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Endoscopic Evaluation of Neurogenic Bladder
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Romain Caremel, Jacques Corcos
Sphincterotomies are rarely used. Some patients have received in the past endoluminal stents instead (i.e., Urolume—AMS). These stents are no longer available. It is usually easy to introduce a flexible cystoscope through these stents, which “disappear” completely after a few months as the device is epithelialized through and in between its pores: 90%–100% of epithelialization of the stent has been demonstrated in 47.1% of cases 3 months after insertion, and in 87.7% of cases 12 months after insertion. Mild epithelial hyperplasia can occur (34%–44.4%) after stent insertion and may look like an obstructed urethra. Much less frequently, these strictures are severe (3.1%), requiring urethrotomy or sometimes laser resection of the excess tissue.3 Occasionally, however, and even several years later, part of the stent may remain visible but usually does not cause any problem. Calcifications of the stents are rare. No stone formation has been reported.4
The Urinary System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Urethroscopy and cystoscopy allow the practitioner to view the lumen of the urethra and interior of the bladder, respectively, via fiber-optic techniques. Surgical procedures can be performed using the same technology. For example, urethrotomy to repair a stricture may be done with the aid of a urethroscope as well as by surgically opening the abdomen.
Urethra and Penis
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Endoscopic (internal) urethrotomy Internal urethrotomy is performed using the optical urethrotome. The stricture is cut under visual control using a knife passed through the sheath of a rigid urethroscope. The stricture is usually cut at the 12 o’clock position, taking care not to cut too deeply into the vascular spaces of the corpus spongiosum that surrounds the urethra. It is possible to get lost when trying to cut a way through a very tight stricture, and this is especially true when there are false passages because of previous dilatation attempts. Accordingly, a guidewire should be passed through to the bladder prior to incision of the stricture in order to establish the true lumen of the urethra. Following urethrotomy a catheter should be left in situ for 1-3 days afterwards.
Intermittent urethral infusion of dimethylsulfoxide for urethral amyloidosis: a case report and literature review
Published in The Aging Male, 2022
Yunzhi Ii, Guojing Gao, Xiaoxing Liao, Jianghua Yang, Rongzhen Ye, Xiaofeng Zheng
The natural history, clinical symptoms, diagnostic methods, and treatment methods of UA cases in the past 20 years were reviewed (Table 1). The result showed that UA usually has a long course when it develops, and it often has such symptoms as mass, hematuria, blood sperm, and dysuria. Imaging examinations, such as ultrasound, scans, and MRI, are often used to diagnose urethral abnormalities, but MRI is more helpful in determining the extent of lesion invasion [4]. The definite diagnosis of UA requires tissue biopsy and special pathological staining. Treatment strategies for UA remain controversial for limited number of case reports and large differences in treatment options [5]. Thus, the treatment may be selected according to patient’s individual symptoms including cystostomy, intermittent urethral dilatation, and urethroplasty with buccal mucosa or perineal skin flap (Table 1). Yao et al. [6] reported 4 cases of UA, and found that urethral dilatation and transperineal urethrotomy had recurrence, while urethroplasty did not have recurrence and had a good effect.
One-year follow-up after urethroplasty, with the focus on both lower urinary tract and erectile function
Published in Scandinavian Journal of Urology, 2020
David Míka, Jan Krhut, Kateřina Ryšánková, Radek Sýkora, Libor Luňáček, Peter Zvara
In the past, most USD cases were treated with urethral dilatations and/or internal urethrotomy. These methods are currently reserved for palliative care, while urethroplasty became the gold standard. This trend is evident, as the number of open urethroplasties performed in the United States increased more than 3-fold between 2004 and 2012 [3]. Urethroplasty is a safe surgical procedure with low incidence of perioperative morbidity and mortality [4]. Studies conducted at specialized centers with a sufficient volume of urethroplasty procedures report a success rate above 80% [5]. On the other hand, it must be recognized that a consensus on the definition of success in the US treatment is lacking. Previously, no need for re-treatment was accepted as a definition of success [6]. Today, most studies report success based on quantifiable functional outcome data obtained mostly from retrograde urethrography and uroflowmetry. The effect of urethral surgery on erectile function was first evaluated in a study by Mundy [7] published in 1993. Since then, only a limited number of studies focusing on this aspect of treatment have been published, yielding conflicting results [8].
Urinary tract infection in a human male patient with Staphylococcus pseudintermedius transmission from the family dog
Published in Journal of Chemotherapy, 2022
L. D. Blondeau, M. Deutscher, J. E. Rubin, H. Deneer, R. Kanthan, S. Sanche, J. M. Blondeau
Patient GH is a 77 year-old male patient with a history of chronic urinary retention. In 2013 he was diagnosed with non-obstructive urinary retention. No surgical option was available and the patient was instructed and trained to start intermittent urinary catheterization for the bladder atony. In August 2018, the patient was further investigated following complaints of difficulty performing intermittent catheterization- sometimes taking ∼5 minutes to insert the catheter, frequently causing bleeding. The patient had been using a coude tipped catheter and had intermittent haematuria and with the increasing difficulty of catheterization, he was investigated for urethral stenosis. A flexible scope insertion revealed the anterior urethra was normal down to the bulbar urethra where a urethral stenosis was observed. The scope would not pass this point. The patient agreed to a dilation procedure versus an internal urethrotomy. The urethra was dilated up to a 20-French and then rescoped to visualize the bladder and urethra. His prostrate was noted to have growth with the median lobe protruding into the bladder. As such there was an element of bladder outlet obstruction that was not previously noted. Endoscopic examination of the bladder did not identify any anatomical or gross abnormalities. The patient was discharged home with a leg bag and instruction to remove the catheter the next day and resume intermittent catheterization. Although an obstruction was noted, a transurethral resection was deferred as this was unlikely to result in normal voiding. The patient continues on self-intermittent catheterization with disposable catheters and does not use them more than once.