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Chen C, Qin J, Wang C, Huang H, Li H, Wen Z, Liu Y, Yang X. Comparison of laser versus cold knife visual internal urethrotomy in the treatment of urethral stricture (stricture length <2 cm): A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e37524. [PMID: 38701298 PMCID: PMC11062742 DOI: 10.1097/md.0000000000037524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/15/2024] [Indexed: 05/05/2024] Open
Abstract
PURPOSE There is still controversy regarding the safety and efficacy of cold knife visual internal urethrotomy and laser incisions for the treatment of urethral stricture. This study aims to compare the results of postoperative long-term and short-term maximum urinary flow rates (Qmax), surgical time, postoperative complications, and 1-year recurrence rates between the cold knife and laser surgery. METHODS We searched databases including Embase, PubMed, Cochrane, and Clinical Trials.gov to identify relevant literature published in English up to September 2023. We used Stata to compare various parameters. This study is registered in PROSPERO (CRD42023471634). Nine comparative experiments were conducted, involving a total of 659 participants. RESULTS The laser group showed significantly better results compared to the cold knife group in terms of postoperative 12-month maximum urinary flow rate (mean differences [MD] 2.131; 95% [1.015, 3.249], P < .0001), postoperative bleeding (RR 0.277, 95% [0.079, 0.977], P = .046), and 1-year recurrence rate (RR 0.667, 95% [0.456, 0.976], P = .037). However, there were no significant differences in postoperative 6-month and 3-month Qmax, surgical time, urethral leakage complications, overall complications, and Visual Analog Scale (VAS) scores. CONCLUSION The current study results suggest that laser urethral incision has greater advantages in the long-term (12 months), 1-year recurrence rate, and bleeding complications compared to cold knife urethral incision in the treatment of urethral stricture (<2 cm). Therefore, laser urethral incision may be a better choice for patients with urethral stricture.
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Affiliation(s)
- CaiXia Chen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jiao Qin
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - ChongJian Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - HaoTian Huang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - HongYuan Li
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Zhi Wen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yang Liu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - XueSong Yang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Wu MH, Liu JX, Zhang YF, Cao ZB, Song HC, Yang BY, Shi MJ, Du Y, Song J, Li XH. Bladder neck contracture following transurethral surgery of prostate: a retrospective single-center study. World J Urol 2024; 42:14. [PMID: 38189837 DOI: 10.1007/s00345-023-04715-2] [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: 05/24/2023] [Accepted: 09/06/2023] [Indexed: 01/09/2024] Open
Abstract
PURPOSE Bladder neck contracture (BNC) is a rare but intolerant complication after transurethral surgery of prostate. The present study aims to investigate the incidence and risk factors of BNC in patients diagnosed benign prostate hyperplasia (BPH) and following transurethral resection or enucleation of the prostate (TURP/TUEP). METHODS This retrospective study included 1008 BPH individuals who underwent transurethral surgery of the prostate between January 2017 and January 2022. Patients' demographics, medical comorbidities, urologic characteristics, perioperative parameters, and the presence of BNC were documented. Univariate and multivariate analyses were conducted to identify the risk factors. RESULTS A total of 2% (20/1008) BPH patients developed BNC postoperatively and the median occurring time was 5.8 months. Particularly, the incidences of BNC were 4.7% and 1.3% in patients underwent Bipolar-TURP and TUEP respectively. Preoperative urinary tract infection (UTI), elevated PSA, smaller prostate volume (PV), bladder diverticulum (BD), and B-TURP were significantly associated with BNC in the univariate analysis. Further multivariate logistic regression demonstrated preoperative UTI (OR 4.04, 95% CI 2.25 to 17.42, p < 0.001), BD (OR 7.40, 95% CI 1.83 to 31.66, p < 0.001), and B-TURP (OR 3.97, 95% CI 1.55 to 10.18, p = 0.004) as independent risk factors. All BNC patients were treated with transurethral incision of the bladder neck (TUIBN) combined with local multisite injection of betamethasone. During a median follow-up of 35.8 months, 35% (7/20) of BNC patients recurred at a median time of 1.8 months. CONCLUSION BNC was a low-frequency complication following transurethral surgery of prostate. Preoperative UTI, BD, and B-TURP were likely independent risk factors of BNC. TUIBN combined with local multisite injection of betamethasone may be promising choice for BNC treatment.
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Affiliation(s)
- Meng-Hua Wu
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Urology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jia-Xin Liu
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Urology, Beijing Fuxing Hospital, Capital Medical University, Beijing, China
| | - Yu-Feng Zhang
- School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Zi-Bing Cao
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Urology, Beijing Miyun District Traditional Chinese Medicine Hospital, Beijing, China
| | - Hong-Chen Song
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Bo-Yu Yang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ming-Jun Shi
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yuan Du
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jian Song
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Xuan-Hao Li
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Klemm J, Dahlem R, Kluth LA, Rosenbaum CM, Shariat SF, Fisch M, Vetterlein MW. [Evaluation and management of urethral strictures-guideline summary 2024 : Part 2-posterior urethra]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:15-24. [PMID: 38057615 DOI: 10.1007/s00120-023-02241-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 12/08/2023]
Abstract
In light of recently published international guidelines concerning the diagnosis, treatment, and aftercare of urethral strictures and stenoses, the objective of this study was to synthesize an overview of guideline recommendations provided by the American Urological Association (AUA, 2023), the Société Internationale d'Urologie (SIU, 2010), and the European Association of Urology (EAU, 2023). The recommendations offered by these three associations, as well as the guidelines addressing urethral trauma from the EAU, AUA, and the Urological Society of India (USI), were assessed in terms of their guidance on posterior urethral stenosis. On the whole, the recommendations from the various guidelines exhibit considerable alignment. However, SIU and EAU place a stronger emphasis on the role of repeated endoscopic treatment compared to AUA. The preferred approach for managing radiation-induced bulbomembranous stenosis remains a subject of debate. Furthermore, endoscopic treatments enhanced with intralesional therapies may potentially serve as a significant treatment modality for addressing even fully obliterated stenoses.
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Affiliation(s)
- Jakob Klemm
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
- Comprehensive Cancer Center, Medizinische Universität Wien, Universitätsklinik für Urologie, Wien, Österreich
| | - Roland Dahlem
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Luis A Kluth
- Klinik für Urologie, Universitätsklinikum Frankfurt am Main, Frankfurt am Main, Deutschland
| | | | - Shahrokh F Shariat
- Comprehensive Cancer Center, Medizinische Universität Wien, Universitätsklinik für Urologie, Wien, Österreich
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordanien
- Karl Landsteiner Institut für Urologie und Andrologie, Wien, Österreich
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prag, Tschechien
| | - Margit Fisch
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Malte W Vetterlein
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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Abbasi B, Shaw NM, Lui JL, Li KD, Sudhakar A, Low P, Hakam N, Nabavizadeh B, Breyer BN. Posterior urethral stenosis: a comparative review of the guidelines. World J Urol 2022; 40:2591-2600. [PMID: 36018366 PMCID: PMC9617833 DOI: 10.1007/s00345-022-04131-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/08/2022] [Indexed: 02/01/2023] Open
Abstract
PURPOSE We aimed to provide a thorough comparative review of the available guidelines on the diagnosis, management, and follow-up for patients with posterior urethral stenosis by the American Urologic Association (2016), Société Internationale d'Urologie (2010), and European Urologic Association (2022). METHODS The AUA, SIU, and EAU guidelines were evaluated for recommendations on the diagnosis, evaluation, and treatment of posterior urethral stenosis. We also included the EAU and AUA urologic trauma guidelines for the trauma-related stenosis. The level or strength of recommendations is included in case of disparity between the guidelines. RESULTS The three guidelines align considerably in recommendations provided for the diagnosis, management, and follow-up of patients with posterior urethral stenosis. SIU and EAU emphasize the role of repeat endoscopic treatment in guidelines compared to AUA. CONCLUSION The preferred method to repair bulbo-membranous stricture/stenosis following radiation therapy remains an area of active interest, focusing on continence preservation. Additionally, there may be a role for advanced endoscopic treatments with or without adjunct therapies to manage even obliterated stenoses.
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Affiliation(s)
- Behzad Abbasi
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Nathan M Shaw
- Department of Urology, University of California San Francisco, San Francisco, USA
- Department of Urology, MedStar Georgetown University Hospital, Washington DC, USA
| | - Jason L Lui
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Architha Sudhakar
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Patrick Low
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Behnam Nabavizadeh
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, USA.
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA.
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Transurethral Incisions for Bladder Neck Contracture: Comparable Results without Intralesional Injections. J Clin Med 2022; 11:jcm11154355. [PMID: 35955973 PMCID: PMC9369124 DOI: 10.3390/jcm11154355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
To present our 12-year experience using an endoscopic approach to manage bladder neck contracture (BNC) without adjunctive intralesional agents and compare it to published series not incorporating them, we retrospectively reviewed 123 patients treated for BNC from 2008 to 2020. All underwent 24 Fr balloon dilation followed by transurethral incision of BNC (TUIBNC) with deep incisions at 3 and 9 o’clock using a Collins knife without the use of intralesional injections. Success was defined as a patent bladder neck and 16 Fr cystoscope passage into the bladder two months later. Most with recurrent BNC underwent repeat TUIBNC. Success rates, demographics, and BNC characteristics were analyzed. The etiology of BNC in our cohort was most commonly radical prostatectomy with or without radiation (36/123, 29.3%, 40/123, 32.5%). Some had BNC treatment prior to referral (30/123, 24.4%). At 12-month follow-up, bladder neck patency was observed in 101/123 (82.1%) after one TUIBNC. An additional 15 patients (116/123, 94.3%) had success after two TUIBNCs. On univariate and multivariate analyses, ≥2 endoscopic treatments was the only factor associated with failure. TUIBNC via balloon dilation and deep bilateral incisions without the use of adjunctive intralesional injections has a high patency rate. History of two or more prior endoscopic procedures is associated with failure.
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Pranata FH, Hidayatullah F, Kloping YP, Rahman ZA, Rizaldi F, Soebadi DM. The efficacy and safety of mitomycin C intra urethral injection to prevent recurrent urethral stricture: A systematic review and meta-analysis. Ann Med Surg (Lond) 2022; 77:103576. [PMID: 35638056 PMCID: PMC9142380 DOI: 10.1016/j.amsu.2022.103576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 10/24/2022] Open
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Hacker EC, Maganty A, Pere MM, Rusilko PJ. Outcomes of Vesicourethral Anastomotic Stenosis and Bladder Neck Contracture with Direct Visual Internal Urethrotomy with Mitomycin-C After Prostate Cancer Treatment. Urology 2022; 165:331-335. [DOI: 10.1016/j.urology.2022.01.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 12/22/2022]
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8
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Abbosov S, Sorokin N, Shomarufov A, Kadrev A, Nuriddinov KU, Mukhtarov S, Akilov F, Kamalov A. Bladder neck contracture as a complication of prostate surgery: Alternative treatment methods and prospects (literature review). UROLOGICAL SCIENCE 2022. [DOI: 10.4103/uros.uros_127_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Martins FE, Holm HV, Lumen N. Devastated Bladder Outlet in Pelvic Cancer Survivors: Issues on Surgical Reconstruction and Quality of Life. J Clin Med 2021; 10:4920. [PMID: 34768438 PMCID: PMC8584541 DOI: 10.3390/jcm10214920] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
Bladder outlet obstruction following treatment of pelvic cancer, predominantly prostate cancer, occurs in 1-8% of patients. The high incidence of prostate cancer combined with the long-life expectancy after treatment has increased concerns with cancer survivorship care. However, despite increased oncological cure rates, these adverse events do occur, compromising patients' quality of life. Non-traumatic obstruction of the posterior urethra and bladder neck include membranous and prostatic urethral stenosis and bladder neck stenosis (also known as contracture). The devastated bladder outlet can result from benign conditions, such as neurogenic dysfunction, trauma, iatrogenic causes, or more frequently from complications of oncologic treatment, such as prostate, bladder and rectum. Most posterior urethral stenoses may respond to endoluminal treatments such as dilatation, direct vision internal urethrotomy, and occasionally urethral stents. Although surgical reconstruction offers the best chance of durable success, these reconstructive options are fraught with severe complications and, therefore, are far from being ideal. In patients with prior RT, failed reconstruction, densely fibrotic and/or necrotic and calcified posterior urethra, refractory incontinence or severe comorbidities, reconstruction may not be either feasible or recommended. In these cases, urinary diversion with or without cystectomy is usually required. This review aims to discuss the diagnostic evaluation and treatment options for patients with bladder outlet obstruction with a special emphasis on patients unsuitable for reconstruction of the posterior urethra and requiring urinary diversion.
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Affiliation(s)
- Francisco E. Martins
- Department of Urology, School of Medicine, University of Lisbon, Hospital Santa Maria/CHULN, 1649-035 Lisbon, Portugal
| | | | - Nicolaas Lumen
- Department of Urology, Ghent University Hospital, 9000 Ghent, Belgium;
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Transurethral Incision with Transverse Mucosal Realignment for the Management of Bladder Neck Contracture and Vesicourethral Anastomotic Stenosis. Urology 2021; 152:102-108. [PMID: 33766717 DOI: 10.1016/j.urology.2021.02.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess efficacy and safety of a novel cystoscopic technique for definitive repair of bladder neck contracture (BNC) and vesicourethral anastomotic stenosis (VUAS). METHODS A retrospective review of patients who underwent a transurethral incision with transverse mucosal realignment between July 2019 and December 2020 by a single surgeon was completed. This is novel procedure of incising a scar cystoscopically and using a laparoscopic suturing device transurethrally to bring healthy bladder mucosa across the defect, like a YV plasty. Patients were only included if they had ≥4 months follow-up. Surgical success was defined as ability to pass a 17 French flexible cystoscope through the previously stenotic segment at 4 month follow up. RESULTS Nineteen patients with a median follow-up of 6 months were included in this analysis. Etiology of posterior urethral stenosis was 53% from VUAS and 47% from BNC, with 32% of patients having prior pelvic radiation. Success was achieved in 89% of patients after 1 procedure and 100% of patients achieved success after a second procedure. There was no de novo incontinence or major complications. CONCLUSION Transurethral incision with transverse mucosal realignment for VUAS and BNC has a high success rate after only 1 procedure. This is the first reported series of an endoscopic Y-V plasty type repair for BNC and VUAS. Longer term follow up to ensure durability and reporting from other institutions will be needed to establish reproducibility.
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Waterloos M, Martins F, Verla W, Kluth LA, Lumen N. Current Management of Membranous Urethral Strictures Due to Radiation. Front Surg 2021; 8:635060. [PMID: 33748181 PMCID: PMC7969877 DOI: 10.3389/fsurg.2021.635060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/01/2021] [Indexed: 11/13/2022] Open
Abstract
Radiotherapy is a frequently used treatment for prostate cancer. It does not only causes the intended damage to cancer cells, but also affects healthy surrounding tissue. As a result radiation-induced urethral strictures occur in 2.2% of prostate cancer patients. Management of urethral strictures is challenging due to the presence of poor vascularized tissue for reconstruction and the proximity of the sphincter, which can impair the functional outcome. This review provides a literature overview of risk factors, diagnostics and management of radiation-induced urethral strictures.
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Affiliation(s)
- Marjan Waterloos
- Department of Urology, AZ Maria Middelares Ghent, Ghent, Belgium
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - Francisco Martins
- Department of Urology, University of Lisbon School of Medicine, Lisbon, Portugal
| | - Wesley Verla
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - Luis Alex Kluth
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Nicolaas Lumen
- Department of Urology, University Hospital Ghent, Ghent, Belgium
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Yao HH, Sengupta S, Chee J. Incorporating intra-lesional injection of mitomycin C in the management algorithm for bladder neck contractures and vesicourethral anastomotic strictures. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820961901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This study aims to describe the experience of a single-surgeon series with the use of intra-lesional mitomycin C (MMC) in the treatment of bladder neck contracture (BNC) and vesicourethral anastomotic stenosis (VUAS). Patients and methods: From July 2014 to January 2019, patients who underwent bladder neck incision (BNI) and intra-lesional MMC injection performed by a single surgeon were included in this retrospective study. Clinico-pathological data were extracted from medical records. The primary outcome was recurrence rate following BNI and MMC injection. Results: Ten patients were included in the study. The median age was 68 years. The cause of BNC or VUAS was secondary to radical prostatectomy in eight patients and to endoscopic prostatectomy in two patients. The median follow-up was 16.4 months. The success rate was 70% after first treatment with BNI and MMC injection, and 80% after repeated treatment. There were no serious adverse events or complications related to the MMC injection. Conclusion: BNI and intra-lesional MMC injection is a minimally invasive treatment for refractory bladder neck contractures with a good success rate and minimal risk of side effects when a low dose of MMC is used. Further prospective multicentre study is warranted. Level of evidence: Level 4.
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Affiliation(s)
- Henry H Yao
- Department of Urology, Western Health, Melbourne, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Shomik Sengupta
- Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Justin Chee
- Department of Urology, Western Health, Melbourne, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Australia
- MURAC Health, Melbourne, Australia
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Rozanski AT, Zhang LT, Holst DD, Copacino SA, Vanni AJ, Buckley JC. The Effect of Radiation Therapy on the Efficacy of Internal Urethrotomy With Intralesional Mitomycin C for Recurrent Vesicourethral Anastomotic Stenoses and Bladder Neck Contractures: A Multi-Institutional Experience. Urology 2020; 147:294-298. [PMID: 33035561 DOI: 10.1016/j.urology.2020.09.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/20/2020] [Accepted: 09/24/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the efficacy, effect of radiotherapy, and complications of direct visual internal urethrotomy (DVIU) and intralesional mitomycin C (MMC) for recurrent bladder neck contracture/vesicourethral anastomotic stenosis (BNC/VUAS). METHODS Patients who underwent DVIU with intralesional MMC for recurrent BNC/VUAS between 2007 and 2019 at 2 institutions were included. Cold knife incisions were performed in a reproducible fashion followed by injection of 0.3-0.4 mg/mL MMC at each incision site. Those with evidence of complete urethral obliteration, stenosis of the entire posterior urethra, or <3 months follow-up were excluded. Success was defined as the ability to pass a 17-French cystoscope postoperatively without the need for catheterization or additional procedures. RESULTS Eighty-six patients were analyzed over a median follow-up of 21.1 months. Around 91% had at least 1 prior DVIU, 56% had at least 1 prior dilation, and 44% presented with an indwelling catheter or performed intermittent catheterization. Success was achieved in 65% after 1 procedure, an additional 18% after 2 procedures, and another 7% after 3 or more procedures (90% overall success rate). Nonradiated patients showed a higher overall success rate compared to radiated patients (94% vs 76%, P = 0.04). Of the 9 cystoscopic failures, 5 were asymptomatic and pursued observation. Only 2 (5%) patients with a history of catheterization required this postoperatively. Two patients underwent subsequent urinary diversion surgery. No long-term complications were seen. CONCLUSION DVIU with low-dose MMC remains a safe and effective BNC/VUAS treatment. A patent bladder neck was achieved in >90% of nonradiated patients and >75% of radiated patients.
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Affiliation(s)
| | | | - Daniel D Holst
- University of California San Diego School of Medicine, San Diego, CA
| | | | - Alex J Vanni
- Lahey Hospital and Medical Center, Burlington, MA
| | - Jill C Buckley
- University of California San Diego School of Medicine, San Diego, CA
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Azab SS. Comparative study between Amplatz renal dilator vs visual internal urethrotomy (cold knife) for the treatment of male urethral stricture. Scand J Urol 2020; 54:431-437. [PMID: 32723114 DOI: 10.1080/21681805.2020.1798504] [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: 10/23/2022]
Abstract
AIM The study aimed to assess and compare urethral stricture (US) management outcomes, efficiency, and complications, treated by either Amplatz renal dilator or visual internal urethrotomy (VIU). PATIENTS AND METHODS This prospective comparative study was carried out on 88 male patients with stricture urethra. All patients have performed a physical examination, ascending and micturition urethrography, urodynamic, and pelvic ultrasound. The patients were randomized divided into group 1 (Amplatz group) 44 patients treated with Amplatz dilator, and group 2 (VIU group) 44 patients treated with a cold knife. Patients were followed up at 15 days,3,6, and 12 months after the procedure. RESULT The mean age was 41.2 (22-73) years. The mean stricture length in group 1 and group 2 was 1.01 ± 0.40 and 1.04 ± 0.30, respectively (p = 0.421). The average IPSS score at baseline for group 1 and group 2 was 21.2 and 21.9 points, respectively. During the 12 months follow-up, IPSS improved, with average scores of 16.1 and 17.3 for group 1 and group 2, respectively (p > 0.05). The mean values of (Q max) between group 1 and group 2 at baseline, day 15, day 90 and 180 days showed no significant difference but at 12 months, (Q max) showed a higher significant difference in group 1 than group 2 (p = 0.003). The post-void residual (PVR) displayed a significant decline in both groups from baseline. After 1 year, PVR showed that group 2 was a little higher than group 1 (no significance) compared to baseline The procedures were found effective without recurrence in all patients (both groups) during the 12 months (Q max > 15m/s). However, group 2 reported (11.4%) intra-operative bleeding, and (6.8%) extravasations. CONCLUSION The guided urethral dilation and internal urethrotomy are safe, short time procedures, and offer satisfactory results with the advance to VIUD in Qmax at 12 months. No recurrence was documented in both groups after 12 months. VIU reported 18% intraoperative complication.
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Affiliation(s)
- Sherif Salah Azab
- Urology Department, Faculty of Medicine, October 6 University, Cairo, Egypt
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15
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Vesicourethral Anastomotic Stenosis after Prostate Cancer Treatment. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00539-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Irdam GA, Wahyudi I, Andy A. Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis. F1000Res 2019; 8:1390. [PMID: 36726448 PMCID: PMC9843087 DOI: 10.12688/f1000research.19704.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2020] [Indexed: 02/04/2023] Open
Abstract
Background and Aim Mitomycin-C is a potent agent that plays an important role in tissue healing and scar formation. This study aims to investigate the efficacy of Mitomycin-C in treating anterior urethral stricture after internal urethrotomy. Methods Studies evaluating efficacy of mitomycin-c for anterior urethral stricture post urethrotomy were searched using Pubmed, Scopus, Sciencedirect, MEDLINE, and Cochrane Reviews as directory databases. The search was done in March 15th 2020. Terms being used in the searching process were "mitomycin-c" or "mitomycin", "urethral stricture", "urethral stenosis", "internal urethrotomy", "optical urethrotomy" and its synonyms. Every study with the design of retrospective or prospective clinical study being done in human subject was included. Study appraisal conducted in accordance to Oxford University Center for Evidence-Based Medicine. The conclusion of each study was summarized and the calculation of random effects from every study was conducted in meta-analysis. Random effects model is chosen because small number of studies and quite different. Results Three studies involving 311patients were included in this review, all of them reported less recurrence of in patients treated with mitomycin-c post urethrotomy (p<0.001). Risk ratio of all studies was 0.41 with 95% confidence interval (0.25-0.68). Conclusion Mitomycin-C has the potential of efficacy in treating anterior urethral stricture post internal urethrotomy. Relatively few numbers of studies may impact in the strength of this review and further studies need to be done.
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Affiliation(s)
- Gampo Alam Irdam
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Irfan Wahyudi
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Andy Andy
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
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Irdam GA, Wahyudi I, Andy A. Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis. F1000Res 2019; 8:1390. [PMID: 36726448 PMCID: PMC9843087 DOI: 10.12688/f1000research.19704.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2019] [Indexed: 09/19/2023] Open
Abstract
Background: Mitomycin-C is an agent that plays an important role in the tissue healing process and scar formation. This study aims to investigate the efficacy of mitomycin-C in treating anterior urethral stricture following internal urethrotomy. Methods: Studies evaluating the efficacy of mitomycin-c for anterior urethral stricture post urethrotomy were searched using PubMed, Scopus, ScienceDirect, EBSCOHost, Cochrane Reviews, and OVID as directory databases. Terms used in the searching process were "mitomycin-c" or "mitomycin", "urethral stricture", "urethral stenosis", "internal urethrotomy", "optical urethrotomy" and its synonyms. Every randomized controlled trial study conducted in human subjects was included. Study appraisals were conducted in accordance with Oxford University Center for Evidence-Based Medicine guidelines. The conclusion of each study was summarized and the calculation of fixed effect from every study was conducted in meta-analysis. Results: Included in this study were three studies involving 231 patients. All of them reported less recurrence of in patients treated with mitomycin-c post urethrotomy (p<0.001). The fixed risk ratio of all studies was 0.32 with 95% confidence interval (0.19-0.54). All studies also reported less stricture length after treatment with mitomycin-c, but there were not statistical differences between with or without treatment group. Conclusion: Mitomycin-C has efficacy in treating anterior urethral stricture after internal urethrotomy. However, the inclusion of relatively few studies may affect the strength of this review and further studies need to be done.
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Affiliation(s)
- Gampo Alam Irdam
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Irfan Wahyudi
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Andy Andy
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
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Irdam GA, Wahyudi I, Andy A. Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis. F1000Res 2019; 8:1390. [PMID: 36726448 PMCID: PMC9843087 DOI: 10.12688/f1000research.19704.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 09/19/2023] Open
Abstract
Background and Aim Mitomycin-C is a potent agent that plays an important role in tissue healing and scar formation. This study aims to investigate the efficacy of Mitomycin-C in treating anterior urethral stricture after internal urethrotomy. Methods Studies evaluating efficacy of mitomycin-c for anterior urethral stricture post urethrotomy were searched using Pubmed, Scopus, Sciencedirect, MEDLINE, and Cochrane Reviews as directory databases. The search was done in March 15th 2020. Terms being used in the searching process were "mitomycin-c" or "mitomycin", "urethral stricture", "urethral stenosis", "internal urethrotomy", "optical urethrotomy" and its synonyms. Every study with the design of retrospective or prospective clinical study being done in human subject was included. Study appraisal conducted in accordance to Oxford University Center for Evidence-Based Medicine. The conclusion of each study was summarized and the calculation of random effect from every study was conducted in meta-analysis. Random effect model is chosen because small number of studies and quite different. Results Three studies involving 311patients were included in this review, all of them reported less recurrence of in patients treated with mitomycin-c post urethrotomy (p<0.001). Risk ratio of all studies was 0.41 with 95% confidence interval (0.25-0.68). Conclusion Mitomycin-C has the potential of efficacy in treating anterior urethral stricture post internal urethrotomy. Relatively few numbers of studies may impact in the strength of this review and further studies need to be done.
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Affiliation(s)
- Gampo Alam Irdam
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Irfan Wahyudi
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Andy Andy
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
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A Comprehensive Review Emphasizing Anatomy, Etiology, Diagnosis, and Treatment of Male Urethral Stricture Disease. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9046430. [PMID: 31139658 PMCID: PMC6500724 DOI: 10.1155/2019/9046430] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/31/2019] [Indexed: 12/21/2022]
Abstract
To date, urethral stricture disease in men, though relatively common, represents an often poorly managed condition. Therefore, this article is dedicated to encompassing the currently existing data upon anatomy, etiology, symptoms, diagnosis, and treatment of the disease, based on more than 40 years of experience at a tertiary referral center and a PubMed literature review enclosing publications until September 2018.
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Campos-Juanatey F, Portillo Martín JA. [Management of vesicourethral anastomotic stenosis after radical prostatectomy]. Rev Int Androl 2018; 17:110-118. [PMID: 30237067 DOI: 10.1016/j.androl.2018.05.003] [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: 01/15/2018] [Revised: 05/13/2018] [Accepted: 05/20/2018] [Indexed: 11/24/2022]
Abstract
Vesicourethral anastomotic stenosis is a relatively uncommon problem after radical prostatectomy, but it could become recurrent and difficult to treat. Risk factors are known, and they can help to decrease the incidence. When discussing the therapeutic plan, we must consider the stenosis risk, and also the urinary continence after the prostatectomy. Many treatment schedules are proposed, some of them with low available evidence, limited to case series with different number of patient and follow-up length, or reviews on the subject. Endoscopic options are the commonest, obtaining different success rates depending on the incision, resection or vaporization of the tissue. They could also benefit from the use of adjuvant local injections of drugs regulating tissue growth. Recurrent or obliterated cases could require surgical reconstruction using perineal, abdominal or combined approaches, or even suprapubic urinary diversions.
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Affiliation(s)
- Félix Campos-Juanatey
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
| | - José Antonio Portillo Martín
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, España
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Browne BM, Vanni AJ. Management of Urethral Stricture and Bladder Neck Contracture Following Primary and Salvage Treatment of Prostate Cancer. Curr Urol Rep 2018; 18:76. [PMID: 28776126 DOI: 10.1007/s11934-017-0729-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This article discusses the incidence, evaluation, and treatment of bladder outlet obstruction from urethral stricture, vesicourethral anastomotic stricture, and bladder neck contracture following primary and salvage treatment of prostate cancer. RECENT FINDINGS Rates of stenosis after prostate cancer treatment appear similar across all primary treatment modalities including radical prostatectomy, radiation therapy, cryoablation, and high-intensity focused ultrasound in contemporary series. Urethral dilation and urethrotomy continue to report moderate patency rates. Urethroplasty achieves high patency rates even for long strictures, but more extensive reconstruction increases the risk of postoperative urinary incontinence. Recent AUA guidelines on urethral strictures provide new recommendations for management of these patients. All treatment options for prostate cancer carry a risk for bladder outlet obstruction, and intervention is often necessary to relieve long-lasting morbidity. Careful preoperative evaluation should be completed to assess location and extent of the stricture in order to choose optimal therapy. Endoscopic treatments, open reconstruction, and urinary diversion all play a role in relief of stenosis depending on stricture length, location, characteristics, and patient comorbidities.
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Affiliation(s)
- Brendan Michael Browne
- Department of Urology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Alex J Vanni
- Department of Urology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA.
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Endoscopic Management of Urethral Stricture: Review and Practice Algorithm for Management of Male Urethral Stricture Disease. Curr Urol Rep 2018; 19:19. [PMID: 29479640 DOI: 10.1007/s11934-018-0771-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE OF REVIEW Male urethral stricture disease is characterized by the formation of scar tissue within the urethra resulting in lower urinary tract symptoms, infection, and potentially kidney dysfunction. There is significant variability in clinical practice for the treatment of urethral stricture. We sought to summarize the known data on endoscopic management of urethral stricture disease as part of this larger edition on urethral stricture management. RECENT FINDINGS Older studies quoted high rates of success with endoscopic management of urethral stricture, including repeated DVIU. There is now evidence to support a limited role of endoscopic intervention in the management of urethral stricture, and especially strong evidence that repeated endoscopic procedures are not effective. There is poor evidence to support the long-term efficacy of endoscopic urethral stricture management. Furthermore, novel advances in adjunctive therapies have not yet demonstrated durable patency. We discuss the limited role of endoscopic management and suggest an algorithm for its use in stricture management.
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Mitomycin-C and urethral dilatation: A safe, effective, and minimally invasive procedure for recurrent vesicourethral anastomotic stenoses. Urol Oncol 2017; 35:672.e15-672.e19. [DOI: 10.1016/j.urolonc.2017.07.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/30/2017] [Accepted: 07/31/2017] [Indexed: 11/17/2022]
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25
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26
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Salvage Surgery after Failure of Urethroplasty for Stricture Disease. J Urol 2015; 194:1192-3. [DOI: 10.1016/j.juro.2015.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 11/15/2022]
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Treatment of Urethral Strictures from Irradiation and Other Nonsurgical Forms of Pelvic Cancer Treatment. Adv Urol 2015; 2015:476390. [PMID: 26494994 PMCID: PMC4606407 DOI: 10.1155/2015/476390] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/13/2015] [Indexed: 12/12/2022] Open
Abstract
Radiation therapy (RT), external beam radiation therapy (EBRT), brachytherapy (BT), photon beam therapy (PBT), high intensity focused ultrasound (HIFU), and cryotherapy are noninvasive treatment options for pelvic malignancies and prostate cancer. Though effective in treating cancer, urethral stricture disease is an underrecognized and poorly reported sequela of these treatment modalities. Studies estimate the incidence of stricture from BT to be 1.8%, EBRT 1.7%, combined EBRT and BT 5.2%, and cryotherapy 2.5%. Radiation effects on the genitourinary system can manifest early or months to years after treatment with the onus being on the clinician to investigate and rule-out stricture disease as an underlying etiology for lower urinary tract symptoms. Obliterative endarteritis resulting in ischemia and fibrosis of the irradiated tissue complicates treatment strategies, which include urethral dilation, direct-vision internal urethrotomy (DVIU), urethral stents, and urethroplasty. Failure rates for dilation and DVIU are exceedingly high with several studies indicating that urethroplasty is the most definitive and durable treatment modality for patients with radiation-induced stricture disease. However, a detailed discussion should be offered regarding development or worsening of incontinence after treatment with urethroplasty. Further studies are required to assess the nature and treatment of cryotherapy and HIFU-induced strictures.
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Editorial Comment. Urology 2015; 85:1499. [PMID: 26099893 DOI: 10.1016/j.urology.2015.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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