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Patrick Mershon J, Bennett J, Murtha M, Goodstein TA, Posid T, Johnsen N, Charles Osterberg E, Cohen AJ, Heh V, Murphy GP, Baradaran N. Early Post-Operative Events After Urethroplasty in Obese Patients: A Multi-Institutional Retrospective Series. Urology 2024:S0090-4295(24)00355-8. [PMID: 38754790 DOI: 10.1016/j.urology.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/29/2024] [Accepted: 05/03/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To compare early urethroplasty outcomes in non-obese, obese and morbidly obese patients undergoing urethroplasty for urethral stricture disease. The impact of obesity on outcomes is poorly understood but will be increasingly important as obesity continues to rise. METHODS Patients underwent urethroplasty at one of the 5 institutions between January 2016 and December 2020. Obese (BMI 30-39.9, n = 72) and morbidly obese (BMI >40, n = 49) patients were compared to normal weight (BMI <25, n = 29) and overweight (BMI 25-29.9, n = 51) patients. Demographics, comorbidities, and stricture characteristics were collected. Outcomes including complications, recurrence, and secondary interventions were compared using univariate and multivariate analysis. RESULTS Two hundred and one patients (Mean BMI 34.1, Range 18.4-65.2) with mean age 52.2 years (SD=17.2) were analyzed. Median follow-up time was 3.71 months. Obese patients were younger (P = .008), had more anterior (P <.001), iatrogenic and LS-associated strictures (P = .036). Sixty-day complication rate was 26.3% with no differences between cohorts (P = .788). Around 9.5% of patients had extravasation at catheter removal, 18.9% reported stricture recurrence, and 7.4% required additional interventions. Obese patients had greater estimated blood loss (P = .001) and length of stay (P = .001). On multivariate analysis, smoking associated with contrast leak (OR 7.176, 95% CI 1.13-45.5) but not recurrence or need for intervention (P = .155, .927). CONCLUSION Obese patients in our cohort had more anterior, iatrogenic, and LS-related strictures. However, obesity is not associated with complications, contrast leak, secondary interventions, or recurrence. Obese had higher blood loss and length of stay. Urethroplasty is safe and effective in obese patients.
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Affiliation(s)
- J Patrick Mershon
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Janine Bennett
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Matthew Murtha
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Taylor A Goodstein
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Tasha Posid
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Niels Johnsen
- Department of Urology, Vanderbilt University, Nashville, TN
| | - E Charles Osterberg
- Department of Urology, University of Texas at Austin Dell Medical School, Austin, TX
| | - Andrew J Cohen
- Department of Urology, Johns Hopkins University, Baltimore, MD
| | - Victor Heh
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Greg P Murphy
- Department of Urology, Washington University of St. Louis, St. Louis, MO
| | - Nima Baradaran
- Department of Urology, Eastern Virginia Medical School, Norfolk, VA
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Tokuc E, Eksi M, Kayar R, Demir S, Topaktas R, Bastug Y, Akyuz M, Ozturk M. Inflammation indexes and machine-learning algorithm in predicting urethroplasty success. Investig Clin Urol 2024; 65:240-247. [PMID: 38714514 PMCID: PMC11076797 DOI: 10.4111/icu.20230302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/06/2023] [Accepted: 12/29/2023] [Indexed: 05/10/2024] Open
Abstract
PURPOSE To assess the predictive capability of hematological inflammatory markers for urethral stricture recurrence after primary urethroplasty and to compare traditional statistical methods with a machine-learning-based artificial intelligence algorithm. MATERIALS AND METHODS Two hundred eighty-seven patients who underwent primary urethroplasty were scanned. Ages, smoking status, comorbidities, hematological inflammatory parameters (neutrophil-lymphocyte ratios, platelet-lymphocyte ratios [PLR], systemic immune-inflammation indexes [SII], and pan-immune-inflammation values [PIV]), stricture characteristics, history of previous direct-visual internal urethrotomy, urethroplasty techniques, and grafts/flaps placements were collected. Patients were followed up for one year for recurrence and grouped accordingly. Univariate and multivariate logistic regression analyses were conducted to create a predictive model. Additionally, a machine-learning-based logistic regression analysis was implemented to compare predictive performances. p<0.05 was considered statistically significant. RESULTS Comparative analysis between the groups revealed statistically significant differences in stricture length (p=0.003), localization (p=0.027), lymphocyte counts (p=0.008), PLR (p=0.003), SII (p=0.003), and PIV (p=0.001). In multivariate analysis, stricture length (odds ratio [OR] 1.230, 95% confidence interval [CI] 1.142-1.539, p<0.0001) and PIV (OR 1.002, 95% CI 1.000-1.003, p=0.039) were identified as significant predictors of recurrence. Classical logistic regression model exhibited a sensitivity of 0.76, specificity of 0.43 with an area under curve (AUC) of 0.65. However, the machine-learning algorithm outperformed traditional methods achieving a sensitivity of 0.80, specificity of 0.76 with a higher AUC of 0.82. CONCLUSIONS PIV and machine-learning algorithms shows promise on predicting urethroplasty outcomes, potentially leading to develop possible nomograms. Evolving machine-learning algorithms will contribute to more personalized and accurate approaches in managing urethral stricture.
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Affiliation(s)
- Emre Tokuc
- Urology Clinic, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Türkiye.
| | - Mithat Eksi
- Urology Clinic, Bakırkoy Dr. Sadi Konuk SUAM, University of Health Sciences, Istanbul, Türkiye
| | - Ridvan Kayar
- Urology Clinic, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Türkiye
| | - Samet Demir
- Urology Clinic, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Türkiye
| | - Ramazan Topaktas
- Urology Clinic, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Türkiye
| | - Yavuz Bastug
- Urology Clinic, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Türkiye
| | - Mehmet Akyuz
- Urology Clinic, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Türkiye
| | - Metin Ozturk
- Urology Clinic, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Türkiye
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Isali I, Wong TR, Wu CHW, Scarberry K, Gupta S, Erickson BA, Breyer BN. Genomic Risk Factors for Urethral Stricture: A Systematic Review and Gene Network Analysis. Urology 2024; 184:251-258. [PMID: 38160764 DOI: 10.1016/j.urology.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/14/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To identify genes that may play a role in urethral stricture and summarize the results of studies that have documented variations in gene expression among individuals with urethral stricture compared to healthy individuals. METHODS A systematic search was conducted in Cochrane, Ovid, Web of Science, and PubMed, limiting the results to articles published between January 1, 2000 and January 30, 2023. Only studies comparing the difference in gene expression between individuals with urethral stricture and healthy individuals utilizing molecular techniques to measure gene expression in blood, urine, or tissue samples were included in this systematic review. Gene network and pathway analyses were performed using Cytoscape software, with input data obtained from our systematic review of differentially expressed genes in urethral stricture. RESULTS Four studies met our criteria for inclusion. The studies used molecular biology methods to quantify gene expression data from specimens. The analysis revealed gene expressions of CXCR3 and NOS2 were downregulated in urethral tissue samples, while TGFB1, UPK3A, and CTGF were upregulated in plasma, urine and urethral tissue samples, respectively, in patients with urethral stricture compared to healthy controls. The analysis demonstrated that the most significant pathways were associated with phosphoinositide 3-kinase (PI3 kinase) and transforming growth factor beta 1/suppressor of mothers against decapentaplegic (TGF-β1/SMAD) signaling pathways. CONCLUSION This systematic review identified gene expression variations in several candidate genes and identified underlying biological pathways associated with urethral stricture. These findings could inform further research and potentially shift treatment and prevention strategies for urethral stricture.
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Affiliation(s)
- Ilaha Isali
- Department of Urology, Case Western Reserve University, Cleveland, OH
| | - Thomas R Wong
- Department of Urology, Case Western Reserve University, Cleveland, OH
| | - Chen-Han Wilfred Wu
- Department of Urology, Case Western Reserve University, Cleveland, OH; Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH
| | - Kyle Scarberry
- Department of Urology, Case Western Reserve University, Cleveland, OH
| | - Shubham Gupta
- Department of Urology, Case Western Reserve University, Cleveland, OH
| | | | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA; Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA.
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Luo H, Lou KC, Xie LY, Zeng F, Zou JR. Pharmacotherapy of urethral stricture. Asian J Androl 2024; 26:1-9. [PMID: 37738151 PMCID: PMC10846832 DOI: 10.4103/aja202341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/21/2023] [Indexed: 09/24/2023] Open
Abstract
Urethral stricture is characterized by the chronic formation of fibrous tissue, leading to the narrowing of the urethral lumen. Despite the availability of various endoscopic treatments, the recurrence of urethral strictures remains a common challenge. Postsurgery pharmacotherapy targeting tissue fibrosis is a promising option for reducing recurrence rates. Although drugs cannot replace surgery, they can be used as adjuvant therapies to improve outcomes. In this regard, many drugs have been proposed based on the mechanisms underlying the pathophysiology of urethral stricture. Ongoing studies have obtained substantial progress in treating urethral strictures, highlighting the potential for improved drug effectiveness through appropriate clinical delivery methods. Therefore, this review summarizes the latest researches on the mechanisms related to the pathophysiology of urethral stricture and the drugs to provide a theoretical basis and new insights for the effective use and future advancements in drug therapy for urethral stricture.
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Affiliation(s)
- Hui Luo
- The First Clinical College, Gannan Medical University, Ganzhou 341000, China
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
| | - Ke-Cheng Lou
- The First Clinical College, Gannan Medical University, Ganzhou 341000, China
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
| | - Ling-Yu Xie
- The First Clinical College, Gannan Medical University, Ganzhou 341000, China
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
| | - Fei Zeng
- The First Clinical College, Gannan Medical University, Ganzhou 341000, China
| | - Jun-Rong Zou
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
- Institute of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
- Jiangxi Engineering Technology Research Center of Calculi Prevention, Ganzhou 341000, China
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5
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Borgognone A, Santi GD, Baffigo G, Capobianco SV, Goletti S. Is a pedicular flap coupled to the double turnover flaps urethroplasty suitable for urethral-perineal reconstruction? Considerations about a relapsing urethral-cutaneous fistula condition. JPRAS Open 2023; 38:91-97. [PMID: 37745010 PMCID: PMC10514385 DOI: 10.1016/j.jpra.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/08/2023] [Indexed: 09/26/2023] Open
Abstract
Background: This study highlights the effectiveness, in one surgical stage, of two combined local techniques for perineal fistula repair in a patient with spinal cord injury: the " Turn over flaps urethroplasty" and the "Pedicular fasciocutaneous flap" from the inferior gluteal fold. Unlike the traditional Perforator flap, we harvested a Pedicular flap; by definition, this is a flap with a narrow diffuse microvascular supply aimed in our case at shielding the neourethra and substituting the remaining scarred perineum. Method: The urethroplasty technique adopted, the 'Double turn over flaps urethroplasty', has been based on sculpting two opposing local cutaneous flaps circumscribing the fistulous cutaneous openings. Eventually, the neourethra continuity has been re-established by turning over both flaps and making them meet medially. The dimension and thickness of the "Pedicular fasciocutaneous flap", have been considered to prevent any damage to the urethroplasty and at the same time to replace all the debrided scarred perineal tissue. Results: The follow-up confirmed a well-consolidated supple perineal area and a competent neourethra. Conclusions: The "Pedicular flap" is by definition a random vascular flap nourished through a narrow pedicle, not based on a single perforator but only on a diffuse, spread micro-perforators. When associated with the double "Turn over flaps urethroplasty", it represents a possible alternative to achieve satisfactory results for those physical and psychological challenges encountered in the treatment of recurrent urethral fistula of the perineum in a patient with spinal cord injury.
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Affiliation(s)
- Alessandro Borgognone
- Operative Unit of Plastic Surgery and Burns, S. Eugenio – C.T.O. Hospital, Rome, Italy
| | - Giancarlo Delli Santi
- Operative Unit of Plastic Surgery and Burns, S. Eugenio – C.T.O. Hospital, Rome, Italy
| | - Giulio Baffigo
- Operative Unit of Neuro- Urology, S. Eugenio – C.T.O. Hospital, Rome, Italy
| | | | - Stefania Goletti
- Operative Unit of Radiology, S. Eugenio – C.T.O. Hospital, Rome, Italy
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Combining Transurethral Resection of Fibrous Tissue and Temporary Urethral Stent Insertion Is an Optimal Strategy for Minimally Invasive Treatment of Recurrent and Long Urethral Strictures. J Clin Med 2023; 12:jcm12051741. [PMID: 36902528 PMCID: PMC10003251 DOI: 10.3390/jcm12051741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
This study investigated the optimal strategy for the treatment of chronic recurrent urethral strictures longer than 3 cm, using a temporary urethral stent. Between September 2011 and June 2021, 36 patients with chronic bulbomembranous urethral strictures underwent temporary urethral stent placement. Retrievable self-expandable polymer-coated bulbar urethral stents (BUSs) were placed in 21 patients (group A), and thermo-expandable nickel-titanium alloy urethral stents were placed in 15 patients (group M). Each group was subdivided into those with and without transurethral resection (TUR) of fibrotic scar tissue. The urethral patency rates at 1 year after stent removal were compared between the groups. The patients in group A showed a higher urethral patency maintenance rate at 1 year after stent removal than those in group M (81.0% vs. 40.0%, log rank test p = 0.012). Analysis of subgroups in which TUR was performed due to severe fibrotic scar, showed that the patients in group A showed a significantly higher patency rate than patients in group M (90.9% vs. 44.4%, log rank test p = 0.028). In the treatment of chronic urethral strictures with a long fibrotic scar, temporary BUS combined with TUR of fibrotic tissue seems to be the optimal minimally invasive treatment strategy.
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Harraz AM, Nabeeh A, Elbaz R, Abdelhamid A, Tharwat M, Elbakry AA, El-Hefnawy AS, El-Assmy A, Mosbah A, Zahran MH. Could the bulbar urethral end location on the cystourethrogram predict the outcome after posterior urethroplasty for pelvic fracture urethral injury? Arab J Urol 2022; 21:94-101. [PMID: 37234680 PMCID: PMC10208150 DOI: 10.1080/2090598x.2022.2138119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives To identify cystourethrogram (CUG) findings that independently predict the outcome of posterior urethroplasty (PU) following pelvic fracture urethral injury (PFUI). Methods Findings of CUG included the location of the proximal end of the bulbar urethra in zones A (superficial) or B (deep) according to its relationship with the pubic arch. Others included the presence of pelvic arch fracture, bladder neck, and posterior urethral appearance. The primary outcome was the need for reintervention either endoscopically or by redo urethroplasty. Independent predictors were modeled using a logistic regression model and a nomogram was constructed and internally validated using 100-bootstrap resampling. Time-to-event analysis was performed to validate the results. Results A total of 196 procedures in 158 patients were analyzed. The success rate was 83.7% with 32 (16.3%) procedures requiring direct vision internal urethrotomy, urethroplasty, or both in 13 (6.6%), 12 (6.1%), and 7 (3.6%) patients, respectively. On multivariate analysis, bulbar urethral end located at zone B (odds ratio [OR]: 3.1; 95% confidence interval [CI]: 1.1-8.5; p = 0.02), pubic arch fracture (OR: 3.9; 95%CI: 1.5-9.7; p = 0.003), and previous urethroplasty (OR: 4.2; 95% CI: 1.8-10.1; p = 0.001) were independent predictors. The same predictors were significant in the time-to-event analysis. The nomogram discrimination was 77.3% and 75% in the current data and after validation. Conclusions The location of the proximal end of the bulbar urethra and redo urethroplasty could predict the need for reintervention after PU for PFUI. The nomogram could be used preoperatively for patient counseling and procedure planning.
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Affiliation(s)
- Ahmed M. Harraz
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Adel Nabeeh
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ramy Elbaz
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | - Mohamed Tharwat
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Amr A. Elbakry
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | - Ahmed El-Assmy
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Mosbah
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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8
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Topcuoglu M, Topaloglu H, Kartal İ, Kokurcan A, Sarı H, Yalçınkaya F. Assessments of ReDo buccal mucosal urethroplasty in terms of functional outcomes. Int Urol Nephrol 2022; 54:2547-2553. [PMID: 35838830 DOI: 10.1007/s11255-022-03279-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE We aimed to assess the success rates and functional outcomes of ReDo buccal mucosal graft urethroplasty (BMGU) following failed primary BMGU and evaluate the oral morbidity and changes in quality of life (QoL) after this surgery. MATERIALS AND METHODS Data of the patients with recurrent anterior urethral stricture who underwent ReDo BMGU after failed primary BMGU were retrospectively reviewed. The collected data included the results of the urethral stricture surgery patient-reported outcome measure-lower urinary tract symptoms (USS-PROM-LUTS) and euro-quality of life visual analog scale (EQ-VAS) questionnaires performed preoperatively before and one year after surgery. The cohort was divided into two groups according to procedural success, and these groups were compared. RESULTS Thirty-two men patients were included. Among these, twenty-seven (84.3%) cases were considered successful following ReDo BMGU. The pre-ReDo BMGU mean stricture length was significantly longer in the failure group (2.3 ± 0.6 vs. 4.4 ± 1.2 cm, p = 0.001). Except for one patient with persistent oral numbness, no severe complication was reported postoperatively in the first year. The mean USS-PROM-LUTS score decreased significantly, while the mean LUTS-related quality of life score increased significantly following ReDo BMGU (p < 0.001, p < 0.001). In addition, the mean total EQ-VAS score increased significantly from 62.75 to 78.45, indicating remarkable improvement (p < 0.001). CONCLUSIONS Although less favorable outcomes can be anticipated in ReDo BMGU due to extensive scar tissue formation and reduced vascularity, high success and patient satisfaction rates and low oral morbidity rates were detected in ReDo BMGU cases.
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Affiliation(s)
- Murat Topcuoglu
- Department of Urology, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mah. Şehit Ömer Halisdemir Cad. No: 20, 06110, Dışkapı, Ankara, Turkey.,Department of Urology, Medical School of Aladdin Keykubat University, Alanya, Antalya, Turkey
| | - Hikmet Topaloglu
- Department of Urology, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mah. Şehit Ömer Halisdemir Cad. No: 20, 06110, Dışkapı, Ankara, Turkey.
| | - İbrahim Kartal
- Department of Urology, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mah. Şehit Ömer Halisdemir Cad. No: 20, 06110, Dışkapı, Ankara, Turkey.,Department of Urology, Faculty of Medicine, Kutahya Health Science University, Kutahya, Turkey
| | - Alihan Kokurcan
- Department of Urology, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mah. Şehit Ömer Halisdemir Cad. No: 20, 06110, Dışkapı, Ankara, Turkey
| | - Hilmi Sarı
- Department of Urology, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mah. Şehit Ömer Halisdemir Cad. No: 20, 06110, Dışkapı, Ankara, Turkey
| | - Fatih Yalçınkaya
- Department of Urology, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mah. Şehit Ömer Halisdemir Cad. No: 20, 06110, Dışkapı, Ankara, Turkey
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9
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Inouye BM, Nosé BD, Krughoff K, Boysen WR, Peterson AC. Buccal Reharvest for Urethroplasty After Graft Site Closure is Safe and Does Not Affect Long-Term Oral Health. Urology 2022; 164:262-266. [PMID: 35032544 DOI: 10.1016/j.urology.2021.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/26/2021] [Accepted: 12/27/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To understand the effects of reharvest on safety and long-term oral health in patients requiring buccal mucosa reharvest from a previously harvested and closed site for management of recurrent urethral stricture disease. METHODS We conducted an IRB approved retrospective chart review from 2014 to 2019 of all patients who underwent buccal graft urethroplasty at our referral based academic medical center. Surgical data was collected, and the validated Oral Health Impact Profile (OHIP-14) survey was administered to each patient. Descriptive statistics were performed and compared between patients who underwent a buccal graft reharvest and patients who underwent standard first time buccal harvest. Buccal graft beds were closed on both initial and reharvest. RESULTS Four patients underwent a total of 5 ipsilateral buccal graft reharvests and 6 patients underwent first time buccal harvest. Median length of follow-up for all patients was 6 months (1-35 mo) and the median length of all grafts was 6 cm (5-6 cm) with no difference in the reharvest and first-time cohorts. For patients that underwent buccal reharvest, their median post-operative OHIP-14 score was 0 (0-9 pts) out of a possible 56 points. This compared to a median postoperative OHIP-14 score of 0 (0-10 pts) for patients who underwent first time buccal harvests with oral complications limited to one post-operative hematoma in the first-time cohort. CONCLUSION Buccal grafts can safely be reharvested from a previous site with minimal concern for long-term oral health outcomes.
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Affiliation(s)
- Brian M Inouye
- Duke University Medical Center, Division of Urology, Durham, NC
| | - Brent D Nosé
- Duke University Medical Center, Division of Urology, Durham, NC.
| | - Kevin Krughoff
- Duke University Medical Center, Division of Urology, Durham, NC
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10
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Mershon JP, Baradaran N. Recurrent Anterior Urethral Stricture: Challenges and Solutions. Res Rep Urol 2021; 13:237-249. [PMID: 34012927 PMCID: PMC8128502 DOI: 10.2147/rru.s198792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/14/2021] [Indexed: 12/05/2022] Open
Abstract
Recurrent male anterior urethral stricture disease is a complex surgical challenge that should be managed by reconstructive urologists with experience in stricture management. Diagnosis of recurrence requires both anatomic narrowing and patient symptoms identified on validated questionnaires, with limited role for intervention in asymptomatic treatment “failures”. Endoscopic management has a very specific role in recurrence, and the choice of technique for urethroplasty depends on pre-operative urethrography and cystoscopy. Surgical success depends on addressing patient concerns, complete stricture excision, tissue quality optimization, and the use of multi-stage repair when indicated. Augmentation with genital skin flaps and/or grafts is often required, with buccal mucosa as the ideal graft source if local tissue is compromised. Salvage options including urinary diversion and perineal urethrostomy must also be considered in debilitated patients with severe disease or repeated treatment failures. Unique patient populations including patients with hypospadias and lichen sclerosis are among the highest risk for repeated recurrence and require special care in surgical technique, graft selection, and post-operative management.
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Affiliation(s)
| | - Nima Baradaran
- The Ohio State University Department of Urology, Columbus, OH, USA
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11
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Oyelowo N, Ahmed M, Tolani MA, Lawal AT, Awaisu M, Sudi A, Jemila O, Bello A, Maitama HY. Analysis of the Determinants, Characteristics and Management of Recurrent Urethral Strictures. Niger J Surg 2020; 26:130-134. [PMID: 33223811 PMCID: PMC7659749 DOI: 10.4103/njs.njs_54_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/06/2020] [Accepted: 05/29/2020] [Indexed: 12/04/2022] Open
Abstract
Background: The presentation and management of the recurrent urethral stricture varies and depends largely on the initial treatment and the characteristics of the recurrent stricture. What are the likely determinants of recurrence? Patients and Methods: This is a retrospective review of all patients who had urethroplasties from January 2013 to December 2017 for anterior urethral strictures in our institution. Patients with a recurrence of the strictures were identified and reviewed, while patients with hypospadias and posterior urethral stenosis or contractures were excluded from the study. The etiology, length, site, and type of urethroplasties were evaluated as variables that may contribute to the recurrence of strictures using inferential statistics and logistic regression analysis. Time to recurrence was analyzed using the Kaplan–Meier method. Results: A total of 206 urethroplasties for anterior urethral strictures were evaluated with recurrence of strictures noted in 29 patients and a recurrence rate of 14.1%. Recurrence was higher in long-segment strictures, penobulbar strictures, and postinflammatory strictures. Pedicle flaps were used in 45% of the strictures that reoccurred. Using Chi-square, the length, site, of urethroplasties were statistically significant determinants of recurrence; however, only the site of stricture was found to be statistically significant following logistic regression analysis. The site of recurrence was in the bulbar urethra in 79% and the penile urethra in 21%. The choice of treatment of the recurrent strictures was anastomotic urethroplasty in 76.5%. The mean time to failure in this study was 13 months with a range of 6-120 months. Conclusion: In this study, the site of stricture was found to be the most determinant of stricture recurrence, with penobulbar strictures mostly implicated. Long-segment strictures were also noted to contribute to some extent in recurrence. These recurrent strictures were mostly short-segment strictures in the bulbar urethra which were amenable to excision and anastomosis to achieve cure.
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Affiliation(s)
- Nasir Oyelowo
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Muhammed Ahmed
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Musliu Adetola Tolani
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Ahmad Tijani Lawal
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Mudi Awaisu
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Abdullahi Sudi
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Olagunju Jemila
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Ahmad Bello
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Husseini Yusuf Maitama
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
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Barbagli G, Bandini M, Balò S, Montorsi F, Sansalone S, Dominicis MD, Butnaru D, Lazzeri M. Patient-reported outcomes for typical single cheek harvesting vs atypical lingual, labial or bilateral cheeks harvesting: a single-center analysis of more than 800 patients. World J Urol 2020; 39:2089-2097. [PMID: 32770388 DOI: 10.1007/s00345-020-03400-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 08/01/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The optimal harvesting site for oral grafting in patients with urethral strictures remain controversial, with no study investigating morbidity on large scale. We aimed to compare typical single cheek harvesting vs atypical lingual, labial or bilateral cheeks harvesting in terms of complications and patient-reported outcomes. METHODS Within 827 patients treated at our referral center with oral graft urethroplasty, we compared typical vs atypical harvesting techniques. A self-administered, semiquantitative, non-validated questionnaire assessed early (10 days) and late (4 months) postoperative complications and patient-reported outcomes. A semiquantitative score was calculated according to patient responses, and it was used to assess early (6 questions) and late (13 questions) patient dissatisfaction status. Patients were defined early and/or late dissatisfied when they scored ≥ 7 and ≥ 10 at the early or late questionnaires, respectively. RESULTS Between 1998 and 2019, our patients predominantly received typical single cheek harvesting (89% vs 11%), with + 1.5% increase rate per year (p < 0.001). Early and late dissatisfied patients were, respectively, 170 (23%) vs 39 (44%) and 59 (8%) vs 16 (18%) in the typical vs atypical groups. Atypical harvesting was associated with higher rates of early (Odds ratio [OR]: 2.34; 95% Confidence interval [CI] 1.44-3.75; p = 0.001) and late (OR: 2.37; 95%CI 1.22-4.42; p = 0.008) postoperative dissatisfaction. CONCLUSIONS Typical single cheek harvesting was the preferred surgical option at our center and it was associated with negligible early and late rates of complications and patient's dissatisfaction. Conversely, atypical lingual, labial or bilateral cheeks harvesting was associated with higher complications and frequent patient dissatisfaction.
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Affiliation(s)
- Guido Barbagli
- Center for Reconstructive Urethra Surgery, Arezzo, Rome, Milan, Italy.,Centro Chirurgico Toscano, Arezzo, Italy
| | - Marco Bandini
- Centro Chirurgico Toscano, Arezzo, Italy. .,Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele Hospital, Via Olgettina 60, Vita-Salute San Raffaele University, 20132, Milan, Italy.
| | - Sofia Balò
- Centro Chirurgico Toscano, Arezzo, Italy
| | - Francesco Montorsi
- Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele Hospital, Via Olgettina 60, Vita-Salute San Raffaele University, 20132, Milan, Italy
| | | | | | - Denis Butnaru
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Massimo Lazzeri
- Department of Urology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milano, Italy
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Perdzyński W, Adamek M. Calibration of urethra with anti-scar gel as a new preventive method for stricture recurrence after urethroplasty performed due to refractory anterior urethral stricture disease. Cent European J Urol 2020; 73:80-90. [PMID: 32395329 PMCID: PMC7203771 DOI: 10.5173/ceju.2020.0050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this article was to determine if scar contraction can be prevented by calibration of urethra with anti-scar gel (ASG). Material and methods The authors operated on 36 men with recurrent urethral strictures (US). Strictures were localized in the penile (n = 26), penile and bulbar (8) or in the bulbar (2) part of the urethra. In 34 patients, dorsal inlay buccal mucosa graft urethroplasty (BMGU) was performed and in the remaining 2 patients dorsal onlay BMGU was performed. First calibration was done one month after operation by hegar size 3.5 (diameter in millimeters) with ASG. Patients were instructed how to perform this action and repeated this action for 4-6 weeks. Then, every 4-6 weeks, the size of the calibrator was increased by 0.5 up to 6.0, if it was introduced with ease. Results were assessed by uroflowmetry and urethral calibration. Afterwards, calibrations were carried out twice a week for 6 months and then once a week for another 6 months followed by once a month. Results Mean follow-up was 61 months. In uroflowmetry examination, voiding improved in all patients. Both preoperative mean Qmax and mean Qavg increased, the former from 6.2 to 22.5 ml/s, the latter from 4.3 to 12.4 ml/s, (p <0.001), at 12 months post-operation. Mean post-void residual volume (PVR) decreased from 89 ml before operation to 10 ml, (p <0.001), at 12 months post-operation. Mean inner urethral size increased from 3.9 mm one month post-operation to 5.4 mm, (p <0.001), 9 months post-operation. No recurrent US was detected in any of the patients. Conclusions Routine calibration with ASG prevents scar contraction after urethroplasty in the long-term. Calibration of urethra with ASG is a safe and effective method of postoperative management.
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Affiliation(s)
- Wojciech Perdzyński
- Department of Reconstructive Surgery of the Male Genitourinary Tract, Damian's Hospital, Warsaw, Poland
| | - Marek Adamek
- Department of Reconstructive Surgery of the Male Genitourinary Tract, Damian's Hospital, Warsaw, Poland
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Advances in Urogenital Trauma and Reconstruction. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2907204. [PMID: 32149097 PMCID: PMC7053461 DOI: 10.1155/2020/2907204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 11/29/2022]
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