Posterior Urethral Research Articles

SECONDARY BLADDER NECK OBSTRUCTION IN BOYS WITH A HISTORY OF POSTERIOR URETHRAL VALVE: REVISITED

You have accessJournal of Urology1 Apr 2009SECONDARY BLADDER NECK OBSTRUCTION IN BOYS WITH A HISTORY OF POSTERIOR URETHRAL VALVE: REVISITED Andrew J Combs, Mark Horowitz, and Kenneth I. Glassberg Andrew J CombsAndrew J Combs More articles by this author , Mark HorowitzMark Horowitz More articles by this author , and Kenneth I. GlassbergKenneth I. Glassberg More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(09)60490-0AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "SECONDARY BLADDER NECK OBSTRUCTION IN BOYS WITH A HISTORY OF POSTERIOR URETHRAL VALVE: REVISITED." The Journal of Urology, 181(4S), p. 171 © 2009 by American Urological AssociationFiguresReferencesRelatedDetailsCited byGlassberg K and Combs A (2016) The Valve Bladder Syndrome: 35+ Years LaterJournal of Urology, VOL. 196, NO. 1, (16-17), Online publication date: 1-Jul-2016. Volume 181Issue 4SApril 2009Page: 171 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information Andrew J Combs More articles by this author Mark Horowitz More articles by this author Kenneth I. Glassberg More articles by this author Expand All Advertisement PDF downloadLoading ...

RECONSTRUCTION OF COMPLEX POSTERIOR URETHRAL AND BLADDER NECK STENOSIS AFTER PROSTATE CANCER TREATMENT

You have accessJournal of Urology1 Apr 2008RECONSTRUCTION OF COMPLEX POSTERIOR URETHRAL AND BLADDER NECK STENOSIS AFTER PROSTATE CANCER TREATMENT Bryan B Voelzke, Sean P Elliott, and Jack W McAninch Bryan B VoelzkeBryan B Voelzke More articles by this author , Sean P ElliottSean P Elliott More articles by this author , and Jack W McAninchJack W McAninch More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)60749-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "RECONSTRUCTION OF COMPLEX POSTERIOR URETHRAL AND BLADDER NECK STENOSIS AFTER PROSTATE CANCER TREATMENT." The Journal of Urology, 179(4S), p. 259 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 259 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Bryan B Voelzke More articles by this author Sean P Elliott More articles by this author Jack W McAninch More articles by this author Expand All Advertisement PDF downloadLoading ...

Gapometry and Anterior Urethrometry in the Repair of Posterior Urethral Defects

We determined the influence of bulbar urethral length on the anastomotic repair approach to bulboprostatic urethral distraction defects. We reviewed the medical records and radiographic studies of 120 patients 6 to 52 years old who had undergone anastomotic repair of bulboprostatic urethral gaps. Repair was accomplished by a simple perineal operation in 84 patients (group 1) and an elaborated perineal or a transpubic procedure in 36 (group 2). The length of the urethral gap and bulbar urethra was measured on preoperative urethrogram. Also, the length of the urethral gap as a fraction of bulbar urethral length (index of elastic lengthening) was calculated. Mean length of the urethral gap was 1.5 cm in group 1 vs 4.2 cm in group 2 (p <0.001). Mean bulbar urethral length was 7.3 cm in group 1 vs 6.6 cm in group 2 (p >0.05). The mean index of elastic lengthening was 0.21 (range 0.06 to 0.34) in group 1 vs 0.64 (range 0.38 to 0.88) in group 2 (p <0.001). The difference in the mean length of the urethral gap between children and adults in the 2 groups was not statistically significant (2.4 vs 2.5 cm, p >0.05), while the difference in the mean length of the bulbar urethra was highly significant (5.6 vs 7.7 cm, p <0.001). Bulboprostatic urethral gaps shorter than a third of bulbar urethral length are usually corrected by a simple perineal operation. For longer gaps an elaborated perineal or transpubic procedure is usually done. Also, the latter 2 procedures are more commonly performed in children than in adults because of the shorter bulbar urethra.

Simplified Reconstruction of Traumatic Posterior Urethral Defects

Simplified Reconstruction of Traumatic Posterior Urethral Defects

URETHROPLASTY IN POSTERIOR URETHRAL INJURIES

URETHROPLASTY IN POSTERIOR URETHRAL INJURIES SABAH A. AI-Kadi & SAFAA A. Mohssin Department of Urology, University of Baghdad, Iraq. Abstract To assess the efficacy of urethroplasy (excision with end to end anastomosis) in posterior urethral injuries. Fifteen patients with complete urethra! disruption were treated by this method and followed with objectives and subjectives parameters for 2 years. The results are graded into 3 grades (excellent, satisfactory and poor) according to continence and flow rate of urine, 80% of cases have stricture (>2 cm) in length. Those patients who are treated with perineal approach result in (92%) excellent, in comparison to those with transpubic urethroplasty who give only (50%) excellent results. Patients with no history of urethral handling give (100%) excellent results, while only (25%) excellent results in patients with previous urethral surgical intervention. Urethroplasty is the best method for repairing completely obliterated strictures. Intraoperative endoscopic checking of posterior urethra is important to avoid fistulous tracts. Dilatation and urethrotomy may be used as complementary procedures to urethroplasty. Pubectomy sometimes necessary in complicated cases.

Management of Severe Urethral Complications of Prostate Cancer Therapy

We present our management of urethral stenosis and rectourinary fistula resulting from prostate cancer therapy. We concentrated on cases refractory to minimally invasive treatment, such as dilation, urethrotomy, and urinary and/or fecal diversion. In our prospectively collected urethral reconstruction database we identified patients who underwent reconstruction of urethral stenosis or rectourinary fistula who also received prior treatment for prostate cancer. We documented demographics, prostate cancer pretreatment characteristics, prostate cancer therapy type, urethral reconstruction type and success. A total of 48 patients met the inclusion criteria, including 16 with rectourinary fistula and 32 with urethral stenosis. Urethral complications followed prior radical prostatectomy, brachytherapy, external beam radiotherapy, cryotherapy, thermal ablation and any combination of these procedures. Stenosis repair was successful in 23 of 32 cases (73%) and it differed little between anterior and posterior urethral stenosis. Repair was accomplished by anastomotic urethroplasty in 19 cases, flap urethroplasty in 2, perineal urethrostomy in 2 and a urethral stent in 9. Prior external beam radiotherapy was a risk factor for urethral reconstruction failure. Fistula repair was successful in 14 of 15 patients (93%), excluding 1 who died postoperatively. The complexity of fistula management was dictated by fistula size and the presence or absence of coincident urethral stenosis. Urethral stenosis or rectourethral fistula following prostate cancer therapy can be managed by urethral reconstruction, such that normal voiding via the urethra is maintained, rather than abandoning the urethral outlet and performing heterotopic diversion. This can be accomplished with an acceptable rate of failure, given the complexity of the cases.

BOYS WITH POSTERIOR URETHRAL VALVES: OUTCOME CONCERNING RENAL FUNCTION, BLADDER FUNCTION AND PATERNITY AT AGES 31 TO 44 YEARS

The short-term prognosis for boys with posterior urethral valves (PUV) has improved in recent decades, but the long-term prognosis in terms of renal and bladder function and fertility is still a matter of great concern. This study is a followup of boys with PUV and dilated upper urinary tract treated in 1956 to 1970 at the Children's Hospital in Göteborg, Sweden. The records of 54 boys treated for PUV were reviewed. Of 27 boys with PUV and upper urinary tract dilation, 5 boys (18%) died at an early age and 3 boys were lost to followup during adolescence, leaving 19 to be included in the followup. They all answered a questionnaire about renal and bladder function and paternity. Of the 19 men 32% were uremic, 21% had moderate renal failure and 47% had not been checked since adolescence. There were signs of bladder dysfunction in 40% and all these subjects had bladder symptoms suggesting detrusor weakness as the cause. All the men were continent. The ability to father children was dependent on whether or not the man was uremic. This long-term followup study emphasizes the importance of checking renal and bladder function throughout life in men born with PUV. Increasing attention to bladder dysfunction and its early treatment could probably improve the long-term prognosis.

LONG-TERM BLADDER DYSFUNCTION AND RENAL FUNCTION IN BOYS WITH POSTERIOR URETHRAL VALVES BASED ON URODYNAMIC FINDINGS

Posterior urethral valves are the most common cause of congenital obstructive uropathy leading to renal failure in childhood. We investigate the influence of bladder dysfunction on renal function impairment. We retrospectively reviewed the records of 116 patients with posterior urethral valves. After valve ablation urodynamic studies were performed in all patients. The presence of vesicoureteral reflux (VUR), renal dysplasia, serum creatinine during followup as well as urodynamic abnormalities were recorded. Mean followup was 10.3 years after valve ablation. All patients underwent endoscopic valve ablation and urinary diversion was performed in 32. Renal dysplasia was found in 9 patients. Renal function impairment at the end of followup was present in 35 patients. Urodynamic studies showed poor compliance in 30 boys, detrusor overactivity in 44, and poor compliance and detrusor overactivity in 17. Bilateral VUR was found in 17 boys at the time of diagnosis. Urodynamic studies were normal in 23 (20%) patients, of whom 4 had renal failure. Univariate analysis showed that poor compliance and detrusor overactivity had a significant correlation to renal function impairment in addition to bilateral VUR and renal dysplasia. In a multivariate analysis bilateral VUR was an independent prognostic factor for poor prognosis. Bladder dysfunction may contribute to renal function impairment eventually but normal urodynamic findings do not preclude renal deterioration. It is likely that loss of compliance and detrusor overactivity would actually result in a valve bladder reaching its end point function.

CONGENITAL POSTERIOR URETHRAL MEMBRANE: VARIABLE MORPHOLOGICAL EXPRESSION

We assessed the variable morphological expression of posterior urethral membrane by reviewing video recorded cystoscopy. Between December 1990 and July 2000, 86 males newborn to 15 years old undergoing cystoscopy for urethral anomalies were identified with a posterior urethral membrane. Recorded cystoscopy was reviewed and membrane degree was graded as minimal, moderate or severe. Of the 86 boys with a membranous lesion in the posterior urethra the condition was considered severe in 40, moderate in 21 and minimal in 21. Four patients on whom data were too inadequately recorded to be properly classified were excluded from study. This study demonstrates that congenital posterior urethral membrane represents a spectrum of lesions and may vary in the degree of obstruction.

DOES NEONATAL PYELOURETEROSTOMY WORSEN BLADDER FUNCTION IN CHILDREN WITH POSTERIOR URETHRAL VALVES?

DOES NEONATAL PYELOURETEROSTOMY WORSEN BLADDER FUNCTION IN CHILDREN WITH POSTERIOR URETHRAL VALVES?

TEMPORARY HIGH DIVERSION FOR POSTERIOR URETHRAL VALVES

Temporary high diversion for posterior urethral valves remains controversial. Even in the most severe cases some physicians deny the efficacy of this treatment. They assert that high diversion does not change the outcome of kidney function and has an iatrogenic, deleterious effect on the bladder. We believe that these 2 assertions may be inaccurate. We evaluated 17 of 120 boys with posterior urethral valves who underwent temporary high diversion via Sober-en-T ureterostomy. This procedure immediately decompresses the upper urinary tract and leaves the bladder functional. Mean duration of diversion was 13 months. Bladder function results were good and diversion clearly had no deleterious effect. However, our series was too small to conclude with certainty that renal function improved due to diversion and not to valve resection only. Rapid improvement in creatinine was noted in all cases after diversion. In this study we reviewed opposing opinions. It appears clearly evident that physicians who believe that ureterostomy creates a valve bladder are considering only loop diversion, which temporarily defunctionalizes the bladder. On the contrary, Sober-en-T diversion preserves bladder cycling. In addition, those who report poor kidney function after high diversion fail to mention that this procedure is usually performed only in the most severe cases. For severe cases of posterior urethral valves one should not hesitate to create temporary high diversion, which may possibly improve renal function. Sober-en-T ureterostomy does not damage the bladder.

Urethral calculi in children

Sixty patients diagnosed to have urethral calculi in Diyarbakir State Hospital Department of Pediatric Surgery were evaluated retrospectively to determine factors influencing the clinical picture and treatment. All the patients were boys. Pain in the penis and retracting of the penis by the patient himself were most common symptoms. The patients with posterior urethral calculi had continuous urinary dribbling, and those with anterior urethral calculi had acute urinary retention. At the time of initial admittance, the calculi were posterior urethral in 10 cases, bulbous in 13, penile in 20, and external urethral meatal in 17. The 10 calculi located in the posterior urethra and four located in the bulbous urethra were manipulated retrogradely into the bladder. Forty-two calculi were extracted through the external urethral meatus. However, a calculus required urethrotomy, and other calculi required extraction trough a urethracutaneous fistula. The mode of clinical presentation and treatment in children with urinary calculi depends on localization. Localization is determined by the shape and diameter of the calculi.

Endoscopic Treatment of Posttraumatic Urethral Obliteration: Experience in 396 Patients

Of 396 patients with posttraumatic posterior urethral strictures treated endoscopically during 10 years 352 had no vesical displacement (group 1) and 44 had marked displacement (group 2). Group 1 patients were treated by suprapubic diversion and delayed optical urethrotomy. Exploration and railroad alignment to the urethra were done in group 2 and followup internal urethrotomy was performed in 33 patients. Eleven patients in group 2 and 68 in group 1 were considered failures due to complete short segment urethral obliteration. These 79 patients who failed initial visual urethrotomy underwent endoscopic resection of the stricture, that is core through optical urethrotomy. After 6 to 55 months (average 2 years) 46 patients (58.2%) were voiding satisfactorily (4 had stress incontinence). The 33 patients (41.8%) with failed minor or major endoscopic treatment due to persistent obstruction were treated with open urethroplasty. We conclude that posttraumatic posterior urethral obliteration can be treated by simple or major endoscopic techniques and that core through optical urethrotomy is a reasonable alternative to urethroplasty in patients with an impassable short stricture.

Magnetic Resonance Imaging of Traumatic Posterior Urethral Defects and Pelvic Crush Injuries

A total of 18 patients 4 to 71 years old with complete occlusion of the prostatomembranous urethra from pelvic crush injury underwent magnetic resonance imaging (MRI) of the pelvis just before open urethroplasty. MRI studies included T2-weighted sagittal and coronal images as well as transaxial T1 and T2-weighted spin-echo images. Operative findings and erectile function were correlated with MRI findings. All patients underwent conventional cystography and retrograde urethrography. The mean interval from injury to operation was 5.5 months (range 3 to 12 months) and followup averaged 12 months (range 3 to 40 months).Posttraumatic pelvic anatomy can be distorted and imaging in all 3 planes was needed. The severity and direction of prostatourethral dislocation, and the length of the urethral defect could be accurately determined, which often is not possible with conventional radiographic studies. MRI also demonstrated injuries at many locations along the erectile pathway, including sacral and ischial fractures as well as fractures and avulsions of the cavernous bodies. Pelvic MRI can accurately define the pelvic anatomy after crush injury and, therefore, it can provide useful preoperative information that cannot be obtained by conventional radiographic studies. Our results correlating MRI findings of cavernous avulsion with clinical impotence require further study.

Repair of Pelvic Fracture Posterior Urethral Defects Using an Elaborated Perineal Approach: Experience with 74 Cases

A total of 74 patients with posterior urethral distraction defects (1.5 to 7cm. long) that followed pelvic fracture was managed by a 1-stage perineal repair. End-to-end anastomosis was performed in all cases but in 66 a variety of surgical maneuvers were necessary to accomplish a tension-free anastomosis. These techniques, which included distal urethral mobilization, corporeal body separation, inferior pubectomy and supracrural urethral rerouting, were resorted to in a sequential manner as needed. Excellent results were achieved in 96% of the cases. These surgical techniques are described and discussed.

POSTERIOR URETHRAL VALVE Problems in management of the Upper Urinary Tract

SUMMARY Our experience with posterior urethral valve in 32 cases, with emphasis on problems in the management of the upper urinary tract is reported.