Publicações científicas

Specific characteristics of urethral strictures in a developing country (Brazil).
Astolfi RH1, Lebani BR1, Krebs RK2, Dias-Filho AC3, Bissoli J4, Cavalcanti AG5, Ximenes SF1,6, Bertolla RP1, Geminiani JJ7.
Author information
1
Department of Surgery, Division of Urology, Sao Paulo Federal University (UNIFESP), São Paulo, Brazil.
2
Division of Urology, Paraná Federal University (UFPR), Curitiba, Brazil.
3
Division of Urology, Federal District Base Hospital, Brasília, Brazil.
4
Division of Urology, University of São Paulo Medical School (FMUSP), São Paulo, Brazil.
5
Urogenital Research Unit from Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil.
6
Oswaldo Ramos Foundation, São Paulo, Brazil.
7
Department of Surgery, Division of Urology, Sao Paulo Federal University (UNIFESP), São Paulo, Brazil. juliogeminiani@gmail.com.
Abstract
PURPOSE:
Evaluate the main etiologies and clinical characteristics of male urethral stricture disease (USD) in Brazil.

METHODS:
This multicentric study was performed using retrospective data collected from six Brazilian referral centers of urethral reconstruction. The database comprised data from 899 patients with USD who had undergone surgical treatment from 2008 to 2018. Age, stricture site and primary stricture etiology were identified for each patient.

RESULTS:
The mean age was 52.13 ± 16.9 years. The most common etiology was iatrogenic (43.4%), followed by idiopathic (21.7%), trauma (21.5%) and inflammatory (13.7%). Of the iatrogenic causes, 59% were secondary to urethral instrumentation (60% by urethral catheterization and 40% by transurethral procedures), 24.8% by other procedures (prostatectomy, radiotherapy, postectomy) and 16.2% by failed hypospadia repairs. Pelvic fracture urethral distraction injuries were responsible for most of the trauma-related strictures (62.7%). When stratified by age, the most common stricture etiology was trauma in the 0-39 years old group (42.8%), idiopathic in the 40-59 years old group (32.4%) and iatrogenic in patients over 60 years old (68%). In regard to the stricture site, 80% presented with an anterior urethral stricture and 20% with a posterior stenosis. In the anterior stenosis group, the most common stricture site was bulbar (39.5%).

CONCLUSION:
In Brazil, as in many developed countries, the most common cause of urethral stricture diseases is iatrogenic, especially urethral catheterization. These findings emphasize the need of a careful urethral manipulation and a better training of healthcare professionals. Trauma is still responsible for a great proportion of strictures and inflammatory etiologies are now less frequently observed.

KEYWORDS:
Ethiology; Iatrogenic disease; Lichen sclerosus; Urethral stricure; Urethritis; Urinary catheterization

What Is the Best Way to Prepare A Buccal Mucosa Graft for Urethroplasty? A Histology-Based Preliminary Report.
Cavalcanti AG1, Restrepo CF1, Simões M2, Costa WS2, Sampaio FJB2, de Souza DB2.
Author information
1
Department of General and Specialized Surgery, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.
2
Urogenital Research Unit, Rio de Janeiro State University, Rio de Janeiro, Brazil.
Abstract
PURPOSE:
To evaluate the histological characteristics of buccal mucosa samples prepared using different dissection techniques.

METHODS:
The buccal mucosae harvested from 9 men submitted to a substitution urethroplasty were used in this study. Biopsy specimens of buccal mucosae were grouped according to the macroscopic appearance after dissection: Group 1 – yellowish appearance (minimal dissection), Group 2 – whitish appearance (more aggressive dissection), and Group 3 – translucent appearance (ultra-aggressive dissection). The biopsy specimens were evaluated using histomorphometric techniques. The thicknesses of the graft, epithelium, and sub-epithelial connective tissue were compared.

RESULTS:
The samples from Group 3 and Groups 2 and 3 presented lower total and lower sub-epithelial connective tissue thickness, respectively, when compared with Group 1. The epithelial thickness was not affected by the dissection method. Muscular and adipose tissues were present in 77 and 55% of samples from Group 1, respectively, whereas these were observed in 44 and 22% of samples from Group 2 respectively. The muscular tissue was observed in 11% of the cases, and the adipose tissue was not observed in samples prepared with ultra-aggressive dissection.

CONCLUSION:
We conclude that an intermediate graft dissection (whitish appearance, as performed in Group 2) presents the best balance between subepithelial connective tissue preservation and adipose and muscle tissue removal.

© 2018 S. Karger AG, Basel.

KEYWORDS:
Buccal mucosa; Graft; Urethra; Urethroplatsy

PMID: 29649831 DOI: 10.1159/000488805

Nesse estudo, desenvolvido em parceria com o laboratório de pesquisa urogenital da UERJ, o Dr. André Cavalcanti define, utilizando técnicas histológicas, a melhor forma de preparo da mucosa oral para utilização em uretroplastias.

Dr. André Cavalcanti apresenta nova técnica desenvolvida para a avaliação de estenoses de uretra, desenvolvida em conjunto com o Dr. Leonardo Kayatt.

Neste estudo, são apresentados os resultados particulares do Dr. André Cavalcanti no manejo da estenose de uretra pós-prostatectomia radical.

• Substitution urethroplasty or anastomotic urethroplasty for bulbar urethra strictures? Or endoscopic urethrotomy? Opinion: Endoscopic Urethrotomy. Int Braz J Urol. 2015 Jul-Aug;41(4):619-22.
• Neste artigo o Dr. André Cavalcanti apresenta, juntamente com outros colegas de referência internacional ( Professores Allen Moorey (EAU) e Richard Santucci (EAU) sobre as melhores indicações cirúrgicas para o tratamento das estenoses de uretra bulbar.