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Alberca-Del Arco F, Santos-Pérez DE LA Blanca R, Amores Vergara C, Herrera-Imbroda B, Sáez-Barranquero F. Bulbar urethroplasty techniques and stricture recurrence: differences between end-to-end urethroplasty versus the use of graft. Minerva Urol Nephrol 2024; 76:563-569. [PMID: 39045660 DOI: 10.23736/s2724-6051.24.05812-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Urethral stricture (US) affects most commonly the anterior portion of the urethra, concretely the bulbar, with a significant incidence in men. Open urethroplasty is the gold standard treatment. However, stricture recurrence (SR) remains a current subject of concern. The aim of the present review is to provide an updated literature summary on surgical urethroplasty techniques for bulbar US and prognostic factors for SR, comparing the different approaches. For short strictures, excision and primary anastomosis (EPA) is the preferred option, with success rates exceeding 90%. Substitution techniques are usually required for longer strictures (>2-3cm). Buccal mucosa graft (BMG) remains the first choice as it complies with ideal features, with no significant differences regarding the site of graft implantation. Stricture length, time since urethroplasty and number of previous urethral interventions are risk factors for failure. Also, surgeon's experience affects technique selection and future outcomes. There seems to be consensus on a higher SR rate following substitution techniques compared to EPA, which appears to be influenced by the stricture length, usually longer in the former group. Furthermore, there is a trend in favor of endoscopic management of SR, except for long and complex recurrences where grafts should be used. In conclusion, multiple urethroplasty techniques are available and selection must be carefully individualized, focusing on stricture characteristics, patient's history, and surgeon's experience. Well-designed studies with clear definitions and follow-up protocols are still necessary to develop standardized guidelines on the management of bulbar US.
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Horiguchi A, Shinchi M, Hirano Y, Asanuma H, Ishiura Y, Inoue K, Kanematsu A, Tabei T, Tamura Y, Nakajima Y, Moriya K, Yagihashi Y, Fukagai T, Fujii Y. Clinical questions in the Japanese Urological Association's 2024 clinical practice guidelines for urethral strictures. Int J Urol 2024; 31:956-967. [PMID: 38874432 DOI: 10.1111/iju.15512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/30/2024] [Indexed: 06/15/2024]
Abstract
Transurethral procedures such as direct vision internal urethrotomy and urethral dilation have been the traditional treatments for urethral strictures. However, transurethral procedures are associated with high recurrence rates, resulting in many uncured cases and prompting major international urological societies to recommend urethroplasty as the standard treatment owing to its high success rate. In contrast, many Japanese general urologists have little doubts about treating urethral strictures with transurethral treatment. Therefore, urethral stricture treatments in Japan are not in line with those used in other countries. To address this, the Trauma, Emergency Medicine, and Reconstruction Subcommittee of the Japanese Urological Association has developed guidelines to offer standardized treatment protocols for urethral stricture, based on international evidence and tailored to Japan's medical landscape. These guidelines target patients with a clinically suspected urethral stricture and are intended for urologists and general practitioners involved in its diagnosis and treatment. Following the Minds Clinical Practice Guideline Development Manual 2020, the committee identified eight critical clinical issues and formulated eight clinical questions using the "patient, intervention, comparison, and outcome" format. A comprehensive literature search was conducted. For six clinical questions addressed by the existing guidelines or systematic reviews, the level of evidence was determined by qualitative systematic reviews. Quantitative systematic reviews and meta-analyses were performed for the two unique clinical questions. The recommendation grades were determined using the Delphi method and consensus by the committee. These guidelines will be useful to clinicians in daily practice, especially those involved in the care of urethral strictures.
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Affiliation(s)
- Akio Horiguchi
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
- Division of Trauma Reconstruction, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masayuki Shinchi
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yusuke Hirano
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hiroshi Asanuma
- Department of Urology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | | | - Koji Inoue
- Department of Urology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Akihiro Kanematsu
- Department of Urology, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Tadashi Tabei
- Department of Urology, Fujisawa Shonandai Hospital, Fujisawa, Kanagawa, Japan
| | - Yoshimi Tamura
- Department of Urology, Shibukawa Medical Center, Shibukawa, Gunma, Japan
| | | | - Kimihiko Moriya
- Department of Pediatric Urology, Jichi Children's Medical Center Tochigi, Shimotsuke, Tochigi, Japan
| | - Yusuke Yagihashi
- Department of Urology, Shizuoka City Shizuoka Hospital, Shizuoka City, Shizuoka, Japan
| | - Takashi Fukagai
- Department of Urology, Showa University, Shinagawa, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
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Shrivastava N, Jena R, Bhirud DP, Singh M, Choudhary GR, Sandhu AS. Analysis of the urethral stricture score and patient-related factors as predictors of outcomes following oral mucosal graft urethroplasty. Asian J Urol 2024; 11:473-479. [PMID: 39139526 PMCID: PMC11318388 DOI: 10.1016/j.ajur.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/21/2023] [Indexed: 08/15/2024] Open
Abstract
Objective The complexity of urethral strictures can predict outcomes following urethroplasty. The previously described urethral stricture score (U score) considered only stricture-related factors to grade the complexity of urethral strictures and to predict recurrence post urethroplasty, but not considered patient-related factors for the same. We aimed to study the correlation of both of these factors to the outcomes of oral mucosal graft urethroplasty. Methods We retrospectively reviewed data of 101 patients who underwent oral mucosal graft urethroplasty in our institute with a minimum follow-up of 6 months. Baseline patient characteristics and stricture-related parameters were noted. The U score was calculated for all patients which consisted of the length, location, number, and etiology of stricture. Univariate and multivariate Cox proportional hazard regression models were used to determine significant risk factors of recurrence. Results The mean follow-up of patients was 15 months. Recurrence was seen in 28 patients and the mean time for detection of recurrence was 8 months of follow-up. The Charlson Comorbidity Index, history of previous intervention, length of strictures, location of strictures, number of strictures, history of smoking, and etiology were independent predictors of recurrence following urethroplasty. Based on these parameters, we formulated the modified U score (MU score). The scores ranged from 0 to 6 and a score of >2 was found to be predictive of recurrence. On comparing receiver operating characteristic curves for both scores by the DeLong test, the MU score had larger area under the curve than the U score. Conclusion The MU scoring system is the first of its kind attempt taking into consideration both patient- and stricture-related factors to predict recurrence following oral mucosal graft urethroplasty.
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Affiliation(s)
- Nikita Shrivastava
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rahul Jena
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Deepak Prakash Bhirud
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mahendra Singh
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Gautam Ram Choudhary
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Arjun Singh Sandhu
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Cahill E, Islam R, Chua K, Balraj V, Boyle J, Patel H, Kaldany A, Doppalapudi SK, Velez D, Tunuguntla H, Sterling J. Smoking is not associated with wound complications in augmented urethroplasty: a NSQIP analysis. Int Urol Nephrol 2024:10.1007/s11255-024-04085-7. [PMID: 38811450 DOI: 10.1007/s11255-024-04085-7] [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: 04/12/2024] [Accepted: 05/16/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To investigate if predictors of wound complications differed between patients undergoing excision and primary anastomosis urethroplasty (EPA) and augmented urethroplasty. METHODS The National Surgical Quality Improvement Program database from 2006 to 2018 was queried for male patients undergoing urethroplasty. Thirty-day wound complications were identified and categorized (superficial/deep/organ-space surgical site infections and dehiscence). Multivariable logistic regression was performed to determine risk factors associated with wound complications. Smoking history was defined as current smoker within the past year. RESULTS Urethroplasty was performed in 2251 males, with 25.46% (n = 573) using a flap or graft. There was no significant difference in wound complications for patients undergoing augmented urethroplasty (n = 17, 2.97%) or EPA (n = 45, 2.68%) (p = 0.9). The augmented group had a higher BMI, longer operative time, and longer length of stay. On multivariable logistic regression, risk factors associated with wound complications for patients undergoing EPA were diabetes (OR 2.56, p = 0.03) and smoking (OR 2.32, p = 0.02). However, these factors were not associated with wound complications in patients undergoing augmented urethroplasty. CONCLUSIONS Smoking and diabetes were associated with increased wound complications for men undergoing EPA, but not in patients undergoing augmented urethroplasty. Patients with comorbidities associated with worse wound healing may be more likely to have a wound complication when undergoing EPA.
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Affiliation(s)
| | - Raeesa Islam
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Kevin Chua
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | | | - Hiren Patel
- University of California, San Francisco, San Francisco, USA
| | - Alain Kaldany
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Danielle Velez
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Hari Tunuguntla
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Gul A, Ekici O, Zengin S, Barali D, Keskin T. Investigation of risk factors in the development of recurrent urethral stricture after internal urethrotomy. World J Clin Cases 2024; 12:2324-2331. [PMID: 38765734 PMCID: PMC11099401 DOI: 10.12998/wjcc.v12.i14.2324] [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: 01/08/2024] [Revised: 02/08/2024] [Accepted: 04/01/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Urethral stricture is a condition that often develops with trauma and results in narrowing of the urethral lumen. Although endoscopic methods are mostly used in its treatment, it has high recurrence rates. Therefore, open urethroplasty is recommended after unsuccessful endoscopic treatments. AIM To investigate the risk factors associated with urethral stricture recurrence. METHODS The data of male patients who underwent internal urethrotomy for urethral stricture between January 2017 and January 2023 were retrospectively analyzed. Demographic data, comorbidities, preoperative haemogram, and biochemical values obtained from peripheral blood and operative data were recorded. Patients were divided into two groups in terms of recurrence development; recurrence and non-recurrence. Initially recorded data were compared between the two groups. RESULTS A total of 303 patients were included in the study. The mean age of the patients was 66.6 ± 13.6 years. The mean duration of recurrence development was 9.63 ± 9.84 (min-max: 1-39) months in the recurrence group. Recurrence did not occur in non-recurrence group throughout the follow-up period with an average time of 44.15 ± 24.07 (min-max: 12-84) months. In the comparison of both groups, the presence of diabetes mellitus (DM), hypertension (HT), and multiple comorbidities were significantly higher in the recurrence (+) group (P = 0.038, P = 0.012, P = 0.013). Blood group, postoperative use of non-steroidal anti-inflammatory drugs, preoperative cystostomy, cause of stricture, iatrogenic cause of stricture, location and length of stricture, indwelling urinary cathater size and day of catheter removal did not differ between the two groups. No statistically significant difference was observed between the two groups in terms of age, uroflowmetric maximum flow rate value, hemogram parameters, aspartate aminotransferase (AST), alanine aminotransferase (ALT), fasting blood sugar, creatinine, glomerular filtration rate, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, lymphocyte-monocyte ratio, monocyte-lymphocyte ratio and AST/ALT ratios. CONCLUSION In patients with urethral stricture recurrence, only the frequency of DM and HT was high, while inflammation marker levels and stricture-related parameters were similar between the groups.
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Affiliation(s)
- Abdullah Gul
- Department of Urology, University of Health Sciences, Bursa Yüksek İhtisas Education and Research Hospital, Bursa 16100, Türkiye
| | - Ozgur Ekici
- Department of Urology, University of Health Sciences, Bursa City Hospital, Bursa 16000, Türkiye
| | - Salim Zengin
- Department of Urology, University of Health Sciences, Bursa Yüksek İhtisas Education and Research Hospital, Bursa 16100, Türkiye
| | - Deniz Barali
- Department of Urology, University of Health Sciences, Bursa Yüksek İhtisas Education and Research Hospital, Bursa 16100, Türkiye
| | - Tarik Keskin
- Department of Urology, University of Health Sciences, Bursa Yüksek İhtisas Education and Research Hospital, Bursa 16100, Türkiye
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Tokuc E, Eksi M, Kayar R, Demir S, Topaktas R, Bastug Y, Akyuz M, Ozturk M. Inflammation indexes and machine-learning algorithm in predicting urethroplasty success. Investig Clin Urol 2024; 65:240-247. [PMID: 38714514 PMCID: PMC11076797 DOI: 10.4111/icu.20230302] [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: 09/05/2023] [Revised: 10/06/2023] [Accepted: 12/29/2023] [Indexed: 05/10/2024] Open
Abstract
PURPOSE To assess the predictive capability of hematological inflammatory markers for urethral stricture recurrence after primary urethroplasty and to compare traditional statistical methods with a machine-learning-based artificial intelligence algorithm. MATERIALS AND METHODS Two hundred eighty-seven patients who underwent primary urethroplasty were scanned. Ages, smoking status, comorbidities, hematological inflammatory parameters (neutrophil-lymphocyte ratios, platelet-lymphocyte ratios [PLR], systemic immune-inflammation indexes [SII], and pan-immune-inflammation values [PIV]), stricture characteristics, history of previous direct-visual internal urethrotomy, urethroplasty techniques, and grafts/flaps placements were collected. Patients were followed up for one year for recurrence and grouped accordingly. Univariate and multivariate logistic regression analyses were conducted to create a predictive model. Additionally, a machine-learning-based logistic regression analysis was implemented to compare predictive performances. p<0.05 was considered statistically significant. RESULTS Comparative analysis between the groups revealed statistically significant differences in stricture length (p=0.003), localization (p=0.027), lymphocyte counts (p=0.008), PLR (p=0.003), SII (p=0.003), and PIV (p=0.001). In multivariate analysis, stricture length (odds ratio [OR] 1.230, 95% confidence interval [CI] 1.142-1.539, p<0.0001) and PIV (OR 1.002, 95% CI 1.000-1.003, p=0.039) were identified as significant predictors of recurrence. Classical logistic regression model exhibited a sensitivity of 0.76, specificity of 0.43 with an area under curve (AUC) of 0.65. However, the machine-learning algorithm outperformed traditional methods achieving a sensitivity of 0.80, specificity of 0.76 with a higher AUC of 0.82. CONCLUSIONS PIV and machine-learning algorithms shows promise on predicting urethroplasty outcomes, potentially leading to develop possible nomograms. Evolving machine-learning algorithms will contribute to more personalized and accurate approaches in managing urethral stricture.
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Affiliation(s)
- Emre Tokuc
- Urology Clinic, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Türkiye.
| | - Mithat Eksi
- Urology Clinic, Bakırkoy Dr. Sadi Konuk SUAM, University of Health Sciences, Istanbul, Türkiye
| | - Ridvan Kayar
- Urology Clinic, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Türkiye
| | - Samet Demir
- Urology Clinic, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Türkiye
| | - Ramazan Topaktas
- Urology Clinic, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Türkiye
| | - Yavuz Bastug
- Urology Clinic, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Türkiye
| | - Mehmet Akyuz
- Urology Clinic, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Türkiye
| | - Metin Ozturk
- Urology Clinic, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Türkiye
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Palminteri E, Toso S, Preto M, Gatti L, Sedigh O, Buffi NM, Ferrari G, Gobbo A. Small intestinal submucosa graft bulbar urethroplasty is a viable technique: results compared to buccal mucosa graft urethroplasty after propensity score matching. World J Urol 2024; 42:123. [PMID: 38453722 DOI: 10.1007/s00345-024-04795-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 01/16/2024] [Indexed: 03/09/2024] Open
Abstract
PURPOSE Small intestinal submucosa (SIS) graft urethroplasty has been employed to decrease buccal mucosa morbidity and facilitate the procedure. The first published series had a short follow-up, inhomogeneous patient selection, and a lack of a control group. Our purpose is to report treatment outcomes at 13 years in a propensity score-matched cohort comparing bulbar urethroplasty with SIS (SISU) or buccal mucosa (BMU). METHODS From our institutional database of 1132 bulbar urethroplasties, we used propensity score matching with the nearest-neighbor method without replacement to generate a study sample of 25 BMU and 25 SISU. Failure was defined as any treatment after urethroplasty. Survival analyses were used to analyze treatment failure occurrence with data censored at 156mo. RESULTS Matching resulted in a complete correction of bias between the two samples except for the follow-up duration, which was slightly longer in the SIS group. The cumulative treatment success probability of BMU and SISU at 156mo was 83.4% and 68%, respectively. At multivariable Cox regression, SIS graft, previous urethrotomy, stricture length, and lower postoperative Qmax (within 2mo after catheter removal) were predictors of failure. Stricture length had a more remarkable effect in SISU, with estimated survival probabilities from the Cox model lower than 80% in strictures > = 3 cm. CONCLUSION SIS has poorer outcomes compared to BM but may still be useful when BM grafting is not possible. The best candidates for SISU, with similar success to BMU, are patients with strictures shorter than 3 cm, preferably without a history of DVIU.
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Affiliation(s)
- Enzo Palminteri
- Center for Urethral and Genitalia Reconstructive Surgery, Humanitas Cellini, Via Benvenuto Cellini 5, 10126, Turin, Italy
| | - Stefano Toso
- Department of Urology, University of Modena and Reggio Emilia, Via Università 4, 41121, Modena, Italy
| | - Mirko Preto
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | - Lorenzo Gatti
- CURE Group, Department of Urology, Hesperia Hospital, Via Arguà 80, 41125, Modena, Italy
| | - Omid Sedigh
- Department of Urology and Reconstructive Andrology, Humanitas Gradenigo, Corso Regina Margherita 8, 10153, Turin, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giovanni Ferrari
- CURE Group, Department of Urology, Hesperia Hospital, Via Arguà 80, 41125, Modena, Italy
| | - Andrea Gobbo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
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Gabrielson AT, Galansky L, Shneyderman M, Cohen AJ. The Impact of Hypogonadism on Surgical Outcomes Following Primary Urethroplasty: Analysis of a Large Multi-institutional Database. Urology 2024; 185:116-123. [PMID: 38190864 DOI: 10.1016/j.urology.2023.12.015] [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: 10/19/2023] [Revised: 12/19/2023] [Accepted: 12/26/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To compare surgical outcomes among a cohort of eugonadal and hypogonadal patients undergoing primary urethroplasty (UP). METHODS A retrospective cohort study was conducted using TriNetX between 2008-2023. Patients who were eugonadal and hypogonadal (symptoms plus testosterone <300 ng/dL) prior to UP were compared. A subgroup analysis of hypogonadal patients was performed to compare those with testosterone replacement therapy (TRT) vs TRT-naïve prior to UP. Propensity-score matching was used to adjust for differences in comorbidities. Outcomes were 5-year revision rates and revision-free survival for endoscopic revision and redo UP following primary UP. RESULTS We identified 12,556 eugonadal and 488 hypogonadal patients (153 TRT+, 335 TRT-) undergoing UP. Median age at UP and follow-up was 55years and 5years, respectively. After propensity-score matching, we compared 477 eugonadal and 477 hypogonadal patients. Hypogonadal patients had a statistically significantly higher 5-year redo UP rate (11% vs 6%, relative risk [RR] 1.5 [95%CI, 1.2-2.2]; P = .01) when compared to eugonadal patients however there was no difference in 5-year rates of endoscopic revision (11% vs 11%, RR 1.0 [95%CI, 0.7-1.5]; P = 1.0). We observed no difference in 5-year revision-free survival time for endoscopic revision or redo UP between groups. Hypogonadal patients treated with TRT had a significantly higher 5-year redo UP rate (15% vs 7%, RR 1.8 [95%CI, 1.1-3.3]; P = .02) compared to hypogonadal patients that were TRT-naïve prior to UP. There was no difference in rates of endoscopic revision (14% vs 10%, RR 1.3 [95%CI, 0.7-2.4]; P = .2) between subgroups. CONCLUSION Pre-existing hypogonadism may modestly adversely affect surgical outcomes following primary UP based on data from a large, retrospective cohort study.
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Affiliation(s)
- Andrew T Gabrielson
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Logan Galansky
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Matthew Shneyderman
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrew J Cohen
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
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Tao F, Han Q, Yang P. Interface-mediated protein aggregation. Chem Commun (Camb) 2023; 59:14093-14109. [PMID: 37955330 DOI: 10.1039/d3cc04311h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
The aggregation of proteins at interfaces has significant roles and can also lead to dysfunction of different physiological processes. The interfacial effects on the assembly and aggregation of biopolymers are not only crucial for a comprehensive understanding of protein biological functions, but also hold great potential for advancing the state-of-the-art applications of biopolymer materials. Recently, there has been remarkable progress in a collaborative context, as we strive to gain control over complex interfacial assembly structures of biopolymers. These biopolymer structures range from the nanoscale to mesoscale and even macroscale, and are attained through the rational design of interactions between biological building blocks and surfaces/interfaces. This review spotlights the recent advancements in interface-mediated assembly and properties of biopolymer materials. Initially, we introduce the solid-liquid interface (SIL)-mediated biopolymer assembly that includes the inorganic crystalline template effect and protein self-adoptive deposition through phase transition. Next, we display the advancement of biopolymer assembly instigated by the air-water interface (AWI) that acts as an energy conversion station. Lastly, we discuss succinctly the assembly of biopolymers at the liquid-liquid interface (LLI) along with their applications. It is our hope that this overview will stimulate the integration and progression of the science of interfacial assembled biopolymer materials and surfaces/interfaces.
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Affiliation(s)
- Fei Tao
- Key laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, school of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an 710119, China.
| | - Qian Han
- Key laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, school of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an 710119, China.
| | - Peng Yang
- Key laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, school of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an 710119, China.
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Özsoy E, Kutluhan MA, Tokuç E, Kayar R, Demir S, Akyüz M, Öztürk Mİ. Is testosterone deficiency a predictive factor for recurrence of urethral stricture? Andrology 2023. [PMID: 37924277 DOI: 10.1111/andr.13554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Testosterone plays a vital role in maintaining tissue homeostasis, and testosterone deficiency may potentially influence the likelihood of urethral stricture recurrence. OBJECTIVES To evaluate the prognostic value of testosterone levels in the recurrence after direct visual internal urethrotomy in primary short segment bulbar urethral strictures and its clinical reflections. MATERIALS AND METHODS A total of 723 patients who underwent direct vision internal urethrotomy between January 2000 and October 2022 were retrospectively analyzed. After implying exclusion criteria, 116 patients with available data were enrolled. Patients were divided into two groups as recurrence and no recurrence. Age, stricture length, etiology, time of recurrence, diagnosis of previous diabetes mellitus, hypertension, smoking, body mass index, and total testosterone levels were recorded. Free testosterone and bioavailable testosterone values were calculated using total testosterone, albumin, and sex hormone binding globulin values. Hypogonadism was considered as a total testosterone level less than 300 ng/dL. Demographic characteristics and total testosterone, free testosterone, and bioavailable testosterone levels were compared between the two groups for statistical significance. The recurrence rates of patients with and without hypogonadism were compared. RESULTS Recurrence was observed in 41.4% of the cases (n = 48). There was no statistically significant difference between the groups in terms of age, body mass index values, diabetes mellitus, hypertension, smoking status, presence of hypogonadism, and etiology (p = 0.745, 0.863, 0.621, 0.622, 0.168, 0.051, and 0.232). In terms of total testosterone levels and bioavailable testosterone levels, the recurrence group had significantly lower values (p = 0.018 and 0.04). There was no significant difference between the two groups in terms of stricture length (p = 0.071). Sixteen of 28 patients with hypogonadism had recurrence, whereas 32 of 88 patients without hypogonadism had recurrence (p = 0.051). DISCUSSION Testosterone levels have potential to predict recurrence in primary short-segment bulbar urethral strictures. This study represents the inaugural analysis of the impact of testosterone deficiency on recurrence within the cohort of patients with primary short-segment bulbar urethral strictures. CONCLUSION Testosterone levels and ratios may serve as predictive factors for identifying recurrent cases in primary short-segment bulbar strictures. For patients at a higher risk of recurrence, urethroplasty may be considered as an initial treatment option, even in cases of primary and short-segment strictures.
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Affiliation(s)
| | - Musab Ali Kutluhan
- Department of Urology, Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Emre Tokuç
- Department of Urology, Health Sciences University Haydarpasa Numune Training and Research Hospital, İstanbul, Turkey
| | - Rıdvan Kayar
- Department of Urology, Health Sciences University Haydarpasa Numune Training and Research Hospital, İstanbul, Turkey
| | - Samet Demir
- Department of Urology, Health Sciences University Haydarpasa Numune Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Akyüz
- Department of Urology, Health Sciences University Haydarpasa Numune Training and Research Hospital, İstanbul, Turkey
| | - Metin İshak Öztürk
- Department of Urology, Health Sciences University Haydarpasa Numune Training and Research Hospital, İstanbul, Turkey
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11
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Tian J, Fu D, Liu Y, Guan Y, Miao S, Xue Y, Chen K, Huang S, Zhang Y, Xue L, Chong T, Yang P. Rectifying disorder of extracellular matrix to suppress urethral stricture by protein nanofilm-controlled drug delivery from urinary catheter. Nat Commun 2023; 14:2816. [PMID: 37198161 PMCID: PMC10192346 DOI: 10.1038/s41467-023-38282-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 04/24/2023] [Indexed: 05/19/2023] Open
Abstract
Urethral stricture secondary to urethral injury, afflicting both patients and urologists, is initiated by excessive deposition of extracellular matrix in the submucosal and periurethral tissues. Although various anti-fibrotic drugs have been applied to urethral stricture by irrigation or submucosal injection, their clinical feasibility and effectiveness are limited. Here, to target the pathological state of the extracellular matrix, we design a protein-based nanofilm-controlled drug delivery system and assemble it on the catheter. This approach, which integrates excellent anti-biofilm properties with stable and controlled drug delivery for tens of days in one step, ensures optimal efficacy and negligible side effects while preventing biofilm-related infections. In a rabbit model of urethral injury, the anti-fibrotic catheter maintains extracellular matrix homeostasis by reducing fibroblast-derived collagen production and enhancing metalloproteinase 1-induced collagen degradation, resulting in a greater improvement in lumen stenosis than other topical therapies for urethral stricture prevention. Such facilely fabricated biocompatible coating with antibacterial contamination and sustained-drug-release functionality could not only benefit populations at high risk of urethral stricture but also serve as an advanced paradigm for a range of biomedical applications.
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Affiliation(s)
- Juanhua Tian
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, West Five Road, No. 157, 710004, Xi'an, China
| | - Delai Fu
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, West Five Road, No. 157, 710004, Xi'an, China
| | - Yongchun Liu
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, 710119, Xi'an, China
| | - Yibing Guan
- Department of Urological Surgery, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan Province, China
| | - Shuting Miao
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, 710119, Xi'an, China
| | - Yuquan Xue
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, West Five Road, No. 157, 710004, Xi'an, China
| | - Ke Chen
- Key Laboratory of Bio-Inspired Smart Interfacial Science and Technology of Ministry of Education, School of Chemistry, Beihang University (BUAA), 100191, Beijing, China
| | - Shanlong Huang
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, West Five Road, No. 157, 710004, Xi'an, China
| | - Yanfeng Zhang
- School of Chemistry, Xi'an Jiaotong University, 710049, Xi'an, China
| | - Li Xue
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, West Five Road, No. 157, 710004, Xi'an, China
| | - Tie Chong
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, West Five Road, No. 157, 710004, Xi'an, China.
| | - Peng Yang
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, 710119, Xi'an, China.
- International Joint Research Center on Functional Fiber and Soft Smart Textile, School of Chemistry and Chemical Engineering, Shaanxi Normal University, 710119, Xi'an, China.
- Xi'an Key Laboratory of Polymeric Soft Matter, School of Chemistry and Chemical Engineering, Shaanxi Normal University, 710119, Xi'an, China.
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12
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Bandini M, Basile G, Lazzeri M, Montorsi F, Valli B, Balò S, Barbagli G. Optimizing decision-making after ventral onlay buccal mucosa graft urethroplasty failure. BJU Int 2023; 131:339-347. [PMID: 36114780 DOI: 10.1111/bju.15895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate factors predicting recurrence after treatment and to assess the best rescue option for patients failing buccal mucosa graft (BMG) urethroplasty. MATERIALS AND METHODS We evaluated the data from 575 patients treated with ventral onlay BMG urethroplasty. Multivariable Cox regression analysis was performed to identify predictors of BMG urethroplasty failure, and their effect on failure risk was estimated using the Kaplan-Meier method and compared using log-rank tests. Then, for those patients who underwent a rescue treatment, namely, direct visual internal urethrotomy (DVIU) vs open urethroplasty, we assessed the probability of success after retreatment using the Kaplan-Meier method and regression tree analyses. RESULTS On multivariable Cox regression analysis, only stricture length ≥5 cm (hazard ratio 3.46, 95% confidence interval 1.50-7.94; P = 0.003) was a predictor of failure. A total of 103 patients had at least one re-intervention. Notably, 12-month success rates after first rescue DVIU, second rescue DVIU, third rescue DVIU, and fourth rescue DVIU were 66.3%, 62.5%, 37.5% and 25%, respectively. Conversely, for those patients who underwent open urethroplasty retreatment, success rates at 12 months were 83.3%, 79%, 92.3% and 75% after BMG ventral onlay, first rescue DVIU, second rescue DVIU and third rescue DVIU, respectively. These data were confirmed in regression tree analyses. CONCLUSION Ventral BMG urethroplasty fails in approximately one out of five patients. Despite DVIU as a rescue treatment being a good option, its success rate becomes lower as the number of DVIU treatments performed increases. Conversely, open urethroplasty improves patient outcomes in almost three out of four patients, even in the case of previous failed DVIU treatments for stricture recurrence.
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Affiliation(s)
- Marco Bandini
- Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.,Centro Chirurgico Toscano, Arezzo, Italy
| | - Giuseppe Basile
- Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Lazzeri
- Instituto Clinico Humanitas IRCCS-Clinical and Researcher Hospital, Rozzano, Italy
| | - Francesco Montorsi
- Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Sofia Balò
- Centro Chirurgico Toscano, Arezzo, Italy
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13
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MacDonald SM, Decter RM, DeGraff DJ, Raman JD, Warrick JI. Histologic Analysis of Buccal Graft Quality Stratified by Tobacco Use in Patients Undergoing Substitution Urethroplasty. Urology 2023; 172:203-209. [PMID: 36563969 DOI: 10.1016/j.urology.2022.08.068] [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: 05/13/2022] [Revised: 08/07/2022] [Accepted: 08/11/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine if there are histologic differences relative to tobacco exposure in buccal mucosa. Substitution urethroplasty outcomes may be worse in tobacco users and we investigate if the buccal graft is inherently damaged due to chronic tobacco exposure. METHODS Subjects undergoing substitution urethroplasty with buccal graft harvest were prospectively consented in this IRB approved study. Subjects with poor dentition were excluded. A detailed tobacco use history was obtained. Cotinine testing was performed day of surgery to confirm or exclude active tobacco use. Trimmed portions of harvested graft were sent for tissue processing. Standard hematoxylin and eosin staining was performed. A single blinded pathologist performed analysis of the slides. Using a scale of none, mild, moderate, or severe slides were analyzed for cytologic atypia, architectural complexity, inflammation, and keratinization. Evidence of vascular damage was noted and the type of inflammation if present was classified. RESULTS Twenty-five buccal grafts were analyzed. No evidence of vascular damage or cytologic atypia were noted in any grafts. While mild architectural complexity and mild inflammation, typically lymphocytic, were noted in several of the buccal mucosa sections, this did not appear to correlate with tobacco exposure. The majority of grafts demonstrating increased keratinization correlated with significant tobacco exposure, but this was not consistently noted in all those with tobacco use. CONCLUSIONS Buccal mucosa in patients with tobacco exposure did not show significant histologic alterations. Outcomes of substitution urethroplasty may be more impacted by persistent systemic exposure causing local ischemia as opposed to the graft tissue itself.
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Affiliation(s)
- Susan M MacDonald
- Department of Urology, College of Medicine, The Pennsylvania State University, Hershey, PA.
| | - Ross M Decter
- Department of Urology, College of Medicine, The Pennsylvania State University, Hershey, PA
| | - David J DeGraff
- Department of Urology, College of Medicine, The Pennsylvania State University, Hershey, PA
| | - Jay D Raman
- Department of Urology, College of Medicine, The Pennsylvania State University, Hershey, PA
| | - Joshua I Warrick
- Department of Pathology, College of Medicine, The Pennsylvania State University, Hershey, PA
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14
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Sawyer KN, Cofield SS, Selph JP. Race as a Predictor of Recurrence and Complications After Urethroplasty in Men With Urethral Stricture Disease. Urology 2022; 163:69-75. [PMID: 34852248 PMCID: PMC9142758 DOI: 10.1016/j.urology.2021.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the role of race in surgical outcomes of and complications after urethroplasty. METHODS A single institution, retrospective review was conducted from 2011 to 2019 on male patients ≥18 years of age who underwent urethroplasty. Exclusion criteria included previous urethral cancer, lack of follow up, or revision urethroplasty. Failure of urethroplasty was defined as requiring revision surgery or recurrence on imaging or cystoscopy. Risk factors for recurrence were determined using descriptive statistics, Wilcoxon comparisons, and multivariate logistic regression. RESULTS Three hundred and seven patients were identified with 234 patients meeting inclusion criteria. 63.2% identified as White/Caucasian (CA), 32.5% Black/African American (AA), and 4.3% other race. Mean age was 49.4 years. Between CA and AA patients, there was no difference in mean age, body mass index, smoking status, prior urethroplasty, or prior dilation/DVIU. CAs were more likely to have a fossa navicularis stricture compared to AAs (P = .0094), but there were no significant differences in bulbar, penile, or posterior stricture rates (all P >.05) or length (P = .32). The overall stricture recurrence rate was 15.8% with a median of 242 days to recurrence and no significant difference by race for either outcome (P = .83, P = .64). The only predictor of stricture recurrence was prior dilation/DVIU (P = .0404, OR 2.3, 95% CI 1.0, 5.6). Overall complication rate was 17.5%, with no difference between CA and AAs rates (P = .83) or complication type (P = .62). CONCLUSION There was no significant difference in the rate of surgical failure for urethral stricture repair based on race. The only predictor of surgical failure was having a prior urethral dilation/DVIU.
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Affiliation(s)
| | - Stacey S Cofield
- Department of Biostatistics, University of Alabama at Birmingham, School of Public Health, Birmingham, AL
| | - John P Selph
- Department of Urology, University of Alabama School of Medicine, Birmingham, AL.
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15
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Feddal MS, Delporte G, Marcelli F, Villers A. [Urethroplasties for male urethral strictures: Success rates and predictive factors]. Prog Urol 2022; 32:426-434. [PMID: 35148955 DOI: 10.1016/j.purol.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 11/22/2021] [Accepted: 12/14/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Urethroplasty has reported success rates ranging from 60 to 98%. Predictive factors for recurrence are rarely studied, postoperative urinary drainage modalities are not investigated. The primary objective was to evaluate the success rate of urethroplasty in our center. Secondary objectives were to identify recurrence predictive factors. METHODS A single-center retrospective cohort including men treated with urethroplasty for stricture between 2007-2017, followed up for a minimum of 12 months. Recurrence was defined as the necessity of a new procedure (endo-urethral or surgical). Data from penile urethra (SUP) and bulbo-membranous urethra (SUBM) stenosis were analyzed separately. Recurrence-free survival (success) was analyzed according to the Kaplan-Meier model. The characteristics of the patients, the stenosis, the surgical technique, the modalities of postoperative urinary drainage were analyzed in subgroups for the bulbo-membranous urethra looking for a correlation with recurrence. RESULTS A total of 103 patients included: 25 with SUP, 78 with SUBM. The overall success rate was 69%, CI95% [60-79] with a mean follow-up of 62.85 months. The success was 68%, CI95%[46-82] for SUP, 69.23%, CI95% [58-78] for SUBM. Recurrences occurred during the first 12 months. Only postoperative suprapubic urinary drainage was a predictive factor (HR=0.947, CI95% [0.905-0.992]). A period longer than 14 days reduced recurrence by 37%. CONCLUSION Urethroplasty had a success rate of 69%, comparable to published series. Suprapubic urinary drainage improved the surgery outcomes. LEVEL OF PROOF 2, Grade B.
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Affiliation(s)
- M S Feddal
- Urologie, CHU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France.
| | - G Delporte
- Urologie, CHU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France.
| | - F Marcelli
- Urologie, CHU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France.
| | - A Villers
- Urologie, CHU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France.
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16
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Yildirim H, Hennus PML, Wyndaele MIA, de Kort LMO. Do previous urethral endoscopic procedures and preoperative self-dilatation increase the risk of stricture recurrence after urethroplasty? Low Urin Tract Symptoms 2021; 14:163-169. [PMID: 34794210 PMCID: PMC9299484 DOI: 10.1111/luts.12419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/15/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022]
Abstract
Objective To evaluate the relation between clinically relevant stricture recurrence after first urethroplasty and prior endoscopic treatments (dilatation and/or direct visual internal urethrotomy) or intermittent self‐dilatation (ISD). Methods Patients with bulbar urethral strictures treated with first urethroplasty between 2011 and April 2019 were included in a prospectively gathered database with standardized follow‐up. Stricture recurrence was defined as any need for reintervention. Primary outcome was the analysis of recurrence risk after first urethroplasty in relation with the number of prior endoscopic treatments or performance of ISD. Univariate and multivariate statistical analyses were performed. Results Overall, 106 patients were included with a median follow‐up of 12 months (interquartile range 8‐13]. Reintervention was necessary in 16 patients (15%). Recurrence was more prevalent in patients with ≥3 prior endoscopic treatments (28%, P = .009). No increased risk of recurrence was found in patients with 1 or 2 prior endoscopic treatments. The prevalence of prior ISD was twice as high in the stricture recurrence group (56% vs 26%, P = .014), and ISD was performed in 61% of the patients with ≥3 prior endoscopic treatments (P < .001). The number of prior endoscopic interventions and performance of ISD were no independent predictors for recurrence in the multivariable analysis. Conclusions This study shows that the risk of recurrence after first urethroplasty is increased in patients with ≥3 prior endoscopic treatments and in those who performed ISD. Patients performing ISD more often had ≥3 prior endoscopic treatments. Prior endoscopic treatment and performance of ISD were not independent predictors of stricture recurrence.
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Affiliation(s)
- Hilin Yildirim
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pauline M L Hennus
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michel I A Wyndaele
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Laetitia M O de Kort
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
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17
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Abstract
Urethral strictures most frequently affect the bulbar but are also observed in the penile, glandular, or membranous urethra. They are often iatrogenic. Radiologic diagnosis can be established easily and safely by cystourethrography. Simple Sachse urethrotomy can result in permanent relief in the case of short bulbar strictures in initial findings. Recurrent structures or strictures in other locations should however be treated by open surgery, as cure cannot be achieved by other means. Depending on the diagnosis and comorbidities, end-to-end anastomosis, graft/flap urethroplasty, or perineal urethrostomy can be performed. If open surgery is delayed, aggravation of the diagnosis and worsening of the prognosis can be expected, regardless of the applied treatment.
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Affiliation(s)
- Stefan Tritschler
- Klinik für Urologie und urologische Onkologie, Loretto-Krankenhaus Freiburg, Mercystraße 6-14, 79100, Freiburg, Deutschland.
| | - Vincent Beck
- Klinik für Urologie und urologische Onkologie, Loretto-Krankenhaus Freiburg, Mercystraße 6-14, 79100, Freiburg, Deutschland
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18
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Ma Y, Jian Z, Zhou L, Luo D, Jin X, Xiang L, Li H, Wang K. A novel nomogram for the delayed transperineal anastomotic urethroplasty based on relative position between the proximal urethra and the pubic ramus in pelvic fracture injury patients: a retrospective analysis. World J Urol 2021; 39:4227-4234. [PMID: 34146123 DOI: 10.1007/s00345-021-03764-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/11/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Many reconstructive urologists have observed that higher urethra injuries lead to potentially less successful repairs. This article introduces a novel prognostic factor for pelvic fracture caused urethral injury (PFUI) to predict stricture recurrence after delayed transperineal anastomotic urethroplasty (TAU) patients with PFUI based on urethra injury locations. MATERIALS AND METHODS Patients who underwent suprapubic cystostomy tube placement and delayed TAU for PFUI by a single surgeon between 2009 and 2018 were screened. A total of 151 patients completed the follow-up. The relative location between the proximal urethra and the pubic ramus (PUE-PR), a novel stricture length classification method based on the anatomical landmark, was divided into a lower, middle, and upper group reflected by urethrogram. The nomogram was developed based on significant coefficients identified by multivariable Cox regression. RESULTS Based on the relative position between the proximal urethra end and the pubic ramus (PUE-PR), 47 (31%), 66 (44%), and 38 (25%) patients were assigned to the lower, middle, and upper group, respectively. A total of 33 patients (22%) patients had a recurrence. The median (IQR) follow-up was 49 months (28-75). Smoking, endoscopic treatment history, and PUE-PR were identified as independent risk factors for stricture recurrence. The nomogram showed good discrimination with a C-index of 76.67%. The decision curve analysis (DCA) indicated that the model could bring more clinical net benefit when a threshold probability is larger than 8%. CONCLUSIONS PUE-PR is a new prognostic factor for PFUI to predict stricture recurrence after TAU. A novel nomogram incorporating PUE-PR could be applied to facilitate the prediction of stricture recurrence after delayed TAU for PFUI.
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Affiliation(s)
- Yucheng Ma
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan, People's Republic of China
| | - Zhongyu Jian
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan, People's Republic of China
| | - Liang Zhou
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan, People's Republic of China
| | - Deyi Luo
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan, People's Republic of China
| | - Xi Jin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan, People's Republic of China
| | - Liyuan Xiang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan, People's Republic of China
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan, People's Republic of China
| | - Kunjie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan, People's Republic of China.
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19
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Karapanos L, Akbarov I, Zugor V, Kokx R, Hagemeier A, Heidenreich A. Safety and mid-term surgical results of anterior urethroplasty with the tissue-engineered oral mucosa graft MukoCell ® : A single-center experience. Int J Urol 2021; 28:936-942. [PMID: 34053150 DOI: 10.1111/iju.14606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/27/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the mid-term efficacy and safety of anterior urethroplasty using an autologous tissue-engineered oral mucosa graft (MukoCell® ). METHODS The data of 77 patients with anterior urethral strictures undergoing treatment with MukoCell® at a tertiary center from June 2016 to May 2019 were analyzed. Patients' characteristics, pre- and postoperative diagnostics, perioperative complications, and follow-up data were obtained. The overall stricture-free survival, outcomes of the different surgical techniques, stricture localizations, stricture length, early complications of the procedure and risk factors of recurrence were assessed. RESULTS The median follow-up period was 38 months (interquartile range 31-46). The overall recurrence-free rate of anterior urethroplasty using MukoCell® was 68.8%, 24 patients (31.2%) developed a recurrence of the stricture. The stricture recurrences were observed at a median of 7 months (interquartile range 3-13) only in patients with at least one previous surgery or repeated dilatations in their medical history. No oral-urethral adverse events related to the use of MukoCell® were observed, except for a urethrocutaneous fistula (1.3%) requiring reoperation. CONCLUSIONS Anterior one-stage urethroplasty using MukoCell® showed in our hands a mid-term success rate of up to 68.8% without significant adverse events after a median follow-up period of 38 months. This procedure might be an alternative option for long-segment urethral reconstruction.
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Affiliation(s)
- Leonidas Karapanos
- Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ilgar Akbarov
- Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Urology, University Hospital Basel, Basel, Switzerland
| | - Vahudin Zugor
- Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Urology, Sozialstiftung Bamberg, Bamberg, Germany
| | - Ruud Kokx
- Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna Hagemeier
- Institute of Medical Statistics and Computational Biology, Medical Faculty, University of Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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20
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Pallares-Méndez R, Cota-Agüero JA, Gutierrez-Gonzalez A, Cervantes-Miranda DE, Hernández-Aranda KL, Ochoa-Arvizo M, Aguilar-Rivera LG. Risk factors associated with urethral stricture recurrence after end-to-end urethroplasty and buccal mucosal graft urethroplasty. Urologia 2021; 89:268-273. [PMID: 33832381 DOI: 10.1177/03915603211008739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES (1) Assess risk factors associated with urethral stricture recurrence (USR). (2) Assess urethral stricture recurrence after end-to-end urethroplasty (EE) and buccal mucosal graft urethroplasty (BMG). SUBJECTS AND METHODS A total of 29 males with urethral stricture who underwent either an end-to-end urethroplasty or a buccal mucosal graft urethroplasty were included in this study and followed for 18 months. The association between risk factors and stricture recurrence was assessed. RESULTS Overall mean patient age was 51.69 ± 14.22 years, time to recurrence was 3 months (IQR: 1-6.25), and stricture length was 2.57 ± 1.30 cm. Important risk factors for USR were stricture length ⩾ 2 cm (p = 0.024), older age (p = 0.042), BMI > 25 kg/m2 (p = 0.021), Qmax after catheter removal <15 ml/s (χ2 = 14.87 p ⩽ <0.001) and previous urethral procedures adjusted for re-do BMG urethroplasty (χ2 = 6.10, p = 0.021). End-to-end urethroplasty showed less USR than BMG, however, these differences were not statistically significant (41.6% vs 22.2%, respectively, p ⩾ 0.05). CONCLUSIONS Stricture length, age, BMI, and previous urethral procedures predict USR, furthermore, an initial Qmax after catheter removal is an objective measure predictive of USR. There's no difference in USR rate between BMG and EE urethroplasties.
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Affiliation(s)
- Rigoberto Pallares-Méndez
- Hospital Universitario "Dr. José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Adrian Gutierrez-Gonzalez
- Hospital Universitario "Dr. José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | | | - Mario Ochoa-Arvizo
- Hospital Universitario "Dr. José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, Mexico
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21
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Furr JR, Wisenbaugh ES, Gelman J. Long-term outcomes for 2-stage urethroplasty: an analysis of risk factors for urethral stricture recurrence. World J Urol 2021; 39:3903-3911. [PMID: 33811511 PMCID: PMC8519822 DOI: 10.1007/s00345-021-03676-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/16/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose To report long-term results and patient reported outcomes of staged anterior urethroplasties, and isolate risk factors for recurrence. Methods We reviewed urethroplasty database for all patients who underwent staged urethroplasty from 2000 to 2017. Follow-up included a cystoscopy 4 months after their 2nd stage to assess early success, and then annual follow-up thereafter with post-void residual and symptom assessment. Stricture characteristics, etiology and graft type were analyzed with regards to success. Results Forty-nine patients were eligible for inclusion. The median stricture length was 7 cm (3–17 cm). The early success rate demonstrated by cystoscopy at 4 months was 100%. Long-term success was 96.4% in buccal graft (BMG) only patients; however, long-term success fell considerably to 53% in patients requiring any use split thickness skin graft (STSG) in the first stage. Median follow up time was 57 months (6–240 months). On analysis, age, increased stricture length and especially the use of STSG all appeared to be associated with late recurrence. The recurrence group had longer stricture length and were more likely to be panurethral. All recurrences occurred after the initial 4-month cystoscopy with a median time to recurrence of 78 months. Conclusion Staged repairs that are amenable to BMG-only repairs have high long-term success rates. Increasing stricture length and the addition of split-thickness skin graft were associated with lower success rate in staged urethral reconstruction. Patients requiring staged repairs often experience recurrence in a very delayed fashion reinforcing the need for close, long-term follow up.
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Affiliation(s)
- James R. Furr
- University of Oklahoma College of Medicine, 920 Stanton L. Young BLVD, WP 2140, Oklahoma City, OK 73104 USA
| | - Eric S. Wisenbaugh
- University of Oklahoma College of Medicine, 920 Stanton L. Young BLVD, WP 2140, Oklahoma City, OK 73104 USA
| | - Joel Gelman
- Department of Urology, University of California, 333 City Blvd West, Suite 1240, IrvineOrange, CA 92868 USA
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Multi-Factorial Analysis of Recurrence and Complications of Lingual Mucosa Graft Urethroplasty for Anterior Urethral Stricture: Experience from a Chinese Referral Center. Urology 2021; 152:96-101. [PMID: 33785402 DOI: 10.1016/j.urology.2021.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the risk factors that pertain to stricture recurrence and oral complications. METHODS Patients with long segmented anterior urethral stricture who visited our hospital from 2009 to 2016 were treated with lingual mucosa graft (LMG) urethroplasty. The incidence of complications in all of 128 patients were evaluated. The data were analyzed using the chi-squared test and Fisher's exact test. A multi-factorial regression analysis was performed to identify the risk factors responsible for the recurrence and complications. RESULTS For patients having LMG urethroplasty, there were no significant difference in recurrence of urethral stricture according to the studied variables. Binary logistic regression analysis reveals that previous surgery involving the urethra was a significant predictor of urethral stricture recurrence (odds ratio [OR]=5.07; 95% confidence interval [95% CI], 1.06-24.40; P = .043). The length of the substitute was significantly related to oral morbidity (P = .020), even after controlling for the studied variables. Patients with a harvested oral mucosa longer than 7 cm had a higher risk of oral morbidity than those with a harvested oral mucosa shorter than 7 cm (OR=4.35; 95% CI, 1.35-14.06; P = .014). CONCLUSION Our study shows that LMG urethroplasty is effective for patients with long segmented anterior urethral stricture. Previous urethral surgery was identified as a risk factor to cause recurrence and injury to the tip of the tongue for the oral complications.
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Kay HE, Srikanth P, Srivastava AV, Tijerina AN, Patel VR, Hauser N, Laviana AA, Wolf JS, Osterberg EC. Preoperative and intraoperative factors predictive of complications and stricture recurrence following multiple urethroplasty techniques. BJUI COMPASS 2021; 2:286-291. [PMID: 35475301 PMCID: PMC8988843 DOI: 10.1002/bco2.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/06/2021] [Accepted: 02/28/2021] [Indexed: 11/08/2022] Open
Abstract
Objectives To investigate factors predictive of postoperative recurrence and complications in patients undergoing urethroplasty for stricture repair at a single center. Patients and methods We retrospectively reviewed the records of 108 men who underwent urethroplasty for urethral stricture disease (USD) at a single center from 2016 to 2020. Demographic data, comorbidities, stricture history including etiology and prior treatments, patient‐reported symptoms, and outcomes data were collected for analysis. Data were analyzed in aggregate, then, stratified by type of urethroplasty performed. Descriptive statistics, univariate analysis, multivariate logistic regression, and intergroup comparisons were completed using STATA, with an alpha value of 0.05 and a confidence interval of 95%. Results The median age of our patients was 58 years (interquartile range: 42‐69; range: 29‐83), with a median stricture length of 2.0 cm (interquartile range: 1.0‐4.5; range: 0.5‐10). The most common stricture etiology was iatrogenic (n = 33, 31%) and the most common urethroplasty was anterior anastomotic urethroplasty (n = 38, 35%), followed by buccal mucosal graft (BMG) urethroplasty (n = 35, 32%). Twenty‐four patients (22%) had stricture recurrence. Within the aggregate data, recurrence was significantly predicted by obesity (BMI > 30) (Odds Ratio [OR] 3.2, 95% Confidence Interval [CI]: 1.06‐10), and the presence of postoperative complications (OR 6.3, CI: 1.9‐21). The presence of any postoperative complications within 90 days was significantly predicted by stricture length ≥ 5 cm (OR 3.5, CI 1.09‐12) and recurrence (OR 6.0, CI 1.7‐21). Conclusion Despite serving as the most definitive treatment for urethral stricture management, stricture recurrence and postoperative complications are not uncommon after urethroplasty. Obesity and stricture length negatively impact outcomes while a penile stricture location is associated with a lower recurrence rate, though this is not statistically significant.
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Affiliation(s)
- H. E. Kay
- Dell Medical SchoolUniversity of TexasAustinTXUSA
| | - P. Srikanth
- Dell Medical SchoolUniversity of TexasAustinTXUSA
| | | | | | - V. R. Patel
- Dell Medical SchoolUniversity of TexasAustinTXUSA
| | - N. Hauser
- Department of UrologyMiller School of MedicineUniversity of MiamiMiamiFLUSA
| | - A. A. Laviana
- Dell Medical SchoolUniversity of TexasAustinTXUSA
- Department of Surgery and Perioperative CareDell Medical SchoolAscension Seton Hospital NetworkAustinTXUSA
| | - J. S. Wolf
- Dell Medical SchoolUniversity of TexasAustinTXUSA
- Department of Surgery and Perioperative CareDell Medical SchoolAscension Seton Hospital NetworkAustinTXUSA
| | - E. C. Osterberg
- Dell Medical SchoolUniversity of TexasAustinTXUSA
- Department of Surgery and Perioperative CareDell Medical SchoolAscension Seton Hospital NetworkAustinTXUSA
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Voelzke BB, Leddy LS, Myers JB, Breyer BN, Alsikafi NF, Broghammer JA, Elliott SP, Vanni AJ, Erickson BA, Buckley JC, Zhao LC, Wright T, Rourke KF. Multi-institutional Outcomes and Associations After Excision and Primary Anastomosis for Radiotherapy-associated Bulbomembranous Urethral Stenoses Following Prostate Cancer Treatment. Urology 2021; 152:117-122. [PMID: 33556448 DOI: 10.1016/j.urology.2020.11.077] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/28/2020] [Accepted: 11/30/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate the outcomes of excision and primary anastomosis (EPA) for radiation-associated bulbomembranous stenoses using a multi-institutional analysis. The treatment of radiation-associated urethral stenosis is typically complex owing to the adverse impact of radiation on adjacent tissue. METHODS An IRB-approved multi-institutional retrospective review was performed on patients who underwent EPA for bulbomembranous urethral stenosis following prostate radiotherapy. Preoperative patient demographics, operative technique, and postoperative outcomes were abstracted from 1/2007-6/2018. Success was defined as voiding per urethra without the need for endoscopic treatment and a minimum follow-up of 12 months. RESULTS One hundred and thirty-seven patients from 10 centers met study criteria with a mean age of 69.3 years (50-86), stenosis length of 2.3 cm (1-5) and an 86.9% (119/137) success rate at a mean follow-up 32.3 months (12-118). Univariate Cox regression analysis identified increasing patient age (P = .02), stricture length (P <.0001) and combined modality radiotherapy (P = .004) as factors associated with stricture recurrence while body mass index (P = .79), diabetes (P = .93), smoking (P = .62), failed endoscopic treatment (P = .08) and gracilis muscle use (P = .25) were not. On multivariate analysis, increasing patient age (H.R.1.09, 95%CI 1.01-1.16; P = .02) and stenosis length (H.R.2.62, 95%CI 1.49-4.60; P = .001) remained associated with recurrence. Subsequent artificial urinary sphincter was performed in 30 men (21.9%), of which 25 required a transcorporal cuff and 5 developed cuff erosion. CONCLUSIONS EPA for radiation-associated urethral stenosis effectively provides unobstructed instrumentation-free voiding. However, increasing stenosis length and age are independently associated with surgical failure. Patients should be counseled that further surgery for incontinence may be necessary.
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Affiliation(s)
- B B Voelzke
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - L S Leddy
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - J B Myers
- Division of Urology, University of Utah, Salt Lake City, UT
| | - B N Breyer
- Department of Urology, University of California-San Francisco Medical Center, San Francisco, CA
| | | | - J A Broghammer
- Department of Urology, University of Kansas Medical Center, Kansas City, KS
| | - S P Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN
| | - A J Vanni
- Department of Urology, Lahey Clinic, Burlington, MA
| | - B A Erickson
- Department of Urology, University of Iowa, Iowa City, IA
| | - J C Buckley
- Department of Urology, University of California-San Diego, San Diego, CA
| | - L C Zhao
- Department of Urology, New York University Langone Health, New York City, NY
| | - T Wright
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - K F Rourke
- Division of Urology, University of Alberta, Edmonton, AB, Canada.
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Single-surgeon experience of excision and primary anastomosis for bulbar urethral stricture: analysis of surgical and patient-reported outcomes. World J Urol 2021; 39:3063-3069. [PMID: 33388917 DOI: 10.1007/s00345-020-03539-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To report our experience with excision and primary anastomosis (EPA) for bulbar urethral stricture. METHODS Patients who underwent EPA for bulbar stricture between 2012 and 2019 were retrospectively analyzed (n = 308). Successful urethroplasty was defined as the absence of the need for additional treatment. For follow-up, uroflowmetry was performed and the patients completed the validated Urethral Stricture Surgery Patient-reported Outcome Measure and Sexual Health Inventory for Men (SHIM) questionnaires before (baseline) and 6 months after EPA. Overall patient satisfaction after urethroplasty was also evaluated. RESULTS Urethroplasty was successful in 97.1% of patients (n = 299) with a median follow-up of 37 months. A total of 215 patients (69.8%) completed the questionnaires at 6 months postoperatively. The mean maximum flow rate, lower urinary tract symptom (LUTS)-total score, Peeling's picture score, LUTS-specific quality of life, and EuroQol-visual analog scale scores improved significantly from 7.7 ml/s, 11.6, 3.3, 2.4, and 58.0 at baseline to 24.1 ml/s, 2.7, 1.9, 0.4, and 82.1 postoperatively (p < 0.0001 for all comparisons). However, five-point or greater deterioration in the SHIM score was found in 41 patients (19.1%). Regarding patient satisfaction, 98.6% of patients (212/215) were "satisfied" (32.6%) or "very satisfied" (66.0%) with the outcome. A low postoperative LUTS-total score and Peeling's picture score were independent predictors of a "very satisfied" patient (p = 0.001 and p = 0.01, respectively). CONCLUSIONS EPA had a high success rate and was associated with significant benefits in both subjective and objective outcomes. Contrarily, a high incidence of postoperative erectile dysfunction was observed.
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Shalkamy O, Abdelazim H, Elshazly A, Soliman A, Agha M, Tagreda I, Hindawy M, Kotb A, Farid M, Ahmed AF. Factors Predicting Urethral Stricture Recurrence after Dorsal Onlay Augmented, Buccal Mucosal Graft Urethroplasty. Urol Int 2020; 105:269-277. [PMID: 33333534 DOI: 10.1159/000512065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/25/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study was carried out to identify the predictors of urethral stricture recurrence after dorsal onlay buccal mucosal graft (BMG) urethroplasty. MATERIALS AND METHODS The medical records of patients with anterior urethral stricture who underwent dorsal onlay BMG urethroplasty at a single tertiary medical center during the period from March 2010 to January 2018 were reviewed. Only patients with ≥2-year follow-up were included. Data regarding patient demographics, clinical characteristics, stricture characteristics, postoperative course, and adverse events were recorded. Kaplan-Meier analysis was used to assess the recurrence-free survival and likelihood of stricture recurrence. Cox regression analysis was used to identify potential independent predictors of stricture recurrence. RESULTS This study included 266 patients with a mean age of 37.71 years and a mean follow-up period of 49.77 months. From the overall study cohort, 34 (12.8%) reported stricture recurrence and 232 (87.2%) were not. The mean recurrence-free time was 79.93 months and mean time to recurrence was 21.59 months. On multivariate analysis, obesity (hazard ratio (HR): 6.02; 95% conference interval (CI): 1.91, 19.03: p = 0.002), inflammatory aetiology (HR: 9.13; 95% CI: 3.50, 23.81; p < 0.001), prior urethroplasty (HR: 8.81; 95% CI: 3.26, 23.86; p < 0.001), penile stricture location (HR: 3.09; 95% CI: 1.10, 8.71; p = 0.033), and stricture length >4.5 cm (HR: 6.83; 95% CI: 1.69, 27.62; p = 0.007) were the significant independent predictors of stricture recurrence. CONCLUSIONS Dorsal onlay BMG urethroplasty has a reasonable recurrence-free rate with acceptable postoperative complications. Obesity, inflammatory etiology, prior urethroplasty, penile stricture location, and longer stricture were the factors associated with urethral stricture recurrence.
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Affiliation(s)
- Osama Shalkamy
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hassan Abdelazim
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Elshazly
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Soliman
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohammed Agha
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ibrahim Tagreda
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohammed Hindawy
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ayman Kotb
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mamdouh Farid
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abul-Fotouh Ahmed
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt,
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Oyelowo N, Ahmed M, Tolani MA, Lawal AT, Awaisu M, Sudi A, Jemila O, Bello A, Maitama HY. Analysis of the Determinants, Characteristics and Management of Recurrent Urethral Strictures. Niger J Surg 2020; 26:130-134. [PMID: 33223811 PMCID: PMC7659749 DOI: 10.4103/njs.njs_54_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/06/2020] [Accepted: 05/29/2020] [Indexed: 12/04/2022] Open
Abstract
Background: The presentation and management of the recurrent urethral stricture varies and depends largely on the initial treatment and the characteristics of the recurrent stricture. What are the likely determinants of recurrence? Patients and Methods: This is a retrospective review of all patients who had urethroplasties from January 2013 to December 2017 for anterior urethral strictures in our institution. Patients with a recurrence of the strictures were identified and reviewed, while patients with hypospadias and posterior urethral stenosis or contractures were excluded from the study. The etiology, length, site, and type of urethroplasties were evaluated as variables that may contribute to the recurrence of strictures using inferential statistics and logistic regression analysis. Time to recurrence was analyzed using the Kaplan–Meier method. Results: A total of 206 urethroplasties for anterior urethral strictures were evaluated with recurrence of strictures noted in 29 patients and a recurrence rate of 14.1%. Recurrence was higher in long-segment strictures, penobulbar strictures, and postinflammatory strictures. Pedicle flaps were used in 45% of the strictures that reoccurred. Using Chi-square, the length, site, of urethroplasties were statistically significant determinants of recurrence; however, only the site of stricture was found to be statistically significant following logistic regression analysis. The site of recurrence was in the bulbar urethra in 79% and the penile urethra in 21%. The choice of treatment of the recurrent strictures was anastomotic urethroplasty in 76.5%. The mean time to failure in this study was 13 months with a range of 6-120 months. Conclusion: In this study, the site of stricture was found to be the most determinant of stricture recurrence, with penobulbar strictures mostly implicated. Long-segment strictures were also noted to contribute to some extent in recurrence. These recurrent strictures were mostly short-segment strictures in the bulbar urethra which were amenable to excision and anastomosis to achieve cure.
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Affiliation(s)
- Nasir Oyelowo
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Muhammed Ahmed
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Musliu Adetola Tolani
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Ahmad Tijani Lawal
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Mudi Awaisu
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Abdullahi Sudi
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Olagunju Jemila
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Ahmad Bello
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Husseini Yusuf Maitama
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
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Longitudinal Evaluation of Perineogenital Pain and Postoperative Complications After One-stage Buccal Mucosal Graft Urethroplasty: A Secondary Analysis of a Randomized Controlled Trial. Eur Urol Focus 2020; 7:1157-1165. [PMID: 33069623 DOI: 10.1016/j.euf.2020.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/16/2020] [Accepted: 09/29/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Little is known about patient-reported intensity and quality of pain at the receiver site as well as postoperative complications following one-stage buccal mucosal graft urethroplasty (BMGU). OBJECTIVE To evaluate perineogenital pain intensity and quality as well as short-term complications after BMGU, and to describe the impact of pain and complications on stricture recurrence. DESIGN, SETTING, AND PARTICIPANTS A secondary analysis of a randomized controlled trial including 135 patients, who underwent BMGU from 2014 to 2015, was performed. INTERVENTION One-stage BMGU. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patient-reported perineogenital pain was assessed by the Numeric Pain Rating Scale and the Short-form McGill Pain Questionnaire preoperatively and at 1, 5, and 21 d, and 3, 6, and 12 mo postoperatively. Complications were assessed by the Clavien-Dindo classification and the Comprehensive Complication Index. Pain and complications were compared according to stricture recurrence. RESULTS AND LIMITATIONS At a mean follow-up of 21±15 mo, 29 patients (21%) had stricture recurrence. Pain intensity as well as sensory and affective pain quality decreased over time, reaching a minimum at 6 mo. Postoperative complications at days 5 (95% of patients) and 21 (27% of patients) were predominantly "minor" (Clavien-Dindo classification grade≤IIIa). Neither patient-reported perineogenital pain nor cumulative morbidity burden was different between patients with and those without stricture recurrence (all p ≥ 0.05). CONCLUSIONS Perineogenital pain is frequent after BMGU, but pain intensity and quality decrease over time. The same holds true for postoperative complications, which are frequent but mostly present as minor events. Current findings allow for thorough preoperative patient counseling regarding the expected perineogenital pain intensity and quality over time as well as complications following BMGU. PATIENT SUMMARY In this study, we looked at pain intensity and pain quality as well as complications following buccal mucosal graft urethroplasty. We found that pain in the perineogenital region is frequent, but pain intensity and quality decrease over time. Similarly, postoperative complications are frequent, but mainly present as minor events.
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Meyer CP, Lamp J, Vetterlein MW, Soave A, Engel O, Dahlem R, Fisch M, Kluth LA. Impact of Cardiovascular and Metabolic Risk Factors on Stricture Recurrence After Anterior One-stage Buccal Mucosal Graft Urethroplasty. Urology 2020; 146:253-259. [PMID: 32950595 DOI: 10.1016/j.urology.2020.07.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate the impact of cardiovascular, metabolic and smoking related risk factors on recurrence in patients with buccal mucosal graft urethroplasty for anterior urethral strictures. PATIENTS AND METHODS Retrospective single-center analysis between 2009 and 2016. Covariates included American Society of Anesthesiology (ASA) score, body mass index, and smoking status (never vs ever), coronary artery disease, arterial hypertension, diabetes mellitus, change in hemoglobin, creatinine, c-reactive protein, and leucocyte count. Descriptive and survival analyses evaluated the association with stricture recurrence. RESULTS Overall, 1039 patients had buccal mucosal graft urethroplasty of which 517 remained for final analysis. Patients with stricture recurrence (n = 76) were significantly older (P < .001), had a higher American Society of Anesthesiology score (P = .006), higher proportion coronary artery disease (P = .011), and hypertension (P = .003) compared to those patients without stricture recurrence. Patients without stricture recurrence had a significantly larger drop in hemoglobin (1.5 [0.9, 2.1] vs 1.2 [0.7, 1.8]) mg/dl ( = .005).Overall stricture-free recurrence rate was 86%, with a median follow-up of 32 (95% confidence interval: 26-30) months. In multivariable analysis, a larger drop of hemoglobin remained the only independent, statistically significant negative predictor of stricture recurrence (Hazard ratio, 95% confidence interval: 0.74, 0.57-0.97, P = .03). CONCLUSION A larger drop of hemoglobin is independently associated with recurrence free survival. This may be considered as a surrogate marker for good microvascular circulation of the corpus spongiosum and therefore neovascularization of the graft. Contrary to the existing and mostly heterogenous previous studies, our findings suggest that stricture recurrence is largely independent of cardiovascular and metabolic risk factors.
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Affiliation(s)
- Christian P Meyer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Jule Lamp
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Frankfurt, Frankfurt (Main), Germany
| | - Armin Soave
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Engel
- 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
| | - Luis A Kluth
- Department of Urology, University Medical Center Frankfurt, Frankfurt (Main), Germany
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Kulkarni SB, Pathak H, Khanna S, Choubey S. A prospective, multi-center, open-label, single-arm phase 2b study of autologous adult live cultured buccal epithelial cells (AALBEC) in the treatment of bulbar urethral stricture. World J Urol 2020; 39:2081-2087. [PMID: 32929625 DOI: 10.1007/s00345-020-03415-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of autologous adult live cultured buccal epithelial cells (AALBEC) in treatment and management of bulbar urethral stricture in men. METHODS This was a prospective, multi-center, open-label, single-arm phase 2b study. A total of 18 male patients with bulbar urethral stricture of at least 1 - 4 cm in length were enrolled in the study. All 16 patients had AALBEC implanted and were included in the safety set. Change in total American Urology Association (AUA) symptom score, urinary flow rates assessed by uroflowmetry and a requirement for surgery after 24 weeks from baseline were determined in patients. Data of treatment efficacy were analyzed. RESULTS The AUA score at baseline was 21 (3.9) that showed a statistically significant reduction starting from week 2 [8 (4.4), p = 0.0001] which sustained until week 24 [2 (1.2), p = 0.0005]. Overall mean total AUA symptom score was reduced by 90.5% after the treatment. Significant reductions from baseline at week-24 were also observed in voiding time (92.5 (47.3) vs. 51.9 (17.4) s, p = 0.0046) and flow time [86.9 (48.2) vs. 47.9 (19.6) s, p = 0.0052]. All patients showed absence of any significant adverse events. CONCLUSION Significant improvement was seen in the AUA symptom score and uroflowmetry parameters and no patients required surgery during 24 weeks post-treatment. It can be concluded that AALBEC is a safe and effective treatment for bulbar urethral stricture of 1 - 4 cm length to improve the quality of life and the physiological function of urethra.
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Affiliation(s)
- Sanjay B Kulkarni
- Kulkarni Endo Surgery Institute and Reconstructive Urology Centre, Pune, India.
| | - Hemant Pathak
- TNMC Medical College and B. Y. L. Nair Charitable Hospital, Leelavati Hospital, Mumbai, India
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Lane GI, Smith AL, Stambakio H, Lin G, Al Hussein Alawamlh O, Anger JT, Brandes ER, Carmel ME, Chung DE, Cox L, DeLong J, Elliott CS, Eltahawy E, Aparecido França W, Gousse A, Gupta P, Hagedorn JC, High RA, Khan A, Kowalik C, Lee RK, Lee UJ, Lucioni A, MacDonald S, Malaeb B, McKay S, Padmanabhan P, Powell CR, Sajadi KP, Sutherland SE, Theva D, Vollstedt A, Welk B, Zheng Y, Cameron AP. Treatment of urethral stricture disease in women: A multi‐institutional collaborative project from the SUFU research network. Neurourol Urodyn 2020; 39:2433-2441. [PMID: 32926460 DOI: 10.1002/nau.24507] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/11/2020] [Accepted: 08/27/2020] [Indexed: 01/18/2023]
Abstract
AIM Female urethral stricture disease is rare and has several surgical approaches including endoscopic dilations (ENDO), urethroplasty with local vaginal tissue flap (ULT) or urethroplasty with free graft (UFG). This study aims to describe the contemporary management of female urethral stricture disease and to evaluate the outcomes of these three surgical approaches. METHODS This is a multi-institutional, retrospective cohort study evaluating operative treatment for female urethral stricture. Surgeries were grouped into three categories: ENDO, ULT, and UFG. Time from surgery to stricture recurrence by surgery type was analyzed using a Kaplan-Meier time to event analysis. To adjust for confounders, a Cox proportional hazard model was fit for time to stricture recurrence. RESULTS Two-hundred and ten patients met the inclusion criteria across 23 sites. Overall, 64% (n = 115/180) of women remained recurrence free at median follow-up of 14.6 months (IQR, 3-37). In unadjusted analysis, recurrence-free rates differed between surgery categories with 68% ENDO, 77% UFG and 83% ULT patients being recurrence free at 12 months. In the Cox model, recurrence rates also differed between surgery categories; women undergoing ULT and UFG having had 66% and 49% less risk of recurrence, respectively, compared to those undergoing ENDO. When comparing ULT to UFG directly, there was no significant difference of recurrence. CONCLUSION This retrospective multi-institutional study of female urethral stricture demonstrates that patients undergoing endoscopic management have a higher risk of recurrence compared to those undergoing either urethroplasty with local flap or free graft.
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Affiliation(s)
- Giulia I. Lane
- Department of Urology University of Michigan Ann Arbor Michigan USA
| | - Ariana L. Smith
- Division of Urology University of Pennsylvania Philadelphia Pennsylvania USA
| | - Hanna Stambakio
- Division of Urology University of Pennsylvania Philadelphia Pennsylvania USA
| | - George Lin
- Division of Urology University of Pennsylvania Philadelphia Pennsylvania USA
| | | | | | - Eileen R. Brandes
- Section of Urology Dartmouth Hitchcock Medical Center Lebanon New Hampshire USA
| | - Maude E. Carmel
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas USA
| | | | - Lindsey Cox
- Department of Urology Medical University of South Carolina Charleston South Carolina USA
| | - Jessica DeLong
- Department of Urology Eastern Virginia Medical School Norfolk Virginia USA
| | | | - Ehab Eltahawy
- Department of Urology University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | - Wagner Aparecido França
- Department of Urology Hospital do Servidor Público Estadual de São Paulo ‐ IAMSPE São Paulo Brazil
| | - Angelo Gousse
- Department of Urology Memorial Hospital Miramar Miramar Florida USA
| | - Priyanka Gupta
- Department of Urology University of Michigan Ann Arbor Michigan USA
| | | | - Rachel A. High
- Department of Urology Baylor Scott and White Health Temple Texas USA
| | - Aqsa Khan
- Department of Urology Mayo Clinic Phoenix Arizona USA
| | - Casey Kowalik
- Department of Urology Kansas University Medical Center Kansas City Kansas USA
| | - Richard K. Lee
- Department of Urology Weill Cornell Medicine NYC New York USA
| | - Una J. Lee
- Department of Urology Virginia Mason Seattle Washington USA
| | - Alvaro Lucioni
- Department of Urology Virginia Mason Seattle Washington USA
| | - Susan MacDonald
- Division of Urology Penn State Hershey Medical Center Hershey Pennsylvania USA
| | - Bahaa Malaeb
- Department of Urology University of Michigan Ann Arbor Michigan USA
| | - Scotty McKay
- Department of Urology University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | | | | | - Kamran P. Sajadi
- Department of Urology Oregon Health & Science University Portland Oregon USA
| | | | - Didi Theva
- Department of Urology Memorial Hospital Miramar Miramar Florida USA
| | - Annah Vollstedt
- Division of Urology University of Pennsylvania Philadelphia Pennsylvania USA
| | - Blayne Welk
- Division of Urology Western University London Ontario Canada
| | - Yu Zheng
- Department of Urology Medical University of South Carolina Charleston South Carolina USA
| | - Anne P. Cameron
- Department of Urology University of Michigan Ann Arbor Michigan USA
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Favorito LA. Editorial Comment: Larger patients shouldn't have fewer options: urethroplasty is safe in the obese. Int Braz J Urol 2020; 46:971. [PMID: 32822125 PMCID: PMC7527090 DOI: 10.1590/s1677-5538.ibju.2019.0511.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Luciano A Favorito
- Unidade de Pesquisa Urogenital - Universidade Estadual do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
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Akpayak IC, Shuaibu SI, Ofoha CG, Oshagbemi AO, Dakum NK, Ramyil VM. Dorsal onlay buccal mucosa graft urethroplasty for bulbar urethral stricture: a single centre experience. Pan Afr Med J 2020; 36:305. [PMID: 33282088 PMCID: PMC7687486 DOI: 10.11604/pamj.2020.36.305.21398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 07/13/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction the successful treatment for urethral strictures demands not just attention to surgical details but careful selection of the reconstructive technique. For long segment urethral strictures substitution urethroplasty is required. This study sought to determine the success rate and complications of dorsal onlay buccal mucosal graft (BMG) urethroplasty for long segment urethral strictures in our hospital. Methods this was a retrospective study carried out at Jos University Teaching Hospital from March 2015 to March 2018. The case notes of male patients who had dorsal onlay buccal mucosal graft urethroplasty for long segment bulbar urethral stricture within the study period were retrieved. Patients´ demographics, cause and nature of urethral strictures, duration of follow up, the success rate and complications were collected and subjected to statistical analysis using SPSS® version 22. Results twenty-four men with mean age of 45 years (range 14-67 years) had dorsal onlay buccal mucosal graft urethroplasty during the study period. The mean stricture length was 4.5cm (range, 2-7cm). After a mean follow up duration of 2 years (range, 1 4 years), 21(87.5%) patients had a successful urethroplasty as they were able to pass urine at one year post urethroplasty without lower urinary tract symptoms, while 3(12.5%) had recurrence of the urethral stricture. At the recipient site, 2(8.3%) patients had primary bleeding that did not require blood transfusion. Also, 2(8.3%) patients had superficial wound infection which was treated with antibiotics. At the donor site, 4(16.7%), 2(8.3%), 4(16.7%) had donor site swelling, transient bleeding and soreness respectively. Conclusion dorsal onlay BMG urethroplasty has a good success rate and minor complications and therefore suitable for long segment bulbar urethral strictures.
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Affiliation(s)
| | | | - Chima Gideon Ofoha
- Urology Division, Surgery Department, Jos University Teaching Hospital, Jos, Nigeria
| | | | - Nuhu Kutan Dakum
- Urology Division, Surgery Department, Jos University Teaching Hospital, Jos, Nigeria
| | - Venyir Mamzhi Ramyil
- Urology Division, Surgery Department, Jos University Teaching Hospital, Jos, Nigeria
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Urethrogram: Does Postoperative Contrast Extravasation Portend Stricture Recurrence? Urology 2020; 145:262-268. [PMID: 32763321 DOI: 10.1016/j.urology.2020.05.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To demonstrate our hypothesis that the presence of extravasation on postoperative urethrogram is inconsequential for disease recurrence in urethroplasty postoperative follow-up. MATERIALS AND METHODS We utilized the Trauma and Urologic Reconstructive Network of Surgeons database to assess 1691 patients who underwent urethroplasty and post-operative urethrogram. Anatomic and functional recurrence were defined as <17 Fr stricture documented at 12-month cystoscopy and need for a secondary procedure during 1 year of follow-up, respectively. Our primary outcomes were the sensitivity and positive predictive value of post-operative urethrogram for predicting anatomic and functional recurrence of urethral stricture disease. RESULTS Among 1101 patients with cystoscopy follow-up, 54 (4.9%) had extravasation on initial postoperative urethrogram. Among those 54, 74.1% developed an anatomic recurrence vs 13% without extravasation (P <.001). Similarly, functional recurrence was 9.3% with extravasation vs 3.2 % without extravasation (P = .04). Patients with extravasation more often reported a postoperative urinary tract infection (12.9% vs 2.7%; P <.01) or wound infection (7.4% vs 2.6%; P = .04). Sensitivity of postoperative urethrogram in predicting any recurrence was 27.3%, specificity 98.7%, positive predictive value 77.8%, and negative predictive value 89.3%. Fourty-five of 54 patients with extravasation had a recurrence of some kind, equating to a 22.2% urethroplasty success rate at 1 year. CONCLUSION Postoperative urethrogram has a high specificity but low sensitivity for anatomic and functional recurrence during short term follow-up. The positive predictive value of urinary extravasation is high: patients with extravasation incur a high risk of anatomic recurrence within 1 year and such patients may warrant increased monitoring.
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Alger J, Wright HC, Desale S, Venkatesan K. Larger patients shouldn't have fewer options: urethroplasty is safe in the obese. Int Braz J Urol 2020; 46:962-970. [PMID: 32758305 PMCID: PMC7527104 DOI: 10.1590/s1677-5538.ibju.2019.0511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/16/2019] [Indexed: 11/22/2022] Open
Abstract
Objective To examine the impact of obesity on perioperative outcomes and urethral stricture recurrence after anterior urethroplasty. Material and Methods We reviewed our prospectively maintained single-surgeon database to identify men with anterior urethral strictures who had undergone anastomotic or augmentation urethroplasty between October 2012 and March 2018. In all, 210 patients were included for primary analysis of perioperative outcomes, while 193 patients with at least 12 months follow-up were included for secondary analysis of stricture recurrence. Patients grouped by BMI were compared using univariate and multivariate analyses for perioperative outcomes and log rank testing for recurrence-free survival. Results Overall, 41% (n=86) of patients were obese and 58.6% (n=123) had bulbar urethral strictures. Obese patients had significantly longer urethral strictures (mean=6.7cm±4.7) than nonobese patients (p <0.001). Though urethroplasty in obese patients was associated with increased estimated blood loss (EBL) relative to normal BMI patients on both univariate (p=0.003) and multivariate (p <0.001) analyses, there was no difference in operative time, length of stay, or complication rate between BMI groups. At a mean follow-up interval of 36.7 months, 15% (n=29) of patients had stricture recurrence, yet recurrence-free survival was not significantly different between groups (log rank p=0.299). Dorsal augmentation urethroplasty resulted in significantly fewer recurrences in obese patients compared to nonobese patients (p=0.036). Conclusion Despite the association with increased urethral stricture length and EBL, obesity is not predictive of adverse perioperative outcomes or stricture recurrence. Obese patients should be offered urethral reconstruction, but patient selection and preoperative counseling remain imperative.
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Affiliation(s)
- Jordan Alger
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Henry Collier Wright
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Sameer Desale
- MedStar Health Research Institute, Hyattsville, MD, USA
| | - Krishnan Venkatesan
- Department of Urology, MedStar Washington Hospital Center, Washington, DC, USA
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Rourke KF, Welk B, Kodama R, Bailly G, Davies T, Santesso N, Violette PD. Canadian Urological Association guideline on male urethral stricture. Can Urol Assoc J 2020; 14:305-316. [PMID: 33275550 DOI: 10.5489/cuaj.6792] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Urethral stricture is fundamentally a fibrosis of the urethral epithelial and associated corpus spongiosum, which in turn, causes obstruction of the urethral lumen. Patients with urethral stricture most commonly present with lower urinary tract symptoms, urinary retention or urinary tract infection but may also experience a broad spectrum of other signs and symptoms, including genitourinary pain, hematuria, abscess, ejaculatory dysfunction, or renal failure. When urethral stricture is initially suspected based on clinical assessment, cystoscopy is suggested as the modality that most accurately establishes the diagnosis. This recommendation is based on several factors, including the accuracy of cystoscopy, as well as its wide availability, lesser overall cost, and comfort of urologists with this technique. When recurrent urethral stricture is suspected, we suggest performing retrograde urethrography to further stage the length and location of the stricture or referring the patient to a physician with expertise in reconstructive urology. Ultimately, the treatment decision depends on several factors, including the type and acuity of patient symptoms, the presence of complications, prior interventions, and the overall impact of the urethral stricture on the patient's quality of life. Endoscopic treatment, either as dilation or internal urethrotomy, is suggested rather than urethroplasty for the initial treatment of urethral stricture. This recommendation applies to men with undifferentiated urethral stricture and does not apply to trauma-related urethral injuries, penile urethral strictures (hypospadias, lichen sclerosus), or suspected urethral malignancy. In the setting of recurrent urethral stricture, urethroplasty is suggested rather than repeat endoscopic management but this may vary depending on patient preference and impact of the symptoms on the patient.The purpose of this guideline is to provide a practical summary outlining the diagnosis and treatment of urethral stricture in the Canadian setting.
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Affiliation(s)
- Keith F Rourke
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Blayne Welk
- Division of Urology, Western University, London, ON, Canada
| | - Ron Kodama
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Greg Bailly
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Tim Davies
- McMaster University, Hamilton, ON, Canada
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Primary versus Redo Urethroplasty: Results from a Single-Center Comparative Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7214718. [PMID: 32076612 PMCID: PMC7013303 DOI: 10.1155/2020/7214718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 01/16/2020] [Indexed: 11/23/2022]
Abstract
Objectives To explore the differences between primary and redo urethroplasty and to directly compare according stricture-free survival (SFS). Materials and Methods. Data of all male patients who underwent urethroplasty at Ghent University Hospital were collected between 2000 and 2018. Exclusion criteria for this analysis were age <18 years and follow-up <1 year. Two patient groups were created for further comparison: the primary urethroplasty (PU) group (no previous urethroplasty) and redo urethroplasty (RU) group (≥1 previous urethroplasty), irrespective of prior endoscopic treatments. A comparison between groups was performed using the Mann–Whitney U test and Fisher's Exact test. SFS was calculated using Kaplan–Meier statistics. A functional definition of failure, being the need for further urethral manipulation, was used. Uni- and multivariate Cox regression analyses were performed on the entire patient cohort. Results 805 patients were included. Median (IQR) follow-up of the PU (n = 556) and RU (n = 556) and RU (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures ( Conclusions Several differences between primary and redo urethroplasties exist. Redo urethroplasty entails a distinct patient population to treat and is, in general, associated with lower stricture-free survival than primary urethroplasty, although more homogeneous series are required to corroborate these results. Prior urethroplasty and diabetes are independent risk factors for urethroplasty failure.
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Independent risk factors for failure after anterior urethroplasty: a multivariate analysis on prospective data. World J Urol 2020; 38:3251-3259. [DOI: 10.1007/s00345-020-03123-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/03/2020] [Indexed: 11/26/2022] Open
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Urkmez A, Topaktas R, Ozsoy E, Tokuc E, Kutluhan MA, Artuk I, Kayar R, Ozturk MI. Is neutrophil to lymphocyte ratio a predictive factor for recurrence of urethral stricture? ACTA ACUST UNITED AC 2020; 65:1448-1453. [PMID: 31994624 DOI: 10.1590/1806-9282.65.12.1448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/30/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Due to spongiofibrosis and inflammatory processes underlying the pathogenesis of urethral stricture, it is possible that the neutrophil-lymphocyte ratio (NLR) may give essential information about the course of the disease and recurrence possibilities. Our study aims to evaluate the correlation between NLR and recurrence rates. METHODS A total of 512 patients who underwent direct visual internal urethrotomy (DVIU) due to urethral stricture in our clinic between February 2010 and January 2018 were evaluated retrospectively. RESULTS The median follow up for non-recurrent and recurrent groups after DVIU was 30 and 36 months, respectively. During the follow-up, 280 (54.7%) of the patients had recurrences, and 232 (45,3%) had no recurrences. The mean time for recurrence after DVIU was 6,5±1,4 months, with a range of 1-36 months. The mean NLR in the non-recurrence group was 2,02±0,87, with a median of 1.9, and 3,66±2,30, with a median of 3 in the recurrence group. A highly significant statistical difference was observed between two groups in terms of neutrophil count and NLR (p: 0.000 - both). The area under curve value for NLR was 0.767, with a standard error of 0.021 (95% CI 0.727-0.808). The cut-off value of NLR was determined as 2.25, with a 70% sensitivity and 67,7% specificity. CONCLUSION By using NLR, the inflammatory features of the urethral tissue can be predicted, and possible recurrences after surgery can be estimated. Consequently, open urethroplasty techniques can be used in cases with a significant NLR value instead of the recurrent endoscopic procedure.
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Affiliation(s)
- Ahmet Urkmez
- . Haydarpasa Numune Research & Training Hospital, Dept. of Urology, Istanbul, Turkey
| | - Ramazan Topaktas
- . Haydarpasa Numune Research & Training Hospital, Dept. of Urology, Istanbul, Turkey
| | - Emrah Ozsoy
- . Haydarpasa Numune Research & Training Hospital, Dept. of Urology, Istanbul, Turkey
| | - Emre Tokuc
- . Haydarpasa Numune Research & Training Hospital, Dept. of Urology, Istanbul, Turkey
| | - Musab Ali Kutluhan
- . Fatih Sultan Mehmet Research & Training Hospital, Dept. of Urology, Istanbul, Turkey
| | - Ilker Artuk
- . Haydarpasa Numune Research & Training Hospital, Dept. of Urology, Istanbul, Turkey
| | - Ridvan Kayar
- . Haydarpasa Numune Research & Training Hospital, Dept. of Urology, Istanbul, Turkey
| | - Metin Ishak Ozturk
- . Haydarpasa Numune Research & Training Hospital, Dept. of Urology, Istanbul, Turkey
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Tai JW, Yu H, Chilukuri AT, Bhargava R, Deshpande R, Li W, Ongkeko WM, Bhargava V, Rajasekaran MR. Characterization of urethral fibrosis in a rabbit model: Potential roles of Wnt-β catenin pathway and epithelial to mesenchymal transition. Neurourol Urodyn 2020; 39:625-632. [PMID: 31961960 DOI: 10.1002/nau.24281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/23/2019] [Indexed: 12/24/2022]
Abstract
AIM To elucidate the precise cellular and molecular mechanisms that underlie urethral fibrogenesis. METHODS Endoluminal electrocautery injury (using Karl Storz 10 Fr. Pediatric urethroscope) was employed in male rabbits (n = 6) to create mucosal injury. Retrograde urethrogram (RUG) and endoluminal ultrasound techniques were used to assess severity and changes in luminal cross-sectional area. Six control rabbits were subjected to sham injury, in which the electrocautery was inserted but not powered. Urethral tissues were harvested 30 days postinjury and subjected to RNA sequencing and quantitative polymerase chain reaction (qPCR) to determine changes in gene expression. Histological, immunostaining, and Western blot studies were used to determine changes in protein expression of known markers of fibrosis (eg, collagen, Integrinαv, GIV/Girdin, transforming growth factor-β (TGF-β), and pSMAD1,2,3). RESULTS Trichrome staining confirmed increased connective tissue in urethral scar tissues. Immunostaining revealed a potential role for epithelial to mesenchymal cell transition (EMT) and positive labeling for all fibrotic markers (eg, collagen-1, Integrin αv, GIV/Girdin, transforming growth factor-β (TGF-β), and SMAD1,2,3). Western blot analysis confirmed increased protein levels of these fibrotic markers. CONCLUSION Our RNA sequencing and qPCR studies, in conjunction with our protein data, suggest that urethral mucosal fibrogenesis may be mediated by novel fibrogenic signaling pathways involving Wnt-β catenin, TGF-β, GIV/Girdin, and EMT which lead to increased collagen deposition. Therapeutic strategies targeting these pathways may be beneficial in attenuating fibrogenesis and stricture progression.
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Affiliation(s)
- Jesse W Tai
- Department of Urology, San Diego VA Health Care System and University of California, San Diego, California
| | - Hosong Yu
- Department of Urology, San Diego VA Health Care System and University of California, San Diego, California
| | - Abinav T Chilukuri
- Department of Urology, San Diego VA Health Care System and University of California, San Diego, California
| | - Raag Bhargava
- Department of Urology, San Diego VA Health Care System and University of California, San Diego, California
| | - Rucha Deshpande
- Department of Urology, San Diego VA Health Care System and University of California, San Diego, California
| | - Wei Li
- Department of Surgery, San Diego VA Health Care System and University of California, San Diego, California
| | - Weg M Ongkeko
- Department of Surgery, San Diego VA Health Care System and University of California, San Diego, California
| | - Valmik Bhargava
- Division of Cardiology, San Diego VA Health Care System and University of California, San Diego, California
| | - Mahadevan Raj Rajasekaran
- Department of Urology, San Diego VA Health Care System and University of California, San Diego, California
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Critical analysis of urethroplasty for male anterior urethral stricture: a single-center experience. World J Urol 2019; 38:2313-2319. [PMID: 31732770 DOI: 10.1007/s00345-019-03014-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Urethroplasty is the most effective treatment method for anterior urethral strictures, which constitute an important health concern for males. This study aims to investigate factors that may predict treatment failure following urethroplasty for anterior urethral strictures and evaluate outcomes of different urethroplasty techniques. METHODS This retrospective study utilized univariate and multivariate analyses to identify factors affecting treatment success following different urethroplasty techniques performed by a single surgeon on male patients with anterior urethral strictures. Surgical outcomes of different urethroplasty techniques were evaluated individually. RESULTS Urethroplasty procedures performed on 244 patients with a mean age of 54 years and a mean stricture length of 4.7 cm produced a success rate of 79.1%. Multivariate analyses identified stricture length and number of previous internal urethrotomy procedures as factors predicting urethroplasty success (HR 1.265, 95% CI 1.129-1.416, p < 0.001 and HR 1.188, 95% CI 1.038-1.361, p = 0.013, respectively). The eight surgical techniques used by the surgeon produced success rates that varied between 50% and 86.2%. CONCLUSION Urethroplasty can offer satisfactory outcomes for anterior urethral strictures. Accordingly, a longer stricture length and greater number of previous internal urethrotomy procedures were associated with greater risk for urethroplasty failure. Moreover, urethroplasty techniques must be selected based on multifactorial evaluation and performed at experienced centers.
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Kumar M, Aggarwal A, Pandey S, Agarwal S, Sankhwar SN. Assessment of long term outcomes after buccal mucosal graft urethroplasty: the impact of chronic kidney disease. Int Braz J Urol 2019; 45:981-988. [PMID: 31626521 PMCID: PMC6844351 DOI: 10.1590/s1677-5538.ibju.2019.0176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/31/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives To compare and assess various outcomes and success of buccal mucosal graft urethroplasty (BMGU) in patients with CKD versus patients having normal renal function. Material and Methods This was a retrospective, single centre study, during period 2013 to 2017. Patients were grouped into two groups. Group 1 had patients with estimated Glomerular Filtration Rate (eGFR)>60mL/min/1.73m2 while group 2 had patients with eGFR <60mL/min/1.73m2. eGFR was calculated according to the MDRD equation. The two groups were compared with regard to various outcomes like length, location of stricture, technique of graft placement, intra-operative blood loss (haemoglobin drop), duration of hospital stay, post-operative complications and recurrence. Results A total of 223 patients were included in study with group 1 had 130 patients and group 2 had 93 patients. Mean age of patients with CKD were higher (47.49 years versus 29.13 years). The mean follow-up period was comparable between both groups (23.29 months and 22.54 months respectively). Patients with CKD had more post-operative Clavien Grade 2 or higher complications (p=0.01) and a greater recurrence rates (p<0.001) than in non-CKD patients. On multivariate analysis, age and CKD status was significant predictor of urethroplasty success (p=0.004) (OR= 14.98 (1.952-114.94, 95% CI). Conclusions CKD patients are more prone to post-operative complications in terms of wound infection, graft uptake and graft failure and higher recurrence rates following BMGU.
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Affiliation(s)
- Manoj Kumar
- Department of Urology, King George's Medical University, Lucknow, India
| | - Ajay Aggarwal
- Department of Urology, King George's Medical University, Lucknow, India
| | - Siddharth Pandey
- Department of Urology, King George's Medical University, Lucknow, India
| | - Samarth Agarwal
- Department of Urology, King George's Medical University, Lucknow, India
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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]
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Austen M, Breul J, Tritschler S. [Bulbar urethral strictures : A trivial urological disease or a surgical challenge?]. Urologe A 2019; 57:17-20. [PMID: 29236143 DOI: 10.1007/s00120-017-0545-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Urethral strictures are often located in the bulbar urethra, and bulbar strictures are commonly due to urethral trauma. Diagnosis is confirmed by radiographic imaging of the urethra. In cases of short primary bulbar strictures, a simple internal urethrotomy may be curative. In contrast, open surgery should be performed in long segment or recurrent strictures because recurrence rates are near 100% in these cases. Depending of the actual findings and comorbidities, end-to-end anastomosis, graft urethroplasty, flap urethroplasty, or perineal urethrostomy may be used. If definitive treatment using open surgery is delayed and multiple endoscopic treatments are tried, urethroplasty becomes more complex and success rates of definitive treatment decline.
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Affiliation(s)
- M Austen
- Klinik für Urologie und urologische Onkologie, Loretto-Krankenhaus Freiburg, Mercystraße 6-14, 79100, Freiburg, Deutschland.
| | - J Breul
- Klinik für Urologie und urologische Onkologie, Loretto-Krankenhaus Freiburg, Mercystraße 6-14, 79100, Freiburg, Deutschland
| | - S Tritschler
- Urologische Klinik und Poliklinik, Klinikum Großhadern, LMU München, München, Deutschland
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Antibiotic prophylaxis after urethroplasty may offer no benefit. World J Urol 2019; 38:1295-1301. [DOI: 10.1007/s00345-019-02880-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 07/18/2019] [Indexed: 01/28/2023] Open
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Ofoha CG, Ramyil VM, Dakum NK, Shu'aibu SI, Akpayak IC, Magnus FE, Swem U, Oshagbemi A, Osunaiye O, Akhaine J. Predictors of urethral stricture recurrence following urethroplasty: a retrospective review at the Jos University Teaching Hospital, Nigeria. Pan Afr Med J 2019; 32:190. [PMID: 31312302 PMCID: PMC6620064 DOI: 10.11604/pamj.2019.32.190.18504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/10/2019] [Indexed: 12/04/2022] Open
Abstract
Introduction Incidence of urethral stricture recurrence ranges between 2% to 36.4% with 75% occurring within the first 6 months of surgery. Hence, they need to identify the predictors of recurrence following urethroplasty. Methods This is a retrospective study involving patients that had urethroplasty from January 2008 to December 2017. Patients' records were reviewed. Analyzed data were for patients with a minimum follow up of one year from the time of urethroplasty and included aetiology of urethral stricture, presence of suprapubic cystostomy, prior urethral dilatation, urine M/C/S, site of urethral stricture, length of urethral stricture, type of urethroplasty, level of training of the surgeon, type of urethral stent used and duration of stenting. Analysis was done using SPSS version 23. P-value of < 0.05 was considered significant. Results Eighty seven urethroplasties were done, from January 2008 to December 2017. However, only records of 44 patients were accessible. Twenty patients completed duration of follow up ≥ one year. Urethral stricture recurrence was defined as resurgence of Lower Urinary Tract Symptoms (LUTS) within one year. Median age of the patients was 39.5 (± 19) years. Urethral stricture recurrence rate was 25% with mean time to recurrence from urethroplasty of 5.3 (±3) months. The use of preoperative suprapubic catheter (SPC) for urinary diversion as well as urethroplasties performed by the consultants had a lower incidence of recurrence. Conclusion This study found urethral stricture recurrence of 25%. The level of training of surgeon vis-à-vis the expertise and experience seems to be an important factor, though not statistically significant in determining the outcome of urethroplasty.
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Affiliation(s)
- Chimaobi Gideon Ofoha
- Jos University Teaching Hospital (JUTH), Nigeria.,College of Medicine, University of Jos, Jos University Teaching Hospital, Nigeria
| | - Venyir Mamhzi Ramyil
- Jos University Teaching Hospital (JUTH), Nigeria.,College of Medicine, University of Jos, Jos University Teaching Hospital, Nigeria
| | - Nuhu Kutan Dakum
- Jos University Teaching Hospital (JUTH), Nigeria.,College of Medicine, University of Jos, Jos University Teaching Hospital, Nigeria
| | - Samaila Ibrahim Shu'aibu
- Jos University Teaching Hospital (JUTH), Nigeria.,College of Medicine, University of Jos, Jos University Teaching Hospital, Nigeria
| | - Idorenyin Cletus Akpayak
- Jos University Teaching Hospital (JUTH), Nigeria.,College of Medicine, University of Jos, Jos University Teaching Hospital, Nigeria
| | | | - Ushaaka Swem
- Jos University Teaching Hospital (JUTH), Nigeria
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Dornbier RA, Kirshenbaum EJ, Nelson MH, Blackwell RH, Gupta GN, Farooq AV, Gonzalez CM. Socioeconomic and patient-related factors for the management of male urethral stricture disease. World J Urol 2019; 37:2523-2531. [PMID: 30810835 DOI: 10.1007/s00345-019-02702-0] [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: 09/19/2018] [Accepted: 02/22/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE We sought to determine the socioeconomic and patient factors that influence the utilization of urethroplasty and location of management in the treatment of male urethral stricture disease. METHODS A retrospective review using the Healthcare Cost and Utilization Project State Inpatient and Ambulatory Surgery and Services Databases for California and Florida was performed. Adult men with a diagnosis of urethral stricture who underwent treatment with urethroplasty or endoscopic dilation/urethrotomy between 2007 and 2011 in California and 2009 and 2014 in Florida were identified by ICD-9 or CPT codes. Patients were categorized based on whether they had a urethroplasty or serial dilations/urethrotomies. Patients were assessed for age, insurance provider, median household income by zip code, Charlson Comorbidity Index, race, prior stricture management, and location of the index procedure. A multivariable logistic regression model was fit to assess factors influencing treatment modality (urethroplasty vs endoscopic management) and location (teaching hospital vs non-teaching hospital). RESULTS Twenty seven thousand, five hundred and sixty-eight patients were identified that underwent treatment for USD. 25,864 (93.8%) treated via endoscopic approaches and 1704 (6.2%) treated with urethroplasty. Factors favoring utilization of urethroplasty include younger age, lower Charlson Comorbidity score, higher zip code median income quartile, private insurance, prior endoscopic treatment, and management at a teaching hospital. CONCLUSION Socioeconomic predictors of urethroplasty utilization include higher income status and private insurance. Patient-specific factors influencing urethroplasty were younger age and fewer medical comorbidities. A primary driver of urethroplasty utilization was treatment at a teaching hospital. Older and Hispanic patients were less likely to seek care at these facilities.
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Affiliation(s)
- Ryan A Dornbier
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Fahey #54, Rm 239A, Maywood, IL, 60153, USA.
| | - Eric J Kirshenbaum
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Fahey #54, Rm 239A, Maywood, IL, 60153, USA
| | - Marc H Nelson
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Fahey #54, Rm 239A, Maywood, IL, 60153, USA
| | - Robert H Blackwell
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Gopal N Gupta
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Fahey #54, Rm 239A, Maywood, IL, 60153, USA
| | - Ahmer V Farooq
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Fahey #54, Rm 239A, Maywood, IL, 60153, USA
| | - Christopher M Gonzalez
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Fahey #54, Rm 239A, Maywood, IL, 60153, USA
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Topaktaş R, Ürkmez A, Tokuç E, Akyüz M, Kutluhan MA. Hematologic parameters and neutrophil / lymphocyte ratio in the prediction of urethroplasty success. Int Braz J Urol 2019; 45:369-375. [PMID: 30785704 PMCID: PMC6541144 DOI: 10.1590/s1677-5538.ibju.2018.0682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 11/15/2018] [Indexed: 11/21/2022] Open
Abstract
Objective: The pathophysiology of urethral stricture and its recurrence remains vague and one of the important causes is progressive inflammation. It has been shown in recent years that the neutrophil / lymphocyte ratio is a marker of systemic inflammation and is associated with prognosis in many cardiovascular diseases, malignancies and chronic inflammatory diseases. We assessed simple systemic inflammation markers preoperatively and surgical techniques for urethral stricture recurrence after urethroplasty. Patients and Methods: After exclusion criteria applied, a total of 117 male cases operated with urethroplasty in our clinic between January 2012 and June 2017 were included in the study and analyzed retrospectively. Localization and length of the strictures of the patients, neutrophil counts and percentages, lymphocyte counts and percentages, and neutrophil / lymphocyte ratios in preoperative peripheral blood samples were statistically analyzed. Recurrent stricture during first 12 months follow-up after the surgery has been assessed as recurrence. Results: The mean age of the patients was 54.12 ± 16.35 and the mean urethral stricture length was 3.44 ± 1.83 cm. Recurrence was observed in 30.1% of cases who received buccal graft, 30% in penile skin applied cases and 26.1% of cases treated with end-to-end anastomosis and there was no statistically significant difference between neutrophil, lymphocyte, neutrophil / lymphocyte ratio and average stricture segment length between recurrent and non-recurrent cases (p > 0.005). Conclusions: We consider that neutrophil, lymphocyte counts and their ratio prior to urethroplasty and the technique performed are not parameters that can be used to predict stricture recurrence. Prospective and randomized new trials with larger patient populations are needed to make more accurate judgments about the role of these inflammatory parameters.
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Affiliation(s)
- Ramazan Topaktaş
- Department of Urology, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Ürkmez
- Department of Urology, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Emre Tokuç
- Department of Urology, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Akyüz
- Department of Urology, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Musab A Kutluhan
- Department of Urology, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
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Aydemir H, Sağlam HS, Köse O, Erdik A, Halis F, Gökçe A. The effect of recurrent direct vision internal urethrotomy for short anterior urethral strictures on the disease course and the predictors of treatment failure. Can Urol Assoc J 2019; 13:E366-E370. [PMID: 30763233 DOI: 10.5489/cuaj.5754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The objective of this study was to investigate the disease course after direct vision internal urethrotomy (DVIU) for short anterior urethral strictures. METHODS We retrospectively analyzed 94 patients who underwent DVIU of the anterior urethra. Patients' age, etiology, length and localization of the strictures, total number of DVIU procedures, comorbidities, and other data were evaluated. RESULTS The mean age of the patients was 67.2 years. The mean followup duration was 27.1 months. Recurrence was observed in 27.6% of the patients. Recurrence had occurred in these patients at a mean of 12 months. Both the comorbidity score (rs=0.395; p<0.001) and the urinary tract infection (UTI) score (rs=0.492; p<0.001) had significant correlation with the recurrence. In patients with recurrent urethral stricture, as the number of DVIU increased, the length and number of the urethral stricture increased as well. Patients with recurrence had a single stricture in the first DVIU procedure, while the number of strictures increased to a mean of two in the second and/or third DVIU procedures. CONCLUSION DVIU is an effective treatment method in short anterior urethral stricture if it has been applied as a first intervention. However, if the stricture recurs, repeated DVIU application appears to be a negative predictive factor. The presence of perioperative treated UTI, smoking, and total number of comorbidities were negative predictive factors for the recurrence of urethral stricture. The disadvantages of our study is that it is retrospective, it includes a low number of patients, and the followup period is short.
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Affiliation(s)
- Hüseyin Aydemir
- Department of Urology, Sakarya University, Education and Research Hospital, Sakarya, Turkey
| | - Hasan Salih Sağlam
- Department of Urology, Sakarya University, Education and Research Hospital, Sakarya, Turkey
| | - Osman Köse
- Department of Urology, Sakarya University, Education and Research Hospital, Sakarya, Turkey
| | - Anıl Erdik
- Department of Urology, Sakarya University, Education and Research Hospital, Sakarya, Turkey
| | - Fikret Halis
- Department of Urology, Sakarya University, Education and Research Hospital, Sakarya, Turkey
| | - Ahmet Gökçe
- Department of Urology, Sakarya University, Education and Research Hospital, Sakarya, Turkey
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Rourke K. Editorial Comment. J Urol 2018. [DOI: 10.1016/j.juro.2018.04.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Keith Rourke
- Division of Urology, Department of Surgery, University of Alberta, Northern Alberta Urology Centre, Edmonton, Alberta, Canada
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