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.

Penile Skin Flap Urethroplasty for Urethral Stenosis at SominéDOLO Hospital of Mopti (MALI)

Introduction: Penile skin flap urethroplasty is a technique for replacing or enlarging an obstructed urethra. We aim to report our experience in the practice of this surgical technique. Patients and method: This was a prospective and descriptive study of penile skin flap urethroplasty indicated for urethral stenosis between January 2014 and December 2019. Results: A total of 21 penile skin flap urethroplasties for urethral stenosis were performed. The average age was 38.6 years old. The stenosis was of sclero-inflammatory origin in 15 cases (71.43%). It was of bulbo-perineal, penile, and penile-bulbar topography in about a third each. A history of urethral surgery was reported in 80.95% of the cases. The average length of the stenosis was 6.8 cm. Mundy circular skin flap urethroplasty about 15 cases (71.43%), and Quartey rectangular skin penile flap urethroplasty about 6 cases (28.57%) were the surgical techniques performed. The postoperative follow-up was favorable in 19 cases (90.48%). Two cases of urethral fistula (9.52%) underwent the 2nd urethroplasty. Urination at 1 year was satisfactory. No relapse has been reported to date. However, 4 patients (19.04%) reported asthenic ejaculation, and 1 patient (4.76%) a marked decrease in sexual pleasure. Conclusion: This surgical technique is effective in terms of voiding when the surgical indications are well chosen. The sexual aspect must be taken into account and the intervention only offered to those who really need it.

Efficacy comparison between Mathieu combined urethral plate incision and onlay island flap urethroplasty for distal hypospadias in patients with urethral plate stenosis

The aim of the study was to compare the efficacy of Mathieu combined urethral plate incision(Mathieu-IP)versus onlay island flap urethroplasty in patients with distal hypospadias complicated by urethral stenosis.The clinical data of 70 patients with distal hypospadias complicated by urethral plate stenosis treated in the Department of Urology,Anhui Provincial Children’s Hospital(Hefei,China),from May 2019 to May 2022,were retrospectively analyzed.Thirty-eight patients underwent Mathieu-IP(Mathieu-IP group)and 32 underwent onlay island flap urethroplasty(Onlay group).Follow-ups at 1 month,6 months,and 12 months postoperatively assessed operative time,complications,urethral meatus morphology,and family satisfaction.The Mathieu-IP group had significantly shorter operative time(mean±standard deviation[s.d.]:81.58±5.18 min)versus the Onlay group(mean±s.d.:110.75±6.05 min;P<0.05).Surgical success rates were 78.9%(Mathieu-IP group)and 75.0%(Onlay group),with no significant difference(P>0.05).Complications were comparable between the groups.The Mathieu-IP group resulted in a vertical slit-shaped urethral meatus in 89.5%versus 13.8%in the Onlay group(P<0.05).Family satisfaction with general penile appearance and skin shape showed no significant differences,but the Mathieu-IP group had higher satisfaction with meatal position(P<0.05).Mathieu-IP offers simplicity,safety,and shorter operative time compared to Onlay.Both the techniques effectively treat urethral plate stenosis in distal hypospadias,with reduced postoperative complications compared to tubularized incised plate urethroplasty.Mathieu-IP results in a vertical slit-shaped urethral meatus which enhances urinary stream,indicating its potential for broader adoption.

Posterior urethral stenosis:Contemporary management options

Posterior urethral stenosis(PUS)is a known complication following prostate cancer treatment as well as other benign endoscopic treatments.Patients with PUS often fail initial endoscopic treatments and have persistent symp-toms negatively affecting quality of life.In the past decade,a variety of dif-ferent surgical techniques and approaches have changed the landscape of PUS management.The goal of this review is to provide details on the his-torical,current,and future direction of the surgical management for PUS.

Surgical treatment of pelvic fracture urethral distraction defects in boys:which approach is suitable?

Pelvic fracture urethral distraction defects(PFUDDs)are relatively infrequent in boys,and treatment for PFUDDs presents one of the most difficult problems in urological practice.Anastomotic urethroplasty is considered an ideal surgical procedure for PFUDDs in boys.However,various surgical approaches for anastomotic urethroplasty have been proposed,including a simple transperineal approach,a tran sperineal in tercorporal septal separati on approach,a tran sperineal in ferior pubic approach,and a combined transpubic・perineal approach.This study aims to determine which surgical approach is best for PFUDDs in boys.We retrospectively identified 22 boys with PFUDDs aged 2-14 years who underwent anastomotic urethroplasty via different approaches between January 2008 and December 2017.Follow-up was performed in all the 22 patients for 6-123(mean:52.0)months.Finally,20 of the 22 boys(90.9%)were successfully treated,including 1 of 2 patients treated with a simple transperineal approach,3 of 3 with a transperineal approach with intercorporal septal separation,14 of 15 with a transperineal inferior pubic approach,and 2 of 2 with a combined transpubic-perineal approach.Two patients had failed outcomes after the operation,and stenosis recurred.Based on the outcome of the 22 patients,we can draw a preliminary conclusion that most boys(20/22)can be treated with a transperineal inferior pubic approach or simpler procedures without the need of completely removing or incising the pubis.The combined transpubic-perineal approach can be used in cases of extremely long urethral distract defects.

Combined grafts and flaps in urethral stricture repair

Although urethral strictures have been known since antiquity,the surgical management of urethral strictures has undergone a great(re)evolution over the last six decades,both in the perception of the disease and in the surgical repair techniques,always presenting itself as a challenge for the surgeon and patient.Reconstruction of urethral stricture disease involving a combination of grafts and flaps consists of a group of complex procedures with specific clinical indications.The knowledge of these procedures by reconstructive urologists is both necessary and relevant.A thorough understanding of the anatomy,including blood supply,is a crucial proviso for the correct evaluation and successful management of urethral stricture disease.We discuss the main techniques and indications in combined graft and flap urethroplasties.