Translational Research in Urology (May 2020)

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

  • Sobhan Alishah,
  • Feraidoon Khayyamfar ,
  • Seyed kazem Foroutan

DOI
https://doi.org/10.22034/TRU.2020.251313.1034
Journal volume & issue
Vol. 2, no. 2
pp. 37 – 44

Abstract

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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.

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