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Urologic Clinics of North America

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https://www.readbyqxmd.com/read/27908377/management-of-urethral-strictures
#1
EDITORIAL
Lee C Zhao
No abstract text is available yet for this article.
February 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27908376/urethral-strictures-and-artificial-urinary-sphincter-placement
#2
REVIEW
Jeremy B Myers, William O Brant, James N Hotaling, Sara M Lenherr
Patients undergoing artificial urinary sphincter (AUS) placement often have complex medical and surgical histories, such as radical prostatectomy, endoscopic treatment of urethral strictures, previous AUS placement, and prior open urethral surgery. Urethral strictures at the bladder neck, membranous urethra, or site of a previous AUS erosion are problems that profoundly affect the timing and treatment success of AUS placement. Understanding the complexities and outcomes in this subset of patients is the only way to inform shared decision making about treatment of urinary incontinence...
February 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27908375/treatment-of-radiation-induced-urethral-strictures
#3
REVIEW
Matthias D Hofer, Joceline S Liu, Allen F Morey
Radiation therapy may result in urethral strictures from vascular damage. Most radiation-induced urethral strictures occur in the bulbomembranous junction, and urinary incontinence may result as a consequence of treatment. Radiation therapy may compromise reconstruction due to poor tissue healing and radionecrosis. Excision and primary anastomosis is the preferred urethroplasty technique for radiation-induced urethral stricture. Principles of posterior urethroplasty for trauma may be applied to the treatment of radiation-induced urethral strictures...
February 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27908374/effect-of-lichen-sclerosis-on-success-of-urethroplasty
#4
REVIEW
Michael A Granieri, Andrew C Peterson, Ramiro J Madden-Fuentes
Lichen sclerosis (LS) is a chronic, relapsing disease with a variable presentation. In men, genitourinary LS may affect the penile foreskin, glans, meatus, and urethra. Treatment is multifaceted, ranging from pharmacotherapy to surgery. Urethral reconstruction due to stricture disease from LS is frequently plagued by a high recurrence rate. At the authors' institution, the high recurrence rate has shifted their practice toward potent steroids and minimally invasive surgical techniques. Management of recurrence includes dilation, meatotomy/meatoplasty, 1-stage and 2-stage repairs...
February 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27908373/management-of-panurethral-stricture
#5
REVIEW
Sanjay Kulkarni, Jyotsna Kulkarni, Sandesh Surana, Pankaj M Joshi
Panurethral stricture, involving the penile and bulbar urethra, is seen across the world .It is a complex disease with a relative paucity of literature on the subject. In India, Lichen Sclerosus is the most common cause of panurethral stricture followed by iatrogenic causes. The article presents the authors' experiences of Panurethral stricture repair using a single stage, One side dissection, dorsal onlay repair with oral mucosa graft.
February 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27908372/the-nontransecting-approach-to-bulbar-urethroplasty
#6
REVIEW
Stella Ivaz, Simon Bugeja, Anastasia Frost, Daniela Andrich, Anthony R Mundy
The standard treatment of bulbar urethral strictures of appropriate length is excision and primary anastomosis (EPA), irrespective of the cause of the stricture. This involves transection of the corpus spongiosum (CS) and disruption of the blood flow within the CS as a consequence. The success rate of EPA in curing these strictures is very high, but there is a considerable body of evidence and of opinion to suggest that there is a significant risk of sexual dysfunction and, potentially, of other adverse consequences that occur because of transection of the CS...
February 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27908371/sexual-dysfunction-after-urethroplasty
#7
REVIEW
Prem Nath Dogra, Prabhjot Singh, Rishi Nayyar, Siddharth Yadav
Posturethroplasty sexual dysfunction (SD) is multifactorial and its true incidence is unknown. Even with the current evidence suggesting that it is uncommon, de novo SD causes dissatisfaction even after a successful surgery. Posterior urethroplasty carries the highest chance of SD, mostly attributable to the pelvic fracture itself rather than the urethroplasty. With anterior urethroplasty, transecting bulbar urethroplasty leads to greater SD compared with penile or nontransecting bulbar urethroplasty. Most patients with posturethroplasty SD recover within 6 months after surgery...
February 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27908370/graft-use-in-bulbar-urethroplasty
#8
REVIEW
Mya E Levy, Sean P Elliott
The gold standard for bulbar urethroplasty has been excision and primary anastomosis. Application of this approach is generally limited to strictures that are 2 cm or less in the bulbar urethra due to penile shortening. Strictures greater than 2 cm are successfully treated with augmentation urethroplasty wherein the narrowed segment is not excised but widened with the use of a skin flap or a tissue graft. Buccal mucosa is the most prevalent tissue for bulbar urethral stricture repair for strictures greater than 2 cm...
February 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27908369/patient-selection-for-urethroplasty-technique-excision-and-primary-reanastomosis-versus-graft
#9
REVIEW
Judith C Hagedorn, Bryan B Voelzke
There are many management options for patients with urethral stricture disease. Regarding strictures of the bulbar urethra, ideal management strategies remain controversial. This article reviews important anatomic principles for surgeons to consider when repairing bulbar urethral strictures. Specific presenting features of a bulbar urethral stricture that can serve as a guide for the optimal surgical approach are described. Patient characteristics that are important and may have an impact on the outcome of repair are discussed...
February 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27908368/endoscopic-treatment-of-urethral-stenosis
#10
REVIEW
Brittney H Cotta, Jill C Buckley
Urethral stricture disease continues to be a common problem for patients and urologists alike. Endoscopic treatment offers a simple, potentially effective treatment of primary, short, urethral strictures. For patients who recur after endoscopic management, urethral or bladder neck reconstruction should be offered with an experienced urologic reconstructionist familiar with the complexity of the situation and subtleties of the surgery. With the advent of adjunctive antifibrotic agents the durability of endoscopic repair seems to improve, but their use requires continued research and longer follow-up to determine their efficacy...
February 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27908367/use-of-alternative-techniques-and-grafts-in-urethroplasty
#11
REVIEW
Brendan Michael Browne, Alex J Vanni
The current management for complex urethral strictures commonly uses open reconstruction with buccal mucosa urethroplasty. However, there are multiple situations whereby buccal mucosa is inadequate (eg, pan-urethral stricture or prior buccal harvest) or inappropriate for utilization (eg, heavy tobacco use or oral radiation). Multiple options exist for use as alternatives or adjuncts to buccal mucosa in complex urethral strictures. This article reviews the current state of alternate techniques for urethral stricture treatment besides buccal mucosa, including injectable antifibrotic agents, augmentation urethroplasty with skin flaps, lingual mucosa, colonic mucosa, and new developments in tissue engineering for urethral graft material...
February 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27908366/urologic-sequelae-following-phalloplasty-in-transgendered-patients
#12
REVIEW
Dmitriy Nikolavsky, Yuka Yamaguchi, Jamie P Levine, Lee C Zhao
In recent years, the issues of the transgender population have become more visible in the media worldwide. Transgender patients at various stages of their transformation will present to urologic clinics requiring general or specialized urologic care. Knowledge of specifics of reconstructed anatomy and potential unique complications of the reconstruction will become important in providing urologic care to these patients. In this article, we have concentrated on describing diagnosis and treatment of the more common urologic complications after female-to-male reconstructions: urethrocutaneous fistulae, neourethral strictures, and symptomatic persistent vaginal cavities...
February 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27908365/cost-effective-strategies-for-the-management-and-treatment-of-urethral-stricture-disease
#13
REVIEW
E Charles Osterberg, Gregory Murphy, Catherine R Harris, Benjamin N Breyer
Following failed endoscopic intervention, the most cost-effective strategy for recurrent urethral stricture disease (USD) is urethroplasty. Inpatient hospital costs associated with urethroplasty are driven by patient comorbidities and postoperative complications. Symptom-based surveillance for USD recurrence will reduce unnecessary diagnostic procedures and cost.
February 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27908364/management-of-urethral-strictures-after-hypospadias-repair
#14
REVIEW
Warren T Snodgrass, Nicol C Bush
Strictures of the neourethra after hypospadias surgery are more common after skin flap repairs than urethral plate or neo-plate tubularizations. The diagnosis of stricture after hypospadias repair is suspected based on symptoms of stranguria, urinary retention, and/or urinary tract infection. It is confirmed by urethroscopy during anticipated repair, without preoperative urethrography. The most common repairs for neourethra stricture after hypospadias surgery are single-stage dorsal inlay graft and 2-stage labial mucosa replacement urethroplasty...
February 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27908363/definition-of-successful-treatment-and-optimal-follow-up-after-urethral-reconstruction-for-urethral-stricture-disease
#15
REVIEW
Bradley A Erickson, George M Ghareeb
The definition of a successful urethroplasty, the lack of need for a secondary procedure, is outdated and must be amended to incorporate objective and subjective outcomes. Success is assigned if a flexible cystoscope can traverse the reconstructed urethra without force. Functional success is assigned if patient-reported outcome measures reveal improvement in voiding symptoms and urinary quality of life. Optimal follow-up strategy allows determination of anatomic and functional outcomes, protects genitourinary health, and prevents excessive invasive testing, unnecessary cost, discomfort, anxiety, and risk...
February 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27717442/penile-urethral-and-scrotal-cancer
#16
Philippe E Spiess
No abstract text is available yet for this article.
November 2016: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27717441/penile-urethral-and-scrotal-cancer
#17
Samir S Taneja
No abstract text is available yet for this article.
November 2016: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27717440/advances-in-surgical-reconstructive-techniques-in-the-management-of-penile-urethral-and-scrotal-cancer
#18
Michael Bickell, Jonathan Beilan, Jared Wallen, Lucas Wiegand, Rafael Carrion
This article reviews the most up-to-date surgical treatment options for the reconstructive management of patients with penile, urethral, and scrotal cancer. Each organ system is examined individually. Techniques and discussion for penile cancer reconstruction include Mohs surgery, glans resurfacing, partial and total glansectomy, and phalloplasty. Included in the penile cancer reconstruction section is the use of penile prosthesis in phalloplasty patients after penectomy, tissue engineering in phallic regeneration, and penile transplantation...
November 2016: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27717439/surgical-management-of-primary-scrotal-cancer
#19
Jonathan H Huang, Matt Broggi, Adeboye O Osunkoya, Viraj A Master
Primary scrotal cancer is a rare urologic malignancy with various histologic subtypes. Management and outcomes are not designed optimally. Surgical excision is the recommended treatment for localized scrotal cancer, with assessment of the margins for disease. Closure of the defect can be performed with primary closure, skin grafts, flaps, or by secondary intention. Analysis of outcomes suggests that high-risk scrotal cancer may have a worse prognosis compared with penile cancer, and low-risk scrotal cancer may have a comparable prognosis...
November 2016: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27717438/preneoplastic-and-primary-scrotal-cancer-updates-on-pathogenesis-and-diagnostic-evaluation
#20
Yao Zhu, Ding-Wei Ye
Occupational exposure has been causally linked to scrotal cancer. Primary preventative care and avoiding carcinogenic substances have decreased the incidence and changed the treatment of scrotal cancer. The current incidence of scrotal malignancy is approximately 1 per 1,000,000 male persons/year. The rarity of cases and of research impedes our understanding of the changing nature of scrotal cancer. This article summarizes the current knowledge, focusing mainly on pathogenesis and diagnostic evaluation, which may influence prevention and early recognition of the disease...
November 2016: Urologic Clinics of North America
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