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At least 109 records · Page 6Linked to original sources
PubMed2005

Correlation between urethral sphincter activity and Valsalva leak point pressure at different bladder distentions: revisiting the urethral pressure profile.

PURPOSE: We determined the correlation between Valsalva leak point pressure (LPP) and the urethral pressure profile (UPP) in urodynamically selected patients with stress urinary incontinence (SUI) as well as the interference of bladder volume on this correlation. MATERIALS AND METHODS: A total of 450 consecutive women with SUI were clinically evaluated and underwent urodynamic study. Inclusion criteria were urodynamically demonstrable SUI with normal bladder compliance, sensitivity and capacity. Severe pelvic prolapse, detrusor overactivity and a pattern suggestive of obstruction were excluded. Urodynamic study was performed using a 7Fr 4 channel membrane catheter. LPP was determined at mid bladder capacity and UPP was determined at 50 ml, between 200 and 250 ml, and at bladder capacity. RESULTS: A total of 200 women fulfilled the selection criteria, of whom 30, 114 and 56 had a LPP of 60 or less, between 60 and 120, and greater than 120 cm H2O, respectively. Except for age and the number of pads the 3 groups were well matched in clinical and bladder urodynamic parameters. A progressive correlation of LPP with maximum urethral closure pressure was found when UPP was performed at 50 ml (r = 0.305, p <0.0001), at 250 ml (r = 0.483, p <0.0001) and at maximum bladder filling (r = 0.561, p <0.0001). Urethral functional length did not show a correlation with LPP at a bladder distention of 50 ml (r = 0.117, p = 0.100) or 200 ml (r = 0.167, p = 0.019) but there was a minor correlation at bladder capacity (r = 0.234, p = 0.002). CONCLUSIONS: There is a significant correlation between maximum urethral closure pressure and LPP. Patients with a LPP of 60 cm H2O or less have a shorter urethral functional length and lower sphincter activity. Patients with SUI have a more remarkable correlation between UPP and Valsalva LPP when UPP is determined after filling the bladder to more than 200 ml.

Aged↗
PubMed1990

Stress incontinence and low urethral closure pressure. Correlation of preoperative urethral hypermobility with successful suburethral sling procedures.

Forty-eight women with genuine stress incontinence and low urethral closure pressure were treated with a suburethral sling procedure using polytetrafluoroethylene. All patients underwent a preoperative clinical evaluation and multichannel urodynamic testing. The clinical examination included a "Q-tip" test to determine the presence or absence of urethral hypermobility. Urethral hypermobility was defined as a maximal angle change of greater than or equal to 30 degrees from the horizontal, measured during straining or coughing in the lithotomy position. Thirty-four patients underwent repeat multichannel urodynamic testing three months postoperatively to determine the objective surgical success. Ninety-three percent of patients (27/29) with a positive preoperative Q-tip test were cured. Of patients with a negative preoperative Q-tip test, only 20% (1/5) were cured. Preoperative urethral hypermobility was a good prognostic indicator of operative success when a suburethral sling procedure was used to treat genuine stress incontinence and low urethral closure pressure.

Adult↗
PubMed2000

Female urethral adenocarcinoma arising from urethritis glandularis.

INTRODUCTION: Female urethral adenocarcinoma is extremely rare and more than one tissue of origin has been suggested other than the Skene's gland. Immunohistochemistry with cytokeratins (CK) 7 and 20 is used to define the origin of the tumor. CASE REPORT: A 72-year-old woman presented with a 2-cm polypoid tumor at the external urethral meatus and bleeding. Wide local excision and bilateral inguinal lymphadenectomy were performed. Postoperative convalescence was uneventful. It was a poorly differentiated mucinous adenocarcinoma without direct urothelial involvement. There were focal areas of intestinal metaplasia. The tumor cells were positive for CK 7 and 20 and negative for prostate-specific antigen. DISCUSSION: This case provides supportive evidence that mucinous urethral adenocarcinoma may arise from malignant transformation of urethritis glandularis.

Adenocarcinoma↗
PubMed2004

Urethral stricture after pancreas-kidney transplantation due to polypoid urethritis.

Urologic complications are common after pancreas-kidney transplantation using bladder drainage. We report a case of urethral stricture caused by polypoid urethritis occurring 4 years after simultaneous pancreas-kidney transplantation. Endoscopic exploration revealed irregular, ragged-appearing urethral mucosa. The diagnosis of polypoid urethritis was confirmed histopathologically.

Adult↗
PubMedDate not supplied

The role of Chlamydia trachomatis in urethritis and urethral symptoms in women.

One hundred and fifty women who attended a genitourinary medicine clinic and who required a speculum examination were investigated to determine the association between Chlamydia trachomatis and urethral symptoms and signs. Those who had taken antibiotics with anti-chlamydial activity within 3 months or those who were menstruating, pregnant or using an intrauterine contraceptive device were excluded. C. trachomatis infection of the urethra, or infection of the urethra and cervix together, combined with each separately, were strongly associated with > = 5 polymorphonuclear (PMN) leucocytes per high-power field (x 1000) in a Gram-stained urethral smear (P < 0.00005 and P < 0.0005, respectively). This appeared not to arise from leucocyte contamination from the lower genital tract. However, C. trachomatis infection of the urethra was not associated with symptoms of dysuria or frequency. In conclusion, it seems likely that C. trachomatis infection of the urethra in women probably causes urethritis which is usually asymptomatic. Women who have objective evidence of urethritis might best be managed by appropriate antibiotic therapy and counselling, and advice that partners should attend for review.

Adolescent↗
PubMed2006

Outcome of urethral closure in patients with neurologic impairment and complete urethral destruction.

AIMS: The purpose of this study is to describe the problems associated with prolonged urethral catheterization in 12 patients with neurological problems and to report the results of surgical treatment. METHODS: A retrospective study of patients with neurogenic bladder and urethral dysfunction treated with prolonged catheterization resulting in incontinence associated with loss of urethral tissue and or function selected 12 patients. All had video urodynamics. Twelve were continuously incontinent despite a catheter. Bladder compliance, where that could be measured, was low is 10, and there were multiple and serious co-morbidities including sepsis, hypoalbuminemia, skin breakdown, osteomyelitis, respiratory insuffiency, etc. There were 4 males and 8 females, 9 had a spinal cord injury and 3 progressive multiple sclerosis. RESULTS: Male patients underwent transperineal closure of the membranous urethra; females transvaginal closure of the urethra. All patients had a urinary diversion, either an ileovesicostomy, or an augmentation cystoplasty and construction of a neourethra. Continence was ultimately achieved in 11 of 12 patients at a median 20 months. Four patients had one additional procedure to gain continence, but five patients required 3.8 procedures/patient to achieve continence. Closure of the male urethra was more easily accomplished than closure of an extensively damaged eroded female urethra. CONCLUSIONS: Patients with urethral damage and erosion related to prolonged catheter present a formidable challenge in surgical reconstruction. Most have serious co-mobidities and a single operation does not usually solve all the problems. Persistence does almost always result in continence.

Adult↗
PubMed1992

Surgical management of urethral strictures based on etiology. Where do urethral stents fit in?

Recent studies in the urologic literature indicate a renewed interest in the management of urethral stricture disease. Specifically, urologists are now treating all types of urethral strictures regardless of location, etiology, or extent with methods other than primary urethroplasty or direct vision internal urethrotomy (DVIU), i.e., balloon dilation or urethral stenting. To see which patients might best be managed by these new modalities, we reviewed our experience with urethral strictures at LAC-USC Medical Center.

Humans↗
PubMed1998

Urethral strictures after fulguration of posterior urethral valves.

This report discusses the incidence and predisposing factors for postfulguration urethral strictures in 82 boys with posterior urethral valves treated over 20 years and followed up for a period ranging from 1 to 21 years. A urethral stricture developed in three of the 82 patients (3.6%). All newborns and infants with small urethral caliber at presentation were treated on a temporary tubeless diversion, and fulguration of the valves was deferred until 9 to 12 months of age. A 9F resectoscope with a loop electrode was used to fulgurate at 5, 7, and 12 o'clock positions. A definite technical factor leading to a stricture could be identified in one of these three patients. Comparison of the "stricture" group with the "no stricture" group suggested that although dry fulguration did not have a definite correlation with stricture formation, it is best avoided. Refulguration and properly managed preoperative catheterization did not predispose to stricture formation. Meticulous surgical technique and avoiding oversized instrumentation were the most important factors for preventing this complication.

Adolescent↗
PubMed1989

Prevention of urethral stricture formation after transurethral resection of the prostate: a controlled randomized study of Otis urethrotomy versus urethral dilation and the use of the polytetrafluoroethylene coated versus the uninsulated metal sheath.

Stricture formation after transurethral prostatectomy was studied in a randomized clinical trial including 185 patients. The patients were allocated to either a 2-day urethral catheter-dilation or internal Otis urethrotomy and to an operation with either a polytetrafluoroethylene coated or an uninsulated metal resectoscope. Urethral stricture was defined as an obstruction resulting in a maximum urine flow rate of less than 15 ml. per second and not permitting the passage of a 21F cystoscope. The frequency of urethral strictures was significantly lower after Otis internal urethrotomy (4 per cent) than after a 2-day urethral catheter dilation (16 per cent). The incidence of stricture formation was similar in patients operated on with a polytetrafluoroethylene coated (8 per cent) and with an uninsulated metal (12 per cent) resectoscope sheath. The incidence of stricture formation was unrelated to age, duration of preoperative and postoperative catheterization, operating time and presence of urinary tract infection.

Aged↗
PubMed2006

Using stainless steel chopstick for self-performing urethral sounding in preventing recurrence of anterior urethral stricture.

Male urethral stricture is prone to recurrence, ranging from 40% to 80% according to the length of stricture no matter what treatment is introduced. Therefore, it has long been a common challenge for urologists to handle the problem. Sounding or self-dilation has proved to be effective in reducing the recurrence rate significantly. However, a standard equipment set of urethral bougie is too expensive for a patient's own use. On the other hand, the performance of regular outpatient sounding is time-consuming and costly. We present an easy way to perform urethral self-dilation using a stainless steel chopstick, which has proved to be cost effective and satisfactory for patients. From February 2001 to February 2003, 6 patients, with a mean age of 64.6 years (range 47-79), were introduced to this maneuver after a urethrotomy and were taught how to perform self-sounding with a stainless steel chopstick (18 Fr equivalent). The distance of advancement was determined individually by calibrating the location of the stricture. The long-term result of this maneuver was later checked with a telephone questionnaire about urination status in April 2005. The urethral strictures were located at penile in 3 patients, bulbar in 1, and navicular fossa with meatus in 2. The mean period for performing self-dilation was 15.3 weeks (range, 2-52). The mean follow-up period was 41.5 months (range, 26-55). No recurrence of stricture was found.

Aged↗
PubMed2000

The use of self-expanding metallic urethral stents in the treatment of recurrent bulbar urethral strictures: long-term results.

OBJECTIVE: To evaluate the effectiveness and long-term results of using a self-expanding metallic urethral stent (Urolumetrade mark, American Medical Systems, Minnetonka, MI, USA) to treat recurrent bulbar urethral strictures. PATIENTS AND METHODS: Between 1990 and 1999, 65 stents were placed in 60 men (mean age 45.2 years, range 20-71) with a urethral stricture (mostly caused by trauma and present for a mean of 4.3 years, range 0.16-26) and who had previously undergone different unsuccessful treatments. RESULTS: During a mean (range) follow-up of 3.8 (1-9) years the strictures in 52 of the 60 patients (87%) were treated successfully. All patients initially had postvoid dribbling incontinence, but this resolved in most within one week; 19 patients remain incontinent. CONCLUSION: The Urolume is a cost-effective alternative to other treatments for recurrent bulbar urethral strictures of whatever cause.

Adult↗
PubMed2006

Urethral stricture assessment: a prospective study evaluating urethral ultrasonography and conventional radiological studies.

OBJECTIVE: To evaluate the accuracy of urethral ultrasonography (sono-urethrography, SUG) in determining the length of anterior urethral strictures, and for predicting the degree of spongiofibrosis. PATIENTS AND METHODS: In all, 52 patients with anterior urethral strictures detected on retrograde urethrography (RUG) were also examined using SUG, to assess the stricture location, length and degree of spongiofibrosis. The findings of both procedures were then compared with the operative findings. RESULTS: The mean (sd) stricture length on RUG, SUG and at surgery was 2 (0.8), 3.8 (1.4) and 3.5 (1.6) cm, respectively. The mean length on SUG was closer to that at surgery. Spongiofibrosis was detected by SUG with an overall accuracy of 42%, 56% and 83% for mild, moderate and severe degrees of fibrosis, respectively. There were no significant complications during the procedure. CONCLUSION: SUG is more accurate for evaluating the length of anterior urethral strictures than RUG, and gives additional information about spongiofibrosis.

Fibrosis↗
PubMed1989

Characteristics of inflammatory cells in urethral smears from men with non-gonococcal urethritis.

Differential cell counts in inflammatory exudates were undertaken in urethral smears from men with non-gonococcal urethritis (NGU) for the first time, recurrent NGU (presumably reinfection) after a new sexual contact, or persistent NGU (in patients with no recent history of sexual exposure). Patients experiencing first episodes of NGU had significantly higher macrophage counts, both in relative and absolute terms, than the other two groups, regardless of the presence or absence of Chlamydia trachomatis in the urethral culture. The estimated total inflammatory cell count (ETICC) in the urethral exudate was assessed by counting the number of inflammatory cells in the first voided urine. The ETICC was significantly lower in patients with persistent NGU but no recent history of sexual exposure than in patients with NGU for the first time or with NGU presumably caused by a new infection. The ETICC in all three groups of patients was significantly higher than in controls. A more precise definition of NGU or more reproducible methods of diagnosis may possibly differentiate patients without an infective cause.

Adolescent↗
PubMed1996

Urethral lymphocyte isolation in non-gonococcal urethritis.

AIMS: A pilot feasibility study to investigate the local immune response in patients with non-gonococcal urethritis (NGU). METHODS: Urethral lymphocytes were extracted from first void urine (FVU) of patients with non-gonococcal urethritis and gonorrhoea using magnetic beads coated with antibody against either the pan-T cell marker CD2 or to CD4. The CD2+ and CD4+ lymphocyte content of FVU were compared between chlamydia-positive and chlamydia-negative and between first and subsequent attacks of NGU. RESULTS: Median CD2+ lymphocyte content of FVU was significantly higher in cases of gonorrhoea and chlamydia-positive urethritis than in chlamydia-negative NGU. Median CD2+ lymphocyte content of FVU in chlamydia-negative NGU was 15.6 x 10(4), (n = 14 range 3.2-111) which was significantly lower than in chlamydia positive NGU (35.2 x 10(4), n = 18, range 7.4-390 p = 0.037) and gonorrhoea (67.7 x 10(4), n = 8 range 13-501, p = 0.019). Comparing the first with subsequent attacks of NGU, CD2+ cell numbers were greater in those presenting with their first episode of chlamydia-negative NGU (21.8 x 10(4), range 5.6-111) compared with those who had experienced NGU before (12.3 x 10(4), range 3.2-20.4, p = 0.033), but not in those presenting with chlamydia-positive NGU. There was no difference in CD4+ cells between any of the groups. CONCLUSION: The lower total lymphocyte content of subsequent attacks of chlamydia-negative NGU compared with the first attack chlamydia-positive and negative NGU suggests that a different aetiology may be operating in some of these patients. Sufficient lymphocytes can be isolated from the urethra in patients with NGU for studies of lymphocyte subsets to be carried out.

CD4 Lymphocyte Count↗
PubMed1991

European experience with the urethral Wallstent for urethral strictures.

We describe the use of the urethral Wallstent in 71 patients with urethral strictures. The stainless steel stent is self expanding when released from its endoscopic introducer. The results over a 3-year period have been good with only mild discomfort and slight urethral leakage for up to 3 months. Migration, infection and encrustation have not been a problem and serial endoscopic review shows healing to be variable but complete in up to 12 months. It is considered that this simple endoscopic technique offers a simple, safe and effective alternative to multiple dilatations, urethrotomies and urethroplasty procedures in patients with bulbar urethral strictures.

Equipment Design↗
PubMed1999

[An experience of indwelling of a urethral stent (Urolume Wallstent) for urethral stricture accompanying pelvic fracture in a young man].

The patient was a 15-year-old boy, who sustained pelvic fracture and complete disruption of the urethra in a traffic accident. The previous doctor performed two-staged treatment for complete disruption of the urethra, which ended in postoperative urethral stricture. We performed two sessions of endoscopic operations and a pull-through procedure, but the procedures were not effective. Five years later, a urethral stent was indwelt. Urolume Wallstent of AMS, Co, Ltd. was used as the urethral stent. At 4 months, the stent started to be enveloped in the urethral epithelia and no complications have been found in particular. However, detention of a permanent-type stent in a young man such as ours remains a controversial issue and long-term follow-up is needed.

Accidents, Traffic↗