Treatment Of Posterior Urethral Stricture Research Articles

The use of a modified tanagho flap in the repair of posterior urethral stricture after primary exstrophy closure

In patients with classic bladder exstrophy (CBE), posterior urethral strictures after primary bladder closure can be difficult to manage and therefore necessitate alternative techniques in reconstruction of the proximal urethra. There is a paucity of literature describing treatment and management of posterior urethral stricture arising after repair of classic bladder exstrophy. To describe the technique of a bladder neck reconstruction (BNR) with a modified Tanagho anterior detrusor flap in the treatment of posterior urethral stricture arising after repair of classic bladder exstrophy. A prospectively maintained, IRB-approved database of 1401 exstrophy-epispadias patients was reviewed for patients who underwent bladder neck or proximal urethral reconstruction with modified Tanagho flap for proximal urethral stricture disease from the time period of 1975-2021. A total of 5 patients (1 female and 4 males) with classic bladder exstrophy who underwent proximal urethral reconstruction with modified Tanagho flap were identified. Of these 5 patients, the 1 female patient was treated for ongoing incontinence, not posterior urethral stricture, and was thus excluded from this report. Outcomes measured included post operative bladder capacity, post-operative continence status, upper urinary tract status, and stricture recurrence. Four male patients with CBE were treated for posterior urethral strictures and are reviewed here. Three patients underwent successful primary closure (1 via modern staged repair of exstrophy (MSRE) and 2 via complete primary repair of exstrophy (CPRE)), and 1 patient (MSRE) required repeat closure at the time of stricture repair. Mean age at BNR Tanagho flap was 3.8 (range 2.3-5.0) years. All patients remained stricture free with post-operative urinary incontinence; 2 patients underwent subsequent elective bladder neck transection to achieve continence. Mean follow up 9.9 (range 2.1-15.6) years. All 4 patients had excellent long term success rates, comparable to results reported in several adult studies utilizing a modified Tanagho flap in women with post-traumatic bladder neck contractures. In addition, our technique described here shares similarities with both the originally described Tanagho flap as well as with a dorsal onlay graft urethroplasty. In this limited series, modified Tanagho flap reconstruction is effective in treating posterior urethral stricture disease in CBE. This technique adds a valuable adjunct to the armamentarium of surgical options for this difficult to manage condition.

V80 - Transperineal prerectal approach for the treatment of posterior urethral stricture after radical prostatectomy

V80 - Transperineal prerectal approach for the treatment of posterior urethral stricture after radical prostatectomy

Urosymphyseal Fistulas Resulting From Endoscopic Treatment of Radiation-induced Posterior Urethral Strictures

To describe the inciting events leading to urosymphyseal fistulas (UFs) and pubic osteomyelitis (PO) in patients who had radiation-induced urethral strictures. We retrospectively reviewed patients who underwent simultaneous pubic debridement, simple cystectomy, and urinary diversion for refractory UF and PO from 2014 to 2016. We investigated inciting events leading to UF, as well as patient presenting symptoms, diagnosis, management, and outcomes. Five patients were identified over a 2-year period. All patients had a previous history of radiation for prostate cancer. The median age was 67 years. All patients developed UF and PO after endoscopic intervention for urethral stricture. The number of endoscopic interventions per patient for stricture ranged from 1 to 7, including serial dilation, balloon dilation, and urethrotomy. Sterile urine cultures were obtained before all endoscopic interventions. All patients had pelvic pain with ambulation and recurrent urinary tract infections at presentation. Patients were diagnosed using a combination of retrograde urethrography and magnetic resonance imaging. Simultaneous pubic debridement with simple cystectomy and diversion was used for management in all cases. One patient died postoperatively with the remainder recovering well without PO or fistula recurrence, with a median follow-up of 16 months. UF can occur as a complication of endoscopic treatment of posterior urethral stricture in patients with a history of radiation therapy for prostate cancer. This study demonstrates that UF and PO may develop even with minimally traumatic procedures and sterile urine. All patients treated for posterior stricture must be considered at risk of development of fistulas and osteomyelitis.

Preliminary clinical study on non-transecting anastomotic bulbomembranous urethroplasty.

This study aims to investigate the effect of non-transecting anastomotic urethroplasty for treatment of posterior urethral stricture. A total of 23 patients with traumatic posterior urethral stricture were enrolled and then divided into two groups. In one group, 12 patients underwent non-transecting anastomotic urethroplasty. In the other group, 11 patients underwent conventional posterior urethra end-to-end anastomosis. The effect of operation was evaluated using the following parameters: the bleeding amount during operation, operation time, IIEF-5 scores after operation, maximum flow rate (Qmax), and rating scale of quality of life (QoL). The comparison between the conventional posterior urethra end-to-end anastomosis group and the non-transecting anastomotic urethroplasty group showed no significant difference with regard to average operation time. However, a significant difference was observed between the groups with regard to the bleeding amount during operation. The patients in the group of non-transecting anastomotic urethroplasty urinated smoothly after the removal of catheter. Meanwhile, one patient from the group of conventional posterior urethra end-to-end anastomosis had difficulty urinating after the removal of catheter. Furthermore, significant differences in the operation time, bleeding amount during operation, IIEF-5 scores after operation, and rating scale of QoL were observed, whereas no significant difference was observed between urine flow rates of the two groups after operation. Overall, nontransecting anastomotic urethroplasty is effective for posterior urethra reconstruction, and it can reduce the occurrence rate of erectile dysfunction after operation.

Trans-symphyseal urethroplasty in children

Post traumatic posterior urethral strictures were managed by trans-symphyseal urethroplasty in 11 male patients of pediatric age group. The aim of the study was to evaluate the results of the technique in patients who underwent multiple unsuccessful procedures in the past. Two(18.2%) patients were 3-5 years old, 3 (27.3%) were between 6 and 8 years, 1 (9.1 %)was 10 years old whereas 5(45.5%) were 12-14 years of age. The length of the strictures varied from 1-3cm. Repair was performed after excising the stricture and anastomosing the spatulated urethral ends with interrupted sutures of 5/0 vicryl over a Foley`s catheter. Post operative follow up showed incontinence in 1(9.1%) case and prolonged urinary tract infection in 4(36.4%) cases. Postoperative stricture was not noted in only one of them at I year follow up. The authors recommend that trans-symphyseal urethroplasty is a satisfactory procedure for the treatment of posterior urethral strictures in children as it provides excellent approach and visualization with minimal post operative complications.

The Selection of Procedures in One-stage Urethroplasty for Treatment of Coexisting Urethral Strictures in Anterior and Posterior Urethra

To explore selection of the procedures in one-stage urethroplasty for treatment of coexisting urethral strictures in the anterior and posterior urethra. Between 2008 and 2014, a total of 27 patients with existing strictures simultaneously at anterior urethra and posterior urethra were treated in our hospital. Two types of procedures were selected for treatment of the anterior urethral strictures. A penile skin flap and the lingual mucosa were used for augmented urethroplasty in 20 and 7 cases, respectively. Three types of procedures, namely, non-transecting end-to-end urethral anastomosis (n = 3), traditional end-to-end urethral anastomosis (n = 17), other grafts substitution urethroplasty, including pedicle scrotal skin urethroplasty (n = 2), and lingual mucosal graft urethroplasty (n = 5), were utilized in the treatment of posterior urethral strictures. The patients were mean followed up 30 months with an overall success rate of 88.9%. The majority of the patients exhibited wide patent urethras on retrograde urethrography and the patients' urinary peak flow ranged from 14.2 to 37.9 ml/s. Complications developed in 3 patients (11.1%). Of the 17 patients who underwent traditional urethral end-to-end anastomosis, urethral strictures occurred in 2 patients at 4 and 6 months after the operation. These patients achieved a satisfactory voiding function after salvage pedicle scrotal skin urethroplasty. A urethral pseudodiverticulum was observed in another patient 9 months after pedicle penile flap urethroplasty; and after a salvage procedure, he regained excellent voiding function. Synchronous anterior and posterior strictures can be successfully reconstructed with a combination of substitution and anastomotic urethroplasty techniques.

Bipolar plasma vaporization using plasma-cutting and plasma-loop electrodes versus cold-knife transurethral incision for the treatment of posterior urethral stricture: a prospective, randomized study

OBJECTIVE:Evaluate the efficiency and safety of bipolar plasma vaporization using plasma-cutting and plasma-loop electrodes for the treatment of posterior urethral stricture. Compare the outcomes following bipolar plasma vaporization with conventional cold-knife urethrotomy.METHODS:A randomized trial was performed to compare patient outcomes from the bipolar and cold-knife groups. All patients were assessed at 6 and 12 months postoperatively via urethrography and uroflowmetry. At the end of the first postoperative year, ureteroscopy was performed to evaluate the efficacy of the procedure. The mean follow-up time was 13.9 months (range: 12 to 21 months). If re-stenosis was not identified by both urethrography and ureteroscopy, the procedure was considered “successful”.RESULTS:Fifty-three male patients with posterior urethral strictures were selected and randomly divided into two groups: bipolar group (n=27) or cold-knife group (n=26). Patients in the bipolar group experienced a shorter operative time compared to the cold-knife group (23.45±7.64 hours vs 33.45±5.45 hours, respectively). The 12-month postoperative Qmax was faster in the bipolar group than in the cold-knife group (15.54±2.78 ml/sec vs 18.25±2.12 ml/sec, respectively). In the bipolar group, the recurrence-free rate was 81.5% at a mean follow-up time of 13.9 months. In the cold-knife group, the recurrence-free rate was 53.8%.CONCLUSIONS:The application of bipolar plasma-cutting and plasma-loop electrodes for the management of urethral stricture disease is a safe and reliable method that minimizes the morbidity of urethral stricture resection. The advantages include a lower recurrence rate and shorter operative time compared to the cold-knife technique.

The efficacy of non-transecting spongiosum end to end anastomosis of urethra for treatment of posterior urethral stricture

Objective To report preliminary experiences with a novel procedure of end-to-end anastomotic repairment of posterior urethral strictures. Methods From January 2011 to December 2014, a total of 26 patients with posterior urethral strictures(2 patients with exist simultaneously anterior urethral stricture)were treated. The mean age was 43 years (rang 13-83 years). The etiology of urethral strictures were trauma in 23 patients and iatrogenic causes in 3 patients. The mean length of urethral stricture was 2 cm (rang 1-3 cm). Suprapubic cystostomies were performed in all 26 patients. All patients accepted the non-transecting spongiosum bulbar-membranous end to end anastomosis. During the operation, the perineal incision was made. The dorsal stricture urethra was incised, extending to the 1.5 cm normal urethra at each side. Then, the interrupted end to end suture was performed with 3-0 absorbable suture. Results The mean surgical time was 55 minutes in 24 patients(45-65 minutes). There was no evidence of wound infection or urethrocutaneous fistula during perioperation period. The mean follow-up time for 26 patients were 16 months(4 months-3 years). There was no recurrent stricture on symptomatic assessment or uroflowmetry. The patients voided well with mean peak flows rate 25.4 ml/s (16.8-59.1 ml/s). Urethrography showed that each patient had a patent urethra with adequate lumen. Conclusions Non-transecting spongiosum end to end anastomosis of urethra technique could retain spongiosal blood support. In present preliminary study, it appears to give similar results as those of traditional anastomotic urethroplasty. Key words: Posterior urethral stricture; Urethral reconstruction; Non-transecting corpus spongiosum

MP29-14 MANAGEMENT OF PUBIC OSTEOMYELITIS FOLLOWING RADIATION THERAPY FOR PROSTATE CANCER

You have accessJournal of UrologyTrauma/Reconstruction: Ureter, Bladder, External Genitalia and Urotrauma II1 Apr 2015MP29-14 MANAGEMENT OF PUBIC OSTEOMYELITIS FOLLOWING RADIATION THERAPY FOR PROSTATE CANCER McCabe C. Kenny, Andrew P. Windsperger, Brian J. Flynn, and Ty T. Higuchi McCabe C. KennyMcCabe C. Kenny More articles by this author , Andrew P. WindspergerAndrew P. Windsperger More articles by this author , Brian J. FlynnBrian J. Flynn More articles by this author , and Ty T. HiguchiTy T. Higuchi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.617AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pubic osteomyelitis (PO) is a rare condition and has been reported following surgery, radiation, and cryotherapy for prostate cancer. PO can cause significant morbidity and few studies have described the optimal treatment of this devastating condition. We describe our experience with management of pubic osteomyelitis following radiation therapy for prostate cancer. METHODS We retrospectively reviewed patients presenting with PO and a history of radiation therapy for prostate cancer from 2012-2014. PO was diagnosed with physical examination, elevated C-reactive protein (CRP), and CT or MRI. We recorded patient demographics, prostate cancer treatment history, urinary history, labs, imaging results, management, and outcomes. RESULTS Eight patients met study criteria and all patients had biopsy confirmed prostate cancer. Prostate cancer treatment included; prostatectomy with adjuvant external beam radiation (XRT) (n=4), XRT alone (2), XRT with adjuvant brachytherapy (1) and brachytherapy alone (1). Median time from last radiation dose to PO was 12 years (range 6-23). All patients had radiographic evidence of PO, pubic pain, waddling gait, and elevated CRP (range 1.3-132.1). Six patients had a history of posterior urethral stricture and underwent transurethral treatment (range 1-3 procedures) and 7 patients required chronic oral pain medications for pubic pain. Pubocutaneous fistula was present in 6 patients. Primary surgical management included cystectomy and diversion with concomitant orthopedic pubectomy and omental flap in four patients. Three patients had previously undergone urinary diversion and presented with persistent symptoms that were managed by pubectomy with gracilis flap (n=2) and hemipelvectomy (n=1). One patient was not a surgical candidate and was managed with bilateral nephrostomy tubes and suppressive antibiotics. Six of the seven surgical patients were continued on 6 weeks of IV antibiotics. Median follow up in the surgical patients is 7 months (range 1-30) and all surgical patients have had improvement in their pubic pain. One patient developed a recurrent fistula (rectal to urethral stump) while one patient died from an unrelated cause. CONCLUSIONS PO is a devastating condition that presents with pubic pain, waddling gait, and elevated CRP. A majority of patients had transurethral treatment of posterior urethral stricture that may seed the pubic bone with urine inciting the inflammatory process. Surgical removal of the urinary system in combination with pubic debridement and long term antibiotic appears to be a treatment option. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e344 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information McCabe C. Kenny More articles by this author Andrew P. Windsperger More articles by this author Brian J. Flynn More articles by this author Ty T. Higuchi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Surgical repair of the iatrogenic falsepassage in the treatment of trauma-induced posterior urethral injuries

Pelvic fracture associated urethral injury (PFAUI) is a rare and challenging sequel of blunt pelvic trauma. Treatment of iatrogenic false urethral passage (FUP) remains as a challenge for urologists. In this case report we reviewed the iatrogenic FUP caused by wrong procedures performed in the treatment of a patient with PFAUI and the treatment of posterior urethral stricture with transperineal bulbo-prostatic anatomic urethroplasty in the management of FUP. A 37-year-old male patient with PFAUI had undergone a laparotomy procedure for pelvic bone fracture, complete urethral rupture, and bladder perforation 8 years ago. After stricture formation, patient had undergone procedures that caused FUP. Following operations, he had a low urinary flow rate, and incontinence and urgency even with small amounts of urine. FUP was diagnosed by voiding cystourethrography and retrograde urethrography. FUP was fixed with open urethroplasty with the guidance of flexible antegrade urethtoscopy. False passage should always be taken into account in the differential diagnosis of patients with persistent symptoms that underwent PFAUI therapy. In addition, we believe that in the evaluation of patients with PFAUI suspected for having a false passage, bladder neck and urethra should be assessed by combining routine voiding cystourethrography and retrograde urethrography with preoperative flexible cystoscopy via suprapubic route.

Effect of modified Badenoch operation on the treatment of posterior urethral stricture

To determine the effects of modified pull-through operation (Badenoch operation) on the treatment of posterior urethral stricture. From September 2001 to December 2010 traditional pull-through operation was Modified for two times in our center. A total of 129 patients with posttraumatic posterior urethral stricture resulting from pelvic fracture injury underwent the modified urethral pull-through operation. Stricture length was 1.5 to 5.3 cm (mean 2.9 cm). Of the patients 43 had undergone at least 1 previous failed management for stricture. In phase 1 (from September 2001 to January 2008), the improving items include: (1) The distal urethral end was stitched and tied to the catheter. (2) As catheter was inserted into bladder and 20 ml water was injected into catheter balloon, the distal urethral end was fixed in the proximal urethra and an overlaying of 1.5 cm was formed between the two ends. (3) Three weeks later, it was tried to insert the catheter to bladder. After the urethral stump necrosis and the catheter separating from the urethra, the catheter was removed. In phase 2 (from February 2008 to December 2010), based on the above, irrigating catheter was used. After the surgery, urethra was irrigated with 0.02% furacillin solution through the catheter 3 times a day. All patients were followed up for at least 6 months. If patients had no conscious dysuria and maximum urinary flow rate (Qmax) > 15 ml/s, the treatment was considered successful. All complications were recorded. In phase 1, the 96 patients (101 times) underwent the procedure. The treatment was successful in 88 patients (success rate 92%). Within 1 to 13 days after removal of the catheter, urethral stricture was recurred in 8 patients. They had to undergo cystostomy once more for 3 to 11 months before reoperation (the 3 patients' reoperation was in phase 2). The 8 cases were treated successfully. In phase 2, 33 patients (total 36 times) underwent the procedure. One patient was failed (success rate 97%). The actual follow-up time is 7 to 93 months (An average of 37.6 months). Qmax is (22 ± 5) ml/s. No complications such as urinary incontinence, erectile pain, urinary shortening happened. The modified urethral pull-through operation is effective for the surgical treatment of posttraumatic posterior urethral stricture. It has a high success rate with durable long-term results. Complications are few. The procedure is simple, less demanding and especially suitable in patients who had previously undergone failed surgical treatments.

POD-12.04: Diagnosis and Treatment of Posterior Urethral Stricture: A Twenty-Year Clinical Experience

POD-12.04: Diagnosis and Treatment of Posterior Urethral Stricture: A Twenty-Year Clinical Experience

Two-Stage Transperineal Management of Posterior Urethral Strictures or Bladder Neck Contractures Associated with Urinary Incontinence after Prostate Surgery and Endoscopic Treatment Failures

ObjectivesThe treatment of posterior urethral strictures or bladder neck contracture associated with severe urinary incontinence after prostate surgery and failure of endoscopic treatments is controversial. We report our experience with a transperineal approach in two steps: end-to-end urethroplasty/anastomosis and subsequent artificial urinary sphincter implantation. MethodsBetween September 2001 and January 2005, we observed six patients (58–68 yr old), with a combination of severe urinary incontinence and posterior urethral stricture with anastomotic bladder neck contracture after prostate surgery. In all cases, repeated endoscopic treatments of the strictures failed. The patients underwent transperineal end-to-end urethroplasty or anastomosis followed by transperineal artificial urinary sphincter placement after 6 mo. ResultsAfter the first surgical step, all patients were completely incontinent with absence of urethral strictures and complete anastomotic healing in all cases. Therefore, all patients underwent artificial urinary sphincter insertion. After a mean follow-up of 38 mo (range: 18–57 mo), five patients are continent with no postvoid residual urine and a perfectly functioning device. One artificial urinary sphincter was removed due to urethral erosion. ConclusionsIn patients with posterior urethral strictures or bladder neck contractures associated with severe urinary incontinence, an artificial urinary sphincter implantation as a second step allows verification of the outcome of a previous end-to-end urethroplasty or anastomosis and utilizes a dedicated operative field to reduce the risks of prosthesis implants.

Iatrogenic prostatic urethral strictures: classification and endoscopic treatment

Objectives. The treatment of posterior urethral strictures is a controversial subject. For proper treatment, it is important to differentiate between iatrogenic prostatic urethral strictures and post-traumatic membranous urethral strictures. Methods. Iatrogenic strictures of the prostatic urethra have been classified according to location and etiology into three categories: type I, located exclusively at the bladder neck; type II, located in the midportion of the prostatic fossa; and type III, when the whole prostatic fossa is replaced by stricture. From 1970 to 1996, 163 patients with postoperative strictures of the prostatic urethra were treated endoscopically. Results. The results obtained in 122 patients are reported; 41 patients are not evaluable. The median follow-up was 63 months (range 12 to 239). Seven patients required a second endoscopic procedure to attain cure. Good results were achieved in 54 (91%) of 59 patients with type I strictures, in 45 (98%) of 46 patients with type II strictures, and in 13 (76%) of 17 patients with type III strictures. The overall success rate was 92% (112 of 122). Complications occurred in 21 patients (17%), including postoperative urinary tract infection (11%), incontinence (4%), stress incontinence (1%), and severe bleeding (1%). Conclusions. Postoperative strictures of the prostatic urethra must be recognized and can be easily treated with endoscopic therapy.

Treatment of Posterior Urethral Strictures with a Titanium Urethral Stent

A total of 5 patients with recurrent posterior urethral strictures underwent endoscopic placement of an expandable endourethral stent made of titanium. Patient age ranged from 17 to 66 years (mean age 42.6 years). Followup ranged from 13 to 20 months (mean 14.1 months). Of the patients 4 presently have unobstructed voiding with no incontinence. To date no side effects have been directly related to the stents and no incrustations or calculi have formed. Our preliminary study supports the use of titanium urethral stents as an alternative form of treatment for selected urethral strictures.