Visual internal urethrotomy in management or urethral strictures

Visual internal urethrotomy was used in the treatment of urethral strictures in 103 patients. The procedure was performed mostly under local anesthesia. Urethral catheter for forty-eight hours or urethral splinting for two weeks was used as complementary treatment in some cases. We obtained an overall success rate of 95.1 per cent.     

Long-term outcome of visual internal urethrotomy for the management of pediatric urethral strictures

PURPOSE: We evaluated the long-term results of visual internal urethrotomy for pediatric urethral strictures to evaluate the efficacy and final outcome of this procedure in children and to evaluate the risk factors for stricture recurrence. MATERIALS AND METHODS: The computerized surgical records of our hospital were reviewed to identify children who underwent visual internal urethrotomy between 1980 and 2001. Hospital and followup clinical charts were then reviewed. Many variables were analyzed, including age, etiology, length and site of the strictures, and catheter duration. Only patients with a minimum followup of 2 years were included. Regular self-catheterization was not used by any child. RESULTS: A total of 31 patients (mean age 11.2 years, range 2 to 18) were identified. Followup ranged from 2 to 20 years, with a mean of 6.6 years. The most common etiology for stricture formation was failed previous urethroplasty and post instrumentation (35.5% and 32.3%, respectively). The success rate after initial urethrotomy was 35.5% (11 of 31 patients). Mean interval to first recurrence was 26 months. A second urethrotomy improved the success rate of 58.1%. Eight patients required 2 or more urethrotomies, of whom half required open urethroplasty. Among the evaluated variables only stricture length shorter than 1 cm was associated with good results. CONCLUSIONS: Visual internal urethrotomy provides a safe first line therapeutic option for pediatric urethral strictures shorter than 1 cm, independent of etiology and location. For patients with more than 1 recurrence or with strictures longer than 1 cm, who are at high risk for recurrence after internal urethrotomy, open urethroplasty remains the treatment of choice.     

Low-power holmium:YAG laser urethrotomy for treatment of urethral strictures: functional outcome and quality of life

PURPOSE: To evaluate the efficacy of endourethrotomy with the holmium:YAG laser as a minimally invasive treatment for urethral stricture. PATIENTS AND METHODS: Between January 2002 and January 2004, 32 male patients with symptomatic urethral strictures (8 bulbar, 9 penile, 9 combined) were treated with Ho:YAG-laser urethrotomy in our department. The stricture was iatrogenic in 60% (N = 18), inflammatory in 16.6% (N = 5), traumatic in 13.3% (N = 4), and idiopathic in 7% (N = 3). The stricture was incised under vision at the 12 o'clock location or the site of maximum scar tissue or narrowing in asymmetric strictures. Laser energy was set on 1200 to 1400 mJ with a frequency of 10 to 13 Hz. Postoperatively, drainage of the bladder was performed for 4 days using a 18F silicone catheter. Triamcinolone was instilled intraurethrally after removal of the catheter in all patients. Patients were followed up by mailed questionnaire, including International Prostate Symptom Score and quality of life. RESULTS: Retrograde endoscopic Ho:YAG laser urethrotomy could be performed in all 32 patients. Most patients (22; 68.7%) did not need any reintervention. Ten patients developed recurrent strictures that were treated by another laser urethrotomy in 4 patients (12.5%), while 6 patients (18.7%) needed open urethroplasty with buccal mucosa. Including 2 patients treated with repeat laser urethrotomy, 24 patients (75%) were considered successful after a mean follow-up of 27 months (range 13-38 months). No intraoperative complications were encountered, although in 5% of patients, a urinary-tract infection was diagnosed postoperatively. No gross hematuria occurred. CONCLUSIONS: The Ho:YAG laser urethrotomy is a safe and effective minimally invasive therapeutic modality for urethral stricture with results comparable to those of conventional urethrotomy. Further data from long-time follow-up are necessary to compare the success rate with that of conventional urethrotomy and urethroplasty. Nevertheless, the Ho:YAG laser urethrotomy might at least be an alternative to urethroplasty in patients with high comorbidity who are not suitable for open reconstruction.     

Core-through optical internal urethrotomy in management of impassable traumatic posterior urethral strictures

During a 2 1/2-year period 10 patients with a traumatically obliterated posterior urethra underwent core-through optical internal urethrotomy 3 to 6 months after pelvic fracture. After 6 to 24 months of followup the peak urine flow rate was more than 15 ml. per second in 6 patients and 8 to 15 ml. per second in 2. Six patients were continent and 2 had transient stress urinary incontinence. Of the 10 patients 2 were failures because of peak urinary flow rates less than 8 ml. per second and/or urinary incontinence. Subsequently, 1 patient underwent successful scrotal flap urethroplasty. Core-through optical internal urethrotomy is an attractive alternative to urethroplasty when the impassable stricture is short.     

腔镜下钬激光治疗长段尿道闭锁临床体会

目的 探讨尿道长段闭锁的微创腔内钬激光治疗方法和经验.方法 73例尿道长段闭锁患者,在膀胱镜、输尿管镜或前列腺切除镜下,利用钬激光行尿道内切开,切除尿道瘢痕组织,恢复尿道的连续性.术后出现尿道狭窄者,给予尿道扩张.结果 73例尿道长段闭锁患者均一次性手术解除闭锁,术后2例因未及时行尿道扩张再次手术,31例行尿道扩张1～6次均排尿道畅.未发现尿道严重出血、穿孔、尿失禁、勃起功能障碍等并发症. 结论应用钬激光行尿道瘢痕切除手术治疗尿道长段闭锁,安全高效,手术创伤小,并发症少,住院时间短.     

Comparison of treatment results between holmium laser endourethrotomy and optical internal urethrotomy for urethral stricture

Purpose

We comparatively evaluated urethral stricture (US) treatment outcomes, efficacy and complications, using either holmium laser endourethrotomy (HLU) or optical internal urethrotomy (OIU) since studies such as this are scarce in literature.

Methods

During 2003?C2008, 50 men aged 17?C78?years were operated on for primary or refractory US, 32 (64%) and 18 (36%) patients, respectively. The average stricture length was 1.86?cm. Strictures were single or multiple, forty-one (82%) and nine (18%) patients, respectively, and were located in the anterior or posterior urethra in 27 (54%) and 32 (64%) patients, respectively. US were iatrogenic in 32 (64%) and idiopathic in 18 (36%). Patients were divided into two groups, grpA and grpB, each containing 25 patients who were treated using either HLU or OIU, respectively. An evaluation scale of 1?C3 was adopted and took maximum flow rate (Q_max), postvoid residual (PVR), and quality of life (QL) into consideration. A score of ??1 was very good, ??2 was good, and ??3 was poor.

Results

Treatment results were evaluated after 3, 6, and 12?months, respectively. Evaluation of grpA was as follows: five (20%), nine (36%), and seven (28%) patients scored a ??1; thirteen (52%), nine (20%), and four (16%) patients scored a ??2; and seven (28%), eleven (44%), and fourteen (56%) patients scored a ??3. Evaluation of grpB: seven (28%), ten (40%), and five (20%) patients scored a ??1; eleven (44%), seven (28%), and ten (40%) patients scored a ??2; and seven (28%), eight (32%), and ten (40%) patients scored a ??3.

Conclusions

Neither complication rate nor degree of efficacy between HLU and OIU for US revealed a significant difference. We found both laser and conventional urethrotomies to be safe and effective modes of treatment.     

双窥镜法联合钬激光内切开术治疗严重尿道狭窄疗效观察

目的观察双窥镜法联合钬激光内切开术治疗严重尿道狭窄的初期疗效。方法2005年5月至2009年4月,应用双窥镜法联合钬激光内切开术治疗8例尿道狭窄或尿道闭锁,狭窄段长度0.8-2.5cm。结果8例患者均尝试逆行内切开术均无法通过狭窄段,应用双窥镜法联合钬激光内切开术治疗均获成功,术后留置尿管4-6周,拔管后均排尿通畅,无尿失禁。8例患者中7例获随访6.24个月（平均18个月）,其中2例患者无需任何后续治疗,3例需行6-16次尿道扩张（平均11次）以维持正常排尿;2例术后3及4个月再次因尿道狭窄行开放手术治疗。结论双窥镜法联合钬激光内切开术治疗尿道狭窄提高了一期腔内手术的成功率,可作为严重尿道狭窄、尿道闭锁患者的可选微创治疗术式。该术式早期疗效良好,但远期效果不尽满意尚待长期观察。     

Direct vision internal urethrotomy in the treatment of urethral fistulas due to urethral strictures

Five cases of urethral fistula--three with single and two with multiple fistulous tracts--were treated by optical urethrotomy. All of the fistulas healed completely.     

Endoscopic urethrotomy versus urethrotomy plus Nd-YAG laser in the treatment of urethral stricture

Between February 1987 and May 1988, 30 patients who presented with single, iatrogenic, annular strictures of the bulbar urethra were included in this prospective study. They were randomly divided into two groups; group 1: 15 patients who underwent direct-vision endoscopic urethrotomy (cold-knife incision at 12 o'clock) and group 2: 15 patients who underwent internal urethrotomy plus Nd-YAG laser. The results obtained were analyzed and compared at 1 and 2 years by clinical evaluation, uroflowmetry and retrograde-voiding urethrography. Group 1 obtained 80% good results at 1 year, falling to 60% at 2 years follow-up. Group 2 presented good results in 73.3% both at 1 and 2 years of follow-up.     

腔镜下钬激光内切开加定期尿道扩张治疗男性尿道狭窄及闭锁

目的探讨腔镜下钬激光内切开治疗男性尿道狭窄及闭锁的效果及安全性。方法我院2007年4月～2009年11月收治男性尿道狭窄或闭锁病人17例,狭窄段长0.5～3.0cm,平均1.4cm,采用腔镜下钬激光狭窄段内切开治疗。术后留置尿管2～4周。拔除尿管后根据随访排尿状况定期作尿道扩张。结果 17例病例均取得手术成功,手术时间30～90min,平均40min,术后排尿显著改善,最大尿流率(Qmax)由术前平均6.5(2.8～11.5)ml/s提高到术后20.4(16.6～25.3)ml/s,无尿失禁、阳痿、尿瘘并发症。术后随访3～18个月,均排尿良好,无再狭窄发生,B超检查剩余尿<20ml。结论腔镜下钬激光内切开加定期尿道扩张治疗男性尿道狭窄及闭锁安全有效,近期治疗效果良好,手术创伤小,并发症少,值得推广应用。     

Direct vision internal urethrotomy for the treatment of pediatric urethral strictures: analysis of 50 patients

PURPOSE: In an attempt to evaluate our experience with the treatment of pediatric urethral stricture disease we performed a retrospective review of patients undergoing direct vision internal urethrotomy (DVIU). MATERIALS AND METHODS: The computerized surgical logs at 2 pediatric hospitals were reviewed to identify patients who underwent DVIU between 1992 and 2001. Hospital and clinical charts were then reviewed. Many variables were analyzed, including patient age, etiology of stricture, technique and clinical outcomes. Minimum followup to be included in clinical outcome analysis was 12 months. RESULTS: A total of 50 patients were identified (mean age 7.7 years, range 6 months to 17 years). The most common etiology for stricture formation was previous hypospadias repair (20 patients [40%]). Forty patients met the 12-month minimum followup requirement for clinical outcome analysis. Of these patients 20 (50%) had no symptoms to suggest recurrent stricture at a median of 2.0 years (mean 2.7 years, range 12 months to 7 years). Seventeen patients (42.5%) had symptoms of recurrent stricture at a median of 8 months (mean 13 months, range 2 months to 5 years). Technical factors did not influence the ultimate success or failure of the procedure. CONCLUSIONS: DVIU provides a therapeutic option that successfully treats approximately half of the patients with a reasonably low complication rate. Complications following DVIU should not preclude its use as a therapeutic modality for the treatment urethral strictures in children. If the child fails the initial DVIU, repeat attempts at endoscopic correction of urethral stricture should be abandoned in favor of definitive urethroplasty.     

直视下尿道内切开术联合尿道扩张治疗男性尿道狭窄36例疗效分析

目的:探讨直视下尿道冷刀内切开术联合尿道扩张治疗尿道狭窄的疗效。方法:36例尿道狭窄患者,均接受直视下尿道内切开术联合留置尿管治疗,现对其临床资料进行回顾性分析。结果:36例中,32例一次手术成功,4例行二次手术成功。36例患者中34例获随访6～24个月,平均15个月,5例排尿通畅,27例行尿道扩张后排尿通畅,2例术后3～4个月再次因尿道狭窄行开放手术。结论:直视下尿道内冷刀切开术联合尿道扩张治疗尿道狭窄疗效是肯定的,但远期疗效尚待长期观察。     

Intralesional corticosteroid injections in combination with internal urethrotomy in the treatment of urethral strictures

In the treatment of 38 patients with urethral stricture, 21 received intralesional corticosteroid injections, combined in 17 cases with internal urethrotomy. The aetiology of the lesion is discussed, together with a review of the pertaining literature, and the results of the treatment are evaluated.     

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.     

A comparative study of electrosurgical vs. cold urethrotomy in the treatment of urethral strictures

Thirty-one patients with urethral stricture were subjected to internal urethrotomy under visual control. The patients were divided into two groups according to the surgical procedure: electrosurgical or cold resection. A modification of the Sachse knife was introduced in order to permit its use with the American Cystoscope Makers Inc. instruments. The success rate with cold resection was 81.81% and with the electrosurgical procedure 40%. Internal urethrotomy with cold resection is a simple and harmless operation, being a first choice in the treatment of urethral stricture.     

A pilot study of transperineal urethrosphincteric block for visual internal urethrotomy in patients with anterior urethral strictures

PURPOSE: To evaluate the effectiveness of transperineal urethrosphincteric block (TUSB) in providing analgesia during visual internal urethrotomy for patients with anterior urethral strictures. PATIENTS AND METHODS: A total of 26 consecutive patients scheduled for elective visual internal urethrotomy for symptomatic urethral stricture were considered for this prospective study. Twenty-four patients agreed to participate in the study. Their demographics and medical conditions were recorded. Twenty-five percent of the patients had comorbid conditions that would have put them at high risk for general anesthesia. All patients had TUSB as the primary method of analgesia, using 1% lidocaine. Postoperatively, patients were asked to score the severity of the pain experienced during TUSB and during the transurethral surgery on a scale from 0 to 10. Postoperative adverse effects and the need for sedation or additional analgesia were recorded. All patients rated their overall satisfaction with the analgesia. RESULTS: Patient mean age was 43.5 years (range 26-71 years). The mean pain score during instillation of the transperineal block was 1.9 (range 0-3), and for visual internal urethrotomy was 1 (range 0-5). No sedation, narcotics, or additional analgesia were required and no postoperative adverse effects were encountered. Ninety-two percent of the patients were very satisfied with the method of analgesia. CONCLUSION: TUSB is a safe and effective method of local analgesia for visual internal urethrotomy in patients with anterior urethral strictures, and is particularly suitable for those at high risk of general anesthesia.