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Prospects and Challenges of Electrospun Cell and Drug Delivery Vehicles to Correct Urethral Stricture. Int J Mol Sci 2022; 23:ijms231810519. [PMID: 36142432 PMCID: PMC9502833 DOI: 10.3390/ijms231810519] [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: 07/30/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
Current therapeutic modalities to treat urethral strictures are associated with several challenges and shortcomings. Therefore, significant strides have been made to develop strategies with minimal side effects and the highest therapeutic potential. In this framework, electrospun scaffolds incorporated with various cells or bioactive agents have provided promising vistas to repair urethral defects. Due to the biomimetic nature of these constructs, they can efficiently mimic the native cells’ niches and provide essential microenvironmental cues for the safe transplantation of multiple cell types. Furthermore, these scaffolds are versatile platforms for delivering various drug molecules, growth factors, and nucleic acids. This review discusses the recent progress, applications, and challenges of electrospun scaffolds to deliver cells or bioactive agents during the urethral defect repair process. First, the current status of electrospinning in urethral tissue engineering is presented. Then, the principles of electrospinning in drug and cell delivery applications are reviewed. Finally, the recent preclinical studies are summarized and the current challenges are discussed.
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Wayne G, Perez A, Demus T, Nolte A, Mallory C, Boyer J, Cordon B. Ventral onlay glanuloplasty for treatment of fossa navicularis strictures. Int Braz J Urol 2022; 48:798-804. [PMID: 35838505 PMCID: PMC9388189 DOI: 10.1590/s1677-5538.ibju.2022.0067] [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: 02/07/2022] [Accepted: 05/30/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose: Management of fossa navicularis (FN) strictures balances restoring urethral patency with adequate cosmesis. Historically, FN strictures are managed via glans cap or glans wings, and in severe cases, multi-stage procedures. Ventral onlay glanuloplasty (VOG) is an easily reproducible technique that involves a single-stage augmentation with buccal mucosal graft. We have been applying this technique for several years and present early promising outcomes of this novel approach. Materials and Methods: We retrospectively reviewed all patients with FN strictures who underwent VOG at our institution. Treatment success was designated by the absence of extravasation on voiding cystourethrogram and no need for further urethral instrumentation on follow up. Glans cosmesis was assessed by patients providing binary (yes/no) response to the satisfaction in their appearance. We also noted stricture length, stricture etiology, demographic characteristics and any post-operative complications and reported median, interquartile range (IQR) and count, frequency (%), accordingly. Results: Ten patients underwent VOG and fit our inclusion criteria. Median stricture length was 2.0 cm (IQR 1.6 -2). Success rate was 90% (9/10) with a median follow up of 30 months (IQR 24.3 – 36.8). The one recurrence was treated by dilation combined with triamcinolone injection at 419 days post-op. Stricture etiology included primarily iatrogenic causes such as transurethral prostate resection (4/10), greenlight laser vaporization (2/10), cystolitholapaxy (1/10), and traumatic catheterization (3/10). All patients were satisfied with penile cosmesis. Conclusion: VOG is a simple technique for treating FN strictures. Based on our preliminary series, VOG provides sustained distal urethral patency and patients are pleased with the appearance.
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Affiliation(s)
- George Wayne
- Division of Urology, Columbia University at Mount Sinai Medical Center, Miami Beach, Fl, USA
| | - Alejandra Perez
- Division of Urology, Columbia University at Mount Sinai Medical Center, Miami Beach, Fl, USA
| | - Timothy Demus
- Division of Urology, Columbia University at Mount Sinai Medical Center, Miami Beach, Fl, USA
| | - Adam Nolte
- Division of Urology, Columbia University at Mount Sinai Medical Center, Miami Beach, Fl, USA
| | - Chase Mallory
- Florida International University School of Medicine, Fl, USA
| | - Jessica Boyer
- Division of Urology, Columbia University at Mount Sinai Medical Center, Miami Beach, Fl, USA
| | - Billy Cordon
- Division of Urology, Columbia University at Mount Sinai Medical Center, Miami Beach, Fl, USA
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Naud E, Rourke K. Recent Trends and Advances in Anterior Urethroplasty. Urol Clin North Am 2022; 49:371-382. [PMID: 35931430 DOI: 10.1016/j.ucl.2022.04.002] [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: 11/30/2022]
Abstract
While patient preference often helps guide treatment decisions, poor long-term success combined with cumulative risk of repeat endoscopic treatments and the complications innately associated with urethral stricture emphasize that urethroplasty is most often the best choice for successful treatment in the long-term. This has led to the need to better refine urethroplasty techniques and optimize patient outcomes. Urethroplasty has now largely transitioned to a day-surgery procedure in the majority of centers. Some evidence suggests that avoiding urethral transection and/or avoiding overzealous urethral mobilization may lead to a reduction in post-operative sexual dysfunction. The trend toward single stage penile urethroplasty with buccal mucosal grafts likely minimizes patient morbidity without compromising urethroplasty success. For urethroplasty success to further improve particularly in patients at high risk for stricture recurrence, the synergistic potential of combining wound healing enhancing agents with evolving tissue-engineering represents an exciting future opportunity in the quest to perfect urethroplasty outcomes.
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Affiliation(s)
- Elizabeth Naud
- Division of Urology, Department of Surgery, University of Alberta, Kipnes Urology Centre, 7th Floor, Kaye Edmonton Clinic, 11400 University Avenue, Edmonton, Alberta T6G1Z1, Canada
| | - Keith Rourke
- Division of Urology, Department of Surgery, University of Alberta, Kipnes Urology Centre, 7th Floor, Kaye Edmonton Clinic, 11400 University Avenue, Edmonton, Alberta T6G1Z1, Canada.
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Farrell MR, Campbell JG, Zhang L, Nowicki S, Vanni AJ. Transurethral reconstruction of fossa navicularis strictures with dorsal inlay buccal mucosa graft urethroplasty. World J Urol 2022; 40:1523-1528. [PMID: 35384486 DOI: 10.1007/s00345-022-03994-5] [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: 12/13/2021] [Accepted: 03/04/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To describe a single stage, glans-sparing urethroplasty technique for fossa navicularis strictures using a transurethral dorsal inlay buccal mucosa graft. METHODS We conducted a retrospective review of a prospectively maintained urethral stricture database to identify all fossa navicularis strictures reconstructed with a single stage, transurethral dorsal inlay buccal mucosa graft urethroplasty (5/2015-6/2020). Primary outcomes were anatomic success, defined as the ability to pass a 17 Fr flexible cystoscope, and functional success, defined as the lack of obstructive voiding symptoms and no need for further procedures. Secondary outcomes were postoperative complications and patient satisfaction. RESULTS Sixteen patients were included. Mean age was 63.1 years (43.9-75.6) and mean stricture length was 1.7 cm (1.4-2.0). Stricture etiology included internal trauma (62.5%), idiopathic (25.0%), and lichen sclerosus (12.5%). Prior endoscopic procedures were done in 75% of patients. Over a median follow-up of 28.8 months (IQR 17.6-38.0), anatomic success was 15/16 (93.8%) and functional success was 16/16 (100%). The single anatomic recurrence was at 4.2 months postoperatively. No additional procedures were required. Urinary tract infection occurred in 25% (4/16). There were no instances of de novo erectile dysfunction, chordee, or wound infection. All patients would recommend urethroplasty to others and all patients were either very satisfied (83.3%) or satisfied (16.7%) with the procedure. Penile sensitivity was unchanged in 83.3%, increased in 8.3% and decreased in 8.3%. CONCLUSION Transurethral dorsal inlay buccal mucosa graft urethroplasty is a viable option for reconstruction of fossa navicularis strictures that avoids splitting the glans and results in excellent cosmesis.
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Affiliation(s)
- M Ryan Farrell
- Center for Reconstructive Urologic Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Jack G Campbell
- Center for Reconstructive Urologic Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Lawrence Zhang
- Center for Reconstructive Urologic Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Samuel Nowicki
- Center for Reconstructive Urologic Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Alex J Vanni
- Center for Reconstructive Urologic Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA.
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Hofer MD, Cooley LF, Elmasri A, Martins FE. Revisiting One-Stage Urethroplasties for Distal Urethral Strictures. J Clin Med 2021; 10:jcm10245905. [PMID: 34945200 PMCID: PMC8708882 DOI: 10.3390/jcm10245905] [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: 11/03/2021] [Revised: 12/07/2021] [Accepted: 12/12/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Reconstructive approaches for distal urethral strictures range from simple meatotomy to utilizing grafts or flaps depending on the etiology, length and location. We describe a contemporary cohort of distal urethral strictures and report a surgical technique termed distal one-stage urethroplasty developed to address the majority of distal urethral strictures encountered. Methods: Thirty-four patients were included. The mean age was 56.7 years (range 15.7–84.9 years), the mean stricture length was 1.1 cm (0.5–1.5) and the mean follow-up was 42.5 months (28–61.3). Results: The vast majority of distal strictures (27/34 (79.4%)) were treated with our hybrid one-stage approach combining a distal urethral reconstruction with excision of the scar tissue without the need to use grafts or flaps. The average stricture length was 0.68 cm and average operative time was 24.43 min. Post-operative spraying was reported in a minority of patients (4/27 (14.8%)). The length of stricture and surgery were significantly longer in those 7/34 (20.6%) patients in whom grafts or flaps were used (2.88 cm and 154.8 min, respectively, p < 0.001 for both when compared to the hybrid one-stage approach). We noted 6/34 (17.6%) recurrences of distal urethral strictures, all of which were treated successfully with graft and flap repairs. Conclusions: The vast majority of distal urethral strictures are amenable to a distal one-stage urethroplasty, avoiding the use of grafts and/or flaps while achieving reasonable outcomes. This limited approach, at least initially, is associated with shorter operative time and time of catheter placement and avoids morbidity associated with graft or flap harvesting. Spraying of urine is seldomly encountered and comparable to other approaches addressing distal urethral strictures.
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Affiliation(s)
| | - Lauren Folgosa Cooley
- Department of Urology, Northwestern University, Chicago, IL 60611, USA; (L.F.C.); (A.E.)
| | - Ayman Elmasri
- Department of Urology, Northwestern University, Chicago, IL 60611, USA; (L.F.C.); (A.E.)
| | - Francisco E. Martins
- Department of Urology, School of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal;
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Wirtz M, Claeys W, Francois P, Waterloos M, Waterschoot M, Lumen N. Treatment of Meatal Strictures by Dorsal Inlay Oral Mucosa Graft Urethroplasty: A Single-Center Experience. J Clin Med 2021; 10:jcm10194312. [PMID: 34640331 PMCID: PMC8509526 DOI: 10.3390/jcm10194312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/01/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022] Open
Abstract
Background: To report on the use of oral mucosa graft urethroplasty for meatal strictures using the dorsal inlay technique. Methods: Patients who underwent a single-stage dorsal inlay oral mucosal graft urethroplasty between January 2000 and May 2021 were included in this study. A follow-up of a minimum of 12 months was necessary for inclusion. Exclusion criteria were stricture extension into the penile urethra, concomitant stricture at another location, flap urethroplasty for a meatal stricture, dorsal inlay urethroplasty with another type of graft, ventral onlay graft urethroplasty or staged urethroplasty. Recurrence was defined by the inability to pass a 14F metal sound through the reconstructed meatus irrespective of patients’ complaints. Results: Our study cohort included 40 patients. Buccal mucosal graft (BMG) urethroplasty was used in 25 patients and 15 patients were treated with the aid of lingual mucosal graft (LMG). The median follow-up was 85 (IQR: 69–110) months. Seven (17.5%) patients suffered a stricture recurrence of which four (10%) needed re-intervention. The median 5-y recurrent free survival (RFS) for the entire cohort was 85 (±6)%. The median 5-y RFS was 96 (±4)% versus 65 (±13)% for respectively BMG and LMG (p = 0.03). Post-operative complications were identified in 11 (27.5%) patients with only one (2.5%) patient who had a grade 3a complication. Conclusions: Dorsal inlay oral mucosa graft urethroplasty is a safe and feasible technique for selected patients with meatal stenosis.
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Affiliation(s)
- Michel Wirtz
- Department of Urology, Ghent University Hospital, 9000 Gent, Belgium; (W.C.); (M.W.); (M.W.); (N.L.)
- Correspondence:
| | - Wietse Claeys
- Department of Urology, Ghent University Hospital, 9000 Gent, Belgium; (W.C.); (M.W.); (M.W.); (N.L.)
| | | | - Marjan Waterloos
- Department of Urology, Ghent University Hospital, 9000 Gent, Belgium; (W.C.); (M.W.); (M.W.); (N.L.)
| | - Mieke Waterschoot
- Department of Urology, Ghent University Hospital, 9000 Gent, Belgium; (W.C.); (M.W.); (M.W.); (N.L.)
| | - Nicolaas Lumen
- Department of Urology, Ghent University Hospital, 9000 Gent, Belgium; (W.C.); (M.W.); (M.W.); (N.L.)
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Hughes M, Blakely S, Nikolavsky D. Advancements in transurethral management of urethral stricture disease. Curr Opin Urol 2021; 31:504-510. [PMID: 34175872 DOI: 10.1097/mou.0000000000000913] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To explore and report the recent evolution of transurethral management of urethral stricture disease. RECENT FINDINGS In recent years, new promising techniques in the transurethral management of urethral stricture disease have emerged including adjuvant therapies to direct vision internal urethrotomy, regenerative therapy with buccal mucosa cells and minimally invasive transurethral urethroplasty procedures that avoid skin incisions. SUMMARY Although further work is needed, the expanding field of transurethral therapies for urethral stricture disease demonstrates early promising results through a variety of modalities.
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Affiliation(s)
- Michael Hughes
- SUNY Upstate Medical University, Department of Urology, Syracuse, New York, USA
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Distale Urethrastriktur: Neuartige Operationsmethode international erfolgreich. Aktuelle Urol 2021; 52:414-417. [PMID: 34428813 DOI: 10.1055/a-1323-9999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Esperto F, Verla W, Ploumidis A, Barratt R, La Rocca R, Lumen N, Yuan Y, Campos-Juanatey F, Greenwell T, Martins F, Osman N, Riechardt S, Waterloos M, Dimitropoulos K. What is the role of single-stage oral mucosa graft urethroplasty in the surgical management of lichen sclerosus-related stricture disease in men? A systematic review. World J Urol 2021; 40:393-408. [PMID: 34448008 DOI: 10.1007/s00345-021-03803-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/04/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The benefits and harms of the available types of surgical management for lichen sclerosus-related (LS) strictures remain unclear and, thus, clear and robust clinical practice recommendations cannot be given. MATERIALS AND METHODS To assess the role of single-stage OMGU in the management of LS strictures and explore how its benefits and harms compare with the alternative management options. Medline, Embase and Cochrane controlled trial databases (CENTRAL, CDSR) were systematically searched. Randomized (RCTs) and nonrandomized studies (NRCSs) comparing single-stage OMGU with other surgical management options for LS strictures and single-arm studies on single-stage OMGU were included. Risk of bias (RoB) was assessed. RESULTS Of the 1912 abstracts identified, 15 studies (1 NRCS and 14 single-arm studies) were included, recruiting in total 649 patients. All studies were at high RoB. In the only NRCS available, stricture-free rate (SFR) for single-stage and staged OMGU was 88% vs 60%, respectively (p = 0.05), at a mean follow-up of 66.5 months. SFR range for single-stage OMGU in single-arm studies was 65-100% (mean/median follow-up, 12-59 months). Single-stage OMGU had low complication rates and beneficial impact on LUTS and QoL. CONCLUSIONS The present SR highlights the methodological limitations of the available literature. In the absence of adverse local tissue conditions, and taking into consideration benefit-harm balance and surgeon's skills and expertise, single-stage OMGU can be justified in patients with LS strictures.
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Affiliation(s)
- Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Via Álvaro Del Portillo, 200 00128, Rome, Italy.
| | - Wesley Verla
- Division of Urology, Gent University Hospital, Gent, Belgium
| | | | - Rachel Barratt
- Department of Urology, University College London Hospital, London, UK
| | - Roberto La Rocca
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Nicolaas Lumen
- Division of Urology, Gent University Hospital, Gent, Belgium
| | - Yuhong Yuan
- Department of Medicine, Health Science Centre, McMaster University, Hamilton, ON, Canada
| | | | - Tamsin Greenwell
- Department of Urology, University College London Hospital, London, UK
| | - Francisco Martins
- Department of Urology, Santa Maria University Hospital, University of Lisbon, School of Medicine, Lisbon, Portugal
| | - Nadir Osman
- Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Silke Riechardt
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Swatesutipun V, Yoosuksomboon N, Zaontz MR. A novel transurethral approach to inlay oral mucosal graft urethroplasty technique for meatal and fossa navicularis stricture resulting from distal hypospadias repair. J Pediatr Urol 2021; 17:585-586. [PMID: 34284958 DOI: 10.1016/j.jpurol.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/23/2021] [Accepted: 07/04/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Meatal and fossa navicularis stricture after hypospadias repair is a challenging condition. A range of management techniques have been applied to treat meatal and fossa navicularis stenosis but, as yet, there is no consensus as to the best method. Open urethroplasty with oral mucosal graft (OMG) has been widely accepted to be the gold standard in repairing the stricture. Generally, the stricture site is approached through a ventral midline, subcoronal, and circumcising incision. A novel effective technique for short segment stricture, transurethral approach to inlay oral mucosal graft urethroplasty would help in avoiding ventral glans, distal penis or ventral urethral incision and can preserve glans of the penis. METHOD A 5-year-old boy with mid-shaft hypospadias underwent repair when he was 3 years old. Two months after surgery, he had developed urethral meatal and fossa navicularis stenoses. He is to undergo a novel transurethral approach of inlay OMG urethroplasty. The procedure consisted of transurethral excising the fibrotic tissue at the dorsal site of the stricture urethra. The bougies dilator was used for calibrating the size of the urethra up to 12 Fr. An OMG with a size of 5 × 6 mm was then harvested from the lower lip and applied to cover the defect. A urethral catheter was inserted for 1 week. RESULT The outcome was shown to be successful and the patient can void with a good flow after removing the catheter. The graft was well vascularized and the glans was cosmetically acceptable. There was no recurrent stricture after 12 months follow up. CONCLUSION This novel technique is simple, effective and may be beneficial as it obviates the need for complex reconstruction. However, this technique would only be feasible in selected patients with suitable conditions of meatal opening and those with a short segment of stricture.
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Affiliation(s)
| | | | - Mark R Zaontz
- Children's Hospital of Philadelphia, Pennsylvania, USA
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Gn M, Sterling J, Sinkin J, Cancian M, Elsamra S. The Expanding Use of Buccal Mucosal Grafts in Urologic Surgery. Urology 2021; 156:e58-e65. [PMID: 34097942 DOI: 10.1016/j.urology.2021.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/07/2021] [Accepted: 05/27/2021] [Indexed: 12/21/2022]
Abstract
The advent and success of buccal mucosal grafts as a substitution material in the urinary tract has changed the landscape of reconstructive urology. Due to its ease to harvest, low morbidity, and advantageous properties, there has been a growing number of applications for buccal mucosal grafts in upper and lower urinary tract reconstruction as well as genital reconstruction. In this article, we review the historical application and the evolution of buccal mucosal grafts and provide an up-to-date review on its utilization in urologic procedures.
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Affiliation(s)
- Martus Gn
- Department of Urology, Warren Alpert Medical School, Providence, RI.
| | - Joshua Sterling
- Department of Urology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jeremy Sinkin
- Department of Plastic Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Madeline Cancian
- Department of Urology, Warren Alpert Medical School, Providence, RI
| | - Sammy Elsamra
- Department of Urology, Robert Wood Johnson Medical School, New Brunswick, NJ
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Hofer MD, Cooley LF, Martins FE. Narrative review of penile distal urethroplasties and suggestions for optimizing outcomes. Transl Androl Urol 2021; 10:2609-2616. [PMID: 34295747 PMCID: PMC8261416 DOI: 10.21037/tau-20-1289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/27/2021] [Indexed: 11/20/2022] Open
Abstract
Distal urethral strictures can be a challenging entity for urologists. Endoscopic maneuvers such as optical internal urethrotomies or dilations are even less successful than in other urethral locations and the repeated trauma will increase the scarring which advocates for a urethroplasty as primary option for patient management. Success rates of distal urethroplasties have been lower than those for other urethral strictures due to the anatomy of the distal urethra with a very thin corpus spongiosum associated with decreased mucosal blood supply. Also, the high prevalence of lichen sclerosus in this population with circumferential scarring is often a complicating factor. However, in the past two decades several surgical techniques have been described and further developed which has led to significant improvement in stricture recurrence rates. Meatoplasties are indicated for strictures limited to the meatus and involve opening of the stenotic meatus with subsequent reconstruction of it to minimize spraying of urine. Often, however, distal urethral strictures involve the fossa navicularis and may even extend further proximally. These strictures can be addressed with dorsal or ventral inlay procedures using buccal mucosa graft. In addition or alternatively, skin flaps can be mobilized to increase the urethral diameter. Lastly, multi-stage urethroplasty with buccal mucosa are a very successful approach yet given the high success rates of above mentioned procedures are usually reserved for revision surgery or most severe distal urethral strictures. In the following report, we are describing a variety of surgical techniques and their indication which should allow the practicing urologist to successfully address all encountered distal urethral strictures.
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Favre GA, Villa SG, Scherñuk J, Tobia IP, Giudice CR. Glans Preservation in Surgical Treatment of Distal Urethral Strictures With Dorsal Buccal Mucosa Graft Onlay by Subcoronal Approach. Urology 2020; 152:148-152. [PMID: 33359490 DOI: 10.1016/j.urology.2020.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe dorsal onlay buccal mucosa graft urethroplasty technique by subcoronal approach and glans preservation in distal penile urethral strictures with fossa navicularis involvement and to report safety, effectiveness, and cosmetic outcomes. METHODS Retrospective review of a prospective database of patients treated at Hospital Italiano de Buenos Aires between January 2011 and December 2019. Main surgical steps: ventral subcoronal incision, dorsal dissection of glandelar urethra until piercing the tip of the glans, dorsal urethrotomy, and graft transposition. Low urinary tract symptoms, uroflowmetry, and urinalysis were assessed at follow-up. Simplified International Index Erectile Function and Hypospadias Objective Scoring Evaluation were applied 1 year after surgery. RESULTS Sixteen patients with a median age of 56.5 years (IQR 35.7-66.7) were included. Median stricture length was 5.5 cm (IQR 4-8.7). In 3 patients, Clavien-Dindo grade I-II complications were reported. At 1 year, median peak flow was 18 mL/seg (IQR 12.7-27.4) and median mean flow 7.8 mL/seg (IQR 6.1-9.9). At 41.5 months follow-up (IQR 13.2-74), all patients were stricture free and had no changes in erectile function. Hypospadias Objective Scoring Evaluation score ≥14 points was achieved by 14 patients (87.5%). CONCLUSION For treatment of distal penile urethral strictures with fossa navicularis involvement, dorsal onlay buccal mucosa graft by subcoronal approach and glans preservation is a feasible technique with excellent functional outcomes, minimal complications, and substantial cosmetic results.
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Affiliation(s)
- Gabriel Andrés Favre
- Genitourinary Reconstructive Surgery Division, Department of Urology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Sergio Gil Villa
- Genitourinary Reconstructive Surgery Division, Department of Urology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Jordán Scherñuk
- Genitourinary Reconstructive Surgery Division, Department of Urology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
| | - Ignacio Pablo Tobia
- Genitourinary Reconstructive Surgery Division, Department of Urology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Carlos Roberto Giudice
- Genitourinary Reconstructive Surgery Division, Department of Urology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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