Repeat Transurethral Manipulation of Bulbar Urethral Strictures is Associated With Increased Stricture Complexity and Prolonged Disease Duration
ABSTRACT We examined the association of previous transurethral manipulation with stricture complexity and disease duration among men referred for bulbar urethral reconstruction.
We retrospectively reviewed the records of 340 consecutive urethroplasties performed by a single surgeon between July 2007 and October 2010. Only men treated with initial open surgery for bulbar strictures were included in analysis, thus excluding those with hypospadias, lichen sclerosus, pelvic radiation, prior urethroplasty, incomplete data, or pure penile or posterior urethral stenosis. Cases were divided into 2 groups based on the history of transurethral treatment for urethral stricture before urethroplasty, including group 1-0 or 1 and group 2-2 or greater treatments.
Of 101 patients with bulbar urethral stricture and all data available 50 and 51 underwent 0 to 1 and 2 or greater previous transurethral treatments, respectively. Repeat transurethral manipulation was strongly associated with longer strictures and the need for complex reconstruction. Repeat transurethral manipulation of bulbar urethral strictures was also associated with an eightfold increase in disease duration between stricture diagnosis and curative urethroplasty.
Repeat transurethral manipulation of bulbar strictures is associated with increased stricture complexity and a marked delay to curative urethroplasty.
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ABSTRACT: To review previous reports and present our experience on the outcomes after treating pelvic fracture urethral injuries (PFUIs) with primary endoscopic realignment (PER) vs. placing a suprapubic tube (SPT) with elective bulbomembranous anastomotic urethroplasty (BMAU).
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ABSTRACT: Purpose: We evaluated the clinical course of patients with pelvic fracture urethral injury referred to our institution to elucidate the differences between initial management strategies. Materials and Methods: We retrospectively reviewed our institutional review board approved, prospectively maintained urethroplasty database from 2007 to 2013. Patients with pelvic fracture urethral injury were stratified into 2 groups based on initial treatment before referral. Group 1 (21 of 38, 55%) was treated with suprapubic tube placement alone followed by elective bulbomembranous anastomotic urethroplasty and group 2 (17 of 38, 45%) underwent early primary endoscopic realignment. We recorded the number of endoscopic interventions and time from injury to successful definitive treatment. Data regarding stricture length, reconstruction technique and treatment outcomes were analyzed. Results: Among 766 urethroplasties performed during the study interval 38 (5%) consecutive pelvic fracture urethral injury cases were identified with complete information available and all underwent repair with excision with primary anastomosis. For suprapubic tube/bulbomembranous anastomotic urethroplasty cases the mean time to definitive resolution of stenosis was dramatically shorter (7 months, range 3 to 15) compared to primary endoscopic realignment cases (122 months, range 4 to 574; p < 0.01). The majority of patients treated with primary endoscopic realignment required multiple endoscopic urethral interventions (median 4, range 1 to 36; p < 0.01) and/or experienced various other adverse events which were rarely noted in the suprapubic tube/bulbomembranous anastomotic urethroplasty group (14 of 17 [82%] vs 2 of 21 [10%], p < 0.05). Conclusions: Treatment of pelvic fracture urethral disruption injuries with primary endoscopic realignment appears to be associated with unintended negative consequences including additional interventions and a prolonged clinical course.The Journal of Urology 06/2014; 192(6). DOI:10.1016/j.juro.2014.06.069 · 3.75 Impact Factor
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ABSTRACT: Die Urethrotomie nach Sachse ist die am häufigsten durchgeführte Behandlungsmethode bei Harnröhrenstrikturen. Sie stellt eine effektive kurzzeitige Therapieoption für diese Patienten dar, allerdings steigt die Rezidivrate deutlich mit zunehmendem Follow-up. Faktoren wie eine penile Lokalisation der Striktur, Spongiofibrose oder vorhergehende Operationen beeinflussen das Ergebnis der Urethrotomie negativ, und multiple Urethrotomien beeinflussen ihrerseits das Ergebnis einer offenen Harnröhrenrekonstruktion negativ. Eine ausführliche präoperative Diagnostik mit kombiniertem RUG/MCU und Urethrozystoskopie ist folglich essentiell, um Strikturlokalisation, -länge und Spongiofibrose beurteilen und Patienten bezüglich der Rezidivwahrscheinlichkeit und der Therapiealternativen aufklären zu können. Nach einer erfolglosen primären Urethrotomie sind Folgeurethrotomien als nicht kurativ anzusehen.Der Urologe 05/2013; 52(5). · 0.44 Impact Factor