Analysis of the urethral stricture score and patient-related factors as predictors of outcomes following oral mucosal graft urethroplasty

Objective:The complexity of urethral strictures can predict outcomes following urethroplasty.The previously described urethral stricture score(U score)considered only stricture-related factors to grade the complexity of urethral strictures and to predict recurrence post urethroplasty,but not considered patient-related factors for the same.We aimed to study the correlation of both of these factors to the outcomes of oral mucosal graft urethroplasty.Methods:We retrospectively reviewed data of 101 patients who underwent oral mucosal graft urethroplasty in our institute with a minimum follow-up of 6 months.Baseline patient characteristics and stricture-related parameters were noted.The U score was calculated for all patients which consisted of the length,location,number,and etiology of stricture.Univariate and multivariate Cox proportional hazard regression models were used to determine significant risk factors of recurrence.Results:The mean follow-up of patients was 15 months.Recurrence was seen in 28 patients and the mean time for detection of recurrence was 8 months of follow-up.The Charlson Comorbidity Index,history of previous intervention,length of strictures,location of strictures,number of strictures,history of smoking,and etiology were independent predictors of recurrence following urethroplasty.Based on these parameters,we formulated the modified U score(MU score).The scores ranged from 0 to 6 and a score of>2 was found to be predictive of recurrence.On comparing receiver operating characteristic curves for both scores by the DeLong test,the MU score had larger area under the curve than the U score.Conclusion:The MU scoring system is the first of its kind attempt taking into consideration both patient-and stricture-related factors to predict recurrence following oral mucosal graft urethroplasty.

Prospective randomized study correlating intra-operative urethral mucosal injury with early period after transurethral resection of the prostate stricture urethra: A novel concept

Objective:To investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate(TURP)and correlate its incidence with intra-operative urethral mucosal injury during TURP.Also to compare the other established risk factors affecting the development of urethral stricture among patients undergoing monopolar or bipolar TURP over a period of 6 months follow-up as the prospective randomized study.Methods:One hundred and fifty men older than 50 years with lower-urinary tract symptoms associated with benign prostatic hyperplasia were randomized to undergo either standard monopolar TURP with glycine as the irrigation fluid or bipolar TURP with normal saline as irrigant.The prostate size,operative time,intra-operative mucosal rupture,catheter time,catheter traction duration,uroflowmetry,and post-operative stricture rate were compared.Results:A total of 150 patients underwent TURP,including 74 patients undergoing monopolar TURP(one patient was excluded as his post-operative histopathological examination report was of adenocarcinoma prostate)and 75 patients undergoing bipolar-TURP,all of which were performed using a 26 Fr sheath resectoscope.The mean International Prostate Symptom Score and maximum urinary flow rate score at post-operative 3 months and 6 months were comparable between the groups.Out of 149 patients,nine patients(6.0%)developed urethral stricture.The severity of the injury(urethral mucosal injury)correlated with the likelihood of developing a subsequent complication(stricture urethra).Patients with stricture had significantly larger prostate volume than patients without stricture(65.0 mL vs.50.0 mL;p=0.030).Patients with stricture had longer operative time than patients without stricture(55.0 min vs.40.0 min;p=0.002).In both procedures,formation of post-operative stricture urethra was independently associated with intra-operative mucosal injury.Conclusion:Intra-operative recognition of urethral mucosal injury helps in prediction of stricture urethra formation in early post-operative period.

First report of the histopathological effect of electrocautery using on the urethral taste rosea during glans penis injury by incision in rabbits

Objective:Currently,electrocautery devices have frequently been used in penile surgical procedures.We hypothesized that electrocautery using during penile surgical procedures may harm the taste rosea and the dorsal nerve of the penis or clitoris.Methods:Eighteen young age male New Zealand rabbits were studied:five in the control(Group I,n=5),five in the penile surgery without using electrocautery(sham group,Group II,n=5),eight in the monopolar cautery(study group,Group III,n=8)groups under general anesthesia.The animals were followed for 3 weeks and sacrificed.Penile tissue—pudendal nerve root complexes and dorsal root ganglion of sacral 3 level were examined using stereological methods.The results were compared statistically.Results:The live and degenerated taste bud-like structures and degenerated neuron densities of pudendal ganglia(mean±standard deviation,n/mm^(3))were estimated as 198±24/mm^(3),4±1/mm^(3),and 5±1/mm^(3) in Group I;8±3/mm^(3),174±21/mm^(3),and 24±7/mm^(3) in Group II;and 21±5/mm^(3),137±14/mm^(3),and 95±12/mm^(3) in Group III,respectively.Neurodegeneration of taste buds and pudendal ganglia was significantly different between groups.Conclusion:Intact spinal cord and normal parasympathetic and thoracolumbar sympathetic networks are crucial for human sexual function.The present study indicates that the glans penis injury by using electrocautery may lead to pudendal ganglia degeneration.Iatrogenic damage to taste rosea and retrograde degeneration of the pudendal nerve may be the cause of sexual dysfunction responsible mechanism.

Long-term outcomes of urethral balloon dilation for anterior urethral stricture: A prospective cohort study

Objective:To prospectively follow up a cohort of anterior urethral stricture disease patients managed with balloon dilation(BD)for 3 years to evaluate the long-term outcomes and to study factors that contribute to recurrence.Methods:This study included men who had urethral BD for significant anterior urethral stricture disease between January 2017 and March 2019.Data about the patient age,stricture characteristics,and recurrence date were recorded,along with information on postoperative indwelling catheter use and operative complications.Furthermore,information about the self-calibration procedure was collected and where available,free flow(FF)measurements during the follow-up period were recorded and analyzed.Success was defined as a lack of symptoms and acceptable FF rates(maximum flow rate>12 mL/s).Results:The final analysis was conducted on 187 patients.The mean follow-up period was 37 months.The long-term overall success rate at the end of our study was 66.8%.Our recurrence rate was 7.4%at 12 months,24.7%at 24 months,and reached 33.2%at the end of our study.The time to recurrence ranged from 91 days to 1635 days,with a mean of 670 days.The stricture-free survival was significantly shorter with lengthy peno-bulbar(p=0.031)and multiple strictures(p=0.015),and in the group of patients who were not committed to self-calibration protocol(p<0.011).However,post-procedural self-calibration was the most important factor that may have decreased the incidence of recurrence(odds ratioZ5.85).Adjuvant self-calibration after BD not only reduced the recurrence rate from 85.4%in the non-self-calibration group to 15.1%in the self-calibration one(p<0.001),but also improved the overall stricture-free survival and FF parameters.

Etiology and management of urethral calculi:A systematic review of contemporary series

Objective:To conduct a systematic literature review on urethral calculi in a contemporary cohort describing etiology,investigation,and management patterns.Methods:A systematic search of MEDLINE and Cochrane Central Register of Controlled Trials(CENTRAL)databases was performed.Articles,including case reports and case series on urethral calculi published between January 2000 and December 2019,were included.Full-text manuscripts were reviewed for clinical parameters including symptomatology,etiology,medical history,investigations,treatment,and outcomes.Data were collated and analyzed with univariate methods.Results:Seventy-four publications met inclusion criteria,reporting on 95 cases.Voiding symptoms(41.1%),pain(40.0%),and acute urinary retention(32.6%)were common presenting features.Urethral calculi were most often initially investigated using plain X-ray(63.2%),with almost all radio-opaque(98.3%).Urethral calculi were frequently associated with coexistent bladder or upper urinary tract calculi(16.8%)and underlying urethral pathology(53.7%)including diverticulum(33.7%)or stricture(13.7%).Urethral calculi were most commonly managed with external urethrolithotomy(31.6%),retrograde manipulation(22.1%),and endoscopic in situ lithotripsy(17.9%).Conclusion:This unique systematic review of urethral calculi provided a summary of clinical features and treatment trends with a suggested treatment algorithm.Management in contemporary urological practice should be according to calculus size,shape,anatomical location,and presence of urethral pathology.

Understanding female urinary continence-lessons from complications of female urethral surgery

Dear Editor,We share our experience of two significant complications associated with female urethroplasty and their management in understanding the factors contributing to urinary continence.We have also tried to assess the different components of female urinary continence mechanism and the ways to combat the postoperative urinary continence while performing female urethral surgeries(Fig.1).Informed consent was taken from each of the patients before their evaluation and management.They were explained properly and informed consents were taken from them before the publication of this article.

Investigation of risk factors in the development of recurrent urethral stricture after internal urethrotomy

BACKGROUND Urethral stricture is a condition that often develops with trauma and results in narrowing of the urethral lumen.Although endoscopic methods are mostly used in its treatment,it has high recurrence rates.Therefore,open urethroplasty is recommended after unsuccessful endoscopic treatments.AIM To investigate the risk factors associated with urethral stricture recurrence.METHODS The data of male patients who underwent internal urethrotomy for urethral stricture between January 2017 and January 2023 were retrospectively analyzed.Demographic data,comorbidities,preoperative haemogram,and biochemical values obtained from peripheral blood and operative data were recorded.Patients were divided into two groups in terms of recurrence development;recurrence and non-recurrence.Initially recorded data were compared between the two groups.RESULTS A total of 303 patients were included in the study.The mean age of the patients was 66.6±13.6 years.The mean duration of recurrence development was 9.63±9.84(min-max:1-39)months in the recurrence group.Recurrence did not occur in non-recurrence group throughout the follow-up period with an average time of 44.15±24.07(min-max:12-84)months.In the comparison of both groups,the presence of diabetes mellitus(DM),hypertension(HT),and multiple comorbidi-ties were significantly higher in the recurrence(+)group(P=0.038,P=0.012,P=0.013).Blood group,postoperative use of non-steroidal anti-inflammatory drugs,preoperative cystostomy,cause of stricture,iatrogenic cause of stricture,location and length of stricture,indwelling urinary cathater size and day of catheter removal did not differ between the two groups.No statistically significant difference was observed between the two groups in terms of age,uroflowmetric maximum flow rate value,hemo-gram parameters,aspartate aminotransferase(AST),alanine aminotransferase(ALT),fasting blood sugar,creati-nine,glomerular filtration rate,neutrophil-lymphocyte ratio,platelet-lymphocyte ratio,lymphocyte-monocyte ratio,monocyte-lymphocyte ratio and AST/ALT ratios.CONCLUSION In patients with urethral stricture recurrence,only the frequency of DM and HT was high,while inflammation marker levels and stricture-related parameters were similar between the groups.

Endoscopic Internal Urethrotomy in the Treatment of Male Urethral Stenosis in the Urology-Andrology Department of KARA Teaching Hospital (Togo)

Introduction: Endoscopic internal urethrotomy (EIU) is a method for stricture opening using transurethral incision by direct visualisation of the urethral channel, resulting in a widening of the urinary canal with the aim of improving the quality of bladder emptying. The aim of the study was to evaluate the indication and results of EIU in the treatment of stenosis of the male urethra in the Urology-Andrology Department of Kara Teaching Hospital. Methodology: This was a cross-sectional descriptive study with retrospective data collection in the Urology-Andrology department of Kara Teaching Hospital. It involved 21 records of patients with urethral stenosis treated by endoscopic internal urethrotomy (EIU) in the said department during the period from January 2021 to September 2023. The following variables were evaluated: age, circumstance of discovery, site, length, number, etiology of the urethral stenosis and evolution of the patients. Results: The mean age of the patients was 59.2 ± 11.7 years. Infectious etiology of stenosis was predominant with 10 patients (47.6%) followed by trauma with 5 cases (23.8%). The bulbar urethra was the most frequently observed site, with 11 cases (52.4%). The length was mostly less than 2 cm in 12 patients (57.1%). Stenosis was unique in 14 patients (66.7%). The mean postoperative follow-up time was 3.2 months. The result was immediately better in 11 patients (52.4%) and it was poor in 8 patients (38.1%) who required maintenance dilation sessions.

Management and Outcome of Urethral Strictures at Two Tertiary Health Facilities in Cameroon

Introduction and Objectives: Urethral stricture is a reduction in the caliber of the urethral lumen impeding the outflow of urine. It predominantly affects males. The disease burden is severe in our milieu where access to specialized care is limited. Our goal was therefore to assess the management and outcome of male urethral stricture at two tertiary hospitals in Douala, Cameroon. Materials and Methods: This was a hospital-based retrospective study of patients managed for urethral stricture over 5 years (January 1st, 2017 to December 31st, 2021) at the Douala General and Laquintinie Hospitals. Data on sociodemographic, clinical, paraclinical, and treatment options were extracted using pre-structured forms. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 28. Statistical significance was set at p-value Results: We exploited 130 medical records. The mean age of patients was 46.5 years. Dysuria and weak urine stream were the major presenting complaints (63.8% and 23.8% respectively). The etiology of urethral stricture was iatrogenic in 42.3% of cases. The strictures were mostly single (89.8%), and the bulbar urethra was most affected (46.9%). 28 patients had urinary tract infections and the most frequently isolated germ was E. coli in 29.6%. Direct visual internal urethrotomy (DVIU) was performed in 42.3% of cases. Surgery, especially excision and primary anastomosis (EPA) was done in 28.5% of cases. Major complications were wound infection, acute kidney injury (AKI), and urethrocutaneous fistulae affecting 3.1, 2.3, and 1.5% of cases respectively. The recurrence rate was 17% with a mortality rate of 0.08%. Conclusion: Urethral stricture is common in our adult male population. The cause is mainly iatrogenic and the bulbar urethra is most affected. Minimally invasive and open reconstruction are frequently used treatment options with significant recurrence rates in the long term.

Management of urethral strictures and stenosis caused by the endo-urological treatment of benign prostatic hyperplasiad-a single-center experience

Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retrospective observational case series.Methods:One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated.Among them,76 were eligible for this study and underwent reconstructive surgery.Preoperative and postoperative assessments were done with symptom scores,uroflowmetry,ultrasound for post-void residue,and urethrogram.Any intervention during follow-up was classed as a failure.The recurrence and 95%confidence interval for recurrence percentage were calculated.Results:The following five categories of patients were identified:Bulbo-membranous(33[43.4%]),navicular fossa(21[27.6%]),penile/peno-bulbar(8[10.5%]),bladder neck stenosis(6[7.9%]),and multiple locations(8[10.5%]).The average age was 69 years(range:60-84 years).Overall average symptom score,flow rate,and post-void residue changed from 21 to 7,6 mL/s to 19 mL/s,and 210 mL to 20 mL,respectively.The average follow-up was 34 months(range:12-58 months).Overall recurrence and complication rates were 10.5%and 9.2%,respectively.The recurrence in each category was seen in 3,1,2,1,and 1 patient,respectively.Overall 95% confidence interval for recurrence percentage was 4.66-19.69.Conclusion:Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH.The bulbo-membranous strictures need continence preserving approach.Navicular fossa strictures require minimally invasive and cosmetic consideration.Peno-bulbar strictures require judicious use of grafts and flaps.Bladder neck stenosis in this cohort could be treated with endoscopic measures.Multiple locations need treatment based on their sites in single-stage as far as possible.

Double-face urethroplasty in patients with obliterative bulbar strictures post-transurethral resection of the prostate mid-term outcomes in high-volume referral center

Objective Incidences of post-transurethral resection of the prostate(post-TURP)strictures are between 2.2%and 9.8%.Stricture commonly occurs within the first 6 months.Our objective was to assess the outcomes of patients with obliterative strictures post-TURP that underwent a double-face urethroplasty.Methods This is a single-center prospective study of 17 patients with obliterative proximal bulbar stricture post-TURP who underwent double-face graft urethroplasty by two surgeons between January 2014 and January 2020.We defined post-TURP obliterative strictures as those patients who presented with complete or almost complete obstruction of the urethral lumen and who have had a history of acute urine retention.We have excluded patients with bladder neck contracture.Primary outcome was treatment success,defined as the no need for further treatments.Secondary outcome was post-urethroplasty continent rate.Results Seventeen patients were included in the study with median age of 66(interquartile range 40-77)years;median time of follow-up was 24(interquartile range 12-84)months;median stricture length was 4(interquartile range 2-6)cm.Of the 17 patients,15(88.2%)were successful.All patients were continent after urethroplasty.Conclusion With mid-term follow-up,treatment of obliterative proximal bulbar strictures with double-face buccal mucosa graft is a safe and effective procedure.Obliterative proximal bulbar strictures merit double-face urethroplasty with high-rate success and functional outcomes.

Management of complex and redo cases of pelvic fracture urethral injuries

Objectives:Pelvic fracture urethral injuries(PFUI)result from traumatic disruption of the urethra.A significant proportion of cases are complex rendering their management challenging.We described management strategies for eight different complex PFUI scenarios.Methods:Our centre is a tertiary referral centre for complex PFUI cases.We maintain a prospective database(1995e2016),which we retrospectively analysed.All patients with PFUI managed at our institute were included.Results:Over two decades 1062 cases of PFUI were managed at our institute(521 primary and 541 redo cases).Most redo cases were referred to us from other centres.Redo cases had up to five prior attempts at urethroplasty.We managed complex cases,which included bulbar ischemia,young boys and girls with PFUI,PFUI with double block,concomitant PFUI and iatrogenic anterior urethral strictures.Bulbar ischemia merits substitution urethroplasty,most commonly,using pedicled preputial tube.PFUI in young girls is usually associated with urethrovaginal fistula.Young boys with PFUI commonly have a long gap necessitating trans-abdominal approach.Our success rate with individualised management is 85.60%in primary cases,79.13%in redo cases and 82.40%in cases of bulbar ischemia.Conclusion:The definition of complex PFUI is ever expanding.The best chance of success is at the first attempt.Anastomotic urethroplasty for PFUI should be performed in experienced hands at high volume centres.

Tunica albuginea versus buccal mucosa graft urethroplasty for anterior urethral stricture: A prospective randomised pilot study

Objective:The objective of the study was to compare the outcome of tunica albuginea urethroplasty(TAU)and buccal mucosa graft(BMG)urethroplasty for anterior urethral stricture.Methods:Thirty patients who met the inclusion criteria were randomised into two groups:TAU(Group A)and BMG urethroplasty(Group B).Surgical outcome was evaluated with pre-and post-operative work-up involving retrograde urethrogram,voiding cystourethrogram,uroflowmetry,and urethroscopy.Patients were followed up till 1 year.Results:Mean duration of surgery was statistically significant between two groups(p=0.0005).Maximum urine flow rate was comparable when compared between two groups(p=0.22)but statistically significant when compared pre-and post-operatively(p<0.001).At follow-up of 1 year,the successful outcomes were 80% in Group A and 87%in Group B.A total of five patients who had unsuccessful results required redo urethroplasty.Complications were minimal in both the groups.Conclusion:TAU provides outcomes equivalent to those of BMG urethroplasty.TAU has less operative time,easy to perform,and beneficial in patients with poor oral hygiene.

Severe Coital Accident: A Rare Case of Simultaneous Fracture of the Penis and a Complete Urethral Rupture at the University Hospital of Bouake

Cavernous body fracture is a rare urological emergency. Its association with complete rupture of the urethra remains exceptional. This is a report of simultaneous penile fracture and complete rupture of the urethra following a misstep in coitus. It is about a 41-year-old young adult, admitted to the surgical emergency department of the University Hospital of Bouaké on March 2, 2020 for penile pain associated with acute retention of urine. The clinical examination confirmed the diagnosis of a corpus cavernosa fracture associated with a ruptured urethra. The patient underwent cystostomy, right cavernoraphy and urethrorrhaphy. The postoperative follow-up was straightforward and the patient was discharged from the hospital on D3 postoperatively. The urethral catheter was removed on D21 postoperatively. With a follow-up of 1 year, the patient presents a good erection and does not report any voiding disorder.

Male Urethral Stricture: Epidemiological, Clinical, and Therapeutic Aspects in Kara

Background: Urethral stricture is a pathology frequently encountered in urological practice. Management is often surgical, with possible recurrences. What about this pathology in Kara, a semi-urban city? Objective: Assess the management of male urethral stricture in Kara. Patients and Methods: This was a descriptive study with retrospective data collection. The study took place in the urology department of the teaching hospital of Kara, from December 2020 to December 2022. All cases of male urethral stricture, surgically treated at the teaching hospital of Kara, were listed. The inclusion criteria were as follows: any patient who had been treated surgically for male urethral stricture in the urology department of the teaching Hospital of Kara. The operating theater register and hospital records were used to collect the data. The diagnosis of urethral stricture had been made with retrograde urethrogram. A total of 24 patients were treated for male urethral stricture during the study period. The following variables were studied: age, reason for consultation, location, length, and etiology of the stricture;the type of treatment received: optical internal urethrotomy, or anastomotic urethroplasty, and the results. The result was considered good if, after removal of the urethral catheter, the patient regained his micturition without the need for dilatation;the result was considered average if, after removal of the urethral catheter, the patient needed one or more dilatation sessions to regain urination;the result was considered poor if, after removal of the catheter, the patient did not regain good micturition despite the urethral dilatation sessions. Microsoft excel and epi info 7 software were used for data processing. Results: The average age of our patients was 43.7 years ± 10.18 with extremes ranging from 27 to 70 years. The most represented age groups were that of 40 to 50 years, with 37.5% of cases;and that of 30 to 40 years with 33.3% of cases. The patients had consulted for urine retention in 66.6% of cases;the location of urethral stricture was bulbar in 45.8% of cases. The most found etiology was infectious in 58.3% of cases. Among our patients, 58.3% had received optical internal urethrotomy as treatment, while 41.6% of our patients had received anastomotic urethroplasty as treatment. Postoperatively, after removal of the urinary catheter, 87.5% of patients had benefited from one or repeated dilatation. In terms of results, we had a good result in 20.8% of patients;the result was average in 45.8% of patients, and poor in 33.3% of patients. The average duration of follow-up was 14.3 +/- 7.2 months (3-27). Conclusion: Male urethral stricture mainly affects young adults in Kara. Surgical management is done by optical internal urethrotomy and/or anastomotic urethroplasty.

Phallic rubber band application to prevent enuresis unusual cause of urethral stricture in a child:A case report

BACKGROUND Urethral stricture is the abnormal narrowing of the urethra due to spongiofibrosis.The established aetiological factors for urethral stricture abound in our environment.However,the application of a penile rubber band to prevent enuresis thereby causing this pathology is not a familiar occurrence.Patients with enuresis can suffer psycho-social challenges and trauma,especially for a child due to peer stigmatization.This has a great impact on the child's psyche and may affect even his performance at school.The aim of this paper is to highlight the psychosocial impact and management challenges of a child with enuresis(nocturnal urinary incontinence).CASE SUMMARY This is the case of a 10-year-old boy who presented with a history of nocturnal urinary incontinence since birth and lower urinary tract symptoms(LUTS)for 3 years culminating in chronic urinary retention.He maintained a normal urge to micturate and continent of urine during the daytime before the onset of LUTS.He had an antecedent longstanding history of tying a rubber band to the penile shaft mostly before going to the bed at night to prevent enuresis due to his peer stigmatization.He was acutely ill-looking,with distended suprapubic region.The phallus and scrotum were enlarged and oedematous with a circumferential proximal penile shaft scar and ventral penile shaft urethrocutaneous fistula.He was diagnosed to have complete short segment bulbopenile stricture and right ectopic ureter.He subsequent had augmented anastomotic urethroplasty and bilateral non-refluxing ureteroneocystostomy at different sitting.CONCLUSION The adherence to surgical principles of urethral stricture and enuresis management where surgically correctable in a child is associated with the resolution of enuresis and social reintegration.

Direct Visual Internal Urethrotomy (DVIU) in the Management of Male Urethral Strictures. A Single Center Experience about 44 Patients

Introduction: Male urethral stricture is one of the oldest urological disorders. Many techniques have been proposed to treat them, including endoscopic internal urethrotomy (DVIU). Material and Methods: To evaluate the contribution of this technique in the treatment of urethra narrowing, a retrospective study on the records of patients with urethral stricture treated with endoscopic internal urethrotomy between January 2014 and December 2021 in the urology division of the Souro Sanou University Teaching Hospital. Results: A total of 44 male patients with urethral stricture were treated with this technique and 48 procedures were performed. The average age of the patients was 53.2 ± 18.2 years. The etiology of the stricture was dominated by iatrogenic, infectious, traumatic and idiopathic causes in 43.2% (n = 19), 27.3% (n = 12), 20.4 % (n = 9), and 9.1% (n = 4) respectively. The location of the stricture was bulbar in 72.7%, and the anterior penile urethra in 15.9%. The overall success rate was 72.7% with satisfactory urination without dysuria, evaluated after removal of the urinary catheter, at three months this rate fell to 69.1%, and at 6 months this rate was 67.5%. Five cases (5) of extravasation of blood or irrigation fluid into the scrotum were reported and managed conservatively as well as two (2) cases of false routes with postoperative oedema of the penis were observed. Conclusion: DVIU is a simple technique, free of major morbidity and requiring only short-term hospitalization. It can be proposed as a first-line treatment for urethral stricture.

The treatment of complex female urethral pathology

Lower urinary tract symptoms(LUTS)in women produce significant bother.Common conditions causing LUTS in women include urinary tract infections,overactive bladder,and stress incontinence.Urethral diverticulae and female urethral strictures are rare pathologies.They can cause symptoms,which can mimic commoner conditions,leading to delay in diagnosis and unnecessary delay in treatment.In this article,we discuss in detail the definition,symptoms,epidemiology,pathogenesis,diagnosis,and treatment option for these two conditions.Further understanding of these conditions will aid in the proper diagnosis and prevent delay in management.

A brief review on anterior urethral strictures

The treatment of urethral strictures remains a challenging field in urology even though there are a variety of procedures to treat it at present,as no one approach is superior over another.This paper reviewed the surgical options for the management of different sites and types of anterior urethral stricture,providing a brief discussion of the controversies regarding this issue and suggesting possible future advancements.Among the existing procedures,simple dilation and direct vision internal urethrotomy are more commonly used for short urethral strictures(<1 cm,soft and no previous intervention).Currently,urethroplasty using buccal mucosa or penile skin is the most widely adopted clinical techniques and have proved successful.Nonetheless,complications such as donor site morbidity remain problem.Tissue engineering techniques are considered as a promising solution for urethral reconstruction,but require further investigation,as does stem cell therapy.

Erectile function after urethral reconstruction

Advances in urogenital plastic surgical tissue transfer techniques have enabled urethral reconstruction surgery to become the new gold-standard for treatment of refractory urethral stricture disease. Questions remain, however, regarding the long-term implications on sexual function after major genital reconstructive surgery. In this article, we review the pathologic features of urethral stricture disease and urologic trauma that may affect erectile function （EF） and assess the impact of various specific contemporary urethroplasty surgical techniques on male sexual function.