Endoscopic reconstructions of complete posttraumatic obstruction of the urethra
Article published in Urologia Polska 2006/59/4.

authors

Andrzej Zbigniew Buczyński: Specjalistyczne Centrum Rehabilitacji im. Prof. M. Weissa w Konstancinie

keywords

urethra, complete impatency, endoscopic treatment

summary

Introduction. Introduction of optical urethrotome created new possibilities of endoscopic treatment and allowed to search for alternative methods of treatment of posttraumatic complete urethral impatency.

The aim of the study. Assessment of endoscopic treatment of long posttraumatic completely obstructed parts of bulbar and membranous urethra.

Method. The new, original method of endoscopic treatment (presented during Urological Day in Toruń in 1985 [1] and subsequently during IVth International Congress of Endourology and ESWL in Madrid in 1986 [2]) which allowed to create urethral canal using simultaneously two instruments was introduced. Benique was put through cystostomy into the posterior urethra and optical urethrotome was introduced from the opposite side of impatent part of bulbar part. Position of both instruments and cutting the scar tissue by urethrotome until they met each other were additionally controlled by finger put into the rectum. Subsequently Foley catheter was left for prolonged time, usually for two months.

Clinical material. In years 1980-2002 fifteen patients with long, posttraumatic, completely impatent parts of bulbar and membranous urethra were treated using this method. Since 1992, Urolume urethral stents have been implemented instead of prolonged Foley catheter usage.

Results and discussion. In almost all patients, urethral lumen was created using this method. 67% of late good results of treatment were obtained as well. This method of treatment, however, technically difficult, would be alternative for other surgical methods of treatment of complete, posttraumatic urethral obstruction.

Conclusions. Endoscopic method could be an alternative for open surgery. Obtained results are similar to results with other methods. Endoscopic treatment does not preclude usage of other methods of treatment.

references

Buczyński A., Pypno W: Nowa, endoskopowa metoda leczenia całkowitej niedrożności cewki moczowej. Dzień Urologiczny PTU, Toruń 28 wrzesień 1985.
Buczyński A: Endoscopic treatment of complete urethral impatency. IV World Congress on Endourology and ESWL. Madrid, 11-13th September 1986.
Buczyński AZ: Siatkowe protezy urologiczne Urolume w leczeniu nawrotowych zwężeń cewki moczowej. Urol Pol. 1993, 46, 4, 300-304.
Buczyński AZ: Odległe wyniki leczenia przeszkody podpęcherzowej metodą implantacji siatkowych protez Urolume. Urol Pol. 2002, 55, 3, 71-74.
Buczyński AZ: Zastosowanie sztucznych zwieraczy AUS 800 w leczeniu nietrzymania moczu. Urol Pol. 1994, 47, 3, 151-157.
Buczyński AZ: Leczenie powikłań po radykalnej prostatektomii metodą podwójnej alloplastyki. Urol Pol. 1994, 47, 3, 139-141.
Levine J, Wessells H: Comparison of open and endoscopic treatment of posttraumatic posterior urethral strictures. World J Surg 2001, 25, 12, 1597-1601.
Gonzalez R, Chiou R-K, Hekmat K, Fraley EE: Endoscopic re-establishment of urethral continuity after traumatic disruption of the membranous urethra. J Urol 1983, 130, 785-787.
Brzozowski C, Borówka A, Judycki J: Leczenie pourazowego zarośnięcia męskiej cewki moczowej metodą endoskopowej tunelizacji. Urol Pol 1991, 44, 1, 53-56.
Leonard MP, Emtage J, Perez R, Morales A: Endoscopic management of urethral stricture: "cut to the light" procedure. Urology 1990, Feb; 35, 2, 117-120.
Chang SY: Endourologic management of impassable urethra stricture. J Formos Med Assoc 1994, 93, 8, 694-696.
al-Ali M, al-Shukry M: Endoscopic repair in 154 cases of urethral occlusion: the promise of guided optical urethral reconstructions. J Urol 1997, 157, 1, 129-131.

correspondence