Urethrography Research Articles

MP78-11 DORSAL BUCCAL MUCOSAL GRAFT URETHROPLASTY FOR VESICO-URETHRAL ANASTOMOTIC STENOSIS: LONG TERM FOLLOW UP

You have accessJournal of UrologyCME1 Apr 2023MP78-11 DORSAL BUCCAL MUCOSAL GRAFT URETHROPLASTY FOR VESICO-URETHRAL ANASTOMOTIC STENOSIS: LONG TERM FOLLOW UP Waleed Shabana, Vahid Mehrnoush, Hazem Elmansy, Ahmed Kotb, Ahmed S. Zakaria, and Walid Shahrour Waleed ShabanaWaleed Shabana More articles by this author , Vahid MehrnoushVahid Mehrnoush More articles by this author , Hazem ElmansyHazem Elmansy More articles by this author , Ahmed KotbAhmed Kotb More articles by this author , Ahmed S. ZakariaAhmed S. Zakaria More articles by this author , and Walid ShahrourWalid Shahrour More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003355.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess long term outcomes of dorsal buccal mucosal graft (BMG) urethroplasty for the repair of refractory vesico-urethral anastomotic stenosis (VUAS) post open radical prostatectomy. METHODS: We retrospectively reviewed collected data of patients underwent buccal mucosa graft urethroplasty following at least 3 interventions for VUAS. Patients were included if they completed 24 months after surgery. Patients’ demographics, preoperative continence status, number of dilations, and urine flow preoperatively and postoperatively were collected. Trial of void and retrograde urethrogram were done after 1-3 weeks. Patients were followed every 6 months up to 4 years by flowrate, postvoiding residual urine volume, cystourethroscopy and GRA questionnaire. RESULTS: Twelve patients underwent dorsal BMG urethroplasty between Jan 2018-Jan 2022. Eleven out 12 patients (91%) received adjuvant radiotherapy. Strictures were in the anastomotic site and median stricture length was 3 cm (2-4). All patients were incontinent preoperatively with median preoperative flow of 4.5 mL/s (2-7 mL/s). Mean operative time and blood loss were 182 minutes and 250 mL respectively. We did not record any case of intraoperative rectal injuries. No change in erectile function was noted. Median follow up was 24 months (range 9-48 months). The median flow at 24 months was 23 ml/sec. success rate at 24 months was 91% with one patient that failed immediately post operatively. Three out of 12 patients had artificial urinary sphincter post urethroplasty. GRA score of 4-5 was found in 100% of patients CONCLUSIONS: Dorsal BMG urethroplasty post VUAS has a solid promising urinary functional outcome. Dorsally placed BMG eliminate risk of rectal injuries associated with other approaches although incontinence persisted post repair. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1136 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Waleed Shabana More articles by this author Vahid Mehrnoush More articles by this author Hazem Elmansy More articles by this author Ahmed Kotb More articles by this author Ahmed S. Zakaria More articles by this author Walid Shahrour More articles by this author Expand All Advertisement PDF downloadLoading ...

PD35-07 DYNAMIC MRI URETHROGRAM: A NEW FRONTIER IN URETHRAL STRICTURE EVALUATION

You have accessJournal of UrologyCME1 Apr 2023PD35-07 DYNAMIC MRI URETHROGRAM: A NEW FRONTIER IN URETHRAL STRICTURE EVALUATION André Cavalcanti, Rafael Cobo, Gabriel Affonso, and Felipe Da Silva André CavalcantiAndré Cavalcanti More articles by this author , Rafael CoboRafael Cobo More articles by this author , Gabriel AffonsoGabriel Affonso More articles by this author , and Felipe Da SilvaFelipe Da Silva More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003333.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The urethral stricture is a disease that cause severe impact on the quality of life in male patients. As a disease were the definitive treatment is a surgical procedure, an adequate pre-operative image study for the surgical planning is essencial. The Retrograde Urethrogram has been the gold standard method for the urethral stricture evaluation during the paste decades. This method has limitations as technical points associated to failures to a precise measure of the stricture length/localization and the incapacity to evaluate the peri-urethral fibrosis. The objective of this study is to test the Dynamic MRI Urethrogram as a unique method to urethral stricture diagnostic and pre-operative evaluation. METHODS: A Group of 25 consecutive patients with a suspicion of urethral stricture disease were submitted to a Dynamic MRI Urethrogram as the unique image study to confirm the diagnosis, disease characterization and surgical planning. All patients were submitted to the same MRI protocol: peripheral venous access and hydration with at least 500 ml of saline solution to stimulate diuresis, installation of 20 ml to 40 ml of lidocaine gel through the meatus, noosing the balanoprepucial sulcus with a sterile gauze. After, routine sequences were performed: Axial T1w, Axial and Sagittal T2, SPACE coronal, MIP Sagittal, T2 Urographic effects techniques images obtained during rest and miccional strain, T1 FS Sagittal before and after gadolinium. All patients were submitted to a urethral reconstruction performed by the same surgeon: anastomotic urethroplasty in 16 patients (64%) and substitution urethroplasty with buccal mucosa graft in 9 patients (36%). RESULTS: In The Dynamic MRI Urethrogram was considered adequate for the definition of surgical proposal in all patients. A diagnostic of anterior urethra strictures was observed in 12 patients (48%) and posterior urethra strictures in 13 patients (53%). The surgeon observed a correspondence between MRI images and surgical findings regarding the location and length of the stricture in all patients. The Dynamic MRI Urethrogram was also adequate to evaluate the urethral caliber in the site of the stricture and the peri-urethral fibrosis. An advantage observed with the use of this method was the possibility to evaluate other organs, structures and the relation with the urethra and the stricture area as rectum, prostate and pubis. The Dynamic MRI Urethrogram also gives the possibility of 3 D reconstructions. CONCLUSIONS: The Dynamic MRI Urethrogram is an excellent method to evaluate the urethral stricture in different portions such anterior and posterior urethra with possible advantages over other methods as the precision measure of location, length, caliber and also evaluation of peri-urethral fibrose and relation with other organ and structures. All those characteristics are important to the surgical planning, specially using a unique image method. 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 André Cavalcanti More articles by this author Rafael Cobo More articles by this author Gabriel Affonso More articles by this author Felipe Da Silva More articles by this author Expand All Advertisement PDF downloadLoading ...

Congenital anterior urethral diverticulum in children: case series and review of the literature

BackgroundCongenital anterior urethral diverticulum (CAUD) is a rare condition in children. This condition can present at any age; however, it is more commonly identified in infants and older children. The patient may present with difficulty in micturition, dribbling of urine, poor urinary stream, or urinary tract infection. Children with large anterior urethral diverticulum with poor spongiosal support may also complain of cystic ventral penile swelling during micturition.MethodsIn this series, we report seven such cases of congenital anterior urethral diverticulum treated over a period of 12 years (2008–2020). All cases presented to the Pediatric Surgery Department with dysuria, dribbling of urine, recurrent urinary tract infection, and/or fluctuant ventral penile swelling. They were further evaluated with retrograde urethrography with micturating cysto-urethrogram and cysto-urethroscopy.ResultsThree cases had anterior urethral valves that were managed by cystoscopic fulguration of valves. Surprisingly, all these three cases had concomitant posterior urethral valves, while the other four cases presented with relatively larger and saccular anterior urethral diverticulum required excision of the diverticulum and primary urethral reconstruction.ConclusionsThe cases with congenital anterior urethral diverticulum secondary to anterior urethral valves may also be associated with posterior urethral valves as seen in our case series. Surgeons should be aware of this association, and both valves should be fulgurated in the same sitting. A larger and saccular anterior urethral diverticulum requires excision and urethroplasty as a definitive procedure.

Retrograde urethrography in children: a decade of experience at a children's hospital.

Retrograde urethrography (RUG) is a radiologic procedure that optimizes imaging evaluation of the urethra, particularly in settings of difficulty with micturition or urethral injury. To review our experience with RUG at a large pediatric radiology practice. We conducted a retrospective review of medical records and fluoroscopic images of RUGs performed from January 2010 to December 2020. We identified 180 RUG exams (median frequency 17 exams per year), all in male children (median age 13years). The most common indications were stricture (42%; n=76), postsurgical evaluation (34%; n=62) and trauma (16%; n=29). The most commonly used catheter was Foley (40%; n=72), with a median catheter size of 5 French (Fr) for infants younger than 1year, 7 Fr for children ages 1-5years and 8 Fr for children older than 5years. About a third of the children (57; 32%) had combined voiding cystourethrography (VCUG)-RUG exams. Water-soluble contrast agent, either 17% or 43% Cysto-Conray, was used. Most RUG exams were normal (46%; n=83). The most common urethral pathology was stricture (30%; n=54), commonly involving a bulbar urethra (n=26). Urethral trauma was seen in 11 children (6%), 10 bulbar and 1 membranous. Most children with stricture were surgically treated (n=40; 74%), whereas most children with trauma were conservatively treated (n=8; 73%). The remaining diagnoses included diverticula, polyps, valves, fistulas and duplications, constituting <17% of our sample; most of these were surgically treated. Four exams (2%) were non-diagnostic. RUG showed 89% sensitivity and 97% specificity compared to cystourethroscopy/VCUG findings. Technical difficulties occurred in 14 (8%) children (e.g., pain or inappropriate catheter seal). Our experience indicates that when catheterization techniques are properly tailored, RUG provides a useful and successful radiologic method of evaluating the pediatric male urethra.

Inter-rater reliability of retrograde urethrograms.

Reliability of pre-operative testing is important for adequate surgical planning. For urethral stricture disease, preoperative planning frequently includes retrograde urethrogram (RUG). The radiographic interpretation of RUGs is often done by urologists themselves. We aimed to evaluate the reliability of RUG interpretation by urologists at our institution. We examined the RUGs of 193 patients. These were deidentified and interpreted by three urologists, two general urologists and one reconstructive urologist. These interpretations were compared in 2 ways. Each of the general urologists was compared to the "gold standard" reconstructive urologist interpretation, and the general urologists were additionally compared to each other. We used intraclass correlation coefficient (ICC) for numerical variables and Fleiss' Kappa or Cohen's Kappa statistic (κ) for categorical variables to rate inter-interpreter reliability and agreement among interpretations with regards to the quantitative variables of stricture length and caliber. Level of agreement ranged from poor to moderate across all variables interpreted. Comparing general urologists to the gold standard yielded no better than moderate agreement, with the majority being poor to fair. Similarly, agreement amongst the general urologists did not reach above moderate, with the majority being poor to slight. To our knowledge, this is the first analysis of inter-rater reliability of RUGs among practicing urologists. Our analysis showed clinically unacceptable reliability with regards to stricture length, location, caliber, and indicated procedures. This study suggests a need for standardized interpretation of RUGs and poses an opportunity for actionable improvement in management of strictures.

Urethral Injuries: Diagnostic and Management Strategies for Critical Care and Trauma Clinicians

Urologic trauma is a well-known cause of urethral injury with a range of management recommendations. Retrograde urethrogram remains the preferred initial diagnostic modality to evaluate a suspected urethral injury. The management thereafter varies based on mechanism of injury. Iatrogenic urethral injury is often caused by traumatic catheterization and is best managed by an attempted catheterization performed by an experienced clinician or suprapubic catheter to maximize urinary drainage. Penetrating trauma, most commonly associated with gunshot wounds, can cause either an anterior and/or posterior urethral injury and is best treated with early operative repair. Blunt trauma, most commonly associated with straddle injuries and pelvic fractures, can be treated with either early primary endoscopic realignment or delayed urethroplasty after suprapubic cystostomy. With any of the above injury patterns and treatment options, a well thought out and regimented follow-up with a urologist is of utmost importance for accurate assessment of outcomes and appropriate management of complications.

MRI in Preoperative Planning for the Repair of Pelvic Fracture Urethral Distraction Defects: A New Tool for Determining Reconstructive Options

Pelvic fracture urethral distraction defects are typically imaged with retrograde urethrogram and voiding cystourethrogram during the work up for delayed posterior urethroplasty following trauma. The imaging results often dictate the decision-making regarding treatment options. Magnetic resonance imaging can offer a more detailed picture of the defect and can aid in preoperative planning. We present the case of an individual who was deemed unrepairable by routine imaging, however, the MRI indicated that surgery was possible.

Imaging in urethral stricture disease: an educational review of current techniques with a focus on MRI.

Urethral stricture disease refers to narrowing of the urethral lumen obstructing the flow of urine. Urethral strictures can significantly impact daily life due to incontinence, incomplete emptying, hesitancy, and increased risk of urinary tract infections. Imaging is central to the evaluation of suspected urethral stricture, as assessment of stricture length and severity is crucial for guidance of surgical management. The currently employed modalities include radiography, chiefly retrograde urethrography (RUG) and voiding cystourethrography (VCUG); magnetic resonance urethrography (MRU); and sonourethrography (SUG). MRU has become a recent focus of research as it provides high spatial resolution, multiplanar capacity, and soft tissue type differentiation for evaluation of periurethral compartments and concurrent soft tissue defects. The protocol for MRU has evolved over the years to now include dynamic micturition imaging and image reconstruction options. In this review, we discuss each of the imaging modalities used in the diagnosis and evaluation of urethral stricture and provide an overview of literature on MRU over the last decade, including suggested indications that have not yet been incorporated into current guidelines. We delineate scenarios where special diagnostic imaging beyond radiography is beneficial, providing examples from our practice and description of our techniques for each modality.

3D CT Urethrography With Cinematic Rendering (3DUG): A New Modality for Evaluation of Complex Urethral Anatomy and Assessment of the Postoperative Phalloplasty Urethra

To develop an imaging modality for the postoperative phalloplasty urethra. Despite high urologic complication rates after masculinizing genital surgery, existing methods for postsurgical evaluation after phalloplasty have drawbacks. Fluoroscopic studies like the retrograde urethrogram have limitations like user-dependence and need for meticulous positioning but also are inadequate for the evaluation of the anatomically complex postphalloplasty urethra. We developed a novel protocol utilizing CT urethrography with 3D reconstruction using cinematic rendering (3DUG) for neo-urethral imaging. Patients who underwent 3DUG after either phalloplasty, metoidioplasty, or prior to revision surgery were included. Low-dose imaging protocols were used to avoid any increases in radiation exposure. The first iteration of our protocol utilized retrograde contrast administration via the penile urethra, whereas the second iteration of our protocol utilized an antegrade technique with contrast instillation via the suprapubic catheter and a voiding scan. Imaging was initially obtained according to symptoms and then per protocol at 3 weeks after urethral lengthening. Twenty-six patients were included in the series. Among postoperative phalloplasty patients imaged for symptoms, contrast extravasation/fistula was identified in 5 (63%), vaginal remnant in 3 (38%), and stricture in 2 (25%) compared to 5 (45%), 1 (9%), and zero respectively for patients imaged routinely. When intervention was required, operative findings correlated to anatomy on imaging. We present a new protocol for the use of 3D CT urethrography with cinematic rendering for neo-urethral reconstruction. This technique has the potential to improve surgical planning and surveillance of urologic complications in postphalloplasty patients.

Urogenital fistula associated with complex dystocia and emergency ovariohysterectomy in a juvenile dog

AbstractA 1‐year‐old, female, spayed dog was referred for urinary incontinence, first noted after a complex dystocia and caesarean section with ovariohysterectomy. Transabdominal ultrasonography and computed tomography with intravenous contrast administration revealed a fluid‐filled tubular structure caudodorsal to the urinary bladder. Routine cystourethroscopy was unremarkable. A retrograde cystourethrogram revealed a 15 mm long connection between the urethra and a structure presumed to be a uterine body remnant. During exploratory laparotomy, the uterine remnant and urethra were separated, leaving oval defects approximately 15 mm long in both; these were then closed. A urinary catheter was left in place for 6 days. A urethrogram performed during catheter removal confirmed closure of the fistula, and the dog was subsequently continent. To the authors’ knowledge, this is the first description of a urogenital fistula suspected to be associated with dystocia and emergency ovariohysterectomy in a dog.

Multi-stage surgery for anterior urethral strictures: assessment of immediate and long-term surgical outcomes

BACKGROUND: The progress made in reconstructive urethral surgery over the past 20 years has shown the effectiveness of one-stage repair of anterior urethral strictures. Nevertheless, multi-stage urethroplasty retains its primary role in the treatment of patients with the most complex urethral narrowing and obliterations.&#x0D; AIM: To evaluate the immediate and long-term surgical results of multi-stage urethroplasty for penile and bulbar urethral strictures.&#x0D; MATERIALS AND METHODS: The study included 110 men aged 1884 years who underwent multi-stage urethroplasty for the anterior urethral structures in 20102019. The techniques of buccal and skin augmentation or urethral replacement plastics were applied. Before surgery, all patients underwent a standard urological examination. Early surgical complications were evaluated from medical records. Late surgical complications were determined according to examinations that included symptomatic assessment with specialized questionnaires, laboratory tests of serum and urine, physical examination, uroflowmetry, and retrograde urethrography and ureteroscopy (if urinary disorders were detected). The median follow-up was 5 years and 2 months.&#x0D; RESULTS: Early surgical complications were detected in 27 (24.5%) patients. Surgical interventions to resolve them were required in 7 (31.8%) cases: urethrocutaneous fistulas (5), acute urinary retention (1), scrotal hematoma (1). Late surgical complications were detected in 33 (30.0%) patients, including 29 (26.7%) cases of recurrent urethral strictures. All late complications cases were classified as Clavien-Dindo IIIb, and a total of 49 additional operations were performed to eliminate them. The primary success rate for multi-stage urethroplasty was 67.3 % with a median follow-up of 62 months. Only 73 (66.4%) completed all stages of the planned surgery. Urethral integrity throughout its entire length was restored in 67 (60.9%) cases, spontaneous urination in 106 (96.4%) cases.&#x0D; CONCLUSIONS: Multi-stage surgery for anterior urethral strictures is associated with relatively high risks of surgical complications at each stage of treatment. The probability of surgical revision of complications can reach 31.8%. Patients should be informed about the risks of developing surgical complications and the potential for more than two surgeries to achieve treatment goals when planning multi-stage urethroplasty.

Urethrocystography: a guide for urological surgery?

Urethrocystography remains the gold-standard technique for urethral pathology diagnosis. Nowadays, of the various indications for performing urethrocystography, the most common is due to a clinical suspicion of urethral stricture. Due to the high prevalence of strictures and their substantial impact on a patient's quality of life, the examination must allow the location, exclusion of multifocality, and assessment of the extent of the stricture to influence surgical planning. This article intends to demonstrate that the radiologist's role, by performing and interpreting the modality of urethrocystography, influences and is crucial for the urologic therapeutic decision and that the patients who were submitted to reconstruction by urethroplasty had a better success rate. The authors aim to review the radiological anatomy of the male urethra, discuss the modalities of choice for imaging the urethra (retrograde urethrography and voiding cystourethrography), provide an overview of the different indications for performing the study, examine the different etiologies for urethral strictures, understand the relevance of the different appearances of urethral pathology, and identify the surgical options, especially in the treatment of urethral strictures. Simultaneously, the study exposes cases of urethral trauma, fistulas, diverticulum, and congenital abnormalities.

Voiding dysfunction: Postsuccessful anastomotic urethroplasty for pelvic fracture urethral injury

Introduction: Anastomotic urethroplasty (AU) is the standard of care for pelvic fracture urethral injuries (PFUIs). Few patients despite having successful AU have postoperative voiding dysfunction due to an unrecognized neurogenic bladder. This article outlines clinical signs which may predict these injuries. Materials and Methods: We retrospectively evaluated our database of more than 1000 cases. Patients who underwent successful AU with postoperative voiding dysfunction were included. The success of urethroplasty was determined by a retrograde urethrogram (RGU) and endoscopic evaluation. Voiding dysfunction was defined as patients with poor urine flow (Qmax <10 ml/s) postsurgery. Urodynamics (UDS) was performed postoperatively on all patients. Results: Six men were included with an average age of 27 years (all required step 3 AU). A RGU and endoscopy revealed a patent anastomosis. UDS showed neurogenic detrusor underactivity. There were variable occurrences of other lower motor neuron findings – muscle atrophy, fasciculations, sensory loss, areflexia, and fecal incontinence. The common factor was that all patients had a foot drop on preoperative assessment. Conclusions: Coexistent neurogenic bladder with PFUI is rare. The presence of foot drop and other lower motor neuron signs is a predictor for voiding dysfunction. We recommend these patients should have UDS before surgical repair and must be counseled accordingly.

Anastomotic urethroplasty as management for iatrogenic posterior urethral injuries in an infant

Introduction: Boys born with high imperforate anus have a rectourethral fistula, which usually occurs at the prostatomembranous junction. A recent trend has been to perform a single-stage posterior sagittal posterior anorectoplasty (PSARP) with pull-through and closure of the rectourethral fistula. Inadvertent posterior urethral injury during repair may result in traumatic obliteration of the posterior urethra. Posterior urethral injury is also possible after other procedures such as ablation of posterior urethral valves (PUVs). We evaluated our outcomes of posterior anastomotic urethroplasty in such infants. Materials and Methods: We managed four infants with posterior urethral injury after PSARP and one after endoscopic ablation of PUVs during 2012–2018 at our institution. Iatrogenic injury was noticed post-PSARP on the removal of the urinary catheter. Suprapubic catheter (SPC) was subsequently inserted. Retrograde urethrogram, voiding cystourethrogram, and endoscopy through the SPC tract and urethra were performed before undertaking an anastomotic urethroplasty. Results: Three infants required crural separation and inferior pubectomy. Four infants had an uneventful recovery. One infant had an annular narrowing at the anastomotic site and required endoscopic urethrotomy twice. We waited till the child was older (age 4) and performed urodynamics. This revealed obstructive uropathy. The patient subsequently underwent redo anastomotic urethroplasty with crural separation and inferior pubectomy. He had an uneventful recovery. Our follow-up ranged from 1 to 7 years. Conclusions: Iatrogenic urethral injuries are rare in infants. Anastomotic urethroplasty achieves physiological voiding and prevents complications of prolonged SPC. Even though surgery is challenging, our series suggests that it is feasible with good outcomes.

Male Urethral Stricture: Epidemiological, Clinical, and Therapeutic Aspects in Kara

Background: Urethral stricture is a pathology frequently encountered in urological practice. Management is often surgical, with possible recurrences. What about this pathology in Kara, a semi-urban city? Objective: Assess the management of male urethral stricture in Kara. Patients and Methods: This was a descriptive study with retrospective data collection. The study took place in the urology department of the teaching hospital of Kara, from December 2020 to December 2022. All cases of male urethral stricture, surgically treated at the teaching hospital of Kara, were listed. The inclusion criteria were as follows: any patient who had been treated surgically for male urethral stricture in the urology department of the teaching Hospital of Kara. The operating theater register and hospital records were used to collect the data. The diagnosis of urethral stricture had been made with retrograde urethrogram. A total of 24 patients were treated for male urethral stricture during the study period. The following variables were studied: age, reason for consultation, location, length, and etiology of the stricture; the type of treatment received: optical internal urethrotomy, or anastomotic urethroplasty, and the results. The result was considered good if, after removal of the urethral catheter, the patient regained his micturition without the need for dilatation; the result was considered average if, after removal of the urethral catheter, the patient needed one or more dilatation sessions to regain urination; the result was considered poor if, after removal of the catheter, the patient did not regain good micturition despite the urethral dilatation sessions. Microsoft excel and epi info 7 software were used for data processing. Results: The average age of our patients was 43.7 years ± 10.18 with extremes ranging from 27 to 70 years. The most represented age groups were that of 40 to 50 years, with 37.5% of cases; and that of 30 to 40 years with 33.3% of cases. The patients had consulted for urine retention in 66.6% of cases; the location of urethral stricture was bulbar in 45.8% of cases. The most found etiology was infectious in 58.3% of cases. Among our patients, 58.3% had received optical internal urethrotomy as treatment, while 41.6% of our patients had received anastomotic urethroplasty as treatment. Postoperatively, after removal of the urinary catheter, 87.5% of patients had benefited from one or repeated dilatation. In terms of results, we had a good result in 20.8% of patients; the result was average in 45.8% of patients, and poor in 33.3% of patients. The average duration of follow-up was 14.3 +/- 7.2 months (3-27). Conclusion: Male urethral stricture mainly affects young adults in Kara. Surgical management is done by optical internal urethrotomy and/or anastomotic urethroplasty.

Ventral onlay graft urethroplasty using bladder mucosa in a cat with a urethral stricture.

A 3-year-old, 4.0 kg, intact male domestic shorthair cat presented with postoperative dysuria following urethral resection and anastomosis for urethral rupture. Retrograde urethrography revealed a stricture in the pelvic urethra. Urethroplasty with bladder mucosa was performed following a bilateral pubic-ischial osteotomy. The bladder wall was resected to harvest an appropriately sized bladder mucosa graft. The graft was placed over the urethral defect in patch fashion and stabilized with interrupted sutures. The cat was able to urinate normally with no evidence of lower urinary tract signs 2 year postoperatively. Therefore, urethroplasty with an onlay bladder mucosa graft may be a feasible alternative to prepubic or subpubic urethrostomy for the treatment of pelvic urethral stricture in cats.

URETHRAL STRICTURE MANAGED WITH HOMEOPATHIC MEDICINE: A STUDY OF FOUR CASES

Urethral stricture is the narrowing of the urethral mucosa, commonly resulting from trauma followed by inflammation and fibrous changes of the corpus spongiosum along the male urethra. Clinical manifestation contains gradual deterioration of hesitancy, intermittency, dribbling of urine, and in association with a sensation of incomplete voiding of the bladder, increased frequency, urgency, straining, and urethralgia during micturition. A low Qmax in Uroflowmetry will give a primary idea of stricture; however, a Retrograde Urethrography (RUG) confirms the stricture location, length, and other identifiable pathology affecting the urethra. In this particular disease, the scope of conventional medicinal treatment is limited, however, there transurethral (dilation, internal urethrotomy) and open surgical (stricture resection and anastomosis, urethroplasty, and perineal urethrostomy) procedures are available, and recurrence is common. Homeopathic medicine is mostly an individualized medicine with a minimum number and high dilution. The use of homeopathic medicine for urological diseases is an opportunistic option. However, a group of patients with similar set of symptoms might be treated with a specific homeopathic medicine. The author is reporting a study of four urethral stricture cases treated with homeopathic medicines, namely Clematis erecta, Medorrhinum, and Aurum metallicum; within 6-24 weeks of homeopathic medicine treatment, all four patients experienced improved uroflowmetry and RUG. The current study results shows homeopathic medicine helped the patients in a harmless, cost-effective way which might encourage awareness among the medical practitioners regarding the available homeopathic medicinal treatment of urethral stricture. Bioresearch Commu. 9(1): 1245-1251, 2023 (January)

Multi-stage urethroplasy for anterior urethral strictures: objective parameters of long-term efficacy and patient-reported outcomes

Introduction. Multi-stage urethral surgery is used in cases of the most complex urethral strictures. The evaluation of surgical treatment results given by patients is a significant criterion for the efficacy of urethroplasty along with the assessment of urethral patency through instrumental examinations.Objective. To evaluate the long-term efficacy of multistage urethroplasty for complex anterior urethral strictures considering the patients' quality of life and satisfaction with the surgical outcomes.Materials and methods. The study included 73 patients aged 18 – 84 years with anterior urethral strictures who underwent multi-stage urethroplasty in 2010 – 2019. Surgical and functional outcomes of urethroplasty were assessed through general blood and urine tests, physical examination, uroflowmetry, and retrograde urethrography and urethroscopy in case of urinary disorders. Subjective parameters of treatment efficacy were studied using questionnaires: International Prostate Symptom Score (IPSS); Quality of life (QoL); Patient-reported Outcome Measure for Urethral Stricture Surgery (USS-PROM); Patient Global Impression of Improvement (PGI-I).Results. Recurrent urethral stricture was detected in 19 (26,0%) patients with the average follow-up period being 65 months. Independent urination was restored in 71 (97.3%) cases, including repeated interventions. After surgery, there was a significant increase in urinary flow rate parameters (Q max: 8.1 vs 19.1 ml/s, p &lt; 0.0001; Q ave: 5.5 vs 10.7 ml/s; p = 0.0004), decrease in residual urine volume (62.4 vs 18.6 ml, p &lt; 0.0001), decrease in total IPSS score (18.7 vs 5.7 points; p &lt; 0.0001) and QoL index (4.3 vs 1 .8 points, p &lt; 0.0001). A comparative analysis of preoperative and postoperative USS-PROM questionnaire results demonstrated an improvement in indicators assessing LUTS (12.9 vs 3.4 points; p &lt; 0.0001; 3.6 vs 1.7 points; p &lt; 0.0001), and urination-associated quality of life (2.6 vs 0.6 points; p &lt; 0.0001) and overall health (EQ-5D index: 0.73 vs 0.91 points; p = 0.025; EQ-VAS: 68.0 vs 88.1 points, p = 0.004). Fifty-seven (81.4%) men were “very satisfied” or “satisfied” with the treatment outcomes, while nine (12.9%) respondents noted a moderate effect of residual urinary disorders on the quality of life. Significantly higher satisfaction was observed among cystostomy patients and in cases where repeated interventions were unnecessary.Conclusion. Multi-stage urethroplasty for complex anterior urethral strictures achieves efficacy in 97.3% of cases and is accompanied by high levels of quality of life and patient’s satisfaction during long-term follow-up.

Urethral obstruction due to an inflammation and necrosis in the os penis of a dog

AbstractA 2‐year‐old, 24.8 kg, entire, male, mixed breed dog was evaluated because of acute onset of pollakiuria and stranguria. Abdominal radiographs identified no obvious underlying cause for the stranguria. Abdominal ultrasound revealed prostatic cysts with a periprostatic inflammation. Retrograde contrast urethrography and urethrocystoscopy demonstrated a compressive lesion of the urethra at the caudal end of os penis. Initially, a balloon‐expandable metallic stent was placed in the area of the urethral obstruction. Haematuria and compression of the stent were observed 2 weeks after stent placement. Penile amputation in combination with cryptorchidectomy and neutering as well as scrotal urethrostomy were performed. Recovery was uneventful and the dog was doing well at the 2‐week follow‐up recheck. Histopathology diagnosed a well‐circumscribed necrotic area with haemorrhage within the os penis. The patient was clinically doing well over the next 13 months, but then humanely euthanased due to unrelated reasons.

Identifying urethral strictures using machine learning: a proof-of-concept evaluation of convolutional neural network model.

To evaluate urethral strictures and to determine appropriate surgical reconstructive options, retrograde urethrograms (RUG) are used. Herein, we develop a convolutional neural network (CNN)-based machine learning algorithm to characterize RUG images between those with urethral strictures and those without urethral strictures. Following approval from institutional REB from participating institutions (The Hospital for Sick Children [Toronto, Canada], St. Luke's Medical Centre [Quezon City, Philippines], East Virginia Medical School [Norfolk, United States of America]), retrograde urethrogram images were collected and anonymized. Additional RUG images were downloaded online using web scraping method through Selenium and Python 3.8.2. A CNN with three convolutional layers and three pooling layers were built (Fig. 1). Data augmentation was applied with zoom, contrast, horizontal flip, and translation. The data were split into 90% training and 10% testing set. The model was trained with one hundred epochs. A total of 242 RUG images were identified. 196 were identified as strictures and 46 as normal. Following training, our model achieved accuracy of up to 92.2% with its training data set in characterizing RUG images to stricture and normal images. The validation accuracy using our testing set images showed that it was able to characterize 88.5% of the images correctly. It is feasible to use a machine learning algorithm to accurately differentiate between a stricture and normal RUG. Further development of the model with additional RUGs may allow characterization of stricture location and length to suggest optimal operative approach for repair.