Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: OBJECTIVES The aim of this study was to determine long-term renal function in boys presenting with posterior urethral valves at Tygerberg Children’s Hospital and to determine the prognostic value of certain clinical, biochemical and radiological variables DESIGN Retrospective, descriptive study of boys diagnosed and treated with posterior urethral valves at Tygerberg Children’s Hospital between 2001 and 2011. RESULTS Between 2001 and 2011, 47 cases of posterior urethral valves were diagnosed and treated at our institution. Thirteen patients were excluded from this study. Seven (20,6%) were diagnosed antenatally and 27 (79,4%) presented postnatally. Mean age at presentation was 13,9 months (median 2; range 0-74). The most common postnatal presentation was urinary tract infection (51,9%). Mean follow-up was 54,2 months (median 47,5; range 12-133). A total of 13 boys (38,2%) progressed to chronic renal failure or end-stage renal disease. Initial and nadir serum creatinine, poor corticomedullary differentiation and moderate-severe hydronephrosis were significant predictors of final renal function (p<0,050). Patient age at presentation, type of primary surgical intervention, increased renal echogenicity, bladder wall thickness, the presence of vesicoureteric reflux (no matter what the laterality or severity), severe bladder dysfunction and initial or breakthrough urinary tract infection had no significant impact on future renal function. Receiver operating characteristic curve analysis confirmed that boys with an initial serum creatinine ≥145μmol/L and a nadir serum creatinine ≥62μmol/L were at highest risk to develop chronic renal insufficiency (area under the curve 0,8 and 0,9, respectively). CONCLUSION More than a third of boys (38,2%) developed chronic renal failure or end-stage renal disease at the end of follow-up. Our data confirmed the high prognostic value of initial and nadir serum creatinine. Optimal threshold levels for initial and nadir serum creatinine to predict final renal function were 145μmol/L and 62μmol/L, respectively. Similarly, poor corticomedullary differentiation and moderate-severe hydronephrosis on initial kidney ultrasound were significant indicators of poor renal prognosis. Although all patients with posterior urethral valves should be counselled on potential renal morbidity, children with risk factors warrant closer monitoring. / AFRIKAANSE OPSOMMING: DOELWITTE Die doel van hierdie studie was om langtermyn nierfunksie te bepaal in seuns wat gediagnoseer is met posterior uretrale kleppe by Tygerberg-kinderhospitaal. Die prognostiese waarde van sekere kliniese, biochemiese en radiologiese veranderlikes is ook ondersoek. STUDIE ONTWERP Retrospektiewe, beskrywende studie van seuns wat tussen 2001 en 2011 by Tygerberg-kinderhospitaal gepresenteer het met posterior uretrale kleppe. RESULTATE Tussen 2001 en 2011 is 47 gevalle van posterior uretrale kleppe gediagnoseer en behandel by ons instelling. Dertien pasiënte is uitgesluit van hierdie studie. Sewe (20,6%) is met voorgeboorte sonar gediagnoseer en 27 (79,4%) het ná geboorte gepresenteer. Die gemiddelde ouderdom by diagnose was 13,9 maande (mediaan 2; reeks 0-74 ). Urienweginfeksie was die mees algemene metode waarmee postnatale pasiënte gepresenteer het (51,9%). Die gemiddelde opvolgperiode was 54,2 maande (mediaan 47,5; reeks 12-133). Dertien seuns (38,2%) het chroniese nierversaking of eind-stadium nierversaking ontwikkel. Aanvanklike en nadir serumkreatinien, swak kortiko-medullêre differensiasie en matig-erge hidronefrose was beduidende voorspellers van finale nierfunksie (p<0,050). Pasiënt ouderdom met diagnose, tipe chirurgiese ingryping, verhoogde niereggogenisiteit, blaaswanddikte, vesikoureteriese refluks, blaasdisfunksie en aanvanklike of deurbraak urienweginfeksies het geen beduidende impak op toekomstige nierfunksie gehad nie. Seuns met 'n aanvanklike serumkreatinien ≥145μmol/L en 'n nadir serumkreatinien ≥62μmol/L het die grootste risiko om chroniese nierversaking te ontwikkel, soos bevestig met ‘n ROC-ontleding (AUC 0,8 en 0,9, onderskeidelik). GEVOLGTREKKING Meer as 'n derde van die pasiënte (38,2%) het chroniese nierversaking of eindstadium nierversaking ontwikkel. Ons data bevestig die prognostiese waarde van aanvanklike en nadir serumkreatinienvlakke. Die optimale drempelwaardes vir die aanvanklike en nadir serumkreatinien om finale nierfunksie te voorspel was 145μmol/L en 62μmol/L, onderskeidelik. Swak kortiko-medullêre differensiasie en matig-erge hidronefrose op die aanvanklike niersonar was ook beduidende aanwysers van toekomstige nierfunksie. Alhoewel alle pasiënte met posterior uretrale kleppe berading moet ontvang oor potensiële niermorbiditeit, regverdig seuns met risikofaktore noukeurige monitering.

Background: Primary urethral carcinoma is a very rare condition, and no large-scale experience with such cases has been published. Treatment will therefore have to follow rules established for the treatment of similar conditions. Patients: Six cases of primary urethral carcinoma (5 male, 1 female) who had been treated at our institution between 1995 and 1999 were retrospectively analyzed. In 3 male cases, a primary urothelial carcinoma of the distal urethra was treated by distal urethrectomy only. In 3 other cases with locally advanced tumors and/or lymph node metastases surgical treatment was followed by adjuvant cisplatinum-containing chemotherapy. Results: In the 3 cases with distal urethral carcinoma, partial urethrectomy with preservation of the penis resulted in cure, with a follow-up of 12–71 months. In the cases with advanced disease, adjuvant chemotherapy after surgery has resulted in complete remissions in all 3 cases, with a follow-up of 4–47 months at present. Conclusions: In localized, noninvasive carcinoma of the distal male urethra, partial urethrectomy seems adequate and the avoidance of penile amputation justified. In advanced cases, after local excision and lymphadenectomy adjuvant chemotherapy which by necessity must follow the guidelines established for the treatment of other urothelial or squamous cell malignancies seems to be beneficial. / Hintergrund: Das primäre Harnröhrenkarzinom ist eine sehr seltene Erkrankung, und in der Literatur gibt es keine prospektiven Serien mit größeren Fallzahlen. Die Behandlung wird sich daher an Erfahrungen orientieren müssen, die bei der Behandlung ähnlicher Krankheitsbilder gewonnen wurden. Patienten: Sechs Fälle von primärem Urethralkarzinom (5 Männer, 1 Frau), die zwischen 1995 und 1999 in unserer Klinik behandelt wurden, wurden retrospektiv analysiert. Bei 3 der männlichen Patienten lag ein primäres Urothelkarzinom der distalen Harnröhre vor, und es wurde eine Urethrateilresektion ohne adjuvante Therapie durchgeführt. In den 3 anderen Fällen mit lokal fortgeschrittenen Tumoren und/oder Lymphknotenbefall wurde nach operativer Behandlung eine adjuvante Cisplatin-haltige Chemotherapie durchgeführt. Ergebnisse: In allen 3 Fällen nach Urethrateilresektion wurde eine komplette Heilung bei einer Nachbeobachtung von 12–71 Monaten erzielt. Bei den fortgeschrittenen Fällen mit lymphogener Metastasierung wurde nach adjuvanter Chemotherapie in allen 3 Fällen eine komplette Remission bei einer Nachbeobachtung von bislang 4–47 Monaten erzielt. Schlußfolgerungen: Beim lokalisierten, nichtinvasiven distalen Urethralkarzinom des Mannes ist eine organerhaltende Strategie gerechtfertigt. In lokal fortgeschrittenen und/oder lymphogen metastasierten Fällen ist nach lokaler Exzision und Lymphadenektomie eine adjuvante Chemotherapie, die sich an den Erfahrungen der Behandlung von anderen Plattenepithel- und Urothelkarzinomen orientieren muß, sinnvoll und erfolgversprechend. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

Call number: LD2668 .T4 1961 A75

INTRODUÇÃO: O tratamento cirúrgico das estenoses uretrais com enxertos limita-se ao emprego de materiais orgânicos, mais freqüentemente autoenxertos. O sucesso no uso de biomateriais sintéticos em diferentes áreas da medicina motivou a pesquisa desses materiais na reconstrução uretral. A informação de que o uso de prótese mamária de silicone recoberta com espuma de poliuretano revelou menor retração cicatricial que as próteses convencionais e o fato desses polímeros já serem empregados como elastômero na confecção de cateteres urinários, levou à escolha deste material para estudo. MÉTODOS: Foi realizada a ressecção de segmento dorsal da uretra anterior de 20 coelhos machos NZW. O defeito uretral foi tratado com o implante no leito uretral dorsal de uma placa não tubularizada de silicone, revestida externamente com espuma de poliuretano (Si-Pu). Como controle foi confeccionado o grupo Sham (GS) com 12 animais. Este grupo foi submetido à uretrotomia dorsal longitudinal e uretrorrafia, sem qualquer tipo de implante. As análises foram feitas com 2, 4, 8 e 24 semanas após a cirurgia. Analisaram-se alterações da circunferência da uretra e complicações cirúrgicas. Fez-se estudo histológico com coloração de Tricrômico de Mason, Hematoxilina-eosina e Picrosírirus red. Foram avaliadas: intensidade e características da resposta inflamatória, espessura da parede da uretra (edema) e concentração do colágeno na submucosa da uretra. Foi realizada análise microbiológica e pesquisa de incrustação do implante por termogravimetria. Os achados foram comparados com os dados de três coelhos que não sofreram qualquer intervenção. RESULTADOS: Não foram encontradas fístulas, estenoses, obstrução, calcificação, retração cicatricial ou deiscências. Ocorreu expulsão do implante em 1/5 dos animais após 4 semanas, em 2/5 com 8 semanas e em 3/5 com 24 semanas. Não houve redução da circunferência da uretra na comparação entre os grupos Experimental (GE) e GS, exceto para o intervalo de 8 semanas. Ocorreu infecção do sítio cirúrgico em 11 de 12 animais do GS e em 13 de 20 animais do GE. As bactéria mais comumente encontradas foram Staphylococcus DNAse negativa (9/32) e Escherichia coli (5/32). A presença de infecção por Enterobacter cloacae foi acompanhada de menor ganho de peso pelos animais (P=0,02), fato não observado na infecção com outras bactérias. A circunferência uretral foi maior (P=0,006) na vigência de infecção por Staphylococcus do que nas amostras estéreis. A histologia do GE mostrou processo inflamatório severo e substituição das fibras musculares da lâmina própria por colágeno com regressão do edema e das células inflamatórias, tardiamente. No GS ocorreu deposição tardia de colágeno e inflamação leve, porém constante. Houve re-epitelização da uretra nos dois grupos. A concentração de colágeno na área manipulada foi maior apenas na comparação entre os GE e GS com 24 semanas (P<0,001). O edema da parede uretral foi maior no GE que no GS nos intervalos de 2 semanas e de 4 semanas com P<0,001, e após 8 semanas com P<0,05. Após 24 semanas não se verificou diferença entre as espessuras da submucosa. Na análise descritiva da termogravimetria observou-se incrustação de material orgânico no implante, que não se mostrou significante estatisticamente na análise quantitativa de perda de massa. A incrustação de material inorgânico ao implante foi desprezível. CONCLUSÕES: O uso do Si-Pu leva à formação de cápsula colágena que permite a re-epitelização da uretra sem ocasionar retração local, funcionando como um biomolde, porém a expulsão do implante limita seu uso / BACKGROUND: Actually, the treatment of urethral stenosis employs biological grafts, usually autologous grafts. The success with synthetic biomaterials in others medical specialtys motivated the search of these materials in urethral reconstruction. The knowledge about the silicone mamarian prosthesis covered with polyurethane foam reduces capsular contracture in breast implants and because these polymers are already used in the urinary tract like catheters make the choice for these materials. METHODS: The resection of dorsal segment of anterior urethra of 20 male rabbits NZW was carried through. The urethral defect was treated with the on lay dorsal graft in urethra, compound a silicone not tabularized, coated with polyurethane foam in one face (Si-Pu). The control group (sham) was confectioned with 12 animals was submitted to longitudinal dorsal uretrotomy and suture, without any type of implantation (SG). The analyses intervals were 2, 4, 8 and 24 weeks after surgery. The circumference of urethra and surgical complications had been analyzed. Material for histological evaluation was stained with Massons thrichrome, hematoxylin and eosin and Picrosirius red. Intensity and characteristics of the inflammatory response, thickness of the urethra (oedema) and concentration of the collagen in the submucosa had been evaluated. Still, was performed microbiological analysis and research of implants incrustation with thermogravimetry. The findings had been compared with the data of three rabbits that had not suffered any intervention. RESULTS: The morfological analysis not founded fistula, obstruction, stenosis, cicatricial retraction, calcification and dehiscence. The graft was extruded after 4 weeks in 1/5 of the animals, in 2/5 after 8 weeks and after 24 weeks, 3/5 of the animals had failure of union with the surrounding tissue. Except for the interval of 8 weeks, It did not have urethral circumference reduction in the comparison between groups, Experimental (EG) and SG. Infection of the surgical place occurred in 11 of 12 animals of the GS and in 13 of 20 animals of EG. Staphylococcus DNAse-negative and Escherichia coli were the most frequent bacterium founded, and occurred in 9/32 and 5/32, respectively. The infection with Enterobacter cloacae was associated to lesser weight gain for the animals (P=0,02), fact not observed in infection with other bacteria. The Staphylococcus infection was associated to larger urethral circumference (P=0,006), when compared to sterile samples. The EG histological analysis showed early severe inflammatory process and substitution of smooth muscle fibers for collagen and regression of edema and inflammatory cells decrease laterly. Occurred delayed deposition of collagen and slight inflammation in the SG, however this process was constant. Was observed urothelial reepithelialization in both groups. The collagen concentration in urethral wall at surgical site was larger in EG with 24 weeks when compared to SG at same time (P< 0.001). There was significantly less urethral wall oedema in SG at 2 weeks, at 4 weeks (P< 0.001) and after 8 weeks (P< 0,05) than EG at the same time. After 24 weeks no difference was verified in submucosa thickness between the groups. The descriptive thermogravimetric analysis showed graft incrustation with organic material, however without statistic significance in quantitative analysis of mass loss. The inorganic graft incrustation was negligible. CONCLUSIONS: The use of Si-Pu implants in urethra originated a fibrous collagen capsule that allows reepitelialization without local contracture, like a biological skeleton. Nevertheless, grafts extrusion limits their clinical employment

Orientador: João Luiz Amaro / Banca: José Carlos Souza Trindade Filho / Banca: Cássio Luiz Z. Riccetto / Banca: Silvio Tucci Junior / Banca: Miguel Zeratti Filho / Resumo: A estenose uretral complexa, frequentemente, requer tecidos extragenitais para seu adequado tratamento. Estudos recentes têm sugerido, nestes casos, a utilização de um novo biomaterial à base de colágeno acelular derivado da submucosa intestinal suína (SIS). O objetivo deste estudo foi comparar os resultados da matriz de colágeno acelular (SIS) em uma ou quatro camadas à mucosa oral na substituição parcial da uretra em coelhos. Material e Métodos: Realizou-se um estudo prospectivo e randomizado utilizando-se 36 coelhos machos da raça North Folk divididos em 3 grupos. Os animais foram submetidos à ressecção padronizada da uretra ventral (segmento de 0,5 x 1 cm) que foi substituído por um enxerto tipo ilha de SIS com 1 camada no Grupo I (G1), SIS com 4 camadas no Grupo II (G2) e mucosa oral no Grupo III (G3). Nenhuma derivação urinária foi utilizada no pós-operatório. A uretrografia foi realizada no pré-operatório e antes do sacrifício. Os enxertos obtidos a partir da uretra regenerada foram avaliados 12 semanas após o implante por meio de exames histológicos de rotina. A retração do enxerto foi caracterizada objetivamente pelo cálculo matemático da área e pela análise computadorizada utilizando-se o software Scion Image®. A quantificação do colágeno foi obtida Resumo pela análise da coloração pelo Picrosirius red sob luz polarizada que permitiu a diferenciação das fibras de colágeno tipos I e III. Resultados: A uretrografia confirmou a manutenção de um calibre uretral adequado sem sinais de estenose. Fístulas uretrais foram diagnosticadas por meio de exame radiológico em 8,3% dos casos nos diferentes grupos (1 animal por grupo). A análise da área do enxerto pós-sacrifício pelos métodos matemático e computadorizado foi significativamente... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Several urethral conditions often require nongenital tissues for reconstruction. One collagen-based biomaterial that has recently emerged is small intestinal submucosa (SIS). The aim of our study was to compare the results between SIS and oral mucosa membrane in the partial substitution of the urethra in rabbits. Material and Methods: A prospective and randomized study was performed using 36 North Folk male rabbits divided into 3 equal groups. The animals were submitted to a ventral urethral defect (resection of 0,5 x 1 cm segment of the urethra) that was replaced by a patch graft of 1 layer SIS in group I (G1), 4 layers SIS in Group II (G2) and buccal mucosa in Group III (G3). No urethral catheter was left behind. Urethrography was performed pre-operatively and before sacrificing. The grafts of regenerated urethras were harvested at 12 weeks after implantation. The urethra was excised and evaluated by Hematoxylin and eosin stained sections. The patch retraction was objectively measured using mathematic calculation and Scion Image® computer analysis. The quantification of collagen was obtained by Picrosirius red analysis under polarized light. This technique allowed the differentiation of collagen fibers types I and III. Urethrograms confirmed the maintenance of a wide urethral caliber without any signs of strictures. Urethral fistulae was diagnosed by radiology in 8,3% of all groups (1 animal each group). Average graft shrinkage evaluated by computer analysis was significantly lower in G2 (p<0.05). The intensity of chronic inflammation, neovascularization, fibrosis and epithelium regeneration was similar among the three groups (p>0.05). The analysis of type III:I collagen index was higher in the animals of group II. Conclusions: The patch area analyzed by computer or mathematic method was smaller in group III (buccal mucosa) which showed a high percentage of retraction. Histological parameters were similar among the three groups. / Doutor

INTRODUÇÃO: O tratamento cirúrgico das estenoses uretrais com enxertos limita-se ao emprego de materiais orgânicos, mais freqüentemente autoenxertos. O sucesso no uso de biomateriais sintéticos em diferentes áreas da medicina motivou a pesquisa desses materiais na reconstrução uretral. A informação de que o uso de prótese mamária de silicone recoberta com espuma de poliuretano revelou menor retração cicatricial que as próteses convencionais e o fato desses polímeros já serem empregados como elastômero na confecção de cateteres urinários, levou à escolha deste material para estudo. MÉTODOS: Foi realizada a ressecção de segmento dorsal da uretra anterior de 20 coelhos machos NZW. O defeito uretral foi tratado com o implante no leito uretral dorsal de uma placa não tubularizada de silicone, revestida externamente com espuma de poliuretano (Si-Pu). Como controle foi confeccionado o grupo Sham (GS) com 12 animais. Este grupo foi submetido à uretrotomia dorsal longitudinal e uretrorrafia, sem qualquer tipo de implante. As análises foram feitas com 2, 4, 8 e 24 semanas após a cirurgia. Analisaram-se alterações da circunferência da uretra e complicações cirúrgicas. Fez-se estudo histológico com coloração de Tricrômico de Mason, Hematoxilina-eosina e Picrosírirus red. Foram avaliadas: intensidade e características da resposta inflamatória, espessura da parede da uretra (edema) e concentração do colágeno na submucosa da uretra. Foi realizada análise microbiológica e pesquisa de incrustação do implante por termogravimetria. Os achados foram comparados com os dados de três coelhos que não sofreram qualquer intervenção. RESULTADOS: Não foram encontradas fístulas, estenoses, obstrução, calcificação, retração cicatricial ou deiscências. Ocorreu expulsão do implante em 1/5 dos animais após 4 semanas, em 2/5 com 8 semanas e em 3/5 com 24 semanas. Não houve redução da circunferência da uretra na comparação entre os grupos Experimental (GE) e GS, exceto para o intervalo de 8 semanas. Ocorreu infecção do sítio cirúrgico em 11 de 12 animais do GS e em 13 de 20 animais do GE. As bactéria mais comumente encontradas foram Staphylococcus DNAse negativa (9/32) e Escherichia coli (5/32). A presença de infecção por Enterobacter cloacae foi acompanhada de menor ganho de peso pelos animais (P=0,02), fato não observado na infecção com outras bactérias. A circunferência uretral foi maior (P=0,006) na vigência de infecção por Staphylococcus do que nas amostras estéreis. A histologia do GE mostrou processo inflamatório severo e substituição das fibras musculares da lâmina própria por colágeno com regressão do edema e das células inflamatórias, tardiamente. No GS ocorreu deposição tardia de colágeno e inflamação leve, porém constante. Houve re-epitelização da uretra nos dois grupos. A concentração de colágeno na área manipulada foi maior apenas na comparação entre os GE e GS com 24 semanas (P<0,001). O edema da parede uretral foi maior no GE que no GS nos intervalos de 2 semanas e de 4 semanas com P<0,001, e após 8 semanas com P<0,05. Após 24 semanas não se verificou diferença entre as espessuras da submucosa. Na análise descritiva da termogravimetria observou-se incrustação de material orgânico no implante, que não se mostrou significante estatisticamente na análise quantitativa de perda de massa. A incrustação de material inorgânico ao implante foi desprezível. CONCLUSÕES: O uso do Si-Pu leva à formação de cápsula colágena que permite a re-epitelização da uretra sem ocasionar retração local, funcionando como um biomolde, porém a expulsão do implante limita seu uso / BACKGROUND: Actually, the treatment of urethral stenosis employs biological grafts, usually autologous grafts. The success with synthetic biomaterials in others medical specialtys motivated the search of these materials in urethral reconstruction. The knowledge about the silicone mamarian prosthesis covered with polyurethane foam reduces capsular contracture in breast implants and because these polymers are already used in the urinary tract like catheters make the choice for these materials. METHODS: The resection of dorsal segment of anterior urethra of 20 male rabbits NZW was carried through. The urethral defect was treated with the on lay dorsal graft in urethra, compound a silicone not tabularized, coated with polyurethane foam in one face (Si-Pu). The control group (sham) was confectioned with 12 animals was submitted to longitudinal dorsal uretrotomy and suture, without any type of implantation (SG). The analyses intervals were 2, 4, 8 and 24 weeks after surgery. The circumference of urethra and surgical complications had been analyzed. Material for histological evaluation was stained with Massons thrichrome, hematoxylin and eosin and Picrosirius red. Intensity and characteristics of the inflammatory response, thickness of the urethra (oedema) and concentration of the collagen in the submucosa had been evaluated. Still, was performed microbiological analysis and research of implants incrustation with thermogravimetry. The findings had been compared with the data of three rabbits that had not suffered any intervention. RESULTS: The morfological analysis not founded fistula, obstruction, stenosis, cicatricial retraction, calcification and dehiscence. The graft was extruded after 4 weeks in 1/5 of the animals, in 2/5 after 8 weeks and after 24 weeks, 3/5 of the animals had failure of union with the surrounding tissue. Except for the interval of 8 weeks, It did not have urethral circumference reduction in the comparison between groups, Experimental (EG) and SG. Infection of the surgical place occurred in 11 of 12 animals of the GS and in 13 of 20 animals of EG. Staphylococcus DNAse-negative and Escherichia coli were the most frequent bacterium founded, and occurred in 9/32 and 5/32, respectively. The infection with Enterobacter cloacae was associated to lesser weight gain for the animals (P=0,02), fact not observed in infection with other bacteria. The Staphylococcus infection was associated to larger urethral circumference (P=0,006), when compared to sterile samples. The EG histological analysis showed early severe inflammatory process and substitution of smooth muscle fibers for collagen and regression of edema and inflammatory cells decrease laterly. Occurred delayed deposition of collagen and slight inflammation in the SG, however this process was constant. Was observed urothelial reepithelialization in both groups. The collagen concentration in urethral wall at surgical site was larger in EG with 24 weeks when compared to SG at same time (P< 0.001). There was significantly less urethral wall oedema in SG at 2 weeks, at 4 weeks (P< 0.001) and after 8 weeks (P< 0,05) than EG at the same time. After 24 weeks no difference was verified in submucosa thickness between the groups. The descriptive thermogravimetric analysis showed graft incrustation with organic material, however without statistic significance in quantitative analysis of mass loss. The inorganic graft incrustation was negligible. CONCLUSIONS: The use of Si-Pu implants in urethra originated a fibrous collagen capsule that allows reepitelialization without local contracture, like a biological skeleton. Nevertheless, grafts extrusion limits their clinical employment

This study compared the effects of urinary diversion by tube cystostomy catheterization, urethral catheterization and tube cystostomy and urethral catheterization on healing urethral anastomoses in the canine urethra. Fifteen intact, mature males were divided into three groups of five dogs. Urodynamic studies were performed under halothane anesthesia preoperatively and at ten weeks postoperatively. Urethral anastomosis was performed in all dogs over a urethral catheter with 4-0 polyglyconate. Group U dogs (n=5) received transurethral catheters. Group C dogs (n=5) received tube cystostomy catheters, and Group B dogs (n=5 ) had both a transurethral catheter and a cystostomy tube placed. All dogs had catheters maintained with a closed urine collection system for seven days. Dogs were observed for ten weeks following surgery, and urinalysis and urine cultures were performed on weeks 1, 4, and 8. Preoperative evaluations were repeated ten weeks postoperatively just prior to termination of the study. Radiographic and histopathologic evaluation of the urethral specimen was performed. No significant differences among the groups were noted after the second postoperative week when comparing observation scores for urination and posturing. Measurements made on in-vivo and in-vitro urethrographic studies revealed less luminal reduction at the anastomotic site in Group C when compared to Groups B and U. Results of this study indicated that urinary diversion by tube cystostomy will minimize the percent luminal diameter reduction (PLDR) when compared to transurethral catheterization alone and tube cystostomy combined with transurethral catheterization. The author recommends tube cystostomy be considered for urinary diversion following primary closure of urethral defects due to the ease of maintenance and increased patient tolerance of the technique. / Master of Science

Background: Primary urethral carcinoma is a very rare condition, and no large-scale experience with such cases has been published. Treatment will therefore have to follow rules established for the treatment of similar conditions. Patients: Six cases of primary urethral carcinoma (5 male, 1 female) who had been treated at our institution between 1995 and 1999 were retrospectively analyzed. In 3 male cases, a primary urothelial carcinoma of the distal urethra was treated by distal urethrectomy only. In 3 other cases with locally advanced tumors and/or lymph node metastases surgical treatment was followed by adjuvant cisplatinum-containing chemotherapy. Results: In the 3 cases with distal urethral carcinoma, partial urethrectomy with preservation of the penis resulted in cure, with a follow-up of 12–71 months. In the cases with advanced disease, adjuvant chemotherapy after surgery has resulted in complete remissions in all 3 cases, with a follow-up of 4–47 months at present. Conclusions: In localized, noninvasive carcinoma of the distal male urethra, partial urethrectomy seems adequate and the avoidance of penile amputation justified. In advanced cases, after local excision and lymphadenectomy adjuvant chemotherapy which by necessity must follow the guidelines established for the treatment of other urothelial or squamous cell malignancies seems to be beneficial. / Hintergrund: Das primäre Harnröhrenkarzinom ist eine sehr seltene Erkrankung, und in der Literatur gibt es keine prospektiven Serien mit größeren Fallzahlen. Die Behandlung wird sich daher an Erfahrungen orientieren müssen, die bei der Behandlung ähnlicher Krankheitsbilder gewonnen wurden. Patienten: Sechs Fälle von primärem Urethralkarzinom (5 Männer, 1 Frau), die zwischen 1995 und 1999 in unserer Klinik behandelt wurden, wurden retrospektiv analysiert. Bei 3 der männlichen Patienten lag ein primäres Urothelkarzinom der distalen Harnröhre vor, und es wurde eine Urethrateilresektion ohne adjuvante Therapie durchgeführt. In den 3 anderen Fällen mit lokal fortgeschrittenen Tumoren und/oder Lymphknotenbefall wurde nach operativer Behandlung eine adjuvante Cisplatin-haltige Chemotherapie durchgeführt. Ergebnisse: In allen 3 Fällen nach Urethrateilresektion wurde eine komplette Heilung bei einer Nachbeobachtung von 12–71 Monaten erzielt. Bei den fortgeschrittenen Fällen mit lymphogener Metastasierung wurde nach adjuvanter Chemotherapie in allen 3 Fällen eine komplette Remission bei einer Nachbeobachtung von bislang 4–47 Monaten erzielt. Schlußfolgerungen: Beim lokalisierten, nichtinvasiven distalen Urethralkarzinom des Mannes ist eine organerhaltende Strategie gerechtfertigt. In lokal fortgeschrittenen und/oder lymphogen metastasierten Fällen ist nach lokaler Exzision und Lymphadenektomie eine adjuvante Chemotherapie, die sich an den Erfahrungen der Behandlung von anderen Plattenepithel- und Urothelkarzinomen orientieren muß, sinnvoll und erfolgversprechend. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Thesis (doctoral)--Lund University, 1998. / Added t.p. with thesis statement inserted. Includes bibliographical references.