BJU International, 2008

2021

Background: The study aimed to evaluate the outcomes of transecting bulbar urethroplasty techniques used for management of bulbar urethral stricture as regards the success rate and sexual dysfunction.Methods: Our study was a prospective study and it was carried out at urology department Tanta university, Egypt. The study was approved our ethical committee and an informed consent was obtained from all participants. Thirty patients underwent transecting urethroplasty either excision and primary anastomosis (EPA) or augmented anastomotic urethroplasty. Assessment of the sexual function by sexual health inventory for men (SHIM) questionnaire and postoperatively. Retrograde urethrogram (RGU) and micturating cystourethrogram (MCUG) were performed by an experienced urological surgeon.Results: The age of studied patients ranged from 15-72 years with a mean of 41±13.87. The length of stricture ranged from 2-3 cm with a mean of 2.57±0.38. The stricture was non obliterative in 13 patients (43...

International Surgery Journal

Background: Anterior urethral stricture involves penile, bulbar or panurethra with varied aetiology. Direct vision internal urethrotomy (DVIU), stricture excision with primary end to end anastomosis, single stage or staged reconstruction with local flap or buccal mucosal graft (BMG) are surgical options.Methods: This single centre retrospective study was conducted from April 2017 to March 2019. Patient underwent DVIU, stricture excision with primary end to end anastomotic, staged urethroplasty, BMG urethroplasty (BMGU) dorsal inlay Asopa technique, dorsal onlay Kulkarni technique and ventral onlay technique depending on site and extent of strictures. Preoperative, intraoperative, post-operative data were reviewed.Results: Here, 51 patients underwent DVIU for single soft short segment bulbar urethral stricture with success rate 58.82%. 26 patients with post traumatic short segment bulbar urethral stricture underwent excision and primary end to end anastomosis with success rate 92.31%...

ijnu.ir

Background: Surgical treatment of urethral strictures includes numerous options such as dilation, internal urethrotomy, stenting and reconstructive surgical techniques. Short uncomplicated strictures are generally amenable to complete excision with primary anastomosis. We performed a retrospective evaluation and analysis of outcome in patients who underwent any kind of treatment for urethral strictures. Objectives: To evaluate and analyze the outcome in patients who underwent treatment for urethral stricture disease over the last 15 years (May 1993 to June 2008), at a tertiary care centre, as well as to determine the treatment option to be utilized in different varieties of urethral strictures. Patients and Methods: We reviewed 524 patients who underwent treatment for urethral strictures between May 1993 and June 2008. Mean follow-up was 68 months. Preoperative evaluation included clinical history, physical examination, urine culture, residual urine estimation, uroflowmetry, and retrograde and voiding cystourethrography. Since 2000 urethral ultrasound was also performed in all patients. Clinical outcome was assessed by comparing pre and post operative investigation and patient satisfaction. Results: Stricture etiology was catheter induced (15.36%), blunt perineal trauma (59.2%), instrumentation (12%), spontaneous (3.52%) and infection (10%). Stricture length was 0 to1cm (in 9.92%) 1 to 2 cm (in 32%), 2 to 3 cm (17.28%), 3 to 4 cm (24%) or 4 to 5 cm (8.8%) more than 5cm (16%). The success rates in these procedures were 93.6% (TAU-Tunica albuginea urethroplasty), 94.4% (USPBA-U shaped Prostato-bulbar Anastomosis), 91.7% (BMSU-Buccal Mucosa urethroplasty), 90% (IOU-Internal optic urethrotomy), 90.35% (dilatation) and 81% (two staged urethroplasty). There were 129 patients (25.49%) who experienced ejaculatory dysfunction. Good and fair results were considered successful. Of 524 cases 480 (91.6%) were successful and 44 (8.4%) were treatment failures. Conclusions: We conclude that the treatment of urethral strictures should be individualized, taking into account the location, length and extent of spongiofibrosis.

Journal of Ayub Medical College, Abbottabad : JAMC, 2020

BACKGROUND Urethral stricture disease has significant economic impact throughout world. The bulbar urethra is the commonest site for urethral strictures (Approx 50%) followed by penile urethra in most of the published literature. In developing countries trauma (road traffic accident and iatrogenic) is the leading cause of urethral stricture disease. Younger patients have usually idiopathic type as compare to old age group, which present more frequently with iatrogenic and trauma related urethral strictures. METHODS This Qausi Experimental study was conducted from May2012-June2016 of duration at Liaquat National Hospital Karachi. All the patients diagnosed with short urethral strictures related to bulbar urethra were included in this study. All the patients underwent non transecting bulbar urethroplasty. All patients were assessed preoperatively, peri-operatively and postoperatively and on follow-up visits as; on 2nd, 8th and 24th week. All the data regarding outcome was recorded on ...

Indian Journal of Urology, 2013

Objective: Objective: To understand the reasons for choosing the type of urethroplasty for bulbous strictures shorter than 2 cm in length that were ideally suited for anastomotic urethroplasty (AU). Materials and Methods: Materials and Methods: Data of adult men, who underwent urethroplasty between November 2002 and September 2011 for isolated bulbous strictures less than 2 cm in length, as measured intra-operatively, were reviewed. Patients who had undergone urethroplasty before were excluded. Data recorded were details of previous interventions, the etiology of the stricture and the type of urethroplasty performed. Results: Results: Out of 277 men who underwent urethroplasty for bulbous stricture, 65 men fulfi lled the inclusion criteria. The etiologies were trauma in 24, post catheterization in 16, and idiopathic in 25. The mean stricture length was 1.60 cm (range 0.8 to 1.9). Anastomotic urethroplasty was performed in 41 men (Group 1). In the remaining 24 men, buccal mucosa graft urethroplasty was performed in 20 and augmented AU in 4 (Group 2). Comparing the two groups we found that Group 2 patients had undergone more internal urethrotomies (mean 2.45±0.88 vs. 1.58±0.63; P=0.005) and had longer stricture length as compared to men in Group 1 (mean 1.8±0.83 vs. 1.48±0.23 cm; P=0.005). The reason why AU could not be performed (Group 2) was shortening of the length of the urethra, making mobilization diffi cult. Conclusions: Conclusions: Even short strictures are associated with urethral shortening as the fi brosis is not only circumferential but also longitudinal. The surgeon should be prepared for an alternate plan even for bulbous urethral strictures shorter than 2 cm.

International Journal Of Community Medicine And Public Health

Urethral stricture is defined as pathological urethral narrowing caused by corpus spongiosum fibrosis. The etiology of this condition is mostly idiopathic, which can also result from iatrogenic (like previous urethral surgeries, catheterization, or resection), inflammatory and traumatic causes. The evidence discussing the management of urethral strictures is scarce. The management starts with an appropriate evaluation of the condition through a comprehensive history taking (obstructive symptoms) and physical examination. Diagnostic investigations include cystoscopy (the most specific), urethrography, patient reported scales, like American urological association symptom index, uroflowmetry, and retrograde urethrography. Previous literature shows urethroplasty is cost effective, whether when it is used as the primary treatment or following a non-successful dilation and direct visualization internal urethrotomy. Moreover, open urethroplasty and endoscopic urethrotomy were comparable am...

Urology, 2019

While the author cannot speak for churches of Christ, common among them are unique ways of understanding holy scripture, believed to have been written by the apostles and prophets of the Lord before the destruction of Jerusalem (70 A.D.) and circulated among the early Christian communities (E.g. A letter called First Clement in about 95 A.D., refers to at least ten New Testament books), then collected as a volume by the self-identified Christian community of the second century A.D. or earlier, e.g. the list of Marcion (140 A.D.).

What consumed Pericles as a thinker and a public figure was how to get out of this trap, how to be truly rational in an arena dominated by emotions. The solution he came up with is unique in history and devastatingly powerful in its results. It should serve as our ideal. In his conception, the human mind has to worship something, has to have its attention directed to something it values above all else. For most people, it is their ego; for some it is their family, their clan, their god, or their nation. For Pericles it would be nous, the ancient Greek word for "mind" or "intelligence." Nous is a force that permeates the universe, creating meaning and order. The human mind is naturally attracted to this order; this is the source of our intelligence. For Pericles, the nous that he worshipped was embodied in the figure of the goddess Athena. Athena was literally born from the head of Zeus, her name itself reflecting this-a combination of "god" (theos) and "mind" (nous). But Athena came to represent a very particular form of nous-eminently practical, feminine, and earthy. She is the voice that comes to heroes in times of need, instilling in them a calm spirit, orienting their minds toward the perfect idea for victory and success, then giving them the energy to achieve this. To be visited by Athena was the highest blessing of them all, and it was her spirit that guided great generals and the best artists, inventors, and tradesmen. Under her influence, a man or woman could see the world with perfect clarity and hit upon the action that was just right for the moment. For Athens, her spirit was invoked to unify the city, make it prosperous and productive. In essence, Athena stood for rationality, the greatest gift of the gods to mortals, for it alone could make a human act with divine wisdom. Inflaming Individuals There are people in the world who by their nature tend to trigger powerful emotions in almost everyone they encounter. These emotions range among the extremes of love, hatred, confidence, and mistrust. Some examples in history would include King David in the Bible, the longer you can resist reacting, the more mental space you have for actual reflection, and the stronger your mind will become. Accept people as facts. Interactions with people are the major source of emotional turmoil, but it doesn't have to be that way. The problem is that we are continually judging people, wishing they were something that they are not. We want to change them. We want them to think and act a certain way, most often the way we think and act. And because this is not possible, because everyone is different, we are continually frustrated and upset. Instead, see other people as phenomena, as neutral as comets or plants. They simply exist. They come in all varieties, making life rich and interesting. Work with what they give you, instead of resisting and trying to change them. Make understanding people a fun game, the solving of puzzles. It is all part of the human comedy. Yes, people are irrational, but so are you. Make your acceptance of human nature as radical as possible. This will calm you down and help you observe people more dispassionately, understanding them on a deeper level. You will stop projecting your own emotions on to them. All of this will give you more balance and calmness, more mental space for thinking. It is certainly difficult to do this with the nightmare types who cross our path-the raging narcissists, the passive aggressors, and other inflamers. They remain a continual test to our rationality. Look at the Russian writer Anton Chekhov, one of the most fiercely rational people who ever lived, as the model for this. His family was large and poor, and his father, an alcoholic, mercilessly beat all of the children, including young Chekhov. Chekhov became a doctor and took up writing as a side career. He applied his training as a doctor to the human animal, his goal to understand what makes us so irrational, so unhappy, and so dangerous. In his stories and plays, he found it immensely therapeutic to get inside his characters and make sense of even the worst types. In this way, he could forgive anybody, even his father. His approach in these cases was to imagine that each person, no matter how twisted, has a reason for what they've become, a logic that makes sense to them. In their own way, they are striving for fulfillment, but irrationally. By stepping back and imagining their story from the inside, Chekhov demythologized the brutes and aggressors; he cut them down to human size. They no longer elicited hatred but rather pity. You must think more like a writer in approaching the people you deal with, even the worst sorts. At last I have what I wanted. Am I happy? Not really. But what's missing? My soul no longer has that piquant activity conferred by desire.. .. Oh, we shouldn't delude ourselves-pleasure isn't in the fulfillment, but in the pursuit.-Pierre-Augustin Caron de Beaumarchais Keys to Human Nature By nature, we humans are not easily contented with our circumstances. By some perverse force within us, the moment we possess something or get what we want, our minds begin to drift toward something new and different, to imagine we can have better. The more distant and unattainable this new object, the greater is our desire to have it. We can call this the grass-is-always-greener syndrome, the psychological