Poor Quality of Life in Patients with Urethral Stricture Treated with Intermittent Self-Dilation (original) (raw)
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The Journal of Urology, 2013
Aires Argentina. The proposed is a retrospective observational study of all adult patients who underwent urethral reconstruction to a perineal urethrostomy with the use of a single buccal mucosal graft between January 1, 1999 and December 31, 2010, and had at least one post-operative follow-up visit. All surgeries were performed by 3 surgeons, which applied the same technique (GHJ, KAM, and RV). RESULTS: A total of 57 patients were included in this series. Patients' age range from 27 to 81 years (mean 59). Stricture length ranged from 4 to 20 cm (mean 15,22). Etiologies included unknown in 27, Hypospadias in 9, Lichen Sclerosus in 8, iatrogenic in 7, Fournier in 3, urethral cancer in 2 and penile cancer in 1. Mean follow up was 42 months (R 6.43 to 119). Overall success was 91%. Five patients had recurrence, of which two had a successful redo urethrostomy, two are being managed with periodic dilations and one patient died of another cause. CONCLUSIONS: BMG perineal urethrostomy is a valid alternative for complex urethral strictures due to Lichen Sclerosus, previous failed reconstructions or hypospadias cripples. Midterm results are encouraging for this novel technique.
The New Journal of Urology, 2018
Üretra darlığı erişkin erkeklerde sıklıkla ikincil nedenlere bağlı gelişen yaygın görülen klinik bir durumdur. Üretral darlıkların tedavisinde optik internal üretrotomi (OIU), üretral dilatasyon ve açık üretroplasti gibi tedavi seçenekleri vardır. Aralıklı selfdilatasyon işleminin üretral darlık tedavisindeki yeri tartışmalıdır. Bu çalışmada tekrarlayan üretral darlıklarda self-dilatasyonun etkinliliği araştırılmıştır. Gereç Yöntem: Bu prospektif çalışmamızda hastalar iki gruba ayrılarak değerlendirildi. 67 hastadan oluşan çalışma grubuna OIU sonrası haftada iki kez self-dilatasyon uygulanırken, 63 hastadan oluşan kontrol grubuna ise OIU sonrası herhangi bir işlem yapılmadı. Hastalar primer olarak maksimum idrar akış hızı (Qmax) ile takip edildi. Sekonder olarak ise hastalar Uluslararası Erektil Fonksiyon indeksi, Uluslararası Prostat Semptom Skoru, rezidüel idrar hacmi, üriner sistem infeksiyonu ve Yaşam Kalite Skoru bakımından değerlendirildi. Bulgular: Cerrahi sonrası birinci ay kontrolünde, kontrol grubu ve çalışma gruplarında sırasıyla ortalama Qmax 14,0±3,0 mL/s ve 14,3±2,4 idi (p = 0,44). Cerrahi sonrası üçüncü ayda ortalama Qmax değerleri sırasıyla 11,6±2,9 mL/s ve 13,3±2 mL/s bulundu (p=0,01) ve gruplar arasında IIEF skorları
To assess the impact of prior urethral dilatation or DVIU on the outcome of anterior urethroplasty
International Journal of Endorsing Health Science Research
Background: Male urethral stricture has remained the major problem in urologic practice. Patients presenting with urethral stricture disease are commonly managed by dilatation, DVIU, and urethroplasty. Methodology: This is a descriptive study of male patients who underwent anterior urethroplasty at our setup from 5th August 2021 to 25th February 2022. We analyzed the age, duration, type, length, and location of the stricture and the surgical treatment outcome after urethroplasty. The post-operative catheter was removed after 3 weeks, and UFM is advised. Qmax (max flow rate) > 15 ml/sec was measured on UFM (uroflowmetry) on the 1st week, 6 weeks, and followed on 3 months. Final outcome in terms of success was assessed by uroflowmetry. A maximum urine flow greater than 15mL/s after 3 months’ treatment assessed by uroflowmetry was considered as success. Results: In our study, the blood loss in group A and group B patients, those patients who had DVIU or dilation in the past, had mor...
Urethral dilation in women: a questionnaire-based analysis of practice patterns
Urology, 1999
Objectives. To assess current practice patterns among urologists and to determine the perceived efficacy of urethral dilation. Urethral dilation has been advocated as a treatment for a variety of urologic disorders in women for several decades. Recent changes in Medicare reimbursement have again focused attention on this issue. Methods. A 15-item questionnaire was mailed to all urologists actively practicing in the state of Texas (n ϭ 642). The questionnaire consisted of 12 items about indications for, technique of, and outcome of urethral dilation, and three demographic questions regarding location and type of practice and number of years since completing residency. Results. A total of 194 physicians completed and returned the questionnaire (30%). Overall, 48.2% of practitioners used dilation six or fewer times during the past year; 23.7% reported having used it more than 30 times. Most urologists used dilation for urethral syndrome only (61.1%), although urethral stricture was also a frequently reported condition requiring dilation (29%). Most urologists trained within the past decade (60.9%) reported never offering dilation for urethral syndrome; only 34.2% of the remainder never offered it (P ϭ 0.002). Urologists normally performed this procedure with local or no anesthesia (85%) and most commonly dilated to 32F (45%). Overall, 21% of urologists trained more than 10 years ago considered dilation very or extremely successful in treating urethral syndrome; 0 of 42 trained more recently considered it to be this successful (P ϭ 0.014). Conclusions. The use of urethral dilation in women remains controversial. Recently trained urologists use it less frequently and find it less efficacious than those who have been practicing for longer periods. Since such obvious biases exist, it is imperative that the clinical merit of urethral dilation be carefully scrutinized. UROLOGY 54: 37-43, 1999.
2019
Introduction: Current methods for Urethral dilatation include filiforms and followers, metal sounds, balloon dilators, catheters of increasing size, introduction of a Council catheter over a guidewire, and coaxial dilators of increasing size. These methods however are effective but expensive and use of them is limited in many third world countries. In this retrospective study, we report the feasibility, complication and long-term follow-up of the newly Nelaton based urethral dilation method following by self calibration plan as a single referral center experience. Method: We reviewed the records of 333 men with urethral stricture longer than 1 cm over a 16-year period between March 2001 to December 2018. In this method the straight flexi-tip guide-wire is introduced through the urethra and advanced under cystoscopic vision. This wire then was used to guide the dilatation after withdrawal of the cystoscope. The tip of well-lubricated Nelaton urethral catheters incised and then advanced gently over the guide-wire serially from the smallest to the largest appropriate sizes. The patients were followed up regularly after the dilatation 1, 3, 6, 12 months and then annually postoperatively with taking history, PVR and uroflowmetry and all underwent retrograde urethrography at the 6 th and 12 th months of follow-up. Result: The mean age of patients was 39.19±16.9 years old (10 to 86 years). The mean period of the follow-up was 3.6±1.1 years (range, 3 to 4.3 years). Success rate after first attempted was 58.5% and after two attempted was 77.7% in two years follow up. After one year 51 (15.3%), two years 23 (6.9%) and after three years 11 (3.3%) cases required continued self dilatation once a month. Conclusion: Guide wire-assisted urethral dilatation is shown to be acceptable, cost-effective, simple, safe and feasible techniques for urethral dilation. Our technique may be the choice manner in selected patients with short memberanous urethral stricture, because of decrease the risk of incontinency.
Male urethral strictures and their management
Nature Reviews Urology, 2013
| Male urethral stricture disease is prevalent and has a substantial impact on quality of life and health-care costs. Management of urethral strictures is complex and depends on the characteristics of the stricture. Data show that there is no difference between urethral dilation and internal urethrotomy in terms of long-term outcomes; success rates range widely from 8-80%, with long-term success rates of 20-30%. For both of these procedures, the risk of recurrence is greater for men with longer strictures, penile urethral strictures, multiple strictures, presence of infection, or history of prior procedures. Analysis has shown that repeated use of urethrotomy is not clinically effective or cost-effective in these patients. Long-term success rates are higher for surgical reconstruction with urethroplasty, with most studies showing success rates of 85-90%. Many techniques have been utilized for urethroplasty, depending on the location, length, and character of the stricture. Successful management of urethral strictures requires detailed knowledge of anatomy, pathophysiology, proper patient selection, and reconstructive techniques.
A retrospective analysis of urethral strictures and their management at a tertiary care center
ijnu.ir
Background: Surgical treatment of urethral strictures includes numerous options such as dilation, internal urethrotomy, stenting and reconstructive surgical techniques. Short uncomplicated strictures are generally amenable to complete excision with primary anastomosis. We performed a retrospective evaluation and analysis of outcome in patients who underwent any kind of treatment for urethral strictures. Objectives: To evaluate and analyze the outcome in patients who underwent treatment for urethral stricture disease over the last 15 years (May 1993 to June 2008), at a tertiary care centre, as well as to determine the treatment option to be utilized in different varieties of urethral strictures. Patients and Methods: We reviewed 524 patients who underwent treatment for urethral strictures between May 1993 and June 2008. Mean follow-up was 68 months. Preoperative evaluation included clinical history, physical examination, urine culture, residual urine estimation, uroflowmetry, and retrograde and voiding cystourethrography. Since 2000 urethral ultrasound was also performed in all patients. Clinical outcome was assessed by comparing pre and post operative investigation and patient satisfaction. Results: Stricture etiology was catheter induced (15.36%), blunt perineal trauma (59.2%), instrumentation (12%), spontaneous (3.52%) and infection (10%). Stricture length was 0 to1cm (in 9.92%) 1 to 2 cm (in 32%), 2 to 3 cm (17.28%), 3 to 4 cm (24%) or 4 to 5 cm (8.8%) more than 5cm (16%). The success rates in these procedures were 93.6% (TAU-Tunica albuginea urethroplasty), 94.4% (USPBA-U shaped Prostato-bulbar Anastomosis), 91.7% (BMSU-Buccal Mucosa urethroplasty), 90% (IOU-Internal optic urethrotomy), 90.35% (dilatation) and 81% (two staged urethroplasty). There were 129 patients (25.49%) who experienced ejaculatory dysfunction. Good and fair results were considered successful. Of 524 cases 480 (91.6%) were successful and 44 (8.4%) were treatment failures. Conclusions: We conclude that the treatment of urethral strictures should be individualized, taking into account the location, length and extent of spongiofibrosis.