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González-Espinosa C, Castro-Nuñez P, Averbeck MA, Gomez R, Castaño-Botero JC, Aparicio A, Moreno-Palacios J. Diagnosis and treatment of urethral stricture in men with neurogenic lower urinary tract dysfunction: A systematic review. Neurourol Urodyn 2022; 41:1248-1257. [PMID: 35686544 DOI: 10.1002/nau.24982] [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: 01/21/2022] [Revised: 05/16/2022] [Accepted: 05/24/2022] [Indexed: 11/05/2022]
Abstract
AIM To summarize available data focused on diagnosis and management of urethral stricture in men with neurogenic lower urinary tract dysfunction by a systematic review of the literature. MATERIALS AND METHODS A systematic review of the literature was carried out through an extensive electronic database search performed in PubMed/MEDLINE and Scopus databases for full texts, and International Continence Society, American Urology Association, and European Association of Urology abstracts for citations related to urethral structure. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. RESULTS A total of 316 articles were identified, 48 of which were selected for this review. Different strategies are currently being used for the management of urethral strictures, such as clean intermittent catheterization (CIC) which reduces stricture by up to 68%; direct vision internal urethrotomy which shows lower rates of renarrowing; urethroplasty which shows a success rate up to 70%; urinary diversion is the treatment of choice when reconstruction is not possible. CONCLUSIONS Further studies are needed in this population because of the heterogeneity of the outcomes and the lack of a standardized definition and classification of this population.
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Affiliation(s)
- Carlos González-Espinosa
- Urology Department, UMAE, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", IMSS, Ciudad de México, México
| | - Patricia Castro-Nuñez
- Urology Department, UMAE, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", IMSS, Ciudad de México, México
| | - Marcio A Averbeck
- Neuro-Urology Department, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Reynaldo Gomez
- Urology Department-Hospital del Trabajador, Santiago, Chile
| | | | | | - Jorge Moreno-Palacios
- Urology Department, UMAE, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", IMSS, Ciudad de México, México
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Rodríguez ES, Serna LA, Agressot WA. Uretroplastia bulbar con injerto: Una actualización sobre las diferentes técnicas quirúrgicas. Rev Urol 2021. [DOI: 10.1055/s-0039-1696697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ResumenEn pacientes con estrechez uretral bulbar de una longitud mayor a 2 cm, que no sean candidatos a otras técnicas, se realiza uretroplastia con injerto. Actualmente se emplean diversas técnicas, cada una con ventajas y desventajas propias.Describir las ventajas y desventajas de las técnicas quirúrgicas empleadas actualmente en la uretroplastia con injerto, así como sus tasas de éxito.Se hizo una búsqueda en PubMed, ClinicalKey y en ScienceDirect, utilizando las palabras claves: “urethral stricture,” “urethroplasty,” “oral graft” y “flap.” Se utilizaron los estudios más relevantes, tanto originales como revisiones sistemáticas y meta-análisis, en inglés y en español.Las diferentes técnicas quirúrgicas ofrecen ventajas y desventajas teóricas frente a las otras, aunque las tasas de éxito en todas es cercana al 90%, sin ser una francamente superior frente a las demás.La elección de la técnica quirúrgica a realizar depende de las preferencias y experiencia del cirujano, dado que la tasa de éxito para todas las técnicas es similar.
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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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Sapienza LG, Ning MS, Carvalho EDF, Spratt D, Calsavara VF, McLaughlin PW, Gomes MJL, Baiocchi G, Abu-Isa E. Efficacy and Incontinence Rates After Urethroplasty for Radiation-induced Urethral Stenosis: A Systematic Review and Meta-analysis. Urology 2021; 152:109-116. [PMID: 33631205 DOI: 10.1016/j.urology.2021.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/30/2020] [Accepted: 02/05/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To estimate the efficacy of urethroplasty and rates of de novo stress urinary incontinence (SUI) in the specific setting of radiation-induced urethral stenosis. METHODS A systematic search of databases (PubMed and EMBASE) was performed between 1980-2019 (CRD42020144845). Inclusion criteria were: (1) prior pelvic radiotherapy; (2) surgical urethroplasty; (3) rates of successful treatment and/or SUI development and (4) total case number provided. The pooled summary of stenosis resolution rate and SUI were calculated using the random-effects model weighted by the inverse variance. Accessory analyses were performed by reconstructive technique and type of RT. RESULTS Ninety-six studies were identified, of which 8 retrospective studies met inclusion criteria, comprising 256 patients. The proportion of cases treated with external beam RT (EBRT), brachytherapy (BT), or combination (EBRT+BT) were 52%, 33%, and 15%, respectively, of studies that specified modality. Most strictures involved the bulbomembranous region (n = 212; 83%). Sixty-one percent of cases (n = 157) entailed primary anastomosis, while the remainder underwent augmentation reconstruction (graft or flap). The mean follow-up time after urethroplasty varied from 10 to 50.5 months. The pooled stenosis resolution rate was 80% (95% CI: 74%-86%). There were no significant associations between stenosis resolution rate and reconstructive technique (rho=0.20, P = .74) or RT modality (rho=-0.31, P = .53). Fifty-three cases developed subsequent SUI, with a pooled complication rate of 19% (95% CI: 10%-31%). CONCLUSIONS Urethroplasty after radiation-induced urethral stenosis is effective for 80% of cases, independent of prior RT modality or urethroplasty technique; however, 1 out of every 5 patients develops SUI post-procedure.
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Affiliation(s)
| | - Matthew Stephen Ning
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Daniel Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | | | | | - Maria Jose Leite Gomes
- Department of Radiation Oncology, Hospital Federal dos Servidores do Estado (HFSE-RJ), Rio de Janeiro, RJ, Brazil
| | - Glauco Baiocchi
- Department of Gynecologic Oncology, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Eyad Abu-Isa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
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Development and Validation of A Male Anterior Urethral Stricture Classification System. Urology 2020; 143:241-247. [DOI: 10.1016/j.urology.2020.03.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 01/20/2023]
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Al-Hakeem Y, Chung A, Chung B, Tse V. Substitution urethroplasty for the treatment of male urethral stricture: Outcomes in an Australian center. Low Urin Tract Symptoms 2019; 11:211-216. [PMID: 31064032 DOI: 10.1111/luts.12265] [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: 09/13/2018] [Revised: 03/08/2019] [Accepted: 03/24/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study evaluated the outcomes of urethroplasty performed in male patients by a single surgeon. METHODS A retrospective review of male patients who underwent substitution urethroplasty by a single surgeon was performed. Baseline and perioperative parameters were recorded. Follow-up involved a pericatheter urethrogram at 3 weeks, a flow study at 8 weeks, and cystoscopic calibration within 6 to 12 months. Patient satisfaction was assessed using the Patient Global Impression of Improvement questionnaire. Primary outcome was functional success, as defined by no need for further intervention. Secondary outcomes were complications, patient satisfaction, and factors associated with stricture recurrence. RESULTS Sixty male patients were included; two were lost to follow-up. Median patient age was 47 years (range 17-83 years). Mean stricture length was 5 cm (range 1.5-18 cm). Urethroplasty was performed using buccal mucosa graft repair in 53 patients (92%), flap repair in three patients (5%), and a combination of both techniques in two patients (3%). All complications were Clavien-Dindo Grade I to III, recorded in 20 patients (34%). At a mean follow-up of 50 months (range 12-124 months), functional success was evident in 90% of patients. Cystoscopic calibration at 6 to 18 months was performed in 28 patients (49%). Most patients (93%) reported a better quality of life after the procedure. Oral complications were low grade and uncommon (6%). Stricture recurrence was not related to age, stricture length, or etiology (all P > 0.05). CONCLUSIONS Substitution urethroplasty has a high success rate, durable response, and high patient satisfaction. Standardization of surveillance protocol after urethroplasty is recommended.
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Affiliation(s)
- Yasser Al-Hakeem
- Department of Urology, Macquarie University Hospital, Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
| | - Amanda Chung
- Department of Urology, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Belinda Chung
- General Practitioner, Myhealth Medical Centre, Sydney, New South Wales, Australia
| | - Vincent Tse
- Department of Urology, Concord Repatriation General Hospital, University of Sydney, Sydney, New South Wales, Australia
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Scarberry K, Kiechle JE. EDITORIAL COMMENT. Urology 2019; 125:238. [PMID: 30798972 DOI: 10.1016/j.urology.2018.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/14/2018] [Accepted: 05/17/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Kyle Scarberry
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH
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Vetterlein MW, Stahlberg J, Zumstein V, Engel O, Dahlem R, Fisch M, Rosenbaum CM, Kluth LA. The Impact of Surgical Sequence on Stricture Recurrence after Anterior 1-Stage Buccal Mucosal Graft Urethroplasty: Comparative Effectiveness of Initial, Repeat and Secondary Procedures. J Urol 2018; 200:1308-1314. [DOI: 10.1016/j.juro.2018.06.067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Malte W. Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Justus Stahlberg
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Valentin Zumstein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, Cantonal Medical Center St. Gallen, St. Gallen, Switzerland
| | - 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
| | - Clemens M. Rosenbaum
- 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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