Management of bladder outflow obstruction by serial urethral dilatation (original) (raw)

Study on Role of Urethral Dilator in Bladder Outflow Obstruction.

IOSR Journals , 2019

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.

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.

Clinical study and management of bladder outlet obstruction

International Surgery Journal, 2017

Background: The incidence of bladder outlet obstruction is different and varied in both age and gender. Hence this study was conducted to assess the incidence, etiology and management of bladder outlet obstruction in patients above 18 years of age in both sexes.Methods: This was a tertiary care hospital based longitudinal study. A total of 100 cases were recruited during the period between 01st June 2014 to 31st May 2016 with objective evidence of bladder outlet obstruction. The subject's demographic data, incidence, etiological factors and clinical presentations of bladder outlet obstruction were recorded on data sheet and analyzed.Results: Male preponderance was observed in the study. Maximum incidence of bladder outlet obstruction was observed in the age group of 60-69 years. The most common cause for bladder outlet obstruction in males was benign prostate hyperplasia (BPH), where as in females the major etiological factor was bladder neck stenosis. Out of 94 cases causing bl...

Surgical Management and Post-Operative Outcomes of Urinary Outflow Obstruction: Experience of 50 Cases in Bangladesh

Journal of National Institute of Neurosciences Bangladesh, 2018

Background: Management of urinary outflow obstruction is very crucial. Objective: The purpose of the present study was to see the different management of urinary outflow obstruction with their post-operative outcomes. Methodology: This non-randomized clinical trial was conducted in the Department of Surgery at Rajshahi Medical College, Rajshahi, Bangladesh from September 1994 to December 1995 for a period of one year and three months. All the patients who were presented with bladder outflow obstruction and were admitted in the general surgical unit of the hospital were taken as study population. These patients were surgically managed in different procedures. The follow up was done to record the post-operative surgical outcomes. Result: A total number of 50 patients were recruited for this study. Benign enlargement of prostate was found in 13 cases of which 11(22.0%) cases were managed by suprapubic transvesical prostatectomy. Impacted urethral stone was found in 13 cases of which 4(8.0%) cases were managed by urethro-lithotomy followed by repair of urethra and indwelling catheter. Stricture urethra was found in 11 cases and all cases (100.0%) cases were managed by intermittent dilatation under general anesthesia. In 7 cases of rupture urethra, initially all patients were managed by suprabpublic cystostomy which was 7(14.0%) cases in number. All the 3 cases of carcinoma prostate were managed by prostatectomy and radiotherapy plus hormone therapy. A total number of 16 patients were managed by prostatectomy of which 1(2.0%) case was developed immediate postoperative hemorrhage which was managed by blood transfusion and continuous irrigation with normal saline. One patient developed postoperative clot retention due to blockage of Foley's catheter, two patients developed postoperative incontinence, immediately after removal of the catheter. Out of 11 patients of impacted urethral stone, one developed urethral fistula and one developed UTI. Recurrent stricture urethra occurred in 3 patients. Seven patients with rupture urethra, 3 developed stricture urethra and 3 developed stricture urethra. Conclusion: In conclusion different surgical procedure are employed during the management of urinary outflow obstruction and immediate postoperative hemorrhage, postoperative clot retention, postoperative incontinence, urethral fistula, UTI and recurrent stricture urethra are the most common complication after surgical management of urinary outflow obstruction patients.

CLINICAL PROFILE OF BLADDER OUTLET OBSTRUCTION {BOO} IN FEMALE.

Aim:- To evaluate female patients of bladder outlet obstruction and find out common causes and clinical presentation of boo . To understand diagnostic modalities, treatment modalities and complications of boo in female. Study Design:- This is a prospective study of 50 female patients presented with bladder outlet obstruction in a single centre. including only female patients > 15 years age and excluding females with prior surgery of urinary tract / perineal surgery / spine surgery / known spine pathology . Result:- According to age: the maximum number of cases (22%) is seen in the age group of 56 years to 65 years , body mass index(bmi) majority (52%) of the patients were in the bmi group of 26 - 29 kg/m2. Symptoms in female boo majority (96%, n: 48) had sensation of incomplete emptying at the end of micturation. etiology most common causative pathology was urinary tract infection28% (n: 14) surgical treatment offered 30% (n: 15) and received urethral dilatation/ urethrotomy.

Feasibility, complication and long-term follow-up of the newly nelaton based urethral dilation method, retrospective study

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.

Efficacy and safety of urethral de-obstruction in boys with overactive bladder complaints

Journal of Pediatric Urology, 2013

Objective: To gain insight into the efficacy and safety of urethral de-obstruction in boys with overactive bladder (OAB) complaints refractory to conservative treatment. Materials and methods: All boys, older than 5 years, referred in 2009 for OAB complaints were included, n Z 180. Nine had abdominal or penile pain as predominant complaint. 82% were tertiary referrals after unsuccessful conservative treatment with antimuscarinic medication and/or urotherapy for OAB. In 121, urethral obstruction was urodynamically proven or seriously suspected, and they underwent urethrocystoscopy with relief of obstruction, when present. Average duration of unsuccessful conservative pre-treatment in this group of patients was 1.2 years. Postoperative results, in terms of relief of complaints, were analyzed. Safety was assessed by analyzing those patients who had a secondary transurethral procedure in the same year, or in the 3 years after primary treatment. Results: Of 106 boys with OAB, urge incontinence or therapy-resistant bedwetting, after deobstruction 33 became free of complaints and 39 showed significant improvement, totaling 72 (68%); dry after additional urotherapy 11 (10%); no change 21 (20%). Nine boys had deobstruction because of penile or abdominal pain, with 5 completely cured after the procedure. Follow-up treatment was cognitive training in 39, temporary anticholinergic treatment in 26 and CIC in 2 cases. Recurrence of obstruction was seen in 10% during the 3-year follow-up period. Conclusion: After failure of conservative therapy, one should actively look for any urethral obstruction as underlying cause of OAB. For such patients, urethral de-obstruction is highly effective, with only a few minor late complications resulting in recurrence of obstruction.

“Close-loop” urethral obstruction: Clinico-radiological features and management consideration in a resource-constraint environment

African Journal of Urology, 2013

Objective: To document our observation of "close-loop" obstruction among patients with dual urethral obstruction from BPH and urethral stricture disease. Materials and Methods: The hospital records of all patients that presented to our centres with evidences of urethral stricture co-existing with BPH were retrospectively reviewed from January 2007 to December 2011. Among other things, the salient features in the contrast radiograph of those with "close-loop" obstruction and their treatment were documented and analysed. Results: Forty three patients were managed for radiological evidence of urethral stricture and elevated bladder base (dual obstruction). Thirty (69.7%) of these patients had open prostatectomy with easy dilatation of the urethral stricture. Twelve (27.9%) of the patients had urethroplasty for urethral stricture diseases; of these twelve, five patients presented with persistent LUTS ("close loop" obstruction). These five (11.6%) patients were aged between 50 to 80 years; they all had suprapubic cystostomy. In addition to delineating the anatomy of the urethral stricture and elevated bladder base, other salient features on the contrast *

Benefits and Harms of Conservative, Pharmacological, and Surgical Management Options for Women with Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel

European Urology Focus, 2021

While the management of bladder outlet obstruction (BOO) in men has been a topic of several systematic reviews and meta-analysis, no such evidence base exists for female BOO. Objective: The aim of this systematic review was to evaluate the benefits and harms of therapeutic interventions for the management of BOO in women. Evidence acquisition: This systematic review was conducted in accordance with the PRISMA statement. The study protocol was registered with PROSPERO (CRD42020183839). A systematic literature search was performed and updated by a research librarian in May 2021. The study population consisted of adult female patients diagnosed with BOO and who underwent treatment. Evidence synthesis: Out of 6344 records, we identified 33 studies enrolling 1222 participants, of which only six RCTs were found. One placebo-controlled cross-over randomized trial assessed the role of baclofen in 60 female patients with dysfunctional voiding. The trial met its primary endpoint with a significantly greater decrease in the number of voids/day in the baclofen group (-5.53 vs.-2.70; p=0.001). The adverse events were mild and comparable in both groups (25% vs. 20%). One placebocontrolled cross-over randomized trial assessed the role of sildenafil in 20 women with Fowler's syndrome. There were significant improvements from baseline in Qmax, IPSS, and post-void residual (PVR) but with no statistically significant difference when compared with placebo. In a large RCT including 197 female patients with functional BOO, the alpha-blocker alfusozin significantly improved IPSS, Qmax and PVR compared to baseline but the differences compared to the placebo group were not statistically significant. Several small single arm prospective series reported improvement of BOO related symptoms and voiding parameters with urethroplasty, sling revision, urethral dilation, vaginal pessary and pelvic organ prolapse repair. Conclusion: Evidence to support the use of conservative, pharmacological and surgical treatments for BOO are scarce. Patient summary: According to the present systematic review of the literature, evidence to support the use of conservative, pharmacological and surgical treatments for either anatomical or functional BOO are scarce.