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Ma YC, Lin L, Luo Z, Jin T. Smoking is an independent risk factor for stricture recurrence after the urethroplasty: a systematic review and meta-analysis. Int Braz J Urol 2022; 49:8-23. [PMID: 36512452 PMCID: PMC9881806 DOI: 10.1590/s1677-5538.ibju.2022.0244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/15/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To clarify the association between smoking and stricture recurrence after urethroplasty. MATERIALS AND METHODS Pubmed, Web of Science, Embase, and Cochrane databases were searched with keywords: "urethroplasty," "buccal mucosa graft urethroplasty," "oral mucosa graft urethroplasty," "excision and primary anastomosis urethroplasty," "urethral stricture recurrence" until July 1, 2022. Inclusion and exclusion criteria were based on PICOS principles. The quality of included studies was assessed by Newcastle-Ottawa Scale (N.O.S.) system. Hazard ratio (H.R.), odds ratio (OR), and relative risk (RR) with 95% confidence interval (CI) were extracted or re-calculated from included studies. Meta-analysis was performed with Stata 15.0 based on univariate and multivariate data separately. Sensitivity analysis was performed to test the stability of the meta-analysis. I2 was calculated to evaluate heterogeneity. Publication biases were assessed by Egger's and Begg's tests. Funnel plots of univariate analysis and multivariate analysis were also offered. RESULTS Twenty one studies with 6791 patients were involved in this meta-analysis. The analysis results of the two stages were consistent. In the univariate meta-analysis stage, 18 studies with 5811 patients were pooled, and the result indicated that smoking might promote stricture recurrence (RR=1.32, P=0.001). Based on the adjusted estimate, 11 studies with 3176 patients were pooled in the multivariate meta-analysis stage, and the result indicated that smoking might promote stricture recurrence (RR=1.35, P=0.049). There was no significant heterogeneity in both the univariate and multivariate stages. CONCLUSION Our study demonstrates that smoking may prompt stricture recurrence after the urethroplasty. Quitting smoking may be a good option for patients undergoing urethroplasty surgery.
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Affiliation(s)
- Yu-cheng Ma
- Sichuan UniversityWest China HospitalInstitute of UrologyChengduSichuanChinaDepartment of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China;
| | - Lede Lin
- Sichuan UniversityWest China HospitalInstitute of UrologyChengduSichuanChinaDepartment of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China;
| | - Zhumei Luo
- Third People's Hospital of ChengduDepartment of OncologySichuanChinaDepartment of Oncology, the Third People's Hospital of Chengdu, Sichuan, China
| | - Tao Jin
- Sichuan UniversityWest China HospitalInstitute of UrologyChengduSichuanChinaDepartment of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China;,Correspondence address: Tao Jin, MD, Department of Urology, Institute of Urology Laboratory of Reconstructive Urology, West China Hospital, Sichuan University, Chengdu, 610041, China. E-mail:
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Awad SMT, Ahmed MAM, Abdalla YMO, Ahmed MEIM, Gismalla MDA. Buccal mucosal graft urethroplasty for anterior urethral stricture, experience from a low-income country. BMC Urol 2021; 21:171. [PMID: 34876087 PMCID: PMC8653536 DOI: 10.1186/s12894-021-00918-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background/purpose This study was conducted to present our experience in urethral mucosal graft urethroplasty to repair urethral stricture, as the first experience in our context. Methods This is a prospective hospital-based study that had been designed to review management outcomes of buccal mucosal graft urethroplasty for anterior urethral stricture from January 2017 to January 2019.
Results The total number of involved patients was 60. The success rate was found to be 90% (n = 54), while 6 (10%) had a recurrence of stricture. Pain and pain combined bleeding from internal suture lines were the only early complication encountered in 50 (83.3%) and 2 (3.3%) patients, respectively. late complications occurred as follows 14 (23.3%) patients had UTI, 12 (20%) had wound infections, 8 (13.3%) had changes in ejaculation, and decrease in intensity of orgasm, and 6 (10%) had erectile dysfunction. One of the long-term complications was graft diverticulum in one case and was treated conservatively (in ventral on lay BMG).
Conclusion Improvement of the service in limited resources countries like Sudan and was reflected in the excellent outcome of BMG urethroplasty as treatment of anterior urethral stricture (success rate 90%).
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Affiliation(s)
- Sami Mahjoub Taha Awad
- Department of Surgery, Faculty of Medicine, University of Gezira, Wad Medani, Gezira State, Sudan. .,Department of Urology, Gezira Hospital for Kidney Disease and Surgery, Wad Medani, Gezira State, Sudan.
| | - Musab Abdalla M Ahmed
- Department of Urology, Gezira Hospital for Kidney Disease and Surgery, Wad Medani, Gezira State, Sudan.,Sudan Medical Specialization Board, Khartoum, Sudan
| | | | - Mohammed El Imam M Ahmed
- Department of Surgery, Faculty of Medicine, University of Gezira, Wad Medani, Gezira State, Sudan.,Department of Urology, Gezira Hospital for Kidney Disease and Surgery, Wad Medani, Gezira State, Sudan
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Madec FX, Karsenty G, Yiou R, Robert G, Huyghe E, Boillot B, Marcelli F, Journel NM. [Which management for anterior urethral stricture in male? 2021 guidelines from the uro-genital reconstruction urologist group (GURU) under the aegis of CAMS-AFU (Committee of Andrology and Sexual Medicine of the French Association of Urology)]. Prog Urol 2021; 31:1055-1071. [PMID: 34620544 DOI: 10.1016/j.purol.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/17/2021] [Accepted: 07/08/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this first french guideline is to provide a clinical framework for the diagnosis, treatment and follow-up of anterior urethral strictures. The statements are established by the subgroup working on uro-genital reconstruction surgery (GURU) from the CAMS-AFU (Andrology and Sexual Medicine Committee from the French Association of Urology). MATERIAL AND METHODS These guidelines are adapted from the Male Urethral Stricture : American Urological Association Guideline 2016, updated by an additional bibliography from January 2016 to December 2019. Twenty-seven main scenarios seen in clinical practice are identified: from diagnosis, to treatment and follow-up. In addition, this guidelines are powered by anatomical diagrams, treatment algorithms, summaries and follow-up tables. RESULTS Anterior urethral strictures are a common condition (0,1 à 1,4 %) in men. The diagnosis is based on a trifecta including an examination with patient reported questionnaires, urethroscopy and retrograde urethrography with voiding cystourethrography. Short meatal stenosis can be treated by dilation or meatotomy, otherwise a urethroplasty can be performed. First line treatment of penile strictures is urethroplasty. Short bulbar strictures (<2cm) may benefit from endourethral treatment (direct visual internal urethrotomy or dilation). In case of recurrence or when the stenosis measures more than 2 cm, a urethroplasty will be proposed. Repeated endourethral treatment management are no longer recommended except in case of palliative option. Urethroplasty is usually done with oral mucosa graft as the primary option, in one or two stages approach depending on the extent of the stenosis and the quality of the tissues. Excision and primary anastomosis or non-transecting techniques are discussed for bulbar urethra strictures. Follow-up by clinical monitoring with urethroscopy, or retrograde urethrography with voiding cystourethrography, is performed at least the first year and then on demand according to symptoms. CONCLUSION Anterior urethral strictures need an open surgical approach and should be treated by urethroplasty in most cases. This statement requires a major paradigm shift in practices. Training urologist through reconstructive surgery is the next challenge in order to meet the demand.
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Affiliation(s)
- F-X Madec
- Service d'urologie, hôpital Foch, 40, rue de Worth, 92150 Suresnes, France.
| | - G Karsenty
- Service d'urologie, hôpitaux universitaires de Marseille Conception, 147, boulevard Baille, 13005 Marseille, France
| | - R Yiou
- Service d'urologie, hôpital Henri-Mondor, CHU Paris est, 51, avenue du Marechal de Lattre de Tassigny, 94010 Créteil Cedex, France
| | - G Robert
- Service d'urologie, CHU de Bordeaux GH Pellegrin, 30000 Bordeaux, France
| | - E Huyghe
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, 1, avenue du Professeur Jean-Poulhès, 31400 Toulouse, France
| | - B Boillot
- Service d'urologie et de la transplantation rénale, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
| | - F Marcelli
- Service d'urologie, CHRU-hopital huriez, rue Michel Polonowski, 59037 Lille, France
| | - N M Journel
- Service d'urologie, Centre Hospitalier Lyon Sud (HCL), chemin du Grand Revoyet, 69310 Pierre Benite, France
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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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5
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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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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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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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Şimşek A, Yenice MG, Şeker KG, Arıkan Y, Çolakoğlu Y, Şam E, Tuğcu V. Evaluation of the results of dorsolateral buccal mucosal augmentation urethroplasty. Turk J Urol 2018; 45:223-229. [PMID: 29975633 DOI: 10.5152/tud.2018.47827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 02/15/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Evaluation of the results of dorsolateral buccal mucosal augmentation urethroplasty in patients with a long- segment urethral strictures. MATERIAL AND METHODS Twenty male patients who underwent urethroplasty in our clinic between November 2015 and January 2017 were evaluated. The outcomes of single-stage dorsolateral buccal mucosal augmentation urethroplasty were retrospectively evaluated. Patients were followed-up at 2nd-3rd weeks, 3rd and 6th months after the operation. RESULTS Mean age of the patients was 59.45±13.6 years. Mean length of the strictures was 4.59±1.99 cm (3-11 cm) and mean length of buccal mucosal graft was 6.8±1.98 cm (5-13 cm). Mean duration of operation was 149.25±47.39 minutes (95-270 min) and mean blood loss was calculated as 165.5±63.05 mL (75-280 mL). The success rate of dorsolateral buccal mucosal augmentation urethroplasty was calculated as 85% after a mean follow-up of 7.38±2.6 months. There were no perioperative or postoperative complications in the urethroplasty region or the mouth except one patient. Three patients who were found to have a decline in the maximum voiding rate in the postoperative 3rd month were included in the dilation program. CONCLUSION Single-stage dorsolateral buccal mucosal augmentation urethroplasty is a surgical option to be used in the treatment of long segment urethral strictures with high success and low complication rates in experienced hands.
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Affiliation(s)
- Abdulmuttalip Şimşek
- Clinic of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Mustafa Gürkan Yenice
- Clinic of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Kamil Gökhan Şeker
- Clinic of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Yusuf Arıkan
- Clinic of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Yunus Çolakoğlu
- Clinic of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Emre Şam
- Clinic of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Volkan Tuğcu
- Clinic of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
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Independent Predictors of Stricture Recurrence Following Urethroplasty for Isolated Bulbar Urethral Strictures. J Urol 2017; 198:1107-1112. [DOI: 10.1016/j.juro.2017.05.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2017] [Indexed: 11/19/2022]
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Horiguchi A. Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: Current topics and reviews. Int J Urol 2017; 24:493-503. [DOI: 10.1111/iju.13356] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/21/2017] [Indexed: 01/27/2023]
Affiliation(s)
- Akio Horiguchi
- Department of Urology; National Defense Medical College; Saitama Japan
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11
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[Analysis of success rates of uretroplasty for adult male bulbar urethral stricture: A systematic review]. Prog Urol 2017; 27:49-57. [PMID: 28117233 DOI: 10.1016/j.purol.2016.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/26/2016] [Accepted: 12/08/2016] [Indexed: 11/24/2022]
Abstract
Male urethral stricture disease is prevalent and has an important impact on quality of life. Direct visual urethrotomy and dilatations have high rates of recurrence. OBJECTIVES The aim of this review of literature was to evaluate the success rates of different techniques of urethroplasty for strictures of the bulbar urethra. METHODS We performed a systematic review of the MEDLINE literature from 2004 to 2015 following the PRISMA's statement recommendations. Key words were: urethroplasty, urethral reconstruction, onlay, graft, urethral stricture. Inclusion criteria were original articles describing the results of urethroplasty for bulbar urethral stricture in an adult male population. A minimum follow-up of 24 months was required. RESULTS From 891 articles of the literature, 20 are studied in this review. Only 3 studies were prospective. The success rate of anastomotic urethroplasty varied from 68.7 to 98.8% for strictures from 1 to 3.5cm, from 60 to 96.9% for augmented urethroplasty performed for strictures from 4.2 to 4.7cm. Substitution urethroplasty with grafts presented from 75 to 89.8% of success for strictures from 2.6 and 4.36cm. Overall, 19/20 studies used buccal mucosal graft. CONCLUSION The success rate of urethroplasty for bulbar urethral stricture is high; the surgical technique should be adapted to the length of the stricture.
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Wessells H. Ventral onlay graft bulbar urethroplasty using buccal mucosa. AFRICAN JOURNAL OF UROLOGY 2016. [DOI: 10.1016/j.afju.2015.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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13
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Primary dorsal buccal mucosa graft urethroplasty for anterior urethral strictures in patients with lichen sclerosus. Int Urol Nephrol 2016; 48:541-5. [PMID: 26754465 DOI: 10.1007/s11255-015-1202-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 12/25/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To report our ongoing experience with dorsal buccal mucosa graft (BMG) urethroplasty for the primary repair of anterior urethral strictures in patients with lichen sclerosus (LS). PATIENTS AND METHODS A total of 32 men with LS underwent BMG urethroplasty from January 2010 to September 2012. In 27 patients, stricture was limited to the penile urethra, while in five patients, both bulbar and penile urethra were involved. In these five patients, the entire anterior urethra was replaced with BMG. In nine (28.1%) younger patients (mean age 38.2 years, range 33-45), with adverse local conditions and significant scarring, two-stage repair was done. The paired t test was performed on preoperative and postoperative Qmax as well as on preoperative and postoperative post-void residual urine volume, and the Fisher exact test was used to assess success between treatment groups. The chi-squared test was used to compare categorical data. RESULTS The overall success rate was 90.6%. Complications occurred in 9.4% of the patients (3 of 32) including hematoma in two patients and fistula in one patient. In this cohort of patients, mean preoperative Qmax was 6.2 ml per second (range 2.6-10.2) versus 18.2 (range 15.8-21.2) postoperatively (at 9 months), which was statistically significant (p < 0.002). Also, mean preoperative post-void residual urine volume was 110 ml (range 75-180) versus 19 ml (range 10-40) postoperatively at 9 months, which was statistically significant (p < 0.004). CONCLUSION Buccal mucosa is the most reliable graft for repairing anterior urethral strictures in patients with LS. Minimal complications are observed, even in cases of long stenosis completely afflicting anterior urethra.
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The Use of Flaps and Grafts in the Treatment of Urethral Stricture Disease. Adv Urol 2015; 2015:979868. [PMID: 26664357 PMCID: PMC4668293 DOI: 10.1155/2015/979868] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 11/04/2015] [Indexed: 01/28/2023] Open
Abstract
The use of various grafts and flaps plays a critical role in the successful surgical management of urethral stricture disease. A thorough comprehension of relevant anatomy and principles of tissue transfer techniques are essential to understanding the appropriate use of grafts or flaps to optimize outcomes. We briefly review these principles and discuss which technique may be best suited for a given anterior urethral stricture, depending on the location and length of the stricture, the presence or absence of an intact corpus spongiosum, and the availability of adequate and healthy penile skin.
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15
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Kovell RC, Terlecki RP. Ventral inlay buccal mucosal graft urethroplasty: a novel surgical technique for the management of urethral stricture disease. Korean J Urol 2015; 56:164-7. [PMID: 25685305 PMCID: PMC4325122 DOI: 10.4111/kju.2015.56.2.164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 12/10/2014] [Indexed: 11/25/2022] Open
Abstract
To describe the novel technique of ventral inlay substitution urethroplasty for the management of male anterior urethral stricture disease. A 58-year-old gentleman with multifocal bulbar stricture disease measuring 7 cm in length was treated using a ventral inlay substitution urethroplasty. A dorsal urethrotomy was created, and the ventral urethral plated was incised. The edges of the urethral plate were mobilized without violation of the ventral corpus spongiosum. A buccal mucosa graft was harvested and affixed as a ventral inlay to augment the caliber of the urethra. The dorsal urethrotomy was closed over a foley catheter. No intraoperative or postoperative complications occurred. Postoperative imaging demonstrated a widely patent urethra. After three years of follow-up, the patient continues to do well with no voiding complaints and low postvoid residuals. Ventral inlay substitution urethroplasty appears to be a safe and feasible technique for the management of bulbar urethral strictures.
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Affiliation(s)
- Robert Caleb Kovell
- Department of Urology, Wake Forest Baptist Medical Center, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Ryan Patrick Terlecki
- Department of Urology, Wake Forest Baptist Medical Center, Wake Forest School of Medicine, Winston Salem, NC, USA
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Abstract
Surgical treatment of long urethral stricture disease remains one of the most challenging problems in urology. In recent years there has been continuous discussion with regard to the etiology, location, length, and management of extensive urethral stricture disease. Various tissues such as genital and extragenital skin, buccal mucosa, lingual mucosa, small intestinal submucosa, and bladder mucosa have been proposed for urethral reconstruction. The most frequent questions pertain to the optimal technique for urethroplasty and the optimal graft for substitution urethroplasty, as judged by both patient satisfaction and outcome success. We review the recent literature with respect to any new information on graft urethroplasty for extensive urethral stricture.
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Affiliation(s)
- Miroslav L Djordjevic
- Department of Urology, School of Medicine, University of Belgrade, Tirsova 10, Belgrade, Serbia, 11000,
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Sharma P, Goel A, Sankhwar SN. Re: Figler et al.: Impact of graft position on failure of single-stage bulbar urethroplasties with buccal mucosa graft. (Urology 2013;82:1166-1170). Urology 2014; 83:512. [PMID: 24468521 DOI: 10.1016/j.urology.2013.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 10/20/2013] [Accepted: 10/21/2013] [Indexed: 10/25/2022]
Affiliation(s)
| | - Apul Goel
- King George Medical University, Lucknow, UP, India
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