Urethral stricture is an abnormal narrowing or loss of distensibility of any part of the urethra as a result of fibrosis at the site of injury or inflammation.
This document discusses the management of urethral strictures. It defines urethral strictures and describes their etiology, including congenital causes and acquired causes like infection, inflammation, trauma, and iatrogenic factors. Treatment options for urethral strictures include instrumentation methods like dilation and internal urethrotomy as well as open reconstruction techniques like excision and anastomosis or substitution urethroplasty using grafts or flaps. The document provides details on various surgical techniques and factors that influence treatment outcomes.
This document discusses urethral strictures, which are narrowings of the urethra caused by scarring. It covers the anatomy and epidemiology of urethral strictures and their various causes including iatrogenic, traumatic, inflammatory, and idiopathic factors. Diagnostic tests like retrograde urethrography and treatments options are outlined, including dilation, direct vision internal urethrotomy, and urethroplasty surgery. Urethroplasty is considered the gold standard treatment but has the highest success rate for short, simple strictures.
This document discusses stricture urethra and its management. It provides details on the epidemiology, etiology, clinical evaluation and surgical options for urethral strictures. Key points include that bulbar strictures are the most common, iatrogenic causes have increased in prevalence, clinical evaluation involves uroflowmetry, retrograde urethrogram and cystoscopy, and surgical options range from dilation and direct visual internal urethrotomy for short strictures to various types of urethroplasty using grafts or flaps for longer or complex strictures.
Urodynamics tests measure how the urinary bladder functions and provide objective evidence about any dysfunction. Common tests include uroflowmetry to measure urine flow, cystometry to evaluate bladder capacity and pressure, and pressure flow studies to identify bladder outlet blockage. Symptoms like urine leakage, frequent urination, and incomplete emptying may indicate the need for urodynamics to inform treatment for conditions like prostate enlargement or spinal injuries.
The document discusses urethral stricture, which refers to scarring in the urethra that narrows the passageway for urine. It describes the anatomy of the male urethra and its divisions. Common causes of urethral stricture include trauma, infections like gonorrhea, prolonged catheterization, and complications after surgery. Left untreated, stricture can lead to urinary retention, infections, kidney damage from back pressure, and fistula formation. Symptoms include weak urinary stream and sudden retention.
This document discusses complications of percutaneous nephrolithotomy (PCNL). It describes the most common complications as acute hemorrhage from the renal parenchyma or collecting system. Delayed hemorrhage can also occur due to arteriovenous fistulas or pseudoaneurysms. Collecting system injuries like tears or perforations need drainage with stents or nephrostomy tubes. Rare but serious complications include visceral injuries to nearby organs, pleural injuries, metabolic disturbances, and neurological issues from positioning. Management involves drainage, angioembolization, or open surgery depending on the complication. The document also reviews drainage techniques after PCNL including tubeless procedures with just ureteral stents or
A urethral stricture is a narrowing of the urethra caused by scarring that can develop from infections, injuries, or other trauma. Men are more susceptible to urethral strictures since their urethras are longer. Common causes include sexually transmitted diseases, catheterization, or other instrumentation of the urethra. Symptoms include a slow or weak urine stream, pain while urinating, and blood in the urine. Diagnosis involves imaging tests of the urethra. Treatment options depend on the severity and location of the stricture, and may include gradual stretching through dilation, cutting the scar tissue, or surgical reconstruction of the urethra.
This document defines interstitial cystitis (IC) and bladder pain syndrome (BPS) as chronic bladder pain and discomfort perceived to be related to the urinary bladder. It discusses the epidemiology, etiology, signs and symptoms, diagnosis, and treatment of IC/BPS. Regarding treatment, it emphasizes conservative therapies like behavioral modification, physical therapy, and oral medications first before more invasive options like intravesical therapies, cystoscopy, neuromodulation, or in rare cases, surgery. The goal is to avoid surgery if possible and use multiple simultaneous treatments for best outcomes.
This document discusses the management of urethral strictures. It defines urethral strictures and describes their etiology, including congenital causes and acquired causes like infection, inflammation, trauma, and iatrogenic factors. Treatment options for urethral strictures include instrumentation methods like dilation and internal urethrotomy as well as open reconstruction techniques like excision and anastomosis or substitution urethroplasty using grafts or flaps. The document provides details on various surgical techniques and factors that influence treatment outcomes.
This document discusses urethral strictures, which are narrowings of the urethra caused by scarring. It covers the anatomy and epidemiology of urethral strictures and their various causes including iatrogenic, traumatic, inflammatory, and idiopathic factors. Diagnostic tests like retrograde urethrography and treatments options are outlined, including dilation, direct vision internal urethrotomy, and urethroplasty surgery. Urethroplasty is considered the gold standard treatment but has the highest success rate for short, simple strictures.
This document discusses stricture urethra and its management. It provides details on the epidemiology, etiology, clinical evaluation and surgical options for urethral strictures. Key points include that bulbar strictures are the most common, iatrogenic causes have increased in prevalence, clinical evaluation involves uroflowmetry, retrograde urethrogram and cystoscopy, and surgical options range from dilation and direct visual internal urethrotomy for short strictures to various types of urethroplasty using grafts or flaps for longer or complex strictures.
Urodynamics tests measure how the urinary bladder functions and provide objective evidence about any dysfunction. Common tests include uroflowmetry to measure urine flow, cystometry to evaluate bladder capacity and pressure, and pressure flow studies to identify bladder outlet blockage. Symptoms like urine leakage, frequent urination, and incomplete emptying may indicate the need for urodynamics to inform treatment for conditions like prostate enlargement or spinal injuries.
The document discusses urethral stricture, which refers to scarring in the urethra that narrows the passageway for urine. It describes the anatomy of the male urethra and its divisions. Common causes of urethral stricture include trauma, infections like gonorrhea, prolonged catheterization, and complications after surgery. Left untreated, stricture can lead to urinary retention, infections, kidney damage from back pressure, and fistula formation. Symptoms include weak urinary stream and sudden retention.
This document discusses complications of percutaneous nephrolithotomy (PCNL). It describes the most common complications as acute hemorrhage from the renal parenchyma or collecting system. Delayed hemorrhage can also occur due to arteriovenous fistulas or pseudoaneurysms. Collecting system injuries like tears or perforations need drainage with stents or nephrostomy tubes. Rare but serious complications include visceral injuries to nearby organs, pleural injuries, metabolic disturbances, and neurological issues from positioning. Management involves drainage, angioembolization, or open surgery depending on the complication. The document also reviews drainage techniques after PCNL including tubeless procedures with just ureteral stents or
A urethral stricture is a narrowing of the urethra caused by scarring that can develop from infections, injuries, or other trauma. Men are more susceptible to urethral strictures since their urethras are longer. Common causes include sexually transmitted diseases, catheterization, or other instrumentation of the urethra. Symptoms include a slow or weak urine stream, pain while urinating, and blood in the urine. Diagnosis involves imaging tests of the urethra. Treatment options depend on the severity and location of the stricture, and may include gradual stretching through dilation, cutting the scar tissue, or surgical reconstruction of the urethra.
This document defines interstitial cystitis (IC) and bladder pain syndrome (BPS) as chronic bladder pain and discomfort perceived to be related to the urinary bladder. It discusses the epidemiology, etiology, signs and symptoms, diagnosis, and treatment of IC/BPS. Regarding treatment, it emphasizes conservative therapies like behavioral modification, physical therapy, and oral medications first before more invasive options like intravesical therapies, cystoscopy, neuromodulation, or in rare cases, surgery. The goal is to avoid surgery if possible and use multiple simultaneous treatments for best outcomes.
This document summarizes benign prostatic hyperplasia (BPH). It finds that the incidence of BPH increases with age, affecting 20% of men aged 41-50 and over 90% of men over 80. Risk factors include genetics and race. BPH causes both obstructive symptoms like weak urinary stream and irritative symptoms like frequent urination. Treatment options range from watchful waiting for mild cases to drug therapies like alpha blockers and 5-alpha reductase inhibitors to surgical procedures like transurethral resection of the prostate. Minimally invasive procedures also exist like laser therapy, transurethral vaporization of the prostate, and transurethral needle ablation of the prostate.
Urethral stricture is an abnormal narrowing of the urethra caused by fibrosis due to injury or inflammation. It is most common in males and usually occurs around age 50. Symptoms include poor urine stream and retention. Diagnosis involves tests like cystoscopy and retrograde urethrogram. Treatment depends on location and severity but may include dilation, internal urethrotomy, or open urethroplasty surgery to repair or bypass the stricture. Effective drainage of the bladder is important to manage this condition.
This document discusses ureteroceles, which are cystic dilations of the terminal ureter. It describes classifications of ureteroceles and their embryology. Diagnosis can be made through prenatal ultrasound or MRI showing hydronephrosis and the intravesical cyst. Evaluation involves ultrasound, intravenous pyelography, voiding cystourethrography, and nuclear scans. Management is individualized and may include prenatal decompression or postnatal surgical procedures to preserve renal function, eliminate infection/obstruction/reflux, and maintain continence. Treatment aims to minimize morbidity while meeting these goals.
This document summarizes the surgical management of urethral strictures. It discusses investigations like retrograde urethrography and various types of urethroplasty procedures including dilation, internal urethrotomy, lasers, stents, and open reconstruction. Specific procedures covered include anastomotic urethroplasty, substitution urethroplasty using grafts and flaps, and augmented anastomotic urethroplasty. Complications of different procedures like buccal mucosal graft urethroplasty, fasciocutaneous urethroplasty, and anterior and posterior urethroplasty are also summarized.
The urethra's main job in males and females is to pass urine outside the body. This thin tube also has an important role in ejaculation for men. When a scar from swelling, injury or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Some people feel pain with a urethral stricture.
This document provides guidelines from the British Association of Urological Surgeons on suprapubic catheter placement and care. It discusses indications for suprapubic catheters including acute urinary retention and long-term bladder drainage needs. Risks like bowel injury are addressed, and techniques like ultrasound-guidance are recommended to mitigate these risks. Precatheter assessment, consent discussions, and various insertion methods are outlined. Complications, long-term care including catheter changes, and blockage management are also covered. The guidelines aim to standardize safe suprapubic catheter practice based on evidence and expert consensus.
This document discusses ureteroceles, which are cystic dilations of the distal ureter that may be associated with defects in ureteral maturation. Ureteroceles can be intravesical, extending into the bladder, or extravesical/ectopic, extending beyond the bladder neck. They are usually associated with the upper renal moiety in a duplex system. Clinical presentations include infections, incontinence, pain, or being found incidentally. Diagnostic imaging includes ultrasound, IVU, VCUG, nuclear medicine scans, and cystoscopy. Management goals are preserving renal function, eliminating obstruction/reflux, and continence. Treatment depends on individual factors and may include observation, acute decomp
Cystitis cystica and glandularis is a rare proliferative disease of the bladder epithelium characterized by foci of transitional cells that undergo glandular metaplasia. It is often found incidentally but can cause irritative voiding symptoms. While some case reports have linked cystitis glandularis to bladder cancer, larger studies found no clear association and no subsequent cancers in patients followed for several years. The role of these lesions as potential precursors to cancer is still unclear.
This document provides an overview of flexible ureteroscopy (URS) and retrograde intrarenal surgery (RIRS) for treating conditions of the urinary tract. It discusses the history and rising trends of URS, types of flexible ureteroscopes, instrumentation used in RIRS including guidewires, dilators, and laser lithotrites. Indications for diagnostic and therapeutic RIRS are outlined. The document details techniques for flexible ureteroscope deflection and passage of instruments through the working channel. Potential complications of procedures like basket extraction are also reviewed.
DIFFERENTIAL DIAGNOSIS OF INGUINOSCROTAL SWELLINGStudying
This document provides information on the differential diagnosis of inguinoscrotal swelling. It discusses various conditions that can cause swelling in the groin or scrotum including hernias (direct, indirect), hydrocele, hematocele, pyocele, varicocele, lymph varix, lipoma of the cord, funiculitis, undescended testis, ectopic testis, torsion of testis, epididymal cyst, spermatocele, multiple sebaceous cyst, tuberculosis epididymo-orchitis, and acute epididymo-orchitis. For each condition, it describes relevant history, examination findings, distinguishing characteristics, and other important clinical details.
This document discusses flexible ureterorenoscopy (RIRS) for treating conditions of the kidney and urinary tract. RIRS uses flexible instruments introduced through the ureter to access the kidney in a minimally invasive manner. It has advantages over rigid ureteroscopy like shorter hospital stays and recovery time. The document outlines the history, indications, instrumentation, technique and complications of RIRS. Emerging technologies discussed include digital flexible ureteroscopy, flexible robotic assistance and virtual reconstruction of ureteroscopic views.
Posterior urethral valves are congenital anomalies that obstruct the urethra in males. They were first recognized in the 18th century but were not diagnosed endoscopically until the early 20th century. PUVs cause damage to the urinary tract including the bladder, ureters, and kidneys due to increased pressure from blocked urine flow. Treatment involves endoscopic resection of the valves to restore urine flow. Long term follow up is needed due to risks of bladder dysfunction, infections, and renal impairment. Prognosis depends on factors like age of presentation, presence of reflux, and kidney function.
Transurethral resection of the prostate (TURP)JOFREY MTEWELE
TURP (transurethral resection of the prostate) is a common surgery to remove parts of an enlarged prostate gland through the penis to relieve urinary obstruction caused by BPH (benign prostatic hyperplasia). During TURP, a resectoscope is inserted through the urethra to cut and remove prostate tissue blocking the urethra using an electrical loop, with pieces flushed out by irrigating fluid. Complications can include bleeding, infection, and electrolyte imbalances from excessive fluid absorption. Nurses prepare instruments, assist during irrigation, and clean equipment after the procedure.
bladder pain syndrome is highly prevalent. it is a diagnosis of exclusion. the biggest hurdle in management is diagnosis. more often than not patients suffering with BPS move from pillar to post, from a clinician to another, often getting urethral dilatations, receiving NSAIDS and even antipsychotics (having been labelled as 'psychiatric' patient).
once diagnosis is made, treatment is multipronged and based on phenotype - the concept is called UPOINT. interstitial cystitis is a small but significant minority (moreover ulcerative type) of BPS.
Gabapentin, amitriptyline and pentosan polysulfate are cornerstone pharmacotherapeutic agents for IC/BPS
Dr. Abdellatif Zayed discusses various types of genitourinary trauma including renal, ureteral, bladder, and urethral injuries. Renal injuries are most commonly caused by blunt trauma from car accidents and are typically minor. Ureteral injuries require surgical repair depending on the location of the injury. Bladder injuries can be intraperitoneal, extraperitoneal, or a combination and are treated with exploration and repair or catheterization. Urethral injuries involve the anterior or posterior urethra and are managed with suprapubic catheterization and delayed repair when possible to reduce complications.
This document discusses urethral trauma, including classification, etiology, clinical manifestations, investigations, and principles of management. It separates discussions of posterior and anterior urethral injuries. For posterior injuries, immediate suprapubic cystostomy is standard, while delayed reconstruction is typically done via open posterior urethroplasty after 3 months. Anterior injuries may be treated with catheter diversion or primary realignment, while anastomotic urethroplasty is preferred for obliterated bulbar urethras after several weeks.
Urethral injuries can be caused by blunt trauma such as motor vehicle accidents or falls, or penetrating injuries near the urethra. Injuries are classified as either posterior injuries involving the membranous or prostatic urethra, often associated with pelvic fractures, or anterior injuries distal to the membranous urethra from blunt perineal trauma. Diagnosis involves retrograde urethrography to detect extravasation of contrast at the injury site. Treatment depends on injury location and patient stability, often initially involving suprapubic catheter placement, with delayed repair of posterior injuries once hematomas resolve and associated injuries stabilize. Proper early management can lead to good long-term outcomes while
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...JohnJulie1
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...NainaAnon
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
This document summarizes benign prostatic hyperplasia (BPH). It finds that the incidence of BPH increases with age, affecting 20% of men aged 41-50 and over 90% of men over 80. Risk factors include genetics and race. BPH causes both obstructive symptoms like weak urinary stream and irritative symptoms like frequent urination. Treatment options range from watchful waiting for mild cases to drug therapies like alpha blockers and 5-alpha reductase inhibitors to surgical procedures like transurethral resection of the prostate. Minimally invasive procedures also exist like laser therapy, transurethral vaporization of the prostate, and transurethral needle ablation of the prostate.
Urethral stricture is an abnormal narrowing of the urethra caused by fibrosis due to injury or inflammation. It is most common in males and usually occurs around age 50. Symptoms include poor urine stream and retention. Diagnosis involves tests like cystoscopy and retrograde urethrogram. Treatment depends on location and severity but may include dilation, internal urethrotomy, or open urethroplasty surgery to repair or bypass the stricture. Effective drainage of the bladder is important to manage this condition.
This document discusses ureteroceles, which are cystic dilations of the terminal ureter. It describes classifications of ureteroceles and their embryology. Diagnosis can be made through prenatal ultrasound or MRI showing hydronephrosis and the intravesical cyst. Evaluation involves ultrasound, intravenous pyelography, voiding cystourethrography, and nuclear scans. Management is individualized and may include prenatal decompression or postnatal surgical procedures to preserve renal function, eliminate infection/obstruction/reflux, and maintain continence. Treatment aims to minimize morbidity while meeting these goals.
This document summarizes the surgical management of urethral strictures. It discusses investigations like retrograde urethrography and various types of urethroplasty procedures including dilation, internal urethrotomy, lasers, stents, and open reconstruction. Specific procedures covered include anastomotic urethroplasty, substitution urethroplasty using grafts and flaps, and augmented anastomotic urethroplasty. Complications of different procedures like buccal mucosal graft urethroplasty, fasciocutaneous urethroplasty, and anterior and posterior urethroplasty are also summarized.
The urethra's main job in males and females is to pass urine outside the body. This thin tube also has an important role in ejaculation for men. When a scar from swelling, injury or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Some people feel pain with a urethral stricture.
This document provides guidelines from the British Association of Urological Surgeons on suprapubic catheter placement and care. It discusses indications for suprapubic catheters including acute urinary retention and long-term bladder drainage needs. Risks like bowel injury are addressed, and techniques like ultrasound-guidance are recommended to mitigate these risks. Precatheter assessment, consent discussions, and various insertion methods are outlined. Complications, long-term care including catheter changes, and blockage management are also covered. The guidelines aim to standardize safe suprapubic catheter practice based on evidence and expert consensus.
This document discusses ureteroceles, which are cystic dilations of the distal ureter that may be associated with defects in ureteral maturation. Ureteroceles can be intravesical, extending into the bladder, or extravesical/ectopic, extending beyond the bladder neck. They are usually associated with the upper renal moiety in a duplex system. Clinical presentations include infections, incontinence, pain, or being found incidentally. Diagnostic imaging includes ultrasound, IVU, VCUG, nuclear medicine scans, and cystoscopy. Management goals are preserving renal function, eliminating obstruction/reflux, and continence. Treatment depends on individual factors and may include observation, acute decomp
Cystitis cystica and glandularis is a rare proliferative disease of the bladder epithelium characterized by foci of transitional cells that undergo glandular metaplasia. It is often found incidentally but can cause irritative voiding symptoms. While some case reports have linked cystitis glandularis to bladder cancer, larger studies found no clear association and no subsequent cancers in patients followed for several years. The role of these lesions as potential precursors to cancer is still unclear.
This document provides an overview of flexible ureteroscopy (URS) and retrograde intrarenal surgery (RIRS) for treating conditions of the urinary tract. It discusses the history and rising trends of URS, types of flexible ureteroscopes, instrumentation used in RIRS including guidewires, dilators, and laser lithotrites. Indications for diagnostic and therapeutic RIRS are outlined. The document details techniques for flexible ureteroscope deflection and passage of instruments through the working channel. Potential complications of procedures like basket extraction are also reviewed.
DIFFERENTIAL DIAGNOSIS OF INGUINOSCROTAL SWELLINGStudying
This document provides information on the differential diagnosis of inguinoscrotal swelling. It discusses various conditions that can cause swelling in the groin or scrotum including hernias (direct, indirect), hydrocele, hematocele, pyocele, varicocele, lymph varix, lipoma of the cord, funiculitis, undescended testis, ectopic testis, torsion of testis, epididymal cyst, spermatocele, multiple sebaceous cyst, tuberculosis epididymo-orchitis, and acute epididymo-orchitis. For each condition, it describes relevant history, examination findings, distinguishing characteristics, and other important clinical details.
This document discusses flexible ureterorenoscopy (RIRS) for treating conditions of the kidney and urinary tract. RIRS uses flexible instruments introduced through the ureter to access the kidney in a minimally invasive manner. It has advantages over rigid ureteroscopy like shorter hospital stays and recovery time. The document outlines the history, indications, instrumentation, technique and complications of RIRS. Emerging technologies discussed include digital flexible ureteroscopy, flexible robotic assistance and virtual reconstruction of ureteroscopic views.
Posterior urethral valves are congenital anomalies that obstruct the urethra in males. They were first recognized in the 18th century but were not diagnosed endoscopically until the early 20th century. PUVs cause damage to the urinary tract including the bladder, ureters, and kidneys due to increased pressure from blocked urine flow. Treatment involves endoscopic resection of the valves to restore urine flow. Long term follow up is needed due to risks of bladder dysfunction, infections, and renal impairment. Prognosis depends on factors like age of presentation, presence of reflux, and kidney function.
Transurethral resection of the prostate (TURP)JOFREY MTEWELE
TURP (transurethral resection of the prostate) is a common surgery to remove parts of an enlarged prostate gland through the penis to relieve urinary obstruction caused by BPH (benign prostatic hyperplasia). During TURP, a resectoscope is inserted through the urethra to cut and remove prostate tissue blocking the urethra using an electrical loop, with pieces flushed out by irrigating fluid. Complications can include bleeding, infection, and electrolyte imbalances from excessive fluid absorption. Nurses prepare instruments, assist during irrigation, and clean equipment after the procedure.
bladder pain syndrome is highly prevalent. it is a diagnosis of exclusion. the biggest hurdle in management is diagnosis. more often than not patients suffering with BPS move from pillar to post, from a clinician to another, often getting urethral dilatations, receiving NSAIDS and even antipsychotics (having been labelled as 'psychiatric' patient).
once diagnosis is made, treatment is multipronged and based on phenotype - the concept is called UPOINT. interstitial cystitis is a small but significant minority (moreover ulcerative type) of BPS.
Gabapentin, amitriptyline and pentosan polysulfate are cornerstone pharmacotherapeutic agents for IC/BPS
Dr. Abdellatif Zayed discusses various types of genitourinary trauma including renal, ureteral, bladder, and urethral injuries. Renal injuries are most commonly caused by blunt trauma from car accidents and are typically minor. Ureteral injuries require surgical repair depending on the location of the injury. Bladder injuries can be intraperitoneal, extraperitoneal, or a combination and are treated with exploration and repair or catheterization. Urethral injuries involve the anterior or posterior urethra and are managed with suprapubic catheterization and delayed repair when possible to reduce complications.
This document discusses urethral trauma, including classification, etiology, clinical manifestations, investigations, and principles of management. It separates discussions of posterior and anterior urethral injuries. For posterior injuries, immediate suprapubic cystostomy is standard, while delayed reconstruction is typically done via open posterior urethroplasty after 3 months. Anterior injuries may be treated with catheter diversion or primary realignment, while anastomotic urethroplasty is preferred for obliterated bulbar urethras after several weeks.
Urethral injuries can be caused by blunt trauma such as motor vehicle accidents or falls, or penetrating injuries near the urethra. Injuries are classified as either posterior injuries involving the membranous or prostatic urethra, often associated with pelvic fractures, or anterior injuries distal to the membranous urethra from blunt perineal trauma. Diagnosis involves retrograde urethrography to detect extravasation of contrast at the injury site. Treatment depends on injury location and patient stability, often initially involving suprapubic catheter placement, with delayed repair of posterior injuries once hematomas resolve and associated injuries stabilize. Proper early management can lead to good long-term outcomes while
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...JohnJulie1
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...NainaAnon
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay
Abstract
This case report describes the diagnosis and management of a large mesenteric cyst in a 55 year old lady who presented with abdominal distension & with mass in the left upper quadrant. Mesenteric cysts are rare, benign, abdominal tumors to which <1000 cases have been reported in the literature. While 40% of cases are incidental findings found either through physical examination or imaging, they can cause non-specific abdominal symptoms including pain, altered bowel habits, nausea/vomiting or anorexia. Less commonly, 10% of cases can present with bowel obstruction, volvulus, torsion or shock. In general, the lack of characteristic clinical and radiological features presents as a diagnostic difficulty.
The mainstay in imaging is computerized tomography (CT). CT identifies and helps aid the decision to pursue a laparoscopic or open laparotomy approach, where complete surgical resection is the ultimate goal. In our patient a CT Abdomen & Pelvis showed a large, loculated cystic mass measuring 30cm in cranio-caudal length and 16cm in the transverse and anterior/posterior diameter. While different approaches have been described in the literature to surgically resect such cysts, our approach was largely reflective of size and adherence to surrounding structures in this case. A laparotomy was performed using an upper mid-line 7 cm incision; 4500cc of fluid was aspirated from the cyst which was found to originate from the small bowel mesentery. A complete resection of the multi-loculated cystic sac was done that included the resection of the middle mesenteric vein. The post-operative period was uneventful. The patient was discharged on post-operative day 2. The Histopathology identified the mass as a multi-loculated peritoneal inclusion-type cyst.
Recent Update on Management of Ulcerative ColitisDr Amit Dangi
Recent update on the surgical and medical management of ulcerative colitis, including various controversies regarding IPAA and recent medical management incorporating the role of biologicals
Vesicouterine Fistula Following Cesarean Delivery – Ultrasound Diagnosis and ...Michelle Fynes
Vesicouterine fistulae are uncommon, with most units reporting 1–5 cases over 5–15 year periods. To date there has been a paucity of case reports regarding this problem and only a few case series. In this report we outline the presentation and management of a vesicouterine fistula complicating a repeat Cesarean delivery, specifically describing the role of transvaginal ultrasound.
The ureter is approximately 25-30 cm long and runs from the kidney to the bladder. It can be injured through external trauma, iatrogenic causes, or underlying conditions. Treatment for ureteral injuries depends on the location and severity of the injury. Options include primary repair, ureteroureterostomy, Boari flap, psoas hitch, intestinal interposition, or nephrectomy in some cases. Laparoscopic and robotic techniques are being used more often for ureteral reconstruction. The goal is always to preserve renal function through anatomical reconstruction of the urinary tract.
This study evaluated outcomes of the ReMeEx adjustable sling system for treating female stress urinary incontinence (SUI) over 15 years in 55 patients. The ReMeEx system allows postoperative readjustment of sling tension to improve continence without reoperation. At long-term follow-up, 50 patients were cured with 10 requiring readjustment. Complications like temporary retention were minor. The ReMeEx system achieved high cure rates and improved quality of life for SUI patients, including those with prior incontinence surgery or worse prognosis, by enabling durable sling tension adjustment without reoperation.
This document discusses surgical procedures for stress urinary incontinence (SUI), specifically mid-urethral slings (MUS). It provides a timeline of significant SUI procedures, from anterior repairs in the 1800s to tension-free tapes in the 1990s. The transobturator tape (TOT) procedure is described, which places a synthetic sling under the mid-urethra via the obturator foramen to support the urethra without entering the retropubic space. Complications of MUS procedures are generally low but can include bladder perforation, urethral injury, and voiding dysfunction. Long-term success rates of over 90% are reported with MUS.
STUDY OF eTEP FOR VENTRAL HERNIA REPAIR.pptxAnandaHegde1
This study aims to describe the technique of endoscopic eTEP Rives-Stoppa repair for ventral hernia repair. 41 patients undergoing eTEP ventral hernia repair were evaluated. The mean age was 57.1 years. Umbilical hernias were the most common based on EHS classification. The mean operative time was 3.7 hours. The mean hospital stay was 3.7 days. Post-operative complications included 1 recurrence and 1 seroma. The study concludes that eTEP is a cost-effective ventral hernia repair technique with low recurrence and morbidity rates.
Intravenous & Endocavitary Contrast Enhanced Ultrasound (CEUS) in Multiseptat...pateldrona
Pyogenic liver abscess is a potentially life-threatening pathology, while image-guided drainage is highly indicative as first-line treatment approach. We report the case of an 84-year-old woman, diagnosed with large multiseptated pyogenic liver abscess, aiming to stress out the immense contribution...
Intravenous&EndocavitaryContrastEnhancedUltrasound(CEUS) in Multiseptated Pyo...komalicarol
This case report describes the use of intravenous and endocavitary contrast-enhanced ultrasound (CEUS) to guide drainage of a complex multiseptated pyogenic liver abscess in an 84-year-old woman. CEUS with Sonovue contrast agent allowed visualization of abscess cavities, septations, and surrounding structures to safely place drainage catheters. Endocavitary CEUS through the catheters confirmed correct positioning. CEUS provided real-time imaging guidance without radiation, avoiding surrounding vessels and confirming drainage between cavities. The successful drainage with CEUS guidance improved the patient's condition.
Intravenous & Endocavitary Contrast Enhanced Ultrasound (CEUS) in Multiseptat...AnonIshanvi
Pyogenic liver abscess is a potentially life-threatening pathology, while image-guided drainage is highly indicative as first-line treatment approach. We report the case of an 84-year-old woman, diagnosed with large multiseptated pyogenic liver abscess, aiming to stress out the immense contribution...
Intravenous & Endocavitary Contrast Enhanced Ultrasound (CEUS) in Multiseptat...AnnalsofClinicalandM
Pyogenic liver abscess is a potentially life-threatening pathology, while image-guided drainage is highly indicative as first-line treatment approach. We report the case of an 84-year-old woman, diagnosed with large multiseptated pyogenic liver abscess,
Ureteral injury is one of the most serious complications of gynecologic surgery. Ureteral injury during laparoscopic surgery has become more common as a result of the increased number of laparoscopic hysterectomies and retroperitoneal procedures that are being performed.
Laparoscopic Natural Orifice Specimen Extraction (NOSE) Total Colectomy with ...semualkaira
The benefit of laparoscopic surgery in terms of
reduced pain and fewer cosmetic problems is not always obvious,
and surgeons continue to seek the best ways to limit incision trauma and improve outcomes in laparoscopic colorectal surgery
Abdominal Wall Endometrioma: A Diagnostic Enigma—A Case Report and Review of ...KETAN VAGHOLKAR
Background. Abdominal wall endometriomas are quite uncommon. They are usually misdiagnosed by both the surgeon and the
gynaecologist. Awareness of the details of this rare condition is therefore essential for prompt diagnosis and adequate treatment.
Introduction. Endometriosis though a condition commonly seen in the pelvic region can also occur at extrapelvic sites giving
rise to a diagnostic dilemma. Abdominal wall endometrioma is one such complex variant of extrapelvic endometriosis with an
incidence of less than 2% following gynaecologic operations. Case Report. A case of abdominal wall endometrioma diagnosed
clinically and treated by wide surgical resection is presented to highlight the importance of clinical evaluation in the diagnosis of
this condition. Discussion. The etiopathogenesis, presentation, investigations, and management are discussed briefly. Conclusion.
Clinical evaluation confirmed by supportive imaging is diagnostic.Wide local excision is the mainstay of treatment.
Testicular torsion refers to the torsion of the spermatic cord structures and subsequent loss of the blood supply to the ipsilateral testicle.
Urological emergency; early diagnosis and treatment are vital.
Mainly disease of Neonates, Adolescents.
The rate of testicular viability decreases significantly after 6 hours from onset of symptoms.
The document summarizes the histology of the female reproductive system. It describes the layers of the ovary including the cortex containing ovarian follicles and stroma, and the medulla containing blood vessels, connective tissue, and hilus cells. It also describes the layers of the uterus (perimetrium, myometrium, endometrium), uterine tubes (mucous membrane, muscle coat, serosa), and vagina (mucous membrane with stratified squamous epithelium, muscle coat, adventitia).
There are marked variations in the incidence of gastric cancer worldwide.
The UK it is approximately 15 per 100000 per year
The USA 10 per 100000 per year
Eastern Europe 40 per 100 000 per year.
It is more common in Japan—70 per 1,00,000 population.
Common in males 2:1.
Decrease incidence in western world (Western Europe and US)—last four decades.
The document discusses the histology of lymphoid organs including the thymus, lymphatic nodules, spleen, palatine tonsils, and lymph nodes. These organs play important roles in the immune system through the development, storage, and activation of lymphocytes that help the body fight infections and diseases.
The male reproductive system consists of the testes, conducting tubules and ducts (epididymis, vas deferens, ejaculatory ducts), accessory sex glands (seminal vesicles, prostate, and bulbourethral glands), and the penis.
Evaluating Tools for Characterizing Anterior Urethral Stricture Disease A Com...Dr Abdul Qayyum Khan
We evaluated if scores generated by the LSE classification system and
the Urethral Stricture Score system are associated with intraoperative surgical
complexity and stricture recurrence risk.
The document discusses electrohydraulic lithotripsy (EHL), a technique that uses electric sparks delivered in pulses between electrodes at the tip of a fiber to create shock waves. These shock waves oscillate and generate sufficient pressure to fragment stones by inducing the immediate expansion of surrounding liquid from the electric sparks. Modifications to the acoustic lens of an electromagnetic lithotripter produced a broader focal zone and improved pressure waveform, demonstrating better stone fragmentation in vitro.
This document provides updates made in Version 1.2023 of the National Comprehensive Cancer Network (NCCN) Guidelines for Testicular Cancer. Key updates include:
- Adding consideration of abdomen/pelvis CT with contrast to the primary treatment workup.
- Modifying footnotes regarding mildly elevated tumor marker levels and sperm banking recommendations.
- Adding links to the AJCC TNM Staging Classification and modifying footnotes on tumor marker levels and staging.
- Adding new headers for sections addressing recurrence across various clinical stages and treatment pathways.
- Adding a footnote on treatment options for recurrence in patients previously on surveillance.
Amputation is surgery to remove all or part of a limb or extremity. You may need an amputation if you’ve undergone a severe injury or infection or have a health condition like peripheral arterial disease (PAD). Many people live a healthy, active lifestyle after an amputation, but it may take time to get used to life without a limb.
The term basal nuclei is applied to a collection of masses of gray matter situated within each cerebral hemisphere.
They are the
corpus striatum,
amygdaloid nucleus,
claustrum.
The subthalamic nuclei, the substantia nigra, and the red nucleus are functionally closely related to the basal nuclei.
Bladder injuries may result from blunt,Penetrating and Iatrogenic trauma.
Full bladder is more susceptible to injury than empty bladder.
Management varies from conservative to surgical aiming to directly repair the injury.
1.Detect presence of liver disease.
2.Distinguish among different types of liver diseases.
3.Estimate the extent of known liver damage.
4.Follow the response of treatment
Rabies causes an estimated 31,000 deaths annually in Asia, with 20,000 deaths in India and 2,000-5,000 deaths in Pakistan. The virus has an incubation period of 2 weeks to 6 months after a bite, and once symptoms appear the disease is fatal. Symptoms can include fever, headache, hydrophobia, aerophobia, and ascending paralysis. Diagnosis is usually clinical but rabies virus can be detected by PCR or antibodies measured by ELISA. For bite victims, the wound should be thoroughly washed and rinsed, rabies immunoglobulin and vaccine administered based on wound category, and a vaccine series given. Modern cell culture vaccines have replaced nerve tissue vaccines globally and include purified vero cell, chick
Disorders that perturb cardiovascular, renal, or hepatic function are often marked by the accumulation of fluid in tissues (edema) or body cavities (effusions).
Transmission Based Precautions are a set of infection control guidelines used to prevent the spread of diseases that are spread by contact or airborne methods. They include using gloves and gowns for contact precautions when in close contact with patients, as well as using masks for airborne precautions when treating patients with illnesses like tuberculosis. Hospitals implement Transmission Based Precautions with certain patients to stop the spread of infections to others.
This document outlines learning objectives for understanding the thoracic cage and diaphragm. The key points are:
- Describe the boundaries of the thoracic cage, openings of the thorax, and components of the diaphragm including its origin, direction of fibers, blood supply and nerve supply.
- List the structures that pass through openings in the thorax and diaphragm.
- Explain the functions of the diaphragm in respiration and other acts.
- Enumerate conditions related to damage of the phrenic nerve including diaphragmatic paralysis and hernias.
Autoimmunity disorders occur when the immune system mounts an attack against the body's own tissues and organs. They are difficult to diagnose due to nonspecific initial symptoms, fluctuating symptoms, and the potential for multiple autoimmune conditions. Diagnostic methods include initial laboratory tests of inflammatory markers and autoantibodies, immunological studies, flow cytometry to analyze immune cells, cytokine studies, and examination of major histocompatibility complex genes associated with autoimmunity. A variety of autoantibodies against nuclear, cytoplasmic, and other cellular components can indicate autoimmune disease patterns and targets.
Negative pressure pulmonary edema (NPPE) or postobstruction pulmonary edema (POPE) is a clinical entity of great relevance in anesthesiology and intensive care. The presentation of NPPE can be immediate or delayed, which therefore necessitates immediate recognition and treatment by anyone directly involved in the perioperative care of a patient.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. INTRODUCTION
Urethral stricture is an abnormal narrowing or
loss of distensibility of any part of the urethra as
a result of fibrosis at the site of injury or
inflammation.
3. RELEVANTANATOMY OF THE MALE
URETHRA
• Male urethra extends from the bladder neck and
terminates at the external urethral meatus.
• It measures about 20.5cm in length and comprises
two(2) part – the anterior and posterior urethra.
• Longer anterior urethra measures about 15cm and
comprises the bulbous and penile urethra
• Shorter posterior urethra comprises the
prostatic and membranous urethras.
4.
5. AETIOLOGY
Idiopathic
Traumatic
Trauma
Foreign body or uretheral stone
Post surgical
INFLAMMATORY
Post gonococcal (70%)
Non specific urethritis Schistosomiasis
Tuberculous urethritis
Balanitis xerotica obliterance (BXO)
6. PATHOGENESIS
• Urethral stricture forms when the urethra heals by
proliferation of fibroblasts which later contracts.
• Post inflammatory strictures are usually confined to
the anterior urethra particularly the bulbous urethra.
• Instrumental injury usually occurs at the bulb but stricture
following prostatic surgery is found at the bladder neck.
• Urethral stricture following pelvic injuries usually
occurs at the membranous urethra
7. PATHOLOGY
Urethral stricture leads to
• Dilatation of the urethra proximal to the stricture
• Compensatory changes in the bladder musculature
resulting in hypertrophy, trabecculation, sacculation and
diverticular formation
• Hypertrophy of the uretero-trigonal complex or
vesicoureteral reflux causing hydroureters and
hydronephrosis.
• Stasis of urine and subsequent infection of the urinary
tract
8.
9. CLINICAL FEATURES
• Although stricture following urethritis is formed within a
year, it takes on an average of about 20 years for symptoms
to become apparent.
• Traumatic strictures on the other hand are
symptomatic in two months.
• Symptoms are usually insidious in onset and are usually
LUS which include poor stream, spraying of urine,
frequency, hesitancy, dribbling, acute and chronic
retention.
10. INVESTIGATIONS
Urinalysis, Urine microscopy and culture.
Blood urea and serum creatinine.
Ultrasound KUB
Ultrasound of the urethra
X.ray pelvis
Retrograde urethrogram
Antegrade cystourethrogram
Cystourethroscopy
11.
12.
13. TREATMENT OPTIONS
Urethral dilation
Direct vision internal urethrotomy (DVIU)
Open urethral reconstruction.
Indications
Failed conservative management i.e Intermittent
Urethrotomy
Very long strictures or complete strictures with extensive spongiofibrosis
Complicated strictures with periurethral abscess, calculi or neoplasia.
14. Urethroplasty can be anastomostic or substitutional
Grafts include:
Buccal mucosa
bladder mucosa
penile skin
scrotal skin
prepuce
postauricular skin
15. TREATMENT OPTIONS
Anterior urethra Strictures :
• Two stage urethroplasty such as the Swinney
technique which involves the initial laying
of the stricture and subsequent reconstruction
the urethra using a graft/flap.
• Free Graft urethroplasty
• Skin island flap implantation
• End to end anastomosis
16.
17. Evaluating Tools for Characterizing
Anterior Urethral Stricture Disease: A
Comparison of the LSE System and the
Urethral Stricture Score
18. Article information
This study was conducted in Department of Urology,
Columbia University Irving Medical Center,
New York, New York and Published in journal of
American Association of Urology on 1 Aug, 2022.
19. Introduction
Several attempts have been made to create
classification systems to describe USD severity, including
the
ultrasound-based U.L.T.R.A. measurement system,
the Urethral Stricture Score (U-Score),
and the LSE classification system (LSE) created from the
Trauma and Urologic Reconstruction Network of
Surgeons database.
However, none of these schemes have achieved
widespread use.
20. The U-Score
The U-Score is a simple
classification tool that
results in a composite
numerical score, which
has
been reported to
correlate with operative
time and surgical
complexity for anterior
USD.
21. LSE system
Unlike the U-Score, the LSE
system does not provide a
composite numerical score,
as it was initially developed
as a classification system
rather than a staging tool. It
provides a shorthand and
standardized way for
surgeons to communicate
about the characteristics of a
stricture, for both research
and clinical purposes. It was
developed without
assumptions that one disease
class is worse than another.
As such, it is a nominal
classification system rather
than an ordinal staging
system.
22.
23. Objective of the study
The objective of this study was to evaluate if scores
generated using the LSE and U-
Score systems are associated with surgical complexity,
operative time, and stricture recurrence.
Hypothesis was that increasing scores in both systems
would be associated with intraoperative outcomes, but
that only increasing scores based in the LSE system
would be associated with stricture recurrence risk.
24. Materials and Methods
Study design: Retrospective
Population: All patients who underwent a single-stage
anterior urethroplasty and all of them
were operated on by a single surgeon from 1998 to 2020
at a single tertiary care center.
A U-Score and an LSE score were calculated for each
patient.
25. Statistical analysis
A total of 187 patients, with a
mean age of 48 years (SD 16),
were included. The Table
displays the cohort
characteristics. Mean stricture
length was 4.2 cm (SD 3.1,
range 0.4-20 cm) and mean
follow-up was 21 months (SD
24). Of the patients 32%(n [
60) had penile urethral
strictures and 68% (n [ 127)
had bulbar strictures. Nearly
half (47%) of the patients had
idiopathic USD. Mean U-Score
was 5.6 (SD 1.3, range 4-8)
and mean LSE was 5.8 (SD 1.6,
range 3-10). Mean surigical
complexity score was 2.9 (SD
1.5, range 1-5). Forty-six of
187 patients recurred over
time.
26. Outcomes and results
Kaplan-Meier curves displaying the relationship between LSE score
(LSE) (A) and Urethral Stricture Score (U-Score) (B) stratified as high
versus low scores and stricture recurrence risk.
27. Outcomes and results
We found a strong and
significant linear
correlation between U-
Score and LSE (r[0.79, P <
.0001, Fig. 1). Both
increasing U-Score and
increasing LSE were
linearly associated with
increasing surgical
complexity (r[0.44, P <
.0001 and r[0.42, P <
.0001, respectively).
Frequency tables
displaying these data are
available in
supplementary Table 4
28. Discussion
Both increasing U-Score and LSE were significantly
associated with increasing surgical complexity; however,
only LSE was associated with early stricture recurrence
risk. As LSE increased, the risk of stricture recurrence
increased. In particular, patients with an LSE >7 were at
particularly increased risk.
29. Strengths
Increasing U-Score and LSE are both associated with
increasing intraoperative surgical complexity, but only
LSE is associated with short-term stricture recurrence
risk.
30. Limitations
First, this was a single-surgeon retrospective cohort study of patients treated
at tertiary care academic center.
Second, the LSE classification system is previously unstudied and therefore
not validated
Third, the overall follow-up time for our cohort was relatively short.
Therefore, results only reflect short-term(<3 years) stricture recurrence risk.
Fourth, both of the scoring systems do not incorporate several important
potentially
confounding variables that could impact recurrence risk, including:
postoperative infection
compromised wound healing, comorbidities, or prolonged preoperative
urethral catheterization.
Finally, neither scoring system utilized statistical modeling to determine cut-
off values or point
allocation for each component variable. As such, allocating points using
single-point increments may be flawed.