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- Ekerhult, Teresa, et al.
(author)
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Outcomes of reintervention after failed urethroplasty
- 2017
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In: Scandinavian Journal of Urology. - : Medical Journals Sweden AB. - 2168-1805 .- 2168-1813. ; 51:1, s. 68-72
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Journal article (peer-reviewed)abstract
- Objective: Urethroplasty is a procedure that has a high success rate. However, there exists a small subgroup of patients who require multiple procedures to achieve an acceptable result. This study analyses the outcomes of a series of patients with failed urethroplasty. Materials and methods: This is a retrospective review of 82 failures out of 407 patients who underwent urethroplasty due to urethral stricture during the period 1999-2013. Failure was defined as the need for an additional surgical procedure. Of the failures, 26 patients had penile strictures and 56 had bulbar strictures. Meatal strictures were not included. Results: The redo procedures included one or multiple direct vision internal urethrotomies, dilatations or new urethroplasties, all with a long follow-up time. The patients underwent one to seven redo surgeries (mean 2.4 procedures per patient). In the present series of patients, endourological procedures cured 34% (28/82) of the patients. Ten patients underwent multiple redo urethroplasties until a satisfactory outcome was achieved; the penile strictures were the most difficult to cure. In patients with bulbar strictures, excision with anastomosis and substitution urethroplasty were equally successful. Nevertheless, 18 patients were defined as treatment failures. Of these patients, nine ended up with clean intermittent self-dilatation as a final solution, five had perineal urethrostomy and four are awaiting a new reintervention. Complicated cases need centralized professional care. Conclusion: Despite the possibility of needing multiple reinterventions, the majority of patients undergoing urethroplasty have a good chance of successful treatment.
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- Ekerhult, Teresa, et al.
(author)
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Sclerosis as a predictive factor for failure after bulbar urethroplasty: a prospective single-centre study.
- 2018
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In: Scandinavian journal of urology. - : Medical Journals Sweden AB. - 2168-1813 .- 2168-1805. ; 52:4, s. 302-308
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Journal article (peer-reviewed)abstract
- The aim of this study was to assess whether sclerosis in histology following bulbar urethroplasty is a predictive factor for failure of surgery.Resected stricture specimens from 45 patients undergoing open urethroplasty with excision and anastomosis were collected prospectively during 2011-2014. Histopathological characteristics, including fibrosis (grade I-III), inflammation and sclerosis, were evaluated using different routine staining. These specimens were compared to normal urethral resection specimens from patients undergoing sex-correction surgery. The uropathologist who conducted the analyses was blinded to the study design.The outcomes of the histological classifications were as follows: 19 patients had grade I fibrosis, of whom three had failures; 13 patients had grade II fibrosis, without any failures; and the most severe fibrosis, grade III, including sclerosis, was found in 13 patients (11 with sclerosis), with failure in eight. Sclerosis was a significant risk factor for restricture when comparing patients with sclerosis and those without sclerosis, and likewise when adjusting for age, inflammation and stricture length.Histological findings of sclerosis in the resected urethral stricture specimen indicate a significantly higher risk for restricture after urethroplasty surgery.
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- Lindqvist, Klas, 1957, et al.
(author)
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Extracorporeal shock-wave lithotripsy or ureteroscopy as primary treatment for ureteric stones: a retrospective study comparing two different treatment strategies.
- 2006
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In: Scand J Urol Nephrol. - : Informa UK Limited. ; 40:2, s. 113-118
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Journal article (peer-reviewed)abstract
- Objective. Our extracorporeal shock-wave lithotripsy (ESWL) lithotripter with ultrasound localization technique was replaced in 1999 by a Storz SLX-MX lithotripter with both X-ray and ultrasound detection possibilities. Before replacing our lithotripter, most ureteric stones were treated with ureteroscopy (URS); subsequently, almost all patients underwent ESWL as primary treatment. The aim of this retrospective study was to compare the results of these two treatment strategies in all consecutive patients attending our hospital in 1998 and 2000 for ureteric stone treatment. Material and methods. The medical records of all patients treated for ureteric stones in 1998 and 2000 were reviewed. In 1998, 173 ureteric stones were treated. Primary treatment was URS in 124 patients, push back/ESWL in 24, ESWL in 21 and open surgery in four. In 2000, 176 ureteric stones were treated: 158 with ESWL and 18 with URS. ESWL or URS monotherapy was defined as ESWL or URS, respectively as the only stone-treatment therapy, with or without the use of a ureteric catheter or nephrostomy tube. Treatment success was defined as a stone-free ureter. Results. In 1998, the success rate for URS monotherapy was 95%, with a retreatment rate (sessions per stone situation) of 1.06. Corresponding figures for ESWL monotherapy in 2000 were 90% and 1.69. All URS patients received general anaesthesia; ESWL patients received opiods. Complication rates were 6% for URS and 3% for ESWL. In the URS group, 4/8 complications were considered to be major. Conclusion. ESWL should be considered the first-line treatment for ureteric stones because of its non-invasive nature, lack of a requirement for general anaesthesia and low complication rates.
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- Lindqvist, Klas, 1957, et al.
(author)
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Immediate versus deferred radiological investigation after acute renal colic: a prospective randomized study
- 2006
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In: Scand J Urol Nephrol. - : Informa UK Limited. ; 40:2, s. 119-124
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Journal article (peer-reviewed)abstract
- Objective. The timing of radiological assessment after acute renal colic is controversial. The aim of this study was to investigate the value of immediate versus deferred radiological imaging and to compare morbidity rates after an attack of acute renal colic. Material and methods. Between September 2001 and December 2002 all 686 patients with acute renal colic attending our university hospital were registered. Of these, 172 patients rendered pain-free after analgesic injection were randomized to either immediate or deferred radiological investigation. All patients received a questionnaire encompassing questions on consumption of analgesics, impact of symptoms on normal daily activity (including working ability), need for additional emergency department visits and hospitalization. Stone treatments were registered. Results. The incidence of renal colic was 0.9/1000 inhabitants per year. In total, 74% of all patients became pain-free after analgesic injection. Morbidity was low among the randomized patients, and did not differ between the immediate or deferred radiological investigation groups. In both groups, the duration of impairment of normal daily activities and analgesic consumption was a median of 2 days. In the immediate group, 14% needed another emergency visit and 4% were hospitalized. Corresponding figures for the deferred group were 15% and 7%. In the immediate group, 17% had stone treatment, compared with 8% in the deferred group. Conclusion. For most patients with acute renal colic, parenteral analgesia resulted in complete symptom resolution. When initial medical treatment was successful, patient morbidity was low. In these patients, immediate radiological imaging did not lead to reduced morbidity compared with radiological imaging after 2-3 weeks.
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| 6. |
- Lindqvist, Klas, 1957
(author)
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On the diagnosis and treatment of upper urinary tract stones
- 2004
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Doctoral thesis (other academic/artistic)abstract
- Aims: Papers I&II: To compare treatment outcome for renal stones treated with different ESWL-machines and treatment results of ESWL and ureteroscopy (URS) for ureteric stones. Paper III: To investigate the morbidity and incidence of acute renal colic and the proportion of patients with absolute and relative indications for immediate radiological examination. Paper IV: To compare sensitivity for stone detection and renal outflow obstruction with non-enhanced helical CT (NCCT) versus urography in the diagnosis of acute renal colic.Patients and methods: Paper I: In a prospective cohort study in Sweden, 1171 patients treated for renal stones with ESWL with 7 different ESWL-machines at 11 centres were evaluated regarding treatment results. Paper II: In a retrospective study, an unselected patient material was reviewed. In 1998, 173 ureteric stones were treated, URS was first-line treatment in 124 patients. In 2000, 176 patients were treated, ESWL was first-line treatment in 158 patients. Paper III: In a prospective randomised study, 172 patients with renal colic who became pain-free after analgetics were included. They were randomised to immediate or deferred (within 2-3 weeks) radiological examination. All patients answered a questionnaire on a daily basis regarding morbidity, defined as impairment of daily activities, consumption of analgetics, need for emergency department revisits or hospitalisation. Treatments were registered Paper IV: Prospectively, 131 patients with acute renal colic were included. All patients underwent NCCT immediately followed by urography. Two independent, blinded radiologists assessed the NCCT findings regarding stone detection and renal outflow obstruction, in comparison with urography. Results: Paper I: Treatment outcome differed statistically between centres and between centres with the same type of EWSL-machines. Larger and multiple stones as well as location in a cavity increased the risk for treatment failure. Paper II: Treatment success with ESWL was 90% compared with 95% for URS, no statistical difference was noted. Paper III: The incidence of acute renal colic was 0.9/1000 inhabitants and year, 74% became pain-free after analgetics. There was no statistical difference regarding morbidity or treatment incidence between the two groups. Impairment of daily activities lasted a median of two days in both groups. Paper IV: In patients with absolute indication for immediate radiological examination, NCCT detected all stones, urography missed two stones of 22. Corresponding figures for patients with relative indication were 49 out of 52, urography missed 15 stones. In each group, NCCT detected all but one patient with moderate or severe renal outflow obstruction. Conclusion: Paper I: Treatment outcome after ESWL was dependent on the machine used, stone status and treatment policy at each center. Paper II: Treatment results were equally good for ESWL and URS. Paper III: In patients with renal colic, 74% had relative indications for immediate radiological examination. The morbidity following renal colic was low and was not altered by performing the radiological examination within 24 hours, as compared with 2-3 weeks. Paper IV: For stone detection in the upper urinary tract, NCCT appears more accurate than urography. NCCT can identify clinically important renal outflow obstruction with a high degree of certainty.
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- Nilsen, O. J., et al.
(author)
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To Transect or Not Transect: Results from the Scandinavian Urethroplasty Study, A Multicentre Randomised Study of Bulbar Urethroplasty Comparing Excision and Primary Anastomosis Versus Buccal Mucosal Grafting
- 2022
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In: European Urology. - : Elsevier BV. - 0302-2838. ; 81:4, s. 375-382
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Journal article (peer-reviewed)abstract
- Background: Open surgical treatment of short bulbar urethral strictures (urethroplasty) is commonly performed as transecting excision and primary anastomosis (tEPA) or buccal mucosa grafting (BMG). Erectile dysfunction and penile complications have been reported, but there is an absence of randomised trials. Objective: To evaluate sexual dysfunction and penile complications after urethroplasty with tEPA versus BMG. Design, setting, and participants: Centres in Finland, Sweden and Norway participated. Patients with a bulbar urethral stricture of ≤2 cm without previous urethroplasty were randomised. The primary endpoints were the degree of erectile dysfunction and penile complications. Follow-up was 12 mo. Intervention: Patients were randomised to either tEPA or BMG urethroplasty. Outcome measurements and statistical analysis: Sexual dysfunction was measured using the International Index of Erectile Function, 5-item version (IIEF-5) and a penile complications questionnaire (PCQ) designed for this study. Continuous data were analysed using analysis of covariance and categorical data were compared using a χ2 test. Results and limitations: A total of 151 patients were randomised to either tEPA (n = 75) or BMG (n = 76). The tEPA group reported more penile complications (p = 0.02), especially reduced glans filling (p = 0.03) and a shortened penis (p = 0.001). There were no differences in postoperative IIEF-5 total scores. Recurrence rates were similar in both groups (12.9%) but the study was not designed to detect differences in recurrence rates. The PCQ is not validated, which is a limitation. Conclusions: More patients reported penile complications after urethroplasty with tEPA than with BMG. This should be considered when choosing the operative method, and patients should be informed accordingly. Patient summary: This study compared two common operations for repair of narrowing of the male urethra. Neither of the two methods seems to cause worsened erections. However, penile problems are more common after the transection technique than after the grafting technique.
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