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Li X, Xu C, Ji X, Zhu Z, Cai T, Guo Z, Lin J. Balloon dilation for the treatment of male urethral strictures: a systematic review and meta-analysis. BMJ Open 2024; 14:e071923. [PMID: 38320837 PMCID: PMC10860052 DOI: 10.1136/bmjopen-2023-071923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/22/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE The use of minimally invasive endoluminal treatment for urethral strictures has been a subject for debate for several decades. The aim of this study was to review and discuss the safety, efficacy and factors influencing the clinical application of balloon dilation for the treatment of male urethral strictures. DESIGN Systematic review and meta-analysis. DATA SOURCES Embase, Medline, Web of Science, Cochrane Library and Scopus were searched for publications published before 17 July 2022. STUDY SELECTION Two independent researchers screened and assessed the results, and all clinical studies on balloon dilation for the treatment of urethral strictures in men were included. DATA EXTRACTION AND SYNTHESIS The success rate, rate of adverse events, International Prostate Symptom Scores, maximum uroflow (Qmax) and postvoid residual urine volume were the main outcomes. Stata V.14.0 was used for statistical analysis. RESULTS Fifteen studies with 715 patients were ultimately included in this systematic review. The pooled results of eight studies showed that the reported success rate of simple balloon dilation for male urethral strictures was 67.07% (95% confidence interval [CI]: 55.92% to 77.36%). The maximum urinary flow rate at 3 months (risk ratio [RR]= 2.6510, 95% CI: 1.0681 to 4.2338, p<0.01) and the maximum urinary flow rate at 1 year (RR= 1.6637, 95% CI: 1.1837 to 2.1437, p<0.05) were significantly different after dilation. There is insufficient evidence to suggest that balloon dilation is superior to optical internal urethrotomy or direct visual internal urethrotomy (DVIU) (RR= 1.4754, 95% CI: 0.7306 to 2.9793, p=0.278). CONCLUSION Balloon dilation may be an intermediate step before urethroplasty and is a promising alternative therapy to simple dilation and DVIU. The balloon is a promising drug delivery tool, and paclitaxel drug-coated balloon dilation is effective in reducing retreatment rates in patients with recurrent anterior urethral strictures. The aetiology, location, length, previous treatment of urethral stricture may be associated with the efficacy of balloon dilation. PROSPERO REGISTRATION NUMBER CRD42022334403.
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Affiliation(s)
- Xiaoyu Li
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
| | - Chunru Xu
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
| | - Xing Ji
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
| | - Zhenpeng Zhu
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
| | - Tianyu Cai
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
| | - Zhenke Guo
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
| | - Jian Lin
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
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González-Espinosa C, Castro-Nuñez P, Averbeck MA, Gomez R, Castaño-Botero JC, Aparicio A, Moreno-Palacios J. Diagnosis and treatment of urethral stricture in men with neurogenic lower urinary tract dysfunction: A systematic review. Neurourol Urodyn 2022; 41:1248-1257. [PMID: 35686544 DOI: 10.1002/nau.24982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/16/2022] [Accepted: 05/24/2022] [Indexed: 11/05/2022]
Abstract
AIM To summarize available data focused on diagnosis and management of urethral stricture in men with neurogenic lower urinary tract dysfunction by a systematic review of the literature. MATERIALS AND METHODS A systematic review of the literature was carried out through an extensive electronic database search performed in PubMed/MEDLINE and Scopus databases for full texts, and International Continence Society, American Urology Association, and European Association of Urology abstracts for citations related to urethral structure. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. RESULTS A total of 316 articles were identified, 48 of which were selected for this review. Different strategies are currently being used for the management of urethral strictures, such as clean intermittent catheterization (CIC) which reduces stricture by up to 68%; direct vision internal urethrotomy which shows lower rates of renarrowing; urethroplasty which shows a success rate up to 70%; urinary diversion is the treatment of choice when reconstruction is not possible. CONCLUSIONS Further studies are needed in this population because of the heterogeneity of the outcomes and the lack of a standardized definition and classification of this population.
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Affiliation(s)
- Carlos González-Espinosa
- Urology Department, UMAE, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", IMSS, Ciudad de México, México
| | - Patricia Castro-Nuñez
- Urology Department, UMAE, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", IMSS, Ciudad de México, México
| | - Marcio A Averbeck
- Neuro-Urology Department, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Reynaldo Gomez
- Urology Department-Hospital del Trabajador, Santiago, Chile
| | | | | | - Jorge Moreno-Palacios
- Urology Department, UMAE, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", IMSS, Ciudad de México, México
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Long-Term Experience with Balloon Dilation for Short Bulbar and Membranous Urethral Strictures: Establishing a Baseline in the Active Drug Treatment Era. J Clin Med 2022; 11:jcm11113095. [PMID: 35683482 PMCID: PMC9181788 DOI: 10.3390/jcm11113095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/20/2022] [Accepted: 05/25/2022] [Indexed: 11/17/2022] Open
Abstract
Transurethral balloon dilation (BD) is a minimally invasive treatment for urethral stricture disease (USD) performed primarily or as a recurrence salvage maneuver. With the introduction of drug-coated balloons, we sought to characterize patient outcomes using non-medicated balloons. A retrospective review identified patients who underwent BD from 2007 to 2021. Patient and stricture characteristics were collected. All dilations employed the 24Fr UroMaxTM system. Clinical failure was defined by patient-reported lower urinary tract symptom recurrence or need for further stricture management. Ninety-one patients underwent BD with follow-up median (IQR) 12 (3–40) months. Most (75/91, 82%) had prior treatment for USD (endoscopic 50/91 (55%), 51/91 (56%) urethroplasty) before BD. Recurrence rates did not significantly differ between treatment-naïve and salvage patients (44% vs. 52% (p = 0.55)). Median (IQR) time to failure was 6 (3–13) months. The most common complications were urinary tract infection (8%) and post-operative urinary retention requiring catheterization (3%). Radiation history was noted in 33/91 (36%) with 45% recurrence. Patients without previous radiation had a similar recurrence rate of 52% (p = 0.88). Balloon dilation had minimal complications and overall, 50% recurrence rate, consistent regardless of stricture characteristics, radiation history, or prior treatments. These results represent an important clinical benchmark for comparing outcomes using drug-coated balloons.
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Abbosov S, Sorokin N, Shomarufov A, Kadrev A, Vitalevich M, Fozilov A, Nadjimitdinov Y, Alexsandrovich O, Giyasov S, Mukhtarov S, Akilov F, Kamalov A. Assessment of the balloon dilation efficiency in bladder neck contracture after transurethral interventions on the prostate. UROLOGICAL SCIENCE 2022. [DOI: 10.4103/uros.uros_148_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Azab SS. Comparative study between Amplatz renal dilator vs visual internal urethrotomy (cold knife) for the treatment of male urethral stricture. Scand J Urol 2020; 54:431-437. [PMID: 32723114 DOI: 10.1080/21681805.2020.1798504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM The study aimed to assess and compare urethral stricture (US) management outcomes, efficiency, and complications, treated by either Amplatz renal dilator or visual internal urethrotomy (VIU). PATIENTS AND METHODS This prospective comparative study was carried out on 88 male patients with stricture urethra. All patients have performed a physical examination, ascending and micturition urethrography, urodynamic, and pelvic ultrasound. The patients were randomized divided into group 1 (Amplatz group) 44 patients treated with Amplatz dilator, and group 2 (VIU group) 44 patients treated with a cold knife. Patients were followed up at 15 days,3,6, and 12 months after the procedure. RESULT The mean age was 41.2 (22-73) years. The mean stricture length in group 1 and group 2 was 1.01 ± 0.40 and 1.04 ± 0.30, respectively (p = 0.421). The average IPSS score at baseline for group 1 and group 2 was 21.2 and 21.9 points, respectively. During the 12 months follow-up, IPSS improved, with average scores of 16.1 and 17.3 for group 1 and group 2, respectively (p > 0.05). The mean values of (Q max) between group 1 and group 2 at baseline, day 15, day 90 and 180 days showed no significant difference but at 12 months, (Q max) showed a higher significant difference in group 1 than group 2 (p = 0.003). The post-void residual (PVR) displayed a significant decline in both groups from baseline. After 1 year, PVR showed that group 2 was a little higher than group 1 (no significance) compared to baseline The procedures were found effective without recurrence in all patients (both groups) during the 12 months (Q max > 15m/s). However, group 2 reported (11.4%) intra-operative bleeding, and (6.8%) extravasations. CONCLUSION The guided urethral dilation and internal urethrotomy are safe, short time procedures, and offer satisfactory results with the advance to VIUD in Qmax at 12 months. No recurrence was documented in both groups after 12 months. VIU reported 18% intraoperative complication.
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Affiliation(s)
- Sherif Salah Azab
- Urology Department, Faculty of Medicine, October 6 University, Cairo, Egypt
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Kelly D, Isaac I, Cruzado‐Perez J, Juvet F. Balloon dilation of a urethral stricture caused by a congenital obstructive proximal urethral membrane (COPUM) in a dog. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2020-001084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Darren Kelly
- Internal Medicine ServiceSouthern Counties Veterinary Specialists LLPRingwoodUK
| | - Ingrid Isaac
- Internal Medicine ServiceSouthern Counties Veterinary Specialists LLPRingwoodUK
| | | | - Florence Juvet
- Internal Medicine ServiceSouthern Counties Veterinary Specialists LLPRingwoodUK
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Abstract
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.
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Affiliation(s)
- James Furr
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Joel Gelman
- Department of Urology, University of California, Irvine, Orange, California, USA
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Yi YA, Rozanski AT, Shakir NA, Viers BR, Ward EE, Bergeson RL, Morey AF. Balloon dilation performs poorly as a salvage management strategy for recurrent bulbar urethral strictures following failed urethroplasty. Transl Androl Urol 2020; 9:3-9. [PMID: 32055459 PMCID: PMC6995931 DOI: 10.21037/tau.2019.08.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/23/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The optimal management strategy for recurrent urethral stricture disease (USD) following urethroplasty remains undefined. We aim to evaluate the role and efficacy of endoscopic urethral balloon dilation in temporizing recurrent USD after failed urethroplasty. METHODS Between 2007-2018 at our institution, 80 patients underwent balloon dilation procedures for bulbomembranous urethral strictures. Balloon dilation was performed with an 8-cm, 24-French UroMax Ultra™ balloon dilator, under direct vision, guided by a 16-French flexible cystoscope. Patients who underwent concomitant open or endoscopic urethral procedures were excluded. Treatment failure was defined as the need for subsequent surgical intervention for stricture recurrence. Stricture characteristics including etiology, length, location, severity stage, and prior surgical procedures were compared between patients with and without treatment failure. RESULTS Failure cases were more likely to have strictures following urethroplasty (21/27, 78%) [vs. the no-failure group (27/53, 51%)]. Among the 27/80 (33.8%) failures with a median follow-up of 8.4 months (IQR, 3.9-22.5 months), median time to recurrence was 4 months (IQR, 2-12 months). These patients had a greater incidence of prior stricture intervention in general (P=0.01) and prior urethroplasty specifically (P=0.03). On multivariable analysis, the number of prior treatments specifically independently remained associated with treatment failure. Complications of balloon dilation were uncommon (6/80, 7.5%) and minor in nature. CONCLUSIONS Endoscopic balloon dilation performs poorly as a salvage strategy after failed open urethral reconstruction in addition to prior urethral dilations.
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Affiliation(s)
- Yooni A Yi
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Nabeel A Shakir
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Boyd R Viers
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ellen E Ward
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rachel L Bergeson
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Allen F Morey
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
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Benincasa A, Saita A, Pinto A, Pilerci C, Francesco L, Russo A, Benincasa G. Double Intracavernous Breakage of Sachse's Knife Blade: Management of a Rare Complication Performing Direct Vision Internal Urethrotomy. J Endourol Case Rep 2017; 3:126-129. [PMID: 29098193 PMCID: PMC5655839 DOI: 10.1089/cren.2017.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Although the breakage of a Sachse's knife blade is already a rare event while performing optical internal urethrotomy, a double failure appears to be at the same time a unique and a challenging complication to manage since no reference has emerged from literature review. Case Presentation: A male patient, 80 years of age, underwent retreatment of recurrent urethral stricture that occurred after transurethral resection of the prostate. The latter was complicated by severe intraoperative urethrorrhagia; this is the reason he was transferred from another institution where at first a suprapubic cystostomy was carried out, followed by urethral recanalization through internal urethrotomy and finally he underwent intracavernous Sachse's knife blade discharge. Preoperative evaluation included combined retrograde and voiding urethrography and CT to evaluate the complete resolution of the urethral stenosis and to establish the correct location of the blades inside the corpus cavernosum. A transperineal approach to the left corpus cavernosum was carried out with manageable removal of the foreign body and postoperative assessment showed no early considerable complications for the patient. Conclusion: To our knowledge, this is the first case of double breakage of Sachse's knife blade performing optical internal urethrotomy reported in literature. Although it may appear to be an easy procedure, close attention to its execution must always be paid to prevent major complications. A transperineal approach has proven to be effective and safe without creating any further outcomes to the patient.
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Affiliation(s)
- Alfonso Benincasa
- Department of Urology, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Italy
| | - Alberto Saita
- Department of Urology, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Italy
| | - Angelo Pinto
- Department of Urology, San Luca Hospital, Vallo della Lucania, Italy
| | - Carmine Pilerci
- Department of Urology, San Luca Hospital, Vallo della Lucania, Italy
| | | | - Aniello Russo
- Department of Urology, San Luca Hospital, Vallo della Lucania, Italy
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Akkoc A, Aydin C, Kartalmıs M, Topaktas R, Altin S, Yilmaz Y. Use and outcomes of amplatz renal dilator for treatment of urethral strictures. Int Braz J Urol 2017; 42:356-64. [PMID: 27256192 PMCID: PMC4871399 DOI: 10.1590/s1677-5538.ibju.2014.0578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 09/09/2015] [Indexed: 11/21/2022] Open
Abstract
Introduction Urethral stricture disease is still a major problem in men. Many procedures are available for the treatment of urethral strictures; urethral dilatation is one of the oldest. The blind dilatation of urethral strictures may be a difficult and potentially dangerous procedure. The purpose of this study was to describe safe urethral dilatation using amplatz renal dilator and to report outcomes. Materials and Methods From 2010 to 2014, a total of 26 men with primary urethral strictures were managed by urethral dilatation using amplatz renal dilators. The parameters analyzed included presentation of patients, retrograde urethrography (RGU) findings, pre-and postoperative maximum flow rate (Qmax) on uroflowmetry (UF) and post-void residual urine (PVR). Patients were followed-up at 1.6 and 12 months. The technique described in this paper enables such strictures to be safely dilated after endoscopic placement of a suitable guidewire and stylet over which amplatz renal dilators are introduced. Results The mean age of the patients was 57.6 (35–72) years. The median stricture length was 0.82 (0.6–1.5)cm. Pre-operative uroflowmetry showed Qmax of 7.00 (4–12) mL/sec and ultrasonography showed PVR of 75.00 (45–195)mL. Postoperatively, Qmax improved to 18.00 (15–22)mL/sec (p<0.001) at 1 month, 17.00 (13–21)mL/sec (p<0.001) at 6 months and 15.00 (12–17)mL/sec (p<0.001) at 12 months. The post-operative PVR values were 22.50 (10–60)mL (p<0.001), 30.00 (10–70)mL (p<0.001) and 30.00 (10–70) mL (p<0.001) at 1.6 12 months, respectively. The median procedure time was 15.00 (12–22) minutes. None of the patients had a recurrence during a 12-month period of follow-up. Conclusion Urethral dilatation with amplatz renal dilators avoids the risks associated with blind dilatation techniques. This tecnique is a safe, easy, well-tolerated and cost-effective alternative for treatment of urethral strictures.
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Affiliation(s)
- Ali Akkoc
- Department of Urology, Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Cemil Aydin
- Department of Urology, Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Mahir Kartalmıs
- Department of Urology, Selahaddin Eyyubi State Hospital, Diyarbakir, Turkey
| | - Ramazan Topaktas
- Department of Urology, Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Selcuk Altin
- Department of Urology, Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Yakup Yilmaz
- Department of Urology, Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
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Antegrade cystoscopic light source guided laser urethrotomy for the treatment of completely obliterated urethra. UROLOGICAL SCIENCE 2017. [DOI: 10.1016/j.urols.2015.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Trela JM, Dechant JE, Culp WT, Whitcomb MB, Palm CA, Nieto JE. Use of an Absorbable Urethral Stent for the Management of a Urethral Stricture in a Stallion. Vet Surg 2016; 45:O41-O48. [DOI: 10.1111/vsu.12530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 05/26/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Jan M. Trela
- School of Veterinary Medicine; University of California-Davis; Davis California
| | - Julie E. Dechant
- School of Veterinary Medicine; University of California-Davis; Davis California
| | - William T. Culp
- School of Veterinary Medicine; University of California-Davis; Davis California
| | - Mary B. Whitcomb
- School of Veterinary Medicine; University of California-Davis; Davis California
| | - Carrie A. Palm
- School of Veterinary Medicine; University of California-Davis; Davis California
| | - Jorge E. Nieto
- School of Veterinary Medicine; University of California-Davis; Davis California
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Chhabra JS, Balaji SS, Singh A, Mishra S, Ganpule AP, Sabnis RB, Desai MR. Urethral Balloon Dilatation: Factors Affecting Outcomes. Urol Int 2016; 96:427-31. [PMID: 26845345 DOI: 10.1159/000443704] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/29/2015] [Indexed: 11/19/2022]
Abstract
UNLABELLED Background/Aims/Objectives: The study aims to review our experience with balloon dilatation of urethral strictures and retrospectively analyze predictors of improved success rates. METHODS One hundred and forty-four cases were analyzed from January 2011 to December 2012. Patients underwent balloon dilatation using 6-Fr Balloon dilator set (Cook Urological, Spencer, Ind., USA). Patients analyzed with respect to demography, uroflowmetry (Qmax) and need for auxiliary procedures in the immediate postoperative period, at 6 months and at 1 year. Comparisons were made between those who performed self-calibration against those who did not. RESULTS Overall success rate of balloon dilatation in our study was 84.4%. Procedural failure was observed with 3 patients (2.1%). Auxiliary procedure was required in 21 cases (15.6%) during follow-up. The mean Qmax (ml/s) in those who regularly performed self-calibration (n = 73) and in those who did not perform self-calibration (n = 39) in the immediate postoperative period, at 6 months and at 1 year were 24.2 ± 10.5, 16.5 ± 7.5, 14.4 ± 6.3 and 21.2 ± 10.6, 14.5 ± 7, 10.8 ± 5.6, respectively. Statistical significance was noted at 1 year (p = 0.003). Lesser re-treatments were required in those who performed self-calibration (12.3 vs. 20.5%). Improved success rates were noted with focal and bulbar strictures. Iatrogenic strictures and pan-anterior urethral strictures had poor outcomes despite self-calibration. CONCLUSIONS Balloon dilation with self-calibration significantly improves flow rates at 1 year and lessens auxiliary procedures required. It is simple, easy to perform under local anesthesia and repeatable in case of re-strictures.
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Affiliation(s)
- Jaspreet S Chhabra
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
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Djordjevic ML. Treatment of Urethral Stricture Disease by Internal Urethrotomy, Dilation, or Stenting. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.eursup.2015.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Tian Y, Wazir R, Yue X, Wang KJ, Li H. Prevention of stricture recurrence following urethral endoscopic management: what do we have? J Endourol 2014; 28:502-8. [PMID: 24341856 DOI: 10.1089/end.2013.0538] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Strictures of the urethra are the most common cause of obstructed micturition in younger men and there is frequent recurrence after initial treatment. This review was performed to determine the best strategy for stricture recurrence prevention following urethral endoscopic management. METHODS We reviewed the published literature in PubMed, the Cochrane Library, and Google Scholar focusing on this intractable problem regardless of language restrictions. Outcomes of interest included the study methods and the applied strategy's efficacy. The level of evidence and grade of recommendations of included studies were appraised with an Oxford Centre for Evidence-Based Medicine Scale. RESULTS Currently, numerous techniques, including catheterization, repeated dilation, brachytherapy, and intraurethral use of various antifibrosis agents, have been employed to oppose the process of wound contraction or regulate the extracellular matrix. But unfortunately, none of these techniques or agents have demonstrated efficacy with enough evidence. CONCLUSIONS Although lots of strategies are available, still, we do not have a suitable, single optimum solution for all the conditions. The clinical decision of stricture-recurrence-prevention techniques should be carefully tailored to every individual patient. As the studies are not sufficient, more efforts are warranted to address this interesting but challenging issue.
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Affiliation(s)
- Ye Tian
- Department of Urology, West China Hospital, Sichuan University , Chengdu, P.R. China
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Della Maggiore AM, Steffey MA, Westropp JL. Treatment of traumatic penile urethral stricture in a dog with a self-expanding, covered nitinol stent. J Am Vet Med Assoc 2013; 242:1117-21. [PMID: 23547676 DOI: 10.2460/javma.242.8.1117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION An 8-month-old castrated male mixed-breed dog was evaluated because of hematuria, stranguria, and dysuria of approximately 2 weeks' duration that developed immediately following elective castration. CLINICAL FINDINGS Results of physical examination, ultrasonography, retrograde double-contrast cystourethrography, and urethroscopy were consistent with a traumatic urethral stricture immediately proximal to the os penis resulting in a partial obstruction of urine outflow. Results of ultrasonographic examination of abdominal organs were considered normal. Digital radiography revealed no evidence of calculi. TREATMENT AND OUTCOME Balloon dilation of the urethral stricture was performed and was followed by 2 bougienage procedures during the subsequent 2 weeks when clinical signs returned. The owners declined scrotal urethrostomy, and a self-expanding, covered nitinol stent was placed approximately 3 weeks after the initial evaluation, resulting in amelioration of clinical signs. Results of follow-up urethroscopy and contrast cystourethrography 1 year after stent placement revealed a statically positioned, patent urethral stent, although a small number of polypoid mucosal structures were identified distal to the stent and 1 small structure consistent with tissue ingrowth into the stent was identified. CLINICAL RELEVANCE Placement of a covered nitinol stent resulted in long-term resolution of clinical signs associated with traumatic stricture of the penile urethra in this young dog. Because the os penis in dogs limits radial expansion of the urethra, its presence may limit the use of stents in this location.
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Affiliation(s)
- Ann-Marie Della Maggiore
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA
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Current world literature. Curr Opin Urol 2012; 22:521-8. [PMID: 23034511 DOI: 10.1097/mou.0b013e3283599868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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