Gonococcal urethral stricture and watering-can perineum.
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A total of sixteen patients with urethral stricture and/or perineal urinary fistulae (water-can perineum) complicating gonorrhoea were seen at the Special Treatment Clinic, University College Hospital, Ibadan, Nigeria. The patients were aged between 25 and 80 years, and the latent period between the time of original attack of gonococcal infection and the development of complications varied from 4 to 50 years. The rate of divorce or marital separation is high among these patients with late sequelae of gonorrhoea. The factors responsible for the present higher incidence of early and late complications of gonorrhoea among patients in Nigeria and other tropical countries compared with their counterparts in Europe and North American include: (a) Lack of medical facilities in most rural areas; (b) Inadequate treatment of veneral diseases, including the urban areas where self-medication is practised on a large scale by the general population; (c) Illiteracy and ignorance of venereal diseases. The cases of watering-can perineum reported here, and the subsequent chronic pyelonephritis and hypertension, reinforce the plea for early and energetic treatment of acute gonorrhoea in Africa as well as large-scale control measures by the health authorities. (+info)
Evrim Bougie: a new instrument in the management of urethral strictures.
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BACKGROUND: In this study a new instrument and technique is described for the endoscopic treatment of complete posterior urethral strictures, which may result in serious complications and sometimes require troublesome treatments. METHODS: Three patients with complete posterior urethral obstruction were treated endoscopically with the guidance of a new instrument: Evrim Bougie. Evrim Bougie looks like a Guyon Bougie, has a curved end, which facilitates getting into the bladder through the cystostomy tract and with a built in channel of 1.5 mm in diameter for a sliding needle exiting at its tip. Having confirmed fluoroscopically and endoscopically that the sliding needle had passed across the strictured segment, the strictured segment was incised with internal urethrotomy, distal to the strictured segment, and urethral continuity was accomplished. At the end of the operation a Foley urethral catheter was easily placed into the bladder per urethra. Patients were instructed in self-catheterization after removal of the urethral catheter. All patients achieved normal voiding at postoperative 7th month follow-up evaluation. CONCLUSION: Internal urethrotomy could be performed under the guidance of the sliding needle of Evrim Bougie advanced from above the posterior urethral strictures, which to our knowledge was described for the first time in the English literature. We also believe that there may be other possible indications of Evrim Bougie for different procedures in urethral surgery. (+info)
One-stage urethral reconstruction using colonic mucosa graft: an experimental and clinical study.
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AIM: To investigate the possibility of urethral reconstruction with a free colonic mucosa graft and to present our preliminary experience with urethral substitution using a free graft of colonic mucosa for treatment of 7 patients with complex urethral stricture of a long segment. METHODS: Ten female dogs underwent a procedure in which the urethral mucosa was totally removed and replaced with a free graft of colonic mucosa. A urodynamic study was performed before the operation and sacrifice. The dogs were sacrificed 8 to 16 weeks after the operation for histological examination of urethra. Besides, 7 patients with complex urethral stricture of a long segment were treated by urethroplasty with the use of a colonic mucosal graft. The cases had undergone an average of 3 previous unsuccessful repairs. Urethral reconstruction with a free graft of colonic mucosa ranged from 10 to 17 cm (mean 13.1 cm). Follow-up included urethrography, urethroscopy and uroflowmetry. RESULTS: Urethral stricture developed in 1 dog. The results of urodynamic studies showed that the difference in the maximum urethral pressure between the pre-operation and pre-sacrifice in the remaining 9 dogs was not of significance (P>0.05). Histological examination revealed that the colonic free mucosa survived inside the urethral lumen of the 10 experimental dogs. Plicae surface and unilaminar cylindric epithelium of the colonic mucosa was observed in dogs sacrificed 8 weeks after the operation. The plicae surface and unilaminar cylindric epithelium of the colonic mucosa was not observed, and metaplastic transitional epithelium covered a large proportion of the urethral mucosa in dogs sacrificed 12 weeks after the operation. Clinically, the patients were followed up for 3-18 months postoperatively (mean 8.5 months). Meatal stenosis was developed in 1 patient 3 months postoperatively and needed reoperation. The patient was voiding very well with urinary peak flow 28.7 ml/s during the follow-up of 9 months after reoperation. The other patients were voiding well with urinary peak flow greater than 15 ml/s. Urethrogram revealed a patent urethra with an adequate lumen with no significant graft sacculation. Neither necrosis of neourethral mucosa nor stenosis at the anastomosis sites has been observed on urethroscopy in 4 patients over 6 months after operation. CONCLUSION: Urethral mucosa can be replaced by colonic mucosa without damaging the continence mechanism in female dogs. Colonic mucosa graft urethral substitution is a feasible procedure for the treatment of complex urethral stricture of a long segment. The technique may be considered when more conventional options have failed or are contraindicated. (+info)
Folding and everting distal end of graft flap to reduce orifice stenosis following onlay urethroplasty.
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AIM: Orifice stenosis remained to be a common complication of hypospadias repair. We had modified the preputial island flap urethroplasty by folding and everting the distal end of the pedicle graft flap to prevent the neo-orifice from stenosis. METHODS: Sixteen patients had undergone hypospadias repair using a modified onlay island flap technique. A urethral catheter was retained for 8 days to 10 days after operation. RESULTS: Satisfactory results were seen in all the patients with a cosmetically fine appearance. One patient had a urinary tract infection and another, urethrocutaneous fistula and both were amply treated. No glanular adhesion or stenosis occurred. A long-term follow up of 6 months to 4 years (mean: 2 years) in 15 patients did not find any complication. CONCLUSION: The modified preputial island flap urethroplasty technique is an easy, reliable and effective approach to reduce orifice stenosis in hypospadias repair. (+info)
Treatment of bulbar urethral strictures a review, with personal critical remarks.
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This is a review article on treatment of bulbar urethral strictures with personal critical remarks on newer developments. As a treatment of first intention there exists 4 options : dilatation, urethrotomy, end to end anastomosis and free graft, open urethroplasty. Success rate of dilatation and visual urethrotomy after 4 years is only 20 en 40% respectively. Laser urethrotomy could not fulfill expectations. End to end anastomosis obtains a very high success rate but is only applicable for short strictures. Free graft urethroplasty obtains success rates of +/- 80%. There is considerable debate on the best material for grafting. Buccal mucosa graft is the new wave, but this is not based on scientific data. Whether this graft should be used dorsally or ventrally is also a point of discussion. In view of the good results published with both techniques it is probably of no importance. Intraluminal stents are not indicated for complicated cases and give only good results in those cases which can easily be treated with other techniques. Metal self-retaining urethral stent, resorbable stents and endoscopic urethroplasty is briefly discussed. Redo's and complicated urethral strictures need often other solutions. Here skin flap from the penile skin and scrotal flap can be used. Advantages and drawbracks of both are discussed. There is still a place for two-stage procedures in complicated redo"s. The two-stage mesh-graft urethroplasty offers advantage over the use of scrotal skin. Some other rare techniques like substitution with bowel and pudendal thigh flap, to cover deep defects, are also discussed. (+info)
Transurethral resection in children with urethral stricture and occlusion.
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Technical considerations of urethral surgery in children are critical because of the small size and delicacy of their urethra. From 1984 to 1989, 10 children with serious traumatic urethral stricture (5 cases) and occlusion (5) were treated satisfactorily by an improved transurethral resection (TUR). The age of the children ranged from 4 to 14 years. The TUR technique, curative effects and prevention of urethral stricture are discussed. (+info)
Use of epidural anaesthesia for surgery in a patient with Kennedy's disease.
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Use of neuraxial block in a patient with motor neuron disease is controversial. We describe the anaesthetic management by epidural anaesthesia of a patient with Kennedy's disease, a rare lower motor neuron disease characterized by progressive weakness and wasting of limbs and bulbar muscles. The perioperative course was uneventful, and there was no exacerbation of neurologic signs or symptoms. We suggest that a patient with Kennedy's disease may be successfully managed by epidural anaesthesia for surgical internal urethrotomy. (+info)
Treatment of the posterior urethral stricture: experience with 13 cases.
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OBJECTIVE: To review our experience with the treatment of posterior urethral stricture. METHOD: A elaborated retrospective analysis of the treatment of 13 cases of posterior urethral stricture was conducted with the typical cases. RESULT: Good therapeutic results were achieved in these cases after treatment with cryoablation, electrotome or open surgery. CONCLUSION: Proper initial treatment, adequate surgical approach, anti-infection measures and postoperative urethral dilatation are the key elements in successful treatment of posterior urethral stricture. (+info)