1
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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; 190:125-131. [PMID: 38754790 DOI: 10.1016/j.urology.2024.05.003] [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: 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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Hu J, Wang Z, Hu H, Zhao J, Li H, Zhang X, Bi J, Li J. In vitro and in vivo assessment of a bilayered degradable rapamycin-eluting stent for ureteral stricture caused by holmium: YAG laser lithotripsy. Acta Biomater 2023; 172:321-329. [PMID: 37821034 DOI: 10.1016/j.actbio.2023.10.009] [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: 05/16/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
Ureteral stricture caused by holmium: YAG laser lithotripsy is one of the most challenging issues for urologists. Currently, evidence for rapamycin application in reducing ureterostenosis is not sufficient. This study aimed to assess the inhibition of ureteral stricture of rapamycin-eluting stents in vitro and in vivo. A bilayered drug-eluting ureteral stent consisted of drug blending with poly (lactic-co-glycolic acid) (PU/drug stent), which was over-layered by polycaprolactone (PCL) by ultrasonic atomizing spraying. Stent morphology was observed by scanning electron microscope. A kidney-ureter-bladder model was established to simulate the stents-releasing condition, and high-performance liquid chromatography was used to measure the drug release rate. The inhibitory proliferation was detected by CCK-8. The bladder of rats was injured through electro tome, and stents were implanted for 7, 14, and 28 days. The effects of drug-eluting stents was investigated by hematoxylin-eosin staining, immunofluorescence staining, real-time quantitative polymerase chain reaction and western blot. The bilayered stents could block the burst loss of the drug and maintained a sustained delivery period because of the 5.3 μm thickness of the PCL layer. The relative growth rates of cells plotted inhibitory effect on the proliferation of human urethral scar fibroblast cells. For in vivo results of 28 days, the bilayered stent maintained structural integrity and induced less deposition of crystals, thinner and less lamina propria connective tissues were formed, and α-SMA and TGF-β1 were downregulated. Bilayered rapamycin-eluting stent is significantly effective in alleviating fibrosis in in vitro and in vivo models. STATEMENT OF SIGNIFICANCE: The occurrence of ureteral stricture resulting from holmium: YAG laser lithotripsy presents a significant challenge for urologists. Traditional double J stents have not been proven to offer a shorter indwelling time or improved inhibition of tissue blocking. While drug-eluting stents containing rapamycin, paclitaxel, and other substances have been extensively used in treating artery stenosis, there is insufficient evidence supporting their application in reducing ureterostenosis. Consequently, a biodegradable polymer ureteric scaffold incorporating rapamycin was fabricated in this study, employing ultrasonic atomization spraying technology to optimize the bilayers composed of 75/25 poly (lactic-co-glycolic acid) (PLGA) and polycaprolactone (PCL). The efficacy of the scaffold was subsequently confirmed through in vitro and in vivo experiments.
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Affiliation(s)
- Jiyuan Hu
- Department of Urology, the First Affiliated Hospital of China Medical University, Shenyang, 110002, China; Department of Urology, General Hospital of Northern Theater Command, Shenyang, 110840, China
| | - Zhenyu Wang
- Department of Urology, General Hospital of Northern Theater Command, Shenyang, 110840, China
| | - Hao Hu
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China.
| | - Jing Zhao
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, 110016, China
| | - Hongwei Li
- Department of Urology, General Hospital of Northern Theater Command, Shenyang, 110840, China
| | - Xinyu Zhang
- Department of Urology, General Hospital of Northern Theater Command, Shenyang, 110840, China
| | - Jianbin Bi
- Department of Urology, the First Affiliated Hospital of China Medical University, Shenyang, 110002, China
| | - Jianzhong Li
- Department of Urology, the First Affiliated Hospital of China Medical University, Shenyang, 110002, China; Department of Urology, General Hospital of Northern Theater Command, Shenyang, 110840, China.
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3
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Abramowitz D, Sam AP, Pachorek M, Ruel N, Martins F, Angulo J, Simhan J, Li E, Nikolavsky D, Policastro C, Ramirez-Perez E, Burks F, Shetty Z, Venkatesan K, Hunter C, Gallegos M, Foreman J, Pariser J, Kasabwala K, Lopez D, Macdonald S, Warner J. Multi-institutional review of non-hypospadiac penile urethral stricture management and outcomes. Int J Urol 2022; 29:376-382. [PMID: 35118726 DOI: 10.1111/iju.14786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 12/08/2021] [Accepted: 12/22/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Penile urethral stricture disease not associated with hypospadias is rare, and there is a wide range of commonly used surgical repair techniques for this disease. We sought to compile a multi-institutional database of patients who had surgical correction of strictures in the penile urethra not limited to the meatus, and who had no history of hypospadias, for analysis using the Trauma and Urologic Reconstructive Network of Surgeons length, urethral segment and etiology classification system. METHODS A retrospective database from 13 institutions was compiled of patients who had undergone surgical correction of Trauma and Urologic Reconstructive Network of Surgeons length, urethral segment and etiology urethral stricture segments S2b/S2c and excluding E5, with a minimum follow-up time of 4 months. Failure was defined as cystoscopically confirmed recurrence of a stricture measuring less than 16-Fr. RESULTS We analyzed 222 patients with a median age of 57 years and a follow-up of 49 months. The overall surgical success rate was 80.2%. On multivariate analysis, the two variables identified that were predictive of surgical success were stricture length ≤2 cm as well as use of a buccal mucosa graft as compared to use of a fasciocutaneous flap, which had success rates of 83% and 52%, respectively (P = 0.0004). No statistically significant differences were found based on incisional approach or surgical technique, nor were outcomes different based on etiology or preoperative patient demographics. CONCLUSIONS Surgical repair of penile urethral strictures of non-hypospadiac origin have a favorable overall success rate, at 80.2%. Regardless of incisional approach or surgical technique, all operations appear to have similar outcomes other than repairs using fasciocutaneous flap, which were statistically less successful than those using buccal mucosa graft.
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Affiliation(s)
| | | | | | - Nora Ruel
- Department of Biostatistics, City of Hope Medical Center, Duarte, CA, USA
| | | | - Javier Angulo
- Universidad Europea: Universidad Europea de Madrid SLU, Madrid, Spain
| | - Jay Simhan
- Albert Einstein Healthcare Network, Philadelphia, PA, USA
| | - Eric Li
- Albert Einstein Healthcare Network, Philadelphia, PA, USA
| | - Dmitriy Nikolavsky
- State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Connor Policastro
- State University of New York Upstate Medical University, Syracuse, NY, USA
| | | | | | | | | | - Craig Hunter
- Urology Specialists of Nevada, Las Vegas, NV, USA
| | - Maxx Gallegos
- University of New Mexico Health Sciences Center, Santa Fe, NM, USA
| | - Jordan Foreman
- University of New Mexico Health Sciences Center, Santa Fe, NM, USA
| | | | | | - Damian Lopez
- Hospital Regional Licenciado Adolfo Lopez Mateos, Mexico City, Mexico
| | - Susan Macdonald
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
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4
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Ozturk SA, Guzel A, Ergun O. The success of dorsal onlay buccal mucosal graft urethroplasty in challenging urethral stricture cases after multiple failed urethrotomies. Niger J Clin Pract 2022; 25:794-800. [DOI: 10.4103/njcp.njcp_1440_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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5
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Samarska IV, Dani H, Bivalacqua TJ, Burnett AL, Matoso A. Histopathologic and clinical comparison of recurrent and non-recurrent urethral stricture disease treated by reconstructive surgery. Transl Androl Urol 2021; 10:3714-3722. [PMID: 34804815 PMCID: PMC8575568 DOI: 10.21037/tau-21-477] [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: 05/28/2021] [Accepted: 08/26/2021] [Indexed: 11/21/2022] Open
Abstract
Background Urethral stricture is a relatively frequent problem often requiring multiple surgical interventions. The objective of this study was to compare the clinicopathologic features of urethral resections from patients who underwent open end-to-end anastomotic urethroplasty and later recurred compared to those who did not. Methods A retrospective review of the pathology files identified 36 consecutive patients who underwent urethroplasty. The histopathological analysis included evaluation of the inflammatory infiltrate based on the predominant (>50%) cell type: lymphocyte-rich, neutrophil-rich, plasma cell-rich, and mixed; length and thickness of the fibrous plaque; and the cellularity of the fibrous plaque: cellular (>40 stroma nuclei/HPF) or paucicellular (<40 stroma nuclei/high power field). Results Ten (28%) patients recurred, and 26 (72%) did not. There was no significant difference between recurrent and non-recurrent cases in age, race, comorbidities, location of the stricture, and etiology. All patients with recurrent strictures showed dense paucicellular fibrotic plaques (10/10; 100%), while this was seen in 14/26 (53.8%) non-recurrent cases (P=0.01). Only one patient with cellular fibrosis showed recurrence during follow-up. The log-rank test shows that time to recurrence is significantly shorter in patients with paucicellular fibrosis compared to those with cellular fibrosis (P=0.036). The inflammation consisted of a mixed population of CD3(+) T-lymphocytes, CD20(+) B-lymphocytes, and CD68(+) histiocytes, and there was no difference in the composition of the inflammation between groups. All cases with plasma cell-rich infiltrate showed normal IgG4:IgG. Conclusions Our study supports reporting cellularity of the fibrous plaque as a potential predictor of outcome in patients undergoing reconstructive urethroplasty. Patients with paucicellular fibrosis are at increased risk of recurrence.
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Affiliation(s)
- Iryna V Samarska
- Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Hasan Dani
- Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Trinity J Bivalacqua
- Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Arthur L Burnett
- Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Andres Matoso
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
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6
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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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7
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Eredics K, Röthlin F, Wachabauer D, Sevcenco S, Marszalek M, Mock K, Madersbacher S. The long-term outcome of urethrotomy for primary urethral strictures: a population-based analysis. BJU Int 2021; 128:477-481. [PMID: 33484218 DOI: 10.1111/bju.15347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the long-term outcome of endoscopic urethrotomy for primary urethral strictures based on a population-based approach. PATIENTS AND METHODS We analysed a nationwide database of all patients with urethral stricture disease who underwent endoscopic urethrotomy as a primary intervention between January 2006 and December 2007. All patients were followed individually for 7-9 years. Frequencies and types of surgical re-interventions were documented. Repeat surgical interventions were stratified into three treatment types: urethrotomy, urethroplasty, and end-to-end urethral anastomosis. RESULTS A total of 1203 men underwent urethrotomy during the index period. The median (SD, range) patient age was 63 (15.7, 20-85) years. A total of 136 patients (11%) died during follow-up. Within the follow-up period, 932 patients (78%) received no further surgical re-intervention for recurrent disease, and 176 patients (14.6%) required one, 53 (4.5%) two, and 41 (3.4%) three or more procedures. The mean number of re-interventions was 1.5/patient and the lowest re-intervention rate was in patients aged ≥80 years (13.9%). In 236 cases (68%) at least one repeat urethrotomy was performed. An open reconstruction was performed in 87 cases (32%), with urethroplasty in 21 patients (24%), and end-to-end anastomosis in 66 patients (76%). The mean interval until re-intervention was 29.5 months. CONCLUSIONS This long-term population-based study suggests that the invasive re-treatment rate in men following initial urethrotomy is 22% within 8 years and lowest in the advanced age cohort.
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Affiliation(s)
- Klaus Eredics
- Department of Urology, Klinik Donaustadt, Wien, Austria
| | - Florian Röthlin
- Austrian National Public Health Institute (Gesundheit Österreich GmbH/GÖG), Wien, Austria
| | - David Wachabauer
- Austrian National Public Health Institute (Gesundheit Österreich GmbH/GÖG), Wien, Austria
| | - Sabina Sevcenco
- Department of Urology, Klinik Donaustadt, Wien, Austria.,Paracelsus Medical University, Salzburg, Austria
| | | | - Karl Mock
- Department of Urology, Klinik Donaustadt, Wien, Austria
| | - Stephan Madersbacher
- Department of Urology, Klinik Favoriten, Wien, Austria.,Sigmund Freud Private University, Wien, Austria
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8
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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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9
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Nnabugwu II, Onuh AC, Anyimba SK, Mgbor SO. Comparing complications of urethral stricture across various ages: a retrospective analysis of findings from retrograde urethrogram and voiding cysto-urethrogram over 10 years. BMC Med Imaging 2019; 19:84. [PMID: 31664932 PMCID: PMC6820902 DOI: 10.1186/s12880-019-0384-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/04/2019] [Indexed: 12/19/2022] Open
Abstract
Objective To determine the rate and the distribution of the structural defects in the urinary bladder complicating urethral stricture in men, and to compare the complications observed in the younger patients to those observed in the older patients. Methods Retrospectively, case files of patients diagnosed of urethral stricture using retrograde urethrogram (RUG) and voiding cysto-urethrogram (VCUG) from February 2009 to August 2018 were analyzed. Stricture characteristics were outlined. In addition, complicating structural defects in the lower urinary tract proximal to the stricture site were documented. The complicating defects identified in the patients were segregated according to age for any observable associations. Logistic regression analysis was used to define the nature of the association of patient age, stricture site, number and length, with distribution of complicating structural defects. Analyses were done using SPSS® version 20. Results Within the 10-year review period, 257 of 421 suspected cases of urethral stricture were confirmed. Patients are between 1 and 104 years of age (mean: 50.1 ± 19.1 years; median: 51.0 years IQR 35.0–65.0). Bulbar (34.2%); short segment (62.6%); partial (73.9%) strictures are prevalent. Forty-seven (18.3%) of 257 patients presented with 1 or more complications. Bladder diverticulum (8.6%) and urethra-cutaneous fistula (6.6%) are prevalent complications. The distribution of complications does not vary with age, or with stricture characteristics. Conclusion Presentation with complications is not uncommon. The distribution of these complications does not vary with age or with stricture characteristics.
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Affiliation(s)
- Ikenna I Nnabugwu
- Department of Surgery, College of Medicine, University of Nigeria Ituku-Ozalla, PMB 01129, Enugu, Nigeria. .,Department of Surgery, University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu, Nigeria.
| | - Augustine C Onuh
- Department of Radiology, University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu, Nigeria.,Hansa Diagnostic Clinic, Plot 8A Ozubulu Street, Independence Layout, Enugu, Nigeria
| | - Solomon K Anyimba
- Department of Surgery, University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu, Nigeria
| | - Samuel O Mgbor
- Hansa Diagnostic Clinic, Plot 8A Ozubulu Street, Independence Layout, Enugu, Nigeria
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10
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Irdam GA, Wahyudi I, Andy A. Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis. F1000Res 2019; 8:1390. [PMID: 36726448 PMCID: PMC9843087 DOI: 10.12688/f1000research.19704.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2020] [Indexed: 02/04/2023] Open
Abstract
Background and Aim Mitomycin-C is a potent agent that plays an important role in tissue healing and scar formation. This study aims to investigate the efficacy of Mitomycin-C in treating anterior urethral stricture after internal urethrotomy. Methods Studies evaluating efficacy of mitomycin-c for anterior urethral stricture post urethrotomy were searched using Pubmed, Scopus, Sciencedirect, MEDLINE, and Cochrane Reviews as directory databases. The search was done in March 15th 2020. Terms being used in the searching process were "mitomycin-c" or "mitomycin", "urethral stricture", "urethral stenosis", "internal urethrotomy", "optical urethrotomy" and its synonyms. Every study with the design of retrospective or prospective clinical study being done in human subject was included. Study appraisal conducted in accordance to Oxford University Center for Evidence-Based Medicine. The conclusion of each study was summarized and the calculation of random effects from every study was conducted in meta-analysis. Random effects model is chosen because small number of studies and quite different. Results Three studies involving 311patients were included in this review, all of them reported less recurrence of in patients treated with mitomycin-c post urethrotomy (p<0.001). Risk ratio of all studies was 0.41 with 95% confidence interval (0.25-0.68). Conclusion Mitomycin-C has the potential of efficacy in treating anterior urethral stricture post internal urethrotomy. Relatively few numbers of studies may impact in the strength of this review and further studies need to be done.
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Affiliation(s)
- Gampo Alam Irdam
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Irfan Wahyudi
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Andy Andy
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
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11
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Irdam GA, Wahyudi I, Andy A. Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis. F1000Res 2019; 8:1390. [PMID: 36726448 PMCID: PMC9843087 DOI: 10.12688/f1000research.19704.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2019] [Indexed: 09/19/2023] Open
Abstract
Background: Mitomycin-C is an agent that plays an important role in the tissue healing process and scar formation. This study aims to investigate the efficacy of mitomycin-C in treating anterior urethral stricture following internal urethrotomy. Methods: Studies evaluating the efficacy of mitomycin-c for anterior urethral stricture post urethrotomy were searched using PubMed, Scopus, ScienceDirect, EBSCOHost, Cochrane Reviews, and OVID as directory databases. Terms used in the searching process were "mitomycin-c" or "mitomycin", "urethral stricture", "urethral stenosis", "internal urethrotomy", "optical urethrotomy" and its synonyms. Every randomized controlled trial study conducted in human subjects was included. Study appraisals were conducted in accordance with Oxford University Center for Evidence-Based Medicine guidelines. The conclusion of each study was summarized and the calculation of fixed effect from every study was conducted in meta-analysis. Results: Included in this study were three studies involving 231 patients. All of them reported less recurrence of in patients treated with mitomycin-c post urethrotomy (p<0.001). The fixed risk ratio of all studies was 0.32 with 95% confidence interval (0.19-0.54). All studies also reported less stricture length after treatment with mitomycin-c, but there were not statistical differences between with or without treatment group. Conclusion: Mitomycin-C has efficacy in treating anterior urethral stricture after internal urethrotomy. However, the inclusion of relatively few studies may affect the strength of this review and further studies need to be done.
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Affiliation(s)
- Gampo Alam Irdam
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Irfan Wahyudi
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Andy Andy
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
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12
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Irdam GA, Wahyudi I, Andy A. Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis. F1000Res 2019; 8:1390. [PMID: 36726448 PMCID: PMC9843087 DOI: 10.12688/f1000research.19704.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 09/19/2023] Open
Abstract
Background and Aim Mitomycin-C is a potent agent that plays an important role in tissue healing and scar formation. This study aims to investigate the efficacy of Mitomycin-C in treating anterior urethral stricture after internal urethrotomy. Methods Studies evaluating efficacy of mitomycin-c for anterior urethral stricture post urethrotomy were searched using Pubmed, Scopus, Sciencedirect, MEDLINE, and Cochrane Reviews as directory databases. The search was done in March 15th 2020. Terms being used in the searching process were "mitomycin-c" or "mitomycin", "urethral stricture", "urethral stenosis", "internal urethrotomy", "optical urethrotomy" and its synonyms. Every study with the design of retrospective or prospective clinical study being done in human subject was included. Study appraisal conducted in accordance to Oxford University Center for Evidence-Based Medicine. The conclusion of each study was summarized and the calculation of random effect from every study was conducted in meta-analysis. Random effect model is chosen because small number of studies and quite different. Results Three studies involving 311patients were included in this review, all of them reported less recurrence of in patients treated with mitomycin-c post urethrotomy (p<0.001). Risk ratio of all studies was 0.41 with 95% confidence interval (0.25-0.68). Conclusion Mitomycin-C has the potential of efficacy in treating anterior urethral stricture post internal urethrotomy. Relatively few numbers of studies may impact in the strength of this review and further studies need to be done.
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Affiliation(s)
- Gampo Alam Irdam
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Irfan Wahyudi
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Andy Andy
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
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13
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Liang Y, Li X, Wu Y, Ke Z, Liu Z, Chen S, Wei Y, Zheng Q, Xue X, Xu N. LIMK1 depletion enhances fasudil‐dependent inhibition of urethral fibroblast proliferation and migration. J Cell Biochem 2019; 120:12977-12988. [PMID: 30861189 DOI: 10.1002/jcb.28569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/17/2018] [Accepted: 01/02/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Ying‐Chun Liang
- Departments of Urology The First Affiliated Hospital of Fujian Medical University Fuzhou China
| | - Xiao‐Dong Li
- Departments of Urology The First Affiliated Hospital of Fujian Medical University Fuzhou China
| | - Yu‐Peng Wu
- Departments of Urology The First Affiliated Hospital of Fujian Medical University Fuzhou China
| | - Zhi‐Bin Ke
- Departments of Urology The First Affiliated Hospital of Fujian Medical University Fuzhou China
| | - Zhang‐Qi Liu
- Departments of Urology The First Affiliated Hospital of Fujian Medical University Fuzhou China
| | - Shao‐Hao Chen
- Departments of Urology The First Affiliated Hospital of Fujian Medical University Fuzhou China
| | - Yong Wei
- Departments of Urology The First Affiliated Hospital of Fujian Medical University Fuzhou China
| | - Qing‐Shui Zheng
- Departments of Urology The First Affiliated Hospital of Fujian Medical University Fuzhou China
| | - Xue‐Yi Xue
- Departments of Urology The First Affiliated Hospital of Fujian Medical University Fuzhou China
| | - Ning Xu
- Departments of Urology The First Affiliated Hospital of Fujian Medical University Fuzhou China
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Kahokehr AA, Granieri MA, Webster GD, Peterson AC. A Critical Analysis of Bulbar Urethroplasty Stricture Recurrence: Characteristics and Management. J Urol 2018; 200:1302-1307. [PMID: 30012364 DOI: 10.1016/j.juro.2018.07.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE We evaluated the management of recurrent bulbar urethral stricture disease after urethroplasty at our institution. MATERIALS AND METHODS We performed an institution review board approved, retrospective case study of our urethroplasty database to collect stricture related and postoperative information with an emphasis on bulbar urethral stricture disease recurrence after urethroplasty between 1996 and 2012. Repair types included primary anastomotic, augmented anastomotic and onlay repair. Recurrence, which was defined as the need for intervention, was diagnosed with cystoscopy or retrograde urethrogram. RESULTS We identified 437 men who underwent urethroplasty of bulbar urethral stricture disease as performed by 2 surgeons from January 1996 to December 2012. Of the men 395 had available followup data. Recurrence was identified in 25 men (6.3%), of whom all presented with symptoms, including a weak stream in 23, urinary tract infection in 1 and pyelonephritis in 1. Median time to recurrence was 10 months. Recurrence was initially treated endoscopically in 23 of 25 cases (92%), dilatation in 12 and visual urethrotomy in 11. In 5 patients (22%) further recurrence developed after endoscopic treatment, which was managed by repeat urethroplasty in 2, self-calibration only in 2 and visual urethrotomy with subsequent self-calibration in 1. We identified 2 distinct phenotypes of recurrent stricture, including type A-short focal recurrence, which may be salvaged with an endoscopic procedure, and type B-the long graft length type, which is less likely to be salvaged with endoscopy. CONCLUSIONS Recurrence after urethroplasty is most likely to develop within the first 12 months. Type A short focal recurrence may be managed by a salvage endoscopic procedure, including dilation or visual urethrotomy. These data on the phenotype of recurrence may be useful for patient treatment.
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Affiliation(s)
- Arman A Kahokehr
- Division of Urology, Duke University Medical Center, Durham, North Carolina, and New York University School of Medicine (MAG), New York, New York.
| | - Michael A Granieri
- Division of Urology, Duke University Medical Center, Durham, North Carolina, and New York University School of Medicine (MAG), New York, New York
| | - George D Webster
- Division of Urology, Duke University Medical Center, Durham, North Carolina, and New York University School of Medicine (MAG), New York, New York
| | - Andrew C Peterson
- Division of Urology, Duke University Medical Center, Durham, North Carolina, and New York University School of Medicine (MAG), New York, New York
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Brown ET, Mock S, Dmochowski R, Reynolds WS, Milam D, Kaufman MR. Direct visual internal urethrotomy for isolated, post-urethroplasty strictures: a retrospective analysis. Ther Adv Urol 2017; 9:39-44. [PMID: 28203286 PMCID: PMC5298410 DOI: 10.1177/1756287216679946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Urethroplasty is often successful for the treatment of male urethral stricture disease, but limited data exists on recurrence management. Our goal was to evaluate direct visual internal urethrotomy (DVIU) as a treatment option for isolated, recurrent strictures after urethroplasty. METHODS We retrospectively identified male patients who underwent urethroplasty from 1999 to 2013 and developed an isolated, recurrent stricture at the urethroplasty site treated with DVIU. Success was defined as lack of symptomatology and no subsequent intervention. Comparative analysis identified characteristics and stricture properties associated with success. RESULTS A total of 436 urethroplasties were performed in 401 patients at our institution between 1999 and 2013. Stricture recurrence was noted in 64 (16%) patients. Of these, 47 (73%) underwent a DVIU. A total of 37 patients met inclusion criteria and underwent 50 DVIU procedures at the urethroplasty site. A single DVIU was successful in 13 of 37 patients (35%). A total of 4 of 6 patients required a second DVIU (67%). Overall, 17 of 43 (40%) of the total DVIUs were successful after urethroplasty. Success did not differ by age, stricture length or location, surgical technique, radiation history, prior urethroplasty or DVIU, time to failure, or etiology. CONCLUSIONS Post-urethroplasty DVIU for isolated, recurrent strictures may be offered as a minimally invasive treatment option. Approximately 40% of patients were spared further intervention.
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Affiliation(s)
| | - Stephen Mock
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Douglas Milam
- Vanderbilt University Medical Center, Nashville, TN, USA
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