MR urethrography versus X-ray urethrography compared with operative findings for the evaluation of urethral strictures

International Urology and Nephrology - We compared the accuracy of magnetic resonance (MR) urethrography and X-ray urethrography with operative findings for urethral strictures and observed their...     

Full thickness skin graft urethroplasty for anterior urethral strictures.

Thirty-two free full thickness skin graft urethroplasties were performed over a thirty-nine-month period. Follow-up of more than six months was available in 27 patients. Results were good or fair in 26 patients (96 per cent). Only 1 patient has been classified as a failure and required reoperation.     

Urethral pressure profile and retrograde urethrography in diagnosis of urethral strictures.

In 20 male patients with urethral strictures, urethral pressure profile was compared with retrograde urethrography. There was good accordance between the two methods with only minor discrepancies in multiple or very distal strictures. Urethral profile did not provide more exact information than did urethrography.     

Functional evaluation of anterior urethral strictures with combined antegrade and retrograde urethrography

The merits of radiological examination for functional evaluation of urethral strictures of the anterior male urethra were studied by comparing the results of combined retro- and antegrade urethrography with the patient's maximum urinary flow-rate. A correlation was found between stricture diameter and maximum flow-rate (r=0.67) and a still higher correlation between the ratio stricture diameter-prestenotic urethral diameter and the flow-rate (r=0.73). A low but significant (p less than 0.05) negative correlation was obtained between the prestenotic urethral diameter and the flow-rate (r=0.25).     

Buccal mucosa urethroplasty for the treatment of bulbar urethral strictures

PURPOSE: We report the results of urethroplasty with a free graft of buccal mucosa as a dorsal onlay for the treatment of bulbar urethral strictures. MATERIALS AND METHODS: Since June 1994, 30 patients with bulbar urethral strictures have been treated with buccal mucosa urethroplasty. Urethroplasty was performed with a free graft of buccal mucosa using a ventral onlay in the first 7 patients and a dorsal onlay in 23. Dorsal urethrotomy was performed with a Sachse urethrotome after the bulbar urethra was separated from the corpora. The buccal mucosa onlay was sutured to the urethra and corpora cavernosa to ensure a patent urethra. RESULTS: At 20-month followup (range 3 to 50) the success rate was 96% (29 of 30 patients). Urethral stricture recurred in only 1 of 7 patients in the ventral onlay and none of 23 in the dorsal onlay group. CONCLUSIONS: Preliminary results of urethroplasty for bulbar urethral strictures with a dorsal onlay graft of buccal mucosa are excellent. Longer followup is needed to evaluate definitive results.     

尿道下裂尿道成形术后尿道狭窄的处理

目的 探讨尿道下裂尿道成形术后尿道狭窄的病因及治疗方法。方法 对１９８５－１９９８年７７例尿道下裂术后尿道狭窄患者的临床资料进行回顾性分析。结果 单纯尿道扩张９例,治愈２例（２２％）;尿道扩张放钛镍合金支架２２例,治愈１７例（７７％）;狭窄段尿道切开皮肤造瘘２３例,其中１８例行二期尿道成形术,治愈１６例;５例待手术;切开狭窄段同期尿道成形术２３例,治愈１２例。     

Dorsal onlay lingual mucosal graft urethroplasty for urethral strictures in women

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To describe the technique and results of dorsal onlay lingual mucosal graft (LMG) urethroplasty for the definitive management of urethral strictures in women.

PATIENTS AND METHODS

In all, 15 women (mean age 42 years) with a history suggestive of urethral stricture who had undergone multiple urethral dilatations and/or urethrotomy were selected for dorsal onlay LMG urethroplasty after thorough evaluation, from October 2006 to March 2008. After a suprameatal inverted‐U incision, the dorsal aspect of the urethra was dissected and urethrotomy was done at the 12 o’clock position across the strictured segment. Tailored LMG harvested from the ventrolateral aspect of the tongue was then sutured to the urethrotomy wound over an 18 F silicone catheter.

RESULTS

The preoperative mean maximum urinary flow rate of 7.2 mL/s increased to 29.87 mL/s, 26.95 mL/s and 26.86 mL/s with a ‘normal’ flow rate curve at 3, 6 and 12 months follow‐up, respectively. One patient at the 3‐month follow‐up had submeatal stenosis and required urethral dilatation thrice at monthly intervals. At the 1‐year follow‐up, none of the present patients had any neurosensory complications, urinary incontinence, or long‐term functional/aesthetic complication at the donor site.

CONCLUSION

LMG urethroplasty using the dorsal onlay technique should be offered for correction of persistent female urethral stricture as it provides a simple, safe and effective approach with durable results.     

应用口腔颊黏膜Ⅰ期修复女童复杂性前尿道缺损(附3例报告)

目的：探索颊黏膜在修复女童复杂性前尿道缺损中的应用价值。方法：采用部分耻骨劈开联合阴道前庭切口，截取相应大小的口腔颊黏膜作管状成形I期修复女童前尿道缺损3例。结果：3例女童术后均排尿通畅，最大尿流率为l9．6—24．4m1／s，平均为20．5m1／s，尿道造影示尿道通畅。结论：口腔颊黏膜具有取材方便、对患者创伤小、抗感染能力强等特性，是一种较好的尿道替代材料，尤其适合尿道狭窄段＜5cm的患者。     

Outcome of dorsal buccal graft urethroplasty for recurrent bulbar urethral strictures

OBJECTIVE

To audit our results of dorsal buccal mucosal graft urethroplasty for recurrent bulbar urethral stricture disease and compare them with those from specialist centres.

PATIENTS AND METHODS

Data were collected prospectively on 52 men who had urethroplasty with ≥1 year of follow‐up; failure was defined as the need for further intervention.

RESULTS

The mean (range) age of the patients was 39 (19–61) years and 23 (45%) had an identifiable cause for their stricture. The mean (range) stricture length was 3.5 (1.5–6) cm and was associated with moderate or severe spongiofibrosis in 38 (73%) men. Ten (19%) men had minor complications after surgery. The mean (range) follow‐up was 34 (12–80) months, with the mean maximum urinary flow rate increasing from 6 to 24 mL/s after surgery. The surgery failed, requiring dilatation or urethrotomy, in seven (14%) men at a mean (range) of 25 (15–50) months after urethroplasty, giving an overall success rate of 86%.

CONCLUSION

This prospective audit of dorsal buccal patch augmentation urethroplasty for bulbar strictures shows an equivalent outcome to the standard set by the expert originators, suggesting that is transferable to less specialized centres. The efficacy, low complication rate, short hospital stay and general applicability of the technique encourage its use for all men with recurrent bulbar stricture disease, but formal comparison with other options in randomized trials, including cost‐effectiveness analysis, is needed.     

Retrograde urethrography in the postoperative control of urethral strictures treated with visual internal urethrotomy

Urinary flow measurement and often retrograde urethrography are used in the postoperative control of urethral strictures treated with urethrotomy. In the present study we have evaluated the usefulness of retrograde urethrography and find that the postoperative control should consist of a history and uroflowmetry.     

Operative techniques of anastomotic posterior urethroplasty for traumatic posterior urethral strictures

Objective： To elucidate the details of operative technique of anastomotic posterior urethroplasty for traumatic posterior urethral strictures in attempt to offer a successful result. Methods： We reviewed the clinical data of 106 patients who had undergone anastomotic repair for posterior urethral strictures following traumatic pelvic fracture between 1979 and 2004. Patients＇ age ranged from 8 to 53 years （mean 27 years ）. Surgical repair was performed via perinea in 72 patients, modified transperineal repair in 5 and perineoabdominal repair in 29. Follow-up ranged from 1 to 23 years （ mean 8 years ）. Results： Among the 77 patients treated by perineal approaches, 69 （95.8 % ） were successfully repaired and 27 out of the 29 patients （93. 1% ） who were repaired by perineoabdominal protocols were successful. The successful results have sustained as long as 23 years in some cases.Urinary incontinence did not happen in any patients while impotence occurred as a result of the anastomotic surgery. Conclusions： Three important skills or principles will ensure a successful outcome, namely complete excision of scar tissues, a completely normal mucnsa ready for anastomosis at both ends of the urethra, and a tension-free anastomosis. When the urethral stricture is below 2. 5 cm long, restoration of urethral continuity can be accomplished by a perineal procedure. If the stricture is over 2. 5 cm long, a modified perineal or transpubic perineoabdominal procedure should be used. In the presence of a competent bladder neck, anastomotic surgery does not result in urinary incontinence. Impotence is usually related to the original trauma and rarely （5.7 % ） to urethroplasty.