Post-traumatic Urethral Strictures Research Articles

Traumatic Obliterative Urethral Strictures in Pediatric Patients: Failure of the Cut to Light Technique at Long-Term Followup

The cut to light procedure or antegrade and retrograde urethroscopy with endoscopic incision of obliterative urethral strictures is an accepted method of treating posterior urethral distraction injuries. We report long-term followup on 22 pediatric patients treated with this technique. The records of all pediatric patients with a posterior urethral distraction injury treated from 1986 through 2006 were reviewed. The cut to light procedure was performed for obliterative strictures less than 1 cm via a cold knife or laser in 11 patients each. A urethral catheter was left in situ for 3 weeks. Patients were then followed a minimum of 2 years. A total of 22 patients at a median age of 11 years (range 3 to 16) were treated. Followup revealed stricture recurrence in all patients. Median time to recurrence was 3 months after catheter removal (range 5 days to 1 year). Although intermittent catheterization to maintain patency was attempted in all patients, the development of impassable urethral strictures in 16 (73%) and complaints of chronic pain with catheterization in 4 (18%) led to end-to-end urethroplasty. Successful reconstruction with open surgery was achieved in 19 of 20 patients (95%). Two patients (9%) maintained urethral patency with intermittent catheterization. In children with obliterative posterior urethral distraction injuries a cut to light procedure had a long-term success rate of 0%. All patients required daily intermittent catheterization (9%) or formal urethral reconstruction (91%) to maintain patency. We would strongly recommend against treating pediatric obliterative urethral strictures with a cut to light procedure.

Anastomotic Urethroplasty for Posttraumatic Urethral Stricture: Previous Urethral Manipulation Has a Negative Impact on the Final Outcome

We evaluated the long-term results of anastomotic urethroplasty for posttraumatic urethral stricture and assessed the impact of previous endourethral/surgical intervention on the subsequent outcome. From January 1988 to April 2005, 51 patients underwent anastomotic urethroplasty for posttraumatic urethral stricture following pelvic fracture (41) or perineal blunt trauma (10). Of these patients 28 (55%) underwent previous surgical procedures, including endoscopic urethrotomy with endoscopic realignment in 20 and open urethroplasty in 8. Median followup was 4.6 years. Results were evaluated. Success was characterized by a maximum urine flow of more than 15 ml per second, sterile urine, and normal urethral imaging and/or endoscopy. A satisfactory result was considered to be 1 episode of recurrence diagnosed on routine imaging/endoscopy that was successfully managed by 1 or 2 direct vision internal urethrotomies. Failure was characterized by the necessity for repeat instrumental and/or open surgery. Results were analyzed using Kaplan-Meier curves and the log rank test. At 1, 5 and 10 years overall success rates were 63%, 55% and 43%, while satisfactory result rates were 84%, 80% and 76%, respectively. However, the 23 patients without urethral manipulation before anastomotic urethroplasty had a satisfactory result of more than 90% vs more than 60% in patients with previous surgical treatment. These results were maintained for 100 months (p <0.05). Endoscopic and/or open urethral manipulation before anastomotic urethroplasty for posttraumatic urethral stricture has a significant impact on the outcome of urethral reconstruction. Cases of posttraumatic urethral stricture should preferably be referred to a center of expertise.

Harnröhrenplastik nach Urethraabriss und simultane perineale Prostatektomie

We present a case of post-traumatic posterior urethral stricture and localized prostate cancer, which could be treated successfully with simultaneous radical perineal prostatectomy and membranous urethral stricture excision. After 6 months follow-up, the patient is continent with no evidence of stricture recurrence. Post-traumatic posterior urethral strictures can be managed surgically through a perineal approach with high success rates. Prostate surgery after pelvic fracture with posterior urethral distraction defects does not necessarily lead to stress urinary incontinence.

122: Anastomotic Urethroplasty for Post-Traumatic Urethral Stricture: Negative Impact of Previous Urethral Manipulations

122: Anastomotic Urethroplasty for Post-Traumatic Urethral Stricture: Negative Impact of Previous Urethral Manipulations

Managing Varicoceles in Children: Results With Microsurgical Varicocelectomy

Authors from New York present their experience of elective varicocelectomy, using microsurgical techniques, in a large series of children. They found the procedure to be safe and effective, and gave a much lower complication rate than the published rate in open varicocelectomy. The results of urethroplasty in post-traumatic paediatric urethral strictures are presented by authors from Mansoura. They found the overall success of one-stage perineal anastomotic repair of such strictures to be excellent, with very little morbidity. OBJECTIVE To report our experience of microsurgical subinguinal varicocelectomy in boys aged ≤ 18 years. PATIENTS AND METHODS Boys aged ≤ 18 years treated with microsurgical varicocelectomy between 1996 and 2000 at one institution were retrospectively reviewed. Indications for surgery included ipsilateral testicular atrophy, large varicocele or pain. Microsurgery was assisted by an operating microscope (×10–25) allowing preservation of the lymphatics, and the testicular and cremasteric arteries. Patient age, varicocele grade, complications and follow-up interval were recorded. RESULTS In all there were 97 microsurgical subinguinal varicocelectomies (23 bilateral) in 74 boys (mean age 14.7 years). Left-sided varicoceles were significantly larger (mean grade 2.9) than right-sided (mean grade 1.4) varicoceles. The mean follow-up was 9.6 months. There were four complications: two hydroceles, of which one resolved spontaneously after 4 months; one patient had persistent orchialgia that resolved after 8 months; and one developed hypertrophic scarring at the inguinal incision site. There were no infections, haematomas or intraoperative injuries to the vas deferens or testicular arteries. All boys were discharged home on the day of surgery. CONCLUSIONS Microsurgical subinguinal varicocelectomy in boys is a safe, minimally invasive and effective means of treating varicoceles. Compared with published results of the retroperitoneal mass ligation technique, which has a 15% overall complication rate and a 7–9% hydrocele occurrence rate, the microsurgical subinguinal approach appears to offer less morbidity, with a 1% hydrocele rate. We consider that microsurgical subinguinal varicocelectomy offers the best results with lower morbidity than other techniques.

Perineal Anastomotic Urethroplasty for Managing Post-Traumatic Urethral Strictures in Children

Perineal Anastomotic Urethroplasty for Managing Post-Traumatic Urethral Strictures in Children

Perineal Anastomotic Urethroplasty for Managing Post-Traumatic Urethral Strictures in Children: The Long-Term Outcome

OBJECTIVE To evaluate the long-term results of one-stage perineal anastomotic urethroplasty for post-traumatic paediatric urethral strictures. PATIENTS AND METHODS Thirty-five boys who had a perineal anastomotic urethroplasty for post-traumatic bulbous or posterior urethral strictures between 1991 and 2003 were analysed retrospectively. Patients were followed up for a mean (range) of 46 (6-132) months by a history, urinary flow rate estimate, retrograde urethrography and voiding cysto-urethrography. RESULTS The mean (range) age of the patients was 11.9 (6-18) years. The estimated radiographic stricture length before surgery was 2.6 (1-5) cm. The perineal anastomotic repair was successful in 31 of 35 (89%) patients. All treatment failures were at the anastomosis and were within the first year. Failed repairs were successfully managed endoscopically in two patients and by repeat perineal anastomotic repair in the remaining two, giving a final success rate of 100%. All boys are continent except two who had early stress incontinence, and that resolved with time. There was no chordee, penile shortening or urethral diverticula during the follow-up. CONCLUSIONS The overall success of a one-stage perineal anastomotic repair of post-traumatic urethral strictures in boys is excellent, with minimal morbidity. Substitution urethroplasty or abdomino-perineal repair should be reserved for the occasional patients with concomitant anterior urethral stricture disease or a complex posterior urethral stricture, respectively.

A Comparison of One-Stage Procedures for Post-Traumatic Urethral Stricture Repair

No AccessJournal of UrologyUrological Survey: Trauma, and Genital and Urethral Reconstruction1 Dec 2005A Comparison of One-Stage Procedures for Post-Traumatic Urethral Stricture Repair Allen F. MoreyM.D. Allen F. MoreyAllen F. Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)68978-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "A Comparison of One-Stage Procedures for Post-Traumatic Urethral Stricture Repair." The Journal of Urology, 174(6), pp. 2264–2265 References 1 : Anterior urethral strictures: etiology and characteristics. Urology2005; 65: 1055. Google Scholar 2 : Failed anterior urethroplasty: guidelines for reconstruction. J Urol1997; 158: 1383. Link, Google Scholar 3 : Management of urethral stricture disease: developing options for surgical intervention. BJU Int2004; 94: 971. Google Scholar © 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 174Issue 6December 2005Page: 2264-2265 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.MetricsAuthor Information Allen F. Morey More articles by this author Expand All Advertisement PDF DownloadLoading ...

A Comparison of One-Stage Procedures for Post-Traumatic Urethral Stricture Repair

A Comparison of One-Stage Procedures for Post-Traumatic Urethral Stricture Repair

A comparison of one‐stage procedures for post‐traumatic urethral stricture repair

To compare the results and complication rates of various one-stage treatments for repairing a post-traumatic urethral stricture. The medical records of 153 patients who had a post-traumatic urethral stricture repaired between 1977 and 2003 were evaluated retrospectively, and analysed for the different types of urethral reconstruction. The procedures included direct end-to-end anastomosis in 86 (56%) patients, free dorsal onlay graft urethroplasty using preputial or inguinal skin in 40 (26%), ventral onlay urethroplasty using buccal mucosa in seven (5%) and ventral fasciocutaneous flaps on a vascular pedicle in 20 (13%). At a mean (median, range) follow-up of 75.2 (38, 12-322) months, 121 (79%) patients had no evidence of recurrent stricture, while in 32 men (21%) they were detected at a mean follow-up of 30.47 (1-96) months. Patients having a dorsal onlay urethroplasty had the longest strictures. The re-stricture rate was lowest after a dorsal onlay urethroplasty (5% vs 27% when treated with end-to-end anastomosis, 15% after fasciocutaneous flaps and 57% after a ventral buccal mucosal graft). The surgical technique used had no effect on postoperative incontinence or erectile dysfunction rates. In patients with strictures which are too long to be excised and re-anastomosed, tension-free dorsal onlay urethroplasty is better than ventral graft or flap techniques. In patients with short urethral strictures direct end-to-end anastomosis remains an option for the one-stage repair of urethral stricture.

Perineal anastomotic urethroplasty for managing post‐traumatic urethral strictures in children: the long‐term outcome

To evaluate the long-term results of one-stage perineal anastomotic urethroplasty for post-traumatic paediatric urethral strictures. Thirty-five boys who had a perineal anastomotic urethroplasty for post-traumatic bulbous or posterior urethral strictures between 1991 and 2003 were analysed retrospectively. Patients were followed up for a mean (range) of 46 (6-132) months by a history, urinary flow rate estimate, retrograde urethrography and voiding cysto-urethrography. The mean (range) age of the patients was 11.9 (6-18) years. The estimated radiographic stricture length before surgery was 2.6 (1-5) cm. The perineal anastomotic repair was successful in 31 of 35 (89%) patients. All treatment failures were at the anastomosis and were within the first year. Failed repairs were successfully managed endoscopically in two patients and by repeat perineal anastomotic repair in the remaining two, giving a final success rate of 100%. All boys are continent except two who had early stress incontinence, and that resolved with time. There was no chordee, penile shortening or urethral diverticula during the follow-up. The overall success of a one-stage perineal anastomotic repair of post-traumatic urethral strictures in boys is excellent, with minimal morbidity. Substitution urethroplasty or abdomino-perineal repair should be reserved for the occasional patients with concomitant anterior urethral stricture disease or a complex posterior urethral stricture, respectively.

Nd-YAG laser core-through urethrotomy in obliterative posttraumatic urethral strictures in children.

This study analysed the feasibility and effectiveness of Nd-YAG laser core-through urethrotomy in the management of obliterative posttraumatic urethral strictures in children. Between May 1997 and April 2000, 61 patients underwent core-through urethrotomy in posttraumatic urethral strictures, ten of whom were children (ages 5-15 years). Three patients had had previous railroading procedures, two attempted core-through urethrotomy, and two underwent end-to-end urethroplasties. Patients were on suprapubic cystostomy for a mean period of 12 months with mean stricture length of 2 cm. Nd-YAG laser core-through urethrotomy was carried out using 600- micro m bare-contact fibre as a day care procedure. There were no intraoperative or postoperative complications. Micturating cystourethrography was performed 6 weeks following urethral catheter removal. Urethroscopy and uroflowmetry were carried out after 3 months. Mean follow-up was 24 months.Nd-YAG laser core-through urethrotomy was seen to be successful in all patients without any complications. All patients are voiding without obstructive symptoms. Four required optical urethrotomy/endoscopic dilatation at least twice. Nd-YAG laser core-through urethrotomy is a safe and effective procedure for the management of obliterative posttraumatic urethral strictures in children

Neodymium-YAG Laser Core through Urethrotomy in Obliterative Posttraumatic Urethral Strictures after Failed Initial Urethroplasty

Objective: To assess the feasibility, problems and results of Nd-YAG laser core through urethrotomy in the management of failed urethroplasty for posttraumatic bulbomembranous urethral strictures. Material and Methods: 61 patients with obliterative posttraumatic urethral strictures were treated by Nd-YAG laser core through urethrotomy between May 1997 to April 2000. Of these, 5 patients had failed end-to-end urethroplasty done as an initial procedure at various periods of time. The procedure was performed as day care and patients were discharged within 6 h of procedure. Results: At 24–30 months of follow-up, all patients are voiding well and are continent. Auxiliary procedures were required in 2 cases. Conclusion: Nd-YAG laser core through urethrotomy is a feasible day care option for patients of obliterative urethral strictures following failed initial urethroplasty with successful outcome.

CORE-THROUGH URETHROTOMY USING THE NEODYMIUM: YAG LASER FOR OBLITERATIVE URETHRAL STRICTURES AFTER TRAUMATIC URETHRAL DISRUPTION AND/OR DISTRACTION DEFECTS: LONG-TERM OUTCOME

We assessed the feasibility, efficacy and long-term outcome of neodymium (Nd):YAG laser core-through urethrotomy for posttraumatic urethral stricture. Between May 1997 and April 2000, 65 patients 5 to 62 years old underwent laser core-through urethrotomy for posttraumatic urethral stricture. Most patients had been involved in a motor vehicle accident but 8 and 3 sustained trauma after tractor injury and a railroad accident, respectively. All patients underwent suprapubic cystostomy formation and 18 had previously undergone anastomotic urethroplasty, railroad or attempted cold knife core-through urethrotomy. Mean stricture length was 2.2 cm. on bi-directional uroradiography and endoscopy. All strictures were in the bulbomembranous urethra except 3, which were prostatic-supraprostatic. The procedure was technically unsuccessful in 4 cases. Core-through urethrotomy was performed using Nd:YAG a 600 mu. contact bare fiber at 15 to 20 W. on an outpatient basis. Catheter removal and voiding cystourethrography were performed at 6 weeks. Uroflowmetry and urethroscopy were done 3 months after urethral catheter removal. Followup was 9 to 44 months. Nd:YAG laser core-through urethrotomy was performed on an outpatient basis successfully in all except 4 cases without any intraoperative or postoperative complications. Blood transfusion was not required. Although most patients were symptom-free, a few underwent initial optical internal urethrotomy and/or endoscopic dilation before the stricture became stable. The urethral lumen was obliterated again in 2 cases. Nd:YAG laser core-through urethrotomy is feasible and effective with good long-term results for posttraumatic urethral stricture.

Outcome of pull-in procedure in children with severe post-disruption posterior urethral strictures.

A total of 17 children aged 5 to 15 years with the diagnosis of posttraumatic posterior urethral stricture were operated upon using a pull-in procedure during the last 9 years. Among the diagnostic tools, synchronous inspection of both the anterior and posterior urethra by cystoscopy yielded the most valuable information. A success rate of 70% was achieved with the procedure plus postoperative re-catheterization. A pedunculated tube prepared from the scrotal skin cured 2 patients after a series of failed operations. Difficult voiding occurring after removal of the stent due to an inappropriate pressure gradient created between the bladder neck and urethra usually benefits from short-term catheterization. Mild chordee was present in 1 patient. Ejaculation and erection were present in 3 children who reached puberty.

LONG-TERM OUTCOME OF URETHROPLASTY AFTER FAILED URETHROTOMY VERSUS PRIMARY REPAIR

LONG-TERM OUTCOME OF URETHROPLASTY AFTER FAILED URETHROTOMY VERSUS PRIMARY REPAIR

Marjolin’s ulcer of the suprapubic cystostomy site infiltrating the urinary bladder: a rare occurrence

We report a case of a 40-year-old man who had presented with a spontaneous suprapubic urinary leak from a well-healed suprapubic cystostomy tract scar, 20 years following a successful scrotal tube substitution urethroplasty done for a post-traumatic urethral stricture. Preoperative contrast studies suggested a recurrent bulbomembranous urethral stricture. Excision biopsy of the suprapubic fistulous tract revealed scar cancer infiltrating the bladder wall. Of 3 similar cases reported in the past, only 1 had bladder involvement. Ours is the second such case with bladder involvement.

Contemporary management of urethral trauma and the post-traumatic stricture.

This review discusses the contemporary management of urethral trauma and post-traumatic urethral strictures occurring in both the anterior and posterior urethra. Experience in the full spectrum of urethral reconstructive procedures is important. The initial management of patients relies upon adequate drainage of the bladder and management of any other associated acute life-threatening injuries. The principles of urethral reconstruction in both the anterior and posterior urethra are discussed, with reference to the recent literature on the subject.

Urolume double prosthesis in the treatment of complex urethral strictures: A 5-year follow-up case report

The 5-year follow-up of the implantation of a UroLume double urethral stent in 2 patients with recurrent, post-traumatic urethral strictures is presented. The double implantation for each patient was done by the long extension of the urethral lesion. Only 1 patient presented a single phosphatic concretion in the implantation area during the extended follow-up. Urinary flow rates remained absolutely normal. Sexual life was unaffected. This simple modification of the UroLume implantation may offer effective treatment for extended and recurrent posterior urethral strictures in young sexually active men, for almost 5 years without early or delayed complications of clinical relevance.

Urodynamically based modification of Mitrofanoff procedure.

This paper reviews our experience with the Mitrofanoff principle as applied in eight patients. Of four patients with post-traumatic urethral stricture, three required the appendix as continent catheterizable conduit, with a modified appendicovesical anastomosis technique-that is, without a submucosal tunnel- and in one patient, the remnant ureter of a previous simple nephrectomy was used. Of the four remaining patients, one with a hypotonic bladder and three with urethral stricture, a complete laparoscopic approach was used to perform the same modified Mitrofanoff procedure with the appendix. With a mean follow-up of 19.5 months, all patients were completely dry. Only three patients had persistently positive urine cultures, but without evidence of renal function impairment. The modified direct appendicovesical anastomosis technique reduces the operative time, has a lower complication rate, and allows us to use a laparoscopic approach with the resulting benefits of a minimally invasive surgical procedure. As shown in urodynamic tests, urinary continence is preserved.