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PubMed2005

Obstruction after Burch colposuspension: a return to retropubic urethrolysis.

We compare our postoperative outcomes of a vaginal vs abdominal urethrolysis after an obstructed Burch colposuspension. We performed a retrospective review of all women who had undergone a Burch urethrolysis from 1997 through 2003. Data collected included pelvic examination, cystoscopic and urodynamic findings, surgical morbidity, and pre- and postoperative urogynecologic symptomatology. Sixteen women underwent Burch urethrolysis. Preoperative symptoms were obstructive in 6, overactive in 2, and both (obstructive/overactive) in 8. All had an acute retropubic angulation of the urethral axis as well as a retropexed urethra that prohibited sagittal rotation of a rigid cystoscope. Seventy-eight percent of the women with urodynamic information met urodynamic criteria for urethral obstruction. Average follow-up was 7 months, and of those undergoing a vaginal urethrolysis, three out of seven (43%) had resolution of their obstructive or overactive symptoms postoperatively. In contrast, seven out of nine women (78%) who underwent a retropubic urethrolysis had relief of their obstructive or overactive bladder symptoms. In our cohort study, an abdominal retropubic urethrolysis was more successful in relieving urethral obstruction than a vaginal urethrolysis.

Abdomen↗
PubMed1986

Prognosis of posterior urethral valves presenting at birth.

Urethral obstruction due to posterior urethral valves (PUV) is a more lethal condition in the newborn than is commonly recognized. To study its prognosis when the diagnosis of PUV is made shortly after birth, cases of PUV presenting in the first week of life were reviewed. Eleven cases were seen at the University of California, San Francisco from 1974 to 1982. Five babies died, three within two hours of birth of respiratory insufficiency secondary to severe pulmonary hypoplasia, and two within three weeks with rapidly progressive renal failure. Of the six survivors, four exhibited respiratory difficulty (prolonged ventilatory support required in two, and bilateral pneumothoraces in two), three developed renal failure despite early urinary diversion, and one had renal tubular dysfunction. Only two infants had normal renal function after undergoing a successful series of reconstructions. Prune-belly syndrome and limb deformities were present in two surviving and two fatal cases. Although most cases of congenital hydronephrosis can be successfully treated after birth, those presenting in the newborn period represent a subset with high morbidity and mortality. With advances in prenatal diagnosis of congenital hydronephrosis, salvage of severe cases detected early in gestation may require more aggressive management in the prenatal period.

Humans↗
PubMed2004

Spontaneous resolution of prenatal megalourethra.

Urethral obstruction in the fetus is rare. Whereas proximal obstruction most often is caused by posterior urethral valves, causes of distal obstruction are less well recognized and can include urethral atresia, urethral webs, and anterior urethral valves. These latter abnormalities can lead to urinary retention, incontinence, enuresis, spontaneous bladder rupture, and megacystis. The authors present 3 fetuses (gestational age range, 18 to 20 weeks) in whom distal urethral obstruction was suspected by prenatal ultrasonography in the absence of a demonstrable lesion. All 3 experienced spontaneous resolution of the presumed obstruction. On follow-up, all are alive and well with no adverse genitourinary tract sequelae. No postpartum intervention was required.

Adult↗
PubMed1994

Inability to pass a urethral catheter: the bedside role of the flexible cystoscope.

An all too common cause of urologic consultation is the inability to place a urethral catheter. Often other health care providers have unsuccessfully attempted catheter placement. Urethral false passages, perforations, and edema are common sequelae. Diseases such as urethral strictures, bladder neck contractures, and prostate cancer are often the underlying etiologies for failed catheterization. Traditionally, the use of filiforms and followers or the placement of a suprapubic tube is required to drain the lower urinary tract. Bedside flexible endoscopy was performed in this series not only to define the area and etiology of urethral obstruction, but also to facilitate catheter placement. Fifty-four patients were studied prospectively. Initial endoscopic assessment was based on bedside flexible cystoscopy. Most procedures were performed under topical lidocaine anesthetic. Under direct vision a 0.038 inch standard guide wire was directed through the area or areas of obstruction. Strictures, fibrosis, and false passages were dilated using a series of graduated Nottingham dilators over the guide wire. A Council-tipped urethral catheter was then placed over the guide wire to assure bladder drainage. In 52 of the 54 patients urethral obstructions were dilated and drainage catheters were placed into the bladder. No complications were encountered. This technique is simple, it avoids suprapubic puncture, and it minimizes unneeded trips to the operating room.

Cystoscopes↗
PubMed2001

[Intrauterine therapy of obstructive uropathy--case report].

The use of vesicoamniotic shunt in the case of obstructive uropathy was described. On the base of ultrasound screening it has been diagnosed urethral obstruction. This abnormality of urinary tract was found in male fetus. It has been diagnosed the posterior urethral valve. Qualification to intrauterine therapy was based on normal parameters of renal function. Under ultrasound guidance the vesicoamniotic shunt was installed. The normal drenage was observed within 6 weeks, until it was dislocated. In 36th week of gestation the cesarean section was performed. The indications were signs of urethral obstruction. The boy was born in whom posterior urethral valves were recognized. He was born in good condition without any biochemical features of renal damage as well as signs of hypoplastic lung.

Adult↗
PubMed2005

Balloon dilation of a urethral stricture in a dog.

A 2-year-old male neutered Scottish Terrier presented with dysuria caused by complete urethral obstruction due to a stricture secondary to catheter-induced trauma. The urethral obstruction was resolved by balloon dilation of the stricture under fluoroscopic guidance.

Animals↗
PubMed2002

Management of urinary retention and obstruction following surgery for stress urinary incontinence.

Urethral obstruction is a potential consequence of all types of anti-incontinence surgery. Not all patients will present in frank urinary retention: the surgeon must have a high index of suspicion to make the correct diagnosis in these cases. Important considerations in the diagnosis of these patients include the timing and methodology of evaluation. Formal urethrolysis in a variety of approaches has demonstrated similar cure rates and recurrent stress incontinence rates. Sling incision may provide an easier and less morbid approach to relieving obstruction caused by a pubovaginal sling with equal efficacy. The procedures are described and recent outcomes discussed.

Humans↗
PubMed2003

Short-term effect of a single levodopa dose on micturition disturbance in Parkinson's disease patients with the wearing-off phenomenon.

We investigated the short-term effects of a single dose of levodopa (L-dopa) on micturition function in PD patients with wearing-off phenomenon. Eighteen PD patients who had median Hoehn and Yahr scores of 5 during the off phase and 3 during the on phase were recruited. We carried out urodynamic studies before and about 1 hour after the patients had taken 100 mg of L-dopa with dopa-decarboxylase inhibitor (DCI). After taking the L-dopa/DCI, urinary urgency and urge incontinence aggravated, whereas voiding difficulty was alleviated in all 12 patients. When compared to the baseline assessment, urodynamic study results after taking 100 mg of L-dopa/DCI showed aggravated detrusor hyperreflexia; decreased maximum bladder capacity (P = 0.006); an increased maximum Watts Factor value (P = 0.001), reflecting the detrusor power on voiding; an increased Abrams-Griffiths number (P = 0.042), reflecting urethral obstruction on voiding; decreased residual urine volume (P = 0.025); and increased static urethral closure pressure (P = 0.012). One hundred milligrams of L-dopa/DCI worsened detrusor hyperreflexia, producing worsened urinary urgency and urge incontinence during the storage (bladder-filling) phase. It also increased detrusor contractility much more than it did urethral obstruction in the voiding phase, producing overall lessening of voiding difficulty and improving voiding efficiency in our PD patients with the wearing-off phenomenon.

Antiparkinson Agents↗
PubMed1993

[Histological study of fetal hydronephrosis. Development background of prenatal treatment].

It is still unclear whether prenatal decompression of the dilated urinary tracts can preserve renal development and function. Following the previous report on the relationship between the nephrogenesis and the gestational weeks in normal fetuses, we studied the hydronephrotic kidneys to find the histological background of the fetal treatment. Of the fetuses autopsied in the Department of Pathology of our Institute from 1982 to 1992, 32 kidneys from 21 fetuses associated with dilatation of the upper urinary tracts irrespective of the presence of urethral obstruction on macroscopic inspections were reviewed. The underlying disorders causing hydronephrosis included urethral obstruction in 7, vesico-intestinal fissure in 3, hydrometrocolpos in 2 and double ureter in 1. The etiology of the hydronephrosis was not clarified in another 8. The position and configuration of the ureteral orifices were not described in the autopsy reports. Microscopic examination was done to define the radial glomerular count (RGC), presence or absence of the nephrogenic zone, cortical cysts and dysplastic elements, changes of the collecting tubules and interstitium. Of the kidneys 19 had cortical cysts of various sizes. In some kidneys, the normal cortex was mixed with pathological segments where there were subcapsular small cysts and tubular dilatation. Nephrogenic zone, which was observed in specimens of 33-weeks fetus with moderate hydronephrosis, was already missing by 28 weeks in severe hydronephrosis. Collecting tubules were dilated in 12 kidneys with mild to moderate hydronephrosis. Tubular atrophy and increase in the interstitium were seen in 12 kidneys, eleven of which were of the fetus over 30 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Embryonic and Fetal Development↗
PubMed1995

[Obstruction of the urethral conduct following implantation of the endoprosthesis Urolume: therapeutic management].

The introduction of self-expandable urethral endoprostheses for the management of relapsing urethral stenosis has required the development of a minimally invasive therapeutical approach of widespread acceptance by the urological community. The reason for its success is the simplicity of implantation and the low rate of complications up to date. This paper reports on a patient carrying a ¿Urolume¿ urethral endoprosthesis for a relapsing bulbar urethral stenosis, which two years after implantation presents re-stenosis secondary to endoluminal inflammatory tissue growth. After two failure endoscopic resections, endoscopic removal of the prosthesis was required. Currently the patient carries a ¿Urocoil¿ spiral endoprosthesis to avoid tissular reaction. The therapeutical aspects found in the literature are reviewed, emphasizing the need of follow-up to detect complications, to improve indications and to select those patients that may be candidates for this treatment.

Adult↗
PubMed2005

Evaluation of clinical signs and causes of lower urinary tract disease in European cats.

OBJECTIVES: To investigate the clinical signs and causes of lower urinary tract disease (LUTD) in 77 cats. METHODS: Cats diagnosed with LUTD over a two-year period were included in the study. RESULTS: The study population comprised 67 male and 10 female cats. Uroliths occurred in 17 of the 77 cats (22 per cent), urethral plugs in eight cats (10 per cent) and urinary tract infection in six cats (8 per cent). In 44 cats (57 per cent), no specific cause for the disease was found and they were classified as having idiopathic LUTD. In two of the 77 cats (3 per cent) no definitive diagnosis was established. Pain was less common in cats with uroliths and haematuria was more often seen in cats with urinary tract infection. At presentation, urethral obstruction was diagnosed in 45 of the 77 cats (58 per cent). CLINICAL SIGNIFICANCE: The causes of LUTD found in cats in this study are similar to those that have been previously documented, and idiopathic LUTD is the most frequent diagnosis. However, the rate of urethral obstruction, particularly in cats with idiopathic LUTD, was higher than in other reports. The cause of this difference is unknown.

Animals↗
PubMed1991

Clinical evaluation of cats with lower urinary tract disease.

In a prospective study, 141 cats with hematuria, dysuria, urethral obstruction, or combinations of these signs were evaluated by contemporary diagnostic methods and compared with 26 clinically normal cats (controls). Specific diagnosis was established in 45% (64/141) of cats affected with lower urinary tract disease (LUTD). Crystalline matrix plug-induced urethral obstruction was diagnosed in 21% (30/141) of affected cats, uroliths were identified in 21% (30/141) of affected cats, uroliths with concomitant bacterial urinary tract infection (UTI) were identified in less than 2% (2/141) of affected cats, and bacterial UTI alone was identified in less than 2% (2/141) of cats with LUTD. Viruses, mycoplasmas, and ureaplasmas were not isolated from urine samples collected from affected or control cats. Bovine herpesvirus 4 (BHV-4)-neutralizing antibodies were not detected in any serum sample obtained from cats with LUTD or from control cats. In contrast, BHV-4 antibodies were detected by an indirect immunofluorescent antibody (IFA) test in sera obtained from 31% (44/141) of cats with LUTD and 23% (6/26) of control cats. The prevalence of positive BHV-4 IFA test results in affected cats was not significantly different from that observed in control cats. Significant association was not apparent between positive BHV-4 IFA test results and clinical diagnosis, abnormal laboratory findings, or cat age. However, the number of male cats with BHV-4 IFA titer was significantly (P less than 0.02, chi 2 test) greater than that of female cats. Detection of BHV-4 antibodies in approximately 30% of affected and control cats indicates prior virus exposure. Further investigations are warranted to clarify the specific role of BHV-4 in cats with naturally acquired LUTD.

Animals↗
PubMed2001

The effect of bladder outflow obstruction on detrusor blood flow changes during the voiding cycle in conscious pigs.

PURPOSE: We monitored detrusor blood flow in pigs with bladder outflow obstruction. MATERIALS AND METHODS: Partial urethral obstruction was created in 9 immature, female large white pigs with an implanted ring, and 10 normal animals were used for comparison. Urodynamic parameters and detrusor blood flow were measured using chronically implanted access catheters and laser Doppler fibers. Repeated recordings were made from each animal while it was lightly sedated. RESULTS: The animals with implanted rings developed prolonged, high pressure voiding contractions in association with poor urinary flow, indicating bladder outflow obstruction, and had evidence of detrusor instability. In obstructed and normal animals detrusor blood flow was maintained during bladder filling. Elevated detrusor pressure during voiding significantly decreased blood flow to similar levels in each group. The duration of the ischemic period was much greater in obstructed animals. CONCLUSIONS: Bladder outflow obstruction is associated with repeated episodes of prolonged detrusor ischemia which may account for the biochemical and neuronal alterations in such bladders.

Animals↗
PubMed2004

A new tension-adjustment technique for sling operation: an animal model.

OBJECTIVE: To investigate the effectiveness of a new tension-adjustment technique for postoperative voiding difficulties encountered after sling operations. METHOD: To test our new method, urethral obstruction was developed in 5 female dogs by modifying the sling operation by exerting more tension on a specially prepared polypropylene strip in which a gap had been developed. After filling the bladder with isotonic solution, detrusor contractions were induced by pelvic nerve stimulations, and urodynamic studies were performed to document the urethral obstruction. In each case Foley catheters were inserted into the bladder and left in place until the time of tension adjustment. Tension adjustment was performed in the 1st, 2nd, 3rd, 4th and 5th weeks postoperatively for dogs 1, 2, 3, 4, and 5, respectively. RESULTS: On the day of tension adjustment, after filling the bladder with isotonic solution and removing the Foley catheter, none of the dogs, except dog 3, was able to produce a free flow of urine either spontaneously or provoked by detrusor contractions. The release of the prolene sutures was readily achieved in all cases except dog 5. In this case, sling takedown was achieved after surgical exploration in which the sling location was confirmed by following the prolene sutures and Hegar's dilator. After identifying the sling, the gap was opened by cutting the prolene sutures, instead of a sling incision. Release of the prolene sutures resulted in a distinct drop in the urethra with decreased resistance of Hegar's dilator. The improvement in voiding was confirmed by postoperative urodynamic studies and was immediate in all cases. CONCLUSION: Our new technique for postoperative voiding difficulties encountered after sling operation is simple, effective and avoids re-operation in the early postoperative period.

Animals↗
PubMed1990

Prostatodynia or painful male urethral syndrome?

A prospective video-pressure-flow-EMG urodynamic evaluation in two groups of patients was undertaken to show possible differences in the prostatodynia versus nonprostatodynia group regarding their urodynamic characteristics. There was no statistically significant difference, and the main characteristic in both groups was the increased maximum urethral closure pressure (MUCP) recorded at the distal prostatic and membranous urethral segments. During voiding there was a distal urethral narrowing along with a proximal one seen in several patients and a synchronous decrease in urinary flow rate (peak and average flow) in the majority of patients. This functional urethral obstruction should be named "painful urethral syndrome" and not prostatodynia and may be only a step in a chain of events leading finally to chronic nonspecific prostatitis.

Action Potentials↗
PubMed1981

The pathogenesis of renal dysplasia. III. Complete and incomplete urinary obstruction.

We graded obstructed kidneys of infants on the hypodysplasia scale to assess the influence of complete and partial obstruction on the pathogenesis of hypodysplasia. Kidneys with complete obstruction exhibited severe grades; those with partial ureteral obstruction had near normal grades. Those kidneys subjected to partial urethral obstruction ranged from mild to severe grades which correlated with degrees of lateral ectopy of the urethral office. Renal parenchymal development was impaired by complete obstruction but was tolerant to incomplete obstruction. Abnormal orifice positions associated with urethral obstructions were considered to be manifestations of ectopic ureteric buds and the hypodysplasia to be evidence of abnormal induction of abnormal renal blastema.

Humans↗
PubMed2002

Rate of recurrent stress urinary incontinence after retropubic urethrolysis.

PURPOSE: We determined the rate of recurrent female stress urinary incontinence after retropubic urethrolysis without a concomitant anti-incontinence procedure. MATERIALS AND METHODS: We reviewed the charts of all women who underwent urethrolysis at our institution for urethral obstruction due to an anti-incontinence procedure. The study was limited to patients who underwent retropubic urethrolysis without a synchronous anti-incontinence operation or interposition flap inlay for obstruction associated with a suburethral sling. Variables reviewed included the history of urethrolysis, success of retropubic urethrolysis and incidence of urinary incontinence after the operation. RESULTS: A total of 12 patients met our study criteria, of whom 1 had stress urinary incontinence before retropubic urethrolysis. Of the 12 patients 10 achieved a successful result after urethrolysis and 2 achieved improvement but not success secondary to urinary urge incontinence. Protective padding was needed postoperatively for urinary incontinence in 5 of the 12 cases, including 3 (25%) and 2 (17%) due to stress and urgency incontinence, respectively. New onset stress urinary incontinence developed postoperatively in 2 of the 11 patients (18%) who did not have stress urinary incontinence before retropubic urethrolysis. A history of failed urethrolysis did not significantly increase the urinary incontinence rate postoperatively. CONCLUSIONS: Although retropubic urethrolysis has a high potential success rate for resolving urethral obstruction, it may cause a higher incidence of recurrent stress urinary incontinence than transvaginal approaches. There is no clear need for a synchronous anti-incontinence procedure at the time of retropubic urethrolysis.

Adult↗