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1
Palminteri, E., G. Barbagli, A. Mottola, and M. Rizzo. "Enlargement urethroplasty using retrospongious epidermal flap." Urologia Journal 65, no. 1 (1998): 59–61. http://dx.doi.org/10.1177/039156039806500112.
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Free or pedunculated skin flaps may be used to repair stenoses of the anterior urethra. The authors prefer using free preputial flaps in reconstructing the bulbar urethra which, having a spongy body, guarantees an adequate vascular and mechanical support for the transplanted flaps. The bulbar reconstruction technique uses an epidermal epithelial strip along the dorsal face of the urethra. The dorsal approach to the urethral channel prevents mechanical yielding of the transplanted area and consequent formation of symptomatic urethrocele. Dorsal enlargement urethroplasty has the advantage that invasion of both the area of skin removal and the urethral channel is reduced to a minimum.
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Joshi, Pankaj M., Marco Bandini, Christian Yepes, et al. "Flaps for bulbar urethral ischemic necrosis in pelvic fracture urethral injury." Plastic and Aesthetic Research 9, no. 3 (2022): 22. http://dx.doi.org/10.20517/2347-9264.2021.98.
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Bulbar urethral ischemic necrosis (BUIN) is an iatrogenic entity resulting from repeated attempts at performing anastomotic urethroplasty for pelvic fracture urethral injuries. Etiologically speaking, BUIN is related to a compromised blood supply of the bulbar urethra, which normally relies on anterograde supply from bulbar arteries and retrograde supply from recurrent branches of dorsal penile arteries, through the glans. At each transection of the bulbar urethra, both the anterograde and retrograde supplies are compromised, increasing the risk of BUIN. Even though this term is widely used among reconstructive urologists, BUIN is orphan of an accepted scientific definition. We aim to report our personal perspective on BUIN, to identify factors associated with its occurrence, and to describe the management options in these patients.
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Mladenovic, Ana, Daniel Yachia, Biljana Markovic, and Perica Adnadjevic. "Metal self-expandable covered temporary urethral stent Allium in patients with irreversibile uroobstruction: Ten-year experience." Acta chirurgica Iugoslavica 61, no. 3 (2014): 19–24. http://dx.doi.org/10.2298/aci1403019m.
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Aim of this study is to judge effectiveness of new design, temporary, cover, metal selective urethral Allium stents in lower urinary tract symptoms treatment concerning all peri and post procedural complications. Material and methods: We observed group of 40 patients with longstanding history of lower urinary tract symptom, in which outflow obstruction was localized in bulbar urethra in 24 pts and in prostatic urethra in 13 pts. Residual voiding volume and prostate volume measurements by ultrasonography, urethrocystography, urine culture and uroflowmetry (bulbar urethra stricture PTS) were done before stent insertion. Procedure was done in all cases but one in ambulatory conditions, under local anesthesia with oral antibiotics administration day before and 5 days after. Objective and subjective parameters of stent effectiveness were estimated and statistically revealed. Results: Majority of pts (32/40) were satisfied with all the aspects of the procedure and with quality of life while urethra was stented. Urinary infection did not happen in any case, encrustation of the migrated stent occurred in 2 cases (6,4%). Emptying of the bladder was adequate while wearing either prostatic or bulbar urethra stent. Residual volume was significantly smaller, urinary flow significantly higher. In pts with bulbar urethra stricture urinary flow and morphology of patent urethra lumen, 6 months after stent extraction suggested prolonged-permanent recanalisation results. Conclusion: Site specific, metal Allium urethral stents enable adequate emptying of the urinary bladder with minimal and transient patient discomfort. Stent insertion and explantation are simple procedures to perform, when correctly indicated without significant early and late complications.
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A, Berthe,, Ballo, B, Drago, A. A, et al. "Duplication of Hypospad of the Urethra Associated with Bulbar Stricture in a Young Man aged 29 Years: Case Report from the Urology Unit of the Bamako Commune I Reference Health Center." Scholars Journal of Medical Case Reports 12, no. 03 (2024): 243–46. http://dx.doi.org/10.36347/sjmcr.2024.v12i03.002.
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Urethral duplicity is a rare congenital malformation most commonly found in boys. Many anatomical forms have been described. The form associated with urethral stricture is a fairly rare combination. We report a case of hypospad urethral duplicity associated with bulbar urethral stricture. The patient was a 29-year-old male who presented with a double stream of urine associated with dysuria. On completion of the clinical and paraclinical examinations, we made the diagnosis of Effmann and Lebowitz type IB hypospade urethral duplicity associated with narrowing of the bulbar urethra. We proceeded to section the mucosal partition separating the 2 urethras from the meatus up to the bifurcation zone, followed by endoscopic internal uretrotomy of the stricture. Follow-up was straightforward and the result was deemed satisfactory after two years.
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Spilotros, Marco, Suzie Venn, Paul Anderson, and Tamsin Greenwell. "Penile urethral stricture disease." Journal of Clinical Urology 12, no. 2 (2018): 145–57. http://dx.doi.org/10.1177/2051415818774227.
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Patients affected by a urethral stricture account for a considerable cost to all healthcare systems. The estimated prevalence of all urethral stricture in the UK is 10/100,000 men during youth, increasing to about 40/100,000 by age 65 years and to more than 100/100,000 thereafter. A penile urethral stricture is a narrowing of the lumen of the urethra due to ischaemic fibrosis of the urethral epithelium and/or spongiofibrosis of the corpus spongiosum occurring within the penile urethra. Its aetiology is largely idiopathic but other important causes are failed hypospadias repair and lichen sclerosus, which account for 60% of all cases. Strictures of the anterior urethra account for 92% of cases: bulbar strictures are more frequent (46.9%), followed by penile (30.5%) and combined bulbar/penile (9.9%), that is, 40.4% of all men presenting with stricture will have a penile urethral stricture alone or in combination with a bulbar urethral stricture. There are several options for the treatment of penile urethral strictures ranging from less invasive treatments, including urethral dilatation and direct vision internal urethrotomy, to more complex augmentation graft and flap urethroplasty. The aim of the present review is to describe the aetiology and epidemiology of anterior urethral strictures and the available options reported in literature for their treatment. Level of evidence: 1a
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Chukwubuike, Kevin Emeka, Joseph Tochukwu Enebe, and Obinna Chukwuebuka Nduagubam. "Urethral injury in children: Experience in a teaching hospital in Enugu, Nigeria." Proceedings of Singapore Healthcare 29, no. 3 (2020): 151–55. http://dx.doi.org/10.1177/2010105820927423.
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Background: Urethral injury in children is uncommon, and its treatment is challenging. This study evaluated our experience in the management of urethral injuries in children who presented at the paediatric surgical unit of a teaching hospital in Enugu, Nigeria. Methods: The medical records of patients younger than 15 years old admitted to our centre with urethral injury from January 2008 and December 2017 were reviewed retrospectively. Results: During the period of the study, 11 cases (all male) were managed. The mean age of the patients at presentation was 11 years. Road traffic accident was the most common mechanism of injury, and the bulbar urethra was the most injured part of the urethra. All the patients had urethroplasty through the perineal approach. There was 90% success at first instance. One patient required redo urethroplasty. Conclusion: Urethral trauma is associated with considerable morbidity. Road traffic accident was the most common mechanism of injury, and the bulbar urethra was the part of the urethra most affected. Transperineal urethroplasty was an effective modality of treatment.
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Mukesh, Jaysawal, Ranjan Amit, and Alam Khursheed. "Clinico-Etiological Profile of the Urethral Stricture in Adult Patients: An Observational Study." International Journal of Current Pharmaceutical Review and Research 15, no. 12 (2023): 841–44. https://doi.org/10.5281/zenodo.11530983.
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AbstractAim: The aim of the present study was to assess the etiological spectrum of urethral stricture in adult patients.Methods: The present study was conducted in the Department of Surgery. We prospectively collected a database on all male patients with urethral stricture disease who underwent urethroplasty. In all patients, stricture wasdiagnosed and evaluated by retrograde urethrography combined with voiding cystourethrography. A total of 250male patients underwent urethroplasty. Of the patients 150 were 45 years old or older and 100 were younger than45 years.Results: In the penile urethra hypospadias surgery, idiopathy, urethral catheterization and lichen sclerosus werethe main causes. Hypospadias surgery was significantly more important as an etiology than etiologies at all otherlocations (p <0.005). Lichen sclerosus was the cause of stricture making it by far the most important etiology ofstricture in the distal penile area. In the bulbar urethra idiopathic strictures were most prevalent, followed by TUR.Idiopathic strictures were significantly more prevalent in the bulbar urethra than at other locations (p <0.001). Themain cause of multifocal or panurethral anterior stricture disease was urethral catheterization. Respectively 58and 125 were strictly located at the penile or the bulbar urethra. Panurethral or multifocal anterior urethralinvolvement was present in 32 patients. Posterior urethral strictures accounted for 35 cases.Conclusion: Iatrogenic causes such as TUR, urethral catheterization, cystoscopy, prostatectomy, brachytherapyand hypospadias surgery account for about half of the cases of urethral stricture disease treated with urethroplasty.Further research is needed on the cause of these so-called idiopathic strictures. Pelvic fracture was the main causeof posterior urethral stricture and an important cause in young patients. The etiology is significantly different inyounger vs older patients and among stricture locations
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Moorthy, Krishna, and Biju S. Pillai. "Urethro-urethral fistula: A rare cause of post-TURP incontinence." Canadian Urological Association Journal 8, no. 11-12 (2014): 916. http://dx.doi.org/10.5489/cuaj.2269.
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Prostatic abscess rarely follows acute prostatitis and can sometimes lead to a fistula by breaking into the prostatic urethra, peri-rectal tissues, the perineum, or the rectum. We report a case of a prostatic abscess tracking into the bulbar urethra after a transurethral resection of the prostate. This created a fistula, mimicking a urethral duplication and leading to urinary incontinence.
9
HG, Ibrahim. "Non-Neurogenic ‘Christmas Tree’ Urinary Bladder in A 30-Year-Old Man with Urethral Stricture: A Case Report." International Journal of Clinical Case Reports and Reviews 16, no. 1 (2024): 01–04. http://dx.doi.org/10.31579/2690-4861/361.
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condition the urinary bladder appears elongated and pointed with a thickened, trabeculated wall likened to a Christmas tree. It is most commonly the result of neurogenic bladder from detrusor hyperreflexia which most commonly occurs after spinal trauma. Christmas tree bladder also may rarely be seen in cases of bladder neck obstruction of non- neurogenic cause. A 30-year-old male presented with two weeks history of leakage of urine par the perineum. There was prior history of urethral discharge, poor urinary stream, urine dribbling and dysuria. No history of genital trauma, urethral instrumentation or catheterization in past. Attempt at passage of urethral catheter failed. He subsequently had open supra pubic cystostomy. Ultrasonography shows multiple internal echoes in the urine with thickened irregular bladder wall. The upper urinary tract was normal. Combine RUG and VCUG demonstrate short segments strictures at the bulbar and membranous urethra. A track of contrast column was noted from the region of the bulbar stricture to the exterior consistent with urethro-cutaneous fistula. The urinary bladder appears large, elongated superiorly with irregular outline resembling ‘Christmas tree’ configuration.
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Krukowski, Jakub, Adam Kałużny, Jakub Kłącz, and Marcin Matuszewski. "Comparison between cystourethrography and sonourethrography in preoperative diagnostic management of patients with anterior urethral strictures." Medical Ultrasonography 20, no. 4 (2018): 436. http://dx.doi.org/10.11152/mu-1613.
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Aim: To evaluate the urethral lesions and the degree of spongiofibrosis using cystourethrography (CUG) and sonourethrography (SUG) in order to propose the best imaging method for further surgical treatment.Material and methods: The study involved 66 patients with anterior urethral strictures with indication for urethroplasty. Results of CUG and SUG were compared with each other and data from surgical protocol.Results: Totally 72 strictures were detected; 47 in the bulbar part of urethra and 25 in the penile urethra. The mean length of the stenosis was 16.43 mm for CUG and 27.41 mm for SUG and 31.05 mm during surgery. The correlation levels between imaging techniques and intraoperative measurements were 0.55 (p<0.001) for CUG and 0.73 (p<0.001) for SUG. After dividing the strictures according to their location, better correlation for stenoses was obtained in penile urethra: 0.66 (p<0.001) for CUG and 0.86 (p<0.001) for SUG.Conclusions: SUG seems to be a simple and fast examination to evaluate urethral strictures. It is more accurate in comparison to CUG and gives a possibility to assess the spongiofibrosis. This information suggests that SUG can be a good complement to CUG in diagnosis of anterior urethtral strictures.
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Polyakov, N. V., N. G. Keshishev, A. D. Trofimchuk, et al. "The use of a buccal graft for urethroplasty of urethral strictures in men." Experimental and Сlinical Urology 13, no. 4 (2020): 120–25. http://dx.doi.org/10.29188/2222-8543-2020-13-4-120-125.
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Introduction. The urethroplasty of the urethral stricture disease is still a severe problem for surgeons. The aim of this study is to evaluate own results of buccal mucosa graft urethroplasty (BMGU) for the treatment of urethral stricture. Aim. Evaluation of own results of urethroplasty with a graft of the oral mucosa in the treatment of urethral strictures. Materials and methods. Between 01.08.2014 and 01.06.2020 we treated 136 patients with urethral stricture at our Medical Centers, where we provided buccal mucosa graft urethroplasty for bulbar and penile urethra. Results. The bulbar stricture was found among 105 patients of 136 (77,1 % cases), in which 64 had stricture in proximal part and 41 – in distal part of the urethra, 19 patients – in penile urethra and the other part had panurethral lesion. The median length of the stricture was measured as 3,8 ± 0,6 sm in the first three groups, and in the last group it was 10,4 ± 1,5 sm. At a median follow-up of 16,3 months 87,5% of patients in the first group, 90,2 % in the second, 84,2 % in the third and 83,3 % in the fourth group had no stricture recurrence and were satisfied with BMGU. Conclusion. For patients with urethral stricture disease, BMGU offers excellent success, morbidity with different techniques and methods, which statistically are equal to each other.
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Melonakos, Emmanuel J., and Richard A. Santucci. "Treatment of Low-Grade Bulbar Transitional Cell Carcinoma with Urethral Instillation of Mitomycin C." Advances in Urology 2008 (2008): 1–2. http://dx.doi.org/10.1155/2008/173694.
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A 63-year old man was referred to us after three rapid recurrences of low-grade urethral papillary transitional cell carcinoma of the bulbar urethra, after repeated primary excision. Cystoscopy confirmed 3-4 low-grade urethral transitional cell carcinomas, which were subsequently fulgurated. After urethral healing, a solution of Mitomycin C (40 mg/80 cc) was instilled into the urethra for fifteen minutes and held in place with a penile clamp. Urethral instillations were repeated weekly for six weeks. The patient is currently disease-free more than one year and three months posttreatment. This case highlights the successful treatment of urethral carcinoma with topical chemotherapy, which is usually reserved for the bladder, using a slight modification of standard technique.
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Singh, Preet Mohan, Bhavya Krishna, and Siddharth Yadav. "“Primary” bulbar urethral ischemic necrosis following pelvic fracture urethral injury: A rare surgical challenge." Indian Journal of Urology 40, no. 1 (2023): 62–64. http://dx.doi.org/10.4103/iju.iju_329_23.
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ABSTRACT Ischemic necrosis of the bulbar urethra in a patient with pelvic fracture urethral injury without a prior history of surgical intervention is extremely rare and results in long-segment obliterative strictures that are difficult to manage. Instead of the more traditional approach of vascular reconstruction followed by transpubic end-to-end urethroplasty, these patients are better managed by up-front urethroplasty with a tubed flap or as a staged procedure with grafting and tubularization. Herein, we report a case of primary bulbar urethral ischemic necrosis due to pelvic fracture managed with tubularized preputial flap (McAninch flap) urethroplasty.
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Kumar, Siddharth, Ankur Mittal, Vikas Kumar Panwar, and Arup Kumar Mandal. "Laser epilation of luminal hair following skin graft urethroplasty for hypospadias: the hair snare." BMJ Case Reports 14, no. 9 (2021): e244123. http://dx.doi.org/10.1136/bcr-2021-244123.
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A 66-year-old man, who underwent urethral reconstruction using skin grafts for hypospadias five decades earlier as a 13-year-old child, presented with burning micturition and recurrent UTI. A retrograde urethrogram along with micturating cystourethrogram revealed a bulbar urethral stricture and broad neck distal penile urethral diverticulum. On a cystourethroscopic examination, a urethral diverticulum was seen just proximal to the hypospadiac external urethral meatus with 12–15 hair follicles inside the diverticulum and a 1 cm long mid-bulbar stricture. Visual internal urethrotomy for the bulbar stricture, a diverticular neck incision, laser epilation and hair follicle photocoagulation was performed using a 30 W Ho:YAG laser. The depilated hair tufts were extracted. The process was repeated again in 6 months due to recurrent symptoms. A patent urethra with a wide open diverticulum without any residual hair follicles was confirmed. No perioperative complications noted and the patient is doing well on 1 month of follow-up.
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Agarwal, A., G. Sigdel, and WK Belokar. "A rare case of giant urethral calculus and multiple urethral diverticulum." Journal of College of Medical Sciences-Nepal 8, no. 2 (2012): 46–48. http://dx.doi.org/10.3126/jcmsn.v8i2.6838.
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Urethral stones in adults are rare and usually encountered with urethral stricture or diverticulum. We report a 54 years old gentleman who presented with urinary retention due to a large urethral calculus impacted in bulbar urethra with multiple stones in anterior and posterior urethral diverticulum. On examination a mass of size 5.5cmx4cmx3cm was palpable at anterior perineum with a fistulous tract from which pus was oozing out. On retrograde urethrogram a large urethral calculus with bulbar diverticulum and multiple radio opacity in prostatic area were revealed. Patient was managed by suprapubic cystostomy initially and later on by external urethrotomy, diverticulectomy, urethroscopic removal of multiple stones in prostatic urethral diverticulum and urethroplasty. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-2, 46-48 DOI: http://dx.doi.org/10.3126/jcmsn.v8i2.6838
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Bettez, Mathieu, Melanie Aubé, Mohamed El Sherbiny, Tatiana Cabrera, and Roman Jednak. "A bulbar artery pseudoaneurysm following traumatic urethral catheterization." Canadian Urological Association Journal 11, no. 1-2 (2017): 47. http://dx.doi.org/10.5489/cuaj.4050.
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Traumatic urethral catheterization may result in a number of serious complications. A rare occurrence is the development of a urethral pseudoaneurysm. We report the case of a 13-year-old male who required placement of a Foley catheter for an orthopedic surgical procedure. The Foley was misplaced in the bulbourethra, resulting in the development of a bulbar artery pseudoaneurysm. Profuse bleeding via the urethra was noted after removal of the catheter, and the patient experienced severe intermittent hematuria during the postoperative period. Cystoscopy revealed a pulsatile mass within the bulbourethra. Angiography confirmed a bulbar artery pseudoaneurysm, which was successfully embolized with resolution of bleeding.
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Ranno, S., R. Leonardi, G. Stracuzzi, G. Minaldi, and P. Miria. "Strictures and fistulas of the anterior urethra." Urologia Journal 64, no. 4 (1997): 400–404. http://dx.doi.org/10.1177/039156039706400405.
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– The first documents of urethral surgery for urethral strictures date back to the 4th century BC. In the past, endoscopic surgery was the best solution for most urologists. Nowadays, literature shows that the approach to urethral strictures depends on the degree of involvement of the spongy body. The choice of surgical reconstruction technique depends on the anatomical differences in the anterior portion of the urethra, which is divided anatomically into navicular, penile and bulbar. The gold standard for urethroplasty of the navicular urethra is the free graft which can take root due to the presence of glandular tissue. Techniques using a preputial pedunculated graft are good for penile urethra, while a free graft of preputial origin, that has first been perforated and then tubularised, is suggested for very long strictures (> 5 cm). Epidermal or mucosal free grafts can be used for bulbous urethral strictures, due to the presence of thick spongy tissue. The urethra should be completely substituted with a neo-urethra formed by preputial pedunculated and tubularised graft only for wide strictures with associated fibrosis of the spongy portion. Recurrent strictures can be treated twice with surgery.
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Coddington, Nathaniel, Margaret Higgins, Abrar Mian, and Brian Flynn. "Non-Transecting Urethroplasty for Bulbar Urethral Strictures—Narrative Review and Treatment Algorithm." Journal of Clinical Medicine 11, no. 23 (2022): 7033. http://dx.doi.org/10.3390/jcm11237033.
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The bulbar urethra is the most common site of stricture disease for which urethroplasty remains standard of care. A decrease in trauma as an etiology in the developed world and concerns regarding sexual dysfunction related to transection of the corpus spongiosum have placed a renewed emphasis on non-transecting urethroplasty techniques. Here, we present our surgical algorithm with emphasis on non-transecting techniques for bulbar urethral stricture disease and review the current state of literature comparing transecting to non-transecting approaches in order to provide guidance to practitioners on patient selection, counseling, and technique.
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Bertrand, L. A., S. P. Elliott, B. N. Breyer, and B. A. Erickson. "Management of Delayed Onset Postoperative Hemorrhage after Anastomotic Urethroplasty." Case Reports in Urology 2015 (2015): 1–4. http://dx.doi.org/10.1155/2015/646784.
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Excision with primary anastomosis (EPA) urethroplasty is generally the preferred method for short strictures in the bulbar urethra, given its high success rate and low complication rate compared to other surgical interventions. Bleeding is a presumed risk factor for any surgical procedure but perioperative hemorrhage after an EPA requiring hospitalization and/or reintervention is unreported with no known consensus on the best course for management. Through our experience with three separate cases of significant postoperative urethral hemorrhage after EPA, we developed an algorithm for treatment beginning with conservative management and progressing through endoscopic and open techniques, as well as consideration of embolization by interventional radiology. All the three of these cases were managed successfully though they did require multiple interventions. We theorize that younger patients with more robust corpus spongiosum and more vigorous spontaneous erections, patients that have undergone fewer prior urethral procedures and therefore have more prominent vasculature, and those patients managed with a two-layer closure of the ventral urethra without ligation of the transected bulbar arteries are at a higher risk for this complication.
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Shah, Amit Kumar, Dipesh Shrestha, and Sajid Iqbal. "Outcome of everted end-to-end urethroplasty in traumatic bulbar and membranous urethra." JMMC 9, no. 2 (2019): 55–59. http://dx.doi.org/10.62118/jmmc.v9i2.85.
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Introduction: Numerous options are available for the surgical management of urethral strictures. Everted End-to-end anastomosis is the utmost effective management for bulbar and membranous urethral strictures with a documented high success rate with low postoperative morbidity.
 Methodology: This study was conducted at department of Urology, Lahore General hospital, Lahore from May 2012 till May 2014. Total 30 patients were included in the study. Procedure was done by a single surgical team and Uroflowmetry and subjective evaluation was done on 2nd week, 1st month and 4th month and 12th month post operatively.
 Results: Mean age of patients was 24.43±12.39 years. Mean stricture length preoperatively was 1.83±0.63 cm. On follow up 50% of patients were in each grade whose subjective grading were 1 and 2 at 2 week post operatively. After 1-month post operatively 76.67% patients had Grade-1 and 6.67% patients had Grade-2. After 1 month follow up 63.34% patients presented with grade-1, 20% with Grade-2 and 6.67% presented with Grade-3. Only 80% of the patients at 4th month and 1-year post operatively presented with grade-1 subjective improvement. 10% of the patients had stricture recurrence at 1-month follow up and another 10% had recurrence at 4 months of follow up.
 Conclusion: Everted End-to-end urethroplasty is treatment of choice for short traumatic bulbar and membranous urethral strictures with a high success rate.
 Key Words: Urethral Strictures, Everted End-to-end Urethroplasty, Bulbar Urethra, Membranous Urethra
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Odeyemi, Peter Olalekan, Ibukun Adewumi Okunade, Najeem Adedamola Idowu, et al. "“Close-loop Urethral Stricture:" A Variant of Multiple Urethral Stricture Disease - Its Description, Management and Outcome: A Case Report." Sierra Leone Journal of Medicine 1, no. 2 (2024): 105–7. http://dx.doi.org/10.69524/sljm.v1i2.70.
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Abstract Urethral stricture disease is an abnormal narrowing and loss of distensibility of the urethra due to spongiofibrosis. It is commoner in young adult males. The management of this condition is diverse with various factors influencing the choice of treatment. However, length of the stricture is a major determinant of the choice of treatment. Two or more stricture sites close together are also treated as long segment stricture. Our aim is to describe a variant of multiple urethral strictures consisting of two short segment complete strictures involving the proximal bulbar urethral and urethral meatus with intervening significant length of normal urethra "close-loop stricture" in a 46-year old man who had traumatic urethral catheterization and was referred to the urology clinic six months following suprapubic tube cystostomy. KeywordsStricture, Meatotomy, Urethroplasty, Catheterization, Bouginage
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Abhulimen, Victor, and Vitalis Obisike Ofuru. "Aetiopathogenesis of urethral stricture disease in a tertiary hospital in Southern Nigeria." International Surgery Journal 10, no. 1 (2022): 11. http://dx.doi.org/10.18203/2349-2902.isj20223586.
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Background: The urethra provides passage for urine in both sexes and additionally for ejaculation in males. Urethral stricture disease (USD), results in the narrowing of the urethra due to spongiofibrosis. Understanding the pathology of this disease is important to treatment. This study aims to evaluate the aetiology, pathology and pathogenesis of USD at the University of Port Harcourt Teaching Hospital.Methods: This was a 6-year retrospective study conducted on all patients with features of USD who presented to the University of Port Harcourt Teaching Hospital UPTH. Ethical approval was sought and obtained from the hospital’s ethical committee. Data were obtained from ward admission, theatre, and discharge records. The information gotten included the age of the patient, aetiologic agent, site of stricture, number of strictures, length of stricture and complications present at the presentation. The data retrieved was analysed and categorical data were presented in the form of frequencies and percentages using tables. Continuous variables were presented as means and standard deviation. Results were presented in tables and charts.Results: The mean age from this study was 44.1±16.7 years. The commonest site of USD was bulbar with 74 (67.27%) patients. The commonest cause of urethral stricture was iatrogenic (41 patients).Conclusions: Strictures are commonest amongst middle-aged men. The commonest site of urethral stricture disease is the bulbar region because of its unique anatomy. Iatrogenic strictures are the commonest cause of urethra stricture disease.
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Tavakkoli Tabassi, Kamyar, and Alireza Ghoreifi. "Dorsally Placed Buccal Mucosal Graft Urethroplasty in Treatment of Long Urethral Strictures Using One-Stage Transperineal Approach." International Scholarly Research Notices 2014 (July 6, 2014): 1–6. http://dx.doi.org/10.1155/2014/792982.
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Objectives. To evaluate the results of one-stage buccal mucosal urethroplasty in treatment of long urethral strictures. Methods. This retrospective study was carried out on 117 patients with long urethral strictures who underwent one-stage transperineal urethroplasty with dorsally placed buccal mucosal grafts (BMG). Success was defined as no need for any intervention during the follow-up period. Results. Among 117 patients with mean age of 39.55±15.98 years, the strictures were located in penile urethra in 46 patients (39.32%), bulbar urethra in 33 (28.20%) and were panurethral in 38 (32.48%). The etiology of the urethral stricture was sexually transmitted disease (STD) in 17 (14.53%), lichen sclerosus in 15 (12.82%), trauma in 15 (12.82%), catheterization in 13 (11.11%), transurethral resection (TUR) in 6 (5.13%), and unknown in 51 (43.59%). The mean length of strictures was 9.31±2.46 centimeters. During the mean followup of 18.9±6.7 months success rate was 93.94% in bulbar strictures, 97.83% in penile strictures, and 84.21% in panurethral strictures (P value: 0.061). Conclusions. The success rate of transperineal urethroplasty with dorsally placed buccal mucosal grafts is equal in different sites of strictures with different etiologies. So reconstruction of long urethral strictures may be safely and effectively performed at a simple single operative procedure using this method of urethroplasty.
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Scutelnic, Ghenadie, and Edgar Gutu. "Urethral strictures. Diagnosis and treatment." InterConf, no. 32(151) (April 20, 2023): 473–78. http://dx.doi.org/10.51582/interconf.19-20.04.2023.050.
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Urethral strictures represent the intrinsic and permanent narrowing of the urethral lumen with urodynamic effects and genitourinary complications resulting from obstruction in the path of urine and seminal fluid elimination. In men, urethral stricture refers to a narrowed segment of the anterior urethra caused by a process of fibrosis and scarring of the urethral mucosa and surrounding spongiosum tissue ("spongiofibrosis"). In the male posterior urethra, there is no spongiosum tissue, and the term stenosis is preferred in this location. The definition of meatal stenosis is accepted as a distal narrowing at the level of the meatus, without involving the navicular fossa. There is no universal definition of female urethral stricture. Female urethral stricture is defined by most authors as "a fixed anatomical narrowing" that leads to a reduction in urethral caliber. This reduced urethral caliber is defined as being between <10 Fr and <20 Fr, with most studies defining it as <14 Fr, compared to the normal urethral caliber of 18-30 Fr. In transgender patients, the term stricture is used to define narrowing of the reconstructed urethra despite the absence of spongiosum tissue around it.[1] In men, a marked increase in incidence is observed after the age of 55, with a median age of 45.1 years. The estimated incidence is generally 229-627 cases per 100,000 men [2]. The anterior urethra is most commonly affected (92.2%), especially the bulbar urethra (46.9%) [3]. In women, 2-29% of patients with refractory lower urinary tract symptoms have obstructive flow at the level of the bladder, of which 4-20% will have urethral strictures [4]. There is a significantly increased incidence in women over 64 years of age. In children, most strictures are traumatic: iatrogenic causes account for 27.8-48% and external trauma for 34-72% of cases [1]. Congenital (13%), inflammatory (4%), or postinfectious (1%) strictures are less commonly observed. The bulbar urethra is the most frequently affected part of the urethra [1]. After hypospadias repair, meatal stenosis and urethral strictures are reported in 1.3-20% of cases, depending on the severity of hypospadias and the technique used [5]. There is a significantly higher incidence of this type of stricture in resource-rich countries due to a higher rate of surgical interventions. It has been reported that up to 18% of urethral strictures involving the meatus or navicular fossa are caused by surgical repair of hypospadias, lichen sclerosus, instrumental/traumatic causes, or idiopathic causes. Post-circumcision meatal stenosis has been reported in less than 0.2% of infants undergoing circumcision. In transgender patients ("trans men"), approximately 51% will suffer from a urethral stricture, while in "trans women" (male to female), the incidence is 14.4% [6].
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Bagchi, Puskal Kumar, Sarbartha K. Pratihar, Rajeev T. P., Sasanka K. Barua, Debanga Sarma, and Mandeep Phukan. "An audit of management of male urethral stricture and it’s outcome: a single centre retrospective review." International Surgery Journal 7, no. 3 (2020): 774. http://dx.doi.org/10.18203/2349-2902.isj20200821.
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Background: Anterior urethral stricture involves penile, bulbar or panurethra with varied aetiology. Direct vision internal urethrotomy (DVIU), stricture excision with primary end to end anastomosis, single stage or staged reconstruction with local flap or buccal mucosal graft (BMG) are surgical options.Methods: This single centre retrospective study was conducted from April 2017 to March 2019. Patient underwent DVIU, stricture excision with primary end to end anastomotic, staged urethroplasty, BMG urethroplasty (BMGU) dorsal inlay Asopa technique, dorsal onlay Kulkarni technique and ventral onlay technique depending on site and extent of strictures. Preoperative, intraoperative, post-operative data were reviewed.Results: Here, 51 patients underwent DVIU for single soft short segment bulbar urethral stricture with success rate 58.82%. 26 patients with post traumatic short segment bulbar urethral stricture underwent excision and primary end to end anastomosis with success rate 92.31%. Patients with long segment bulbar urethral stricture underwent either dorsal onlay (n=19) or ventral onlay (n=14) BMGU with success rate 89.47% and 85.71% respectively. Total 59 patients with long segment penile or pan urethral stricture underwent either single stage (n=27) or staged reconstruction (n=32) with success rate of 85.18% and 90.63% respectively. Patients with staged reconstruction had significantly longer hospital stay (p<0.0001) and poor quality of life due to laid opened urethra. Asopa’s dorsal inlay (n=15) and Kulkarni’s dorsal onlay (n=12) BMGU had equivalent success rate of 86.67% and 83.33% and comparable complications.Conclusions: Surgery for urethral stricture differs according to site and extent of stricture. Single stage BMG urethroplasty is preferred modality for long segment bulbar, penile and panurethral stricture.
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Ruiz, Sonia, Miguel Virseda-Chamorro, Fabian Queissert, Andrés López, Ignacio Arance, and Javier C. Angulo. "The Mode of Action of Adjustable Transobturator Male System (ATOMS): Intraoperative Urethral Pressure Measurements." Uro 1, no. 2 (2021): 45–53. http://dx.doi.org/10.3390/uro1020007.
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(1) Background: The Adjustable Transobturator Male System (ATOMS) device is increasingly used to treat post-prostatectomy incontinence as it enhances residual urinary sphincteric function and allows continence recovery or improvement by dorsal compression of the bulbar urethra through a fixed transobturator mesh passage. The mode of action and the profile of the patients with best results are not totally understood. (2) Methods: Intraoperative urethral pressure measurements at different filling levels of the ATOMS device show increased urethral resistance and enhanced residual sphincteric activity. We evaluated whether the pattern of urethral pressure change secondary to serial progressive intraoperative filling of the cushion can predict postoperative results after ATOMS placement. (3) Results: The regression analysis showed a significant direct relationship between cushion volume and intraurethral pressure (p = 0.000). The median intraurethral pressure at atmospheric pressure was 51 ± 22.7 cm H2O, and at atmospheric pressure plus 4 mL was 80 ± 23.1 cm H2O). Cluster analyses defined a group of patients (n = 6) formed by patients with a distensible urethra and 100% continence after adjustment in contrast to another group (n = 3) with rigid urethras and 33% continence after adjustment. (4) Conclusions: As a part of its continence mechanism, the ATOMS device leads to continence by increasing intraurethral pressure owing to the stretching effect on the urethral wall caused by cushion filling that increases urethral resistance.
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Hosseini, Jalil, Arshia Zamani Hajiabadi, and Ali Mohammad Mirjalili. "Ventral-Onlay Buccal Mucosal Graft Urethroplasty of a Perineal Fistula in a 26-Year-Old Patient With 46 XX Male Syndrome: A Case Report." American Journal of Men's Health 17, no. 2 (2023): 155798832311566. http://dx.doi.org/10.1177/15579883231156663.
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Substitution urethroplasty with either a flap or graft is the gold standard for treating long segment urethral strictures. In 1992, Burger and colleagues rediscovered and popularized buccal mucosal graft (BMG). After that El-Kassaby and colleagues, in 1993, used BMG to repair anterior urethral stricture. De la Chapelle syndrome or 46 XX male syndrome is a rare genetic disorder found in 1 in 20,000–25,000 men. This condition described as a presentation of male phenotype along a 46 xx karyotype. In this case report, we report a reconstructive surgery of a 46 XX male syndrome with ambiguous genitalia who presented with the chief complaint of bulbar urethral fistula opened in the perineal space. In this case, we used a buccal mucous graft with the ventral-onlay urethroplasty technique for reconstructing the failed bulbar urethra and closure of the fistula.
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Palminteri, E., G. Lombardi, F. Travaglini, and G. Barbagli. "New urethroplasty for treating anterior urethral stenosis." Urologia Journal 64, no. 4 (1997): 443–46. http://dx.doi.org/10.1177/039156039706400417.
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– Urethroplasties with free or pedicle preputial flaps are widely used in strictures of the spongy urethra. These techniques involve application of the preputial flap on the ventral surface of the urethra, with collapse of the spongy body and the frequent development of pseudodiverticula or urethroceles which are responsible for post-micturitional dribbling. The authors suggest a new urethroplasty for treating anterior urethral strictures, in which the free flap is applied dorsally and not ventrally, mechanically supported by the overlying spongy body and the underlying corpora cavernosa, and thus avoiding collapse of the flap. Thirty male patients with stenosis of the penile or bulbar urethra were treated with 2 different techniques using a free dorsal flap. Long-term results, with a mean follow-up of 34.5 months, were satisfying.
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Kobirnichenko, A. A., O. V. Shevchuk, and Y. O. Bidula. "Application of augmented anastomotic urethroplasty with buccal graft in treatment of decompensated posttraumatic urethral stricture of bulbar urethra (case report)." Urologiya 27, no. 1-2 (2023): 37–43. https://doi.org/10.26641/2307-5279.27.1-2.2023.291349.
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Introduction: treatment of decompensated urethral stricture is a challengeable issue of modern operative urology. Presented case of successful operative treatment of complex stricture of bulbous urethra with combination of anastomotic technique and augmentation by buccal graft. Case presentation: 54-years old male admitted to urology clinic of National Military Medical Clinical Center for the decompensated bulbous urethra stricture, previously repeatedly treated by internal optical urethrotomies and dilatations. During examination, almost complete obliteration of 4 cm segment of urethra was detected. Augmented anastomotic urethroplasty with application of buccal graft as substitution material was performed. After excision of obliterated and adjacent fibrous parts of urethra, end to end anastomosis on the ventral semicircle of urethra was performed with subsequent augmentation of defect on the dorsal wall by oral mucosa patch fixed to cavernous bodies. No recurrence observed after 5 months of observation. Augmented anastomotic urethroplasty is useful for treatment of complex posttraumatic strictures of bulbous urethra. Practicing urologists should know indications to all reconstructive treatment options and avoid repeated ineffective attempts of dilatations.
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Miah, Md Latifur Rahman, Moynul Hoque Chowdhuy, Anup Roy Chowdhuy, Md Shawkat Alam, Md Fazal Naser, and Md Safiul Alam Babul. "Short Term Outcome of Dorsal Onlay Buccal Mucosa Graft for the Management of Bulbar Urethral Stricture." Bangladesh Journal of Urology 22, no. 1 (2020): 15–19. http://dx.doi.org/10.3329/bju.v22i1.50069.
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Objective: To assess the success of buccal mucosal graft (BMG) urethroplasty by the dorsal onlay technique in long anterior urethral stricture (> 2 cm long).
 Method: This prospective interventional study was conducted in the Department of Urology, National Institute of Kidney Diseases and Urology, Sher-e-Bangla Nagar, Dhaka from January 2016 to December 2017 over a period of two years. Thirty three patients with primary and recurrent stricture of anterior urethra involving the bulbar urethra scheduled for single buccal mucosa graft urethroplasty were included in this study. Written consent was taken from each patient. Patients with stricture at posterior urethra or at distal penile urethra or stricture length <2 cm or above 6 cm were excluded from this study. Urethral malignancy cases were also excluded. All the patients were treated with dorsal onlay BMG urethroplasty.
 Results: Maximum patients were more than 40 years old. Mean age was 44.42 ± 7.43 years. Maximum patients had stricture more than 3 cm long. Mean length of stricture was 3.14 ± 0.65 cm. Cause of stricture was inflammatory (42.4%), idiopathic (27.3%), traumatic (21.2%) and iatrogenic (9.1%). Regarding clinical presentation, Poor urinary stream was found in 30 (90.9%) patients, urethral discharge in 12 (36.4%) patients, LUTS in 25 (75.8) patients and acute urinary retention in 9 (27.3) patients. Baseline peak urinary flow rate was 9.59 ± 1.68 ml/s. Peak urinary flow rate after 3 months of operation was 16.50 ± 2.19 ml/s and after 6 months of operation was 18.33 ± 4.40 ml/s. Post operative voided urine volume after 3 months of operation was 253.21 ± 41.22 ml and after 6 months of operation was 301.21 ± 50.38 ml. UTI was 3 (9.09) after 3 months and 5 (15.15) after 6 months of operation. Recurrence of stricture was 3 (9.09) after 3 months and 4 (12.12) after 6 months of operation. Urethra was seen narrow in 4 (12.12%) cases after 3 months and 6 (18.18%) cases after 6 months of operation. Regarding complications, Bleeding was in 4 (12.12%) cases, dribbling of urine in 5 (15.15%) cases, wound infection in 2 (6.06%) cases and 3 (9.09%) cases.
 Conclusion: Dorsal onlay BMG urethroplasty seems as an effective method for the management of long anterior urethral strictures.
 Bangladesh Journal of Urology, Vol. 22, No. 1, January 2019 p.15-19
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Gelman, Joel, and Eric S. Wisenbaugh. "Posterior Urethral Strictures." Advances in Urology 2015 (2015): 1–11. http://dx.doi.org/10.1155/2015/628107.
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Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty.
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Purnomo, Athaya, Paksi Satyagraha, and Kurnia Seputra. "Complex Complicated Posterior Urethral Stricture with Contracted Bladder and Prostatorectal Fistula: How Do We Manage It?" Medical Archives 77, no. 6 (2023): 493. http://dx.doi.org/10.5455/medarh.2023.77.493-495.
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Background: Posterior traumatic urethral strictures due to PFUI have a wide variety of complication, such as erectile dysfunction, incontinence, bulbar urethral necrosis, and fistula. Bulbar urethral necrosis caused by inadequate blood supply for bulbar urethra, fistula developed by many surgical attempts done by inexperience surgeon worsen the patient’s condition, low vascular capability manifested as erectile dysfunction as well, and long term catheterization causes contracted bladder. This condition deteriorates the function and quality of life. Therefore this is very challenging condition to treat. Case Presentation Thirty-years-old man presented with the chief complaint of urine leakage from rectum and cutaneous fistula since 9 years ago. Patient also come with complex PFUI, iatrogenic bulbar urethral necrosis, erectile dysfunction with EHS score of 1, contracted bladder, and prostatorectal fistula. Patient underwent eight various surgical procedures including open surgery and internal urethrotomy previously. We performed cystoprostatectomy and fistula repair transabdominally. Continent cutaneous stoma ileal neobladder with Mansoura approach was performed afterwards. Patient was counselled and educated on how to do clean intermittent self-catheterization, patient was fully satisfied with his bladder function which increase quality of life. Conclusion: In this case of BUN with contracted bladder and prostatorectal fistula, continent cutaneous stoma is an option to improve patient’s quality of life. PFUI could be treated with high success rate if treated properly from the beginning, more intervention by inexperience surgeon could deteriorate success rate and also quality of life.
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Tiwari, Kabir, Amit Mani Upadhaya, Ashok Kunwar, and Sanjesh Bhakta Shrestha. "Urethral Strictures and its Management at Tertiary Hospital of Nepal." Journal of Nepal Health Research Council 18, no. 2 (2020): 310–12. http://dx.doi.org/10.33314/jnhrc.v18i2.2503.
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Background: Urethral stricture can occur from urethral meatus to bladder neck. Treatment of urethral stricture include dilatation, endoscopic incision and anastomotic urethroplasty. The aim of this study is to report our experience in the management of different types of urethral strictures.Methods: We retrospectively reviewed the chart of all the patients of urethral stricture who received treatment at Kathmandu model hospital between January 2015 and October 2019. Different types of urethral stricture along with various modalities of treatment given were recorded.Results: Fifty patients were included in this study, all were males. Mean age was 49 (16-82) years. Bulbar urethra was the most common site in 54% of cases and bulbomembranous least common, only 10% of cases. Depending on sites and size of stricture, different types of surgery performed were meatoplasty, dviu and anastomotic urethroplasty.Conclusions: Urethral stricture is a troublesome disease and can occur anywhere from meatus to the bladder neck. Different surgical techniques are present and the treatment should be individualized, depending on location and length of the stricture.Keywords: Urethra; urethral stricture; urethroplasty
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Peng, Xufeng, Hailin Guo, Xinru Zhang, and Jihong Wang. "Straddle injuries to the bulbar urethra." Journal of Trauma and Acute Care Surgery 87, no. 4 (2019): 892–97. http://dx.doi.org/10.1097/ta.0000000000002388.
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YING-HAO, SUN, X. U. CHUAN-LIANG, GAO XU, LIAO GUO-QIANG, and HOU JIAN-GUO. "URETHROSCOPIC REALIGNMENT OF RUPTURED BULBAR URETHRA." Journal of Urology 164, no. 5 (2000): 1543–45. http://dx.doi.org/10.1016/s0022-5347(05)67024-3.
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Shahzad, Iqbal, Khadim Hussain, Muhammad Ali Yousuf, Mumtaz Manzoor, Ghulam Mustafa Pathan, and Tanveer Ahmed. "Buccal mucosa substitution urethroplasty." International journal of health sciences 7, S1 (2023): 2021–28. http://dx.doi.org/10.53730/ijhs.v7ns1.14448.
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Objective: We present our experience of buccal mucosa substitution urethroplasty in all segments of the Anterior urethra, as the buccal mucosal graft (BMG) is now recognized as the tissue of choice for single-stage reconstruction of bulbar urethral strictures. Patients and methods: Twenty-five patients underwent BMG substitution urethroplasty at our center between January 2015 and January 2019: 18 underwent a single-stage dorsal on lay BMG urethroplasty (pendulous, bulbous), 2 underwent a single-stage ventral onlay BMG urethroplasty (1 pendulous, 1 bulbous), 2 underwent an inlay buccal mucosa grafting (pendulous) followed by tabularization for six months. Results in terms of recurrence, comorbidities, and aesthetics were evaluated. Results: In six months follow-up period, 23 (88%) patients with a one-stage reconstruction remained stricture-free. One patient experienced a recurrence after 3 months and was treated with a one-stage optical urethrotomy, and another patient developed an urethro-cutaneous fistula and was treated with clean, self-intermittent catheterization once a day for 1 month, then twice a week for 3 months. Conclusion: When the anterior urethra is affected by a stricture, a BMG urethroplasty performed in a single stage is highly effective.
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Fourel, Mathieu, François-Xavier Madec, Gilles Karsenty, Olivier Puyuelo, François Marcelli, and Nicolas Morel-Journel. "Treatment of strictures of the male anterior urethra: Bulbar urethra." French Journal of Urology 34, no. 11 (2024): 102714. http://dx.doi.org/10.1016/j.fjurol.2024.102714.
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Tariq, Kifayat, Samiullah Opal, Sikandar Hayat, and Ihsanullah Khan. "Management of Patients with Urinary Stone Obstruction a Single-Center Study." Pakistan Journal of Medical and Health Sciences 16, no. 12 (2022): 416–17. http://dx.doi.org/10.53350/pjmhs20221612416.
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Aim: This study aims to characterize the clinical manifestations, location of the obstruction, and surgical intervention results of individuals with obstructive urethral stones. Study design: A single-center study Place and Duration: IKD Peshawar, Departboyst of Urology, from January 1, 2020, to January 1, 2021. Methods: 124 obstructive urethral stones were treated at IKD Peshawar. 4 to 14-year-old patients Obstructive urethral stones were treated surgically by removing the stone from the external urethral meatus (stone retrieval) with or without Meatotomy, retrograde manipulation (push back), and then cystolithoclasty or cystolitholapaxy, depending on the stone's position and size. Results: The mean age was 04±12.14 was between 10 and 12 years old. A total of 118 boys (98%), together with 06 girls (02%), were aged 13 and above. Sixty boys had stones in the proximal urethra (prostatic and membranous) or bulbar urethra, while 24 boys had stones in the external urethral meatus. Stones were found in the external urethral meatus of 60 boys individuals. Conclusion: For the most part, obstructive urethral stones may be managed with endoscopic therapy, but in certain situations, a minor operation like a meatotomy is necessary. Keywords: urethral obstruction, managment t, outcome, surgery, intervention
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Kanda, Shigeru, Osamu Takahara, and Takashi Ide. "Urethral Narrowing due to Ectopic Prostatic Tissue in the Bulbar Urethra." Urologia Internationalis 48, no. 4 (1992): 434–35. http://dx.doi.org/10.1159/000282371.
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Abuzeid, Abdel Moneim M., and M. S. Abdel Kader. "Reconstruction of Long Anterior Urethral Strictures by Dorsally Quilted Penile Skin Flap." ISRN Urology 2012 (March 4, 2012): 1–4. http://dx.doi.org/10.5402/2012/651513.
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Objective. To present the results of reconstruction of long (>5 cm), penile, bulbar, and bulbopenile urethral strictures by penile skin flap as dorsal onlay in one-stage procedure. Patients and Methods. Between January, 1998 and December, 2004, 18 patients (aged from 28-65 years) presented with long urethral strictures, 5.6–13.2 cm (penile in 6, bulbar in 2 and combined in 10 cases), those were repaired utilizing long penile skin flaps placed as dorsal onlay flap in one stage (Orandi flap 6 cm in 6 cases, circular flaps 7–10 cm in 8, and spiral flaps 10–15 cm in 4). Followup of all patients after reconstruction included urine flow rate at weekly intervals, RUG at 6–12 weeks, and urethrocystoscopy at 12 and 18 months. Results. The urethral patency was achieved in 77% of patients. The complications were fistula in one patient (5.5%), restricture occurred in 3 patients (16.6%) that required visual internal urethrotomy and two patients (11%) showed curvature on erection that dose not interfere with sexual intercourse. Diverticulum (penile urethra) was seen in one patient (5.5%) containing stones and was excised surgically. There was penile skin loss in 3 patients (16.6%). All patients completed at least one-year followup period. Conclusion. Free penile skin flaps offer good results (functional and cosmetic) in long penile and/or bulbar urethral strictures. Meticulously fashioned longitudinal, circular or spiral penile skin flaps could bridge urethral defects up to 15 cm long.
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Mukhtarov, Sh T., F. R. Nasirov, M. M. Bakhadirkhanov, et al. "Endoscopic treatment for bulbar-membranous urethral obliteration: evaluation of the efficacy and safety." Urology Herald 10, no. 4 (2022): 79–87. http://dx.doi.org/10.21886/2308-6424-2022-10-4-79-87.
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Introduction. The problem of endoscopic treatment for urethral strictures and obliterations remains unresolved. It is necessary to note that the effectiveness depends not only on the right indications, but also on the surgical technique and the study of the postoperative period management.Objective. To evaluate the efficacy and safety of endoscopic treatment of patients with bulbar-membranous urethral obliteration.Materials and methods. The study included 103 patients aged 20 to 89 years with bulbar-membrane urethral obliteration, who, for some reason or another, cannot perform urethroplasty. The patients underwent endoscopic recanalization of the urethra under X-ray control with further circular transurethral electroresection (TUR) of the scar tissues in the urethral obliteration zone (after 6 – 7 days).Results. The average age of the patients was 61.1 ± 18.3 years. After the operation, self-urination was restored in all patients. The average maximum urine flow rate (Q max) before discharge from the hospital was 12.6 ± 0.5 ml/s. Throughout the follow-up period, Q max tended to increase and at the end of the study (36 months) reached values of 16.5 ± 0.5 ml/s. During the first year of follow-up, 18 (17.5%) patients developed recurrent urethral stricture. Seventeen (16.5%) patients underwent repeated circular TUR of scar tissue in the zone of recurrent stricture. The effectiveness of the treatment was 90.0%.Conclusion. Endoscopic urethral recanalization followed by TUR of scar tissue in the obliteration zone is an effective and safe method in the treatment of bulbar-membranous urethral obliteration with length less than 1.0 cm.
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Samuel B and Iya-Benson J. "Sonographic evaluation of male anterior urethral strictures: Correlation with retrograde urethrography – A review." Ibom Medical Journal 11, no. 2 (2018): 7–14. http://dx.doi.org/10.61386/imj.v11i2.171.
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In general, the term urethral stricture refers to a fibrous scarring of the urethra caused by collagen and fibroblast proliferation.1-3 The scarring process can extend through the tissue of the corpus spongiosum into adjacent structures and this associated scarring in the surrounding corpus spongiosum is known as spongiofibrosis.1,4 Contraction of this scar reduces the width of the urethral lumen. Bulbar urethral strictures represent the overwhelming majority of cases, while prostatic urethral strictures are rare.5 The causes of anterior urethral strictures may be inflammatory (e.g., infectious urethritis, balanitis xerotica obliterans), traumatic (straddle injury, iatrogenic instrumentation) or congenital.1,6 However, most urethral strictures are the result of infection, instrumentation or other iatrogenic causes.1 The most common external cause of traumatic stricture is straddle injury.1,7 The male urethra is longer than that of the female and traverses through several anatomical structures such as the prostate, urogenital diaphragm, and corpus spongiosum of the penis, it is therefore more vulnerable to injury and stricture than the female urethra.1,8 Inflammatory strictures associated with gonococcal urethritis have become less common despite the fact that gonococcus remains the most common sexually transmitted disease.1 In developing countries, infection is the predominant cause of anterior urethral stricture, unlike in the developed world where trauma is the predominant cause.9-13 Iatrogenic trauma to the urethra may result from pressure necrosis at fixed points in the urethra from indwelling catheters.1 Instrumentation-related strictures usually occur in the bulbomembranous region and, less commonly, at the penoscrotal junction.1 Congenital hypospadias could be associated with urethral stricture, and following repair of hypospadias, there is an increased likelihood of post-surgical stricturing.14There is currently progressive increase in the incidence of urethral stricture due to the increased number of permanent catheter bearers, the surge of sexually transmitted diseases, and misuse of transurethral diagnostic or therapeutic instrumentation.1,6
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Bondavalli, C., C. Pegoraro, L. Schiavon, et al. "Uretroplastica a lembo libero dorsale." Urologia Journal 64, no. 1_suppl (1997): 127–28. http://dx.doi.org/10.1177/039156039706401s31.
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The Authors report their experience in the new urethroplasty technique by Barbagli for penile and bulbar urethral strictures. This procedure involves a free skin graft sutured to the corpora cavernosa. With this dorsal approach mechanical weakening is virtually impossible, so pseudo-diverticulum or urethrocele cannot develop. We adopted this technique in 5 patients during the last 12 months. The strictures of the urethra were 2.5 to 8 cm long. The follow-up, even thought short, show that this technique is safe and quite simple.
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Markovic, B., Z. Markovic, J. Filimonovic, and J. Hadzi-Djokic. "New generation urethral stents in treatment bladder outlet obstruction caused by prostate cancer." Acta chirurgica Iugoslavica 52, no. 4 (2005): 89–92. http://dx.doi.org/10.2298/aci0504089m.
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Our clinical trial included until now, 22 patients in whom new generation urethral stent named Allium, were inserted due to bladder outlet obstruction caused in 7 patients (pt) with benign prostae hyperplasia, in 13 pt with bulbar urethral stricture of different ethiology and in 2 pt with prostate cancer. Allium prostatic stents, designed by Daniel Yachia differs in some crucial characteristics from previously used stents: they are covered for the first time in urethra stenting history, without relatively low radiation force and because of that nonirritative. the indications, contraindications and preliminary results in this study are discussed concerning the patients with cancer of the prostate.
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Kashinath V Thakare, Tappa Mahammad Mustaq Rasool, Abhiram Kucherlapati, Ifrah Ahmad Qazi, Veda Murthy Reddy Pogula, and Mude Sai Priyanka. "Observational study on histopathology of male anterior urethral stricture: Toward better understanding of stricture pathophysiology." Asian Journal of Medical Sciences 14, no. 4 (2023): 172–77. https://doi.org/10.71152/ajms.v14i4.3752.
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Background: Stricture urethra is generally limited to anterior urethra. At present, there are only a few studies which focus exclusively on the histopathology of stricture urethra disease. Aims and Objectives: The aims of this study were to assess the urethral stricture pathology specimens for determining the severity of chronic inflammation and characteristics of stricture, demographics, and patient-reported outcome measures in patients with inflammatory and non-inflammatory strictures. Materials and Methods: This was a prospective and observational study done on 60 male patients of anterior urethral stricture disease who underwent excision biopsy of stricture during urethroplasty. Pre-operative urinary symptoms assessment was done with a questionnaire provided to all patients and data maintained to assess patient-reported outcomes in inflammatory and non-inflammatory stricture urethra. Cohorts comprising strictures with no inflammation, mild, and moderate to severe inflammation were developed and stricture, the patient characteristics were compared. Results: In a total of 60 histopathological stricture specimens, there was no inflammation in 40%, mild and moderate inflammation was in 28% and 3.3%, respectively. Lichen sclerosis-related strictures had moderate to severe inflammation and most of the strictures were in bulbar urethra (51.6%). Patients with BXO changes showed more inflammation. In patients with inflammatory strictures, hesitancy, straining, and stream were statistically more compared to non-inflammatory strictures. Idiopathic is the most predominant etiology for stricture which showed no inflammation. Conclusion: Histopathological analysis of urethral stricture showed significant tissue heterogeneity in clinically similar strictures. Chronic inflammation was commonly found in stricture specimens indicating active antigen presentation for underlying pathology and patients with inflammatory strictures reported worse health outcomes.
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Kashinath V Thakare, Tappa Mahammad Mustaq Rasool, Abhiram Kucherlapati, Ifrah Ahmad Qazi, Veda Murthy Reddy Pogula, and Mude Sai Priyanka. "Observational study on histopathology of male anterior urethral stricture: Toward better understanding of stricture pathophysiology." Asian Journal of Medical Sciences 14, no. 4 (2023): 172–77. http://dx.doi.org/10.3126/ajms.v14i4.48795.
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Background: Stricture urethra is generally limited to anterior urethra. At present, there are only a few studies which focus exclusively on the histopathology of stricture urethra disease. Aims and Objectives: The aims of this study were to assess the urethral stricture pathology specimens for determining the severity of chronic inflammation and characteristics of stricture, demographics, and patient-reported outcome measures in patients with inflammatory and non-inflammatory strictures. Materials and Methods: This was a prospective and observational study done on 60 male patients of anterior urethral stricture disease who underwent excision biopsy of stricture during urethroplasty. Pre-operative urinary symptoms assessment was done with a questionnaire provided to all patients and data maintained to assess patient-reported outcomes in inflammatory and non-inflammatory stricture urethra. Cohorts comprising strictures with no inflammation, mild, and moderate to severe inflammation were developed and stricture, the patient characteristics were compared. Results: In a total of 60 histopathological stricture specimens, there was no inflammation in 40%, mild and moderate inflammation was in 28% and 3.3%, respectively. Lichen sclerosis-related strictures had moderate to severe inflammation and most of the strictures were in bulbar urethra (51.6%). Patients with BXO changes showed more inflammation. In patients with inflammatory strictures, hesitancy, straining, and stream were statistically more compared to non-inflammatory strictures. Idiopathic is the most predominant etiology for stricture which showed no inflammation. Conclusion: Histopathological analysis of urethral stricture showed significant tissue heterogeneity in clinically similar strictures. Chronic inflammation was commonly found in stricture specimens indicating active antigen presentation for underlying pathology and patients with inflammatory strictures reported worse health outcomes.
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Maiti, Krishnendu, Siddharth Saraf, Chhanda Datta, and Dilip Kumar Pal. "PRIMARY TRANSITIONAL CELL CARCINOMA OF BULBAR URETHRA." Indian Journal of Case Reports 4, no. 1 (2018): 40–42. http://dx.doi.org/10.32677/ijcr.2018.v04.i01.014.
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Memon, Sameer, A. Craig Lynch, Laurence Cleeve, Declan G. Murphy, Miklos J. Pohl, and Alexander G. Heriot. "Squamous Cell Carcinoma of the Bulbar Urethra." Journal of Clinical Oncology 29, no. 28 (2011): e733-e735. http://dx.doi.org/10.1200/jco.2011.36.5890.
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Kulkarni, Sanjay. "Stop transecting bulbar urethra for nontraumatic strictures!!" International Journal of Reconstructive Urology 1, no. 2 (2023): 59. http://dx.doi.org/10.4103/ijru.ijru_20_23.
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Shahrour, Walid, Pankaj Joshi, Craig B. Hunter, et al. "The Benefits of Using a Small Caliber Ureteroscope in Evaluation and Management of Urethral Stricture." Advances in Urology 2018 (November 21, 2018): 1–5. http://dx.doi.org/10.1155/2018/9137892.
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Introduction and Objective. The proper evaluation of urethral strictures is an essential part of the surgical planning in urethral reconstruction. The proper evaluation of the stricture can be challenging in certain situations, especially when the meatus is involved. We propose that the use of a small caliber ureteroscope (4.5 Fr and 6.5 Fr) can offer additional help and use for the surgical planning in urethroplasty. Methods. We prospectively collected data on 76 patients who underwent urethroplasties in Kulkarni Reconstructive Urology Center, Pune, India and Thunder Bay Regional Health Sciences Center, Thunder Bay, Canada. Patients had retrograde and micturition urethrograms performed preoperatively. The stricture was assessed visually using a 6.5 Fr ureteroscope. If the stricture was smaller than 6.5 Fr, we attempted using the 4.5 Fr ureteroscope. In nonobliterated strictures, we attempted bypassing the stricture making sure not to dilate the stricture. A glide wire would be passed to the bladder under vision. Stricture length, tissue quality, presence of other proximal strictures, false passages, and bladder tumors or stones would be assessed visually. If the penile stricture was near obliterative (smaller than 4.5 Fr caliber), a two-staged procedure is elected to be performed. For proximal bulbar strictures, if the urethral caliber is less than 4.5 Fr and the stricture length is less than 1 cm, we perform a nontransecting anastomotic urethroplasty (NTAU). If the stricture length is >1 cm, we perform a double-face augmented urethroplasty (DFAU). If the urethral caliber is >4.5 Fr and particularly those who are sexually active, ventral inlay with buccal mucosal grafts (BMGs) is performed. In mid to distal bulbar strictures, if the urethral caliber is >4.5 Fr, our procedure of choice is dorsal onlay with BMG. For those with urethral caliber <4.5 Fr and a stricture less than 1 cm, we perform a NTAU. For strictures longer than 1 cm, we perform a DFAU. With the exception of trauma, we very rarely transect the urethra. For panurethral strictures, we almost exclusively perform Kulkarni one-sided dissection. Results. Urethroscopy was performed in 76 patients who presented for urethroplasty from July 2014 to September 2014 (in Pune) and between April 2016 and September 2017 (in Thunder Bay). Bypassing the stricture was achieved in 68 patients (89%) while it was unsuccessful in 8 patients (11%). In all unsuccessful urethroscopies, the stricture was near obliterative <4.5 Fr. Our surgical planning changed in (13) 17% of the cases. Out of 43 bulbar strictures, the decision was changed in (9) 21% where we performed 4 DFAU, 3 AAU (augmented anastomotic urethroplasty), and 2 EAU (end anastomotic urethroplasty). In 13 penile strictures, we opted for staged urethroplasty including 3 Johansons and 1 first-stage Asopa in 30.7%. In 20 panurethral urethroplasties, 1 patient (5%) had a urethral stone found in a proximal portion of the bulbar urethra distal to a stricture ring that was removed using an endoscopic grasper. Conclusion. The use of the small caliber ureteroscope can help in evaluation of the stricture caliber, length, and tissue quality. The scope can also aid in placing a guide wire, evaluating the posterior urethra, and screening for urethral or bladder stones. It can also improve the preoperative patient counselling and avoid unwanted surprises.