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Esophageal Strictures-I: Introduction01:30

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Esophageal strictures involve abnormal narrowing or tightening of the esophagus. They vary in length and severity, ranging from mild constriction to complete obstruction, and are classified as benign (noncancerous) or malignant (cancerous).
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Related Experiment Video

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Urethral Stricture Induction Followed by Buccal Mucosa Graft Urethroplasty in a Rat Model
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Versatile algorithmic midline approach to perineal urethrostomy for complex urethral strictures.

Maxim J McKibben1, Alexander T Rozanski1, Joceline S Fuchs1

  • 1Department of Urology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA.

World Journal of Urology
|October 19, 2018
PubMed
Summary

This study shows an algorithmic midline approach to perineal urethrostomy (PU) provides excellent outcomes for complex urethral strictures. The versatile technique offers high success and patient satisfaction, even in challenging cases.

Keywords:
Patient-reported outcomesPerineal urethrostomyUrethral strictureUrethroplasty

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Anogenital Distance and Perineal Measurements of the Pelvic Organ Prolapse POP Quantification System
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Area of Science:

  • Urology
  • Surgical Techniques
  • Reconstructive Surgery

Background:

  • Complex urethral strictures present significant reconstructive challenges.
  • Perineal urethrostomy (PU) is a reconstructive option for these strictures.
  • Standardized algorithmic approaches can improve surgical outcomes.

Purpose of the Study:

  • To evaluate an algorithmic midline perineal incision approach for perineal urethrostomy (PU).
  • To assess surgical outcomes and patient satisfaction in men with complex urethral strictures undergoing PU.
  • To determine the efficacy of two PU maturation techniques: urethral plate mobilization (loop) and lateral perineal skin flap (7-flap).

Main Methods:

  • Retrospective review of 62 patients undergoing PU by a single surgeon (2008-2017).
  • Patients were stratified into loop (distal strictures/low BMI) or 7-flap (longer strictures) groups.
  • Outcomes included success (functional voiding without reoperation) and patient-reported satisfaction via validated questionnaires.

Main Results:

  • The 7-flap technique was used in 67.7% of patients (42/62), including reoperative cases.
  • The loop technique was used in 32.3% (20/62).
  • Success rates were high: 100% for loop PU and 92.9% for 7-flap PU, with a median follow-up of 30.7 months. Patient-reported outcomes indicated significant symptom improvement.

Conclusions:

  • An algorithmic midline approach to perineal urethrostomy is a versatile and effective strategy.
  • This approach yields excellent surgical success and high patient satisfaction.
  • It is a viable option for complex urethral strictures, including in obese or previously operated patients.