Urethral Stricture Surgery Research Articles

Surgery For Bulbous Urethral Strictures In Boys - What Is The Optimal Surgical Strategy?

PURPOSE Optimal management of bulbous urethral strictures in children is poorly defined. We compared our long-term experience with direct vision internal urethrotomy (DVIU) and open repair with the objective of defining optimal surgical strategy. MATERIAL AND METHODS Sixty-three patients who had undergone DVIU or open repair were reviewed. Forty-six (73%) were treated with one or more DVIU's. Seventeen (27%) had urethroplasty, 13 end to end and 4 patch graft or tube. Eight of the 17 required urethroplasty only, whereas 9 had a combined approach of open and DVIU. Mean patient age was 14.1 years (range: 5 months to 21 years). Follow-up assessment entailed either VCUG, RUG, cystoscopy or flow rate or a combination. Mean follow-up was 30 months for those undergoing DVIU and 16 months for those having open urethroplasty. RESULTS When DVIU was the initial approach, one procedure was successful in 53% (28/53). Multiple DVIU's increased the success rate to 59% (43/73). Patients undergoing an initial DVIU required a mean of 1.6 procedures (84/53). When open repair was the initial approach one procedure was successful in 80% (8/10). This group required a mean of 1.2 procedures (12/10). A combined (DVIU/open) approach was successful in 78% (7/9). CONCLUSIONS Open reconstruction is more successful than DVIU as an initial approach to bulbous urethral strictures. Initial DVIU is successful in half. Repeat DVIU's add little to success. Success with a combined approach (DVIU/open) approximates that of initial open reconstruction. We advocate only one initial attempt DVIU followed by open urethroplasty, if necessary.

Suprapubic electroresection of prostate in three patients with benign prostatic hyperplasia and previous surgery for long urethral stricture

The treatment of patients presenting with severe symptoms of obstruction due to benign prostatic hyperplasia and a history of previous surgery for long urethral stricture is still a matter of discussion. We report on 3 patients in whom resection of the prostate was performed using a dilated cystostomy approach under spinal anesthesia. All men had undergone dorsal onlay urethroplasty for long urethral stricture before prostate resection. The good outcome demonstrated the feasibility and safety of prostate resection using a suprapubic approach, which may become a treatment option in this group of patients.

Long-term Results of Surgery For Urethral Stricture: A Statistical Analysis

We assessed the long-term results of surgery for urethral stricture by statistical methods using guidelines for survival analysis. Of the 267 patients who underwent surgery for urethral strictures between March 1993 and December 1999, 238 (89%) were followed prospectively. The primary end point was success rate of urethroplasty. Secondary end points were variables that might influence success rates. Survival data were analyzed by the Kaplan-Meier method and Cox regression using guidelines for survival analysis. The success rate of all urethroplasties was 82% (95% CI 66 to 89) at 7.5 years. A 6.5-year success rate of 86% (95% CI 70 to 95) was achieved by flap, of 86% (95% CI 66 to 100) by anastomotic, of 79% (95% CI 64 to 94) by mesh graft and of 56% (95% CI 20 to 100) by graft urethroplasty. No significant difference was found among the surgical procedures using the log rank (p = 0.269) or Gehan-Wilcoxon (p = 0.259) test. Multivariate analysis showed an increased risk of failed urethroplasty in patients previously treated with urethral stents (HR 3.69, 95% CI 1.27 to 10.8) and by 2 or more urethrotomies (HR 2.25, 95% CI 1.05 to 4.8). Using standardized success criteria and statistical methods that applied guidelines for survival analysis conclusions were drawn. Excellent results are achievable by all forms of urethroplasty, justifying a more liberal indication for urethral reconstruction.

Patient Satisfaction With the Outcome of Surgery for Urethral Stricture

We assessed patient satisfaction with the outcome of surgery for urethral strictures and compared it with objective clinical data. A total of 267 consecutive patients who underwent surgery for urethral stricture between March 1993 and December 1999 were questioned regarding satisfaction. Mailed questionnaires or a telephone interview, if questionnaires were not returned, provided information on the urinary tract, voiding, sexual function, overall satisfaction and miscellaneous impairments after surgery for urethral strictures. The response rate was 87% (233 of 267 patients). Subjective data were compared with objective clinical findings. Of the 203 patients who underwent successful urethroplasty 159 (78%) and 24 of the 30 (80%) in whom urethroplasty was considered a failure from the physician viewpoint were satisfied or very satisfied with the outcome of urethral surgery. Patients who underwent re-intervention for complications other than re-stricture and those who complained of a weak or very weak urinary stream were considerably less satisfied. Factors influencing sexual function also had an important impact on patient satisfaction. Patients with marked or severe penile curvature, penile shortening, erection deterioration and a markedly or severely impaired sexual life were especially dissatisfied. Patients consider the outcome of surgery for urethral strictures differently than physicians. The outcome of urethroplasty should be assessed not only by objective, but also by subjective criteria. Patients need appropriate preoperative counseling. With realistic expectations most men are satisfied with surgery for urethral stricture.

Patient Satisfaction With the Outcome of Surgery for Urethral Stricture

Patient Satisfaction With the Outcome of Surgery for Urethral Stricture

Anastomotic Urethroplasty For Bulbar Urethral Stricture: Analysis Of 168 Patients

We reviewed our experience with anastomotic urethroplasty for anterior urethral stricture. A chart review revealed 168 patients 6 to 82 years old (mean age 38) with at least 6 months of followup (mean 70, range 6 to 291) after anastomotic urethroplasty. Average stricture length was 1.7 cm. Of the 168 patients stricture recurred in 8 (5%) but was managed by direct vision internal urethrotomy or a single dilation in 5, while repeat urethroplasty was required in 3 (2%). In these 3 cases extenuating circumstances included patient dislodgment of the catheter with attempts to replace it that disrupted repair, a history of urethrocutaneous fistula and periurethral abscess, and previous irradiation complicating the stricture in 1 each. Other complications were uncommon, such as transient thigh pain or numbness in 3 patients (2%), small wound dehiscence in 2 (1%), and scrotal hematoma, erectile dysfunction and self-limited pulmonary edema in 1 (less than 1%) each. Anastomotic urethroplasty for anterior stricture has a high success rate of 95%. It is technically straightforward and complications are uncommon. Cure by anastomotic urethroplasty should be strongly favored over long-term management by direct vision internal urethrotomy or dilation.

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

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

Combined Reconstructive and Prosthetic Surgery In Complicated Lower Urinary Tract Dysfunction

The combined use of the appropriate reconstructive technique and available prosthetic material was evaluated to achieve an optimal functional result in complicated lower urinary tract dysfunction. The study included 16 male and 8 female patients. Urinary dysfunction was classified into 2 main categories: 1) neuropathic and 2) nonneuropathic. Of the patients 22 underwent some form of augmentation (21) or substitution (1) cystoplasty, 24 received an artificial urinary sphincter, 2 underwent abdominoperineal urethroplasty and 2 received a permanent urethral stent. One patient underwent renal transplantation and 1 received a penile prosthesis for concurrent impotence. A total of 20 patients (83.3%) became continent, 10 void spontaneously, while 14 must empty the bladder or pouch by clean intermittent self-catheterization. All patients have stable or improved renal function. Combined reconstructive and prosthetic surgery has an important role in the treatment of lower urinary tract dysfunction, with a high success rate and good quality of life.

Posttraumatic posterior urethral stricture repair: anatomy, surgical approach and long-term results.

We describe the anatomy, surgical approach and long-term results of posterior urethral stricture repair. Between 1975 and 1991, 86 patients underwent surgery for posttraumatic posterior urethral stricture. In 65 patients the urethral lesion was corrected by 1-stage reconstructive surgery via the perineal approach. In 21 patients the urethra was reconstructed with a 2-stage procedure. In an anatomical study the course of the urethra through the pelvic floor was investigated and the concomitant structures were dissected. According to the anatomy a perineal approach was used in 7 male adult cadavers. Due to the optimized anastomotic technique urinary flow rates of more than 20 ml. per second could be achieved in 29 of all 42 patients followed. Only 6 of these patients had peak urinary flow rates of less than 15 ml. per second. No patient had any recurrent strictures at the anastomotic site that would have required surgical revision. Our results suggest that adequate primary care and the perineal approach combined with an exact anastomosis technique are essential for successful treatment of posttraumatic strictures of the posterior urethra.

Analysis of Factors Contributing to Success or Failure of 1-Stage Urethroplasty for Urethral Stricture Disease

We reviewed charts with adequate documentation and followup (mean 24.6 months) between 1970 and 1987 of 110 patients who had undergone 1-stage urethroplasty for urethral stricture disease at our institutions. Two age peaks were observed, 1 in the younger population (21 to 30 years old) with traumatic strictures (50% of all strictures) and 1 in elderly men (61 to 70 years old) with mainly post-inflammatory strictures (28.2% of all strictures). The majority of all strictures (63.6%) were in the bulbous urethra. Only strictures induced by trauma were located in the membranous urethra (total 28.2%). A patch graft repair was used in 49.1% of all cases, an end-to-end technique in 29.1% and a transpubic repair in 21.8%. Overall, a 57% rate of excellent results was observed with 24% failures. The results were best for patch graft repairs (65% excellent), followed by end-to-end repairs (56% excellent) and transpubic repairs (42% excellent). The choice of the surgical approach in urethral stricture surgery is dictated by the location of the stricture. The location in turn is dependent on the etiology of the stricture. Consequently, the cause of the stricture affects the location and character of the stricture and, therefore, has an immediate impact on the choice of the surgical approach and, thus, the outcome of the patient. The failure rate doubled overall when the patients had a previous manipulation for the stricture disease or if the urine was infected preoperatively despite antibiotic coverage. While our patient population may not be representative for other institutions, some general conclusions regarding proper management and treatment selection can be drawn from our experience.

251 - Laser Surgery for Urethral Strictures

No AccessJournal of Urology1 Jun 1987Laser Surgery for Urethral Strictures Sanford Luria and Robert Shapiro Sanford LuriaSanford Luria More articles by this author and Robert ShapiroRobert Shapiro More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)75401-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Laser Surgery for Urethral Strictures." The Journal of Urology, 137(6), p. 166A © 1987 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 137Issue 6June 1987Page: 166A Advertisement Copyright & Permissions© 1987 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Sanford Luria More articles by this author Robert Shapiro More articles by this author Expand All Advertisement PDF downloadLoading ...

Transurethral laser surgery for urethral stricture

Transurethral laser surgery for urethral stricture

Turner-Warwick urethroplasty and urethral stricture Results in 60 patients

Sixty patients with urethral strictures at the bulbous and membranous levels were treated with Turner-Warwick urethroplasty. Initially, there were significant difficulties with restenosis of either the proximal or distal stoma following the first-stage urethroplasty. Use of nitrofurazonehydrocortisone (Furacin-Hc) urethral suppositories practically eliminated recurrent stomal stenosis after the first stage. Several additional modifications were made in the original technique; these included placement of urethral sutures prior to scrotal mobilization and abandonment of the suprapubic cystotomy for drainage at the second stage of the procedure. These modifications increased the chances of achieving a successful result while facilitating the actual surgery and improving the patients' comfort. The over-all success rate was approximately 90 per cent. Patients with urethral stricture surgery subsequent to prostatectomy had problems with urinary control, but not so if prostatectomy was done after the first stage of urethroplasty. It appears that the Turner-Warwick urethroplasty is a good one, and predictably good results can be expected on selected patients with urethral strictures.