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PubMed1997

[Treatment of posterior urethral break caused by pelvic fracture and inflammatory urethral stricture via laying three silicone tubers into urethra].

We investigated a new approach for the treatment of posterior urethral break caused by pelvic fracture and inflammatory urethral stricture. 7-10 days after the operation of urethral realignment on patients with urethral break caused by pelvic fracture or after forced dilatation of inflammatory urethral stricture, three silicone tubers were laid into urethra and kept there for three months. In 66 cases of urethral break, the cure rate (58/66) was 87.9%, the improving rate (2/66) 3.0% and the failure rate (6/66) 9.1%. In 15 cases of inflammatory urethral stricture, the recovery rate was 100%. In this group of 81 cases, the cure rate was 92.6% and failure rate was only 7.4%. This new therapeutic approach proved to be simple, safe and effective. It could also dramatically reduce the infection or the stricture of urethra.

Adolescent↗
PubMed1981

Incidence of urethral stricture after transurethral resection of prostate. Effects of urinary infection, urethral flora, and catheter material and size.

Urethral stricture is the most common complication of transurethral resection of prostate, occurring in up to 29 per cent of cases. A prospective trial was initiated to ascertain if the presence of positive urine and urethral bacterial cultures made any significant difference in urethral stricture incidence. One hundred patients were entered in the trial, 50 receiving latex catheters and 50 receiving Teflon catheters. There was no significant difference between the two groups in incidence of urethral stricture, and there was no correlation between positive urine and urethral bacterial cultures and stricture formation. It is suggested, therefore, tha urethral catheter material and size and the presence of organisms in the urine and in the urethra do not contribute significantly to the formation of urethral stricture following transurethral resection of the prostate.

Humans↗
PubMed1987

Urethral complications following ischiectomy in spinal cord injury patients: a urethral pressure study.

Ischial ulcers are the most common pressure sores in spinal cord injury patients and ischiectomy often is used in the over-all management. Because a high percentage of spinal cord injury patients with total ischiectomy had complications of the membranous and proximal bulbous urethra, we evaluated urodynamically 15 ischiectomy patients in the supine and sitting positions to determine if pressure usually borne by the ischial tuberosities was transmitted to the membranous and proximal bulbous urethra. Of the 8 patients with a complete ischiectomy at least on 1 side 5 had problems of the membranous and proximal bulbous urethra, and the average urethral pressure increase from the reclining to the sitting position was 111 cm. water. The increase in urethral pressure was not related to any change in bladder or abdominal pressure. The average urethral pressure increase in the nonischiectomy patients was only 16 cm. water and none had any problems of the membranous and proximal bulbous urethra. Some retrospective clinical studies have implicated ischiectomy in the development of these urethral complications. Our urodynamic data lend some direct evidence that a more complete ischiectomy results in excessive urethral pressure with the patient in the sitting position, thereby predisposing the membranous and proximal bulbous urethra to problems related to ischemia. Five of the 8 patients with more complete ischiectomy and 1 with bilateral partial ischiectomy had high urethral pressures and complications, such as pseudodiverticulum, diverticulum and dilatation. More incomplete ischiectomy should be used to obviate this urethral damage.

Humans↗
PubMed1995

[Value of urethral ultrasound in evaluation of pathologic urethral changes].

AIM: To compare the evaluation of urethral stricture disease using ultrasonic urethrography and standard retrograde urethrography (RUG). METHOD: 175 male patients suspected of having urethral stricture disease underwent urethral sonography prior to RUG in a prospective, non-randomized study. RESULTS: A correct positive diagnosis was established in 98% of the cases; a correct negative diagnosis in 96%. The sensitivity and specificity of urethral ultrasound in detecting urethral strictures were 98% and 96%, respectively. CONCLUSION: Ultrasound offers a three-dimensional study to evaluate the urethral without exposing the gonads to ionizing radiation. The exact length and depth of a stricture, the severity of the strictured segment as well as the anatomy of the periurethral scars were diagnosed accurately. Urethral ultrasound is a simple, inexpensive and rapid investigation of the urethra which should be the preferred diagnostic procedure in the evaluation of strictures in the anterior urethra of men.

Diagnosis, Differential↗
PubMed2000

[Male cervico-urethral obstruction of organic cause: transrectal prostatic ultrasonography versus permicturition and urethral ultrasonography].

AIM: This paper reports personal experience relating to the use of "static" and "permicturition" prostatic transrectal ultrasonography and urethral ultrasonography in the imaging diagnosis of obstructed patients. METHODS: Between January 1996 and January 1998 we selected 96 consecutive patients aged between 25 and 73 years old (mean 54 years) with symptoms of obstructive dysuria with pathological uroflowmetry and pressure/flow rates (Qmax ranging between 5-12 ml/sec and URA between 34-81). Eighteen of the patients selected had previously undergone prostate surgery for benign pathologies. All patients underwent a standard and permicturition transrectal ultrasonography and urethral ultrasonography using a retrograde approach. The results were compared with those obtained by retrograde urethrocystography and urethrocystoscopy, regarded as the "gold standard" for the diagnosis of urethral obstruction. RESULTS: Sixty-three (65.5%) patients were able to execute the permicturition phase, but only 54 (56.2%) reported that the test was indicative of "real urination", whereas retrograde urethral ultrasonography was well tolerated in all cases and easy to accomplish. In 19 (20%) patients (6 of whom had undergone prostate surgery and 13 were suffering from urethral stenosis), "major" organic alterations responsible for urethral obstruction were observed with the combined use of these ultrasonographic methods. These were not evident using static transrectal ultrasonography and increased the diagnostic sensitivity from 80 to 98%. CONCLUSIONS: We feel that an increasingly complete ultrasonographic study of the lower urinary tract is necessary, above all in obstructed patients. This can be achieved using permicturition and urethral transrectal ultrasonography, ensuring an accurate diagnosis and optimising health expenditure.

Adult↗
PubMed1998

Urethral diverticulectomy and pubovaginal sling for simultaneous treatment of urethral diverticulum and intrinsic sphincter deficiency.

The purpose of this article is to determine the efficacy and safety of simultaneous urethral diverticulectomy and placement of a pubovaginal sling in patients with concomitant urethral diverticula and intrinsic sphincter deficiency (ISD). Sixteen women (mean age of 53 years) underwent simultaneous urethral diverticulectomy and pubovaginal sling. ISD was determined by fluorourodynamic evaluation and Valsalva leak point pressures. Treatment outcome was determined by resolution of the diverticula and change in individual incontinence grades before and after surgical repair. All 16 who underwent urethral diverticulectomy had symptomatic resolution at a mean follow-up of 25 months. Fourteen of 16 patients (88%) had no physical or radiologic evidence of residual or recurrent diverticula, while 2 of 16 (12%) had small, stable residual diverticula. All 16 patients reported significant improvement in incontinence status after placement of the pubovaginal sling, with 14 of 16 (88%) cured and 2 of 16 (12%) significantly improved. Five of 16 (31%) had mixed incontinence preoperatively: 2 of 5 had resolution of detrusor instability (DI) after surgery, 3 of 5 had persistent DI. De novo DI developed in two patients. No patient had erosion of the sling despite its close proximity to the urethral mucosal suture line. The average time to complete bladder emptying was approximately 5 weeks, and no patient developed permanent urinary retention. Simultaneous pubovaginal sling and urethral diverticulectomy can be performed safely without increased risk to the urethral reconstruction, yet with excellent continence rates.

Adult↗
PubMed2003

Comparison of partial urethral replacement with acellular matrix versus spontaneous urethral regeneration in a canine model.

OBJECTIVE: To determine whether acellular matrix could be used for partial urethral replacement and to compare regeneration over acellular matrix versus normal spontaneous urethral regeneration. MATERIALS AND METHODS: The study included 21 male mongrel dogs in which a 3-cm segment including half of the urethral circumference was excised. In 13 dogs (study group), the defect was covered by acellular matrix of the same length and width obtained from female mongrel dogs and prepared to have complete cell lysis with keeping of the fiber framework. In 8 dogs (control group), the urethral defect was not covered by any urethral tissue. In both groups, an 8F feeding tube was kept inside the urethra for a mean duration of 2 weeks. In the study group, dogs were sacrificed at 1 week, 2 weeks, 3 weeks and then one dog every month for 10 months. In the control group, one dog was sacrificed every month for 8 months. RESULTS: All dogs survived the procedure. In the study group, 10 dogs underwent urethrogram; 8 were normal, 1 had diverticulum and 1 had relative narrowing. In the control group, 6 dogs underwent urethrogram; 5 were normal and 1 showed relative narrowing. Histopathological examination of the study group showed gradual regeneration over the acellular matrix with normal appearance at 20 weeks. In the control group, normal healing was observed at 2 months and thereafter. CONCLUSION: Regeneration of all components of the urethra can occur gradually over acellular matrix and is complete at 20 weeks. Regeneration of a urethral defect 3-cm long including half of the urethral lumen is possible with or without acellular matrix.

Animals↗
PubMed1997

Diagnosing intrinsic sphincteric deficiency: comparing urethral closure pressure, urethral axis, and Valsalva leak point pressures.

OBJECTIVES: Our purpose was to compare three measures proposed to diagnose intrinsic sphincteric deficiency: maximum urethral closure pressure, Valsalva leak point pressure, and straining urethral axis. STUDY DESIGN: A total of 159 women with pure genuine stress incontinence had the three measures determined in a standardized fashion. Critical cutoff values for the Valsalva leak point pressure (52 cm) and urethral axis (22 degrees) were established by examining relative frequency distribution curves, using closure pressure of 20 as the arbitrary benchmark value for the prevalence of intrinsic sphincteric deficiency. The distribution of cutoff values is described and differences among the measures with respect to risk factors for intrinsic sphincteric deficiency and incontinence severity were determined. RESULTS: Half the subjects fell below at least one cutoff value, but only 10% fell below all three. Sixty-four percent of subjects with either low closure pressure or leak point pressure had low values for the other, whereas 21% had discordance between them. Only 53% of subjects with low closure pressure and 40% with low leak point pressure had an axis < or = 22 degrees. Conversely, a substantial portion (36%) of subjects with pure genuine stress incontinence without urethral hypermobility had neither low urethral or leak point pressures. All three cutoff-values were associated with risk factors for intrinsic sphincteric deficiency, but only low closure and leak point pressures had significant associations with the severity of incontinence. CONCLUSIONS: Intrinsic sphincteric deficiency should be diagnosed by a composite of historic, urodynamic, anatomic, and clinical severity criteria. We would include a maximum urethral closure pressure < or = 20, a Valsalva leak point pressure < or = 50, and a stress urethral axis < or = 20 in this composite.

Adolescent↗
PubMed1984

Urethral response during bladder contraction induced by subcutaneous bethanechol chloride: elicitation of a sympathetic reflex urethral constriction.

The responses of the urethra to bladder filling and to subcutaneous bethanechol were studied in a surgically separated bladder-urethra preparation in chloralose anesthetized cats. With the pudendal nerves cut or the neuromuscular junction blocked with gallamine, urethral closure pressure increased during bladder filling and the initial phase of the micturition contraction. It then fell spontaneously or in response to bladder emptying through a vent. With the bladder volume held constant subcutaneous bethanechol induced an increase in basal bladder pressure which culminated in a sustained (reflex) contraction. The urethral constrictor response resembled that seen during the cystometrogram; an increase during the rise in detrusor pressure and a fall during the latter part of the sustained (reflex) contraction. In both cases the urethral response was substantially depressed by hypogastric nerve transection or by intravenous prazosin, implying that the urethral responses were reflexly mediated through the sympathetic system. Intra-arterial bethanechol also produced a urethral constriction, but this response was abolished by atropine and not affected by hypogastric nerve section or prazosin. It is therefore concluded that although bethanechol can produce urethral constriction through a direct muscarinic action on the urethra, it does not do so after subcutaneous administration in a neurally intact cat. The urethral response seen after subcutaneous bethanechol administration is part of the micturition reflex complex and is sympathetically mediated.

Animals↗
PubMed1996

Comparison of urethral pressure profilometry and contrast radiography in the diagnosis of incompetence of the urethral sphincter mechanism in bitches.

Three diagnostic indicators of urethral sphincter mechanism incompetence were compared in 25 continent and 25 incontinent anaesthetised bitches: the resting urethral pressure profile, the stressed urethral pressure profile and the radiographic position of the bladder neck. Logistic regression indicated that the best predictor of continence status was the stressed urethral pressure profile as assessed by the percentage of negative peaks extending below the resting intravesical pressure; it classified 43 of the 50 dogs correctly. The radiographic position of the bladder neck was a better predictor of continence than either the measurement of functional profile length or the maximum urethral closure pressure from the resting urethral pressure profile, whether alone or in combination. By combining the percentage of negative peaks on the stressed profile with the position of the bladder neck, 46 of the 50 dogs were classified correctly. Cut-off values for the percentage of negative peaks on the stressed urethral pressure profile, and for the radiographic position of the bladder neck are suggested for use in evaluating incontinent bitches in clinical practice.

Animals↗
PubMed2006

Translabial ultrasonography in the assessment of urethral diameter and intrinsic urethral sphincter deficiency.

OBJECTIVE: The purpose of this study was to determine the role of translabial ultrasonography in the investigation of intrinsic urethral sphincter deficiency (ISD), assessing bladder neck hypermobility and urethral diameter in continent and incontinent patients. METHODS: A case-control study evaluated 94 women with the diagnosis of urinary incontinence and 96 continent women. Both groups underwent translabial ultrasonography to assess bladder neck hypermobility by means of the x-y coordinate system and urethral diameter. The study was performed at Hospital de Clínicas de Porto Alegre. RESULTS: Women with urinary stress incontinence showed significantly greater bladder neck descent than continent women and women with urge and mixed incontinence (P = .05). Women with ISD showed significantly larger urethral diameters than control subjects and incontinent women without ISD (P = .05). Of women with urinary incontinence, 78.7% had descent of greater than 10 mm, and 91.7% of the women with ISD had urethral diameters of greater than 6 mm. A urethral diameter of greater than 6 mm showed sensitivity of 91.7% and specificity of 75.6% for ISD. CONCLUSIONS: Translabial ultra-sonography has an important role in the assessment of women with urinary stress incontinence and intrinsic urethral sphincter deficiency.

Analysis of Variance↗
PubMed1986

Electromyographic and urethral pressure evaluations: assessment of urethral function in female and ovariohysterectomized female cats.

Urethral pressure and electromyographic evaluations were performed in 10 healthy, intact female cats and in 10 healthy, ovariohysterectomized (OVH) female cats. Mean maximum urethral closure pressure was 71.4 +/- 25 cm of water for intact cats and 77.5 +/- 31.3 cm of water for OVH cats. Mean maximum pressure of the proximal 60% of the urethral pressure profile length was 39.2 +/- 7.4 cm of water for intact cats and 32.1 +/- 11.6 cm of water for OVH cats. Mean maximum pressure of the distal 40% of the urethral pressure profile length was 76.2 +/- 27.4 cm of water in intact cats and 80.5 +/- 32.9 cm of water in OVH cats. Significant differences between intact and OVH cats were not found in mean maximum urethral closure pressure, proximal urethral sphincter pressure, or distal urethral sphincter pressure.

Animals↗
PubMed2002

Primary urethral tuberculosis masquerading as a urethral caruncle: a diagnostic curiosity!

Primary urethral tuberculosis associated with a caruncle is an extremely rare entity and ours is the second such case to be reported. A middle-aged woman presented with symptoms of frequency dysuria syndrome for the last 2 years. Local examination and cystoscopy revealed localized parurethral induration, tenderness and a urethral caruncle with chronic obliterative urethritis. Transvaginal ultrasound revealed a solid lesion arising from the posterior urethral wall. Excision of the caruncle and transurethral resection of the paraurethral mass lesion revealed chronic granulomatous inflammation with chronic urethritis and fibrocollagenous tissue. The literature regarding the genesis of urethral caruncle, the underlying conditions, its differential diagnosis and management has been reviewed.

Diagnosis, Differential↗
PubMed2004

Observations on the function of the female urethra: II: Relation between maximum urethral closure pressure at rest and the degree of urethral incompetence.

AIMS: To study the relation between maximum urethral closure pressure (MUCP) at rest and the degree of urethral incompetence in the female. PATIENTS AND METHODS: Two hundred fifty five patients aged 20 years or older, with stable bladders on multichannel urodynamics, without known neurological pathology, and with no previous history of pelvic or anti-incontinence surgery were included in the study. Resting urethral pressure profile (UPP) and the grade of urethral incompetence was registered. RESULTS: Mean age of the group was 45.6+/-12.7 years; mean MUCP was 62.7+/-28.5 cm of water. There was a statistically significant difference in the MUCP when the different grades of urethral incompetence were compared to each other, the higher grades being associated with a lower maximal closure pressure. CONCLUSIONS: This study demonstrates that there is a highly significant relationship between MUCP and between all grades of urethral incompetence. This supports previous observations that MUCP decreases when abdominal leak point pressure (ALPP) is low and that this might be secondary to some mechanical failure in the pressure transmission from the abdominal cavity to the urethra. Studies should never compare continent to incontinent cohorts without considering their ALPP because in doing so they are comparing groups that are functionally heterogeneous.

Adult↗
PubMed2006

Application of endoscopic Ho:YAG laser incision technique treating urethral strictures and urethral atresias in pediatric patients.

Endoscopic holmium:yttrium-aluminum-garnet (Ho:YAG) laser incision is a new method applied in pediatric urology recent years. To evaluate its therapeutic efficacy on treating the pediatric patients with urethral strictures and urethral atresias, a retrospective study was performed from June 2001 to July 2005 in a total of 28 pediatric patients who underwent endoscopic internal urethrotomy using Ho:YAG laser in our center. In these patients, 25 had urethral strictures and 3 urethral atresias. Follow-up was done ranging from 2 months to 4 years to assess the treatment. Of the 28 patients, 25 (89.3%) have achieved satisfied result without complications following initial incisions. Two patients with urethral atresias and another with long lesion of stricture (> 2 cm) have postoperative stenosis (10.7%). Among the three reoccurred patients, two were successfully reoperated by Ho:YAG laser and open end-to-end anastomosis, respectively. One patient failed to follow-up. With the advantages of safety, efficacy and minimal invasion, endoscopic Ho:YAG laser incision technique could be used as a primary treatment in urethral stricture patients and is worthy to be popularized further in pediatric surgery.

Adolescent↗
PubMed1990

Urethral strictures and aortic surgery. Suprapubic rather than urethral catheters.

Urethral strictures associated with the use of a urethral catheter may be more common after cardiac and aortic surgery when compared with other surgical procedures. The reasons for this are obscure. Fifty-two aortic procedures in males from 1980-1983 were reviewed with an incidence of urethral stricture of 21%. Forty anterior resections of the rectum in which a urethral catheter was used were also reviewed with an incidence of urethral stricture of only 5%. Since 1985 supra-pubic catheters have been used now in over 200 aortic procedures with no morbidity and no urethral stricture. Bacteriuria has been significantly reduced by the use of supra-pubic catheters and there would appear to be considerable advantages in the use of this technique.

Aged↗
PubMed1993

Chemotactic activity of urethral secretions in men with urethritis and the effect of treatment.

The chemotactic activity of urethral exudate and the effect of treatment were assessed in 67 patients with nongonococcal urethritis (NGU) or gonorrhea. All samples demonstrated chemotactic activity related to the number of neutrophils seen on Gram's staining of the urethral smear. Chemotactic activity decreased after treatment in patients with Chlamydia-positive NGU (mean +/- SE, 21.1 +/- 2.7 cells/high-power field [hpf] before treatment; 8.7 +/- 2.2 after treatment; P < .004) and gonorrhea (25.6 +/- 5.2 cells/hpf before treatment; 1.6 +/- 0.7 after treatment; P < .015). Chemotactic activity increased again in Chlamydia-positive NGU patients to 21.0 +/- 3.3 cells/hpf (P < .05) 2-3 weeks after cessation of therapy in the absence of demonstrable infection or further intercourse. There was no significant decrease in chemotactic activity after therapy in the Chlamydia-negative NGU or persistent urethritis groups. These data suggest a previously unrecognized persistent chemotactic stimulus in urethral exudate from patients with urethritis.

Chemotaxis, Leukocyte↗
PubMed1997

Adjuvant home urethral balloon dilation for the recalcitrant urethral stricture.

PURPOSE: We determined the efficacy of adjuvant home balloon self-dilation as an alternative to office dilation and to reduce the likelihood of recurrence in patients with recalcitrant urethral strictures. MATERIALS AND METHODS: A total of 31 men participated in a urethral self-dilating protocol following phallic construction, urethroplasty or visual internal urethrotomy, or as conservative management in 2 nonoperative candidates. Uroflow data and subjective information obtained by blinded questionnaire were reviewed. RESULTS: The 31 patients were followed for a mean of 18.7 months (range 3 to 45) after initial balloon dilation, and 25 (81%) were available for followup interviews. Of the 25 patients 24 (96%) found no difficulty in learning the technique and 21 (84%) thought they received adequate training with 1 office visit. Most patients noted improvement in voiding with balloon dilation, and peak uroflowmetry rates were preserved or improvement with long-term followup. Six patients (19%) complained of discomfort with balloon placement, 3 (10%) noticed minor bleeding with dilation and 4 (13%) had urinary tract infections during followup. Following visual internal urethrotomy, no stricture recurrences were noted in 9 patients. Strictures recurred in 2 of 13 (15%) urethroplasty patients following balloon dilation. After radial forearm free flap phallic construction, a technique known to have a high re-stricture rate, 5 of 7 patients (71%) had recurrent urethral stricture. CONCLUSIONS: Preliminary results indicate that adjuvant outpatient urethral self-dilation following surgical correction of urethral strictures in patients at high risk for recurrence is inexpensive and safe, as well as a potentially effective option in reducing stricture recurrence and maintaining urethral patency.

Adult↗