Urethroplasty for male urethral strictures: Experience from a national teaching hospital in Senegal

ObjectivesTo report our experience with urethroplasties due to male urethral stricture disease and to identify factors affecting the results.Patients and MethodsBetween January 2007 and December 2010, 75 urethroplasties performed due to male urethral stricture were prospectively collected.ResultsThe mean age of patients was 52.6 years (median: 56 years) for urethroplasties by substitution and 47.3 years (median: 47.5 years) for anastomotic urethroplasties. The most common localization of urethral stricture was the bulbar urethra (63.3%). The length of the stricture averaged 1.95 ± 0.72 cm (median 2 cm) in anastomotic urethroplasties and 4.40 ± 1.54 cm (median 4 cm) in urethroplasties by substitution. The success rate was 69.8% (37/53) for anastomotic urethroplasties, 23.1% (3/13) for urethroplasties using Quartey's technique, 25% (1/4) for Blandy's urethroplasties. The success rate was 81% (17/21) in patients operated on by experienced surgeons, and 53.7% (29/54) in those operated on by young surgeons (p = 0.02). The success of urethroplasty was more frequent for urethral strictures between 1 and 5 cm (46/69) than in those greater than 5 cm (0/6) (p < 0.05), when the diagnosis of stricture was done within the phase of dysuria (11/13) than when it was done during the phase of progressive complications of the urethral stricture (35/62) (p < 0.05).ConclusionsIn our hands, the results of anastomotic urethroplasty were better, while those of substituting urethroplasties were disappointing. These results are explained by the complexity of the strictures and the limited experience in urethral reconstruction of most surgeons.     

Management of complex urethral stricture disease: Algorithm and experience from a single institute

ObjectiveThere are currently no practical guidelines regarding recurrent or complex urethral strictures in Taiwan. Furthermore a specific urological reconstruction center focusing on urethroplasties in this area is currently unavailable. In this study we aim to share the experience of our institute according to an algorithm for this disease entity.Materials and methodsFrom December 2007 to October 2013, adult males with complex urethral strictures were enrolled. Six different surgical techniques were used for treatment. Clinical features and outcomes were analyzed through a retrospective chart review.ResultsThe mean age was 39 years, with a mean follow-up period of 42 months (range, 5–76 months). An average of three sessions of previous treatments was noted. The overall primary success, requiring no further intervention, was 46%. Permanent failure occurred in one patient (2.6%). The primary success for urethroplasty in distal, penile, bulbar, posterior urethra, and in stricture with hypospadias was 100%, 40%, 83%, 29%, and 60%, respectively. From the perspective of procedure type, anterior anastomotic urethroplasty (80%) and skin-based flaps (75%) resulted in the highest success rate. Following anterior or posterior buccal mucosal graft-augmented urethroplasties, 40% of patients received additional short-term dilatations or urethrotomies.ConclusionComplex urethral strictures can be managed by a variety of surgical techniques according to specific stricture locations. However, a careful postoperative follow-up for recurrences is mandatory, since ∼40% of patients undergoing buccal mucosal graft-augmented urethroplasties were expected to have additional procedures after the index urethroplasty.     

前尿道狭窄的病因和治疗

前尿道狭窄的发生率有增高趋势,如治疗不当,会进一步加重尿道损伤而造成复杂性前尿道狭窄,难于处理。近年来在其治疗上取得了很大进步,但多数泌尿外科医师对此病认识不足,治疗上存在差异,可能导致并发症的发生。     

后尿道狭窄的诊断和治疗——2O年经验总结

吻合术142例次;经会阴加阴茎海绵体中隔切开86例次;经会阴加耻骨下缘切除196例次;经耻骨劈开联合会阴径路后尿道端端吻合术68例次.426例随访3～120个月,平均32个月.其中302例排尿通畅,无需尿道扩张;12例分别行尿道扩张2～6次后排尿稳定;32例行直视下尿道内切开术后排尿通畅;53例经过再次或3次后尿道端端吻合术获得治愈.总手术治愈率为93.7%(399/426). 结论 根据后尿道狭窄或闭锁患者的病情选择合适的影像学诊断方法和合理有效的手术径路和手术技巧,有助于提高后尿道狭窄的诊治水平.     

前尿道替代膜部尿道治疗男性后尿道狭窄52例报告

目的：探讨长段后尿道狭窄手术治疗方法。方法：同顾性总结前尿道替代膜部尿道端端吻合治疗狭窄段〉2cm的后尿道狭窄患者52例。结果：一次手术成功49例,成功率94．2％,3例术后尿线细,排尿不畅经内窥镜切除0．3～0．5cm瘢痕后排尿通畅。随访5～20年,全部排尿通畅,最大尿流率20～25ml／s,平均22ml／s。结论：切除狭窄段瘢痕前尿道替代膜部尿道端一端吻合治疗后尿道狭窄成功率高,远期效果好。术中彻底切除瘢痕,满意的无张力外翻端一端吻合及术后预防感染是手术成功的关键。     

The morbidity of urethral stricture disease among male Medicare beneficiaries

Background

To date, the morbidity of urethral stricture disease among American men has not been analyzed using national datasets. We sought to analyze the morbidity of urethral stricture disease by measuring the rates of urinary tract infections and urinary incontinence among men with a diagnosis of urethral stricture.

Methods

We analyzed Medicare claims data for 1992, 1995, 1998, and 2001 to estimate the rate of dual diagnoses of urethral stricture with urinary tract infection and with urinary incontinence occurring in the same year among a 5% sample of beneficiaries. Male Medicare beneficiaries receiving co-incident ICD-9 codes indicating diagnoses of urethral stricture and either urinary tract infection or urinary incontinence within the same year were counted.

Results

The percentage of male patients with a diagnosis of urethral stricture who also were diagnosed with a urinary tract infection was 42% in 2001, an increase from 35% in 1992. Eleven percent of male Medicare beneficiaries with urethral stricture disease in 2001 were diagnosed with urinary incontinence in the same year. This represents an increase from 8% in 1992.

Conclusions

Among male Medicare beneficiaries diagnosed with urethral stricture disease in 2001, 42% were also diagnosed with a urinary tract infection, and 11% with incontinence. Although the overall incidence of stricture disease decreased over this time period, these rates of dual diagnoses increased from 1992 to 2001. Our findings shed light into the health burden of stricture disease on American men. In order to decrease the morbidity of stricture disease, early definitive management of strictures is warranted.     

The treatment of urethral stricture disease by internal urethrotomy: a clinical review

The results of internal urethrotomy with 6 weeks of postoperative catheter drainage and antimicrobial therapy in the treatment of urethral strictures in 28 patients are presented. Satisfactory results were obtained in 68 per cent of the patients. Because of the simplicity of this technique and the good results obtained we believe that internal urethrotomy often is the best initial approach to strictures that become difficult to manage by periodic dilation.     

Dorsal onlay buccal mucosal graft urethroplasty in female urethral stricture disease: a single-center experience

Introduction and hypothesis

The aim of this report is to present our initial, short-term experience with dorsal onlay buccal mucosal graft urethroplasty (DBMGU) in women with urethral stricture.

Methods

Between May 2011 and April 2013, eight women with moderate to severe bothersome lower urinary tract symptoms due to mid- or distal urethral stricture underwent DBMGU. All women were evaluated preoperatively with the American Urological Association (AUA) symptom score, uroflowmetry with post-void residual volume (PVR) estimation, urodynamic study, calibration with 14 F catheter, and voiding cystourethrography. Postoperatively, the women were followed at regular intervals with AUA symptom score, uroflowmetry, and PVR estimation. Increase in AUA symptom score, maximum flow rate (Q_max)?<?12 ml/s, and failure to calibrate with 18 F catheter were considered as recurrence of the disease.

Results

The mean age of the patients was 40.6 years. The mean follow-up period was 14.8 months. All women voided successfully after catheter removal. One patient was lost to follow-up after 3 months. There was significant improvement in AUA symptom score and Q_max and reduction in PVR (p?<?0.0001) at 3, 6, and 9 months. Two women had recurrence of stricture at 12 months, while another had recurrence at 18 months which was treated by urethral dilatation followed by a self-dilatation protocol. The limitations of the study include the small number of cases with short follow-up.

Conclusions

DBMGU is a simple and safe method of urethroplasty in women with unsatisfactory results. Large size studies with long-term follow-up are desirable to document the success rates.     

尿道成形术在男性尿道狭窄中的应用及疗效

尿道成形术是当前治疗大多数男性尿道狭窄的最佳方案。组织替代技术在过去数十年中快速发展并为进行尿道成形术后实现良好的远期疗效提供了极大可能。尿道成形术需要的辅助手段如可明确狭窄的部位、长度以及狭窄严重程度的尿道造影和移植物组织质量的严格评估对手术的成功至关重要。本文就不同解剖位置的尿道狭窄可用的尿道成形术及疗效进行综述。     

不同手术方法治疗男性外伤性尿道狭窄的多中心临床研究

目的探讨不同手术方法影响男性外伤性尿道狭窄治疗效果的相关因素。方法回顾性分析多中心的237例外伤性尿道狭窄的初次治疗效果,采用多因素分析,用卡方、卡方分割分析的统计方法分析临床疗效。结果在狭窄复发的因素中,狭窄长度分组（0～2cm,2～4cm）的P〈0.05,围手术期尿路感染的P〈0.05,狭窄初次治疗方式（尿扩,尿道内切开,尿道吻合）的P〈0.05;狭窄的初次治疗方式,尿扩与尿道吻合比较P〈0.01,尿道内切开与尿扩比较的P〉0.05,尿道内切开与尿道吻合比较P〈0.01。结论外伤导致的尿道狭窄长度、围手术期尿路感染、狭窄初次治疗方式是影响尿道狭窄复发的重要因素;尿道狭窄的长度与尿道内切开的疗效相关,狭窄长度〈2cm复发率低,〉2cm复发率高;尿道吻合术的影响因素与狭窄长度、狭窄部位、既往手术史无关,与围手术期尿路感染及手术本身有关,与其他手术方式相比,尿道吻合治疗外伤性尿道狭窄复发率最低。     

Surgical management of urethral stricture in the male

Urethral dilatation has long been the standard treatment for patients with urethral stricture. However, in many patients such dilatations may be difficult, painful, or have to be done at frequent intervals. The alternative techniques of direct vision urethrotomy or urethroplasty have been considered in 101 patients over a twelve-year period. Skin inlay urethroplasty in this series showed a significant level of complications and an absolute failure rate of 15 per cent. A prospective study of 39 patients undergoing urethrotomy using the Sachse optical urethrotome has shown that 82 per cent of patients are symptom-free and 13 per cent symptomatically improved at a follow-up ranging from sixteen months to three and one-half years (mean twenty-five months). We believe that urethrotomy using the Sachse optical urethrotome should now be the initial treatment of choice in the management of urethral stricture. Urethral dilatations or urethroplasty should be reserved for those patients who have persisting stricture despite such urethrotomy.     

Clinical presentation and treatment of urethral stricture: Experience from a tertiary hospital in Port Harcourt,Nigeria

Introduction

Urethral stricture disease (USD) is a common urological problem. The aetiology of strictures has been changing. Different treatment modalities are available.

中国男性尿道狭窄病因与治疗变化的多中心调查

目的 了解国内近年男性尿道狭窄的病因与治疗方式的变化状况. 方法 回顾性收集2004年1月至2009年12月国内8个医疗中心收治的3455例男性尿道狭窄患者的资料,分析尿道狭窄的主要病因、治疗方法及随时间变迁病因和治疗技术的变化. 结果 3455例患者的病因分别为:外伤1833例(53.05％),其中骨盆骨折1327例(38.41％),骑跨伤506例(14.65％);医源性1181例(34.18％),其中经尿道手术602例(17.42％),尿道下裂术后291例(8.42％),留置导尿管164例(4.75％);其他较少见的为尿道炎201例(5.82％),硬化性苔藓样病149例(4.31％),原因不明者91例(2.63％)等.2004 - 2006年,腔内技术是治疗尿道狭窄最为常见的方法,共709例(52.67％);而2007 -2009年这种技术应用减少,共726例(34.42％),两者间差异有统计学意义(P＜0.01).2007 - 2009年开放性尿道成形术逐年增多(1243例,58.94％),与2004 - 2006年相比(563例,41.83％)差异有统计学意义(P＜0.01). 结论 外伤和医源性损伤是尿道狭窄的常见原因,近年逐渐增多;尿道狭窄治疗方法主要是腔内微创手术和开放性尿道成形.2007 - 2009年经腔内手术比例显著下降,而开放性尿道成形手术比例显著上升.     

Lichen sclerosus of the male genitalia and urethral stricture diseases

INTRODUCTION: The true incidence of urethral involvement in patients with genital lichen sclerosus (LS) is unknown. We review the epidemiology and discuss the pathogenesis of LS and urethral stricture diseases. MATERIALS AND METHODS: During the period 1991-2002, of 925 patients who underwent urethroplasty for anterior urethral stricture, 130 patients (14%) received the diagnosis of LS. In all patients with LS the histology was re-examined to confirm the clinical diagnosis. Retrograde and voiding urethrography was used to establish urethral involvement in the disease. RESULTS: In 106 patients (82%) the histology provided the classical features of LS, and 24 patients (18%) showed some histological variations. In 49 patients (37%) the LS involved the pendolous urethra (meatus-navicularis-penile), and in 53 cases (41%) a panurethral stricture was evident. CONCLUSIONS: LS urethral involvement appears to be a much more common and extensive disease than previously reported, and requires particular care in its early diagnosis.     

Sonourethrography in the evaluation of urethral stricture disease

Ultrasonography of the anterior urethra offers a dynamic three-dimensional study that can easily be repeated. It holds the promise of defining accurately, not only the exact length and severity of the strictured urethral segment, but also the extent of urethral fibrosis and the anatomy of the periurethral structures. A significant reduction in the incidence of recurrent stricture may be obtained by selecting patients for treatment on the basis of the findings of sonourethrography. Moreover, the potential exists for the use of this imaging method during internal urethrotomy to ensure a more accurate and aggressive incision of the stricture.