Urethral Stricture Following Cardiovascular Surgery: Role of Urethral Ischemia

Elhilali, Mostafa; Hassouna, Magdy; Abdel-Hakim, Amr M.; Teijeira, J

doi:10.1016/s0022-5347(17)45608-4

Cited by 31 publications

(9 citation statements)

References 6 publications

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“…9,10 However, these strictures usually affected the anterior urethra, and none solely involved the fossa navicularis. Abdel-Hakim 11 and Elhilali 12 found some evidence for urethral ischemia in stricture cases utilizing strain gauge plethysmography to determine penile-brachial indexes. In addition, Nacey 13 demonstrated a significantly increased incidence of urethral strictures following catheterization with silastic catheters compared with silicone catheters in a controlled randomized prospective study of patients undergoing elective cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

812: Fossa Navicularis Strictures in Robotic Radical Prostatectomy Due to 22F Catheters

Yee¹,

Gelman²,

Skarecky³

et al. 2007

Journal of Urology

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Background and Objectives:Fossa navicularis strictures following radical prostatectomy are reported infrequently. We recently experienced a series of fossa strictures following robot-assisted laparoscopic radical prostatectomy. Fossa strictures are usually procedure-induced, arising from urethral trauma or infection; catheter size has not been reported as a factor. We describe herein our experience to determine and prevent fossa navicularis stricture development.Methods:From June 2002 until February 2005, 248 patients underwent robot-assisted laparoscopic prostatectomy with the da Vinci surgical system at our institution. Fossa strictures were diagnosed based on acute onset of obstructive voiding symptoms, IPSS and flow pattern changes, and bougie calibration. During our series, we switched from an 18F to a 22F catheter to avoid inadvertent stapling of the urethra when dividing the dorsal venous complex. All patients had an 18F catheter placed after the anastomosis for 1 week. Parameters were evaluated using Fisher's exact test and the Student t test for means.Results:The 18F catheter group (n=117) developed 1 fossa stricture, whereas the 22F catheter group (n=131) developed 9 fossa strictures (P=0.02). The fossa stricture rate in the 18F group was 0.9% versus 6.9% in the 22F group. The 2 groups had no differences in age, body mass index, cardiovascular disease, International Prostate Symptom Score, urinary bother score, SHIM score, preoperative PSA, operative time, estimated blood loss, cautery use, prostate size, or catheterization time.Conclusions:Using a larger urethral catheter size during intraoperative dissection appears to increase the risk 8-fold for fossa stricture as compared with the 18F catheter. The pneumoperitoneum and prolonged extreme Trendelenberg position could potentially contribute to local urethral ischemia.

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Section: Discussionmentioning

confidence: 99%

812: Fossa Navicularis Strictures in Robotic Radical Prostatectomy Due to 22F Catheters

Yee¹,

Gelman²,

Skarecky³

et al. 2007

Journal of Urology

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“…The pathogenesis of iatrogenic US is not fully clarified [8,13,19,23,25,30,31,32]. The pathogenesis of iatrogenic US is not fully clarified [8,13,19,23,25,30,31,32].…”

Section: Discussionmentioning

confidence: 99%

The effect of the somatostatin analogue lanreotide on the prevention of urethral strictures in a rabbit model

et al. 2003

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We evaluated the effect of the somatostatin analogue lanreotide on the development of surgically induced experimental strictures in the anterior urethra of the male rabbit. A total of 74 male rabbits were randomly allocated into four groups. Lanreotide was administered to the rabbits in groups 2 and 4 from day 0 to 14. To create a stricture, a resection was made in the urethra of the rabbits in groups 3 and 4 on day 2. On day 30, all rabbits were examined with urethrography, impedance planimetry and either histology or for collagen content. Urethrography and impedance planimetry demonstrated a urethral stricture in all operated animals. No difference was found between the two stricture groups, regardless of lanreotide administration, with respect to luminal cross-sectional area (CSA), circumferential tension-strain relation, histology or collagen content. The CSA of the urethra of the normal controls treated with lanreotide was smaller than the CSA of the normal controls not treated with lanreotide, however, no difference was found in histology or collagen content. Lanreotide had no measurable effect on the development of a surgically induced stricture in the male rabbit anterior urethra, however, lanreotide seems to exert an inhibitory effect on the normal growth of the urethra.

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“…It is caused by microvessel disease and an elevated calcium/phosphate product [ 1]. CABG has been implicated in urethral stricture disease secondary to the combination of hypoperfusion‐induced ischaemia and Foley catheter drainage [ 2], but never to frank necrosis. Coumarin therapy has a well known association with dermal necrosis and eight cases of penile necrosis have been reported in the English literature [ 3, 4].…”

Section: Commentmentioning

confidence: 99%