Search

Introduction: Mayer–Rokitansky–Küster‐Hauser (MRKH) syndrome is a female congenital disorder characterized by an underdeveloped or absent vagina and uterus. The first‐line treatment to create a neovagina is patient‐performed vaginal dilatation. We report here the rare case of an MRKH patient who presented with urethral dilatation and was successfully treated with Davydov vaginoplasty. Case Report: Seventeen‐year‐old patient with known single kidney was consulted by a gynaecologist, and a diagnosis of MRKH syndrome was established. As the patient had urethral dilatation—resulting from repetitive intraurethral intercourse—neovaginal creation by means of self‐performed vaginal dilatation was precluded. Rather, the Davydov vaginoplasty was successfully performed; there were no postoperative complications, and the patient was fully continent postsurgery. Conclusion: MRKH patients and healthcare providers should be educated on the damaging consequences of intraurethral intercourse. More cases need to be reported to establish the best treatment options for a normal sexual life. [ABSTRACT FROM AUTHOR]

Urethral stricture disease is a commonly presenting problem to the urologist. Any condition that damages the urethral epithelium or underlying spongy tissue has the potential to cause a stricture. Patients with a urethral stricture can present either acutely or chronically with a range of urinary symptoms. An understanding of urethral stricture disease and a systematic approach to the history and investigations will enable clinicians to manage patients appropriately. This article aims to give an overview, appropriate for surgeons in their early years of training, on the aetiology, presentation and investigation of urethral stricture disease, as well as a basic understanding of the principles of management. [ABSTRACT FROM AUTHOR]

Aim:Most of the surgical strategies for pediatric urethral strictures (PUS) are derived from adult experiences. Owing to this, we carried out this study to assess the management strategies for PUS in our institute.Materials and Methods:This prospective study included 28 patients with PUS. Preoperatively, patients were assessed clinically and were subjected to voiding cystourethrography (VCUG) and pre-procedure cystoscopy. Intraoperatively, urethroscopy, VCUG and retrograde urethrography were used to evaluate the length of the stricture. Urethral dilatation (UD), direct visualization and internal urethrotomy (DVIU), excision and primary anastomosis (EPA) with or without pubectomy and dorsal onlay urethroplasty (DOU) were the procedures instituted to treat the strictures. After the procedure, a silicone catheter was left in situ for 1-2 weeks in cases of DU or DVIU and 4-6 weeks in cases of EPA or DOU. Postoperatively, patients were assessed in terms of their symptoms and for VCUG/cystoscopic evidence of reestablishment of urethral continuity. There was an average follow-up period of 1.9 years.Results:Three patients were successfully treated with single session UD and another three with multiple sessions. Two UD patients required EPA. DVIU was performed in four patients. This procedure failed in one and so required EPA. EPA was carried out in fourteen patients with two requiring redo-EPA. Graft onlay urethroplasty was performed in five patients with satisfactory results.Conclusion:The procedure to address a stricture should be tailored to the individual urethral anatomy, stricture length and the surgeons’ experience. For smaller and partially obstructing strictures, DVIU and DU can be tried but these procedures seem to be less effective than EPA, with high rates of secondary procedures. However, if not accompanied by complete excision of fibrosed spongiosum, EPA may have to be repeated. For longer bulbar strictures, substitution urethroplasties are viable alternatives.

Introduction and hypothesis: Female urethral stricture (FUS) is an uncommon entity. Although there is no clinical consensus on the best modality of treatment, several studies have been published describing different techniques of FUS management. We carried out a literature review of the different surgical techniques used in the management of FUS and their results. Methods: We performed a systematic search of the PubMed and EMBASE databases and several cross-references. We grouped the data available from the studies into four general treatment categories. Results: We reported 35 studies (488 patients) with outcome measures; 53.48% of cases were presumably idiopathic in origin. A history of prior intervention was described in 91.29% of cases. As a surgical intervention, urethral dilatation (UD) had the lowest success rate of only 41.25%. In contrast, local flaps performed better (92.54% success rate) than local or oral grafts (87.30% and 89.94%, respectively). Only 9.43% of patients experienced mild to moderate post-surgery de novo incontinence; most of them recovered with pelvic floor exercises. Conclusion: In practice, UD is tried first for FUS, at least once, before urethroplasty. In case of failure or short recurrence following UD, urethroplasty should not be delayed. In experienced hands, urethroplasty has a better outcome. [ABSTRACT FROM AUTHOR]

Objective: Female urethral stricture (FUS) accounts for about 4%-13% of cases of female bladder outlet obstruction. FUS was and is still managed by repeated dilatations and/or direct visual internal urethrotomy. There are many alternative options for reconstruction like buccal or vaginal mucosal graft urethroplasty. Our aim was to describe the technique of dorsal onlay buccal mucosal graft (BMG) urethroplasty for FUS and present the outcomes., Methods: Between January 2014 and December 2021, 37 patients who underwent dorsal onlay BMG urethroplasty were included in the study. Their pre-operative diagnosis was confirmed with uroflowmetry, micturating cystourethrogram, urethral calibration, and on table cystoscopy. Bladder catheter was removed after 2 weeks. Patients were followed up at 3 months, 6 months, 1 year, and then annually with urine analysis, uroflowmetry, and post-void residual assessment. We defined success as a maximum flow rate (Q max ) above 15 mL/s without the need for an additional instrumentation., Results: The mean age of patients was 47.8 (standard deviation [SD] 11.3) years. Twenty patients had previously undergone urethral dilatations. The mean pre-operative Q max was 7.79 (SD 3.73) mL/s. However, the mean Q max improved to 23.20 (SD 8.25) mL/s after surgery. The mean post-void residual urine after surgery was 30.50 (SD 10.70) mL. This reduced from a mean value of 139.00 (SD 147.24) mL before surgery. The mean follow-up was 30.2 (SD 18.3, range 18-44) months. There was no post-operative incontinence. There were Clavien-Dindo Grade 1 complications in 6 out of 37 (16.2 %) patients during hospital stay. The only long-term complication was recurrence of stricture in 4 (10.8%) patients., Conclusion: Dorsal onlay BMG urethroplasty in females is a safe, effective technique which can avoid repeated painful dilatations and multiple urethrotomies. One should always consider reconstruction in FUS without any fear of incontinence., Competing Interests: The authors declare no conflict of interest., (© 2024 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V.)

Aim: Most of the surgical strategies for pediatric urethral strictures (PUS) are derived from adult experiences. Owing to this, we carried out this study to assess the management strategies for PUS in our institute. Materials and Methods: This prospective study included 28 patients with PUS. Preoperatively, patients were assessed clinically and were subjected to voiding cystourethrography (VCUG) and pre-procedure cystoscopy. Intraoperatively, urethroscopy, VCUG and retrograde urethrography were used to evaluate the length of the stricture. Urethral dilatation (UD), direct visualization and internal urethrotomy (DVIU), excision and primary anastomosis (EPA) with or without pubectomy and dorsal onlay urethroplasty (DOU) were the procedures instituted to treat the strictures. After the procedure, a silicone catheter was left in situ for 1-2 weeks in cases of DU or DVIU and 4-6 weeks in cases of EPA or DOU. Postoperatively, patients were assessed in terms of their symptoms and for VCUG/cystoscopic evidence of reestablishment of urethral continuity. There was an average follow-up period of 1.9 years. Results: Three patients were successfully treated with single session UD and another three with multiple sessions. Two UD patients required EPA. DVIU was performed in four patients. This procedure failed in one and so required EPA. EPA was carried out in fourteen patients with two requiring redo-EPA. Graft onlay urethroplasty was performed in five patients with satisfactory results. Conclusion: The procedure to address a stricture should be tailored to the individual urethral anatomy, stricture length and the surgeons' experience. For smaller and partially obstructing strictures, DVIU and DU can be tried but these procedures seem to be less effective than EPA, with high rates of secondary procedures. However, if not accompanied by complete excision of fibrosed spongiosum, EPA may have to be repeated. For longer bulbar strictures, substitution urethroplasties are viable alternatives. [ABSTRACT FROM AUTHOR]

Urethral stricture disease (USD) is initially managed with minimally invasive techniques such as urethrotomy and urethral dilatation. Minimally invasive techniques are associated with a high recurrence rate, especially in recurrent USD. Adjunctive measures, such as local drug injection, have been used in an attempt to reduce recurrence rates. To systematically review evidence for the efficacy and safety of adjuncts used alongside minimally invasive treatment of USD. A systematic review of the literature published between 1990 and 2020 was conducted in accordance with the PRISMA checklist. A total of 26 studies were included in the systematic review, from which 13 different adjuncts were identified, including intralesional injection (triamcinolone, n = 135; prednisolone, n = 58; mitomycin C, n = 142; steroid-mitomycin C-hyaluronidase, n = 103, triamcinolone-mitomycin C- N -acetyl cysteine, n = 50; platelet-rich plasma, n = 44), intraluminal instillation (mitomycin C, n = 20; hyaluronic acid and carboxymethylcellulose, n = 70; captopril, n = 37; 192-iridium brachytherapy, n = 10), application via a lubricated catheter (triamcinolone, n = 124), application via a coated balloon (paclitaxel, n = 106), and enteral application (tamoxifen, n = 30; deflazacort, n = 36). Overall, 13 randomised controlled trials were included in the meta-analysis. Use of any adjunct was associated with a lower rate of USD recurrence (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.27–0.50; p < 0.001) compared to no adjunct use. Of all the adjuncts, mitomycin C was associated with the lowest rate of USD recurrence (intralesional injection: OR 0.23, 95% CI 0.11–0.48; p < 0.001; intraluminal injection: OR 0.11, 95% CI 0.02–0.61; p = 0.01). Urinary tract infection (2.9–14%), bleeding (8.8%), and extravasation (5.8%) were associated with steroid injection; pruritis of the urethra (61%) occurred after instillation of captopril; mild gynaecomastia (6.7%) and gastrointestinal side effects (6.7%) were associated with oral tamoxifen. Adjuncts to minimally invasive treatment of USD appear to lower the recurrence rate and are associated with a low adjunct-specific complication rate. However, the studies included were at high risk of bias. Mitomycin C is the adjunct supported by the highest level of evidence. We reviewed studies on additional therapies (called adjuncts) to minimally invasive treatments for narrowing of the urethra in men. Adjuncts such as mitomycin C injection result in a lower recurrence rate compared to no adjunct use. The use of adjuncts appeared to be safe and complications are uncommon; however, the studies were small and of low quality. Adjuncts to minimally invasive treatment of urethral strictures may reduce recurrence rates and thereby avoid the need for urethroplasty. Further adequately powered studies are needed to establish the safety, efficacy, and cost effectiveness of adjuncts and optimal drug dosing and delivery protocols. [ABSTRACT FROM AUTHOR]

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.

Urethral stricture management guidelines are an important tool for guiding evidence-based clinical practice. To present a summary of the 2021 European Association of Urology (EAU) guidelines on diagnosis, classification, perioperative management, and follow-up of male urethral stricture disease. The panel performed a literature review on the topics covering a time frame between 2008 and 2018, and using predefined inclusion and exclusion criteria for the literature. Key papers beyond this time period could be included if panel consensus was reached. A strength rating for each recommendation was added based on a review of the available literature after panel discussion. Routine diagnostic evaluation encompasses history, patient-reported outcome measures, examination, uroflowmetry, postvoid residual measurement, endoscopy, and urethrography. Ancillary techniques that provide a three-dimensional assessment and may demonstrate associated abnormalities include sonourethrography and magnetic resonance urethrogram, although these are not utilised routinely. The classification of strictures should include stricture location and calibre. Urethral rest after urethral manipulations is advised prior to offering urethroplasty. An assessment for urinary extravasation after urethroplasty is beneficial before catheter removal. The optimal time of catheterisation after urethrotomy is <72 h, but is unclear following urethroplasty and depends on various factors. Patients undergoing urethroplasty should be followed up for at least 1 yr. Objective and subjective outcomes should be assessed after urethral surgeries, including patient satisfaction and sexual function. Accurate diagnosis and categorisation is important in determining management. Adequate perioperative care and follow-up is essential for achieving successful outcomes. The EAU guidelines provide relevant evidence-based recommendations to optimise patient work-up and follow-up. Urethral strictures have to be assessed adequately before planning treatment. Before surgery, urethral rest and infection prevention are advised. After urethral surgery, x-ray dye tests are advised before removing catheters to ensure that healing has occurred. Routine follow-up is required, including patient-reported outcomes. These guidelines aim to guide doctors in the diagnosis, care, and follow-up of patients with urethral stricture. The evaluation and postoperative follow-up of patients with urethral strictures should include an assessment of both symptoms and objective parameters. Herein, we describe recommendations for diagnostic evaluation and follow-up, as well as a classification system for urethral strictures. [ABSTRACT FROM AUTHOR]

To present a summary of the 2021 version of the European Association of Urology (EAU) guidelines on management of male urethral stricture disease. The panel performed a literature review on these topics covering a time frame between 2008 and 2018, and used predefined inclusion and exclusion criteria for the literature to be selected. Key papers beyond this time period could be included as per panel consensus. A strength rating for each recommendation was added based on a review of the available literature and after panel discussion. Management of male urethral strictures has extensively been described in literature. Nevertheless, few well-designed studies providing high level of evidence are available. In well-resourced countries, iatrogenic injury to the urethra is one of the most common causes of strictures. Asymptomatic strictures do not always need active treatment. Endoluminal treatments can be used for short, nonobliterative strictures at the bulbar and posterior urethra as first-line treatment. Repetitive endoluminal treatments are not curative. Urethroplasty encompasses a multitude of techniques, and adaptation of the technique to the local conditions of the stricture is crucial to obtain durable patency rates. Management of male urethral strictures is complex, and a multitude of techniques are available. Selection of the appropriate technique is crucial, and these guidelines provide relevant recommendations. Injury to the urethra by medical interventions is one of the most common reasons of male urethral stricture disease in well-resourced countries. Although different techniques are available to manage urethral strictures, not every technique is appropriate for every type of stricture. These guidelines, developed based on an extensive literature review, aim to guide physicians in the selection of the appropriate technique(s) to treat a specific type of urethral stricture. Clinical practice guidelines on the management of male urethral stricture disease are provided, with recommendations based on a standardised approach by an expert panel using a systematic literature search, level of evidence evaluation, benefit to harm assessment, and patient preferences. These guidelines should help the clinician to optimise the management of a patient with a urethral stricture. [ABSTRACT FROM AUTHOR]

Background/Aim: Difficult urethral catheterization (DUC) is a frequent urological emergency in daily practice. Anticoagulant and antiaggregant drugs, included in the treatment protocols for COVID-19, tend to increase the risk of possible complications of alternative interventions, such as cystoscopy and suprapubic percutaneous cystostomy. Therefore, a less invasive method is needed in patients with DUC. This study aims to evaluate the results of Foley catheter insertion and urethral dilatation over a hydrophilic guidewire in patients with DUC. Methods: A total of 23 male patients who visited the urology outpatient clinic or were referred due to urinary retention or inability to place a Foley catheter in the last 8 months were included in this case series. The patient charts were evaluated retrospectively. After the hydrophilic guidewire, blindly advanced from the urethral meatus under sterile conditions, reached the bladder, a Foley catheter was placed over the guidewire. In cases of urethral stricture, dilatation was performed over the guidewire with the help of hydrophilic S-Curve dilators, and a Foley catheter of suitable diameter was placed. Results: A Foley catheter was successfully placed in 22 out of 23 patients. Urethral dilatation was performed in 13 patients due to urethral stricture, and a transurethral Foley catheter was placed in the other 10 patients without the need for dilatation. Although most of our patients (17 of 23 patients) were receiving anticoagulant or antiaggregant treatment during the procedure, no significant hemorrhagic complications occurred. A Foley catheter could not be placed in one patient with this technique; a percutaneous cystostomy catheter was placed instead. Conclusion: The results of this study, conducted during the COVID-19 pandemic, show that our technique is safe and successful. We believe that our technique will be useful in preventing additional surgical interventions due to complications, especially during this pandemic. [ABSTRACT FROM AUTHOR]

Abstract Background Primary bladder neck obstruction is a rare clinical entity, reported to be responsible for 2.7–8% of lower urinary tract symptoms. It can lead to various urinary storage and voiding symptoms. The mainstay of treatment of female urethral strictures is urethral dilatation. Despite the long history of this method, it is unclear how far the female urethra should be dilated in correlation with residual urine volume. Case presentation A 79-year-old Caucasian woman presented to our institute with urgency (12–15 times/day), nocturia (3 times/night), and reoccurring urinary tract infections. A physical examination revealed no anatomical malformation in her genital organs, 150 mL post-void urine retention, and a significant narrowing in the mid-segment of the urethra (4 mm). After informed consent, our patient underwent urethral dilatation ranging from Ch9 (3 mm) to Ch39 (13 mm), and reported no symptoms at the 4-week follow-up, with no post-void residual urine. Conclusions The relatively low (around 50%) success rate of urethral dilatation might be improved by the utilization of wider dilatators, and the relaxation of the pubourethral ligament, achieved by a gentle downward saggital push during the intervention, although long-term studies with a large number of participants are necessary to prove our hypothesis.

Urethral stricture disease is a commonly presenting problem to the urologist. Any condition that damages the urethral epithelium or underlying spongy tissue has the potential to cause a stricture. Patients with a urethral stricture can present either acutely or chronically with a range of urinary symptoms. An understanding of urethral stricture disease and a systematic approach to the history and investigations will enable clinicians to manage patients appropriately. This article aims to give an overview, appropriate for surgeons in there early years of training, on the aetiology, presentation and investigation of urethral stricture disease, as well as a basic understanding of the principles of management. [ABSTRACT FROM AUTHOR]

Introduction The rarity in detecting female urethral stricture (FUS) backed by the inconsistency regarding the cutoff on the caliber to direct any treatment for its increase poses a challenge to its existence. Therefore, the present study was conducted to determine the caliber of the urethra that clearly identifies a FUS. Materials and method In this prospective observational study conducted between November 2015 and July 2017, women with obstructive lower urinary tract symptoms (LUTS) and a history of relief on at least a single urethral dilatation were included if the American Urological Association (AUA) score was more than seven and the maximum flow rate (Qmax) was less than 20 mL/sec. Of the 71 women recruited, 10 women had recognizable external causes: caruncle (five), mucosal prolapse (three), and meatal stenosis (two). The remaining 61 underwent voiding cystourethrogram (VCUG) and urodynamics followed by urethrocystoscopy, if the findings suggested a stricture. A definitive diagnosis was sought in those without stricture disease. We categorized all patients as either having a "true" stricture or an alternate etiology. Categorical variables were presented in number and percentage (%) and continuous variables as mean ± standard deviation (SD). Results The mean dilatation ranged between one and six; the mean AUA score, ~17.82 ± 3.59; mean Qmax, ~10.21 ± 3.39 mL/sec; and the mean post-void residue (PVR), 106.65 ± 51 mL. A total of 29 patients were diagnosed to have stricture (dense = 17; flimsy = 12). None of the patients in this group had a urethral caliber of more than 14 French (Fr). Other etiologies were dysfunctional voiding (17), underactive bladder (seven), cystocele (four), and primary bladder neck obstruction (PBNO) (four). Conclusion Women with voiding LUTS should be screened for FUS only if the urethral caliber is ≤14 Fr., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Nagabhairava et al.)

Background: Male urethral stricture disease is a challenging condition with a propensity for recurrence following endoscopic management. In recent years, earlier definitive urethral reconstruction has been advocated through international guidelines, prompted by series suggesting the underutilization of urethroplasty at rates of 0.6–0.8%. However, little local data exists to characterize our urethral stricture patients and we aimed to characterize the management of patients with urethral stricture disease presenting over a 10‐year period to a single regional centre. Methods: Patients with urethral stricture disease and admitted to a regional health service were identified. Retrospective chart review was undertaken for patients detailing basic demographics, stricture characteristics, clinical management and follow up. Results: We identified 360 patients with median age 69 years (interquartile range 56–77). A total of 191 (53%) presented with lower urinary tract symptoms, 122 (34%) urethral strictures were incidental, and 13% presented in urinary retention. Bulbar urethral strictures were the commonest strictures at 40% with most being spontaneous or idiopathic (67%). A total of 339 patients had treatment during their first admission, 48% of patients had subsequent treatment on a second episode, and over 20% had a third or subsequent treatment. Only 21 (5.8%) underwent urethroplasty. Urethral dilatation and optical urethrotomy were most commonly performed (54%). With follow up 19 months (interquartile range 2–56), 205 (57%) were voiding, 38 (11%) were performing intermittent catheterization, and 59 were catheterized permanently. Conclusion: Definitive urethral reconstruction appears underutilized in our cohort of patients. A high proportion of incidentally presenting urethral strictures emphasizes the importance of wider education to optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Infra-vesical obstruction is uncommon in infants and generally due to urethral valves. Congenital urethral strictures (CUS), instead, defined as a concentric narrowing of the urethral lumen, are exceedingly rare in infants. Materials and Methods: We reviewed our experience with 7 patients treated at our institution for CUS

Voiding dysfunction following midurethral sling procedures is not a rare event. There is no current consensus regarding management of this complication. Although it is often transient and self-limiting, chronic post-midurethral sling voiding dysfunction may lead to irreversible changes affecting detrusor function. Initial management includes intermittent catheterization, and addressing circumstantial factors interfering with normal voiding, such as pain. Early sling mobilization often resolves the dysfunction, and is associated with minimal morbidity. Sling incision or excision at a later stage, although fairly effective, could be associated with recurrence of stress urinary incontinence. There is insufficient evidence to justify urethral dilatation in this context. [ABSTRACT FROM AUTHOR]

Urethral stricture disease is a commonly presenting problem to the urologist. Any condition that damages the urethral epithelium or underlying spongy tissue has the potential to cause a stricture. Patients with a urethral stricture can present either acutely or chronically with a range of urinary symptoms. An understanding of urethral stricture disease and a systematic approach to the history and investigations will enable clinicians to manage patients appropriately. This article aims to give an overview, appropriate for surgeons in there early years of training, on the aetiology, presentation and investigation of urethral stricture disease, as well as a basic understanding of the principles of management. [ABSTRACT FROM AUTHOR]

Objective: To determine the success rate and complications of diff erent urethroplasty techniques at a single tertiary care center in Pakistan. Materials and methods: All consecutive patients who underwent various types of urethroplasty at Sindh Institute of Urology and Transplantation (SIUT), from January 2010 to August 2015 were included in this study. Urethroplasty techniques were divided according to the site. Short-term success rate and complications were noted. Data was retrieved from the case fi les and entered and analyzed on SPSS version 10.0. Results:A total of 467 patients underwent various urethroplasty techniques during the study period. Th e mean age was 32.01±13.35 years (range: 14 to 67 years). Regarding the location of the strictures, 167 (35.7%) were PFUDD, 201 (43%) bulbar, 64 (13.7%) penile and 35 (7.4%) pan urethral strictures. Th e overall success rate in PFUDD was 84.4% (141/167), in bulbar strictures, 89.0% (179/201), in penile, 93.7% (60/64) and in pan urethral strictures, 71.4% (25/35). Th e success rate according to type of urethroplasty showed that EPA for anterior urethral stricture had success rate of 96.1% (99/103), for posterior urethral stricture, 94% (157/166). In BMG urethroplasty, the success rate was 93.2% (124/133), in genital skin fl ap success rate was 87.1% (34/39) and in abdominal wall skin graft ing the success rate was 84.0% (21/25). Th e complications varied according to the type of urethroplasty. EPA urethroplasty had lowest complication rate, i.e., 8.7%, especially when done for short bulbar stricture, while complication rate increased to 13% in EPA urethroplasty done in PFUDD. Th e hospital stay ranged from 2-5 days. Conclusions: Th e success rate of various type of urethroplasty in our institute is comparable with other tertiary care centers in the world. [ABSTRACT FROM AUTHOR]

Background Intermittent self-dilatation (ISD) may be recommended to reduce the risk of recurrent urethral stricture. Level one evidence to support the use of this intervention is lacking. Objectives Determine the clinical and cost-effectiveness of ISD for the management of urethral stricture disease in males. Search Methods The strategy developed for the Cochrane Incontinence Review Group as a whole (last searched May 7, 2014). Selection Criteria Randomised trials where one arm was a programme of ISD for urethral stricture. Data Collection and Analysis At least two independent review authors carried out trial assessment, selection, and data abstraction. Results Data from six trials that were pooled and collectively rated very low quality per the GRADE approach, indicated that recurrent urethral stricture was less likely in men who performed ISD than those who did not (RR 0.70, 95% CI 0.48-1.00). Two trials compared programmes of ISD but the data were not combined and neither were sufficiently robust to draw firm conclusions. Three trials compared devices for performing ISD, results from one of which were too uncertain to determine the effects of a low friction hydrophilic catheter versus a polyvinyl chloride catheter on risk of recurrent urethral stricture (RR 0.32, 95% CI 0.07 to 1.40); another did not find evidence of a difference between 1% triamcinolone gel for lubricating the ISD catheter versus water-based gel on risk of recurrent urethral stricture (RR 0.68, 95% CI 0.35 to 1.32). No trials gave cost-effectiveness or validated PRO data. Conclusions ISD may decrease the risk of recurrent urethral stricture. A well-designed RCT is required to determine whether that benefit alone is sufficient to make this intervention worthwhile and in whom. Neurourol. Urodynam. 35:759-763, 2016. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective: Urethral stricture is a relatively common disease in men with an associated prevalence of 229-627 per 100,000 males. The management of urethral stricture disease is surgical and includes urethral dilatation, optical urethrotomy, urethral stents and open reconstructive techniques. Optical urethrotomy is a minimally invasive, safe and simple procedure. Yet there are many controversies in the literature regarding the overall effectiveness of optical urethrotomy. The purpose of the study was to determine the exact effectiveness of optical urethrotomy in management of urethral stricture disease. Materials and Methods: This study is a descriptive study carried out at Department of Urology, MTI, LRH, Peshawar from 1 January 2015 to 31 December 2016. A total of 141 patients were included in the study using Non-probability consecutive sampling technique. All male patients of urethral stricture disease with average urine flow of 5 ml/ sec or less and age of 18 years and more were included in the study. Patients with enlarged prostate, bladder calculi and those have neurogenic bladder were excluded from the study. All the patients were put on next OT list for optical urethrotomy. All the patients were followed up till 1 year with uroflowmetry to determine effectiveness in terms of improvement in average urine flow rate of > 5ml/sec. Data was collected on a pre-designed proforma and analyzed on SPSS version 17. Mean + Standard deviation was calculated for quantitative variables like age and average urine flow rate. Frequencies and percentages were calculated for categorical variables like effectiveness, stratified among age and pre-operative average urine flow rate to see the effect modifications Results: During the study period 141 cases of urethral stricture disease were included in the study. The mean age of the study group was 38.30 and with a standard deviation of 11.69. The mean average urine flow rate before the surgery was 3.53 ml/s. The mean average urine flow rate after the surgery was 13.20 ml/. Internal optical urethrotomy was found to be efficacious in 88.7% of the study group. The mean hospital stay was 3.04 days. We could not find any association between the effectiveness of optical urethrotomy, age of the patient and average pre-operative urine flow rate. Conclusions: It is concluded from our study that optical urethrotomy is an effective procedure for the management of urethral stricture disease. [ABSTRACT FROM AUTHOR]

Objective To examine the durability after 3 months deployment of a urethral ( Memokath™) stent in conjunction with endoscopic treatment of recurrent bulbar urethral strictures, as repeated endoscopic treatment of urethral strictures can cause worsening of underlying spongiofibrosis. Patients and Methods Prospective series of 22 patients with recurrent bulbar strictures requiring repeat endoscopic treatment were included. The median age was 38 years and the mean stricture length was 2.4 cm. The median number of previous dilatation or direct visual internal urethrotomy ( DVIU) procedures was three with a mean time to stricture recurrence of 2 months. After endoscopic dilatation or DVIU, the urethral ( Memokath™) stent was deployed and left situ for 3 months. Re-stricture rates were examined with uroflowmetry at 3, 6 and 12 months and confirmed with 17- F cystoscopy at 1 year after stent removal. A telephone survey was conducted at >1-year follow-up. Results Five of the 22 (22%) patients had stricture recurrence after stent removal. In all, 17/22 (78%) patients remained stricture-free at a median (range) follow-up of 23 (9-31) months. Uroflowmetry showed significantly improved flow rates, which were sustained at 12 months after stent removal. On Kaplan- Meier analysis, there was a significant delay (23 vs 2 months) in stricture or symptom recurrence after stent removal. Conclusion The medium term results of temporary urethral stent placement are encouraging with 78% of patients remaining stricture-free at a median follow-up of 23 months. [ABSTRACT FROM AUTHOR]

Aim To evaluate the effect of urethral dilatation (UD) on urgency symptoms in women with overactive bladder (OAB) and voiding dysfunction. Methods Women with OAB symptoms and a maximum flow rate of less than 15 ml/sec on a volume voided of 200 ml were eligible for entry to the trial. Fifty women with OAB symptoms and a maximum flow rate of less than 15 ml/sec on a volume voided of over 200 ml were randomized to undergo UD plus cystoscopy or cystoscopy alone. All subjects underwent filling and voiding cystometry pre-operatively and at 6 weeks' post-operatively. Subjective outcomes were assessed using the Urgency Perception Scale (UPS) and King's Health Questionnaire at baseline, 6 weeks and 6 months. The primary outcome measure was cure of urgency, defined using the UPS. Results Urgency was cured in 10/22 (45%) patients in the UD group and 5/28 (18%) in the non-UD group at 6 weeks (Odds ratio 3.8, 95% confidence interval 1.1-13.8, P = 0.03). Cystometric flow data were available for all patients pre- and post-UD. UD was associated with a significant increase in the flow rate centile from 1.66 to 8.54 ( P = 0.01). At 6 months there was no benefit from UD with 4/22 in the UD group cured of urgency and 4/28 in the non-UD group cured (Odds ratio 1.3, 95% confidence interval 0.3-6.1, P = 0.50). Conclusion UD confers a significant short-term benefit in cure of urgency over cystoscopy alone, but there is no significant benefit in symptom relief in the long term. Neurourol. Urodynam. 33:283-288, 2014. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Urethral stricture is a common cause of morbidity and sometime mortality in West Africa. A variety of investigative tool and techniques are currently available to evaluate and manage this condition. Major urological societies have issued evidence based guidelines for the evaluation and management of this disease. In Ghana and West Africa the resources available in the developed world may not be available. The patient population is different with most patients presenting with complications like acute urinary retention. Therefore evidence based guidelines may not be strictly adhered to. We performed a retrospective audit of the evaluation and management of urethral stricture at Korle Bu Teaching hospital in Accra Ghana between November 2011 and November 2012 and compared our findings with published studies from the sub region. Post inflammatory strictures predominate but the percentage is decreasing due to the rapid increase in the incidence of pelvic fracture urethral injury. To reduce the cost of investigation a thorough history and physical examination is essential, imaging tests performed are those that will influence management plan. Although urethrotomy and dilatation are not curative, patients who otherwise would have benefited from urethroplasty are still offered repeated urethrotomy because of lack of theatre space and trained surgeons to perform urethroplasty. For the same reason many patients in the sub region spend many months to years with a suprapubic catheter. [ABSTRACT FROM AUTHOR]

Stricture urethra, though a rare condition, still is a rational and troublesome problem in the international society. Major complications caused by this disease are obstructed urine flow, urine stasis leading to urinary tract infection, calculi formation, etc. This condition can be correlated with Mutramarga Sankocha in Ayurveda. Modern medical science suggests urethral dilatation, which may cause bleeding, false passage and fistula formation in few cases. Surgical procedures have their own complications and limitations. Uttarabasti, a para-surgical procedure is the most effective available treatment in Ayurveda for the diseases of Mutravaha Strotas. In the present study, total 60 patients of urethral stricture were divided into two groups and treated with Uttarabasti (Group A) and urethral dilatation (Group B). The symptoms like obstructed urine flow, straining, dribbling and prolongation of micturation were assessed before and after treatment. The results of the study were significant on all the parameters. [ABSTRACT FROM AUTHOR]

In resource limited settings victims of urethral strictures often seek healthcare,when the strictures are far advanced. For a surgeon, management is indeed a challenging task, given the severity and extent of disease, lack of expertise, enough skills and equipment in the healthcare facility. This study was conducted at a rural teaching hospital in central India. All patients were assessed for the extent and severity of strictures and to rule out other causes of lower urinary obstruction. Outcome of all patients was assessed with American Urological Association Urinary Symptom Score and Urinary Flow Rate (ml/sec) before procedure, post procedure and at 6-12 months. Between 2007 and 2009, 110 patients, between 18-75 years of age were enrolled in this study which showed that a third of patients treated with urethral dilatation and optical internal urethrotomy required another intervention. It is conclude that urethral dilatation and internal optical dilatation result in short term improvement in urine flow rates and symptoms. Urethroplasty, the current gold standard of therapy for urethral strictures, results in outcomes that are clinically meaningful and more cost effective for a patient. The Americal Urological Association (AUA) symptom score and Urinarry Flow Ratemay be used to objectively assess outcome following surgical management of urethral strictures. [ABSTRACT FROM AUTHOR]

Objective: To find out the role of clean intermitting self dilatation (CISD) for the prevention of recurrent urethral stricture. Material and Methods: This comparative study of patients undergoing optical urethrotomy for anterior urethral stricture was conducted in Surgical Unit Hayatabad Medical Complex, Khyber Medical Centre and Khyber Teaching Hospital Peshawar from July 2004 to June 2008. Results: A total of 146 male patients were included in the study. They were divided into two groups of 73 each on alternate basis. Group A was control group and group B with clean intermitting self dilatation and were followed upto 8 months. Study results showed a high rate of recurrence in control group A i.e. 42 patients (57.53%) in comparison to self dilatation group B i.e. 26 patients (35.61%). Conclusion: Clean intermitting self dilatation is an effective procedure in the prevention of recurrent urethral strictures for primary strictures and deep strictures between 0.5-1.5cm length after optical urethrotomy. [ABSTRACT FROM AUTHOR]

Despite a lack of evidence for its efficacy in the literature, urethral dilatation (UD) has been used by urologists and urogynecologists for many years to treat a variety of lower urinary tract symptoms in women. Recent surveys of clinical practice suggest that a significant proportion of clinicians continue to perform UD, with it being more commonly used by those trained more than 10 years ago. Recent outcome data on UD in women with overactive bladder and voiding dysfunction have shown poor long-term efficacy, with a 13% risk of de novo urodynamic stress incontinence. Resolution of symptoms is associated with a postprocedure increase in maximum flow rate and a decrease in detrusor pressure at maximum flow. Further studies are needed to delineate the role, if any, of UD in the management of women with overactive bladder and voiding dysfunction. [ABSTRACT FROM AUTHOR]