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Urodynamic studies in boys with disorders of the lower urinary tract. I. Urethral strictures. A pre-and postoperative
Insights
Urodynamic investigation of boys with urethral strictures revealed decreased urinary flow and high energy loss. While treatment improved symptoms, flow measurement is recommended for long-term follow-up.
Area of Science:
- Urology
- Pediatric Surgery
- Urodynamics
Background:
- Urethral strictures in boys can significantly impact bladder voiding function.
- Urodynamic investigation is crucial for assessing lower urinary tract symptoms.
Observation:
- Preoperative urodynamics showed varied intravesical pressure and consistently decreased maximum urinary flow, plateau formation, and slow initiation in boys with urethral strictures.
- High urethral energy losses and decreased maximum exit velocity were observed.
- Postoperative improvement was noted, though normalization of outflow occurred in only some cases.
Findings:
- Patients with shorter strictures exhibited greater obstruction but better prognoses, with some achieving supernormal flow rates.
- Postoperative after-contraction occurred in approximately half of the patients, suggesting potential functional bladder neck changes.
- One case of partial detrusor muscle insufficiency was identified.
Implications:
- Flow measurement alone is recommended for long-term follow-up of pediatric urethral stricture patients.
- Findings suggest potential functional bladder neck alterations post-treatment.
- Urodynamic assessment provides valuable insights into voiding dysfunction severity and treatment response.
Abstract:
Sixteen boys with urethral strictures underwent urodynamic investigation pre- and postoperatively. The intravesical pressure preoperatively showed wide variations during micturition and was increased in only half of the patients. The urinary flow pre-operatively displayed a uniform picture with a decreased maximum flow in all the patients, plateau-formation and slow initiation of the flow curve. The maximum exit velocity of the urinary stream was decreased and the urethral energy losses were very high. After treatment, the out-flow situation was generally improved, but restored to normal only in some cases. Patients with short strictures showed the highest degree of urethral obstruction, but they also seemed to have the best prognosis, some of them even reaching supernormal flows. Flow measurement alone is recommended in the long-term follow-u, which is necessary in these patients. After-contraction was not present in any of the patients pre-operatively, blt occurred in about half of them postoperatively. This and some other findings may indicate the existence of functional changes in the bladder neck in patients with urethral stricture. On case with partial detrusor muscle insufficiency is reported.