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Moring N, Juneau A, Feustel PJ, Anele UA, Inouye BM. Current urethroplasty trends in recent GURS fellowship graduates. World J Urol 2024; 42:443. [PMID: 39046552 DOI: 10.1007/s00345-024-05153-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 06/27/2024] [Indexed: 07/25/2024] Open
Abstract
PURPOSE To assess self-reported urethroplasty success rates and outcomes of recent GURS fellowship graduates and compare these data to the large body of published urethroplasty outcomes literature. METHODS A voluntary survey was distributed from June 1 to June 30, 2023 to GURS fellowship graduates of the last 5 years. Participants were surveyed on time since graduation, operative volume, outcomes, and quoted success rates for urethroplasty. Data were then analyzed using descriptive statistics, binary logistic regression, and correlative analyses. RESULTS We received responses from 49/101 (48.5%) GURS graduates. Five-year post-graduates were most represented (44.7%). The majority (52.2%) consider 81-90% of urethroplasty successful, without significant change with years in practice. Approximately 65% quoted excision and primary anastomosis (EPA) as > 90% successful. Over half of the respondents had performed > 60 urethroplasties since graduation. Only 31.3% of respondents reported re-intervening in > 10% of their postop patients, with a weak positive correlation between years in practice and need for re-intervention (p 0.01). Nearly 20% of respondents referred patients to an external reconstructionist. CONCLUSION Increased length of time in practice does not result in higher reported urethroplasty success rates, counseling on successful outcomes, or rates of re-intervention and complications. Our survey highlights that the traditionally used success rates for urethroplasty may not be reflective of new graduates and lower volume reconstructive surgeons in their early career.
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Affiliation(s)
- Nikolas Moring
- Department of Urology, Albany Medical Center, 25 Hackett Blvd, Albany, NY, 12208, USA.
| | - Andrea Juneau
- Urology, University of Louisville School of Medicine, Louisville, KY, USA
| | | | - Uzoma A Anele
- Urology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Brian M Inouye
- Department of Urology, Albany Medical Center, 25 Hackett Blvd, Albany, NY, 12208, USA
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Ostrovsky AM, Prebay ZJ, Chung PH. Trends in Male and Female Urethral Endoscopic Management and Urethroplasty Using the TriNetX Database. J Clin Med 2023; 12:jcm12062137. [PMID: 36983140 PMCID: PMC10057331 DOI: 10.3390/jcm12062137] [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: 01/09/2023] [Revised: 02/20/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND How quickly providers adapt to new practice guidelines is not well known. The objective of this study was to evaluate temporal trends in the performance of urethral endoscopic management and urethroplasty surrounding the release of the American Urological Association (AUA) Male Urethral Stricture Guidelines in 2017. We also evaluate in parallel trends in female urethral stricture disease, where AUA guidelines are not present. We hypothesized that the ratio of urethroplasty versus urethral endoscopic management in both males and females is increasing and that guidelines do not result in immediate changes in management trends. METHODS Endoscopic management and urethroplasty data were collected from the TriNetX database on adult males and females five years before (starting 1 January 2012) and after (ending 31 December 2022) the 2017 AUA guidelines. Cohorts were built using Current Procedural Terminology (CPT) codes and grouped into urethral endoscopic management (Males: CPT 52275, 52281, 52282, 53600, 53601, 53620, 53621; Females: CPT 52270, 53660, 53661, 53665) or urethroplasty (Males: CPT 53000, 53010, 53400, 53410, 53415, 53420, 53450, 53460; Females: CPT 53430). Data on patient age, race, and geographic distribution were also collected. RESULTS In total, 27,623 (Males: 25,039; Females: 2584) endoscopic managements and 11,771 (Males: 11,105; Females: 666) urethroplasties were reviewed across 51 Health Care Organizations. The mean age of endoscopic management and urethroplasty patients was 67.1 and 55.7, respectively (p < 0.01). The urethroplasty-to-endoscopic management ratio decreased for males between 2012 and 2013 and then steadily increased until 2017. The ratio steadily increased for females from 2012 to 2017. The urethroplasty-to-endoscopic management ratio showed a slight decline from 2017 to 2020 across both males and females before rising again through 2022 to a study high (Males: 0.62; Females: 0.63). Regional differences were identified, with the West having the highest urethroplasty-to-endoscopic management ratios for both males and females, the Northeast having the lowest urethroplasty-to-endoscopic management ratio for males, and the Midwest having the lowest ratio for females. CONCLUSIONS The utilization of urethroplasty for males and females is increasing. An immediate benefit on post-guideline urethroplasty rates was not observed, and the utilization of female urethroplasty increased despite the absence of AUA guidelines. These illustrate that the impact of guideline dissemination takes time and supports the need for continued provider outreach and education on urethral stricture disease and management.
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Affiliation(s)
- Adam M Ostrovsky
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Zachary J Prebay
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Paul H Chung
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Gallo N, Natali ML, Curci C, Picerno A, Gallone A, Vulpi M, Vitarelli A, Ditonno P, Cascione M, Sallustio F, Rinaldi R, Sannino A, Salvatore L. Analysis of the Physico-Chemical, Mechanical and Biological Properties of Crosslinked Type-I Collagen from Horse Tendon: Towards the Development of Ideal Scaffolding Material for Urethral Regeneration. MATERIALS (BASEL, SWITZERLAND) 2021; 14:7648. [PMID: 34947245 PMCID: PMC8707771 DOI: 10.3390/ma14247648] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/05/2021] [Accepted: 12/09/2021] [Indexed: 11/19/2022]
Abstract
Urethral stenosis is a pathological condition that consists in the narrowing of the urethral lumen because of the formation of scar tissue. Unfortunately, none of the current surgical approaches represent an optimal solution because of the high stricture recurrence rate. In this context, we preliminarily explored the potential of an insoluble type-I collagen from horse tendon as scaffolding material for the development of innovative devices for the regeneration of injured urethral tracts. Non-porous collagen-based substrates were produced and optimized, in terms of crosslinking density of the macromolecular structure, to either provide mechanical properties compliant with the urinary tract physiological stress and better sustain tissue regeneration. The effect of the adopted crosslinking strategy on the protein integrity and on the substrate physical-chemical, mechanical and biological properties was investigated in comparison with a decellularized matrix from porcine small intestinal submucosa (SIS patch), an extensively used xenograft licensed for clinical use in urology. The optimized production protocols allowed the preservation of the type I collagen native structure and the realization of a substrate with appealing end-use properties. The biological response, preliminarily investigated by immunofluorescence experiments on human adult renal stem/progenitor cells until 28 days, showed the formation of a stem-cell monolayer within 14 days and the onset of spheroids within 28 days. These results suggested the great potential of the collagen-based material for the development of scaffolds for urethral plate regeneration and for in vitro cellular studies.
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Affiliation(s)
- Nunzia Gallo
- Department of Engineering for Innovation, University of Salento, 73100 Lecce, Italy; (M.L.N.); (A.S.); (L.S.)
| | - Maria Lucia Natali
- Department of Engineering for Innovation, University of Salento, 73100 Lecce, Italy; (M.L.N.); (A.S.); (L.S.)
- Typeone Biomaterials, Via Vittorio Veneto 64/C, 73036 Muro Leccese, Italy
| | - Claudia Curci
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.C.); (A.G.)
| | - Angela Picerno
- Nephrology Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Anna Gallone
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.C.); (A.G.)
| | - Marco Vulpi
- Urology and Andrology Unit, Department of Emergency and Organ Transplant, University of Bari “Aldo Moro”, 70124 Bari, Italy; (M.V.); (A.V.); (P.D.)
| | - Antonio Vitarelli
- Urology and Andrology Unit, Department of Emergency and Organ Transplant, University of Bari “Aldo Moro”, 70124 Bari, Italy; (M.V.); (A.V.); (P.D.)
| | - Pasquale Ditonno
- Urology and Andrology Unit, Department of Emergency and Organ Transplant, University of Bari “Aldo Moro”, 70124 Bari, Italy; (M.V.); (A.V.); (P.D.)
| | - Mariafrancesca Cascione
- Department of Mathematics and Physics “Ennio De Giorgi”, University of Salento, 73100 Lecce, Italy; (M.C.); (R.R.)
| | - Fabio Sallustio
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Rosaria Rinaldi
- Department of Mathematics and Physics “Ennio De Giorgi”, University of Salento, 73100 Lecce, Italy; (M.C.); (R.R.)
| | - Alessandro Sannino
- Department of Engineering for Innovation, University of Salento, 73100 Lecce, Italy; (M.L.N.); (A.S.); (L.S.)
| | - Luca Salvatore
- Department of Engineering for Innovation, University of Salento, 73100 Lecce, Italy; (M.L.N.); (A.S.); (L.S.)
- Typeone Biomaterials, Via Vittorio Veneto 64/C, 73036 Muro Leccese, Italy
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Favre GA, Carminatti T, Gil SA, Tobia González IP, Giudice CR. Safety and efficacy of urethroplasty based on age groups. Actas Urol Esp 2021; 45:557-563. [PMID: 34526253 DOI: 10.1016/j.acuroe.2021.07.004] [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: 12/10/2019] [Accepted: 03/22/2020] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To analyze the results and complications after urethroplasty based on patient age groups. As secondary objective, we analyzed the impact of operative complexity on each age group. MATERIAL AND METHODS This is a retrospective cohort study that include male patients who underwent urethroplasty between January 2011 and December 2018. Data was obtained from the patients' electronic health records. Patients were grouped as follows: <60 years, 60-79 years and >80 years. Variables evaluated were history, comorbidities, previous surgeries and operative complexity. Restenosis-free survival and complications presented in each group were determined according to the Clavien-Dindo classification system. The SPSS® program was used for statistical analysis. RESULTS A total of 783 patients were included, and the mean follow-up was 19 months. The estimated 2-year restenosis-free survival in the population under 60, 60-79 and over 80 years was 87, 87 and 93.9% (IC 95%), respectively. Univariate analysis showed that the age group was not a predictor of restenosis. Complex surgery is the only predictor of recurrence, increasing the risk by 60% (HR 1.64, 95% CI 1.05-2.56, p = 0.029). There was an overall complication rate of 30.8%, and 62% of these were Clavien ≤ II. We found no association between the frequency of complications and age. CONCLUSIONS Urethroplasty is safe and effective regardless of age group. There are no statistically significant differences in outcomes and complications shown by the age group comparison. There were no significant differences when analyzing the impact of complex surgeries among the different age groups. The data indicate that age alone should not be taken as an absolute exclusion criterion for patients needing urethral reconstruction.
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Affiliation(s)
- G A Favre
- Sector de Cirugía Uretral y Genital Reconstructiva, Servicio de Urología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - T Carminatti
- Sector de Cirugía Uretral y Genital Reconstructiva, Servicio de Urología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - S A Gil
- Sector de Cirugía Uretral y Genital Reconstructiva, Servicio de Urología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - I P Tobia González
- Sector de Cirugía Uretral y Genital Reconstructiva, Servicio de Urología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - C R Giudice
- Sector de Cirugía Uretral y Genital Reconstructiva, Servicio de Urología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Benson CR, Li G, Brandes SB. Long term outcomes of one-stage augmentation anterior urethroplasty: a systematic review and meta-analysis. Int Braz J Urol 2021; 47:237-250. [PMID: 32459452 PMCID: PMC7857757 DOI: 10.1590/s1677-5538.ibju.2020.0242] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective is to summarize and characterize the long-term success of anterior augmentation urethroplasty (AU) in published series. The current literature on AU consists largely of retrospective series reporting intermediate follow-up and incompletely characterize the long term outcomes of AU. MATERIALS AND METHODS A systematic literature review was performed consistent with PRISMA guidelines to characterize long-term outcomes of AU with a minimum upper limit follow-up of 100 months. Penile/preputial skin flaps and graft and oral mucosal graft urethroplasties were included. The primary outcome was stricture-free survival for one-stage AU. Secondary analysis evaluated differences in outcomes based on two failure definitions: the need for intervention versus presence of recurrent stricture on cystoscopy or urethrography. Hazard rates were induced from the reported failure rates of one-stage AU and fixed and random effect models were fitted to the data. Additional subset analysis, removing potential confounders (lichen sclerosus, hypospadias and penile skin graft), was performed. RESULTS Ten studies met inclusion criteria, and two studies reported separate outcomes for grafts and flaps, and thus were included separately in the analysis. The mean hazard rate across all studies was 0.0044, the corresponding survival rates at 1 year 0.948, 5 years 0.766, 10 years 0.587, and 15 years 0.45. Subset analysis of the 4 select and homogeneous studies noted 1, 5, 10, and 15 years survival rates of 0.97, 0.96, 0.74, and 0.63, respectively. CONCLUSIONS The long-term success rates of augmentation urethroplasty are appear to be worse than previously appreciated and patients should be counseled accordingly. Available at. https://www.intbrazjurol.com.br/pdf/aop/2019-0242RW.pdf.
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Affiliation(s)
- Cooper R. Benson
- Columbia University Medical CenterDepartment of UrologyNew YorkNYUSADepartment of Urology, Columbia University Medical Center, New York, NY, USA
| | - Gen Li
- Columbia University Medical CenterDepartment of BiostatisticsNew YorkNYUSADepartment of Biostatistics, Columbia University Medical Center, New York, NY, USA
| | - Steven B. Brandes
- Columbia University Medical CenterDepartment of UrologyNew YorkNYUSADepartment of Urology, Columbia University Medical Center, New York, NY, USA,Correspondence address: Steven B. Brandes, MD, Department of Urology, Columbia Univeristy, 161 Ft. Washington Ave 11th Floor, New York, NY 10032, USA. Telephone: +1 212 305-6151. E-mail:
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Mazdak H, Tolou Ghamari Z, Khorrami A. Investigation of Triamcinolone Instillation in the Long-term Rate of Anterior Urethral Strictures' Recurrence. Curr Urol 2021; 14:206-210. [PMID: 33488339 DOI: 10.1159/000499237] [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: 08/13/2019] [Accepted: 11/08/2019] [Indexed: 11/19/2022] Open
Abstract
Background/Aims Previous publications confirmed that after internal urethrotomy success rates in the short-term (less than 6 months) are varied (70-80%) and in the long-term results are generally low. In this study, the efficacy of triamcinolone instillation based on a newly introduced protocol on the rate of recurrence in patients with anterior urethral strictures was evaluated. Methods A total of 66 patients were divided into treatment group (n = 33), in which triamcinolone was instilled on urethra after removing of Foley catheter and control group (n = 33) that not received any intervention. Each 40 mg/1 ml of triamcinolone vial was dissolved in 9 ml of distilled water and then a 2 ml of diluted solution was used for each instillation and 8 ml was kept in 4°C. Triamcinolone was instilled based on daily in week 1, every other day for week 2 and then every Monday and Friday for 2 months. Penile clamp was used after instillation for 1 hour. Treatment failure was based on urine flow rate, rate of recurrence and time to appearance of recurrence. Results There were not any significant differences regrading to age (p = 0.09), length (p = 0.41) and diameter (p = 0.36) of stricture between 2 groups. Time to appearance of recurrence showed significantly in the treatment group when compared with that in the control group (1,350 ± 900 vs. 124.3 ±112 days; p < 0.01). In the treatment group, 88% had reasonable consequence, while in control 48%. There were 3 patients with a mean length-diameter of stricture around 0.3-5 cm who showed recurrence free with the mean of 720 days after intervention. Conclusion Administration of triamcinolone instillation in urethra is associated with a decreased risk of stricture recurrence. Superior outcomes were seen in patients with a stricture length of more than 2 cm and this may in part reflect the increasing efficacy of the instillation method in the management of urethral strictures. These findings help identify patients with aggressive features of strictures in urethra who may benefit from intensified treatment efficacy of triamcinolone instillation.
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Affiliation(s)
- Hamid Mazdak
- Isfahan Kidney Transplantation Research Center.,Department of Urology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Favre GA, Carminatti T, Gil SA, Tobia González IP, Giudice CR. Safety and efficacy of urethroplasty based on age groups. Actas Urol Esp 2020; 45:S0210-4806(20)30078-4. [PMID: 32682509 DOI: 10.1016/j.acuro.2020.03.006] [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: 12/10/2019] [Revised: 01/29/2020] [Accepted: 03/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyze the results and complications after urethroplasty based on patient age groups. As secondary objective, we analyzed the impact of operative complexity on each age group. MATERIAL AND METHODS This is a retrospective cohort study that include male patients who underwent urethroplasty between January 2011 and December 2018. Data was obtained from the patients' electronic health records. Patients were grouped as follows: < 60 years, 60-79 years and > 80 years. Variables evaluated were history, comorbidities, previous surgeries and operative complexity. Restenosis-free survival and complications presented in each group were determined according to the Clavien-Dindo classification system. The SPSS® program was used for statistical analysis. RESULTS A total of 783 patients were included, and the mean follow-up was 19 months. The estimated 2-year restenosis-free survival in the population under 60, 60-79 and over 80 years was 87, 87 and 93.9% (IC 95%), respectively. Univariate analysis showed that the age group was not a predictor of restenosis. Complex surgery is the only predictor of recurrence, increasing the risk by 60% (HR 1.64, 95% CI 1.05-2.56, p = 0.029). There was an overall complication rate of 30.8%, and 62% of these were Clavien ≤ II. We found no association between the frequency of complications and age. CONCLUSIONS Urethroplasty is safe and effective regardless of age group. There are no statistically significant differences in outcomes and complications shown by the age group comparison. There were no significant differences when analyzing the impact of complex surgeries among the different age groups. The data indicate that age alone should not be taken as an absolute exclusion criterion for patients needing urethral reconstruction.
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Affiliation(s)
- G A Favre
- Sector de Cirugía Uretral y Genital Reconstructiva, Servicio de Urología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - T Carminatti
- Sector de Cirugía Uretral y Genital Reconstructiva, Servicio de Urología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - S A Gil
- Sector de Cirugía Uretral y Genital Reconstructiva, Servicio de Urología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - I P Tobia González
- Sector de Cirugía Uretral y Genital Reconstructiva, Servicio de Urología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - C R Giudice
- Sector de Cirugía Uretral y Genital Reconstructiva, Servicio de Urología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Choi J, Lee CU, Sung HH. Learning curve of various type of male urethroplasty. Investig Clin Urol 2020; 61:508-513. [PMID: 32734726 PMCID: PMC7458868 DOI: 10.4111/icu.20200076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/28/2020] [Accepted: 04/15/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose To determine the number of cases required to achieve a specified recurrence-free rate (>80%) among urethroplasty types. Materials and Methods A retrospective analysis of consecutive patients, who underwent urethroplasty performed by a single surgeon between April 2013 and January 2019, was conducted. Urethroplasty subtypes were divided according to stricture location: penile, bulbar, and posterior. If there was no recurrence for >6 months after surgery, the surgery was considered to be a success. The average success rates among quintile groups were compared to determine the learning curve for each type. Results Of 150 patients who underwent urethroplasty, 112 were included in this study. The overall success rate was 89.7% in penile, 97.8% in bulbar, and 74.1% in posterior urethroplasty. Bulbar urethroplasty reached the target success rate in the first quintile group (1–9 cases). Penile urethroplasty also achieved the target success rate in the first quintile group (1–8 cases), and the success rate gradually increased until the fifth quintile group (32–39 cases). In posterior urethroplasty, the target success rate was achieved in the fifth quintile group (20–27 cases). Conclusions Bulbar urethroplasty had the fastest learning curve, and posterior urethroplasty the slowest.
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Affiliation(s)
- Joongwon Choi
- Department of Urology, VHS Medical Center, Seoul, Korea
| | - Chung Un Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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