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Tyraskis A, El-Sayed J, Tiusaba L, Jacobs SE, Russell TL, Feng C, Teeple E, Ho CP, Pohl HG, Badillo AT, Levitt MA, Varda BK. Posterior Sagittal Approach Provides Optimal Exposure for Urethral Reconstruction in Children With a History of Anorectal Malformations. Urology 2024; 183:192-198. [PMID: 37805049 DOI: 10.1016/j.urology.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/27/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To present a unique series of children with previously repaired anorectal malformations (ARM) with subsequent urethral pathology repaired via a posterior sagittal exposure and highlight the associated technical advantages. METHODS Using a retrospective review of all procedures performed in our pediatric colorectal and pelvic reconstruction program from January 2020 through December 2022, we compiled a case series of patients with a history of ARM and prior posterior sagittal anorectoplasty (PSARP) who had urethral pathology and concurrent indication for redo-PSARP. Clinical features, operative details, and postoperative outcomes were collected. RESULTS Six male patients presented at a median age of 4.3 years, all born with an ARM of recto-urinary fistula type, of which 3 were recto-prostatic, 1 recto-bladder-neck, and 2 unknown type. In addition to redo-PSARP, 2 underwent remnant of the original fistula excision and 4 had urethral stricture repair. One required post-operative Heineke-Mikulicz anoplasty. Patients underwent cystoscopy 4-6 weeks post-reconstruction, and none showed urethral stricture requiring treatment. Post-procedurally, 5 patients were able to void urethrally and 1 required additional bladder augmentation/Mitrofanoff. CONCLUSION Redo-PSARP completely mobilizes the rectum, thereby providing excellent exposure to the posterior urethra for repair. This approach also allows the option of a rectal flap for augmented urethroplasty as well as harvest of an ischiorectal fat pad for interposition.
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Affiliation(s)
- Athanasios Tyraskis
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington DC
| | - Jana El-Sayed
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington DC
| | - Laura Tiusaba
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington DC
| | - Shimon E Jacobs
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington DC
| | - Teresa L Russell
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington DC
| | - Christina Feng
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington DC
| | - Erin Teeple
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington DC
| | - Christina P Ho
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington DC
| | - Hans G Pohl
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington DC
| | - Andrea T Badillo
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington DC
| | - Marc A Levitt
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington DC
| | - Briony K Varda
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington DC.
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Khalid A, Nasiru M, Abdulwahab-Ahmed A, Muhammad AS, Agwu NP, Lukong CS. Phallic rubber band application to prevent enuresis unusual cause of urethral stricture in a child: A case report. World J Clin Urol 2023; 12:10-16. [DOI: 10.5410/wjcu.v12.i2.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/21/2023] [Accepted: 07/07/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Urethral stricture is the abnormal narrowing of the urethra due to spongiofibrosis. The established aetiological factors for urethral stricture abound in our environment. However, the application of a penile rubber band to prevent enuresis thereby causing this pathology is not a familiar occurrence. Patients with enuresis can suffer psycho-social challenges and trauma, especially for a child due to peer stigmatization. This has a great impact on the child's psyche and may affect even his performance at school. The aim of this paper is to highlight the psychosocial impact and management challenges of a child with enuresis (nocturnal urinary incontinence).
CASE SUMMARY This is the case of a 10-year-old boy who presented with a history of nocturnal urinary incontinence since birth and lower urinary tract symptoms (LUTS) for 3 years culminating in chronic urinary retention. He maintained a normal urge to micturate and continent of urine during the daytime before the onset of LUTS. He had an antecedent longstanding history of tying a rubber band to the penile shaft mostly before going to the bed at night to prevent enuresis due to his peer stigmatization. He was acutely ill-looking, with distended suprapubic region. The phallus and scrotum were enlarged and oedematous with a circumferential proximal penile shaft scar and ventral penile shaft urethrocutaneous fistula. He was diagnosed to have complete short segment bulbopenile stricture and right ectopic ureter. He subsequent had augmented anastomotic urethroplasty and bilateral non-refluxing ureteroneocystostomy at different sitting.
CONCLUSION The adherence to surgical principles of urethral stricture and enuresis management where surgically correctable in a child is associated with the resolution of enuresis and social reintegration.
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Affiliation(s)
- Abdullahi Khalid
- Department of Surgery, Tetfund Centre of Excellence in Urology and Nephrology, Institute of Urology and Nephrology, Usmanu Danfodiyo University and Teaching Hospital, Sokoto 840000, Nigeria
| | - Musa Nasiru
- Department of Surgery, Paediatric Surgery Unit, Usmanu Danfodiyo University and Teaching Hospital, Sokoto 840000, Nigeria
| | - Abdullahi Abdulwahab-Ahmed
- Department of Surgery, Tetfund Centre of Excellence in Urology and Nephrology, Institute of Urology and Nephrology, Usmanu Danfodiyo University and Teaching Hospital, Sokoto 840000, Nigeria
| | - Abubakar Sadiq Muhammad
- Department of Surgery, Tetfund Centre of Excellence in Urology and Nephrology, Institute of Urology and Nephrology, Usmanu Danfodiyo University and Teaching Hospital, Sokoto 840000, Nigeria
| | - Ngwobia Peter Agwu
- Department of Surgery, Tetfund Centre of Excellence in Urology and Nephrology, Institute of Urology and Nephrology, Usmanu Danfodiyo University and Teaching Hospital, Sokoto 840000, Nigeria
| | - Christopher Suiye Lukong
- Department of Surgery, Paediatric Surgery Unit, Usmanu Danfodiyo University and Teaching Hospital, Sokoto 840000, Nigeria
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Cheng X, Ding M, Peng M, Zhou L, Li Y, Peng S, Cheng S, Wang Y. The Changing Trend in Clinical Characteristics and Outcomes of Male Patients With Urethral Stricture Over the Past 10 Years in China. Front Public Health 2022; 9:794451. [PMID: 35004597 PMCID: PMC8739884 DOI: 10.3389/fpubh.2021.794451] [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: 10/13/2021] [Accepted: 11/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Male urethral stricture is a disease with a high incidence rate. With social-economic development in the developing countries, the trend of etiology and treatment of male urethral stricture changed was speculated. Methods: The clinical data of the male patients with urethral stricture from 2000 to 2019 were analyzed. The subjects were divided into Group A (2000–2009) and Group B (2010–2019) according to treatment time. The pooled analysis of the data extracted from pieces of literature was also performed. Results: About 540 patients were included in the present study, including 235 patients in Group A and 305 patients in Group B. In recent 10 years, trauma has still been the main cause of urethral stricture. Iatrogenic injury, especially transurethral operation, increases significantly, while male urethral stricture secondary to radiotherapy and infection decrease. Urethroplasty increases and the reoperation rate decreases in treating simple urethral stricture, and flap urethroplasty also increases in treating complex urethral stricture. The results of a pooled analysis of data from 11 centers in Mainland China are partially consistent with it. Complications, such as urethral fistula, false canal, ejaculation disorder, and penile curvature, decrease significantly. Conclusions: The main causes of urethral stricture in the recent 10 years are still trauma and iatrogenic injuries, and the etiology of urethral stricture is related to socioeconomic development. With the increase of intracavitary minimally invasive treatment and flap urethroplasty, the curative effect is increasing, while iatrogenic urethral stricture cannot be ignored.
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Affiliation(s)
- Xu Cheng
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Mao Ding
- Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Mou Peng
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lizhi Zhou
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yijian Li
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuang Peng
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shunhua Cheng
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yinhuai Wang
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
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Hou C, Gu Y, Yuan W, Wang Z, Lin J, Fu Q, Song L. Diagnosis and treatment of anterior urethral strictures in China: an internet-based survey. BMC Urol 2021; 21:185. [PMID: 34972508 PMCID: PMC8720216 DOI: 10.1186/s12894-021-00950-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the current diagnostic and therapeutic approaches to anterior urethral strictures of Chinese urologists and to compare with developed countries and the American Urologic Association guidelines. METHODS Anonymous questionnaires were distributed to members of Official Wechat Account of urology from March 19, 2020 to April 10, 2020. Descriptive and multiple correspondence analysis were used to analyze the data. RESULTS A total of 1276 online questionnaires were received. The response rate was 21.7% (1276/5878). The most common diagnostic methods for anterior urethral stricture were urethrography (90.7%) and urethrocystoscopy (85.4%), while urethral dilation (92.3%) and internal urethrotomy (60.1%) were the main therapeutic procedures. End-to-end urethroplasty (45.2%) was the most common open surgery, followed by skin flap urethroplasty (14.9%) and free graft urethroplasty (12.4%). 76.2% of urologists used urethroplasty only after the failure of minimally invasive surgery (reconstructive ladder treatment strategy). Furthermore, middle-aged or elderly urologists who had attended trainings, had senior practice roles, and who utilized a reconstructive ladder treatment approach were most likely to perform urethroplasties. CONCLUSIONS Anterior urethral stricture treatment in China is still dominated by minimally invasive surgery, with most urologists using the reconstructive ladder treatment strategy. In general, the overall diagnostic and therapeutic strategies were similar between China and developed countries, with some deviations from the American Urologic Association guidelines.
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Affiliation(s)
- Changhao Hou
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.,Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China
| | - Yubo Gu
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.,Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China
| | - Wei Yuan
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.,Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China
| | - Zeyu Wang
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.,Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China
| | - Jiahao Lin
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.,Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China
| | - Qiang Fu
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China. .,Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China.
| | - Lujie Song
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China. .,Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China.
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Patil N, Javali T. Paediatric Buccal Mucosal Graft Urethroplasty for Non-Hypospadias Urethral Strictures: A Single Centre Experience with Long Term Outcomes. Urology 2021; 158:174-179. [PMID: 34274391 DOI: 10.1016/j.urology.2021.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/26/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To review our experience in the management of paediatric urethral strictures with buccal mucosal graft urethroplasty and its long term outcomes. METHODS This was a retrospective analysis of a prospectively maintained data base between 2009-2019. Circumcised children with long segment urethral strictures (> 1.5 cm) were included. They were characterized as either peno-bulbar (PBS) or isolated bulbar strictures (IBS) based on a standardized protocol. All children underwent single stage dorsal onlay buccal mucosal graft urethroplasty by either the Kulkarni technique (PBS group) or the Barbagli technique (IBS group). All children were followed up at 3 months, then annually thereafter with flow rates at each visit. Success was defined as a flow rate > 10ml/sec with a bell-shaped curve and absence of need for any secondary procedures. RESULTS 28 children underwent buccal mucosal graft uretheroplasty.16 children were diagnosed with PBS & 12 children with IBS. The median age was 7.5 years (2-17 years) in PBS and 5.5 years (3-10 years) in IBS. Iatrogenic injury was the commonest aetiology ie 71 % (20/28). Mean length of stricture was 4 cm (3-5.5 cm) in PBS and 2.5 cm (2-3.5 cm) in IBS. Median follow up was 96 months (24-120 months) in PBS and 90 months (36-120 months) in IBS. The success rate was 87.5% (14/16) in PBS and 83.3% (10/12) in IBS. CONCLUSION Single stage dorsal on lay buccal mucosal graft urethroplasty, ie Kulkarni and Barbagli techniques are safe and feasible in children with long segment urethral strictures with good long-term outcomes.
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Affiliation(s)
- Neehar Patil
- Department of Paediatric Surgery and Urology, Ramaiah Medical College and Hospital, Bangalore, India.
| | - Tarun Javali
- Department of Urology, Ramaiah Medical College and Hospital, Bangalore, India.
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