1
|
Faizan M, Mahboob E, Samad MA, Fatima L, Fatima A, Iqbal A, Rauf R, Naeem M, Shoaib UB, Siddiqui SA, Imran MH. Safety and efficacy of lasers compared to cold knife in direct visual internal urethrotomy: a systematic review and Meta-analysis. Lasers Med Sci 2024; 39:209. [PMID: 39101963 DOI: 10.1007/s10103-024-04134-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/08/2024] [Indexed: 08/06/2024]
Abstract
Cold knife urethrotome was introduced in 1971 and it had an 80% success rate. New advancements in this field have shed light on the use of various lasers such as carbon dioxide, Nd: YAG, KTP, Argon, Ho: YAG, and excimer lasers. It has been observed that cold knife urethrotomy has a higher recurrence rate than laser urethrotomy, but the superiority of either treatment modality has not been established yet. Data were thoroughly searched through PubMed, Scopus, and clinicaltrials.gov. We also used clinicaltrials.gov for ongoing and published research. The data was analyzed via R studio version 2023.12.1 (oceanstorm). For dichotomous variables, Odds Ratio (OR) were used to pool data and standardized mean difference was used for continuous variables with 95% confidence intervals (CIs). A total of 14 studies including 1114 participants were included in this meta-analysis. The results of the combined analysis revealed significant relation with a mean difference of 0.99 (95% CI: 0.37; 1.62), and favored laser group. The overall results have shown the laser to have a significant favorable profile demonstrating a recurrence, Odds Ratio of 0.42 (95% CI:0.27;0.65). Patients with laser therapy had a lower risk of complication rate (OR 0.49, 95% Cl: 0.35; 0.67). All the findings obtained by the analysis in this study favour lasers significantly over the cold knife technique especially when mean Qmax, with recurrence and complications taken into account.
Collapse
Affiliation(s)
| | - Eman Mahboob
- Dow University of Health Sciences, Karachi, Pakistan
| | | | - Leenah Fatima
- Dow University of Health Sciences, Karachi, Pakistan
| | - Ammara Fatima
- Dow University of Health Sciences, Karachi, Pakistan
| | - Amna Iqbal
- Dow University of Health Sciences, Karachi, Pakistan
| | - Rafia Rauf
- Sindh Institute of Urology and Transplant, Karachi, Pakistan
| | - Mustafa Naeem
- Liaquat University of Health Sciences, Karachi, Pakistan
| | - Umer Bin Shoaib
- Sindh Institute of Urology and Transplant, Karachi, Pakistan
| | | | | |
Collapse
|
2
|
Ming W, Zuo J, Han J, Chen J. Local adjuncts to minimally invasive endoscopic interventions for benign laryngotracheal stenosis: a meta-analysis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08810-x. [PMID: 38967672 DOI: 10.1007/s00405-024-08810-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 06/24/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Benign laryngotracheal stenosis is widely managed with minimally invasive endoscopic interventions, such as laser incision or excision scar, and dilation. However, various endoscopic treatments are significantly associated with a high recurrence rate. Local auxiliary measures, including inhalation of steroids, injection of steroids, and local topical application of mitomycin C, have been studied in order to increase the success rate. PURPOSE To compare the efficacy of endoscopic treatments with and without local adjuncts in patients with benign laryngotracheal stenosis, and analyze their clinical outcomes, recurrence, and complications. METHODS In the meta-analysis, databases including PubMed, EMBASE, OVID, and Web of Science were searched for papers comparing the outcomes of adjunct therapy with non-adjunct therapy in patients with laryngotracheal stenosis. The duplicate publications, reviews, comments or letters, conference abstracts, and case reports were excluded. The random effect model was used for assessing the pooled risk estimates. RESULTS Eight studies (1204 cases) referring to two prospective randomized controlled studies, two prospective cohort studies, and four retrospective cohort studies were ultimately included in the meta-analysis. Three delivery modes of adjuncts were identified, including intralesion steroid injection (n = 2), inhaled steroid (n = 2), and topical application of mitomycin C (n = 4). The decreased risk estimates of recurrence rate were detected in patients receiving endoscopic treatments with steroid injection or inhaled steroid, compared with endoscopic interventions alone (P < 0.05). Additionally, patients undergoing adjunct therapies had lower risk estimates of recurrence, compared to those receiving endoscopic procedures alone (P < 0.05), based on the subgroup of prospective cohort studies, subglottis, Mayer-Cotton scale of I-II degree, and stenosis length of < 3 cm. The high heterogeneity of the pooling risk estimates perhaps was due to factors of auxiliary drug, clinical characteristics of patients, and methodology. No discernible difference in the incidence of complication was identified. CONCLUSIONS Local application of steroids to minimally invasive interventions appear to reduce the recurrence rate of laryngotracheal stenosis. Various adjuncts available, including steroids and mitomycin C, appear to be safe and associated with a low risk estimate of adjuncts-specific complication rate. High quality multi-center randomized controlled studies are needed, with sufficient periods for follow-up and subjective and objective outcome indicators, to properly evaluate the efficacy, safety, and cost-effectiveness of adjuvant drugs.
Collapse
Affiliation(s)
- Wei Ming
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
| | - Jingjing Zuo
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jibo Han
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jinhui Chen
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| |
Collapse
|
3
|
Abdel Gawad AM, Patil A, Singh A, Ganpule AP, Sabnis RB, Desai MR. Long-term outcomes of urethral balloon dilation for anterior urethral stricture: A prospective cohort study. Asian J Urol 2024; 11:480-485. [PMID: 39139530 PMCID: PMC11318443 DOI: 10.1016/j.ajur.2023.04.006] [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: 11/08/2022] [Accepted: 04/21/2023] [Indexed: 08/15/2024] Open
Abstract
Objective To prospectively follow up a cohort of anterior urethral stricture disease patients managed with balloon dilation (BD) for 3 years to evaluate the long-term outcomes and to study factors that contribute to recurrence. Methods This study included men who had urethral BD for significant anterior urethral stricture disease between January 2017 and March 2019. Data about the patient age, stricture characteristics, and recurrence date were recorded, along with information on postoperative indwelling catheter use and operative complications. Furthermore, information about the self-calibration procedure was collected and where available, free flow (FF) measurements during the follow-up period were recorded and analyzed. Success was defined as a lack of symptoms and acceptable FF rates (maximum flow rate>12 mL/s). Results The final analysis was conducted on 187 patients. The mean follow-up period was 37 months. The long-term overall success rate at the end of our study was 66.8%. Our recurrence rate was 7.4% at 12 months, 24.7% at 24 months, and reached 33.2% at the end of our study. The time to recurrence ranged from 91 days to 1635 days, with a mean of 670 days. The stricture-free survival was significantly shorter with lengthy peno-bulbar (p=0.031) and multiple strictures (p=0.015), and in the group of patients who were not committed to self-calibration protocol (p<0.011). However, post-procedural self-calibration was the most important factor that may have decreased the incidence of recurrence (odds ratio=5.85). Adjuvant self-calibration after BD not only reduced the recurrence rate from 85.4% in the non-self-calibration group to 15.1% in the self-calibration one (p<0.001), but also improved the overall stricture-free survival and FF parameters. Conclusion Urethral BD has a high recurrence rate in the long-term, especially with long and multiple strictures. Adjuvant self-calibration has proven to reduce the recurrence risk and the need for re-intervention.
Collapse
Affiliation(s)
- Ahmed M. Abdel Gawad
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
- Department of Urology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Abhijit Patil
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Abhishek Singh
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Arvind P. Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Ravindra B. Sabnis
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Mahesh R. Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| |
Collapse
|
4
|
Pagonis K, Peteinaris A, Adamou C, Tatanis V, Vagionis A, Natsos A, Obaidat M, Faitatziadis S, Liatsikos E, Kallidonis P. Minimal invasive treatment of urethral strictures: An experimental study of the effect of paclitaxel coated balloons in the wall of strictured rabbit's urethra. Arch Ital Urol Androl 2024; 96:12248. [PMID: 38389459 DOI: 10.4081/aiua.2024.12248] [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: 12/31/2023] [Accepted: 01/15/2024] [Indexed: 02/24/2024] Open
Abstract
PURPOSE The aim of this study is the evaluation of the distribution of paclitaxel (PTX) released by a coated balloon in the layers of rabbit's urethra. METHODS 18 rabbits were included. A laser device was used for the stricture formation. After two weeks, dilation of the strictured urethra was performed by using Advance 35LP PTA balloons and Advance 18 PTX PTA balloons. The experimental models were divided into 3 groups. The group Α included two rabbits without any intervention except for the stenosis procedure. Group B compromised six rabbits that underwent dilation with Advance 35LP PTA balloons. Group C consisted of 10 rabbits to which dilation with both Advance 35LP PTA balloons and Advance 18 PTX PTA balloons was applied. Histological evaluation and Immunohistochemistry were performed on all specimens. RESULTS Inflammation, fibrosis and ruptures were detected in the specimens of the study. In specimens of Group C the decrease of inflammation and fibrosis rate was greater. Anti-PTX antibody was detected in the epithelium, lamina propria and smooth muscle layer of all specimens of urethras that have been harvested immediately and 1 day after the dilation with Advance 18 PTX PTA balloon and it was not observed in any layer of the urethral wall of the rest of the examined specimens of Group C. CONCLUSIONS PTX's enrichment was detected in the smooth muscle layer of all specimens that have been harvested immediately and 24h after the dilation with Advance 18 PTX PTA balloons. PTX may play an inhibitive role in the recurrence of the stenosis.
Collapse
|
5
|
Li X, Xu C, Ji X, Zhu Z, Cai T, Guo Z, Lin J. Balloon dilation for the treatment of male urethral strictures: a systematic review and meta-analysis. BMJ Open 2024; 14:e071923. [PMID: 38320837 PMCID: PMC10860052 DOI: 10.1136/bmjopen-2023-071923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/22/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE The use of minimally invasive endoluminal treatment for urethral strictures has been a subject for debate for several decades. The aim of this study was to review and discuss the safety, efficacy and factors influencing the clinical application of balloon dilation for the treatment of male urethral strictures. DESIGN Systematic review and meta-analysis. DATA SOURCES Embase, Medline, Web of Science, Cochrane Library and Scopus were searched for publications published before 17 July 2022. STUDY SELECTION Two independent researchers screened and assessed the results, and all clinical studies on balloon dilation for the treatment of urethral strictures in men were included. DATA EXTRACTION AND SYNTHESIS The success rate, rate of adverse events, International Prostate Symptom Scores, maximum uroflow (Qmax) and postvoid residual urine volume were the main outcomes. Stata V.14.0 was used for statistical analysis. RESULTS Fifteen studies with 715 patients were ultimately included in this systematic review. The pooled results of eight studies showed that the reported success rate of simple balloon dilation for male urethral strictures was 67.07% (95% confidence interval [CI]: 55.92% to 77.36%). The maximum urinary flow rate at 3 months (risk ratio [RR]= 2.6510, 95% CI: 1.0681 to 4.2338, p<0.01) and the maximum urinary flow rate at 1 year (RR= 1.6637, 95% CI: 1.1837 to 2.1437, p<0.05) were significantly different after dilation. There is insufficient evidence to suggest that balloon dilation is superior to optical internal urethrotomy or direct visual internal urethrotomy (DVIU) (RR= 1.4754, 95% CI: 0.7306 to 2.9793, p=0.278). CONCLUSION Balloon dilation may be an intermediate step before urethroplasty and is a promising alternative therapy to simple dilation and DVIU. The balloon is a promising drug delivery tool, and paclitaxel drug-coated balloon dilation is effective in reducing retreatment rates in patients with recurrent anterior urethral strictures. The aetiology, location, length, previous treatment of urethral stricture may be associated with the efficacy of balloon dilation. PROSPERO REGISTRATION NUMBER CRD42022334403.
Collapse
Affiliation(s)
- Xiaoyu Li
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
| | - Chunru Xu
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
| | - Xing Ji
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
| | - Zhenpeng Zhu
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
| | - Tianyu Cai
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
| | - Zhenke Guo
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
| | - Jian Lin
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
| |
Collapse
|
6
|
Luo H, Lou KC, Xie LY, Zeng F, Zou JR. Pharmacotherapy of urethral stricture. Asian J Androl 2024; 26:1-9. [PMID: 37738151 PMCID: PMC10846832 DOI: 10.4103/aja202341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/21/2023] [Indexed: 09/24/2023] Open
Abstract
Urethral stricture is characterized by the chronic formation of fibrous tissue, leading to the narrowing of the urethral lumen. Despite the availability of various endoscopic treatments, the recurrence of urethral strictures remains a common challenge. Postsurgery pharmacotherapy targeting tissue fibrosis is a promising option for reducing recurrence rates. Although drugs cannot replace surgery, they can be used as adjuvant therapies to improve outcomes. In this regard, many drugs have been proposed based on the mechanisms underlying the pathophysiology of urethral stricture. Ongoing studies have obtained substantial progress in treating urethral strictures, highlighting the potential for improved drug effectiveness through appropriate clinical delivery methods. Therefore, this review summarizes the latest researches on the mechanisms related to the pathophysiology of urethral stricture and the drugs to provide a theoretical basis and new insights for the effective use and future advancements in drug therapy for urethral stricture.
Collapse
Affiliation(s)
- Hui Luo
- The First Clinical College, Gannan Medical University, Ganzhou 341000, China
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
| | - Ke-Cheng Lou
- The First Clinical College, Gannan Medical University, Ganzhou 341000, China
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
| | - Ling-Yu Xie
- The First Clinical College, Gannan Medical University, Ganzhou 341000, China
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
| | - Fei Zeng
- The First Clinical College, Gannan Medical University, Ganzhou 341000, China
| | - Jun-Rong Zou
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
- Institute of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
- Jiangxi Engineering Technology Research Center of Calculi Prevention, Ganzhou 341000, China
| |
Collapse
|
7
|
Hua Y, Wang K, Huo Y, Zhuang Y, Wang Y, Fang W, Sun Y, Zhou G, Fu Q, Cui W, Zhang K. Four-dimensional hydrogel dressing adaptable to the urethral microenvironment for scarless urethral reconstruction. Nat Commun 2023; 14:7632. [PMID: 37993447 PMCID: PMC10665446 DOI: 10.1038/s41467-023-43421-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023] Open
Abstract
The harsh urethral microenvironment (UME) after trauma severely hinders the current hydrogel-based urethral repair. In fact, four-dimensional (4D) consideration to mimic time-dependent physiological processes is essential for scarless urethral reconstruction, which requires balancing extracellular matrix (ECM) deposition and remodeling at different healing stages. In this study, we develop a UME-adaptable 4D hydrogel dressing to sequentially provide an early-vascularized microenvironment and later-antifibrogenic microenvironment for scarless urethral reconstruction. With the combination of dynamic boronic ester crosslinking and covalent photopolymerization, the resultant gelatin methacryloyl phenylboronic acid/cis-diol-crosslinked (GMPD) hydrogels exhibit mussel-mimetic viscoelasticity, satisfactory adhesion, and acid-reinforced stability, which can adapt to harsh UME. In addition, a temporally on-demand regulatory (TOR) technical platform is introduced into GMPD hydrogels to create a time-dependent 4D microenvironment. As a result, physiological urethral recovery is successfully mimicked by means of an early-vascularized microenvironment to promote wound healing by activating the vascular endothelial growth factor (VEGF) signaling pathway, as well as a later-antifibrogenic microenvironment to prevent hypertrophic scar formation by timing transforming growth factor-β (TGFβ) signaling pathway inhibition. Both in vitro molecular mechanisms of the physiological healing process and in vivo scarless urethral reconstruction in a rabbit model are effectively verified, providing a promising alternative for urethral injury treatment.
Collapse
Affiliation(s)
- Yujie Hua
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, 200233, P. R. China
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, 200011, P. R. China
| | - Kai Wang
- Clinical Research Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, P. R. China
| | - Yingying Huo
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, 200011, P. R. China
| | - Yaping Zhuang
- Department of Orthopaedics, Shanghai Institute of Traumatology and Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - Yuhui Wang
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, 200233, P. R. China
| | - Wenzhuo Fang
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, 200233, P. R. China
| | - Yuyan Sun
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, 200011, P. R. China
| | - Guangdong Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, 200011, P. R. China
| | - Qiang Fu
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, 200233, P. R. China.
| | - Wenguo Cui
- Department of Orthopaedics, Shanghai Institute of Traumatology and Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China.
| | - Kaile Zhang
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, 200233, P. R. China.
| |
Collapse
|
8
|
Uguzova S, Beisland C, Honoré A, Juliebø-Jones P. Refractory Bladder Neck Contracture (BNC) After Radical Prostatectomy: Prevalence, Impact and Management Challenges. Res Rep Urol 2023; 15:495-507. [PMID: 37954870 PMCID: PMC10638897 DOI: 10.2147/rru.s350777] [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: 07/28/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023] Open
Abstract
Bladder neck contracture is a recognised complication associated with radical prostatectomy. The management can be challenging, especially when refractory to initial intervention strategies. For the patient, the burden of disease is high and continence status cannot be overlooked. This review serves to provide an overview of the management of this recognised clinical pathology. Consideration needs to be given to minimally invasive approaches such as endoscopic incision, injectables, implantable devices as well as major reconstructive surgery where the condition persists. For the latter, this can involve open and robotic surgery as well as use of grafts and artificial sphincter surgery. These elements underline the need for a tailored and a patient centred approach.
Collapse
Affiliation(s)
- Sabine Uguzova
- Department of Urology, Stepping Hill Hospital, Manchester, UK
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Alfred Honoré
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
9
|
Özsoy E, Kutluhan MA, Tokuç E, Kayar R, Demir S, Akyüz M, Öztürk Mİ. Is testosterone deficiency a predictive factor for recurrence of urethral stricture? Andrology 2023. [PMID: 37924277 DOI: 10.1111/andr.13554] [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: 06/16/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Testosterone plays a vital role in maintaining tissue homeostasis, and testosterone deficiency may potentially influence the likelihood of urethral stricture recurrence. OBJECTIVES To evaluate the prognostic value of testosterone levels in the recurrence after direct visual internal urethrotomy in primary short segment bulbar urethral strictures and its clinical reflections. MATERIALS AND METHODS A total of 723 patients who underwent direct vision internal urethrotomy between January 2000 and October 2022 were retrospectively analyzed. After implying exclusion criteria, 116 patients with available data were enrolled. Patients were divided into two groups as recurrence and no recurrence. Age, stricture length, etiology, time of recurrence, diagnosis of previous diabetes mellitus, hypertension, smoking, body mass index, and total testosterone levels were recorded. Free testosterone and bioavailable testosterone values were calculated using total testosterone, albumin, and sex hormone binding globulin values. Hypogonadism was considered as a total testosterone level less than 300 ng/dL. Demographic characteristics and total testosterone, free testosterone, and bioavailable testosterone levels were compared between the two groups for statistical significance. The recurrence rates of patients with and without hypogonadism were compared. RESULTS Recurrence was observed in 41.4% of the cases (n = 48). There was no statistically significant difference between the groups in terms of age, body mass index values, diabetes mellitus, hypertension, smoking status, presence of hypogonadism, and etiology (p = 0.745, 0.863, 0.621, 0.622, 0.168, 0.051, and 0.232). In terms of total testosterone levels and bioavailable testosterone levels, the recurrence group had significantly lower values (p = 0.018 and 0.04). There was no significant difference between the two groups in terms of stricture length (p = 0.071). Sixteen of 28 patients with hypogonadism had recurrence, whereas 32 of 88 patients without hypogonadism had recurrence (p = 0.051). DISCUSSION Testosterone levels have potential to predict recurrence in primary short-segment bulbar urethral strictures. This study represents the inaugural analysis of the impact of testosterone deficiency on recurrence within the cohort of patients with primary short-segment bulbar urethral strictures. CONCLUSION Testosterone levels and ratios may serve as predictive factors for identifying recurrent cases in primary short-segment bulbar strictures. For patients at a higher risk of recurrence, urethroplasty may be considered as an initial treatment option, even in cases of primary and short-segment strictures.
Collapse
Affiliation(s)
| | - Musab Ali Kutluhan
- Department of Urology, Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Emre Tokuç
- Department of Urology, Health Sciences University Haydarpasa Numune Training and Research Hospital, İstanbul, Turkey
| | - Rıdvan Kayar
- Department of Urology, Health Sciences University Haydarpasa Numune Training and Research Hospital, İstanbul, Turkey
| | - Samet Demir
- Department of Urology, Health Sciences University Haydarpasa Numune Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Akyüz
- Department of Urology, Health Sciences University Haydarpasa Numune Training and Research Hospital, İstanbul, Turkey
| | - Metin İshak Öztürk
- Department of Urology, Health Sciences University Haydarpasa Numune Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
10
|
Verla W, Barratt R, Chan G, Dimitropoulos K, Esperto F, Yuhong Y, Greenwell T, Lumen N, Martins F, Osman N, Ploumidis A, Riechardt S, Waterloos M, Campos-Juanatey F. Is a Course of Intermittent Self-dilatation with Topical Corticosteroids Superior at Stabilising Urethral Stricture Disease in Men and Improving Functional Outcomes over a Course of Intermittent Self-dilatation Alone? A Systematic Review and Meta-analysis. EUR UROL SUPPL 2023; 51:95-105. [PMID: 37122691 PMCID: PMC10130070 DOI: 10.1016/j.euros.2023.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 05/02/2023] Open
Abstract
Context Intermittent self-dilatation (ISD) is a therapeutic strategy used to stabilise a urethral stricture and postpone or avoid further treatment. Adding corticosteroids to this mode of management might further enhance its outcomes by downregulation of collagen deposition and excessive scar tissue formation. Objective To explore whether a course of ISD with topical corticosteroids is superior at stabilising urethral stricture disease in men and improving functional outcomes over a course of ISD alone. Evidence acquisition This systematic review and meta-analysis was undertaken by the European Association of Urology Urethral Strictures Guideline Panel according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines (CRD42021256744). The primary benefit outcome was successful stabilisation of the urethral stricture. Treatment-related complications were the primary harm outcome. Evidence synthesis In total, 978 records were screened for eligibility, ultimately leading to five included studies, all randomised controlled trials, comprising 250 patients, of whom 124 underwent a course of ISD with corticosteroids and 126 underwent a course of ISD alone, all after direct vision internal urethrotomy (DVIU). Successful stabilisation of the stricture was achieved in 77% and 64% of patients in the group with and without corticosteroids, respectively (p = 0.04). No extra complications related to the addition of corticosteroids to the ISD regimen were reported. The risk of bias of the included studies was generally unclear to high. Conclusions Based on the currently available data, a course of ISD with topical corticosteroids appears to be safe and superior at stabilising a urethral stricture after DVIU in the short term to a course of ISD alone. However, given the unclear to high risk of bias in the included studies, further high-quality studies are needed to fully underpin this. Patient summary This study shows that addition of topical corticosteroids to intermittent self-dilatation after direct vision internal urethrotomy can better stabilise the stricture in the short term.
Collapse
Affiliation(s)
- Wesley Verla
- Dept. of Urology, Ghent University Hospital, Ghent, Belgium
- Corresponding author. Tel.: (+32) 9 332 22 76. Fax.: (+32) 9 332 38 89.
| | - Rachel Barratt
- Dept. of Urology, University College London Hospital, London, UK
| | - Garson Chan
- Dept. of Urology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | - Yuan Yuhong
- Department of Medicine, Health Science Centre, McMaster University, Hamilton, ON, Canada
| | - Tamsin Greenwell
- Dept. of Urology, University College London Hospital, London, UK
| | - Nicolaas Lumen
- Dept. of Urology, Ghent University Hospital, Ghent, Belgium
| | - Francisco Martins
- Dept. of Urology, Universidade de Lisboa, Hospital de Santa Maria, Lisbon, Portugal
| | - Nadir Osman
- Dept. of Urology, Royal Hallamshire Hospital, Sheffield, UK
| | | | - Silke Riechardt
- Dept. of Urology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Marjan Waterloos
- Dept. of Urology, Ghent University Hospital, Ghent, Belgium
- Dept. of Urology, AZ Maria Middelares, Ghent, Belgium
| | | | | |
Collapse
|
11
|
El Ansari W, AlRumaihi K, El-Ansari K, Arafa M, Elbardisi H, Majzoub A, Shamsodini A, Al Ansari A. Reporting quality of abstracts of systematic reviews/meta-analyses: An appraisal of Arab Journal of Urology across 12 years: the PRISMA-Abstracts checklist. Arab J Urol 2023; 21:52-65. [PMID: 36818377 PMCID: PMC9930775 DOI: 10.1080/2090598x.2022.2113127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Objective We appraised the reporting quality of abstracts of systematic reviews/meta-analyses (SR/MAs) published in one urology journal and explored associations between abstract characteristics and completeness of reporting. Methods The Arab Journal of Urology (AJU) was searched for SR/MAs published between January 2011 and 31 May 2022. SR/MAs with structured abstract and quantitative synthesis were eligible. Two reviewers simultaneously together selected the SR/MAs by title, screened the abstracts, and included those based on inclusion/exclusion criteria. Data of a range of characteristics were extracted from each SR/MAs into a spreadsheet. To gauge completeness of reporting, the PRISMA-Abstract checklist (12 items) was used to appraise the extent to which abstracts adhered to the checklist. For each abstract, we computed item, section, and overall adherence. Chi-square and t-tests compared the adherence scores. Univariate and multivariate analyses identified the abstract characteristics associated with overall adherence. Results In total, 66 SR/MAs published during the examined period; 62 were included. Partial reporting was not uncommon. In terms of adherence to the 12 PRISMA-A items were: two items exhibited 100% adherence (title, objectives); five items had 80% to <100% adherence (interpretation, included studies, synthesis of results, eligibility criteria, and information sources); two items displayed 40% to <80% adherence (description of the effect, strengths/limitations of evidence); and three items had adherence that fell between 0% and 1.6% (risk of bias, funding/conflict of interest, registration). Multivariable regression revealed two independent predictors of overall adherence: single-country authorship (i.e. no collaboration) was associated with higher overall adherence (P = 0.046); and abstracts from South America were associated with lower overall adherence (P = 0.04). Conclusion This study is the first to appraise abstracts of SR/MAs in urology. For high-quality abstracts, improvements are needed in the quality of reporting. Adoption/better adherence to PRISMA-A checklist by editors/authors could improve the reporting quality and completeness of SR/MAs abstracts.
Collapse
Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar,College of Medicine, Qatar University, Doha, Qatar,Weill Cornell Medicine – Qatar, Doha, Qatar,CONTACT Walid El Ansari Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khalid AlRumaihi
- College of Medicine, Qatar University, Doha, Qatar,Weill Cornell Medicine – Qatar, Doha, Qatar,Urology Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Mohamed Arafa
- Weill Cornell Medicine – Qatar, Doha, Qatar,Urology Department, Hamad Medical Corporation, Doha, Qatar,Andrology Department, Cairo University, Cairo, Egypt
| | - Haitham Elbardisi
- College of Medicine, Qatar University, Doha, Qatar,Weill Cornell Medicine – Qatar, Doha, Qatar,Urology Department, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Majzoub
- Weill Cornell Medicine – Qatar, Doha, Qatar,Urology Department, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Shamsodini
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar,Weill Cornell Medicine – Qatar, Doha, Qatar,Urology Department, Hamad Medical Corporation, Doha, Qatar
| | - Abdulla Al Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar,Weill Cornell Medicine – Qatar, Doha, Qatar,Urology Department, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
12
|
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.
Collapse
|
13
|
Soliman C, Pan HYC, Mulholland CJ, Furrer MA, Agarwal DK, Lawrentschuk N, Sathianathen NJ. Effect of local steroids on urethral strictures: A systematic review and meta-analysis. Investig Clin Urol 2022; 63:273-284. [PMID: 35534216 PMCID: PMC9091821 DOI: 10.4111/icu.20210391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/20/2021] [Accepted: 03/17/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Urethral stricture disease is common and has high associated morbidity and impact on quality-of-life. This systematic review and meta-analysis aims to summarise current evidence on the efficacy of local urethral steroids post-direct vision internal urethrotomy (DVIU) for the treatment of urethral strictures in males. MATERIALS AND METHODS A comprehensive search was performed using reputable databases and registries, up to 22 February 2022. Only randomised control trials in which participants were randomised to DVIU plus local urethral steroids versus DVIU only were included. Statistical analyses were performed using a random-effects model. Quality of evidence was rated according to the GRADE approach. RESULTS The search identified seven studies in which 365 participants were randomised to DVIU plus local urethral steroids versus DVIU only. The application of local steroids appeared to reduce recurrence rates (risk ratio, 0.67; 95% confidence interval [CI], 0.49-0.90) and time-to-recurrence (hazard ratio, 0.58; 95% CI, 0.39-0.85). Qmax also improved following steroid application (mean difference, 0.82; 95% CI, -1.02-2.66); however, this was not statistically significant. No heterogeneity was identified between included studies for all outcomes. The certainty of evidence was downgraded due to study limitations with a small sample size and unclear risk-of-bias related to insufficient trial information. CONCLUSIONS Compared to DVIU alone, adjuvant steroids applied to the urethra may reduce risk of recurrence and time-to-recurrence. These findings were statistically significant and likely also clinically significant given low associated costs and risk. However, more robust randomised trials are necessary to enhance the validity of these outcomes.
Collapse
Affiliation(s)
- Christopher Soliman
- Department of Urology, The Royal Melbourne Hospital, Parkville, VIC, Australia.
| | - Henry Y C Pan
- Department of Urology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Clancy J Mulholland
- Department of Urology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Marc A Furrer
- Department of Urology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Dinesh K Agarwal
- Department of Urology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Nathan Lawrentschuk
- Department of Urology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | | |
Collapse
|
14
|
Pranata FH, Hidayatullah F, Kloping YP, Rahman ZA, Rizaldi F, Soebadi DM. The efficacy and safety of mitomycin C intra urethral injection to prevent recurrent urethral stricture: A systematic review and meta-analysis. Ann Med Surg (Lond) 2022; 77:103576. [PMID: 35638056 PMCID: PMC9142380 DOI: 10.1016/j.amsu.2022.103576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 10/24/2022] Open
|
15
|
Virasoro R, DeLong JM, Estrella RE, Pichardo M, Rodriguez Lay R, Espino G, Elliott SP. A Drug-Coated Balloon Treatment for Urethral Stricture Disease: Three-Year Results from the ROBUST I Study. Res Rep Urol 2022; 14:177-183. [PMID: 35572815 PMCID: PMC9091705 DOI: 10.2147/rru.s359872] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/03/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Endoscopic management of male anterior urethral stricture disease is common; however, repeat treatment is associated with high recurrence rates. Here, we report the 3-year results of the ROBUST I trial, which evaluated the safety and efficacy of the Optilume® drug coated balloon (DCB) in men with recurrent urethral strictures. Methods Adult men with recurrent bulbar urethral strictures ≤2 cm in length and 1–4 prior endoscopic interventions were treated with the Optilume DCB. Functional success was defined as ≥50% reduction in International Prostate Symptom Score (IPSS) without need for retreatment. Other outcomes included quality of life, maximum flow rate, post-void residual urine volume, erectile function, and freedom from repeat intervention. Results Of the 53 enrolled and treated men, 33 completed the 3-year visit, with 10 patients experiencing clinical failures at previous visits, giving a total of 43 subjects evaluable for the functional success endpoint. Functional success was achieved in 67% (29/43) and freedom from retreatment in 77% (33/43). Average IPSS improved from 25.2 at baseline to 5.5 at 3 years (p<0.0001). Significant improvements were observed in quality of life, flow rate, and post-void residual urine volume. Erectile function was not affected by treatment. Device-related adverse events were mild or moderate in nature and resolved quickly after onset. There were no serious treatment-related adverse events. Conclusion Symptomatic improvement after treatment with the Optilume DCB was maintained through 3 years in a population highly susceptible to recurrent urethral stricture disease. This minimally invasive therapy is safe with no negative impact on sexual function.
Collapse
Affiliation(s)
- Ramón Virasoro
- Urology of Virginia PLLC, Virginia Beach, VA, USA
- Correspondence: Ramón Virasoro, Urology of Virginia PLLC, 225 Clearfield Ave, Virginia Beach, VA, 23462, USA, Tel +1 757-457-5100, Email
| | | | - Rafael E Estrella
- Clinica Unión Medica, Santiago de los Caballeros, Dominican Republic
| | | | | | | | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
16
|
Re: One-year Results for the ROBUST III Randomized Controlled Trial Evaluating the Optilume® Drug-coated Balloon for Anterior Urethral Strictures. Eur Urol 2022; 82:238-239. [DOI: 10.1016/j.eururo.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/07/2022] [Indexed: 11/18/2022]
|
17
|
The use of local therapy in preventing urethral strictures: A systematic review. PLoS One 2021; 16:e0258256. [PMID: 34614033 PMCID: PMC8494308 DOI: 10.1371/journal.pone.0258256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/22/2021] [Indexed: 12/09/2022] Open
Abstract
Background Urethral stricture disease is a common problem amongst men in Western countries often leading to a decreased quality of life. Current endoscopic treatment procedure shows an unsatisfying stricture recurrence rate which could be improved by addition of local therapies. Objectives To provide an overview of both preclinical and clinical studies in order to investigate current level of evidence on the addition of local therapy to improve urethral stricture recurrence rates after endoscopic procedures. Methods We performed a literature search in December 2020 and August 2021 using Cochrane, Embase, PubMed, Scopus and Web of Science and identified articles through combinations of search terms for ‘urethral stricture disease’, ‘stricture formation’ and ‘local interventions’. We used the SYRCLE, RoB-2 and ROBINS-I tools to assess risk of bias across included studies. We did not perform a meta-analysis due to methodological differences between studies. Results We included 32 articles in the qualitative analysis, 20 of which were preclinical studies and 12 clinical studies. Regarding preclinical articles using an animal model, nearly all interventions showed to have a positive effect on either urethral fibrosis, urethral stricture formation and/or fibrotic protein expression levels. Here, immunosuppressants and chemotherapeutics seemed most promising for possible clinical purposes. Regarding clinical studies, mitomycin-C and hyaluronic acid and carboxymethylcellulose showed positive effects on urethral stricture recurrence rates with low to intermediate risk of bias across studies. However, the positive clinical effects of mitomycin-C and steroids seemed to decrease in studies with a longer follow-up time. Conclusion Although local adjuvant use of mitomycin-C or hyaluronic acid and carboxymethylcellulose may carry clinical potential to improve urethral structure recurrence rates after endoscopic procedures, we believe that a large, well-designed RCT with a yearlong follow-up time is necessary to identify the true clinical value.
Collapse
|