Document Detail


Urethral rest: role and rationale in preparation for anterior urethroplasty.
MedLine Citation:
PMID:  21513968     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To report the outcomes of men treated initially with a period of urethral rest to allow tissue recovery before anterior urethroplasty. Many men referred to referral centers for anterior urethral reconstruction often present soon after the endoscopic manipulation of severe strictures.
METHODS: We reviewed our database of all anterior urethroplasties performed by a single surgeon from 2007 to 2009. Urethral rest was accomplished by removal of the indwelling catheter, cessation of self-catheterization, and/or suprapubic urinary diversion before urethral reconstruction.
RESULTS: During the study period, 210 patients underwent urethral reconstruction at our center. Men who had undergone meatoplasty or posterior urethroplasty were excluded, leaving 128 anterior urethroplasty patients available for analysis. Of these men, 28 (21%) were preoperatively given an initial period of urethral rest (median duration 3 months) because of recent urologic manipulation occurring immediately before referral. Of the 28 patients, 15 (54%) received suprapubic catheters. Urethral rest promoted identification of severely fibrotic stricture segments, enabling focal or complete excision in 75% (excision and primary anastomosis in 12 [43%] and augmented anastomosis in 9 [32%]), a percentage similar to that for those undergoing reconstruction without preliminary manipulation mandating urethral rest (82%). Stricture recurrence developed in 4 (14%) of the 28 rest patients, a rate again similar to that for the remainder of the urethroplasty population (10%).
CONCLUSIONS: The results of our study have shown that recently manipulated anterior urethral strictures often declare themselves to be obliterative within several months of urethral rest, thus enabling successful urethroplasty by focal or complete excision.
Authors:
Ryan P Terlecki; Matthew C Steele; Celeste Valadez; Allen F Morey
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Publication Detail:
Type:  Journal Article     Date:  2011-04-21
Journal Detail:
Title:  Urology     Volume:  77     ISSN:  1527-9995     ISO Abbreviation:  Urology     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-31     Completed Date:  2011-08-12     Revised Date:  2012-02-15    
Medline Journal Info:
Nlm Unique ID:  0366151     Medline TA:  Urology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1477-81     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Department of Urology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
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MeSH Terms
Descriptor/Qualifier:
Anastomosis, Surgical
Catheterization
Catheters
Endoscopy / methods
Humans
Male
Reconstructive Surgical Procedures / adverse effects
Recurrence
Treatment Outcome
Urethra / pathology*,  surgery*
Urethral Stricture / surgery*
Urologic Surgical Procedures / methods*
Urology / methods
Wound Healing
Comments/Corrections
Comment In:
J Urol. 2012 Feb;187(2):550-1   [PMID:  22237335 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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