Trujillo-Ortiz L, Morales-Montor G, Cantellano-Orozco M, Martínez-Arroyo C, Fernández-Noyola G, Sedano-Basilio J, Pacheco-Gahbler C

Language: Spanish
References: 24
Page: 191-198
PDF size: 199.52 Kb.

ABSTRACT

Background: Urethral stricture is an alteration that reduces urine flow and hampers bladder voiding. Its origin is multifactorial and there is no definitive consensus on approach or standard treatment.
Objective: To determine the recurrence of bulbar urethral stricture in patients that underwent primary anastomotic urethroplasty or primary internal urethrotomy.
Materiales and methods: A retrospective cohort study was conducted on patients that underwent anastomotic urethroplasty or internal urethrotomy within the time frame of 2007 and 2014 at the Hospital General "Dr. Manuel Gea González", in Mexico City. The preoperative characteristics analyzed were: age, urinary retention, etiology, length and location of the strictured segment, preoperative and postoperative uroflowmetry (Qmax) results, stricture recurrence, and treatment after recurrence.
Results: Thirty-one (22.3%) patients that underwent anastomotic urethroplasty and 108 (77.7%) that had internal urethrotomy were registered. Mean patient age was 54.12 ± 14.6 years and the most frequent etiology was iatrogenic (57.6%), followed by traumatic causes (29.5%), idiopathic causes (8.6%), and infectious origin (4.3%). Mean stricture length was 13.20 ± 4.9 mm, 5.8% of patients had urinary retention, preoperative Qmax was 6.81 ± 1.53, and postoperative Qmax was 11.78 ± 2.44 mL/sec. There was no recurrence at 6 months in the patients that underwent anastomotic urethroplasty. Recurrence in the patients that had internal urethrotomy was 43.9%. Postoperative Qmax was 10.77 ± 1.82 mL/sec in the patients that had recurrence at 6 months vs 12.5 ± 2.59 mL/sec in those that did not have recurrence (p=0.002).
Conclusions: Anastomotic urethroplasty can be considered firstline treatment in patients with bulbar urethral stricture ≤2 cm in length. Internal urethrotomy is the minimally invasive surgical treatment of greater availability in urologic practice.

REFERENCES

1. Mangera A, Chapple C. Urethral stricture disease. Surgery (Oxford) 2014;32(6):304-309.

2. Latini JM, McAninch JW, Brandes SB, et al. SIU/ICUD Consultation on urethral strictures: Epidemiology, etiology, anatomy, and nomenclature of urethral stenoses, strictures, and pelvic fracture urethral disruption injuries. Urology. 2014;83(3 Suppl):S1-7.

3. Anger JT, Santucci R, Grossberg AL, et al. The morbidity of urethral stricture disease among male medicare beneficiaries. BMC Urol. 2010;10:3.

4. Prevención, diagnóstico y tratamiento de estrechez (estenosis) de uretra postraumática por estenosis y por procedimientos terapéuticos en el hombre adulto. México: I Secretaría de Salud, 2010. Disponible en: www.cenetec. salud.gob.mx/interior/gpc.html

5. Lazzeri M, Sansalone S, Guazzoni G, et al. Incidence, Causes, and Complications of Urethral Stricture Disease. Eur Urol Suppl. 2016;15(1):2-6.

6. Fenton AS, Morey AF, Aviles R, et al. Anterior urethral strictures: Etiology and characteristics. Urology. 2005;65:1055-8.

7. Stein DM, Thum DJ, Barbagli G, et al. A geographic analysis of male urethral stricture aetiology and location. BJU Int. 2013;112:830-834

8. Palminteri E, Berdondini E, Verze P, et al. Contemporary urethral stricture characteristics in the developed world. Urology. 2013;81:191-6.

9. Angermeier KW, Rourke KF, Dubey D, et al. SIU/ICUD consultation on urethral strictures: Evaluation and follow-up. Urology. 2014;83(3 Suppl):S8-17.

10. Gallentine ML, Morey AF. Imaging of the male urethra for stricture disease. Urol Clin North Am. 2002;29:361-72.

11. Tam CA, Voelzke BB, Elliott SP. Critical analysis of the use of uroflowmetry for urethral stricture disease surveillance. Urology. 2016;91:197-202.

12. Schafer W, Abrams P, Liao L. Good Urodynamic Practices: Uroflujometry Filling Cystometry, and Pressure-Flow Studies. Neurourol Urodyn. 2002:21:261-274.

13. Jackson MJ, Veeratterapillay R, Harding CK, et al. Intermittent self-dilatation for urethral stricture disease in males. Cochrane Database Syst Rev. 2014;12:CD010258.

14. Buckley JC, Heyns C, Gilling P, et al. SIU/ICUD consultation on urethral strictures: Dilation, internal urethrotomy, and stenting of male anterior urethral strictures. Urology. 2014;83 (3 Suppl):S18-22.

15. Morey AF, Watkin N, Shenfeld O, et al. SIU/ICUD consultation on urethral strictures: Anterior urethra-Primary anastomosis. Urology. 2014;83(3 Suppl):S23-6.

16. Terlecki RP, Steele MC, Valadez C, et al. Grafts are unnecessary for proximal bulbar reconstruction J Urol, 2010;184:2395-2399.

17. Barbagli G, Fossati N, Sansalone S, et al. Prediction of early and late complications after oral mucosal graft harvesting: multivariable analysis from a cohort of 553 consecutive patients. J Urol, 2014;191:688-693.

18. Morey AF, Watkin N, Shenfeld O, et al. SIU/ICUD consultation on urethral strictures: anterior urethra-primary anastomosis. Urology, 2014;(83):S23-S26.

19. Granieri MA, Webster GD, Peterson AC. The evolution of urethroplasty for bulbar urethral stricture disease: lessons learned from a single center experience. J Urol 2014;192(5):1468-1472.

20. Fall BY, Diallo SY, Sarr A, Thiam A. et al. Urethroplasty for male urethral strictures: Experience from a national teaching hospital in Senegal. African J Urol 2014;20:76-81.

21. Cisneros RM, Aragón A, Morales O. Estenosis uretral: etiología y tratamiento. Experiencia en el Centro Médico ISSEMYM. Rev Mex Urol 2013;73(5):229-236.

22. Bullock TL, Brandes SB. Adult anterior strictures: a national practice patterns survey of board certified urologists in the United States. J Urol 2007;177:685-690.

23. Santucci R, Eisenberg L. Urethrotomy has a much lower success rate than previously reported. J Urol 2010;183:1859- 1862.

24. Saavedra DV, Merayo CE, Sánchez G. Recurrencia de estenosis uretral posterior a uretrotomía interna. Rev Mex Urol 2009;69(4):15.