Cases reported "Urethral Stricture"

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1/176. Free vascularized appendix transfer for reconstruction of penile urethras with severe fibrosis.

    Despite the development of newer techniques with a free radial forearm tube flaps for phallus reconstruction, severe urethral strictures are still seen in such cases after irradiation or repeated infection because of the paucity of healthy, well-vascularized tissue. For urethral reconstruction in cases with poorly vascularized tissue as well as for total penile creation, a new technique involving a free vascularized appendix transfer combined with a radial forearm osteocutaneous flap was successfully used in two cases. The appendix provides a normal tube structure composed of a muscular tubular layer lined with mucosal epithelium. It has no hair and has rich vascularization. This results in little stricture at the junction with the original urethra, no occurrence of urethral stones, and possible postoperative enlargement of the diameter with changes in catheters. This method will allow a patient with severe fibrosis around the urethra to undergo one-stage phallus reconstruction with minimal complications. ( info)

2/176. Reconstruction ('undiversion') of the diverted urinary tract.

    Two operations to permit urinary drainage had been performed in a 2 1/2-year-old boy born with obstructing urethral valves, but infections and other compications were a constant threat, especially since the child had only one functioning kidney. After the anomalous valves were ablated endoscopically, the urinary tract was reconstructed, as shown here, to "undivert" the previously fashioned ileal loop bypass. ( info)

3/176. Treatment of traumatic urethral lesions.

    From 1955 to 1975 the author has treated 705 patients with stricture of the urethra. He has elaborated his own procedure consisting of radical excision of the stricture and scar tissues with end-to-end anastomosis. In cases of long strictures, reconstruction of the urethra has been by the use of a scrotal flap. ( info)

4/176. Fibroelastosis of the posterior urethra associated with urinary, cardiac and digestive anomalies.

    A case of fibroelastosis of the posterior urethra associated with ectopic opening of the ureter of a solitary kidney in the urethra is described. Oesophageal atresia and anomalous origin of the left coronary artery were also observed. Management of fibroelastosis is pointed out. ( info)

5/176. Urethral strictures: treatment with intralesional steroids.

    A review of steroid management of urethral strictures is presented. The 96 patients were followed for a year or more after urethral injection with triamcinolone. Intralesional steroid may be used in many types of strictures but it is especially useful in those cases with strictures in the distal urethra or the meatus, those occurring after radical prostatectomy and in some cases when 1 or more urethroplasties have been done. Every practicing urologist can benefit from using stricture injection in selected cases. ( info)

6/176. Treatment of anastomotic strictures and urinary incontinence after radical prostatectomy with urolume wallstent and AMS 800 artificial sphincter.

    Anastomotic strictures and urinary incontinence are severe complications after a radical prostatectomy. We report on two patients suffering from both complications. We treated the anastomotic stricture with a Urolume Wallstent and inserted an AMS 800 artificial sphincter prosthesis 4 to 6 months later for treating urinary incontinence. Finally, the patients were fully continent with no evidence of recurrent strictures. ( info)

7/176. Balloon dilation of posterior urethral stricture secondary to radiation and cryotherapy in a patient with a functional artificial urethral sphincter.

    Severe urethral stricture disease as an isolated entity can be a management dilemma. In the patient described here, this problem was associated with prior external-beam radiation and cryosurgical ablation of the prostate, and a functional artificial urethral sphincter (AUS) had been placed. An attempt to relieve partial urinary obstruction while preserving AUS function led to successful balloon dilation proximal to the sphincter cuff. ( info)

8/176. Posttraumatic complete and partial loss of urethra with pelvic fracture in girls: an appraisal of management.

    PURPOSE: Urethral injury in girls accompanying fracture of the pelvis is rare. We present our experience with 5 such complex cases and review the literature to define the types of problem and determine appropriate management. MATERIALS AND methods: We report on 5 girls with posttraumatic urethral injuries and pelvic fracture resulting in stricture as well as management based on the site and length of urethral stricture. Associated injuries and results are discussed. RESULTS: Of the 5 girls who presented with stricture 4 had undergone suprapubic cystostomy as initial treatment, whereas in 1 primary repair had failed. Urethral reconstruction using a bladder flap tube and distal urethrotomy into the vagina were performed in 3 and 1 cases, respectively. These 4 girls were continent although 1 required clean intermittent catheterization for a short period. The 3 patients with complete urethral loss had a more severe degree of pelvic fracture, including 1 treated with core through internal urethrotomy. CONCLUSIONS: Posttraumatic urethral injury accompanying pelvic fracture in young girls results in challenging management situations. More severely displaced pelvic fracture is associated with greater urethral loss and requires more complex repair. Cases of partial urethral injury or urethral transection without much displacement are better managed by primary repair of the transected urethra, which decreases morbidity. Primary repair may not be feasible in patients with extensive injury, who should be treated with secondary appropriate reconstruction after preliminary suprapubic cystostomy. Complete urethral loss may be managed by bladder flap tube neourethra creations with effective continence and excellent outcomes. Short segment distal urethral strictures may be treated with meatotomy or core through internal urethrotomy. ( info)

9/176. leiomyoma of the male urethra: a case report and review of the literature.

    We describe the case of a 48-year-old quadriplegic black man with history of C4-C5 cervical spine and cord injury secondary to a fall, who presented to the University of Cincinnati Medical Center urology Service with obstructive symptoms at urination. A bulbous urethral stricture was diagnosed and subsequently resected with primary urethral reanastomosis. On pathologic examination, the surgical specimen contained an epithelioid leiomyoma at the site of the urethral stricture. Although leiomyomas of the female urethra are relatively common, we identified only 2 previously reported cases of leiomyomas of the male urethra in the English-language medical literature. To the best of our knowledge, we describe the third case of leiomyoma of the male urethra, the first of the epithelioid type. ( info)

10/176. balanitis xerotica obliterans with urethral stricture after hypospadias repair.

    Three cases of urethral stricture due to balanitis xerotica obliterans (BXO) after hypospadias repair are reported. The first patient showed white, dense scarring on the prepuce before the hypospadias repair and developed a stricture of the urethra after the operation. The second and the third were uneventful for 6 and 2 years, respectively, after the hypospadias repair, and then developed urethral strictures. Pathologic diagnosis of the stenotic lesion is essential. Complete excision of the affected urethra with topical steroid ointment or sublesional triamcinolone injection is recommended for this condition. Although the complication of BXO after hypospadias repair is rare (3 out of 796 cases with hypospadias in our series), surgeons need to be aware of this condition as a cause for late onset of urethral problems. ( info)
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