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Oszczudlowski M, Yepes C, Dobruch J, Martins FE. Outcomes of transecting versus non-transecting urethroplasty for bulbar urethral stricture: a meta-analysis. BJU Int 2023; 132:252-261. [PMID: 37402622 DOI: 10.1111/bju.16108] [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] [Indexed: 07/06/2023]
Abstract
OBJECTIVES To assess outcomes of transecting vs non-transecting urethroplasty for bulbar urethral stricture in terms of stricture recurrence rate, sexual dysfunction, and patient-reported outcome measures (PROMs) related to lower urinary tract (LUT) function. METHODS Electronic literature searches were conducted using PubMed, Cochrane Library, Web of Science and Embase databases. The studied population was limited to men with bulbar urethral stricture included in studies that compared outcomes after transecting and non-transecting urethroplasty. The main outcome appraised was the stricture recurrence rate. Additionally, the incidence of sexual dysfunction appraised in three domains (erectile function, penile complications, and ejaculatory function) and PROMs related to LUT function after transecting vs non-transecting urethroplasty were assessed. The pooled risk ratio (RR) respectively for stricture recurrence, erectile dysfunction and penile complications was calculated using a fixed-effect model with inverse variance method. RESULTS In all, 694 studies were screened with 72 identified as relevant. Finally, 19 studies were suitable for analysis. The pooled difference between the transecting and non-transecting groups relating to stricture recurrence was not significant. Overall, the RR was 1.06 (95% confidence interval [CI] 0.82-1.36) and the 95% CI crossed the line of no effect (line RR = 1). Overall, the RR for erectile dysfunction was 0.73 (95% CI 0.49-1.08) and the 95% CI crossed the line of no effect (line RR = 1). Overall, the RR for penile complications was 0.47 (95% CI 0.28-0.76) and the 95% CI did not cross the line of no effect (line RR = 1). Hence, the risk of penile complications was significantly lower in the non-transecting group. CONCLUSIONS Our analysis of available evidence indicates that both transecting and non-transecting urethroplasties, are equal in terms of the recurrence rate. On the other hand, non-transecting techniques are better in terms of sexual function, causing less penile complications.
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Affiliation(s)
| | - Christian Yepes
- Belgrade Centre for Genital Reconstructive Surgery, Belgrade, Serbia
| | - Jakub Dobruch
- Urology Clinic, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Francisco E Martins
- Department of Urology, School of Medicine, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal
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Le W, Wu D, Xu C, Zhou W, Li C. Study on clinical outcomes between non-transecting urethroplasty and lingual mucosal urethroplasty for iatrogenic bulbar urethral stricture treatment. Basic Clin Androl 2023; 33:12. [PMID: 37138233 PMCID: PMC10157920 DOI: 10.1186/s12610-023-00185-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/08/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND This study aimed to compare the clinical outcomes of non-transecting urethroplasty and lingual mucosal urethroplasty in the treatment of iatrogenic bulbar urethral stricture. RESULTS A total of 25 patients with iatrogenic bulbar urethral stricture were enrolled, 12 of whom underwent lingual mucosal urethroplasty, 13 patients who underwent non-transecting urethroplasty. All patients were followed-up and evaluated at 3 postoperative months. Evaluations included urethrography, maximum urine flow rate (Qmax), nocturnal erectile function testing, International Index of Erectile Function (IIEF-5) assessment, and Anxiety Related Scale (SAS) assessment. In terms of operation time, there was a significant difference between non-transecting urethroplasty and lingual mucosal urethroplasty. However, there was no significant intergroup difference in intraoperative blood loss. Both techniques were associated with significantly improved Qmax relative to preoperative rates, but there was no significant difference between the groups in this regard over 3 months of postoperative follow-up. Nocturnal penile tumescence and rigidity results showed that there was no significant change in tip hardness after surgery in the non-transecting urethroplasty group. Moreover, IIEF-5 scores indicated that there was no significant intergroup difference in terms of subjective postoperative erectile function. According to the preliminary psychological evaluations during postoperative follow-up, the anxiety scores of patients undergoing non-transecting urethroplasty significantly improved, but there was no significant change in the mean SAS score among patients who underwent lingual mucosal urethroplasty. CONCLUSION Both surgical methods can achieve the clinical goal of treating iatrogenic bulbar urethral stricture. Non-transecting urethroplasty has the characteristics of short operation time, relative technical simplicity, and retention of the original erectile function of most patients, and the surgical outcomes of non-transecting urethroplasty are not inferior to those of lingual mucosal urethroplasty, and it is a promising technique for widespread use to treat bulbar urethral strictures.
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Affiliation(s)
- Wei Le
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
| | - Denglong Wu
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
| | - Chengdang Xu
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
| | - Weidong Zhou
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
| | - Chao Li
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China.
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Palminteri E, Preto M, Mari A, Lenci N, Vitelli D, Iacovelli V, Bove P, Buffi N, Cindolo L. Non-transecting dorsal mucosal anastomosis plus ventral oral graft for the treatment of urethral bulbar strictures: single surgeon experience. Int Urol Nephrol 2022; 54:3171-3177. [PMID: 35962907 DOI: 10.1007/s11255-022-03257-7] [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: 03/03/2022] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To report our experience with the non-transecting dorsal mucosal anastomosis plus ventral oral graft urethroplasty (NTAVOG) for the repair of tight bulbar urethral strictures. METHODS Data of 68 men with tight bulbar strictures underwent NTAVOG urethroplasty between 2012 and 2019 were retrospectively revised. The urethra was opened ventrally; the dorsal scarred mucosa was excised preserving the spongiosum; the mobilized mucosal edges were anastomosed to recreate the dorsal urethral plate; the repaired urethral plate was augmented by the ventral oral graft and the spongiosum was closed over it. Successful urethral reconstruction was defined as normal voiding without the need for any postoperative procedure. Sexual function was investigated using a validated questionnaire. RESULTS Median follow-up was 58 months (IQR 38-63) and mean stricture length was 1 cm (IQR 1-1.5). Of 68 cases, 56 (82.4%) were successful and 12 (17.6%) were failures requiring re-treatment. At multivariable analysis, no preoperative factor was significantly associated with recurrence. None of the preoperatively sexually active 53 patients reported postoperative erectile impairment and all were satisfied with their sexual life. The main limitation is the retrospective design. CONCLUSIONS In cases of tight bulbar stricture, the NTAVOG urethroplasty provides adequate urethral augmentation by preserving the spongiosum and avoiding postoperative sexual complications. We presented a series of patients undergone non-transecting dorsal anastomosis plus ventral oral graft urethroplasty for tight bulbar stricture. This treatment seems to be safe and with limited postoperative complications thanks to the preservation of the corpus spongiosum.
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Affiliation(s)
- Enzo Palminteri
- Center for Urethral Reconstructive Surgery, Humanitas University, Via Leoni 6, 52100, Arezzo, Italy
| | - Mirko Preto
- Center for Urethral Reconstructive Surgery, Humanitas University, Via Leoni 6, 52100, Arezzo, Italy
| | - Andrea Mari
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Nicolò Lenci
- Center for Urethral Reconstructive Surgery, Humanitas University, Via Leoni 6, 52100, Arezzo, Italy
| | - Daniele Vitelli
- Department of Urology, Hesperia Hospital, CURE Group, Modena, Italy
| | - Valerio Iacovelli
- U.O. Urologia Ospedale San Carlo di Nancy Roma-GVM Care and Research, Dip. di Chirurgia Università di Roma Tor Vergata, Rome, Italy
| | - Pierluigi Bove
- U.O. Urologia Ospedale San Carlo di Nancy Roma-GVM Care and Research, Dip. di Chirurgia Università di Roma Tor Vergata, Rome, Italy
| | - Nicolò Buffi
- Urology Department, Humanitas Research Hospital, Rozzano, Italy
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, CURE Group, Modena, Italy.
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Nilsen OJ, Holm HV, Ekerhult TO, Lindqvist K, Grabowska B, Persson B, Sairanen J. To Transect or Not Transect: Results from the Scandinavian Urethroplasty Study, A Multicentre Randomised Study of Bulbar Urethroplasty Comparing Excision and Primary Anastomosis Versus Buccal Mucosal Grafting. Eur Urol 2022; 81:375-382. [PMID: 35012771 DOI: 10.1016/j.eururo.2021.12.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/20/2021] [Accepted: 12/14/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Open surgical treatment of short bulbar urethral strictures (urethroplasty) is commonly performed as transecting excision and primary anastomosis (tEPA) or buccal mucosa grafting (BMG). Erectile dysfunction and penile complications have been reported, but there is an absence of randomised trials. OBJECTIVE To evaluate sexual dysfunction and penile complications after urethroplasty with tEPA versus BMG. DESIGN, SETTING, AND PARTICIPANTS Centres in Finland, Sweden and Norway participated. Patients with a bulbar urethral stricture of ≤2 cm without previous urethroplasty were randomised. The primary endpoints were the degree of erectile dysfunction and penile complications. Follow-up was 12 mo. INTERVENTION Patients were randomised to either tEPA or BMG urethroplasty. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Sexual dysfunction was measured using the International Index of Erectile Function, 5-item version (IIEF-5) and a penile complications questionnaire (PCQ) designed for this study. Continuous data were analysed using analysis of covariance and categorical data were compared using a χ2 test. RESULTS AND LIMITATIONS A total of 151 patients were randomised to either tEPA (n = 75) or BMG (n = 76). The tEPA group reported more penile complications (p = 0.02), especially reduced glans filling (p = 0.03) and a shortened penis (p = 0.001). There were no differences in postoperative IIEF-5 total scores. Recurrence rates were similar in both groups (12.9%) but the study was not designed to detect differences in recurrence rates. The PCQ is not validated, which is a limitation. CONCLUSIONS More patients reported penile complications after urethroplasty with tEPA than with BMG. This should be considered when choosing the operative method, and patients should be informed accordingly. PATIENT SUMMARY This study compared two common operations for repair of narrowing of the male urethra. Neither of the two methods seems to cause worsened erections. However, penile problems are more common after the transection technique than after the grafting technique.
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Affiliation(s)
- Ole Jacob Nilsen
- Department of Urology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | | | - Teresa O Ekerhult
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Klas Lindqvist
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Beata Grabowska
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Beata Persson
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jukka Sairanen
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Madec FX, Karsenty G, Yiou R, Robert G, Huyghe E, Boillot B, Marcelli F, Journel NM. [Which management for anterior urethral stricture in male? 2021 guidelines from the uro-genital reconstruction urologist group (GURU) under the aegis of CAMS-AFU (Committee of Andrology and Sexual Medicine of the French Association of Urology)]. Prog Urol 2021; 31:1055-1071. [PMID: 34620544 DOI: 10.1016/j.purol.2021.07.012] [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: 03/20/2021] [Revised: 06/17/2021] [Accepted: 07/08/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this first french guideline is to provide a clinical framework for the diagnosis, treatment and follow-up of anterior urethral strictures. The statements are established by the subgroup working on uro-genital reconstruction surgery (GURU) from the CAMS-AFU (Andrology and Sexual Medicine Committee from the French Association of Urology). MATERIAL AND METHODS These guidelines are adapted from the Male Urethral Stricture : American Urological Association Guideline 2016, updated by an additional bibliography from January 2016 to December 2019. Twenty-seven main scenarios seen in clinical practice are identified: from diagnosis, to treatment and follow-up. In addition, this guidelines are powered by anatomical diagrams, treatment algorithms, summaries and follow-up tables. RESULTS Anterior urethral strictures are a common condition (0,1 à 1,4 %) in men. The diagnosis is based on a trifecta including an examination with patient reported questionnaires, urethroscopy and retrograde urethrography with voiding cystourethrography. Short meatal stenosis can be treated by dilation or meatotomy, otherwise a urethroplasty can be performed. First line treatment of penile strictures is urethroplasty. Short bulbar strictures (<2cm) may benefit from endourethral treatment (direct visual internal urethrotomy or dilation). In case of recurrence or when the stenosis measures more than 2 cm, a urethroplasty will be proposed. Repeated endourethral treatment management are no longer recommended except in case of palliative option. Urethroplasty is usually done with oral mucosa graft as the primary option, in one or two stages approach depending on the extent of the stenosis and the quality of the tissues. Excision and primary anastomosis or non-transecting techniques are discussed for bulbar urethra strictures. Follow-up by clinical monitoring with urethroscopy, or retrograde urethrography with voiding cystourethrography, is performed at least the first year and then on demand according to symptoms. CONCLUSION Anterior urethral strictures need an open surgical approach and should be treated by urethroplasty in most cases. This statement requires a major paradigm shift in practices. Training urologist through reconstructive surgery is the next challenge in order to meet the demand.
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Affiliation(s)
- F-X Madec
- Service d'urologie, hôpital Foch, 40, rue de Worth, 92150 Suresnes, France.
| | - G Karsenty
- Service d'urologie, hôpitaux universitaires de Marseille Conception, 147, boulevard Baille, 13005 Marseille, France
| | - R Yiou
- Service d'urologie, hôpital Henri-Mondor, CHU Paris est, 51, avenue du Marechal de Lattre de Tassigny, 94010 Créteil Cedex, France
| | - G Robert
- Service d'urologie, CHU de Bordeaux GH Pellegrin, 30000 Bordeaux, France
| | - E Huyghe
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, 1, avenue du Professeur Jean-Poulhès, 31400 Toulouse, France
| | - B Boillot
- Service d'urologie et de la transplantation rénale, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
| | - F Marcelli
- Service d'urologie, CHRU-hopital huriez, rue Michel Polonowski, 59037 Lille, France
| | - N M Journel
- Service d'urologie, Centre Hospitalier Lyon Sud (HCL), chemin du Grand Revoyet, 69310 Pierre Benite, France
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McCammon KA. Genitourinary reconstruction. World J Urol 2020; 38:3001. [PMID: 33245370 DOI: 10.1007/s00345-020-03533-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Kurt A McCammon
- Department of Urology, Eastern Virginia Medical School, Norfolk, VA, 23507, USA.
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Comparison of efficiency of vascular-preserving urethroplastic methods of the bulbo-membranous part of the urethra. Wideochir Inne Tech Maloinwazyjne 2020; 16:151-162. [PMID: 33786129 PMCID: PMC7991951 DOI: 10.5114/wiitm.2020.94281] [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: 12/12/2019] [Accepted: 03/07/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction There are several options for vessel-sparing anastomotic procedures that allow one to avoid disturbances in the normal blood supply to the spongy body and successfully perform plastic surgery of distal urethral strictures. Aim To perform a comparative analysis of the effectiveness of reconstructive surgical treatment of strictures of the bulbo-membranous urethra with anastomotic surgery with and without vessel-sparing. Material and methods A prospective study was carried out on 28 patients with a diagnosis of stricture of the bulbo-membranous urethra who underwent treatment in the period 2012–2018 in the conditions of a urological hospital of Irkutsk City Clinical Hospital No. 1. Anastomotic urethroplasty was performed using one of two methods: with full mobilization of the spongy body bulb and a vessel-sparing method when the spongy body does not intersect. Results The effectiveness of the classical method of anastomosing EPA-TWW ((excision and primary anastomosis urethroplasty (Turner-Warwick) and excision and Jordan’s technique of vessel sparing excision and primary anastomosis)) was comparable with the method of anastomosing without crossing the (spongy body of EPA-J). Postoperative changes in the parameters of the functional status of patients based on the International Prostate Symptom Score (IPSS), International Index of Erectile Function, and Quality of Life were comparable in patients undergoing EPA-TWW and EPA-J. The final data indicate a statistically equivalent risk of developing complications such as urinary incontinence, shortening of the penis, and decreased erectile function. Conclusions The study did not demonstrate a statistically significant difference in the effectiveness of the treatment and the risks of complications during anastomotic surgery with or without vessel-sparing. However, an unformalized assessment demonstrates the best state of erectile function in patients after vascular-preserving surgery.
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