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Title: To assess the impact of prior urethral dilatation or DVIU on the outcome of anterior urethroplasty.
Authors: Kanwal Naz, Tanzeel ur Rahman Gazder, Vikram Seetlani, Syed Rabiullah, Usman Qamar, Mazahir Zulfiqar, Hamza Akhter, Saeed Abdi, Manzoor Hussain
Journal: International Journal of Endorsing Health Science Research
Publisher: Advance Educational Institute & Research Centre
Country: Pakistan
Year: 2023
Volume: 11
Issue: 1
Language: English
Keywords: Urethral StrictureUrethroplastyDirect Visual Internal UrethrotomyUrethral Instrumentation.
Background: Male urethral stricture has remained the major problem in urologic practice. Patients presenting with urethral stricture disease are commonly managed by dilatation, DVIU, and urethroplasty.
Methodology: This is a descriptive study of male patients who underwent anterior urethroplasty at our setup from 5th August 2021 to 25th February 2022. We analyzed the age, duration, type, length, and location of the stricture and the surgical treatment outcome after urethroplasty. The post-operative catheter was removed after 3 weeks, and UFM is advised. Qmax (max flow rate) > 15 ml/sec was measured on UFM (uroflowmetry) on the 1st week, 6 weeks, and followed on 3 months. Final outcome in terms of success was assessed by uroflowmetry. A maximum urine flow greater than 15mL/s after 3 months’ treatment assessed by uroflowmetry was considered as success.
Results: In our study, the blood loss in group A and group B patients, those patients who had DVIU or dilation in the past, had more bleeding during surgery than those who did not have a history of surgery. 66.67% of group B patients have bleeding from 200 ml to 500 ml, which is higher than group A patients. In our study, we found that if the patient had undergone surgery or no surgery had taken place before urethroplasty, the results in terms of UFM were quite similar, as in group A, 96.69% of patients had UFM more than 15 ml/sec, and in group B 87.88% had UFM more than 15 ml/sec.
Conclusion: Urethral dilatation or DVIU delays definitive treatment and increases operative challenges by increasing the length of stricture, more adhesion, and more fibrosis but has minimal impact on the outcome of urethroplasty success.
To assess the impact of prior urethral dilatation or Direct Visual Internal Urethrotomy (DVIU) on the outcome of anterior urethroplasty.
This was a descriptive study of male patients who underwent anterior urethroplasty at the Sindh Institute of Urology and Transplantation from August 5, 2021, to February 25, 2022. Patients were divided into two groups: Group A (no prior surgery) and Group B (prior surgery). Data collected included age, duration, type, length, and location of stricture, and surgical outcomes. Post-operative uroflowmetry (UFM) was performed at 1 week, 6 weeks, and 3 months, with success defined as a maximum flow rate (Qmax) > 15 ml/sec at 3 months. Data were analyzed using SPSS version 20, with descriptive statistics and chi-square tests.
graph TD
A[Patient Recruitment Anterior Urethral Stricture] --> B[Inclusion/Exclusion Criteria Check];
B -- Included --> C[Data Collection Demographics, Stricture details, Prior history];
C --> D[Group Assignment Group A: No prior surgery, Group B: Prior surgery];
D --> E[Surgical Procedure Anterior Urethroplasty];
E --> F[Intra-operative Data Recording Bleeding, Operative time, Fibrosis];
F --> G[Post-operative Follow-up UFM at 1 week, 6 weeks, 3 months];
G --> H[Outcome Assessment Qmax > 15 ml/sec at 3 months];
H --> I[Data Analysis SPSS v20];
I --> J[Conclusion];
Urethral stricture is a common urologic problem. While prior urethral instrumentation like DVIU or dilatation can lead to increased operative challenges such as more bleeding, longer operative times, and greater fibrosis, the study suggests that skilled surgical expertise can mitigate these issues, leading to comparable success rates in urethroplasty outcomes. Advancements in tissue transfer techniques and a multidisciplinary approach are recommended for complex cases.
Patients with a history of DVIU or dilation (Group B) experienced more bleeding during surgery and had longer operative times compared to those without prior surgery (Group A). Group B also showed a significantly higher incidence of fibrosis during surgery. Despite these intraoperative challenges, the success rates of urethroplasty, as measured by UFM at 3 months, were comparable between the two groups (96.97% in Group A vs. 87.88% in Group B), with no statistically significant difference.
Prior urethral dilatation or DVIU can increase operative challenges in anterior urethroplasty, including increased bleeding, operative time, and fibrosis. However, these factors have a minimal impact on the overall success rate of urethroplasty, which remains comparable between patients with and without a history of prior instrumentation, provided skilled surgical techniques are employed.
1. Success Rate Definition: Success in the study was defined as a maximum urine flow rate (Qmax) greater than 15 mL/s measured by uroflowmetry at 3 months post-treatment.
2. Group B UFM Success: 87.88% of patients in Group B (with prior surgery) achieved a UFM greater than 15 ml/sec at 3 months.
3. Blood Loss Comparison: 66.67% of patients in Group B experienced blood loss between 200 ml to 500 ml, which was higher than the 15.16% observed in Group A.
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