Urethral dilation in women: a questionnaire-based analysis of practice patterns (original) (raw)
Related papers
International Urogynecology Journal, 2013
Introduction and hypothesis The aim of this manuscript is to review the subject of urethral dilation (UD) in female patients and to conduct a critical appraisal of the available evidence for its use. Methods We used an online search of electronic databases. Results UD has been cited as a treatment option for various conditions that do not share common etiologies and that affect the lower urinary tract in female patients. Outcome measurement was not consistent, even when performed for the same conditions. A total of six randomized controlled trials failed to prove any benefit for UD in repetitive urinary tract infections (UTI), urethral syndrome, and overactive bladder. Conclusions Conflicting results and diverse opinions have characterized the use of UD until present time. Professional societies are urged to attend to this issue, and to identify possible areas where UD could be potentially investigated.
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.
Female urethral dilatation (bougierung): a case report
Journal of Medical Case Reports
Background: Primary bladder neck obstruction is a rare clinical entity, reported to be responsible for 2.7-8% of lower urinary tract symptoms. It can lead to various urinary storage and voiding symptoms. The mainstay of treatment of female urethral strictures is urethral dilatation. Despite the long history of this method, it is unclear how far the female urethra should be dilated in correlation with residual urine volume. Case presentation: A 79-year-old Caucasian woman presented to our institute with urgency (12-15 times/day), nocturia (3 times/night), and reoccurring urinary tract infections. A physical examination revealed no anatomical malformation in her genital organs, 150 mL post-void urine retention, and a significant narrowing in the mid-segment of the urethra (4 mm). After informed consent, our patient underwent urethral dilatation ranging from Ch9 (3 mm) to Ch39 (13 mm), and reported no symptoms at the 4-week follow-up, with no post-void residual urine. Conclusions: The relatively low (around 50%) success rate of urethral dilatation might be improved by the utilization of wider dilatators, and the relaxation of the pubourethral ligament, achieved by a gentle downward saggital push during the intervention, although long-term studies with a large number of participants are necessary to prove our hypothesis.
Management of Urethral Stricture in Women
The Journal of Urology, 2012
We describe the diagnosis and treatment of urethral strictures in women. Materials and Methods: We retrospectively identified female urethral strictures from 1998 to 2010. Study inclusion criteria were 1) clinical diagnosis of stricture, 2) stricture seen on cystoscopy, 3) urethral obstruction on videourodynamics according to the Blaivas-Groutz nomogram and/or 4) urethral caliber less than 17Fr. Postoperative recurrence was defined by the preoperative criteria. Results: We identified 17 women with a mean age of 62 years (range 32 to 91) with stricture. Stricture was idiopathic in 8 patients, iatrogenic in 6, traumatic in 2 and associated with a urethral diverticulum in 1. Videourodynamics could not be done in 3 women due to complete obliteration of the urethra. Ten of 14 patients satisfied videourodynamic criteria for obstruction and 4 had impaired detrusor contractility. Nine women underwent vaginal flap urethroplasty, including 5 who also had a pubovaginal sling and 1 who had a Martius flap. One patient received a buccal mucosal graft as primary treatment after initial dilation. There was no recurrence at a minimum 1-year followup but 2 strictures recurred 5½ and 6 years postoperatively, respectively. These 2 women received a buccal mucosal graft and were stricture free 12 to 15 months postoperatively. Of 17 patients initially treated with urethral dilation recurrence developed in 16, requiring repeat dilations until urethroplasty was performed. Conclusions: In select women vaginal flap urethroplasty and buccal mucosal graft have high success rates, including 100% at 1 year and 78% at 5 years. Urethral dilation has a 6% success rate. Long-term followup is mandatory. Treatment should be individualized.
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...
Poor Quality of Life in Patients with Urethral Stricture Treated with Intermittent Self-Dilation
The Journal of Urology, 2014
We assessed patient perceptions of regular intermittent self-dilation in men with urethral stricture. We constructed and distributed a visual analog questionnaire to evaluate intermittent self-dilation via catheterization by men referred for urethral stricture management at a total of 4 institutions. Items assessed included patient duration, frequency, difficulty and pain associated with intermittent self-dilation as well as interference of intermittent self-dilation with daily activity. The primary outcome was patient perceived quality of life. Multivariate analysis was performed to assess factors that affected this outcome. Included in the study were 85 patients with a median age of 68 years, a median of 3.0 years on intermittent self-dilation and a median frequency of 1 dilation per day. On a 1 to 10 scale the median intermittent self-dilation difficulty was 5.0 ± 2.7, the median pain score was 3.0 ± 2.7 and median interference with daily life was 2.0 ± 1.3. Overall quality of life in patients with stricture was poor (median score 7.0 ± 2.6 with poor quality of life defined as 7 or greater). On univariate analysis younger age (p <0.01), interference (p = 0.03), pain (p <0.01) and difficulty performing intermittent self-dilation (p = 0.03) correlated with poor quality of life in a statistically significant manner. On multivariate analysis only difficulty catheterizing (p <0.01) and younger age (p = 0.05) were statistically significant predictors. Patients with stricture involving the posterior urethra had a statistically significant increase in difficulty and decrease in quality of life (each p = 0.04). Most patients with urethral stricture who are on intermittent self-dilation rate difficulty and pain as moderate, and inconvenience as low but report poor quality of life.
Reconstruction of urethral strictures in patients with a long history of blind urethral dilatation
Urology journal, 2014
PURPOSE To compare urethral reconstructions in patients after several years with or without blind urethral dilatation. MATERIALS AND METHODS A retrospective study of 107 patients with urethral reconstructions was performed. Sixty patients with a long history of blind urethral dilatation (group 1) were compared with 47 patients without prior dilatations (group 2). RESULTS The type of surgery planned according to urethrography and endoscopy findings was appropriate in 37/60 (61.6%) patients in group 1 and in 39/47 (83%) patients in group 2(P < .03). Anastomotic repairs were more frequent among the patients in group 2 (P < .001).Eighty five out of 107 patients were available for the 24 months follow-up. The success rate was higher in group 2 (91.4%) than patients in group 1 (70%) (P < .04). The greatest improvement in symptoms and quality of life occurred three months after the surgery (P < .05).Postoperative infection was persistent in 20/107 (18.7%) patients. CONCLUSION U...
Neurourology and Urodynamics, 2020
Objective: To evaluate the management methods of female urethral stricture (FUS) and analyze the outcomes of surgical treatments. A meta-analysis was done in an attempt to identify the best approach of urethroplasty and the graft-of-choice. Materials and Methods: A systematic search of Pubmed/Medline and Embase databases was performed according to the Preferred Reporting Items For Systematic Review And Meta-Analysis statement, for articles reporting on FUS management in the last decade. The Newcastle-Ottawa scale was used to assess the quality of 28 included non-randomized studies. The data on FUS management was summarized and pooled success rates (taken as symptom improvement and no need for further instrumentation) were compared. The secondary outcome was to establish a diagnostic modality of choice and define a "successful-outcome" of repair. Results: The outcome was separately reported for 554 women undergoing surgical intervention for FUS in the literature. The criteria defining FUS were varied. A combination of tests was used for diagnosis as none was singularly conclusive. A total of 301 patients had previous urethral instrumentations. The pooled success rate of urethral dilatation (234 women) was 49% at a mean follow-up of 32 months; flap urethroplasty (108 cases) was 92% at a mean followup of 42 months; buccal mucosal graft (BMG) urethroplasty (133 cases) was 89% at a mean follow-up of 19 months; vaginal graft augmentation (44 cases) was 87% at a mean follow-up of 15 months; and labial graft reconstruction (19 cases) was 89% at a mean follow-up of 18.4 months. The dorsal approach of graft augmentation met with 88% (95% confidence interval [CI] 0.79-0.95) success compared with 95% (95% CI 0.86-1) for the ventral approach. Conclusion: FUS is a rare condition requiring a meticulous diagnostic workup using multiple tests. All urethroplasties have shown better pooled success rates (86%-93%) compared with dilatation (49%). BMG is equally effective as vaginal graft urethroplasty.
Management of bladder outflow obstruction by serial urethral dilatation
Objectives To present our center's experience in managing bladder outlet obstruction (BOO) conditions using bougie dilators. We described the dilation technique methodically for teaching purpose. Patients and method Retrospectively, a total of 196 medical records over the last four years denoting BOO conditions in men, women, and children were retrieved for analysis. Data reviewed for common complications was namely: perforation, recurrence, urinary tract obstruction (UTI) and inability to overcome the obstruction. Results Among the 196 analyzed cases, 24 (12.2%) cases were cured, whereas 172 (87.8%) cases reported complications. Within the complicated cases analyzed, 134 (68.4%) cases had recurrent obstructions, 13 (6.6%) cases had perforations, 6 (3.0%) cases developed UTI, while in 19 (9.7%) cases, we failed to pass the obstruction. Conclusions In our center where urethral dilation technique has revived four years ago, it turned back to be the standard choice in managing BOO cases. We propose the technique to Urology training program directors, all over the world, to teach it as a compulsory skill for junior urologists to master.
Use and outcomes of amplatz renal dilator for treatment of urethral strictures
International braz j urol, 2016
ARTICLE InfO ______________________________________________________________ ______________________ Introduction: Urethral stricture disease is still a major problem in men. Many procedures are available for the treatment of urethral strictures; urethral dilatation is one of the oldest. The blind dilatation of urethral strictures may be a difficult and potentially dangerous procedure. The purpose of this study was to describe safe urethral dilatation using amplatz renal dilator and to report outcomes. Materials and Methods: From 2010 to 2014, a total of 26 men with primary urethral strictures were managed by urethral dilatation using amplatz renal dilators. The parameters analyzed included presentation of patients, retrograde urethrography (RGU) findings, pre-and postoperative maximum flow rate (Q max) on uroflowmetry (UF) and post-void residual urine (PVR). Patients were followed-up at 1.6 and 12 months. The technique described in this paper enables such strictures to be safely dilated after endoscopic placement of a suitable guidewire and stylet over which amplatz renal dilators are introduced. Results: The mean age of the patients was 57.6 (35-72) years. The median stricture length was 0.82 (0.6-1.5)cm. Pre-operative uroflowmetry showed Q max of 7.00 (4-12) mL/sec and ultrasonography showed PVR of 75.00 (45-195)mL. Postoperatively, Q max improved to 18.00 (15-22)mL/sec (p<0.001) at 1 month, 17.00 (13-21)mL/sec (p<0.001) at 6 months and 15.00 (12-17)mL/sec (p<0.001) at 12 months. The post-operative PVR values were 22.50 (10-60)mL (p<0.001), 30.00 (10-70)mL (p<0.001) and 30.00 (10-70) mL (p<0.001) at 1.6 12 months, respectively. The median procedure time was 15.00 (12-22) minutes. None of the patients had a recurrence during a 12-month period of follow-up. Conclusion: Urethral dilatation with amplatz renal dilators avoids the risks associated with blind dilatation techniques. This tecnique is a safe, easy, well-tolerated and cost-effective alternative for treatment of urethral strictures.