Русский
The choice of treatment for recurrent urethral structure after the direct vision internal urethro-tomy
DOI: https://dx.doi.org/10.18565/urology.2020.5.10-14
S.V. Kotov, R.I. Guspanov, S.A. Pulbere, M.M. Iritsyan, M.K. Semenov, A.G. Yusufov, I.I. Survillo, E.Kh. Abdulkhalygov, А.А. Nemenov
1Department of Urology and Andrology N.I. Pirogov Russian National Research Medical University, Moscow, Russia; 2N.I. Pirogov City Clinical Hospital №1, Moscow, Russia
Introduction. Urethral stricture is a complex urological pathology that requires a comprehensive and expert approach for the treatment, the selection of optimal surgical tactics and improving the quality of life of patients.
Aim of study. To evaluate the effectiveness of various methods of treatment of recurrent urethral stricture after direct vision internal urethrotomy (DVIU).
Materials and methods. In N.I. Pirogov City Clinical Hospital №1 analyzed the results of surgical treatment of patients with urethral stricture since 2011 till 2018. The study included patients with a history of an initially performed direct vision internal urethrotomy. A total of 77 patients were included in the study.
The median age was 66 years old (min-max 17-85 years old). The median of observation is 22 months (12-72). The median length of the stricture (min-max) is 2 cm (0.3-16). The median maximum speed of urination before surgery is 4.55 ml/s (1.8-11).
Results. The patients were divided into 4 groups: I- 16 (20,8%) patients to whom the DVIU - was repeated - in highly selective patients, with a period of up to recurrence from 1.5 to 3 years, a length of not more than 0.5 cm in the bulbar urethra, informed about more effective methods of urethroplasty, which in the postoperative period performed intermittent auto-catheterization 1 time per week for 3 months; II – 37 (48,1%) patients who underwent EPA or one of the options for anastomotic urethroplasty in cases of recurrent stricture in the bulbar urethra from 0.5 to 2 cm; III – 22 (28,6%) patients with one-stage urethroplasty with buccal graft or skin flap in cases of recurrent anterior urethral stricture from 2 to 7 cm; IV-2 (2,6%) patients, who underwent multi-stage urethroplasty in cases of extensive recurrent urethral strictures with severe spongiofibrosis requiring complete excision of the urethral site.
In the first group, the effectiveness of the operation was 75%. In the second group, the effectiveness of the operation was 86,5%. In the third group, the effectiveness of the operation was 82%. In group IV the effectiveness is 100%.
The median Qmax was (min-max) 19.2 ml/s (12-29.6).
Conclusion. The choice of treatment for recurrent urethral stricture after DVIU certainly depends on the localization of stricture, etiology of primary stricture, the severity of spongiofibrosis and time to reccurence.
Aim of study. To evaluate the effectiveness of various methods of treatment of recurrent urethral stricture after direct vision internal urethrotomy (DVIU).
Materials and methods. In N.I. Pirogov City Clinical Hospital №1 analyzed the results of surgical treatment of patients with urethral stricture since 2011 till 2018. The study included patients with a history of an initially performed direct vision internal urethrotomy. A total of 77 patients were included in the study.
The median age was 66 years old (min-max 17-85 years old). The median of observation is 22 months (12-72). The median length of the stricture (min-max) is 2 cm (0.3-16). The median maximum speed of urination before surgery is 4.55 ml/s (1.8-11).
Results. The patients were divided into 4 groups: I- 16 (20,8%) patients to whom the DVIU - was repeated - in highly selective patients, with a period of up to recurrence from 1.5 to 3 years, a length of not more than 0.5 cm in the bulbar urethra, informed about more effective methods of urethroplasty, which in the postoperative period performed intermittent auto-catheterization 1 time per week for 3 months; II – 37 (48,1%) patients who underwent EPA or one of the options for anastomotic urethroplasty in cases of recurrent stricture in the bulbar urethra from 0.5 to 2 cm; III – 22 (28,6%) patients with one-stage urethroplasty with buccal graft or skin flap in cases of recurrent anterior urethral stricture from 2 to 7 cm; IV-2 (2,6%) patients, who underwent multi-stage urethroplasty in cases of extensive recurrent urethral strictures with severe spongiofibrosis requiring complete excision of the urethral site.
In the first group, the effectiveness of the operation was 75%. In the second group, the effectiveness of the operation was 86,5%. In the third group, the effectiveness of the operation was 82%. In group IV the effectiveness is 100%.
The median Qmax was (min-max) 19.2 ml/s (12-29.6).
Conclusion. The choice of treatment for recurrent urethral stricture after DVIU certainly depends on the localization of stricture, etiology of primary stricture, the severity of spongiofibrosis and time to reccurence.
Keywords: urethral stricture, recurrent urethral stricture, urethroplasty, urethral stenosis, direct visual internal urethrotomy, buccal mucosa graft
About the Autors
Corresponding author: S.V Kotov – MD, Chairman Department of Urology and Andrology N.I. Pirogov Russian National Research Medical University, Moscow, Russia; e-mail: urokotov@mail.ru
