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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. [PMID: 38874432 DOI: 10.1111/iju.15512] [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: 04/18/2024] [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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Fendereski K, McCormick BJ, Keihani S, Hagedorn JC, Voelzke B, Selph JP, Figler BD, Johnsen NV, da Silva RD, Broghammer JA, Gupta S, Miller B, Burks FN, Eswara JR, Osterberg EC, Carney KJ, Erickson BA, Gretzer MB, Chung PH, Harris CR, Murphy GP, Rusilko P, Anderson KT, Shridharani A, Benson CR, Alwaal A, Blaschko SD, Breyer BN, McKibben M, IanSchwartz, Simhan J, Vanni AJ, Moses RA, Myers JB. The Outcomes of Pelvic Fracture Urethral Injuries Stratified by Urethral Injury Severity: A Prospective Multi-institutional Genitourinary Trauma Study (MiGUTS). Urology 2022; 170:197-202. [PMID: 36152870 DOI: 10.1016/j.urology.2022.09.006] [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: 05/06/2022] [Revised: 09/05/2022] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To determine patient outcomes across a range of pelvic fracture urethral injury (PFUI) severity. PFUI is a devastating consequence of a pelvic fracture. No study has stratified PFUI outcomes based on severity of the urethral distraction injury. METHODS Adult male patients with blunt-trauma-related PFUI were followed prospectively for a minimum of six months at 27 US medical centers from 2015-2020. Patients underwent retrograde cystourethroscopy and retrograde urethrography to determine injury severity and were categorized into three groups: (1) major urethral distraction, (2) minor urethral distraction, and (3) partial urethral injury. Major distraction vs. minor distraction was determined by the ability to pass a cystoscope retrograde into the bladder. Simple statistics summarized differences between groups. Multi-variable analyses determined odds ratios for obstruction and urethroplasty controlling for urethral injury type, age, and Injury Severity Score. RESULTS There were 99 patients included, 72(72%) patients had major, 13(13%) had minor, and 14(14%) had partial urethral injuries. The rate of urethral obstruction differed in patients with major (95.8%), minor (84.6%), and partial injuries (50%) (p< 0.001). Urethroplasty was performed in 90% of major, 66.7% of minor, and 35.7% of partial injuries (p<0.001). CONCLUSIONS In PFUI, a spectrum of severity exists that influences outcomes. While major and minor distraction injuries are associated with a higher risk of developing urethral obstruction and need for urethroplasty, up to 50% of partial PFUI will result in obstruction, and as such need to be closely followed.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jairam R Eswara
- St. Elizabeth's Medical Center, Boston University School of Medicine.
| | | | | | | | | | - Paul H Chung
- Sidney Kimmel Medical College of Thomas Jefferson University.
| | | | | | | | | | | | | | | | | | | | | | - IanSchwartz
- Division of Urology Hennepin County Medical Center, University of Minnesota.
| | | | | | | | - Jeremy B Myers
- University of Utah, Department of Surgery (Primary Investigator).
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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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Daneshvar M, Simhan J, Blakely S, Angulo JC, Lucas J, Hunter C, Chee J, Alvarado DL, Perez EAR, Madala A, de Benito JJ, Martins F, Felício J, Rusilko P, Flynn BJ, Nikolavsky D. Transurethral ventral buccal mucosa graft inlay for treatment of distal urethral strictures: international multi-institutional experience. World J Urol 2020; 38:2601-2607. [PMID: 31894369 DOI: 10.1007/s00345-019-03061-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/15/2019] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To critically evaluate a multi-institutional patient cohort undergoing single-stage distal urethral repair using a novel transurethral buccal mucosa graft inlay urethroplasty technique (TBMGI). METHODS A retrospective multi-institutional review of consecutive patients with fossa navicularis (FN) strictures treated with a single-stage TBMGI technique at 12 institutions from March 2014-March 2018 was performed. Patient demographics, stricture characteristics, clinical and patient-reported outcomes were analyzed. The primary outcomes were stricture recurrence and complications. Secondary outcomes were change in maximum urinary flow rate (Qmax), PVR, and changes in IPSS, SHIM and global response assessment (GRA) questionnaire responses. Descriptive statistical analysis was used for evaluation of outcomes. RESULTS Sixty-eight men met inclusion criteria. Median age and stricture length were 60 years (IQR 48-69) and 2 cm (IQR 2-3), respectively. Most common stricture etiology was lichen sclerosus (34%). Median operative time and EBL were 72 min (IQR 50-120) and 20 mL (IQR 10-43), respectively. Fifty-seven men completed ≥ 12-month follow-up. At a median follow-up of 17 months (IQR 13-22), 54 patients (95%) remained stricture-free. Median Qmax improved from 5 to 18 mL/s (p < 0.0001), PVR 76-21 mL (p < 0.0001), and IPSS 15-5 (p < 0.0001); IPSS-QOL score: 5-1 (p < 0.0001). SHIM score did not significantly change following repair (median 22-21 p = 0.85). On GRA assessment, a majority of men reported "marked" (64%) or "moderate" (28%) overall improvement. No patient developed fistula, glanular dehiscence, graft necrosis or chordee. CONCLUSIONS This novel minimally invasive transurethral urethroplasty technique is feasible and has demonstrated generalizable outcomes in a multi-institutional cohort with varying etiologies.
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Affiliation(s)
- Michael Daneshvar
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, 13078, USA
| | - Jay Simhan
- Department of Urology, Einstein Healthcare Network/Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Stephen Blakely
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, 13078, USA
| | - Javier C Angulo
- Departamento Clinico, Facultad de Ciencias Biomedicas Y de La Salud, Universidad Europea de Madrid, Laureate Universitites, Madrid, Spain.,Urologia Hospital Universitario de Getafe, Madrid, Spain
| | - Jacob Lucas
- Department of Urology, Einstein Healthcare Network/Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | - João Felício
- University of Lisbon, Hospital Santa Maria, Lisbon, Portugal
| | | | | | - Dmitriy Nikolavsky
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, 13078, USA.
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5
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Baradaran N, Fergus KB, Moses RA, Patel DP, Gaither TW, Voelzke BB, Smith TG, Erickson BA, Elliott SP, Alsikafi NF, Vanni AJ, Buckley J, Zhao LC, Myers JB, Breyer BN. Clinical significance of cystoscopic urethral stricture recurrence after anterior urethroplasty: a multi-institution analysis from Trauma and Urologic Reconstructive Network of Surgeons (TURNS). World J Urol 2019; 37:2763-2768. [PMID: 30712091 DOI: 10.1007/s00345-019-02653-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/24/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess the functional Queryoutcome of patients with cystoscopic recurrence of stricture post-urethroplasty and to evaluate the role of cystoscopy as initial screening tool to predict future failure. METHODS Cases with cystoscopy data after anterior urethroplasty in a multi-institutional database were retrospectively studied. Based on cystoscopic evaluation, performed within 3-months post-urethroplasty, patients were categorized as small-caliber (SC) stricture recurrence: stricture unable to be passed by standard cystoscope, large-caliber (LC) stricture accommodating a cystoscope, and no recurrence. We assessed the cumulative probability of intervention and the quality of life scores in association with cystoscopic recurrence 1-year post-urethroplasty. Patients with history of hypospadias, perineal urethrostomy, urethral fistula, and meatal pathology were excluded. RESULTS From a total of 2630 men in our cohort, 1054 patients met the inclusion criteria: normal (n = 740), LC recurrence (n = 178), and SC recurrence (n = 136) based on the first cystoscopic evaluation performed at median 111 days postoperatively. Median follow-up was 350 days (IQR 121-617) after urethroplasty. Cystoscopic recurrence was significantly associated with secondary interventions (2.7%, 6.2%, 33.8% in normal, LC, and SC groups, respectively). Quality of life variables were not statistically significantly different among the three study groups. CONCLUSIONS Many patients with cystoscopic recurrence do not need an intervention after initial urethroplasty. Despite good negative predictive value, cystoscopy alone may be a poor screening test for stricture recurrence defined by patient symptoms and need for secondary interventions.
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Affiliation(s)
- Nima Baradaran
- Department of Urology, Ohio State University, Columbus, OH, USA
| | - Kirkpatrick B Fergus
- Department of Urology, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA
| | - Rachel A Moses
- Division of Urology, University of Utah, Salt Lake City, UT, USA
| | - Darshan P Patel
- Division of Urology, University of Utah, Salt Lake City, UT, USA
| | - Thomas W Gaither
- Department of Urology, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA
| | - Bryan B Voelzke
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Thomas G Smith
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | | | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | | | - Alex J Vanni
- Department of Urology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Jill Buckley
- Department of Urology, University of California San Diego, San Diego, CA, USA
| | - Lee C Zhao
- New York University School of Medicine, New York, NY, USA
| | - Jeremy B Myers
- Division of Urology, University of Utah, Salt Lake City, UT, USA
| | - Benjamin N Breyer
- Department of Urology, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA.
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Rapamycin Inhibits the Growth and Collagen Production of Fibroblasts Derived from Human Urethral Scar Tissue. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7851327. [PMID: 29850566 PMCID: PMC5932518 DOI: 10.1155/2018/7851327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/15/2018] [Accepted: 03/01/2018] [Indexed: 11/17/2022]
Abstract
Rapamycin can inhibit fibroblast proliferation, collagen accumulation, and urethral stricture in rabbits. Transforming growth factor-beta-1 (TGF-β1) signaling, with downstream recruitment of Smad2, is known to promote fibrosis. This in vitro study examined the effects of rapamycin on fibroblasts derived from human urethral scar tissue (FHUS) and investigated the possible mechanism with respect to regulation of TGF-β1 signaling. FHUS were cultured from urethral scar tissues collected from four patients with urethral stricture. The cells were exposed to different concentrations of rapamycin (0, 10, 20, 40, 80, or 160 ng/ml) for 24 or 48 hours. Cell growth was assessed by the MTT assay. Collagen content was measured based on hydroxyproline levels. The mRNA expressions of Smad2, eIF-4E, and alpha-1 chains of collagen types I and III (Col1α1 and Col3α1) were determined by semiquantitative reverse-transcription PCR. The protein expressions of Smad2, phospho-Smad2, and eIF-4E were evaluated by western blot. Rapamycin caused a concentration-dependent inhibition of FHUS growth at 24 and 48 hours (P < 0.01). Rapamycin decreased total collagen content (P < 0.01), collagen content per 105 cells (P < 0.05), and mRNA expressions of Col1α1 and Col3α1 (P < 0.05) in a concentration-dependent manner. Rapamycin elicited concentration-dependent reductions in the mRNA (P < 0.05) and protein (P < 0.01) expressions of Smad2 and eIF-4E. The two highest concentrations of rapamycin also enhanced phospho-Smad2 levels (P < 0.01). In conclusion, the present study confirmed that rapamycin may reduce the growth and collagen production of FHUS, possibly through inhibition of TGF-β1 signaling.
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7
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Lucas ET, Koff WJ, Rosito TE, Berger M, Bortolini T, Neto BS. Assessment of satisfaction and Quality of Life using self -reported questionnaires after urethroplasty: a prospective analysis. Int Braz J Urol 2017; 43:304-310. [PMID: 28128915 PMCID: PMC5433370 DOI: 10.1590/s1677-5538.ibju.2016.0207] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 01/15/2017] [Indexed: 01/08/2023] Open
Abstract
Objectives To assess patient satisfaction and quality of life after urethroplasty using two different self-reported outcome measures and to compare it with objective clinical data. Materials and Methods We prospectively collected data from 35 consecutive patients who underwent urethroplasty from January 2013 to September 2014. Patient demographics, International Prostate Symptom Score (IPSS), quality of life score, urethral stricture surgery patient-reported outcome measure (USS-PROM), maximum flow rate (Qmax) and post-void residual urine were collected before, two and eight months after surgery. Failure occurred when any postoperative instrumentation was performed. General estimation equation was used to compare the results and linear regression analysis to correlate both questionnaires with objective data. Results Mean age was 61 years. Urethroplasties were equally divided between anastomotic and buccal mucosa grafts and 19 patients (59.3%) had a previous urethral procedure. Overall success rate was 87.5%. IPSS improved from a mean 19 at baseline to 5.32 at 8 months (p <0.001). The mean USS-PROM score also improved from 13.21 preoperatively to 3.36 after surgery (p <0.001) and 84.3% of patients were satisfied or very satisfied with surgical results. Mean Qmax increased from 4.64mL/s to 11mL/s (p <0.001). Strong negative correlation was found respectively between flow rate and USS-PROM (r=-0.531, p <0.001) and with IPSS (r=-0.512, p <0.001). Conclusions Significant improvements in urinary symptoms and in quality of life are expected after urethroplasty and they are correlated with objective measures.
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Affiliation(s)
- Eduardo Terra Lucas
- Departamento de Urologia, Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Brasil
| | - Walter José Koff
- Departamento de Urologia, Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Brasil
| | - Tiago Elias Rosito
- Departamento de Urologia, Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Brasil
| | - Milton Berger
- Departamento de Urologia, Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Brasil
| | - Tiago Bortolini
- Departamento de Urologia, Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Brasil
| | - Brasil Silva Neto
- Departamento de Urologia, Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Brasil
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Bayne DB, Gaither TW, Awad MA, Murphy GP, Osterberg EC, Breyer BN. Guidelines of guidelines: a review of urethral stricture evaluation, management, and follow-up. Transl Androl Urol 2017; 6:288-294. [PMID: 28540238 PMCID: PMC5422698 DOI: 10.21037/tau.2017.03.55] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/21/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Our objective is to report a comparative review of recently released guidelines for the evaluation, management, and follow-up of urethral stricture disease. METHODS This is an analysis of the American Urologic Association (AUA) and Société Internationale d'Urologie (SIU) guidelines on urethral stricture. Strength of recommendations is stratified according to letter grade that corresponds to the level of evidence provided by the literature. RESULTS Although few, the discrepancies between the recommendations offered by the two guidelines can be best explained by varying interpretations of the literature and available evidence on urethral strictures. When comparing the AUA guidelines and the SIU guidelines on urethral stricture, there are very few discrepancies. Perhaps the most notable difference is in the use of repeat DVIU or urethral dilation after an initial failed attempt. SIU guidelines state that there are instances where repeat DVIU or urethral dilation can be indicated, and they give a range of time at which stricture recurrence post procedure mandates an urethroplasty (less than 3 to 6 months). The AUA guidelines definitively state that repeat endoscopic procedures should not be offered as an alternative to urethroplasty, and they do not mention time of stricture recurrence as a factor. SIU guidelines allow for management of urethral stricture with indwelling urethral stenting. CONCLUSIONS Overall there is a need for more high quality research in the work up, management, and follow up care of urethral stricture.
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Affiliation(s)
- David B. Bayne
- Department of Urology, University of California, San Francisco, USA
| | | | - Mohannad A. Awad
- Department of Urology, University of California, San Francisco, USA
| | | | | | - Benjamin N. Breyer
- Department of Urology, University of California, San Francisco, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
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9
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Önol FF, Bindayi A, Tahra A, Basibuyuk I, Onol SY. Turkish validation of the urethral stricture surgery specific patient-reported outcome measure (USS-PROM) with supplemental assessment of erectile function and morbidity due to oral graft harvesting. Neurourol Urodyn 2017; 36:2089-2095. [PMID: 28220592 DOI: 10.1002/nau.23243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 01/12/2017] [Accepted: 01/18/2017] [Indexed: 02/03/2023]
Abstract
AIMS We validated a Turkish language version of the urethral stricture surgery specific patient-reported outcome measure (USS-PROM) in men undergoing anterior urethroplasty. We also investigated changes in erectile function (EF) and quality of life (QoL) due to oral mucosa graft (OMG) harvesting. METHODS The USS-PROM captures lower urinary tract symptoms (LUTS), health related QoL (HRQoL) with EQ-5D visual analogue scale (EQ-VAS). To evaluate EF and OMG morbidity, we used International Index of Erectile Function (IIEF-5) and a self-completed questionnaire, respectively. Psychometric assessment of USS-PROM included test-retest reliability, internal consistency, criterion validity, and responsiveness. Objective evidence for urethroplasty success was demonstrated with fluoroscopic imaging and urethral calibration at post-operative six months. RESULTS Among the 101 men included during study period, 42 had complete pre- and postoperative 6th month data for analysis. The test-retest intraclass correlation was 0.79. Cronbach's α for internal consistency of the LUTS construct was 0.79. There was a significant negative correlation between total LUTS scores and peak flow rates, both preoperatively (r = -0.478) and postoperatively (r = -0.508). Mean baseline EQ-VAS increased from 70 to 84 postoperatively (P < 0.001), indicating improved HRQoL. IIEF scores did not change significantly after urethroplasty. Early and late-term QoL impairment rates due to OMG harvesting were 28.9 and 13.1%, respectively. Three (7.1%) men required endoscopic intervention for recurrence within 6 months. CONCLUSIONS Turkish version of USS-PROM showed comparable psychometric properties with the original version. Complementation of this instrument with additional measures that address sexual function and OMG morbidity provides better QoL assessment for urethral reconstruction.
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Affiliation(s)
| | - Ahmet Bindayi
- Department of Urology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Tahra
- Department of Urology, Umraniye Training and Research Hospital, Istanbul, Turkey
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10
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Osterberg EC, Murphy G, Harris CR, Breyer BN. Cost-effective Strategies for the Management and Treatment of Urethral Stricture Disease. Urol Clin North Am 2016; 44:11-17. [PMID: 27908365 DOI: 10.1016/j.ucl.2016.08.002] [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] [Indexed: 10/20/2022]
Abstract
Following failed endoscopic intervention, the most cost-effective strategy for recurrent urethral stricture disease (USD) is urethroplasty. Inpatient hospital costs associated with urethroplasty are driven by patient comorbidities and postoperative complications. Symptom-based surveillance for USD recurrence will reduce unnecessary diagnostic procedures and cost.
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Affiliation(s)
- E Charles Osterberg
- Department of Urology, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA 94143, USA
| | - Gregory Murphy
- Department of Urology, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA 94143, USA
| | - Catherine R Harris
- Department of Urology, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA 94143, USA; Department of Urology, Stanford University, 300, Palo Alto, CA 94304, USA
| | - Benjamin N Breyer
- Department of Urology, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA 94143, USA.
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11
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Harris CR, Osterberg EC, Sanford T, Alwaal A, Gaither TW, McAninch JW, McCulloch CE, Breyer BN. National Variation in Urethroplasty Cost and Predictors of Extreme Cost: A Cost Analysis With Policy Implications. Urology 2016; 94:246-54. [PMID: 27107626 DOI: 10.1016/j.urology.2016.03.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine which factors are associated with higher costs of urethroplasty procedure and whether these factors have been increasing over time. Identification of determinants of extreme costs may help reduce cost while maintaining quality. MATERIALS AND METHODS We conducted a retrospective analysis using the 2001-2010 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS). The HCUP-NIS captures hospital charges which we converted to cost using the HCUP cost-to-charge ratio. Log cost linear regression with sensitivity analysis was used to determine variables associated with increased costs. Extreme cost was defined as the top 20th percentile of expenditure, analyzed with logistic regression, and expressed as odds ratios (OR). RESULTS A total of 2298 urethroplasties were recorded in NIS over the study period. The median (interquartile range) calculated cost was $7321 ($5677-$10,000). Patients with multiple comorbid conditions were associated with extreme costs [OR 1.56, 95% confidence interval (CI) 1.19-2.04, P = .02] compared with patients with no comorbid disease. Inpatient complications raised the odds of extreme costs (OR 3.2, CI 2.14-4.75, P <.001). Graft urethroplasties were associated with extreme costs (OR 1.78, 95% CI 1.2-2.64, P = .005). Variations in patient age, race, hospital region, bed size, teaching status, payor type, and volume of urethroplasty cases were not associated with extremes of cost. CONCLUSION Cost variation for perioperative inpatient urethroplasty procedures is dependent on preoperative patient comorbidities, postoperative complications, and surgical complexity related to graft usage. Procedural cost and cost variation are critical for understanding which aspects of care have the greatest impact on cost.
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Affiliation(s)
- Catherine R Harris
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - E Charles Osterberg
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Thomas Sanford
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Amjad Alwaal
- Department of Urology, King Abdul Aziz University, Jeddah, Saudi Arabia
| | - Thomas W Gaither
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Jack W McAninch
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Benjamin N Breyer
- Department of Urology, University of California, San Francisco, San Francisco, CA.
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Alwaal A, Sanford TH, Harris CR, Osterberg EC, McAninch JW, Breyer BN. Urethral Stricture Score is Associated with Anterior Urethroplasty Complexity and Outcome. J Urol 2016; 195:1817-21. [PMID: 26804753 DOI: 10.1016/j.juro.2015.12.100] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 01/20/2023]
Abstract
PURPOSE Several surgical techniques are available to treat anterior urethral stricture. The choice of surgical technique largely depends on the severity of stricture disease. The U-score (urethral stricture score) is based on urethral stricture characteristics, namely length (1 to 3 points), number (1 or 2 points), location (1 or 2 points) and etiology (1 or 2 points), which are tallied to provide a total score of 4 to 9 points. Our aim was to identify whether the U-score system is predictive of the surgical complexity and outcome of anterior urethroplasty. MATERIALS AND METHODS We retrospectively reviewed the records of all patients who underwent anterior urethroplasty from 2002 to 2012 by examining our prospectively collected urethroplasty database. We calculated the U-score and looked for an association with surgical complexity, recurrent stricture and time to recurrence. We defined recurrent stricture as the need for a secondary procedure. RESULTS There were 341 patients who underwent low complexity urethroplasty (anastomotic, buccal mucosal graft and augmented anterior urethroplasty) with a mean U-score of 4.7 while 48 underwent high complexity urethroplasty (double buccal mucosal graft, flap and graft/flap combination) with a mean score of 6.9. Higher U-score was predictive of higher surgical complexity (p <0.001). U-score was also significantly associated with recurrence. There was a consistent increase in the risk of recurrence with each additional U-score point. However, there was no association of U-score with time to recurrence. CONCLUSIONS We confirmed the validity of U-score to predict the complexity of surgery for anterior urethral strictures. For the first time to our knowledge we report an association between higher U-score and anterior urethroplasty outcome. The U-score could be used to risk stratify patients and help with perioperative counseling.
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Affiliation(s)
- Amjad Alwaal
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Urology, University of California-San Francisco, San Francisco, California.
| | - Thomas H Sanford
- Department of Urology, University of California-San Francisco, San Francisco, California
| | - Catherine R Harris
- Department of Urology, University of California-San Francisco, San Francisco, California
| | - E Charles Osterberg
- Department of Urology, University of California-San Francisco, San Francisco, California
| | - Jack W McAninch
- Department of Urology, University of California-San Francisco, San Francisco, California
| | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, California
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Peterson AC. Editorial comment. Urology 2015; 85:1199. [PMID: 25819625 DOI: 10.1016/j.urology.2014.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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