The Experts below are selected from a list of 297 Experts worldwide ranked by ideXlab platform
Enzo Palminteri - One of the best experts on this subject based on the ideXlab platform.
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Management of Urethral Stent Failure for Recurrent Anterior Urethral Strictures
'Elsevier BV', 2010Co-Authors: Enzo Palminteri, Mauro Gacci, Elisa Berdondini, Maurizio Poluzzi, Giorgio Franco, Vincenzo GentileAbstract:Background: Urethral stent placement for recurrent anterior urethral strictures may cause restenosis and complications. Objective: To describe our experience with patients who had restenoses and complications following urethral stent placement for the treatment of recurrent anterior urethral strictures. Design, setting, and participants: We evaluated retrospectively the records of 13 men with anterior urethral stricture who experienced restenosis and complications after stent insertion. We recorded stent position, prestent and poststent urethral procedures, restenosis location, stent-related complications, and management of stent failures. Surgical procedure: The stent was removed en bloc with the whole strictured urethral segment or wire by wire after a ventral or a double-ventral plus dorsal-sagittal urethrotomy and stent section. Measurements: Successful outcome was defined as standard voiding, without need of any postoperative procedure, and full recovery from complications. Results and limitations: Four patients did not undergo surgery and the stent was left in situ. Of these patients, two required permanent suprapubic cystostomy. Nine patients underwent challenging surgical stent removal and salvage Urethrostomy: After the first stage, three patients are waiting for further reconstructive steps, five elected the Urethrostomy as a permanent diversion, and one completed the staged reconstruction using a buccal mucosa graft at the second stage. After surgery, seven of the nine patients (77.8%) were free of strictures and stent-related complications, while a restenosis occurred in two of the nine (22.2%) cases. Conclusions: The management of urethral stent failure represents a therapeutic challenge. The stent risks converting a simple stenosis into a complex stenosis requiring a staged urethroplasty, a definitive Urethrostomy, or a permanent suprapubic diversion. (c) 2009 European Association of Urology. Published by Elsevier B. V. All rights reserved
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Management of Urethral Stent Failure for Recurrent Anterior Urethral Strictures
European urology, 2009Co-Authors: Enzo Palminteri, Mauro Gacci, Elisa Berdondini, Maurizio Poluzzi, Giorgio Franco, Vincenzo GentileAbstract:Abstract Background Urethral stent placement for recurrent anterior urethral strictures may cause restenosis and complications. Objective To describe our experience with patients who had restenoses and complications following urethral stent placement for the treatment of recurrent anterior urethral strictures. Design, setting, and participants We evaluated retrospectively the records of 13 men with anterior urethral stricture who experienced restenosis and complications after stent insertion. We recorded stent position, prestent and poststent urethral procedures, restenosis location, stent-related complications, and management of stent failures. Surgical procedure The stent was removed en bloc with the whole strictured urethral segment or wire by wire after a ventral or a double-ventral plus dorsal-sagittal urethrotomy and stent section. Measurements Successful outcome was defined as standard voiding, without need of any postoperative procedure, and full recovery from complications. Results and limitations Four patients did not undergo surgery and the stent was left in situ. Of these patients, two required permanent suprapubic cystostomy. Nine patients underwent challenging surgical stent removal and salvage Urethrostomy: After the first stage, three patients are waiting for further reconstructive steps, five elected the Urethrostomy as a permanent diversion, and one completed the staged reconstruction using a buccal mucosa graft at the second stage. After surgery, seven of the nine patients (77.8%) were free of strictures and stent-related complications, while a restenosis occurred in two of the nine (22.2%) cases. Conclusions The management of urethral stent failure represents a therapeutic challenge. The stent risks converting a simple stenosis into a complex stenosis requiring a staged urethroplasty, a definitive Urethrostomy, or a permanent suprapubic diversion.
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combined dorsal plus ventral double buccal mucosa graft in bulbar urethral reconstruction
European Urology, 2008Co-Authors: Enzo Palminteri, Elisa Berdondini, Maurizio Poluzzi, Gianantonio Manzoni, Francesco Di Fiore, Gianfranco Testa, Angelo MolonAbstract:Abstract Objectives We describe a technique for bulbar urethral reconstruction using a combined dorsal plus ventral double buccal mucosa graft (BMG). Methods From March 2002 to June 2006, 48 men, mean age 35 yr, with bulbar strictures underwent patch urethroplasty using a dorsal plus a ventral double BMG. Average stricture length was 3.65cm (range: 2–10cm). The stenotic urethral segment was opened along its ventral surface; the exposed dorsal urethra was incised in the midline to create an elliptical area over the tunica albuginea where the dorsal inlay BMG was placed and quilted to the corpora to augment dorsally the urethral plate. Subsequently, the ventral onlay BMG was sutured to the urethral lateral margins to complete the augmented urethroplasty. Finally, the spongiosum was closed over the graft. Successful reconstruction was defined as normal voiding without the need for any postoperative procedure including dilation. Results Mean follow-up was 22 mo (range: 13–59 mo). At the catheter removal 3 wk after surgery, in three patients the voiding cystourethrography showed a fistula, which recovered after a prolonged catheterization. Of 48 cases, 43 (89.6%) were successful and 5 (10.4%) failures with recurrence of the stricture; 4 were treated with internal urethrotomy and 1 with a temporary perineal Urethrostomy. Conclusions Preliminary results with a combined double BMG urethroplasty for severe bulbar stricture are encouraging. The double dorsal and ventral graft may provide a simple and reliable solution to achieve an adequate urethral lumen in selected patients.
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heroic measures may not always be justified in extensive urethral stricture due to lichen sclerosus balanitis xerotica obliterans
Urology, 2004Co-Authors: Andrew C Peterson, Enzo Palminteri, Massimo Lazzeri, Giorgio Guanzoni, Guido Barbagli, George D WebsterAbstract:Abstract Objectives Strictures due to lichen sclerosus (LS) may affect the urethra as far proximally as the mid-bulb. For such strictures, a staged full-length repair is required and should use a nonpenile graft source such as buccal mucosa. Many cases occur in a population already accustomed to seated voiding, leading us to re-evaluate this approach and, in some circumstances, recommend definitive perineal Urethrostomy alone. Methods We reviewed the medical records and retrograde urethrograms of all patients undergoing surgery for LS at our facilities between January 1991 and June 2002. Results A total of 63 patients, with an average age of 54.2 years, underwent surgery for LS stricture with an average follow-up of 38.5 months (range 4 to 117). Of the 63 patients, 19 underwent grafting in preparation for future reconstruction. Of these, 11 completed the second-stage repair, and 8 patients elected not to undergo the second stage of the repair, leaving a functional perineal Urethrostomy. This led us to look more critically at definitive perineal Urethrostomy alone for some patients. Parallel with the staged repairs, and subsequent to them, 44 patients underwent perineal Urethrostomy alone. Conclusions The often extensive nature of LS, the prevailing philosophy that urethroplasty must use nonpenile skin, the limited availability of such sources, and the acceptance of many patients for seated voiding makes definitive perineal Urethrostomy alone a viable treatment option. In all our cases, this satisfied patients' quality of life concerns, leaving the anterior urethra dry and amenable to future repair. Younger men desirous of penile voiding should still be considered for staged repair using current techniques.
Vincenzo Gentile - One of the best experts on this subject based on the ideXlab platform.
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Management of Urethral Stent Failure for Recurrent Anterior Urethral Strictures
'Elsevier BV', 2010Co-Authors: Enzo Palminteri, Mauro Gacci, Elisa Berdondini, Maurizio Poluzzi, Giorgio Franco, Vincenzo GentileAbstract:Background: Urethral stent placement for recurrent anterior urethral strictures may cause restenosis and complications. Objective: To describe our experience with patients who had restenoses and complications following urethral stent placement for the treatment of recurrent anterior urethral strictures. Design, setting, and participants: We evaluated retrospectively the records of 13 men with anterior urethral stricture who experienced restenosis and complications after stent insertion. We recorded stent position, prestent and poststent urethral procedures, restenosis location, stent-related complications, and management of stent failures. Surgical procedure: The stent was removed en bloc with the whole strictured urethral segment or wire by wire after a ventral or a double-ventral plus dorsal-sagittal urethrotomy and stent section. Measurements: Successful outcome was defined as standard voiding, without need of any postoperative procedure, and full recovery from complications. Results and limitations: Four patients did not undergo surgery and the stent was left in situ. Of these patients, two required permanent suprapubic cystostomy. Nine patients underwent challenging surgical stent removal and salvage Urethrostomy: After the first stage, three patients are waiting for further reconstructive steps, five elected the Urethrostomy as a permanent diversion, and one completed the staged reconstruction using a buccal mucosa graft at the second stage. After surgery, seven of the nine patients (77.8%) were free of strictures and stent-related complications, while a restenosis occurred in two of the nine (22.2%) cases. Conclusions: The management of urethral stent failure represents a therapeutic challenge. The stent risks converting a simple stenosis into a complex stenosis requiring a staged urethroplasty, a definitive Urethrostomy, or a permanent suprapubic diversion. (c) 2009 European Association of Urology. Published by Elsevier B. V. All rights reserved
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Management of Urethral Stent Failure for Recurrent Anterior Urethral Strictures
European urology, 2009Co-Authors: Enzo Palminteri, Mauro Gacci, Elisa Berdondini, Maurizio Poluzzi, Giorgio Franco, Vincenzo GentileAbstract:Abstract Background Urethral stent placement for recurrent anterior urethral strictures may cause restenosis and complications. Objective To describe our experience with patients who had restenoses and complications following urethral stent placement for the treatment of recurrent anterior urethral strictures. Design, setting, and participants We evaluated retrospectively the records of 13 men with anterior urethral stricture who experienced restenosis and complications after stent insertion. We recorded stent position, prestent and poststent urethral procedures, restenosis location, stent-related complications, and management of stent failures. Surgical procedure The stent was removed en bloc with the whole strictured urethral segment or wire by wire after a ventral or a double-ventral plus dorsal-sagittal urethrotomy and stent section. Measurements Successful outcome was defined as standard voiding, without need of any postoperative procedure, and full recovery from complications. Results and limitations Four patients did not undergo surgery and the stent was left in situ. Of these patients, two required permanent suprapubic cystostomy. Nine patients underwent challenging surgical stent removal and salvage Urethrostomy: After the first stage, three patients are waiting for further reconstructive steps, five elected the Urethrostomy as a permanent diversion, and one completed the staged reconstruction using a buccal mucosa graft at the second stage. After surgery, seven of the nine patients (77.8%) were free of strictures and stent-related complications, while a restenosis occurred in two of the nine (22.2%) cases. Conclusions The management of urethral stent failure represents a therapeutic challenge. The stent risks converting a simple stenosis into a complex stenosis requiring a staged urethroplasty, a definitive Urethrostomy, or a permanent suprapubic diversion.
Nicolaas Lumen - One of the best experts on this subject based on the ideXlab platform.
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urethroplasty after urethral urolume stent an international multicenter experience
Urology, 2018Co-Authors: J C Angulo, Sanjay Kulkarni, Joshi Pankaj, Dmitriy Nikolavsky, Pedro Suarez, Javier Belinky, Ramon Virasoro, Jessica Delong, Francisco Martins, Nicolaas LumenAbstract:Objective To evaluate the outcomes and factors affecting success of urethroplasty in patients with stricture recurrence after Urolume urethral stent. Material and Methods This is a retrospective international multicenter study on patients treated with urethral reconstruction after Urolume stent. Stricture and stent length, time between urethral stent insertion and urethroplasty, age, mode of stent retrieval, type of urethroplasty, complications and baseline, and posturethroplasty voiding parameters were analyzed. Successful outcome was defined as standard voiding, without need of any postoperative adjunctive procedure. Results Sixty-three patients were included. Stent was removed at urethroplasty in 61 patients. Reconstruction technique was excision and primary anastomosis in 14 (22.2%), dorsal onlay buccal mucosa graft (BMG) in 9 (14.3%), ventral onlay BMG in 6 (9.5%), dorsolateral onlay BMG in 9 (14.3%), ventral onlay plus dorsal inlay BMG in 3 (4.8%), augmented anastomosis in 5 (7.9%), pedicled flap urethroplasty in 6 (9.5%), 2-stage procedure in 4 (6.4%), and perineal Urethrostomy in 7(11.1%). Success rate was 81% at a mean 59.7 ± 63.4 months. Dilatation or internal urethrotomy was performed in 10 (15.9%) and redo-urethroplasty in 5 (7.9%). Total International Prostate Symptom Score, quality of life, urine maximum flow, and postvoid residual significantly improved (P Conclusion Urethroplasty in patients with Urolume urethral stents is a viable option of reconstruction with a high success rate and very acceptable complication rate. Numerous techniques are viable; however, urethral preservation, tine-by-tine stent extraction, and use of BMG augmentation produced significantly better outcomes.
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Revision of Perineal Urethrostomy Using a Meshed Split-Thickness Skin Graft
Case reports in nephrology, 2014Co-Authors: Nicolaas Lumen, Philippe Houtmeyers, Anne-françoise Spinoit, Stan Monstrey, Willem Oosterlinck, Piet HoebekeAbstract:Perineal Urethrostomy is considered to be the last option to restore voiding in complex/recurrent urethral stricture disease. It is also a necessary procedure after penectomy or urethrectomy. Stenosis of the perineal Urethrostomy has been reported in up to 30% of cases. There is no consensus on how to treat a stenotic perineal Urethrostomy, but, in general, a form of urinary diversion is offered to the patient. We present the case of a young male who underwent perineal Urethrostomy after urethrectomy for urethral cancer. The postoperative period was complicated by wound dehiscence with subsequent complete obliteration of the perineal Urethrostomy. Revision surgery was performed with reopening of the obliterated urethral stump and coverage of the skin defect between the urethra and the perineal/scrotal skin with a meshed split-thickness skin graft. To date, this patient is voiding well and satisfied with the offered solution.
Elisa Berdondini - One of the best experts on this subject based on the ideXlab platform.
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Management of Urethral Stent Failure for Recurrent Anterior Urethral Strictures
'Elsevier BV', 2010Co-Authors: Enzo Palminteri, Mauro Gacci, Elisa Berdondini, Maurizio Poluzzi, Giorgio Franco, Vincenzo GentileAbstract:Background: Urethral stent placement for recurrent anterior urethral strictures may cause restenosis and complications. Objective: To describe our experience with patients who had restenoses and complications following urethral stent placement for the treatment of recurrent anterior urethral strictures. Design, setting, and participants: We evaluated retrospectively the records of 13 men with anterior urethral stricture who experienced restenosis and complications after stent insertion. We recorded stent position, prestent and poststent urethral procedures, restenosis location, stent-related complications, and management of stent failures. Surgical procedure: The stent was removed en bloc with the whole strictured urethral segment or wire by wire after a ventral or a double-ventral plus dorsal-sagittal urethrotomy and stent section. Measurements: Successful outcome was defined as standard voiding, without need of any postoperative procedure, and full recovery from complications. Results and limitations: Four patients did not undergo surgery and the stent was left in situ. Of these patients, two required permanent suprapubic cystostomy. Nine patients underwent challenging surgical stent removal and salvage Urethrostomy: After the first stage, three patients are waiting for further reconstructive steps, five elected the Urethrostomy as a permanent diversion, and one completed the staged reconstruction using a buccal mucosa graft at the second stage. After surgery, seven of the nine patients (77.8%) were free of strictures and stent-related complications, while a restenosis occurred in two of the nine (22.2%) cases. Conclusions: The management of urethral stent failure represents a therapeutic challenge. The stent risks converting a simple stenosis into a complex stenosis requiring a staged urethroplasty, a definitive Urethrostomy, or a permanent suprapubic diversion. (c) 2009 European Association of Urology. Published by Elsevier B. V. All rights reserved
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Management of Urethral Stent Failure for Recurrent Anterior Urethral Strictures
European urology, 2009Co-Authors: Enzo Palminteri, Mauro Gacci, Elisa Berdondini, Maurizio Poluzzi, Giorgio Franco, Vincenzo GentileAbstract:Abstract Background Urethral stent placement for recurrent anterior urethral strictures may cause restenosis and complications. Objective To describe our experience with patients who had restenoses and complications following urethral stent placement for the treatment of recurrent anterior urethral strictures. Design, setting, and participants We evaluated retrospectively the records of 13 men with anterior urethral stricture who experienced restenosis and complications after stent insertion. We recorded stent position, prestent and poststent urethral procedures, restenosis location, stent-related complications, and management of stent failures. Surgical procedure The stent was removed en bloc with the whole strictured urethral segment or wire by wire after a ventral or a double-ventral plus dorsal-sagittal urethrotomy and stent section. Measurements Successful outcome was defined as standard voiding, without need of any postoperative procedure, and full recovery from complications. Results and limitations Four patients did not undergo surgery and the stent was left in situ. Of these patients, two required permanent suprapubic cystostomy. Nine patients underwent challenging surgical stent removal and salvage Urethrostomy: After the first stage, three patients are waiting for further reconstructive steps, five elected the Urethrostomy as a permanent diversion, and one completed the staged reconstruction using a buccal mucosa graft at the second stage. After surgery, seven of the nine patients (77.8%) were free of strictures and stent-related complications, while a restenosis occurred in two of the nine (22.2%) cases. Conclusions The management of urethral stent failure represents a therapeutic challenge. The stent risks converting a simple stenosis into a complex stenosis requiring a staged urethroplasty, a definitive Urethrostomy, or a permanent suprapubic diversion.
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combined dorsal plus ventral double buccal mucosa graft in bulbar urethral reconstruction
European Urology, 2008Co-Authors: Enzo Palminteri, Elisa Berdondini, Maurizio Poluzzi, Gianantonio Manzoni, Francesco Di Fiore, Gianfranco Testa, Angelo MolonAbstract:Abstract Objectives We describe a technique for bulbar urethral reconstruction using a combined dorsal plus ventral double buccal mucosa graft (BMG). Methods From March 2002 to June 2006, 48 men, mean age 35 yr, with bulbar strictures underwent patch urethroplasty using a dorsal plus a ventral double BMG. Average stricture length was 3.65cm (range: 2–10cm). The stenotic urethral segment was opened along its ventral surface; the exposed dorsal urethra was incised in the midline to create an elliptical area over the tunica albuginea where the dorsal inlay BMG was placed and quilted to the corpora to augment dorsally the urethral plate. Subsequently, the ventral onlay BMG was sutured to the urethral lateral margins to complete the augmented urethroplasty. Finally, the spongiosum was closed over the graft. Successful reconstruction was defined as normal voiding without the need for any postoperative procedure including dilation. Results Mean follow-up was 22 mo (range: 13–59 mo). At the catheter removal 3 wk after surgery, in three patients the voiding cystourethrography showed a fistula, which recovered after a prolonged catheterization. Of 48 cases, 43 (89.6%) were successful and 5 (10.4%) failures with recurrence of the stricture; 4 were treated with internal urethrotomy and 1 with a temporary perineal Urethrostomy. Conclusions Preliminary results with a combined double BMG urethroplasty for severe bulbar stricture are encouraging. The double dorsal and ventral graft may provide a simple and reliable solution to achieve an adequate urethral lumen in selected patients.
Maurizio Poluzzi - One of the best experts on this subject based on the ideXlab platform.
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Management of Urethral Stent Failure for Recurrent Anterior Urethral Strictures
'Elsevier BV', 2010Co-Authors: Enzo Palminteri, Mauro Gacci, Elisa Berdondini, Maurizio Poluzzi, Giorgio Franco, Vincenzo GentileAbstract:Background: Urethral stent placement for recurrent anterior urethral strictures may cause restenosis and complications. Objective: To describe our experience with patients who had restenoses and complications following urethral stent placement for the treatment of recurrent anterior urethral strictures. Design, setting, and participants: We evaluated retrospectively the records of 13 men with anterior urethral stricture who experienced restenosis and complications after stent insertion. We recorded stent position, prestent and poststent urethral procedures, restenosis location, stent-related complications, and management of stent failures. Surgical procedure: The stent was removed en bloc with the whole strictured urethral segment or wire by wire after a ventral or a double-ventral plus dorsal-sagittal urethrotomy and stent section. Measurements: Successful outcome was defined as standard voiding, without need of any postoperative procedure, and full recovery from complications. Results and limitations: Four patients did not undergo surgery and the stent was left in situ. Of these patients, two required permanent suprapubic cystostomy. Nine patients underwent challenging surgical stent removal and salvage Urethrostomy: After the first stage, three patients are waiting for further reconstructive steps, five elected the Urethrostomy as a permanent diversion, and one completed the staged reconstruction using a buccal mucosa graft at the second stage. After surgery, seven of the nine patients (77.8%) were free of strictures and stent-related complications, while a restenosis occurred in two of the nine (22.2%) cases. Conclusions: The management of urethral stent failure represents a therapeutic challenge. The stent risks converting a simple stenosis into a complex stenosis requiring a staged urethroplasty, a definitive Urethrostomy, or a permanent suprapubic diversion. (c) 2009 European Association of Urology. Published by Elsevier B. V. All rights reserved
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Management of Urethral Stent Failure for Recurrent Anterior Urethral Strictures
European urology, 2009Co-Authors: Enzo Palminteri, Mauro Gacci, Elisa Berdondini, Maurizio Poluzzi, Giorgio Franco, Vincenzo GentileAbstract:Abstract Background Urethral stent placement for recurrent anterior urethral strictures may cause restenosis and complications. Objective To describe our experience with patients who had restenoses and complications following urethral stent placement for the treatment of recurrent anterior urethral strictures. Design, setting, and participants We evaluated retrospectively the records of 13 men with anterior urethral stricture who experienced restenosis and complications after stent insertion. We recorded stent position, prestent and poststent urethral procedures, restenosis location, stent-related complications, and management of stent failures. Surgical procedure The stent was removed en bloc with the whole strictured urethral segment or wire by wire after a ventral or a double-ventral plus dorsal-sagittal urethrotomy and stent section. Measurements Successful outcome was defined as standard voiding, without need of any postoperative procedure, and full recovery from complications. Results and limitations Four patients did not undergo surgery and the stent was left in situ. Of these patients, two required permanent suprapubic cystostomy. Nine patients underwent challenging surgical stent removal and salvage Urethrostomy: After the first stage, three patients are waiting for further reconstructive steps, five elected the Urethrostomy as a permanent diversion, and one completed the staged reconstruction using a buccal mucosa graft at the second stage. After surgery, seven of the nine patients (77.8%) were free of strictures and stent-related complications, while a restenosis occurred in two of the nine (22.2%) cases. Conclusions The management of urethral stent failure represents a therapeutic challenge. The stent risks converting a simple stenosis into a complex stenosis requiring a staged urethroplasty, a definitive Urethrostomy, or a permanent suprapubic diversion.
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combined dorsal plus ventral double buccal mucosa graft in bulbar urethral reconstruction
European Urology, 2008Co-Authors: Enzo Palminteri, Elisa Berdondini, Maurizio Poluzzi, Gianantonio Manzoni, Francesco Di Fiore, Gianfranco Testa, Angelo MolonAbstract:Abstract Objectives We describe a technique for bulbar urethral reconstruction using a combined dorsal plus ventral double buccal mucosa graft (BMG). Methods From March 2002 to June 2006, 48 men, mean age 35 yr, with bulbar strictures underwent patch urethroplasty using a dorsal plus a ventral double BMG. Average stricture length was 3.65cm (range: 2–10cm). The stenotic urethral segment was opened along its ventral surface; the exposed dorsal urethra was incised in the midline to create an elliptical area over the tunica albuginea where the dorsal inlay BMG was placed and quilted to the corpora to augment dorsally the urethral plate. Subsequently, the ventral onlay BMG was sutured to the urethral lateral margins to complete the augmented urethroplasty. Finally, the spongiosum was closed over the graft. Successful reconstruction was defined as normal voiding without the need for any postoperative procedure including dilation. Results Mean follow-up was 22 mo (range: 13–59 mo). At the catheter removal 3 wk after surgery, in three patients the voiding cystourethrography showed a fistula, which recovered after a prolonged catheterization. Of 48 cases, 43 (89.6%) were successful and 5 (10.4%) failures with recurrence of the stricture; 4 were treated with internal urethrotomy and 1 with a temporary perineal Urethrostomy. Conclusions Preliminary results with a combined double BMG urethroplasty for severe bulbar stricture are encouraging. The double dorsal and ventral graft may provide a simple and reliable solution to achieve an adequate urethral lumen in selected patients.
