INNOVATIVE APPROACH FOR THE TREATMENT OF URETHRAL STRICTURES AFTER TRANSURETRAL RESECTIONS
Keywords:
urethral stricture, transurethral resection, post-surgery complications, prostate, urinary bladder, cystostomy, urethroplasty, urethrotomy, buccal graft.Abstract
Introduction. The development of endoscopic surgery of the upper and lower urinary tract has led to an increase in the number of urethral strictures after transurethral interventions.
Purpose of the work. Reveal the utilization efficiency of the innovative method of treatment for urethral strictures after transurethral interventions using extracorporal electromagnetic stimulation with the Avantron apparatus.
Material and methods. A retrospective analysis has been carried out, which included 180 patients with urethral stricture treated in the period 2017-2020 and who did not receive treatment with the Avantron apparatus. Of them, 74 (41%) were the patients with urethral stricture after transurethral interventions, and 106 (59%) were the patients with other types of urethral strictures.
Patients underwent a complete physical routine examination, including ultrasound diagnostics, urofluometry, retained urine assessment, retrograde and voiding urethrography, questioning using IPSS questionnaires and the QoL scale, and general clinical analyses.
Findings of the study. The median follow-up was 18 months. The most common localization: bulbous urethra – 85%. The median length of the stricture was 2 cm. The mean value of the maximum peak flow rate was 5.9±2.7 ml/s. The median total points of the IPSS score are 25. Type (number) of operations for urethral strictures after transurethral interventions: internal optical urethrotomy (29), anastomo-
tic urethroplasty (18), single-stage seed grafting (4), single-stage urethroplasty with a buccal graft (17),
multi-stage urethroplasty with a buccal graft (2), meatotomy (3), single-stage fossa navicularis plastics with a buccal graft (1). The IOU efficiency was 52% (15 patients), 31% (9 patients) noted a recurrence of urethral stricture within 6 months, and 17% (5 patients) noted a recurrence of urethral stricture within 12 months. The efficiency of various types of urethroplasty was 81% (36 patients), 19% (9 patients) noted a recurrence within 6 months. Pathomorphological studies indicated the presence of apparent inflammation without signs of stromal fibrosis in the area of urethral stricture.
Discussion of the results. To date, 33 patients have been analyzed, of which 21 patients underwent IOU with urethral stricture using extracorporal electromagnetic stimulation with the Avantron apparatus. The efficiency was 82% (18 patients), 18% (4 patients) noted a recurrence within 6 months. 12 patients underwent open surgeries, who also received postoperative treatment with extracorporal electromagnetic stimulation using the Avantron apparatus. The efficiency of various types of urethroplasty was 83.3% (10 patients), 17% (2 patients) noted a recurrence within 6 months. Long-term outcomes have not been identified yet. The patient enrollment and monitoring is under way.
Conclusions. Transurethral surgery is the leading etiological factor in the formation of iatrogenic urethral strictures, reaching 52%.
References
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