Iatrogenic Urethral Strictures Research Articles

Стриктуры мочеиспускательного канала, как осложнение трансуретральной хирургии предстательной железы.

Introduction. The inclusion of antibiotic therapy into clinical practice in the second half of the 20th century radically changed the «etiological landscape» of urethral stricture disease. Against the background of a decrease in the proportion of inflammatory strictures, the introduction of new technologies, the spread of transurethral interventions in urology has led to an increase in the incidence of iatrogenic strictures. The purpose of this review is to systematize risk factors for urethral strictures after transurethral prostate surgery. Materials and methods. A search was made for the keywords «transurethral resection of the prostate», «urethral stricture», «iatrogenic urethral strictures», «urethral injuries» in the databases PubMed, eLibrary, Scopus, EMBASE, websites of professional associations. 58 publications were selected for review and analysis, 5 of which are domestic. Results. The influence of the following factors was analyzed: the method of energy supply, the type of energy, the method of removing prostatic tissue; instrument diameter and anatomical features of the patient; resection speed, operation time and volume of removed prostatic tissue; urinary tract infection; electrical damage; other risk factors for TURP. Conclusion. The proven factors include: the diameter of the instrument, operating times, urinary tract infection. Probable factors should be considered the anatomical features of the patient: «narrow urethra», a short penile suspensory ligament.

Iatrogenic Urethral Stenoses: Epidemiological Aspects Clinics and Therapeutic in the Urology Department of the National Hospital of Conakry

The aim is to highlight the epidemiological, clinical and therapeutic aspects of iatrogenic urethral strictures. Methodology: This was a retrospective study, descriptive type, 6 years from January 1st 2012, to December 31st 2017 carried out in the Urology-Andrology department of the National Hospital Ignace Deen of Conakry. All records of patients carrying the Diagnosis of iatrogenic urethral stricture were included in this study. Results: We collected 30 cases of iatrogenic urethral stricture, with a frequency of 2.5%. The average age of the patients was 62.33 years. The most affected age group is from 71 to 80 years (33.33%). Dysuria was the main reason for consultation. Retrograde urethrocystography plus voiding cystourethrography (RUC-VCU) allowed us to make the diagnosis. The treatment was essentially surgical and several techniques were used. Endoscopic internal urethrotomy alone was the most performed surgical technique, followed by segmental uretrectomy associated with end-to-end urethrography. Conclusion: Iatrogenic urethral stricture is easy to diagnose but difficult to manage due to the frequency of recurrences. Improving the quality of care, in particular urethral catheterizations and transurethral endoscopic maneuvers, makes it possible to prevent it.

An Audit of Management of Male Urethral Stricture and its Outcome: A Retrospective Review

Background: Urethral stricture leads to obstructive voiding dysfunction. We report an audit of surgical management of urethral stricture in adult males. Methods: The records of all patients diagnosed with urethral stricture from December 2017 to March 2019 at B. P. Koirala Institute of Health Sciences, Nepal were retrieved. Preoperative, surgical, and postoperative follows-up data were evaluated. The American Urological Association International Prostatic Symptom Score (AUA-IPSS) and Uroflowmetry (voided volume and peak urinary flow rate (Qmax)) were used to assess the outcome of the surgery. Results: Among 50 patients, the majority (46%) belonged to 40 - 59 years. Twenty-five patients (78.1%) with traumatic anterior urethral stricture underwent excision and primary end to end anastomotic (EPA) urethroplasty; seven patients (21.9%) with pelvic fracture urethral injury (PFUI) underwent progressive perineal urethroplasty (PPU) with EPA; eight patients with inflammatory urethral stricture underwent Kulkarni urethroplasty; four patients with iatrogenic urethral stricture underwent EPA; six patients with idiopathic urethral stricture underwent Barbagli dorsal onlay urethroplasty. All patients had preoperative voided volume < 150ml, Qmax < 15ml/s. Thirty patients had complete obliteration; the remaining patients had severe storage and voiding symptoms (AUA-IPSS ≥ 20) before surgery. Except for two patients who underwent redo surgery, outcome of urethroplasty was successful in terms of storage and voiding symptoms (AUA-IPSS < 7) and uroflometry findings (voided volume > 150ml and Qmax >15ml/s). Conclusion: Urethreal stricture was most common in the age group of 40 - 59 years and traumatic stricture was the most common cause.

Long-term outcomes of Blocksom vesicostomy for elderly patients with chronic urinary retention.

To report on the long-term outcomes of vesicostomy in elderly patients with chronic urinary retention. We conducted a study of 16 elderly patients with chronic urinary retention who underwent Blocksom vesicostomy between April 2010 and March 2021. Postoperative follow-up was conducted every 3 months to check for abnormal findings, such as stoma outlet obstruction, infection, bleeding, bladder prolapse, and bladder stones. The incidence of these findings and the time until they occurred, as well as the rate of achieving a catheter-free status and the time until catheter reinsertion, were then calculated using the Kaplan-Meier curve. The mean age (±standard deviation) of patients whose cases were observed was 78.6 (±7.8) years; the oldest patient was 87 years of age. The study population included 14 male patients and 2 female patients, with a higher number of males. The causes of urinary retention included neurogenic bladder in 12 patients (including patients with 3 spinal cord injury), advanced prostate cancer in 2 patients, and iatrogenic urethral stricture in 2 patients. The average follow-up period was 55.7 months. During follow-up, 14 patients (87.5% of the total) achieved a catheter-free status under conditions that required no additional treatment. Complications were observed in 6 cases (37.5%); among them, two cases required reoperation. All complications were observed within 2 years after surgery. Blocksom vesicostomy may become a viable option in the treatment of elderly patients with chronic urinary retention whose symptoms do not improve with medical therapy.

Urethral reconstruction for iatrogenic urethral stricture after transurethral prostate surgery: An analysis of surgical and patient-reported outcomes.

We investigated the efficacy of urethral reconstruction in male patients with iatrogenic urethral stricture after transurethral prostate surgery. We retrospectively reviewed the cases of 82 patients who underwent urethral reconstruction for iatrogenic urethral stricture caused by transurethral prostate surgery between August 2011 and July 2021. Patients were followed up postoperatively with uroflowmetry, postvoid residual urine measurement, and questionnaires using Peeling's picture score, International Prostate Symptom Score, International Consultation on Incontinence Questionnaire Short Form, Sexual Health Inventory for Men, EuroQol-5 dimensions, and EuroQol-5 dimensions visual analog scores. Successful urethral reconstruction was defined as the absence of a postoperative decrease in urinary force and any additional treatment. The median patient age was 72 years, and the stricture site was the urethral meatus in eight (9.8%) patients, penoscrotal junction in 42 (51.2%), and proximal bulbar urethra in 26 (31.7%). Six patients (7.3%) had synchronous urethral strictures. Urethral reconstruction was successful in 78 patients (95.1%), with a median follow-up of 43 months. The mean maximum flow rate (P < 0.0001), postvoid residual urine (P = 0.004), Peeling's picture score (P < 0.0001), the score for each question and total International Prostate Symptom Score and International Prostate Symptom Score-quality of life scores (P < 0.0001 for all comparisons), and EuroQol-5 dimensions and EuroQol-5 dimensions visual analog scores (P < 0.0001 for both) significantly improved postoperatively. However, the Sexual Health Inventory for Men and International Consultation on Incontinence Questionnaire Short Form scores remained unchanged (P = 0.09 and 0.70, respectively). Urethral reconstruction was effective for urethral stricture due to transurethral prostate surgery in both subjective and objective aspects.

The Changing Trend in Clinical Characteristics and Outcomes of Male Patients With Urethral Stricture Over the Past 10 Years in China.

Background: Male urethral stricture is a disease with a high incidence rate. With social-economic development in the developing countries, the trend of etiology and treatment of male urethral stricture changed was speculated.Methods: The clinical data of the male patients with urethral stricture from 2000 to 2019 were analyzed. The subjects were divided into Group A (2000–2009) and Group B (2010–2019) according to treatment time. The pooled analysis of the data extracted from pieces of literature was also performed.Results: About 540 patients were included in the present study, including 235 patients in Group A and 305 patients in Group B. In recent 10 years, trauma has still been the main cause of urethral stricture. Iatrogenic injury, especially transurethral operation, increases significantly, while male urethral stricture secondary to radiotherapy and infection decrease. Urethroplasty increases and the reoperation rate decreases in treating simple urethral stricture, and flap urethroplasty also increases in treating complex urethral stricture. The results of a pooled analysis of data from 11 centers in Mainland China are partially consistent with it. Complications, such as urethral fistula, false canal, ejaculation disorder, and penile curvature, decrease significantly.Conclusions: The main causes of urethral stricture in the recent 10 years are still trauma and iatrogenic injuries, and the etiology of urethral stricture is related to socioeconomic development. With the increase of intracavitary minimally invasive treatment and flap urethroplasty, the curative effect is increasing, while iatrogenic urethral stricture cannot be ignored.

Frank haematuria secondary to ruptured pseudoaneurysm of the inferior vesical artery: a case report and review of the literature

BackgroundPseudoaneurysm of a vesical artery is an extremely rare iatrogenic complication; however, it may cause fatal haematuria.Case presentationA 21-year-old Arab Jordanian male had multiple optical urethrotomies for an iatrogenic urethral stricture after he had rectal surgery for Hirschsprung’s disease at the age of 2 years. During one of his admissions to the Emergency Room (ER) with urinary retention, an attempt at suprapubic catheter insertion was complicated by massive bleeding at the insertion site of the catheter. Abdominal exploration showed a distended urinary bladder with clots and bleeding seen at the bladder neck that was controlled with multiple sutures. The patient rebled again two times; the first was controlled with cystoscopy and cautery for a pulsatile bleeder seen at the bladder neck. The second time, the patient required blood transfusion of three units of packed red blood cells. Angiography was performed, and a pseudoaneurysm at the base of the urinary bladder from the inferior vesical artery was diagnosed, which was controlled by embolization.ConclusionPulsatile bladder haemorrhage following urological intervention is suggestive of pseudoaneurysm or arteriovesical fistula, and angiography with embolization is recommended.

Urethral Strictures after Transurethral Surgery: Treatment and Histological Issues

Introduction. The development of upper and lower urinary endoscopic surgery has brought about an increase in the number of urethral strictures after transurethral procedures. Material and methods . A retrospective analysis was performed involving the treatment results of 72 patients with urethral strictures after transurethral surgery in 2011-2016. All the patients underwent standard examination, including US, residual urine analysis, uroflowmetry, retrograde and micturating urethrography, IPSS and QoL questioning and general clinical tests. Results and discussion . The median of observation comprised 28 months. Bulbous urethra appeared to be the most frequent localisation of urethral strictures (87.5 %). The median stricture length was 2 cm with the mean maximum urine flow rate equal to 5.9 ± 2.7 mL/s. The median IPSS score counted 25 points. The type and number of surgical procedures were as follows: internal optic urethrotonomy (29), anastomotic urethroplasty (18), single-stage skin flap urethroplasty (3), single-stage urethroplasty using buccal mucosa graft (17), multiple-stage urethroplasty using buccal mucosa graft (1), meatotomy (1), single-stage navicular fossa urethroplasty using buccal mucosa graft (1). Internal optic urethrotonomy was to be effective in 52 % cases, while other surgical procedures showed 89 % effectiveness. The pathomorpho-logic studies revealed severe inflammation without signs of stroma fibrosis within urethral strictures. Conclusion. Transurethral endoscopic procedures appear to be the main causative factor (in 54 % cases) for iatrogenic urethral strictures.

Transurethral resection of the prostate stricture management.

For more than nine decades, transurethral resection of the prostate remains the gold standard for the surgical treatment of lower urinary tract symptoms due to benign prostatic obstruction. The occurrence of urethral strictures after transurethral resection of the prostate is one of the major late complications and has been reported as the leading cause of iatrogenic urethral strictures in patients older than 45 years who underwent urethroplasty. Although several postulations have been proposed to explain the urethral stricture after transurethral resection of the prostate, the exact etiology of urethral stricture after TURP is still controversial. Suggested etiological factors of urethral stricture formation after transurethral resection of the prostate include infection, mechanical trauma, prolonged indwelling catheter time, use of local anesthesia, and electrical injury by a stray current. One single treatment option is not appropriate for all stricture types. The management of urethral stricture following transurethral resection of the prostate includes minimally invasive endoscopic methods, including urethral dilation and direct visual incision, or open surgical procedures with varying urethroplasty techniques. Although scientific studies focusing on urethral strictures after transurethral resection of the prostate are relatively limited and sparse, we can apply the principles of urethral stricture management before making decisions on individual stricture treatment.

Результаты лечения и факторы риска рецидива ятрогенных стриктур уретры у мужчин

Iatrogenic etiologies continue playing an increasing role in the formation of urethral strictures (US) in the industrially developed countries. Our aim was to study specific iatrogenic causative factors in the etiology of US, treatment efficacy and risk factors of their recurrence. A total of 230 men with iatrogenic urethral strictures operated between 2008 and 2017 were included into the study group. Median age was 58.7+/-15.3 years. Inclusion criteria were presence of iatrogenic etiologic factor, open reconstruction or visual internal urethrotomy as a treatment, absence of other etiologic factors. Patients were investigated using the standard protocol. Postoperative follow up time ranged from 14 to 102 months, median 43 months. Average stricture length was 5,8+/-4,7 cm (1-24 cm). Primary stricture was diagnosed in 107 (46.5%) patients, while 123 (53.5%) patients with recurrent stricture were treated. Localization of urethral stricture was as following: anterior urethra (62.2%), posterior urethra (12.6%) and combined anterior/posterior strictures (25.2%). Endoscopic surgical procedures were the major cause of iatrogenic US followed by urethral catheterizations, hypospadias repair and surgical/radiation therapy of prostate cancer. The whole efficacy of surgical treatment in iatrogenic US was 84,8%. Treatment success after anastomotic urethroplasties was higher than after augmented or substitution surgical procedures. Independent risk factors for US recurrence were: 1) augmentation or substitution urethroplasty; 2) history of hypospadias repair; 3) stricture length more or equal 5,5 cm. Establishment of the particular etiologic factors may help to prevent iatrogenic US. Current methods of the US surgical management are highly effective but anastomotic urethroplasties should be preferred over augmentation and substitution techniques when possible.

Ятрогенные стриктуры уретры у мужчин: распространенность и основные этиологические факторы

Ятрогенные стриктуры уретры у мужчин: распространенность и основные этиологические факторы

Ятрогенные стриктуры уретры у мужчин

Iatrogenic urethral damage is the leading etiologic factor for urethral stricture in men in developed countries and second after traumatic injury in developing ones. This study aimed to evaluate the frequency of iatrogenic strictures of the urethra and the results of their treatment. This retrospective analysis comprised 133 patients who were treated for iatrogenic urethral stricture from 2011to 2016. Group I included 72 (54%) patients after trans(intra)urethral interventions (transurethral resection of the prostate or urinary bladder), urethral dilation, traumatic catheterization, etc. Forty-five (34%) patients with post-catheter strictures (ischemic/post-inflammatory), 7 (5%) patients after failed treatment of hypospadias, and 9 (7%) patients after open adenomectomy made up groups II, III, and IV. The diagnosis of recurrent stricture and the need for repeat surgical intervention were determined based on uroflowmetry, urethrography, and urethrocystoscopy. In group I, the mean extent (rank) of the stricture was 2 (0.1-15) cm, the most frequent location (85%) was the bulbar urethra. In group II, the most frequent location (71%) was also the bulbar urethra with a mean stricture length of 2.4 (0.3-13) cm. There were 4 cases of panurethral strictures, lesions of the penile urethra and meatal stenosis. In group III, the strictures were on average 6 (2-12) cm long. Patients group IV had strictures of the bulbar and prostatic urethra. In general, the effectiveness of endoscopic treatment (direct vision internal urethrotomy, DVIU) was 52%, the effectiveness of urethroplasty varied from 83 to 100% depending on the method. In group I, the effectiveness of the DVIU was 52%, various types of urethroplasty - 88-100%, in group II - 50% and 82-100%, respectively. In group III, the effectiveness of the single-stage/multi-stage buccal mucosa urethroplasty was estimated at 0%/100%. In group IV, the effectiveness of DVIU/urethroplasty/perineal prostatectomy was 20%/75%/100%. The proportion of iatrogenic urethral strictures in large megacities can reach 45%. Iatrogenic urethral strictures most commonly result from catheterization and transurethral interventions. Each subgroup of iatrogenic strictures is characterized by its location, extent and degree of urethral spongiofibrosis. With the correct choice of surgical modality, urethroplasty is almost twice more effective than DVIU.

Causes and management for male urethral stricture

To explore the etiology of male urethral stricture, analyze the therapeutic strategies of urethral stricture, and summarize the complicated cases. Methods: The data of 183 patients with urethral stricture were retrospectively analyzed, including etiology, obstruction site, stricture length, therapeutic strategy, and related complications. Results: The mean age was 49.7 years, the average course was 64.7 months, and the constituent ratio of 51 to 65 years old patients was 38.8% (71/183). The traumatic injury of patients accounted for 52.4% (96/183), in which the pelvic fracture accounted for 35.5% (65/183) and the straddle injury accounted for 16.9% (31/183). There were 54 cases of iatrogenic injury (29.5%). The posterior urethral stricture accounted for 45.9% (84/183), followed by the anterior urethral stricture (44.8%, 82/183) and the stenosis (6.6%, 12/183). A total of 99 patients (54.1%) received the end to end anastomosis, and 40 (21.9%) were treated with intracavitary surgery, such as endoscopic holmium laser, cold knife incision, endoscopic electroknife scar removal, balloon dilation, and urethral dilation. In the patients over 65-years old, the urethral stricture rate was 14.8% and the complication rate (70.4%) for transurethral resection of the prostate (TURP) was significantly higher than that of all samples (P<0.01). Conclusion: Both the etiology of male urethral stricture and the treatment strategy have changed and the incidence of traumatic and iatrogenic urethral stricture has increased in recent 3 years. The main treatment of urethral stricture has been transformed from endoscopic surgery into urethroplasty.

Etiology and Management of Male Iatrogenic Urethral Stricture: Retrospective Analysis of 172 Cases in a Single Medical Center

Purpose: To investigate the etiology and management of male iatrogenic urethral stricture in China. Methods: The data of 172 patients with iatrogenic urethral stricture who underwent treatment at a high volume reference center in China from January 2008 to February 2014 were analyzed retrospectively. Databases were analyzed to understand the impact of different types of iatrogenic injury on stricture location, length and treatment of urethral strictures, as well as success rates. Results: The most common type of iatrogenic stricture was urethral instrumentations in 80 patients (46.51%). Mean stricture length was 3.3 ± 2.54 cm and the longest strictures were those caused by intravesical instillation. Substitution urethroplasty was the most common intervention and was performed in 60.47% (104/172) of patients. The overall success rate was 85.00% (136/160). Univariable analyses revealed that the type of iatrogenic injury was significantly related to restenosis (p = 0.036), and it is more apt to postoperative restenosis in the type of intravesical instillation than others. Conclusion: Our results showed that urethral instrumentation is the most common etiology of iatrogenic urethral stricture, and most iatrogenic urethral strictures involve the anterior urethra. The different etiologies are closely associated with stricture location, length and the overall prognosis of urethral strictures.

Les rétrécissements iatrogènes de l’urètre: expérience d’un hôpital Sénégalais

Objectivesto report on the etiopathogenic, clinical and therapeutic aspects of iatrogenic urethral stricture (IUS). Patients and Methodsprospective descriptive study gathering 28 patients treated for IUS in a urology department in Senegal from 1st January 2012 to 30 September 2013. Age, place of origin, reasons for consultation, consultation periods, type of urethral maneuver, physical examination, investigations, treatment modalities and Outcomes were analyzed. Resultsmean age was 34, 5±19, 4 years. The majority of patients (89, 5%) had been sent by colleagues practicing in hospital structures without a urology department. The average consultation time was 5, 4±4, 5 months. Dysuria was the most observed complaint. Urethral catheterization was the most common source of IUS (75%) and the Foley catheter latex was the most used (86%). The flow measurements was performed in 4 patients and showed a decrease in maximum urinary flow rate in favor of a urethral stricture. Uretrogram had confirmed urethral stenosis in 22 patients (79%) and the bulbar urethra was the predilection. Urethral dilatation metal candle was therapeutic means most noted. With a follow-up period of 13 months, the therapeutic outcomes assessed on the existence or absence of dysuria was satisfactory. Conclusionthe IUS had a high incidence. Urethral catheterization was the most common source of IUS. Stenosis few stretches of the bulbar urethra were the most numerous and their treatment by dilatation using metal candles gave satisfactory results.

MP19-16 HUMAN ADIPOSE TISSUE DERIVED STEM CELLS (HADSCS) PREVENTS FIBROSIS AND BLADDER DYSFUNCTION IN A RAT MODEL OF URETHRAL STRICTURE

You have accessJournal of UrologyStem Cell Research1 Apr 2015MP19-16 HUMAN ADIPOSE TISSUE DERIVED STEM CELLS (HADSCS) PREVENTS FIBROSIS AND BLADDER DYSFUNCTION IN A RAT MODEL OF URETHRAL STRICTURE Fabio Castiglione, Maarten Albersen, Andrea Russo, Trinity J. Bivalacqua, Francesco Montorsi, Steven Joniau, Dirk De Ridder, and Petter Hedlund Fabio CastiglioneFabio Castiglione More articles by this author , Maarten AlbersenMaarten Albersen More articles by this author , Andrea RussoAndrea Russo More articles by this author , Trinity J. BivalacquaTrinity J. Bivalacqua More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Steven JoniauSteven Joniau More articles by this author , Dirk De RidderDirk De Ridder More articles by this author , and Petter HedlundPetter Hedlund More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1008AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The cure rate of urethrotomy for urethral stricture (US) is lower than 10%. Reduction of high recurrence rates would improve patient comfort and a decrease healthcare costs. We aimed to evaluate if local injection of hADSCs could prevent fibrosis in a rat model of iatrogenic US. METHODS After ethical approval, partial damage of the spongious urethra of male rats was created with a hypodermic needle. Then, TGFβ1 (1μg) was injected into the site of urethral damage. Rats were divided into 3 groups: vehicle (n=7), hADSCs (n=7), and sham (no damage; no TGFβ1, n=7). Vehicle (100μl) or hADSCs (1 million in 100μl) was injected to the site of urethral damage one day later. After 4 weeks, rats were implanted with bladder catheters and underwent awake cystometry. Following euthanasia, penises and bladders were harvested for histology and western blot analysis (WB). RESULTS Vehicle rats exhibited higher (p<0.05) threshold pressure (TP: 23.95 ± 3.4cmH2O), flow pressure (FP: 36.32 ± 2.89 cmH2O) and basal pressure (BP: 14.27 ± 2.39 cmH2O) compared to the hADSCs group (TP: 14.07 ± 1.44; FP: 26.05 ± 3.19; BP: 9.65 ± 0.89 cmH2O) and sham group. Vehicle rats showed lower (p<0.05) threshold compliance (TC: 0.064±0.025 ml/cmH2O) and flow compliance (FC: 0.022 ± 0.010 ml/cmH2O) than hADSCs (TC: 0.23±0.03; FC: 0.061 ± 0.09 ml/cmH2O) and sham group. No differences in these endpoints were detected between ADCS and Sham groups. Maximum micturition pressure was higher in vehicle and hADSCs groups than in the sham rats (p<0.05). By WB, collagen III expression was higher in penises of vehicle rats (2.25±0.25) than in sham (1.49±0.16) and hADSCs groups (1.13±0.27) (p<0.05). No differences were noted in elastin expression between the three groups (p>0.05). Collagen I was more expressed in vehicle and hADSCs groups compared to sham group (p<0.05). Interestingly, the eNOS expression was higher in hADSCs group compared to the other groups (p<0.05). The WB results were corroborated by immunofluorescence analysis. Bladder-to-body weight ratio was higher in vehicle group compared to hADSCs and sham group (p<0.05). By WB, vehicle bladders showed more collagen III than the others groups (p<0.05). No differences were detected in collagen I or elastin expressions between the groups. CONCLUSIONS Local injection of hADSCs seems to prevent fibrosis and counteract urodynamic changes in a male rat model for US. Additional studies are required to understand the role of eNOS in this process. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e221 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fabio Castiglione More articles by this author Maarten Albersen More articles by this author Andrea Russo More articles by this author Trinity J. Bivalacqua More articles by this author Francesco Montorsi More articles by this author Steven Joniau More articles by this author Dirk De Ridder More articles by this author Petter Hedlund More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

962 Periurethral injection of human adipose tissue derived stem cells prevents fibrosis and counteracts bladder dysfunction in a rat model of iatrogenic urethral stricture

962 Periurethral injection of human adipose tissue derived stem cells prevents fibrosis and counteracts bladder dysfunction in a rat model of iatrogenic urethral stricture

Iatrogenic urethral strictures following pull-through procedures: Buccal mucosa inlay repair

Background Damage to the male urethra following pelvic surgery for anorectal malformations (ARM) is a well known problem, usually seen in boys with rectourethral fistulas. Urethral strictures located in the posterior urethra are difficult to treat because surgical exposure of the posterior urethra is difficult and conventional reconstructive procedures do not consistently yield good results. Free buccal mucosa grafts placed either ventrally or dorsally have shown superior results to other techniques. We herein describe our technique of urethral reconstruction in three boys with iatrogenic strictures of the posterior urethra following pull-through procedures. Methods Exposure of the posterior urethra was achieved by a posterior sagittal approach. In a boy with Hirschsprung's disease a trans-anorectal approach was used and in two boys with ARM the anus and rectum were fully mobilized. The posterior urethra was opened in the midline ventrally and the stricture was incised dorsally. A free buccal mucosal graft was placed and sutured into the incision. The urethra was closed dorsally and the bowel reconstructed. Results Mean age at operation was 22 months (9–39 months) and mean follow up was 17 months (6–22 months). No patient developed complications due to the operation. Stenting of the urethra was done with a silicone Foley catheter for 14 days. All three boys were able to void spontaneously following the operation and were continent for urine. No urinary tract problems developed. Both boys with ARM had colostomies which were closed 6 weeks later. Both are socially continent for feces. The boy with Hirschsprung's disease had no colostomy for the procedure and is fully continent. Conclusions The buccal mucosa inlay repair procedure via a posterior sagittal approach yields good results with low morbidity. Exposure of the posterior urethra is excellent with this approach, which we thus recommend in boys with posterior urethral strictures. However, the surgeon should be very experienced with anorectal surgery and the posterior sagittal approach.

CONSTRUCTION OF FEMALE URETHRA USING BUCCAL MUCOSA GRAFT

We reviewed our experience with buccal mucosa grafts for reconstructing difficult female urethral problems. Since 1994, we have used a buccal mucosa graft to reconstruct the urethra in 7 girls 3 to 13 years old. The underlying pathological condition was a fibrotic urethra after previous operations for cloacal exstrophy, cloacal malformation, iatrogenic urethral stricture, and multiple false passages in a previously reconstructed urethra of vaginal mucosa that made clean intermittent catheterization difficult. A full-thickness buccal mucosa graft was tubularized in situ as the neourethra to the base of the clitoris. In patients with cloacal exstrophy and cloacal malformation the bladder neck and urethra were widely exposed transabdominally by splitting the pubic symphysis. The fibrotic mucosa was excised and the tubularized buccal mucosa graft was wrapped with periurethral tissues. Other patients underwent transvaginal surgery in the prone position and the graft was covered with a buttock flap. Patients were followed for 12 to 58 months (mean 34.7). Those with cloacal exstrophy and cloacal malformation had been completely incontinent before urethral reconstruction but all attained complete continence postoperatively. They and the girl who underwent urethral reconstruction for difficult catheterization performed clean intermittent catheterization easily. The patient with urethral stricture voided via the urethra without difficulty. In select female patients with difficult urethral reconstructive problems a tubularized free graft obtained from the buccal mucosa may be effectively used when local tissue is fibrotic and unsuitable for creating a supple new urethra.

Value of electrical dispersion as a cause of urethral stenosis after endoscopic surgery.

We have evaluated the incidence of iatrogenic urethral strictures in a prospective study of 125 patients with a diagnosis of initial, superficial bladder tumors (without prior urethral instrumentation) and who were treated with endoscopic surgery. A global incidence of 12% was found after 24 months of follow-up with the strictures detected a mean of 9.5 months after the endoscopic procedure. These patients were divided into two groups. Group 1 was treated using standard transurethral resection (TUR) and group 2 underwent Nd:YAG laser photocoagulation. Both populations of patients underwent cystoscopic controls every 4 months as part of our standard follow-up protocol in bladder tumors. In the group of patients who underwent diathermy using a 24-F sheath (85 patients), the percentage of stenosis was 16.4%. In the patients treated with laser via a 21-F panendoscope (40 patients), the incidence of postoperative urethral stenosis was only 2.5%. We believe that the electrical dispersion generated by the unipolar electric current as well as the caliber of the operating instruments are factors which may influence the development of iatrogenic endoscopic urethral strictures.