Post-traumatic Urethral Strictures Research Articles

Injectable Decellularized Extracellular Matrix-Based Bio-Ink with Excellent Biocompatibility for Scarless Urethra Repair.

In recent years, decellularized extracellular matrices (dECM) derived from organs have attracted much attention from researchers due to their excellent biocompatibility, capacity to promote cell proliferation and migration, as well as pro-vascularization. However, their inferior mechanical properties, slow cross-linking, weak strengths, and poor supporting properties remain their inevitable challenges. In our study, we fabricated a novel dECM hydrogel with better crosslinking strength and speed, stronger support properties, and better mechanical properties. The hydrogel, which we named gelatin-based dECM powder hydrogel (gelatin-dECM hydrogel), was prepared by mixing dECM microparticles in gelatin solution and adding certain amount of 1-Ethyl-3-(3-dimethyl-aminopropyl-1-carbodiimide) (EDC) and N-hydroxysuccinimide (NHS). We evaluated the utility of this hydrogel by assessing the degradation rate, mechanical properties, and biocompatibility. The results showed that the gelatin-dECM hydrogel has high mechanical properties and biocompatibility and also has the ability to promote cell proliferation and migration. After injection of this hydrogel around the surgical sites of urethras in rabbits, the incorporation of dECM powder was demonstrated to promote angiogenesis as well as scarless repair by histological sections after surgery. The application of this novel hydrogel provides a new perspective for the treatment of post-traumatic urethral stricture.

Exosomal MiR-381 from M2-polarized macrophages attenuates urethral fibroblasts activation through YAP/GLS1-regulated glutaminolysis.

Post-traumatic urethral stricture is a clinical challenge for both patients and clinicians. Targeting glutamine metabolism to suppress excessive activation of urethral fibroblasts (UFBs) is assumed to be a potent and attractive strategy for preventing urethral scarring and stricture. In cellular experiments, we explored whether glutaminolysis meets the bioenergetic and biosynthetic demands of quiescent UFBs converted into myofibroblasts. At the same time, we examined the specific effects of M2-polarized macrophages on glutaminolysis and activation of UFBs, as well as the mechanism of intercellular signaling. In addition, findings were further verified in vivo in New Zealand rabbits. It revealed that glutamine deprivation or knockdown of glutaminase 1 (GLS1) significantly inhibited UFB activation, proliferation, biosynthesis, and energy metabolism; however, these effects were rescued by cell-permeable dimethyl α-ketoglutarate. Moreover, we found that exosomal miR-381 derived from M2-polarized macrophages could be ingested by UFBs and inhibited GLS1-dependent glutaminolysis, thereby preventing excessive activation of UFBs. Mechanistically, miR-381 directly targets the 3'UTR of Yes-associated protein (YAP) mRNA to reduce its stability at the transcriptional level, ultimately downregulating expression of YAP, and GLS1. In vivo experiments revealed that treatment with either verteporfin or exosomes derived from M2-polarized macrophages significantly reduced urethral stricture in New Zealand rabbits after urethral trauma. Collectively, this study demonstrates that exosomal miR-381 from M2-polarized macrophages reduces myofibroblast formation of UFBs and urethral scarring and stricture by inhibiting YAP/GLS1-dependent glutaminolysis.

Single-cell transcriptome reveals cellular heterogeneity and lineage-specific regulatory changes of fibroblasts in post-traumatic urethral stricture

Fibroblast is the critical repair cell for urethral wound healing. The dysfunction of fibroblasts can lead to excessive fibrosis and hypertrophic scar, which eventually leads to post-traumatic urethral stricture. However, the fibroblast subpopulation and intercellular communication in urethral stricture remains poorly understood. Therefore, a comprehensive single-cell resolution transcript landscape of human PTUS needs to be reported. We performed single-cell RNA-sequencing of 13,411 cells from post-urethral stricture tissue and adjacent normal tissue. Unsupervised clustering, function enrichment analysis, cell trajectory construction and intercellular communication analysis were applied to explore the cellular microenvironment and intercellular communication at single-cell level. We found that there is highly cell heterogeneity in urethral stricture tissue, which includes 11 cell lineages based on the cell markers. We identified the molecular typing of fibroblasts and indicated the key fibroblast subpopulations in the process of fibrogenesis during urethral stricture. The intercellular communication between fibroblasts and vascular endothelial cells was identified. As an important bridge in the communication, integrins may be a potential therapeutic target for post-traumatic urethral stricture. In conclusion, this study reveals the cellular heterogeneity and lineage-specific regulatory changes of fibroblasts in post-traumatic urethral stricture, thereby providing new insights and potential genes for post-traumatic urethral stricture treatment.

Atypically extended post-traumatic stricture of the bulbous urethra in a teenager: a Case report

Presentation of clinical observation of a patient with an atypically extended stricture of the bulbar urethra.
 A 15-year-old boy came to the clinic with complaints of difficult and prolonged urination after an injury to the perineum and scrotum. The patient underwent a 3-fold surgical treatment for an extended stricture of the bulbous urethra. Complete recovery of the patient was achieved after repeated surgical interventions. At follow-up for 2.5 years, he urinates freely and painlessly. The average urination rate is 18 ml/s, urine tests are without deviations according to echography, and adequate emptying of the bladder is noted.
 In children, a post-traumatic urethral stricture is a rare condition, and patient management has not been finalized. In most cases, the methods of operations adopted in adult patients are used. Reconstructive surgery in this patient was performed in the cold postoperative period. With extended strictures, preference should be given to open urethroplasty, namely, augmentation techniques using a free buccal mucosal graft.
 The presented clinical case demonstrates the complexity of determining the therapeutic strategies and the surgical treatment in cases of an extended bulbous urethra stricture.

Можливості використання ендоскопічного обладнання в лікуванні коротких посттравматичних стриктур уретри в дітей

Актуальність. Пошкодження уретри при пошкодженні кісток таза в дітей відмічається рідше, ніж у дорослих (менше 1 %) (Tarman G.J. et al., 2002). Посттравматична стриктура уретри в дітей є досить рідкісною та складною урологічною патологією. З урахуванням анатомічних особливостей лікування стриктури уретри в дітей відрізняється від її лікування в дорослих (Onen A. et al., 2005; Nerli R.B. et al., 2008; Ranjan P. et al., 2011). М.М. Koraitim (2012) описав досвід лікування 20 хворих з ускладненнями після трансперинеальної пластики уретри. Автор відмітив, що у разі відсутності необхідності реконструкції шийки сечового міхура достатньо ефективним є ендоскопічне розсічення стриктури уретри. Т.Е. Helmy, А.Т. Hafez (2013) теж описали результати успішного застосування ендоскопічного обладнання (пряма візуальна уретротомія) після відкритих уретропластик. Важливим моментом, що спонукає до пошуку ефективних малоінвазивних методів лікування посттравматичних стриктур уретри в дітей, є розвиток еректильної дисфункції у подальшому, що, за даними деяких авторів (Koraitim M.M., 2014), становить до 47 %. Мета дослідження: на основі доступних літературних даних і власних результатів лікування дітей із стриктурами задньої уретри установити роль ендоскопічного лікування вказаної складної патології як методу профілактики та лікування нервово-м’язової дисфункції сечового міхура. Матеріали та методи. На базі хірургічних відділень Житомирської обласної дитячої клінічної лікарні широко впроваджені малоінвазивні ендоскопічні методи діагностики та лікування патології нижніх сечових шляхів. Наявне обладнання дає можливість проводити діагностичні процедури, починаючи з місячного віку. Виконується цілий ряд ендоскопічних оперативних втручань на нижніх сечових шляхах, а саме: видалення конкрементів, розсічення клапанів та стриктур задньої уретри, розсічення кіст уретри та ектопічних уретероцеле тощо. Також у 2010 році вперше виконано спробу за допомогою черезшкірної трипортової цистоскопії видалити вклинений у рубцево-змінену задню уретру конкремент. З 2013 року розпочато лікування посттравматичних стриктур задньої уретри під ендоскопічним контролем. Результати. Подано результати успішного малоінвазивного лікування із застосуванням сучасного ендоскопічного обладнання у двох хворих із посттравматичними стриктурами задньої уретри. Особливо наголошено на ефективності методу в діагностиці та лікуванні нервово-м’язової дисфункції сечового міхура в даної категорії хворих. Висновки. Отже, застосування сучасного малоінвазивного обладнання не лише дає можливість ефективно діагностувати пошкодження нижніх сечових шляхів, а й може бути дієвим механізмом малотравматичного хірургічного лікування при коротких посттравматичних стриктурах уретри в дитячому віці. Своєчасне якісне лікування рубцевих стриктур уретри в дітей зведе до мінімуму розвиток інфравезикальної обструкції та порушення евакуаторної функції сечового міхура із розвитком його нервово-м’язової дисфункції.

Outcome of Delayed Perineal Anastomotic Urethroplasty in Children with Post-Traumatic Urethral Stricture in a Tertiary Center, Addis Ababa, Ethiopia.

BackgroundUrethral stricture is a challenging urologic problem resulting from congenital, idiopathic, traumatic, iatrogenic,and inflammatory causes. Road traffic accidents and falling-down accidents are the most common traumatic causes. Although most management principles are extrapolated from adults, stricture in children has a unique anatomic challenge. The outcome of urethroplasty is reported to be good in nearly all patients according to different studies. Since there is no study from Ethiopia on this subject, our work will show our experience with the problem.Patients and MethodsWe conducted a retrospective study of children who underwent delayed urethroplasty for post-traumatic urethral stricture from November 2011 to November 2019. A retrospective study was conducted on boys for whom delayed perineal anastomotic urethroplasty was performed after they sustained trauma. Sociodemographic data, pre-operative presentation of patients, and intraoperative conditions were assessed. The need of any further procedure to micturate, stream of urine and urethral caliber on post-operative cystourethrography were parameters used to measure the outcome. Data were entered into SPSS version 24 and analyzed, taking a p-value of 0.05 as statistically significant.ResultsNineteen boys had delayed perineal anastomotic urethroplasty in the study period, with a mean age at the time of surgery being 9.8 years. Out of these 19 patients, nine had been involved in road traffic accidents, eight had fallen from a height, and two had bullet injuries. The membranous urethra was the most commonly affected part and, in seven of them, associated pelvic bone fracture was documented. The affected urethral segment length ranged from 1–3 cm, with a mean of 1.77 cm. For all of them delayed perineal urethroplasty was performed after a minimum of 3 months. Successful outcome after primary surgery and re-do surgery was 58% and 82%, respectively.ConclusionUrethral stricture is an uncommon condition in children but is one of the challenging conditions a pediatric urologist faces. Our study showed that perineal urethroplasty can be done safely in most children with urethral stricture, but unless adequate pre-operative evaluation and strict surgical principles are followed the outcome will be poor.

Relapses of urethral strictures associated with a pelvic ring fracture and osteosynthesis: the features of treatment and prevention

Introduction. Pelvic ring fracture with complex bone fragments displacement is associated with the urethral distraction injury in about 10% of cases. Emergency care for these patients includes the provision of trauma management and urinary diversion followed by delayed urethroplasty.Purpose of the study. To determine the effect of extramedullary osteosynthesis in a pelvic ring fracture on the outcome of treatment in patients with post-traumatic urethral strictures.Materials and methods. The study included 17 patients with post-traumatic urethral strictures associated with pelvic ring fractures (Types B, C). The average age of the patients was 35.8 ± 10.2 (19 - 61) yrs. All patients underwent submerged osteosynthesis and cystostomy drainage as an emergency. Localization of strictures: 10 (58.8%) - membranous, 7 (41.2%) - bulbo-membranous. Length of strictures: 1.47 ± 0.5 (0.5 - 2.5) cm. Post-traumatic period: 6.6 ± 1.3 (4 - 10) mo.Results. All patients underwent anastomotic urethroplasty. No early postoperative complications were identified. Spontaneous urination was restored by 14 - 15 days in all patients. Early urethral stricture relapses were revealed in 9 (52.9%) patients during 3-mo follow-up. These patients underwent removal of the metal structures fixing the pelvic bones. Repeated urethroplasty was performed a month later. Subsequent relapses of urethral stricture were not detected in any of 17 cases with a median follow-up of 28 (12 - 128) mo.Conclusion. Surgical treatment of urethral strictures associated with a pelvic ring fracture and osteosynthesis is advisable after removal of the metal structures fixing the pelvic bones. This is since the excessed retropubic screws protrusion (> 0.2 - 0.3 mm) is associated with a large area of periurethral fibrous inflammation and causes high relapse risks of stricture disease (52.9%) in the case of urethral surgery preceding the removal of metal structures.

Mesenchymal Stem Cell-Derived Exosomes Induced by IL-1β Attenuate Urethral Stricture Through Let-7c/PAK1/NF-κB-Regulated Macrophage M2 Polarization.

BackgroundUrethral stricture is a clinical challenge for both patients and clinicians. Post-traumatic urethral stricture is associated with formation of scar tissue caused by excessive inflammation. The aim of this study is exploring potential therapeutic strategies for this condition.MethodsIn vivo experiments on New Zealand rabbits and in vitro experiments on THP-1 monocytes and urethral fibroblasts were performed to investigate the effects on post-traumatic urethral stricture of exosomes isolated from IL-1β-treated mesenchymal stem cells (Exo-MSCsIL−1β) and the role of macrophage M2 polarization in this process. Additionally, related signaling and mechanism behind were explored.ResultsIn a New Zealand rabbit model of post-traumatic urethral stricture, injection of Exo-MSCsIL−1β significantly reduced urethral stricture and collagen fiber accumulation compared with Exo-MSCs. Addition of Exo-MSCsIL−1β to THP-1 monocytes in vitro induced M2 macrophage polarization, which, in turn, inhibited activation of urethral fibroblasts and synthesis of collagen. Mechanistically, Exo-MSCsIL−1β were found to contain high levels of the microRNA let-7c, and luciferase reporter assays showed that let-7c interacted with the 3′UTR of PAK1 mRNA. Transfection of THP-1 cells with a let-7c mimic downregulated PAK1 expression and inhibited activation of the NF-κB signaling pathway.ConclusionThese results support a role for let-7c-containing Exo-MSCsIL−1β in reducing urethral stricture via inhibition of PAK1–NF-κB signaling, M2 macrophage polarization, and differentiation of urethral myofibroblasts.

IJU this issue

In this issue, one Review Article, seven Original Articles, two Urological Notes and nine Editorial Comments (total 19 manuscripts) are published. Shigemura and Fujisawa (Hyogo, Japan) reviewed the prevention and management of infectious complications in prostate biopsy. Miyamoto et al. (Nara, Japan) reported on the clinical outcomes after intravesical bacillus Calmette–Guérin for the highest-risk non-muscle-invasive bladder cancer newly defined in the Japanese Urological Association Guidelines 2019. Tabei et al. (Kanagawa, Japan) investigated the efficacy of re-do urethroplasty for post-traumatic urethral stricture in terms of anatomical and functional outcomes to show a high success rate and beneficial effects on both anatomical and functional outcomes. Taoka et al. (Kagawa, Japan) showed the therapeutic benefits of a surgical checklist in improving the quality of resection during transurethral resection and reducing the recurrence rate in patients with non-muscle-invasive bladder cancer. Hata et al. (Fukushima, Japan) identified the preoperative low bladder contractile index as the predictor of postoperative detrusor underactivity during the early postoperative period after robot-assisted radical prostatectomy. Shin and Mimata (Oita, Japan) described the “early pull-out” technique for intracorporeal ileal conduit urinary diversion after robot-assisted radical cystectomy. Aizawa et al. (Kyoto, Japan) reported that prostate-targeted treatment plus metastasis-directed therapy through external beam radiation therapy can result in favorable long-term disease-free and survival outcomes with acceptable morbidities among synchronous oligometastatic prostate cancer patients. Iguchi et al. (Osaka, Japan) reported that enzalutamide plus androgen deprivation therapy has clinical benefit with a tolerable safety profile in Japanese men with metastatic hormone-sensitive prostate cancer, consistent with the overall population. Yamashita et al. (Wakayama, Japan) evaluated the prognostic impact of sarcopenia and myosteatosis on survival after radical cystectomy for bladder cancer. Unfortunately, the limited space does not allow me to introduce all the papers. However, all the articles in this issue are very informative and interesting, so please enjoy it by all means. None declared.

Safety and Efficacy of Trans-Perineal Urethroplasty for Management of Post-Traumatic Urethral Strictures in Pediatric Age-Group

Introduction: Trans-perineal urethroplasty is the preferred treatment for distraction urethral injuries in adults. However, management of such injuries in children is challenging because of functional implications in a growing child. In the present study, we aim to evaluate the safety and efficacy of perineal urethroplasty for distraction urethral injuries in children. Methods: The medical records of prepubertal pediatric patients (age <14 years) with traumatic urethral distraction injuries managed by perineal urethroplasty were retrospectively reviewed and analyzed with respect to demographics, stricture characteristics, management, complications, follow-up, and outcome. Results: A total of 14 patients were included in the study. Ten had membranous, and 4 had bulbar urethral strictures. All membranous strictures were secondary to pelvic trauma; bulbar strictures were secondary to blunt perineal trauma; 7 patients had associated pelvic fractures. Anastomotic urethroplasty was used in 10 patients (71.4%) and buccal mucosal graft urethroplasty was done in 4 patients (38.6%). The mean follow-up duration was 56 months (range 24–76). Surgery was primarily successful in 85.7%. Failed repair in 2 patients was successfully managed with augmented anastomotic urethroplasty. Post-operatively, the mean maximal urinary flow rate was 26.4 mL/s. No significant complications occurred. All boys are continent. There was no chordee or urethral diverticula, during follow-up. Conclusion: In pediatric patients, bulbar and membranous strictures can be treated successfully with urethroplasty using the perineal approach. Longer follow-up is needed to confirm that these good results are maintained as these patients cross into adulthood, especially as these repairs were done before puberty.

Efficacy of re-do urethroplasty for post-traumatic urethral stricture: An analysis of the anatomical and functional outcomes.

To investigate the efficacy of re-do urethroplasty for post-traumatic urethral stricture in terms of anatomical and functional outcomes. A total of 48 patients who underwent re-do urethroplasty for post-traumatic urethral stricture due to perineal trauma (n=21) and pelvic fracture urethral injury (n=27) between October 2010 and March 2020 were retrospectively reviewed. Patients were followed by uroflowmetry, post-void residual volume assessment and 17-Fr flexible cystoscopy after re-do urethroplasty. Successful urethroplasty was defined as having a urethral caliber adequate for the passage of a cystoscope and requiring no additional treatments. Patients completed a validated patient-reported outcome measure for urethral stricture surgery, including overall satisfaction, and the sexual health inventory for men. The type of re-do urethroplasty was anastomotic urethroplasty in 45 (94%) patients and buccal mucosa urethroplasty in three (6%) patients. Urethroplasty was successful in 47 (98%) patients (median follow up 35months, interquartile range 21-75). The patient-reported outcome measure for urethral stricture surgery and Sexual Health Inventory for Men were assessed in 36 (75%) patients, and the mean lower urinary tract symptom-specific quality of life, EuroQol-5D and EuroQol-visual analog scale scores improved from 2.86, 0.63 and 54.17 preoperatively to 0.78 (P<0.001), 0.86 (P<0.001) and 76.94 (P<0.001) postoperatively, respectively. The pre- and postoperative mean Sexual Health Inventory for Men scores (5.92 and 4.94, respectively) did not significantly differ (P=0.318). All 36 patients were satisfied with their urethroplasty outcomes, with 20 (56%) very satisfied patients. Re-do urethroplasty for post-traumatic urethral stricture shows a high success rate and beneficial effects on both anatomical and functional outcomes.

67] End-to-end anastomotic urethroplasty for post-traumatic complete rupture of the membranous urethra

ObjectiveTo report our experience and the feasibility of end-to-end anastomotic urethroplasty, as this is an excellent technique for the management of post-traumatic urethral stricture.

Surgical selection and outcome for treating the post-traumatic posterior urethral strictures via transperineal approach

Objective To evaluate the outcome of various operative selection for treating posterior urethral stricture via transperineal approach. Methods The clinical data of 5 000 patients with posterior urethral stricture or obstruction from January 1990 to January 2017 were analyzed retrospectively. All patients were male. The age of those patients ranged from 18 months to 77 years old, mean 36.6 years old. Pelvic crush injury caused by car accident occurred in 2010 cases. Falling injury occurred in 1680 cases. Pelvic compressed injury occurred in 1 310 cases. Accompanied visceral damage occurred in 2 590 cases, including the liver and spleen rupture in 920 cases, lower limb fracture in 1 200 cases. 2 200 cases accepted urethral realignment under emergency. 2 800 cases were treated with pubic cystostomy. All patients were undergone a retrograde and voiding urethrogram. 562 patients accepted urethral ultrasongraphy, and 2 448 patients accepted urethroscopy. 204 patients accepted MRI examination. The mean stricture length was 4.3 cm, ranged from 1.8 to 8.6 cm. Posterior urethral stricture was found in 810(16.2%)cases. The complete obstruction of posterior urethra was found in 4 190(83.8%)cases, of which the length of the distraction defects≤3 cm was found in 2 650(53.0%)cases and the length of the distraction defects>3 cm was found in 1 540(30.8%)cases. Bladder calculi was found in 2 300 cases. The perineal fistula or abscess was noticed in 290 cases. False passage was found in 460 cases. Urethra rectum fistula was found in 160 cases. Bladder neck open was noticed in 89 cases. Repairing was performed via a simple anastomosis after urethral mobilization in 1 700 patients, via separation of the corporeal bodies in 1 302 patients, via separation of the corporeal bodies and inferior pubectomy in 1 910 patients and via scrotal skin flap urethroplasty in 68 patients. Pull-through operation was performed in 20 patients. Results Postoperative follow-up were conducted from 6 to 72 months with average duration of 23 months. The overall successive results after operation was 92.2%(4 608/5 000), which the Qmax was more than 15 ml/s .The successive rate of urethroplasty were 97%(1 649/1 700 )in simple anastomosis; 93%(1 211/1 302 )in separation of the corporeal bodies; 88% (1 680/1 910) in separation of the corporeal bodies and inferior puberctomy; 78%(53/68) in scrotal skin flap urethroplasty and 83%(15/18) in pull-through operation. The successive rate were 96%(778/810)in posterior urethral stricture; 95%(2 517/2 650)in distraction with the length of obstruction less than 3 cm and 86%(1 324/1 540)in distraction with the length of obstruction more than 3 cm. Conclusions The transperineal end to end anastomotic urethroplasty has become the first-line therapy for posterior urethral atresia. The length of the strictures or distraction defect which is lower than 3 cm is much more successfully corrected. Key words: Urethral stricture; Urological surgical procedure; Transperineal; Wound and injuiry

Fasudil reduces the recurrence of urethral stricture treated by laser internal urethrotomy in rabbits

Objective To establish a stable laser internal urethrotomy model in New Zealand rabbits with post-traumatic urethral stricture and to explore the role of Rho-associated protein kinase (ROCK) inhibitor fasudil in the recurrence of urethral stricture treated by laser internal urethrotomy. Methods Post-traumatic urethral stricture was established by microsurgical techniques. Thereafter, the rabbits underwent laser internal urethrotomy. The rabbits were allocated into 5 groups: the sham operation group, the operation with fasudil injection (3, 10, 30 mg/kg) groups, and the operation with normal saline group. After 3 months, the diameter of the urethra was evaluated by urethrography. The fibroblasts were isolated from urethral scar, and then incubated with fasudil (0, 12.5, 25.0, 50.0 μmol/L), or co-incubated with fasudil (0, 12.5, 25.0, 50.0 μmol/L) in the presence of transforming growth factor-β1 (TGF-β1, 10 μg/L). The cell activity was measured by methyl thiazol tetrazolium (MTT) assay. The protein expression of collagen Ⅰ, collagen Ⅲ and ROCK was detected by Western blotting. Results Fasudil significantly reduced the recurrence of urethral stricture treated by laser internal urethrotomy, the diameter of the urethra was (2.26±1.21), (5.57±1.13), (6.61±1.03), (7.59±1.39), (8.18±1.22) mm, respectively (F=49.207, P=0.000; F=7.010, P=0.001). Van Gieson stain showed that the content of collagen fiber was decreased as the dose of fasudil increased, the fiber density was 50.67±6.73, 48.51±6.58, 42.11±8.10, 38.52±4.98, 33.41±7.10, respectively (F=10.172, P=0.000; F=9.221, P=0.000). As the dose of fasudil increasing, the cell activity was decreased. In non-TGF-β1-treated group, after 24 h treatment of fasudil, the inhibitory rate was 0, 0.208 8±0.012 5, 0.364 0±0.012 4, 0.520 3±0.015 6, respectively (F=47.117, P=0.000); after 72 h treatment of fasudil, the inhibitory rate was 0, 0.244 2±0.013 4, 0.396 5±0.010 9, 0.556 8±0.011 1, respectively (F=53.069, P=0.000). In TGF-β1-treated group, after 24 h treatment of fasudil, the inhibitory rate was 0, 0.117 6±0.013 8, 0.294 1±0.014 5, 0.431 4±0.013 7, respectively (F=55.341, P=0.000); after 72 h treatment of fasudil, the inhibitory rate was 0, 0.150 2±0.013 5, 0.322 9±0.010 3, 0.459 6±0.010 9, respectively (F=61.217, P=0.001). And the synthesis of collagen Ⅰ and Ⅲ, and ROCK was also decreased as the dose of fasudil increased. The expression of ROCK was 0.398±0.011, 0.317±0.017, 0.254±0.032, 0.178±0.057, 0.549±0.024, 0.469±0.033, 0.381±0.027, 0.264±0.014, respectively (F=11.318, P=0.000); the expression of collagen Ⅰ was 0.509±0.036, 0.415±0.025, 0.337±0.046, 0.227±0.037, 0.872±0.044, 0.704±0.021, 0.582±0.019, 0.425±0.023, respectively (F=9.715, P=0.000); the expression of collagen Ⅲ was 0.387±0.019, 0.301±0.010, 0.230±0.033, 0.116±0.015, 0.507±0.042, 0.404±0.023, 0.339±0.036, 0.240±0.026, respectively (F=13.657, P=0.000). Conclusion Fasudil could be efficacious in preventing the recurrence of urethral stricture treated by laser internal urethrotomy and the formation of urethral scar, and the proliferation of fibroblasts by downregulating TGF-β1-induced Rho/ROCK pathway activation. Key words: Fasudil; Urethral trauma; Urethral stricture; Laser therapy

Posttraumatic urethral stricture or loss secondary to pelvic fracture in girls: appropriate management

Objective To explore the appropriate management for girls with posttraumatic urethral stricture or loss secondary to pelvic fracture . Methods Between January 2009 and December 2015, a total of 20 girls, mean age of 9.5 years (range 2-14 years), whose posttraumatic urethral stricture associated with urethrovaginal fistula were treated using a variety of procedures. The mean urethral stricture or loss length was 2.6 cm (range 2-4 cm). Six patients presented with vaginal distal stricture and associated with a large hydrocolpos in the proximal vagina. Of the 20 girls, urethroplasty was performed using labial pedicle flap or vulvar flap in 10 patients, using a bladder flap tube in 5 girls with total urethral loss, using vaginal flap in 5 cases. Colpoplasty using island vulvar skin flaps or hydrocolpos vagina were performed in the 6 patients associated with vaginal stricture during urethroplasty. Results There were no serious complications postoperatively. The mean follow-up period was 41 months (range 12-70 months) postoperatively. The overall anatomical success rate was 90% (18 /20) and the functional success rate was 70% (14 / 20). Of 10 patients underwent pedicle labial or an island flap of vulva urethroplasty, 2 patients were recurrent, and 2 patients present stress incontinence. Five patients underwent urethral reconstruction using a bladder flap tube and voiding well postoperatively, of which stress incontinence appeared in 2. All 5 patients who underwent vaginal flap urethroplasty could void normally and continently. The hydrocolpos disappeared in all 6 patients with vaginal distal severe stricture. Conclusions A differential surgical repair strategy should be determined by fistula location, stricture length and vaginal condition for posttraumatic urethral stricture associated with urethrovaginal fistula in girls. It is probably good choice to reconstruct distal urethra and vagina using a large hydrocolpos in the proximal vagina for the treatment of coexisting strictures of urethra and vagina. Key words: Girl; Urethral stricture; Vaginal stricture; Urethroplasty

P-01-053 Deficiency of testosterone in patients with post-traumatic urethral stricture

P-01-053 Deficiency of testosterone in patients with post-traumatic urethral stricture

Our experience with progressive perineal urethroplasty and anastomotic urethroplasty in post-traumatic urethral strictures in pediatric patients

Background: Confined perineum and elevated prostate and bladder in children make management of post-traumatic stricture in children technically difficult.Methods: A retrospective study of patients from 2007 till September 2016 was conducted. 15 pediatric patients with a mean age of 7.3 years presented with post traumatic urethral stricture or distraction defect. 11 patients had pelvic fracture urethral distraction defect (PFUDD) and underwent PPU. Four had bulbar stricture caused by straddle injury and underwent EEU. Post operatively patients were evaluated using uroflowmetry at 3, 6 and 12 months. Maximum velocity of less than 10 ml/s and symptoms of straining was considered as recurrence and such cases were evaluated further with MCU, RGU and cystoscopy.Results: Mean stricture length was of 2.3 cm and was at bulbo-membranous junction in 11 and in proximal bulbar urethra in 4. Of the 11 PPUs, crural separation was done in nine and inferior pubectomy in six patients. Transpubic approach was required in one patient. Gracilis flap was placed in one patient as an onlay over anastomotic urethroplasty. Of the 11 PPUs, 2 patients and 1 of 4 EEU patients had recurrence. All recurrent strictures were &lt;1.5 cm long and at the site of the anastomosis. Two patients were managed with anastomotic urethroplasty. The remaining one patient could be managed with laser visual internal urethrotomy.Conclusions: PPU and EEU are treatment of choice in paediatric patients with PFUDD and proximal bulbar strictures respectively. Both are technically feasible, have good outcome and have an acceptable morbidity.

Is Post-Inflammatory Urethral Stricture Commoner Than Post-Traumatic Urethral Stricture? A Study in South-South Nigerian Hospital

Is Post-Inflammatory Urethral Stricture Commoner Than Post-Traumatic Urethral Stricture? A Study in South-South Nigerian Hospital

Management of Post Traumatic Posterior Urethral Stricture; Internal Urethrotomy verses Perennial Urethroplasty

Objective: To compare the efficacy and cost effectiveness of cold knife optical internal urethrotomy with perineal urethroplasty (excision and end to end anastomosis) in the management of post traumatic short posterior urethral stricture. Design: an observational prospective study. Place and duration of study: the study was performed in the department of urology and kidney transplantation Services hospital/post graduate medical institute Lahore, from September 1997 to December 1999. Patients and methods: Forty male patients of post traumatic posterior urethral stricture revealed by their urethrogram were included in the study. Patients were divided in two groups randomly (group A &amp; group B). After complete evaluation, patients of group A were managed by internal uretherotomy, while those of group B by perineal urethroplasty. Follow up was done at 1,3,6,9 &amp; 12 months. Results: age range of the patients was 20 to 59 years with the mean age of 35.5 years. Road traffic accident was the main cause (82.5%). After facing the traumatic urethral injury, there was history of attempted Foley catheterization (47.5%), bouginage (15%) and intervention by rail road technique in 10% of the patients. All patients were with supra pubic catheter because of failure to void. The length of stricture varied from 0.5 to 2.0 cm (mean 1.4 cm). Clinical response at the end of the study in group A &amp; B was "good" in 58.82% &amp; 66.66%, "satisfactory" in 23.52% &amp; 22.22% and "poor" in 17.64% &amp;11.11% respectively. The mean cost of operation, hospital stay and loss of working hours were less in group A as compared to that of group B. Conclusion: The results of perineal urethroplasty are comparatively better than optical urethrotomy. The other differences of the two procedures lie in operative time cost of the operation and mean hospital stay. It is concluded that optical urethrotomy is an acceptable alternative to urethroplasty in patients with short post traumatic posterior urethral stricture.

One-stage Anastomotic Urethroplasty for Traumatic Urethral Strictures. January 2004-January 2013.

Purpose:One-stage anastomotic urethroplasty is an attractive procedure for reconstructing the urethra following trauma. This prospective study highlights the advantages of the procedure and outcome of treatment.Materials and Methods:A total of 87 patients, age range 11–68 years with a mean of 35.4 years were included in the study. These patients were seen at two tertiary Institutions in South East Nigeria. The stricture lengths varied between 0.8 cm and 3.2 cm. All had suprapubic cystostomy initially followed by an end to end perineal anastomosis after thorough work up. Preoperatively 9 (10.3%) patients had impotence from the trauma. Postoperatively the patients were assessed with peri-catheter retrograde urethrogram, micturating cystourethrogram, and uroflowmetery.Results:All the patients were males. At 6 months, 13 out of 21 (62%) patients who had bulbo-prostatic anastomosis and 62 out of 66 (94%) patients that had bulbo-membranous, bulbo-bulbar anastomosis had satisfactory micturition with urine flow rate >15 ml/s. Totally, 12 (13.8%) patients had urine flow rate of <12 ml/s. At 1-year, there were 12 re-strictures, no urinary incontinence and four cases of a decrease in the strength of penile erection that needed no treatment.Conclusion:Delayed one-stage anastomotic urethroplasty provides for decreased incidence of postoperative morbidity, re-stricture, impotence and urinary incontinence for most short segment posttraumatic urethral strictures.