Search

Purpose: We report the 5-year study closeout results for the ROBUST I trial evaluating the safety and efficacy of the Optilume drug-coated balloon (DCB) for men with short, recurrent bulbar urethral strictures. Materials and Methods: Adult men with recurrent bulbar urethral strictures ≤ 2 cm long and lumen < 12F were included in the study and treated with the Optilume DCB. Outcome measures included symptom questionnaires, maximum urinary flow rate, postvoid residual, and freedom from repeat intervention. Functional success was defined as improvement in International Prostate Symptom Score ≥ 50% without re-treatment. Results: Fifty-three men were enrolled and treated, and 31 subjects completed all follow-up. Functional success was achieved in 58% (25/43) patients at 5 years. Average International Prostate Symptom Score improved from a mean of 25.2 at baseline to 7.2 at 5 years (P <.001). Freedom from repeat intervention was maintained through 5 years at 71.7% estimated by Kaplan-Meier. Maximum urinary flow rate improved from 5.0 mL/s at baseline to 19.9 (P <.01), and average postvoid residual was reduced from 141.4 mL to 59.5 mL (P <.01) at 5 years of follow-up. Erectile function remained unaffected. There were no serious treatment-related adverse events. Conclusions: In this challenging cohort of men with failed prior endoscopic treatment, the Optilume DCB shows sustained improvement in subjective and objective voiding parameters at 5 years. Optilume is a safe and effective treatment option for appropriately selected men with recurrent bulbar urethral stricture who wish to avoid urethroplasty. Results are in line with the ROBUST III randomized controlled trial that will continue follow-up through 5 years. Clinical Trial No.: NCT03014726. [ABSTRACT FROM AUTHOR]

Abstract Objective The aim of this study is to report the updated 2‐year results of the intervention arm of the ROBUST III randomized trial evaluating the safety and efficacy of the Optilume drug‐coated balloon (DCB) versus standard endoscopic management of recurrent male anterior urethral stricture. Materials and Methods Eligible patients included men with recurrent anterior urethral stricture ≤3 cm in length and ≤12Fr in diameter, International Prostate Symptom Score (IPSS) ≥11 and peak flow rate (Qmax)

Introduction:: We report the findings of a survey conducted to ascertain practice patterns of members of the Urological Society of India (USI) with regard to diagnosis and management of female voiding dysfunction (FVD). Methods:: A19-question survey was conducted on the SurveyMonkey® platform from December 17, 2019 to January 9, 2020. Questions included demographic details of respondents and policies regarding evaluation and treatment of FVD. Results:: 1278 of the 2649 qualified urologists of USI responded (48.2%). 1090 valid responses were included in the final analysis. While the majority of the respondents opted to check post void residual urine and 2/3rd ordered uroflowmetry in patients presenting with history of poor flow and/or incomplete emptying of urine, 38.6% and 45.7% of the respondents did not consider invasive urodynamics and cystoscopy, respectively, to be appropriate investigations in these patients. 29.6% were comfortable in dilating the urethra of female patients based on obstructive symptoms alone. 60% of respondents had performed at least one of the specialized surgical procedures for FVD. Conclusion:: Most Indian urologists treat FVD with 60% having at least some experience with surgical interventions. However, this survey revealed considerable heterogeneity and identified critical lacunae in the practice of FVD by Indian urologists. Inappropriate evaluation and management practices are surprisingly common. Findings of this survey could be useful in designing appropriate training programs for practitioners.

Ramón Virasoro,1 Jessica M DeLong,1 Rafael E Estrella,2 Merycarla Pichardo,3 Ramón Rodriguez Lay,4 Gustavo Espino,5 Sean P Elliott6 1Urology of Virginia PLLC, Virginia Beach, VA, USA; 2Clinica Unión Medica, Santiago de los Caballeros, Dominican Republic; 3URUS, Santo Domingo, Dominican Republic; 4Cirujano Urologo Royal Center Panama City, Panama City, Panama; 5Centro Especializado San Fernando, Panama City, Panama; 6Department of Urology, University of Minnesota, Minneapolis, MN, USACorrespondence: Ramón Virasoro, Urology of Virginia PLLC, 225 Clearfield Ave, Virginia Beach, VA, 23462, USA, Tel +1 757-457-5100, Email viravira@yahoo.comIntroduction: Endoscopic management of male anterior urethral stricture disease is common; however, repeat treatment is associated with high recurrence rates. Here, we report the 3-year results of the ROBUST I trial, which evaluated the safety and efficacy of the Optilume® drug coated balloon (DCB) in men with recurrent urethral strictures.Methods: Adult men with recurrent bulbar urethral strictures ≤ 2 cm in length and 1– 4 prior endoscopic interventions were treated with the Optilume DCB. Functional success was defined as ≥ 50% reduction in International Prostate Symptom Score (IPSS) without need for retreatment. Other outcomes included quality of life, maximum flow rate, post-void residual urine volume, erectile function, and freedom from repeat intervention.Results: Of the 53 enrolled and treated men, 33 completed the 3-year visit, with 10 patients experiencing clinical failures at previous visits, giving a total of 43 subjects evaluable for the functional success endpoint. Functional success was achieved in 67% (29/43) and freedom from retreatment in 77% (33/43). Average IPSS improved from 25.2 at baseline to 5.5 at 3 years (p< 0.0001). Significant improvements were observed in quality of life, flow rate, and post-void residual urine volume. Erectile function was not affected by treatment. Device-related adverse events were mild or moderate in nature and resolved quickly after onset. There were no serious treatment-related adverse events.Conclusion: Symptomatic improvement after treatment with the Optilume DCB was maintained through 3 years in a population highly susceptible to recurrent urethral stricture disease. This minimally invasive therapy is safe with no negative impact on sexual function.Keywords: lower urinary tract symptoms, paclitaxel, urethral dilation, medical device, clinical trial

Antenatal hydronephrosis is the most frequent urinary tract anomaly detected on prenatal ultrasonography. It occurs approximately twice as often in males as in females. Most antenatal hydronephrosis is transient with little long-term significance, and few children with antenatal hydronephrosis will have significant obstruction, develop symptoms or complications, and require surgery. Some children will be diagnosed with more serious conditions, such as posterior urethral valves. Early detection of obstructive uropathy is necessary to mitigate the potential morbidity from loss of renal function. Imaging is an integral part of screening, diagnosis, and monitoring of children with antenatal hydronephrosis. Optimal timing and appropriate use of imaging can reduce the incidence of late diagnoses and prevent renal scarring and other complications. In general, follow-up neonatal ultrasound is recommended for all cases of antenatal hydronephrosis, while further imaging, including voiding cystourethrography and nuclear scintigraphy, is recommended for moderate or severe cases, or when renal parenchymal or bladder wall abnormalities are suspected. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Antenatal hydronephrosis is the most frequent urinary tract anomaly detected on prenatal ultrasonography. It occurs approximately twice as often in males as in females. Most antenatal hydronephrosis is transient with little long-term significance, and few children with antenatal hydronephrosis will have significant obstruction, develop symptoms or complications, and require surgery. Some children will be diagnosed with more serious conditions, such as posterior urethral valves. Early detection of obstructive uropathy is necessary to mitigate the potential morbidity from loss of renal function. Imaging is an integral part of screening, diagnosis, and monitoring of children with antenatal hydronephrosis. Optimal timing and appropriate use of imaging can reduce the incidence of late diagnoses and prevent renal scarring and other complications. In general, follow-up neonatal ultrasound is recommended for all cases of antenatal hydronephrosis, while further imaging, including voiding cystourethrography and nuclear scintigraphy, is recommended for moderate or severe cases, or when renal parenchymal or bladder wall abnormalities are suspected. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Urethral stricture disease (USD) is a progressive scar-forming disease commonly encountered by urologists and is challenging to manage. USD most frequently occurs in the bulbar urethra. Patients typically present with chronic obstructive voiding symptoms but may develop recurrent urinary tract infections, detrusor failure, or renal disease. The authors review the pathophysiology, diagnostic workup, and evidence-based management of bulbar urethral strictures (BUS). There are multiple surgical options to treat BUS. Endoscopic techniques (eg, dilation and urethrotomy) are suitable for the initial management of short strictures but new evidence-based guidelines recommend against repeated endoscopic treatment. Urethroplasty is the gold standard treatment for BUS of all lengths, with anastomotic techniques appropriate for strictures <2 cm and tissue substitution performed for longer strictures. New techniques, such as non-transecting urethroplasty, lack long-term data but may represent a paradigm shift in the field. Future treatments may utilize tissue-engineered grafts and agents that inhibit inflammation and scar formation. [ABSTRACT FROM AUTHOR]

This section aims to review general principles of endoscopic management of urethral stricture disease and posterior urethral stenosis, with a special focus on the indications for treatment and technical aspects of urethral dilation and internal incision. [ABSTRACT FROM AUTHOR]

• Twenty-two geldings underwent perineal urethrotomy for removal of cystoliths. • Perineal urethrotomy facilitated urethral dilation using customized dilators. • Urethral dilation allowed for the simultaneous introduction of multiple instruments. • Urethral dilation allowed removal of cystoliths up to 90 mm. • No post-operative complications were recorded. This retrospective case series describes the use of progressive urethral dilation in 22 client-owned male horses undergoing perineal urethrotomy (PU) for cystolith removal. Medical records of horses undergoing PU and urethral dilation for treatment of cystolithiasis were reviewed. Dilation of the pelvic urethra was performed following PU and using customized dilators with the same length (30cm) and with various outer diameters (25 to 45mm). Analyzed data included: signalment, cystolith size, renal ultrasound findings, method used for cystolith removal, diameter of urethral dilators, intra- and post-operative complications, and hospitalization time. Cystolith size ranged between 37mm and 90mm. Dilation of the pelvic urethra was as follows: 35mm (n=8), 25mm (n=6), 39mm (n=3), 33mm (n=2), 28mm (n=2) and 45mm (n=1). In 6 cases, the cystolith was removed without fragmentation. In the remaining 16 horses, lithotripsy was performed with forceps (n=9) or a pneumatic scaler (n=7). In 15 horses a retrieval device was used to aid in calculi removal. Hospitalization time ranged between 1 and 5 days. Intra-operative complications occurred in one horse. No post-operative complications were recorded. Follow-up information was available for 21 horses (range 1-8 years). Urethral dilation via PU may be a viable option for cystolith removal in male horses. [ABSTRACT FROM AUTHOR]

Introduction: Urethral strictures are a common urologic problem that could require complex reconstructive procedures. Urethral dilatation represents a frequent practiced intervention associated with high recurrence rates. Drug-coated percutaneous angioplasty balloons (DCBs) with cytostatic drugs have been effectively used for the prevention of vascular restenosis after balloon dilatation. To reduce restenosis rates of urethral dilatation, these balloons could be used in the urethra. Nevertheless, the urothelium is different than the endothelium and these drugs may not be distributed to the outer layers of the urethra. Thus, an experiment was performed to evaluate the distribution of paclitaxel (PTX) in the rabbit urethra after the inflation of a PTX-coated balloon (PCB). Materials and Methods: Eleven rabbits underwent dilatation of the posterior urethra with common endoscopic balloons after urethrography. Nine of these rabbits were additionally treated with PCB. The urethras of the two control animals were removed along with three more dilated with PCB urethras immediately after the dilatation. The remaining of the urethras were removed after 24 (n = 3) and 48 hours (n = 3). The posterior segments of the urethras were evaluated with hematoxylin and eosin staining as well as with immunohistochemistry with polyclonal anti-PTX antibody. Results: The two control specimens showed denudation of the urothelium after balloon dilatations and no PTX was observed. All specimens from dilated PCB urethras showed distribution of PTX to all layers of the urethra. The specimens that were immediately removed exhibited denudation of the urothelium without any inflammation. The specimens removed at 24 and 48 hours showed mild acute inflammation. Conclusion: PTX was distributed to the urothelial, submucosal, and smooth muscle layers of the normal rabbit urethra immediately after dilatation with a DCB. PTX and mild inflammation were present at the site 24 and 48 hours after the dilatation. [ABSTRACT FROM AUTHOR]

Background: Foley’s catheter indwelling gives temporary relief for lower urinary tract obstruction, especially in case of severely symptomatizing benign prostatic hyperplasia (BPH). Several complications of long-term or frequent catheter indwelling have been reported in catheter dependent patients, specifically to those who are unfit for operative intervention. Objectives: Our aim was to find a safe, non-invasive relief from symptom severity, as well as, incapacitating complications of Foley’s catheter in catheter-dependent patients. Methods: A total of 107 catheter-dependent men, or who had frequent Foley’s catheter indwelling in case of BPH, participated in the present study. Preliminary estimation of the post-micturition residual urine was obtained. Ultrasound elastography was used to assess the transurethral balloon pressure of the double balloon silicon-coated catheter, adjudicated by ureteromat, and maintained in situ for 6 days in all patients. Basic follow up once-a-month has been performed up to 6 months. Results: Effectual urethral patency was noted in 89.7% patients at the end of the third month. The procedure was repeated for 11 patients shortly after 3 months, for 7 patients after 4 months and for 28 patients after 5 months, with no reported prostatic urethral injury. No stricture recurrence was noted in 61 patients up to 6 months. Conclusions: Preliminary results indicate that prostatic urethral balloon dilation in BPH catheter-dependent patients is inexpensive, safe, and would be a potentially effective option in maintaining the prostatic urethral patency. Elastographic justification of the transurethral balloon has proved to be helpful.

Introduction and hypothesis: The objective was to report our long-term experience of luminal urethral stricture (LUS) in women treated with dilation under general anesthesia. Methods: Following institutional review board approval, charts of women who underwent urethral dilation (UD) under general anesthesia for LUS and had over 6 months' follow-up were reviewed. LUS was confirmed by urethroscopy. UD was performed using female dilators with guidewire and Heyman dilators when required. Outcome measures included the number of UD procedures and the duration and frequency of clean intermittent catheterization (CIC). Success was defined as the ability to void without repeat UD and with no need for CIC 1 year after UD. Possible predictive variables were analyzed. Results: Between 2000 and 2013, a total of 30 out of the 32 women who underwent UD for LUS met the inclusion criteria. Mean follow-up was 59 (range: 7 to 151) months. Thirteen women in the success group showed improvement in the mean maximum flow rate (pre 11 ml/s to post 27.8 ml/s) and post-void residual (pre 85 ml to post 43 ml). In the failure group of 17 patients, 2 required chronic CIC 1 year after a single UD. Fifteen opted for repeat UD. After second ( n = 5), third ( n = 2), and fourth ( n = 2) UD, 9 patients came off CIC and reported durable satisfaction. Four women remained on regular CIC. Two required a permanent suprapubic catheter. Conclusion: At a mean follow-up of 5 years, UD for LUS produced durable resolution in 43 % of our patients. Another 30 % fully benefited from repeat UDs. Shorter duration of symptoms before presentation was significantly associated with success. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency and type of applied for correction of urethral stricture in patients operated for a period of 20 years surgery. Material and methods: Retrospective review of 46 patients with anterior urethral stricture. The patient's age was between one to 76 years, the length of the stricture was from two to 12 cm. Results: The technique was used in 21 patients as a terminal end urethroplasty, no pedicle flap tubularized in eight, pedicle onlay only in six patients, and urethroplasty with oral mucosa in 11 patients. Success with one surgery in 36 patients, in five patients was necessary endoscopic urethrotomy for section of the stenotic ring and in four patients a new urethroplasty, and only one patient needed a continent urinary Mitrofanoff divertion. [ABSTRACT FROM AUTHOR]

Background Foley’s catheter indwelling gives temporary relief for lower urinary tract obstruction, especially in case of severely symptomatizing benign prostatic hyperplasia (BPH). Several complications of long-term or frequent catheter indwelling have been reported in catheter dependent patients, specifically to those who are unfit for operative intervention. Objectives Our aim was to find a safe, non-invasive relief from symptom severity, as well as, incapacitating complications of Foley’s catheter in catheter-dependent patients. Methods A total of 107 catheter-dependent men, or who had frequent Foley’s catheter indwelling in case of BPH, participated in the present study. Preliminary estimation of the post-micturition residual urine was obtained. Ultrasound elastography was used to assess the transurethral balloon pressure of the double balloon silicon-coated catheter, adjudicated by ureteromat, and maintained in situ for 6 days in all patients. Basic follow up once-a-month has been performed up to 6 months. Results Effectual urethral patency was noted in 89.7% patients at the end of the third month. The procedure was repeated for 11 patients shortly after 3 months, for 7 patients after 4 months and for 28 patients after 5 months, with no reported prostatic urethral injury. No stricture recurrence was noted in 61 patients up to 6 months. Conclusions Preliminary results indicate that prostatic urethral balloon dilation in BPH catheter-dependent patients is inexpensive, safe, and would be a potentially effective option in maintaining the prostatic urethral patency. Elastographic justification of the transurethral balloon has proved to be helpful. [ABSTRACT FROM AUTHOR]

Congenital megalourethra, first described in 1955, is a rare urethral anomaly resulting from dysgenesis of the penile corpus spongiosum, with or without corpus cavernosum involvement, leading to dilatation of the penile urethra. Presentations come in two forms, scaphoid and fusiform, with the former being more common and resulting from deficient or absent corpus spongiosum. Fusiform types are much rarer, and consist of absence of both the corpus spongiosum and cavernosum.3 Here, we present a case involving the surgical correction of an isolated scaphoid-type congenital megalourethra with significantly improved postoperative cosmetic and functional outcomes.

Female urethral stricture (FUS) is a distressing disease in the field of urology both for the patient and for the health care provider. It has been treated using various techniques such as urethral dilatation (UD), urethrotomy and urethroplasty. The disease's recurrence after urethral dilation, however, is not uncommon. Female urethroplasty carries the risk of stress urinary incontinence, and long‐term studies on its success are lacking. We present our study of treating FUS by repeated UD in a dedicated cystoscopy and dilation clinic managed by nurses. After the initial cystoscopy and dilation of FUS to 30 Fr, patients were followed up with in the dilation clinic at regular intervals. Over the past 5 years, 190 patients have been treated at our cystoscopy and dilation clinic and at are various stages of follow up. We find that the primary treatment of FUS by nurses at our institute leads to improved outcomes. Nurse‐led cystoscopies have been in vogue in Australia and the UK for some time now. There is an urgent need to expand the conventional indications of nurse‐led surgical interventions in order to allow medical care to reach the community at large. [ABSTRACT FROM AUTHOR]

We report the results of a long-term follow-up study in 78 children with urethral strictures. The ages ranged from 1 month to 20 years and the follow-up from 8 months to 15 years (average 5.9 years). Balloon dilation was the primary treatment in 66 patients. Manipulative management (balloon dilation and endoscopic urethrotomy) was performed in 68 cases and was successful in 55. There were no complications. Balloon dilation alone provided an 80% success rate (53/66). Twenty-two patients were treated by one-stage urethroplasty, with an overall 95.5% success rate. The surgical repair was performed in 12 patients as a secondary procedure after failure of conservative treatment. Our data do not support the rather poor results usually reported in the pediatric literature associated with the balloon dilation technique. [ABSTRACT FROM AUTHOR]

Twelve (12) goats were presented for treatment of hypospadias and urethral dilation. Detailed clinical, radiological, chromosomal, gross and histopathological studies, were undertaken confirming the same as intersex condition. Clinical examination revealed lemon sized pinkish or blackish swelling posterior to the prepuce with distention of urine. The goats were observed for a period of one year. Surgery was performed in few goats which showed difficulty in urination and urethra was reconstructed. In unoperated cases, urethral dilation atrophied allowing normal urination. Radiologically, contrast study revealed normal kidney and bladder, but hypospadias and urethral dilation. Chromosomal examination revealed that genotypically the goats were female but phenotypically, they were males. Gross examination revealed presence of both ovaries and testes. Penis was short, where as vulva was absent. Histologically, ovary and uterus did not reveal all their features. In contrast, testicles revealed normal seminiferous tubules, interstitial cells of Leydig and spermatocyes. Such goats should be identified and culled for economic goat husbandry. [ABSTRACT FROM AUTHOR]

Objective To evaluate the clinical value of the combination of S-shaped urethral dilator and nephroscope for the treatment of male urethral stricture disease. Methods Guidewires were inserted into bladder through the nephroscope under direct vision. The urethral dilation with S-shaped urethral dilator was carried out by nephroscope in 41 male patients. All catheters were located across the strictures and remained for 4-6 weeks. The regular follow-up was done on all cases to assess the clinical effect on urine flow. Results All surgeries were successful without serious complications. The mean operative time was (40.16°5.78) min. The voiding symptoms were significantly improved after catheter removal compared with those of preoperation in all cases. Patients were followed up after surgery and were regularly urethral dilation at least 6 weeks. The mean follow-up time was (34.75°6.42) weeks.There were incontinence, diminished sexual function and other complications after operation in all cases. Conclusion Nephroscope combined with S-shaped urethral dilator for the treatment of male urethral stricture disease is feasible, minimally invasive and safe, which is worthy of recommendation. [ABSTRACT FROM AUTHOR]