1
|
Uğur R, Şimşek A. The best method for erection function in urethroplasty; is excision and primary anastomosis or buccal mucosal graft urethroplasty? Actas Urol Esp 2024; 48:170-176. [PMID: 37981167 DOI: 10.1016/j.acuroe.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION The aim of this study is to evaluate and compare erection function (EF) after Excision and Primary Anastomosis Urethroplasty (EPAU) and Buccal Mucosal Graft Urethroplasty (BMGU) in bulbar urethral stricture. METHODS Patients who underwent urethroplasty were identified retrospectively. The criteria for inclusion in the study were determined as being over 18 years old and under 70 years old, being sexually active. Exclusion criteria are; preoperative severe erectile dysfunction, stricture outside the bulbar urethra, psychosocial incompatibility, urethral stricture related to pelvic fracture, follow-up time less than a year. As the primary endpoint, the International Index of Erectile Function-5 (IIEF-5) was determined as a comparison of EF in the preoperative and third, sixth and twelfth months after surgery. The secondary endpoint was the evaluation of the effects of demographic data, stricture and treatment characteristics on EF. RESULTS Fifty patients were identified considering the inclusion/exclusion criteria. It was observed that there were 30 patients who underwent EPAU and 20 patients who underwent BMGU. At the third month after surgery, EF showed a statistically significant decrease in the EPAU group. In both patient groups, it was observed that the early negative effects after the operation in EF started to improve in the sixth month and returned to the baseline level by the first year. CONCLUSION EPAU and BMGU techniques have a similar effect on EF in the medium and long term. Both methods can be used safely and effectively in the appropriate patient group.
Collapse
Affiliation(s)
- R Uğur
- Servicio de Urología, Hospital Urbano de Basaksehir Cam y Sakura, Estambul, Turkey.
| | - A Şimşek
- Servicio de Urología, Hospital Urbano de Basaksehir Cam y Sakura, Estambul, Turkey
| |
Collapse
|
2
|
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
|
3
|
Blair Y. How Do We Assess Success After Surgical Management of Urethral Stricture Disease? CURRENT BLADDER DYSFUNCTION REPORTS 2023. [DOI: 10.1007/s11884-023-00686-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
|
4
|
'Pee'BuSt Trial: A single-centre prospective randomized study comparing functional and anatomic outcomes after augmentation urethroplasty with penile skin graft versus buccal mucosa graft for anterior urethral stricture disease. World J Urol 2021; 40:475-481. [PMID: 34655304 PMCID: PMC8520101 DOI: 10.1007/s00345-021-03843-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/18/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To assess the surgical outcomes of augmentation urethroplasty (AU) using penile skin graft (PSG) compared to buccal mucosa graft (BMG) in anterior urethral stricture disease. Method Between January 2018 and January 2019, 100 patients with anterior urethral stricture planned for AU were randomized into PSG or BMG arms (CTRI/2018/07/015028). Anatomic and functional variables were compared pre-operatively and post-operatively. Primary outcome was success rate at 18 months and it was defined if any of the three criteria were met, i.e. either maximum urinary flow (Qmax) > 15 ml/s or urethral calibration of 16 French or ability to traverse the repair with 17 French cystoscope. Secondary outcomes were functional parameters such as International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF) Score, Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EJD), and Urethral Stricture Surgery-Patient Related Outcome Measure (USS-PROM). Results Pre-operative variables were comparable between both the arms. Median duration of follow-up was 22 months (18–24 months). At 18 months, the success rates of AU with PSG and BMG were comparable (89% v/s 91%; p = 0.70, 95% CI-0.33 to 5.21). The improvements in Qmax (p = 0.06), IPSS (p = 0.43) and USS-PROM (p = 0.49) were comparable between the two arms. There was no statistically significant difference in the IIEF-Erectile domain (p = 0.07), IIEF-Orgasmic domain (p = 0.11) and MSHQ-EJD (p = 0.20) following AU at 18 months. Clavien–Dindo grade I complications were 12.7% in PSG and 16.7% in BMG. Conclusion This study provides level 1 evidence of no statistical significant difference in outcomes of AU using BMG or PSG. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03843-x.
Collapse
|
5
|
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
|
6
|
Hoare DT, Bekkema J, Rourke KF. Prospective Assessment of Patient-perceived Short-term Changes in Penile Appearance After Urethroplasty. Urology 2021; 158:222-227. [PMID: 34461146 DOI: 10.1016/j.urology.2021.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/11/2021] [Accepted: 08/15/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To define the incidence and associations of patient-reported penile curvature and shortening after urethroplasty. Alterations in penile curvature or length post-urethroplasty are associated with patient dissatisfaction but are poorly described. METHODS From 2011 to 2019, 387 patients completed enrollment in a prospective single-centre study assessing patient-reported outcomes pre-operatively and 6-months post-urethroplasty. Primary outcomes of perceived penile shortening and curvature were assessed at 6-months follow-up. Descriptive statistics were used to summarize findings while univariate and multivariate binary logistic regression was used to identify associations between loss of penile length or chordee with other clinical factors. RESULTS Of the 387 patients, mean age was 49.5 years with mean stricture length of 4.5 cm. Postoperatively, 12.7% of patients perceived penile curvature (8.0% "somewhat", 4.7% "severe") and 22.8% of patients perceived penile shortening (14.5% "somewhat", 8.3% "a lot"). Multivariate binary logistic regression identified stricture location (P = .02) to be associated with perceived curvature while prior urethroplasty (P = .17), type of urethroplasty (P = .08) and other factors were not. Specifically, penile (O.R. 4.27, 95%CI 1.56-11.68, P = .005) and panurethral (O.R. 10.15, 95%CI 3.46-29.77, P <.001) locations were independently associated with this outcome. In a multivariate model, panurethral strictures (O.R. 4.23, 95%CI 1.10-16.20, P = .04) and hypospadias (O.R. 5.46, 95%CI 1.32-22.70, P = .02) were associated with patient perceived shortening while other factors such as age (P = .19), type of urethroplasty (P = .14) and other etiologies or locations were not. CONCLUSION Clinically significant changes in penile appearance are more common post-urethroplasty than generally thought. Stricture location and etiology are important predictors of these patient-perceived changes.
Collapse
Affiliation(s)
- Dylan T Hoare
- Division of Urology, University of Alberta, Edmonton, Alberta, Canada
| | - Jordan Bekkema
- Division of Urology, University of Alberta, Edmonton, Alberta, Canada
| | - Keith F Rourke
- Division of Urology, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
7
|
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
|
8
|
Calleja Hermosa P, Campos-Juanatey F, Varea Malo R, Correas Gómez MÁ, Gutiérrez Baños JL. Sexual function after anterior urethroplasty: a systematic review. Transl Androl Urol 2021; 10:2554-2573. [PMID: 34295743 PMCID: PMC8261436 DOI: 10.21037/tau-20-1307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/27/2021] [Indexed: 11/09/2022] Open
Abstract
Background Urethral surgery outcomes are often evaluated by assessing urinary flow and urethral patency. However, sexual consequences may appear after urethroplasty, impairing quality of life and patient’s perception of success. The aim of this study is to assess the relationship between anterior urethral reconstruction and postoperative sexual dysfunction, including the proposed factors predicting sexual outcomes. Methods We searched in PubMed database using the terms: “anterior urethroplasty”, bulbar urethroplasty” or “penile urethroplasty”, and “sexual dysfunction”, “erectile function” or “ejaculation”. Articles were independently evaluated for inclusion based on predetermined criteria. Systematic data extraction was followed by a comprehensive summary of evidence. Results Thirty-eight studies were included for final analysis. No randomised trial on the topic was found. Urethral surgery might affect different aspects of sexual function: erectile function, ejaculatory function, penile shape and length, and genital sensitivity, leading to severe sexual dysfunction. Patient perception of sexual impairment was related to post-operative satisfaction. Conclusions Sexual dysfunction after anterior urethral reconstruction is an important issue that must be appropriately discussed during preoperative patient counselling. Reported outcomes after anterior urethroplasty should include sexual consequences and relevance, evaluated using validated tools.
Collapse
Affiliation(s)
| | - Felix Campos-Juanatey
- Urology Department, Marques de Valdecilla University Hospital, Santander, Spain.,Valdecilla Research Institute (IDIVAL), Santander, Spain
| | - Raquel Varea Malo
- Urology Department, Marques de Valdecilla University Hospital, Santander, Spain
| | - Miguel Ángel Correas Gómez
- Urology Department, Marques de Valdecilla University Hospital, Santander, Spain.,Medical and Surgical Sciences Department, School of Medicine, University of Cantabria, Santander, Spain
| | - Jose Luis Gutiérrez Baños
- Urology Department, Marques de Valdecilla University Hospital, Santander, Spain.,Medical and Surgical Sciences Department, School of Medicine, University of Cantabria, Santander, Spain
| | | |
Collapse
|
9
|
Mershon JP, Baradaran N. Recurrent Anterior Urethral Stricture: Challenges and Solutions. Res Rep Urol 2021; 13:237-249. [PMID: 34012927 PMCID: PMC8128502 DOI: 10.2147/rru.s198792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/14/2021] [Indexed: 12/05/2022] Open
Abstract
Recurrent male anterior urethral stricture disease is a complex surgical challenge that should be managed by reconstructive urologists with experience in stricture management. Diagnosis of recurrence requires both anatomic narrowing and patient symptoms identified on validated questionnaires, with limited role for intervention in asymptomatic treatment “failures”. Endoscopic management has a very specific role in recurrence, and the choice of technique for urethroplasty depends on pre-operative urethrography and cystoscopy. Surgical success depends on addressing patient concerns, complete stricture excision, tissue quality optimization, and the use of multi-stage repair when indicated. Augmentation with genital skin flaps and/or grafts is often required, with buccal mucosa as the ideal graft source if local tissue is compromised. Salvage options including urinary diversion and perineal urethrostomy must also be considered in debilitated patients with severe disease or repeated treatment failures. Unique patient populations including patients with hypospadias and lichen sclerosis are among the highest risk for repeated recurrence and require special care in surgical technique, graft selection, and post-operative management.
Collapse
Affiliation(s)
| | - Nima Baradaran
- The Ohio State University Department of Urology, Columbus, OH, USA
| |
Collapse
|
10
|
Lane GI, Gracely A, Uberoi P, Lee U, Smith AL, Anger JT, Theva D, DeLong J, Kowalik C, Padmanabhan P, Powell CR, Carmel ME, Clemens JQ, Cameron AP, Gupta P. Changes in patient reported outcome measures after treatment for female urethral stricture. Neurourol Urodyn 2021; 40:986-993. [PMID: 33719145 DOI: 10.1002/nau.24653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION There is a paucity of patient reported outcome measure (PROM) data for women with urethral strictures. To address this gap, we aim to evaluate change in PROM among women who underwent surgery for a stricture. METHODS American Urological Association Symptom Index (AUA-SI) and Urogenital Distress Inventory (UDI-6) data from a multi-institutional retrospective cohort study of women treated for urethral stricture was assessed. RESULTS Fifty-seven women had either AUA-SS or UDI-6 and 26 had baseline and postoperative data for either. Most women underwent urethroplasty (77%) and the majority (73%) remained stricture free at median follow-up of 21 months (interquartile range [IQR] 7-37). The median baseline AUA-SI was 21 (IQR 12-28) and follow-up was 10 (IQR 5-24). After treatment, there was a median decrease of 12 (IQR -18 to -2) in AUA-SI (p = 0.003). The median AUA Quality of life (QOL) score at baseline and follow-up were 6 (IQR 4-6) and 3 (IQR 2-5), respectively. There was a median AUA-QOL improvement of 2 points (-5,0; p = 0.007) from a baseline 5 (unhappy) to 3 (mixed). Median UDI-6 scores were 50 (IQR 33-75) at baseline and 17 (IQR 0-39), at follow-up. After treatment, there was a median decrease of 19 (-31 to -11; p = 0.01). CONCLUSION Women with urethral strictures have severe lower urinary tract symptoms which improved after surgery. This study substantiates the claims that recognizing and treating women with urethral stricture disease greatly improves lower urinary tract symptoms and QOL.
Collapse
Affiliation(s)
- Giulia I Lane
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Alyssa Gracely
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Una Lee
- Virginia Mason, Seattle, Washington, USA
| | - Ariana L Smith
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Didi Theva
- Memorial Hospital Miramar, Miramar, Florida, USA
| | | | - Casey Kowalik
- Kansas University Medical Center, Kansas City, Kansas, USA
| | - Priya Padmanabhan
- Kansas University Medical Center, Kansas City, Kansas, USA.,Beaumont Hospital, Royal Oak, Michigan, USA
| | | | - Maude E Carmel
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - J Quentin Clemens
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Priyanka Gupta
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | | |
Collapse
|
11
|
Vetterlein MW, Gödde A, Zumstein V, Gild P, Marks P, Soave A, Meyer CP, Riechardt S, Dahlem R, Fisch M, Kluth LA. Exploring the intersection of functional recurrence, patient-reported sexual function, and treatment satisfaction after anterior buccal mucosal graft urethroplasty. World J Urol 2021; 39:3533-3539. [PMID: 33709201 PMCID: PMC8510905 DOI: 10.1007/s00345-021-03648-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/19/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose To evaluate the interplay of stricture recurrence, sexual function, and treatment satisfaction after substitution urethroplasty. Methods Observational study of men undergoing 1-stage buccal mucosal graft urethroplasty for anterior urethral stricture between 2009 and 2016. Patients were dichotomized by self-reported treatment satisfaction. Sexual function was assessed by validated and non-validated patient-reported outcome measures. Functional recurrence was defined as symptomatic need of re-intervention. Bivariate analyses, Kaplan–Meier estimates, qualitative and quantitative analyses by uni- and multivariable regression were employed to evaluate the interplay of sexual function, functional recurrence, and treatment satisfaction. Results Of 534 men with bulbar (82%), penobulbar (11%), and penile strictures (7.3%), 451 (84%) were satisfied with the surgery. There were no differences in stricture location, previous treatment, graft length, or surgical technique between satisfied and unsatisfied patients (all p ≥ 0.2). Recurrence-free survival was 85% at a median follow-up of 33 mo and decreased significantly with each Likert item towards increasing dissatisfaction (p < 0.001). Dissatisfied patients more often reported postoperative loss of rigidity, tumescence, reduced ejaculatory volume, ejaculatory pain, and reduced penile length (all p ≤ 0.042). In 83 dissatisfied men, functional recurrence (28%) and oral morbidity (20%) were the main drivers of dissatisfaction in qualitative analysis. Multivariable analyses revealed functional recurrence and impaired postoperative ejaculatory function as independent predictors of treatment dissatisfaction (all p ≤ 0.029) after adjusting for confounders. Conclusion We found an association of both functional success and sexual function with patient-reported treatment satisfaction after substitution urethroplasty. Such findings validate the clinical significance of defining the symptomatic need for re-intervention as an endpoint and underline the importance of further research evaluating sexual function before and after open urethral reconstruction. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03648-y.
Collapse
Affiliation(s)
- Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Almut Gödde
- Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Valentin Zumstein
- Department of Urology, School of Medicine, University of St, Gallen, St. Gallen, Switzerland
| | - Philipp Gild
- Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Phillip Marks
- Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Armin Soave
- Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Christian P Meyer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Silke Riechardt
- Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Luis A Kluth
- Department of Urology, University Medical Center, Frankfurt, Frankfurt (Main), Germany
| | | |
Collapse
|
12
|
Benson CR, Li G, Brandes SB. Long term outcomes of one-stage augmentation anterior urethroplasty: a systematic review and meta-analysis. Int Braz J Urol 2021; 47:237-250. [PMID: 32459452 PMCID: PMC7857757 DOI: 10.1590/s1677-5538.ibju.2020.0242] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective is to summarize and characterize the long-term success of anterior augmentation urethroplasty (AU) in published series. The current literature on AU consists largely of retrospective series reporting intermediate follow-up and incompletely characterize the long term outcomes of AU. MATERIALS AND METHODS A systematic literature review was performed consistent with PRISMA guidelines to characterize long-term outcomes of AU with a minimum upper limit follow-up of 100 months. Penile/preputial skin flaps and graft and oral mucosal graft urethroplasties were included. The primary outcome was stricture-free survival for one-stage AU. Secondary analysis evaluated differences in outcomes based on two failure definitions: the need for intervention versus presence of recurrent stricture on cystoscopy or urethrography. Hazard rates were induced from the reported failure rates of one-stage AU and fixed and random effect models were fitted to the data. Additional subset analysis, removing potential confounders (lichen sclerosus, hypospadias and penile skin graft), was performed. RESULTS Ten studies met inclusion criteria, and two studies reported separate outcomes for grafts and flaps, and thus were included separately in the analysis. The mean hazard rate across all studies was 0.0044, the corresponding survival rates at 1 year 0.948, 5 years 0.766, 10 years 0.587, and 15 years 0.45. Subset analysis of the 4 select and homogeneous studies noted 1, 5, 10, and 15 years survival rates of 0.97, 0.96, 0.74, and 0.63, respectively. CONCLUSIONS The long-term success rates of augmentation urethroplasty are appear to be worse than previously appreciated and patients should be counseled accordingly. Available at. https://www.intbrazjurol.com.br/pdf/aop/2019-0242RW.pdf.
Collapse
Affiliation(s)
- Cooper R. Benson
- Columbia University Medical CenterDepartment of UrologyNew YorkNYUSADepartment of Urology, Columbia University Medical Center, New York, NY, USA
| | - Gen Li
- Columbia University Medical CenterDepartment of BiostatisticsNew YorkNYUSADepartment of Biostatistics, Columbia University Medical Center, New York, NY, USA
| | - Steven B. Brandes
- Columbia University Medical CenterDepartment of UrologyNew YorkNYUSADepartment of Urology, Columbia University Medical Center, New York, NY, USA,Correspondence address: Steven B. Brandes, MD, Department of Urology, Columbia Univeristy, 161 Ft. Washington Ave 11th Floor, New York, NY 10032, USA. Telephone: +1 212 305-6151. E-mail:
| |
Collapse
|
13
|
Tyagi S, Parmar K, Sharma A, Devana S, Kumar S, Singh SK, Bora G, Mavuduru RM. Dorsolateral inner preputial graft urethroplasty for anterior urethral strictures: long-term outcomes from a single tertiary care centre. World J Urol 2021; 39:3549-3554. [PMID: 33582831 PMCID: PMC7882039 DOI: 10.1007/s00345-021-03613-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/25/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose Buccal mucosa graft (BMG) is long used as favoured substitute by most reconstructive surgeons for substitution urethroplasty (SU). Though inner preputial skin graft (IPG) was described even earlier than BMG, its usage lately has fallen out of favour. The aim of the study was to evaluate the outcome of a SU with IPG from a tertiary care centre. Methods A retrospective analysis of prospectively maintained clinical data was conducted at our tertiary care centre enrolling 80 patients with anterior urethral stricture from January 2015 to January 2018. Patients were evaluated for the aetiology, length and site of the urethral stricture. All patients underwent dorsolateral SU with IPG. Post-operative assessment including uroflowmetry and sexual outcomes using IIEF and MSHQ-EJD questionnaires was done at 3 weeks, 3 months, 12 months and half-yearly thereafter. Success was defined by the stable maximum urinary flow value > 14 ml/s or urethral calibration with 16 French Foley catheter. Results Mean age of patients was 40 years (18–69). The most common aetiology was post-instrumentation (65%) and 60% had stricture at penobulbar site. Mean stricture length was 65 mm. At a mean follow-up of 48 months (range 30–66 months), successful outcomes were seen in 69/80 (87%). Patients with failure were managed with optical internal urethrotomy (OIU). Uroflowmetry and obstructive symptoms significantly improved and sexual function remained unaffected using IPG for SU. Conclusions Preputial graft is a tissue familiar to the urologist, located very close to the surgical field, easily harvested and operated under regional anaesthesia. Overall success outcomes are acceptable to BMG urethroplasty. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03613-9.
Collapse
Affiliation(s)
- Shantanu Tyagi
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kalpesh Parmar
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Anuj Sharma
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudheer Devana
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Santosh Kumar
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shrawan Kumar Singh
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Girdhar Bora
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravi Mohan Mavuduru
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
14
|
Kałużny A, Krukowski J, Frankiewicz M, Matuszewski M. The impact of post-urethroplasty erectile dysfunction on the quality of life and treatment satisfaction. Cent European J Urol 2021; 74:116-120. [PMID: 33976926 PMCID: PMC8097642 DOI: 10.5173/ceju.2021.0306.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/29/2020] [Accepted: 01/02/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this article was to assess the influence of sexual disorders after urethroplasty on patient's quality of life (QoL) and satisfaction of treatment. Material and methods We studied 106 sexually active patients who underwent urethroplasty due to urethral stricture. Patients completed the Urethral Stricture Surgery - Patient Reported Outcome Measure (USS - PROM) and International Index of Erectile Function (IIEF-5) questionnaires before and after the treatment. Spearman rank correlations were used for correlation analyses. Multiple linear regression and ordinal logistic regression analyses were used for evaluating the influence of lower urinary tract symptoms (LUTS) and IIEF-5 scores on EuroQol-5D (EQ-5D) index, EuroQol-Visual Analogue Scale (EQ-VAS), and satisfaction with treatment. Both LUTS and IIEF-5 scores were independent, significant predictors of EQ-VAS in the multiple linear regression model. Results Mean follow-up was 9 months (3-24). Reduction of LUTS and micturition improvement in the USS-PROM questionnaire after the surgery was found in 90 patients (85%). The average IIEF-5 score in the whole group did not change significantly, but in 39 cases (37%) worsened, and in 42 (39%) improved. Spearman's rank-order correlation indicated a significant positive correlation between improvement in IIEF-5 and general QoL in EQ-5D and also a positive correlation between improvement in IIEF-5 and improvement in EQ-VAS, which was also statistically significant (rho = 0.377, p <0.001). Conclusions Urethral surgery can influence sexual performance. The appearance of sexual dysfunction negatively affects the patient's quality of life, regardless of the effective restoration of the urethral patency and reduction of LUTS.
Collapse
Affiliation(s)
- Adam Kałużny
- Medical University of Gdańsk, Department of Urology, Gdańsk, Poland
| | - Jakub Krukowski
- Medical University of Gdańsk, Department of Urology, Gdańsk, Poland
| | | | | |
Collapse
|
15
|
Fougerousse JA, Selph JP. Sexual Dysfunction Following Urethroplasty for Urethral Stricture Disease. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00288-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
16
|
Ong M, Duncan C, McGrail M, Desai DJ. Evaluation of patient reported outcome measures post urethroplasty: Piloting a “Trifecta” approach. World J Clin Urol 2020; 9:9-15. [DOI: 10.5410/wjcu.v9.i1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/27/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Buccal mucosal graft urethroplasty is the gold standard treatment for urethral stricture disease. Toowoomba has obtained a fellowship trained urethroplasty surgeon who has been performing urethroplasties for the last two years. Patient reported outcome measure (PROM) questionnaires allow for a detailed and standardized analysis of success and morbidity post urethroplasty and can be used as a reference point against which urethral surgeons can benchmark their performance.
AIM To assess whether patient compliance rates improved with the use of an abridged PROM questionnaire.
METHODS Our database of urethroplasty patients was searched to identify patients who had completed the original PROM. This is routinely requested to be completed at the 3-, 6- and 12-mo mark. All patients are asked to complete the questionnaire and to bring it back to their next appointment. Our original PROM consists of the international prostate symptom score, the sexual health index measure and the Global Response Assessment. An abridged version of the questionnaire was derived focusing on urinary flow, sexual function and overall quality of life and consisted of three questions.
RESULTS Sixty-six patients were included in our study. Fifty-four patients had been invited to complete the original PROM with an overall compliance rate of 30%. Compliance rates improved to 91% with the introduction of the modified PROM. No correlation between non-compliance and patient factors were found. There was also no significant difference in patient reported quality of life when comparing urinary flow and sexual function.
CONCLUSION We recommend the use of PROMs pre- and post-operatively to accurately determine the level of patient satisfaction. We acknowledge the aversion of patients in completing PROMs due to the length of these questionnaires. We propose a simplistic version aimed at the “Trifecta” of urethroplasty comprising of three questions focusing each on urinary flow, sexual function and quality of life. Our modified PROM demonstrated markedly improved compliance rates and can be used as a screening tool to identify patients who might have had a poor outcome and who require a more in-depth assessment.
Collapse
Affiliation(s)
- Michelle Ong
- Department of Urology, Toowoomba Hospital, Toowoomba 4350, Queensland, Australia
| | - Catriona Duncan
- Department of Urology, Toowoomba Hospital, Toowoomba 4350, Queensland, Australia
| | - Matthew McGrail
- Department of Head Regional Training Hub Research, University of Queensland Rural Clinical School, Rockhampton 4700, Queensland, Australia
| | - Devang J Desai
- Department of Urology, Toowoomba Hospital, Toowoomba 4350, Queensland, Australia
- University of Queensland Rural Clinical School, Toowoomba 4350, Queensland, Australia
| |
Collapse
|
17
|
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
|
18
|
Surgical and patient-reported outcomes of urethroplasty for bulbar stricture due to a straddle injury. World J Urol 2019; 38:1805-1811. [DOI: 10.1007/s00345-019-02971-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022] Open
|
19
|
Fuehner C, Dahlem R, Fisch M, Vetterlein MW. Update on managing anterior urethral strictures. Indian J Urol 2019; 35:94-100. [PMID: 31000913 PMCID: PMC6458800 DOI: 10.4103/iju.iju_52_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/18/2019] [Indexed: 06/09/2023] Open
Abstract
A number of techniques have been described for managing anterior urethral strictures in men. In this review, we aimed to summarize contemporary considerations regarding the holistic management of such strictures. The efficacy of reported outcomes is compared to provide evidence-based treatment recommendations. For anterior urethral strictures, durable long-term success rates of >90% may be achieved if the procedure is performed in capable hands at a high-volume referral center, even in recurrent strictures after previous open reconstruction. A one-stage urethroplasty is preferable to avoid a protracted treatment course with multiple interventions after dilation and direct vision internal urethrotomy. Staged urethroplasties are useful in complex anterior strictures providing durable success rates. In addition, perineal urethrostomy represents a valid last resort option with sufficient objective and subjective results. A follow-up evaluation should incorporate objective assessments such as radiographic and functional diagnostics as well as subjective, validated, and disease-specific patient-reported outcome measurement tools to allow for a better comparability and to improve individual risk prediction.
Collapse
Affiliation(s)
- Constantin Fuehner
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W. Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
20
|
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
|
21
|
Evaluation of the effect of urethroplasty for anterior urethral strictures by a validated disease-specific patient-reported outcome measure. World J Urol 2018; 37:601-606. [PMID: 30361955 DOI: 10.1007/s00345-018-2540-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/20/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To better understand our urethroplasty outcome, we translated the English version of a urethral stricture surgery patient-reported outcome measure (USS-PROM) into Japanese and used it to evaluate the effect of urethroplasty for anterior urethral strictures. METHODS The PROM quantifies lower urinary tract symptoms (LUTS) and health-related quality of life (EQ-5D), and it evaluates overall satisfaction by asking patients to choose "very satisfied", "satisfied", "unsatisfied", or "very unsatisfied". 93 Japanese-speaking male patients with anterior urethral stricture who underwent urethroplasty completed it before (baseline) and 6 months after urethroplasty. The psychometric criteria evaluated in the present study were the PROM's internal consistency, test-retest reliability, criterion validity, and responsiveness. RESULTS Qmax was negatively correlated with the LUTS-total scores (r = - 0.61). Cronbach's alpha was 0.80 and the test-retest intraclass correlation coefficient for the LUTS-total score was 0.82. 83 patients (89.2%) achieved stricture-free, which was defined as no re-stricture on cystoscopy and no need for additional treatment. The mean total LUTS-score improved from 12.4 at baseline to 3.7 postoperatively (p < 0.0001). The mean EQ-5D visual analogue scores and EQ-5D index improved from 61.2 and 0.76, respectively, at baseline to 77.9 and 0.89 postoperatively (p < 0.0001, p < 0.0001). 55 patients (59.1%) were "very satisfied" with the outcome of their urethroplasty and 33 (35.5%) were "satisfied". CONCLUSIONS The Japanese version of the USS-PROM has adequate psychometric properties. Urethroplasty improved not only objective data but also voiding symptoms and health-related QOL, and it resulted in a high rate of patient satisfaction.
Collapse
|
22
|
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
|
23
|
Evans P, Keihani S, Breyer BN, Erickson BA, Hotaling JM, Lenherr SM, Myers JB. A Prospective Study of Patient-reported Pain After Bulbar Urethroplasty. Urology 2018; 117:156-162. [PMID: 29656064 DOI: 10.1016/j.urology.2018.02.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/13/2018] [Accepted: 02/17/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To understand the prevalence of chronic perineal pain, activity limitations, and patient satisfaction after urethroplasty. METHODS From 2014 to 2016, we prospectively enrolled men undergoing urethroplasty for bulbar urethral strictures. Patients, before and after surgery, completed questions from the Core Lower Urinary Tract Symptom Score assessing pain frequency in the bladder and penis or urethra, as well as nonvalidated questions assessing perineal pain. Overall satisfaction with their current urinary condition and pain-related activity limitations at home, work, or during exercise were also measured. Patients with <3 months of follow-up were excluded. Pre-and postoperative scores were compared using the Wilcoxon signed-rank test. RESULTS Thirty-five men were included in the study. Mean age and body mass index were 44.6 years and 30.9 kg/m2, respectively. Urethroplasties were anastomotic in 24 (69%) and were single-stage buccal graft substitution in 11 (31%). Median follow-up after surgery was 483 days (range: 90-810 days). A total of 10 patients (29%) reported worsening perineal pain intensity after surgery, whereas 8 (23%) reported improvement and 17 (48%) reported no change. Overall, pain frequency in the bladder, penis or urethra, and perineum improved. Home and exercise pain-related activity restrictions improved significantly after surgery. Satisfaction with current urinary condition also improved with 91% reporting feeling "delighted," "pleased," or "mostly satisfied" with their current condition. CONCLUSION Patients are highly satisfied with their urinary condition after urethroplasty. Pain frequency in the bladder and the urethra significantly improves after urethroplasty; however, perineal pain intensity can worsen and become chronic after surgery in some patients.
Collapse
Affiliation(s)
- Patrick Evans
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Sorena Keihani
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT.
| | - Benjamin N Breyer
- Department of Urology, University of San Francisco California, San Francisco, CA
| | | | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Sara M Lenherr
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| |
Collapse
|
24
|
Froehler MT, Chitale R, Magarik JA, Fusco MR. Comparison of a pressure-sensing sheath and radial arterial line for intraoperative blood pressure monitoring in neurointerventional procedures. J Neurointerv Surg 2018; 10:784-787. [PMID: 29487193 PMCID: PMC6204936 DOI: 10.1136/neurintsurg-2018-013769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/06/2018] [Accepted: 02/08/2018] [Indexed: 12/16/2022]
Abstract
Purpose The efficiency of neuroendovascular procedures may partly depend on the time devoted to placement of a radial arterial line (RAL) for intraoperative blood pressure monitoring. An alternative approach is to use a pressure-sensing sheath (PSS) that serves to provide invasive blood pressure monitoring without requiring a separate procedure for placement. We compared the use of a RAL versus PSS and assessed procedure time, anesthetist and patient satisfaction, and cost. Methods We performed a single-center, prospective, blockwise, comparative trial of procedure start time using traditional RAL placement versus the EndoPhys PSS for invasive blood pressure monitoring. Endpoints included time from room arrival to groin puncture, patient and anesthetist satisfaction ratings, and costs associated with RAL placement. Results Twenty patients were enrolled in the PSS+RAL arm and 20 in the PSS-alone arm. Mean time from arrival in the room until groin puncture was 61.9±14.0 min in the RAL group and 51.2±10.8 min in the PSS-alone group (P=0.01; difference=10.7 min). Patients in the PSS-alone group reported less pain than those in the RAL group. Furthermore, anesthetists reported accurate blood pressure in the PSS group. The average cost estimate of RAL placement was US$774.70, with a range of US$743 to US$1171. Conclusions Placement of a RAL at the start of the neuroendovascular procedures resulted in increased delays to procedure start time and more patient-reported pain compared with the PSS, which may offer a more efficient means of blood pressure monitoring for neurointerventional procedures. Clinical trial registration NCT03239847.
Collapse
Affiliation(s)
- Michael T Froehler
- Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rohan Chitale
- Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jordan A Magarik
- Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew R Fusco
- Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
25
|
Buckley JC. Moving Beyond an Age-Old Intervention. J Urol 2018; 199:353-354. [DOI: 10.1016/j.juro.2017.11.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jill C. Buckley
- Department of Urology, Reconstructive Urology and GU Trauma, UC San Diego Health, San Diego, California
| |
Collapse
|
26
|
Comprehensive Qualitative Assessment of Urethral Stricture Disease: Toward the Development of a Patient Centered Outcome Measure. J Urol 2017; 198:1113-1118. [DOI: 10.1016/j.juro.2017.05.077] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2017] [Indexed: 11/17/2022]
|
27
|
Elliott SP. Re: Comprehensive Qualitative Assessment of Urethral Stricture Disease: Toward the Development of a Patient Centered Outcome Measure. Eur Urol 2017; 72:1022. [PMID: 28890244 DOI: 10.1016/j.eururo.2017.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/27/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Sean P Elliott
- Urology Department, University of Minnesota, Minneapolis, MN, USA.
| |
Collapse
|
28
|
Spencer J, Blakely S, Daugherty M, Angulo JC, Martins F, Venkatesan K, Nikolavsky D. Clinical and Patient-reported Outcomes of 1-sided Anterior Urethroplasty for Long-segment or Panurethral Strictures. Urology 2017; 111:208-213. [PMID: 28864340 DOI: 10.1016/j.urology.2017.08.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate clinical and patient-reported urinary and sexual outcomes after a long-segment stricture repair using the 1-sided urethral dissection, penile invagination, and dorsal buccal mucosa graft onlay technique described by Kulkarni et al. METHODS Patients from 4 institutions after single-stage repairs for long-segment urethral strictures (>8 cm) from January 2002 to April 2016 were reviewed. Technique described by Kulkarni et al was used in all cases. Clinical outcomes included uroflowmetry (Qmax) and post-void residuals. Patient-reported outcome measures included International Prostate Symptom Score survey, Sexual Health Inventory for Men, Male Sexual Health Questionnaire, and Global Response Assessment questionnaire to measure voiding, sexual, ejaculatory symptoms, and overall improvement, respectively. RESULTS Seventy-three patients with a minimum of 12 months' follow-up were included. The mean age and stricture length were 56 (21-80) years and 13.6 (8-21) cm, respectively. At a mean follow-up of 44 (12-162) months, 9 of 73 (12%) strictures recurred. The mean baseline International Prostate Symptom Score of 23 (7-24) decreased to 10 (1-17) on follow-up (P <.001). Eight of 42 patients (21.4%) reported an increase, and 6 of 42 patients (14.3%) decreased in Sexual Health Inventory for Men following urethroplasty. Ejaculatory function on Male Sexual Health Questionnaire improved after urethroplasty from 8 preoperatively to 11 postoperatively (P <.004). All patients reported improvement after urethroplasty on Global Response Assessment questionnaire. Post-void dribbling and chordee occurred in 45% and 25% of patients, respectively. CONCLUSION Durable patency in most patients is demonstrated in this study. PROMs indicate an improvement in urinary function and moderate effect on sexual function. Transient penile chordee was evident in 25% of patients.
Collapse
Affiliation(s)
- Jeffrey Spencer
- SUNY Upstate Medical University, Department of Urology, Syracuse, NY
| | - Stephen Blakely
- SUNY Upstate Medical University, Department of Urology, Syracuse, NY
| | - Michael Daugherty
- SUNY Upstate Medical University, Department of Urology, Syracuse, NY
| | - Javier C Angulo
- Departamento Clinico, Facultad de Ciencias Biomedicas y de la Salud, Universidad Europea de Madrid, Laureate Universities, Madrid, Spain; Servicio de Urologia, Hospital Universitario de Getafe, Madrid, Spain
| | - Francisco Martins
- Departamento de Urologia, Universidade de Lisboa, Hospital de Santa Maria, Lisboa, Portugal
| | | | | |
Collapse
|
29
|
Chung ASJ, McCammon KA. Incidence and Management of Lower Urinary Tract Symptoms After Urethral Stricture Repair. Curr Urol Rep 2017; 18:70. [DOI: 10.1007/s11934-017-0716-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
30
|
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
|