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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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Xu C, Zhu Z, Lin L, Lv T, Cai T, Lin J. Efficacy of Mitomycin C Combined with Direct Vision Internal Urethrotomy for Urethral Strictures: A Systematic Review and Meta-Analysis. Urol Int 2021; 107:344-357. [PMID: 34670219 DOI: 10.1159/000518977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 04/30/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The high recurrence of a urethral stricture after direct vision internal urethrotomy (DVIU) has been a problem for years. Mitomycin C (MMC) is an excellent antifibrosis antigen that has been used in many fields, but its effect on a urethral stricture remains controversial. The purpose of this review was to investigate the effectiveness of MMC in reducing the recurrence rate of a urethral stricture after the first urethrotomy. METHODS Common databases were searched for publications prior to November 30, 2020. Randomized controlled and cohort trials were all included. Recurrence and success rates after the first urethrotomy of the posterior urethra were the main outcomes. Revman 5.3 was used for statistical analysis. Two evaluation systems, the Cochrane risk of bias tool and the Newcastle Ottawa Scale, were used to examine the risk of bias for RCTs and all studies. The quality of evidence was assessed by the Grading of Recommendations, Assessment, Development, and Evaluation standard. RESULTS Sixteen trials were included, the reporting quality of which was generally poor, and the evidence level was very low to moderate. The addition of MMC could significantly reduce the recurrence rate of urethral strictures (risk ratio [RR] = 0.42; 95% confidence interval [CI]: 0.26, 0.67; p = 0.0002; 9 trials; 550 participants). The results of the subgroup analysis suggested that the effect of MMC combined with DVIU was significant in short (≤2 cm) anterior urethral strictures (RR = 0.39; 95% CI: 0.20, 0.78; p = 0.008), >12-month follow-up (RR = 0.45; 95% CI: 0.26, 0.76; p = 0.003). It also increased the success rate of the first urethrotomy procedure for posterior urethral contracture (RR = 0.74; 95% CI: 0.65, 0.84; p < 0.00001; 7 trials; 342 participants). Low-dose local injection of MMC was the most commonly used method. CONCLUSION MMC combined with DVIU is a promising way to reduce the long-term recurrence rate of a short-segment anterior urethral stricture. It also increases the success rate of the first urethrotomy of the posterior urethra. However, more high-quality randomized controlled trials are needed.
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Affiliation(s)
- Chunru Xu
- Department of Urology, Peking University First Hospital, Beijing, China, .,Institute of Urology, Peking University, Beijing, China, .,National Urological Cancer Center, Beijing, China,
| | - Zhenpeng Zhu
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Lanruo Lin
- College of Basic Medicine, Capital Medicine University, Beijing, China
| | - Tongde Lv
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Tianyu Cai
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Jian Lin
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
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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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Darlington D. A Novel Method of Local Anesthesia for Optical Internal Urethrotomy. Cureus 2019; 11:e6043. [PMID: 31824809 PMCID: PMC6886644 DOI: 10.7759/cureus.6043] [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: 12/03/2022] Open
Abstract
Direct vision internal urethrotomy (DVIU) is the treatment of choice for short anterior urethral strictures. It is performed under spinal or general anesthesia although it can also be done under local anesthesia. We describe a novel method of local anesthesia for internal urethrotomy. The technique described is feasible in morbid patients who are deemed unfit for spinal or general anesthesia and achieves good analgesia.
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Affiliation(s)
- Danny Darlington
- Urology, Pondicherry Institute of Medical Sciences, Pondicherry, IND
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Das SK, Jana D, Ghosh B, Pal DK. A comparative study between the outcomes of visual internal urethrotomy for short segment anterior urethral strictures done under spinal anesthesia and local anesthesia. Turk J Urol 2019; 45:431-436. [PMID: 31603417 DOI: 10.5152/tud.2019.49354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 02/19/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study is a randomized controlled study comparing the effectiveness and outcomes of direct visual inter urethrotomy (DVIU) for short segment anterior urethral strictures performed under local anesthesia versus spinal anesthesia. MATERIAL AND METHODS Patients presenting with an anterior urethral stricture up to 2 cm were randomized into two interventional groups: Group I-DVIU done under spinal anesthesia and Group II-DVIU performed under local anesthesia. Procedural discomfort was analyzed with a visual analog scale (VAS) immediately postoperatively and after one hour of the procedure. The changes in the vital parameters (systolic blood pressure and pulse rate) were recorded. The success of the procedure was defined as the absence of symptoms of recurrent stricture along with the ability of self-urethral calibration with an 18Fr catheter on follow-up. RESULTS One hundred and twenty patients, between December 2015 and February 2017, were randomized into the two above-mentioned groups with 60 patients each. The demographic profile, the stricture characteristics (etiology, length, and duration of symptoms), and the preoperative parameters (Qmax, preoperative pulse rate, and systolic blood pressures) were comparable in both the groups. The mean (±SD) intraoperative and one-hour postoperative VAS scores were 1.96 (±1.04) and 1.20 (±0.73), respectively, for Group I, which were significantly less (p<0.05) than the VAS scores 4.26 (± 1.98) and 2.13 (±1.71), respectively, for Group II. The intraoperative mean increases in pulse rate and systolic blood pressure were also significantly lower in Group I (p<0.05). The change in postoperative Qmax (mL/sec) was comparable in both the groups (mean of 20.75±4.31 vs. 19.041 4.88) and so is the stricture free rate at a one-year follow-up. No significant differences in complication rates were observed in both the groups. CONCLUSION Although perioperative procedural parameters seem to be in favor of spinal anesthesia, the outcome of DVIU is independent of the type of anesthesia used.
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Affiliation(s)
- Susanta Kumar Das
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Debarshi Jana
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Bastab Ghosh
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Dilip Kumar Pal
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, India
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Irdam GA, Wahyudi I, Andy A. Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis. F1000Res 2019; 8:1390. [PMID: 36726448 PMCID: PMC9843087 DOI: 10.12688/f1000research.19704.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2019] [Indexed: 09/19/2023] Open
Abstract
Background: Mitomycin-C is an agent that plays an important role in the tissue healing process and scar formation. This study aims to investigate the efficacy of mitomycin-C in treating anterior urethral stricture following internal urethrotomy. Methods: Studies evaluating the efficacy of mitomycin-c for anterior urethral stricture post urethrotomy were searched using PubMed, Scopus, ScienceDirect, EBSCOHost, Cochrane Reviews, and OVID as directory databases. Terms used in the searching process were "mitomycin-c" or "mitomycin", "urethral stricture", "urethral stenosis", "internal urethrotomy", "optical urethrotomy" and its synonyms. Every randomized controlled trial study conducted in human subjects was included. Study appraisals were conducted in accordance with Oxford University Center for Evidence-Based Medicine guidelines. The conclusion of each study was summarized and the calculation of fixed effect from every study was conducted in meta-analysis. Results: Included in this study were three studies involving 231 patients. All of them reported less recurrence of in patients treated with mitomycin-c post urethrotomy (p<0.001). The fixed risk ratio of all studies was 0.32 with 95% confidence interval (0.19-0.54). All studies also reported less stricture length after treatment with mitomycin-c, but there were not statistical differences between with or without treatment group. Conclusion: Mitomycin-C has efficacy in treating anterior urethral stricture after internal urethrotomy. However, the inclusion of relatively few studies may affect the strength of this review and further studies need to be done.
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Affiliation(s)
- Gampo Alam Irdam
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Irfan Wahyudi
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Andy Andy
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
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Irdam GA, Wahyudi I, Andy A. Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis. F1000Res 2019; 8:1390. [PMID: 36726448 PMCID: PMC9843087 DOI: 10.12688/f1000research.19704.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 09/19/2023] Open
Abstract
Background and Aim Mitomycin-C is a potent agent that plays an important role in tissue healing and scar formation. This study aims to investigate the efficacy of Mitomycin-C in treating anterior urethral stricture after internal urethrotomy. Methods Studies evaluating efficacy of mitomycin-c for anterior urethral stricture post urethrotomy were searched using Pubmed, Scopus, Sciencedirect, MEDLINE, and Cochrane Reviews as directory databases. The search was done in March 15th 2020. Terms being used in the searching process were "mitomycin-c" or "mitomycin", "urethral stricture", "urethral stenosis", "internal urethrotomy", "optical urethrotomy" and its synonyms. Every study with the design of retrospective or prospective clinical study being done in human subject was included. Study appraisal conducted in accordance to Oxford University Center for Evidence-Based Medicine. The conclusion of each study was summarized and the calculation of random effect from every study was conducted in meta-analysis. Random effect model is chosen because small number of studies and quite different. Results Three studies involving 311patients were included in this review, all of them reported less recurrence of in patients treated with mitomycin-c post urethrotomy (p<0.001). Risk ratio of all studies was 0.41 with 95% confidence interval (0.25-0.68). Conclusion Mitomycin-C has the potential of efficacy in treating anterior urethral stricture post internal urethrotomy. Relatively few numbers of studies may impact in the strength of this review and further studies need to be done.
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Affiliation(s)
- Gampo Alam Irdam
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Irfan Wahyudi
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Andy Andy
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
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Jhanwar A, Sokhal AK, Singh K, Sankhwar S, Saini DK. Assessment of quality of life in patients of urethral stricture on clean intermittent catheterization following direct vision internal urethrotomy. Urol Ann 2018; 10:395-399. [PMID: 30386093 PMCID: PMC6194795 DOI: 10.4103/ua.ua_34_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Context: Clean intermittent catheterization (CIC) after direct vision internal urethrotomy (DVIU) Aims: The aim is to assess the quality of life (QOL) in patients with urethral strictures on CIC following DVIU. Settings and Design: Prospective study. Materials and Methods: This prospective study was conducted between August 2013 and July 2015 in the Department of Urology at KGMU, Lucknow. We included patients above the age of 18 years with stricture urethra, who were on CIC following direct visual internal urethrotomy. Patients below the age of 18 years, noncompliance, concomitant neurogenic voiding dysfunction, multiple strictures, pan anterior strictures, and posterior stenosis were excluded from the study. A 16 French Foley catheter was used for CIC following DVIU. Patients were evaluated at follow-up visit at 3, 6, and 12 months. At each follow-up visits, patients were assessed using CIC-QOL questionnaire, maximum urine flow rate and complications related to CIC if any. Statistical Analysis Used: Unpaired t-test was used to compare continuous data, and Fisher's exact test was used to analyze categorical data. Results: Among total 144 male patients evaluated, we included 97 patients, who underwent DVIU. Mean age of the study population was 37.7 ± 14.03 years. Most urethral strictures were idiopathic (64.02%) followed by postinflammatory (24.25%). A significant number of patients reported difficulty in performing CIC, which hampered daily activities. No major procedure related complications were reported. Patients who were compliant to CIC reported no stricture recurrence till 6 months follow-up. Conclusions: CIC following DVIU remains a reasonable adjunctive option. All the parameters of CIC-QOL questionnaire had improved on continuing CIC. Young men on CIC had greater impairment of QOL when compared to aged patients.
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Affiliation(s)
- Ankur Jhanwar
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ashok Kumar Sokhal
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Kawaljit Singh
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Satyanarayan Sankhwar
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Durgesh Kumar Saini
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Daneshvar M, Hughes M, Nikolavsky D. Surgical Management of Fossa Navicularis and Distal Urethral Strictures. Curr Urol Rep 2018; 19:43. [DOI: 10.1007/s11934-018-0792-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Endoscopic Management of Urethral Stricture: Review and Practice Algorithm for Management of Male Urethral Stricture Disease. Curr Urol Rep 2018; 19:19. [PMID: 29479640 DOI: 10.1007/s11934-018-0771-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE OF REVIEW Male urethral stricture disease is characterized by the formation of scar tissue within the urethra resulting in lower urinary tract symptoms, infection, and potentially kidney dysfunction. There is significant variability in clinical practice for the treatment of urethral stricture. We sought to summarize the known data on endoscopic management of urethral stricture disease as part of this larger edition on urethral stricture management. RECENT FINDINGS Older studies quoted high rates of success with endoscopic management of urethral stricture, including repeated DVIU. There is now evidence to support a limited role of endoscopic intervention in the management of urethral stricture, and especially strong evidence that repeated endoscopic procedures are not effective. There is poor evidence to support the long-term efficacy of endoscopic urethral stricture management. Furthermore, novel advances in adjunctive therapies have not yet demonstrated durable patency. We discuss the limited role of endoscopic management and suggest an algorithm for its use in stricture management.
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Zhang K, Chen J, Zhang D, Wang L, Zhao W, Lin DYT, Chen R, Xie H, Hu X, Fang X, Fu Q. microRNA expression profiles of scar and normal tissue from patients with posterior urethral stricture caused by pelvic fracture urethral distraction defects. Int J Mol Med 2018; 41:2733-2743. [PMID: 29436608 PMCID: PMC5846665 DOI: 10.3892/ijmm.2018.3487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/23/2018] [Indexed: 12/31/2022] Open
Abstract
Pelvic fracture urethral distraction defect (PFUDD) seriously affects the quality of life of patients. At present, there are few effective drug treatments available for PFUDD-induced urethral stricture, which is associated with fibrosis and scar formation in urethra lumen. Emerging evidence suggests that microRNAs (miRNAs/miRs) may be involved in the regulation of fibrosis, and analysis of miRNA expression profiles in urethral scar and normal urethra tissues may therefore benefit the discovery of novel treatments for urethral stricture with micro invasive procedures. In the present study, miRNA sequencing and quantitative polymerase chain reaction (qPCR) validation using paired scar and normal tissues from patients with PFUDD, and functional analysis of the miRNAs involved in the fibrosis associated signaling pathway was performed. A total of 94 differentially expressed miRNAs were identified in the scar tissue of patients with PFUDD. Among them, 26 miRNAs had significantly altered expression in the scar tissue compared with the normal tissue from the same patient. qPCR validation confirmed that miR-129-5p was overexpressed in scar tissue. The TGF-β pathway-associated functions of a total of 5 miRNAs (hsa-miR-129-5p, hsa-miR-135a-5p, hsa-miR-363-3p, hsa-miR-6720-3p and hsa-miR-9-5p) were further analyzed, as well as their key molecular targets and functional mechanisms in signaling regulation. To conclude the miRNA sequencing indicated a significantly altered expression of hsa-miR-129-5p, hsa-miR-135a-5p, hsa-miR-363-3p, hsa-miR-6720-3p and hsa-miR-9-5p in patients with PFUDD. These miRNAs and their potential target genes were associated with fibrosis in several diseases, and the data from the present study may help explore potential miRNA targets for future precision treatments for urethral stricture.
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Affiliation(s)
- Kaile Zhang
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai JiaoTong University, Shanghai 200233, P.R. China
| | - Jun Chen
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai JiaoTong University, Shanghai 200233, P.R. China
| | - Dongliang Zhang
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai JiaoTong University, Shanghai 200233, P.R. China
| | - Lin Wang
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai JiaoTong University, Shanghai 200233, P.R. China
| | - Weixin Zhao
- Wake Forest Institute for Regenerative Medicine, Winston‑Salem, NC 27157, USA
| | | | - Rong Chen
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai JiaoTong University, Shanghai 200233, P.R. China
| | - Hong Xie
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai JiaoTong University, Shanghai 200233, P.R. China
| | - Xiaoyong Hu
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai JiaoTong University, Shanghai 200233, P.R. China
| | | | - Qiang Fu
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai JiaoTong University, Shanghai 200233, P.R. China
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Žiaran S, Galambošová M, Danišovič L. Tissue engineering of urethra: Systematic review of recent literature. Exp Biol Med (Maywood) 2017; 242:1772-1785. [PMID: 28893083 DOI: 10.1177/1535370217731289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The purpose of this article was to perform a systematic review of the recent literature on urethral tissue engineering. A total of 31 articles describing the use of tissue engineering for urethra reconstruction were included. The obtained results were discussed in three groups: cells, scaffolds, and clinical results of urethral reconstructions using these components. Stem cells of different origin were used in many experimental studies, but only autologous urothelial cells, fibroblasts, and keratinocytes were applied in clinical trials. Natural and synthetic scaffolds were studied in the context of urethral tissue engineering. The main advantage of synthetic ones is the fact that they can be obtained in unlimited amount and modified by different techniques, but scaffolds of natural origin normally contain chemical groups and bioactive proteins which increase the cell attachment and may promote the cell proliferation and differentiation. The most promising are smart scaffolds delivering different bioactive molecules or those that can be tubularized. In two clinical trials, only onlay-fashioned transplants were used for urethral reconstruction. However, the very promising results were obtained from animal studies where tubularized scaffolds, both non-seeded and cell-seeded, were applied. Impact statement The main goal of this article was to perform a systematic review of the recent literature on urethral tissue engineering. It summarizes the most recent information about cells, seeded or non-seeded scaffolds and clinical application with respect to regeneration of urethra.
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Affiliation(s)
- Stanislav Žiaran
- 1 Department of Urology, Faculty of Medicine, Comenius University in Bratislava, Bratislava 833 05, Slovak Republic
| | - Martina Galambošová
- 2 Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, Bratislava 811 08, Slovak Republic
| | - L'uboš Danišovič
- 2 Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, Bratislava 811 08, Slovak Republic.,3 Regenmed Ltd, Bratislava 811 02, Slovak Republic
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Nomikos M, Papanikolaou S, Athanasopoulos G, Papatsoris A. The use of Amplatz renal dilators in the minimally invasive management of complex urethral strictures. Cent European J Urol 2017; 70:301-305. [PMID: 29104795 PMCID: PMC5656362 DOI: 10.5173/ceju.2017.1218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 04/11/2017] [Accepted: 05/28/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION To present the outcomes of using Amplatz renal dilators in the management of complex urethral strictures. MATERIAL AND METHODS From September 2011 to August 2015, 34 patients with complex urethral strictures were treated with Amplatz renal dilators assisted with internal urethrotomy. Evaluation included uroflowmetry, IPSS and post-void residual volume measurement. Under spinal anesthesia, sequential dilatations were performed with Amplatz renal dilators measuring from 8 Fr up to 24 Fr. Urethrotomy was sequentially performed. RESULTS The mean stricture length was 2.6 (1.5-3.5) cm. Preoperative mean Qmax was 4.4( 3.2-9.6) ml/sec. From September 2011 to August 2015, 34 patients with complex urethral strictures were treated with Amplatz renal dilators assisted with internal urethrotomy. Evaluation included uroflowmetry, IPSS and post- void residual volume measurement. Under spinal anesthesia, sequential dilatations with Amplatz renal dilators over an 8 Fr stylet were performed up to 24 Fr. Urethrotomy was sequentially performed. PVR was 155 (75-380) ml. Postoperative mean Qmax at 1 month was 18.4 (14.6-21.8) ml/sec, p <0.001, at 6 months was 16.6 (9.8-18.2) ml/sec, p <0.003 and at 12 months was 12.7 (7.4-17.3) ml/sec, p <0.005. Accordingly, mean PVR was significantly improved postoperatively, at 32 (12-88) ml in 1 month, p <0.001, while at 6 months was 34 (28-101) ml, p <0.005 and at 12 months was 62 (38-115) ml, p <0.005. Only 8 patients (23.5%) had a stricture recurrence in the first nine months and were treated with Amplatz dilatations alone. CONCLUSIONS The use of Amplatz renal dilators in combination with internal urethrotomy is a safe and effective technique for the endoscopic treatment of complex urethral strictures in patients unfit for reconstructive surgery.
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Affiliation(s)
- Michael Nomikos
- Department of Urology, Thriassion General Hospital, Athens, Greece
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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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Kanodia GK, Sankhwar S, Jhanwar A, Bansal A, Kumar M, Gupta A. Intraoperative breakage of Sachse's knife blade: A rare complication of optical internal urethrotomy (one case managing experience). Int Braz J Urol 2017; 43:163-165. [PMID: 28124540 PMCID: PMC5293398 DOI: 10.1590/s1677-5538.ibju.2016.0081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 03/13/2016] [Indexed: 11/22/2022] Open
Abstract
Optical internal urethrotomy (OIU) is the most common procedure performed for short segment bulbar urethral stricture worldwide. This procedure most commonly performed using Sachse’s cold knife. Various perioperative complications of internal urethrotomy have been described in literature including bleeding, urinary tract infection, extravasation of fluid, incontinence, impotence, and recurrence of stricture. Here we report a unique complication of breakage of Sachse knife blade intraoperatively and its endoscopic management.
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Affiliation(s)
| | | | - Ankur Jhanwar
- King George Medical University, Lucknow, Uttar Pradesh, India
| | - Ankur Bansal
- King George Medical University, Lucknow, Uttar Pradesh, India
| | - Manoj Kumar
- King George Medical University, Lucknow, Uttar Pradesh, India
| | - Ashok Gupta
- King George Medical University, Lucknow, Uttar Pradesh, India
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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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17
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Abstract
Male anterior urethral stricture disease is a commonly encountered condition that presents to many urologists. According to a National Practice Survey of Board Certified Urologist in the United States most urologists treat on average 6-20 urethral strictures yearly. Many of those same urologists surveyed treat with repeated dilation or internal urethrotomy, despite continual recurrence of the urethral stricture. In point of fact, the urethroplasty despite its high success rate, is underutilized by many practicing urologists. Roughly half of practicing urologist do not perform urethroplasty in the United States. Clearly, the reconstructive ladder for urethral stricture management that was previously described in the literature may no longer apply in the modern era. The following article reviews the etiology, diagnosis, management and comparisons of treatment options for anterior urethral strictures.
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Affiliation(s)
- Marshall J Stein
- 1 UT Urology Resident, 6410 Fannin, Suite 420, Houston, Texas 77030, USA ; 2 Division of Urology, Medical Director of UTP Urology Clinic, USA
| | - Rowena A DeSouza
- 1 UT Urology Resident, 6410 Fannin, Suite 420, Houston, Texas 77030, USA ; 2 Division of Urology, Medical Director of UTP Urology Clinic, USA
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Tricard T, Padja E, Story F, Saeedi Y, Mouracade P, Saussine C. [Benefit of clean intermittent self-catheterization in the management of urethral strictures]. Prog Urol 2015; 25:705-10. [PMID: 26381320 DOI: 10.1016/j.purol.2015.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 07/27/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Urethral stenosis has a recurrent character. The urethroplasty is often proposed for repeat stenosis. This study seeks to explore the interest of clean intermittent self-catheterization in the evolution of urethral stenosis after urethrotomy. METHODS Single-center retrospective study from 2008 to 2013, concerning patients who received urethrotomy to treat urethral stenosis which was confirmed by endoscopy and a flow chart. Some accomplished self-catheterization in addition to urethrotomy to prevent recurrence. The monitoring was provided during consultation by a subjective assessment (patient and surgeon) and a flow chart. The restenosis were confirmed by endoscopy and flow chart. RESULTS Ninety-three patients treated with urethrotomy alone (50 patients) or associated with self-catheterization (43) was included. Urethral stenosis were mostly iatrogenic (75%), short <10mm (84%), single (74%) and primary (50.5%). Mean follow-up was 99.3±72.8 weeks. Eighteen patients (19%) had symptomatic recurrence suspected by flow chart with a mean Qmax at recurrence was 6.25±2.8mL/s (P<0.001), 8 in urethrotomy group and 10 in the urethrotomy+self-catheterization group. Recurrence rates were comparable in the 2 groups, urethrotomy (16%) urethrotomy+self-catheterization (23%) (P=0.46). The mean time to recurrence was 81.1±87 weeks and was different in the 2 groups: 76.8±76.3 weeks in urethrotomy group, 83.3±93.9 in urethrotomy+self-catheterization group (P=0.014). An analysis recurrence for the primitive urethral stenosis showed that the recurrence rate was not statistically different: 18% for urethrotomy+self-catheterization group vs 14% for urethrotomy group. An analysis of recurrent relapses for urethral stenosis showed a rate of 26%, comparable in the 2 groups (P=1). CONCLUSION After urethrotomy, urethral stenosis recurs in 1 patient over 5, after 18 months especially if they were complicated (multiple, recurrent, extended). Self-catheterization do not provide benefit in terms of recurrence (for the general population and for primitive urethral stenosis) compared to only urethrotomy but seem to extend the time without recurrence (76.8 weeks vs 83.3 weeks). LEVEL OF EVIDENCE 5.
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Affiliation(s)
- T Tricard
- Service d'urologie, nouvel hôpital civil, 1, place de l'Hôpital, 67091 Strasbourg, France.
| | - E Padja
- Service d'urologie, nouvel hôpital civil, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - F Story
- Service d'urologie, nouvel hôpital civil, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - Y Saeedi
- Service d'urologie, nouvel hôpital civil, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - P Mouracade
- Service d'urologie, nouvel hôpital civil, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - C Saussine
- Service d'urologie, nouvel hôpital civil, 1, place de l'Hôpital, 67091 Strasbourg, France
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Harraz AM, El-Assmy A, Mahmoud O, Elbakry AA, Tharwat M, Omar H, Farg H, Laymon M, Mosbah A. Is there a way to predict failure after direct vision internal urethrotomy for single and short bulbar urethral strictures? Arab J Urol 2015; 13:277-81. [PMID: 26609447 PMCID: PMC4656799 DOI: 10.1016/j.aju.2015.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 07/06/2015] [Accepted: 07/13/2015] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To identify patient and stricture characteristics predicting failure after direct vision internal urethrotomy (DVIU) for single and short (<2 cm) bulbar urethral strictures. PATIENTS AND METHODS We retrospectively analysed the records of adult patients who underwent DVIU between January 2002 and 2013. The patients' demographics and stricture characteristics were analysed. The primary outcome was procedure failure, defined as the need for regular self-dilatation (RSD), redo DVIU or substitution urethroplasty. Predictors of failure were analysed. RESULTS In all, 430 adult patients with a mean (SD) age of 50 (15) years were included. The main causes of stricture were idiopathic followed by iatrogenic in 51.6% and 26.3% of patients, respectively. Most patients presented with obstructive lower urinary tract symptoms (68.9%) and strictures were proximal bulbar, i.e. just close to the external urethral sphincter, in 35.3%. The median (range) follow-up duration was 29 (3-132) months. In all, 250 (58.1%) patients did not require any further instrumentation, while RSD was maintained in 116 (27%) patients, including 28 (6.5%) who required a redo DVIU or urethroplasty. In 64 (6.5%) patients, a redo DVIU or urethroplasty was performed. On multivariate analysis, older age at presentation [odds ratio (OR) 1.017; P = 0.03], obesity (OR 1.664; P = 0.015), and idiopathic strictures (OR 3.107; P = 0.035) were independent predictors of failure after DVIU. CONCLUSION The failure rate after DVIU accounted for 41.8% of our present cohort with older age at presentation, obesity, and idiopathic strictures independent predictors of failure after DVIU. This information is important in counselling patients before surgery.
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Affiliation(s)
- Ahmed M Harraz
- Urology and Nephrology Center, Mansoura University, Egypt
| | - Ahmed El-Assmy
- Urology and Nephrology Center, Mansoura University, Egypt
| | - Osama Mahmoud
- Urology and Nephrology Center, Mansoura University, Egypt
| | - Amr A Elbakry
- Urology and Nephrology Center, Mansoura University, Egypt
| | | | - Helmy Omar
- Urology and Nephrology Center, Mansoura University, Egypt
| | - Hashim Farg
- Urology and Nephrology Center, Mansoura University, Egypt
| | - Mahmoud Laymon
- Urology and Nephrology Center, Mansoura University, Egypt
| | - Ahmed Mosbah
- Urology and Nephrology Center, Mansoura University, Egypt
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20
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Ali L, Shahzad M, Orakzai N, Khan I, Ahmad M. Efficacy of mitomycin C in reducing recurrence of anterior urethral stricture after internal optical urethrotomy. Korean J Urol 2015; 56:650-5. [PMID: 26366278 PMCID: PMC4565900 DOI: 10.4111/kju.2015.56.9.650] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 07/25/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose To determine the efficacy of mitomycin C in reducing the recurrence of anterior urethral stricture after internal optical urethrotomy (IOU). Materials and Methods This was a randomized controlled trial conducted in the Department of Urology at the Institute of Kidney Diseases Peshawar from March 2011 to December 2013. A total of 151 patients who completed the study were divided into two groups by the lottery method. Group A (cases) comprised 78 patients in whom mitomycin C 0.1% was injected submucosally in the stricture after conventional IOU. Group B (controls) comprised 73 patients in whom IOU only was performed. Self-clean intermittent catheterization was not offered in either group. All patients were regularly followed up for 18 months. Recurrence was diagnosed by use of retrograde urethrogram in all patients and flexible urethroscopy in selected cases. Data were collected on a structured pro forma sheet and were analyzed by SPSS. Results The mean age of the patients in group A was 37.31±10.1 years and that in group B was 40.1±11.4 years. Recurrence of urethral stricture was recorded in 11 patients (14.1%) in group A and in 27 patients (36.9%) in group B (p=0.002). The mitomycin group also showed a delay in recurrence compared with the control group (p=0.002). Conclusions Recurrence of urethral stricture is high after optical urethrotomy. Mitomycin C was found to be highly effective in preventing the recurrence of urethral stricture after IOU.
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Affiliation(s)
- Liaqat Ali
- Department of Urology, Institute of Kidney Diseases Hayatabad Medical Complex, Peshawar, Pakistan
| | - Muhammad Shahzad
- Department of Urology, Institute of Kidney Diseases Hayatabad Medical Complex, Peshawar, Pakistan
| | - Nasir Orakzai
- Department of Urology, Institute of Kidney Diseases Hayatabad Medical Complex, Peshawar, Pakistan
| | - Ihsanullah Khan
- Department of Urology, Institute of Kidney Diseases Hayatabad Medical Complex, Peshawar, Pakistan
| | - Mubashira Ahmad
- Department of Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
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Isen K, Nalçacıoğlu V. Direct vision internal urethrotomy by using endoscopic scissors. Int Urol Nephrol 2015; 47:905-8. [PMID: 25894958 DOI: 10.1007/s11255-015-0960-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/21/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effectiveness and safety of direct vision internal urethrotomy (DVIU) by using endoscopic scissors for incision of short (<1 cm) urethral strictures in adult men. PATIENTS AND METHODS Twenty-one patients who had short bulbar urethral strictures were evaluated in this study. Endoscopic scissors was used for incision of urethral strictures in all patients. Retrograde urethrography (RGU) and maximum flow rate(Qmax) <15.0 ml/s by uroflowmetry were used for the definition of recurrences. RESULTS The procedure was found successful in all patients. The mean size of stricture was 0.73 cm. The mean pre-procedure Qmax was 7.9 ml/s. The mean procedure time was 10.2 min. The mean Qmax was 19.4 ml/s at the third month postoperatively. RGU was normal in all patients at the third month postoperatively. The mean follow-up was 8.1 months. Three (14.2 %) patients underwent second DVIU due to recurrence. No complication was observed during the follow-up except urinary tract infection in two (9.5 %) patients. CONCLUSIONS DVIU using endoscopic scissors appears to be an effective and safe treatment modality for incision of short urethral strictures in adult men.
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Affiliation(s)
- Kenan Isen
- Department of Urology, Ministry of Health, Diyarbakır Gazi Yaşargil Education and Research Hospital, Fabrika Mah. 813. Sok., Altınpark Konutları, C blok, Kat: 4 No:9, Diyarbakır, 21100, Turkey,
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22
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Jain SK, Kaza RCM, Singh BK. Evaluation of holmium laser versus cold knife in optical internal urethrotomy for the management of short segment urethral stricture. Urol Ann 2014; 6:328-33. [PMID: 25371611 PMCID: PMC4216540 DOI: 10.4103/0974-7796.140997] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 09/25/2013] [Indexed: 11/06/2022] Open
Abstract
Objectives: Sachse cold knife is conventionally used for optical internal urethrotomy intended to manage urethral strictures and Ho: YAG laser is an alternative to it. The aim of this study was to evaluate the role of urethral stricture treatment outcomes, efficacy, and complications using cold knife and Ho: YAG (Holmium laser) for optical internal urethrotomy Materials and Methods: In this prospective study included, 90 male patients age >18 years, with diagnosis of urethral stricture admitted for internal optical urethrotomy during April 2010 to March 2012. The patients were randomized into two groups containing 45 patients each using computer generated random number. In group A (Holmium group), internal urethrotomy was done with Holmium laser and in group B (Cold knife group) Sachse cold knife was used. Patients were followed up for 6 months after surgery in Out Patient Department on 15, 30 and 180 post-operative days. At each follow up visit physical examination, and uroflowmetry was performed along with noting complaints, if any. Results: The peak flow rates (PFR) were compared between the two groups on each follow up. At 180 days (6 month interval) the difference between mean of PFR for Holmium and Cold knife group was statistically highly significant (P < 0.001). Complications were seen in 12.22% of cases. Conclusion: Both modalities are effective in providing immediate relief to patients with single and short segment (<2 cm long) urethral strictures but more sustained response was attained with Cold knife urethrotomy.
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Affiliation(s)
- Sudhir Kumar Jain
- Department of Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Ram Chandra Murthy Kaza
- Department of Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Bipin Kumar Singh
- Department of Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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Siegel J, Tausch TJ, Simhan J, Morey AF. Innovative approaches for complex penile urethral strictures. Transl Androl Urol 2014; 3:179-85. [PMID: 26816766 PMCID: PMC4708172 DOI: 10.3978/j.issn.2223-4683.2014.04.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Urethral strictures are a common urologic disease that arises from varied etiologies. These strictures range in severity from simple, short lesions to complex, long defects. Likewise, the management approach varies based on the complexity of the lesion. We reviewed the literature of urethral stricture disease and its management. In particular we have focused on complex strictures of the male penile urethra. Often these cases cannot be managed with traditional reconstructive techniques and require newer approaches. Furthermore tissue engineered graft materials provide a possible tissue source for future reconstructive endeavors.
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Abstract
Male urethral stricture disease is prevalent and has a substantial impact on quality of life and health-care costs. Management of urethral strictures is complex and depends on the characteristics of the stricture. Data show that there is no difference between urethral dilation and internal urethrotomy in terms of long-term outcomes; success rates range widely from 8-80%, with long-term success rates of 20-30%. For both of these procedures, the risk of recurrence is greater for men with longer strictures, penile urethral strictures, multiple strictures, presence of infection, or history of prior procedures. Analysis has shown that repeated use of urethrotomy is not clinically effective or cost-effective in these patients. Long-term success rates are higher for surgical reconstruction with urethroplasty, with most studies showing success rates of 85-90%. Many techniques have been utilized for urethroplasty, depending on the location, length, and character of the stricture. Successful management of urethral strictures requires detailed knowledge of anatomy, pathophysiology, proper patient selection, and reconstructive techniques.
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Affiliation(s)
- Lindsay A Hampson
- Department of Urology, University of California, 400 Parnassus Avenue, Suite A-610, Box 0738, San Francisco, CA 94143-0738, USA
| | - Jack W McAninch
- Department of Urology, University of California, 400 Parnassus Avenue, Suite A-610, Box 0738, San Francisco, CA 94143-0738, USA
| | - Benjamin N Breyer
- Department of Urology, University of California, 400 Parnassus Avenue, Suite A-610, Box 0738, San Francisco, CA 94143-0738, USA
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Mensah JE, Asante EK, Kyei MY, Toboh B. Contemporary Evaluation and Treatment of Male Urethral Stricture Disease in West Africa. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0185-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nolte A, Aufderklamm S, Scheu K, Walker T, König O, Böttcher M, Niederlaender J, Schwentner C, Schlensak C, Stenzl A, Wendel HP. Small Interfering RNA Transfection Against Serum Response Factor Mediates Growth Inhibition of Benign Prostatic Hyperplasia Fibroblasts. Nucleic Acid Ther 2013; 23:62-70. [DOI: 10.1089/nat.2012.0392] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrea Nolte
- Department of Thoracic, Cardiac, and Vascular Surgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Stefan Aufderklamm
- University Department of Urology, Tuebingen University Hospital, Tuebingen, Germany
| | - Katrin Scheu
- Department of Thoracic, Cardiac, and Vascular Surgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Tobias Walker
- Department of Thoracic, Cardiac, and Vascular Surgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Olivia König
- Department of Thoracic, Cardiac, and Vascular Surgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Miriam Böttcher
- Department of Thoracic, Cardiac, and Vascular Surgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Jan Niederlaender
- Department of Thoracic, Cardiac, and Vascular Surgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Christian Schwentner
- University Department of Urology, Tuebingen University Hospital, Tuebingen, Germany
| | - Christian Schlensak
- Department of Thoracic, Cardiac, and Vascular Surgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Arnulf Stenzl
- University Department of Urology, Tuebingen University Hospital, Tuebingen, Germany
| | - Hans Peter Wendel
- Department of Thoracic, Cardiac, and Vascular Surgery, Tuebingen University Hospital, Tuebingen, Germany
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Lin JH, Wang WJ, Chang MY, Hung CC. Severe urinary retention following neobladder construction. Intern Med 2013; 52:1749-50. [PMID: 23903513 DOI: 10.2169/internalmedicine.52.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jui-Hsiang Lin
- Division of Nephrology, Department of Medicine, Taoyuan General Hospital, Taiwan
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Randomized clinical trial comparing effectiveness of intracorpus spongiosum block versus topical anesthesia for performing visual internal urethrotomy for urethral stricture disease. Urology 2012. [PMID: 23200974 DOI: 10.1016/j.urology.2012.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of intracorpus spongiosum block (ICSB) over topical anesthesia for performing visual internal urethrotomy (VIU) in a randomized clinical trial. METHODS VIU for urethral stricture can be performed under various types of anesthesia, including topical anesthesia. Although recent studies have shown that ICSB and general anesthesia have comparable efficacy for performing VIU, no studies have compared ICSB with topical anesthesia. Forty consenting patients with single, short, passable anterior urethral stricture were randomized into two groups. Group 1 patients received topical 2% lignocaine jelly and group 2 patients received 1% lignocaine ICSB for undergoing VIU. Pain perception during and after the procedure was assessed by visual analog scale (VAS). The changes in vital parameters during the procedure and procedure-related complications were recorded. Statistical analysis was done using the Mann-Whitney test or t test. RESULTS The mean±standard deviation VAS scores intraoperatively (2.85±1.34) and at 1-hour postoperatively (1.17±0.96) were significantly lower (P<01) in group 2 patients than the corresponding scores in group 1 (4.9±1.9 and 2.35±1.34 respectively). The intraoperative rise in pulse rate and in blood pressure were significantly greater (P<.05) in group 1 patients (13±5.1/min and 11.3±6.44 mm Hg) than in group 2 (8.05±5.54/min and 6.35±5.86 mm Hg). CONCLUSION ICSB is safe and more effective than topical anesthesia for providing pain relief during VIU. This should become the local anesthesia technique of choice for performing VIU.
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Beckley I, Garthwaite M. Post-operative care following primary optical urethrotomy: towards an evidence based approach. JOURNAL OF CLINICAL UROLOGY 2012. [DOI: 10.1016/j.bjmsu.2012.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction: Optical urethrotomy (OU) is the commonest procedure performed for primary bulbar urethral strictures. Recurrence rates of up to 50% are reported, but data is lacking on the influence of post-operative management regimes on patient’s outcomes. The aim of this study was to quantify the variation in treatment approaches within a region and determine from the literature what constitutes best practice. Methods: A survey regarding post-operative management following OU was sent to urologists in the Yorkshire Deanery. The questions related to post-operative catheter usage, intermittent self dilatation (ISD) regimes and follow-up investigations. A literature review regarding these aspects of post-operative care was subsequently performed. Results: Questionnaires were sent to 70 urologists, of which 42 urologists replied. All respondents insert a urethral catheter following OU. Two thirds of respondents advise patients to perform ISD but one third of those advise continuing for only 6 months. Uroflowmetry and post micturition residual estimation are the mainstay of follow up investigations. Conclusions: The practice in our region largely reflects the best available evidence. The literature suggests that catheter size/material has no effect on outcome. Catheter duration should be for less than 3 days due to increased risk of recurrence. ISD should be performed for at least one year as this is associated with significantly lower recurrence rates than 6 months treatment. Urethrography is more accurate than uroflowmetery for follow up but results must be correlated with patient symptoms.
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Affiliation(s)
- Ian Beckley
- Department of Urology, Castle Hill Hospital, Cottingham, Yorkshire, UK
| | - Mary Garthwaite
- Department of Urology, Castle Hill Hospital, Cottingham, Yorkshire, UK
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