Antegrade Urethral Approach for Urethral Stricture in Patients with Previous Failed Retrograde Intervention

Introduction Urethral stricture has challenging difficulties in its treatment. Various treatment modalities had been used e.g.; urethral dilatation is one of the oldest methods. Severe bleeding and several false passages may end in failure, which may make retrograde access impossible. The purpose o...

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Autores principales:	Sobhan Alishah, Feraidoon Khayyamfar, Seyed kazem Foroutan
Formato:	article
Lenguaje:	EN
Publicado:	Urology Research Center 2020
Materias:	antegrade dilatation urethral stricture am platz dilators cystostomy Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/fa4dd21be48e4315ac9cb4393ed0badd
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spelling	oai:doaj.org-article:fa4dd21be48e4315ac9cb4393ed0badd2021-11-28T09:55:21ZAntegrade Urethral Approach for Urethral Stricture in Patients with Previous Failed Retrograde Intervention10.22034/TRU.2020.251313.10342717-042Xhttps://doaj.org/article/fa4dd21be48e4315ac9cb4393ed0badd2020-05-01T00:00:00Zhttps://www.transresurology.com/article_118874.htmlhttps://doaj.org/toc/2717-042XIntroduction Urethral stricture has challenging difficulties in its treatment. Various treatment modalities had been used e.g.; urethral dilatation is one of the oldest methods. Severe bleeding and several false passages may end in failure, which may make retrograde access impossible. The purpose of this study was to describe safety in antegrade accessing followed by retrograde dilatation with am Platz renal dilator. Methods A total number of 15 patients with difficult urethral stricture and failed retrograde approaches were entered into the study. Guidewire was passed through the cystostomy for proper retrograde accessing which was delivered through external urethral meatus followed by retrograde dilation. Patient parameters were analyzed, all patients had retrograde urethrography (RUG) pre-and post-operative, max flow rate (Qmax) on uroflowmetry (UF) in addition to post voiding residual urine (PVR). Patients were followed at 2, 6, and 12 months. The technique described was enabling us to get safe antegrade urethral access followed by stepwise retrograde am Platz renal dilation. Results The mean age of patients was 39.2 ± 16.7 years. Preoperative uroflowmetry demonstrate Qmax 2ml/sec and ultrasonography showed PVR of 315ml ranging from 35 to1000ml. In post-operation uroflowmetry Qmax was raised to 19ml/sec (p-value<0.001), 18 ml/sec (p-value<0.001) and 15ml/sec (p-value<0.001) respectively. PVR values were 9ml with (p-value<0.001), 11ml (p-value<0.001) and 13ml (p-value<0.001) respectively. Operation time was 10 minutes for antegrade passage of a guidewire, followed by 25 minutes for retrograde dilatation. In patients who had was no cystostomy, an average of 32 minutes was required. Two patients had recurrence during a 12 months follow-up. Conclusions The antegrade approach is a safe applicable approach for the treatment of difficult urethral stricture, followed by retrograde stepwise dilatation. This technique can be tolerated well and cost-effective for patients in whom getting retrograde access was not possible and may avoid these patients to go under urethroplasty.Sobhan AlishahFeraidoon Khayyamfar Seyed kazem ForoutanUrology Research Centerarticleantegradedilatationurethral strictuream platz dilatorscystostomyDiseases of the genitourinary system. UrologyRC870-923ENTranslational Research in Urology, Vol 2, Iss 2, Pp 37-44 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	antegrade dilatation urethral stricture am platz dilators cystostomy Diseases of the genitourinary system. Urology RC870-923
spellingShingle	antegrade dilatation urethral stricture am platz dilators cystostomy Diseases of the genitourinary system. Urology RC870-923 Sobhan Alishah Feraidoon Khayyamfar Seyed kazem Foroutan Antegrade Urethral Approach for Urethral Stricture in Patients with Previous Failed Retrograde Intervention
description	Introduction Urethral stricture has challenging difficulties in its treatment. Various treatment modalities had been used e.g.; urethral dilatation is one of the oldest methods. Severe bleeding and several false passages may end in failure, which may make retrograde access impossible. The purpose of this study was to describe safety in antegrade accessing followed by retrograde dilatation with am Platz renal dilator. Methods A total number of 15 patients with difficult urethral stricture and failed retrograde approaches were entered into the study. Guidewire was passed through the cystostomy for proper retrograde accessing which was delivered through external urethral meatus followed by retrograde dilation. Patient parameters were analyzed, all patients had retrograde urethrography (RUG) pre-and post-operative, max flow rate (Qmax) on uroflowmetry (UF) in addition to post voiding residual urine (PVR). Patients were followed at 2, 6, and 12 months. The technique described was enabling us to get safe antegrade urethral access followed by stepwise retrograde am Platz renal dilation. Results The mean age of patients was 39.2 ± 16.7 years. Preoperative uroflowmetry demonstrate Qmax 2ml/sec and ultrasonography showed PVR of 315ml ranging from 35 to1000ml. In post-operation uroflowmetry Qmax was raised to 19ml/sec (p-value<0.001), 18 ml/sec (p-value<0.001) and 15ml/sec (p-value<0.001) respectively. PVR values were 9ml with (p-value<0.001), 11ml (p-value<0.001) and 13ml (p-value<0.001) respectively. Operation time was 10 minutes for antegrade passage of a guidewire, followed by 25 minutes for retrograde dilatation. In patients who had was no cystostomy, an average of 32 minutes was required. Two patients had recurrence during a 12 months follow-up. Conclusions The antegrade approach is a safe applicable approach for the treatment of difficult urethral stricture, followed by retrograde stepwise dilatation. This technique can be tolerated well and cost-effective for patients in whom getting retrograde access was not possible and may avoid these patients to go under urethroplasty.
format	article
author	Sobhan Alishah Feraidoon Khayyamfar Seyed kazem Foroutan
author_facet	Sobhan Alishah Feraidoon Khayyamfar Seyed kazem Foroutan
author_sort	Sobhan Alishah
title	Antegrade Urethral Approach for Urethral Stricture in Patients with Previous Failed Retrograde Intervention
title_short	Antegrade Urethral Approach for Urethral Stricture in Patients with Previous Failed Retrograde Intervention
title_full	Antegrade Urethral Approach for Urethral Stricture in Patients with Previous Failed Retrograde Intervention
title_fullStr	Antegrade Urethral Approach for Urethral Stricture in Patients with Previous Failed Retrograde Intervention
title_full_unstemmed	Antegrade Urethral Approach for Urethral Stricture in Patients with Previous Failed Retrograde Intervention
title_sort	antegrade urethral approach for urethral stricture in patients with previous failed retrograde intervention
publisher	Urology Research Center
publishDate	2020
url	https://doaj.org/article/fa4dd21be48e4315ac9cb4393ed0badd
work_keys_str_mv	AT sobhanalishah antegradeurethralapproachforurethralstrictureinpatientswithpreviousfailedretrogradeintervention AT feraidoonkhayyamfar antegradeurethralapproachforurethralstrictureinpatientswithpreviousfailedretrogradeintervention AT seyedkazemforoutan antegradeurethralapproachforurethralstrictureinpatientswithpreviousfailedretrogradeintervention
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Antegrade Urethral Approach for Urethral Stricture in Patients with Previous Failed Retrograde Intervention

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