U
Anton Sebastian in A Dictionary of the History of Medicine, 2018
Urethral Stricture Rhazes (850–932) from Persia, showed that hematuria was a symptom of bladder disease and he wrote at length on urethral stricture. French surgeon, Ambroise Paré (1510–1590) recognized their existence and called them ‘carnosities’. He also devised two instruments introduced through the urethra to scrape off urethral granulations around the stricture. Urethrotomy, or internal longitudinal incision, was performed by American surgeon, Philip Syng Physick (1768–1837) of Philadelphia in 1795. English surgeon, Claudius Galen Wheelhouse (1826–1909) designed a form of external urethrotomy, where the stricture was identified with a probe before cutting the urethra in front of it. Open urethroplasty was introduced by Johanson in 1953. Physick’s method was revived with modifications and performed under direct vision through a urethroscope by Sachse in 1971.
Urethra and Penis
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
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.
Complications related to neurogenic bladder dysfunction I: Infection, lithiasis, and neoplasia
Jacques Corcos, David Ginsberg, Gilles Karsenty in Textbook of the Neurogenic Bladder, 2015
Treatment of bladder stones is straightforward, because of easy access to the bladder both endoscopically and surgically. The stone can be fragmented endoscopically by mechanical forceps, holmium laser, ultrasonics, pneumatics, or electrohydraulic lithotripsy. Small fragments can then be washed out from the bladder by the Ellik evacuator. Careful monitoring of blood pressure, however, is important because of the fear of development of autonomic dysreflexia, which is also reported after cystolithotripsy in NBD patients.52 Open surgery is indicated only when bladder capacity is small or the size of the stone is so big that endoscopic litholapaxy would be extremely difficult. Impacted urethral stones are rare and occur mainly with obstruction or urethral diverticulum.53 Endoscopic treatment is by visual urethrotomy, pushing the stone into the bladder and fragmenting it. Surgery is performed in cases of a stone in a diverticulum, where diverticulectomy is used for stone removal.
An update on research and outcomes in surgical management of vaginal mesh complications
Published in Expert Review of Medical Devices, 2019
Dominic Lee, Philippe E. Zimmern
Tissue interposition may be required in instances of cystotomy or urethrotomy when mesh excisions are undertaken. Sometimes the native tissue may be too tenuous when primarily repaired and an interposition graft is considered necessary. The graft is seldom used, but its primary objective is to reinforce a repair for outcome success; hence significant long-term data is not available to determine its efficacy or its rate of complication. It is not indicated as a substitute to prevent further recurrence of prolapse or incontinence, although some have argued that a Martius flap, for example could reinforce the sphincter unit and decrease the rate of subsequent SUI after MUS removal. For the transvaginal technique, tissue grafts that have been utilized include: Rectus fascia graftMartius flap
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].
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.
Related Knowledge Centers
- Cystoscopy
- Surgery
- Urethroplasty
- Urethra
- Lithotomy Position
- Urethral Stricture
- Retrograde Urethrogram
- Urinary Meatus
- Povidone-Iodine
- Intravenous Therapy