Urethral Obliteration Research Articles

Non-invasive assessment of the dynamics of change in the vascular bed in the buccal autograph during treatment of extended urethral strictures

The male urethral stricture disease treatment despite all successful achievements and treatment options still remains one of the most actual and complex problems of modern urology. The presence of prolonged urethral strictures complicated with such factors as expressed scared deformation, infection, fistulae, previous unsuccessful urethral interventions, total urethral obliteration require the use of two- or multistage operations. In the light of recent times, the improvement methods dedicated to buccal mucosa graft adaptation assessment and autotransplant microvascularity evaluation are very relevant nowadays. In this study we made an attempt to estimate the dermatoscopy role in objective assessment of buccal mucosa graft microvascular network after two staged substitutive urethroplasty.The analysis of graft microphotos made in different time periods after urethroplasty allows us to define the main thing. In our point of view, the absence of evaluation changes after 90–120 postoperative days allows us to estimate a correct time for the second stage of urethroplasty-tubularization. stages of microvasculature evolution.Considering the statement that microvasculature evolution is the evolution of its graft, we think that the correct research direction is to study microangiogenesis stimulation methods.

Магнитно-резонансная томография в диагностике стриктуры уретры.

Introduction. In order to improve the results of surgical treatment of urethral stricture in men, it is extremely important to accurately diagnose preoperative changes. From this point of view, it seems promising to use magnetic resonance imaging (MRI) in the urethral stricture diagnosis, the assessment of which is the subject of this literature review. Materials and methods. The review is based on articles published throughout history in scientific peer-reviewed journals included in the databases PubMed (https://www.ncbi.nlm.nih.gov/pubmed/), Scopus (https://www.scopus.com/), Scientific Electronic Library eLibrary.ru (https://elibrary.ru/). The search was performed on the following keywords: «magnetic resonance imaging», «MRI», «urethral stricture», «urethral obliteration», «urethral stenosis», «urethral injury», «urethral distraction defect», «urethroplasty», «urethral reconstruction», «urethral surgery», «pelvic fracture». At the first stage, 308 sources were found, of which 23 articles were included in the review. Results. A total of 23 original studies were identified in which MRI was used for urethral stricture in men, of which 2 were Russian studies. Four studies evaluated only anterior urethral strictures, 10 studies evaluated posterior urethral strictures, and 9 studies – both anterior and posterior urethral strictures. These studies included 10 to 121 patients with urethral stricture (mean 42 patients). MRI generally provides more accurate information on the extent of the stricture, the nature of spongiofibrosis and other periurethral changes, the presence of concomitant pathology compared to traditional methods for diagnosing urethral stricture. Conclusions. MRI for urethral stricture provides additional information for treatment planning. However, given the high cost of the method and a small number of works, further research is needed to obtain sufficient grounds for the widespread clinical use of MRI in urethral stricture.

PD35-09 VESSEL-SPARING NON-TRANSECTING ANASTOMOTIC RECONSTRUCTION OF THE POSTERIOR URETHRA: LONG-TERM FOLLOW-UP

You have accessJournal of UrologyCME1 Apr 2023PD35-09 VESSEL-SPARING NON-TRANSECTING ANASTOMOTIC RECONSTRUCTION OF THE POSTERIOR URETHRA: LONG-TERM FOLLOW-UP Reynaldo Gomez, Jessica Pfeifer, Laura Velarde, and Rodrigo Campos Reynaldo GomezReynaldo Gomez More articles by this author , Jessica PfeiferJessica Pfeifer More articles by this author , Laura VelardeLaura Velarde More articles by this author , and Rodrigo CamposRodrigo Campos More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003333.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The classic transecting excision and primary anastomosis (EPA) for reconstruction of posterior urethra stenosis (PUS) entails division of the bulbar arteries. Consequently, irrigation of the spongiosum will depend on the dorsal penile arteries and retrograde flow from the glans. However, if the penile arterial blood supply is compromised, transection may result in ischemia of the bulb and failure of the reconstruction. To decrease this risk, we modified the EPA technique avoiding urethral transection to preserve the bulbar arteries. We report our long-term results with this vessel-sparing posterior EPA approach (vspEPA). METHODS: Surgical Technique. The bulbar urethra is mobilized in a non-transecting fashion by division of the triangular ligament without detachment of the bulb from the perineal body. Distal release and lateral retraction of the bulbar urethra to one side with two vessel loops provides sufficient room for scar removal and anastomosis as with the classic transecting technique. In most cases both bulbar arteries can be spared, but in front of severe local fibrosis, division of one artery may be necessary to remove the scar, preserving the contralateral artery. RESULTS: Since April 2008, 115 patients with PUS received a vspEPA at our institution. The patients had a bulbo-membranous stenosis (n=91, 79%), prostate-membranous stenosis (n=11, 10%), or bulbo-vesical stenosis (n=13, 11%). Median age was 60 years (range 15-83) and median stenosis length was 2.5 cm (range 1-6), Sixty-two patients (54%) had a complete urethral obliteration. Bulbar artery preservation was unilateral in 57 and bilateral in 58. Median operative time was 170 min (range 70-265) and median estimated blood loss was 300 cc (range 50-2,000). A bulbo-membranous anastomosis was performed in 48 patients (42%), bulbo-prostatic in 54 (47%) and bulbo- vesical in 13 (11%). With 47 months of median follow up (range 5-146), vspEPA was successful in 109 patients (95%). Complications occurred in 34 (30%) patients but only 6 (5%) of them were Clavien grade ≥III. CONCLUSIONS: This vspEPA technique is feasible and safe and since 2008 it is our standard approach for anastomotic urethroplasty at the posterior urethra. We believe that vascular preservation may improve the outcome of reconstruction and our results are meaningful and highly encouraging. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e977 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Reynaldo Gomez More articles by this author Jessica Pfeifer More articles by this author Laura Velarde More articles by this author Rodrigo Campos More articles by this author Expand All Advertisement PDF downloadLoading ...

Endoscopic treatment for bulbar-membranous urethral obliteration: evaluation of the efficacy and safety

Introduction. The problem of endoscopic treatment for urethral strictures and obliterations remains unresolved. It is necessary to note that the effectiveness depends not only on the right indications, but also on the surgical technique and the study of the postoperative period management.Objective. To evaluate the efficacy and safety of endoscopic treatment of patients with bulbar-membranous urethral obliteration.Materials and methods. The study included 103 patients aged 20 to 89 years with bulbar-membrane urethral obliteration, who, for some reason or another, cannot perform urethroplasty. The patients underwent endoscopic recanalization of the urethra under X-ray control with further circular transurethral electroresection (TUR) of the scar tissues in the urethral obliteration zone (after 6 – 7 days).Results. The average age of the patients was 61.1 ± 18.3 years. After the operation, self-urination was restored in all patients. The average maximum urine flow rate (Q max) before discharge from the hospital was 12.6 ± 0.5 ml/s. Throughout the follow-up period, Q max tended to increase and at the end of the study (36 months) reached values of 16.5 ± 0.5 ml/s. During the first year of follow-up, 18 (17.5%) patients developed recurrent urethral stricture. Seventeen (16.5%) patients underwent repeated circular TUR of scar tissue in the zone of recurrent stricture. The effectiveness of the treatment was 90.0%.Conclusion. Endoscopic urethral recanalization followed by TUR of scar tissue in the obliteration zone is an effective and safe method in the treatment of bulbar-membranous urethral obliteration with length less than 1.0 cm.

Outcomes of Vesicourethral Anastomotic Stenosis and Bladder Neck Contracture With Direct Visual Internal Urethrotomy With Mitomycin-C After Prostate Cancer Treatment

ObjectiveTo examine the use of Direct Visual Internal Urethrotomy with Mitomycin-C (DVIU-MMC) for bladder neck contracture and vesicourethral anastomotic stenosis in men who have undergone treatment for prostate cancer with radical prostatectomy and/or radiation therapy. MethodsRetrospective chart review of patients at a tertiary care center who underwent DVIU-MMC for recurrent bladder neck contracture/vesicourethral anastomotic stenosis between 2012 and 2020. Patients with complete urethral obliteration, prior bladder neck reconstruction, or less than 3 months of follow-up were excluded. Patients were sorted into three groups based on prostate cancer treatment history: radical prostatectomy (RP), RP with subsequent external beam radiation therapy (RP-EBRT), and radiation therapy (RT). ResultsFifty-one patients with a median follow up of 32 months were included. Twenty-nine percent had pre-operative suprapubic tube (SPT), Foley, or required clean intermittent catheterization. Overall success after initial DVIU-MMC was 45%. In all patients with up to four procedures, cumulative overall success was 84%. There was no significant difference in relative success rates between groups. However, the interval to recurrence after initial DVIU-MMC was shortest for RP-EBRT group (P = .018). Three patients required SPT, all were in the RP-EBRT group. There was no statistical difference in recurrence after any number of procedures between patients in radiation (RP-EBRT and RT) and non-radiation (RP) groups. ConclusionThere was no significant difference in success rates between patients who had undergone RP-EBRT, RT, or RP. However, our data suggests that RP-EBRT patients experience poorer outcomes given that their interval to recurrence was more rapid and all patients requiring SPT placement were in this group.

MP03-20 OUTCOMES OF DIRECT VISUAL INTERNAL URETHROTOMY WITH MITOMYCIN-C (DVIU-MMC) IN BLADDER NECK CONTRACTURE (BNC) AND VESICOURETHRAL ANASTOMOSIS STRICTURE (VUAS) FOLLOWING PROSTATE CANCER TREATMENT

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I (MP03)1 Sep 2021MP03-20 OUTCOMES OF DIRECT VISUAL INTERNAL URETHROTOMY WITH MITOMYCIN-C (DVIU-MMC) IN BLADDER NECK CONTRACTURE (BNC) AND VESICOURETHRAL ANASTOMOSIS STRICTURE (VUAS) FOLLOWING PROSTATE CANCER TREATMENT Emily C. Hacker, Avinash Maganty, Maria M. Pere, and Paul J. Rusilko Emily C. HackerEmily C. Hacker More articles by this author , Avinash MagantyAvinash Maganty More articles by this author , Maria M. PereMaria M. Pere More articles by this author , and Paul J. RusilkoPaul J. Rusilko More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001964.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: BNC and VUAS secondary to radical prostatectomy (RP) and/or radiation represent significant challenges to patient care. Definitive management would likely require complex urethroplasty that may also result in urinary incontinence. The purpose of this study is to evaluate the efficacy of DVIU-MMC in these populations. METHODS: This is a retrospective chart review of patients at a single tertiary care center who underwent DVIU-MMC for recurrent BNC/VUAS between 2015-2020. Patients with complete urethral obliteration, prior bladder neck reconstruction, or <3 months of follow-up were excluded. Patients were sorted into three groups: RP and radiation, radiation alone, or RP alone. RESULTS: 38 patients were included in the study with a median follow-up of 40.1 months. 74% had prior dilation, 50% had prior DVIU, and 29% had prior indwelling catheter or performed intermittent catheterization. Success was achieved in 39% overall after 1 procedure, an additional 16% after 2 procedures, and another 13% after 3 procedures. Overall combined success rate after 4 procedures was 74%. There were no significant differences in recurrence within 4 procedures between patients with RP and radiation, radiation alone, or RP alone (65%, 73%, and 90%, respectively, p=0.362). 7 patients required more than 4 procedures. 3 patients required suprapubic tube placement for refractory disease, all of whom had undergone both RP and radiation. The average interval to first recurrence was significantly shorter in patients who had undergone RP and radiation (average months: RP and radiation 3.7, radiation 22.8, RP 15.7; p=0.002). CONCLUSIONS: Endoscopic management in this patient population appears to require at least 3 procedures for reasonable success rates. Although success rates do not differ significantly between groups, our data suggests that patients who have undergone both RP and radiation experience poorer outcomes given that time to recurrence was more rapid and all patients requiring SP placement were in this group. Previous studies have not differentiated between patients receiving RP and radiation, radiation alone, or RP alone, which may have important clinical implications. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e29-e29 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emily C. Hacker More articles by this author Avinash Maganty More articles by this author Maria M. Pere More articles by this author Paul J. Rusilko More articles by this author Expand All Advertisement Loading ...

The Effect of Radiation Therapy on the Efficacy of Internal Urethrotomy With Intralesional Mitomycin C for Recurrent Vesicourethral Anastomotic Stenoses and Bladder Neck Contractures: A Multi-Institutional Experience

To assess the efficacy, effect of radiotherapy, and complications of direct visual internal urethrotomy (DVIU) and intralesional mitomycin C (MMC) for recurrent bladder neck contracture/vesicourethral anastomotic stenosis (BNC/VUAS). Patients who underwent DVIU with intralesional MMC for recurrent BNC/VUAS between 2007 and 2019 at 2 institutions were included. Cold knife incisions were performed in a reproducible fashion followed by injection of 0.3-0.4 mg/mL MMC at each incision site. Those with evidence of complete urethral obliteration, stenosis of the entire posterior urethra, or <3 months follow-up were excluded. Success was defined as the ability to pass a 17-French cystoscope postoperatively without the need for catheterization or additional procedures. Eighty-six patients were analyzed over a median follow-up of 21.1 months. Around 91% had at least 1 prior DVIU, 56% had at least 1 prior dilation, and 44% presented with an indwelling catheter or performed intermittent catheterization. Success was achieved in 65% after 1 procedure, an additional 18% after 2 procedures, and another 7% after 3 or more procedures (90% overall success rate). Nonradiated patients showed a higher overall success rate compared to radiated patients (94% vs 76%, P=0.04). Of the 9 cystoscopic failures, 5 were asymptomatic and pursued observation. Only 2 (5%) patients with a history of catheterization required this postoperatively. Two patients underwent subsequent urinary diversion surgery. No long-term complications were seen. DVIU with low-dose MMC remains a safe and effective BNC/VUAS treatment. A patent bladder neck was achieved in >90% of nonradiated patients and >75% of radiated patients.

Dorsal oral mucosa graft in combination with ventral penile flap as an alternative to repair obliterative stenosis of the anterior urethra in a single surgical time.

ABSTRACTPurpose:Obliterative urethral stenosis is a type of urethral lesion that compromises the whole corpus spongiosum's circumference. We present our experience in resolving complex long segment urethral obliteration in a single procedure using a combination of dorsal onlay oral mucosa graft (OMG) and ventral fasciocutaneous penile skin flap.Materials and methods:A prospectively maintained database was reviewed, which included data of men presenting long, obliterative strictures. Patients were excluded if they were lost to follow-up before one year. Failure was defined as need for further urethral instrumentation.The surgical technique used consisted on the fixation of OMG to the tunica albuginea of the corpus cavernosum, thus creating a new urethral plate. Penile or foreskin flaps were employed to complete the ventral aspect. Postoperative follow-up was done with a voiding cystourethrography at week 3.Results:A total of 21 patients were included with a median age of 49 years. Mean follow-up was 25 months. Failure was found for 3 patients (2 of them needing dilations and only one required a new urethral reconstruction).Conclusion:Single stage combination of dorsal OMG with ventral fasciocutaneous penile flap showed good results for selected patients affected with obliterative urethral stenosis.

GUA-24 - Endoscopic recanalization of the cicatricial urethral obliteration

GUA-24 - Endoscopic recanalization of the cicatricial urethral obliteration

Outcome determinants of urethroplasty in the management of inflammatory anterior urethral strictures.

Limited data are available on outcomes of the surgical management of inflammatory urethral strictures secondary to infection, a major cause of stricture. Several shortcomings that need to be addressed have been identified in the past. To determine the impact of stricture length, position and degree of obliterative urethral lumen on the surgical outcomes of corrective procedures for inflammatory anterior urethral strictures. This retrospective analysis used the records of patients who presented with proven infective anterior urethral strictures at an academic hospital from 2007 to 2010. All patients were followed up after 48 months. Urethroplasty outcomes were analysed according to stricture location and length and effect of urethral obliteration. The median age of the 174 patients in the study was 47 (range 21 - 86) years. Anastomotic urethroplasty was successful in 59/99 (59.6%) patients. Augmented anastomotic urethroplasty was successful in 11/15 (73.3%) patients. Dorsal onlay buccal mucosa graft urethroplasty was successful in 23/32 (71.9%) patients, significantly higher than in 2/9 (22.2%) patients who underwent ventral onlay buccal mucosa graft urethroplasty (p=0.017; hazard ratio 3.4; 95% confidence interval 1.29 - 9.40). The one-stage circular pedicled penile skin-flap urethroplasty was successful in 1/12 (8.3%) patients. Two-stage urethroplasty was successful in 5/7 (71.4%) patients. A primary component analysis of the 73 failed procedures showed that stricture length was the main contributor to failure (eigenvalue 1.79; 45%). Urethroplasty remains a challenge in inflammatory urethral strictures, where stricture length was the main reason for treatment failure.

The efficacy of construction of neourethra using a bladder anterior wall for treatment of female total urethral stricture or atresia

Objective To explore the efficacy of constructing the neourethra using a bladder anterior wall for the treatment of female total urethral stricture or atresia. Methods We retrospectively reviewed 11 female patients with total urethral stricture or oblitalition, who were underwent a procedure of reconstructive neourethra using a bladder anterior wall, from January 2009 to November 2015. Of the 11 patients , urethral stricture was associated with vesicovaginal fistula and a severe hydrocolpos in the proximal vagina because of vaginal anterior strictures or atresia in four girls. The mean age was 16 years (ranging 5-48 years) in all patients. The etiology was posttraumatic urethral injuries after pelvic fracture in 9 patients, radical urethral resection because of urethral cancer in 1 patient and congenital bladder exstrophy with an absent urethra in 1 patient. All patients underwent a procedure of neourethral construction under general anesthesia. The bladder anterior wall, which was about 2.0 to 2.5 cm in width and 4.0~4.5cm in length, was separated from bladder neck to middle partion of the anterior bladder wall. The bladder flap was tubularized around a 12-14 French catheter using continuous 4-0 polyglycolic acid sutures for the mucosa and interrupted sutures of 3-0 polyglycolic acid for the muscle. The tubularized flap was then flipped caudally to the site of the original external urethral meatus to form a new urethra. 4 patients with severe stenosis or oblitalition of the distal vagina underwent a procedure of vaginoplasty at same time, including island vulvar flaps enlarging vaginoplasty in two girls and reconstructive vaginal orifice using the proximal enlargedvagina wall in other two girls. Results There were no serious complications postoperatively. The catheter was removed 3~4 weeks after the operation. 7 patients were completely continent with excellent voiding, 3 patients had stress incontinence. One patient experienced dysuria. And the urethroscopy in this case showed that the mucosal prolapse was present at the 12 to 3 o'clock position on the neck of the bladder, which caused urinary obstruction. Endoscopic resection of the prolapsed mucosa was performed. The patient could easily void without incontinence after the operation. The patients were followed up a median of 38 months, (ranging 6-72 months). 2 patients experienced dysuria 3 and 4 months after operation, separatively. Examination showed that the mucosal prolapse was present at the position on the neck of the bladder in one patient and urethral meatal stenosis in another patient. The two patients were separatively underwent a procedure of endoscopic resection of the prolapsed mucosa and meatal urethroplasty, using vulvar flap. All of them could easily void without incontinence after the operation. Of the 3 patients with stress urinary incontinence, one underwent a procedure of TVT-O one year later, and after which continence was achieved with good voiding; the other two cases were awaiting for reoperation. Four cases of postoperative vaginal fluid disappeared with unobstructed micturition. Conclusions Female neo-urethral reconstruction using the bladder anterior wall flap was a reliable technique for the management of complete urethral stricture or obliteration. Key words: Female; Bladder wall flap; Urethra; Reconstruction

ENDOSCOPIC TREATMENT OF URETHRAL OBLITERATIONS

High efficiency of endoscopic surgeries of urethral obliterations allowed expanding the indications for their application. As a result a number of complications that can emerge due to these interventions have grown. Types of these interventions, as well as their causes, the diagnostic methods and treatment processes must be studied. In this study the results of 112 endoscopic interventions in patients with urethral obliterations of various aetiology have been examined. The early satisfactory results of urethrotomy confirm the efficacy on the level of 85.7%. A general result of efficacy of endoscopic treatment of urethra obliteration after 2 years of post-operatively treatment is shown by 106 (94.6%) patients and unsatisfactory – by 6 (5.3%) patients.Adequate selection of methods of the urethra obliteration treatment largely depends on the characteristics of the disease: etiology, localization and extent of obliteration. Despite this, the surgical treatment of extensive structures and urethral obliteration requires an individual approach.

V67 Substitution urethroplasty with biaxial epilated scrotal flap in urethral stent obliteration

V67 Substitution urethroplasty with biaxial epilated scrotal flap in urethral stent obliteration

Antegrade cystoscopic light source guided laser urethrotomy for the treatment of completely obliterated urethra

ObjectiveA urethral stricture is the narrowing of the urethra caused by scar formation. The etiologies include infection, trauma with total urethral disruption, and iatrogenic procedures. The impact of urethral stricture diseases is very high. Several kinds of endoscopic procedures have become available for managing the disease. Among them, complete obliteration of the urethra during endoscopic procedures remains a challenge for surgeons. We describe a modified procedure in which laser urethrotomy was guided under the light source from an antegrade flexible cystoscope for treating a short completely obliterated urethra. This procedure is indicated if the obliterated segment is less than 10 mm because longer strictures may increase the chance of extra false lumen formation and bleeding. Materials and MethodsForty-three male patients who underwent optical urethrotomy for urethral strictures at Kaohsiung Municipal Ta-Tung Hospital (Kaohsiung, Taiwan) between March 2013 and January 2015 were induced in the study. Five of these patients were diagnosed as having complete urethral obliteration. ResultsIn all five patients with a completely obliterated urethra, retrograde laser incision was performed successfully. Three patients had total bulbar urethral obstruction and two had penile obstruction. All patients experienced improved urination after the procedure. ConclusionOur preliminary data showed that our modified method for treating a completely obliterated urethra yielded satisfactory results. Long-term follow-up and large-scale studies should be conducted to better examine technique efficacy; however, our current results regarding the simple modification of endoscopic urethrotomy seem promising.

Surgical Treatment of Old Pelvic Ring and Lower Urinary Tract Injuries in Men

Surgical treatment results for 56 men with old pelvic bones and junctions injuries complicated or associated with either strictures or obliteration of membranous and bulbomembranous urethral segment are presented for the period from 2002 to 2013. Terms after trauma made up from 1 month to 6 years, mean age of patients - 36 (16-66) years. All patients were admitted with epicystoma and history of 3-5 failed surgical interventions directed to uresis restoration. The pattern of pathologic mobility, degree of pelvic ring injury, length of urethral defect, and connec- tion of urethra with either bone fragments or displaced pelvic bones were assessed during complex urologic and traumatologic examination. Treatment tactics, i.e. one- or two-step, was chosen depending on the diagnosed injuries. In two-step treatment tactics orthopaedic step always preceded the urologic one (urethra plasty) that followed in about 2 months after primary intervention. Observation terms made up from 1 month to 6 years. Loco-motor function was restored in all patients, urination - in 54 of 56 patients. Thus, elaborated method of surgical treatment for old concomitant pelvic ring and lower urinary tract injuries showed high efficacy in patients with posttraumatic urethral stricture or obliteration

Surgical Treatment of Old Pelvic Ring and Lower Urinary Tract Injuries in Men

Surgical treatment results for 56 men with old pelvic bones and junctions injuries complicated or associated with either strictures or obliteration of membranous and bulbomembranous urethral segment are presented for the period from 2002 to 2013. Terms after trauma made up from 1 month to 6 years, mean age of patients - 36 (16-66) years. All patients were admitted with epicystoma and history of 3-5 failed surgical interventions directed to uresis restoration. The pattern of pathologic mobility, degree of pelvic ring injury, length of urethral defect, and connec- tion of urethra with either bone fragments or displaced pelvic bones were assessed during complex urologic and traumatologic examination. Treatment tactics, i.e. one- or two-step, was chosen depending on the diagnosed injuries. In two-step treatment tactics orthopaedic step always preceded the urologic one (urethra plasty) that followed in about 2 months after primary intervention. Observation terms made up from 1 month to 6 years. Loco-motor function was restored in all patients, urination - in 54 of 56 patients. Thus, elaborated method of surgical treatment for old concomitant pelvic ring and lower urinary tract injuries showed high efficacy in patients with posttraumatic urethral stricture or obliteration

Continent catheterizable vesicostomy in adults: Initial experience at a Scandinavian tertiary referral centre

Objective. The aim of this study was to present the initial experience of continent catheterizable vesicostomy at a Scandinavian tertiary referral centre. Material and methods. Eleven patients, on average 47 years old, with various severe lower urinary tract dysfunctionalities or complete urethral obliteration, underwent reconstruction with a continent catheterizable vesicostomy between 2004 and 2011, with a mean follow-up of 48 months. Results. For eight patients the first reconstructive attempt was successful. Three patients required more than one operation to become continent and to be able to catheterize easily. Two patients had previously been subjected to bladder neck closure and two had complete urethral obliteration, but no patient in this series had undergone bladder neck closure simultaneous to the vesicostomy procedure. Conclusions. For patients who find it difficult to perform self-catheterization via the native urethra, or with an obliteration of the prostatic/membranous/bulbar urethra, construction of a continent catheterizable vesicostomy may be a feasible treatment option. The need for revision is noteworthy. Despite severe difficulties in a few of the patients in the present series, necessitating reoperations, all patients were finally satisfied with the procedure.

Transperineal bulbo‐prostatic anastomosis for posterior urethral stricture associated with false passage: a single‐centre experience

• To evaluate the management of traumatic posterior urethral stricture associated with false passage, as this remains a challenge for urologists. • From January 2000 to February 2010, 19 patients (mean (range) age 34 [25-52] years) with traumatic posterior urethral obliteration associated with false passage were evaluated and treated at our centre. • All patients underwent perineal excision and primary anastomotic urethroplasty using cystoscopy by the suprapubic route to insert a guidewire into the original bladder neck, allowing exposure of the normal posterior urethra. • Patients underwent voiding cysto-urethrography 1 month after the procedure. When symptoms of decreased force of stream were present and uroflowmetry was <15 mL/s, urethrography and urethroscopy were repeated. • Clinical outcome was considered a failure when any postoperative instrumentation was needed, including dilatation. • The mean (range) follow-up was 12 (9-14) months. The overall success rate was 84%. • Three patients (16%) with persistent voiding difficulty developed a short anastomotic stricture 1-3 months after surgery. • The mean maximum urinary flow rate after surgery was 20.01 mL/s and no patient had urinary incontinence. • The preoperative use of flexible cystoscopy via the suprapubic route represented a successful key point of urethroplasty for posterior urethral stricture associated with false passage.

Single-institution Outcomes of Open Reconstruction Techniques for Management of Pediatric and Adolescent Post-traumatic Urethral Strictures

To assess the long-term results and efficiency of open reconstruction techniques for pediatric and adolescent post-traumatic urethral strictures. A total of 75 patients who had undergone open reconstructive urethroplasty for post-traumatic bulbous or posterior urethral obliterative strictures resulting from pelvic fracture urethral injuries were retrospectively analyzed. The mean patient age was 12.3 years (range 6-17). Of the 75 patients, 38 had a bulbar stricture and 37 had posterior urethral obliteration. Perineal end-to-end anastomotic repair, urethral pull-through, and ureteral tube graft urethroplasty were performed in 54, 20, and 1 patient, respectively. All patients were followed up by medical history and a urinary flow rate evaluation at 6 and 12 months postoperatively. The patients were followed up for 12-94 months (mean 43.2). The urethral strictures were successfully treated with end-to-end anastomotic urethroplasty in 37 (68.5%) of 54 patients, urethral pull-through urethroplasty in 14 (70%) of 20 patients, and ureteral tube graft in 1 patient. The total primary success rate was 69.3% (52 of 75 patients). Recurrent stricture developed in 23 patients. Of these 23 patients, 7 and 11 were successfully treated with secondary end-to-end anastomosis and direct vision internal urethrotomy, respectively. The overall success rate was 93.3% (70 of 75 patients). Five patients with treatment failure were still in follow-up, with direct vision urethrotomy performed, as needed. No penile curvature, penile shortening, or urethral diverticula developed. The results of our study have shown that open urethral reconstruction techniques are effective for primary and secondary surgical interventions in pediatric and adolescent patients with post-traumatic urethral strictures in experienced centers. These techniques provide excellent long-term results with minimal morbidity.

Application of pediculated skin flaps in the treatment of complicated long urethratresia

Objective To study the application of pediculated skin flaps in the treatment of com-plicated long urethratresia. Methods From March 1999 to May 2006, a total of 18 male patients with complicated long urethratresia were treated by using the pediculated skin flaps. The causes of urethratresia were 7 cases of postoperative pelvic fractures with posterior urethral stricture, 4 cases of transurethral intravesical chemotherapy, 3 cases of postoperative bulbar urethral stricture, 2 cases of gonorrhea, and 2 cases of long-time urethral catheter placement. Four cases were urethratresia nf cor-pus penis, 7 cases were anterior urethral obliteration, 7 cases were posterior urethral and anterior ure-thral obliteration. Urethro-perineal fistulas were found in 8 cases, posterior urethrorectal fistulas in 7 cases, false passage formations in 8 cases. The average length of urethratresia was 15.1 cm (range 8. 7 to 23. 0 cm). The urethral scar was rasected, the posterior urethrorectal fistula was repaired, and different kinds of pediculated skin flaps depending on the length of urethratreaia was used. Results All the patients were followed up for 12 to 18 months (mean 14 months). Fifteen patients voided well 3 months postoperatively, none of the urography showed stricture. The mean peak urinary flow rate was 16. 9 ml/s (range from 16. 5 to 21.7 ml/s). Of the other 3 cases, 1 case experienced difficult voi-ding due to the long and circuitous tabularized skin flap but recovered after proper shortening;1 case had restenosis for the infection of anastomosis but voided well after excision and reanastomnsis;1 casehad a urinary fistula resulting from hematoma and infection, but was successfully treated by the neo-plasty of the urinary fistula. The mean peak urinary flow rate was 17.0 ml/s (range 15.0 to 22.0 ml/s) for 17 patients 6 months postoperatively, except for one who experienced genuine urinary incon-tinence. At 9-18 months after operations, the mean peak urinary flow rate was 17.5 ml/s (range 15.8 to 22.5 ml/s) for 17 patients. Conclusion The single-stage urethroplasty based on pediculated skin flaps is a reliable and durable method for complicated long urethratresia. Key words: Urethral obstruction; Surgical flaps; Surgical procedures,operative