Etiology and current clinical characteristics of male urethral stricture disease: experience from a public teaching hospital in Senegal

Objective  

To identify the etiology and current clinical characteristics of male urethral stricture disease (USD) in Senegal.     

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.     

Factors affecting urethral stricture development after radical retropubic prostatectomy

Objective  

We determined the factors that can cause urethral stricture after radical retropubic prostatectomy.     

Long-term management of corrosive esophageal stricture with balloon dilation in children

Background and purpose  

There are only a few studies focused on efficacy and safety of balloon dilation in corrosive esophageal stricture in children. The aim of this study is to assess the long-term clinical results of balloon dilation in the treatment of corrosive esophageal stricture in children.     

Endoscopic Management of Urethral Stricture: Review and Practice Algorithm for Management of Male Urethral Stricture Disease

Purpose of Review

Male urethral stricture disease is characterized by the formation of scar tissue within the urethra resulting in lower urinary tract symptoms, infection, and potentially kidney dysfunction. There is significant variability in clinical practice for the treatment of urethral stricture. We sought to summarize the known data on endoscopic management of urethral stricture disease as part of this larger edition on urethral stricture management.

Recent Findings

Older studies quoted high rates of success with endoscopic management of urethral stricture, including repeated DVIU. There is now evidence to support a limited role of endoscopic intervention in the management of urethral stricture, and especially strong evidence that repeated endoscopic procedures are not effective.

Summary

There is poor evidence to support the long-term efficacy of endoscopic urethral stricture management. Furthermore, novel advances in adjunctive therapies have not yet demonstrated durable patency. We discuss the limited role of endoscopic management and suggest an algorithm for its use in stricture management.

     

Transurethral 2-μm laser in the treatment of urethral stricture

Objectives  

To evaluate the curative efficacy of transurethral 2-μm thulium laser urethrotomy in the treatment of urethral stricture.     

Urethral stricture Yemen experience

Purpose  

In order to evaluate the etiology of urethral stricture in our society and outcome of different types of surgical reconstruction used to treat them.     

Ho:YAG-laser: treatment of vesicourethral strictures after radical prostatectomy

Objective  

To review the indication, feasibility and treatment outcome of Ho:YAG laser application for definitive endoscopic treatment of anastomotic stricture formation after radical prostatectomy.     

Urethral stricture and HIV: Unusual presentations and treatment challenge

Objective  

The clinico-pathologic features of urethral stricture in patients with HIV/AIDS are not yet clearly described in the literature. HIV/AIDS has changed the natural course and clinical features of most infectious diseases. We describe some of the features of post-inflammatory strictures associated with HIV Infection and assess the treatment challenges and outcomes of other causes of urethral stricture.     

Linear Stapled Esophagogastrostomy is more Effective than Hand-Sewn or Circular Stapler in Prevention of Anastomotic Stricture: a Comparative Clinical Study

Objective  

The aim of this study was to retrospectively compare the operative effects of linear stapled intrathoracic esophagogastrostomy with hand-sewn or circular stapled anastomosis in prevention of anastomotic stricture.     

A Comprehensive Review of Strictureplasty Techniques in Crohn’s Disease: Types, Indications, Comparisons, and Safety

Introduction  

Crohn’s disease is one of the chronic inflammatory diseases of the gastrointestinal tract that is often complicated by stricture formation with resulting obstructive symptoms. The technical repertoire of strictureplasty procedures has increased over the years in an effort to manage the diverse presentations of this condition while limiting the need for bowel resection. In this comprehensive review, we describe, compare, categorize, and appraise the strengths and weaknesses of 15 unique strictureplasty techniques.     

Entero‐urethroplasty for the salvage of bulbo‐membranous stricture disease or trauma

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

OBJECTIVE

To describe a salvage procedure for bulbo‐membranous stricture disease or trauma.

PATIENTS AND METHODS

Over a 10‐year period 11 patients with otherwise unsalvageable strictures of the bulbo‐membranous urethra or defects after trauma were treated by interposition of a tailored intestinal flap. An intestinal flap, on average 8 cm in length, was harvested from the ileum, the stomach, the right colon or (preferably) the sigmoid colon, and tailored to a calibre of 26–30 F. It was then sutured between the stump of the prostate and the distal bulbar or proximal pendulous urethra either following the normal perineal route for the urethra or a more direct route through a trench cut in the superior pubic ramus.

RESULTS

Three patients developed proximal anastomotic contractures requiring interval dilatation in one and revision in two. Two patients developed a stone in the gut segment one of which was removed traumatically causing irreparable damage to the neourethra. The results were otherwise satisfactory.

CONCLUSION

For an otherwise unsalvageable bulbo‐membranous stricture or defect, a tailored flap of intestine, preferably sigmoid colon, gives satisfactory results. Of the two potential routes for the neourethra, we have more experience with the normal route but the direct route has several advantages.     

Meatoplasty using double buccal mucosal graft technique

Objective  

Glanular urethral/meatal stricture is associated with severe narrowing of the urethral lumen and treatment is sometimes associated with recurrence. We describe our technique and results of double buccal mucosa graft placement for the treatment of these strictures.     

Successful endoscopic wire-guided balloon dilatation of angulated and tight ileal pouch strictures without fluoroscopy

Background  

Ileal pouch strictures that are visually inaccessible by an endoscope may be balloon-dilated by exchange guide wire across the stricture with the aid of fluoroscopy. We present a technique of wire-guided balloon dilation without fluoroscopy to navigate strictures in the ileal pouch.     

Therapeutic Options for Management of Pharyngoesophageal Corrosive Strictures

Introduction  

Pharyngoesophageal strictures due to corrosive injury raise difficult therapeutic problems due to the site of stricture, the possible association with laryngeal injury and the presence of downstream esophageal strictures. We present here our approach to management of 51 consecutive patients with pharyngoesophageal strictures seen over a 30-year period.     

Endoscopic Management of Ureteral Strictures: an Update

Purpose of Review

This review focuses on the role of endoscopic treatment of ureteral stricture disease (USD) in the era of minimally invasive surgery.

Recent Findings

There is a relative paucity of recent literature regarding the endoscopic treatment of USD. Laser endopyelotomy and balloon dilation are associated with good outcomes in treatment-naïve patients with short (<?2 cm), non-ischemic, benign ureteral strictures with a functional renal unit. If stricture recurs, repetitive dilation and laser endopyleotomy is not recommended, as success rates are low in this scenario. Patients with low-complexity ureteroenteric strictures and transplant strictures may benefit from endoscopic treatment options, although formal reconstruction offers higher rates of success.

Summary

Formal ureteral reconstruction remains the gold-standard treatment for ureteral stricture disease as it is associated with higher rates of complete resolution. However, in carefully selected patients, endoscopic treatment modalities provide a low-cost, low-morbidity alternative.

     

Patient knowledge of urethral stricture disease in a state sector South African Academic Hospital

Introduction

The knowledge urethral stricture patients in a developing country Specialist Clinic have regarding their own disease, remains uncertain.

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 Endoscopic-Assisted Esophageal Dilation

Background  

Esophageal stricture is a well-known complication of chemoradiotherapy for head and neck malignancies. These strictures almost exclusively occur in the cervical esophagus within the field of radiation. For some patients, identification of the esophageal lumen for antegrade dilation of these strictures can be a challenge, and creation of a false lumen can occur during attempts at dilation.