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Bugeja S, Payne SR, Eardley I, Mundy AR. The standard for the management of male urethral strictures in the UK: a consensus document. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820933504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: The aim of this study was to establish an evidence-based best clinical practice consensus for the management of urethral stricture disease in the UK. Methods: A systematic review of optimal management of urethral stricture generated a base document which was endorsed by the British Association of Urological Surgeons (BAUS) section of Andrology and Genito-Urinary Reconstructive Surgeons (AGUS). A two-round electronic mail modified Delphi survey of 43 consultant reconstructive urologists, members of the British Association of Genito-Urinary Reconstructive Surgeons (BAGURS), was then performed. The panel’s views about the base document was sought in seven domains: definition, diagnosis, investigation, conservative, endoscopic and reconstructive treatments, and follow up. Responses were collated and used to modify the base to achieve a consensus statement. Results: In round one of the Delphi process four panel members commented on the base document and seven in round two. Consensus was thereby reached on 38 statements regarding definition (one), diagnosis (three), investigation (two), conservative/endoscopic (five) and reconstructive (24) treatments and follow up (three) for the management of urethral stricture disease. Conclusion: This consensus statement will help standardise care, provide guidance on the management of urethral stricture disease, and assist in clinical decision-making for healthcare professionals of all grades.
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Affiliation(s)
- Simon Bugeja
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Anthony R. Mundy
- University College London Hospitals NHS Foundation Trust, London, UK
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Chung JH, Kim KS, Choi JD, Kim TH, Lee KS, Oh CY, Noh JH, Kim JS, Kim WT, Lee SH, Kim JH, Kim TN, Huh W, Lee SW. Effects of poloxamer-based thermo-sensitive sol-gel agent on urethral stricture after transurethral resection of the prostate for benign prostatic hyperplasia: a multicentre, single-blinded, randomised controlled trial. BJU Int 2019; 125:160-167. [PMID: 31444917 DOI: 10.1111/bju.14902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of poloxamer-based thermo-sensitive sol-gel instillation, after transurethral resection of the prostate (TURP), for preventing urethral stricture. PATIENTS AND METHODS In all, 198 patients underwent TURP for benign prostatic hyperplasia. Recruited patients were randomly divided into two groups: groups A and B. Patients in Group A (100 patients, experimental group) received poloxamer-based thermo-sensitive sol-gel instillation and patients in the Group B (98 patients, control group) received lubricant instillation after TURP. Each patient was evaluated at 4 (V1), 12 (V2), and 24 weeks (V3) after TURP. The effectiveness of poloxamer-based thermo-sensitive sol-gel instillation was evaluated based on the International Prostate Symptom Score (IPSS), IPSS-Quality of Life (QoL), Overactive bladder questionnaire (OAB-q), maximum urinary flow rate (Qmax ), post-void residual urine volume (PVR), and cystoscopy. RESULTS Amongst the initial 198 participants, 80 patients in Group A and 83 in Group B completed the study. There were no significant differences in IPSS-QoL and OAB-q between the groups. However, Qmax was significantly different between groups A and B, at a mean (SD) of 18.92 (9.98) vs 15.58 (9.24) mL/s (P = 0.028) at 24 weeks after TURP. On cystoscopic examination, urethral stricture after TURP was found in two of the 80 patients in Group A and 10 of 83 in Group B (P = 0.023). CONCLUSIONS Poloxamer-based thermo-sensitive sol-gel instillation after TURP lowered the incidence of urethral stricture.
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Affiliation(s)
- Jae Hoon Chung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyu Shik Kim
- Department of Urology, Hanyang University College of Medicine, Seoul, South Korea
| | - Jae Duck Choi
- Department of Urology, Eulji Medical Center, Eulji University School of Medicine, Seoul, South Korea
| | - Tae Hyo Kim
- Departments of Urology, College of Medicine, Dong-A University College of Medicine, Busan, South Korea
| | - Ki Soo Lee
- Departments of Urology, College of Medicine, Dong-A University College of Medicine, Busan, South Korea
| | - Cheol Young Oh
- Department of Urology, Hallym University College of Medicine, Seoul, South Korea
| | - Joon Hwa Noh
- Department of Urology, Kwangju Christian Hospital, Gwangju, South Korea
| | - Jun Seok Kim
- Department of Urology, Kwangju Christian Hospital, Gwangju, South Korea
| | - Won Tae Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Seung Hwan Lee
- Department of Urology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Tae Nam Kim
- Department of Urology, Pusan National University Hospital, Busan, South Korea
| | - Wan Huh
- Daewoong Pharmaceutical Co. Ltd, Seoul, South Korea
| | - Seung Wook Lee
- Department of Urology, Hanyang University College of Medicine, Seoul, South Korea
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Park JK, Kim JY, You JH, Choi BR, Kam SC, Kim MK, Jeong YB, Shin YS. Effect of preoperative urethral dilatation on preventing urethral stricture after holmium laser enucleation of the prostate: A randomized controlled study. Can Urol Assoc J 2019; 13:E357-E360. [PMID: 30817290 DOI: 10.5489/cuaj.5781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to evaluate the effect of preoperative urethral dilatation during holmium laser enucleation of the prostate (HoLEP) on the prevention of urethral stricture. METHODS A total of 72 patients without urethral stricture underwent HoLEP for benign prostatic hyperplasia (BPH). Recruited patients were randomly divided into two groups (groups A and B). Patients in group A (36 patients, experimental group) received preoperative urethral dilatation and patients in group B (36 patients, control group) did not. Each patient was evaluated at four weeks, 12 weeks, and 24 weeks after surgery. The effectiveness of preoperative urethral dilatation was evaluated based on the International Prostate Symptom Score (IPSS), peak urine flow rate (Qmax), voided volume, and post-void residual (PVR) volume. To diagnose urethral stricture, Qmax <10 mL/s, as assessed using uroflowmetry and findings of visualization through retrograde urethrography and urethroscopy, were used. RESULTS Among 72 initial participants, 33 patients in group A and 31 patients in group B completed the experiment. Preoperative characteristics were well-balanced between groups. At each postoperative visit, there was no significant difference in voiding symptoms between groups. Two patients (6.06%) in group A and five patients (15.15%) in group B showed a Qmax <10 mL/s on uroflowmetry (p=0.013). On urethroscopy, no patient in group A (0%) and two patients in group B (6.45%) (p=0.021) showed urethral stricture after HoLEP. CONCLUSIONS Preoperative urethral dilatation during HoLEP decreased the incidence of urethral stricture. This procedure could be useful to reduce the risk of urethral stricture after transurethral prostate surgery. One limitation of the current study is the single-centre design. Also, we sought to determine the efficacy of preoperative urethral dilatation for the prevention of urethral stricture after transurethral prostate surgery within a short time period, which could be another limitation of the study. Despite these limitations, to the best of our knowledge, the present study is the first reported prospective, randomized trial analyzing the safety and efficacy of preoperative urethral dilatation for the prevention of urethral stricture after transurethral prostate surgery.
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Affiliation(s)
- Jong Kwan Park
- Department of Urology, Chonbuk National University Medical School, and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Ji Yong Kim
- Department of Urology, Chonbuk National University Medical School, and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jae Hyung You
- Department of Urology, Chonbuk National University Medical School, and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Bo Ram Choi
- Department of Urology, Chonbuk National University Medical School, and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Sung Chul Kam
- Department of Urology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Myung Ki Kim
- Department of Urology, Chonbuk National University Medical School, and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Young Beom Jeong
- Department of Urology, Chonbuk National University Medical School, and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Yu Seob Shin
- Department of Urology, Chonbuk National University Medical School, and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Republic of Korea
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Yürük E, Yentur S, Çakır ÖO, Ertaş K, Şerefoğlu EC, Semerciöz A. Catheter dwell time and diameter affect the recurrence rates after internal urethrotomy. Turk J Urol 2016; 42:184-9. [PMID: 27635294 DOI: 10.5152/tud.2016.90490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Cold-knife direct vision internal urethrotomy (DVIU) is frequently used as the first-line treatment for urethral stricture disease. Although the steps of the procedure are defined in detail, the duration of catheterization and the diameter of the catheter to be used after the operation are not clearly defined. The aim of this study is to evaluate the effects of catheter dwell time and diameter on recurrence rates of urethral stricture disease after DVIU. MATERIAL AND METHODS Data of 193 consecutive treatment naïve bulbar urethral stricture patients who underwent DVIU between January 2009 and June 2013 were retrospectively analyzed. Patient demographics and stricture characteristics were noted. Catheter dwell times were grouped as <5 and ≥5 days. The diameters of catheters used were 16, 18 and 22 Fr. The association between recurrence rates, catheter dwell times, and diameter were evaluated with Tukey's test and Pearson's correlation test, respectively. RESULTS Overall 193 patients with a mean age of 64.51±12.99 (range: 17 to 85) years were enrolled in the study. Urethral stricture disease recurred in 45 (23.31%) patients within the first year after DVIU. Mean duration of catheterization was 7.47±4.03 and 4.79±1.94 days in patients with and without recurrences, respectively (p=0.0001). Catheter dwell times for ≥5 days were also associated with increased recurrence (p=0.0001). Of the patients with recurrent strictures, 16, 18 and 22Fr catheters were placed in 22.22%, 20% and 57.78% of the patients, respectively. Increased catheter diameter was also associated with higher recurrence rates (p=0.004). CONCLUSION Shortening the postoperative duration of catheterization and decreasing the catheter size may result in improved recurrence rates after DVIU. Further prospective randomized trials are necessary to confirm these findings.
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Affiliation(s)
- Emrah Yürük
- Clinic of Urology, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Serhat Yentur
- Clinic of Urology, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Ömer Onur Çakır
- Clinic of Urology, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Kasım Ertaş
- Clinic of Urology, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Ege Can Şerefoğlu
- Clinic of Urology, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Atilla Semerciöz
- Clinic of Urology, Bağcılar Training and Research Hospital, İstanbul, Turkey
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Tian Y, Wazir R, Yue X, Wang KJ, Li H. Prevention of stricture recurrence following urethral endoscopic management: what do we have? J Endourol 2014; 28:502-8. [PMID: 24341856 DOI: 10.1089/end.2013.0538] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Strictures of the urethra are the most common cause of obstructed micturition in younger men and there is frequent recurrence after initial treatment. This review was performed to determine the best strategy for stricture recurrence prevention following urethral endoscopic management. METHODS We reviewed the published literature in PubMed, the Cochrane Library, and Google Scholar focusing on this intractable problem regardless of language restrictions. Outcomes of interest included the study methods and the applied strategy's efficacy. The level of evidence and grade of recommendations of included studies were appraised with an Oxford Centre for Evidence-Based Medicine Scale. RESULTS Currently, numerous techniques, including catheterization, repeated dilation, brachytherapy, and intraurethral use of various antifibrosis agents, have been employed to oppose the process of wound contraction or regulate the extracellular matrix. But unfortunately, none of these techniques or agents have demonstrated efficacy with enough evidence. CONCLUSIONS Although lots of strategies are available, still, we do not have a suitable, single optimum solution for all the conditions. The clinical decision of stricture-recurrence-prevention techniques should be carefully tailored to every individual patient. As the studies are not sufficient, more efforts are warranted to address this interesting but challenging issue.
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Affiliation(s)
- Ye Tian
- Department of Urology, West China Hospital, Sichuan University , Chengdu, P.R. China
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Abstract
Male urethral stricture disease is prevalent and has a substantial impact on quality of life and health-care costs. Management of urethral strictures is complex and depends on the characteristics of the stricture. Data show that there is no difference between urethral dilation and internal urethrotomy in terms of long-term outcomes; success rates range widely from 8-80%, with long-term success rates of 20-30%. For both of these procedures, the risk of recurrence is greater for men with longer strictures, penile urethral strictures, multiple strictures, presence of infection, or history of prior procedures. Analysis has shown that repeated use of urethrotomy is not clinically effective or cost-effective in these patients. Long-term success rates are higher for surgical reconstruction with urethroplasty, with most studies showing success rates of 85-90%. Many techniques have been utilized for urethroplasty, depending on the location, length, and character of the stricture. Successful management of urethral strictures requires detailed knowledge of anatomy, pathophysiology, proper patient selection, and reconstructive techniques.
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Affiliation(s)
- Lindsay A Hampson
- Department of Urology, University of California, 400 Parnassus Avenue, Suite A-610, Box 0738, San Francisco, CA 94143-0738, USA
| | - Jack W McAninch
- Department of Urology, University of California, 400 Parnassus Avenue, Suite A-610, Box 0738, San Francisco, CA 94143-0738, USA
| | - Benjamin N Breyer
- Department of Urology, University of California, 400 Parnassus Avenue, Suite A-610, Box 0738, San Francisco, CA 94143-0738, USA
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Chung JH, Kang DH, Moon HS, Jeong TY, Ha US, Han JH, Yu JH, Park J, Cho JM, Yoo TK, Kim TH, Lee SW. Effects of hyaluronic acid and carboxymethylcellulose on urethral stricture after transurethral resections of the prostate for benign prostatic hyperplasia: a multicenter, single blinded, randomized controlled study. J Endourol 2013; 27:463-9. [PMID: 23368701 DOI: 10.1089/end.2012.0377] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate the effect of hyaluronic acid (HA) and carboxymethylcellulose (CMC) instillation after transurethral resection of the prostate (TURP) on preventing urethral stricture. PATIENTS AND METHODS A total of 180 patients underwent TURP for benign prostatic hyperplasia. Recruited patients were randomly divided into two groups: Groups A and B. Patients in group A (90 patients, experimental group) received HA/CMC instillation, and patients in the group B (90 patients, control group) received lubricant instillation after TURP. Each patient was evaluated at 4 weeks (V1), 12 weeks (V2), and 24 weeks (V3) after the surgery. The effectiveness of HA/CMC instillation was evaluated based on the International Prostate Symptom Score/Quality of Life, peak urine flow rate, voided volume, and postvoid residual volume. The visual analogue scale (VAS) pain score and degree of satisfaction were also determined for each participant. RESULTS Among 180 initial participants, 80 patients in group A and 81 patients in group B had completed the experiment. VAS pain scores were 0.75±0.75 and 1.75±1.37 (P<0.001), and degrees of satisfaction were 0.63±0.66 and 0.91±0.51 in group A and group B at 1 month after surgery (P=0.002). By retrograde urethrography, urethral stricture after TURP was seen in 1 of 80 subjects in group A and 7 of 81 subjects in group B. CONCLUSIONS HA/CMC instillation after TURP decreased the incidence of urethral stricture. In addition, HA/CMC was effective at reducing pain during the early postoperative period, with no adverse effects.
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Affiliation(s)
- Jae Hoon Chung
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
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Beckley I, Garthwaite M. Post-operative care following primary optical urethrotomy: towards an evidence based approach. JOURNAL OF CLINICAL UROLOGY 2012. [DOI: 10.1016/j.bjmsu.2012.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction: Optical urethrotomy (OU) is the commonest procedure performed for primary bulbar urethral strictures. Recurrence rates of up to 50% are reported, but data is lacking on the influence of post-operative management regimes on patient’s outcomes. The aim of this study was to quantify the variation in treatment approaches within a region and determine from the literature what constitutes best practice. Methods: A survey regarding post-operative management following OU was sent to urologists in the Yorkshire Deanery. The questions related to post-operative catheter usage, intermittent self dilatation (ISD) regimes and follow-up investigations. A literature review regarding these aspects of post-operative care was subsequently performed. Results: Questionnaires were sent to 70 urologists, of which 42 urologists replied. All respondents insert a urethral catheter following OU. Two thirds of respondents advise patients to perform ISD but one third of those advise continuing for only 6 months. Uroflowmetry and post micturition residual estimation are the mainstay of follow up investigations. Conclusions: The practice in our region largely reflects the best available evidence. The literature suggests that catheter size/material has no effect on outcome. Catheter duration should be for less than 3 days due to increased risk of recurrence. ISD should be performed for at least one year as this is associated with significantly lower recurrence rates than 6 months treatment. Urethrography is more accurate than uroflowmetery for follow up but results must be correlated with patient symptoms.
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Affiliation(s)
- Ian Beckley
- Department of Urology, Castle Hill Hospital, Cottingham, Yorkshire, UK
| | - Mary Garthwaite
- Department of Urology, Castle Hill Hospital, Cottingham, Yorkshire, UK
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Abstract
What's known on the subject? and What does the study add? Urethral strictures are common and increasingly common in an ageing population. The treatment is controversial and particularly the relative roles of urethrotomy or urethral dilatation on the one hand and urethroplasty on the other. This review aims to provide a comprehensive overview of the subject including less commonly discussed issues such as the history and pathology of stricture disease. We would hope that a comprehensive overview of the subject will give a sharper perspective to aid the investigation and management of patients with urethral strictures.
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Park HJ, Kang JY, Yoo TK. Transurethral Prostatectomy Using a 22F Continuous Running Irrigation System Resectoscope. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.2.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hyun Jung Park
- Department of Urology, EulJi University School of Medicine, Eulji Medical Center, Seoul, Korea
| | - Jeong Yoon Kang
- Department of Urology, EulJi University School of Medicine, Eulji Medical Center, Seoul, Korea
| | - Tag Keun Yoo
- Department of Urology, EulJi University School of Medicine, Eulji Medical Center, Seoul, Korea
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Kural AR, Coskuner ER, Cevik I. Holmium laser ablation of recurrent strictures of urethra and bladder neck: preliminary results. J Endourol 2000; 14:301-4. [PMID: 10795623 DOI: 10.1089/end.2000.14.301] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The management of patients with recurrent urethral strictures represents a challenge for the practicing urologist. PATIENTS AND METHODS We used holmium:yttrium-aluminum-garnet (Ho:YAG) laser in the management of recurrent urethral strictures in 13 patients. The energy level was set at 1.0 at a frequency of 10 pulses/sec. No treatment complications were observed. The mean preoperative maximum flow rate by uroflowmetric analysis was 3.8 mL/sec. RESULTS Nine patients (69%) continue to do well with no symptoms at a median follow-up of 27 months with a mean maximum flow rate of 19 mL/sec. Of the four patients in whom treatment failed, three were retreated with the Ho:YAG laser. One of them was managed by insertion of a permanent urethral stent, another continues to do well without any further treatment, and the other is managed with dilation by self-catheterization. One of the four failures underwent open reconstructive urethroplasty after recurrence following his first treatment with the Ho:YAG laser. CONCLUSION Our preliminary results suggest that Ho:YAG laser ablation of urethral strictures is safe and might be a reasonable alternative endoscopic treatment for recurrent urethral strictures.
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Affiliation(s)
- A R Kural
- Department of Urology, International Hospital, Istanbul, Turkey.
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13
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Steenkamp J, Heyns C, de Kock M. Internal Urethrotomy Versus Dilation as Treatment for Male Urethral Strictures: A Prospective, Randomized Comparison. J Urol 1997. [DOI: 10.1016/s0022-5347(01)65296-0] [Citation(s) in RCA: 194] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J.W. Steenkamp
- Department of Urology, Faculty of Medicine, University of Stellenbosch and Tygerberg Hospital, Tygerberg, South Africa
| | - C.F. Heyns
- Department of Urology, Faculty of Medicine, University of Stellenbosch and Tygerberg Hospital, Tygerberg, South Africa
| | - M.L.S. de Kock
- Department of Urology, Faculty of Medicine, University of Stellenbosch and Tygerberg Hospital, Tygerberg, South Africa
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16
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Prajsner A, Szkodny A, Salamon M, Bar K. Long-term results of treatment of male urethral strictures using direct vision internal urethrotomy. Int Urol Nephrol 1992; 24:171-6. [PMID: 1624261 DOI: 10.1007/bf02549646] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study presents long-term results of treatment of urethral strictures in 178 men who underwent direct vision cold urethrotomy between January 1, 1979 and December 31, 1984. Satisfactory urodynamic results were achieved in 69.7% of cases.
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Greenland JE, Lynch TH, Wallace DM. Optical urethrotomy under local urethral anaesthesia. BRITISH JOURNAL OF UROLOGY 1991; 67:385-8. [PMID: 2032078 DOI: 10.1111/j.1464-410x.1991.tb15167.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A series of 46 patients underwent 76 optical urethrotomies under local urethral anaesthesia in the out-patient clinic; in 70% of patients the strictures were controlled by local anaesthetic urethrotomy alone; 61% felt either no pain or mild pain during the procedure; 72% expressed a preference for local anaesthesia should the procedure have to be repeated and 82% were happy with the result of their treatment. Optical urethrotomy under local urethral anaesthesia produces results comparable to those reported by others using general anaesthesia. If large numbers of patients are to be treated, possibly repeatedly, then out-patient urethrotomy may result in more efficient use of resources.
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Affiliation(s)
- J E Greenland
- Department of Urology, Queen Elizabeth Hospital, Birmingham
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18
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Abstract
Urethral stricture is the most common late complication of transurethral prostatectomy. Uroflowmetry is recommended as the routine screening procedure for strictures postoperatively. If maximal urinary flow rate (Qmax) is below 10 mL/second the patients should be investigated further. The etiology of urethral stricture is still unclear. Further studies are necessary to evaluate the possible etiologic role of infected urine pre- and/or postoperatively, urethral catheterization pre- and postoperatively, catheter material, and the type and size of the resectoscope. A narrow urethra is probably a predisposing factor for stricture formation, but this is not definitively clarified. Only few randomized studies have been performed to evaluate the different prophylactic methods against development of strictures postresection. Resection via perineal urethrotomy, perhaps preceded by urethral calibration, seems to be a way to avoid anterior urethral strictures. The effects of internal urethrotomy preoperatively on stricture formation are conflicting. Further randomized studies are necessary.
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Affiliation(s)
- K K Nielsen
- Department of Urology, Herlev Hospital, University of Copenhagen, Denmark
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Stone AR, Randall JR, Shorrock K, Peeling WB, Rose MB, Stephenson TP. Optical urethrotomy--a 3-year experience. BRITISH JOURNAL OF UROLOGY 1983; 55:701-4. [PMID: 6652442 DOI: 10.1111/j.1464-410x.1983.tb03409.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
One hundred and thirty-seven patients underwent optical urethrotomy and have been followed up over a period of 3 years. The overall improvement rate was 66%. The results were unrelated to the length of history, the number of previous dilatations or the site of the lesion. However, traumatic strictures did significantly less well than the others. Although the procedure can be repeated, the chance of failure following the third or subsequent urethrotomy was much greater than after the first or second procedure. Urethrotomy for post-prostatectomy membranous strictures was followed by incontinence in 31% of patients. Otherwise the procedure was safe and should be the first choice of treatment for most patients with urethral strictures.
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