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Shimizu S. Insights into the associative role of hypertension and angiotensin II receptor in lower urinary tract dysfunction. Hypertens Res 2024; 47:987-997. [PMID: 38351189 DOI: 10.1038/s41440-024-01597-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/05/2024] [Accepted: 01/13/2024] [Indexed: 02/16/2024]
Abstract
In men, the lower urinary tract comprises the urinary bladder, urethra, and prostate, and its primary functions include urine storage and voiding. Hypertension is a condition that causes multi-organ damage and an age-dependent condition. Hypertension and the renin-angiotensin system activation are associated with the development of lower urinary tract dysfunction. Hypertensive animal models show bladder dysfunction, urethral dysfunction, and prostatic hyperplasia. In the renin-angiotensin system, angiotensin II and the angiotensin II type 1 receptor, which are expressed in the lower urinary tract, have been implicated in the pathogenesis of lower urinary tract dysfunction. Moreover, among the several antihypertensives, renin-angiotensin system inhibitors have proven effective in human and animal models of lower urinary tract dysfunction. This review aimed to elucidate the hitherto known mechanisms underlying the development of lower urinary tract dysfunction in relation to hypertension and the angiotensin II/angiotensin II type 1 receptor axis and the effect of renin-angiotensin system inhibitors on lower urinary tract dysfunction. Possible mechanisms through which hypertension or activation of Ang II/AT1 receptor axis causes LUTD such as bladder dysfunction, urethral dysfunction, and prostatic hyperplasia. LUT: lower urinary tract, LUTD: lower urinary tract dysfunction, AT1: angiotensin II type 1, ACE: angiotensin-converting enzyme.
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Affiliation(s)
- Shogo Shimizu
- Department of Pharmacology, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku, 783-8505, Japan.
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Luo H, Lou KC, Xie LY, Zeng F, Zou JR. Pharmacotherapy of urethral stricture. Asian J Androl 2024; 26:1-9. [PMID: 37738151 PMCID: PMC10846832 DOI: 10.4103/aja202341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/21/2023] [Indexed: 09/24/2023] Open
Abstract
Urethral stricture is characterized by the chronic formation of fibrous tissue, leading to the narrowing of the urethral lumen. Despite the availability of various endoscopic treatments, the recurrence of urethral strictures remains a common challenge. Postsurgery pharmacotherapy targeting tissue fibrosis is a promising option for reducing recurrence rates. Although drugs cannot replace surgery, they can be used as adjuvant therapies to improve outcomes. In this regard, many drugs have been proposed based on the mechanisms underlying the pathophysiology of urethral stricture. Ongoing studies have obtained substantial progress in treating urethral strictures, highlighting the potential for improved drug effectiveness through appropriate clinical delivery methods. Therefore, this review summarizes the latest researches on the mechanisms related to the pathophysiology of urethral stricture and the drugs to provide a theoretical basis and new insights for the effective use and future advancements in drug therapy for urethral stricture.
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Affiliation(s)
- Hui Luo
- The First Clinical College, Gannan Medical University, Ganzhou 341000, China
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
| | - Ke-Cheng Lou
- The First Clinical College, Gannan Medical University, Ganzhou 341000, China
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
| | - Ling-Yu Xie
- The First Clinical College, Gannan Medical University, Ganzhou 341000, China
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
| | - Fei Zeng
- The First Clinical College, Gannan Medical University, Ganzhou 341000, China
| | - Jun-Rong Zou
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
- Institute of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
- Jiangxi Engineering Technology Research Center of Calculi Prevention, Ganzhou 341000, China
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Prospects and Challenges of Electrospun Cell and Drug Delivery Vehicles to Correct Urethral Stricture. Int J Mol Sci 2022; 23:ijms231810519. [PMID: 36142432 PMCID: PMC9502833 DOI: 10.3390/ijms231810519] [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] [Received: 07/30/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
Current therapeutic modalities to treat urethral strictures are associated with several challenges and shortcomings. Therefore, significant strides have been made to develop strategies with minimal side effects and the highest therapeutic potential. In this framework, electrospun scaffolds incorporated with various cells or bioactive agents have provided promising vistas to repair urethral defects. Due to the biomimetic nature of these constructs, they can efficiently mimic the native cells’ niches and provide essential microenvironmental cues for the safe transplantation of multiple cell types. Furthermore, these scaffolds are versatile platforms for delivering various drug molecules, growth factors, and nucleic acids. This review discusses the recent progress, applications, and challenges of electrospun scaffolds to deliver cells or bioactive agents during the urethral defect repair process. First, the current status of electrospinning in urethral tissue engineering is presented. Then, the principles of electrospinning in drug and cell delivery applications are reviewed. Finally, the recent preclinical studies are summarized and the current challenges are discussed.
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The effect of intraurethral hyaluronic acid on healing and fibrosis in rats with experimentally induced urethral trauma. Int Urol Nephrol 2022; 54:757-761. [DOI: 10.1007/s11255-022-03128-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/16/2022] [Indexed: 11/25/2022]
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The use of local therapy in preventing urethral strictures: A systematic review. PLoS One 2021; 16:e0258256. [PMID: 34614033 PMCID: PMC8494308 DOI: 10.1371/journal.pone.0258256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/22/2021] [Indexed: 12/09/2022] Open
Abstract
Background Urethral stricture disease is a common problem amongst men in Western countries often leading to a decreased quality of life. Current endoscopic treatment procedure shows an unsatisfying stricture recurrence rate which could be improved by addition of local therapies. Objectives To provide an overview of both preclinical and clinical studies in order to investigate current level of evidence on the addition of local therapy to improve urethral stricture recurrence rates after endoscopic procedures. Methods We performed a literature search in December 2020 and August 2021 using Cochrane, Embase, PubMed, Scopus and Web of Science and identified articles through combinations of search terms for ‘urethral stricture disease’, ‘stricture formation’ and ‘local interventions’. We used the SYRCLE, RoB-2 and ROBINS-I tools to assess risk of bias across included studies. We did not perform a meta-analysis due to methodological differences between studies. Results We included 32 articles in the qualitative analysis, 20 of which were preclinical studies and 12 clinical studies. Regarding preclinical articles using an animal model, nearly all interventions showed to have a positive effect on either urethral fibrosis, urethral stricture formation and/or fibrotic protein expression levels. Here, immunosuppressants and chemotherapeutics seemed most promising for possible clinical purposes. Regarding clinical studies, mitomycin-C and hyaluronic acid and carboxymethylcellulose showed positive effects on urethral stricture recurrence rates with low to intermediate risk of bias across studies. However, the positive clinical effects of mitomycin-C and steroids seemed to decrease in studies with a longer follow-up time. Conclusion Although local adjuvant use of mitomycin-C or hyaluronic acid and carboxymethylcellulose may carry clinical potential to improve urethral structure recurrence rates after endoscopic procedures, we believe that a large, well-designed RCT with a yearlong follow-up time is necessary to identify the true clinical value.
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A Systematic Review and Meta-analysis of Adjuncts to Minimally Invasive Treatment of Urethral Stricture in Men. Eur Urol 2021; 80:467-479. [PMID: 34275660 DOI: 10.1016/j.eururo.2021.06.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/28/2021] [Indexed: 11/23/2022]
Abstract
CONTEXT Urethral stricture disease (USD) is initially managed with minimally invasive techniques such as urethrotomy and urethral dilatation. Minimally invasive techniques are associated with a high recurrence rate, especially in recurrent USD. Adjunctive measures, such as local drug injection, have been used in an attempt to reduce recurrence rates. OBJECTIVE To systematically review evidence for the efficacy and safety of adjuncts used alongside minimally invasive treatment of USD. EVIDENCE ACQUISITION A systematic review of the literature published between 1990 and 2020 was conducted in accordance with the PRISMA checklist. EVIDENCE SYNTHESIS A total of 26 studies were included in the systematic review, from which 13 different adjuncts were identified, including intralesional injection (triamcinolone, n = 135; prednisolone, n = 58; mitomycin C, n = 142; steroid-mitomycin C-hyaluronidase, n = 103, triamcinolone-mitomycin C-N-acetyl cysteine, n = 50; platelet-rich plasma, n = 44), intraluminal instillation (mitomycin C, n = 20; hyaluronic acid and carboxymethylcellulose, n = 70; captopril, n = 37; 192-iridium brachytherapy, n = 10), application via a lubricated catheter (triamcinolone, n = 124), application via a coated balloon (paclitaxel, n = 106), and enteral application (tamoxifen, n = 30; deflazacort, n = 36). Overall, 13 randomised controlled trials were included in the meta-analysis. Use of any adjunct was associated with a lower rate of USD recurrence (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.27-0.50; p < 0.001) compared to no adjunct use. Of all the adjuncts, mitomycin C was associated with the lowest rate of USD recurrence (intralesional injection: OR 0.23, 95% CI 0.11-0.48; p < 0.001; intraluminal injection: OR 0.11, 95% CI 0.02-0.61; p = 0.01). Urinary tract infection (2.9-14%), bleeding (8.8%), and extravasation (5.8%) were associated with steroid injection; pruritis of the urethra (61%) occurred after instillation of captopril; mild gynaecomastia (6.7%) and gastrointestinal side effects (6.7%) were associated with oral tamoxifen. CONCLUSIONS Adjuncts to minimally invasive treatment of USD appear to lower the recurrence rate and are associated with a low adjunct-specific complication rate. However, the studies included were at high risk of bias. Mitomycin C is the adjunct supported by the highest level of evidence. PATIENT SUMMARY We reviewed studies on additional therapies (called adjuncts) to minimally invasive treatments for narrowing of the urethra in men. Adjuncts such as mitomycin C injection result in a lower recurrence rate compared to no adjunct use. The use of adjuncts appeared to be safe and complications are uncommon; however, the studies were small and of low quality.
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Does intraurethral erythropoietin administration effect wound healing after hypospadias correction? an experimental rat study. Int Urol Nephrol 2021; 53:2057-2062. [PMID: 34132972 DOI: 10.1007/s11255-021-02912-9] [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: 04/08/2021] [Accepted: 06/03/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To analyze effects of intraurethral EPO application on urethral wound healing by defining hystopathologic changes in a rat model of hypospadias. METHODS A hypospadias model was created in 30 rats and randomized into 3 groups of 10. For 14 days, the first group was administered 25 iu EPO instillation intraurethrally once a day, while group 2 was administered with 50 iu EPO in the same manner. The third group was assigned as control group. On the day 15, rats were sacrificed and penectomies were performed. One independent pathologist who is blinded to groups and treatments evaluated the penis samples. RESULTS Histopathologic examinations yielded the mean fibrosis scores (± SD) as 1.9 ± 0.568, 1.1 ± 0.786 and 2.5 ± 0.535 in groups I, II and III, respectively. There was significant difference between the EPO groups and the control group (p = 0.04-I, p = 0.003-II). The mean inflammation scar scores (± SD) were determined as 1 ± 1.054, 2 ± 1.247, 2.63 ± 0.744 in groups I, II and III, respectively. There was a significant difference in terms of inflammation between control group and group I (p = 0.005). Mean congestion scores (± SD) were found 1.2 ± 0.789 in groups I-II and 0.75 ± 0.463 in group III (p = 0.310). Hyperemia was seen in 60% 70% and 37.5% in groups I, II and III, respectively (p = 0.387). CONCLUSION Intraurethral EPO therapy effected urethral wound healing in a good way. Thus it could be feasible to treat the patients with after hypospadias surgeries and to improve success rates.
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Portilla-de Buen E, Ramirez-Contreras JP, Chejfec-Ciociano JM, Lopez-Falcony R, Garcia-Martinez D, Vazquez-Camacho JG, Fuentes-Orozco C, Barbosa-Camacho FJ, Ibarrola-Peña JC, Gonzalez-Ojeda A. Hyaluronic Acid Reduces Fibrosis in a Rabbit Model of Urethral Anastomosis. Res Rep Urol 2021; 13:257-262. [PMID: 34017802 PMCID: PMC8131090 DOI: 10.2147/rru.s307397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/20/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Urethral stricture caused by fibrosis is a common medical condition, but top-line therapy for this pathology has a high recurrence rate. This study aimed to determine the efficacy of hyaluronic acid (HA) treatment in preventing the development of fibrosis in a rabbit model of urethral anastomosis. MATERIALS AND METHODS This experimental study involved 20 rabbits. HA (0.5 mL, 25 μg/mL) was applied in the experimental group (n = 10) during an experimental urethral anastomosis, and sterile saline (0.9%) solution was applied in the control group (n = 10). Animals underwent reoperation 12 weeks later for urethral resection. Fibrosis, inflammation, and urethral diameter were measured by two blinded pathologists at the site of the anastomosis. RESULTS The amount of inflammatory infiltrate was similar in both groups. The thicknesses of the collagen fiber band were 275.9 ± 62.3 and 373.4 ± 44.3 μm in the study and control groups (p = 0.001), respectively, and the urethral lumen diameters at the anastomosis site at follow-up were 2575 ± 167 and 2382 ± 214 μm, respectively (p = 0.04). CONCLUSION HA treatment reduced fibrosis at the anastomosis site during this experiment; we suggest further research to corroborate its efficacy in the treatment of urethral stricture.
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Affiliation(s)
- Eliseo Portilla-de Buen
- Surgical Research Division, Western Biomedical Research Center, Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Juan Pablo Ramirez-Contreras
- Biomedical Research Unit 02, Specialties Hospital, Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Jonathan Matias Chejfec-Ciociano
- Biomedical Research Unit 02, Specialties Hospital, Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Rodrigo Lopez-Falcony
- Guanajuato State Transplant Center, Institute of Public Health of Guanajuato, Guanajuato, México
| | - David Garcia-Martinez
- Surgical Research Division, Western Biomedical Research Center, Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Jose Gonzalo Vazquez-Camacho
- Cellular Biology Laboratory, School of Medicine, Instituto Tecnológico de Estudios Superiores de Monterrey, Campus Guadalajara, Jal, México
| | - Clotilde Fuentes-Orozco
- Biomedical Research Unit 02, Specialties Hospital, Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Francisco Jose Barbosa-Camacho
- Biomedical Research Unit 02, Specialties Hospital, Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Juan Carlos Ibarrola-Peña
- Biomedical Research Unit 02, Specialties Hospital, Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Alejandro Gonzalez-Ojeda
- Biomedical Research Unit 02, Specialties Hospital, Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
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Kurniawan W, Soesatyo MHNE, Aryandono T. The effects of docetaxel and/or captopril in expression of TGF-β1, MMP-1, CTGF, and PAI-1 as markers of anterior urethral stricture in an animal model. Ther Adv Urol 2020; 12:1756287220927994. [PMID: 35173811 PMCID: PMC8842176 DOI: 10.1177/1756287220927994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/27/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Treatment of urethral trauma is currently done after urethral stricture
occurs. Stricture therapy after occurrence gives unsatisfactory success
rates. Several genes, such as transforming growth factor beta 1 (TGF-β1),
matrix metalloproteinase 1 (MMP-1), connective tissue growth factor (CTGF),
and plasminogen activator inhibitor 1 (PAI-1), have a proven role in
urethral stricture development. The purpose of this study was to assess the
effect docetaxel and/or captopril on the RNA expression of those genes. Methods: The subjects of this research were 26 male New Zealand rabbits aged
230 ± 20 days weighing 4–5 kg that underwent urethral rupture by endoscopic
resection under anesthetized conditions. Subjects were divided into five
groups; control, stricture, captopril (captopril 0.05 mg/rabbit/day),
docetaxel (docetaxel 0.1 mg/rabbit/day), and docetaxel-captopril (docetaxel
0.1 mg/rabbit/day and captopril 0.05 mg/rabbit/day). Each group consisted of
4–6 rabbits. Each rabbit received a water-soluble transurethral gel
containing drug according to its group for 28 days. After the treatment
period, rabbits were sacrificed with 200 mg Pentothal, and the corpus
spongiosum was then prepared for real-time PCR examination. Results: TGF-β1 RNA expression in the stricture group was statistically different from
that in the control, docetaxel and docetaxel-captopril groups
(p = 0.016; p = 0.016;
p = 0.004). The stricture group did not exhibit any
statistical difference from the captopril group
(p = 0.190). The control group did not show any
statistically difference from the captopril, docetaxel, and
docetaxel-captopril groups (p = 0.114;
p = 0.190; p = 1.000). Docetaxel-captopril
suppresses expression of TGF-β1 RNA most significantly. MMP-1 RNA expression
showed no significant differences among groups (p = 0.827).
The docetaxel group and stricture group pair was most significant
(p = 0.247), compared with other pairs of stricture
groups in MMP-1 RNA expression. CTGF RNA expression in the stricture group
was statistically different from that of control, captopril, docetaxel, and
docetaxel-captopril groups (p = 0.003;
p = 0.019; p = 0.005;
p = 0.005). The control group did not exhibit any
statistically difference from the captopril, docetaxel, and
docetaxel-captopril groups (p = 0.408;
p = 0.709; p = 0.695). There was no
statistical difference among treatment groups. Docetaxel and
docetaxel-captopril groups suppress the most significant expression of CTGF
RNA expression. PAI-1 RNA expression in the stricture group differed statistically
significantly from the control and docetaxel groups
(p = 0.044; p = 0.016). The stricture
group did not show any statistically significant difference from the
captopril and docetaxel-captopril groups (p = 0.763;
p = 0.086). The control group did not exhibit any
statistical difference with any of the treatment groups
(p = 0.101; p = 0.637;
p = 0.669). Conclusion: Docetaxel-captopril gel proved to be able to inhibit RNA expression of TGF-β1
and CTGF significantly. Captopril gel proved to be able to inhibit RNA
expression of CTGF significantly. Docetaxel gel proved to be able to inhibit
RNA expression of TGF-β1, CTGF, and PAI-1 significantly. There were no
differences in MMP-1 expression among all study groups. Longer follow up
after therapy discontinuation and greater sample size is needed to determine
the therapeutic effect.
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Affiliation(s)
- Wikan Kurniawan
- Department of Urology, Academic Hospital, Universitas Gadjah Mada, North Ring Road, Kronggahan, Trihanggo, Gamping, Sleman, Yogyakarta, 55291 Indonesia
| | | | - Teguh Aryandono
- Department of Histology and Cellular Biology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Surgical Oncology, Sardjito General Hospital, Yogyakarta, Indonesia
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Histopathologic Evaluation of the Effects of Intraurethral Platelet Rich Plasma in Urethral Trauma Experimentally Induced in Rat Model. Urology 2020; 141:187.e9-187.e14. [PMID: 32302623 DOI: 10.1016/j.urology.2020.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/08/2020] [Accepted: 03/23/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the efficacy of platelet rich plasma applied early initialization after urethral trauma for preventing inflammation and spongiofibrosis. MATERIALS AND METHODS Twenty-three rats were randomized and divided into 3 groups, with 10 rats in 2 groups. Only sham group had 3 rats. The urethras of all rats were traumatized with a pediatric urethrotome knife at 6- and 12-o'clock. For 15 days, group I was given platelet rich plasma (PRP) once a day without urethral injury (sham group), group II (n = 10) was not given any medical treatment only urethral injury group (UI-PRP), group III (n = 10) was given PRP once a day intraurethrally as instillation using a 22 ga catheter sheath with urethral injury (UI+PRP). On day 15, the penises of the rats were degloved to perform penectomy. RESULTS A significant difference was detected in all parameters when the sham, UI-PRP, UI+PRP groups were compared (respectively, P = .001, / <.001, / .008 / .007) and a significant difference was observed among mucosal inflammation, fibrosis, and edema parameters when UI-PRP and UI+PRP groups were compared. (Respectively; P <.001, / <.001 / .006). CONCLUSION In this study, it was shown that intraurethral PRP applied after urethral trauma significantly decreased mucosal inflammation, spongiofibrosis, and edema. Depending on the results we acquired in this study, we think that PRP may be a promising option in urethral stricture treatment.
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Vesicourethral Anastomotic Stenosis after Prostate Cancer Treatment. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00539-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Scott KA, Li G, Manwaring J, Nikolavsky DA, Fudym Y, Caza T, Badar Z, Taylor N, Bratslavsky G, Kotula L, Nikolavsky D. Liquid buccal mucosa graft endoscopic urethroplasty: a validation animal study. World J Urol 2019; 38:2139-2145. [PMID: 31175459 DOI: 10.1007/s00345-019-02840-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/03/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To validate a novel method of urethral stricture treatment using liquid buccal mucosal grafts (LBMG) to augment direct vision internal urethrotomy (DVIU) in an animal model. MATERIALS AND METHODS A rabbit stricture model was used to test this method. Strictures were induced in 26 rabbits using electroresection of urethral epithelium. The animals were randomized into two groups: Group-1, treated with DVIU and LBMG in fibrin glue, and Group-2, DVIU with fibrin glue only. LBMG was prepared by suspension of mechanically minced buccal mucosa micrografts in fibrin glue. This LBMG-fibrin glue mixture was later injected into the urethrotomies of Group-1 animals. All animals were killed at 24 weeks after repeat retrograde urethrogram (RUG) and urethroscopy by surgeon blinded to the treatment arm. Radiographic images and histological specimens were reviewed by a radiologist and a pathologist, respectively, blinded to the treatment arm. Stricture treatment was considered a success if a diameter measured on RUG increased by ≥ 50% compared to pre-treatment RUG diameter. Histological specimens were assessed for the presence of BMG engraftment. RESULTS In Group-1, 8/12(67%) animals demonstrated engraftment of LBMG, compared to none in Group-2 (p = 0.0005). 7/12(58%) in Group-1 showed radiographic resolution/improvement of strictures compared to 5/13 Group-2 rabbits (38%, p = 0.145). The median percent change for the Group-1 was 59%, compared to 41.6% for Group-2 (p = 0.29). CONCLUSION This proof-of-concept study demonstrates feasibility of LBMG for endoscopic urethral stricture repairs. Further studies are needed to establish the role of this novel concept in treatment of urethral strictures.
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Affiliation(s)
- Kathryn A Scott
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Guanqun Li
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Jared Manwaring
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Daniela A Nikolavsky
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Yelena Fudym
- Department of Pathology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Tiffany Caza
- Department of Pathology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Zain Badar
- Department of Radiology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Nicole Taylor
- Department of Radiology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Gennady Bratslavsky
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Leszek Kotula
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Dmitriy Nikolavsky
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA.
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Intraurethral Erythropoietin to Prevent Fibrosis and Improve Urethral Healing: An Experimental Study in a Rat Model. Urology 2019; 123:297.e9-297.e14. [DOI: 10.1016/j.urology.2018.05.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 05/20/2018] [Accepted: 05/29/2018] [Indexed: 11/20/2022]
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Siregar S, Farenia R, Sugandi S, Roesli RM. Effect of angiotensin II receptor blocker on TGF-β1, MMP-1, and collagen type I and type III concentration in New Zealand rabbit urethral stricture model. Res Rep Urol 2018; 10:127-133. [PMID: 30324094 PMCID: PMC6173177 DOI: 10.2147/rru.s151209] [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
Introduction Urethral stricture is a disease with a high recurrence rate. Angiotensin II via AT1 receptor increases collagen formation through its effects on TGF-β1 and inhibition of collagenase activity. In this study, we evaluated the antifibrotic effect of angiotensin II receptor blocker on urethral stricture formation by creating a urethral stricture model in a male rabbit. Material and methods Thirty three male adult rabbits were separated into 3 groups (control, treatment, and sham). Group I consisted of 15 rabbits with urethral stricture that did not undergo any treatment, group II consisted of 15 rabbits with urethral stricture that were treated with a daily dose of 15 mg/kg losartan, given orally. Group III consisted of 3 rabbits with normal urethra and without any treatment. After 1, 2, and 4 weeks, the urethral tissues were collected, processed, and examined for TGF-β1, MMP-1, collagen type I, and collagen type III using enzyme-linked immunosorbent assay. Data were analyzed using 2-way analysis of variance using SPSS version 20.0. Results Urethral TGF-β1 concentration in the treatment group was significantly lower during the 2nd and 4th week of observation (p<0.0001), MMP-1 was significantly higher in the 1st, 2nd, and 4th week of observation (p<0.0001), collagen type I was significantly lower during the 2nd (p=0.001) and 4th week (p<0.0001), and collagen type III concentration was significantly lower in the 2nd and 4th week of observation (p<0.0001). Conclusion Angiotensin II receptor blocker could limit the progression of urethral stricture. The mechanism may be related to the AT1 blockage that leads to a decrease in TGF-β1 concentration, eventually resulting in lower collagen concentration due to increased MMP-1 activity.
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Affiliation(s)
- Safendra Siregar
- Urology Division, Department of Surgery, Hasan Sadikin Hospital Bandung, Faculty of Medicine Padjadjaran University, Bandung, Indonesia,
| | - Reni Farenia
- Urology Division, Department of Surgery, Hasan Sadikin Hospital Bandung, Faculty of Medicine Padjadjaran University, Bandung, Indonesia,
| | - Suwandi Sugandi
- Urology Division, Department of Surgery, Hasan Sadikin Hospital Bandung, Faculty of Medicine Padjadjaran University, Bandung, Indonesia,
| | - Rully M Roesli
- Urology Division, Department of Surgery, Hasan Sadikin Hospital Bandung, Faculty of Medicine Padjadjaran University, Bandung, Indonesia,
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Siregar S, Parardya A, Sibarani J, Romdan T, Adi K, Hernowo BS, Yantisetiasti A. AT 1 expression in human urethral stricture tissue. Res Rep Urol 2017; 9:181-186. [PMID: 28979891 PMCID: PMC5602470 DOI: 10.2147/rru.s141327] [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 Urethral stricture has a high recurrence rate. There is a common doctrine stating that "once a stricture, always a stricture". This fibrotic disease pathophysiology, pathologically characterized by excessive production, deposition and contraction of extracellular matrix is unknown. Angiotensin II type 1 (AT1) receptor primarily induces angiogenesis, cellular proliferation and inflammatory responses. AT1 receptors are also expressed in the fibroblasts of hypertrophic scars, whereas angiotensin II (AngII) regulates DNA synthesis in hypertrophic scar fibroblasts through a negative cross talk between AT1 and angiotensin II type 2 (AT2) receptors, which might contribute to the formation and maturation of human hypertrophic scars. OBJECTIVE This study was conducted to determine the expression of AT1 receptors in urethral stricture tissues. METHODS Urethral stricture tissues were collected from patients during anastomotic urethroplasty surgery. There were 24 tissue samples collected in this study with 2 samples of normal urethra for the control group. Immunohistochemistry study was performed to detect the presence of AT1 receptor expression. Data were analyzed using Mann-Whitney U test, and statistical analysis was performed with SPSS version 20. RESULTS This study showed that positive staining of AT1 receptor was found in all urethral stricture tissues (n=24). A total of 8.33% patients had low intensity, 41.67% had moderate intensity and 50% had high intensity of AT1 receptors, while in the control group, 100% patients had no intensity of AT1 receptors. Using the Mann-Whitney U test, it was found that urethral stricture tissue had a higher intensity of AT1 receptors than normal urethral tissue with a p-value = 0.012. CONCLUSION The results showed that AT1 receptor had a higher intensity in the urethral stricture tissue and that AT1 receptor may play an important role in the development of urethral stricture.
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Affiliation(s)
| | | | | | | | | | - Bethy S Hernowo
- Department of Pathological Anatomy, Hasan Sadikin Hospital, Faculty of Medicine University of Padjadjaran, Bandung, Indonesia
| | - Anglita Yantisetiasti
- Department of Pathological Anatomy, Hasan Sadikin Hospital, Faculty of Medicine University of Padjadjaran, Bandung, Indonesia
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Novel Concept and Method of Endoscopic Urethral Stricture Treatment Using Liquid Buccal Mucosal Graft. J Urol 2016; 196:1788-1795. [DOI: 10.1016/j.juro.2016.05.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 11/18/2022]
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Modified platelet-rich plasma with transforming growth factor β1 neutralization antibody injection may reduce recurrence rate of urethral stricture. Med Hypotheses 2016; 97:1-3. [PMID: 27876114 DOI: 10.1016/j.mehy.2016.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/18/2016] [Indexed: 01/15/2023]
Abstract
Urethral stricture is one of the most bothersome urologic disease among urologists and has a substantial impact on quality of life and healthcare costs. Although it can be cured with internal urethrotomy easily, post-surgery stricture recurrence is challenging. Several adjuvant therapies have been used in conjunction with internal urethrotomy but none of them are used routinely because the pathophysiology of the disease is still obscure. Fibrosis is the most accused hypothesis for the action. Platelet-rich plasma (PRP) is an autologous blood product containing a high concentration of platelets that is being used for a very wide range of clinical healing applications. It comprises a concentration of fundamental protein growth factors shown to be actively excreted by platelets to initiate accurate wound healing. Although PRP can play a critical role in wound healing and has been used in fibrotic diseases successfully, it has some deleterious cytokines such as transforming growth factor β1 (TGF β1) which can also cause fibrosis. The new hypothesis is that the subcutaneous injection of neutralized platelet-rich plasma with TGFβ1 antibody at the planned urethrotomy site may prevent recurrence and provide superior healing and long-term results.
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Cavalcanti AG, Fiedler G. Substitution urethroplasty or anastomotic urethroplasty for bulbar urethra strictures? Or endoscopic urethrotomy? Opinion: Endoscopic Urethrotomy. Int Braz J Urol 2015; 41:619-22. [PMID: 26401852 PMCID: PMC4756988 DOI: 10.1590/s1677-5538.ibju.2015.04.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- André G Cavalcanti
- Universidade Federal do Rio de Janeiro, RJ, Brasil.,Hospital Federal Cardoso Fontes, Rio de Janeiro, RJ, Brasil
| | - Gustavo Fiedler
- Hospital dos Servidores Federais, Rio de Janeiro, RJ, Brasil
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Sangkum P, Yafi FA, Kim H, Bouljihad M, Ranjan M, Datta A, Mandava SH, Sikka SC, Abdel-Mageed AB, Moparty K, Hellstrom WJG. Collagenase Clostridium histolyticum (Xiaflex) for the Treatment of Urethral Stricture Disease in a Rat Model of Urethral Fibrosis. Urology 2015; 86:647.e1-6. [PMID: 26126692 DOI: 10.1016/j.urology.2015.06.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/11/2015] [Accepted: 06/16/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the treatment effect of collagenase Clostridium histolyticum (CCH) in a rat model of urethral fibrosis. MATERIALS AND METHODS Thirty male Sprague-Dawley rats (300-350 g) were divided into 5 groups. The rat urethra was injected with normal saline in the sham group and, in the other 4 groups, the rat urethra was injected with 10 μg of transforming growth factor beta 1 to create fibrosis of the urethra. Two weeks following transforming growth factor beta 1 injection, the rats were injected with varying doses of CCH or vehicles, depending on their group. The rats were then euthanized at 4 weeks after CCH or vehicle injection. Urethral tissue was harvested for histologic and molecular analyses. Type I and III collagen levels were evaluated by Western blot analysis. RESULTS There was urethral fibrosis and to significant increase in collagen type I and III expressions in the urethral fibrosis group compared with the sham group (P <.05). Urethral injection of CCH appeared to be safe and significantly reduce urethral fibrosis as well as collagen type I and III expressions in the high-dose CCH treatment groups when compared with the treatment control group (P <.01). CONCLUSION This study demonstrated a beneficial effect of CCH injections in a rat model of urethral fibrosis. These findings suggest a potential role for CCH as a therapeutic option in urethral stricture patients and warrant further investigation.
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Affiliation(s)
- Premsant Sangkum
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Faysal A Yafi
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Hogyoung Kim
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Mostafa Bouljihad
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, LA
| | - Manish Ranjan
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Amrita Datta
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Sree Harsha Mandava
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Suresh C Sikka
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Asim B Abdel-Mageed
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Krishnarao Moparty
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA.
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Raheem OA, Buckley JC. Adjunctive maneuvers to treat urethral stricture: a review of the world literature. Transl Androl Urol 2014; 3:170-8. [PMID: 26813349 PMCID: PMC4708170 DOI: 10.3978/j.issn.2223-4683.2014.05.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The development of urethral stricture (US) or bladder neck contracture is a relatively uncommon but well described condition observed primarily in men. Despite familiarity with US disease, management remains challenging for urologists. Risk factors for the development of USs or bladder neck contracture include primary treatment modality, tobacco smoking, coronary artery disease and poorly controlled diabetes mellitus. Numerous treatment options exist for this condition that vary in procedural complexity, including intermittent self catheterization (CIC), serial urethral dilation, endoscopic techniques and open reconstructive repairs. Repetitive procedures for this condition may carry increased failure rates and morbidities. For the treatment of refractory or recalcitrant bladder neck contracture, newer intralesional anti-proliferative, anti-scar agents have been used in combination with transurethral bladder neck incisions to augment outcome and long-term effect. The primary focus of this systematic review of the published literature is to streamline and summarize various and newer therapeutic modalities available to manage patients with US or bladder neck contracture.
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Affiliation(s)
- Omer A Raheem
- Department of Urology, UC San Diego Health System, San Diego, CA, USA
| | - Jill C Buckley
- Department of Urology, UC San Diego Health System, San Diego, CA, USA
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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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Chung JH, Kang DH, Choi HY, Jeong TY, Ha US, Han JH, Yu JH, Cho JM, Yoo TK, Park J, Kim TH, Lee SW. The Effects of Hyaluronic Acid and Carboxymethylcellulose in Preventing Recurrence of Urethral Stricture After Endoscopic Internal Urethrotomy: A Multicenter, Randomized Controlled, Single-Blinded Study. J Endourol 2013; 27:756-62. [DOI: 10.1089/end.2012.0613] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jae Hoon Chung
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Hyuk Kang
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Hong Yong Choi
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Tae Yoong Jeong
- Department of Urology, Myongji Hospital, College of Medicine, Kwandong University, Goyang, Korea
| | - U-Syn Ha
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jun Hyun Han
- Department of Urology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Ji Hyeong Yu
- Department of Urology, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Jeong Man Cho
- Department of Urology, Eulji University College of Medicine, Daejeon, Korea
| | - Tag Keun Yoo
- Department of Urology, Eulji University College of Medicine, Daejeon, Korea
| | - Jinsung Park
- Department of Urology, Eulji University College of Medicine, Daejeon, Korea
| | - Tae Hyo Kim
- Department of Urology, College of Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Seung Wook Lee
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
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Long-term effect of urethral dilatation and internal urethrotomy for urethral strictures. Curr Opin Urol 2012; 22:467-73. [DOI: 10.1097/mou.0b013e32835621a2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Kumar S, Kapoor A, Ganesamoni R, Nanjappa B, Sharma V, Mete UK. Efficacy of holmium laser urethrotomy in combination with intralesional triamcinolone in the treatment of anterior urethral stricture. Korean J Urol 2012; 53:614-8. [PMID: 23060998 PMCID: PMC3460003 DOI: 10.4111/kju.2012.53.9.614] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 07/30/2012] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the outcome of visual internal urethrotomy with a holmium:yttrium-aluminum-garnet laser along with intralesional triamcinolone injection. Materials and Methods Patients with an anterior urethral stricture less than 3 cm in length were evaluated by clinical history, physical examination, uroflowmetry, and retrograde urethrogram preoperatively. All patients were treated with holmium laser urethrotomy and intralesional triamcinolone (80 mg) injection under general or regional anesthesia. An 18 F urethral catheter was placed for 5 days. All patients were followed up for 12 months postoperatively by history, uroflowmetry, and if required, retrograde urethrogram or urethroscopy every 3 months. Results The mean age of the patients was 42.9 years (range, 14 to 70 years). The overall recurrence rate was 24%. The success rate in patients with strictures less than 1 cm in length was 95.8%, whereas that in patients with strictures of 1 to 3 cm in length was 57.7% (p=0.002). The outcome did not depend on age, duration of symptoms, etiology, or location of stricture. Conclusions Holmium laser urethrotomy with intralesional triamcinolone is a safe and effective minimally invasive therapeutic modality for urethral strictures. This procedure has an encouraging success rate, especially in those with stricture segments of less than 1 cm in length.
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Affiliation(s)
- Santosh Kumar
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Dubey D. The current role of direct vision internal urethrotomy and self-catheterization for anterior urethral strictures. Indian J Urol 2011; 27:392-6. [PMID: 22022065 PMCID: PMC3193742 DOI: 10.4103/0970-1591.85445] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction: Direct visual internal urethrotomy (DVIU) followed by intermittent self-dilatation (ISD) is the most commonly performed intervention for urethral stricture disease. The objective of this paper is to outline the current scientific evidence supporting this approach for its use in the management of anterior urethral strictures. Materials and Methods: A Pubmed database search was performed with the words “internal urethrotomy” and “internal urethrotomy” self-catheterization. All papers dealing with this subject were scrutinized. Cross-references from the retrieved articles were also viewed. Only English language articles were included in the analyses. Studies were analyzed to identify predictors for success for DVIU. Results: Initial studies showed excellent outcomes with DVIU with success rates ranging from 50% to 85%. However, these studies reported only short-term results. Recent studies with longer followup have shown a poor success rate ranging from 6% to 28%. Stricture length and degree of fibrosis (luminal narrowing) were found to be predictors of response. Repeated urethrotomies were associated with poor results. Studies involving intermittent self-catheterization following DVIU have shown no role in short-term ISD with one study reporting beneficial effects if continued for more than a year. A significant number of studies have shown long-term complications with SC and high dropout rates. Conclusions: DVIU is associated with poor long-term cure rates. It remains as a treatment of first choice for bulbar urethral strictures <1 cm with minimal spongiofibrosis. There is no role for repeated urethrotomy as outcomes are uniformly poor. ISD, when used for more than a year on a weekly or biweekly basis may delay the onset of stricture recurrence.
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Affiliation(s)
- Deepak Dubey
- Department of Urology, Manipal Hospital, Airport Road, Bangalore, India
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Krane LS, Gorbachinsky I, Sirintrapun J, Yoo JJ, Atala A, Hodges SJ. Halofuginone-coated urethral catheters prevent periurethral spongiofibrosis in a rat model of urethral injury. J Endourol 2011; 25:107-12. [PMID: 21204688 DOI: 10.1089/end.2010.0514] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Urethral strictures are from periurethral spongiofibrosis that develops as a result of urethral trauma, disease, or iatrogenic injury. The spongy tissue that surrounds the strictured urethra has an altered ratio of collagen, with increased collagen type I relative to type III. We evaluated the ability of a urethral catheter that was coated with halofuginone (HF), a potent type I collagen inhibitor, to prevent spongiofibrosis formation in a rat model. MATERIALS AND METHODS HF was coated on silicone catheters and release kinetics were measured. Success of impregnation was evaluated with scanning electron microscopy, serial weights, and drug elution data. Urethral strictures were induced in rats using electrocautery. Half the animals had placement of an HF-coated catheter while the others had uncoated silicone controls. Animals were sacrificed at predetermined time points, and urethral tissue was either processed for staining with Masson trichrome and anti-alpha-1 collagen or digested to determine HF concentration. Serum drug levels were also determined in treated animals. Slides were graded by a pathologist who was blinded to treatment to determine collagen deposition. RESULTS HF was coated successfully on silicone catheters. Local urethral concentration of HF was tenfold higher than serum concentration in treated rats. Animals with HF-coated catheters had no new type I collagen deposition after urethral injury. Control animals had increased periurethral collagen type I deposition, typical of urethral stricture formation. CONCLUSIONS HF can be coated successfully on silicone catheters. HF successfully inhibits periurethral type I collagen deposition after urethral injury. This may become an important therapy to prevent urethral stricture formation or recurrence after endoscopic therapy.
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Affiliation(s)
- Louis S Krane
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA
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The effects of angiotensin-converting enzyme inhibitors on the fibrous envelope around mammary implants. Plast Reconstr Surg 2008; 122:1594-1595. [PMID: 18971758 DOI: 10.1097/prs.0b013e318186cb2c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sahinkanat T, Ozkan KU, Ciralik H, Ozturk S, Resim S. Botulinum toxin-A to improve urethral wound healing: an experimental study in a rat model. Urology 2008; 73:405-9. [PMID: 18799204 DOI: 10.1016/j.urology.2008.07.051] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 07/04/2008] [Accepted: 07/21/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Tensile distracting forces caused by elements such as a muscle pull can cause widening of scars in the tissue during the wound healing process. The aim of the present study was to investigate whether induced immobilization of the urethral muscle using botulinum toxin-A (BTX-A) enhances wound healing and also reduces the amount of scar formation in an experimentally induced urethral injury in a male rat model. METHODS Prepubertal male albino rats were divided into 2 groups: 20 rats in the BTX-A group received BTX-A injection treatment during surgery and 10 rats in the control group received 0.9% saline solution injection. The penile skin was incised circumferentially and degloved. To make the urethral injury at a location approximately 15 mm proximal to the external meatus, the urethra was cut transversally with scissors, from the 2-o'clock to the 10-o'clock position and then sutured by a single suture at the 6-o'clock position. To evaluate chronic inflammation and fibrosis, the rats were killed, and the injured portions of the urethras were harvested for histopathologic examination after a follow-up period of 21 days. RESULTS On histopathologic evaluation, the control group rats had a more severe fibrotic change in the urethral tissue compared with the BTX-A injected rats, which showed a mild fibrotic change. The mean +/- SD and median fibrosis score was 2.4 +/- 0.5 and 2 in the control group and 1.5 +/- 0.5 and 1 in the BTX-A group, respectively (P < .01 and P < .01, respectively). CONCLUSIONS The results of our study have shown that BTX-A prevented increases in collagen content during urethral wound healing.
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Affiliation(s)
- Tayfun Sahinkanat
- Department of Urology, University of Kahramanmaras Sutcu Imam School of Medicine, Kahramanaras, Turkey.
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Latini JM. Minimally invasive treatment of urethral strictures in men. CURRENT BLADDER DYSFUNCTION REPORTS 2008. [DOI: 10.1007/s11884-008-0017-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Namazi H. Effect of intraurethral captopril gel on the recurrence of urethral stricture after direct vision internal urethrotomy: a novel molecular mechanism. Int J Urol 2008; 15:562. [PMID: 18489652 DOI: 10.1111/j.1442-2042.2008.02072.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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