Endourethral urethroplasty--use of a new catheter

Advancements in transurethral management of urethral stricture disease

PURPOSE OF REVIEW

To explore and report the recent evolution of transurethral management of urethral stricture disease.

RECENT FINDINGS

In recent years, new promising techniques in the transurethral management of urethral stricture disease have emerged including adjuvant therapies to direct vision internal urethrotomy, regenerative therapy with buccal mucosa cells and minimally invasive transurethral urethroplasty procedures that avoid skin incisions.

SUMMARY

Although further work is needed, the expanding field of transurethral therapies for urethral stricture disease demonstrates early promising results through a variety of modalities.

Transurethral ventral buccal mucosa graft inlay urethroplasty for reconstruction of fossa navicularis and distal urethral strictures: surgical technique and preliminary results

OBJECTIVES

To introduce a novel surgical technique for the reconstruction of distal urethral strictures using buccal mucosal graft (BMG) through a transurethral approach.

METHODS

A retrospective institution chart review was conducted of all the patients who underwent a transurethral ventral BMG inlay urethroplasty from March 2014 to March 2016. Patients with greater than one-year follow-up were included. Steps of the procedure: transurethral ventral wedge resection of the stenosed segment and transurethral delivery and spread fixation of appropriate BMG inlay into the resultant urethrotomy. The patients were followed for post-operative complications and stricture recurrence with uroflow, PVR, cystoscopy and outcome questionnaires.

RESULTS

Three patients with a minimum of 12-month follow-up are included in this case series. The mean age of the patients was 42 years (35-53); mean stricture length was 2.1 cm (1-4). All patients had at least 2 previous failed procedures. Mean follow-up was 18 months (12-24). There were no stricture recurrences or fistula. Mean pre- and post-operative uroflow values were 4.3 (0-8) and 19 (16-26), respectively. Neither penile chordee nor changes in sexual function were noted in patients on follow-up.

CONCLUSION

Transurethral ventral BMG inlay urethroplasty is a feasible option for treatment of fossa navicularis strictures. This single-stage technique allows for avoiding skin incision or urethral mobilization. It helps to prevent glans dehiscence, fistula formation and avoids the use of genital skin flaps in all patients, especially those affected with LS. This novel surgical technique is an effective treatment alternative for men with distal urethral strictures.

Hybrid minimally invasive urethroplasty for pan-anterior urethral strictures: initial results

INTRODUCTION

To describe our minimally invasive hybrid technique for treating pan-anterior urethral stricture.

PATIENTS AND METHODS

From February 2009 through November 2011, 12 patients with pan-anterior urethral stricture were operated on in our unit. The bulbospongiosus muscle was mobilized on one side, and a 2.5-cm dorsolateral bulbar urethrotomy was made. A full-thickness cold knife optical internal urethrotomy was made to reach the corpus cavernosum as graft bed. A 14- to 16-cm-long, 15- to 16-mm-wide buccal/lingual mucosa graft was harvested and sutured dorsally at the site of urethrotomy, and then distally at the meatus along with meatoplasty.

RESULTS

The mean operating time was 91.66 min. The average hospital stay was 2.4 days. The Foley catheter was removed after 3 weeks. The mean Q(max) preoperatively and postoperatively was 5.5 ± 1.87 and 18.83 ± 2.04 ml/s, respectively. Our mean follow-up was 18.5 ± 6.92 (6-32) months.

CONCLUSIONS

Our hybrid technique provides good short-term results while promoting minimal urethral mobilization and graft vascularity.

Treatment of recurrent vesicourethral anastomotic stricture after radical prostatectomy with endourethroplasty

We report our experience with successful treatment of 2 cases of severe recurrent vesicourethral anastomotic stricture after radical prostatectomy with endourethroplasty. Both patients had multiple failures of conventional treatments but have been free of stricture recurrence after endourethroplasty with 11 and 25 months follow-up, respectively. Follow-up urethroscopy showed open anastomotic segments with epithelialization after endourethroplasty in both patients. The patient who was continent prior to endourethroplasty remained continent afterward.

Alternative endoscopic management in the treatment of urethral strictures

Advances in endoscopic instrumentation and techniques have expanded our armamentarium for safe and effective treatment of urethral strictures. Endoscopic incision or dilation should remain the preferred treatment for uncomplicated primary strictures. Balloon dilation can be useful in the treatment of dense strictures. Incision using laser energy has yet to provide better results than procedures employing a cold knife. As such, it would be difficult to justify the added expense of laser urethrotomy. Endoscopic placement of free skin grafts into the bed of the urethra after transurethral resection or deep incision of the stricture is a novel approach that has shown a great deal of promise. Endourethroplasty is a reasonable alternative to open urethroplasty when treating long strictures, as more than 90% of the reported patients have had a successful outcome with no recurrence. However, larger experience with this procedure is necessary to verify its efficacy and for greater acceptance. The placement of indwelling stents is another new promising treatment option. Overall short-term success rates range from 75% to 100%, but the follow-up period is short, and little is known about the long-term risks of an indwelling foreign body in the urethra. Endoscopic incision via "cut-to-the-light" or "core-through" procedures is an excellent alternative in patients with obliterative strictures. Data from several centers reveal that the majority of patients gain relief of obstruction while maintaining continence and erectile potency. However, at least 25% of these patients will need further endoscopic management to maintain urethral patency.

Endourethroplasty in the management of complicated posterior urethral strictures

A 2-step endourethroplasty was performed to repair complicated posterior urethral strictures in 3 patients. In the first procedure scar tissue was resected transurethrally to create a smooth grafting bed. In a second endourological procedure a piece of full thickness prepuce was grafted at the stricture site. An intraluminal balloon catheter was used to keep the skin graft in close contact with the resected area of the urethra. Of the patients 2 have remained free of stricture for more than 22 months and 1 has remained free of stricture for more than 12 months after endourethroplasty. The technique offers a promising alternative to open surgery in selected patients with complicated posterior urethral strictures.