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Urethral Stricture in the Spinal Cord Injured Patient—What Are the Unique Considerations?

  • Neurogenic Bladder (C Powell, Section Editor)
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Abstract

Urethral stricture disease in spinal cord injured (SCI) patients presents a challenging clinical scenario. Determining the appropriate course of management requires consideration of the unique issues of these patients, and unfortunately there is sparse published literature. The goals of treatment should be determined before the treatment modality is chosen. Endoscopic management options such as direct visual internal urethrotomy (DVIU), although less invasive, have a very high recurrence rate compared to urethral reconstruction or urinary diversion. Catheterization, whether clean intermittent catheterization (CIC), suprapubic catheter (SPC), or indwelling catheter (IDC), is often problematic. Urethral strictures in SCI patients are usually best treated with urethral reconstruction or urinary diversion. However, urethral reconstruction is associated with a significant rate of reoperation and subsequent necessity for urinary diversion; therefore, urinary diversion may be most appropriate in many patients. Detailed discussion and consideration of unique patient factors as well as patient preferences are important components of preoperative counseling.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Singh R, Rohilla RK, Sangwan K, Siwach R, Magu NK, Sangwan SS. Bladder management methods and urological complications in spinal cord injury patients. Indian J Orthop. 2011;45(2):141–7. doi:10.4103/0019-5413.77134. This study assessed the incidence of urinary tract infections and other urological complications in 545 SCI patients according to bladder management subgroups.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Secrest CL, Madjar S, Sharma AK, Covington-Nichols C. Urethral reconstruction in spinal cord injury patients. J Urol. 2003;170(4 Pt 1):1217–21. doi:10.1097/01.ju.0000087614.19425.df. discussion 21. This retrospective review evaluated the role of urethral reconstruction in patients with SCI and neurological disease, with 64.7% rate of eventual urinary diversion and 3.3 years mean time to urinary diversion.

    Article  PubMed  Google Scholar 

  3. Pansadoro V, Emiliozzi P. Internal urethrotomy in the management of anterior urethral strictures: long-term followup. J Urol. 1996;156(1):73–5.

    Article  CAS  PubMed  Google Scholar 

  4. Santucci R, Eisenberg L. Urethrotomy has a much lower success rate than previously reported. J Urol. 2010;183(5):1859–62. doi:10.1016/j.juro.2010.01.020.

    Article  PubMed  Google Scholar 

  5. Steenkamp JW, Heyns CF, de Kock ML. Internal urethrotomy versus dilation as treatment for male urethral strictures: a prospective, randomized comparison. J Urol. 1997;157(1):98–101.

    Article  CAS  PubMed  Google Scholar 

  6. Heyns CF, Steenkamp JW, De Kock ML, Whitaker P. Treatment of male urethral strictures: Is repeated dilation or internal urethrotomy useful? J Urol. 1998;160(2):356–8.

    Article  CAS  PubMed  Google Scholar 

  7. Vaidyanathan S, Hughes PL, Singh G, Soni BM, Watt JW, Darroch J, et al. Location of urethral arteries by colour Doppler ultrasound. Spinal Cord. 2005;43(2):130–2. doi:10.1038/sj.sc.3101686.

    Article  CAS  PubMed  Google Scholar 

  8. Perkash I. Laser sphincterotomy and ablation of the prostate using a sapphire chisel contact tip firing neodymium:YAG laser. J Urol. 1994;152(6 Pt 1):2020–4.

    CAS  PubMed  Google Scholar 

  9. Liu Q, Ma W, Li X, Zhang W, Cao W, Zhou Q, et al. Holmium laser endourethrotomy for the treatment of long-segment urethral strictures: a retrospective study of 190 patients. Urol J. 2014;11(1):1264–70.

    PubMed  Google Scholar 

  10. Jain SK, Kaza RC, Singh BK. Evaluation of holmium laser versus cold knife in optical internal urethrotomy for the management of short segment urethral stricture. Urol Ann. 2014;6(4):328–33. doi:10.4103/0974-7796.140997.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Morey AF, Watkin N, Shenfeld O, Eltahawy E, Giudice C. SIU/ICUD consultation on urethral strictures: anterior urethra—primary anastomosis. Urology. 2014;83(3 Suppl):S23–6. doi:10.1016/j.urology.2013.11.007. This literature search on bulbar urethral strictures treated using excision and primary anastomosis (EPA) reported high success 93.8% and low complication rate <5%; therefore, a recommendation was made that EPA be performed for short isolated bulbar strictures when expected success rates of other procedures are <90%.

    Article  PubMed  Google Scholar 

  12. Warner JN, Wisenbaugh ES, Martins FE. Bulbar urethral stricture: how to optimise the use of buccal mucosal grafts. Arab J Urol. 2016;14(2):78–83. doi:10.1016/j.aju.2016.01.002.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Joshi P, Kaya C, Kulkarni S. Approach to bulbar urethral strictures: which technique and when? Turk J Urol. 2016;42(2):53–9. doi:10.5152/tud.2016.12989.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gil-Vernet A, Arango O, Gil-Vernet JM, Borau A. Total anterior urethral reconstruction with the ‘BAES flap’ in a spinal cord-injured patient. Spinal Cord. 2001;39(5):290–2. doi:10.1038/sj.sc.3101150.

    Article  CAS  PubMed  Google Scholar 

  15. Sorokin I, De E. Options for independent bladder management in patients with spinal cord injury and hand function prohibiting intermittent catheterization. Neurourol Urodyn. 2015;34(2):167–76. doi:10.1002/nau.22516. This is a literature review examining bladder management options (that is, external sphincterotomy, suprapubic tube, ileal conduit, and ileovesicostomy) for spinal cord injured patients unable to perform CIC.

    Article  PubMed  Google Scholar 

  16. Herschorn S, Thijssen AJ, Radomski SB. Experience with the hemi-Kock ileocystoplasty with a continent abdominal stoma. J Urol. 1993;149(5):998–1001. This study describes experience with the hemi-Kock ileocystoplasty with a continent abdominal stoma as an alternative to an IDC or supravesical diversion in 18 patients with end-stage urethra or who could not perform CIC.

    CAS  PubMed  Google Scholar 

  17. Chao R, Mayo ME, Bejany DE, Bavendam T. Bladder neck closure with continent augmentation or suprapubic catheter in patients with neurogenic bladders. J Am Paraplegia Soc. 1993;16(1):18–22.

    Article  CAS  PubMed  Google Scholar 

  18. Krebs J, Wollner J, Pannek J. Urethral strictures in men with neurogenic lower urinary tract dysfunction using intermittent catheterization for bladder evacuation. Spinal Cord. 2015;53(4):310–3. doi:10.1038/sc.2015.15. This retrospective study of patients with neurogenic lower urinary tracts showed high urethral stricture rates in patients performing CIC versus other bladder evacuation methods; and assessed surgical intervention and stricture recurrence rates.

    Article  CAS  PubMed  Google Scholar 

  19. Ku JH, Jung TY, Lee JK, Park WH, Shim HB. Influence of bladder management on epididymo-orchitis in patients with spinal cord injury: clean intermittent catheterization is a risk factor for epididymo-orchitis. Spinal Cord. 2006;44(3):165–9. doi:10.1038/sj.sc.3101825.

    Article  CAS  PubMed  Google Scholar 

  20. Perrouin-Verbe B, Labat JJ, Richard I, Mauduyt de la Greve I, Buzelin JM, Mathe JF. Clean intermittent catheterisation from the acute period in spinal cord injury patients. Long term evaluation of urethral and genital tolerance. Paraplegia. 1995;33(11):619–24. doi:10.1038/sc.1995.131.

    Article  CAS  PubMed  Google Scholar 

  21. Kuhn W, Rist M, Zaech GA. Intermittent urethral self-catheterisation: long term results (bacteriological evolution, continence, acceptance, complications). Paraplegia. 1991;29(4):222–32. doi:10.1038/sc.1991.33.

    Article  CAS  PubMed  Google Scholar 

  22. Vaidyanathan S, Soni BM, Dundas S, Krishnan KR. Urethral cytology in spinal cord injury patients performing intermittent catheterisation. Paraplegia. 1994;32(7):493–500. doi:10.1038/sc.1994.78.

    Article  CAS  PubMed  Google Scholar 

  23. Hollingsworth JM, Rogers MA, Krein SL, Hickner A, Kuhn L, Cheng A, et al. Determining the noninfectious complications of indwelling urethral catheters: a systematic review and meta-analysis. Ann Intern Med. 2013;159(6):401–10. doi:10.7326/0003-4819-159-6-201309170-00006. This systematic review and meta-analysis examined IDC-associated non-infectious complications, which are common.

    Article  PubMed  Google Scholar 

  24. Vaidyanathan S, Singh G, Soni BM, Hughes PL, Mansour P, Oo T, et al. Do spinal cord injury patients always get the best treatment for neuropathic bladder after discharge from regional spinal injuries centre? Spinal Cord. 2004;42(8):438–42. doi:10.1038/sj.sc.3101576.

    Article  CAS  PubMed  Google Scholar 

  25. Vaidyanathan S, Soni BM, Hughes PL, Singh G. Use of open-ended Foley catheter to treat profuse urine leakage around suprapubic catheter in a female patient with spina bifida who had undergone closure of urethra and suprapubic cystostomy: a case report. Cases J. 2009;2:6851. doi:10.4076/1757-1626-2-6851.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Adeyemo B, Makovitch S, Foo D. A peculiar complication of suprapubic catheterization: recurrent ureteral obstruction and hydronephrosis. J Spinal Cord Med. 2013;36(2):166–9. doi:10.1179/2045772312Y.0000000080.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Schaafsma RJ, Delaere KP, Theunissen PH. Squamous cell carcinoma of suprapubic cystostomy tract without bladder involvement. Spinal Cord. 1999;37(5):373–4.

    Article  CAS  PubMed  Google Scholar 

  28. Wilson TS, Lemack GE, Dmochowski RR. UroLume stents: lessons learned. J Urol. 2002;167(6):2477–80.

    Article  PubMed  Google Scholar 

  29. Welk B, Fuller A, Razvi H, Denstedt J. Renal stone disease in spinal-cord-injured patients. J Endourol. 2012;26(8):954–9. doi:10.1089/end.2012.0063.

    Article  PubMed  Google Scholar 

  30. Groen J, Pannek J, Castro Diaz D, Del Popolo G, Gross T, Hamid R, et al. Summary of European Association of Urology (EAU) Guidelines on Neuro-Urology. Eur Urol. 2016;69(2):324–33. doi:10.1016/j.eururo.2015.07.071.

    Article  PubMed  Google Scholar 

  31. Klausner AP, Steers WD. The neurogenic bladder: an update with management strategies for primary care physicians. Med Clin N Am. 2011;95(1):111–20. doi:10.1016/j.mcna.2010.08.027.

    Article  PubMed  Google Scholar 

  32. Shingleton WB, Bodner DR. The development of urologic complications in relationship to bladder pressure in spinal cord injured patients. J Am Paraplegia Soc. 1993;16(1):14–7.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Genitourinary Reconstructive Surgery Fellow, Eastern Virginia Medical School, 700 W. Olney Rd, Norfolk, VA, 23507, USA

    Amanda S. Chung, Oscar A. Suarez & Kurt A. McCammon

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  1. Amanda S. Chung
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  2. Oscar A. Suarez
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  3. Kurt A. McCammon
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Correspondence to Kurt A. McCammon.

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Drs Chung, Suarez, and McCammon have no conflicts of interests to declare.

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This article does not contain any studies with human or animal subjects performed by the author.

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This article is part of the Topical Collection on Neurogenic Bladder

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Chung, A.S., Suarez, O.A. & McCammon, K.A. Urethral Stricture in the Spinal Cord Injured Patient—What Are the Unique Considerations?. Curr Bladder Dysfunct Rep 11, 373–378 (2016). https://doi.org/10.1007/s11884-016-0385-0

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