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Introduction: The high recurrence rate is still the major complication of internal urethrotomy. Our institutes have a protocol to performe urethral dilatation post internal urethrotomy. The aim is to evaluate the effect urethral dilatation on anterior urethral stricture recurrence after internal urethrotomy. Methods: We classified into 2 groups which are urethral dilatation and observation. Data were collected from 2 public hospital and 3 private hospital. All stricture was anterior, single, and partial obstruction. Urethral dilatation was using a metal sound urethral dilatation and performed every 1-2 weeks for first and second month and once a month after that or if there is any voiding complaints or maximal urine flow rate< 10 mL/s. The criteria for recurrence were indicating the need for urethroscopy, DVIU or open surgery, and/or impossible dilatation. We follow up at least 1 month after DVIU. Results: A total 204 cases can be reviewed, which are 188 had urethral dilatation procedure and only 16 had observation. In urethral dilatation group, we found 4 recurrent cases (2,1%) with mean time of recurrence was 4.3 month. In observation group, we found 9 recurrent cases (56,3%) with mean time of recurrence was 10 month. There was no significant differences in time of recurrence between two groups (P = 0,503). By Kaplan Meier survival analysis, urethral dilatation group had better and longer mean recurrent time. Conclusions: We found a urethral dilatation post internal urethrotomy had beneficial effect for decreasing recurrent complication. [ABSTRACT FROM AUTHOR]

Introduction: To report our long term results of reconstruction of extended recurrent urethral strictures with buccal mucosal graft. Methods: From 04/1997 till 12/2007, 374 reconstructions of recurrent urethral strictures were done. 360 of them were reconstructed with buccal mucosal graft. In all the patients, graft was placed ventrally by onlay technique. Patients were aged from 5-88 years (mean 50). Stricture length ranged from 1-25 cm (mean 10.1). Number of prior operative treatments were 1-24 (mean 4.7). The data were prospectively recorded by patients reported questionnaires evaluating uroflow and residual urine every 3 month in the first year and 6 monthly thereafter. In cases of uroflow less than 20ml, residual urine more than 100ml or infections,we performed urethroscopy and or urethrography. Mean follow up was 37 months (range 3-121). Results: 26 of these patients (7.2%) developed a recurrence between 8 and 74 months (mean 33) with the highest risk during first 2 years and after 5 years, postoperatively. The follow up analysis shows that 60% recurrences occur within 2 years and about 40% after 5 years. The age of patients with recurrence was between 31-79 years. Conclusions: Buccal mucosal graft implanted by onlay technique on the ventral aspect of the urethra is an excellent material for reconstruction of extended recurrent urethral strictures. Long term results are very satisfying. Recurrences also occur after 5 years postoperatively hence a long term follow up is necessary. [ABSTRACT FROM AUTHOR]

Introduction: Higher complication rate with ventral onlay buccal mucosa graft urethroplasty as compared to dorsal placement of the mucosal graft has been mainly attributed to poor ventral support for the graft. We herein describe a technique to augment the thickness of ventral portion of the bulb that forms the base of the ventral graft in an attempt to decrease this complication rate. Materials and Methods: In a pilot study conducted between Jan 2007 and July 2007, 5 patients with proximal bulbar urethral stricture underwent ventral onlay buccal mucosal graft urethroplasty. After the graft was sutured with the mucosal edges of the stricture defect, a continuous 4-0 monofilament poliglecaprone-25 suture was applied taking thin bites through the superficial portion of the bulb. The inverted raw edges of the bulb form a large vascularized bed for the buccal mucosal graft. Approximately 5mm on either side of this suture line, parasagittal incisions were given in partial depth of bulb and medial edges were sutured together over the first suture line. The lateral edges of incision were then sutured as a third layer. It is desired to separate fibrofascial adhesions that adhere lateral aspect of bulb to undersurface of perineal membrane by blunt dissection to permit medial advancement of bulbar tissue. The technique described exploits local bulbar anatomy and successfully moves the lateral bulbar tissue medially below the ventrally placed mucosal graft. Postoperative urethroscopy and pericatheteric urethrograms was done to document healing. A retrograde urethrogram was done at three months follow up. Results: Mean patient age was 38.7 years. Mean follow up period is 10 months. Postoperatively all patients were symptom free. None developed a graft pseudodiverticulum. The described technique of VBA leads to a thicker bulb ventrally to provide a sound, wider and vascularized base for the mucosal graft. Conclusion: With ventral bulbar augmentation following buccal mucosal graft urethroplasty, a thicker ventral bulbar platform results which provides enhanced support to the graft. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the clinical relevance of MRI urethrogram in diagnosing stricture urethra and comparing the investigation with the conventional urethrogram. Materials and Methods: Patients with stricture urethra who came to our institution between Jan 2007 and Aug 2007 were investigated with conventional RUG and multiformat MR urethrogram. All the patients underwent urethroscopy under anesthesia and later subjected to definitive endoscopic or open surgical intervention. The accuracy of both these investigations in assessing the stricture length and the advantages of MR urethrogram over RUG were analysed. Conclusion: MR urethrogram is a promising investigation which provides additional data regarding stricture characteristics like the size of the stricture and the extent of spongiofibrosis which cannot be obtained in our RUG, to decide on the treatment approach. [ABSTRACT FROM AUTHOR]

Abstract: Association of the anterior and posterior urethral valve is a rare congenital anomaly which can lead to various urinary tract symptoms. An 8-year-old boy was referred by his primary care physician for urinary dribbling, straining at micturition, and recurrent febrile urinary tract infection since the age of 2 years. Clinically, the bladder was palpable; both testes were normal, and, in addition, he had a subcoronal hypospadias. Diagnosis was confirmed by retrograde urethrogram and voiding cystourethrogram (micturating cystourethrogram) and urethroscopy. Cystoscopic ablation of both valves was done by electrocautery hook using low current at 5 o''clock and 7 o''clock directions. He voided with good flow and to completion. Urinary dribbling had completely subsided and renal function was normal at a follow-up period of 36 months with freedom from recurrent urinary tract infection. Both the anterior and posterior urethral valves develop from different embryological sources; thus, this association is rare. A case with this association has not been reported previously in the literature. [Copyright &y& Elsevier]