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

Document Type : Original Article

Authors

1 Department of medicine, Shahed university, Tehran, Iran

2 Department of urology Mustafa Khomaini Hospital, Shahed University, Tehran, Iran

10.22034/tru.2020.251313.1034

Abstract

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 to 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
The 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 analysis, 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 2 ml/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 15 ml/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.

Highlights

  • A novel technique can be done on the patients as a daycare procedure in Patients with Previous Failed Retrograde Intervention.
  • Antegrade Urethral Approach is easy, cost-effective, and can be tolerated well.

Keywords


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