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Moring N, Juneau A, Feustel PJ, Anele UA, Inouye BM. Current urethroplasty trends in recent GURS fellowship graduates. World J Urol 2024; 42:443. [PMID: 39046552 DOI: 10.1007/s00345-024-05153-4] [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: 06/12/2024] [Accepted: 06/27/2024] [Indexed: 07/25/2024] Open
Abstract
PURPOSE To assess self-reported urethroplasty success rates and outcomes of recent GURS fellowship graduates and compare these data to the large body of published urethroplasty outcomes literature. METHODS A voluntary survey was distributed from June 1 to June 30, 2023 to GURS fellowship graduates of the last 5 years. Participants were surveyed on time since graduation, operative volume, outcomes, and quoted success rates for urethroplasty. Data were then analyzed using descriptive statistics, binary logistic regression, and correlative analyses. RESULTS We received responses from 49/101 (48.5%) GURS graduates. Five-year post-graduates were most represented (44.7%). The majority (52.2%) consider 81-90% of urethroplasty successful, without significant change with years in practice. Approximately 65% quoted excision and primary anastomosis (EPA) as > 90% successful. Over half of the respondents had performed > 60 urethroplasties since graduation. Only 31.3% of respondents reported re-intervening in > 10% of their postop patients, with a weak positive correlation between years in practice and need for re-intervention (p 0.01). Nearly 20% of respondents referred patients to an external reconstructionist. CONCLUSION Increased length of time in practice does not result in higher reported urethroplasty success rates, counseling on successful outcomes, or rates of re-intervention and complications. Our survey highlights that the traditionally used success rates for urethroplasty may not be reflective of new graduates and lower volume reconstructive surgeons in their early career.
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Affiliation(s)
- Nikolas Moring
- Department of Urology, Albany Medical Center, 25 Hackett Blvd, Albany, NY, 12208, USA.
| | - Andrea Juneau
- Urology, University of Louisville School of Medicine, Louisville, KY, USA
| | | | - Uzoma A Anele
- Urology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Brian M Inouye
- Department of Urology, Albany Medical Center, 25 Hackett Blvd, Albany, NY, 12208, USA
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Zhao X, Xing Y, Zhang X, Guo Q, Li C, Guo C, Wang J, Hao C. Low risk of erectile dysfunction after nontransecting bulbar urethroplasty for urethral stricture: a systematic review and meta-analysis. J Sex Med 2023; 21:11-19. [PMID: 37973403 DOI: 10.1093/jsxmed/qdad141] [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: 05/12/2023] [Revised: 07/16/2023] [Accepted: 09/20/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Sexual function after urethroplasty may be a concern for patients, but there are still some controversies regarding the consequences of nontransecting bulbar urethroplasty (ntBU) in terms of erectile dysfunction (ED). AIM This meta-analysis aimed to compare the efficacy and safety of ntBU with that of transecting bulbar urethroplasty (tBU). METHODS The PubMed, Web of Science, Cochrane, and Embase databases were searched and reviewed up to October 31, 2022. Quality evaluation was performed using the Newcastle-Ottawa scale system and Cochrane tools for the nonrandomized and randomized studies, respectively. Baseline characteristics, preoperative information, and postoperative outcomes were collected. OUTCOMES Outcomes included success rate, ED, overall complication, and maximum urinary flow. RESULTS Thirteen studies comprising 1683 patients met the inclusion criteria, with 596 and 1087 patients undergoing ntBU and tBU, respectively. The results revealed that compared with the tBU group, the patients who underwent ntBU had a significantly lower incidence of ED, while there were no significant differences in the other perioperative outcomes. In subgroup analysis, the nontransecting anastomotic urethroplasty group had a lower incidence of ED than excision and primary anastomosis, and other perioperative outcomes were similar between the 2 groups. CLINICAL IMPLICATIONS The results of the study may help clinicians choose procedures that protect sexual function in the treatment of urethral stricture. STRENGTHS AND LIMITATIONS The strength of this study is that it is, to our knowledge, the first meta-analysis to evaluate the efficacy and safety of ntBU. A limitation is that most of the included studies were retrospective cohort studies. CONCLUSION ntBU preserves the high efficacy of its transecting counterpart while reducing postoperative ED.
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Affiliation(s)
- Xingming Zhao
- Department of Urology, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, China
- Department of Clinical Medicine, The Second School of Clinical Medicine, Shanxi Medical University, Taiyuan, 030001, China
| | - Yanbo Xing
- Department of Urology, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, China
| | - Xi Zhang
- Department of Urology, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, China
| | - Qiang Guo
- Department of Urology, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, China
| | - Chengyong Li
- Department of Urology, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, China
| | - Chao Guo
- Department of Urology, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, China
| | - Jingqi Wang
- Department of Urology, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, China
| | - Chuan Hao
- Department of Urology, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, China
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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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Non-Transecting Urethroplasty for Bulbar Urethral Strictures-Narrative Review and Treatment Algorithm. J Clin Med 2022; 11:jcm11237033. [PMID: 36498607 PMCID: PMC9740840 DOI: 10.3390/jcm11237033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/08/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
The bulbar urethra is the most common site of stricture disease for which urethroplasty remains standard of care. A decrease in trauma as an etiology in the developed world and concerns regarding sexual dysfunction related to transection of the corpus spongiosum have placed a renewed emphasis on non-transecting urethroplasty techniques. Here, we present our surgical algorithm with emphasis on non-transecting techniques for bulbar urethral stricture disease and review the current state of literature comparing transecting to non-transecting approaches in order to provide guidance to practitioners on patient selection, counseling, and technique.
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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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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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Anterior Urethroplasty for the Management of Urethral Strictures in Males: A Systematic Review. Urology 2021; 159:222-234. [PMID: 34537198 DOI: 10.1016/j.urology.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/19/2021] [Accepted: 09/02/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To identify the currently utilised techniques of anterior urethroplasty described in literature for treatment of urethral strictures, assess the effectiveness of the identified techniques based on re-stricture and complication rates, evaluate, and suggest treatment options based on current evidence for urethral strictures at different locations and of different lengths. METHODS A systematic review of the MEDLINE, EMBASE, Scopus and Cochrane Library databases from conception up to September 2020 was performed. Primary outcomes included success rates measured via re-stricture rates and the post-operative maximum urinary flow rate (Qmax). Secondary outcomes included patient reported complication rates. RESULTS A total of 52 papers, including 7 RCTs, met the inclusion criteria. Forty studies described the use of free graft urethroplasty with a median success rate of 86.5% (IQR = 8.1). The best outcomes were found in dorsal onlay buccal mucosa grafting in the penile urethra (86.6%). Twelve described the use of pedicled flap urethroplasty with a median success rate of 76% (IQR = 14.4). Excision and Primary Anastomosis results were reported in 5 studies and showed an overall highest success rate of 89.7% (IQR = 7.0) but involved the shortest strictures of median lengths of 2.1 cm (IQR = 0.48). CONCLUSION Graft urethroplasty showed optimal outcomes when utilised in penile and bulbar strictures, with dorsal onlay buccal mucosa grafting presenting with the largest evidence base and best outcomes overall. Flap urethroplasty had the highest success rates in panurethral and bulbar strictures, while anastomotic urethroplasty had the greatest success in bulbar and penobulbar strictures.
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Verla W, Waterloos M, Waterschoot M, Van Parys B, Spinoit AF, Lumen N. VeSpAR trial: a randomized controlled trial comparing vessel-sparing anastomotic repair and transecting anastomotic repair in isolated short bulbar urethral strictures. Trials 2020; 21:782. [PMID: 32917251 PMCID: PMC7488400 DOI: 10.1186/s13063-020-04712-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vessel-sparing anastomotic repair (vsAR) has been developed as a less traumatic alternative to transecting anastomotic repair (tAR) to treat isolated short bulbar urethral strictures. This vessel-sparing technique could result in improved functional outcomes without jeopardizing the excellent surgical outcome after (transecting) anastomotic repair. The purpose of this study is to directly compare vsAR and tAR for both surgical and functional outcomes. METHODS This trial is a prospective, interventional, multi-center, single-blinded, 1:1 randomized, controlled, non-inferiority, phase II trial. Sample size calculation resulted in a required sample size of 100 patients (50 patients per arm). Trial participants will be randomized by an independent third party using a computer-based random sequence generator with permuted blocks of variable size. The primary objective of this trial is to show that vsAR is non-inferior to tAR in terms of failure-free survival after 24 months of follow-up, considering a non-inferiority limit of 10%. Failure is defined as the inability to pass a 16-Fr flexible cystoscope through the reconstructed area without damaging the urethral mucosa. Secondary end-points mainly include differences in postoperative complications and changes in functional outcome parameters, which will be assessed with validated questionnaires. All participants are scheduled for follow-up at 3, 12, and 24 months postoperatively. DISCUSSION This trial will provide level Ib evidence about the differences in both surgical and functional outcome between vsAR and tAR, which may importantly scape the future of bulbar urethral reconstruction. Depending on the trial results, this phase II trial may generate a larger phase III trial with more statistical power and a lower alpha value. TRIAL REGISTRATION This trial is registered at clinicaltrials.gov ( NCT03572348 ) and in the Belgian Clinical Trial Registry (B670201837335). The trial was registered prospectively. Registered on 28 June 2018.
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Affiliation(s)
- Wesley Verla
- Department of Urology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Marjan Waterloos
- Department of Urology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Mieke Waterschoot
- Department of Urology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Benjamin Van Parys
- Department of Urology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Anne-Françoise Spinoit
- Department of Urology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Nicolaas Lumen
- Department of Urology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
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Non-transecting bulbar urethroplasty is favored over transecting techniques. World J Urol 2019; 38:3013-3018. [PMID: 31280330 DOI: 10.1007/s00345-019-02867-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To present current evidence supporting the vessel sparing technique to reconstruct bulbar urethral strictures via primary anastomosis. METHODS English literature review of presented series of transecting and non-transecting bulbar urethroplasty from 2000 to 2018. RESULTS Since its introduction in 2007, vessel-sparing excision and primary anastomosis (VS-EPA) has been utilized in multiple centers across the world. Success rates range from 90 to 98%, comparable to traditional transecting EPA. Complication rates and erectile function outcomes are similar or better in VS-EPA, according to recent publications. CONCLUSIONS Non-transection excision and primary anastomosis is a well-tolerated, highly successful reconstructive option for short bulbar urethral strictures in appropriately selected patients. Results are comparable with traditional transecting anastomosis and mid-term multinational follow-up has proven efficacy and safety of the technique. Further well-designed multi-institutional studies are necessary to determine superiority to traditional EPA in terms of surgical outcomes and erectile function preservation.
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Excision and Primary Anastomosis for Short Bulbar Strictures: Is It Safe to Change from the Transecting towards the Nontransecting Technique? BIOMED RESEARCH INTERNATIONAL 2018; 2018:3050537. [PMID: 30515389 PMCID: PMC6236655 DOI: 10.1155/2018/3050537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/19/2018] [Indexed: 11/17/2022]
Abstract
Objective To explore whether it is safe to change from transecting excision and primary anastomosis (tEPA) towards nontransecting excision and primary anastomosis (ntEPA) in the treatment of short bulbar urethral strictures and to evaluate whether surgical outcomes are not negatively affected after introduction of ntEPA. Materials and Methods Two-hundred patients with short bulbar strictures were treated by tEPA (n=112) or ntEPA (n=88) between 2001 and 2017 in a single institution. Failure rate and other surgical outcomes (complications, operation time, hospital stay, catheterization time, and extravasation at first cystography) were calculated for both groups. Potentially predictive factors for failure (including ntEPA) were analyzed using Cox regression analysis. Results Median follow-up for the entire cohort was 76 months, 118 months, and 32 months for, respectively, tEPA and ntEPA (p<0.001). Nineteen (9.5%) patients suffered a failure, 13 (11.6%) with tEPA and 6 (6.8%) with ntEPA (p=0.333). High-grade (grade ≥3) complication rate was low (1%) and not higher with ntEPA. Median operation time, hospital stay, and catheterization time with tEPA and ntEPA were, respectively, 98 and 87 minutes, 3 and 2 days, and 14 and 9 days. None of these outcomes were negatively affected by the use of ntEPA. Diabetes and previous urethroplasty were significant predictors for failure (Hazard ratio resp. 0.165 and 0.355), whereas ntEPA was not. Conclusions Introduction of ntEPA did not negatively affect short-term failure rate, high-grade complication rate, operation time, catheterization time, and hospital stay in the treatment of short bulbar strictures. Diabetes and previous urethroplasty are predictive factors for failure.
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