suprapubic cystostomy in 11 along with the management of associated injuries as immediate treatment. Of 43 patients, 28 had progressive perineal, and 12 had transpubic repair. Three patients had total bulbar necrosis, and they underwent prepuceal tube reconstruction (1) and staged substitution with BMG and standard scrotal inlay (2). Analysis of various factors like number of attempts at previous surgery and stricture length did not affect the outcome. A successful result was achieved in 36 (83.72%), improved and stable in five and failure in two. The overall result of redo-urethroplasty for pelvic fracture urethral distraction defect continues to be gratifying. Failures happen usually within the first 3months. Substitution urethroplasty can be reserved for those who have long distraction defect. Long-term follow-up is essential using stringent criteria to measure success.

Traitement des sténoses de l’urètre par urétrotomie interne endoscopique: résultats anatomiques et fonctionnels d’une série de 244 cas

ObjectiveTo evaluate the results of a homogeneous series of urethral strictures treated exclusively by endoscopic internal urethrotomy and to determine the factors that may predict the outcome.Patients and MethodsBetween 1989 and 2007, 244 patients were treated for urethral stricture. All of them were subjected to endoscopic direct vision internal urethrotomy (DVIU).Results34.3% of good results were achieved after the first DVIU. Mean follow-up was 3.5 years. No mortality was encountered, while the rate of morbidity was 5%. Better results were achieved in patients with short (< 2 cm) and single strictures in the proximal urethra. Mean post-operative catheterization was 2 days; a further extension of the catheterization time did not yield any significant improvement. Unsatisfactory results (65.5%) were found in patients with large urethral strictures located in the distal urethra or in elderly patients. 62.5% of the patients showed a satisfactory outcome after a second urethrotomy, while the other patients required urethral dilatation or urethroplasty.ConclusionDVIU is a simple procedure which does not have a high rate of morbidity and requires short hospitalization. With a steady success rate of around 75.4% after a follow-up of 3.5 years we feel that DVIU can be recommended as treatment of choice for all short, single and proximal urethral strictures, preferably in young patients without previous interventions on the urethra

Application of endoscopic Ho:YAG laser incision technique treating urethral strictures and urethral atresias in pediatric patients

Endoscopic holmium:yttrium-aluminum-garnet (Ho:YAG) laser incision is a new method applied in pediatric urology recent years. To evaluate its therapeutic efficacy on treating the pediatric patients with urethral strictures and urethral atresias, a retrospective study was performed from June 2001 to July 2005 in a total of 28 pediatric patients who underwent endoscopic internal urethrotomy using Ho:YAG laser in our center. In these patients, 25 had urethral strictures and 3 urethral atresias. Follow-up was done ranging from 2 months to 4 years to assess the treatment. Of the 28 patients, 25 (89.3%) have achieved satisfied result without complications following initial incisions. Two patients with urethral atresias and another with long lesion of stricture (> 2 cm) have postoperative stenosis (10.7%). Among the three reoccurred patients, two were successfully reoperated by Ho:YAG laser and open end-to-end anastomosis, respectively. One patient failed to follow-up. With the advantages of safety, efficacy and minimal invasion, endoscopic Ho:YAG laser incision technique could be used as a primary treatment in urethral stricture patients and is worthy to be popularized further in pediatric surgery.

Endoscopic antegrade laser incision in the treatment of urethral stricture

Objectives To examine the possibility of antegrade incisions at varying stricture lengths. We have developed a new method of using a ureteroscope and holmium:yttrium-aluminum-garnet (YAG) laser to make an antegrade incision without using a guidewire. Endoscopic internal urethrotomy involves the use of a guidewire or ureteral catheter that is passed through the stricture as an indicator for retrograde incision. Methods An antegrade incision was performed in 31 procedures for 28 patients with urethral strictures. We used a semirigid ureteroscope with an outer diameter of 6F at the tip. The ureteroscope was inserted into the urethra and passed through the stricture into the bladder under direct vision. The ureteroscope was pulled distally while an incision was made using the holmium:YAG laser at the 10-o’clock and 2-o’clock positions to a diameter of 17F. The endoscope was then replaced by a 17F panendoscope and an antegrade incision was similarly made up to 21F to 22F. Results An antegrade incision without the use of a guidewire was possible in all cases. Of the 31 incisions, restenosis appeared in 11 (35%). Of the 11 cases, re-incision was performed in 4 cases, and urethral sounding was conducted in the other 7 cases. Of the 4 re-incision cases, restenosis recurred in only 1 case. Of the 31 incisions, 23 (74%) were eventually successful. Conclusions Antegrade incision using the narrow-diameter ureteroscope and holmium:YAG laser is a safe and easy method. This method is especially effective in cases of long strictures.

Endoscopic internal urethrotomy in complete urethral obstruction following straddle injury

2 cas. Cette technique doit etre envisagee avant la chirurgie ouverte, car elle donne de bons resultats

Endoscopic internal urethrotomy for treatment of urethral strictures Midterm survey

Success in the management of urethral strictures can be claimed only after many years, patients sometimes faring well for ten years or more before suffering a recurrence. We used endoscopic urethrotomy as primary treatment for a variety of urethral strictures in 123 patients. Follow-up is over two years for 63 patients and more than five years for 18. Over-all success rate at five years was 76 per cent. Failures are twice as frequent in strictures, regardless of their origin, involving the anterior urethra than in the bulbar or posterior urethra. Two-thirds occurred in the first year of follow-up, but, as in other techniques, recurrence can occur after four years.