[Comparative analysis of patients with spongy urethral strictures undergoing multistage urethroplasty or permanent urethrostomy]

INTRODUCTION

Deciding on the optimal surgical method for treating complex spongy urethral strictures is a challenging clinical task.

PURPOSE OF THE STUDY

To determine the clinical differences between patients undergoing multistage urethroplasty and permanent urethrostomy.

MATERIALS AND METHODS

Two groups of patients were formed for the analysis: group I - 73 patients who underwent multistage urethroplasty; group II - 48 patients underwent permanent urethrostomy. The differences between groups were studied according to the following clinical parameters: age, body mass index, duration of the disease, previous treatment, etiology, length and localization of strictures, complications of stricture disease, concomitant diseases, urine flow parameters, the presence of early postoperative complications, and recurrence of strictures.

RESULTS

Patients of group I compared to group II are significantly younger (43.0 vs 59.6 years; p<0.0001). They have fewer idiopathic strictures (8.2 vs 31.3%; p=0.001), undergo cystostomy less often (26.0 vs 54.2%; p=0.002), have less pronounced lower urinary tract symptoms (I-PSS - 18.6 vs 23.8 points; p<0.0001, QoL 4.3 vs 5, 1 point; p<0.0001) and impaired urination parameters (Qmax - 8.1 vs 6.5 ml/s; p=0.09, Qave - 5.5 vs 4.1 ml/s; p=0.015, PVR - 62.4 vs 126.0 ml; p=0.03). The incidence of concomitant diseases (69.9 vs 87.5%; p<0.025) and their number (1.8 vs 3.1; p<0.002) are significantly higher in group II. Among the comorbidities, cardiovascular diseases (31.5 vs 58.3%; p=0.015), diabetes mellitus (5.5 vs 16.7%; p=0.045) and prostatic hyperplasia (8.2 vs 27.1%; p=0.005) predominate. Early surgical complications in group I were detected in 28,8% of patients, in group II - in 2.1% (p<0,0001) of cases. The primary treatment success among patients with permanent urethrostomy is higher than with multistage urethroplasty (85.4 vs 65,8%; p=0,017).

CONCLUSIONS

It is advisable to perform multistage surgery of extended spongy urethral strictures in young and middle-aged men without serious comorbidities in cases of conscious choice and sufficient awareness. Urethrostomy should initially be discussed with the patient as the operation of choice, considering age, cardiovascular comorbidity, diabetes mellitus and prostatic hyperplasia.

Novel surgical approach to neoplastic lesions in the distal part of the urethra: A pilot cadaver study comparing open and hybrid techniques

Tumours of the distal urethra in female dogs are often difficult to treat, and the surgical methods described thus far have technical limitations. This study aimed to present a novel approach to the surgical treatment of distal urethral tumours. This study used dog cadavers to evaluate the technical feasibility of surgically removing neoplastic lesions in the distal urethra and compared surgical outcomes of open surgery with those of hybrid surgery (combination of laparoscopy and open surgery). Open intact, open spayed, hybrid intact, and hybrid spayed dog cadaver groups underwent surgery (n = 6 per group). The novel surgical method was based on vulvovaginectomy (ovariohysterectomy in intact dogs), resection of the distal part of the urethra, and pre-pubic urethrostomy. Outcomes of interest included technical feasibility of each procedure, using both surgical techniques, wound length, time required to complete the procedure, and the incidence of intraoperative ureter and rectum injuries. Surgical technique and reproductive status affected operating time. Technique choice affected wound length; the surgical wound was longer in the open group than in the hybrid group. Macroscopic evaluation of the rectum did not reveal any damage to the wall. There was no evidence of ureter leakage or obstruction in any case. The present findings suggest that both open and hybrid surgery can be used to treat distal urethral tumours.

[Perineal and penile urethrostomy: surgical outcome and risk assessment of complications]

INTRODUCTION

Urethral repair in the complex urethral strictures (US) is associated with a high risk of failure. In some cases, urethrostomy is justified when choosing a method of treatment for this category of patients.

PURPOSE OF THE STUDY

To assess the results of perineal and penile urethrostomy and identify factors associated with the development of early surgical complications and urethrostomy stenosis (USs).

MATERIALS AND METHODS

85 patients aged 53.9 years underwent urethrostomy from 2010 to 2019: permanent - 48 (56.5%), due to refusal of urethroplasty - 37 (43.5%). Penile urethrostomy was formed in 41 (48.2%) patients, perineal USs - in 44 (51.8%), respectively. The US etiology was as follows: inflammatory - 32.9%, iatrogenic - 29.4%, idiopathic - 28.2%, traumatic - 9.4%. The US length was 6 cm or more in 58.8% patients, multifocal lesions occurred in 22.4% cases, subtotal - in 28.2%. The criterion for successful treatment was the absence of complications requiring repeated surgery on the urethra and / or systemic bougienage (median follow-up - 58 mo). The contribution of various factors to the increased risk of developing USs was assessed using univariate analysis by calculating the odds-ratio (OR, 95% CI). Statistical significance was tested using the 2 test, Fishers test. Multivariate analysis was performed using logistic regression.

RESULTS

Early postoperative complications (EPCs) were detected in 7 (8.2%) patients [urethritis (2), wound phlegmon (2), scrotal hematomas (1), unrecovered urination (1), acute urinary retention (1)]. Of these, only 2 (2.4%) cases required additional surgical intervention. USs was detected in 14 (16.5%) patients during the follow-up period from 3 to 200 mo (median - 8 mo). USs surgical correction was required in 12 (14.1%) cases, systemic bougienage - in 2 (2.4%) cases. Independent risk factors for all complications were UTIs (OR=3.3; 95% CI - confidence interval (CI)=1,17 - 9,1; p=0.013), arterial hypertension (OR=2.3; 95% CI=1.02 - 5.05; p=0.044), bougienage (OR=2.4; 95% CI=1.08 - 5.33; p=0.031), the US multifocal localization (OR=2.8; 95% CI=1.28 - 6.05; p=0.011), and for stenoses, in particular, UTIs (OR=6.1; 95% CI=1.45 - 25.22; p=0.003), arterial hypertension (OR=2.6; 95% CI=1.05 - 6.40; p=0.035), previous hypospadias repair (OR=3.3; 95% CI=1.27 - 8.55; p=0.031) and EPCs (OR=4.1; 95% CI=1.74 - 9.41; p=0.004). The combination of unfavorable factors identified in multivariate analysis determines development from 21.8% to 49.9% cases of early and late complications.

CONCLUSION

Urethrostomy may be the ultimate treatment for spongy complex US with an 82.4% primary success rate. The main factors negatively affecting the surgery outcomes are arterial hypertension, chronic kidney disease, US multifocal localization, previous bougienage, previous hypospadias repair, urethrocutaneous fistulas and EPCs.

Penile amputation and pre-scrotal urethrostomy in a male guinea pig (Cavia porcellus)

Male guinea pigs (Cavia porcellus), especially older animals, are prone to urethritis and posthitis. Severe, chronic balanoposthitis/posthitis can result in fibrosis, localised infection and the deposition of mineralised plaques in the prepuce. Severe cases may require surgical intervention, such as penile amputation and urethrostomy, to achieve resolution.

Congenital urethral dilatation in cattle calves: Diagnosis and surgical intervention

Background and Aim:

Congenital anomalies of the urinary system are common affections in ruminants. Dilatation of the pelvic urethra is one of these affections in which the pelvic urethra dilated than normal diameter. This study aimed to explain the diagnosis and surgical treatment of urethral dilatation in cattle calves.

Materials and Methods:

Twenty-three bull calves (2-7 months old) were presented with a history of stranguria, tenesmus, and straining. Diagnosis of urethral dilatation was relied on the case history and clinical examination and was confirmed using survey and contrast radiography, ultrasonography, and biochemical tests. Treatment was done by urethrostomy under the effect of local infiltration analgesia.

Results:

Physical examination revealed the presence of an oval, firm, and painless swelling at the perineal region, starting just below the anus and extended to the base of the scrotum. The owners reported that the initial swelling size and severity of symptoms increased with the progress of animal age. Biochemical findings revealed non-significant changes in blood urea nitrogen and creatinine levels. Radiographic findings showed an oval radiopaque mass. However, a well-demarcated structure with acoustic enhancement was detected on ultrasonographic examination. Urethrostomy resulted in a successful outcome of all cases.

Conclusion:

Depending on these findings, ultrasonography is the most reliable diagnostic tool and urethrostomy is the intervention of choice with acceptable results for diagnosis and treatment of urethral dilatation in cattle calves, respectively.

An application of sublingual mucosa to establish a new urination passage in male cats with complications after urethrostomy

This is the first study of using sublingual mucosae to establish a new urination passage in male cats suffering from complications from prior urethrostomy. In total, five domestic male cats afflicted with various complications, such as urethra stricture, scalding dermatitis, and urinary tract infection, after urethrostomy were included in the study. Sublingual mucosa was harvested to graft with abdominal muscles and further made into a tube connecting with the remaining urethra of the bladder at the cranial end and with the prepuce at the caudal end, serving as a new passage for urination. Postoperatively, all cats were alive and well recovered with no complications both in the oral cavity and at the surgical site. Radiography with contrast medium at two weeks and six months after surgery showed no leakage, stricture, or abnormality of the new urination passage. Moreover, all cats were able to urinate from the prepuce without any difficulties or signs of discomfort.

Outcome and complications in goats treated by perineal urethrostomy for obstructive urolithiasis: 25 cases (2010-2017)

Background

Obstructive urolithiasis commonly affects male goats. Perineal urethrostomy (PU) can be a permanent treatment option but is generally considered undesirable because of the risk of stricture of the urethral stoma. Limited information exists regarding long‐term outcome and complications in goats undergoing PU for treatment of obstructive urolithiasis.

Objectives

To determine short‐term and long‐term outcome and complications in goats undergoing PU for treatment of obstructive urolithiasis.

Animals

Twenty‐five client‐owned goats.

Methods

Multi‐institutional retrospective case series.

Results

Of the 25 goats, 13 (52%) were alive at the time of follow‐up. Mean time from surgery to follow‐up was 34 months (range, 4‐65). Nine goats (36%) died between discharge and follow‐up with a mean survival time of 46 days (range, 5‐120). Cause of death in 7 of 9 (78%) goats was related to urolithiasis. Goats treated by use of a modified proximal perineal urethrostomy (MPPU) were significantly more likely to survive at least 150 days postoperatively (P < .01). The most common postoperative complications were hemorrhage (10/25 [40%]) and surgical site infection (3/25 [12%]). Hemorrhage was significantly associated with MPPU (P < .0001). Stricture of the surgical stoma occurred in 7 of 22 (32%) discharged goats. Mean time to stricture was 65 days (range, 10‐240).

Conclusions and Clinical Importance

Perineal urethrostomy can provide effective long‐term resolution of obstructive urolithiasis in goats. Re‐obstruction or stricture seems most likely within the 1st 2 months after surgery. MPPU may provide better long‐term results but should be approached cautiously because it can be associated with life‐threatening hemorrhage.