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Objective: To study the feasibility of transvesical prostate resection and its effect on urethral stricture., Materials and Methods: We included 99 patients with symptomatic bladder outlet obstruction who underwent transvesical resection of prostate (TVRP; n = 48) and transurethral (TURP; n = 51) prostatectomy. We examined all the patients by means of digital rectal examination, transrectal ultrasound, and evaluated them by international prostate symptom score, quality of life score, uroflowmetric assessment and PSA level, and established definitive diagnosis. We followed up the patients in first month, third month, and the first year of the operation and monitored once a year in the following years., Results: In this study, totally 99 symptomatic bladder outlet obstruction patients were included (TVRP = 48 and TURP = 51). Mean age of the patients were 66.5 ± 8.2vs 68 ± 9.8years for our patients with TVRP and TURP, respectively. Two groups displayed similar values in terms of improvements in the Qmax and PVR, and there were no statistically significant differences in between. We obtained similar values for resection time and weight of resected prostate tissue in both groups. Urethral stricture was not observed in TVRP group. In TURP group however, stricture was observed in 4 (7.8%) patients in bulbar urethra in sixth month at average. And there was also a concomitant urethral meatal stricture in one of these patients. When the 2 groups were compared, the rate of urethral stricture was statistically significantly higher in the TURP group (P = .001)., Conclusion: Resection of prostate without using urethra significantly reduces the incidence of urethral stricture due to mucosal damage., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Introduction: Lower urinary tract symptoms are a common complaint. Surgery to debulk hyperplastic prostate tissue is indicated for men with symptoms refractory to medical therapy, or for those who cannot tolerate first-line medications. In recent decades, new endoscopic techniques have been developed to reduce the morbidity of transurethral resection of the prostate (TURP). Nonetheless, complications are still frequently encountered in the immediate, early, and remote postoperative setting., Materials and Methods: In this review, we perform an in-depth examination of contemporary treatment strategies for long term complications of surgical outlet reduction procedures. Complications encountered in the remote postoperative setting such as erectile dysfunction (ED), urethral stricture, refractory incontinence, and bladder neck contracture were identified in the literature., Results: Treatment strategies for ED after TURP do not differ from algorithms applied for ED due to other causes. Management of urethral stricture following TURP depends on the size and location of narrowing and can range from simple dilation to complex excision with grafting techniques or perineal urethrostomy. Refractory urinary incontinence requires a full diagnostic evaluation, and artificial urinary sphincter placement is efficacious for cases that do not respond to first-line medical therapy. Finally, numerous therapies for bladder neck contracture exist and vary in their invasiveness., Conclusion: Endoscopic reduction of the prostate for the male with benign prostatic obstruction via most contemporary modalities is a safe and effective means to decrease outlet resistance to urinary flow. However, late complications from these procedures still exist. Management of remote morbidity following TURP can be diagnostically and therapeutically complex, necessitating prompt referral to a genitourinary reconstruction specialist.

The surgical and non-surgical treatment of localised prostate cancer may be complicated by bladder neck contractures, prostatic urethral stenoses and bulbomembranous urethral strictures. In general, such complications following radical prostatectomy are less extensive, easier to treat and associated with a better outcome and more rapid recovery than the same complications following radiotherapy, high-intensity focussed ultrasound and cryotherapy. Treatment options range from minimally invasive endoscopic procedures to more complex and specialised open surgical reconstruction.In this chapter the surgical management of bladder neck contractures following the treatment of prostate cancer is described together with the management of prostatic urethral stenoses and bulbomembranous urethral strictures, given the difficulty in distinguishing them from one another clinically.

Background: We report the familial recurrence of urethral stenosis/atresia in two sibling fetuses with bladder outlet obstruction, severe oligohydramnios, and pulmonary hypoplasia. Urethral obstruction in the fetus, when severe, results in a dilated urinary bladder (megacystis) and associated urinary anomalies (hydroureter, hydronephrosis, renal dysplasia). Distention of the fetal abdomen, the result of megacystis or urinary ascites, leads to stretching and eventually hypoplasia or even absence of abdominal muscles., Cases: This constellation of findings, known by a variety of terms including "prune belly" syndrome, is associated with a variety of urethral changes, including posterior urethral valves and urethral stenosis/atresia. One fetus manifested unilateral postaxial polydactyly of the left hand., Conclusions: A microdeletion of 6p25.3, identified in mother and one fetus, is not associated with a gene known to be involved in urethral development and therefore of unknown significance., ((c) 2009 Wiley-Liss, Inc.)

Female bladder outlet obstruction is uncommon. We report a case of bladder outlet obstruction secondary to urethral stenosis leading to bladder wall trabeculation. The patient presented at our clinic because of lower urinary tract symptoms including nocturia, urgency, bed wetting, hesitancy, straining to void, and incomplete emptying. Urodynamic study revealed a low maximum free uroflow rate, high residual urine volume, and low compliance on filling phase cystometry. Introital ultrasonography with two- and three-dimensional (2D and 3D) scanning displayed a constriction in the echolucent part of the lower-mid urethra with hyperechogenicity and a lattice-like appearance of the bladder wall. Cystourethroscopy confirmed urethral stenosis and bladder wall trabeculation. The voiding symptoms subsided after the urethral stenosis was relieved by urethral dilatation, but, despite some improvement, the irritative symptoms persisted. Introital ultrasonography with 2D and 3D scanning may help to clarify the cause of female bladder outlet obstruction., (Copyright 2006 ISUOG. Published by John Wiley & Sons, Ltd.)

Objectives: Stricture of the vesico-urethral anastomosis is a well-known complication after radical prostatectomy. Dilatation, stricture incision or resection have been proposed for endoscopic treatment., Methods: In a retrospective study of 340 patients with prostatic cancer who underwent a radical retropubic prostatectomy from 1988 until 1996, we looked at the incidence of anastomotic strictures., Results: An anastomotic stricture was found in 24 cases (7%) requiring endoscopic treatment. Based on prospective X-ray studies, we were able to show that the site of stricture is located below the bladder neck musculature in most cases well above the distal urethral sphincter and pelvic floor. No continence problems were encountered following structure resection in a follow-up of 12-72 months determined by a questionnaire and pad test., Conclusion: The transurethral resection of anastomotic stricture allows for a rather generous tissue resection, which is preferable to incision or dilatation in our hands.

The use of stents in the management of prostatic obstruction started in 1980 with the development of the "partial catheter" by Fabian in Germany. Since then, a variety of metals and biostable and biodegradable polymers have been made into temporary or permanent stents for the management of infravesical obstructions such as benign or malignant prostatic enlargement, bladder neck stenoses, or urethral strictures. This paper is an overview of two generations of temporary metal stents used in the patients with infravesical obstruction.

30 patients with strictures of the urethra (n = 19) and bladder cervix (n = 11) received combined treatment including surgical endoscopic correction of the stricture with Ho:YAG laser, pre- and postoperative endourethral radiation with low-energy laser, instillations of collagenase and dimexide solution into the urinary tract. The operation was made by Ho:YAG laser (2.09) microns, 4 J, 15 Hz, 300 mc). Persistent response for 10-12 months was achieved in 93.3% of patients.

Purpose: To assess the efficacy of transurethral balloon dilation of vesicourethral anastomotic strictures after radical retropubic prostatectomy., Materials and Methods: Forty-five consecutive patients in whom vesicourethral anastomotic strictures developed after radical prostatectomy underwent fluoroscopically guided transurethral balloon dilation (n = 27), cystoscopically guided transurethral incision of the bladder neck (n = 10), or dilation performed by urologists who used various techniques (n = 8)., Results: Transurethral balloon dilation was successful in 16 (59%) of 27 patients. Ten of the 11 patients who did not respond favorably underwent transurethral incision of the bladder neck. Seven (70%) of these patients required either repeat attempts or subsequent balloon dilation. New urinary incontinence developed in one patient treated primarily with transurethral incision of the bladder neck but in no patients treated with transurethral balloon dilation., Conclusion: Anastomotic strictures after radical prostatectomy can be effectively treated with transurethral balloon dilation with no serious complication. Refractoriness to balloon dilation may be related to the presence of dense scar tissue.

An expandable titanium stent was used as an alternative to standard treatment for urinary obstruction in 20 men. Six patients had recurrent urethral strictures. Fourteen patients had obstruction secondary to benign prostatic hyperplasia (BPH) and were considered high risk surgical candidates. Complete results with a mean follow-up of 12 months are available for 11 patients. Four of the six stricture patients are currently unobstructed. All seven of the available men with BPH are voiding well. No side effects have been related to the stents, and no encrustations or calculi have formed.

A case report of a child is presented in which double sectioing of the lower ureter was required to close simultaneously low cutaneous loop ureterostomies and to excise congenital ureterovesical junction strictures. One ureteroneocystostomy required revision. The vasculature of the ureteral segments was preserved by not mobilizing the ureter.

Acquired obstructions of the lower urinary tract in children are uncommon. They can be divided into intrinsic and extrinsic lesions, and have a very varied etiology. Several illustrative cases are reported, such as traumatic and infectious strictures, meatal stenosis, benign and malignant tumors, fused labia, and epidermolysis bullosa. Many of these lesions have distinct radiographical features, best demonstrated by micturating cystourethrograms.

A group of 173 prostatic patients were submitted to a prospective study to determine the respective value of symptoms, uroflowmetry, endoscopic and radiological findings in the assessment of the degree of urinary obstruction. Uroflowmetry proved to bring objective evidence of the degree of obstruction with a reasonable degree of accuracy. Maximum urinary flow appears to be more accurate than other flow parameters in the determination of lower urinary tract obstruction.

Within a 5-year period (1970-1974) in the Child Surgery Clinic of Leningrad Pediatric Medical Institute 63 children, aged from 2 months to 14 years (55 boys and 8 girls), were treated for the obstruction of the vesico-urethral segment. It is believed that timely performed surgical removal of the obstruction with simultaneous resection if a non-functioning kidney with the phenomena of vesico-urethral reflux allows an effective treatment of secondary pyelonephritis.

53 patients presenting with post-prostatectomy obstructive complications above the verumontanum were treated in a single session by means of guided dilatation of the stricture followed by transurethral resection of the stenosing fibrotic tissue. The results obtained in cases of vesical neck stenosis were very encouraging. Unsatisfactory results were observed in cases of cervicoprostatic fibrosclerosis where resection was insufficient for resolution of the obstruction. No failures or complications with the guided dilatation technique have been observed.