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Purpose: Meticulous excision of the stricture and any associated spongiofibrosis is critical to the success of urethral reconstruction. However, normal urethral limits are determined during surgical reconstruction based on macroscopic appearance only. We evaluated structural changes of the presumed healthy urethral ends. Materials and Methods: Samples were obtained from 29 patients with a mean age of 40 years who underwent end-to-end anastomotic urethroplasty. Suprapubic catheter drainage was performed for at least 30 days in 15 patients. After the urethral stricture was excised biopsy was performed of the proximal and distal healthy ends. Structural characterization was evaluated by staining histological sections with Masson''s trichrome, Sirius red and Weigert''s resorcin-fuchsin method. The control group consisted of 10 cadaver bulbar urethras. Results: All samples of presumed normal urethral ends showed histological changes. Chronic and acute inflammatory reactions were the most common findings. In the proximal urethral end intense cellularity was found in 18 patients (62.1%). Fibroblast and inflammatory cells were most common and related to the lack of suprapubic cystostomy (p = 0.001). Between proximal urethral edges with and without a suprapubic urinary catheter the elastic fiber distribution and the ratio of collagen types III and I showed a significant change (p = 0.045 and <0.001, respectively). Conclusions: The supposedly healthy urethral ends of end-to-end anastomotic urethroplasty show structural changes. Urethral obstruction and its relief by suprapubic urinary drainage can affect extracellular matrix turnover regulation. Therefore, these changes can lead to urethral remodeling in the proximal bulbar urethra. [Copyright &y& Elsevier]

Purpose: We investigated whether combination therapy with dutasteride and tamsulosin is more effective than either monotherapy alone for improving symptoms and long-term outcomes in men with moderate to severe lower urinary tract symptoms and prostatic enlargement (30 cc or greater). We report preplanned 2-year analyses. Materials and Methods: The CombAT study is an ongoing, multicenter, randomized, double-blind, parallel group study. Men 50 years or older with a clinical diagnosis of benign prostatic hyperplasia, International Prostate Symptom Score 12 points or greater, prostate volume 30 cc or greater, total serum prostate specific antigen 1.5 ng/ml or greater to 10 ng/ml or less and peak urinary flow greater than 5 to 15 ml per second or less with a minimum voided volume of 125 ml or greater were randomized to 0.5 mg dutasteride, 0.4 mg tamsulosin or the combination once daily for 4 years. Symptoms were assessed every 3 months and peak urinary flow was assessed every 6 months. The primary end point at 2 years was the change in International Prostate Symptom Score from baseline. Results: Combination therapy resulted in significantly greater improvements in symptoms vs dutasteride from month 3 and tamsulosin from month 9, and in benign prostatic hyperplasia related health status from months 3 and 12, respectively. There was a significantly greater improvement from baseline in peak urinary flow for combination therapy vs dutasteride and tamsulosin monotherapies from month 6. There was a significant increase in drug related adverse events with combination therapy vs monotherapies, although most did not result in the cessation of therapy. Conclusions: In men with moderate to severe lower urinary tract symptoms and prostate enlargement (30 cc or greater) combination therapy provides a significantly greater degree of benefit than tamsulosin or dutasteride monotherapy. [Copyright &y& Elsevier]