KTP-532 laser ablation of urethral strictures.

In 1988 the KTP-532 laser was used to ablate a series of benign urethral strictures. Rather than using a single incision as in urethrotomy, strictures were treated with 360-degree contact photoradiation. Thirty-one male patients, average age 53.2 years, received thirty-seven treatments; 6 patients underwent a second laser treatment. Stricture etiology was commonly iatrogenic (32%), traumatic (16%), and postgonococcal (10%). Stricture location included mainly bulbar (49%), membranous (20%), and penile (12%) areas. The surgical technique consisted of circumferential ablation, followed by Foley catheter placement (mean, 10 days). Follow-up on 29 of 31 patients ranged from one to sixteen months (mean 9.7). Complete success occurred in 17 patients (59%) who had no further symptoms or instrumentation. Partial success was seen in 6 patients (20.5%) with symptom, but not stricture, recurrence. Six patients (20.5%) failed therapy, requiring additional surgery or regular dilations. No complications were seen. Although longer assessment is required, KTP-532 laser ablation of urethral strictures appears efficacious.     

接触式激光治疗尿道狭窄（附23例报告）

１９９３年１２月～１９９５年８月，应用ＳＬＴ接触式激光（Ｎｂ：ＹＡＧ）治疗仪治疗尿道狭窄２３例，随访１４例排尿良好，９例狭窄复发，复发率３９．１％。接触式激光治疗尿道狭窄方法简便、安全有效、无痛苦、无出血，复发率低。     

K.T.P 532 laser in treatment of urethral strictures

We have had experience in the treatment of 20 patients with 22 strictures with this new laser that has a unique ability to cut and coagulate with minimal forward scatter to help prevent the formation of new scar tissue. All of the patients have had attempts of treatment of the strictures unsuccessfully in the past. The laser was effective in 68.2 % of the patients to keep the urethra open and patent although the follow-up periods have been short at the time of this report ranging from six months to fourteen months. This new laser may have some promise in the treatment of urethral stricture disease.     

The treatment of urethral strictures

Analysis of the results of many-year treatment of 788 patients with traumatic urethral strictures indicated that it was advisable to perform Khol'tsov's operation without leaving a catheter in the urethra in short strictures of the anterior urethral segment, Solovov's operation was indicated for occlusive strictures of the posterior urethral portion, whereas endourethral interventions (urethrotomy, resection) were beneficial in short patent strictures. Vesicourethral strictures required transurethral electroresection. Stenotic urethral changes were seen at different levels in 3.7% of postoperative patients. Some recommendations were proposed by the authors for prevention of the changes. A classification of urethral strictures was also presented.     

The use of split-skin mesh graft in the management of urethral strictures

In the last 3 years 268 patients with urethral strictures have attended this unit. We treat most strictures by urethrotomy and consider an open operation only after two recurrences or in patients whose strictures are considered unsuitable for urethrotomy. Open operations have been performed on 42 patients. Although several types of operation have been used, most comprised an end-to-end anastomosis or Blandy's scrotal flaps. In the last few years a split-skin mesh graft has been used to replace the posterior urethra and the advantage of this technique is that the new urethra is soft and hairless. We present our experience with this method and our overall results.     

European experience with the urethral Wallstent for urethral strictures

We describe the use of the urethral Wallstent in 71 patients with urethral strictures. The stainless steel stent is self expanding when released from its endoscopic introducer. The results over a 3-year period have been good with only mild discomfort and slight urethral leakage for up to 3 months. Migration, infection and encrustation have not been a problem and serial endoscopic review shows healing to be variable but complete in up to 12 months. It is considered that this simple endoscopic technique offers a simple, safe and effective alternative to multiple dilatations, urethrotomies and urethroplasty procedures in patients with bulbar urethral strictures.     

Perineal transpubic repair: a technique for treating post-traumatic prostatomembranous urethral strictures

A perineal, 1-stage, end-to-end anastomotic repair is the preferred method to treat short (2 cm. or less) prostatomembranous urethral strictures. For longer strictures a combined perineal and abdominal transpubic approach is required. We describe a technique that has allowed a 1-stage perineal repair of such strictures, up to 5 cm. long, by wedge excision of the inferior portion of the pubis. This technique has been used in 4 patients with prostatomembranous strictures 2 to 5 cm. long. The results were uniformly good in all of these patients.     

Pubectomy for repair of membranous urethral strictures.

We treated 7 patients with membranous urethral strictures secondary to fractures of the pelvis with pubectomy and termino-terminal anastomosis of the urethra. All patients are free of catheters and urinary tract infection. The surgical technique provided good exposure of the membranous urethra because the incision of the pubis was wide. None of the patients has had orthopedic problems secondary to the operation. Postoperative sexual function has been good.     

The Goodwin sound: an aid in treating obliterated membranous urethral strictures endoscopically

The treatment options for a man with obliteration of the membranous urethra are many today because of the great progress that has been made in the past 40 years. No one procedure is likely to be ideal for all situations. Pullthrough, two-stage scrotal inlay, and transpubic or perineal approaches can be applied with success. Endoscopic treatment can also be used with satisfactory results and less morbidity in selected patients. A failed endoscopic attempt should not interfere with a subsequent open procedure. Conversely, a failed open procedure may be remedied by endoscopic surgery. We feel our technique is simpler than other reported endoscopic techniques, as it requires only one urologist, and it does not require fluoroscopy or endoscopy from above. Significantly, it provides a guide to cut on that relieves the fear of inadvertent incision into the rectum.     

Guidelines for the treatment of urethral strictures

Over a period of 12 years 467 patients with urethral stricture were treated surgically at Tygerberg Hospital. The following surgical guidelines were developed: visual cold-knife urethrotomy should be the first line of treatment; urethroplasty is indicated when urethrotomy fails or is unfeasible; the urethroplasty of choice should be a single-stage operation; and staged procedures should be reserved for complicated cases.     

The surgical treatment of urethral strictures

The authors reviewed the results of surgical management of 233 patients aged 8-76 years who had suffered urethral strictures. A total of 266 operations were made in the period of 1970-1989. Urethral tunneling which had been widely used in clinical practice for strictures of the urethra until 1980 yielded 91.2% recurrences of the disease, which made surgeons modify the surgical policy. During the past decade 127 patients with urethral strictures and obliterations have undergone 138 surgical interventions: 91 (65.9%) urethral resections, 34 (24.6%) internal optical urethrotomies and transurethral resections of scarring tissue, 7 (5.1%) cutaneous urethral plastic surgeries and only 6 (4.4%) urethral tunnelings. The number of relapses was reduced to 13.4%. The authors consider that urethral resection should be the operation of choice in urethral strictures and obliterations. Endoscopic treatment techniques (urethrotomy and transurethral resection) are indicated in short strictures and scarring deformity of the posterior urethra after prostate operation. It is advisable to apply cutaneous urethral plastic surgery in case of extended strictures.     

口腔颊粘膜Ⅰ期修复复杂性前尿道狭窄(附六例报告)

目的：探索修复前尿道狭窄的新型替代材料和手术方法。方法：将狭窄或闭锁的前尿道于腹侧纵形劈开，采用口腔颊粘膜补片法治疗复杂性前尿道狭窄患者6例7次。结果：患者前尿道修复术后排尿通畅，平均最大尿流率25．8ml／s，尿道造影示尿道通畅，B超提示吻合口愈合良好，瘢痕少，无明显狭窄。结论：口腔颊粘膜取材方便，创伤小，粘膜易存活，抗感染能力强，修复尿道效果好。     

New treatment for urethral strictures

A new operative technique using synthetic, absorbable mesh for grafting a urethral defect was applied in 7 mongrel male dogs. The ventral half of the urethral circumference with its surrounding corpus spongiosum was excised for a length of 3 to 4 cm. A Dexon mesh of the same dimensions, woven in our laboratory from polyglycolic acid fibers, was sutured to the defective area. A perineal urethrotomy was established, and no splints were left behind. Dogs were studied between two and six months. Retrograde urethrography showed that the operative area healed without strictures or irregularities. Intravenous urography showed no back pressure effects, and cultured urine was always sterile. Histologic examination two months after surgery showed that the urothelium was completely healed, without inflammatory changes or disruption. Suburothelial tissues were replaced by dense collagenous connective tissue. The excised corpus spongiosum did not regenerate. After six months, the area of dense collagen described was diminished in size so that the operative area could be hardly identified except by the absence of corpus spongiosum.     

Transpublic urethorplasty for membranous urethral strictures

Six patients with traumatic membranous urethral strictures have undergone urethroplasty utilizing the transpubic approach with resection of a wedge of the symphysis pubis. Three patients are free of stricture, 2 required urethral dilatation in the early postoperative period only, and 1 patient requires dilatation every three months. Four patients are completely continent of urine, 1 has mild stress incontinence, and 1 is incontinent because of a neurogenic bladder. This approach provides excellent exposure with minimal morbidity and allows an easy under-vision anastomosis.     

One-stage urethroplasty for bulbomembranous urethral strictures

Summary A total of 23 patients with bulbomembranous urethral strictures (16 after pelvic fractures, 4 following direct perineal trauma, 3 after catheter drainage) were treated with a perineal one-stage anastomotic urethroplasty. The length of the stricture did not exceed 2 cm. The overall final success rate amounted to 95.6%. The one-stage perineal approach is recommended for short strictures of up to 2 cm in length, if mobilization of the distal urethra is possible and the periurethral scar tissue can be resected.