Urethral Stent Research Articles

Functional outcomes of surgical treatment of ureteral injury following gynecological and obstetrical surgery

IntroductionIatrogenic ureteral lesions represent one of the serious complications that can follow obstetric and gynecological surgery. This condition has a fatal consequence on renal function if it's not promptly diagnosed and managed. ObjectiveThe aim of our study was to report our experience in the management of this pathology. Materials & MethodsThis is a retrospective study of 32 patients treated for an iatrogenic ureteral injury after gynecological or obstetrical surgery, collected in the urology department of the Rabta Hospital over a 15-year period (2005–2020). Clinical presentation, investigations, and operative and postoperative details were reviewed from the patients' charts. ResultsThe average age of the patients was 42.6 (21–61). Multiparity was observed in 90.6% of cases. Hysterectomy was the most common cause (71.87%), followed by cesarean operation (18.75%), mainly for patients with placenta percreta (12.5%), and lastly, cure of prolapse by the upper approach in 9.37% of cases. The symptoms were dominated by low back pain and urinary incontinence. Stenosis was the most frequent lesion in 25 cases, followed by a section in 4 cases. A ureterovaginal fistula was observed in 3 case s. The first-line treatment of the patients was drainage by a ureteral stent (15.6%) or by a percutaneous nephrostomy (84.4%). Ureterovesical reimplantation was performed in 26 cases (81.25%). However, one patient had an Ileal ureter replacement. During follow-up, treatment failure was noted in 7 patients. Four patients developed secondary hydronephrosis treated with a urethral stent while 3 patients required nephrectomy. The type of gynecological and obstetrical procedure (open hysterectomy), history of pelvic surgery, and malignant pathology were predictive factors of treatment failure. ConclusionsInjuries to the ureter during gynecological and obstetrical surgery are generally rare. The diversity of repair techniques and the contribution of endo-urological techniques most often allow renal preservation, knowing that the best treatment remains prevention.

A Comparative Study on the Outcomes of Hypospadias Surgery Following Early Versus Late Bladder Catheter Removal.

BackgroundHypospadias is the most common penile malformation affecting up to one in 300 live male births. In general, a urinary diversion (urethral stent or bladder catheter) is maintained in situ for two to seven days or more after hypospadias repair. Because of the low level of evidence, the latest guidelines of the European Association of Urology and the European Society of Paediatric Urology provide no recommendations concerning the timing of catheter removal after hypospadias surgery. In this study, we aimed to compare the outcomes of hypospadias surgery (tubularized incised plate urethroplasty, TIPU) following early versus late bladder catheter removal.MethodologyIn total, 62 patients were included in this study. All patients underwent TIPU by the same team of surgeons. All patients were divided into the following two groups: group A (32 patients) had their catheter removed on or before the fifth postoperative day, and group B (30 patients) had their catheter removed after the fifth postoperative day. All patients were scheduled for an outpatient assessment after two weeks, at one month, after three months, and at six months if necessary.ResultsThe mean age of patients in group A was five years (three to seven years) and in group B was five years (four to 7.25 years) with a p-value of 0.378. Among the early complications of the surgery, the occurrence of wound infections, urinary tract infections, and urinary retention was comparable among the two groups. The rate of bladder spasms (0% versus 13.3%, p = 0.033) was significantly higher in group B than in group A. The rate of urinary retention (12.5% versus 0%, p = 0.045) was significantly higher in group A than in group B. Superficial wound infection occurred in two out of 32 patients in group A (6.3%) and two out of 30 patients in group B (6.7%) (p = 0.94). Both groups had similar incidences of wound complications. Urinary tract infections also had a similar incidence in both early and late catheter removal groups, i.e., one out of 32 patients in group A (3.1%) and three out of 30 patients (10%) in group B (p = 0.271). Urinary extravasation following hypospadias repair occurred in two out of 32 patients (6.3%). No extravasation was noted in the late catheter removal group. However, the difference was not clinically significant (p = 0.164). Two patients in both groups developed urethrocutaneous fistula (6.3% in group A versus 6.7% in group B). However, the difference was not clinically significant. Meatal stenosis developed in three out of 32 patients in group A and two out of 30 patients in group B (9.4% versus 6.7%; p = 0.696). One patient in the early catheter removal group developed urethral stricture as a late complication. None of the patients in the late catheter removal group developed this complication.ConclusionsThe occurrence of long-term complications of TIP hypospadias repair was not affected by the early removal of the bladder catheter. The shortcomings of our study were its descriptive nature and the small sample size. Further prospective randomized controlled trials are needed to ascertain the safety of early catheter removal and improvement in quality of life in the immediate postoperative period.

Use of Temporary Membrane-Covered Self-Expandable Metallic Stent - UVENTATM for Treatment of Recurrent Bulbar Urethral Stricture.

IntroductionRecurrent urethral stricture is a real challenge. Interestingly use of temporary double layered self-expanding nitinol urethral stent with polytetrafluoroethylene (PTFE) membrane coating (UventaTM, Taewoong Medical, South Korea) has been recently reported with promising short-term results in recurrent urethral stricture. However most of the reported studies are published as abstracts of either case reports or case series of miniscule numbers. The aim of our study is to evaluate the outcome of this temporary urethral stent in patients with recurrent urethral stricture after urethroplasty as well as after multiple visual internal urethrotomy.Materials and MethodsIn this retrospective study, 22 patients had placement of double-layered self-expanding stent with PTFE membrane coating (Uventa, Taewoong Medical) for recurrent bulbar strictures. The present study included cases between 2017 and 2020. The stricture in each patient were evaluated with Uroflowmetry and ascending urethrography. The data of demographic and clinical characteristics included age, aetiology, location and length of stricture, along with maximum urinary flow rate (Qmax), number of previous interventions, and stent-related complications.ResultsThe overall clinical success was achieved in 13/22 (59.1%) of patients at a median follow-up of 17 months (range 2–44). The mean maximum urine flow rates were 7.07 ± 3.55mL/sec, 23.50 ± 10.41mL/sec, 21.41± 15.55 mL/sec, 14.88 ± 9.77 and 17.63 ± 12.28 mL/sec before, while stent in place, at 3 months, 6 months and 12 months after the procedure, respectively. ConclusionIn our study, the success rate of temporary urethral stent placement has remained at 59.1% at a median follow-up of 17 months. We conclude that further randomized controlled studies with long-term follow up are required to fully evaluate the outcome.

MP52-11 BLADDER NECK CONTRACTURES STABILIZE AFTER ARTIFICIAL URINARY SPHINCTER PLACEMENT

You have accessJournal of UrologyCME1 May 2022MP52-11 BLADDER NECK CONTRACTURES STABILIZE AFTER ARTIFICIAL URINARY SPHINCTER PLACEMENT Kevin Krughoff, Hayley Premo, and Andrew C. Peterson Kevin KrughoffKevin Krughoff More articles by this author , Hayley PremoHayley Premo More articles by this author , and Andrew C. PetersonAndrew C. Peterson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002627.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The optimal treatment for the combination of stress urinary incontinence (SUI) and bladder neck contracture (BNC) is often vexing to the reconstructive urologist. Anecdotal clinical experience from our group indicates that many BNCs stabilize after AUS placement. We hypothesize that AUS placement may decrease BNC recurrence. METHODS: Men with BNC and voiding LUTS or AUR are treated at our institution with dilation, DVIU or TUR. Men with SUI electing AUS placement undergo simultaneous BNC treatment if symptomatic or if the bladder neck is ≤ 12 French and precludes catheter insertion. We queried our prospectively maintained QI database for all patients seen at our institution from 2001-2021 with a history of SUI and intervention for BNC. A total of 174 records were reviewed. Those with a urethral stent (n=6) or less than 2 months follow up (n=9) were excluded. The odds of recurrence and time between recurrences were compared between those with and without an AUS in place using logistic regression and the Wilcoxon Rank-Sum test. Recurrence rates and recurrence free survival were compared using multivariate Cox regression. RESULTS: The analytic cohort of 159 was comprised of 60 patients who underwent AUS placement and 99 who did not. Baseline characteristics were similar except for a 15% higher prevalence of pelvic radiation in the AUS group (p=0.06). A total of 278 BNC interventions were carried out in the non-AUS group (median 2 per patient) and 83 in the AUS group (median 2 per patient). After any given BNC intervention, the odds of recurrence were 75% lower (OR 0.25, CI: 0.15-0.42, p<0.01) when an AUS was placed. On sub-analysis according to number of prior interventions, AUS placement was associated with a 90% lower odds of recurrence (OR 0.10, CI: 0.03-0.27, p<0.01) and 2.6 years (p=0.02) longer time to recurrence after one intervention. After two interventions, the odds were 61% less (OR 0.39, CI: 0.16-0.97, p=0.04) and time to recurrence was 1.3 years longer (p=0.01). Recurrence rates were 70% and 75% lower at these same time points when adjusting for prior radiation, prostatectomy, receipt of CIC teaching, smoking, age, diabetes and coronary artery disease (Figure 1). CONCLUSIONS: Our data indicate that placement of the AUS seems to be associated with improved bladder neck stability. Source of Funding: Boston Scientific Fellowship Grant © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e891 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Krughoff More articles by this author Hayley Premo More articles by this author Andrew C. Peterson More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP01-01 EXIME® URETHRAL STENT IMPLANTATION (EUSI) AS INITIAL TREATMENT FOR PATIENTS PRESENTING WITH ACUTE URINARY RETENTION (AUR) FOR THE FIRST TIME AS A RESULT OF BPH

You have accessJournal of UrologyCME1 May 2022MP01-01 EXIME® URETHRAL STENT IMPLANTATION (EUSI) AS INITIAL TREATMENT FOR PATIENTS PRESENTING WITH ACUTE URINARY RETENTION (AUR) FOR THE FIRST TIME AS A RESULT OF BPH Nordine Amara, Tarek Al Youssef, Jordan Massa, Elias Elkhouri, and Belur Patel Nordine AmaraNordine Amara More articles by this author , Tarek Al YoussefTarek Al Youssef More articles by this author , Jordan MassaJordan Massa More articles by this author , Elias ElkhouriElias Elkhouri More articles by this author , and Belur PatelBelur Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002513.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Acute urinary retention (AUR) is a painful and distressing condition which is associated with significant morbidity requiring hospitalization, catheterization and often surgery. AUR often develops from benign prostatic hyperplasia (BPH) and its incidence increases with age. Management will often necessitates the insertion of a urinary catheter. We studied the efficacy of Exime® urethral stent implantation (EUSI) as initial treatment for patients presenting with acute urinary retention (AUR) for the first time as a result of BPH. METHODS: From January 2019 to January 2022 61 BPH patients underwent EUSI. The patients were aged 52–91 years old (mean 67.3 years), with a prostate volume of 30–120 ml (mean 67 ml) and IPSS score of 24±5.7. The same technique for insertion of EUSI under local anesthesia was used for each patient. RESULTS: Of the 61 patients 55 (90%) achieved spontaneous urination immediately after procedure; 3 patients (4.9%) developed urinary infection symptoms; 3 patients (4.9%) experienced bladder clot retention. No urethral injury and no false route were noted. CONCLUSIONS: EUSI, with its advantages of simple operation, high safety, definite effectiveness, is a new effective option for the treatment of AUR due to BPH. As more minimally invasive, office-based technologies emerge, physician and patients will have the ability to choose a treatment that is more catered to patient expectations. Further studies are needed to better define its place in this setting. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nordine Amara More articles by this author Tarek Al Youssef More articles by this author Jordan Massa More articles by this author Elias Elkhouri More articles by this author Belur Patel More articles by this author Expand All Advertisement PDF DownloadLoading ...

Hybrid Mathieu Urethroplasty vs. Tubularized Incised Plate Urethroplasty for the Management of Distal Penile Hypospadias With a Small Glans.

IntroductionDistal hypospadias is a common anomaly. Different surgical techniques have evolved through the years to manage this anomaly. Several factors may affect the prognosis. One of them is glans size. We compared the hybrid Mathieu urethroplasty (HMU) and the tubularized incised plate urethroplasty (TIPU) for the management of distal hypospadias with a small glans.MethodsSixty-eight patients with distal hypospadias were included and categorized into two groups. Group A (n = 33) and group B (n = 35) patients were treated by HMU and TIPU, respectively. All patients had a small glans. In group A, the patients underwent Mathieu urethroplasty plus a deep incision of the urethral plate. In group B, the patients underwent TIPU. Urethral stents were used in all cases. Hypospadias objective score evaluation (HOSE) was used to assess the results.ResultsUrethrocutaneous fistulae developed in two cases in group A and six cases in group B. Meatal stenosis was significantly lower (one case in group A vs. eight cases in group B). Glanular dehiscence occurred in two cases in group A and five cases in group B. The small glans strongly correlated with the development of both urethrocutaneous fistulae and meatal stenosis where the odd ratios were 3.500 (1.383–7.879) and 9.481 (1.114–12.669), respectively.ConclusionBoth techniques showed efficacy during management of patients with a small glans. HMU had better outcomes, shorter duration of stent and lesser incidence of complications than TIPU. Small glans was significantly related to urethrocutaneous fistulae and meatal stenosis in group B.

Outcome Analysis of Urethroplasty in Distal Hypospadias with Minimal Period of Postoperative Stenting

Background: Glandular, coronal, and distal penile are the variants of distal hypospadias. Surgical techniques for distal hypospadias varied based on the location of the meatal opening. Usual variants of techniques of surgery are glanduloplasty, MAGPI, and tabularized incised plate with or without internal urethral stenting postoperatively. Aim of the study: To see the outcome of urethroplasty in distal hypospadias with a minimal period (&lt;48 hours) of postoperative stenting. Methodology: This Quasi-experimental study was conducted from January 2018 to April 2019 in the Department of Pediatric Surgery, Mymensingh medical college hospital, Mymensingh. Among the 50 patients with distal hypospadias who fulfill the inclusion and exclusion criteria. MAGPI and TIP procedures were done with a minimum period of postoperative stenting (&lt;48hours). Postoperative care by nothing per oral for 4-6 hours, intravenous fluid, intravenous antibiotics, parenteral, and per rectal analgesics. Postoperative follow-up was observed and recorded if any uneventful events occurred, measures were taken accordingly. The stent was removed on the 2nd POD and discharged the patient on the 3rd POD. After discharge, all patients were followed up for 3 months. Data were analyzed by statistical package for social sciences (SPSS) version 20. Results: Among the 50 patients, the age range was 6 months to 12 years with the mean age 6.08±3.69 years. 8(16%) patients were glandular variety, 22(44%) patients were coronal and 20(40%) were distal shaft variant. Among them, MAGPI procedures were performed in 18(36%) patients and TIP in 32(64%) patients. Immediate postoperative complications- hematoma 2(4%), stent block 2(4%), wound disruption 2(4%). Stent block treated by normal saline irrigation through stent, hematoma, and wound disruption by local wound care. Among the 2(4%) patients with hematoma, 1(2%) patient developed wound infection, later on, U-C fistula occurred and among the 2(4%) patients of wound ....

Urethral stenting in a dog due to compression and invasion by a liposarcoma

AbstractAn approximately 10‐year‐old, mixed breed, entire male dog was referred for acute onset of urethral obstruction. Abdominal ultrasound was unremarkable, complete blood count, serum biochemical analysis and urine analysis were all unremarkable. A retrograde urethrogram demonstrated narrowing of the urethral lumen caudal to the ischiadic arc. Urethral stenting with a self‐expanding nitinol stent was performed and the patient was without symptoms over a 6‐month period. After that time, ingrowth of tissue into the stent lumen could be seen via a new retrograde urethrogram; therefore, a covered stent was placed into the previously placed uncovered stent. Clinical signs resolved immediately. Another contrast study 4 months later demonstrated almost complete obstruction at the distal end of the stent. Scrotal ablation with perineal urethrostomy was performed and tissue samples submitted for histopathology. Liposarcoma was diagnosed. The patient was urinating without problems, but suddenly died at home 1 week after the last surgery.

Tubularized incised plate repair in 473 primary distal hypospadias cases: An evaluation of outcomes according to coverages and stent types

AimWe have previously employed the tubularized incised plate (TIP) repair technique in distal hypospadias cases with a few modifications because of its excellent cosmetic results. In this study, we aimed to evaluate the effects of spongioplasty and dorsal dartos flaps, in addition to short urethral stents on the outcomes of TIP repair. Materials and MethodsOnly distal hypospadias cases were involved in this study. Eligible patients were divided into two groups: group A included patients repaired with both spongioplasty and dorsal dartos flap placement, while group B included patients repaired with dorsal dartos flap placement alone. Group A was further divided into two subgroups according to the type of catheter used (bladder catheter or short urethral stent). ResultsA total of 473 patients were included in this study. There was no statistically significant difference observed in the complication rates between the two groups. In Group A, a bladder catheter was used in 107 patients and a short urethral stent was used in 135 patients. When the results of the two groups were compared, there was no statistically significant difference. ConclusionsSpongioplasty could be combined with dorsal dartos flap placement to reduce the need for dorsal plication rather than to reduce the fistula rate. Short urethral stents can be used safely with no postoperative effects in children who have completed toilet training.

Minimally Invasive Therapy: What Is The Status In 2021 - What's Coming, What's Going?

Due to the large number of men affected and a variable clinical presentation, the widespread disease "benign prostatic syndrome" requires individual treatment options tailored to the patient's specific clinical characteristics and wishes. If surgical treatment is indicated, there is a wide range of invasive procedures available. For a long time, transurethral resection of the prostate and simple prostatectomy were considered the gold standard, but these procedures are associated with increased morbidity and limitations in sexual function. Therefore, there is now an increasing call for minimally invasive treatment options that will provide effective and safe treatment in the outpatient setting. Over the past years, a variety of technologies and procedures have been developed and tested, but only a few of them have found their way into clinical practice, mostly due to insufficient functional results. For instance, transurethral needle ablation, transurethral microwave thermotherapy, intraprostatic botulinum toxin A or PRX302 injections as well as prostatic stents are no longer recommended. In contrast, the European Association of Urology is currently recommending UroLift, Aquablation and prostatic artery embolisation, which achieve significant long-term improvements in functional parameters while providing a good safety profile and preserved sexual function. Promising data are also available for the temporarily implanted nitinol device (iTIND), Rezūm, intraprostatic injection of fexapotide triflutate and transperineal laser ablation of the prostate, but the efficacy and safety of these procedures need to be confirmed in further studies.

Transurethral Retrograde Fishing the Double J Urethral Stent: A Tertiary Children Hospital's Experience With a New Technical Strategy.

PurposeThe purpose of this study is to provide a new strategy for non-cystoscopic double J urethral stent (JJS) removal, the transurethral retrograde fishing the double J urethral stent (TURFJJS), that avoids general anesthesia in pediatric populations.MethodsWe retrospectively reviewed the JJS removal records of patients having ureteropelvic junction obstruction (UPJO). We analyzed differences in the removal success rates, operation-related severe complications, total cost, duration, and parental satisfaction between TURFJJS and traditional cystoscopic double J urethral stent removal (CJJSR) procedures.ResultsA total of 324 patients with UPJO were included in this study. CJJSR yielded a success rate of 100%. TURFJJS achieved a success rate of 94.3%. The TURFJJS was just an outpatient procedure, and its total cost was about 800 Chinese yuan (US$ 124). There were no severe JJS removal-related complications using TURFJJS. Parental satisfaction was 98.2 and 92.5% for the CJJSR and TURFJJS protocols, respectively.ConclusionTURFJJS is safe, effective, cost-effective, and well-tolerated in pediatric patients, minimizing or eliminating the need for general anesthesia, additional hospitalization, and waste of time. TURFJJS should be widely used in pediatric urology.

Docetaxel‐loaded scaffolds manufactured by 3D printing as model, biodegradable prostatic stents

AbstractThe first‐line therapy against locally advanced prostate cancer is radical prostatectomy as well as radiation therapy which might contribute to the swelling of the prostate. To prevent this, prostatic urethral stents might be used and they are mostly made of metal alloys. However, biodegradable prostatic stents are constantly explored. The aim of the study was 3D printing of tubular biodegradable scaffolds intended as a model prostatic stent since 3D printing allows obtaining devices with controlled geometric shape and function. Additional docetaxel‐loaded layers on bioresorbable scaffolds were obtained for local chemotherapeutic delivery. Scaffolds were characterized before and during incubation in artificial urine for 6 weeks. Changes in the chain microstructure of the scaffolding polymer during this period were stable. Weight loss of the scaffolds was very low contrary to molecular weight changes. During incubation, slow release of the docetaxel was observed. After 6 weeks, 20% of the drug was released from the coating. The stable release of the cytostatic drug during chemotherapy is advantageous. Contrary to systemic administration of docetaxel used nowadays as a standard treatment in castration‐resistant prostatic cancer, local administration is proposed instead, with the aim to downstage the disease before radical therapy and thus to minimize the risk of recurrence.

Evaluation of Temporary Urethral Stents in the Management of Malignant and Nonmalignant Urethral Diseases in Dogs.

Urethral stent placement is a minimally invasive interventional procedure commonly performed by specialists to alleviate urethral obstruction. However, the availability of urethral stents is limited by their high cost and the need for special equipment. The aim of this retrospective study was to describe the construction and placement of an inexpensive temporary urethral stent and to report on its outcome in managing dogs with naturally occurring urethral disease. Temporary stents were placed in the urethra of 17 dogs with malignant and nonmalignant urethral pathologies. The most common indication for temporary stent placement was urethral obstruction. In this population, urethral patency was restored in all dogs. The most frequently reported complication was urinary incontinence. To manage this complication, dogs were diapered. Temporary urethral stents served as a durable and inexpensive alternative to expanding metallic stents. Because temporary stents were constructed from readily available materials and inserted without special equipment, practitioners capable of catheterizing the urethra can insert them on demand.

Randomized trial of prophylactic antibiotics vs. placebo after midshaft-to-distal hypospadias repair: the PROPHY Study

Use of prophylactic antibiotics after stented hypospadias repair is very common, but most research has not identified any clinical benefits of this practice. Only one study has found that postoperative prophylaxis reduces symptomatic urinary tract infections (UTIs). Data from the same trial suggested that prophylaxis may also reduce urethroplasty complications. No studies on this subject have been placebo-controlled. We performed a randomized, double-blind, placebo-controlled study to evaluate the effect of postoperative prophylactic antibiotics on the incidence of infection or urethroplasty complications after stented repair of midshaft-to-distal hypospadias. Boys were eligible for this multicenter trial if they had a primary, single-stage repair of mid-to-distal hypospadias with placement of an open-drainage urethral stent for an intended duration of 5-10 days. Participants were randomized in a double-blind fashion to receive oral trimethoprim-sulfamethoxazole or placebo twice daily for 10 days postoperatively. The primary outcome was a composite of symptomatic UTI, surgical site infection (SSI), and urethroplasty complications, including urethrocutaneous fistula, meatal stenosis, and dehiscence. Secondary outcomes included each component of the primary outcome as well as acute adverse drug reactions (ADRs) and C. difficile colitis. Infection or urethroplasty complications occurred in 10 of 45 boys (22%) assigned to receive antibiotic prophylaxis as compared with 5 of 48 (10%) who received placebo (relative risk [RR], 2.1; 95% confidence interval [CI], 0.8 to 5.8; p=0.16). There were no significant differences between groups in symptomatic UTIs, SSIs, or any urethroplasty complications. Mild ADRs occurred in 3 of 45 boys (7%) assigned to antibiotics as compared with 5 of 48 (10%) given placebo (RR, 0.6; 95% CI, 0.2 to 2.5; p=0.72). There were no moderate-to-severe ADRs, and no patients developed C. difficile colitis. In this placebo-controlled trial of 93 patients, prophylactic antibiotics were not found to reduce infection or urethroplasty complications after stented mid-to-distal hypospadias repair. The study did not reach its desired sample size and was therefore underpowered to independently support a conclusion that prophylaxis is not beneficial. However, the result is consistent with most prior research on this subject. NCT02096159.

Tubularización e incisión de la placa uretral para reparación de hipospadias distal primario en 473 casos: evaluación de los resultados según la cobertura y el tipo de sonda

AimWe have previously employed the tubularized incised plate (TIP) repair technique in distal hypospadias cases with a few modifications because of its excellent cosmetic results. In this study, we aimed to evaluate the effects of spongioplasty and dorsal dartos flaps, in addition to short urethral stents on the outcomes of TIP repair. Materials and methodsOnly distal hypospadias cases were involved in this study. Eligible patients were divided into two groups: group A included patients repaired with both spongioplasty and dorsal dartos flap placement, while group B included patients repaired with dorsal dartos flap placement alone. Group A was further divided into two subgroups according to the type of catheter used (bladder catheter or short urethral stent). ResultsA total of 473 patients were included in this study. There was no statistically significant difference observed in the complication rates between the two groups. In Group A, a bladder catheter was used in 107 patients and a short urethral stent was used in 135 patients. When the results of the two groups were compared, there was no statistically significant difference. ConclusionsSpongioplasty could be combined with dorsal dartos flap placement to reduce the need for dorsal plication rather than to reduce the fistula rate. Short urethral stents can be used safely with no postoperative effects in children who have completed toilet training.

Hypospadias in toddlers: a multivariable study of prognostic factors in distal to mid-shaft hypospadias and review of literature.

Tubularized incised plate urethroplasty is the most common hypospadias repair technique. However, there are unanswered questions and debates about the anatomical prognostic factors affecting the repair outcomes. This study tried to address some of the problems in the studies compromising the results of the current body of literature. A prospective cohort of 101 males aged 1-3 years undergoing primary distal to mid-shaft hypospadias repair were enrolled in the study. Complications including edema, erection, inadvertent removal of the urethral stent, surgical wound infection, bladder spasm, hematoma, and hemorrhage were evaluated. Studies in the current literature were reviewed to achieve a better perspective for future investigations. Persistent complications were found in 16 cases (15.8%) including fistula formation, the persistence of chordee, meatal stenosis, glans, and urethral dehiscence. The mean follow-up time was 6.6±3.4 months. In the single-variable analysis, the meatal location, the length and width of the urethral plate, and the reversible acute postoperative events were significantly associated with the complications. Furthermore, fistula formation was associated with acute surgical site infection (p<0.001). However, the multivariable regression study revealed the presurgical meatal location to be the only statistically significant factor (p=0.03). Notably, the glans diameter or glanular groove shape, urethral plate dimensions, or presence of mild chordee were not independently associated with the outcomes (p>0.05). Our study on the toddlers with hypospadias surgery revealed that the location of urethral meatal was the main predicting factor in the development of major complications. Furthermore, the fistula formation at the infected surgical site emphasizes the importance of postsurgical care.

Bladder Neck Contracture as a Complication of Prostate Surgery

Bladder neck contracture (BNC) is one of the most common complications of surgical treatment of prostate diseases. The rate of postoperative BNC varies depending on the type of surgical treatment used. The options for treatment techniques for BNC can vary from endoscopic interventions to complex (abdominal) surgical interventions. This review evaluates various alternative surgical methods of BNC treatment. The search and analysis of publications in the databases PubMed (MEDLINE), Scopus, Cochrane Library, according to the keywords, “bladder neck sclerosis,” “benign prostatic hyperplasia,” “BNC,” “bladder neck stenosis,” “balloon dilation,” “treatment.” As a result, 71 publications were selected and included in this review. In addition to the standard treatment methods in the form of transurethral resection and incision of the bladder neck using electricity and laser energy, the urologist also has alternative methods of treatment, such as balloon dilation, placement of urethral stents, instillation of the bladder or intraoperative injection of cytostatic drugs, hormones, hyaluronic acid derivatives, and biomedical cell products into the bladder neck area. Although transurethral resection is currently the main treatment option for BNC, the recurrence rate after this procedure can reach up to 38%. According to the literature, balloon dilation can be a promising and minimally invasive method of treatment for recurrent BNC. This method can be used as the first stage in the treatment of recurrent contracture deformity. Furthermore, intravesical instillation of various anti-inflammatory drugs and cytostatics can be promising directions in the treatment and prevention of BNC.

Stenting of Malignant Urinary Tract Obstructions in Humans and Companion Animals.

Urine retention secondary to neoplastic obstructions of the upper and lower urinary tracts is a life-threatening condition in both humans and companion animals. Stents can be placed to temporarily or permanently open obstructed urinary tract lumens and are often able to be placed using minimally invasive techniques with guidance via ultrasonography or fluoroscopy. The literature for these techniques is vast for humans and growing for companion animals. The below review provides a discussion of the principles of stenting and types of ureteral and urethral stents, as well as the techniques for placing these stents in humans and companion animals.

Best nonsurgical managements of acute urinary retention: what's new?

To provide a comprehensive review of the nonsurgical management of acute urinary retention (AUR). A recent meta-analysis confirmed that α-blockers are associated with higher rates of successful trial without catheter (TWOC) compared with placebo, while combination therapies do not significantly reduce the rate of recatheterization. Compared with standard TWOC, bladder perfusion with physiological serum prior to catheter removal is a simple and cost-effective method to increase TWOC success rates (odds ratio 2.41, 95% confidence interval 1.53-3.8), and to reduce time-to-discharge (-89.68 min, 95% confidence interval -160.55, -18.88). Clean intermittent catheterization (CIC) is increasingly used for urinary retention in patients with benign prostatic hyperplasia as existing data suggest that it may decrease the risk of urinary tract infections, accelerate spontaneous voiding recovery and might be more cost-effective compared with indwelling urethral catheterization. Ongoing trials are examining whether office-placed prostate stent may be a promising solution in patients with AUR. The recent development of alternative approaches to traditional TWOC may lead to new therapies for treating patients with AUR. Further studies are needed as the level of evidence from published studies remains low.

Comparison of Drainage Methods After Pyeloplasty in Children: A 14-Year Study

Objective: To summarize our experiences with drainage methods after laparoscopic pyeloplasty with a 14-year study.Methods: We reviewed the data of the 838 children operated on for hydronephrosis due to congenital ureteropelvic junction obstruction (UPJO) between July 2007 and July 2020. Patients' demographics, perioperative details, postoperative drainage stents [including double-J stent, percutaneous trans-anastomotic (PU) stent, and trans-uretero-cystic external urethral stent (TEUS)], complications, hospital stay, and long-term follow-up outcomes were analyzed. Long-term follow-up was performed by outpatient visits and telephone follow-up. Moreover, we reviewed the details of nine cases of recurrence after laparoscopic pyeloplasty.Results: Comparison of preoperative general data among the three groups indicated that there was no statistical difference in age, gender, and surgical side of the three groups. Statistical differences were found in the incidence of postoperative complications from the three postoperative drainage method groups, especially the incidence of reoperations (p < 0.01): there were six cases (3.19%) of recurrences in the TEUS group, two cases (0.36%) in the DJ group, and one case (0.93%) in the PU group. In the six recurrent cases from the TEUS group, four cases (44.4%) were found to have stenosis, and two cases (22.2%) have iatrogenic valvular formation.Conclusion: Not all three types of drainage methods are suitable for drainage after pyeloplasty. Based on our findings, TEUS is not recommended.