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At least 91 records · Page 5Linked to original sources
PubMed1988

An evaluation of urethral smear by Papanicolaou stain in men with urethritis.

The objective of this study was to evaluate the usefulness of a Papanicolaou stained urethral smear (Pap smear) to identify sexually transmitted disease (STD) pathogens in men with urethritis. Specimens from the endourethra were obtained for Chlamydia trachomatis and Neisseria gonorrhoeae cultures, a Gram stain, and a Pap smear in 24 symptomatic men aged 16-22 years. All Pap smears were read independent of the culture results. Based on the laboratory techniques employed, nine subjects had gonococcal urethritis (GU), and 11 had nongonococcal urethritis (NGU). Four subjects with GU had concomitant infection with another STD pathogen(s). Papanicolaou smear alone identified four different pathogens in 16 subjects, chlamydia in ten, trichomonads in two, intracellular diplococci in two, multinucleate giant cells of herpes in one, and chlamydia and trichomonad together in one. Out of 11 chlamydia-positive Pap smears, three had a positive culture. One subject had a positive chlamydia culture and a negative Pap smear. Two subjects with intracellular diplococci on Pap smear had culture-confirmed gonorrhea. The Pap smear was useful in identifying some of the different pathogens in NGU, especially trichomonads and herpes, not recoverable by commonly used techniques and in the diagnosis of concomitant infection by more than one STD pathogen in GU. Adding the Pap smear to the diagnostic tests for urethritis increased the etiologic diagnoses from 37.5% to 79%.

Adolescent↗
PubMed2003

Guide wire-assisted urethral dilatation for urethral strictures in pediatric urology.

PURPOSE: The aim of this study was to report the results of 32 cases of dilatation of urethral stricture using a guide wire and sheath dilator technique supplemented by clean intermittent catheterization if further stabilization of the urethral stricture was felt warranted. METHODS: The procedure involves insertion of a straight flexi-tip lubricated guide wire through the urethral stricture under cystoscopic guidance followed by insertion of a series of sheath dilators. Dilatation was followed by insertion of a Foley catheter, which was left in situ for 1 to 3 days. Patients underwent repeat cystoscopy to evaluate the urethra for recurrent stricture and those with a recalcitrant stricture were commenced on clean intermittent catheterization (CIC) to stabilize the narrowing. RESULTS: Thirty-two patients were included. They have been followed up for up to 2(1/2) years after their last cystoscopy (mean, 16 months). Thirteen of 32 patients had more than 4 dilatations under anesthesia. Twelve patients had undergone CIC postoperatively. Complications included a urinary tract infection in 3 boys and bladder spasms in one. No false passage or sepsis occurred with this approach. CONCLUSIONS: Guide wire-assisted urethral dilatation helps avoid risks associated with blind dilatation techniques and appears to be a safe and simple alternative for management of urethral strictures in pediatric urology.

Adolescent↗
PubMed2002

Core-through urethrotomy using the neodymium: YAG laser for obliterative urethral strictures after traumatic urethral disruption and/or distraction defects: long-term outcome.

PURPOSE: We assessed the feasibility, efficacy and long-term outcome of neodymium (Nd):YAG laser core-through urethrotomy for posttraumatic urethral stricture. MATERIALS AND METHODS: Between May 1997 and April 2000, 65 patients 5 to 62 years old underwent laser core-through urethrotomy for posttraumatic urethral stricture. Most patients had been involved in a motor vehicle accident but 8 and 3 sustained trauma after tractor injury and a railroad accident, respectively. All patients underwent suprapubic cystostomy formation and 18 had previously undergone anastomotic urethroplasty, railroad or attempted cold knife core-through urethrotomy. Mean stricture length was 2.2 cm. on bi-directional uroradiography and endoscopy. All strictures were in the bulbomembranous urethra except 3, which were prostatic-supraprostatic. The procedure was technically unsuccessful in 4 cases. Core-through urethrotomy was performed using Nd:YAG a 600 mu. contact bare fiber at 15 to 20 W. on an outpatient basis. Catheter removal and voiding cystourethrography were performed at 6 weeks. Uroflowmetry and urethroscopy were done 3 months after urethral catheter removal. Followup was 9 to 44 months. RESULTS: Nd:YAG laser core-through urethrotomy was performed on an outpatient basis successfully in all except 4 cases without any intraoperative or postoperative complications. Blood transfusion was not required. Although most patients were symptom-free, a few underwent initial optical internal urethrotomy and/or endoscopic dilation before the stricture became stable. The urethral lumen was obliterated again in 2 cases. CONCLUSIONS: Nd:YAG laser core-through urethrotomy is feasible and effective with good long-term results for posttraumatic urethral stricture.

Adolescent↗
PubMed1991

Temporarily implanted urethral coil stent for the treatment of recurrent urethral strictures: a preliminary report.

A new urethral stent developed for use in recurrent urethral strictures is presented. This metallic coil is self-expanding when released from its introducing catheter. The stent was used in 18 patients with recurrent strictures necessitating frequent dilation or urethrotomy. The stent is introduced under fluoroscopic guidance after internal urethrotomy or simple dilation. Strictures of 5 to 60 mm. were treated successfully with this device. All strictures were distal to the external sphincter. No serious complications attributed to the device were recorded. When necessary, the stent could be repositioned either under fluoroscopic control or endoscopically. This device can hold the stenotic area of the urethra open for long intervals allowing for complete healing. Even after 6 months the stent is not covered with urethral epithelium and does not become incorporated into the urethral wall. It can be removed easily without an operation by simple manipulation. The large internal caliber permits passage of endoscopes up to 17F in patients who require cystoscopy. The device can be removed before transurethral resections and then a new stent can be inserted at the end of the procedure. Mean followup of our patients with the stent indwelling was 8 months (range 4 to 11 months). Followup after removal of the stent (6 patients) was 3 to 8 months (mean 5 months). The patients voided well during followup and were fully continent. No incrustations were noted in the removed stents even after 6 months and no stent became obstructed due to tissue proliferation or incrustation. In 1 patient the stricture recurred after 3 months and a new stent was inserted. Urine sterilization was obtained in 7 patients with infected urine after relatively short courses of antibiotics. This stent seems to be a promising tool for the nonoperative treatment of recurrent urethral strictures.

Humans↗
PubMed1986

Urethral stricture following cardiovascular surgery: role of urethral ischemia.

The incidence of urethral stricture has been surprisingly high following cardiovascular surgery in the last few years. We conducted a prospective study on 68 male patients undergoing cardiovascular surgery to determine the main factor(s) responsible for the development of urethral stricture. The penile-brachial pressure index was checked by strain gauge plethysmography. We found that urethral strictures developed in 15 patients (22 per cent) within an average of 3 months after cardiovascular surgery. Of these patients 13 had a penile-brachial index of 0.6 or less and complained of erectile impotence. A latex type of catheter was used in 11 and a silicone catheter in 4 of these 15 patients for urinary drainage. We conclude that urethral ischemia has an important role in the development of stricture, particularly when a latex urethral catheter is used for drainage. We recommend that a vascular penile study should be done in patients with erectile impotence undergoing an open heart operation, and that serious consideration should be given to the use of a cystocatheter diversion the night before the operation in those with a penile-brachial index less than 0.6. We strongly recommend the use of a silicone catheter in all other patients undergoing open heart surgery with hypothermia.

Adult↗
PubMed1984

Role of urethral ischemia in the development of urethral strictures after cardiovascular surgery: a preliminary report.

A high incidence of urethral stricture was noted following cardiovascular surgery. In an attempt to elucidate factors predisposing to the occurrence of urethral stricture, we studied the penile blood flow in 7 patients presenting with strictures after cardiovascular surgery. Of these patients 5 had penile-brachial pressure indexes less than 0.5 and 6 had weak or absent erections. Of 14 patients studied prospectively by penile blood flow 2 had a low penile-brachial pressure index and suffered urethral strictures 6 weeks after cardiovascular surgery. This finding suggests that urethral ischemia could be a predisposing factor for the development of urethral strictures after cardiovascular surgery.

Adult↗
PubMed1996

Mohs' micrographic surgery and distal urethrectomy with immediate urethral reconstruction for glanular carcinoma in situ with significant urethral extension.

OBJECTIVES: To report the use of conservative extirpative surgical techniques to manage glanular carcinoma in situ with significant urethral extension. METHODS: Over a 5-year period, 2 patients with carcinoma in situ of the glans with significant distal urethral involvement, who refused penectomy, were managed with combined treatment modalities using Mohs' micrographic surgery and distal urethrectomy with immediate urethral reconstruction. RESULTS: At follow-up of 5 years and of 12 months, there has been no evidence of meatal or proximal urethral recurrence. CONCLUSIONS: Mohs' micrographic surgical excision and distal urethrectomy with immediate urethral reconstruction offers an acceptable alternative to partial penectomy in patients with perimeatal carcinoma in situ who fail conservative treatment or refuse penectomy.

Aged↗
PubMed2002

A bioabsorbable self-expandable, self-reinforced poly-L-lactic acid urethral stent for recurrent urethral strictures: long-term results.

BACKGROUND AND PURPOSE: Biodegradable urethral stents have been used clinically for some years mainly in order to prevent postoperative urinary retention after minimally invasive thermotreatment of benign prostatic hyperplasia. We previously reported a 15-month-follow-up pilot study of a bioabsorbable self-expandable, self-reinforced poly-L-lactic acid (SR-PLLA) urethral stent in combination with optical urethrotomy in the treatment of recurrent urethral strictures. The present aim was to evaluate the long-term results of this new treatment modality. PATIENTS AND METHODS: A series of 22 patients with severe urethral strictures (mean number of earlier urethrotomies 2.5) were involved. An SR-PLLA spiral stent with a bioabsorption time of 10 to 12 months was inserted into the urethra at the stricture site immediately after optical urethrotomy. Uroflowmetry, measurement of postvoiding residual urine, urine culture, and urethroscopy were performed preoperatively and at 1 and 3 months and then every 3 months up to 12 months, with subsequent follow-up visits every 6 months. The mean follow-up was 46 months. RESULTS: The treatment was successful in 8 of the 22 patients (36%). Six recurrences were found within the stented area and 15 outside. Patients with failure have since been treated with several urethrotomies and repeat self-dilatations or free skin urethroplasties. CONCLUSIONS: The results of the use of a bioabsorbable SR-PLLA urethral stent for the treatment of recurrent strictures were encouraging. Without this additional therapy, the recurrence rate of strictures might have been much higher. The main problem was sudden collapse of the stent, possibly induced by outer compression. A new generation of bioabsorbable stents is already under development.

Absorbable Implants↗
PubMed1979

Persistent urethral leukocytosis and asymptomatic chlamydial urethritis.

Chlamydia trachomatis was isolated from 47% of asymptomatic, sexually active men whose urethral smears contained four or more polymorphonuclear leukocytes (PMN) per high-power field (hpf) one week after their sexual activity was restricted. C. trachomatis was not detected in any of 23 asymptomatic, sexually active men having less than 4 PMN/hpf in two urethral smears obtained one week apart. Semiquantitation of urethral PMN in the urethral Gram-stained smear is useful in the evaluation of asymptomatic men without gonorrhea who are concerned about the possibility of harboring a urethral pathogen.

Chlamydia Infections↗
PubMed1996

The pathogenesis of gonococcal urethritis in men: confocal and immunoelectron microscopic analysis of urethral exudates from men infected with Neisseria gonorrhoeae.

Confocal and immunoelectron microscopic analysis of urethral exudates from 12 men with gonococcal urethritis showed that Neisseria gonorrhoeae can invade urethral epithelial cells. Studies with acridine orange stain demonstrated that the majority of organisms within urethral epithelial cells were viable at the time of fixation. Three-dimensional modeling of an infected epithelial cell using image analysis of 21 digitized confocal sections stained with YOYO-1 and DiIC 18(3) revealed that gonococcal invasion of these cells occurred in a polar fashion, most likely at the epithelial luminal surface. Serial immunoelectron micrographs showed evidence of membrane fusion with pedestal formation between the gonococcus and the epithelial cell, gonococci within vacuoles, and occasional gonococci free in the cytoplasm. Immunoelectron microscopy studies showed ruptured vacuoles at the cell surface releasing organisms. These studies demonstrate that urethral epithelial cells are invaded by gonococci during the course of infection in males.

Epithelium↗
PubMed1998

Urethral sphincter mechanism incompetence in the male dog: importance of bladder neck position, proximal urethral length and castration.

The radiographs of 37 incontinent adult male dogs with urethral sphincter mechanism incompetence were compared with those of 28 control dogs to determine if, as in the bitch, differences in bladder neck position and urethral length were implicated in the pathophysiology of urethral sphincter mechanism incompetence. Bladder neck position was significantly different; compared with continent dogs, incontinent animals were significantly more likely (P < 0.005) to have intrapelvic than intra-abdominal bladder necks. However, after allowing for the influence of body size, and unlike the situation in the bitch, there was no significant difference in proximal urethral length between the two groups. Bladder neck position was significantly related to prostate size (P < 0.001) and it is suggested that this is one reason why castrated male dogs are more prone to urethral sphincter mechanism incompetence than entire animals. A logistic regression analysis revealed that both bladder neck position and castration status were significant risk factors for incontinence and that they appeared to be acting independently of each other.

Animals↗
PubMed1986

Toxic catheters and diminished urethral blood circulation in the induction of urethral strictures.

Local effects of indwelling urinary catheters are poorly characterized. Latex catheter brands of various degrees of tissue toxicity were implanted into the urethra of 27 male piglets. The systemic hemodynamic states varied from normal to hypovolemia, where the circulation changes simulated the extracorporeal perfusion used in open-heart surgery. The urethral epithelial changes caused by the catheters were studied by light ad scanning electron microscopy (SEM). The blood circulation in paraurethral tissue reacted strongly to systemic hemodynamic changes. A reduced local blood flow induced an accumulation of polymorphonuclear leucocytes in the urethral epithelium and subepithelial space in connection with implanted latex urinary catheter strips. This was not seen in normovolemic piglets. Non-toxic wholly silicone control catheter implants did not induce changes. Epithelial cell damage correlated with the tissue toxicity values of implanted catheter strips. In SEM analysis destruction of microvilli and cell membranes was also discovered in connection with a latex catheter brand regarded as non-toxic. The wholly silicone catheters did not cause any detectable changes. The observed cell damage is induced by toxic chemicals dissolving from latex catheters. Local ischemia exacerbates these toxic effects and activates complement cascade. This induces polymorphonuclear granulocyte accumulation in the damaged urethral epithelium leading to demolition and urethral fibrotization. The present findings explain the etiology of the long urethral stricture epidemics seen in open-heart surgery in the early 1980s by showing the interference between indwelling latex catheters and reduced local blood flow.

Animals↗
PubMedDate not supplied

Diagnosing non-gonococcal urethritis: the gram-stained urethral smear in perspective.

The value of microscopy of a Gram-stained urethral smear in the diagnosis of non-gonococcal urethritis and chlamydial urethral infection was assessed in 153 men attending a department of genitourinary medicine. A mean of more than 4 polymorphs in 5 fields (x1000) was considered to be abnormal. In the diagnosis of urethritis, the sensitivity (94%), specificity (91%), positive predictive value (93%) and negative predictive value (93%) were high. In the diagnosis of chlamydial infection, sensitivity (91%) and negative predictive value (96%) were high, but specificity (68%) and positive predictive value (46%) were low. In men with symptoms of genitourinary infection, the sensitivity (96.7%) and negative predictive value (97.4%) of the Gram-stained urethral smear in the diagnosis of chlamydial infection was comparable with modern chlamydial antigen detection tests.

Chlamydia Infections↗
PubMed1987

[Clinical feature of male non-gonorrhoea urethritis and minocycline treatment of Chlamydia or Ureaplasma-infected urethritis].

Thirty-nine male patients with urethritis were studied for gonorrhoea or non-gonorrhoea infections. Only 2 patients were infected with N. gonorrhoeae, the other 37 patients were non-gonorrhoea urethritis (NGU). In 9 of these patients, C. trachomatis was identified and in 6 patients, U. urealyticum was isolated. No chlamydial urethritis was combined with ureaplasma. There was no clinical difference between chlamydia and ureaplasma infection, such as serous urethral discharge or mild pyuria. Minocycline was given orally at the dose of 200 mg daily for 7 to 42 days to these patients. Seven of the 9 patients (78%) with C. trachomatis and 7 of the 6 patients (67%) with U. urealyticum infection showed improvement of subjective and objective symptoms after minocycline. In no case, was an adverse reaction noted. Minocycline was effective in the treatment of both C. trachomatis and U. urealyticum urethral infection.

Adult↗
PubMed1994

Urethral squamous cell carcinoma associated with urethral stricture and urethroplasty.

We reviewed the few published cases of male urethral squamous cell carcinoma after urethroplasty. A new case report is added. Considering the known facts we conclude that urethral cancer following urethroplasty, performed to cure urethral stricture, is a rare complication. One must be aware of possible evolution to malignancy when this surgical procedure is not fully successful, i.e. in the case of recurring urinary obstruction or disturbed wound healing. Alarming symptoms are fistulization, abscess formation, ulceration and induration. Histopathological examination is needed, firstly before urethroplasty to exclude already existing malignant changes of the urethral mucosa and secondly whenever suspicion is raised after surgery. It is of utmost importance to diagnose a urethral carcinoma as early as possible because the cure rate in advanced stage is minimal.

Carcinoma, Squamous Cell↗
PubMed1996

Long-term results of urolume urethral stent for recurrent urethral strictures.

PURPOSE: We present the long-term results of the first 50 patients treated with a new urethral stent (UroLume) developed in 1985 for recurrent bulbomembranous urethral strictures. MATERIALS AND METHODS: All stents were inserted with the patient under general anesthesia using a standard endoscopic delivery system. Of the patients 27 were followed for 5 years or longer, 5 for 4 years and 18 for shorter periods due to death, illness or other factors. RESULTS: Mean (plus or minus standard deviation) maximum flow rate at last following was 19.7 ml. per second (+/- 6.9), and 93% of the patients were satisfied with the stent. In 8 patients (16%) narrowing developed within the lumen of the stent and in the remaining 84% the stent achieved its purpose of maintaining a good urethral lumen. In 9 patients stricture recurred outside the stent because of inaccurate positioning. All of these complications were satisfactorily treated by an additional overlapping stent. Failures occurred particularly in patients with a long stricture history and extensive periurethral fibrosis. CONCLUSIONS: These results indicate that at 4 to 6 years promising early results with the UroLume stent for urethral strictures are maintained with a low late failure rate. This device is not suitable for all strictures and cases with extensive periurethral fibrosis should be avoided but it remains a useful and successful treatment option for many recurrent bulbomembranous urethral strictures.

Adult↗
PubMed1997

The vesico-urethral pressuregram analysis of urethral function under stress.

About one-third of older multiparous women are prone to stress urinary incontinence (SUI): unwanted urine loss during activities which suddenly raise intra-abdominal pressure. In this paper we describe and test a method for visualizing and analyzing the function of the urinary continence control system (CCS) under stress. Intravesical and intraurethral pressure changes from the resting state were recorded at proximal, mid-, and distal urethral locations during increasingly severe coughs and cross-plotted on a 'vesico-urethral pressuregram.' The slope (alpha) and intercept (chi zero) resulting from a linear regression analysis of these data were used to develop a continence equation which can be used to predict the equilibrium point pressure (PE): the intravesical pressure at which urine will leak to the intraurethral pressure recording site. We tested the null hypothesis that these parameters would not differ in six young, nulliparous continent women (mean +/- S.D. age: 30 +/- 3.5 yr) and six multiparous SUI women (52.3 +/- 8.0 yr, parity: 1.7 +/- 0.8), or between urethral locations. Significant differences in continence equation parameters were found between groups and in different urethral locations. In the SUI group static factors calculated from the term (1 - alpha) contributed 27% of the mean (S.D.) midurethral PE value, 145 (46) cm H2O, while dynamic factors, estimated from alpha, contributed 73% of this value. Valuable insights for improving the diagnosis and treatment of SUI may be obtained by analyzing the relative contributions of alpha and chi 0 to urethral closure during physical stress.

Adult↗
PubMed1998

Value of urethral pressure profilometry in the female incontinent patient: a prospective trial with an 8-channel urethral catheter.

OBJECTIVES: To measure the pressure profiles at different positions of the urethral circumference simultaneously. METHODS: Twenty-two women with symptoms of genuine stress incontinence underwent urogynecologic assessment and multichannel urethral pressure profilometry (UPP) at rest with a specially designed 8-channel urethral catheter with radial openings. RESULTS: The distribution pattern of maximum urethral closure pressure (MUCP) and functional urethral length (FUL) values were significantly different (P=0.004 and P=0.0004, respectively). Most of the highest MUCP values per patient were found between channels 2 and 4 (P=0.015); most of the greatest FUL values per patient were found between channels 3 and 4 (P=0.15). CONCLUSIONS: The data of our study substantiate asymmetric radial pressure distribution within the urethra and underline the necessity of cautious interpretation of results of conventional single-channel UPP, which might vary because of transducer orientation.

Female↗