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 inclu...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.展开更多
The recent International Consultation on Urological Disease(ICUD)panel 2010 confirmed that a urethral stricture is defined as a narrowing of the urethra consequent upon ischaemic spongiofibrosis,as distinct from sphin...The recent International Consultation on Urological Disease(ICUD)panel 2010 confirmed that a urethral stricture is defined as a narrowing of the urethra consequent upon ischaemic spongiofibrosis,as distinct from sphincter stenoses and a urethral disruption injury.Whenever possible,an anastomotic urethroplasty should be performed because of the higher success rate as compared to augmentation urethroplasty.There is some debate currently regarding the critical stricture length at which an anastomotic procedure can be used,but clearly the extent of the spongiofibrosis and individual anatomical factors(the length of the penis and urethra)are important,the limitation for this being extension of dissection beyond the peno-scrotal junction and the subsequent production of chordee.More recently,there has been interest in whether to excise and anastomose or to carry out a stricturotomy and reanastomosis using a Heineke-Miculicz technique.Augmentation urethroplasty has evolved towards the more extensive use of oral mucosa grafts as compared to penile skin flaps,as both flaps and grafts have similar efficacy and certainly the use of either dorsal or ventral positioning seems to provide comparable results.It is important that the reconstructive surgeon is well versed in the full range of available repair techniques,as no single method is suitable for all cases and will enable the management of any unexpected anatomical findings discovered intra-operatively.展开更多
Anterior urethral strictures, where the length is more kthan 2 cm, are best treated by substitution urethroplasty with either preputial/penile skin flaps or free grafts.1 The use of dartos pedicled flaps has many adva...Anterior urethral strictures, where the length is more kthan 2 cm, are best treated by substitution urethroplasty with either preputial/penile skin flaps or free grafts.1 The use of dartos pedicled flaps has many advantages in terms of increased survival thanks to its own vascularization. Recently, buccal mucosa has become increasingly popular among urologists for urethral replacement when local penile skin is unavailable. Both penile skin flaps and buccal mucosa grafts have emerged as reliable urethral substitutes with comparable long-term results. These urethral substitutes are traditionally placed on the ventral aspect of the stricture and have a success rate of about 85%.展开更多
目的:比较评价阴茎皮片/口腔黏膜移植物尿道成形术治疗尿道狭窄优劣。方法:利用数据库Medline,EMbase,Cochrane library,Web of Science,Scopus和中国生物医学文献数据库,检索关于阴茎皮片/口腔黏膜移植物尿道成形术治疗尿道狭窄临床研...目的:比较评价阴茎皮片/口腔黏膜移植物尿道成形术治疗尿道狭窄优劣。方法:利用数据库Medline,EMbase,Cochrane library,Web of Science,Scopus和中国生物医学文献数据库,检索关于阴茎皮片/口腔黏膜移植物尿道成形术治疗尿道狭窄临床研究文章,提取资料,应用State12.0进行Meta分析。结果:纳入10个非随机对照研究和1个随机对照试验,共699人。唯一的随机对照试验显示,口腔黏膜组与阴茎皮片组成功率差别无统计学意义(90.5%vs 87.5%,P=0.07)。非随机对照研究Meta分析表明,口腔黏膜组优于阴茎皮片组(RR=0.86,95%CI 0.77-0.96,P=0.008)。按手术方式亚组分析表明,采用背侧镶嵌尿道成形术,口腔黏膜与阴茎皮片效果相当(RR=0.90,95%CI:0.77-1.06)。结论:阴茎皮片移植物与口腔黏膜游离移植物在前尿道狭窄一期背侧镶嵌成形术中效果相当,皆可选择。但此结论仍需大样本随机对照试验进一步证实。展开更多
Urethral stricture disease is increasingly common occurring in about 1%of males over the age of 55.The stricture tissue is rich in myofibroblasts and multi-nucleated giant cells which are thought to be related to stri...Urethral stricture disease is increasingly common occurring in about 1%of males over the age of 55.The stricture tissue is rich in myofibroblasts and multi-nucleated giant cells which are thought to be related to stricture formation and collagen synthesis.An increase in collagen is associated with the loss of the normal vasculature of the normal urethra.The actual incidence differs based on worldwide populations,geography,and income.The stricture aetiology,location,length and patient’s age and comorbidity are important in deciding the course of treatment.In this review we aim to summarise the existing knowledge of the aetiology of urethral strictures,review current treatment regimens,and present the challenges of using tissue-engineered buccal mucosa(TEBM)to repair scarring of the urethra.In asking this question we are also mindful that recurrent fibrosis occurs in other tissuesdhow can we learn from these other pathologies?展开更多
Radiotherapy-induced urethral strictures(RIUS)decrease quality of life and present a great challenge for surgical reconstruction,especially due to proximal location,compromised vascular supply,and poor wound healing.I...Radiotherapy-induced urethral strictures(RIUS)decrease quality of life and present a great challenge for surgical reconstruction,especially due to proximal location,compromised vascular supply,and poor wound healing.It is unclear whether urethroplasty is an option in cases with stricture resulting from exposure to pelvic radiation.We review the pathophysiology,diagnostic workup,and disease-specific aspects of RIUS.Furthermore,we discuss several management alternatives such as excision and primary anastomosis,as well as techniques for open reconstruction with flaps.The most extensive techniques in the treatment of strictures include,for example,those using gracilis muscle flaps,as they can involve periurethral tissue to provide sufficient vascularity for excellent post-surgery urethral healing.In brief,RIUS represent a significant challenge.In carefully chosen patients,urethroplasty should be considered as a feasible and durable treatment.However,medical practitioners should always take into consideration that the results of urethroplasty in RIUS are not comparable to urethroplasties without a radiation background.展开更多
Female urethral stricture(FUS)is a rare condition.It was not studied robustly for many years,but interest has grown recently in the reconstructive urology community,leading to an increase in publications.In this revie...Female urethral stricture(FUS)is a rare condition.It was not studied robustly for many years,but interest has grown recently in the reconstructive urology community,leading to an increase in publications.In this review,we gather the latest data regarding FUS and its different therapeutic options.Studies are summarized,split by technique.We also review the recently published European Guidelines.In addition,we share our preferred surgical technique and our views on future options.Diagnosing FUS can often be challenging and requires a high index of clinical suspicion.Its vague clinical symptoms and empiric initial treatments combine to make FUS an underdiagnosed condition.The lack of consensus on how to define FUS also compounds the problem.Appropriate diagnosis requires thorough investigation,and ancillary studies such as video urodynamics,cystoscopy,and voiding cystourethrogram may be useful.Treatment options range from conservative management to definitive procedures,although studies have shown that conservative measures such as urethral dilation have a low success rate overall.Within definitive management,augmented urethroplasty-using either flaps or grafts,has proven to be the gold standard.Both have shown excellent results over time;however,there is insufficient data available to recommend one over the other.Contemporary data has an overall poor level of evidence.Although challenging due to the rarity of the problem,a proper randomized controlled clinical trial comparing the principal surgical options and their outcomes would be beneficial and would allow for more informed decision making when considering options for women with urethral stricture.展开更多
文摘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.
文摘The recent International Consultation on Urological Disease(ICUD)panel 2010 confirmed that a urethral stricture is defined as a narrowing of the urethra consequent upon ischaemic spongiofibrosis,as distinct from sphincter stenoses and a urethral disruption injury.Whenever possible,an anastomotic urethroplasty should be performed because of the higher success rate as compared to augmentation urethroplasty.There is some debate currently regarding the critical stricture length at which an anastomotic procedure can be used,but clearly the extent of the spongiofibrosis and individual anatomical factors(the length of the penis and urethra)are important,the limitation for this being extension of dissection beyond the peno-scrotal junction and the subsequent production of chordee.More recently,there has been interest in whether to excise and anastomose or to carry out a stricturotomy and reanastomosis using a Heineke-Miculicz technique.Augmentation urethroplasty has evolved towards the more extensive use of oral mucosa grafts as compared to penile skin flaps,as both flaps and grafts have similar efficacy and certainly the use of either dorsal or ventral positioning seems to provide comparable results.It is important that the reconstructive surgeon is well versed in the full range of available repair techniques,as no single method is suitable for all cases and will enable the management of any unexpected anatomical findings discovered intra-operatively.
文摘Anterior urethral strictures, where the length is more kthan 2 cm, are best treated by substitution urethroplasty with either preputial/penile skin flaps or free grafts.1 The use of dartos pedicled flaps has many advantages in terms of increased survival thanks to its own vascularization. Recently, buccal mucosa has become increasingly popular among urologists for urethral replacement when local penile skin is unavailable. Both penile skin flaps and buccal mucosa grafts have emerged as reliable urethral substitutes with comparable long-term results. These urethral substitutes are traditionally placed on the ventral aspect of the stricture and have a success rate of about 85%.
文摘Urethral stricture disease is increasingly common occurring in about 1%of males over the age of 55.The stricture tissue is rich in myofibroblasts and multi-nucleated giant cells which are thought to be related to stricture formation and collagen synthesis.An increase in collagen is associated with the loss of the normal vasculature of the normal urethra.The actual incidence differs based on worldwide populations,geography,and income.The stricture aetiology,location,length and patient’s age and comorbidity are important in deciding the course of treatment.In this review we aim to summarise the existing knowledge of the aetiology of urethral strictures,review current treatment regimens,and present the challenges of using tissue-engineered buccal mucosa(TEBM)to repair scarring of the urethra.In asking this question we are also mindful that recurrent fibrosis occurs in other tissuesdhow can we learn from these other pathologies?
文摘Radiotherapy-induced urethral strictures(RIUS)decrease quality of life and present a great challenge for surgical reconstruction,especially due to proximal location,compromised vascular supply,and poor wound healing.It is unclear whether urethroplasty is an option in cases with stricture resulting from exposure to pelvic radiation.We review the pathophysiology,diagnostic workup,and disease-specific aspects of RIUS.Furthermore,we discuss several management alternatives such as excision and primary anastomosis,as well as techniques for open reconstruction with flaps.The most extensive techniques in the treatment of strictures include,for example,those using gracilis muscle flaps,as they can involve periurethral tissue to provide sufficient vascularity for excellent post-surgery urethral healing.In brief,RIUS represent a significant challenge.In carefully chosen patients,urethroplasty should be considered as a feasible and durable treatment.However,medical practitioners should always take into consideration that the results of urethroplasty in RIUS are not comparable to urethroplasties without a radiation background.
文摘Female urethral stricture(FUS)is a rare condition.It was not studied robustly for many years,but interest has grown recently in the reconstructive urology community,leading to an increase in publications.In this review,we gather the latest data regarding FUS and its different therapeutic options.Studies are summarized,split by technique.We also review the recently published European Guidelines.In addition,we share our preferred surgical technique and our views on future options.Diagnosing FUS can often be challenging and requires a high index of clinical suspicion.Its vague clinical symptoms and empiric initial treatments combine to make FUS an underdiagnosed condition.The lack of consensus on how to define FUS also compounds the problem.Appropriate diagnosis requires thorough investigation,and ancillary studies such as video urodynamics,cystoscopy,and voiding cystourethrogram may be useful.Treatment options range from conservative management to definitive procedures,although studies have shown that conservative measures such as urethral dilation have a low success rate overall.Within definitive management,augmented urethroplasty-using either flaps or grafts,has proven to be the gold standard.Both have shown excellent results over time;however,there is insufficient data available to recommend one over the other.Contemporary data has an overall poor level of evidence.Although challenging due to the rarity of the problem,a proper randomized controlled clinical trial comparing the principal surgical options and their outcomes would be beneficial and would allow for more informed decision making when considering options for women with urethral stricture.
