Management of urethral strictures

Waxman, Steve; Morey, Allen F.

doi:10.1016/s0140-6736(06)68592-9

Cited by 65 publications

(44 citation statements)

References 12 publications

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“…In addition, oedema following dilatation may reduce urine flow rates and the scarred urethra makes the task of subsequent reconstruction technically difficult. Although dilation and urethrotomy continue to be the most commonly used techniques, their failure rate is as high as 47.6% and many patients progress to surgical repair [1,2]. Traumatic 1 6 2 2 1 12 Infective 0 4 23 6 3 36 Inflammatory 0 1 3 1 2 7 Iatrogenic 1 7 21 10 5 44 Post-operative 8 0 2 1 0 11 Total 10 18 51 20 11 - Despite high recurrence rates, urethral dilation continues to enjoy popularity because surgeons lack enough experience to perform urethroplasty [11].…”

Section: Discussionmentioning

confidence: 99%

“…Due to paucity of studies that have looked at standardised outcome measures for evaluation of success of treatment [1], we evaluated outcome by assessing AUA score [8]. Briefly, the score consists of the following variables: incomplete emptying, frequency of micturition, intermittency, urgency, weak stream, straining and nocturia.…”

Section: Methodsmentioning

confidence: 99%

“…The sequelae of urethral strictures includes urinary tract infections, acute urinary retention, high-pressure voiding leading to secondary bladder thickening and irritability, bladder diverticula or perineal fistulas and abscess [1]. Blunt perineal trauma, urological instrumentation, chronic inflammatory disorders such as lichen sclerosus et atrophicus and sexually transmitted diseases are the most frequent causes of strictures; a large proportion are iatrogenic [1]. Treatment of urethral strictures can be challenging and frustrating both for the surgeon and the patient because interventions are associated with poor outcomes and high recurrence rates [2].…”

Section: Introductionmentioning

confidence: 99%

“…According to a narrative review, [3] most patients with urethral stricture are offered urethrotomy-a technique associated with high failure rates. Although open urethroplasty is the current gold standard against which the traditional treatments are compared, this technique needs skills, expertise and equipment, often not available in the resource limited settings [1,4,5].…”

Section: Introductionmentioning

confidence: 99%

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Outcome of Urethral Strictures Managed by General Surgeons in a Rural Setting of India

2011

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In resource limited settings victims of urethral strictures often seek healthcare,when the strictures are far advanced. For a surgeon, management is indeed a challenging task, given the severity and extent of disease, lack of expertise, enough skills and equipment in the healthcare facility. This study was conducted at a rural teaching hospital in central India. All patients were assessed for the extent and severity of strictures and to rule out other causes of lower urinary obstruction. Outcome of all patients was assessed with American Urological Association Urinary Symptom Score and Urinary Flow Rate (ml/sec) before procedure, post procedure and at 6-12 months. Between 2007 and 2009, 110 patients, between 18-75 years of age were enrolled in this study which showed that a third of patients treated with urethral dilatation and optical internal urethrotomy required another intervention. It is conclude that urethral dilatation and internal optical dilatation result in short term improvement in urine flow rates and symptoms. Urethroplasty, the current gold standard of therapy for urethral strictures, results in outcomes that are clinically meaningful and more cost effective for a patient. The Americal Urological Association (AUA) symptom score and Urinarry Flow Ratemay be used to objectively assess outcome following surgical management of urethral strictures.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcome of Urethral Strictures Managed by General Surgeons in a Rural Setting of India

2011

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“…Urethral stricture remains a common problem worldwide, affecting mainly the male urethra (1/10,000-1/1,000) [1]. Perineal trauma, long-term urethral catheterization, urological instrumentation, chronic inflammatory disorders such as lichen sclerosis et atrophicus, and sexually transmitted disease are typical causes of strictures: most cases, however, are idiopathic, probably arising as a result of remote unrecognized straddle injury during childhood [2].…”

Section: Introductionmentioning

confidence: 99%

Combined Dorsal Plus Ventral Double-Graft Urethroplasty in Anterior Urethral Reconstruction

Jiang

Zhu²,

Jiang³

et al. 2014

Indian J Surg

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This study aims to investigate the effect of combined dorsal plus ventral double-graft urethroplasty in anterior urethral reconstruction. Patients who underwent graft urethroplasty for anterior urethral strictures at West China Hospital from 2005 to 2010 were followed up with clinical evaluation. According to the site of graft fixed, patients were divided into single-onlay group (dorsal or ventral) and doubleonlay group (dorsal plus ventral). Success rate and complications were compared between the two groups and were analyzed using t test and chi-square. A total of 77 patients completed the follow-up, 51 in single-onlay group and 26 in double group. There was no statistical difference in terms of age, length, site, stricture reason, and the type of graft used between the two groups. The mean follow-up time was 15.6 months (range from 4 to 33 months) in double group and 39.5 months (range from 15 to 59 months) in single group. The total success rate was 72.5 % in single-onlay group and 88.5 % in doubleonlay group; no statistical difference existed (p >0.05). Subgroup analysis shows the success rate was higher for double-onlay urethroplasty for the stricture of penoscrotal junction (88.9 vs 60.9 %, p<0.05). The main postoperative complications including infection and urethrocutaneous fistula were not significant between the two groups (p> 0.05). Combined dorsal plus ventral double-graft urethroplasty showed a high success and low complication rate for anterior urethral strictures, especially for the penoscrotal junction.

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