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.

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.

Interventional urethral balloon dilatation before endoscopic visual internal urethrotomy for post-traumatic bulbous urethral stricture:A case report

BACKGROUND While several treatment options are available for pediatric urethral strictures,the appropriate treatment must be based on several factors.Although endoscopic visual internal urethrotomy(EVIU)could be a first-line treatment option for short pediatric urethral strictures,it is not feasible if the urethroscope cannot pass through the stricture point.Herein,we present a pediatric case of severe posttraumatic bulbous urethral stricture that was successfully treated by EVIU after securing the urethral route via interventional balloon dilatation.CASE SUMMARY A 12-year-old boy presented at our outpatient clinic with the inability to urinate.He had sustained a straddle injury three months prior.The post-void residual urine volume was 644 mL,and retrograde urethrography confirmed severe stricture of the bulbous urethra.EVIU was planned;however,the first attempt to treat the stricture failed because the urethroscope could not pass through the stricture point.The urethral route was subsequently secured via balloon dilatation of the stricture,which was performed in collaboration with specialists from the department of interventional radiology.The urethroscope was then able to pass,and the repeat EVIU was successful.CONCLUSION Interventional urethral balloon dilatation before EVIU may help secure the urethral route in the treatment of pediatric urethral strictures.

Endoscopic Internal Urethrotomy (EIU) for the Treatment of Ureteral Stenosis: A Review of 233 Cases

Background: Urethral stricture is a not uncommon pathology consisting of the narrowing of the urethra lumen with consequent reduction or cessation of urine flow. Objective: The objective is to retrospectively evaluate the results of treatment of urethral strictures by endoscopic internal urethrotomy in a series of 233 cases. Patients and Methods: It is Retrospective and descriptive study of 233 cases of urethral strictures treated by endoscopic internal urethrotomy under visual control in a private facility in Abidjan (Ivory Coast) over the period from 1 December 2007 to 31 December 2017. The study parameters were epidemiological, etiological, characteristics of the narrowing and the outcome of the treatment according to the predictive elements. Results: 233 patients were treated with endoscopic internal urethrotomy (EIU). All patients were male. The mean age of the patients was 49 years with extremes from 17 to 84 years. Dysuria (55.79%) was the most frequent reason for consultation: the etiologies were infectious (51.50%), traumatic (32.18%), and iatrogenic (13.73%) and not found (2.57%). Retrograde urethrocystography with fictional films performed in all patients showed the following characteristics: the stricture was bulbar (81.04%), unique (55.79%) and short in 68.6%. There was a 39.91% good outcome after the first EUS. The average follow-up was 3 years. Mortality was nil and morbidity was assessed at 4.72%. The result was better when the procedure concerned a short (≤3 cm), single stenosis on the posterior urethra. The average duration of the postoperative urinary catheter was 14 days on average. The poor results (60.08%) were observed in cases of long stenosis, located on the anterior urethra or concerning elderly patients. 69.28% were cured after a second urethrotomy;the remaining cases were managed by urethroplasty or urethral dilatation. Conclusion: IEU is a simple, reproducible and attractive procedure with an overall success rate of 81.54% in 3 years. Its indication must be made in the case of short stenosis, single posterior and in the young subject.

Endoscopic Internal Urethrotomy Outcomes in the Management of Male Urethral Strictures

Background: The aim of this study was to evaluate the outcomes of stricture treatment using endoscopic internal urethrotomy in the male urethra. Patients and Methods: We conducted a retrospective study from 2012 to 2017 at the Urology and Andrology Department of the University Hospital in Brazzaville, Congo. Medical records of 30 patients who underwent endoscopic internal urethrotomy for urethral stricture were analyzed. We studied the following variables: frequency of urethral stricture, age of patient, onset, cause and location of urethral stricture, duration of bladder catheterization, duration of hospitalization, and postoperative complications. The treatment outcome was assessed after a follow-up of 2.6 years (extreme: 2 and 4 years). Outcomes were considered successful or good when the patients had a normal urine flow and an unobstructed urethra at the Retrograde Urethrogram (RUG). Results: The mean age was 47.5 ± 9.7 years (range: 17 to 83 years). Dysuria was the most common symptom reported. We found that urethral stricture was mostly caused by infectious diseases (20 patients). The urethral stricture was located at the membranous urethra in 4 patients, the bulbar urethra in 25 patients, and the penile urethra in 1 patient. The mean duration of the bladder catheterization was 2.3 days. Hospitalization duration was 36 hours. We observed the following complications: urethrorrhagia in 3 patients, acute orchiepididymitis. We achieved good results in 23 patients. Conclusion: In our context where the practice of endoscopic internal urethrotomy is recent, it provides satisfactory results for the treatment of short urethral male stricture.

Value of direct vision internal urethrotomy in treatment of urethral stricture-twenty-year clinical experience

Objective To summarize the experience and evaluate the efficacy of treatment of urethral stricture using direct visual internal urethrotomy ( DVIU) . Methods The clinical data of 361 patients ( age range 16 - 72 years, mean age 38 years) with urethral stricture who underwent urethrotomy from 1990 to 2010 was retrospectively ana-

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.

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.