Urethral Stent Research Articles

Re: Using Temporary Prostatic Stents to Eliminate Bacterial Colonization in Men with Chronic Indwelling Catheters: A Pilot Study.

Re: Using Temporary Prostatic Stents to Eliminate Bacterial Colonization in Men with Chronic Indwelling Catheters: A Pilot Study.

The industrial revolution for the management of benign prostate obstruction: worldwide publication trends for surgical and medical therapies over the past two decades.

IntroductionResearch for management of benign prostate obstruction (BPO) for adult males remains a cornerstone of urology research. This landscape has witnessed the rise and fall of multiple therapies, both surgical and medical. Our aim was to formally evaluate the publication trends for these interventions over the past 20 years.Material and methodsA systematic search was performed in a Cochrane style. Data was analysed using the independent t-test and Pearson's correlation coefficient (SPSS version 24). To observe changes in trends more effectively, data was sub-divided into two time periods: 1997 to 2006 and 2007 to 2016.ResultsOver the past 20 years, 4236 papers have been published concerning for BPO (surgical, n = 2177 and medical, n = 2059). For surgical treatments, these included articles on monopolar transurethral resection of prostate (TURP) (n = 340), bipolar TURP (n = 260), HoLEP (n = 293) and Greenlight laser (n = 395). For medical therapies, these included alpha blockers (848), 5-alpha reductase inhibitors (n = 618) and PDE5I (n = 91). Between the two time periods the change was +18.8% (p = 0.108) for monopolar TURP, +497.1% (<0.001) for bipolar TURP, -54.5% (p <0.001 for prostatic stents and -81.9% (p <0.001) for transurethral microwave therapy (TUMT). There was over 290% rise in number of publications related to BPO laser surgery (p <0.001). For medical interventions, the change was +11.5% (p = 0.397) for alpha blockers, -1.9% (p = 0.867), +49.0%( 0.122) for phytotherapy, +2075% (p <0.001) for PDEI and +2375.0% (p <0.001) for combined alpha blocker and anti-muscarinics.ConclusionsInterventions for BPO have undergone a high volume of research. In particular, minimally invasive laser surgeries and combined medical therapies have seen significant expansion.

Functional outcome and complications of palliative transurethral resection of prostate (pTURP): 5years single centre (Eastern India) experience

Background: Notable number of prostatic carcinoma patients presented with bladder outlet obstruction. Among various treatment options like antiandrogen therapy, catheterisation, laser therapy, prostatic stent and pTURP, pTURP offers expeditious relief of symptoms. As, there is paucity of literature regarding outcome and complication of pTURP in Indian context. So, author did single centre indication (of surgery) matched retrospective case control study to know functional outcomes and morbidity of pTURP in eastern Indian population.Methods: Author did retrospective review of 29 patients who underwent pTURP during study period (January 2013 to January 2018) after exclusion. Same number of TURP (for benign disease) patients were selected. Functional outcome and complications of pTURP were compared with TURP group. Author also tried to find factors associated with un-favourable outcomes.Results: Despite of older pTURP group patients, operative duration, post-operative hospital stay, post-operative catheter duration and post-op maximum urinary flow rate, were statistically similar to TURP group. However, statistically similar but clinically more complication was noted in pTURP arm in terms of failed voiding trial, incontinence and re-operation rate. One capsular tear was noted only in TURP arm. Eight patients developed unfavourable outcome (1 persistent incontinence, 5 needed re-surgery and 2 required re-catheterisation in follow up period). Higher PSA, longer operative time and hormone refractory metastatic prostatic carcinoma were found to be associated with unfavourable outcome.Conclusions: pTURP is safe and effective procedure to relieve bladder outlet obstruction. Hormone refractory status, higher PSA and prolonged operative time may be risk factors of poor outcome.

Glanuloplasty Experiences in the Distal Hypospadias Surgery: A Prospective Comparative Study Focusing on the Patients and Parents

Aim: We aimed to investigate whether there was any difference between the postoperative complications of distal hypospadias patients undergoing MAGPI procedure whose urethral stents were left or removed and to determine pre and post-procedure anxiety levels of patients' parents regarding the current congenital penile disease of their children. Materials and Methods: Patients with urethral stents (group A) was hospitalized for one day. Patients without urethral stents (group B) were discharged on the same day. Patients were evaluated postoperatively regarding the characteristics of the patients and surgical complications. Health anxiety level affecting attitudes towards parents (group A1, B1 and C1) of children with hypospadias and circumcised were assessed with the Beck Anxiety Inventory (BAI) in the first admission and at the first postoperative month. Parents whose children underwent circumcision as a control group were compared with parents of the study groups. Results: Meatal regression and chordee were not observed in any patients, postoperatively. Urethral fistula encountered occurred in 2 (0.83%) and 2 (0.71%) patients in group A and B, respectively. For meatal stenosis, the same ratios and numbers were also present in the groups. Reoperation was performed in 8 (1.53%) patients in both groups. Parents of study groups in the first admission and postoperatively had a high BAI score when compared with parents of the control group, which was statistically significant (p = 0.00). Conclusions: Follow-up without a postoperative urethral catheter in cases of distal hypospadias corrected by MAGPI modifications seems to be more appropriate. Complications may diminish over time with different MAGPI modifications. Hypospadias, a congenital anomaly, has significant psychosocial effects on both the patient and the parent. These effects may be reduced for parents by psychosocial support and training which begins immediately after the birth of their babies.

Hypospadias Reconstructive Surgery Modification Using Double Layer Urethral Stent

Background: Several surgical reconstructive procedures are introduced to repair a hypospadiasis while post-operative complications have still remained high. Poor tissue handling, anastomotic site ischemia, tension on the anastomotic line, and distal obstruction are suggested as the main risk factors contributing to post-operative complications. This article is the introduction of a simple technical modification to perform a uniform straight tension free urethroplasty that is supposed to decrease post hypospadias repair complications. Methods: We used a 6F silicon Foley catheter and covered it by a part of 10 F Nelaton catheter at the most distal part of the Foley. To facilitate the covering and uncovering process, we incised the Nelaton catheter in one side through the whole length. We performed a two-layer closure urethroplasty over our double layer stent and finally uncovered the Foley catheter, which remains in the bladder as a trans-urethral stent and also for further bladder drainage. Results and Conclusions: In our innovative method of urethral stenting, we have suggested to replace the transurethral stent with a tension free lower size catheter easily and safely at the end of procedure, which helps decrease suture line tension and is supposed to improve the local circulation.

The maximum detrusor pressure as a predictive factor of success after sphincterotomy in detrusor-sphincter dyssynergia.

To evaluate the impact of the pre-operative maximum detrusor pressure (MDP) on efficacy outcomes after incontinentation by sphincterotomy or urethral stent placement in male patients with neurogenic detrusor-sphincter dyssynergia (DSD). A retrospective study was performed in 41 male patients treated between 2006 and 2013 in a tertiary reference center. All patients had a neurogenic DSD confirmed by baseline urodynamic studies, and were unable or secondary failed to practice CISC. Success was defined as a post-void residual volume <150 mL. Influence of MDP on treatment efficacy was evaluated through a Mann-Whitney U-Test. Median (range) age was 39 years (20-69). Spinal cord injury was the main underlying condition. Twenty-six patients had a sphincteric stent placement (Memocath®, Bard, Covington) and 15 had surgical sphincterotomy. Treatment was successful in 31 patients (76%). Patients with immediate successful outcomes had a significantly higher mean preoperative MDP (59.6 vs 29.7 cmH2 O; P = 0.002). Patients with MDP over the threshold of 40 cmH2 O had a 90% success rate. These differences were maintained at 6 months, MDP being higher in the success group than in the failure group (59.5 vs 39.8 cmH2 O, respectively, P = 0.008). The technique used (stent placement or incision) had no impact on immediate or 6-month success rates. Our results suggested that MDP is associated with treatment success rate after surgical management of DSD of neurogenic origin by sphincteric stent placement or surgical sphincterotomy. A threshold of 40 mH2 O is associated with higher success rates.

AB016. Effect of interventional urethral stent on dysuria of prostatic hyperplasia

BackgroundClear diagnosis of bladder outlet obstruction with prostatic hyperplasia between January 2004 and December 2014, a total of 990 urethral stents were placed in 762 patients without surgery for various reasons. We made a return visit. The average age of the patients was 83 years old. There were 531 cases of heart and brain diseases, 97 cases of pulmonary diseases, 99 cases of diabetes complications and 35 cases of advanced malignant tumors. Among them, 92 cases with cystostomy.MethodsThe patient lay flat on the DSA examination table and was routinely disinfected. A mixture of 75% meglumine diatrizoate and 2% lidocaine was injected through the urethral orifice. The images were collected by retrograde urography and the urethral mucosal anaesthesia was performed at the same time. After measuring the length of the prostate urethra, we choose the suitable urethral stents. Generally, we use the straight tube type braided reticular memory alloy stent. With obvious asymmetry of the internal urethral orifice patients, the backrest or two urethral stents should be used. Put the stent into prostate through X-ray monitoring. The best upper end of the stent is about ±0.5 centimeter in the internal urethra orifice and the lower end of the stent is 5 millimeter above the membranous urethra. With weak bladder contraction, the sent should be lengthened properly and the membrane urethral dilatation should be 5 millimeters.ResultsAutonomous urination in 752 patients after operations was good. General recent discomfort after operation was the symptoms of urethral irritation. For example, hematuria, frequent micturition, urination urgency, urination pain, tenesmus etc., which usually disappear gradually in 7–10 days. Stents were recently displaced in 25 cases and 1 case fell into the bladder. Stone formation in 37 recent cases need surgery, 239 cases of restenosis. Among them, 210 cases were treated with secondary stenting. 25 cases were treated with electroresection. Four cases underwent cystostomy. The excellent and good rate was 91% in 1 year after surgery, 85% in 2 years, and 78% in more than 4 years.ConclusionsIt is suggested that interventional stenting is suitable for patients with prostatic hyperplasia complicated with dysuria who need surgical treatment but who are unwilling or unqualified to undergo open surgery and TURP therapy. Interventional urethral stent implantation can be used as a simple and safe treatment for high risk patients with prostatic hyperplasia and dysuria.

Stent-related complications after hypospadias repair: a prospective trial comparing Silastic tubing and Koyle urethral stents

There is a paucity of data comparing urethral stents after hypospadias repair. The aim of this study is to compare Silastic tubing vsKoyle stents (Cook Medical), addressing outcomes related to stent-related complications, added visits to healthcare providers in the early postoperative period, and postoperative complications at clinic follow-up. Following an alternate week allocation, 150 patients were prospectively assigned to have Silastic tubes (n=76) and Koyle stents (n=74) after hypospadias repair. Exclusion criteria included fistula repairs, drainage via alternative catheter, or stentless repairs. Silastic tubes were secured with 5-0 Prolene and removed during a planned clinic visit. Koyle stents were secured with 7-0 PDS and left to fall out spontaneously. Questionnaires capturing postoperative outcomes were completed. Median age was 13 and 11 months in the Silastic and Koyle stent groups, respectively (P=0.48). There was no statistically significant difference in hypospadias location. Blockage/kinking of stents occurred in 8% (n=6) of the Silastic and 9% (n=7) Koyle stent groups, P=0.78. Although follow-up was short, there was no difference in fistula rate among the Silastic (21%, n=14) versus Koyle stent group (17%, n=11), P=0.66. There was a twofold higher rate of emergency department (ED) visits in the Silastic (32%, n=24) versus Koyle stent group (16%, n=12), P=0.03. Half of ED visits in the Silastic group were related to stents falling out before planned removal. The authors propose that Silastic stents falling out before the removal date may have led to increased parental anxiety and thusa visit to the ED. With improved parental education, the authors propose that many of these visits may have been preventable. There were no significant differences in stent-related complications or fistula rate between the Silastic and Koyle stent groups. Although there were a twofold higher number of visits to the ED in the Silastic stent group, the authors propose that this was due to parental education rather than the stent itself.

Using Temporary Prostatic Stents to Eliminate Bacterial Colonization in Men with Chronic Indwelling Catheters: A Pilot Study.

BackgroundChronic urinary catheterization is commonly associated with chronic bacterial colonization and high rates of symptomatic infection that increase morbidity and mortality. This study describes the results of replacing chronic catheters with temporary prostatic stents (TPS) to reduce bacterial colonization rates.MethodsTwenty-two chronically catheterized adult male patients were enrolled. Upon removal, the indwelling urinary catheter (IUC) was cultured to identify the presence and type of bacterial flora. The IUC was replaced with a TPS. All patients had five consecutive TPS placed on a 30-day cycle. TPS cultures were obtained at removal of each TPS.ResultsAll patients (100%) demonstrated bacterial colonization at baseline (removal of the IUC). After the third month with TPS, the colonization had fallen to 5% and remained at 5% for the final two months of TPS placement.ConclusionsThis pilot study suggests that replacing an IUC with a TPS interrupts the cycle of bacterial colonization in the urinary tract. This approach could be a strategy for eliminating multi-drug resistant organisms from the urinary tract of men with urinary retention.

Contemporary Treatment of Detrusor Sphincter Dyssynergia: a Systematic Review

To systematically review the literature to determine outcomes of detrusor sphincter dyssynergia (DSD) treatments. DSD can present in patients with neurogenic bladder due to a variety of conditions, but no treatment guidelines currently exist. Ovid Medline, Embase, PubMed, and Web of Science were searched within the last 10 years for “detrusor sphincter dyssynergia.” Results were independently reviewed by two coauthors for inclusion using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA) guidelines. Exclusion criteria were pediatric populations, reviews, non-clinical focus, non-English language, and case reports. There were 515 articles screened to yield 21 full text articles. Fourteen were retrospective studies, five were prospective non-randomized studies, and two were prospective, randomized trials. A total of 830 patients (527 male, 104 female, and 199 not specified) had DSD from spinal cord injury (413), multiple sclerosis (104), multiple system atrophy (33), and not specified (280). Treatments included botulinum A injections into the external sphincter (seven studies, reported success rates = 64–100%) or bladder (three studies, 44–76%), urethral stents (four studies, 9–91%), sphincterotomy (two studies, 48–85%), transurethral incision of the bladder neck (one study, 82%), pharmacologic therapy (three studies, 44–76%), sacral neuromodulation (one study, 60%), and anal stretch (one study). Evaluation of treatment outcomes for DSD is lacking. If conservative therapy fails, botulinum toxin type A injection appears to be a primary intervention strategy. More invasive treatments such as sacral neuromodulation and transurethral incision of the bladder neck also demonstrated high success rates, while urethral stenting was associated with high complication and failure rates.

Minimally invasive open dismembered pyeloplasty technique: Miniature incision, muscle-splitting dissection, and nopelvis reduction in children

ObjectiveTo report the outcomes and complications of open dismembered Anderson-Hynes pyeloplasty with miniature incision in treating children's ureteropelvic junction obstruction. MethodsBetween March 2007 and April 2011, 109 children with a mean age of 2 years and 8 months old with ureteropelvic junction obstruction underwent open dismembered pyeloplasty. Clinical manifestations, radiographic assessments, incision size, surgery time, hospital stay, and complication rate were recorded. All patients had a documented ureteropelvic junction obstruction (having T1/2 more than 20 min in diethylenetriaminepentaacetic acid [DTPA] scan) with symptomatic stenosis or decreased kidney function (differential function <40%). Pyeloplasty was done by a retroperitoneal flank approach with miniature incision without pelvis reduction. One surgeon did all the surgeries. Success rate and complications were assessed in a 3-year follow-up. ResultsMean surgery time was 52 min (47–60 min). Incision size was 18–28 mm. Mean hospital stay was 3 days (2–8 days). The surgery was successful in 98.2% of patients with a mean follow-up time of 36 months (success was defined as disappearance of symptoms, if present, with improved ultrasound imaging results or Reno graphic parameters). The complication rate was 7.33%, including urinary leakage, double-J urethral stent dislocation and infection. ConclusionOpen dismembered pyeloplasty is a safe, technically feasible and effective therapy in treatment of children's ureteropelvic junction obstruction. It takes a short time to do, requires a small incision and has few complications and a short recovery period.

THE EFFECT OF TOPICAL GENTAMYCIN APPLICATION AT THE URETHRAL STENT TO THE URETHRAL STENT’S BACTERIAL COLONY-FORMING-UNIT COUNTS IN HYPOSPADIAS PATIENTS PERFORMED URETHROPLASTY: A PRELIMINARY STUDY

Objective: To determine the effect of topical gentamycin application at the urethral stent to the stent’s colony-forming-unit (CFU) in hypospadias patients. Material &amp; methods: This study is a double blind prospective randomized controlled study, conducted from November 2016 - August 2017 in Urology Department Hasan Sadikin Hospital Bandung. We include patients with distal until penoscrotal hypospadias who underwent urethroplasty for the first time. The subjects were divided into 2 groups: Group A were patients performed urethroplasty with nasogastric tube (NGT) urethral stents only. Group B were patients performed urethroplasty with NGT urethral stents that were coated with topical gentamycin. Both group were operated by a single surgeon using either Tubularized Incised Plate (TIP) or Onlay Preputial Flap technique. Both group used supra pubic urinary diversion. Both group were given the same preoperative and postoperative intravenous antibiotics and given same dressing. At post operative day 7, the stents were removed and swabbed for bacterial culture and resistance test and colony-forming-unit (CFU) counts. Demographic data is described and, among others were analyzed statistically. Other adverse events and complications were also documented. Results: There were 25 hypospadias patients who were performed urethroplasty (12 patients in Group A and 13 patients in Group B). The median age in group A was 7 ± 2.995 (years old) and the mean age in group B was 6 ± 3.178 (years old). In group A, 1 patient (8.3%) were distal shaft type, 1 patient (8.3%) were middle shaft type, 8 patients (66.7%) were penoscrotal type, 1 patient (8.3%) were proximal shaft type, and 1 patient (8.3%) were subcoronal type. In group B, 3 patients (23.1.%) were distal shaft type, 3 patients (23.1%) were middle shaft type, 5 patients (38.5%) were penoscrotal type, and 2 patients (15.7%) were proximal shaft type. In group A, 6 patients (50%) using TIP, 6 patients (50%) using onlay preputial flap. In group B, 5 patients (38.5%) using TIP, 8 patients (61.5%) using onlay preputial flap. In Group A, Staphylococus haemoliticus was the most common bacterial found in urethral stent swabbed culture (50%), followed by Pseudomonas aeroginosa (16.7%), Acinetobacter baumannii (8.3%), Enterococcus faecalis (8.3%), Morganella morgagnii (8.3%) and sterile cultures (8.3%). In Group B, 38.5% were sterile urethral stents culture, followed by Staphylococus haemoliticus (30.8%), Enterobacter cloacae (7.7%), Staphylococus warneri (7.7%), Staphylococus epidermidis (7.7%), and Moraxella catarrhalis (7.7%). The most sensitive antibiotics in both group were Amikacin, Gentamycin, Meropenem, Cotrimoxazole, and Cefepime. In group A, 11 patients (91.7%) had &gt;100.000 CFU counts, and 1 patient (8.3%) with no colony found. In Group B, 2 patients (15.4 %) had &gt;100.000 CFU counts, 6 patients (46.2%) had &lt;100.000 CFU counts, and 5 patient (38.5%) with no colony found. In group A, there were 3 patients (25%) with urethra-cutaneous fistula, 4 patients (33.3%) with hematoma, and 5 patients (38.5%) without any complications. In group B, there were 2 patients (15.4%) with urethra-cutaneous fistula, 3 patients (23.1%) with hematoma and 8 patients (61.5%) without any complication. Using Mann-Whitney U-test, we found a significant difference of CFU counts formation between the two groups (p=0.001). Statistically, the lesser CFU counts found, the lesser complication were developed (p=0.001). Conclusion: Topical gentamycin application at the urethral stents in hypospadias patients performed urethroplasty significantly reduced CFU counts found at the urethral stents and thus reduced the urethra-cutaneous fistula and hematoma formation.

Back to the future: The Cecil-Culp technique for salvage penile reconstructive procedures

Re-operative penile reconstruction is challenging and requires tension-free skin closure. The repair popularized by Cecil and Culp in the 1940s, using the scrotum to provide a temporary vascularized bed for complex hypospadias repairs, fell out of favor due to temporal trends towards single-stage repairs and concern for utilizing hair-bearing skin on the penile shaft. It was hypothesized that a modified Cecil-Culp (CC) concept of penile scrotalization, leaving the penis attached to the scrotum for 1 year rather than 6 weeks as originally described, improves outcomes with this reconstruction for ventral skin deficiency or poor vascular support. Institutional Review Board-approved registries were reviewed to identify patients who underwent a CC repair during 1987-2016 at two institutions. Cecil-Culp technique was utilized in multi-stage hypospadias complication repairs or for insufficient ventral penile shaft skin coverage. Anatomic abnormality, number and type of prior surgeries, and complications before and after CC were recorded. Thirty-nine patients underwent CC: 23 failed hypospadias repairs, three hypospadias after bladder exstrophy, 10 penile curvature following circumcision, and three with skin loss from trauma. Mean age at CC was 61.8 months (hypospadias), and 59.8 months (non-hypospadias). Hypospadias patients underwent a mean of 3.6 surgeries (range 1-9) prior to CC. Four of the 39 patients (10.3%) had perioperative complications after CC, including scrotal abscess, skin infections, and difficulty removing the urethral stent. Eight of 37 (21.6%) patients had longer-term complications related to their hypospadias repair, including fistulae, diverticula, dehiscence, and stricture. Mean time from CC placement to release was 345 and 473 days for hypospadias and non-hypospadias cases, respectively. There was no apparent scrotal skin transferred to the penile shaft at the final take-down. Mean follow-up was 22.3 months. Embedding the penis into the scrotum for added vascularity and ventral skin coverage has been used effectively in cases of the most tenacious fistulas and for significant skin loss and trauma. Limitations of this study were its retrospective approach at two institutions over an extended period of time by multiple surgeons, so patient selection and procedure may have varied. Modification of CC repair by delaying 9-12 months before CC take-down enhanced the benefits of a robust vascular bed for wound healing, and helped to avoid transfer of hair-bearing scrotal skin to the penile shaft. The CC technique is an important tool for penile reconstructive surgery of complex hypospadias repairs with inadequate skin, and for traumatic injuries.

Urethroplasty After Urethral Urolume Stent: An International Multicenter Experience

To evaluate the outcomes and factors affecting success of urethroplasty in patients with stricture recurrence after Urolume urethral stent. This is a retrospective international multicenter study on patients treated with urethral reconstruction after Urolume stent. Stricture and stent length, time between urethral stent insertion and urethroplasty, age, mode of stent retrieval, type of urethroplasty, complications and baseline, and posturethroplasty voiding parameters were analyzed. Successful outcome was defined as standard voiding, without need of any postoperative adjunctive procedure. Sixty-three patients were included. Stent was removed at urethroplasty in 61 patients. Reconstruction technique was excision and primary anastomosis in 14 (22.2%), dorsal onlay buccal mucosa graft (BMG) in 9 (14.3%), ventral onlay BMG in 6 (9.5%), dorsolateral onlay BMG in 9 (14.3%), ventral onlay plus dorsal inlay BMG in 3 (4.8%), augmented anastomosis in 5 (7.9%), pedicled flap urethroplasty in 6 (9.5%), 2-stage procedure in 4 (6.4%), and perineal urethrostomy in 7(11.1%). Success rate was 81% at a mean 59.7 ± 63.4 months. Dilatation or internal urethrotomy was performed in 10 (15.9%) and redo-urethroplasty in 5 (7.9%). Total International Prostate Symptom Score, quality of life, urine maximum flow, and postvoid residual significantly improved (P <.0001). Complications occurred in 8 (12.7%), all Clavien-Dindo ≤2. Disease-free survival rate after reconstruction was 88.1%, 79.5%, and 76.7% at 1, 3, and 5 years, respectively. Explant of individual strands followed by onlay BMG is the most common approach and was significantly advantageous over the other techniques (P = .018). Urethroplasty in patients with Urolume urethral stents is a viable option of reconstruction with a high success rate and very acceptable complication rate. Numerous techniques are viable; however, urethral preservation, tine-by-tine stent extraction, and use of BMG augmentation produced significantly better outcomes.

PD26-08 THERMO-EXPANDABLE METALLIC URETHRAL STENT FOR MANAGING ELDERLY PEOPLE WITH INDWELLING URINARY CATHETER: A COMPELLING OPTION TO AVOID LONG-TERM CATHETERIZATION

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I1 Apr 2018PD26-08 THERMO-EXPANDABLE METALLIC URETHRAL STENT FOR MANAGING ELDERLY PEOPLE WITH INDWELLING URINARY CATHETER: A COMPELLING OPTION TO AVOID LONG-TERM CATHETERIZATION Cyrielle Rambaud, Sébastien Gonfrier, Cyprien Arlaud, Laetitia Imbert de la Phalecque, Jérémy Fallot, Romain Haider, Brannwel Tibi, Olivier Guérin, and Matthieu Durand Cyrielle RambaudCyrielle Rambaud More articles by this author , Sébastien GonfrierSébastien Gonfrier More articles by this author , Cyprien ArlaudCyprien Arlaud More articles by this author , Laetitia Imbert de la PhalecqueLaetitia Imbert de la Phalecque More articles by this author , Jérémy FallotJérémy Fallot More articles by this author , Romain HaiderRomain Haider More articles by this author , Brannwel TibiBrannwel Tibi More articles by this author , Olivier GuérinOlivier Guérin More articles by this author , and Matthieu DurandMatthieu Durand More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1347AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Management of chronic urinary retention in elderly people is challenging and time consuming, leading to high risk to place indwelling urinary catheter (IUC). The use of urethral stent (045-TW Memokath) may be an option in selected patients to avoid long-term catheterization. We assess the efficacy and treatment-related complications in such maintaining urethral patency. METHODS All patient over 70 yo with failed removal of long-term urinary catheter were proposed to a multidisciplinary decision-making. Alternative treatment (AT) was offered after decision process. Urethral stent was indicated for treatment of patients with severe IUC-associated urethral injury and re-current or permanent bladder neck obstruction but unfit for long general anesthesia. All patients were followed using plain radiography, uroflowmetry and urine analysis. RESULTS 118 patients were enrolled with a mean age of 86.4 yo (women: 33.2%). AT were offered to 62.7% (n=74), including 18 urethral stents, 30 catheter withdrawals, 22 photovaporizations of the prostate, 2 prostatic artery embolizations and 2 other surgeries. Overall, the success rate was 89.2% at 7 days and raised up to 92% at 1month. Among the 80 men, an AT was performed in 53 men including 18 urethral stents. Clinical characteristics men who received urethral sents compared to others are presented table 1. The success rate of urethral stent, at 7 days, was 94.5%, with one stent removed for a retention. In all, 10 stents were still functioning at the end of follow-up after a mean 175 days [40-434]. Six patients had died of reasons unrelated to the stent with a functioning stent in situ after an average of 58 days. One stent was removed after 192 days due to an infection. No other serious infections or stent migrations has been reported. Residual urine was <200ml after placement of the stents. CONCLUSIONS In our cohort, urethral stents allowed to 94.4% of frailty patients to avoid an IUC. Urethral stents are indicated for frailed patients with a risk to tear off their catheters. This alternative option to IUC may allow to improve autonomy and quality of life. More data are needed, to confirm the safety and the efficacy of this technic. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e554-e555 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Cyrielle Rambaud More articles by this author Sébastien Gonfrier More articles by this author Cyprien Arlaud More articles by this author Laetitia Imbert de la Phalecque More articles by this author Jérémy Fallot More articles by this author Romain Haider More articles by this author Brannwel Tibi More articles by this author Olivier Guérin More articles by this author Matthieu Durand More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

FR-03 SIMON-EMMANUEL DUPLAY: THE DAWN OF HYPOSPADIOLOGY

You have accessJournal of UrologyHistory Forum1 Apr 2018FR-03 SIMON-EMMANUEL DUPLAY: THE DAWN OF HYPOSPADIOLOGY Marc Cendron, Michael Kurtz, Erin McNamara, and David Diamond Marc CendronMarc Cendron More articles by this author , Michael KurtzMichael Kurtz More articles by this author , Erin McNamaraErin McNamara More articles by this author , and David DiamondDavid Diamond More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.3023AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Repair of the most complex forms of hypospadias was not considered until the late 19th century. Professor Duplay, a prominent French, surgeon provided the impetus for the repair of complex or proximal hypospadias by describing the malformation and its functional implications as well as reporting a new surgical technique, the fundamental principles of which are still in practice. The purpose of this study is to demonstrate his innovative approach to the evaluation and management of proximal hypospadias. METHODS Dr. Duplay published two landmark articles published in 1874 and 1880. After being translated from French to English for the first time, the articles were reviewed. We describe his new classification system as well his surgical technique and clinical experience. RESULTS Dr. Duplay details the anatomic findings of proximal hypospadias adding penoscrotal and perineal-scrotal to the existing Buisson classification. In 1874 he elucidates the functional problems that affect men with proximal hypospadias, specifically voiding dysfunction and sexual dysfunction. He then describes his technique of staged repair, which was inspired by Thiersch's repair of male epispadias. The first stage involves penile straightening. The second entails creation of a tubularized urethra and distal meatus at the tip of the glans. The third connects native urethra to the reconstructed distal segment. All procedures were under chloroform. Silver threads were used as suture material and safety pins maintained apposition. Urethral stents were used for variable lengths of time. In the 1874 report, 3 patients (2 aged 4 years and a 21 year old) underwent 4 to 6 procedures to achieve a straight penis an voiding through a meatus in the glans. In the 1880 report, 5 patients are reported "cured". Complications included hematomas, infections and partial to complete breakdown at various stages of the repair. CONCLUSIONS Given the surgical context of the late 19th century, reconstruction of the severe forms of hypospadias to create a functional urethra with a glanular urethra and a straight penis was a daunting challenge. Dr. Duplay was the first to demonstrate the feasibility of such complex repairs and thus advanced the care of patients with proximal hypospadias. His technique has since been adapted to a modern context, but the basic surgical principles that he put forth appear to have stood the test of time remarkably well. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1241-e1242 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Marc Cendron More articles by this author Michael Kurtz More articles by this author Erin McNamara More articles by this author David Diamond More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Urethral reconstruction in patients with urethral stent failure: An international multicenter experience

Urethral reconstruction in patients with urethral stent failure: An international multicenter experience

Thermo-expandable metallic urethral stent for managing elderly people with indwelling urinary catheter: A compelling option to avoid long-term catheterization

Thermo-expandable metallic urethral stent for managing elderly people with indwelling urinary catheter: A compelling option to avoid long-term catheterization

960 - Long-term outcomes of permanent nitinol urethral stent Memotherm® implantation in neurological patients with detrusor-striated sphincter dyssynergia

960 - Long-term outcomes of permanent nitinol urethral stent Memotherm® implantation in neurological patients with detrusor-striated sphincter dyssynergia

Acute renal failure in a neonate due to bilateral primary obstructive megaureters

Abstract A male newborn was referred to our institute for postrenal acute renal failure with bilateral hydroureteronephrosis, electrolyte imbalance, and anuria. Voiding cystourethrography revealed no vesicoureteral reflux or posterior urethral valves. We performed bilateral percutaneous nephrostomy on the 9th post-natal day. The serum creatinine level improved to the normal range. Antegrade pyelography revealed bilateral uretero-vesical junction stenosis. Subsequently, we inserted bilateral double J urethral stents at 1 month. Bilateral ureteroneocystostomy without ureteral folding was performed at 6 months. The postoperative course was uneventful. This is the second case of postrenal acute renal failure with bilateral primary obstructive megaureters in a neonate.