1
|
Hu S, Quint M, Boysen WR, Coon D, Odeluga N, Dy GW, Pusic AL, Kaur MN. A Content and Readability Analysis of Genitourinary and Sexual Health-Related Patient-Reported Outcome Measures in Gender-Affirming Care. Urology 2024:S0090-4295(24)00495-3. [PMID: 38936626 DOI: 10.1016/j.urology.2024.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/10/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVES To the evaluate the readability and comprehensiveness of genitourinary and sexual health-related patient-reported outcomes (PROMs) used in gender-affirming care. METHODS Common PROMs that measure genitourinary and sexual health-related outcomes in gender-affirming care literature were identified from six recent systematic reviews. Readability analysis was completed at the level of individual items and full scale using established readability assessment tool, including Flesch Kincaid Grade Level (FKGL), Gunning Fog Score (GF), Coleman Liau Index (CLI), and Simple Measure of Gobbledygook (SMOG) Index. The concepts measured by the PROMs were evaluated for comprehensiveness. RESULTS 25 PROMs were included, of which 12 assessed genitourinary outcomes and 13 assessed sexual health outcomes. A total of seven genitourinary domains and eight sexual health domains were identified during concept mapping. Readability analysis showed a median PROM grade level of 9.0 and 9.5 in genitourinary and sexual PROMs, respectively. The Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction v2.0 had the lowest median reading grade level of 5.7, and the Female Sexual Function Index has the highest median reading grade level of 13.9. No single PROM was found to be comprehensive. Multiple PROMs contained double-barreled items or used outdated terminology. CONCLUSIONS Most PROMs used in the genital gender-affirming literature failed to meet the readability recommendations for patient-facing material and were culturally unfit for use in transgender and gender-diverse individuals. None of the PROMs were found to be comprehensive for evaluating outcomes of gender-affirming care. Validated gender-affirming care-specific PROMs that are comprehensible, comprehensive, and relevant are urgently needed.
Collapse
Affiliation(s)
- Sophia Hu
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115 United States.
| | - Meg Quint
- Stanford University School of Medicine, Stanford, 94305 United States; Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115 United States.
| | - William R Boysen
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115 United States.
| | - Devin Coon
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115 United States.
| | - Nkiruka Odeluga
- Department of Urology, Cook County Health, 1950 W. Polk St, 8th Floor, Chicago, IL, 60612.
| | - Geolani W Dy
- Department of Urology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR United States.
| | - Andrea L Pusic
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115 United States.
| | - Manraj N Kaur
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115 United States.
| |
Collapse
|
2
|
Klemm J, Dahlem R, Kluth LA, Rosenbaum CM, Shariat SF, Fisch M, Vetterlein MW. [Evaluation and management of urethral strictures-guideline summary 2024 : part 1-anterior urethra]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:3-14. [PMID: 38153427 DOI: 10.1007/s00120-023-02240-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 12/29/2023]
Abstract
In recent years, several international urological societies have published guidelines on the diagnosis, treatment, and follow-up of urethral strictures, but a guideline for the German-speaking region has not been available to date. This summary provides a detailed comparison of the guidelines of the European Association of Urology (EAU), American Urological Association (AUA) and the Société Internationale d'Urologie (SIU) with regard to the treatment of anterior urethral strictures, i.e. from the bulbar urethra to the meatus. In the following work, differences and specific recommendations in the guidelines are highlighted. In particular, the three guidelines largely agree with regard to diagnostic workup and follow-up. However, divergences exist in the management of anterior urethral strictures, particularly with regard to the use of endoscopic therapeutic approaches and the use of urethral stents. In addition, the EAU provides more comprehensive and detailed recommendations on urethroplasty techniques and specific patient follow-up. The EAU guidelines are the most current and were the first to include instructions for urethral strictures in women and individuals with gender incongruence after genital approximation surgery. Reconstructive urology is a rapidly evolving specialty and, thus, the clinical approach has been changing accordingly. Although guideline recommendations have become more inclusive and comprehensive, more high-quality data are needed to further improve the level of evidence.
Collapse
Affiliation(s)
- Jakob Klemm
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
- Universitätsklinik für Urologie, Comprehensive Cancer Center, Medizinische Universität Wien, Wien, Österreich
| | - Roland Dahlem
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Luis A Kluth
- Klinik für Urologie, Universitätsklinikum Frankfurt am Main, Frankfurt am Main, Deutschland
| | | | - Shahrokh F Shariat
- Universitätsklinik für Urologie, Comprehensive Cancer Center, Medizinische Universität Wien, Wien, Österreich
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordanien
- Karl Landsteiner Institut für Urologie und Andrologie, Wien, Österreich
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prag, Tschechien
| | - Margit Fisch
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Malte W Vetterlein
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| |
Collapse
|
3
|
Redmond EJ, Bekkema J, Rourke KF. Delineating Which Patient-reported Symptoms Are Associated with Satisfaction After Urethroplasty. Urology 2023; 176:194-199. [PMID: 36754234 DOI: 10.1016/j.urology.2023.01.038] [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: 11/08/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To determine which patient-reported symptoms are associated with satisfaction after urethroplasty. METHODS From 2011 to 2018, patients were offered enrollment in a prospective study assessing patient-reported outcomes after urethroplasty. Outcomes were assessed preoperatively and 6-months postoperatively including patient satisfaction, voiding function (International Prostate Symptom Score), erectile function (International Index of Erectile Function 5) and ejaculatory function (ejaculatory component of brief sexual function inventory). Additionally, penile curvature/appearance, genitourinary pain, postvoid dribbling, and standing voiding function were also evaluated using either 3 or 5 point Likert scales. Stricture recurrence was defined as the inability to easily pass a 16Fr flexible videocystoscope. Multivariable binary logistic regression was used to examine the associations between outcomes and patient satisfaction. RESULTS A total of 387 patients completed the study with a mean age of 49.5 years and a mean stricture length of 4.5 cm. Location was bulbar (59.4%), penile (19.6%), posterior (13.7%) and pan-urethral (7.2%). At 6-months, 96.1% of patients were stricture-free, 81.6% reported being satisfied with surgery and 8% were unsatisfied. On multivariable binary logistic regression, improvement in International Prostate Symptom Score (odds ratio [OR]: 1.1, 95% confidence interval [CI]: 1.1-1.2, P = .04), new erectile dysfunction (OR: 0.5, 95% CI: 0.2-0.9, P = .04), new penile curvature (OR: 0.4, 95% CI: 0.2-0.9, P = .03) and improved standing voiding function (OR: 1.3, 95% CI: 1.1-1.5, P = .004) were associated with patient satisfaction. Cystoscopic success (P = .60), change in pain score (P = .14), postvoid dribbling (P = .69), change in penile length (P = .44), and ejaculatory dysfunction (P = .51) were not. CONCLUSION Improved voiding function, patient-reported penile curvature, new erectile dysfunction and improved standing voiding are independently associated with patient satisfaction after urethroplasty and should be incorporated into any patient-centered approach to urethral stricture management.
Collapse
Affiliation(s)
- Elaine J Redmond
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Department of Urology, Cork University Hospital, Cork, Ireland
| | - Jordan Bekkema
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Keith F Rourke
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
4
|
Comparative review of the guidelines for anterior urethral stricture. World J Urol 2022; 40:1971-1980. [PMID: 35316387 DOI: 10.1007/s00345-022-03988-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE We aimed to provide a detailed comparison between the American Urologic Association (AUA), Société Internationale d'Urologie (SIU), and the European Association of Urology (EAU) guidelines on the evaluation, management, and follow-up of the patients with anterior urethral stricture disease (USD). METHODS The urethral stricture guidelines from SUI, AUA, and EAU were collected and evaluated regarding the recommendations on diagnosis, evaluation, and treatment of anterior USD. The strength of evidence for each statement was included and discussed when guidelines differed. RESULTS While the guidelines remarkably align in terms of the diagnostic workup and follow-up, there is discordance in the management of anterior urethral strictures, specifically for the use of endoscopic treatment and stenting. Further, the EAU offers more comprehensive recommendations regarding urethroplasty techniques and patient follow-up. The EAU guidelines are the most recent and first to offer guidance for USD in transgender people and women. CONCLUSION Reconstructive urology is a rapidly adapting field, and best practices change accordingly. Guideline statements have become more inclusive and expansive but will require further research to improve the level of evidence and continue to provide patients and providers with the best treatment plans.
Collapse
|
5
|
Gallo N, Natali ML, Curci C, Picerno A, Gallone A, Vulpi M, Vitarelli A, Ditonno P, Cascione M, Sallustio F, Rinaldi R, Sannino A, Salvatore L. Analysis of the Physico-Chemical, Mechanical and Biological Properties of Crosslinked Type-I Collagen from Horse Tendon: Towards the Development of Ideal Scaffolding Material for Urethral Regeneration. MATERIALS (BASEL, SWITZERLAND) 2021; 14:7648. [PMID: 34947245 PMCID: PMC8707771 DOI: 10.3390/ma14247648] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/05/2021] [Accepted: 12/09/2021] [Indexed: 11/19/2022]
Abstract
Urethral stenosis is a pathological condition that consists in the narrowing of the urethral lumen because of the formation of scar tissue. Unfortunately, none of the current surgical approaches represent an optimal solution because of the high stricture recurrence rate. In this context, we preliminarily explored the potential of an insoluble type-I collagen from horse tendon as scaffolding material for the development of innovative devices for the regeneration of injured urethral tracts. Non-porous collagen-based substrates were produced and optimized, in terms of crosslinking density of the macromolecular structure, to either provide mechanical properties compliant with the urinary tract physiological stress and better sustain tissue regeneration. The effect of the adopted crosslinking strategy on the protein integrity and on the substrate physical-chemical, mechanical and biological properties was investigated in comparison with a decellularized matrix from porcine small intestinal submucosa (SIS patch), an extensively used xenograft licensed for clinical use in urology. The optimized production protocols allowed the preservation of the type I collagen native structure and the realization of a substrate with appealing end-use properties. The biological response, preliminarily investigated by immunofluorescence experiments on human adult renal stem/progenitor cells until 28 days, showed the formation of a stem-cell monolayer within 14 days and the onset of spheroids within 28 days. These results suggested the great potential of the collagen-based material for the development of scaffolds for urethral plate regeneration and for in vitro cellular studies.
Collapse
Affiliation(s)
- Nunzia Gallo
- Department of Engineering for Innovation, University of Salento, 73100 Lecce, Italy; (M.L.N.); (A.S.); (L.S.)
| | - Maria Lucia Natali
- Department of Engineering for Innovation, University of Salento, 73100 Lecce, Italy; (M.L.N.); (A.S.); (L.S.)
- Typeone Biomaterials, Via Vittorio Veneto 64/C, 73036 Muro Leccese, Italy
| | - Claudia Curci
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.C.); (A.G.)
| | - Angela Picerno
- Nephrology Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Anna Gallone
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.C.); (A.G.)
| | - Marco Vulpi
- Urology and Andrology Unit, Department of Emergency and Organ Transplant, University of Bari “Aldo Moro”, 70124 Bari, Italy; (M.V.); (A.V.); (P.D.)
| | - Antonio Vitarelli
- Urology and Andrology Unit, Department of Emergency and Organ Transplant, University of Bari “Aldo Moro”, 70124 Bari, Italy; (M.V.); (A.V.); (P.D.)
| | - Pasquale Ditonno
- Urology and Andrology Unit, Department of Emergency and Organ Transplant, University of Bari “Aldo Moro”, 70124 Bari, Italy; (M.V.); (A.V.); (P.D.)
| | - Mariafrancesca Cascione
- Department of Mathematics and Physics “Ennio De Giorgi”, University of Salento, 73100 Lecce, Italy; (M.C.); (R.R.)
| | - Fabio Sallustio
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Rosaria Rinaldi
- Department of Mathematics and Physics “Ennio De Giorgi”, University of Salento, 73100 Lecce, Italy; (M.C.); (R.R.)
| | - Alessandro Sannino
- Department of Engineering for Innovation, University of Salento, 73100 Lecce, Italy; (M.L.N.); (A.S.); (L.S.)
| | - Luca Salvatore
- Department of Engineering for Innovation, University of Salento, 73100 Lecce, Italy; (M.L.N.); (A.S.); (L.S.)
- Typeone Biomaterials, Via Vittorio Veneto 64/C, 73036 Muro Leccese, Italy
| |
Collapse
|
6
|
Chandrasekharam VVS, Babu R. Single-Stage Versus Two-Stage Repair for Late Hypospadias Urethral Strictures in Adults: a Systematic Review of Incidence and Meta-analysis of Results. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03167-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Hamamoto K, Horiguchi A, Shinchi M, Ojima K, Hirano Y, Takahashi E, Kimura F, Ito K, Azuma R. Impact of urethroplasty on overactive bladder symptoms in patients with anterior urethral strictures. Int J Urol 2021; 29:50-56. [PMID: 34605092 DOI: 10.1111/iju.14713] [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: 07/22/2021] [Accepted: 09/12/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the incidence of overactive bladder in men with anterior urethral stricture and to evaluate the impact of urethroplasty on its improvement. METHODS A total of 104 men with anterior urethral stricture who underwent urethroplasty between 2016 and 2020 completed a validated urethral stricture surgery patient-reported outcome measure comprising six lower urinary tract symptoms questions on voiding symptoms and overactive bladder symptom score before and 3, 6, and 12 months after urethroplasty. Patients with an urgency score of ≥2 for overactive bladder symptom score question 3, and a total overactive bladder symptom score of ≥3 were considered to have overactive bladder. An improvement in overactive bladder was defined as a decrease in the total overactive bladder symptom score by at least three points. RESULTS Thirty-nine patients (37.5%) were considered to have overactive bladder, and improvement in overactive bladder after urethroplasty was found in 30 (76.9%). Maximum flow rate on uroflowmetry, postvoid residual urine volume, lower urinary tract symptoms total score, and total overactive bladder symptom score were all significantly improved after urethroplasty (P < 0.0001 for all variables). There was a positive correlation between changes in lower urinary tract symptoms total score and total overactive bladder symptom score (Spearman's correlation 0.48, P < 0.0001). Multivariate logistic regression analysis showed that greater change in lower urinary tract symptoms score was an independent predictor of improvement in overactive bladder (odds ratio 1.30, 95% confidence interval 1.06-1.59; P = 0.002). CONCLUSIONS Overactive bladder is prevalent in patients with anterior urethral stricture, and can be effectively improved after urethroplasty. Improvement of voiding symptoms are key for improving overactive bladder symptoms.
Collapse
Affiliation(s)
- Koetsu Hamamoto
- Department of Urology, National Defense Medical College, Saitama, Japan
| | - Akio Horiguchi
- Department of Urology, National Defense Medical College, Saitama, Japan
| | - Masayuki Shinchi
- Department of Urology, National Defense Medical College, Saitama, Japan.,Department of Urology, National Hospital Organization, Nishisaitama-Chuo Hospital, Saitama, Japan
| | - Kenichiro Ojima
- Department of Urology, National Defense Medical College, Saitama, Japan
| | - Yusuke Hirano
- Department of Urology, National Defense Medical College, Saitama, Japan
| | - Eiji Takahashi
- Department of Urology, National Hospital Organization, Nishisaitama-Chuo Hospital, Saitama, Japan
| | - Fumihiro Kimura
- Department of Urology, National Hospital Organization, Nishisaitama-Chuo Hospital, Saitama, Japan
| | - Keiichi Ito
- Department of Urology, National Defense Medical College, Saitama, Japan
| | - Ryuichi Azuma
- Department of Plastic Surgery, National Defense Medical College, Saitama, Japan
| |
Collapse
|
9
|
Campos-Juanatey F, Osman NI, Greenwell T, Martins FE, Riechardt S, Waterloos M, Barratt R, Chan G, Esperto F, Ploumidis A, Verla W, Dimitropoulos K, Lumen N. European Association of Urology Guidelines on Urethral Stricture Disease (Part 2): Diagnosis, Perioperative Management, and Follow-up in Males. Eur Urol 2021; 80:201-212. [PMID: 34103180 DOI: 10.1016/j.eururo.2021.05.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/20/2021] [Indexed: 02/01/2023]
Abstract
CONTEXT Urethral stricture management guidelines are an important tool for guiding evidence-based clinical practice. OBJECTIVE To present a summary of the 2021 European Association of Urology (EAU) guidelines on diagnosis, classification, perioperative management, and follow-up of male urethral stricture disease. EVIDENCE ACQUISITION The panel performed a literature review on the topics covering a time frame between 2008 and 2018, and using predefined inclusion and exclusion criteria for the literature. Key papers beyond this time period could be included if panel consensus was reached. A strength rating for each recommendation was added based on a review of the available literature after panel discussion. EVIDENCE SYNTHESIS Routine diagnostic evaluation encompasses history, patient-reported outcome measures, examination, uroflowmetry, postvoid residual measurement, endoscopy, and urethrography. Ancillary techniques that provide a three-dimensional assessment and may demonstrate associated abnormalities include sonourethrography and magnetic resonance urethrogram, although these are not utilised routinely. The classification of strictures should include stricture location and calibre. Urethral rest after urethral manipulations is advised prior to offering urethroplasty. An assessment for urinary extravasation after urethroplasty is beneficial before catheter removal. The optimal time of catheterisation after urethrotomy is <72 h, but is unclear following urethroplasty and depends on various factors. Patients undergoing urethroplasty should be followed up for at least 1 yr. Objective and subjective outcomes should be assessed after urethral surgeries, including patient satisfaction and sexual function. CONCLUSIONS Accurate diagnosis and categorisation is important in determining management. Adequate perioperative care and follow-up is essential for achieving successful outcomes. The EAU guidelines provide relevant evidence-based recommendations to optimise patient work-up and follow-up. PATIENT SUMMARY Urethral strictures have to be assessed adequately before planning treatment. Before surgery, urethral rest and infection prevention are advised. After urethral surgery, x-ray dye tests are advised before removing catheters to ensure that healing has occurred. Routine follow-up is required, including patient-reported outcomes. These guidelines aim to guide doctors in the diagnosis, care, and follow-up of patients with urethral stricture.
Collapse
Affiliation(s)
| | - Nadir I Osman
- Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Tamsin Greenwell
- Department of Urology, University College London Hospital, London, UK
| | - Francisco E Martins
- Department of Urology, Santa Maria University Hospital, University of Lisbon, Lisbon, Portugal
| | - Silke Riechardt
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marjan Waterloos
- Division of Urology, Gent University Hospital, Gent, Belgium; Division of Urology, AZ Maria Middelares, Gent, Belgium
| | - Rachel Barratt
- Department of Urology, University College London Hospital, London, UK
| | - Garson Chan
- Division of Urology, University of Saskatchewan, Saskatoon, Canada
| | - Francesco Esperto
- Department of Urology, Campus Biomedico, University of Rome, Rome, Italy
| | | | - Wesley Verla
- Division of Urology, Gent University Hospital, Gent, Belgium
| | | | - Nicolaas Lumen
- Division of Urology, Gent University Hospital, Gent, Belgium
| |
Collapse
|
10
|
Zamani M, Shakhssalim N, Ramakrishna S, Naji M. Electrospinning: Application and Prospects for Urologic Tissue Engineering. Front Bioeng Biotechnol 2020; 8:579925. [PMID: 33117785 PMCID: PMC7576678 DOI: 10.3389/fbioe.2020.579925] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/18/2020] [Indexed: 12/14/2022] Open
Abstract
Functional disorders and injuries of urinary bladder, urethra, and ureter may necessitate the application of urologic reconstructive surgeries to recover normal urine passage, prevent progressive damages of these organs and upstream structures, and improve the quality of life of patients. Reconstructive surgeries are generally very invasive procedures that utilize autologous tissues. In addition to imperfect functional outcomes, these procedures are associated with significant complications owing to long-term contact of urine with unspecific tissues, donor site morbidity, and lack of sufficient tissue for vast reconstructions. Thanks to the extensive advancements in tissue engineering strategies, reconstruction of the diseased urologic organs through tissue engineering have provided promising vistas during the last two decades. Several biomaterials and fabrication methods have been utilized for reconstruction of the urinary tract in animal models and human subjects; however, limited success has been reported, which inspires the application of new methods and biomaterials. Electrospinning is the primary method for the production of nanofibers from a broad array of natural and synthetic biomaterials. The biomimetic structure of electrospun scaffolds provides an ECM-like matrix that can modulate cells' function. In addition, electrospinning is a versatile technique for the incorporation of drugs, biomolecules, and living cells into the constructed scaffolds. This method can also be integrated with other fabrication procedures to achieve hybrid smart constructs with improved performance. Herein, we reviewed the application and outcomes of electrospun scaffolds in tissue engineering of bladder, urethra, and ureter. First, we presented the current status of tissue engineering in each organ, then reviewed electrospun scaffolds from the simplest to the most intricate designs, and summarized the outcomes of preclinical (animal) studies in this area.
Collapse
Affiliation(s)
- Masoud Zamani
- Department of Chemical and Biological Engineering, University at Buffalo, State University of New York, Amherst, NY, United States
| | - Nasser Shakhssalim
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seeram Ramakrishna
- Department of Mechanical Engineering, National University of Singapore, Singapore, Singapore
| | - Mohammad Naji
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
11
|
D'hulst P, Muilwijk T, Vander Eeckt K, Van der Aa F, Joniau S. Patient-reported outcomes after buccal mucosal graft urethroplasty for bulbar urethral strictures: results of a prospective single-centre cohort study. BJU Int 2020; 126:684-693. [PMID: 32512634 DOI: 10.1111/bju.15131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To describe patient-reported outcome measures (PROMs) after buccal mucosa graft (BMG) urethroplasty. MATERIALS AND METHODS We prospectively collected PROMs in patients who underwent BMG urethroplasty for bulbar urethral strictures between October 2009 and February 2017. Preoperatively and at the first, second and third postoperative follow-up visits, patients completed five PROM questionnaires: the International Prostate Symptom Score (IPSS); the IPSS Quality of Life questionnaire; the Urogenital Distress Inventory Short-Form questionnaire (UDI-6); the International Index of Erectile Function (IIEF)-5 questionnaire, combined with IIEF-Q9 and IIEF-Q10 for assessing ejaculatory and orgasmic functions; and the International Consultation on Incontinence Questionnaire Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTS-QOL) questionnaire. In addition to using these questionnaires, we evaluated maximum urinary flow rate (Qmax ), post-void residual urine volume and total voided urine volume at each follow-up visit. Buccal pain and discomfort were assessed using a visual analogue scale (VAS). Comparison of questionnaire scores was performed using a paired Wilcoxon rank-sum test. Treatment failure was defined as any need for urinary diversion or urethral instrumentation after surgery. RESULTS A total of 97 patients met the inclusion criteria. The first postoperative follow-up visit was at a median of 2.1 months (n = 97/97), and the second and third visits were after a median of 7.8 (n = 82/97) and 17.0 months (n = 70/97), respectively. Significant improvements compared to baseline were observed in IPSS, and IPSS-QOL, UDI-6 and ICIQ-LUTS-QOL scores at the first follow-up, and remained improved during the follow-up period (P ≤ 0.001). Patients with mild to no baseline erectile dysfunction experienced a significant decline in erectile function at the first follow-up (median [interquartile range {IQR}] preoperative IIEF-5 score 23.0 [21.0-25.0] vs median [IQR] IIEF-5 score at first follow-up 19.5 [16.0-23.8]; P ≤ 0.001). This decline fully recovered during further follow-up (median [IQR] IIEF-5 score at third follow-up 24.0 [20.5-25.0]; P = 0.86). No significant changes in median orgasmic and ejaculatory function were noted. The first postoperative median (IQR) VAS score was 3.0 (2.0-4.45), and a significant improvement in local pain and discomfort was observed during the follow-up (median [IQR] VAS at third follow-up: 0.0 [0.0-1.0]; P ≤ 0.001). Nine patients (9/97; 9.3%) had treatment failure. Stratifying recurrence based on a difference of <10 mL/s vs ≥10 mL/s between preoperative and postoperative Qmax could not demonstrate a significant difference (P = 0.06). CONCLUSION Significant improvements in voiding symptoms and quality of life after surgery were reported. Patients with good baseline erections recovered erectile function during follow-up, although a significant decrease in erectile function was observed at the first follow-up. This study highlights the importance of PROMs in urethral reconstructive surgery, emphasizing that success should not be defined only by stricture-free survival.
Collapse
Affiliation(s)
- Pieter D'hulst
- Department of Reconstructive Urology, University Hospitals Leuven, Leuven, Belgium
| | - Tim Muilwijk
- Department of Reconstructive Urology, University Hospitals Leuven, Leuven, Belgium
| | - Kathy Vander Eeckt
- Department of Reconstructive Urology, University Hospitals Leuven, Leuven, Belgium
| | - Frank Van der Aa
- Department of Reconstructive Urology, University Hospitals Leuven, Leuven, Belgium
| | - Steven Joniau
- Department of Reconstructive Urology, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
12
|
Bugeja S, Payne SR, Eardley I, Mundy AR. The standard for the management of male urethral strictures in the UK: a consensus document. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820933504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: The aim of this study was to establish an evidence-based best clinical practice consensus for the management of urethral stricture disease in the UK. Methods: A systematic review of optimal management of urethral stricture generated a base document which was endorsed by the British Association of Urological Surgeons (BAUS) section of Andrology and Genito-Urinary Reconstructive Surgeons (AGUS). A two-round electronic mail modified Delphi survey of 43 consultant reconstructive urologists, members of the British Association of Genito-Urinary Reconstructive Surgeons (BAGURS), was then performed. The panel’s views about the base document was sought in seven domains: definition, diagnosis, investigation, conservative, endoscopic and reconstructive treatments, and follow up. Responses were collated and used to modify the base to achieve a consensus statement. Results: In round one of the Delphi process four panel members commented on the base document and seven in round two. Consensus was thereby reached on 38 statements regarding definition (one), diagnosis (three), investigation (two), conservative/endoscopic (five) and reconstructive (24) treatments and follow up (three) for the management of urethral stricture disease. Conclusion: This consensus statement will help standardise care, provide guidance on the management of urethral stricture disease, and assist in clinical decision-making for healthcare professionals of all grades.
Collapse
Affiliation(s)
- Simon Bugeja
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Anthony R. Mundy
- University College London Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
13
|
Comprehensive Prospective Assessment of Patient-reported Outcomes Following Urethroplasty. Urology 2020; 141:162-167. [PMID: 32283167 DOI: 10.1016/j.urology.2020.02.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/19/2020] [Accepted: 02/23/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To better define patient-reported outcomes after urethroplasty. While urethroplasty is the most effective treatment for urethral stricture, the majority of outcomes are reported using surgeon-defined endpoints. METHODS Patients were enrolled in a prospective study evaluating patient-reported outcomes after urethroplasty from 2012 to 2018. A number of domains were assessed preoperatively and 6 months postoperatively using both validated and nonvalidated measures including satisfaction, voiding function, urinary quality of life, erectile/ejaculatory function, penile appearance/curvature, and genitourinary pain. RESULTS Of 357 patients completing the study, mean age was 49.7 years with mean stricture length of 4.4 cm. Total 95.9% of patients were stricture-free on 6-month cystoscopy. Eighty percent of patients reported being satisfied with surgery, while 7.3% of patients were unsatisfied. Voiding function was globally improved after urethroplasty including International Prostate Symptom Score (19.3 vs 6.0; P < .0001), urinary quality of life (4.7 vs 1.6; P < .0001), postvoid dribbling (2.7 vs 2.5; P = .04), and sitting to void (2.4 vs 1.9; P < .0001). Additionally, genitourinary pain improved postoperatively (2.2 vs 1.6; P < .0001). Mean erectile function remained unchanged (17.7 vs 17.2; P = .46) but 12.0% of patients reported new onset erectile dysfunction. Reported ejaculatory dysfunction did not change significantly postoperatively (P = .13) but 7.1% of patients reported new ejaculatory dysfunction. Total 6.7% and 3.1% of patients complained of bothersome loss of penile length or curvature, respectively. CONCLUSION Urethroplasty improves voiding function and genitourinary pain associated with urethral stricture. While sexual function is preserved for the majority of patients, a small proportion of patients describe new onset erectile dysfunction, penile shortening or curvature and should be counselled accordingly.
Collapse
|
14
|
King C, Rourke KF. Urethral Stricture is Frequently a Morbid Condition: Incidence and Factors Associated With Complications Related to Urethral Stricture. Urology 2019; 132:189-194. [DOI: 10.1016/j.urology.2019.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 01/08/2023]
|
15
|
Kałużny A, Frankiewicz M, Krukowski J, Zdun-Ryżewska A, Trawicka A, Matuszewski M. Evaluation of outcomes of Urethral Stricture Surgery: psychometric validation of a Polish language version of the Patient-Reported Outcome Measure for urethral stricture surgery. Cent European J Urol 2019; 72:198-203. [PMID: 31482030 PMCID: PMC6715091 DOI: 10.5173/ceju.2019.1901] [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: 03/04/2019] [Revised: 03/28/2019] [Accepted: 05/31/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study is to validate the Polish version of the Urethral Stricture Surgery – Patient-Reported Outcome Measure (USS-PROM) by evaluating its psychometric properties. Material and methods Patients with urethral stricture scheduled for urethroplasty between 2014 and 2018 were prospectively enrolled. The results of the USS-PROM were obtained before the operation, and during follow-up visits. The original USS-PROM was translated into Polish and re-translated into English in accordance with the guidelines by Dawson et al. regarding the adaptation process. Psychometric assessment included internal consistency, test-retest reliability, criterion validity and responsiveness. Results One hundred twelve patients were included. 54 patients completed the USS-PROM both before and 3 months after the surgery and 39 of them completed the questionnaire 6 months after the surgery to evaluate the test-retest reliability. Cronbach's α for internal consistency of the lower urinary tract symptoms (LUTS) domain score was 0.87. The test-retest intraclass correlation coefficient was 0.82. Spearman's coefficients showed no correlation between USS-PROM's result and maximal urinary flow (Qmax) result before the surgery (rs = 0.13; p >0.05) and a positive correlation between USS-PROM's result and Qmax result at follow up: 3 months after (rs =- 0.56; p <0.05), 6 months after (rs -0.64; p <0.05), and 12 months after (rs = -0.85; p <0.05). There were statistically significant strong and positive correlations between LUTS score and International Prostate Symptom Score (IPSS). Responsiveness of the test was confirmed with non-parametric Friedman's analysis of variance (ANOVA) with Kendall's coefficient of concordance (χ2 ANOVA = 8.95, p = 0.03). Conclusions The Polish version of the USS-PROM questionnaire has appropriate psychometric properties and can be used in the assessment of patients with urethral stricture undergoing urethroplasty.
Collapse
Affiliation(s)
- Adam Kałużny
- Department of Urology, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Jakub Krukowski
- Department of Urology, Medical University of Gdańsk, Gdańsk, Poland
| | - Agata Zdun-Ryżewska
- Department of Quality of Life Research, Medical University of Gdańsk, Gdańsk, Poland
| | | | | |
Collapse
|
16
|
Cedars BE, Cohen AJ, Fergus KB, Baradaran N, Ndoye M, Kamal P, Breyer BN. Qualitative Analysis of the Content Found in Online Discussion Boards for Urethral Stricture Disease and Urethroplasty. Urology 2019; 130:155-161. [DOI: 10.1016/j.urology.2019.03.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/22/2019] [Accepted: 03/29/2019] [Indexed: 12/11/2022]
|
17
|
Excision and Primary Anastomosis for Bulbar Urethral Strictures Improves Functional Outcomes and Quality of Life: A Prospective Analysis from a Single Centre. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7826085. [PMID: 30809546 PMCID: PMC6364126 DOI: 10.1155/2019/7826085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/14/2018] [Accepted: 01/08/2019] [Indexed: 11/18/2022]
Abstract
Background Excision and primary anastomotic (EPA) urethroplasty remains the gold standard definitive treatment for short urethral stricture disease. For patients, postoperative erectile function and quality of life are the main goals of the surgery. Patient-reported outcome measures (PROMs) are therefore of major importance. Objective The objective of this study was to prospectively analyse functional outcomes and patient satisfaction. Design Settings and Participants We prospectively evaluated 47 patients before and after EPA from August 2009 until February 2017. The first follow-up visit occurred after a median of 2.2 months (n = 47/47), with the second and third follow-ups occurring at a median of 8.5 months (n = 38/47) and 20.2 months (n = 31/47). Before surgery and at each follow-up visit, the patients received five questionnaires: the International Prostate Symptom Score (IPSS), the International Prostate Symptom Score with the Quality of Life (IPSS-QOL) score, the Urogenital Distress Inventory Short Form (UDI-6) score, the International Index of Erectile Function-5 (IIEF-5) score, and the ICIQ-Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTS-QOL) score. Surgical Procedure Surgery was performed in all cases using the same standardized EPA technique. Outcome Measurements and Statistical Analysis Voiding symptoms, erectile dysfunction, and quality of life were analysed using paired sample t-tests, with a multiple-testing Bonferroni correction. Any requirement for instrumentation after surgery was considered treatment failure. Results and Limitations Patients with mild or no baseline erectile dysfunction showed significant decline in erectile function at first follow-up (mean IIEF-5 of 23.27 [standard deviation; SD: 2.60] vs. 13.91 [SD: 7.50]; p=0.002), but this had recovered completely at the third follow-up (IIEF-5: 23.25 [SD: 1.91]; p=0.659). Clinically significant improvements were noted in IPSS, IPSS-QOL-score, UDI-6-score, and ICIQ-LUTS-QOL-score at the first follow-up (p<0.0001). These improvements remained significant at the second and third follow-ups (p<0.0001) for all PROMs. Three of the patients experienced stricture recurrence. The main limitations of this study were incomplete questionnaires, loss to follow-up, and low number of patients. Conclusions EPA results in an initial decline in erectile function, but full recovery occurred at a median of 20 months. Voiding improved significantly, and a major improvement in quality of life was noted, which persisted for up to 20 months after surgery. Patient Summary This study showed the importance of patient-reported outcome measures in indicating the actual outcome of urethral stricture disease surgery.
Collapse
|
18
|
Chung PH, Vanni AJ, Breyer BN, Erickson BA, Myers JB, Alsikafi N, Buckley J, Elliott SP, Zhao LC, Voelzke BB. Evaluation of Generic Versus Condition-Specific Quality of Life Indicators for Successful Urethral Stricture Surgery. Urology 2018; 126:222-226. [PMID: 30580004 DOI: 10.1016/j.urology.2018.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/09/2018] [Accepted: 12/11/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To compare the utility of generic health quality of life (QOL) and condition specific indicators as patient reported outcomes measures for urethral stricture surgery. MATERIALS AND METHODS Patient data were obtained from the Trauma and Urologic Reconstructive Network of Surgeons collaborative database. Patients who underwent any successful urethroplasty and completed both pre- and postoperative generic and condition-specific questionnaires were included. RESULTS A total of 201 patients met inclusion criteria. Urethral-stricture specific measures improved after surgery: mean LUTS score (13.1-4.0, p<0.05), Peeling curve (3.1-1.7, p < 0.05), and overall interference of urinary symptoms on life (3.0-1.6, p < 0.05). Mean overall health status visual analog scale (74.2-80.0, p < 0.05) and generic health QOL EQ-5D index scores (0.90-0.95, p < 0.05) also improved; however, individual EQ-5D measures assessing mobility, self-care, and activity level did not change. EQ-5D measures for pain/discomfort (1.48-1.23, p < 0.05) and anxiety/depression (1.33-1.21, p < 0.05) improved, but not to the same extent as stricture-specific measures. More patients reported improvement in condition-specific urethra/penis pain and bladder pain compared to improvement in generic EQ-5D pain/discomfort (p < 0.001). CONCLUSION Generic health QOL indicators are less meaningful in the assessment of urethral stricture surgery and should be replaced with condition-specific outcomes measures. It is important to ensure that appropriate condition-specific outcomes measures are utilized as patient reported outcomes measures become more prevalent in medicine and potentially become utilized to evaluate surgeon outcomes and determine surgeon reimbursement.
Collapse
Affiliation(s)
- Paul H Chung
- Department of Urology, Thomas Jefferson University, Philadelphia, PA.
| | - Alex J Vanni
- Department of Urology, Lahey Clinic, Burlington, MA
| | | | | | - Jeremy B Myers
- Division of Urology, University of Utah, Salt Lake City, UT
| | | | - Jill Buckley
- Department of Urology, University of California San Diego, San Diego, CA
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN
| | - Lee C Zhao
- Department of Urology, New York University Langone Health, New York City, NY
| | - Bryan B Voelzke
- Department of Urology, University of Washington Medical Center, Seattle, WA
| | | |
Collapse
|
19
|
Baradaran N, Hampson LA, Edwards TC, Voelzke BB, Breyer BN. Patient-Reported Outcome Measures in Urethral Reconstruction. Curr Urol Rep 2018; 19:48. [PMID: 29774434 DOI: 10.1007/s11934-018-0797-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Treatment of anterior urethral stricture disease (USD) has shifted from endoscopic approaches to urethroplasty with significantly higher success rates among reconstructive urologists. This academic stance has led to a critical evaluation of "success" and developing disease-specific instruments to assess surgical outcomes focusing on patients' satisfaction rather than the historical goal of avoiding secondary procedures. RECENT FINDINGS Many disease non-specific and/or non-validated patient-reported outcome measures (PROMs) have been utilized to evaluate the voiding symptoms and sexual of function of patients after urethroplasty in the literature. Urethral Stricture Surgery PROM (USS PROM) is the first validated, disease-specific PROM for anterior USD which has been designed in 2001. Urethral Stricture Symptoms and Impact Measure (USSIM) is a comprehensive PROM and is currently being validated at multiple institutions. This article reviews the tools used to assess success after urethroplasty and elaborates the need to develop a comprehensive USD-specific PROM.
Collapse
Affiliation(s)
- Nima Baradaran
- Department of Urology, University of California - San Francisco, San Francisco, CA, USA
| | - Lindsay A Hampson
- Department of Urology, University of California - San Francisco, San Francisco, CA, USA
| | - Todd C Edwards
- Department of Health Services, Seattle Quality of Life Group, University of Washington, Seattle, WA, USA
| | - Bryan B Voelzke
- Department of Urology, University of Washington - Harborview Medical Center, Seattle, WA, USA
| | - Benjamin N Breyer
- Department of Urology, University of California - San Francisco, San Francisco, CA, USA. .,Zuckerberg San Francisco General Hospital and Trauma Center, University of California - San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA.
| |
Collapse
|
20
|
Cheng L, Li S, Wang Z, Huang B, Lin J. A brief review on anterior urethral strictures. Asian J Urol 2017; 5:88-93. [PMID: 29736370 PMCID: PMC5934508 DOI: 10.1016/j.ajur.2017.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/26/2017] [Accepted: 07/23/2017] [Indexed: 11/24/2022] Open
Abstract
The treatment of urethral strictures remains a challenging field in urology even though there are a variety of procedures to treat it at present, as no one approach is superior over another. This paper reviewed the surgical options for the management of different sites and types of anterior urethral stricture, providing a brief discussion of the controversies regarding this issue and suggesting possible future advancements. Among the existing procedures, simple dilation and direct vision internal urethrotomy are more commonly used for short urethral strictures ( <1 cm, soft and no previous intervention). Currently, urethroplasty using buccal mucosa or penile skin is the most widely adopted clinical techniques and have proved successful. Nonetheless, complications such as donor site morbidity remain problem. Tissue engineering techniques are considered as a promising solution for urethral reconstruction, but require further investigation, as does stem cell therapy.
Collapse
Affiliation(s)
- Li Cheng
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
| | - Sen Li
- Beijing Shunyi District Hospital, Beijing, China
| | - Zicheng Wang
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
| | - Bingwei Huang
- First Affiliated Hospital of PLA General Hospital, Beijing, China
| | - Jian Lin
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- Corresponding author.
| |
Collapse
|
21
|
Long-Term Voiding Outcomes After Adult Urethral Reconstruction for Stricture Disease. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0428-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
22
|
Hampson LA, Lin TK, Wilson L, Allen IE, Gaither TW, Breyer BN. Understanding patients' preferences for surgical management of urethral stricture disease. World J Urol 2017; 35:1799-1805. [PMID: 28664240 PMCID: PMC6452859 DOI: 10.1007/s00345-017-2066-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 06/15/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To understand how prioritization of treatment attributes and treatment choice varies by patient characteristics, we sought to specifically determine how demographic variables affect patient treatment preference. PATIENTS AND METHODS Male patients with urethral stricture disease participated in a choice-based conjoint (CBC) analysis exercise evaluating six treatment attributes associated with internal urethrotomy and urethroplasty. Demographic and past symptom data were collected. Stratified analysis of demographic variables, including age, education, income, was conducted using a mixed effect logistic regression model to evaluate the coefficient size and confidence intervals between the treatments attribute preferences of each strata. RESULTS 169 patients completed the CBC exercise and were included in our analysis. Overall success of the procedure is the most important treatment attribute to patients and this persists across strata. Older patients (≥65) express preferences for better success rates and fewer future procedures, whereas younger patients prefer a less invasive approach and are more willing to accept additional procedures if needed. Patients with lower levels of education preferred open reconstruction and had a stronger preference against multiple future procedures, whereas those with higher levels of education preferred endoscopic treatment and had a less strong preference against multiple future procedures. Low-income individuals express statistically significant stronger negative preferences against high copay costs compared to high-income individuals. CONCLUSION These results can help to inform physicians' counseling about surgical management of urethral stricture disease to better align patient preferences with treatment selection and encourage shared decision making.
Collapse
Affiliation(s)
- Lindsay A Hampson
- Department of Urology, UCSF School of Medicine, 400 Parnassus Ave, A638, Box 0738, San Francisco, CA, 94143, USA.
| | - Tracy K Lin
- Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, USA
| | - Leslie Wilson
- Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, USA
| | - Isabel E Allen
- Department of Epidemiology and Biostatistics, UCSF School of Medicine, San Francisco, USA
| | | | - Benjamin N Breyer
- Department of Urology, UCSF School of Medicine, 400 Parnassus Ave, A638, Box 0738, San Francisco, CA, 94143, USA
| |
Collapse
|
23
|
Maciejewski CC, Haines T, Rourke KF. Chordee and Penile Shortening Rather Than Voiding Function Are Associated With Patient Dissatisfaction After Urethroplasty. Urology 2017; 103:234-239. [PMID: 28065809 DOI: 10.1016/j.urology.2016.12.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/16/2016] [Accepted: 12/22/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To identify factors that predict patient satisfaction after urethroplasty by prospectively examining patient-reported quality of life scores using 3 validated instruments. METHODS A 3-part prospective survey consisting of the International Prostate Symptom Score (IPSS), the International Index of Erectile Function (IIEF) score, and a urethroplasty quality of life survey was completed by patients who underwent urethroplasty preoperatively and at 6 months postoperatively. The quality of life score included questions on genitourinary pain, urinary tract infection (UTI), postvoid dribbling, chordee, shortening, overall satisfaction, and overall health. Data were analyzed using descriptive statistics, paired t test, univariate and multivariate logistic regression analyses, and Wilcoxon signed-rank analysis. RESULTS Patients were enrolled in the study from February 2011 to December 2014, and a total of 94 patients who underwent a total of 102 urethroplasties completed the study. Patients reported statistically significant improvements in IPSS (P < .001). Ordinal linear regression analysis revealed no association between age, IPSS, or IIEF score and patient satisfaction. Wilcoxon signed-rank analysis revealed significant improvements in pain scores (P = .02), UTI (P < .001), perceived overall health (P = .01), and satisfaction (P < .001). Univariate logistic regression identified a length >4 cm and the absence of UTI, pain, shortening, and chordee as predictors of patient satisfaction. Multivariate analysis of quality of life domain scores identified absence of shortening and absence of chordee as independent predictors of patient satisfaction following urethroplasty (P < .01). CONCLUSION Patient voiding function and quality of life improve significantly following urethroplasty, but improvement in voiding function is not associated with patient satisfaction. Chordee status and perceived penile shortening impact patient satisfaction, and should be included in patient-reported outcome measures.
Collapse
Affiliation(s)
- Conrad C Maciejewski
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Trevor Haines
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Keith F Rourke
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
24
|
Granieri MA, Wang HHS, Routh JC, Peterson AC. A Nationwide Assessment of the Emergency Department Management of Acute Urinary Retention Due to Urethral Stricture. Urology 2016; 100:79-83. [PMID: 27658662 DOI: 10.1016/j.urology.2016.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/16/2016] [Accepted: 08/18/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the nationwide practice patterns of the management of acute urinary retention (AUR) secondary to urethral stricture (US) in an emergency department (ED) setting. MATERIALS AND METHODS We used the 2006-2010 Nationwide Emergency Department Sample to identify men with US who received treatment for AUR. We excluded patients with benign prostatic hyperplasia, vesicourethral anastomotic stenosis, neurogenic bladder, and bladder cancer. Primary outcome was urethral dilation or suprapubic tube (SPT) placement as initial AUR management. Patient demographics and hospital factors were also examined. Multivariate logistic regression was performed to examine factors associated with initial AUR management. RESULTS We identified 4794 weighted ED encounters of men with US who underwent urethral dilation or SPT placement for AUR. Mean age was 58.6 ± 0.8 years. A total of 4084 (85%) men received urethral dilation, whereas 710 had SPT (15%) placement. In bivariate analysis, patients who received SPT were likely to be younger (P <.001), treated in recent years (P = .002), and in hospitals in the West region (P = .003). In multivariate analysis, SPT placement was significantly associated with younger age (P = .004), public insurance (P = .03), recent treatment years (P = .02), and hospitals in the West region (P = .02). Income and hospital teaching status did not have significant association with initial treatment choice. CONCLUSION Urethral dilation remains the most common urologic intervention in the ED for AUR due to US; however, there is an increasing trend toward SPT placement. Patients who are younger, publicly insured, or who receive care in the West region are more likely to receive a SPT for initial treatment of AUR due to US.
Collapse
Affiliation(s)
- Michael A Granieri
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC.
| | - Hsin-Hsiao S Wang
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | - Jonathan C Routh
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | - Andrew C Peterson
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| |
Collapse
|
25
|
Haines T, Rourke KF. The effect of urethral transection on erectile function after anterior urethroplasty. World J Urol 2016; 35:839-845. [PMID: 27562579 DOI: 10.1007/s00345-016-1926-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/18/2016] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To prospectively assess the effect of urethral transection on erectile function after anterior urethroplasty. METHODS From February 2012 to December 2014, 104 patients were enrolled in a prospective study assessing erectile function (EF) after anterior urethroplasty. Participants completed the International Index of Erectile Function (IIEF) questionnaire preoperatively and 6 months postoperatively. Outcome measures were the incidence of erectile dysfunction (ED) defined by ≥5-point change in EF and mean change in the EF domain. Factors examined were urethral transection, stricture location, patient age and other demographics. Fisher's exact test, Student's t test and linear regression were used to evaluate associations when appropriate. RESULTS Seventeen patients were excluded because of poor EF, leaving 87 patients for analysis. Twenty-two patients (25.3 %) had urethral transection during urethroplasty, while 65 underwent non-transecting techniques (74.7 %). For the entire cohort, IIEF scores remain unchanged (20.16 versus 20.14; p = 0.98). Eighteen patients (20.7 %) developed ED, while 15 (17.2 %) experienced an improvement in EF. Urethral transection was not associated with ED (p = 0.22) or mean change in EF (-0.8 versus +0.2; p = 0.71). Stricture location was not associated with ED, but patient age ≥50 was associated with a decrease in mean postoperative EF (-2.84 versus +1.85; p = 0.04). On linear regression analysis patient age remained independently associated with adverse change in EF (p = 0.05). CONCLUSIONS Urethroplasty can result in a decline in erectile function in some patients but overall is associated with minimal change in erectile function. Urethral transection is not associated with adverse change in erectile dysfunction after urethroplasty however, advanced patient age is.
Collapse
Affiliation(s)
- Trevor Haines
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Keith F Rourke
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
| |
Collapse
|
26
|
Hampson LA, Elliott SP, Erickson BA, Vanni AJ, Myers JB, McClung C, Breyer BN, Smith TG, Hagedorn JC, Voelzke BB. Multicenter Analysis of Urinary Urgency and Urge Incontinence in Patients with Anterior Urethral Stricture Disease before and after Urethroplasty. J Urol 2016; 196:1700-1705. [PMID: 27521692 DOI: 10.1016/j.juro.2016.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Little published data exist on the impact of urethral stricture surgery on urinary urgency. We evaluated urinary urgency and urge incontinence before and after anterior urethroplasty. MATERIALS AND METHODS Male patients who underwent 1-stage anterior urethroplasty were retrospectively identified at 8 centers. Patients with preoperative and 2-month or greater postoperative subjective urinary urgency assessments were included in study. Patients who received anticholinergic medications preoperatively were excluded. Univariate and multivariate analysis was done to analyze the association of patient characteristics with preoperative and postoperative symptoms as well as improvement or worsening of symptoms after surgery. RESULTS Symptom and followup data on urgency and urge incontinence were available in in 439 and 305 patients, respectively. Preoperatively 58% of the men reported urgency and 31% reported urge incontinence. Postoperatively this decreased to 40% of men for urgency and 12% for urge incontinence (each p <0.01). Of the men 37% reported improvement in urgency and 74% experienced improvement in urge incontinence. Few of those without preoperative symptoms showed worse symptoms, including urgency in 9% and urge incontinence in 5%. New urgency was more likely to develop in men with a higher body mass index (OR 1.09, p = 0.02). Men with stricture recurrence were less likely to show improvement in urgency (OR 0.24, p = 0.03). Older men were more likely to have new urge incontinence (OR 1.06, p = 0.01) and less likely to notice improvement in urge symptoms (OR 0.92, p <0.01). CONCLUSIONS The prevalence of urgency and urge incontinence in male patients with anterior urethral stricture is high. The majority of men experience symptom stability or improvement in urinary urge symptoms following anterior urethroplasty.
Collapse
Affiliation(s)
- Lindsay A Hampson
- Department of Urology, University of California-San Francisco, San Francisco, California
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | | | - Alex J Vanni
- Department of Urology, Lahey Clinic Medical Center, Burlington, Massachusetts
| | - Jeremy B Myers
- Division of Surgery, Department of Urology, University of Utah, Salt Lake City, Utah
| | | | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, California
| | - Thomas G Smith
- Department of Urology, Baylor College of Medicine, Houston, Texas
| | - Judith C Hagedorn
- Department of Urology, University of Washington, Seattle, Washington
| | - Bryan B Voelzke
- Department of Urology, Harborview Medical Center, Seattle, Washington.
| | | |
Collapse
|
27
|
Wessells H, Angermeier KW, Elliott S, Gonzalez CM, Kodama R, Peterson AC, Reston J, Rourke K, Stoffel JT, Vanni AJ, Voelzke BB, Zhao L, Santucci RA. Male Urethral Stricture: American Urological Association Guideline. J Urol 2016; 197:182-190. [PMID: 27497791 DOI: 10.1016/j.juro.2016.07.087] [Citation(s) in RCA: 195] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2016] [Indexed: 01/30/2023]
Abstract
PURPOSE The purpose of this Guideline is to provide a clinical framework for the diagnosis and treatment of male urethral stricture. MATERIALS AND METHODS A systematic review of the literature using the Pubmed, Embase, and Cochrane databases (search dates 1/1/1990 to 12/1/2015) was conducted to identify peer-reviewed publications relevant to the diagnosis and treatment of urethral stricture. The review yielded an evidence base of 250 articles after application of inclusion/exclusion criteria. These publications were used to create the Guideline statements. Evidence-based statements of Strong, Moderate, or Conditional Recommendation were developed based on benefits and risks/burdens to patients. Additional guidance is provided as Clinical Principles and Expert Opinion when insufficient evidence existed. RESULTS The Panel identified the most common scenarios seen in clinical practice related to the treatment of urethral strictures. Guideline statements were developed to aid the clinician in optimal evaluation, treatment, and follow-up of patients presenting with urethral strictures. CONCLUSIONS Successful treatment of male urethral stricture requires selection of the appropriate endoscopic or surgical procedure based on anatomic location, length of stricture, and prior interventions. Routine use of imaging to assess stricture characteristics will be required to apply evidence based recommendations, which must be applied with consideration of patient preferences and personal goals. As scientific knowledge relevant to urethral stricture evolves and improves, the strategies presented here will be amended to remain consistent with the highest standards of clinical care.
Collapse
Affiliation(s)
- Hunter Wessells
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Keith W Angermeier
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Sean Elliott
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | | | - Ron Kodama
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Andrew C Peterson
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - James Reston
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Keith Rourke
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - John T Stoffel
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Alex J Vanni
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Bryan B Voelzke
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Lee Zhao
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Richard A Santucci
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| |
Collapse
|
28
|
Puche-Sanz I, Martín-Way D, Flores-Martín J, Expósito-Ruiz M, Vicente-Prados J, Nogueras-Ocaña M, Tinaut-Ranera J, Cózar-Olmo J. Psychometric validation of the Spanish version of the USS-PROM questionnaire for patients who undergo anterior urethral surgery. Actas Urol Esp 2016; 40:322-7. [PMID: 26877070 DOI: 10.1016/j.acuro.2016.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/07/2016] [Accepted: 01/07/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To translate into Spanish and validate the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROM) questionnaire, assessing its psychometric properties and determining its suitability for clinical use in our community. We also assessed the potential changes in ejaculatory function using the Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD). MATERIAL AND METHODS A systematic translation of the British version was performed. Patients scheduled for anterior urethral stricture surgery between September 2014 and September 2015 were prospectively included in the study. All patients completed the questionnaire before and after the surgery. We conducted an in-depth psychometric study of the questionnaire. RESULTS We assessed the responses of a total of 40 patients. The questionnaire showed its validity, presenting an excellent negative correlation between the voiding symptom scores and the maximum flow (r=-0.6, P<.001), and also showed significant improvement in the EQ5D-VAS (visual analogue scale) and the time trade-off. For internal consistency, the Cronbach's alpha was 0.701. For the test-retest reliability, the overall intraclass correlation coefficient (ICC) was 0.974, and the ICC for each item separately ranged from 0.799 to 0.980. We observed significant improvement in all items regarding urinary symptoms and health-related quality of life (P<.001), thereby demonstrating the response capacity to changing the questionnaire. There were no significant changes in the MSHQ-EjD. CONCLUSIONS The Spanish version of the USS-PROM questionnaire is a valid instrument for quantifying changes in voiding symptoms and the health-related quality of life of patients undergoing anterior urethral surgery.
Collapse
|
29
|
The International Prostate Symptom Score (IPSS) Is an Inadequate Tool to Screen for Urethral Stricture Recurrence After Anterior Urethroplasty. Urology 2016; 95:197-201. [PMID: 27109599 DOI: 10.1016/j.urology.2016.04.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 04/04/2016] [Accepted: 04/06/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To validate the use of the International Prostate Symptom Score (IPSS) as a stand-alone tool to detect urethral stricture recurrence following urethroplasty. MATERIALS AND METHODS This study included 393 men who had undergone anterior urethroplasty and were enrolled in a multi-institutional outcomes study. Data analyzed included pre- and post-operative answers to the IPSS in addition to findings from a same- day cystoscopy. IPSS from men found to have cystoscopic recurrence were then compared to scores from those with successful repairs, and receiver operating characteristic curves were plotted to illustrate the predictive ability of these questions to screen for cystoscopic recurrence. RESULTS Mean postoperative scores were lower (fewer symptoms) in successful repairs; IPSS improved from preoperative values regardless of recurrence. Successful repairs had significantly better degree of improvement in question #5 (assessing weak stream) compared to recurrences. Receiver operating characteristic curves demonstrated the highest area under the curve for the IPSS quality of life question (0.66) that alone outperformed the complete IPSS questionnaire (0.56). CONCLUSION The IPSS had inadequate sensitivity and specificity to be used as a stand-alone screening tool for stricture recurrence in this large cohort of men, highlighting the need to continue development of a disease-specific, validated patient-reported outcome measure.
Collapse
|
30
|
Osterberg EC, Schulster M, Blaivas JG, Maganty A, Lee DJ, Purohit RS. Urethroplasty Improves Overactive Bladder Symptoms in Men With Anterior Urethral Strictures. Urology 2016; 93:208-12. [PMID: 27063611 DOI: 10.1016/j.urology.2016.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/30/2016] [Accepted: 04/01/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the effect of urethroplasty on overactive bladder (OAB) symptoms. MATERIALS AND METHODS From March 2011 to November 2014, 47 anterior urethroplasties were performed by a single surgeon (RSP). Of these, 42 men prospectively completed the validated Overactive Bladder Symptom Score (OABSS) prior to and after urethroplasty. Comparative analysis of preoperative to postoperative OABSS results was performed. RESULTS The median (range) age of men who comprised our cohort was 49 (22-90). Questionnaires were completed preoperatively and at a median of 12 months (2.3-74.6) postoperatively. Stricture location included the following: bulbar (75%), penile (15%), and membranous (7.5%) urethra. Median stricture length was 3 cm (1-6). Half of the men underwent an excision and anastomotic repair, and half underwent buccal mucosal graft. Men experienced significant improvement in urinary flow rate, postvoid residual urine, and OAB symptoms reported on the OABSS. Of the 28/42 men with preoperative, clinically significant OAB (ie, OABSS ≥ 8), 25/28 reported a 54.2% (0%-100%) median reduction in OABSS, with only 1 patient reporting worsening of symptoms following surgery. Those men with the highest preoperative OABSS experienced the greatest improvement in OAB symptoms postoperatively. CONCLUSION In men with anterior urethral strictures and OAB, urethroplasty decreased reported OABSS by >50% and cured 90% of men with clinically significant OAB symptoms.
Collapse
Affiliation(s)
| | | | - Jerry G Blaivas
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Avinash Maganty
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Daniel J Lee
- Department of Urology, Weill Cornell Medical College, New York, NY
| | | |
Collapse
|
31
|
Anterior Urethral Stricture Disease Negatively Impacts the Quality of Life of Family Members. Adv Urol 2016; 2016:3582862. [PMID: 27034658 PMCID: PMC4791496 DOI: 10.1155/2016/3582862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/14/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose. To quantify the quality of life (QoL) distress experienced by immediate family members of patients with urethral stricture via a questionnaire given prior to definitive urethroplasty. The emotional, social, and physical effects of urethral stricture disease on the QoL of family members have not been previously described. Materials and Methods. A questionnaire was administered prospectively to an immediate family member of 51 patients undergoing anterior urethroplasty by a single surgeon (SBB). The survey was comprised of twelve questions that addressed the emotional, social, and physical consequences experienced as a result of their loved one. Results. Of the 51 surveyed family members, most were female (92.2%), lived in the same household (86.3%), and slept in the same room as the patient (70.6%). Respondents experienced sleep disturbances (56.9%) and diminished social lives (43.1%). 82.4% felt stressed by the patient's surgical treatment, and 83.9% (26/31) felt that their intimacy was negatively impacted. Conclusions. Urethral stricture disease has a significant impact on the family members of those affected. These effects may last decades and include sleep disturbance, decreased social interactions, emotional stress, and impaired sexual intimacy. Treatment of urethral stricture disease should attempt to mitigate the impact of the disease on family members as well as the patient.
Collapse
|
32
|
Bertrand LA, Voelzke BB, Elliott SP, Myers JB, Breyer BN, Vanni AJ, McClung CD, Tam CA, Warren GJ, Erickson BA. Measuring and Predicting Patient Dissatisfaction after Anterior Urethroplasty Using Patient Reported Outcomes Measures. J Urol 2016; 196:453-61. [PMID: 26907509 DOI: 10.1016/j.juro.2016.01.117] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE Subjective measures of success after urethroplasty have become increasingly valuable in postoperative monitoring. We examined patient reported satisfaction following anterior urethroplasty using objective measures as a proxy for success. MATERIALS AND METHODS Men 18 years old or older with urethral strictures undergoing urethroplasty were prospectively enrolled in a longitudinal, multi-institutional urethroplasty outcomes database. Preoperative and postoperative assessment included questionnaires to assess lower urinary tract symptoms, pain, satisfaction and sexual health. Analyses controlling for stricture recurrence (defined as the inability to traverse the reconstructed urethra with a flexible cystoscope) were performed to determine independent predictors of dissatisfaction. RESULTS At a mean followup of 14 months we found a high 89.4% rate of overall postoperative satisfaction in 433 patients and a high 82.8% rate in those who would have chosen the operation again. Men with cystoscopic recurrence were more likely to report dissatisfaction (OR 4.96, 95% CI 2.07-11.90) and men reporting dissatisfaction had significantly worse uroflowmetry measures (each p <0.02). When controlling for recurrence, multivariate analysis revealed that urethra and bladder pain (OR 1.71, 95% CI 1.05-2.77 and OR 2.74, 95% CI 1.12-6.69, respectively), a postoperative decrease in sexual activity (OR 4.36, 95% CI 2.07-11.90) and persistent lower urinary tract symptoms (eg straining to urinate OR 3.23, 1.74-6.01) were independent predictors of dissatisfaction. CONCLUSIONS Overall satisfaction after anterior urethroplasty is high and traditional measures of surgical success strongly correlate with satisfaction. However, independently of the anatomical appearance of the reconstructed urethra, postoperative pain, sexual dysfunction and persistent lower urinary tract symptoms were predictors of patient dissatisfaction.
Collapse
Affiliation(s)
- Laura A Bertrand
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Bryan B Voelzke
- Department of Urology, University of Washington, Seattle, Washington
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | - Jeremy B Myers
- Department of Urology, University of Utah, Salt Lake City, Utah
| | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, California
| | - Alex J Vanni
- Department of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | | | - Christopher A Tam
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Gareth J Warren
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Bradley A Erickson
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | | |
Collapse
|
33
|
Abstract
Male anterior urethral stricture disease is a commonly encountered condition that presents to many urologists. According to a National Practice Survey of Board Certified Urologist in the United States most urologists treat on average 6-20 urethral strictures yearly. Many of those same urologists surveyed treat with repeated dilation or internal urethrotomy, despite continual recurrence of the urethral stricture. In point of fact, the urethroplasty despite its high success rate, is underutilized by many practicing urologists. Roughly half of practicing urologist do not perform urethroplasty in the United States. Clearly, the reconstructive ladder for urethral stricture management that was previously described in the literature may no longer apply in the modern era. The following article reviews the etiology, diagnosis, management and comparisons of treatment options for anterior urethral strictures.
Collapse
Affiliation(s)
- Marshall J Stein
- 1 UT Urology Resident, 6410 Fannin, Suite 420, Houston, Texas 77030, USA ; 2 Division of Urology, Medical Director of UTP Urology Clinic, USA
| | - Rowena A DeSouza
- 1 UT Urology Resident, 6410 Fannin, Suite 420, Houston, Texas 77030, USA ; 2 Division of Urology, Medical Director of UTP Urology Clinic, USA
| |
Collapse
|
34
|
Psychometric validation of a German language version of a PROM for urethral stricture surgery and preliminary testing of supplementary ED and UI constructs. World J Urol 2015; 34:369-75. [PMID: 26049865 DOI: 10.1007/s00345-015-1610-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 05/31/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To validate a German language version of the patient-reported outcome measurement (PROM) following urethral stricture surgery (USS) in a cohort of men undergoing one-stage buccal mucosa graft urethroplasty (BMGU) for urethral stricture. Furthermore, to explore the responsiveness of erectile function (EF) and urinary incontinence (UI) constructs in the context of this intervention. METHODS The USS-PROM captures voiding symptoms (ICIQ-MLUTS) and health-related quality of life (HRQoL) (EQ-5D). To evaluate EF and UI, the IIEF-5 and ICIQ-UI SF were included. Between March 2012 and April 2013, all patients undergoing BMGU at our institution were prospectively enrolled in this study. Psychometric assessment included internal consistency, test-retest reliability, criterion validity and responsiveness. RESULTS Ninety-three men completed the USS-PROM before and 3 months after surgery, with 40 (43 %) also completing the USS-PROM 6 months after surgery to assess reliability. Internal consistency: for the ICIQ-MLUTS, Cronbach's α was 0.83. The test-retest intraclass correlation coefficient was 0.94. There was a negative correlation between change in ICIQ-MLUTS total score and change in Q max (r = -0.40). All values exceeded our predefined thresholds. Significant improvements of voiding symptoms and HRQoL demonstrate responsiveness to change (all p values <0.001). While ICIQ-UI scores did not change (p > 0.05), IIEF-5 scores improved significantly (p = 0.048). CONCLUSIONS The German language USS-PROM shows similar psychometric properties to the English language version. This instrument can be improved by assessing EF by the use of IIEF-5. Further studies with larger patient cohorts are needed to evaluate the significance of measuring UI in urethroplasty patients.
Collapse
|
35
|
Perineal urethrostomy: surgical and functional evaluation of two techniques. BIOMED RESEARCH INTERNATIONAL 2015; 2015:365715. [PMID: 25789316 PMCID: PMC4350848 DOI: 10.1155/2015/365715] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 09/28/2014] [Indexed: 11/20/2022]
Abstract
Introduction. PU is an option to manage complex and/or recurrent urethral strictures and is necessary after urethrectomy and/or penectomy. PU is generally assumed to be the last option before abandoning the urethral outlet. Methods. Between 2001 and 2013, 51 patients underwent PU. Mean age (± standard deviation) was 60 ± 15 years. Only 13 patients (25.5%) did not undergo previous urethral interventions. PU was performed according to the Johanson (n = 35) or Blandy (n = 16) technique and these 2 groups were compared for surgical failure, maximum urinary flow (Qmax), urinary symptoms, and quality of life (according to the International Prostate Symptom Score). Results. Both groups were similar for patient's and stricture characteristics. Only follow-up duration was significantly longer after Johanson PU (47.9 months versus 11.1 months; P = 0.003). For the entire cohort, 11 patients (21.6%) were considered a failure (9 or 25.7% for Johanson group and 2 or 12.5% for Blandy group; P = 0.248). There was a significant improvement of Qmax in both groups. Quality of life after PU was comparable in both groups. Conclusions. PU is associated with a 21.6% recurrence rate and the patient should be informed about this risk.
Collapse
|
36
|
Bertrand LA, Warren GJ, Voelzke BB, Elliott SP, Myers JB, McClung CD, Oleson JJ, Erickson BA. Lower urinary tract pain and anterior urethral stricture disease: prevalence and effects of urethral reconstruction. J Urol 2014; 193:184-9. [PMID: 25046621 DOI: 10.1016/j.juro.2014.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE Anterior urethral stricture disease most commonly presents as urinary obstruction. Lower urinary tract pain is not commonly reported as a presenting symptom. We prospectively characterized lower urinary tract pain in association with urethral stricture disease and assessed the effects of urethroplasty on this pain. MATERIALS AND METHODS Men (18 years old or older) with anterior urethral stricture disease were prospectively enrolled in a longitudinal, multi-institutional, urethral reconstruction outcomes study from June 2010 to January 2013 as part of TURNS (Trauma and Urologic Reconstruction Network of Surgeons). Preoperative and postoperative lower urinary tract pain was assessed by the validated CLSS. Voiding and sexual function was assessed using validated patient-reported measures, including I-PSS. RESULTS Preoperatively 118 of 167 men (71%) reported urethral pain and 68 (41%) reported bladder pain. Age was the only predictor of urethral pain with men 40 years or younger reporting more pain than those 60 years old or older (81% vs 58%, p = 0.0104). Lower urinary tract pain was associated with worse quality of life and overall voiding symptoms on CLSS and I-PSS (each p <0.01). Postoperatively lower urinary tract pain completely resolved in 64% of men with urethral pain and in 73.5% with bladder pain. There were no predictive factors for changes in lower urinary tract pain after urethral reconstruction. CONCLUSIONS Lower urinary tract pain is common in urethral stricture disease, especially in younger men. It is associated with worse quality of life and voiding function. In most men lower urinary tract pain resolves after urethral reconstruction.
Collapse
Affiliation(s)
- Laura A Bertrand
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Gareth J Warren
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Bryan B Voelzke
- Department of Urology, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | - Jeremy B Myers
- Division of Urology, University of Utah, Salt Lake City, Utah
| | | | - Jacob J Oleson
- Department of Biostatistics, University of Iowa, Iowa City, Iowa
| | - Bradley A Erickson
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | | |
Collapse
|
37
|
Jackson MJ, Chaudhury I, Mangera A, Brett A, Watkin N, Chapple CR, Andrich DE, Pickard RS, Mundy AR. A prospective patient-centred evaluation of urethroplasty for anterior urethral stricture using a validated patient-reported outcome measure. Eur Urol 2013; 64:777-82. [PMID: 23664422 DOI: 10.1016/j.eururo.2013.04.037] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 04/19/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Studies of interventions for urethral stricture have inferred patient benefit from clinician-driven outcomes or questionnaires lacking scientifically robust evidence of their measurement properties for men with this disease. OBJECTIVE To evaluate urethral reconstruction from the patients' perspective using a validated patient-reported outcome measure (PROM). DESIGN, SETTING, AND PARTICIPANTS Forty-six men with anterior urethral stricture at four UK urology centres completed the PROM before (baseline) and 2 yr after urethroplasty. INTERVENTION A psychometrically robust PROM for men with urethral stricture disease. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Lower urinary tract symptoms (LUTS), health status, and treatment satisfaction were measured, and paired t and Wilcoxon matched-pairs tests were used for comparative analysis. RESULTS AND LIMITATIONS Thirty-eight men underwent urethroplasty for bulbar stricture and eight for penile stricture. The median (range) follow-up was 25 (20-30) mo. Total LUTS scores (0 = least symptomatic, 24 = most symptomatic) improved from a median of 12 at baseline to 4 at 2 yr (mean [95% confidence interval (CI)] of differences 6.6 [4.2-9.1], p < 0.0001). A total of 33 men (72%) felt their urinary symptoms interfered less with their overall quality of life, 8 (17%) reported no change, and 5 (11%) were worse 2 yr after urethroplasty. Overall, 40 men (87%) remained "satisfied" or "very satisfied" with the outcome of their operation. Health status visual analogue scale scores (100 = best imaginable health, 0 = worst) 2 yr after urethroplasty improved from a mean of 69 at baseline to 79 (mean [95% CI] of differences 10 [2-18], p = 0.018). Health state index scores (1 = full health, 0 = dead) improved from 0.79 at baseline to 0.89 at 2 yr (mean [95% CI] of differences 0.10 [0.02-0.18), p = 0.012]). CONCLUSIONS This is the first study to prospectively evaluate urethral reconstruction using a validated PROM. Men reported continued relief from symptoms with related improvements in overall health status 2 yr after urethroplasty. These data can be used as a provisional reference point against which urethral surgeons can benchmark their performance.
Collapse
|
38
|
Voelzke BB. Critical review of existing patient reported outcome measures after male anterior urethroplasty. J Urol 2012; 189:182-8. [PMID: 23174257 DOI: 10.1016/j.juro.2012.08.096] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Male urethral stricture disease can be recurrent and debilitating. The aim of any intervention is to allow men to return to a normal state of voiding while maintaining a strong quality of life. A systematic review of the literature was conducted to assess for the use of patient reported outcome instruments after male anterior urethroplasty. MATERIALS AND METHODS A review of PubMed® was conducted to identify studies that used a patient reported outcome measure to assess patient outcome after open surgical correction of male strictures. Preference was given to studies that used an instrument in the preoperative and postoperative setting. However, use of an outcome measure solely in the postoperative setting was also accepted. After article selection, the 8 attributes recommended by the Scientific Advisory Committee were used to analyze the measurement properties of each patient reported outcome measure. RESULTS A total of 15 studies were identified that included an instrument to assess patients with anterior urethral strictures. The studies used differing instruments to assess anterior urethral strictures in a nonuniform manner. Four studies used a lower urinary tract symptoms instrument, 8 used a sexual/ejaculatory dysfunction instrument, and 3 used a lower urinary tract symptoms and sexual/ejaculatory function instrument. There was only 1 report that described the development of a urethroplasty specific patient reported outcome instrument. CONCLUSIONS Continued effort is necessary to develop a powerful instrument to assess patient reported outcomes after male urethroplasty. The importance of patient perspective is vital to understanding the success of open urethral reconstruction.
Collapse
Affiliation(s)
- Bryan B Voelzke
- Department of Urology, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington 98104, USA.
| |
Collapse
|