Visual internal urethrotomy may be a reasonable initial procedure of complete and incomplete urethral stricture before planning more extensive urethroplasty. However, it is essential to recognize its limitation because careless use can result in complications. So we have experienced 88 cases of complete and incomplete urethral stricture treated by visual internal urethrotomy. 1. In non-obliterated urethral stricture, satisfactory results were achieved in 57 of patients(78 %) after urethrotomy. Patients with more than 2cm long stricture and multiple strictures had the most unsatisfactory results ( required multiple urethrotomy). 2. In obliterated urethral stricture, 54 procedures of urethrotomy were carried out in 15 patients with complete urethral obstruction(average : 3.6times). When stricture was less than 1cm in length, good results were obtained in spite of several recurrences. However, when complete urethral stricture was more than 1cm in length, all patients failed due to recurred strictures. These results suggest that visual internal urethrotomy is a valuable initial method before urethroplasty, when stricture is less than 1cm in length in cases of complete urethral obstruction.
Constriction, Pathologic ; Humans ; Recurrence ; Urethral Obstruction ; Urethral Stricture*

Endoscopic intraluminal implantation of a self expandable stent has been increasing in patients with recurrent urethral strictures because of its simple and relative safe technique. There has been a few reports concerning luminal obstruction after implantation of Wallstent. We have experienced 4 cases of urethral obstruction after variable period of Wallstent implantation in the treatment of traumatic urethral stricture. Herein the methods for treatment of urethral obstruction are discussed. The patients were managed with two different types of treatment. The first one was transurethral resection of granulation tissue inside Wallstent. The other is reinsertion of Wallstent inside the first one after transluminal resection of granulation tissue in patients with urethral obstruction occurring within 5 months after Wallstent implantation. Retrograde urethrography and urethroscopy after 3 months have demonstrated patency of urethra and epithelial covering of the implant. Our experience shows that in all 4 patients with traumatic urethral stricture have developed variable degrees of urethral obstruction after a variable period of wallstent implantation. Therefore, we consider that our method is one of the alternatives to treat urethral obstruction after wallstent implantation in patients with traumatic urethral stricture.
Granulation Tissue ; Humans ; Phenobarbital ; Stents ; Urethra ; Urethral Obstruction* ; Urethral Stricture*

Benign prostatic hyperplasia and urethral stricture are common causes of urethral obstruction over 50 years of age. To evaluate the usefulness of the Gianturco expandable stent for dilatation of the urethra, 14 single stents were placed in the posterior urethra (2 in prostatic urethra, 12 in membranous urethra), 20 in the anterior urethra. And 4 six-eight connected stents ere positioned in the posterior urethra to straddle at the internal sphincter or external sphincter and followed up for 2 weeks (one dog), 1 month (two dog), 2 months (one dog), 3 months (one dog), 5 months (one dog), 9 months (three dogs), and 14 months (two dogs). Seven of 18 stents in the posterior urethra and 5 to 20 in the anterior urethra were migrated during the follow-up. By 2 weeks after placement. 100% expansion was achieved in the posterior urethra, but by 1 month in the anterior urethra. Partial or complete epithelial covering of the stents was observed 1 month after stent placement in the anterior urethra, but mucosal folds were observed in the anterior and posterior urethra. Urinary incontinence was not observed in all cases. Our experience suggests that Gianturco expandable stent can be used in dilating and maintaining the lumen of the prostatic urethra and urethral stricture.
Animals ; Dilatation ; Dogs* ; Follow-Up Studies ; Prostatic Hyperplasia ; Stents* ; Urethra* ; Urethral Obstruction ; Urethral Stricture ; Urinary Incontinence

We describe the use of gold-coating expandable urethral stents implanted into 3 patients with urinary obstruction due to recurrent urethral stricture(one case) and inoperable benign prostatic hypertrophy(two cases) respectively. The stent formed from stainless steel in the form of a cylindrical zigzag pattern and coated with 24 carat gold was inserted via delivering device using fluoroscopy control under heal anesthesia. During 6 months follow-up. the stents remained in situ and there were no urinary incontinence or other complication. The maximum flow rate were 24ml/sec in case of urethral stricture and 20ml/sec in BPH. These patients were satisfied with the procedure which provided a quiet safe and effective alternative to conventional surgical treatment.
Anesthesia ; Fluoroscopy ; Follow-Up Studies ; Humans ; Stainless Steel ; Stents* ; Urethral Obstruction* ; Urethral Stricture ; Urinary Incontinence

PURPOSE: Urethrocutaneous fistulas and urethral strictures are the most frequent complications after hypospadias repair. We reviewed outcomes after surgical repair of these complications to evaluate the factors determining successful outcome. MATERIALS AND METHODS: In 60 patients with fistula or stricture after hypospadias repair performed between September 1993 and January 2008, we reviewed incidences, clinical features, and outcome after repair with respect to initial hypospadias types. RESULTS: Fistulas were observed in 42 patients and were surgically repaired in 39 (92.8%). In 8 (19.0%) and 3 (7.1%) patients, concurrent meatal and urethral strictures were noted, respectively. The number of fistulas was single in 38 (90.5%) and 2 in 4 (9.5%) patients. Fistulas occurred most frequently from the penoscrotal type hypospadias (22/65, 33.8%) and had initially undergone transverse preputial island flap repair (13/26, 50%). Complete excision of the fistulous tract and multilayer advancement flap closure was the most common method for fistula repair (24), followed by cross-suture in 9 and repeat urethroplasty in 6. Initial management was successful in 35 (89.7%) patients. Urethral strictures were observed in 16 patients with equal incidences at the meatus and the other portion of the urethra. Successful outcome was achieved in all metal stenosis after repeat meatoplasty, whereas for urethral strictures, 4 (20%) patients who underwent visual urethrotomy experienced recurrent strictures. CONCLUSIONS: Urethrocutaneous fistulas can be successfully repaired by complete excision and cross-suture closure and multiple coverage with healthy tissues. In urethral strictures, reconstruction of ample neo-meatus is the key to achieving sufficient stream regardless of the stricture site.
Constriction, Pathologic ; Female ; Fistula ; Humans ; Hypospadias ; Incidence ; Male ; Rivers ; Urethra ; Urethral Obstruction ; Urethral Stricture

There is no single method of choice for urethroplasty in the hypospadias and the posterior urethral obstruction and for penoplasty in the paraffinoma. Surgeons must choose a suitable method according to the condition of each individual patient. Herein we experienced severe formed posterior urethral stricture after traffic accident, complicated or severe formed hypospadias and completely denuded penis due to paraffinoma on IV cases from March. 1990 to September. 1992 in our hospital. We used vascularized scrotal pedicle flaps for urethroplasty and penoplasty. So, we herein report that the vascularized scortal pedicle flap is better than the other flaps in vascularity and elasticity. In posterior urethral obstruction and pararfinoma, there is no considerable complication after the surgery using the flap, but in 14 cases or hypospadias, 2 cases of urethro-cutaneous fistulas, 3 cases of meatal stenosis and 1 case of skin necrosis were noted.
Accidents, Traffic ; Constriction, Pathologic ; Elasticity ; Female ; Fistula ; Humans ; Hypospadias ; Male ; Necrosis ; Penis ; Skin ; Urethral Obstruction ; Urethral Stricture

We reviewed our experience retrospectively with 65 patients who had post-traumatic complete urethral stricture secondary to pelvic bone fracture or other causes during last 10 years. All patients underwent delayed endoscopic internal urethrotomy (EIU) 3 to 9 months later after immediate suprapubic diversion. Prior to EIU, the antegrade-retrograde urethrogram demonstrated a complete urethral disruption, and the length of urethral obstruction was measured from 0.5cm to 3.5cm (mean 1.4cm). Of 65 patients, 61 patients (94%) had successful operations, 4 patients (6%) whose strictures were measured more than 2.5cm were failed and treated with open urethroplasty. Sixty-one patients who eventually underwent successful endoscopic internal urethrotomy; 28 patients (46%) achieved satisfactory urethral voiding after first EIU; 33 patients (54%) took operations more than twice due to recurred partial urethral stricture. After 6 to 53 months (average-21months), fifty-six (86%) of 65 patients voided satisfactorily (incontinence in 3 patients). Five patients who did not void well even after successful EIU were diagnosed to have neurogenic bladder (detrusor areflexia). Of 65 patients, 16 patients (25%) had post-traumatic impotence. After the EIUs were performed, there were no newly developed impotences. There were no serious major complications. We concluded that direct visual internal urethrotomy was useful and safe as a primary minimally invasive therapeutic modality for post-traumatic complete urethral stricture in selected patients with relatively short urethral defect (less than 2.5cm).
Constriction, Pathologic ; Erectile Dysfunction ; Humans ; Male ; Pelvic Bones ; Retrospective Studies ; Urethral Obstruction ; Urethral Stricture* ; Urinary Bladder, Neurogenic

PURPOSE: To evaluate the efficacy and safety of the Holmium: yttrium-aluminium-garnet (YAG) laser for the treatment of urethral/bladder neck strictures after high-intensity focused ultrasound for prostate cancer. METHODS: Between February 2007 and July 2010, Holmium: YAG laser urethrotomies were performed in eleven patients for bladder neck strictures or prostatic urethral strictures. The laser was used with a 550-microm fiber at 2 J and frequency 30 to 50 Hz. The medical records were retrospectively reviewed for medical history, perioperative and postoperative data, uroflowmetry, International Prostate Symptoms Score/quality of life, and stricture recurrence. RESULTS: At a median follow-up of 12.0 months (range, 4 to 35 months), the mean postoperative maximal flow rate and residual volume were improved significantly (P<0.05). The mean postoperative total, voiding and quality of life of international prostate symptom score were improved significantly (P<0.05). Of the 11 patients, 7 patients required one treatment, 4 patients two treatment, and 1 patients three treatment. 2 patients who had a documented urinary incontinence prior to the laser treatment subsequently required artificial urinary sphincter implantation and reported satisfaction without developing any recurrent strictures or artificial urinary sphincter erosion. All patients exhibited well-healed strictures and could void without difficulty. CONCLUSIONS: Holmium: YAG laser therapy represents a safe, effective and minimally invasive treatment for urethral/bladder neck strictures occurring secondary to high-intensity focused ultrasound for prostate cancer.
Constriction, Pathologic ; Follow-Up Studies ; Holmium ; Humans ; Lasers, Solid-State ; Medical Records ; Neck ; Prostate ; Prostatic Neoplasms ; Quality of Life ; Residual Volume ; Retrospective Studies ; Ultrasound, High-Intensity Focused, Transrectal ; Urethral Stricture ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urinary Incontinence ; Urinary Sphincter, Artificial

PURPOSE: Variable modalities, with more comfortable and less incidence of post-operative complications over TURP, have been used for the treatment of benign prostatic hyperplasia(BPH) with bladder outlet obstruction. Recently, we performed Interstitial Laser Coagulation(ILC) with the 830nm diode laser, which is considered as a method of minimally invasive treatments for BPH, to assess the efficacy and safety of the device, and to evaluate its capability of replacing TURP for managing BPH. MATERIALS AND METHODS: We analysed 16 patients, who had suffered from symptomatic BPH, treated with ILC using diode laser retrospectively from April 1996 to January 1997. Mean age of the patients was 71.7(52-84) years old and mean size of prostates before the treatments was 52.2(26.8-100.7)gm. Treatment outcome was estimated by comparing IPSS, QOL, Qmax, Qave and residual urine before the operations with them of first and second month after the operations. Post-operative transrectal ultrasonography was able to several cooperative cases and they were compared with them of pre-operative volumes, too, although it was unavailable to evaluate statistically. RESULTS: The operation were performed under epidural or spinal anesthesia with average time of 62 minutes and with 10 days of post-operative catheterization. IPSS reduced from 22.25(+/-4.82), mean value before the operation, to 11.00(+/-5.58) and 5.00(+/-3.10) at first and second month after ILC. QOL was gradually decreased from 4.44(+/-0.51) to 2.31(+/-1.20) and 1.19(+/-0.91), too. In terms of Qmax, mean was 12.29(+/-5.55)ml/sec before the operation and it was increased to 15.94(+/-7.38)ml/sec and 20.75(+/-8.48)ml/sec. Average flow rate was also increased from 6.98(+/-2.05)ml/sec to 10.38(+/-3.72)ml/sec and 14.93(+/-4.37)ml/sec. Significant reduction was observed in residual urine volume from 98.13(+/-91.72)ml to 33.19(+/-36.58)ml and 9.56(+/-11.24)ml respectively. Minimal hematuria and mild bladder irritations were common symptoms after the procedure, and possible significant complications as like anemia, electrolyte imbalance(post-TUR syndrome), epididymoorchitis, erectile dysfunction, urethral stricture, retrograde ejaculation had not found in our experience, but 1 patient was retreated with TURP because of continued bladder outlet obstruction. CONCLUSIONS: Our initial results with ILC showed that it is a relatively simple and minimally invasive method with minimal occurrence of bleeding and no electrolyte imbalance. We concluded that ILC is a safe and efficacious treatment modality, and it can be used even for elder patients with co-morbidity illness as well as patients with too large prostate to perform TURP.
Anemia ; Anesthesia, Spinal ; Catheterization ; Catheters ; Ejaculation ; Erectile Dysfunction ; Hematuria ; Hemorrhage ; Humans ; Incidence ; Lasers, Semiconductor ; Male ; Prostate ; Prostatic Hyperplasia* ; Retrospective Studies ; Transurethral Resection of Prostate ; Treatment Outcome ; Ultrasonography ; Urethral Stricture ; Urinary Bladder ; Urinary Bladder Neck Obstruction

Self expending metallic stents are emerging as an effective alternative treatment procedure in the management of urethral obstruction. Author described the use of gold coating expandable urethral stents implicated into 13 patients with urinary obstruction due to inoperable benign prostatic hypertrophy (11 cases) and complicated urethral stricture(2 cases) respectively. The stents made of stainless steel in the form of cylindrical zigzag pattern and coated with 24 carat gold, were inserted via delivery device using fluomscopic control under local anesthesia. The treatment was successful in 9 patients. All 9 patients were able to void satisfactorily. The mean peak rate of flow measured with umflometry was 14-24 ml, sec (mean 19.5 ml/sec). In one patient, gross hematuria, frequency and dysuria were so severe that removal of the stent and insertion of an indwelling catheter was done. No sent migration was noted during follow-up. The stente reached 70-80% of their fully expanded diameter immediately on placement. By 1 week after placement 100% expansion was achieved on all cases and maintained for the duration of the study. Luminal narrowings due to overgrowing of granulation tissue were occurred 1 week and 1 month after insertion of the stent in urethral stricture patients. And the luminal narrowings were man-aged with insertion of more complexed and Wall stent. Urethroscopy has demonstrated complete covering of the stent with urothelium at 4 to 6 months. Our experience suggests that placement of Gianturco self-expanding metallic stents may be a useful method of dilating and maintaining the luminal diameter of the prostatic urethra and complicated urethral stricture.
Anesthesia, Local ; Catheters, Indwelling ; Dysuria ; Follow-Up Studies ; Granulation Tissue ; Hematuria ; Humans ; Phenobarbital ; Prostatic Hyperplasia ; Stainless Steel ; Stents* ; Urethra ; Urethral Obstruction ; Urethral Stricture ; Urology* ; Urothelium