Long-Term Results of Internal Urethrotomy

Albers, Peter; Fichtner, Jan; Brühl, P.; Müller, Stefan

doi:10.1097/00005392-199611000-00017

Cited by 29 publications

(26 citation statements)

References 8 publications

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“…For example, 2.8% to 9.8% of patients who undergo TURP experience bladder neck contracture 13,14 . Elders who have had internal urethrotomies in the past are at high risk for recurrence; one study documented a 45% recurrence rate over 3 years 15 . Recurrence rates are lower for elders who have undergone open urethroplasty (18%) 16 …”

Section: Resultsmentioning

confidence: 99%

Quality Indicators for Benign Prostatic Hyperplasia in Vulnerable Elders

Saigal

2007

J American Geriatrics Society

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Key words: benign prostatic hypertrophy; quality of care; treatment B enign prostatic hyperplasia (BPH) is a highly prevalent benign neoplasm in older men. Lower urinary tract symptoms (LUTS) associated with BPH include urinary urgency, frequency, nocturia, incomplete emptying, decreased force of urinary stream, and urinary incontinence (UI). The prevalence of these symptoms rises with age. When comparing men aged 30 to 39 with men aged 70 and older, the prevalence of nocturia more than three times per night rises from 3% to 21%, the prevalence of incomplete emptying rises from 6% to 22%, and the prevalence of a weak urinary stream rises from 0% to 57%. 1 Untreated BPH can result in serious clinical sequelae, including acute urinary retention, urinary tract infection (UTI), bladder stone formation, gross hematuria, and rarely, renal failure. Treatment of BPH can often mitigate these outcomes. LUTS associated with BPH can have a significant effect on quality of life, 2 which often compels men to seek care; in 2000, the rate of BPH-related physician office visits was 14,473 visits per 100,000 adult men. 3 Effective medical and surgical therapies are available for BPH treatment. Medication (an alpha adrenergic antagonist, a 5-alpha reductase inhibitor, or both) is usually the initial treatment, whereas surgery (transurethral resection of the prostate (TURP), open simple prostatectomy, or one of the newer minimally invasive therapies) is generally reserved for cases of medication failures. National spending related to BPH in 2000 was estimated at $1.1 billion, exclusive of medication costs. 3 METHODSA total of 57 articles were considered in this review: one identified via a Web search, 24 through a literature search, and 31 through reference mining. One additional article was included after peer review. RESULTSOf the 19 potential quality indicators (QIs), 13 were judged valid using the expert panel process (see the QIs on pages S464-S487 of this supplement), and six were rejected. One QI was moved to Urinary Incontinence because of fit with QIs in that condition. The literature summaries that support each of the indicators judged to be valid in the expert panel process are described.Initial History and Physical Examination 1. IF a male vulnerable elder (VE) complains of new or worsening urinary frequency, urgency, UI, Ã nocturia, decreased force of stream, feeling of incomplete bladder emptying, or postvoid dribbling (LUTS), THEN a history should document medications associated with symptoms; neurological conditions that can affect the urological system; prior urological, neurosurgical, orthopedic, or general surgery procedures; whether symptoms are bothersome; and prior treatment; 2. IF a male VE complains of new LUTS, ÃÃ THEN a rectal examination (including prostate size, degree of tenderness, and nodularity) and abdominal examination should be performed; and 3. IF a male VE complains of new or worsening LUTS, THEN a urinalysis (microscopic examination or dipstick) should be performed, as well as a urine culture if...

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Section: Resultsmentioning

confidence: 99%

Quality Indicators for Benign Prostatic Hyperplasia in Vulnerable Elders

Saigal

2007

J American Geriatrics Society

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“…3 Dilation and DVIU have similar outcomes, whereas urethroplasty has the highest rate of success. 4,5,6,7 Steroid or mitomycin C (MMC) injection have been used as an adjuvant to endoscopic treatment, but results have been mixed. 8,9,10,11 The Optilume Drug Coated Balloon (DCB; Urotronic, Plymouth, MN) combines dilation with circumferential delivery of paclitaxel.…”

Section: Introductionmentioning

confidence: 99%

A drug-coated balloon treatment for urethral stricture disease: Interim results from the ROBUST I study

Virasoro¹,

DeLong²,

Mann

et al. 2020

CUAJ

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Introduction: We aimed to investigate the safety and preliminary efficacy of the OptilumeTM paclitaxel-coated balloon for the treatment of recurrent urethral stricture. Methods: Men with bulbar urethral strictures ≤2 cm with 1–4 prior endoscopic treatments were enrolled at four study sites after Ethics Committee approvals. All subjects were treated with mechanical balloon dilation or direct visualization internal urethrotomy prior to drug-coated balloon treatment. Patients were evaluated at 2–5 days, 14 days, three, six, and 12-months post-treatment. The primary safety endpoint was serious complications through 90 days post-procedure. The preliminary efficacy endpoint was anatomic success, defined as urethral lumen ≥14 Fr at 12 months. Results: A total of 53 subjects were enrolled and treated; 46 completed the 12-month followup. Forty-three percent of men had undergone >1 previous dilation; the mean for the overall study population was 1.7 prior dilations. There were no serious adverse events related to the treatment within 90 days. Anatomic success was achieved in 32/46 (70%; 95% confidence interval [CI] 54–82%) at 12 months. The 14 failures included seven cystoscopic recurrences, five retreatments, and two patients who exited the study early due to symptom recurrence. Conclusions: One-year data indicates the OptilumeTM paclitaxel-coated balloon is safe for the treatment of recurrent bulbar urethral strictures. Early efficacy results are encouraging and support further followup of these men through five years, as well as further investigation with a randomized trial.

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“…Today, however, urethral dilatation can be performed with a balloon, filiform, and selfcatheterization. Of these, balloon dilatation has been shown to be the safest technique (17,18).The reported success rates in the treatment of soft, primary strictures and strictures shorter than 1 cm vary between 50-70% (17). Moreover, the success rates in carefully selected patients treated with internal urethrotomy are similar.…”

Section: Introductionmentioning

confidence: 99%

Approaches in the treatment of urethral strictures

Demir¹,

Taken²

2019

Eastern J Med

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Urethral strictures are defined as the narrowing of the anterior urethral lumen or as corpus spongiosum fibrosis. Anterior urethral strictures can be divided as iatrogenic, inflammatory, idiopathic, and traumatic based on their etiology. Lower urinary tract septomas develop as a result of this disease. Many complications may occur in untreated patients.Cystoscopy, retrograde urethrography and ultrasonography can be used to diagnose the disease.Treatment methods are endoscopic and open surgery.Endoscopic treatment methods include dilatation, cold knife and laser internal uretrotomy. Recurrent bulbar urethral strictures; "End-to-end anastomosis urethroplasty" technique for short stenosis shorter than 2 cm. The technique of like ogmented anastomosis urethroplasty an with buccal graft is used for longer or complicated stenosis.

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Long-Term Results of Internal Urethrotomy

Abstract: Urethroplasty should be considered in patients at high risk for stricture recurrence and with more than 1 treatment failure after urethrotomy.

Cited by 29 publications

References 8 publications

Quality Indicators for Benign Prostatic Hyperplasia in Vulnerable Elders

Quality Indicators for Benign Prostatic Hyperplasia in Vulnerable Elders

A drug-coated balloon treatment for urethral stricture disease: Interim results from the ROBUST I study

Approaches in the treatment of urethral strictures

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