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RE:
CHALLENGING NON-TRAUMATIC POSTERIOR URETHRAL STRICTURES TREATED WITH URETHROPLASTY:
A PRELIMINARY REPORT
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NICOLAAS LUMEN, WILLEM
OOSTERLINCK
Department
of Urology, Ghent University Hospital, Ghent, Belgium
Int
Braz J Urol. 2009; 35: 442-9
To the Editor,
This
interesting paper raises some theories about urethral stricture, its ongoing
process, and how to deal with challenging cases. Although only a small
number of patients were observed, this fact does not compromise the results,
as the incidence of this specific pathology is very low. While urethroplasty
was performed on macroscopically healthy ends, there is no histological
confirmation of whether the urethral margin tissue is free from fibrosis,
which has been suggested by some authors to be one of the most important
aspects to be used when performing end-to-end anastomosis (1-3).
The authors admit that the hypothesis suggested
in their publication lacks both urodynamic and histological studies, which
would add supporting data to all of these theories. This lack of supporting
data compromises the discussion itself. Histological data should clarify
the urethra aspects that suffer from the ischemic effects of radiotherapy,
as mentioned above. The confirmation of these findings would justify the
use of the prolonged urethral catheter during postoperative period. Moreover,
urodynamics studies would confirm the damage of the external sphincter
after urethroplasty. If the study had included all these data, it would
have had a tremendous impact in the area of urethral stricture, but that
is the price to be paid by the pioneers.
The incidence of urethral stricture alone
after non-traumatic procedures is very rare, however, the incidence of
stenosis combined with rectal fistulas is not uncommon, and consequently
there are some publications about this aspect. These publications guide
us to some other ways of studying urethral stricture itself, its complications,
and reconstruction techniques (4,5).
I congratulate the authors for their initiative
in this well described and documented study. With increasing data, histological
confirmation of the ischemic tissue, and urodynamics studies, the contribution
to urology would be even greater.
REFERENCES
- Santucci
RA, Joyce GF, Wise M: Male urethral stricture disease. J Urol. 2007;
177: 1667-74.
- Santucci
RA, Mario LA, McAninch JW: Anastomotic urethroplasty for bulbar urethral
stricture: analysis of 168 patients. J Urol. 2002; 167: 1715-9.
- Cavalcanti
AG, Costa WS, Baskin LS, McAninch JA, Sampaio FJ: A morphometric analysis
of bulbar urethral strictures. BJU Int. 2007; 100: 397-402.
- Lane
BR, Stein DE, Remzi FH, Strong SA, Fazio VW, Angermeier KW: Management
of radiotherapy induced rectourethral fistula. J Urol. 2006; 175: 1382-7;
discussion 1387-8.
- Razi
A, Yahyazadeh SR, Gilani MA, Kazemeyni SM: Transanal repair of rectourethral
and rectovaginal fistulas. Urol J. 2008; 5: 111-4.
Dr.
João P. M. de Carvalho
Fluminense Federal University
Niteroi, Rio de Janeiro, Brazil
E-mail: carvalho.jpm@gmail.com
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