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Comparison of sonourethrography and retrograde urethrography in the evaluation of anterior urethral strictures
N Khan, HM Modishi, LDR Tsatsi, A kahloon, A Segone
South African Journal of Radiology , 2004,
Abstract:
A perfected device for performing retrograde urethrography
Juan D Berná-Mestre Jr,JD Berná-Serna
Medical Devices: Evidence and Research , 2008,
Abstract: Juan D Berná-Mestre Jr1, JD Berná-Serna21Department of Radiology, University Hospital of Salamanca, Spain; 2Department of Radiology, Virgen de la Arrixaca University Hospital, 30120 El Palmar (Murcia), SpainAbstract: The present study describes a perfected device for retrograde urethrography (RUG). The device allows RUG to be performed using a balloonless catheter and with assessment of the various problems of the urethra. The procedure is simple and well tolerated by patients and represents an interesting alternative to the conventional RUG technique.Keywords: urethra, retrograde urethrography, urethral stricture, device
STRICTURE URETHRA
M. ABID BASHIR
The Professional Medical Journal , 2002,
Abstract: A IMS & OBJECTIVES: 1. To demonstrate different etiological factors of stricture urethra. 2. To demonstratedifferent anatomical sites of urethra involved. 3. To describe management as being done at Allied Hospital, Faisalabadand suggest methods to improve it. STUDY DESIGN: Prospective. SETTING: Allied Hospital, Faisalabad.PERIOD: April 1996 to Aug 1998. PATIENTS & METHODS: A total of 100 consecutive male patients rangingfrom 6-80 years presenting to Surgical Unit II of Allied Hospital, Faisalabad with clinical diagnosis of stricture urethrawere included in the study. After history and examination, baseline investigations and retrograde urethrography wereperformed in all patients and micturating cystourethrography in patients with blind strictures. Treatment as being donewas also recorded. Follow up ranges from 4-24 months. RESULTS: Trauma was the most common cause of urethralstricture. Fracture pelvis alone was responsible for half of the strictures while straddle injury accounted for another 20%.The incidence of iatrogenic, infective and congenital stricture was found to be 24%, 4% and 2% respectively. Most of theposterior urethral strictures (86%) were due to indirect urethral trauma (fracture pelvis). Anterior urethra was the site ofinfective, congenital and iatrogenic strictures as well as strictures following direct urethral trauma. Internal urethrotomywas the treatment of first choice and was performed in 73% patients with satisfactory results. Urethroplasty was performedin 27% patients. Clean Intermittent Self Catheterization and active urethral dilatation was performed as adjuvanttreatment to prevent the recurrence of stricture. CONCLUSIONS; The etiological factors of stricture urethra andanatomical sites involved are comparable to international literature. Internal Urethrotomy is safe and reliable procedurefor simple urethral strictures while urethroplasty should be considered for complex strictures. Active urethral dilatation atrepeated intervals still has a role in preventing recurrence or stricture after initial treatment with internal urethrotomy andurethroplasty.
Current concepts in the management of anterior urethral strictures
IA Mungadi, NH Mbibu
Nigerian Journal of Surgical Research , 2006,
Abstract: Objectives: This review paper presents the current trends in the evaluation and treatment of anterior urethral strictures. Stricture disease is recorded as one of the oldest afflictions of mankind and even in the millennium; it is the one disease associated with rapid turn over in treatment options and continuous evolution of new options. The stricture is still a significant burden on the urologist workload right from initiation of treatment and follows up. It may be associated with significant morbidity and deteriorating quality of life and may be frustrating to treat. Current trends are to discover a long lasting satisfactory treatment suitable in most cases ‘the gold standard’. Methods A review of current concepts in anatomy and the patho-physiologic mechanisms of the anterior stricture has been done. A structured literature search through a MEDLINE search was performed. New urethral substitutes have been compared to other techniques of urethroplasty as seen over the. last decade. Expert surgical consensus and opinion have been reviewed. Results The anterior urethral stricture is a consequence of major peri-urethral fibrosis and may be very complex if the inflammation is complicated or prolonged. It can be satisfactorily assessed by routine retrograde urethrography and endoscopic assessment for type and complexity. The urethral ultrasound appears to provide more information about the extent of fibrosis and the length of strictures. In review of recent experience, it has proven to be accurate convenient and a cheap complement to already established studies. Oral mucosa, rectal mucosa, bladder mucosa , dermal grafts, tunica vaginalis, tissue culture and synthetic polymers have all been applied over the last decade in the search for the suitable urethral substitute. The bucccal mucosa is outstanding among several options in the repair of the diseased anterior urethra as popularized by Barbagli. It appears to provide the solution for most situations in the anterior urethral stricture.. Conclusions: The Bucccal mucosal graft(BMG) may as well be the new ‘gold standard' in the management of anterior urethral stricture .
Urethro-venous intravasation during retrograde urethrography (report of 5 cases).  [cached]
Gupta S,Kaur B,Shulka R
Journal of Postgraduate Medicine , 1991,
Abstract: Five instances of urethro-venous intravasation during retrograde urethrography are reported. Four cases were of urethral strictures and one case was of urethral hemangioma. All patients had post procedural bleeding while one patient got allergic reactions, another showed chills and rigors. Anatomy of the drainage veins is described. Factors responsible for this complication and its clinical implications are discussed. It is suggested that urethro-venous intravasation should be considered a diagnostic sign of urethral inflammation.
Traumatic posterior urethral fistula to hip joint following gunshot injury: a case report
Ahmad Rezaee, Behzad Narouie, Rahim Haji-Rajabi, Mohammad Ghasemi-rad, Abdolsamad Shikhzadeh
Journal of Medical Case Reports , 2009, DOI: 10.1186/1752-1947-3-133
Abstract: A 37-year-old Iranian Balochi male was shot with a firearm in the superior part of his right pelvis. He underwent primary closure on the same day. Ten months later, he developed urinary retention. He underwent retrograde urethrography and antegrade cystography which showed a stricture measuring 5 cm in length. There was also a history of progressive pain in the right hip joint accompanied by low grade fever which started 2 months after the initial injury. Hip X-ray showed evidence of an acetabular cavity and femoral head destruction diagnostic of complicated septic arthritis. The patient subsequently underwent reconstructive surgery for the urethral stricture and urethral fistula via a transperineal approach followed by total hip arthroplasty.Hip joint contamination with urine following a urethro-acetabular fistula can lead to severe and disabling complications such as septic arthritis. We recommend that every clinician should keep these fistulas in mind as a complication of penetrating urethral injury and every attempt should be made for their early diagnosis and prompt treatment.Urethral injuries are uncommon and occur most often in men. The membranous urethra which passes through the pelvic floor and voluntary urinary sphincter are the portion of posterior urethra most likely to be injured [1].Blunt trauma of the posterior urethra accounts for 90% of urethral injuries while penetrating injuries are extremely rare [1]. The physical findings for penetrating urethral trauma are the same as those found in blunt urethral trauma, i.e. high riding prostate, blood at the urethral meatus, bladder distension, inability to void, gross hematuria, scrotal, perineal, or penile hematoma, and difficulty passing Foley's catheter [2]. The late complications of posterior urethral injury are bleeding, urinary extravasation, pelvic abscess, and destruction of the posterior urethra, urinary diversion, urethral fistulas and urethral stricture [2]. Peri-urethral or perivesical urinary e
Synchronous Retrograde and Micturating Cysto Urethrography A Modification
OC Okpala, C Okafor, ME Aronu
Afrimedic Journal , 2011,
Abstract: Background: Retrograde Urethrography (RUG) combined with Micturating cystourethrography (MCUG) is imaging method of choice for studying the urethra and its 1-9 abnormalities . Though there are many modern imaging modalities that are also useful but these are not available in most developing countries. Even the standard method of doing the conventional Urethrography using penile clamp cannot be done in our centre because this is not also available. This led us to this study to help us maximize results by improvising on the available technique. Objective: To demonstrate a local modification of method for synchronous/ combined RUG and MCUG. Method: This is a method in which Foley’s catheter, amputated needle cap, and syringe are used to inject contrast into the lower urinary tract to help define the calibre and outline of these structures during the combined RUG and MCUG. Result: This combined technique demonstrates clearly, the anatomy of the lower urinary tract - urethra and bladder. It shows the length of stricture, where this exists. Conclusion: This method of synchronous RUG and MCUG is cheap, available and readily transferable and helps to demonstrate various pathologies of the lower urinary tract. This is recommended in places where materials for other methods of urethrography are deficient.
Experience with Penile Circular Fasciocutaneous Flap in the Treatment of Long Anterior Urethral Strictures
MA Abdalla
African Journal of Urology , 2008,
Abstract: Objective: To evaluate our experience with penile circular fasciocutaneous flap urethroplasty for the repair of long penile and bulbar strictures. Patients and Methods: Between February 2003 and April 2005, a total of 21 circumcised patients with a mean age of 39 (range 11 – 79) years underwent penile circular fasciocutaneous flap urethroplasty for urethral strictures involving the penile and bulbar tracts. The average stricture length was 7 cm. Follow-up included retrograde urethrography at 3 weeks, 3 months and 12 to 18 months, and thereafter when needed, and evaluation of the urinary flow. The mean follow-up was 25.6 months (range 7 to 44 months). The clinical outcome was defined as success when the patient had a good urinary stream, a post void residual urine <50 cc, a peak urinary flow speed >20 ml/sec, a normal and smooth caliber of the urethra as shown on retrograde urethrography and no urinary tract infection. Results: Our initial success rate was 86% (18/21 patients). An immediate successful outcome was achieved in 15/21 (71%) patients. Three patients had an unsatisfactory urinary stream in the immediate post-operative period which resolved after a single dilation or optical urethrotomy. With a mean follow-up of 26 months 2 patients developed a stricture at the proximal site of the repaired urethra necessitating resection and re-anastomosis. One patient with lichen sclerosus developed recurrence of the stricture and was subjected to suprapubic cystostomy, then further staged reconstruction was done. Immediate post-operative complications were encountered in 4 patients in the form of secondary hemorrhage, ischemia and sloughing of the penile skin, urethrocutaneous fistula which closed spontaneously and a decreased sensation at the lower limb in one patient each. Conclusion: Circular fasciocutaneous flap urethroplasty is a highly effective single-stage method of reconstructing long urethral strictures. It provides ample tissue for urethral substitution Africain Journal of Urology Vol. 14 (2) 2008: pp. 81-85
Pelvic fracture urethral injuries revisited: A systematic review
MM Koraitim
Alexandria Journal of Medicine , 2011,
Abstract: Purpose: We attempted to determine the unresolved controversies about pelvic fracture urethral injuries and to present a treatment plan for this lesion. Materials and methods: A systematic review was conducted on all contemporary pelvic fracture urethral injury articles published in the last 60 years. Studies were eligible only if data were complete and conclusive. Results: Pelvic fractures associated with urethral injuries are usually caused by vehicular accidents or falls from heights. The risk of urethral injury is influenced by the number of broken pubic rami and the involvement or non-involvement of the posterior pelvic arch. Urethral rupture is assumed always to be preceded by stretching of the membranous urethra cephalad and usually to occur at the bulbomembranous junction. In children, the urethra and bladder neck may be directly torn by the sharp edge of bone fragments. Retrograde urethrography remains the cornerstone for the diagnostic appraisal of posterior urethral injury. Of the three conventional treatment methods primary suturing has the greatest complication rates of incontinence and impotence (21% and 56%, respectively) and primary realignment has double the incidence of impotence and half that of stricture compared to suprapubic cystostomy alone (36% vs. 19% and 53% vs. 97%, respectively, p< 0.0001). Conclusions: Inflexible policies of one procedure or another are inappropriate for the treatment of pelvic fracture urethral injuries. The key to a good result lies in avoiding under-management of serious injuries as well as over-management of minor injuries. Partial rupture may be managed by either endoscopic urethral stenting in the first place or by suprapubic cystostomy. Complete rupture with minimal urethral distraction may be treated by either endoscopic realignment or suprapubic cystostomy. Complete rupture with marked urethral separation may be explored for primary realignment. Associated injury to the bladder, bladder neck or rectum dictates immediate exploration for repair.
Traumatic Posterior Urethral Fistula to the Hip Joint Following Gunshot Injury: A Case Report
Maria Tajbakhsh,Behzad Narouei,Hamideh Hanafi-Bojd,Rahim Haji-Rajabi
Iranian Journal of Radiology , 2010,
Abstract: Introduction: Fistula of the Urinary system to the hip joint is a rare complication. We report a case of delayed posterior urethral fistula to the hip joint following penetrating gunshot wound injury."nCase Presentation: A 37-year-old man was shot with firearm to the superior part of the right pelvis. He underwent delayed reconstruction surgery for urethral rupture. After 10 months of initial injury, he presented with inability to urinate, and history of progressive pain in the right hip joint accompanied by low-grade fever, which started two months after the initial injury. In retrograde urethrography and antegrade cystography, a 5 cm-long stricture and a fistula tract to the right hip joint were detected. Hip x-ray showed evidence of acetabular cavity and femoral head destruction diagnostic of complicated septic arthritis. The patient subsequently underwent reconstructive surgery for the urethral stricture and urethral fistula via a transperineal approach followed by total hip arthroplasty."nConclusion: Hip joint contamination with urine following urethro-acetabular fistula may lead to severe and disabling complications such as septic arthritis. We recommend that every clinician should have these fistulas in mind as a complication of penetrating urethral injury; every attempt should be made for their early diagnosis and prompt treatment should be performed to prevent further complications."nKeywords: Urethral Fistula, Hip Joint, Gunshot Injury, Urethro-Acetabular Fistula, Trauma
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