It is important to recognize that this staging system describes each individual stricture and not the entire urethra. For example, a patient can have multiple, different stage strictures in different locations of the urethra. Future directions are to expand the system to include the entire urethra with a system that might involve something analogous to the TNM staging system used in oncology.11 Protein Tyrosine Kinase inhibitor Findings such as degree of spongiofibrosis, number and length of

strictures, and symptoms will be evaluated for inclusion in the more complex system. Future research may include examining the correlation between flow rates and stages to determine whether such exclusion limits the use of the staging system. We anticipate additional development of the staging system to better Vorinostat cost aid stricture specialists in identifying what the most efficacious procedure is for particular symptoms. We describe a new staging system that is simple and easy to use, and has excellent intra-observer and interobserver reliability. Reliability for stage 3 and 4 strictures, which usually require treatment, was nearly unanimous. This staging system may help guide clinical decision making for general urologists confronted with a urethral stricture, and provide a common lexicon for clinical and academic discussion of strictures. For stricture specialists, future directions are to provide a staging

modification that may include stricture location, number and length analogous to the TNM staging system. “
“Moderate to severe lower urinary tract symptoms secondary to benign prostatic hyperplasia affect approximately a quarter of men older than 50 years. The mainstays of treatment after behavioral changes include medications such as alpha-blockers, 5α-reductase inhibitors, antimuscarinic agents or phosphodiesterase type 5 inhibitors either as monotherapy or some form of

combination therapy. In the case of medical therapy for LUTS secondary to BPH symptom improvements must be weighed against potentially bothersome side effects such as dizziness or erectile dysfunction, depending on the specific agent. Up to 25% of patients will discontinue treatment Mephenoxalone prematurely, a fact that can be partially attributed to the side effects and inadequate symptom relief.1 When medical therapy does not achieve the desired therapeutic goals and/or results in intolerable adverse events, minimally invasive surgical therapies, ie in office or surgical therapy by either electrosurgical or laser, are reasonable therapeutic options. Laser therapy in the office has worked on the 2 basic principles of either laser vaporization or coagulation.2 Laser vaporization is the application of high level energy to prostatic tissue to desiccate and remove tissue in an attempt to result in a “TURP-like defect.”3 This technology typically requires special high energy electrical outlets and general or spinal anesthesia and, therefore, has not had a widespread uptake or prominent role in the office setting.