The shorter the stricture, the less likely it is to recur after a dilation procedure. Jordan and Schlossberg reported 3 recurrences among patients undergoing primary repair, with a mean follow-up period of 44 months. Excision with primary anastomosis This form of repair for anterior urethral strictures is considered to be the criterion standard.
Direct vision internal urethrotomy DVIU is an endoscopic procedure performed under general anesthesia. Pansadoro and Emiliozzi demonstrated high recurrence rate for strictures greater than 1 cm.
Long-term follow-up of bulbar end-to-end anastomosis: A doctor may recommend surgery in the following circumstances: In patients who had undergone two or more prior urethral surgeries with significant spongiofibrosis, the success rate significantly deteriorated for the acellular matrix relative to buccal mucosa.
None of the patients required urethral dilatation in a mean follow-up period of 6. Consensus of genitourinary trauma: This study demonstrates promise for the use of acellular matrices as a viable option for urethral repair in patients with a healthy urethral bed, no fibrosis of the corpora spongiosis, and good urethral mucosa.
Endoscopic view of the angiographic catheter which served as a guide for the urethrotome. The treatment recommended may vary with the location, length, and severity of the stricture as well as an assessment of the risks and benefits of the procedure.
The tissue matrix that remains consists of collagen, elastin, growth factors, and macromolecules. This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The common procedures include direct vision internal urethrotomy DVIUurethral stent placement, and open urethral reconstruction. With a mean follow-up period of 25 months in patients with a healthy urethral bed, the success rates for the acellular bladder matrix were similar to those using buccal mucosa.
The glans penis distal is at the top of the photograph. A buccal mouth graft has been harvested from the inner aspect of the cheek.
Use of the laser to open up the scar tissue does not appear to be any better than using the knife.
Discussion Internal urethrotomy has advantages of ease, simplicity, speed, and short convalescence. In some cases, a catheter is able to be passed through the urethral injury into the bladder primary realignment at the time of injury, and the urethra is allowed to heal over the catheter.
The harvesting procedure is considered well-tolerated but does carry a risk of long-term complications. Optical internal urethrotomy offers faster recovery, minimal scarring, and less risk of infection, although recurrence is possible.
It has better long-term success rates than other therapies. A health care professional gently inserts thin rods of increasing diameters into the urethra from the tip of the penis meatus in order stretch the narrowing without causing any further injury to the urethra.
Schematic of penile anatomy.
Surgery is the recommended treatment for individuals with symptomatic urethral strictures. If they are placed distally, there is a risk of pain upon sitting and intercourse. Value of perineal ultrasonography for diagnosing anterior urethral strictures.
The angiographic catheter dotted arrow and the guidewire arrowhead have been inserted through the angiographic sheath into the bladder. Complications Postoperative urinary tract infection and wound infections are rare complications of surgery to repair urethral strictures.
Stem cells in urology. Drains, if necessary, are typically removed on postoperative day Oral pain over the harvest site resolves within the first month postoperatively.
Nat Clin Pract Urol. Treatment option depends on the type, length, and aetiology of stricture. Blunt perineal trauma, urological instrumentation, chronic inflammatory disorders such as lichen sclerosus et atrophicus, and sexually transmitted diseases are the most frequent causes of strictures; a large proportion are iatrogenic [ 1 ].
If a suprapubic tube is placed at the time of the pelvic injury, there is a high likelihood that a stricture will form. Parker DC, Simhan J. Erectile function after anterior urethroplasty. The pedicle of the flap left side originates from the dorsolateral aspect of the penis.
Open reconstructive techniques [ 12 ] Large series describing the use of an end-to-end anastomosis after excision of the strictured urethral segment report high success rates.Physicians typically place a urethral catheter after urethral stricture treatment as it may serve as a stent around which the site of urethral intervention can heal.
Urethral dilation is a commonly attempted technique for treating urethral strictures. Urethral stricture is a common condition that can lead to serious complications such as urinary infections and renal insufficiency secondary to urinary retention. Treatment options include catheterization, urethroplasty, endoscopic internal urethrotomy, and dilation.
Optical internal urethrotomy. Case Report A Simple Technique to Facilitate Treatment of Urethral Strictures with Optical Internal Urethrotomy KonstantinosStamatiou, 1 AggelikiPapadatou, 2 HippocratesMoschouris, 2 IoannisKornezos, 2 AnargirosPavlis, 2 andGeorgiosChristopoulos 2 Urology Department, Tzaneio General Hospital, Zanni &.
A simple technique to facilitate treatment of urethral strictures with optical internal urethrotomy. Urethral stricture is a common condition that can lead to serious complications such as urinary infections and renal insufficiency secondary to urinary retention. Treatment options include catheterization, urethroplasty, endoscopic internal.
An urethral stricture is a narrowing of a section of the urethra. It causes a blocked or reduced flow of urine which can result in a range of manifestations, from asymptomatic to severe discomfort. Moreover, it can lead to serious complications such as urinary infections and renal insufficiency secondary to urinary retention.
Nov 21, · Many techniques are available for the treatment of urethral stricture disease. Based on the literature, each technique clearly cannot be applied successfully to every situation.
Urologist who treats patients with urethral strictures must be experienced in several techniques.Download