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At least 127 records · Page 7Linked to original sources
PubMed2002

[Permanent urethral stents in urethral stenosis].

The first-line treatment for bulbar urethral strictures is still dilation. The second-line treatment is usually optical urethrotomy. A real challenge for the urologist is a recurrent bulbar urethral stricture following 1 or more of these procedures. In patients with important spongiofibrosis, repeat dilation or urethrotomy is destined to fail. Urethroplasty is the ideal treatment option for recurrent bulbar urethral strictures. However, some patients with recurrent strictures are either not interested in or are not candidates for surgical urethroplasty. In this group of patients, the placement of an endourethral prosthesis allows a method for maintaining adequate urethral patency without the need for repeat dilation or urethrotomy. The use of endourethral stents provides another form of therapy in this relatively common and often troublesome disease. This article reviews indications for usage, placement technique, results, and complications associated with permanent stent placement.

Humans↗
PubMed1990

[Retrograde balloon catheter dilatation of urethral stenosis--experience in benign prostatic hypertrophy and postoperative urethral stricture].

Retrograde transurethral balloon dilatation of urethral stenosis was performed in five patients: four patients with benign prostatic hypertrophy and one with urethral stricture following open prostatectomy. Significant resolution of symptoms of dysuria was seen in four patients throughout the follow-up period of 12 to 18 months. A balloon diameter of 25 mm was considered to be necessary for prostatic hypertrophy. The unsatisfactory result in one patient with prostatic hypertrophy was believed to be caused by incomplete dilation due to a small balloon diameter. Mild transient hematuria was seen in all cases. Only one patient with postoperative urethral stricture complained of pain during balloon inflation, while other patients with prostatic hypertrophy did not complain of any apparent pain. We conclude that this technique is a safe and effective method of treatment for prostatic hypertrophy and other urethral strictures.

Aged↗
PubMed1982

[Changes in urethral and bladder mucosa in a urethral syndrome].

The mucous membrane of the urinary bladder and urethra was studied histologically and electron microscopically in 20 women varying in age from 17 to 70 years who suffered from the urethral syndrome. Chronic urethritis was found in 19 patients, fibrosis of the submucous layer of the urethra in one. In 8 cases urethritis was combined with diffuse cystitis, in 4 with focal inflammation of the urinary bladder neck. Inflammatory changes in the mucous membrane were characterized by diffuse-focal lymphoplasma cell infiltrates, desquamation of transitional epithelium of the bladder and urethra, parapedesis of lymphocytes and polymorphonuclear leukocytes into the urethra lumen, activation of the fibroblast synthesis with excessive formation of collagen, proliferation of tegmental epithelium of the urethra with formation of deep pockets. The inflammatory etiology of the urethral syndrome of obscure origin is supposed.

Adult↗
PubMed1996

[Urethral reconstruction by pedicled labial flap in the treatment of extensive urethral lesions after obstetrical injury. Apropos of 34 cases].

Reported here is our experience with a new procedure using a pedicled labial flap for urethral reconstruction in patients treated for extensive urethral damage after obstetrical injury. From January 1992 to January 1996, 31 cases of urethral damage in African female patients, with an average age of 18-years-old were treated by pedicled labial urethroplasty. This procedure was done by using a pedicled flap obtained from the major labia. The flap was then introduced as in a tunnel beneath the vaginal epithelium reaching the damaged urethra. A variety of techniques were used: the patch to lengthen sufficiency (13 cases), or the tubularized flap following complete reconstruction of the urethra (21 cases). Good quality urine continence was obtained by using the suburethral Martius' sling procedure. In 6 cases, we combined the treatment with a colposuspension procedure. The average follow-up is 14 months (ranging from 6 to 37 months). Recovery of normal micturition with absence of urinary leak was obtained in 21/30 cases (70%). While 5 moderate failures occurred, 4 cases were considered complete failures. In view of the high success rate, the authors consider that the one-stage procedure by the use of a pedicled labial flap is a choice treatment and highly suitable procedure for the management of extensive urethral cervical damage after obstetrical injury.

Adolescent↗
PubMed1998

Incomplete hypospadiac urethral duplication with posterior urethral valves.

Urethral duplication (UD) is an uncommon malformation. Obstruction rarely occurs in hypospadiac UD. We describe two children with incomplete hypospadiac UD in association with posterior urethral valves, a combination not previously recognised. The embryonic significance of this anomaly is discussed. Keywords Urethral duplication. Hypospadias. Posterior urethral valve. Megalourethra

Child↗
PubMed1991

Simultaneous recording of vesical and urethral pressure in urethane-anesthetized rats: effect of neuromuscular blocking agents on the activity of the external urethral sphincter.

In urethane-anesthetized rats we made a disconnection of the urinary bladder from the urethra and performed a simultaneous recording of the vesical and external urethral sphincter (EUS) pressures. Throughout the collecting phase, the EUS pressure was higher than that recorded into the bladder. Gallamine (10 mg/kg i.v.) or d-tubocurarine (100 micrograms/kg i.v.), did not alter the value of intraurethral pressure. When a reflex bladder contraction occurred in response to filling (expulsion phase) the intravesical pressure exceeded the urethral pressure and at the top of the vesical contraction a series of rapid intraluminal pressure high frequency oscillations (IPHFO) were recorded at the urethral recording site, which were abolished by neuromuscular blocking agents as well as after acute sectioning of pudendal nerves. IPHFO was still present in rats in which the periurethral muscles (pelvic floor), have been precedently dissected. To get further information about the physiological consequence of the EUS functional impairment induced by neuromuscular blocking agents, we used the non-stop transvesical cystometrogram. In these conditions, blockade of the EUS did not produce passive urine dripping during the filling phase, but absence of the rhythmic striated urethral activity during the vesical expulsion phase produced a significant increase of the residual volume from 35% (control) to 75%. We present an original pharmacological method in a species whose small dimensions create technical problems for recording pressure signals from the lower urinary tract. Moreover, we have gained information on the origin of the IPHFOs and about the role of the EUS during the collecting and the expulsion phase of the voiding cycle in urethane anesthetized rats.

Animals↗
PubMed1996

Congenital posterior urethral perineal fistulae: a unique form of urethral duplication.

Three unique cases of urethral duplication, often referred to as congenital posterior urethral perineal fistulae, are presented. Presenting signs and symptoms, evaluation, and treatment are discussed, and the literature is reviewed. Although labeled as a fistula in the literature, this entity most likely represents a distinct type of urethral duplication. A functional dorsal urethra separates it from the other forms of urethral duplication.

Abnormalities, Multiple↗
PubMed1995

An experimental model for long-term examinations of urethral and uterine pressures in conscious dogs: effect of a highly selective compound contracting urethral smooth muscles.

An experiment model was designed for studies of urethral and uterine pressures in a conscious animal, thereby avoiding the interference of anesthesia on these responses. Dogs were trained to stand in cradles for an experimental period of 3 hours, during which urethral and uterine pressures and ECG were recorded. Substances were administered either orally or intravenously. Intravenously given phenylpropanolamine (PPA; 0.3 mg./kg.) and a newly synthetized compound S113 (0.5 mg./kg. intravenously) increased the urethral pressure by about 30 and 100%, respectively. Oral administration of PPA (3.5 mg./kg.) and S113 (6 mg./kg.) increased it by about 60 and 85%, respectively. In contrast to PPA, S113 evoked no cardiac effects. Whereas PPA had pronounced effects on uterine contractility, S113 had only minor effects. Furthermore, the responses in the experiments were stable and reproducible. This dog model seems to be useful for long-term recordings of urethral and uterine pressures.

Administration, Oral↗
PubMed2005

Combined external urethral bulking and artificial urinary sphincter for urethral atrophy and stress urinary incontinence.

OBJECTIVE: To describe a technique of externally bulking the urethra with a soft-tissue graft before placing another artificial urinary sphincter (AUS), as when placing another AUS for recurrent male stress urinary incontinence (SUI) other manoeuvres, e.g. placing a tandem cuff or transcorporal cuff, must be used to obtain urinary continence in an atrophic urethra, and each is associated with morbidity. PATIENTS AND METHODS: From January 2003 to July 2004, five patients (mean age 74 years, range 62-84) treated by radical prostatectomy were referred for recurrent SUI after placing an AUS (four, including one with urethral erosion) or a male sling (one, with a resulting atrophic urethra). Each patient was treated with an external urethral bulking agent (Surgisis) ES, Cook Urological, Spencer, Indiana) and had an AUS placed. RESULTS: In each patient the greatest urethral circumference was <4 cm. To place a functional 4 cm cuff, the diameter of the urethra was enhanced by wrapping it with Surgisis ES. Continence was significantly improved in all patients except one 84-year-old man who had the replanted artificial sphincter removed because of erosion 14 months after surgery. CONCLUSION: In cases of severe recurrent SUI from urethral atrophy after placing an AUS, externally bulking the urethra with Surgisis ES before placing another AUS is well tolerated, and gives satisfactory results.

Aged↗
PubMed1994

[Biochemical analysis of the external striated urethral sphincter of male rabbits. Difference in the proportions of muscle fiber types in the male rabbit external urethral sphincter by axial subdivisional study].

We studied the difference in the proportion of fast and slow myosin subunits in axially subdivided external urethral sphincter of male rabbit using myosin light chain and heavy chain analyses. The whole urethras from 6 adult male Japanese White rabbits were sagittally bisected and one halves from all animals were processed for myosin light chain analysis and another halves from all animals for myosin heavy chain analysis. Each half urethra containing the external urethral sphincter was subdivided into 4 parts, namely prostatic (P), prostatic apical (PA), infraprostatic (IP) and bullbourethral glandular (BUG) portions, from cranial to caudal direction. The electrophoretic samples from 4 different parts were separately processed. The external urethral sphincter muscle in each part from all animals were processed together for a sample because of the minute amount of the muscle. Two-dimensional electrophoresis according to the procedure of O'Farrell for myosin light chains and SDS-polyacrylamide gel electrophoresis containing 40% glycerol for myosin heavy chains were carried out. Molar ratio of myosin subunits were estimated by the dye elution procedure. The relative proportions of slow myosin molecules in respective parts were 33.4% (P), 26.3% (PA), 18.5% (IP) and 11.0% (BUG) from myosin light chain analysis and 20.3% (P), 16.1% (PA), 7.2% (IP) and 5.0% (BUG) from myosin heavy chain analysis. The urethral striated musculature in male rabbit was predominantly composed of fast myosin subunits as a whole. But the proportion of slow myosin subunits occupied a relatively high percentage in the proximal region and tended to decrease toward the distal end.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

[Vesico-urethral and entero-urethral anastomosis: anatomo-surgical considerations and technical note].

Following radical prostatectomy or radical cystectomy with orthotopic ileal bladder (in male patients), the cervico-urethral or entero-urethral anastomosis are at high risk for urinary stress incontinence, due to the shortening of the urethral functional length as well as "unavoidable downward fall" of the perineum after sectioning of the anterior portion of the sacro-pubic ligaments. That descensus of the perineum, if uncorrected, might cause a functional extraabdominal positioning of the residual functional urethra; this feature is close similar to one of the most important pathogenetic factors of genuine stress incontinence in the female. In order to correct that perineal fall is advisable to perform the so-called "secondary sphincter" (after Rocca Rossetti, 1982) by suturing with the same stitches not only the anastomotic edges but the medial part of the levator ani (i.d. pubo-rectal muscles) and the retro-urethral striated musculature as well; this technique ensure a good intraabdominal position of the residual functional urethra and prevents dangerous tensions on the anastomosis. The Authors stress the importance of a delicate dissection of the prostatic apex with no or minimal manipulation of the membranous urethra avoiding to evaginate it from the surrounding pelvic floor, that could damage its vascular supply. Following the before mentioned criteria the Authors performed 17 radical prostatectomies and 7 ileal bladder after radical cystectomy with satisfactory results (4.1% of postoperative urinary incontinence).

Aged↗
PubMed1993

[Decreased urethral pressure after coughing: the concept of urethral fatigability. Its relationship with active forces of continence].

The existence of urethral fatiguability was demonstrated by a sphinctometric study in 30 women. Comparison of the baseline urethral pressure values and after 6 maximal coughs demonstrated a mean reduction in urethral pressure of 40% (range: 24.5 to 90%) in 10 out of 18 women with stress incontinence. This decreased pressure lasted for several seconds. Spectral analysis of the electromyographic recording of the striated urethral sphincter under basal conditions and then after coughing confirmed the intervention of the striated and periurethral musculature with a marked quantitative decrease in the electrical activity of the sphincter. The clinical pathophysiological, prognostic and therapeutic implications of this new concept are discussed.

Adolescent↗
PubMed1994

An unusual cause of urethral stricture: urethral lymphangioma.

We report an unusual case of urethral narrowing which is caused by lymphangioma. The natural history of lymphangioma of the urethra is described. To our knowledge, lymphangioma of the urethra as a cause of urethral stricture has not been reported to date. Although lymphangioma of the urethra is a benign disease, it must be included among the causes of urethral stricture.

Adult↗
PubMed2001

Anterior urethral valves--a rare cause of urethral obstruction.

Anterior urethral valves is a very rare congenital anomaly of the anterior urethra. It produces symptoms of varied intensity with the most severe ones leading to Urosepsis and renal failure (similar to as in posterior urethral valves) to the milder ones which may not produce any obstruction at all. However unlike the Posterior urethral valves this anomaly has milder and reversible sequelae in majority of the cases. The clinical presentation is mainly in the form of obstructed stream of urine and UTI and the diagnosis depends essentially on Micturating Cystographic studies and on the awareness and a high level of suspicion of its existence among Paediatricians and General Practitioners.

Child, Preschool↗
PubMed2005

Urethral adenocarcinoma mimicking urethral caruncle.

Urethral caruncles are considered as benign tumors. They need to be treated surgically; specimens should carefully be evaluated for the presence of any malignancy. We are presenting a 57-year-old female patient with a urethral lesion that looks like caruncle, but histopathologic examination of the excised lesion was reported as urethral adenocarcinoma.

Adenocarcinoma↗
PubMed2007

One-stage urethral reconstruction for stricture recurrence after urethral stent placement.

PURPOSE: We report our 8-year experience with 1-stage open urethral reconstruction in 10 patients with recurrent bulbar and/or membranous strictures after UroLume urethral stent placement. MATERIALS AND METHODS: Ten consecutive referral patients underwent preoperative contrast imaging and urethroscopy followed by primary anastomotic repair or substitution urethroplasty, with concomitant open UroLume removal (when the stent was still present). Postoperative evaluation included contrast imaging 3 weeks after surgery, urethroscopy 4 months after surgery, uroflowmetry, and American Urological Association symptom score assessment. RESULTS: At a medium followup of 51.2 months all patients remain free of bulbar or membranous stricture recurrence. No patient has required dilation or any other intervention. CONCLUSIONS: One-stage open reconstruction with stent extraction offers a definitive treatment option with a high success rate for patients with recurrent bulbar and/or membranous strictures following urethral stent placement.

Adult↗
PubMed1991

Treatment of posterior urethral strictures with a titanium urethral stent.

A total of 5 patients with recurrent posterior urethral strictures underwent endoscopic placement of an expandable endourethral stent made of titanium. Patient age ranged from 17 to 66 years (mean age 42.6 years). Followup ranged from 13 to 20 months (mean 14.1 months). Of the patients 4 presently have unobstructed voiding with no incontinence. To date no side effects have been directly related to the stents and no incrustations or calculi have formed. Our preliminary study supports the use of titanium urethral stents as an alternative form of treatment for selected urethral strictures.

Adolescent↗
PubMed1989

A new treatment for urethral strictures: a permanently implanted urethral stent.

We describe a new urethral stent, originally developed for endovascular use, that we have implanted into 8 patients with urethral strictures. The stent is woven in the form of a tubular mesh from surgical grade stainless steel wire and is self-expanding when released from its small diameter delivery catheter. All patients have been treated successfully with a good caliber urethra visible on urethrography and direct endoscopy, and with improved urine flow rates. Mean followup of these patients is 8 months (range 6 months to 1 year). Urethroscopy had demonstrated complete epithelial covering of the implant at 4 to 6 months. Although the followup is short it seems that this simple technique may offer a lasting treatment for many urethral strictures.

Adult↗