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Kulkarni SB, Orabi H, Kavanagh A, Joshi PM. RE Re Do urethroplasty after multiple failed surgeries of pelvic fracture urethral injury. World J Urol 2020; 38:3019-3025. [PMID: 31485741 DOI: 10.1007/s00345-019-02917-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/20/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION We quantify surgical success rate in the management of pelvic fracture urethral injury (PFUI) with repeat urethroplasty in the setting of two or more failed prior urethroplasties. MATERIALS AND MATERIALS A retrospective analysis was completed of a single surgeon urethroplasty database from Jan 1, 2012 to June 31, 2018. Patients with a history of PFUI recurrent urethral stricture despite two or more failed prior urethroplasty procedures were included. RESULTS We identified 87 patients that had two more more failed prior urethroplasties. These had 2 main categories. One requiring anastomotic urethroplasty and other requiring substitution urethroplasty. Total success rate was 74.75% for anastomotic group and 84.61% for substitution group with a median follow-up of 34 months (range 6-60). Overall success rate for re redo Urethroplasty was 82.70%. Bulbar urethral ischemic necrosis was identified in 14 of 64 patients (21.9%). In these cases urethral substitution measures were performed including 12 with preputial flap and tubularization, 1 sigmoid colon substitution, medial thigh flap. No significant difference was observed between the success or failure group with respect to age, BMI, stricture length, number of prior urethroplasty procedure or endoscopic procedures or comorbidities. CONCLUSIONS Our findings demonstrate that high success rates can be achieved for repeat urethroplasty in recurrent PFUI urethral stricture after two or more failed prior urethroplasty procedures. Bulbar urethral ischemic necrosis is a common finding in this patient population. Patients should be managed at a tertiary high volume referral center.
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Affiliation(s)
- Sanjay B Kulkarni
- Kulkarni Reconstructive Urology Center, 3, Rajpath Society, Opp Vanaz Engineering, Paud Road, Pune, 411038, India.
| | - Hazem Orabi
- Kulkarni Reconstructive Urology Center, 3, Rajpath Society, Opp Vanaz Engineering, Paud Road, Pune, 411038, India
| | - Alex Kavanagh
- Kulkarni Reconstructive Urology Center, 3, Rajpath Society, Opp Vanaz Engineering, Paud Road, Pune, 411038, India
| | - Pankaj M Joshi
- Kulkarni Reconstructive Urology Center, 3, Rajpath Society, Opp Vanaz Engineering, Paud Road, Pune, 411038, India
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Choi DK, Kim S, Oh JJ. Effects of pelvic bone fracture on recurrence-free rate after bulbomembranous anastomotic urethroplasty in men with posterior urethral injuries. Investig Clin Urol 2020; 61:99-106. [PMID: 31942469 PMCID: PMC6946827 DOI: 10.4111/icu.2020.61.1.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/05/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the impact of pelvic bone fracture on the recurrence of urethral stenosis after bulbomembranous anastomotic urethroplasty. Materials and Methods A total of 197 patients with complete posterior urethral injuries underwent bulbomembranous anastomotic urethroplasty. These patients were divided into two groups according to the presence of pelvic bone fracture. Recurrence of urethral stenosis was defined as the need for any postoperative surgical intervention. The surgical outcomes and postoperative recurrence rate of urethral stenosis were compared between the two groups, and significant predictors for posterior urethral restenosis, including pelvic bone fracture, were analyzed via multivariate analysis. Results Of the patients, 92 had pelvic bone fractures and the other 105 patients did not. The patients with pelvic bone fracture had increased involvement of the prostatic urethra compared to the group without pelvic bone fracture (3.8% vs. 17.4%, p=0.002). Recurrence of urethral stenosis was more common in the pelvic bone fracture group (42/92, 45.7%) than the group without pelvic fracture (27/105, 25.7%). In a Kaplan—Meier analysis, the recurrence rate at 5 years was significantly lower in the pelvic bone fracture group (59.1% vs. 72.6%, p=0.003). A Cox proportional hazard analysis showed that the presence of pelvic bone injury was a significant predictor of posterior urethral re-stenosis. Conclusions Patients with posterior urethral injuries associated with pelvic bone fracture had a higher recurrence rate of urethral stenosis after bulbomembranous anastomotic urethroplasty than those without pelvic bone fracture.
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Affiliation(s)
- Don Kyoung Choi
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea
| | - Sungjin Kim
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea
| | - Jong Jin Oh
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Jasionowska S, Brunckhorst O, Rees RW, Muneer A, Ahmed K. Redo-urethroplasty for the management of recurrent urethral strictures in males: a systematic review. World J Urol 2019; 37:1801-1815. [PMID: 30877359 PMCID: PMC6717180 DOI: 10.1007/s00345-019-02709-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/26/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose Redo-urethroplasty is a challenge for any genitourethral surgeon, with a number of techniques previously described. This systematic review aims to identify the surgical techniques described in the literature and evaluate the evidence for their effectiveness in managing recurrent urethral strictures. Materials and methods A systematic review of the MEDLINE and EMBASE databases from 1945 to July 2018 was performed and the urethroplasty procedures were classified according to the site and surgical technique. Primary outcomes included success rates measured via re-stricture rates and the post-op maximum urinary flow rate. Secondary outcomes included complication rates and patient-reported quality of life. Results A total of 39 identified studies met the inclusion criteria. Twenty-two studies described the use of excision and primary anastomotic urethroplasty with success rates showing wide variability (58–100%). Success rates reported according to the site of the stricture also varied: bulbar (58–100%) and posterior (69–100%) recurrent strictures. One-stage substitution urethroplasty was described in 25 studies with success rates of 18–100%, with the best outcomes reported for bulbar (58–100%) and hypospadias-related (78.6–82%) strictures. Two-stage substitution urethroplasty was described in 12 studies with the success rates of 20–100%, with the best evidence related to hypospadias-related and posterior urethral strictures. The buccal mucosa graft was the graft source with the best evidence for substitution urethroplasty (18–100%). Conclusions Trends of effectiveness were identified for redo-urethroplasty modalities in different locations. However, the current levels of evidence are limited to small observational studies, highlighting the need for further larger prospective data to evaluate different techniques used for recurrent urethral strictures. Electronic supplementary material The online version of this article (10.1007/s00345-019-02709-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sara Jasionowska
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK.,Department of Urology, King's College Hospital, London, UK
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK.,Department of Urology, King's College Hospital, London, UK
| | - Rowland W Rees
- Urology Department, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Asif Muneer
- Department of Urology, NIHR Biomedical Research Centre, University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK. .,Department of Urology, King's College Hospital, London, UK.
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Predictors for success of internal urethrotomy in patients with urethral contracture following perineal repair of pelvic fracture urethral injuries. Injury 2017; 48:1035-1039. [PMID: 28259378 DOI: 10.1016/j.injury.2017.02.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/06/2017] [Accepted: 02/24/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Internal urethrotomy (IU) in patients with urethral contracture following perineal repair of pelvic fracture urethral injuries (PRPFUI) is troublesome. We evaluated the clinical factors affecting the surgical outcome of IU for urethral contracture after PRPFUI. MATERIALS AND METHODS We retrospectively reviewed the records of 35 patients who underwent IU for urethral contracture after PRPFUI between March 2004 and June 2013. Ages of patients ranged from 18 to 50, and their follow-up duration was more than 1year after IU. The urethral contracture was confirmed by retrograde urethrogram or cysto-urethroscopy. Success was defined as greater than 15mL/s of peak urinary flow rate at 1year after IU without any clinical evidence of urethral contracture. Success rates were investigated according to the number of IU. Age, body mass index, urethral defect length before PRPFUI, time interval between the original urethral injury and the PRPFUI or between a previous operation and the PRPFUI, time interval between the PRPFUI and the urethral contracture, number of PRPFUI performed, and the type of urethral lengthening procedure were compared between patients with and without success according to the number of IU. RESULTS Among the 35 patients, the overall success rate of IU was 37% (13/35) during the mean follow-up period of 53 months (range: 17-148 months). There were 8 and 5 patients with success in first and second IU, respectively. However, there was no success after third IU. Urethral defect length before PRPFUI was significantly shorter in patients with success who underwent first and second IU (p<0.05). There were significant differences of success between patients with and without previous repeated failures of PRPFUI in first and second IU (p<0.05). CONCLUSIONS Short urethral defect length and no previous surgical failures before PRPFUI are good prognostic factors for IU following PRPFUI. Only one or two IUs will be helpful in patients with urethral contracture following PRPFUI.
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Osman NI, Mangera A, Inman RD, Chapple CR. Delayed repair of pelvic fracture urethral injuries: Preoperative decision-making. Arab J Urol 2015; 13:217-20. [PMID: 26413351 PMCID: PMC4563003 DOI: 10.1016/j.aju.2015.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 06/27/2015] [Accepted: 06/27/2015] [Indexed: 11/25/2022] Open
Abstract
Pelvic fracture urethral injuries comprise one of the most challenging reconstructive procedures in urology. The obliterated or stenosed urethra can usually be effectively repaired by an end-to-end anastomosis (bulbomembranous anastomosis). To achieve this, a progression of surgical steps can be used to make a tension-free anastomosis. Before undertaking surgery it is important to comprehensively assess the patient to define their anatomical defects, in particular the site of the stenosis, the length of the distraction injury and the integrity of the bladder neck, and thus guide preoperative decision-making. Contemporary reports suggest that most pelvic fracture urethral distraction defects (PFUDD) can be adequately managed by a perineal approach. Nevertheless it is essential that all surgeons treating these injuries are familiar with the whole spectrum of operative steps that are necessary to repair PFUDD.
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Affiliation(s)
- Nadir I Osman
- Department of Urology, Royal Hallamshire Hospital, Sheffield, South Yorkshire, UK
| | - Altaf Mangera
- Department of Urology, Royal Hallamshire Hospital, Sheffield, South Yorkshire, UK
| | - Richard D Inman
- Department of Urology, Royal Hallamshire Hospital, Sheffield, South Yorkshire, UK
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Hwang JH, Kang MH, Lee YT, Park DS, Lee SR. Clinical factors that predict successful posterior urethral anastomosis with a gracilis muscle flap. Korean J Urol 2013; 54:710-4. [PMID: 24175047 PMCID: PMC3806997 DOI: 10.4111/kju.2013.54.10.710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 07/31/2013] [Indexed: 12/03/2022] Open
Abstract
Purpose We evaluated the preoperative clinical factors that affect the surgical outcome of posterior urethral anastomosis (PUA) with a gracilis muscle flap (GMF) to determine which factors predict benefit from the use of the GMF. Materials and Methods This was a retrospective analysis of 49 patients who underwent a delayed PUA with a GMF. A successful clinical outcome was defined as achieving a peak urinary flow rate greater than 15 mL/s at 3 and 12 months postoperatively without evidence of stricture recurrence on a retrograde urethrogram or cystourethroscopy at 3 months postoperatively. Multiple clinical factors were evaluated by use of univariate and multivariate analyses. Results The outcome of 21 of 49 patients (42.9%) was deemed successful. The mean age of the 49 patients was 37.2±13.5 years and the mean follow-up duration was 43.4±28.0 months. The length of the urethral defect was significantly shorter in patients with a successful outcome than in patients with an unsuccessful outcome (p=0.010). The outcome differed significantly depending on whether the patients had a previously successful urethroplasty (p=0.036) or whether they had suffered a pelvic bone injury (p=0.012). Multivariate logistic regression analyses revealed that a previous urethroplasty was the only preoperative clinical factor that significantly affected the surgical outcome in PUA with a GMF (odds ratio, 0.218; 95% confidence interval, 0.050 to 0.947; p=0.042). Conclusions A history of previous urethroplasty is a preoperative clinical factor that significantly affects the surgical outcome in PUA with a GMF; the procedure is more likely to be successful in patients who have not previously undergone urethroplasty.
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Affiliation(s)
- Jin Ho Hwang
- Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Fu Q, Zhang J, Sa YL, Jin SB, Xu YM. Recurrence and complications after transperineal bulboprostatic anastomosis for posterior urethral strictures resulting from pelvic fracture: a retrospective study from a urethral referral centre. BJU Int 2013; 112:E358-63. [PMID: 23773274 DOI: 10.1111/bju.12171] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To describe the complications of transperineal end-to-end anastomotic urethroplasty in patients with posterior urethral strictures resulting from pelvic fracture. MATERIALS AND METHODS A total of 573 patients, who underwent bulboprostatic anastomosis for posterior urethral strictures, were enrolled in this study. Distraction defects were measured using retrograde urethrography combined with voiding cysto-urethrography. All patients underwent perineal excision and primary anastomotic urethroplasty. The urethroplasty was considered successful if the patient was free of stricture-related obstruction and did not require any further intervention. The degree of stress incontinence was assessed daily by pad testing. The prevalence of pre- and postoperative sexual disorders was investigated using the International Index of Erectile Function-5 questionnaire. RESULTS Of 573 bulboprostatic anastomosis procedures performed, 504 (88%) were successful and 69 (12%) were not successful. The mean (sd) maximum urinary flow rate, assessed by uroflowmetry 4 weeks after surgery, was 20.52 (5.1) mL/s. Intraoperative rectal injury was repaired primarily in 28 cases. Recurrence of urethral strictures was observed in 10 (1.7%) patients during the first 6 months after surgery, and in 45 patients from 6 months to 1 year. All of these patients underwent re-operation. Twenty-four (4.2%) patients had mild urge incontinence and 28 (4.9%) had mild stress incontinence. Erectile dysfunction (ED) was present in two (<0.1%) patients before trauma and in 487 (85%) patients after trauma. There was no statistical difference between the incidences of preoperative and postoperative ED (85 vs 86%, P > 0.05). Nine (1%) patients were found to have false passage between the posterior urethra and bladder neck. CONCLUSION The majority of complications associated with transperineal bulboprostatic anastomosis can be avoided as long as meticulous preoperative evaluation to define the anatomy and careful intra-operative manipulation are ensured.
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Affiliation(s)
- Qiang Fu
- Department of Urology, Shanghai Sixth People's Hospital, Shanghai, China.
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Aggarwal SK, Sinha SK, Kumar A, Pant N, Borkar NK, Dhua A. Traumatic strictures of the posterior urethra in boys with special reference to recurrent strictures. J Pediatr Urol 2011; 7:356-62. [PMID: 21527235 DOI: 10.1016/j.jpurol.2011.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE We report 18 years' experience of traumatic urethral strictures in boys with emphasis on recurrent strictures. MATERIALS AND METHODS Thirty-four boys with pelvic fracture urethral strictures underwent 35 repairs: 23 in the primary group (initial suprapubic cystostomy, but no urethral repair) and 12 in the re-do group (previously failed attempt(s) at urethroplasty elsewhere). The median age at operation and stricture length was 8.4 years and 3 cm in the primary and 9 years and 5.4 cm in the re-do group, respectively. Anastomotic urethroplasty was performed wherever possible, or failing this a substitution urethroplasty. Median follow up was 9 years for primary group and 8 years for re-do group. RESULTS Primary group: urethroplasty was successful in 22/23, with 10 by perineal and 13 by additional transpubic approach. Two have stress incontinence. Erectile function is unchanged in all and upper tracts are maintained. One had recurrent stricture. Re-do group (12 including 1 recurrence from primary group): anastomotic urethroplasty was done in 5 and substitution urethroplasty in 7. Patients needing substitution had long stricture (>5 cm), stricture extending to distal bulb, or high riding bladder neck. All patients are voiding urethrally. Two patients with substitution required dilatation for early re-stenosis. One appendix substitution required delayed revision. Two have stress incontinence. Erectile function was unaffected. Upper tracts are maintained. CONCLUSIONS Anastomotic urethroplasty was successful in over 95% of primary cases. In re-do cases it was viable in only 41% of cases; the rest required substitution urethroplasty. Urethral substitution also gave acceptable results.
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Fu Q, Zhang J, Sa YL, Jin SB, Xu YM. Transperineal bulbo-prostatic anastomosis for posterior urethral stricture associated with false passage: a single-centre experience. BJU Int 2011; 108:1352-4. [PMID: 21332906 DOI: 10.1111/j.1464-410x.2011.10079.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE • To evaluate the management of traumatic posterior urethral stricture associated with false passage, as this remains a challenge for urologists. PATIENTS AND METHODS • From January 2000 to February 2010, 19 patients (mean (range) age 34 [25-52] years) with traumatic posterior urethral obliteration associated with false passage were evaluated and treated at our centre. • All patients underwent perineal excision and primary anastomotic urethroplasty using cystoscopy by the suprapubic route to insert a guidewire into the original bladder neck, allowing exposure of the normal posterior urethra. • Patients underwent voiding cysto-urethrography 1 month after the procedure. When symptoms of decreased force of stream were present and uroflowmetry was <15 mL/s, urethrography and urethroscopy were repeated. • Clinical outcome was considered a failure when any postoperative instrumentation was needed, including dilatation. RESULTS • The mean (range) follow-up was 12 (9-14) months. The overall success rate was 84%. • Three patients (16%) with persistent voiding difficulty developed a short anastomotic stricture 1-3 months after surgery. • The mean maximum urinary flow rate after surgery was 20.01 mL/s and no patient had urinary incontinence. CONCLUSION • The preoperative use of flexible cystoscopy via the suprapubic route represented a successful key point of urethroplasty for posterior urethral stricture associated with false passage.
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Affiliation(s)
- Qiang Fu
- Department of Urology, Shanghai 6th Hospital, Shanghai, China.
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Kulkarni SB, Barbagli G, Kulkarni JS, Romano G, Lazzeri M. Posterior urethral stricture after pelvic fracture urethral distraction defects in developing and developed countries, and choice of surgical technique. J Urol 2010; 183:1049-54. [PMID: 20092843 DOI: 10.1016/j.juro.2009.11.045] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Indexed: 11/19/2022]
Abstract
PURPOSE We compared posterior urethral strictures after pelvic fracture urethral distraction defects in India and Italy. MATERIALS AND METHODS We retrospectively analyzed the records of patients in India and Italy who underwent repair for posterior urethral stricture after pelvic fracture urethral distraction defect. We investigated etiology, emergency treatment type, the specialist involved in emergency treatment, the type of stricture resulting from trauma and primary repair, posterior urethroplasty techniques and results. RESULTS Of 255 patients with a median age of 33 years 117 (45.8%) and 138 (54.2%) were evaluated in India and Italy, respectively. In India the most common causes of pelvic fracture urethral distraction defects were pedestrian (35%), motorcycle (26.5%) and bicycle (12.8%) accidents. The most common emergency treatment was suprapubic cystostomy (79.5% of cases). Of the patients 70.1% were treated in emergency fashion by a surgeon and 85.4% had complex posterior urethral strictures. The most common technique was anastomosis with inferior and total pubectomy in 56.4% and 15.3% of cases, respectively. In Italy the etiology was mainly automobile accidents (39.2%). The most common emergency treatment was endoscopic realignment (49.2% of cases). Of the patients 92.7% were treated in emergency fashion by a urologist and 68.1% had simple urethral strictures. Perineal anastomosis and laser urethrotomy were the most used techniques (38.4% and 21.1% of cases, respectively). In India 92 cases (78.6%) were successful and 25 (21.4%) failed while in Italy 120 (86.9%) were successful and 18 (13.1%) failed. Median followup was 74 months (range 12 to 239). CONCLUSIONS Differences in emergency treatment for pelvic fracture urethral distraction defects influence the choice of delayed posterior repair and results.
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Abstract
CONTEXT These guidelines were prepared on behalf of the European Association of Urology (EAU) to assist urologists in the management of traumatic urethral injuries. OBJECTIVE To determine the optimal evaluation and management of urethral injuries by review of the world's literature on the subject. EVIDENCE ACQUISITION A working group of experts on Urological Trauma was convened to review and summarize the literature concerning the diagnosis and treatment of genitourinary trauma, including urethral trauma. The Urological Trauma guidelines have been based on a review of the literature identified using on-line searches of MEDLINE and other source documents published before 2009. A critical assessment of the findings was made, not involving a formal appraisal of the data. There were few high-powered, randomized, controlled trials in this area and considerable available data was provided by retrospective studies. The Working Group recognizes this limitation. EVIDENCE SYNTHESIS The full text of these guidelines is available through the EAU Central Office and the EAU website (www.uroweb.org). This article comprises the abridged version of a section of the Urological Trauma guidelines. CONCLUSIONS Updated and critically reviewed Guidelines on Urethral Trauma are presented. The aim of these guidelines is to provide support to the practicing urologist since urethral injuries carry substantial morbidity. The diversity of urethral injuries, associated injuries, the timing and availability of treatment options as well as their relative rarity contribute to the controversies in the management of urethral trauma.
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Singh BP, Andankar MG, Swain SK, Das K, Dassi V, Kaswan HK, Agrawal V, Pathak HR. Impact of Prior Urethral Manipulation on Outcome of Anastomotic Urethroplasty for Post-traumatic Urethral Stricture. Urology 2010; 75:179-82. [DOI: 10.1016/j.urology.2009.06.081] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 05/10/2009] [Accepted: 06/06/2009] [Indexed: 10/20/2022]
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Gupta NP, Mishra S, Dogra PN, Hemal AK, Seth A, Kumar R. Does a previous end-to-end urethroplasty alter the results of redo end-to-end urethroplasty in patients with traumatic posterior urethral strictures? Int J Urol 2008; 15:885-8. [PMID: 18721207 DOI: 10.1111/j.1442-2042.2008.02135.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the success rate of redo anastomotic urethroplasty and to compare it with primary anastomotic urethroplasty. METHODS We compared 52 patients with post-traumatic posterior urethral strictures (group 1, mean age 24.6 years, range 10-62) who had undergone redo urethroplasty with 66 patients (group 2, mean age 22.6, range 6-71) who had undergone primary anastomotic urethroplasty. Mean stricture length was 2.0 cm (1-4.5) and 2.5 cm (1.5-6), respectively. All of the patients in group 1 had a stricture located at the bulboprostatic anastomotic site. In group 2, 43 (65.2%) had a bulbomembranous stricture and 23 (34.8%) had a prostatomembranous stricture. RESULTS Mean operative time was 140 (100-240) and 90 min (75-200) in group 1 and 2, respectively. Mean blood loss was 180 (80-900) and 125 mL (50-700), respectively. Mean hospital stay was comparable (6.6 days vs 5.5 days) between the two groups. Mean follow up was 54 months (10-144) for group 1 and 62 months (12-122) for group 2. Corporal separation, inferior pubectomy, a transpubic approach and urethral rerouting were required in 22 (42.3%) and 12 (18.2%), 7 (13.5%) and 3 (4.5%), 12 (23%) and 5 (7.6%), 2 (3.8%) and nil patients in group 1 and 2, respectively. An excellent or acceptable outcome was achieved in 42 (80.8%) and 57 (86.4%), 8 (15.4%) and 7 (10.6%) patients, respectively. Two patients in each group failed. CONCLUSIONS Previously failed end-to-end urethroplasty does not alter the success rate of redo end-to-end urethroplasty.
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Affiliation(s)
- Narmada P Gupta
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
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Barbagli G. History and Evolution of Transpubic Urethroplasty: A Lesson for Young Urologists in Training. Eur Urol 2007; 52:1290-2. [PMID: 17630102 DOI: 10.1016/j.eururo.2007.07.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Accepted: 07/02/2007] [Indexed: 10/23/2022]
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Pratap A, Gupta DK, Agrawal CS, Pandit RK, Adhikary S, Kumar A, Tiwari A, Singh SN. Complex urethral disruptions: in pursuit of a successful reconstruction. Int J Urol 2007; 14:198-202. [PMID: 17430255 DOI: 10.1111/j.1442-2042.2007.01690.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES We analyzed the methods and outcomes of urethroplasty in men with complex urethral disruptions. METHODS The medical records of 40 men with complex urethral disruptions were analyzed. Surgical methods were individualized according to stricture location, severity and length of the stricture, bladder neck characteristics and presence of complicating factors. Patients were divided into four groups based on the above characteristics. RESULTS End-to-end urethroplasty performed in six patients with short bulbar strictures (<3 cm) was successful in all. Elaborated perineal repair was performed in 10 patients with intermediate (3-6 cm) strictures with or without complicating factors. Elaborated perineal repair with urethral substitution was performed in nine patients with long segment stricture (>6 cm). Abdominal transpubic repair was successfully applied to patients with rectourethral fistula or lacerated bladder neck. Success rate of anastomotic urethroplasty was 95% while over all success rate was 85%. CONCLUSION Guidelines for urethral reconstruction of complex urethral disruptions are predicated on stricture length, location, bladder neck characteristics and associated complicating factors. End-to-end urethroplasty with stricture excision is highly reliable for short strictures for which previous operative repair have failed. Elaborated perineal repair is extremely versatile for intermediate and longer strictures with associated complicating factors. Abdominal transpubic urethroplasty is effective for patients with rectourethral fistula or lacerated bladder neck.
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Affiliation(s)
- Akshay Pratap
- Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
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Culty T, Boccon-Gibod L. Anastomotic Urethroplasty for Posttraumatic Urethral Stricture: Previous Urethral Manipulation Has a Negative Impact on the Final Outcome. J Urol 2007; 177:1374-7. [PMID: 17382735 DOI: 10.1016/j.juro.2006.11.092] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Indexed: 11/29/2022]
Abstract
PURPOSE We evaluated the long-term results of anastomotic urethroplasty for posttraumatic urethral stricture and assessed the impact of previous endourethral/surgical intervention on the subsequent outcome. MATERIALS AND METHODS From January 1988 to April 2005, 51 patients underwent anastomotic urethroplasty for posttraumatic urethral stricture following pelvic fracture (41) or perineal blunt trauma (10). Of these patients 28 (55%) underwent previous surgical procedures, including endoscopic urethrotomy with endoscopic realignment in 20 and open urethroplasty in 8. Median followup was 4.6 years. Results were evaluated. Success was characterized by a maximum urine flow of more than 15 ml per second, sterile urine, and normal urethral imaging and/or endoscopy. A satisfactory result was considered to be 1 episode of recurrence diagnosed on routine imaging/endoscopy that was successfully managed by 1 or 2 direct vision internal urethrotomies. Failure was characterized by the necessity for repeat instrumental and/or open surgery. Results were analyzed using Kaplan-Meier curves and the log rank test. RESULTS At 1, 5 and 10 years overall success rates were 63%, 55% and 43%, while satisfactory result rates were 84%, 80% and 76%, respectively. However, the 23 patients without urethral manipulation before anastomotic urethroplasty had a satisfactory result of more than 90% vs more than 60% in patients with previous surgical treatment. These results were maintained for 100 months (p <0.05). CONCLUSIONS Endoscopic and/or open urethral manipulation before anastomotic urethroplasty for posttraumatic urethral stricture has a significant impact on the outcome of urethral reconstruction. Cases of posttraumatic urethral stricture should preferably be referred to a center of expertise.
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Affiliation(s)
- Thibaut Culty
- Department of Urology, Bichat Hospital, Paris, France
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Pratap A, Agrawal CS, Pandit RK, Sapkota G, Anchal N. Factors Contributing to a Successful Outcome of Combined Abdominal Transpubic Perineal Urethroplasty for Complex Posterior Urethral Disruptions. J Urol 2006; 176:2514-7; discussion 2517. [PMID: 17085145 DOI: 10.1016/j.juro.2006.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2006] [Indexed: 11/16/2022]
Abstract
PURPOSE We present our results of and operative principles essential for a successful outcome of complex posterior urethral disruption management. MATERIALS AND METHODS A total of 25 patients underwent abdominal transpubic perineal urethroplasty for complex posterior urethral disruption. Preoperative voiding cystourethrogram with retrograde urethrogram and cystourethroscopy were done to evaluate the stricture and bladder neck. Followup consisted of symptomatic and radiological assessment. RESULTS Patient age was 22 to 57 years. Average followup was 24 months (range 11 to 39). Four patients had previously undergone failed perineal urethroplasty. A rectourethral fistula was present in 8 patients, of whom 2 required colonic diversion, while there were false passages in 3, a periurethral cavity with abscess in 6 and bladder neck laceration in 20. Mean stricture length +/- SD was 6.5 +/- 2.5 cm (range 4 to 9). Four of the 25 patients had previously undergone failed perineal urethroplasty. The mean period between original trauma/failed repair and definitive repair was 11.5 +/- 4.4 months. Urethroplasty could be achieved through the normal subpubic route in 19 patients, while 6 required supracrural rerouting. A total of 20 patients underwent simultaneous bladder neck repair. In 24 of 25 patients (96%) postoperative cystourethrography showed a wide, patent anastomosis. Postoperatively incontinence developed in 1 of 25 patients (4%). Ten of the 25 patients (40%) were impotent after the primary injury. Potency status in our patients did not change after urethroplasty. The overall urethroplasty success rate was 92%. CONCLUSIONS Hostile conditions in the perineum of patients with complex posterior urethral disruption mitigate against a good result. However, the safety and success of combined abdominal transpubic perineal urethroplasty make it the procedure of choice for these difficult strictures.
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Affiliation(s)
- Akshay Pratap
- Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
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Gorraiz Ortíz MA, Vicente Prados FJ, Tallada Buñuel M, Rosales Leal JL, Honrubia Vílchez B, Fernández Sánchez A, Vázquez F, Martínez Morcillo A, Cózar Olmo JM, Espejo Maldonado E. [Long-term results of end-to-end urethroplasty]. Actas Urol Esp 2005; 29:499-505. [PMID: 16013796 DOI: 10.1016/s0210-4806(05)73281-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We evaluated long term results of end-to-end urethroplasty. MATERIAL AND METHODS We reviewed 40 patients with bulbar urethral stricture of diverse origin: iatrogenic 40%, traumatic 15%, infectious 2% and unknown 40%. In 17 cases internal urethrotomy was made previously. The radiological study with retrograde and voiding cystogram revealed a bulbar location in all cases and a length inferior to 1 cm in 13 cases, between 1-2 cm in 26 cases and 2-3 cm in 1 case. The maximum flow rate varied between 3-13 ml/s. The absence of bacteriuria was valued by means of preoperating culture. The average time of pursuit was 45 months (12-142 months). The stricture was considered resolute when not appear compatible radiological or functional finds of failure. RESULTS In 37 cases (92%) the results were satisfactory, without secondary surgical procedure. After surgery maximum flow-rate varied between 18-45 ml/s. In two patients with failure, internal urethrotomy was decisive. In this case the stricture origin was traumatic. The third patient with failure was finally chosen to make new end-to-end urethroplasty, with good later result. CONCLUSIONS End-to-end urethroplasty is a highly decisive technique for bulbar urethral stricture. The preoperating diagnosis is based on the radiological study (retrograde and voiding cystogram). The postoperating control must be based on clinic and uroflow study. Traumatic stricture repair showed worse results. In cases of failure, internal urethrotomy allows to complement successful results of end-to-end urethroplasty.
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Affiliation(s)
- M A Gorraiz Ortíz
- Servicio de Urología, Hospital Universitario Virgen de las Nieves, Granada
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Shenfeld OZ, Gofrit ON, Gdor Y, Landau EH, Pode D. Anastomotic urethroplasty for failed previously treated membranous urethral rupture. Urology 2004; 63:837-40. [PMID: 15134959 DOI: 10.1016/j.urology.2003.12.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2003] [Accepted: 12/15/2003] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine whether delayed excision and primary anastomosis is appropriate after failed previous therapeutic attempts for post-traumatic membranous urethral strictures. Delayed excision and primary anastomosis is widely accepted as the first-line treatment of post-traumatic membranous urethral strictures. METHODS A review of the medical records identified 13 patients who had undergone anastomotic urethroplasty as a second procedure for traumatic membranous urethral strictures. The previous treatments in these patients included anastomotic urethroplasty in four, staged urethroplasty in four, and endoscopic urethrotomy or primary catheter realignment in five. The mean stricture length was 2.8 cm. All patients underwent excision and primary bulboprostatic anastomosis using the perineal approach. RESULTS Four patients required partial pubectomy and one required corporal rerouting to achieve anastomosis. The mean follow-up was 27 months. Urethrography performed 1 month postoperatively demonstrated a widely patent anastomosis in all cases. Flexible urethroscopy performed 1 year after surgery revealed a widely patent anastomosis with normal urethral mucosa in all patients but one. The mean maximal flow rate at the last follow-up visit was 23.5 mL/s compared with 3.9 mL/s preoperatively. No statistically significant postvoid residual urine volume was found in any patient. One patient developed an anastomotic stricture 3 months after surgery that was treated successfully by internal urethrotomy. Thus, the objective success rate was 92%. Subjectively, all patients but one reported satisfactory voiding. Complications were mild and included urinary tract infection, bladder stone formation, and decreased erectile function in 1 patient each. CONCLUSIONS Even in patients with failed previous surgical attempts, excision and primary anastomosis is feasible and provides good surgical results in post-traumatic posterior urethral strictures. The complications were mild and easily treated.
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Affiliation(s)
- Ofer Z Shenfeld
- Department of Urology, Hadassah Hebrew University Medical Center, Kiryat Hadassah, Jerusalem, Israel
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Xu YM, Qiao Y, Sa YL, Wu DL, Zhang J, Zhang XR, Chen R, Si JM. 1-stage urethral reconstruction using colonic mucosa graft for the treatment of a long complex urethral stricture. J Urol 2004; 171:220-3; discussion 223. [PMID: 14665880 DOI: 10.1097/01.ju.0000094810.60093.bc] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We investigated the possibility of urethroplasty with a free graft of colonic mucosa for long, complex urethral strictures. We report our initial experience with colonic mucosa graft urethroplasty for such urethral strictures in 16 patients. MATERIALS AND METHODS Between September 2000 and December 2002, 16 patients with a long, complex urethral stricture were treated with colonic mucosal graft urethroplasty. Patients had undergone an average of 2.5 previous unsuccessful repairs. Urethral reconstruction was done with a 10 to 17 cm (median 13) graft of colonic mucosa RESULTS Patients were followed 6 to 33 months postoperatively. Meatal stenosis that developed in 1 patient 3 months postoperatively needed reoperation. The patient was voiding well with a urinary peak flow of 28.7 ml per second during 9-month followup after reoperation. Hyperplasia of the verumontanum was observed during urethroscopy and transurethral colliculectomy was performed in 1 patient more than 14 months postoperatively. Uroflowmetry showed a urinary peak flow of 46.5 ml per second postoperatively. The other patients were voiding well with a urinary peak flow of greater than 15 ml per second. Urethrogram revealed a patent urethra with an adequate lumen and no significant graft sacculation. CONCLUSIONS This initial experience in 16 patients indicates that colonic mucosa graft urethroplasty is a feasible procedure for long, complex anterior urethral strictures. The technique may be considered for urethral reconstruction when more conventional procedures have failed.
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Affiliation(s)
- Yue-Min Xu
- Department of Urology, Sixth People's Hospital, Jiao Tong University of Shanghai, People's Republic of China.
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Xu YM, Qiao Y, Sa YL, Zhang J, Zhang HZ, Zhang XR, Wu DL, Chen R. One-stage urethral reconstruction using colonic mucosa graft: An experimental and clinical study. World J Gastroenterol 2003; 9:381-4. [PMID: 12532472 PMCID: PMC4611352 DOI: 10.3748/wjg.v9.i2.381] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the possibility of urethral reconstruction with a free colonic mucosa graft and to present our preliminary experience with urethral substitution using a free graft of colonic mucosa for treatment of 7 patients with complex urethral stricture of a long segment.
METHODS: Ten female dogs underwent a procedure in which the urethral mucosa was totally removed and replaced with a free graft of colonic mucosa. A urodynamic study was performed before the operation and sacrifice. The dogs were sacrificed 8 to 16 wk after the operation for histological examination of urethra. Besides, 7 patients with complex urethral stricture of a long segment were treated by urethroplasty with the use of a colonic mucosal graft. The cases had undergone an average of 3 previous unsuccessful repairs. Urethral reconstruction with a free graft of colonic mucosa ranged from 10 to 17 cm (mean 13.1 cm). Follow-up included urethrography, urethroscopy and uroflowmetry.
RESULTS: Urethral stricture developed in 1 dog. The results of urodynamic studies showed that the difference in the maximum urethral pressure between the pre-operation and pre-sacrifice in the remaining 9 dogs was not of significance (P > 0.05). Histological examination revealed that the colonic free mucosa survived inside the urethral lumen of the 10 experimental dogs. Plicae surface and unilaminar cylindric epithelium of the colonic mucosa was observed in dogs sacrificed 8 wk after the operation. The plicae surface and unilaminar cylindric epithelium of the colonic mucosa was not observed, and metaplastic transitional epithelium covered a large proportion of the urethral mucosa in dogs sacrificed 12 wk after the operation. Clinically, the patients were followed up for 3-18 mo postoperatively (mean 8.5 mo). Meatal stenosis was developed in 1 patient 3 mo postoperatively and needed reoperation. The patient was voiding very well with urinary peak flow 28.7 mL/s during the follow-up of 9 mo after reoperation. The other patients were voiding well with urinary peak flow greater than 15 mL/s. Urethrogram revealed a patent urethra with an adequate lumen with no significant graft sacculation. Neither necrosis of neourethral mucosa nor stenosis at the anastomosis sites has been observed on urethroscopy in 4 patients over 6 mo after operation.
CONCLUSION: Urethral mucosa can be replaced by colonic mucosa without damaging the continence mechanism in female dogs. Colonic mucosa graft urethral substitution is a feasible procedure for the treatment of complex urethral stricture of a long segment. The technique may be considered when more conventional options have failed or are contraindicated.
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Affiliation(s)
- Yue-Min Xu
- Chief of Department of Urology, Sixth People's Hospital, Jiao Tong University of Shanghai, Shanghai 200233, China.
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Zhou FJ, Xiong YH, Zhang XP, Shen PF. Transperineal end-to-end anastomotic urethroplasty for traumatic posterior urethral disruption and strictures in children. Asian J Surg 2002; 25:134-8. [PMID: 12376233 DOI: 10.1016/s1015-9584(09)60161-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To report the long-term results of transperineal end-to-end anastomotic urethroplasty for post-traumatic posterior urethral stenosis in children. METHODS From 1975 to 1996, 25 boys [aged 3 to 12 years] with post-traumatic posterior urethral stenosis or obliteration, and one boy [aged 7 years] with disrupted posterior urethra were treated with transperineal end-to-end anastomotic urethroplasty. Final follow-up assessments including voiding status, urinary continence and erectile function were performed in June 1999. RESULTS Smooth voiding was restored in 25 boys postoperatively. one child failed an ill-prepared repair and was waiting for further intervention. Among the 25 patients, seven were lost to the final follow-up. All seven boys had a single urethroplasty for simple urethral stenosis and had been followed for 3 to 5 years postoperatively with smooth voiding. The other 18 boys, including seven with complex urethral stenosis [three with a history of failed previous urethroplasties, three with urethrorectal fistula and one with urethroperineal fistula], underwent a total of 22 end-to-end anastomotic urethroplasties [one successful primary repair, 17 successful delayed repairs and four failed repairs]. Of the 17 patients with successful delayed repair, 14 succeeded with one repair, two with two repairs and one with three repairs. The success rate per repair for simple urethral strictures was 94.7% [18 of 19], and for complex strictures 63.6% [7 of 11]. Stress incontinence was found in three cases, impotence in two. Concomitant impotence and stress incontinence were found in one of the five patients. CONCLUSION Transperineal end-to-end anastomotic urethroplasty can achieve good long-term outcomes in children with simple post-traumatic posterior urethral stenosis. In experienced hands, good results can also be achieved for complex urethral strictures.
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Affiliation(s)
- F J Zhou
- Cancer Centre, Sun Yat-Sen University, Guangzhou, Department of Urology, XiangYa Affiliated Hospital of Hunan Medical University, Changsha, Peoples Republic of China.
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Aggarwal SK, Goel D, Gupta CR, Ghosh S, Ojha H. The use of pedicled appendix graft for substitution of urethra in recurrent urethral stricture. J Pediatr Surg 2002; 37:246-50. [PMID: 11819208 DOI: 10.1053/jpsu.2002.30265] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Recurrent posterior urethral strictures after failed urethroplasty may need urethral substitution. Skin or mucosal grafts, currently used for this purpose, have a high complication rate. The authors describe the use of pedicled appendix for posterior urethral substitution. METHODS Two boys with pelvic fracture urethral distraction injuries were treated for recurrent posterior urethral strictures after a failed perineal anastomotic urethroplasty. Through a perineal-transpubic approach the stricture tissue was excised, which resulted in a gap of 5 to 7 cm between the healthy ends. The vermiform appendix was mobilised on its own pedicle and transposed to the perineum; the proximal end of appendix was anastomosed to the prostatic urethra and the distal end (tip discarded) to the bulbar/penile urethra. Omentum was transposed to wrap the anastomosis and fill the dead space. RESULTS Normal micturition was restored in both patients. No further treatment was required after 1 dilatation in the first case. Both patients are continent. Potency status remains unchanged from the preoperative period with normal erections in 1 case. Follow-up (1 to 3 years) has been satisfactory with no complications. CONCLUSIONS The appendix is a promising organ for posterior urethral replacement. It can be brought to the perineum on its own vascular pedicle.
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Abstract
PURPOSE We present our results managing anterior urethral strictures previously treated with urethroplasty and/or urethrotomy. MATERIALS AND METHODS During a 32-month period 69 males 10 to 76 years old (mean age 36) underwent treatment for anterior urethral stricture, including 32 (46%) and 26 (38%) previously treated with urethroplasty and urethrotomy, respectively. In 11 patients (16%) no previous procedures had been done. Anastomotic and dorsal patch urethroplasty was performed for bulbar stricture in 13 and 14 cases, respectively, while in 4 a penile skin flap was placed for penile stricture and in 38 a 2-stage procedure was done with urethral substitution using buccal mucosa or post-auricular skin grafts. Patients were followed with ascending urethrography at 3 weeks, and 12 and 18 months as well as with uroflowmetry. Symptoms were assessed for 6 months to 4 years. RESULTS Only 1 stricture recurred in patients treated with anastomotic or patch urethroplasty, or a skin flap. Of the patients scheduled for a 2-stage procedure stage 1 revision was required due to graft scarring or stenosis at the urethrostomy site in 21% and stage 2 revision was required in 23%. Other complications in this series included fistula in 3% of cases, wound infection in 3% and post-void dribbling in 12%. CONCLUSIONS Overall early results are good in our urethroplasty series in patients with a previously instrumented urethra. Patients should be advised of the possible need for multiple revisions of planned staged procedures. The increased rate of revision in these staged procedures compared with the excellent outcome of 1-stage procedures appears to be inherent in this operation in patients with multiple previous procedures rather than due to surgeon experience.
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Al-Rifaei MA, Al-Rifaei A. Management of postoperative obstruction after bulboprostatic anastomotic urethroplasty for membranous urethral defects secondary to pelvic fracture. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 2001; 35:491-6. [PMID: 11848429 DOI: 10.1080/003655901753367604] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To present our experience in the management of postoperative obstruction after bulboprostatic anastomotic urethroplasty for post-traumatic membranous urethral defects secondary to pelvic fracture. MATERIAL AND METHODS Between 1979 and 1998 we managed 25 patients with postoperative posterior urethral obstruction after bulboprostatic anastomotic urethroplasty. Of these patients, 17 had undergone one repair and 8 had undergone more than one repair. One case had multiple perineal fistulae. Visual urethrotomy was done in 3 patients, 1 had cross union at the site of the anastomosis, and the other 2 had short passable strictures. In cases of obliterated strictures, bulboprostatic anastomosis was done in 6 patients via the perineal route and in 10 patients via the transpubic route. In 6 patients the urethral obstruction was due to new bone formation (callus) in the pubic gap (after pubectomy) pressing on the anastomatic line, and these cases were treated by removal of the callus. RESULTS After 1-6 years of follow up (mean 3.16 years) the outcome of the 3 patients who underwent visual urethrotomy was good. Eleven of the 16 patients who underwent anastomotic urethroplasty (68.7%) void well, 2 patients had fair results and the remaining 3 (18.7%) had restenosis. In the 6 patients who had new bone formation in the pubic gap, the obstruction was relieved by removal of the callus. CONCLUSIONS Visual urethrotomy is limited to very short passable urethral strictures, we do not recommend cutting on the light. End-to-end anastomosis was performed in obliterated strictures. Removal of the new bone formation from the pubectomy gap relieved the urethral obstruction.
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Affiliation(s)
- M A Al-Rifaei
- Department of Urology, Faculty of Medicine, University of Alexandria, Egypt
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Abstract
PURPOSE To analyze the effects on voiding and complications of one-stage urethroplasty for urethral stricture. METHODS All patients who underwent one-stage urethroplasty for stricture in two health institutions in Enugu, Nigeria, between January 1989 and December 1998, were included. The age of the patient, duration of symptoms and the cause of the stricture were noted. Retrograde urethrogram and, when necessary, micturating cystourethogram was done. Urethroplasty was either by substitution using pedicled penile skin flap or by end-to-end anastomosis. Patients were followed up monthly for 1 year during which the patient's ability to urinate satisfactorily was assessed and any complications were noted. One hundred and forty-four (144) men, aged between 11 and 76 years (mean 36.3 +/- 11.2 years), were studied. These included 121 cases who had rapidly recurring strictures after internal urethrotomy or dilatation and 23 cases of complete stricture. Etiology of the stricture included external trauma (43.8%), postinflammatory (36.1%) and iatrogenic (post-catheterization; 20.1%). Ninety-one (63.2%) strictures were in the anterior urethra, 47 (32.6%) in the posterior urethra and six (4.2%) bulbomembranous. The mean length of the strictures was 3.1 +/- 1.4 cm. RESULTS Anastomotic urethroplasty was performed in 98 (68.1%) patients and substitution in 46 (31.9%). Hospital stay was between 12 and 14 days, except in those who developed complications. Normal voiding was achieved in 124 (86.1%) patients. Urethral fistula was encountered in five (3.5%) patients and recurrent stricture in 15 (10.4%). There was no mortality. CONCLUSIONS One-stage urethroplasty affords an excellent cost-effective means of reconstruction of the urethra in patients with stricture of various etiologies. In our environment in particular, it avoids the fulminating infection often encountered after the first stage of a two-staged operation.
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Affiliation(s)
- A E Aghaji
- Urology Unit, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria.
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NAGLER ARNON, GOFRIT OFER, OHANA MEIR, PODE DOV, GENINA OLGA, PINES MARK. THE EFFECT OF HALOFUGINONE, AN INHIBITOR OF COLLAGEN TYPE I SYNTHESIS, ON URETHRAL STRICTURE FORMATION: IN VIVO AND IN VITRO STUDY IN A RAT MODEL. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67105-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- ARNON NAGLER
- From the Departments of Bone Marrow Transplantation and Urology, Hadassah University Hospital, Jerusalem and Institute of Animal Science, Agricultural Research Organization, The Volcani Center, Bet Dagan, Israel
| | - OFER GOFRIT
- From the Departments of Bone Marrow Transplantation and Urology, Hadassah University Hospital, Jerusalem and Institute of Animal Science, Agricultural Research Organization, The Volcani Center, Bet Dagan, Israel
| | - MEIR OHANA
- From the Departments of Bone Marrow Transplantation and Urology, Hadassah University Hospital, Jerusalem and Institute of Animal Science, Agricultural Research Organization, The Volcani Center, Bet Dagan, Israel
| | - DOV PODE
- From the Departments of Bone Marrow Transplantation and Urology, Hadassah University Hospital, Jerusalem and Institute of Animal Science, Agricultural Research Organization, The Volcani Center, Bet Dagan, Israel
| | - OLGA GENINA
- From the Departments of Bone Marrow Transplantation and Urology, Hadassah University Hospital, Jerusalem and Institute of Animal Science, Agricultural Research Organization, The Volcani Center, Bet Dagan, Israel
| | - MARK PINES
- From the Departments of Bone Marrow Transplantation and Urology, Hadassah University Hospital, Jerusalem and Institute of Animal Science, Agricultural Research Organization, The Volcani Center, Bet Dagan, Israel
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THE EFFECT OF HALOFUGINONE, AN INHIBITOR OF COLLAGEN TYPE I SYNTHESIS, ON URETHRAL STRICTURE FORMATION: IN VIVO AND IN VITRO STUDY IN A RAT MODEL. J Urol 2000. [DOI: 10.1097/00005392-200011000-00100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chapple CR. What's topical in functional reconstruction and trauma--with particular reference to urethroplasty. Curr Opin Urol 1999; 9:223-6. [PMID: 10726095 DOI: 10.1097/00042307-199905000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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